Common Medical Problems

Topics List:

Blocked Tear Ducts (Dacrostenosis, Dacryocystitis)
Swimmer's Ear (Otitis Externa)
Ticks
Constipation
Diaper Rash
Dry Skin
Colds and Cough
Using Cough & Cold Medicines in Young Children
Conjunctivitis (Pink Eye)
Contact Dermatitis
Croup
Fever
Insect Stings
Sore Throats
Vomiting and Diarrhea

Blocked Tear Ducts (Dacrostenosis, Dacryocystitis)

Many babies have one or both eyes which run or "tear" heavily. It is, of course, normal for tears to flow when the baby cries, but if tears fall even when not crying, the tear duct may be blocked. Usually, this also leads to "matter" and pus forming in the eye because of drying and infection. It can even glue the eye shut each morning.

The tear duct is a tiny tube which carries tears from the inner corner of the eye to the nose cavity. When this fails to open in time for baby's birth or becomes plugged later, the tears cannot reach the nose cavity normally and overflow onto the cheek. Even when there is swelling, redness and infections, this problem does not threaten the baby's eyesight.

General Treatment

We try to massage the tear duct to force it open. This is done by pressing firmly against the inner corner of the eye - squeezing it against the nose bone, and then rolling the finger (still pressing firmly) downward toward the nostril. The main pressure should be away from the eye, toward the nose, but far back where the nose joins the face. This should be done before every feeding. The doctor may also give you some medicine to fight infection in the eye duct.

If massage does not succeed in 6 months, we ask the eye specialist to see the baby and decide whether surgery is indicated to open up the tear ducts. They pass a tiny wire probe through the tear duct and open it directly. The vast majority of babies outgrow this tear duct obstruction without surgical intervention.

Swimmer's Ear (Otitis Externa)

Earaches in children during the summer months are often due to swimmer's ear (otitis externa). This common problem results from repeated moistening of the ear canal without drying the canal after swimming. The moisture allows the water bacteria to thrive and consequently develop and infection in the ear canal. With swimmer's ear the ear hurts but especially when the earlobe is moved.

Prevention of this condition can be accomplished by instilling 3-5 drops of rubbing (isopropyl) alcohol into each ear after swimming. Commercial preparations which will produce the same effect are SWIM-EAR and AQUA-EAR. If preventative measures are not successful and your child has a painful ear that worsens with movement of the ear itself, please contact our office. Initially a trial of antibiotic ear drops (Cortisporin Otic, Colymycin Otic) will be prescribed. If these do not appear to improve the situation, the child should be examined in our office?

Recurrent "swimmer's ear" is quite bothersome as well as frustrating. It is usually caused by a combination of prolonged exposure to heat and moisture (a long swim on a hot day). The best way to deal with it is to prevent it from happening. Here are four things you can do:

1. Limit the time in the water for the child whose infection keeps coming back. The amount will have to be determined by trial and error but in most cases should be less than one hour.
2. Let the ears dry completely for an hour or two before going back in the water. If your child is aware of water in the ear, have him or her shake the head to loosen the water and dry the ear with the corner of a towel. It's okay to take daily showers or baths as long as they are brief and the ears are dried afterwards.
3. If those measures don't work, make a solution of equal parts water and vinegar or water, vinegar and rubbing alcohol. Put a few drops in each ear when the child gets up, after each swim, and at bedtime, and let the solution stay in the ear for at least five minutes each time.
4. In any case, don't pick the ears with a pencil, a cotton ear swab, a bobby pin, or any other object.

Gently moving the ear will help ear drops move deep into the canal. The child should lie with the affected side up for two to three minutes. A small cotton wick inserted in the canal will help keep drops in longer.

Ticks

Ticks are plentiful in this area of the country from May to October. A small percentage of them carry the organisms which cause Rocky Mountain Spotted Fever and Lyme Disease. Ticks rarely transmit these infections until they have fed on a person for several hours. Therefore, prompt removal may prevent disease. Examine your children frequently during the spring and summer months for the presence of ticks. Keeping your pets free of ticks is a good preventative measure.

