Author Archives: Dr. Raffi Sharon

Head injury

Types of Head Injuries:

* Scalp Injury: Most head injuries only damage the scalp (a cut, scrape, bruise, or swelling). It is common for children to fall and hit their head at some point while growing up. This is especially common when a child is learning to walk. Big lumps (bruises) can occur with minor injuries because there is a large blood supply to the scalp. For the same reason, small cuts on the head may bleed a lot. Bruises on the forehead sometimes cause black eyes 1 to 3 days later because the blood spreads downward by gravity.

* Skull Fracture: Only 1% to 2% of children with head injuries will get a skull fracture. Usually there are no other symptoms except for a headache at the site where the head was hit. Most skull fractures occur without any injury to the brain, and they heal easily.

* Concussion: A concussion is a mild injury to the brain that changes how the brain normally works. It is usually caused by a sudden blow or jolt to the head. Many children bump or hit their heads without causing a concussion. The most common signs of a concussion are a brief period of confusion or memory loss following the injury. Other signs of a concussion can include a headache, vomiting, dizziness, acting dazed, or being knocked out. A person does NOT need to be knocked out (lose consciousness) to have had a concussion. Following a concussion, some children have ongoing symptoms such as mild headaches, dizziness, thinking difficulties, school problems, or emotional changes for several weeks.

* Brain injuries are rare but are recognized by the presence of any one of the following symptoms: – Difficult to awaken or keep awake – Confused thinking and talking – Slurred speech – Weakness of arms or legs – Unsteady walking

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

* A seizure (convulsion) occurred

* Knocked unconscious for longer than 1 minute

* Not moving neck normally (CAUTION: Protect the neck from any movement.)

* Difficult to awaken

* Confused thinking, slurred speech, unsteady walking, OR weakness of arms or legs present now

* Major bleeding that can’t be stopped

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

* You think your child has a serious injury

* Your child is younger than 1 year

* Neck pain

* Knocked unconscious for less than 1 minute

* Had confused thinking, slurred speech, unsteady walking, OR weakness of arms or legs, BUT fine now

* Blurred vision persists for more than 5 minutes

* Skin is split open or gaping and may need stitches

* Bleeding that won’t stop after 10 minutes of direct pressure

* Large swelling (larger than 1 inch or 2.5 cm)

* Large dent in skull

* Injury caused by high speed (eg, auto accident) or blow from hard object (eg, golf club)

* Fall from a dangerous height (more than 3 feet [1 m] if child is younger than 2 years, and more than 5 feet [1.5 m] if child is older than 2 years)

* Vomited 2 or more times within 3 days of injury

* Watery fluid dripping from the nose or ear while child is not crying

* Severe headache or crying

* Can’t remember what happened

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

* You think your child needs to be seen

* Headache persists more than 3 days

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* No tetanus shot in more than 5 years for DIRTY cuts (more than 10 years for CLEAN cuts)

Parent Care at Home If: Minor head injury and you don’t think your child needs to be seen

Home Care advice for Scalp Injuries:

1. Wound Care: If there is a scrape or cut, wash it off with soap and water. Then apply pressure with a sterile gauze for 10 minutes to stop any bleeding.

2. Local Cold:

* Apply a cold pack or ice bag wrapped in a wet cloth to any swelling for 20 minutes. Reason: prevent big lumps (“goose eggs”). Also, reduces pain.

* Repeat in 1 hour, then as needed.

3. Observation:

* Observe your child closely during the first 2 hours following the injury.

* Encourage your child to lie down and rest until all symptoms have cleared (Note: mild headache, mild dizziness, and nausea are common).

* Allow your child to sleep if he wants to, but keep him nearby.

• Awaken after 2 hours of sleeping to check the ability to walk and talk.

4. Diet: Offer only clear fluids to drink, in case she vomits. Regular diet OK after 2 hours.

5. Pain Medicine:

* Give acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil) as needed for pain relief

* EXCEPTION: Avoid until 2 hours have passed from injury without any vomiting.

* Never give aspirin to children and teens (Reason: always increases risk of bleeding).

6. Special Precautions at Night:

* Mainly, sleep in the same room as your child for 2 nights. Reason: if a complication occurs, you will recognize it because your child will first develop a severe headache, vomiting, confusion, or other change in behaviour.

* Optional: If you are worried, awaken your child once during the night. Check the ability to walk and talk.

* After 48 hours, return to a normal routine.

7. Expected Course: Most head impact only causes a scalp injury. The swelling may take a week to resolve. The local headache at the site of impact usually clears in 2 to 3 days.

8. Call Your Doctor If:

* Pain or crying becomes severe

* Vomiting occurs 2 or more times

* Your child becomes difficult to awaken or confused

* Walking or talking becomes difficult

* 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

Earache

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Definition:

* Pain or discomfort in or around the ear

* Child reports an earache

* Younger child acts like she did with previous ear infection (eg, crying, fussy)

Cause:

* Usually due to an ear infection

* Ear infections can be caused by viruses or bacteria. Usually, your child’s doctor can tell the difference.

