Category Archives: Medical symptoms

Abdominal Pain

Definition:

* Pain or discomfort located between the bottom of the rib cage and the groin crease.

* The older child complains of a stomachache.

* The younger child should at least point to or hold the abdomen.

Causes:

* Indigestion: Indigestion or overeating causes many mild stomachaches.

* Gastroenteritis: A viral infection of the intestines causes stomach cramps as well as vomiting or diarrhea.

* Food Poisoning: Severe vomiting or diarrhea lasting fewer than 12 hours is often caused by bacterial overgrowth in unrefrigerated foods.

* Constipation: The need to pass a stool causes lower abdominal cramps.

* Strep: Strep throat causes up to 10% of acute abdominal pain.

* Serious Causes: These include appendicitis, kidney infections, and intussusception. Suspect appendicitis if pain is low on the right side, the child walks bent over, the child won’t hop or jump, and the child prefers to lie still.

* Stress: The most common cause of recurrent stomachaches is stress (commonly called the “worried stomach”). More than 10% of children have them. These children tend to be sensitive, serious, conscientious, even model children. This can make them more vulnerable to the normal stresses of life, such as changing schools, moving, or family disagreements. The pain occurs in the pit of the stomach or near the belly button. The pain is mild but real.

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

* You suspect poisoning with a plant, medicine, or chemical

*Unable to walk or walks bent over holding the abdomen

* Pain mainly low on the right side

* Pain or swelling in the scrotum or testicle (male)

* Could be pregnant (female)

* Severe pain anywhere

* Constant pain (or crying) present longer than 2 hours

* Blood in the stool or vomiting blood

* Vomiting bile (bright yellow or green)

* Recent injury to the abdomen

* Child is younger than 2 years

* 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

* Mild pain that comes and goes (cramps) lasts longer than 24 hours

* Fever is present

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Abdominal pains are a recurrent chronic problem

Parent Care at Home If: Mild abdominal pain and you don’t think your child needs to be seen

Home care advice for mild abdominal pain:

1. Reassurance:

* A mild stomachache can be caused by something as simple as gas pains or overeating.

* Sometimes a stomachache signals the onset of a vomiting or diarrhea illness from a virus (gastroenteritis). Watching your child for 2 hours will usually tell you the cause.

2. Rest: Encourage your child to lie down and rest until feeling better.

3. Clear Fluids: Offer clear fluids only (eg, water, flat sofy drinks, half-strength Gatorade). For mild pain, offer a regular diet.

4. Prepare for Vomiting: Keep a vomiting pan handy. Younger children often refer to nausea as a stomachache.

5. Pass a Stool: Encourage sitting on the toilet and trying to pass a stool. This may relieve pain if it is caused by constipation or impending diarrhea. (Note: for constipation, sitting in warm water may relax the anus and help release a stool.)

6. Avoid Medicines: Any drug (especially ibuprofen [eg, Advil]) could irritate the stomach lining and make the pain worse. Do not give any pain medicines or laxatives for stomach cramps. For fever above 102°F (39°C), acetaminophen (eg, Tylenol) can be given.

7. Expected Course: With harmless causes, the pain is usually better or resolved in 2 hours. With gastroenteritis (stomach flu), belly cramps may precede each bout of vomiting or diarrhea and last several days. With serious causes (eg, appendicitis), the pain worsens and becomes constant.

8. Call Your Doctor If:

* Pain becomes severe

* Constant pain present longer than 2 hours

* Mild pain that comes and goes present longer then 24 hours.

* Your child becomes worse

9. Worried Stomach, Extra Advice:

* Help your child talk about events that trigger abdominal pain and how to cope with these triggers next time.

* Help your child worry less about things he can’t control.

* Teach your child to use relaxation exercises (relaxing every muscle in the body) to treat the pain. Lie down in a quiet place; take deep, slow breaths; and think about something pleasant. Listening to CDs or audiotapes that teach relaxation might help.

* Teach your child the importance of getting adequate sleep.

* Make sure that your child doesn’t miss any school because of stomachaches. Stressed children have a tendency to want to stay home when the going gets rough.

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

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

Rash, localized and cause unknown

Definition:

* Rash on one small part of the body (localized or clustered)

* Red or pink rash

* Small spots, large spots, or solid red

* Includes localized areas of redness or skin irritation

Causes:

Main Cause: Skin contact with some irritant

Return to School

* Children with localized rashes do not need to miss any child care or school.

