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Fever

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Definition:

Your child has a fever if:

– 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

– Temporal artery and skin infrared temperatures may be reliable in young infants

– Use this guideline if fever is your child’s only symptom

Causes:

* Main Cause: Colds and other viral infections

* Fever may be the only symptom for the first 24 hours (ie, viral fevers). The onset of symptoms (eg, runny nose, cough, diarrhea) are often delayed. In the case of roseola, fever may be the only symptom for 2 or 3 days.

* The cause of fever usually can’t be determined until other symptoms develop. That may take 24 hours.

* Bacterial infections (eg, strep throat, urinary tract infections) also cause fever

* Teething does not cause fever

Fever and Crying:

* Fever on its own shouldn’t cause much crying

* Frequent crying in a child with fever is caused by pain until proven otherwise

* Possible causes are ear infections, urinary tract infections, and sore throats

Normal Variation of Temperature:

* Rectal: A reading of 98.6°F (37°C) is just the average rectal temperature. It normally can change from 96.8°F (36°C) in the morning to a high of 100.3°F (37.9°C) in the late afternoon

* Oral: A reading of 97.6°F (36.5°C) is just the average oral temperature. It normally can change from a low of 95.8°F (35.5°C) in the morning to a high of 99.9°F (37.7°C) in the late afternoon.

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.

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

* Not moving or very weak

* Unresponsive or difficult to awaken

* Difficulty breathing with bluish lips

* Purple or blood-colored spots or dots on skin

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

* Your child looks or acts very sick

* Not alert when awake

* Any difficulty breathing

* Great difficulty swallowing fluids or saliva

* Child is confused (delirious) or has stiff neck or bulging soft spot

* Had a seizure with the fever

* 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

* Very irritable (eg, inconsolable crying, cries when touched or moved)

* Won’t move an arm or leg normally

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

* Burning or pain with urination

* Pain suspected

* Chronic disease (eg, sickle cell disease) or medication (eg, chemotherapy) that causes decreased immunity

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

* You think your child needs to be seen

* Child 3 to 6 months of age with fever

* Child 6 to 24 months of age with fever present longer than 24 hours but no other symptoms (ie, no cold, cough, diarrhea, etc)

* Fever repeatedly above 104°F (40°C) despite fever medicine

* Fever returns after gone for 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

Parent Care at Home If:

* Fever with no other symptoms and you don’t think your child needs to be seen

Home Care Advice for Fever:

1. Reassurance: Presence of a fever means your child has an infection, usually caused by a virus. Most fevers are good for sick children and help the body fight infection. Use the following definitions to help put your child’s level of fever into perspective:

* 100°F to 102°F (37.8°C to 39°C): Low-Grade Fevers: Beneficial, desirable range

* 102°F to 104°F (39°C to 40°C): Average Fever: Beneficial

* Above 104°F (40°C): High Fever: Causes discomfort but harmless

* Above 106°F (41.1°C): Very High Fever: Important to bring it down

* Above 108°F (42.3°C): Dangerous Fever: Fever itself can cause brain damage

2. Treatment for All Fevers: Extra Fluids and Less Clothing:

* Give cold fluids orally in unlimited amounts (Reason: good hydration replaces sweat and improves heat loss from the skin)

* Dress in 1 layer of lightweight clothing and sleep with 1 light blanket (avoid bundling) (CAUTION: Overheated infants can’t undress themselves)

* For fevers 100°F to 102°F (37.8°C to 39°C), this is the only treatment needed (fever medicines are unnecessary)

3. Fever Medicine:

* Fevers only need to be treated with medicine if they cause discomfort. That usually means fevers above 102°F (39°C).

* Give acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil)

* The goal of fever therapy is to bring the temperature down to a comfortable level. Remember, fever medicine usually lowers the fever by 2°F to 3°F (1°C to 1.5°C)

* Avoid aspirin (Reason: risk of Reye syndrome, a rare but serious brain disease)

4. Sponging:

* Note: sponging is optional for high fevers, not required

* Indication: May sponge if fever above 104°F (40°C) doesn’t come down with acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil) (always give fever medicine first)

* How to Sponge: Use lukewarm water (85°F to 90°F) (29.4°C to 32.2°C). Do not use rubbing alcohol. Sponge for 20 to 30 minutes.

* If your child shivers or becomes cold, stop sponging or increase the water temperature.

5. 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.

6. Expected Course of Fever: Most fevers associated with viral illnesses fluctuate between 101°F and 104°F (38.4°C and 40°C) and last for 2 or 3 days.

7. Call Your Doctor If:

* Fever rises above 104°F (40°C) repeatedly

* Any fever occurs if your child is younger than 12 weeks

* Fever without a cause persists longer than 24 hours (if your child is younger than 2 years)

* Fever persists more than 3 days (72 hours)

*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

Vomiting with diarrhea

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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

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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

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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 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

– 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

Abdominal Pain

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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