Don McInturff, MD
David Denton, MD
Matthew Murdoch, MD
Brian Fulks, MD
Gentry Yost, MD
Shaun Summerill, MD
Laura Duty, MD
Elizabeth Parsons, MD
Matthew Stelzer, MD
David Larsen, MD
Alison McInturff, MD
232-1443www.pocatellochildren.com
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Table of Contents
Office Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
About This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Well-Child Care and Immunizations . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7
Tylenol Dosing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Motrin Dosing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Vomiting and Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-10
Common Cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-12
Sore Throats and Strep Throat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Ear Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Pink Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Fussiness in Infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-17
Constipation in Newborns and Infants . . . . . . . . . . . . . . . . . . . . . . . . 18
Diaper Rash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Head Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Head Injury Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Important Telephone Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
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Welcome to the Pocatello Children’s Clinic!
We believe that nothing is more rewarding than caring for children . As a parent, you know how exciting and sometimes challenging it can be . We are here to help . Every person in our office is dedicated to working just with children . It’s our specialty; we wouldn’t have it any other way .
We provide comprehensive care for all children and adolescents . At the Pocatello Children’s Clinic, a pediatrician is always available to answer your questions or see your child 24 hours a day, 7 days a week .
During regular office hours you can make appointments for well child care and sick visits . We reserve time every day for sick visits should your child need to be seen the same day . If you are unsure whether or not your child needs to be examined, you can ask to speak to a nurse before making an appointment .
After hours, one of our pediatricians is available by phone at all times . We ask that you save calls about scheduling and other non-urgent issues until the next business day . If you have questions or concerns that cannot wait until morning, however, please call us . You should also call us before taking your child to the emergency room unless your child has a life-threatening condition . Many times a call to us can help you avoid costly emergency room visits . If your child does need to be seen at the hospital, we can arrange to meet you there .
We also staff Portneuf Medical Center’s nursery and pediatric inpatient ward . If your child needs to be admitted to the hospital, there is a pediatrician from our clinic ready to care for him or her . In addition, pediatric sub-specialists from Primary Children’s Medical Center regularly work with our pediatricians and see patients in our clinic .
Monday to Friday 8:00 a.m. to 9:00 p.m.and Saturday 8:00 a.m. to 12:00 p.m.
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About this bookWe find that parents often have similar questions about the common illnesses children experience . We’ve written this book to:
• Address some of the most frequent questions we are asked;• Help you understand why we believe well child care is so important and what you
can expect at well child care visits;• Aid you and your child in getting the most out of being seen at the Pocatello
Children’s Clinic .In its pages you’ll find advice and instruction on how to manage things like fever, vomiting and colds . Getting sick is part of growing up . But almost always kids get better, and moms and dads are the best medicine .
The most important advice: Trust your instincts. And if you have questions, ask. That’s why we’re here.
Think of this book as a quick guide . The internet and libraries provide extensive resources on the health and development of children . In fact, there is more information available than any one person could ever digest . Many of these resources offer parents sound advice . Some do not . We caution you to check the references of information you find and if in doubt, discuss it with us . We’ve obtained much of the information found in this book from trusted websites .
You can access some helpful links on our website at:
www.pocatellochildren.com
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WELL CHILD CARE AND IMMUNIZATIONSWellness means more than just not being sick. It involves healthy growth and development. We encourage regular visits with your pediatrician to address all aspects of your child’s health. In a typical visit, we’ll discuss past and on-going medical problems, your child’s development, and parenting advice. Parents are often interested in subjects such as diet, behavior and discipline, and safety issues. We’ll perform a full physical exam and age-appropriate screening tests. This is also a good time for you to ask us questions.
During well child visits, children receive their immunizations, or “shots.” Immunizations have revolutionized the health of children in the past hundred years. Because of vaccines, children no longer die from many of the diseases our parents and grandparents dreaded such as polio, mumps, and measles. We believe that the benefits of vaccination far outweigh any risk. We immunize our own children. However, many parents have questions about vaccines, and we feel it is important to discuss your concerns and will do so during well child care visits.
Below is a schedule of routine childhood immunizations. From time to time, new vaccines are added, and this schedule may change. We will inform you when changes are made.