Methods for removal include:

1. Coating the tick with fingernail polish, polish remover or mineral oil.
2. Grasping and removing with tweezers or fingertips.
3. There is no therapy which will prevent Rocky Mountain Spotted Fever or Lyme Disease, although they are treatable once the disease is present. Obviously, it is most easily treated when recognized early. The common symptoms (fever, headache, abdominal pain, muscle aches and a rash) follow the tick bite in 4-12 days. There is no reason to call upon finding a tick, but call if the child becomes sick within the 4-12 day period or develops a gradually enlarging circular rash.

Constipation

Stool patterns may vary greatly in normal children. One bowel movement (BM) daily is the average, but many may go more frequently or only once every two to three days. An infant or child is constipated when his stool is very hard and has great difficulty passing it. This can normally be prevented with good dietary habits.

Babies often make a big fuss when having a bowel movement. This does not mean they are constipated. If a small baby has gone longer than usual between BMs and seems to be straining, he may be constipated. For older infants, fruits (especially prunes) should be emphasized in the diet. Occasionally, an infant glycerin suppository may be used for acute discomfort. Please call our office if you feel this in needed. If you find yourself using suppositories frequently, an office visit is indicated.

Toddlers and older children may temporarily become constipated when their usual diet and schedule are interrupted, such as during an illness or traveling. Older children will respond overnight to a tablespoonful of Milk of Magnesia or a Dulcolax tablet. Both preparations are available without prescription.

Older children with persistent constipation should be given a diet high in fiber such as whole grain breads, bran, and fresh vegetables. Such high fiber requires lots of liquids daily. A pediatric Fleets enema may be given for sever constipation and mineral oil may be used to maintain good bowel habits. An office visit is recommended before using these measures.

Diaper Rash

Most babies get diaper rash at one time or another. The dark, warm, moist conditions in the diaper area encourage irritations and sometimes bacterial or fungal growth.

Since the major offender is the continued moisture that irritates the skin, the first measure in keeping this area clear is to keep it as dry as possible.

General Treatment

Frequent diaper changes.
Thoroughly cleaning and drying the diaper area with each change.
Exposing the diaper area to air as much as possible.
Avoiding routine use of powders, lotions, etc.

Dry Skin

Dry skin is a condition that occus most frequently during the winter months. A common cause of dry skin is bathing too frequently. This removes the natural oils of the skin, and as a result, the skin becomes more irritated and itchy. A child will scratch these areas and cause more irritation. A simple approach to the treatment of dry skin is to keep the skin well moisturized.

General Treatment

1. Decrease frequency of bathing to every two or three days.
2. Use a mild soap that does not remove the natural skin oil such as Dove or Tone. Purpose, Ivory, and Dial, although good soaps, are drying during cold weather and should not be used in this situation. A liquid preparation, Cetaphil, is excellent for the child with excessive dryness. All of these can be purchased without prescription.
3. Skin moisturizers are helpful, but be aware that the heavily perfumed preparations may contribute to irritation. Gentle preparations are Moisurel, Lubriderm, and Keri lotion. These may be used once or twice a day especially after bath time.
4. Fabric softeners and certain detergents with fabric softeners in them may also contribute to irritation and dryness in children.

If these measures are not successful, and your child's skin becomes more irritated and uncomfortable, let us evaluate the situation.

Colds and Cough

The common cold, with its associated congestion and cough, is the most frequent infection your child will have. The average preschooler who stays at home will have six colds per year. Those children attending day care will average eight to twelve colds per year, particularly during the first year of exposure. The cold is caused by a virus, and this germ is not affected by antibiotics. Our treatment efforts, therefore, must be aimed at making your child more comfortable. Your child will experience one or more of the following symptoms: loss of appetite, fever, irritability, aches, runny/stuffy nose, or cough.