* Ear infections peak at ages 6 months to 2 years

* The onset of ear infections peaks on day 3 of a cold

Return to School:

* An earache or ear infection is NOT contagious. There is no need to miss any school or child care.

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

Not moving or very weak

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

* Your child looks or acts very sick

* Earache is severe and not improved 2 hours after taking ibuprofen (eg, Advil)

* Pink or red swelling behind the ear

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

* Pointed object was inserted into the ear canal (eg, pencil, stick, wire)

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

* 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:

* Earache, but none of the symptoms described previously (Reason: possible ear infection)

* Pus or cloudy discharge from ear canal

Home Care for suspected ear infection (until your child can be seen):

1. Reassurance:

* Your child may have an ear infection. The only way to be sure is to examine the eardrum.

* Diagnosis and treatment can safely wait until morning if the earache begins after your child’s doctor’s office is closed.

* Ear pain can be controlled with pain medicine and ear drops (eg Auralgan)

2. Pain or Fever Medicine: Give acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil) as needed for pain relief or fever above 102°F (39°C)

3. Local Cold: Apply a cold pack or a cold, wet washcloth to the outer ear for 20 minutes to reduce pain while the pain medicine takes effect (Note: some children prefer local heat for 20 minutes).

4. Ear Drainage:

* If pus or cloudy fluid is draining from the ear canal, the eardrum has ruptured from an ear infection.

* Wipe the pus away as it appears.

* Avoid plugging with cotton (Reason: retained pus causes irritation or infection of the ear canal)

5. Ear Drops: pain numbing ear drups (eg Auralgan) will usually relieve pain not helped by pain medicine (available over the counter). If your child has ear tubes or a hole in the eardrum, don’t use them.

6. Contagiousness: Ear infections are not contagious

7. Call Your Doctor If:

* Your child develops severe pain

* 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

Rash, widespread, and cause unknown

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Definition:

* Rash over large areas or most of the body (widespread or generalized)

* Occasionally just on hands, feet, and buttocks—but both sides of body

* Red or pink rash

* Small spots, large spots, or solid red skin

Causes:

Main Cause: A 2- or 3-day rash occurring with a viral illness. Viral rashes usually have symmetrical pink spots on the trunk.

Return to School:

* Most viral rashes are no longer contagious once the fever is gone.

* For minor rashes, your child can return to child care or school after the FEVER is gone.

* For major rashes, your child can return to child care or school after the RASH is gone or your doctor says it’s safe to return with the rash.

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

* Purple or blood-colored rash with fever

* Sudden onset of rash (within 2 hours) AND also has difficulty with breathing or swallowing

* 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

* Purple or blood-colored rash WITHOUT fever

* Bright red skin that peels off in sheets

* Large blisters on skin

* Bloody crusts on lips

* Taken a prescription medication within the last 3 days

* Fever

* Menstruating and using tampons

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

* Widespread rash but none of the symptoms described herein (Reason: needs a diagnosis)

Home care advice for widespread rashes:

1. For Non-Itchy Rashes: No treatment is necessary except for heat rashes, which respond to cool baths.

2. For Itchy Rashes

* Wash the skin once with soap to remove irritants.

* Then give your child cool baths without any soap 4 times per day for 10 minutes whenever the itch is uncomfortable (CAUTION: Avoid any chill).

* Follow with calamine lotion or a baking soda solution (1 teaspoon in 4 oz of water or 5 mL in 120 mL of water).

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

4. Contagiousness:

• If your child has a fever, avoid contact with other children and especially pregnant women until a diagnosis is made.

* Most viral rashes are contagious (especially if a fever is present).

* Your child can return to child care or school after the rash is gone or your doctor says it’s safe to return with the rash.

5. Expected Course: Most viral rashes disappear within 48 hours.

6. Call Your Doctor if 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

Hives

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Definition: An itchy rash made up of raised pink spots with pale centers

Symptoms

* Raised pink bumps with pale centers (welts).

* Hives look like mosquito bites.

* Sizes of hives vary from ½ inch (12 mm) to several inches (cm) across.

* Shapes of hives are variable and change repeatedly.

* Itchy rash.

Causes:

* Widespread hives usually are caused by a viral infection. They can also be an allergic reaction to a food, a drug, an infection, an insect bite, or other substances. Often the cause is not found. Hives from foods usually resolve in 6 hours.

* Localized hives are usually caused by skin contact with plants, pollen, food, or pet saliva. Localized hives are not caused by drugs, infections, or swallowed foods.