Health Supervision Visit Schedule with Immunization Schedule
• 2 weeks - health supervision visit
• 2 months - health supervision visit & Hib, DTaP and Polio, Hep B, Pneumococcal, Rotavirus
• 4 months - health supervision visit & Hib, DTaP and Polio, Pneumococcal, Rotavirus
• 6 months - health supervision visit & Hib, DTaP and Polio, Hep B, Pneumococcal, Rotavirus . Influenza vaccine annually in the fall .
• 9 months - health supervision visit, catch-up immunizations if behind
• 12 months - health supervision visit & MMR, Varicella, Hep A
• 15 months - health supervision visit & DTaP, Hib, Pneumococcal
• 2 years - health supervision visit & Hep A
• 3 years - health supervision visit & Hep A (if needed)
• 4-5 years - health supervision visit & DTaP, Polio, MMR, Varicella
• Every few years - health supervision visit
• 10-12 years - Tdap, Meningococcal and HPV
HOW DO VACCINES WORK?Vaccines work by preparing your child’s body to fight illness. Each immunization (given through a shot your child receives) contains either a dead or a weakened germ, or parts of it, that cause a particular disease. Your child’s body practices fighting the disease by making antibodies that recognize specific parts of that germ. This permanent or long-standing response means that if your child is ever exposed to the actual disease, the antibodies are already in place and his body knows how to combat it, so your child doesn’t get sick. This is called immunity (from www.kidshealth.org).
FEVERFever is a normal response to illness. Fevers, which we define as any temperature over 100.4°, do not harm children. Most of the time a fever can be managed by you at home. Occasionally it can indicate something more serious.
The best way to take the temperature of a small child is by holding a thermometer in the rectum. An older child’s temperature should be taken in the mouth. Ear and armpit thermometers can offer a rough estimate of a child’s temperature but are often inaccurate.
If your child is under the age of 3 months and has a fever, call us immediately.
In older children, what’s more important than the temperature itself is how your child looks and is acting.
Call us if your child has a fever and • looks very ill or is extremely fussy or drowsy
• has a stiff neck or bad headache
• the fever has lasted more than three days
• the fever is higher than 104 degrees
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What to do:
While a fever alone will not hurt children, it can make them feel rotten . Here are some simple things you can do to make your child more comfortable .
• encourage your child to drink plenty of fluids
• dress your child in light clothing
• sponge your child briefly (about ten minutes) with room
temperature water, but never cold water or rubbing alcohol
• let your child rest
Tylenol(acetaminophen) and Motrin(Ibuprofen) are the best medicines for fever . Generic brands work just as well . Children should never take aspirin . But remember if you are thinking of giving any child younger than three months Tylenol for fever, you need to call us first . Here are some simple dosing guidelines .
Heat exhaustion and heat stroke are very different from simple fever. If your child has a fever and has been in an overheated car or
extremely hot environment, call us immediately.
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DOSING INSTRUCTIONS
AcetaminophenTylenol
or Store BrandDosing Chart
Doses may be repeated every 4 hours
IbuprofenMotrin
or Store BrandDosing Chart
Doses may be repeated every
6-8 hours
½ tsp
¾ tsp
Consult your child’s physician
100
VOMITING AND DIARRHEAChildren vomit. And they do it often. Fortunately, vomiting usually doesn’t last too long. Most of the time it is caused by viruses that pass quickly. Vomiting is often associated with diarrhea. Diarrhea generally lasts longer than the vomiting, sometimes up to two weeks.
Like many other childhood illnesses, vomiting and diarrhea can often be managed by you at home. Here are some warning signs to watch for.
Call us if your child is:• less than 3 months old• extremely uncomfortable with belly pain• vomiting blood or bile (bright green stomach content)• having diarrhea that is bloody or black and tar-like• vomiting everything and can keep nothing in his or her stomach• dehydrated
What to do:Encourage your child to drink plenty of fluids, but don’t let them guzzle. The key to avoiding repeated vomiting is frequent small sips. Use a tablespoon or syringe to control the amount your child takes with each sip. Give her 1/2 oz to 1 oz every 15 to 30 minutes depending on her age and daily fluid goal. Below are goals for the amount of fluid your child should drink each day. The best fluids for a vomiting child are Pedialyte, Infalyte, or a generic oral rehydration drink.