General Treatment

1. Expect your child's appetite to be decreased during an illness. Don't worry- he will eat again when the illness passes. In the meantime, encourage your child to drink liquids frequently.
2. If fever, irritability, or aches accompany the cold, use acetaminophen (Tempra/Tylenol) or ibuprofen (Children's Advil/Motrin). (See doses under "Fever".)
3. A runny/stuffy nose is bothersome and aggravating. It is not a threat to your child's ability to breathe. In infants less than six months of age, suctioning with a nasal aspirator may be helpful. Putting two drops of saltwater solution (1/4 tsp. table salt in 4 oz. water) in each nostril prior to suctioning helps remove thick, stubborn mucus. Over six months of age, medicated nose drops (Neo-Synephrine ¼%, Pediatric Afrin, Pediatric Otrivin) may be used. They should be used at bedtime and for only three nights in a row.

All of these symptoms will pass with time. Most colds last 10-15 days. Try to make your child as comfortable as possible using these suggestions. In a few days, your child (and you) will be feeling better. There is no truth that the color of mucus indicates the presence of bacteria and thus "needs antibiotics".

Using Cough & Cold Medicines in Young Children

There has been a lot of media attention paid lately to the issue of over-the-counter (OTC) cough and cold medicines for children. This has been spurred by concerns from healthcare professionals, consumers, and regulatory agencies about how safe and effective these products are for the age groups specified.

To give a little history, OTC products for children's cold symptoms have been available for quite some time, and questions about appropriate products and dosages date back at least thirty years. There have been almost no scientific studies done to prove the safety and efficacy of these products in children.

In the mid 1970's, a group of physicians made dosing recommendations for children ages 2 and up based on adult doses of the same cold and cough medicines. For children under 2, the dose was to be established by his/her healthcare provider.

Many arguments have been made since then that children are not “little adults” and metabolize medicine differently from adults. Also, many experts feel that the common cold presents differently in children than adults, and clinical studies of medications are very much needed.

Additionally, there have been tragic deaths of infants and young children attributed to OTC cough and cold medicines. In most cases, accidental overdosing was thought to be the cause. While the number of deaths (123 in a 37-year reporting period, 1969-2006) may seem low, the FDA cautions that there may be more deaths that have gone unreported to a federal agency such as theirs.

In August of this year, the FDA recommended against the use of OTC cough and cold medicines in children under the age of 2, unless specifically instructed to do so by a healthcare provider. By October, many OTC products for infants and children under 2 had been voluntarily withdrawn from the market.

In late October, the FDA issued another statement recommending that OTC cough and cold medicines not be given to children under 6 years of age without further clinical research.

The American Academy of Pediatrics recently gave their opinion to the FDA on the use of OTC cough/cold medicines in children under the age of 6. The AAP agreed there is a lack of evidence for the use of these products, the potential for harm due to dosing errors, and a lack of evidence-based dosing guidelines.

Because of these concerns, Suburban Pediatrics, along with other pediatric groups in the CMC-Northeast network agree that over-the-counter cough and cold medicines should not be used in children less than 2 years of age. Additionally, children ages 2 to 6 years can be given single ingredient products that target their most bothersome symptom. Parents and caregivers must carefully read labels to avoid giving multiple doses of the same ingredient. Also, it is very important to use the measuring device that comes with the product.

If you have any OTC cough and cold medicines for infants or children under 2 in your medicine chest at home, please discard them. Those products are no longer on the market.

So, if your child less than 2 years old gets a cold, what do you do to help them feel better? The following are suggestions to ease symptoms while their little bodies clear the cold virus. And remember—the cold is caused by a virus, so antibiotics do not help it go away any faster.

If your child is not old enough to blow his/her own nose, then he/she will sneeze out some of the worst secretions. Additionally, you may need to use a nasal bulb suction to remove more mucus. If the mucus won't budge, you may place several saline nose drops in the nose, wait sixty seconds (this will seem like forever!), then suction.

