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On Colds
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My child has had a runny nose for a week, how do I know when it is more than just a cold? |
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Most upper respiratory infections (URIs) or colds will last between one and two weeks. Oftentimes they are associated with a low grade temperature (100-101) in the beginning of the illness. In general, children should be seen if the cold is associated with difficulty breathing or shortness of breath, high fever (>102), fever that lasts more than 72 hours, or a fever that appears at the end of a cold. Of course, if your child is complaining of earache or sinus pain/pressure, a visit to the doctor would also be advised. |
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My child’s runny nose has been thick and green,… does that mean he/she has a sinus infection? |
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No. Most colds will go through a purulent phase, when the nasal secretions appear thick and green. This often occurs at the beginning and the end of colds, and in the morning, when the nasal mucosa tends to be drier. Sinus infections will also produce thick nasal secretions, but are usually associated with sinus pain or pressure, headache, or having these symptoms longer than 2 weeks. |
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What can I do to treat my child’s cold? |
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The treatment of a cold depends on the child’s age. Infants below the age of 6 months should not use over-the-counter cold medications and a recent study by the AAP shows that they have not been proven safe or effective in children less than 2 years old. Decongestants may be used in toddlers and school age children to decrease the amount of mucus production. A cough suppressant may be used, especially at night time, to help your child sleep. Anti-histamines do not generally help cold symptoms, but may act as a mild sedative to help children sleep and help dry up secretions to improve your child's early morning cough. Young Pediatrics does not recommend the use of cold/flu products that combine decongestants or cough suppressants with fever reducers, such as Tylenol or Motrin. Combination products may mask symptoms of fever and may result in over-dosing of fever reducers if subsequent doses of Tylenol or Motrin are given. It is recommended that all children drink plenty of fluids to prevent dehydration and to keep nasal secretions thin. Saline nose drops may also be used at any age to thin nasal secretions. Humidifying the air, especially while your child sleeps, may also help to keep secretions thin. |
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Will an antibiotic help my child’s cold? |
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No. A cold is caused by a virus. Antibiotics only help bacterial infections. Sometimes a cold can lead into an ear infection or a sinus infection. These infections may be bacterial, and therefore, may need an antibiotic. |
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Why not treat all colds with an antibiotic, because my child always gets a sinus infection or an ear infection? |
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Antibiotics can have many potentially harmful side effects. For many years, antibiotics have been over-prescribed. Giving antibiotics for infections that are not bacterial leads to the development of bacteria that are resistant to the commonly-prescribed antibiotics. The more antibiotics your child is prescribed, the greater the likelihood that bacteria will develop resistance. Antibiotics can also kill many good bacteria that live in our intestines and aid with digestion. By killing these bacteria we can harm our digestive tracts and cause diarrhea. Of course if an ear infection were to occur during a cold, the risks of an untreated ear infection would usually outweigh the potential side-effects of the antibiotic. If you think your child may have an ear infection or other bacterial infection, Dr. Young will evaluate him/her to determine the need for antibiotics. |
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Would culturing my child’s nasal secretions tell you what is causing their infection? |
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No. Many bacteria normally live in our noses. Even a completely healthy person will grow some bacteria from their nose. If the clinical suspicion is high enough, we can test for some viruses such as influenze, RSV, and a few other viruses. |
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On Fever
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How high of a fever is dangerous to my child? |
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In general, a fever itself is not dangerous to a child; what is causing the fever may be dangerous. But there is no absolute number above which one must panic; or a number below which, one can be assured of being safe. In general, treat your child, not the thermometer! Pay attention to how the child is acting, if they are in pain, and if they are drinking fluids. Also pay attention to the associated symptoms. The child with a temperature of 101 but who is listless and not drinking, is more of a concern than the child with a temperature of 103, who is playful and well-hydrated. Anytime a fever is accompanied by a severe headache, or is associated with a stiff neck, please notify the pediatrician’s office. |
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How high of a fever will cause a seizure? |
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A small percentage of children are susceptible to having seizures when they have a fever. These are called febrile seizures and are related not only to how high the fever goes, but also how quickly it rises. Most children do not experience febrile seizures, even with high fevers. If your child does experience a seizure with fever, please notify your pediatrician. |
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Can my baby take ibuprofen? |
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Ibuprofen (Motrin, Advil) is not recommended below the age of 6 months. |
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What is the best way to take my child’s temperature? |
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The most accurate temperature will be obtained via a rectal thermometer reading, especially in young babies. You must, however, be very cautious not to insert the thermometer too far. Call our office with questions. Pacifier thermometers are strongly influenced by the temperature of food/drinks the child recently had, and are not accurate if the child is opening their mouth (such as when crying). Oral thermometer readings are acceptable in older children who are able to keep their mouth closed, did not have any recent hot or cold drinks, and who are able to keep the thermometer tip beneath their tongue. Axillary (under the arm) temperatures are highly dependent on how well the arm is held against the body. Axillary temperature is an acceptable alternative if you are uncomfortable with this. The newer ear thermometers are acceptable for older children, but give very inconsistent results with young babies’ ears. |
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Should I alternate Tylenol and ibuprofen if my child has a high fever? |
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No. Alternating these medicines leads to higher risk for overdose. We recommend you pick one medicine and stick with it.