Daily fluid goal by age 6 months - 25 oz 1 year - 30 oz 2 year - 40 oz 4 year - 45 oz
Once the vomiting is finished, slowly reintroduce formula or easy-on-the-stomach foods like crackers, bread, or bananas. As your child proves that she can tolerate solid foods, you can gradually return to a normal diet. If you are breastfeeding, continue to nurse, supplementing with an oral rehydration drink if your baby isn’t tolerating breast milk or isn’t getting enough fluid through breast feeding alone. Remember that diarrhea can take several days to go away and you need to make sure your child is drinking enough to stay hydrated. Children with diarrhea that has lasted longer than 2 weeks should be evaluated in the clinic.
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Is my child dehydrated? Figuring out whether your child is dehydrated can be tricky. If you are unsure, it is best to call. Signs and symptoms of dehydration include
• dry, sticky mouth • sunken eyes or no tears • extreme tiredness • disinterest in drinking • urination less than three times a day
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THE COMMON COLD AND COUGHSYoung children will often have anywhere between 6 and 12 colds per year. That is why we call them “common.” Most experience colds as a runny nose, congestion, and cough. It’s normal for colds to get worse over the first few days and take up to two weeks to clear. Colds are caused by viruses and are not treated with antibiotics.
Parents often ask us which is the best cold medicine to give their child. Cold medicines are meant to treat symptoms, such as cough or congestion. They do not help your child’s body fight the virus nor make the cold go away faster. In addition, studies show that cold medicines are not effective in children, and we do not routinely recommend them.
But you shouldn’t feel helpless when caring for your child with a cold. There are things that you can do to make him feel better. The first thing is to know when to call us.
Call us if your child:
• is having trouble breathing
• is having cough associated with fever or chest pain
• is so sick that they are not drinking and is becoming dehydrated
• has a stiff neck or swollen lymph nodes
What to do:
• treat your child’s discomfort using Tylenol or Motrin (follow the same doses as for fever, page 8)
• encourage your child to drink plenty of fluids
• use a humidifier
• place 1 to 2 drops of saline in each side of the nose and, using a bulb syringe, gently clear the congestion from your child’s nose
You can either buy saline drops or make your own. To do this, combine 1/4 teaspoon of salt
with 4 ounces of warm water.
What is the difference between viruses and bacteria?Bacteria are tiny living organisms. They are everywhere, including in the human body. Many bacteria are necessary for human existence. Some are harmful and cause disease. Viruses are tiny non-living particles that need other living organisms to “survive” and replicate. Viruses cause classic childhood diseases like the flu, chicken pox, and measles.
The bottom line for parents is that antibiotics treat infections caused by bacteria, such as strep throat.
They have no effect on illnesses caused by viruses—including the common cold.
Over-using antibiotics has unintended consequences . Given the chance, bacteria can learn to defend themselves against antibiotics . Scientists refer to this as antibiotic resistance. This is why we are careful in prescribing antibiotics only to children who need them, and ask that you use the medicine as directed . This includes completing the entire course of medicine even if your child is feeling better .
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SORE THROATS AND STREP THROATMost sore throats are associated with colds . If your child has a sore throat and fever, and no cold symptoms, they are more likely to have strep throat . A child will also typically experience headache and stomach pain with strep throat but not cough or congestion . Other things that point to strep throat are swollen glands, white spots on your child’s tonsils or red spots on the roof of the mouth .
Strep throat is almost never an emergency . It doesn’t require a middle-of-the-night emergency room visit, but it should be treated with antibiotics as soon as possible . It will help your child feel better faster and prevent other problems . Sore throats are occasionally associated with more dangerous conditions that demand a more urgent visit with the pediatrician .
Call us if your child:
• is drooling
• is having difficulty swallowing
• has a stiff neck
• is having trouble breathing
What to do:
• complete the entire course of antibiotic if your child is diagnosed with strep throat
• use Tylenol or Motrin for pain relief
• encourage your child to drink plenty of fluid including warm liquids that may ease the discomfort
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EAR INFECTIONSConcern over ear infections is one of the most common reasons children come to the doctor. Ear infections occur when fluid builds up behind the ear drum and becomes infected with bacteria. It often occurs after several days of nasal congestion. Cold air and wind do not cause ear infections though they may cause ear pain for a short time.
The symptoms of ear infections vary. Older children will typically complain of ear pain. Younger children may be fussy, may seem to wake frequently at night, eat less, or have fever. They will often have had a cold for two or three days and then start to appear more ill. A young child with no other symptoms who pulls at his ears usually does not have an ear infection.