Raising the head of the bed 20 to 30 degrees helps your little stuffy head to breathe easier. For a crib, simply roll a blanket or towel and place it under the mattress, since a pillow is dangerous for baby.

A cool mist humidifier adds moisture to the air your child breathes while sleeping, easing coughs and keeping mucus slippery. Offering lots of fluids to drink also eases coughs and keeps your child hydrated. Acetaminophen or ibuprofen (6 mos & up) may be given for fever or discomfort.

Chest rub products specifically designed for infants 3 mos and up may help relieve cough and congestion. Please read labels! Products for older children and adults are not suitable for infants as they contain menthol and camphor.

Please always feel free to call us if you have any questions about how to care for your child, with or without a cold. The common cold is truly a common nuisance, and thankfully rarely serious. When your child is sick, we at Suburban Pediatrics share a common goal with you: to restore your child's health to wellness in the safest, most effective way possible.

Conjunctivitis (Pink Eye)

Conjunctivitis is a superficial inflammation of the eye. It may be caused by environmental irritants, allergy, or infection which may be viral or bacterial.

Your child may experience itching, redness, watering, or draining of one or both eyes. Following sleep the eyelids may stick together.

Children rub their itchy eyes, collect the drainage, and spread conjunctivitis to others. Schools and day care centers will not permit children to attend with conjunctivitis unless they are being treated with antibiotics. Keeping the hands washed, eyes wiped clean, and using antibiotic eye drops (when indicated) will help prevent spread. Viral conjunctivitis usually lasts 3-7 days.

Treatment includes:

1. Cleansing the eye with a warm damp washcloth or cotton balls.
2. Using soothing eyedrops such as Tearsol.
3. Using antibiotic eye drops if the drainage becomes thick and pus-like.
4. These drops may be prescribed over the phone.

An office visit is indicated if your child has a high fever, significant swelling of the eye, or complains of pain, decreased vision, or unusual sensitivity to light.

Contact Dermatitis
(Poison Ivy, Oak, Sumac and Certain Chemicals or Metals)

Contact dermatitis is a condition in which the skin reacts to an irritant from the environment. The sap from the leaf of poison ivy, certain chemicals found in cosmetics, or metals are examples of irritants. The rash occurs at the site of contact and may react as early as six hours after exposure, or as late as two to three weeks after exposure and may last a total of three weeks.

The rash is usually red and elevated and there may be multiple blisters with intense itching. Different areas of the body react differently to the same irritant. For example, the skin of the face (especially around the eyes) and genitals is very thin and may react more intensely than the thicker skin of the palms and soles. Sap from the plant leaf may come into direct contact with skin by handling the plant, or be handling clothing that has been in contact with plants. It can even be spread by handling pets who have rubbed against the plant. Sap on one area of the body may be transferred to other areas of the body and cause further outbreak. It becomes important, therefore, to wash skin and clothes immediately after contact. The fluid within the blisters presents no threat and will not spread the rash.

Prevention is the mainstay of our treatment program. You must be able to indentify the source of irritation and eliminate exposure. If the reaction is severe, we do have medication that will shorten the course of the reaction. This requires an office visit for a physician to evaluate your child.

General Measures to Control Itching

1. Cool baths or cool compresses especially to blistered areas. Tap water is fine; however, the use of Burrows solution may offer even more relief. This preparation may be obtained without a prescription, and can be used four times a day with cool compresses.
2. Cooling topical lotions that contain a menthol preparation are often effective. Calamine lotion is an example of this, and if applied lightly may offer some benefit for itching.
3. Topical corticosteroids may also offer relief and 1% hydrocortisone cream may be obtained at pharmacies without a prescription. These may be applied four times a day or even more frequently, if required.
4. Antihistamines are medications that are taken by mouth to help relieve itching. Benadryl can be obtained over the counter and, at appropriate doses, may be used as noted.

