Author Archives: Dr. Raffi Sharon

Fever: How to take a temperature

Leave a reply

Definition:

* Rectal, Ear, or Temporal Artery (TA) Temperature: 100.4°F (38.0°C) or higher

* Oral or Pacifier Temperature: 100°F (37.8°C) or higher

* Under the Arm (Axillary or Armpit) Temperature: 99°F (37.2°C) or higher

* Limitation: Ear (tympanic membrane) temperatures are not reliable before 6 months of age

Where to Take a Temperature:

* Temperatures measured rectally are the most accurate. Temperatures measured orally, by electronic pacifier, or by ear canal or TA are also accurate if done properly. Temperatures measured in the armpit are the least accurate, but they are better than no measurement.

* Child Younger Than 3 Months (90 Days): An armpit temperature is the safest and may be preferred for screening. If the armpit  temperature is above 99°F (37.2°C), check the rectal temperature. The reason you need to take a rectal temperature for young infants  is that if they have a true fever, they need to be evaluated immediately by a doctor.

* Child Younger Than 4 or 5 Years: A rectal or electronic pacifier temperature is reliable. An ear or TA thermometer can be used after 6 months of age. An axillary (armpit) temperature is adequate for screening if it is taken correctly.

* Child Older Than 4 or 5 Years: take the temperature orally  (by mouth), by ear thermometer, or by TA thermometer

How to Take a Rectal Temperature:

* Have your child lie stomach down on your lap

* Put some petroleum jelly on the end of the thermometer and on the opening of the anus

* Slide the thermometer gently into the opening of the anus for about 1 inch. If your child is younger than 6 months, put it in only about ½ inch (inserting until the silver tip disappears is about ½ inch)

* Hold your child still and leave the thermometer in for about 20 seconds with a digital electronic thermometer. (Note: the AAP recommends that older glass thermometers be discarded because they contain mercury. If that’s all you have, however, leave it in for about 2 minutes to get an accurate reading.)

* Your child has a fever if the rectal temperature is above 100.4°F (38°C).

How to Take an Armpit Temperature:

* Put the tip of the thermometer in an armpit. Make sure the armpit is dry.

* Close the armpit by holding the elbow against the chest for 4 or 5 minutes. The tip of the thermometer must be covered by skin.

* Your child has a fever if the armpit temperature is above 99°F (37.2°C). If you have any doubt, take your child’s temperature rectally.

How to Take an Oral Temperature:

• Be sure your child has not had a cold or hot drink in the last 30 minutes

• Put the tip of the thermometer under one side of the tongue and toward the back. It’s important to put it in the right place.

* Have your child hold the thermometer in place with her lips and fingers (not teeth) for about 30 seconds with a digital electronic thermometer. (Note: the AAP recommends that older glass thermometers be discarded because they contain mercury. If that’s all you have, however, leave it in for about 3 minutes to get an accurate reading.) Keep the lips sealed.

* Your child has a fever if the temperature is above 100°F (37.8°C)

How to Take a Digital Electronic Pacifier Temperature:

* Have your child suck on the pacifier until it reaches a steady state and you hear a beep.

* This usually takes 3 to 4 minutes

* Your child has a fever if the pacifier temperature is above 100°F (37.8°C)

How to Take an Ear Temperature:

* This thermometer reads the infrared heat waves released by the eardrum

* An accurate temperature depends on pulling the ear backward to straighten the ear canal (back and up if your child is older than 1 year)

* Then aim the tip of the ear probe midway between the opposite eye and earlobe

* The biggest advantage of this thermometer is that it measures temperatures in less than 2 seconds. It also does not require cooperation by the child and does not cause any discomfort.

* Limitation: If your child has been outdoors on a cold day, he needs to be inside for 15 minutes before taking his temperature. Earwax, ear infections, and ear tubes, however, do not interfere with accurate readings.

How to Take a Temporal Artery (TA) Temperature:

* The thermometer reads the infrared heat waves released by the TA, which runs across the forehead just below the skin.

* Place the sensor head at the center of the forehead midway between the eyebrow and hairline.