Not all ear infections need to be treated with antibiotics. In fact, most get better with time alone. In children who are older than two years, we may recommend treating your child’s discomfort with Tylenol, Motrin, or ear drops and holding off on antibiotics for a few days to see if the infection will heal itself. If we do prescribe antibiotics, it usually takes one to two days of treatment before your child feels significantly better. And if your child has a cold as well as an ear infection, the antibiotics will not make the cold go away.
Call us if your child:
• has signs of an ear infection
• has redness or swelling around the ear
• has not gotten better after 2 to 3 days of antibiotics
What to do:• treat discomfort with Tylenol or Motrin• have them lie on a heating pad on the low setting
for 10-20 minutes• complete all of the prescribed antibiotic, even if your child is feeling better
— 15 —
PINK EYE OR CONJUNCTIVITISPink eye is a common name for conjunctivitis. It is most commonly caused by an infection with either a virus or bacteria. Allergies are another cause of pink eye. You may notice redness on the whites of the eye or eye drainage. Children often complain of itchiness. Foreign bodies such as a piece of hair or a cut can also cause similar symptoms, but are not conjunctivitis and are treated differently. We will often provide antibiotic eye drops if we find that your child’s pink eye is caused by bacteria. However, almost all pink eye, whether caused by bacteria or virus, will get better with time alone.
Call us if your child:
• has a fever
• has swelling or redness around the eye
• may have been injured in the eye
• isn’t getting better in two or three days
What to do:
• keep the eye clean with a warm, damp, clean washcloth
• use good hygiene and wash your hands after cleaning
your child’s eye
The most important thing you and your child can do to prevent infection of almost any type is to wash hands. Some important times
to wash your hands include before cooking or eating, after playing with pets, after going to the bathroom and before and after helping a sick child.
— 16 —
FUSSINESS IN INFANTSNewborn babies cry. On average, they cry upwards of two hours per day. Crying is a baby’s way of telling us that he needs something. Most of the time infants quickly respond to the warmth and care of their parents. We don’t believe you can spoil a newborn baby; if your baby is crying pick her up and love her.
However, sometimes babies don’t calm as easily as we would like. Colic is a general term that means a baby is fussier than average, and there is no obvious reason for it. About one out of every three babies will be colicky. The typical colicky baby will get more fussy about his third week of life, will cry more often in the evening hours, and will stop being colicky by three months of age.
Don’t let yourself become overwhelmed by colic and don’t blame yourself for it. By knowing when to call us, learning a variety of calming techniques, and asking for help, you and your baby won’t just survive colic, but will grow closer because of it. We don’t routinely recommend colic medicines. Our practice is to always err on the side of caution. If your baby is more fussy than normal and you are concerned, please call us. Fussiness is not always colic. It can be the sign of a significant medical issue. Below are some warning signs for you to be aware of.
Call us if your baby:• has a temperature higher than 100 .4°
• is not feeding as well as before
• is limp or ill appearing
• has bloody or green vomit
• will not stop crying no matter what you do
• won’t stop crying and you are frustrated or tired
— 17 —
What to do:
• be optimistic, it gets better
• provide gentle motion by walking or rocking your baby (Sometimes gentle swings or quiet car rides work too .)
• swaddle your baby snuggly in a blanket
• let your baby suck on a nipple, pacifier or finger
• take your baby to a dark, quiet room
• play peaceful music or sounds of rain or rushing water
Many parents are concerned that their baby is colicky because of gas pain. While fussy babies will often pull up their legs and pass gas, it is usually not the only reason that they are crying. In fact, crying causes babies to swallow more air which leads to more gas.
Parents’ other main concern is that formula is causing the colic. While some babies will benefit from a different formula, this is rarely the case. We recommend that you speak with us before changing formulas.
Ask for helpTaking care of a fussy baby is hard work. It can rattle even the most experienced
parent. We all get frustrated. But before this happens, ask for help. If you are alone, place your baby in a safe place, such as his crib, and give yourself a
break in another room. Don’t ever shake a baby; it can kill him.
— 18 —
CONSTIPATION IN NEWBORNS AND INFANTSBowel movement, or stool, patterns change with age. And each child is a little different.
Most newborns stool meconium on the first day. Newborns start transitioning to typical baby stool by about 3 to 5 days of life. Their stool gradually becomes yellow, seedy, and runny by the end of the first week. Many parents think it looks like mustard. It is normal for infants to stool as often as after every feed or as infrequently as once every five days. Often stooling will become less frequent by 1 to 2 months of age and become greener. It’s all normal.