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

* Difficulty breathing or wheezing

* Hoarseness or cough with rapid onset

* Difficulty swallowing, drooling, or slurred speech with rapid onset

* Severe life-threatening allergic reaction in the past to similar substance

Call Your Doctor Now (Night or Day) If:

* Your child looks or acts very sick

* Hives began after a bee sting, medicine, or high-risk food (eg, peanuts, fish), and no previous reactions

* Child younger than 1 year with widespread hives

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

* You think your child needs to be seen

* Severe hives (eg, eyes swollen shut, very itchy) not improved after second dose of Benadryl

* Fever or joint swelling is present

* Abdominal pain or vomiting is present

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Hives interfere with school or normal activities after taking Benadryl every 6 hours for more than 24 hours

* Food suspected as cause

* Hives have occurred 3 or more times and cause is unknown

* Hives last more than 1 week

Parent Care at Home If:

* Hives with no complications and you don’t think your child needs to be seen

Home care advice for hives:

1. Localized Hives

* For localized hives, wash the allergic substance of the skin with soap and water.

* If itchy, massage the area with a cold pack or ice for 20 minutes.

* Localized hives usually disappear in a few hours and don’t need Benadryl.

2. Benadryl for Widespread Hives

* Give Benadryl 4 times per day for widespread hives that itch (no prescription needed)

* If you only have another antihistamine at home (but not Benadryl), use that.

* Continue Benadryl 4 times per day until the hives are gone for 12 hours.

* Contraindication: Child is younger than 1 year (Reason: Benadryl is a sedative). Give your doctor a call for advice.

3. Food-Related Hives

* Foods can cause widespread hives.

* Sometimes hives are isolated to just around the mouth.

* Hives from foods usually are transient and gone in less than 6 hours.

4. Cool Bath: Give a cool bath for 10 minutes to relieve itching (CAUTION: Avoid causing a chill). Rub very itchy areas with an ice cube for 10 minutes.

5. Remove Allergens: Give a bath or shower if triggered by pollens or animal contact. Change clothes.

6. Avoid Allergens: If you identify a substance that causes hives (eg, a food), help your child avoid that substance in the future.

7. Contagiousness

* Hives are not contagious

* Your child can return to child care or school if the hives do not interfere with normal activities.

* If the hives are associated with an infection, your child can return to school after the fever is gone and your child feels well enough to participate in normal activities.

8. Expected Course: Hives from a viral illness normally come and go for 3 or 4 days, then disappear. Most children get hives once.

9. Call Your Doctor If :

* Severe hives persist after second dose of Benadryl

* Most of the itch is not relieved within 24 hours on continuous Benadryl

* Hives last more than 1 week

* 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

Crying

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Definition:
Excessive crying, irritability, or fussiness in a child 3 months or older.
Child is too young to tell us or show us the cause for his crying. Crying is the only symptom.
If your child is crying from an illness or physical symptom, use that symptom checker instead of this one.

Causes:
Not caused by hunger—by this age, you should be able to recognize hunger. Main Cause: Coming down with an illness. Other Common Causes: * Overtired, stressed, whining, tantrums, and separation anxiety. * Always consider pain as a possible cause of persistent fussiness or crying. Inconsolable crying may be the only symptom initially in a young child with an ear infection or even appendicitis. * Painful causes include earache, blocked nose from a cold, sore throat, mouth ulcers, raw diaper rash, metal ulcer on tip of penis, constipatio, and hair wrapped around toe (take off socks and check).

Call 911 Now (Your Child May Need an Ambulance): If Not moving or very weak

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

* IF Your child looks or acts very sick

* Stiff neck or bulging soft spot

* Possible injury (especially head or bone injury)

* Very irritable, screaming child for longer than 1 hour

* You are afraid you or someone might hurt or shake your baby

* Your child cannot be comforted after trying this advice for 2 hours

* Crying interferes with sleeping for longer than 2 hours

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

* If you think your child needs to be seen

* Pain (eg, earache) suspected as cause of crying

Call Your Doctor During Weekday Office Hours

* If you have other questions or concerns

* Mild, off-and-on fussiness (acts normal when not crying) continues more than 2 days

* Excessive crying is a chronic problem

Parent Care at Home If mild fussiness present fewer than 2 days and you don’t think your child needs to be seen

Home Care Advice for Mild, Consolable Crying:

1. Reassurance: Most infants and toddlers become somewhat irritable and fussy when sick or overtired. Crying tells us your child is not feeling well. If the crying responds to comforting, it’s probably not serious.

2. Comforting: Try to comfort your child by holding, rocking, or massaging her

3. Sleep: If your child is tired, put him to bed. If he needs to be held, hold him quietly in a horizontal position or lie next to him. Some overtired infants need to cry themselves to sleep

4. Undress Your Child: Sometimes part of her clothing is too tight or uncomfortable. Also check her skin for redness or swelling (eg, insect bite)

5. Discontinue Medicines:

* If your child is taking a cough or cold medicine, stop it

* The crying should stop within 4 hours

* Antihistamines (eg, Benadryl) can cause screaming and irritability in some children

* Pseudoephedrine (decongestant) can cause jitteriness and crying

6. Expected Course: Most fussiness with illnesses resolves when the illness does. Most fussiness caused by stress or change (eg, new child care) lasts less than 1 week

7. Call Your Doctor If:

* Constant crying lasts longer than 2 hours

* Intermittent crying lasts more than 2 days

* 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