Tylenol may be given every 4 - 6 hours or ibuprofen every 6 - 8 hours. If after 1 - 2 hours your child's fever has not declined, you may give the other fever reducing medicine. |
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On Diarrhea
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My child was vomiting last week and still has diarrhea, what should I do? |
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When a child has had a stomach virus, they often experience diarrhea much longer than the actual vomiting, sometimes as long as two weeks following an infection. Many of these viruses damage the lining of the intestine, adversely affecting the child’s ability to digest certain foods, thereby causing diarrhea. As the intestines heal, digestion will improve and the diarrhea will slowly resolve. The best way to treat diarrhea initially is with a little modification in the child’s diet… the BRAT diet stands for bananas, rice, apple sauce, and toast. A bland diet could also consist of dry cereals, plain pasta, or even some plain crackers. These items are generally easy to digest and may help bulk up the stools, reducing the severity of the diarrhea. Dairy products are not ideal foods following a vomiting/diarrhea illness because lactose is usually one of the last things the body recovers the ability to digest. As the diarrhea slowly improves, gradual reintroduction of milk products may be attempted. |
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Will an Electrolyte solution such as Pedialyte help my child’s diarrhea? |
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Depends. Electrolyte containing solutions (such as Pedialyte) are clear liquids and as such, will not help stop diarrhea (and actually have very little influence on the consistency of the stools). If your child is actively vomiting, clear liquids are more easily absorbed, are less likely to induce further vomiting, and may help prevent dehydration. If your child is no longer vomiting but is having frequent bowel movements (>8/day), these electrolyte solutions will help replace the salts that are lost in vomiting and diarrhea. If your child is having loose stools, but only having 3-4 bowel movements a day, electrolyte solutions are not going to be helpful, except as a thirst quencher. Always, Pedialyte and the related electrolyte solutions are better than Gatorade, because sports drinks contain more sugar and less salt than the electrolyte solutions. |
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On Influenza
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What is the Flu? |
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People often use the term “flu” to describe many different illnesses. Medical professionals use the term “flu” to describe the illness caused specifically by an influenza virus. The flu is characterized by cough, congestion, sore throat, headaches, body aches, and fever and sometimes vomiting. In general, the flu causes more severe symptoms than a cold, including a higher fever. The flu often leads to secondary infections, such as pneumonia, especially in the very young and the elderly. Children considered at higher risk of developing complications of the flu are those less than 6 months of age, as well as children with chronic medical conditions, such as asthma, diabetes, or congenital heart disease. |
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My child’s runny nose has been thick and green,… does that mean he/she has a sinus infection? |
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No. Most colds will go through a purulent phase, when the nasal secretions appear thick and green. This often occurs at the beginning and the end of colds, and in the morning, when the nasal mucosa tends to be drier. Sinus infections will also produce thick nasal secretions, but are usually associated with sinus pain or pressure. |
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How can I protect my child from the flu? |
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The flu is contagious, and can spread quickly through a daycare, household, school or community. Minimizing your child’s exposure to other sick children is helpful. Frequent hand washing during flu season is also a good idea. If your child is older than 6 months of age, he/she would benefit from receiving the flu vaccine. All children between 6 months and 5 years of age, or any child with a chronic medical condition should receive the flu vaccine. Additionally any household contacts of these high risk groups should receive the flu vaccine. Because children below the age of 6 months can not receive the vaccine, it is strongly encouraged that parents and other household contacts receive the vaccine to prevent the baby from being exposed. The flu vaccine is not a live virus. It is inactivated and therefore you cannot contract flu from the immunization. Flu mist and nasal spray for kids older than 9 is a live virus. |
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How can I tell the difference between a cold and the flu? |
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Generally, children with the flu act much sicker than children with a cold. All of the symptoms tend to be more severe with the flu. The flu usually causes a higher fever, often 104 or higher. Colds rarely go above 102. The fever of a cold usually occurs in the beginning of the illness and lasts only a couple of days. The fever of the flu lasts throughout the course of the illness, often 5 to 7 days. |
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Is there a treatment for the flu? |
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Because the flu is caused by a virus, it does not respond to antibiotics. Many of the over-the-counter cold medications are also helpful in treating flu symptoms. Additionally, Tylenol or Ibuprofen is often necessary to alleviate symptoms of pain and fever. Young Pediatrics does not recommend the use of cold/flu products that combine decongestants or cough suppressants with fever reducers, such as Tylenol or Motrin. Combination products may mask symptoms of fever and may result in over-dosing of fever reducers if subsequent doses of Tylenol or Motrin are given. Of course, pushing fluids to prevent dehydration, and encouraging your child to get plenty of rest are always good ideas. Humidifying the air in their room may help with the congestion.
In some instances, your doctor may prescribe an anti-viral medication. Although these medicines do not cure the flu, they can help to shorten the course of the illness, if started within the first few days of the illness. |
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Should my child receive the flu vaccine? |
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Yes. Young Pediatrics advises giving the flu vaccine to all children, older than six months of age. “High risk” children include those below the age of 5 years, and any child with a chronic medical condition such as asthma, diabetes, cystic fibrosis, congenital heart disease… as well as their household contacts! |
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On MRSA
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What is MRSA? |
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MRSA stands for methicillin-resistant Staphylococcus aureus. Staph. is a bacteria that is commonly found on people’s skin. “Methicillin-resistant” means that the bacteria has developed resistance to (is not killed by) certain antibiotics. Infections caused by these organisms can be difficult to treat. |
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Is MRSA bad? |
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MRSA can cause many different types of infections. Often these infections involve the skin, and resemble bug bites, boils, or other common skin rashes. Occasionally, they are more serious and spread internally, causing bone, blood, or even lung infections. |
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How do I know if I have MRSA? |
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If a boil or a sore does not heal on its own or with topical antibiotics, or if it seems to be spreading, it could be a Staph. infection. Most Staph. infections are treated successfully with topical antibiotics, or a commonly prescribed oral antibiotic. However MRSA is often resistant to these common antibiotics. Your doctor may be able to tell if you have a Staph. infection, but the only way to know if the Staph. is MRSA is to obtain a culture. A laboratory can isolate the Staph. organism and test if it is sensitive to certain antibiotics. If it is resistant to methicillin, then the infection is MRSA. |
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How is MRSA treated? |
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Fortunately, MRSA that is acquired in the community (not in a hospital) is usually sensitive to at least one oral antibiotic. Obtaining a culture will help your doctor decide which antibiotic is best for a given infection. A patient who acquires an infection in a hospital setting may have a more difficult time, as organisms acquired in the hospital tend to be resistant to more antibiotics. Often, these organisms are sensitive to only one or two intravenous (IV) antibiotics. |
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How can I prevent MRSA? |
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The following steps may help prevent MRSA infections:
- Frequent handwashing!
- Keep cuts/scrapes covered and clean. Treat with a topical antibiotic.
- Avoid contact with other people’s cuts, scrapes, or sores.
- Do not share personal items (razors, deodorants, sports equipment)
- Wash sports equipment between uses.
- Use a barrier (towel) on shared sports equipment (such as the gym)
- Be certain hot tubs are properly treated (with bromine or chlorine) and avoid public hot tubs/pools where proper hygiene may be in question.
Finally, do not overuse antibiotics. MRSA can develop from normal Staph bacteria that are overexposed to antibiotics. After repeated exposures, they develop resistance. Never give someone an antibiotic prescribed for a different child, and always complete a course of antibiotics when one is prescribed. Partially treating an infection can be more dangerous than not treating at all! |
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What can I do to eliminate MRSA? |
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Sometimes, MRSA can be difficult to eliminate. It can spread from one family member to another, or teammate to teammate. Some individuals may become “colonized” with the bacteria, meaning they have the bacteria, but don’t have any obvious infection. If you or a family member have been diagnosed with a Staph. infection, several steps may need to be taken:
- Your doctor may prescribe an oral antibiotic for the infected person to take.
- Your doctor may prescribe a special topical antibiotic (mupirocin or Bactroban) that is known to help treat MRSA. This antibiotic can be applied to the infected area directly, or it can be applied to a person’s nostrils twice a day for a week to reduce colonization from the nose (a common place for Staph to “hide out”).
- In some cases, your doctor may prescribe a special anti-septic soap (such as Phisohex) or you can make your own by mixing two capfuls of Chlorine bleach with 6 inches of bath water. Washing twice a week in these anti-septic washes will help reduce colonization with the Staph bacteria. Only use these washes if suggested by a physician during a Staph. outbreak.
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On Vomiting
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My child has started vomiting, what can I do to help them? |
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Vomiting can be a very distressing symptom for both child and parents alike. Illnesses such as rotavirus present with the acute onset of vomiting and diarrhea. The vomiting can be intense and difficult to stop. Initially, it is best to let nature run its course. During an acute episode of vomiting, any amount of liquid is likely to come back up again. The trick is to allow the stomach to rest until it recovers enough to handle small sips of fluids. One strategy is to wait at least one hour from the last vomiting episode and then offer small sips of clear liquids, one teaspoon at a time, every five to ten minutes. The heavy syrup found in canned fruit is excellent for this role, as fruit pectin has anti-emetic (anti-nausea) effects. It also contains a concentrated source of sugar which the body needs. If no vomiting occurs after an hour of giving teaspoons of fluid, the child is probably ready for larger sips of clear fluids. Clear fluids, (such as water, diluted fruit juice, Gatorade/Pedialyte, or even flat ginger ale or jell-o!) are more readily absorbed and will offer better protection against dehydration. Only after several hours of no vomiting should a child be offered more substantial food. Avoid foods that are very acidic or spicy (such as tomato sauce), or foods with a high fat content (milk or creamy foods). Do not be concerned if your child does not eat for a day or two... but it is very important that your child get fluids, to prevent dehydration!
Also, vomiting can be a symptom of other illnesses. If vomiting accompanies a sore throat, it may be a sign of Strep throat. If vomiting accompanies a cough and fever, it may be a sign of pneumonia. And lastly, if vomiting occurs with fever and painful urination, it may be a sign of a kidney infection. The vomiting that accompanies most stomach viruses usually lasts less than 24 hours. If vomiting lasts longer than a day, or is associated with any of the aforementioned symptoms, please contact our office. |
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How do I know if my child is dehydrated? |
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Dehydration occurs when not enough fluid is ingested to meet the output and the demands of the body. Dehydration can occur when a child doesn't drink or vomits; or if there are increased fluid losses such as occurs with diarrhea. Fever accompanying an illness also increases fluid loss through the skin. The younger the child, the easier it is for that child to become dehydrated, due to the higher fluid requirements relative to their size.
Early symptoms of dehydration include a dry mouth, lack of tear production, and reduced urine output. If these symptoms occur, parents should attempt to give the child clear fluids (water, electrolyte solutions such as Pedialyte, or even a tasty treat like popsicles or Italian ice). Later symptoms include a sweet odor to the breath, a doughy consistency to the skin, and extreme lethargy. If these symptoms occur, contact our office immediately!
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