* To scan for your child’s temperature, depress the scan button and keep it depressed

* Slowly slide the TA thermometer straight across the forehead toward the top of the ear, keeping in contact with the skin

* Stop when you reach the hairline and release the scan button

* Remove the thermometer from the skin and read your child’s temperature on the display screen

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

Vomiting with diarrhea

1 Reply

Definition:

* Vomiting is the forceful emptying (throwing up) of a large portion of the stomach’s contents through the mouth

* Nausea and abdominal discomfort usually precede each bout of vomiting

* Vomiting and diarrhea together is covered by this topic

Causes:

* Main Cause: Stomach and intestinal infection (gastroenteritis) from a stomach virus (eg, rotavirus). The illness starts with vomiting but diarrhea usually follows within 12 to 24 hours.

* Food poisoning from toxins produced by bacteria growing in poorly refrigerated foods (eg, Staphylococcus toxin in egg salad, Bacillus cereus toxin in rice dishes).

Severity of Vomiting:

The following is an arbitrary attempt to classify vomiting by risk for dehydration:

* Mild: 1 to 2 times a day

* Moderate: 3 to 7 times a day

* Severe: Vomits everything or nearly everything, or 8 or more times a day

* Severity relates even more to the length of time that the particular severity level has persisted. At the beginning of a vomiting illness (especially following food poisoning), it’s common for a child to vomit everything for 3 or 4 hours and then become stable with   mild or moderate vomiting.

* Watery stools in combination with vomiting carry the greatest risk for causing dehydration

* The younger the child, the greater the risk for dehydration

How to Recognize Dehydration:

* Dehydration means that the body has lost excessive fluids, usually from vomiting or diarrhea. An associated weight loss of more than 3% is required. In general, mild diarrhea, mild vomiting, or a mild decrease in fluid intake does not cause dehydration.

* Dehydration is the most important complication of diarrhea

* The following are signs of dehydration:

– Decreased urination (no urine in more than 8 hours) occurs early in the process of dehydration. So does a dark-yellow, concentrated yellow. If the urine is light straw colored, your child is not dehydrated.

– Dry tongue and inside of the mouth. Dry lips are not helpful.

– Dry eyes with decreased or absent tears

– In infants, a depressed or sunken soft spot

– Delayed capillary refill longer than 2 seconds. This refers to the return of a pink color to the thumbnail after you press it and make it pale. Ask your child’s doctor to teach you how to do this test.

– Irritable, tired out, or acting ill. If your child is alert, happy, and playful, he is not dehydrated.

– A child with severe dehydration becomes too weak to stand or very dizzy if he tries to stand.

Return to School: Your child can return to child care or school after vomiting and fever are gone

Call 911 Now (Your Child May Need an Ambulance) If:

* Unresponsive or difficult to awaken

* Not moving or too weak to stand

Call Your Doctor Now (in Alberta, Canada call 780-408-LINK) If:

* Your child looks or acts very sick

* Signs of dehydration (very dry mouth, no tears, and no urine in more than 8 hours)

* Blood in the stool

* Blood in the vomit that’s not from a nosebleed

* Bile (bright yellow or green) in the vomit

* Abdominal pain is also present (EXCEPTION: Abdominal pain  or crying just before and improved by vomiting is quite common)

* Appendicitis suspected (eg, pain low on right side, won’t jump, prefers to lie still)

* Poisoning with a plant, medicine, or other chemical suspected

* Child is younger than 12 weeks with vomiting 2 or more times (EXCEPTION: spitting up)

* Child younger than 12 months who has vomited Pedialyte (or other brand of oral rehydration solution) 3 or more times and also has watery diarrhea

* Receiving Pedialyte (or clear fluids if older than 1 year) and vomits everything longer than 8 hours

* Weak immune system (eg, sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids)

* Vomiting an essential medicine

* Fever above 104°F (40°C) and not improved 2 hours after fever medicine

* Child is younger than 12 weeks with fever above 100.4°F (38.0°C) rectally (CAUTION: Do NOT give your baby any fever medicine before being seen)

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Has vomited longer than 24 hours

* Fever present for more than 3 days

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Vomiting is a recurrent chronic problem

Parent Care at Home If:

* Mild to moderate vomiting with diarrhea (probably viral gastroenteritis) and you don’t think your child needs to be seen

Home Care Advice for Vomiting with Diarrhea:

1. Reassurance:

* Most vomiting is caused by a viral infection of the stomach and intestines or by food poisoning

* Vomiting is the body’s way of protecting the lower intestinal tract

* When vomiting and diarrhea occur together, treat the vomiting. Don’t do anything special for the diarrhea

2. For Bottle-fed Infants, Offer Oral Rehydration Solution (ORS) for 8 Hours:

* ORS (eg, Pedialyte, store brand) is a special electrolyte solution that can prevent dehydration. It’s readily available in supermarkets and drugstores.

* For vomiting once, continue regular formula

* For vomiting more than once, offer ORS for 8 hours. If ORS is not available, use formula.

* Spoon or syringe feed small amounts of ORS —1 to 2 teaspoons (5 to 10 mL) every 5 minutes.

* After 4 hours without vomiting, double the amount

* After 8 hours without vomiting, return to regular formula

* For infants older than 4 months, also return to cereal and strained bananas

* Return to normal diet in 24 to 48 hours

3. For Breastfed Infants, Reduce the Amount Per Feeding:

* If infant vomits once, nurse 1 side every 1 to 2 hours

* If infant vomits more than once, nurse for 5 minutes every 30 to 60 minutes. After 4 hours without vomiting, return to regular breastfeeding.

* If infant continues to vomit, switch to ORS (eg, Pedialyte) for 4 hours

* Spoon or syringe feed small amounts of ORS —1 to 2 teaspoons (5 to 10 mL) every 5 minutes.

* After 4 hours without vomiting, return to regular breastfeeding. Start with small feedings of 5 minutes every 30 minutes and increase as tolerated.

4. For Older Children (Older Than 1 Year), Offer Small Amounts of Clear Fluids for 8 Hours:

* ORS: Vomiting with watery diarrhea needs ORS (eg, Pedialyte). If child refuses ORS, use half-strength Gatorade.

* Give small amounts—2 to 3 teaspoons (10 to 15 mL) every 5 minutes

* After 4 hours without vomiting, increase the amount

* After 8 hours without vomiting, return to regular fluids

* Solids: After 8 hours without vomiting, add solids

– Limit solids to bland foods. Starchy foods are easiest to digest

– Start with saltine crackers, white bread, cereals, rice, and mashed potatoes

– Return to normal diet in 24 to 48 hours.

5. Avoid Medicines:

* Discontinue all nonessential medicines for 8 hours (Reason: usually make vomiting worse)

* Fever: Fevers usually don’t need any medicine. For higher fevers, consider acetaminophen (eg, Tylenol) suppositories. Never give oral ibuprofen (eg, Advil); it is a stomach irritant

* Call your doctor if your child is vomiting an essential medicine

6. Contagiousness: Your child can return to child care or school after vomiting and fever are gone.

7. Expected Course: Moderate vomiting usually stops in 12 to 24  hours. Mild vomiting (1 to 2 times a day) with diarrhea can continue intermittently for up to a week.

8. Call Your Doctor If:

* Vomiting becomes severe (vomits everything) longer than  8 hours

* Vomiting persists longer than 24 hours

* Signs of dehydration

* Diarrhea becomes severe

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

Headache

Leave a reply

Definition:

* Pain or discomfort of the scalp or forehead areas

* The face and ears are excluded

Causes:

* Viral Illnesses: Most headaches are part of a viral illness, especially with colds. These usually last a few days.

* Muscle Tension Headaches: The most common type of recurrent headaches. Muscle tension headaches give a feeling of tightness around the head. The neck muscles also become sore and tight. Tension headaches can be caused by staying in one position for a long time, such as when reading or using a computer. Other children get tension headaches as a reaction to stress, such as pressure for better grades or family disagreements.

* Migraine Headaches: Recurrent severe, incapacitating headaches

* Other Common Causes: Hunger, exertion, sunlight, coughing

* Frontal Sinusitis: Can cause a frontal headache just above the eyebrow. Rare before 10 years of age because frontal sinus is not developed. Other sinuses cause face pain, not headache.

