Genesis Advice Packet (GAP)

Symptoms:

• Pain or discomfort in the throat, which worsens with swallowing.
• Children less than two years of age may refuse previously enjoyed foods or cry with feedings.

Treatment:

• Gargle with warm salt water (1 tsp per 8 oz glass of water)
• Give Acetaminophen (Tylenol) if child older than 2 months, or Ibuprofen (Motrin or Advil) if child older than 6 months for comfort. See dosing charts.
• Encourage cold fluids or foods.
• Soft bland diet – avoid spicy, acidic or rough textured foods.
• Call during regular office hours if:
  • Sore throat lasts longer than 24 hours.
  • Sore through is accompanied by fever (101° F  or higher).
  • The child has had recent contact or exposure to strep throat.
  • Accompanied by abdominal pain, vomiting or headache.
  • A rash develops.
• Call immediately any of these symptoms develop:
  • Drooling.
  • Difficulty breathing.
  • Difficulty swallowing.

Symptoms:

• Tight, low-pitched barky cough (seal-like bark).
• Voice or cry hoarse sounding.
• Child may have stridor* as illness worsens – a crowing or seal-like noise when child takes a breath in.
• Symptoms tend to increase in the evening/at night and last for 5 -6 days.
• Associated symptoms include fever or nasal congestion.

Treatments:

Croup without stridor:

1. Cool mist vaporizer at night.
2. Increase daily fluid intake. Use warm fluids if having cough spasms to relax airways.
3. Give Ibuprofen if child is older than 6 months - see dosing chart. *Cold medications or antibiotics do not cure the illness.

Croup with stridor:

1. Steamy bathroom – turn on the hot water in the shower and close the bathroom door. Bring the child into the steamy room to breathe the warm moist air for 10-15 minutes.
2. Take the child outside for 5 -10 minutes into cold night air or have the child breathe in air from an open freezer.
3. If these measures are unsuccessful, call the office immediately. If your child has severe difficulty breathing, go straight to the Emergency Department or call 9-1-1.

Symptoms:

• Warmer to the touch than normal. Temperature 100.4° F or higher.
• Increased fussiness.
• Increased heart rate, respiratory rate, flushed face.
• Child not wanting to eat, drink or play like normal.

Be Reassured:

• Fever is a “friend.” It is a sign that the body is fighting off an infection.
• Fever is often higher in the evening and lowers in the morning.
• Fever generally lasts 2-3 days.
• Fevers of 104° F or higher are generally not dangerous; treat the same as a lower fever.

Treatments:

• If the temperature is below 100° F and the child is acting well, no treatment is necessary.
• Increase daily fluid intake.
• Keep child lightly dressed with loose cotton layers.
• Give Acetaminophen (Tylenol) if the child is older than 2 months, or Ibuprofen (Motrin or Advil) if the child is older than 6 months for comfort. See dosing charts.
  • Acetaminophen alone can be given every 4 hours.
  • Ibuprofen alone can be given every 6 hours.
• Call during regular office hours for an appointment if your child’s fever (101° F or higher) persists for more than 3 days.
• Call immediately if:
  • Your child is under 2 months of age and has a rectal temperature 100.4° F   or higher.
  • Your child is difficult to arouse or does not interact with you.
  • Your child is complaining of a stiff neck or not able to move their neck.
  • Your child has a rash that does not lose color when pressed.
• If your child has a seizure with a fever, please call the office to speak with a nurse.

Symptoms:

• Indication of pain or discomfort around the ear (i.e. tugging at ear).
• Child reporting ear pain.
• Crying when lying flat, poor sleeping.
• Different sounding cry, as if in pain.

Treatments:

• Give Acetaminophen (Tylenol) if the child is older than 2 months or Ibuprofen (Motrin or Advil) if the child is older than 6 months for discomfort. See dosing charts.
• Raise the head of the bed 30° – 45°.
• Apply a warm compress to ear – if the child is older than 1 year.
• If symptoms persist to the morning, the child should be seen in the office.  Not all children with an ear infection will have a fever.

Cause:

• Picking.
• Injury.
• Polyps.
• Rare – bleeding disorders

Treatment: 

• Pressure to upper sides of the nose.
• Apply ice to the nose.
• Head forward.

Symptoms:

• If loss of consciousness, call our office immediately.
• If the child remains unconscious or appears critically ill, call 9-1-1.
• A strike or blow to the head, may not always include loss of consciousness.

Treatments (if no loss of consciousness):

• Clean any scrapes or cuts with soap and water. Apply direct pressure to cuts for 10 minutes to control bleeding (Caution: head injuries tend to bleed heavily).
• Apply cool compress or ice pack to the affected area to decrease swelling.
• Give Acetaminophen (Tylenol) for pain - see dosing charts.
• If the child is sleepy and it is their normal sleep/nap time, allow them to sleep, but stay nearby and monitor for normal arousal.