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

* Purple or blood-colored spots or dots that are not from injury or friction

* Bright red area or red streak (but not sunburn)

* Rash area is very painful

* Child is younger than 1 month and tiny water blisters (like chickenpox)

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

* You think your child needs to be seen

* Severe itching or fever is present

* Looks like a boil, infected sore, or other infected rash

* Teenager with genital area rash

* Lyme disease suspected (bull’s-eye rash, tick bite or exposure)

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Blisters unexplained (EXCEPTION: poison ivy)

* Pimples (apply antibiotic ointment until seen)

• Peeling Fingers

* Rash lasts longer than 7 days

Parent Care at Home If: Mild localized rash and you don’t think your child needs to be seen

Home Care advice for localized rashes:

1. Reassurance: New localized rashes are usually caused by skin contact with an irritating substance.

2. Avoid the Cause

* Try to find the cause

* Consider irritants like a plant (eg, poison ivy), chemicals (eg, solvents, insecticides), fiberglass, detergents, a new cosmetic, or new jewelry (eg, nickel).

* A pet may be the intermediary (eg, with poison ivy or oak) or your child may react directly to pet saliva.

3. Avoid Soap: Wash the area once thoroughly with soap to remove any remaining irritants. Thereafter avoid soaps to this area. Cleanse the area when needed with warm water.

4. Local Cold: Apply a cold, wet washcloth or soak in cold water for 20 minutes every 3 to 4 hours to reduce itching or pain.

5. Steroid Cream: If the itch is more than mild, apply 0.5% hydrocortisone cream (no prescription needed) 4 times per day (EXCEPTION: suspected ringworm).

6. Avoid Scratching: Encourage your child not to scratch. Cut the fingernails short.

7. Contagiousness: Children with localized rashes do not need to miss any child care or school.

8. Expected Course: Most of these rashes pass in 2 to 3 days.

9. Call Your Doctor If:

* Rash spreads or becomes worse

* Rash lasts 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

Nose bleed

Definition:

* Bleeding from 1 or both nostrils

* No known injury

Causes:

• Nosebleeds are common because of the rich blood supply of the nose. Common causes include

– Dryness of the nasal lining (eg, from forced air furnace in winter)

– Antihistamines (Reason: they also dry the nose)

– Vigorous nose blowing

– Ibuprofen (eg, Advil) and aspirin (Reason: increase bleeding tendency)

– Suctioning the nose can sometimes cause bleeding

– Picking or rubbing the nose

– Predisposing factors that make the nasal lining more fragile (eg, nasal allergies, colds, sinus infections)

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

Fainted, or too weak to stand

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

* You think your child has a serious injury

* Bleeding does not stop after 10 minutes of direct pressure applied correctly and tried twice

* New skin bruises or bleeding gums not caused by an injury are also present

* Large amount of blood has been lost

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

You think your child needs to be seen

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Child is younger than 1 year

* New-onset nosebleeds are occurring frequently

* Hard-to-stop nosebleeds are a recurrent chronic problem

* Easy bleeding present in other family members

Parent Care at Home If:

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

Home Care Advice for Nosebleeds:

1. Reassurance:

* Nosebleeds are common

* You should be able to stop the bleeding if you use the correct technique

2. Apply Pressure:

* Gently squeeze the soft parts of the lower nose against the centre wall for 10 minutes. This should apply continuous pressure to the bleeding point.

* Use the thumb and index finger in a pinching manner

* If the bleeding continues, move your point of pressure

* Have your child sit up and breathe through the mouth during this procedure

* If it re-bleeds, use the same technique again.

3. Insert Gauze:

* If pressure alone fails, insert a gauze wet with a few decongestant nose drops (eg, nonprescription Afrin) (Reason: the gauze helps to apply pressure and nose drops shrink the blood vessels).

* If not available or your child is younger than 1 year, use petroleum jelly applied to gauze.

* Repeat the process of gently squeezing the lower soft parts of the nose for 10 minutes.

4. Prevent Recurrent Nosebleeds:

* If the air in your home is dry, use a humidifier to keep the nose from drying out

* Apply petroleum jelly to the centre wall of the nose twice a day to promote healing

* For nose blowing, blow gently

* For nose suctioning, don’t put the suction tip very far inside. Also, move it gently.

* Avoid aspirin and ibuprofen (eg, Advil) (Reason: increase bleeding tendency)

5. Expected Course: More than 99% of nosebleeds will stop following 10 minutes of direct pressure if you press on the right spot. After swallowing blood from a nosebleed, your child may vomit a little blood or pass a dark stool tomorrow.

6. Call Your Doctor If:

* Unable to stop bleeding with 20 minutes of direct pressure

* 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

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

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