* Serious Causes: Meningitis or encephalitis. Symptoms include a headache, stiff neck, vomiting, fever, and confusion.

Call 911 Now (Your Child May Need an Ambulance) If:

* Difficult to awaken or passed out

* Confused thinking or talking, or slurred speech

* Blurred or double vision

* Weakness of arm or leg, or unsteady walking

Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK) If:

* Your child looks or acts very sick

* Stiff neck (can’t touch chin to chest)

* Severe headache

* Vomiting

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Fever

* Sinus pain (not just congestion) of forehead

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Headache without other symptoms present longer than 24 hours

* Sore throat present longer than 48 hours

* Any headache present more than 3 days

* Headaches are a recurrent chronic problem

Parent Care at Home If:

Mild headache and you don’t think your child needs to be seen

Home Care Advice for Headaches:

Treatment for Mild Headache

1. Pain Medicine: Give acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil) as needed for pain relief. Headaches caused by fever are also helped by fever reduction.

2. Food: Give fruit juice or food if your child is hungry or hasn’t eaten in more than 4 hours (Reason: skipping a meal can cause a headache in many children).

3. Rest: Lie down in a quiet place and relax until feeling better

4. Local Cold: Apply a cold, wet washcloth or cold pack to the forehead for 20 minutes

5. Stretching: Stretch and massage any tight neck muscles

6. Call Your Doctor If:

* Headache becomes severe

* Vomiting occurs

* Isolated headache lasts longer than 24 hours

* Headache lasts more than 3 days

* Your child becomes worse

7. Muscle Tension Headaches: Extra Advice:

* If something is bothering your child, help him talk about it and get it off his mind

* Teach your child to take breaks from activities that require sustained concentration. Encourage your child to do relaxation exercises during the breaks.

* Teach your child the importance of getting adequate sleep

* If overachievement causes headaches, help your child find more balance

* CAUTION: Your child should have a complete medical checkup before you conclude that recurrent headaches are caused by worrying too much or stress

Treatment for Migraine Headache

8. Reassurance: This headache is similar to previous migraine headaches that your child has experienced.

9. Migraine Medication:

* If your child’s doctor has prescribed a specific medication for migraine, give it as directed as soon as the migraine starts. If not, ibuprofen (eg, Advil) is the best over-the-counter drug for migraine. Give ibuprofen now and repeat in 6 hours if needed.

10. Sleep: Have your child lie down in a dark, quiet place and try to fall asleep. People with migraine often awaken from sleep with their migraine gone.

11. Call Your Doctor If:

* Headache becomes much worse than usual

* Headache lasts longer than usual

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

Diarrhea

Leave a reply

Definition:

Diarrhea is the sudden increase in the frequency and looseness of stools

* The main risk of diarrhea is dehydration

* Loose or runny stools do not cause dehydration

* Frequent, watery stools can cause dehydration

Causes:

* Viral gastroenteritis (viral infection of the stomach and intestines) is the usual cause

* Bacteria (eg, Salmonella, Shigella) cause some diarrhea. The main food-borne bacteria are Campylobacter, Salmonella, and Escherichia coli.

* Food Poisoning: Rapid onset of vomiting and diarrhea within hours after eating a food contaminated with toxins (eg, cream dishes that are not properly refrigerated). Symptoms usually resolve in fewer than 24 hours without a need for medical care.

* Giardia (a parasite) occasionally, especially in child care centres.

How to Recognize Dehydration:

* Dehydration means that the body has lost excessive fluids, usually from vomiting or diarrhea. An associated weight loss of more than 3% is required. In general, mild diarrhea, mild vomiting, or a mild decrease in fluid intake does not cause dehydration.

* Dehydration is the most important complication of diarrhea

* The following are signs of dehydration:

– Decreased urination (no urine in more than 8 hours) occurs early in the process of dehydration. So does a dark-yellow, concentrated yellow. If the urine is light straw coloured, your child is not dehydrated.

– Dry tongue and inside of the mouth. Dry lips are not helpful.