Parents are often worried about constipation because their baby seems to struggle, push hard or turn red in the face. This is also normal and not constipation, but a baby learning the coordination involved with stooling. We strongly discourage using suppositories or enemas.
Call us if your child has:
• blood in the stool
• a hard, tender, bloated belly
• green bile or blood in their vomit
• increasingly forceful vomiting
• painful, hard stools
What is meconium?Meconium is a newborn’s black, thick, and sticky first bowel movements.
It’s what builds up in a baby’s intestines during pregnancy.
— 19 —
DIAPER RASHMost diaper rash is caused by irritation from wet and dirty diapers . The best way to prevent a baby’s sensitive skin from developing a rash is to keep the diaper area clean and dry and change diapers regularly . Sometimes yeast or bacteria will take advantage of already inflamed skin and make the rash worse .
Call us if your child’s rash:
• is progressively getting more inflamed despite keeping it clean and dry
• looks particularly red and beefy
• is spreading with bright red bumps around the edges of the main rash
What to do:
• leave the diaper off several times per day to let the area air dry
• use cleaning wipes for dirty diapers but not wet-only diapers
• protect the clean skin with “barrier” cream like Desitin or
A+D ointment
• keep the diaper area as dry as possible
— 20 —
HEAD INJURIES
Childhood head injuries can be scary, but they are rarely a cause for alarm . Usually the most pressing concern is bleeding from a cut or scalp swelling from the injury . Head trauma can, however, cause subtle internal injury to the brain . It’s important that you observe your child closely .
Call us if your child:
• had a loss of consciousness or episode when they did not respond
• is confused, not acting normally or unusually sleepy
• is having difficulty speaking or walking
• is complaining of double or blurry vision or dizziness
• has vomited more than two or three times
• has seizure-like activity
• has trouble breathing
• has a significant cut that you think may need stitches
• is less than 6 months old
What to do:• observe for any of the above signs listed in the “Call us if”
section above
• stop the bleeding and clean any cut with plenty of water
• apply ice to swelling
• your child does not have to stay awake after a head injury . If it is near bed- or naptime, let her sleep . While she is asleep you should observe her breathing, color, and tone every few hours . If you become concerned wake her up and see if she responds as she normally does when being woken in the middle of sleep . If you have any concerns call us .
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DO NOT MOVE YOUR CHILD AND CALL 911 IF • the injury was from a significant height or from massive force • your child is not responding • your child is not breathing • your child is complaining of weakness in her arms or legs or complaining of neck pain• there is blood or clear fluid coming from your child’s nose or ears
HELPFUL SAFETY TIPS• never leave your baby unattended on a changing table or bed
• supervise playground activity and be cautious about what sort of games children play on jungle gyms
• require helmets for children who are skateboarding or riding scooters or
bicycles
• don’t ever use a wheeled infant walker
• strap children into strollers or shopping carts
• use a car seat or booster seat that is right for your child’s size
Prevention is the cure
Head injuries can be prevented. A child should wear a bicycle helmet whenever she goes riding.
Even small children on tricycles are safer wearing a helmet, and it is good practice for when they are older.
— 22 —
POISONING
Be ready for your child to explore your home and stick everything she finds in her mouth . It will happen before you know it . We usually suggest safety proofing your home around the time your child turns 6 months old .
Store all medications and cleaning supplies in containers with safety lids and place them out of reach of children . Make your cabinets safe with childproof latches . Dispose of old, dangerous items that you no longer use . In addition to poisons, make sure that objects small enough to be placed in a child’s mouth are out of reach and that electrical outlets are covered .
We no longer recommend using syrup of Ipecac to induce vomiting. If your baby ingests something, call the poison control center first and follow all of their instructions.
Poison Control Center 1-800-222-1222
— 23 —
Notes
— 24 —
Pocatello Children’s Clinic Quick Reference
Clinic number 24 hours/day
232-1443
1151 Hospital Way, Bldg. FPocatello, ID 83201
www.pocatellochildren.com
Portneuf Medical Center239-1000
Clinic Hours: Monday to Friday 8:00 a .m . to 9:00 p .m .
and Saturday 8:00 a .m . to 12:00 p .m
Poison Control: 1-800-222-1222