   6 mos-1 year	1/2 tsp.	4 x daily
   1-3 years	1 tsp.	4 x daily
   3-5 years	1-1/2 tsps.	4 x daily
   5 years and older	2 tsps.	4 x daily

Croup

Croup is a viral infection of the larynx (voice box) and upper portions of the respiratory tract. The barky cough, hoarseness, and noisy breathing are caused by swelling and inflammation of the larynx. Most of the time, the illness is caused by a virus and antibiotics will not help.

Usually croup affects children between the ages of three months to five years. Often the child will have one to two days of runny nose, low grade fever, and some hoarseness before the barky cough appears. Typically, the child awakens in the middle of the night with cough, rapid noisy breathing, and fever.

Croup is a scary experience for both the parents and the child. Fortunately, relief is easily obtained and most cases can be handled at home. Try to appear calm and reassuring. Cool, moist air often relieves the harsh noisy breathing and barking cough. Therefore, take your child for a walk in the cool night air for about 20 minutes. If your child has improved but remains croupy, then try warm steam for relief. Make your bathroom into a steam room by closing the bathroom door and turning the shower on hot. Sit with your child in the steamy room for another 20 minutes (take some toys or books for entertainment). Most symptoms will be relieved by either or both of these simple procedures. Acetaminophen or Ibuprofen may be used to decrease fever and discomfort. Give your child plenty of fluids, and use a cool mist vaporizor in his room at night. You should call our office if the simple measures described above have not brought significant improvement within 30-60 minutes.

Croup may last a week. The worst nights are the first and second ones after the barky cough develops - expect a few trips to the shower room or walks in the night air on these nights. Fever may last three to five days and the cough may continue intermittently up to 10 days. Your child often seems a lot better during the day.

Croup - From the Scottish word "croak", which describes the sound these children make.

Fever

Fever is an elevation of body temperature. All children develop fever, and to parents this may be alarming. However, instead of a bad sign, this shows the body is fighting infection. Children tend to run higher temperatures than adults and they tolerate the fever better. The child's appearance and level of activity are more important than the height of the fever. The degree of the temperature is not necessarily an indication that the illness is better or worse. A fever needs to be treated only if your child is uncomfortable.

General Treatment

Treatment includes rest, increased fluid intake, and cool environment. Measures that help reduce fever include acetaminophen, ibuprofen and sponging. Remember that a high fever does not mean an emergency, and it is more important to see how a sick child looks and acts than what the thermometer registers.

Treatment of Fever

1. Give extra fluids.
2. Do not bundle or overdress.
3. Medication: Acetaminophen (Tylenol/Tempra): give 80mg. (0.8ml dropper, ½ tsp.,or 1 chewable tablet) per year of age every four hours as needed. Ibuprofen (Children's Advil/Motrin): 6 mo.-1 yr.- ½ tsp. every 6 hours; 1-3 yrs- 1 tsp. every 6 hours; 3+ years- 2 tsp. every 6 hours.
4. Should the temperature be greater than 104 degrees, in spite of medication, sponging may be helpful. Place the child in a bathtub of tepid (neither hot nor cold water, and scrub the skin vigorously with a wash cloth. Pour the water over the chest and back. Continue to do this for 20-30 minutes. Do not put alcohol in the tepid water.
5. Remember:

   A. The appearance and activity of the child are more important than the degree of temperature.
   B. Don't panic! A hot baby needs cool parents!

Insect Stings

Most of us have had the painful experience of insect stings or bites. When the sting occurs there is an immediate, sharp pricking and burning sensation which lasts several minutes, followed by the formation of a red raised welt that may itch and feel hot. Most signs of the sting will be gone within 12 hours though redness and swelling may last for 24-48 hours.

General Treatment:

1. If there is a stinger, remove it by scraping with a needle or blade. Do not pull this stinger out with tweezers since this may cause more venom to be injected.
2. Place ice on sting.
3. For topical relief of itching try any of the following: baking soda paste, hydrocortisone cream, lotions with menthol, meat tenderizer or dilute household ammonia.
4. For relief of itching, antihistamines may be helpful. Benadryl Elixir cough syrup or Chlor-Trimeton are antihistamines available without prescription. See previous dosing schedule; Two over the counter preparations that will help with itching are Itch-X and Pramagel. They are applied topically four times daily.

Some stinging insects are scavengers and may transmit germs when they sting. Contact the office if pus, new swelling, or tenderness appear in the area of the sting. Multiple stings (usually more than four) may cause a toxic reaction, characterized by fever, diarrhea, vomiting, headache, and swelling. Please contact the office if your child has gotten multiple stings and begins to show any of these symptoms. Although the affected area was not initially swollen, you may notice warmth, redness, and swelling the following day. This is common and should not cause alarm.

Allergic reactions to insect stings are unusual, symptoms such as difficulty breathing, swelling in other areas of the body, fainting or abdominal pain suggest an allergic reaction and, if any of these occur, please call our office immediately.

Sore Throats

Throat infections (pharyngitis, tonsillitis) are painful and make all of us miserable at one time or another. Two types of germs cause throat infections - VIRUSES and BACTERIA. The most important bacteria infecting the throat is the streptococcus (strep throat).

The majority of throat infections in children are caused by viruses and are not "strep". Unfortunately, the symptoms and severity of viral and strep throats are so similar that we often cannot accurately tell one from another by examination. It is important to treat strep throats with antibiotics because treatment prevents the occasional late complication - rheumatic fever with rheumatic heart disease.

We use throat cultures and a rapid strep test to identify strep throats. The results of the rapid strep test are usually available in 24-48 hours. If the culture proves positive, you will be contacted and antibiotics prescribed. A child with "strep" is considered contagious to others until he has been on antibiotics for at least 24 hours. After that period your child may return to his usual activities if feels well. We recommend that other family members be seen by a doctor if they are symptomatic.

Remember:

1. A rapid strep or throat culture is a simple, quick way to identify those children with sore throats that need antibiotics.
2. Children with "strep" should also be isolated from others from 24 hours after the start of therapy.
3. Family contacts should be tested only if symptomatic.
4. General treatment measures include: frequent liquids, gargles, sprays, lozenges. Tylenol and time.

Vomiting and Diarrhea

Vomiting and diarrhea occur in children for many reasons. Most commonly, they occur as symptoms of gastroenteritis ("stomach flu" or "intestinal flu"). The illness usually lasts one to four days and is often accompanied by stomachache and fever. Our main concern in gastroenteritis is prevention of dehydration.

General Treatment

1. When a child begins to vomit, it is best to withhold all solids and liquids for the first complete 8 hours. In an infant or very young child, allow only very small sips of clear liquids during this time. Clear liquids (Infalyte, Gatorade, flat soft drinks) are excellent fluids for small infants. These should be given in small amounts, such as one to two ounces per hour. If the child does not begin vomiting again, the amounts can gradually be increased for the next 24 hours. Soup, toast, crackers and formula may be offered 8-12 hours after vomiting stops. Then you may advance as tolerated. If the vomiting persists, call our office.
2. Diarrhea may accompany vomiting or occur alone. When diarrhea begins, milk, diary products, and solid foods should be discontinued. The child should be allowed only clear liquids for 16-24 hours. Simple solid foods, such as rice, cereal, bananas, toast, or crackers may be added the second day. Milk and dairy products usually should not be added until the third or fourth day; however, normal feeding may begin after vomiting has stopped. As a child recovers, his bowel movements may not be formed for many weeks.
3. As long as a baby has a moist mouth and tongue, cries tears, and is voiding two to three times per day, he is not dehydrated.

Note to Breast Feeding Mothers: Breast feeding usually can be continued in gastroenteritis. Frequent short feedings (5-10 minutes of each breast) are helpful if baby is vomiting. Regularly spaced feedings are appropriate if the baby has diarrhea. Extra fluids may be given between breast feedings such as Infalyte, if diarrhea is excessive.