– Dry eyes with decreased or absent tears

– In infants, a depressed or sunken soft spot

– Delayed capillary refill longer than 2 seconds. This refers to the return of a pink color to the thumbnail after you press it and make it pale. Ask your child’s doctor to teach you how to do this test.

– Irritable, tired out, or acting ill. If your child is alert, happy, and playful, he is not dehydrated.

– A child with severe dehydration becomes too weak to stand or very dizzy if he tries to stand.

Definition of Diarrhea in Breastfed Infants:

• The stools of a breastfed infant are normal unless they contain mucus or blood, or develop a new bad odor.

* The looseness (normally runny and seedy), color (normally yellow), and frequency of stools (normally more than 6 a day) are not much help. Breastfed babies may normally even pass some green stools surrounded by a water ring (normal bile can come out green if intestinal transit time is rapid enough).

* During the first 1 to 2 months of life, the breastfed baby may normally pass a stool after each feeding. (However, if an infant’s stools abruptly increase in number and looseness and persist for 3 or more stools, the baby probably has diarrhea)

* Other clues to diarrhea are poor eating, acting sick, or fever.

Definition of Diarrhea in Formula-Fed Infants:

* Formula-fed babies pass 1 to 8 stools per day during the first week, then 1 to 4 per day until 2 months of age.

* The stools are yellow in colour and peanut butter in consistency

* Formula-fed newborns have true diarrhea if the stools abruptly increase in number or looseness and persist for 3 or more stools, become watery or very runny, contain mucus or blood, or develop a new bad odour.

* Other clues to diarrhea are poor eating, acting sick, or fever

* After 2 months of age, most infants pass 1 or 2 stools per day (or 1 every other day) and no longer appear to have mild diarrhea.

Return to School: Your child can return to child care or school after the stools are formed and the fever is gone. The school-aged child can return if the diarrhea is mild and the child has good control over loose stools.

Call 911 Now (Your Child May Need an Ambulance) If:

Not moving or too weak to stand

Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK) If:

* Your child looks or acts very sick

* Signs of dehydration (eg, no urine longer than 8 hours, no tears with crying, very dry mouth)

* Blood in the stool

* Weak immune system (eg, sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids)

* Abdominal pain present longer than 2 hours

* Vomiting clear liquids 3 or more times

* Child is younger than 1 month with 3 or more diarrhea stools (mucus, bad odor, increased looseness)

* Passed more than 8 diarrhea stools in the last 8 hours

* Severe diarrhea while taking a medicine that could cause diarrhea (eg, antibiotics)

* Fever above 104°F (40°C) and not improved 2 hours after fever medicine

* Child is younger than 12 weeks with fever above 100.4°F (38.0°C) rectally (CAUTION: Do NOT give your baby any fever medicine before being seen)

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Pus in the stool present for more than 2 days

* Loss of bowel control in a toilet-trained child occurs 3 or more times

* Fever present for more than 3 days

* Close contact with person or animal who has bacterial diarrhea

* Contact with reptile (snake, lizard, turtle) in previous 14 days

* Travel to country at risk for bacterial diarrhea within past month

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Diarrhea persists more than 2 weeks

* Loose stools are a chronic problem

Parent Care at Home If:

Mild diarrhea (probably viral gastroenteritis) and you don’t think your child needs to be seen

Home Care Advice for Diarrhea:

1. Reassurance:

* Most diarrhea is caused by a viral infection of the intestines

* Diarrhea is the body’s way of getting rid of the germs

* Here are some tips on how to keep ahead of the fluid losses

2. Mild Diarrhea:

* Continue regular diet

* Eat more starchy foods (eg, cereal, crackers, rice)

* Drink more fluids. Formula or milk are good balanced fluids for diarrhea (EXCEPTION: Avoid all fruit juices and soft drinks because they make diarrhea worse)

3. Formula-Fed Infants With Frequent, Watery Diarrhea: Start Oral Rehydration Solution (ORS)

* ORS (eg, Pedialyte, store brand) is a special electrolyte solution that can prevent dehydration. It’s readily available in supermarkets and drugstores.

* Start ORS for frequent, watery diarrhea (Note: formula is fine for average diarrhea)

* Use ORS alone for 4-6 hours to prevent dehydration. Offer unlimited amounts.