Observe child and notify your doctor if any of the following are noticed:

• Child has a deep cut in the scalp that may need suturing.
• Child becomes disoriented, confused or dizzy.
• Child begins vomiting more than twice ( is not uncommon for child to vomit right after injury occurs if upset).
• Child is having difficulty speaking or complains of blurred vision.
• Child is having blood or watery fluid from nose or ears.
• Child cannot remember how injury occurred.
• Child is unusually sleepy.

Strains and Sprains

Symptoms:

• Swelling.
• Pain.
• Bruising.

Treatments:

• Rest.
• Ice – 15 minutes on, 15 minutes off.
• Elevation.
• If there is a break or deformity, go to the nearest Urgent Care or Emergency Dept.
• If there is a laceration and the edges are spread apart, it may need stitches.

Nursemaid’s Elbow

A dislocation of the elbow caused by pulling on the arm. Putting on a coat, vigorous play or grabbing a child’s arm in case of an emergency all can cause this to occur.

Symptoms:

• Sudden pain and not moving arm (held close to the body); possible deformity.

Treatment:

• Bring the child to the office for evaluation and probably treatment.

Symptoms:

• Hard, dry or very large thick stools. Many babies strain with stooling, but have soft stools (this is normal).
• May cause pain and bleeding during bowel movement (BM).
• No BM for 4+ days (exception – exclusively breast-fed infants may go longer periods up to 7 days without a BM).
• May have stooling accidents.
• May have wetting accidents.

Treatments:

Infant (0 – 2 months)

• Try using a well-lubricated thermometer or Q-tip to stimulate the rectum.
• Give 1/2 – 1 oz prune juice alone or in a bottle mixed with an equal amount of water once or twice daily as needed. You can adjust amount/frequency to make one soft stool per day.
• If these steps do not work, call for an appointment during regular office hours.

2 months – 1 year

• Above treatments.
• Limit binding foods such as bananas, rice cereal, and applesauce.
• Increase high fiber content foods (fresh fruits and veggies).
• Add fruit juices (especially prune or pear) to diet, but no more than 4-6 oz per day.
• A warm bath may decrease abdominal cramps and encourage a BM.
• May try 1/2 of a pediatric glycerin suppository (cut lengthwise) once or twice.
• If these steps do not work, call for an appointment during regular office hours.

Over 1 year

• Above treatments.
• Limit milk intake to 16 oz per day and dairy products (cheese, yogurt, etc.).
• Increase high fiber foods including bran, whole grains, oatmeal, (popcorn if over 3 years of age), or 1-2 teaspoons of Benefiber per day in juice or food.
• Miralax: start with 3 teaspoons, adjust dosing to make at least one soft stool per day. For children 6 years old and older, can use 1-2 capfuls per day.
• May try pediatric glycerin suppository once or twice.
• If no improvement with these measures or if child is holding in stool due to discomfort, please call the office during regular hours for an appointment.

Symptoms:

• Itchy skin that has color and texture change.
• Dry, scaly patches that may be itchy.
• Raised, pinpoint rash that does not seem to bother child.
• Itchy, tender, or open lesions in the diaper area.
• Skin lesions that do not blanch or lose color temporarily when pressed.
• A single raised, warm to touch, tender lesion that has a center with infection.

Treatment:

A child should be seen in the office if:

• A child has a rash that does not lose color when pressed.
• A rash or lesion that is making the child uncomfortable or worsening.
• Routine dry skin (i.e. eczema) preparations or diaper creams are not helping.
• The rash accompanies child being on an antibiotic or any other new medication.
• The school officials or day care staff want the rash to be evaluated.
• Child with rash and a sore throat, and/or headache, stomachache.

Eczema Rash:

• Moisturize twice daily with an emollient such as CeraVe, Aquaphor, Cetaphil, Eucerin, Aveeno Eczema. If skin is especially inflamed, may use a thin layer of Hydrocortisone 1% cream then a moisturizer over top twice a day. Keep bedroom well humidified, keep child well hydrated. OTC antihistamine (Zyrtec/Claritin) can be used for itching.
• Use fragrance and dye free soaps, shampoo, creams, and detergents.

Diaper Rash:

• Keep area moisturized and protected with a barrier cream (Desitin, A&D, Butt Paste, or Triple Paste). May open diaper area up to air to dry and promote  healing. Use sensitive wipes or only water to wash the diaper area. If rash persists, child should be seen.

Viral Rash:

• There are some viral illnesses that produce a fine pinpoint rash as the viral illness is resolving. This type of rash is not bothersome and will resolve on its own.

Newborn Rashes:

• Most rashes in newborns are harmless so long as the infant is not ill-appearing, and the rash loses color temporarily  when pressed(blanches). The most common rash appears in the first days of life as red blotches with a tiny white spot in the center, and it comes and goes. Another common rash is newborn acne which looks like fine pimples. It presents at about 3 weeks of age until ~8 weeks old, and is found on face, neck, shoulders, upper arms, and chest and will resolve on its own. Milia are tiny white bumps on nose/face that resolve on their own. Stork bites are red areas on the back of neck that usually fade over time.

Definition:

Most vomiting and diarrhea is caused by viral infections. This is a common illness and rarely dangerous. If vomiting doesn’t stop within 12-24 hours, please call the office. Diarrhea is a watery stool that occurs more than four times per day and can last for several days.

Treatment For Vomiting:

• Rest the stomach for 20-30 minutes by giving nothing by mouth.
• Then give 1-2 tsp of room temperature clear liquid such as Pedialyte or 1/2 strength juices every 5 minutes for 1 hour. If breastfeeding continue to do so, but for shorter intervals more frequently.
• If the liquids are tolerated, increase the liquids by small amounts (2-3 teaspoons) until the child is tolerating 2-4 oz at a time. If vomiting re-occurs, the process must be restarted. Pedialyte alone should not be continued for more than 24 hours.
• Gradually (over 2 days) return to a regular diet. Start with small amounts of low-fat, bland diet (i.e., dry toast or crackers).
• Monitor for signs and symptoms of dehydration, which include dry mouth, no tears, and decreased urine output (less than 3 wet diapers per 24 hours).

Treatment For Diarrhea:

• If vomiting is also occurring, just follow the above instructions.
• If there is no vomiting, adequate fluid intake is essential to prevent dehydration. It is important to provide more fluid than the child loses through diarrhea. Signs of adequate hydration include a normal or near normal urine output, a moist mouth, and an alert child who is reasonably active.
• For Infant: Continue with breastfeeding or formula feedings, but smaller amounts at more frequent intervals. Supplement with Pedialyte by bottle or syringe to make up for additional fluid losses. Call our office immediately if there has been no wet diaper in 8 hours.
• For Toddler: Replace fluid losses by encouraging ice-pops, popsicles, and Jell-O or by supplementing with Pedialyte.
• Provide a regular diet with a few simple changes. Avoid grape, pear, or prune juices, which can loosen stools. If diarrhea is prolonged, avoid milk products which may become temporarily difficult to digest. Encourage starchy foods as they are absorbed the best; i.e. cereals, rice, bread, crackers, noodles, potatoes, applesauce, bananas("BRAT" diet which includes bananas, rice, applesauce, and toast).
• Monitor for signs and symptoms of dehydration, which include: dry mouth, no tears, and decreased urine output (less than 3 wet diapers per 24 hours).
• Despite the above steps, diarrhea may last days after the illness seems over. If the child seems well, there is nothing to worry about.

Facts:

• Cold symptoms are caused by a viral infection.
• The average child will have as many as 8 colds a year. Children in daycare settings may get a cold every 2-3 weeks during the winter season. 
• The average length of a cold is 10-14 days. There is no cure for a cold. It must run its course. 
• Antibiotics and cold medications are not curing and are not recommended.

Symptoms:

• Runny or stuffy nose (drainage may be clear, cloudy, yellow, or green).
• Associated symptoms: fever, sore throat, cough, red eyes.

Treatments:

Under age of 6 years

1. Give Acetaminophen (if over 2 months of age) or Ibuprofen (if over 6 months of age) for fever or discomfort - see dosing chart.
2.  Increase daily fluid intake.
3. Use a cool mist humidifier to moisturize secretions (change water daily).
4. Raise the head of the bed 30°-45°.
5. Nasal saline drops or spray and nasal suctioning as needed.
6. Cough and cold medications are not recommended for children under the age of 6 years. If you choose to try them, please follow package instructions. Vicks VapoRub may help with stuffy noses.

Over age 6 years

1. Above treatments.
2. If needed, use medications with active ingredients that are most appropriate to treat the symptoms that your child has:
   • Guaifenesin (an expectorant) loosens mucus in chest and nasal passages (found in some Robitussin formulations and Mucinex).
   • Dextromethorphan (a cough suppressant) lessens cough.
   • Brompheniramine maleate, Diphenhydramine, Chlorpheniramine maleate, Cetirizine or Loratadine (all antihistamines): May help with sneezing, itchy eyes, runny nose. May cause drowsiness.

Cough is one of the body's own ways of getting rid of mucus, so unless it is painful or keeping child awake, do not give cough suppressants.

1. Call during regular office hours if:
   • Cough wakes the child frequently at night.
   • Fever over 100.4° F lasting longer than 3 days.
2. Call immediately if the child is working hard to breathe (using their belly or shoulders to assist in breathing, if there is sucking in under/between ribs while breathing, or breathing rapidly).
3. If there is a history of wheezing or asthma, please use the prescribed medications as instructed.