* If ORS is not available, use formula prepared in the usual way (unlimited amounts) until you can get some.

* Avoid Jell-O water, sports drinks, and fruit juice

4. Returning to Formula:

* Go back to formula by 6 hours at the latest (Reason: child needs the calories)

* Use formula prepared in the usual way (Reason: it contains adequate water)

* Offer formula more frequently than you normally do

* Lactose: Regular formula is fine for most diarrhea. Lactose-free formulas (soy formula) are only needed for watery diarrhea persisting more than 3 days.

* Extra ORS: Also give 2 to 4 oz (30 to 120 mL) of ORS after every large, watery stool

5. Solids:

Infants Older Than 4 Months: Continue solids (eg, rice cereal, strained bananas, mashed potatoes).

6. Breastfed Infants With Frequent, Watery Diarrhea:

* Continue breastfeeding at more frequent intervals. Continue solids as for formula fed.

* Offer 2 to 4 oz (60 to 120 mL) ORS (eg, Pedialyte) after every large, watery stool (especially if urine is dark) in addition to breastfeeding.

7. Children Older Than 1 Year With Frequent, Watery Diarrhea:

* Fluids: Offer unlimited fluids. If taking solids, give water or half-strength Gatorade. If child refuses solids, give milk or formula.

* Avoid all fruit juices and soft drinks (Reason: make diarrhea worse)

* ORS (eg, Pedialyte) is rarely needed, but for severe diarrhea, also give 4 to 8 oz (120 to 240 mL) of ORS after every large, watery stool.

* Solids: Starchy foods are absorbed best. Give dried cereals, oatmeal, bread, crackers, noodles, mashed potatoes, or rice. Pretzels or salty crackers can help meet sodium needs.

8. Probiotics:

* Probiotics contain healthy bacteria (lactobacilli) that can replace unhealthy bacteria in the gastrointestinal tract.

* Yogurt is the easiest source of probiotics. If your child is older than 12 months, give 2 to 6 oz (60 to 180 mL) of yogurt twice daily (Note: today, almost all yogurts are “active culture”)

* Probiotic supplements in granules, tablets, or capsules are also available in health food stores.

9. Diaper Rash: Wash buttocks after each stool to prevent a bad diaper rash. Consider applying a protective ointment (eg, petroleum jelly) around the anus to protect the skin.

10. Contagiousness: Your child can return to child care or school after the stools are formed and the fever is gone. The school-aged child can return if the diarrhea is mild and the child has good control over loose stools.

11. Expected Course: Viral diarrhea lasts 5 to 14 days. Severe diarrhea only occurs on the first 1 or 2 days, but loose stools can persist for 1 to 2 weeks.

12. Call Your Doctor If:

* Signs of dehydration occur

* Diarrhea persists more than 2 weeks

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

Cough

1 Reply

Definition:

* A cough is the sound made when the cough reflex suddenly forces air and secretions from the lungs.

* A coughing spasm is more than 5 minutes of continuous coughing

Causes:

* Most acute coughs are part of a cold, a viral infection of the large airway (viral bronchitis).

* Other Common Causes: Croup, bronchiolitis, asthma, allergic cough, whooping cough.

Sputum or Phlegm:

* Yellow or green phlegm is a normal part of the healing process of viral bronchitis.

* This means the lining of the trachea was damaged by the viral infection and is being coughed up as new mucosa replaces it.

* Bacteria do not cause bronchitis in healthy children. Antibiotics are not indicated for the yellow or green phlegm seen with colds.

* The main treatment of a productive cough is to encourage it with good fluid intake, a humidifier (if the air is dry), and warm chicken broth or apple juice for coughing spasms (if child is older than 1 year).

Return to School: Your child can return to child care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of coughs and colds cannot be prevented.

Call 911 Now (Your Child May Need an Ambulance) If:

* Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath)

* Child has passed out or stopped breathing

* Lips are bluish when not coughing

Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK)) If:

* Your child looks or acts very sick

* Choked on a small object that could be caught in the throat

* Difficulty breathing for child younger than 1 year and not relieved by cleaning the nose

* Difficulty breathing present when not coughing

* Lips have turned bluish during coughing

* Ribs are pulling in with each breath (retractions)

* Can’t take a deep breath because of chest pain

* Severe chest pain, coughed up blood, or wheezing

* Weak immune system (eg, sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids)

* Child is younger than 12 weeks with fever above 100.4°F (38.0°C) rectally (CAUTION: Do NOT give your baby any fever medicine before being seen)

* Fever above 104°F (40°C) and not improved 2 hours after fever medicine

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Continuous (nonstop) coughing

* Child is younger than 3 months

* Earache or sinus pain (not just congestion) is also present

* Fever present for more than 3 days

* Fever returns after gone for longer than 24 hours

* Chest pain present even when not coughing

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Coughing has kept child home from school for 3 or more days

* Symptoms of nasal allergy are also present

* Cough has been present more than 3 weeks

Parent Care at Home If: Cough with no complications and you don’t think your child needs to be seen

Home Care Advice for Cough:

1. Reassurance:

* Coughs are a normal part of a cold

* Coughing up mucus is very important for protecting the lungs from pneumonia

* We want to encourage a productive cough, not turn it off

2. Homemade Cough Medicine:

• Goal: Reduce the irritation or tickle in the throat that triggers a dry cough

* Child Aged 3 Months to 1 Year: Give warm, clear fluids (eg, warm water, apple juice) to treat the cough. Amount: 1 to 3 teaspoons (5 to 15 mL) 4 times per day when coughing. Avoid honey until 1 year of age.

* Child Aged 1 Year and Older: Use HONEY, ½ to 1 teaspoon (2 to 5 mL), as needed as a homemade cough medicine. It can thin the secretions and loosen the cough. (If not available, you can use corn syrup)

* Child Aged 6 Years and Older: Use COUGH DROPS to coat the irritated throat. (If not available, you can use hard candy)

3. Nonprescription Cough Medicine (Dextromethorphan):

* Nonprescription cough medicines are NOT recommended (Reason: no proven benefit for children and not approved for children younger than 4 years) (Food and Drug Administration, 2008).

* Honey has been shown to work better for coughs

* If you decide to use cough medicine from your drugstore anyway, and your child is older than 4 years, choose one with dextro-methorphan (DM). It’s present in most nonprescription cough syrups.

* Indication: Give only for severe coughs that interfere with sleep, school, or work (every 8 hours)

4. Coughing Spasms:

* Expose to warm mist (eg, foggy bathroom)

* Give warm fluids to drink (eg, warm water, apple juice) if child is older than 3 months

* Amount: If child is 3 months to 1 year of age, give warm fluids in a dosage of 1 to 3 teaspoons (5 to 15 mL) 4 times per day when coughing. If child is older than 1 year, use unlimited amounts as needed.

* Reason: relax the airway and loosen up the phlegm

5. Vomiting: For vomiting that occurs with hard coughing, reduce the amount given per feeding (eg, in infants, give 2 oz less formula) (Reason: cough-induced vomiting is more common with a full stomach).

6. Fluids: Encourage your child to drink adequate fluids to prevent dehydration. This will also thin out nasal secretions and loosen phlegm in the airway.

7. Humidifier: If the air is dry, use a humidifier (Reason: dry air makes coughs worse)

8. Fever Medicine: For fever above 102°F (39°C), give acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil)

9. Avoid Tobacco Smoke: Active or passive smoking makes coughs much worse

10. Contagiousness: Your child can return to child care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of coughs and colds cannot be prevented.

11. Extra Advice: Antihistamines for Allergic Cough

* Antihistamines can bring an allergic cough and nasal allergy symptoms under control within 1 hour

* Benadryl is very effective and no prescription is needed

• They need to be given every 6 to 8 hours

12. Expected Course:

* Viral bronchitis causes a cough for 2 to 3 weeks

* Sometimes your child will cough up lots of phlegm (mucus). The mucus can normally be gray, yellow, or green.

* Antibiotics are not helpful

13. Call Your Doctor If:

* Difficulty breathing occurs

* Wheezing occurs

* Cough lasts more than 3 weeks

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt