Care of the sick child

Fever

Normal oral (by mouth) temperature is 98.6 degrees F (37 degrees C) and can be as high as 100 degrees F. Rectal temperatures run slightly higher. Fever accompanies many childhood illnesses and is one way the body fights infection. Fever is often the first or only sign of a viral infection or other illness. Fever itself is not harmful but should be treated if the child is fussy or uncomfortable.

If high fever is present, look for other symptoms that suggest a call to the office: high fever associated with vomiting, stiff neck, or pain with urination; a fever that persists longer than 72 hours; fever in a child under 2 months if greater than 100.4 degrees F (38 degrees C).

Treatment of fever consists of using acetaminophen (such as Tylenol) and ibuprofen (such as Motrin and Advil).

Temperature conversion scale

Fahrenheit	Centigrade	Fahrenheit	Centigrade
104	40	101.3	38.5
103.8	39.9	101.1	38.4
103.6	39.8	100.9	38.3
103.5	39.7	100.8	38.2
103.3	39.6	100.6	38.1
103.1	39.5	100.4	38
102.8	39.4	100.2	37.9
102.7	39.3	100	37.8
102.6	39.2	99.9	37.7
102.4	39.1	99.7	37.6
102.2	39	99.5	37.5
102	38.9	99.3	37.4
101.8	38.8	99.1	37.3
101.6	38.7	99	37.2
101.5	38.6	98.8	37.1

These medications can be given along with antibiotics if necessary.

ACETAMINOPHEN AND IBUPROFEN DOSAGE RECOMMENDATIONS

Age Group	0-3 mo.	4-11 mo.	12-23 mo.	2-3 yrs.	4-5 yrs.	6-8 yrs.	9-10 yrs.	11 yrs.	12-14 yrs.
Weight (lbs)	6-11	12-17	18-23	24-35	36-47	48-59	60-71	75-95	96+
Acetaminophen (such as Tylenol)
Suspension (160 mg/5 ml)	¼ tsp. (1.25 ml)	½ tsp. (2.5 ml)	¾ tsp. (3.75 ml)	1 tsp. (5 ml)	1 ½ tsp. (7.5 ml)	2 tsp. (10 ml)	2 ½ tsp. (12.5 ml)	3 tsp. (15 ml)	_
Children’s chewables or soft chews (80mg)	_	_	_	2 tabs	3 tabs	4 tabs	5 tabs	6 tabs	_
Junior strength chewables (160 mg)	_	_	_	_	1 tab	2 tabs	2 ½ tabs	3 tabs	4 tabs
Ibuprofen (such as Advil, Motrin)
Drops (50 mg/ 1.25 cc)	_	1.25	1.875	2.5	_	_	_	_	_
Children’s liquid or suspension (100 MG/5 ml)	_	_	¾ tsp. (3.75 ml)	1 tsp. (5 ml)	1 ½ tsp. (7.5 ml)	2 tsp. (10 ml)	2 ½ tsp. (12.5 ml)	3 tsp. (15 ml)	_
Children’s chewables (50MG)	_	_	_	2-3 tabs	3 tabs	4 tabs	5 tabs	6 tabs	_
Junior strength chewables/ tablets (100 MG)	_	_	_	1 tab	1 ½ tabs	2 tabs	2 ½ tabs	3 tabs	4 tabs

Acetaminophen doses should be given every 4 hours as needed, but not to exceed 5 doses in 24 hours. If weight and age do not correlate, use weight to figure medicine dose. Ibuprofen is given every 6 hours. Tylenol or other acetaminophen suppositories are available over the counter in 80, 120, 325, 650 mg sizes and can be used when unable to take oral medicines.

Leaving the child lightly clothed when he or she has a fever will help to bring the temperature down; bundling the child in heavy clothing and blankets will only drive the temperature higher and make the child uncomfortable.

Temperature measurement

Ear thermometers are not as accurate as oral or rectal thermometers for infants under 6 months. For this age, rectal or armpit is better; for babies younger than 2 months old, a rectal thermometer is preferred. To take rectal temperature, lay your baby on his or her belly and use your forearm to hold the baby still. Place Vaseline on thermometer. Spread buttocks and insert the rounded bulb 1 inch into rectum. Read after 3 minutes or when the thermometer “beeps.”

Colds

“Colds” (upper respiratory infections) are caused by viruses and do not respond to antibiotics. Symptoms consist of runny or stuffy nose, sore throat, cough, and sometimes fever during the first day or two. You can expect your child to have 6 to 10 colds each year.

Treatment consists of measures to relieve the symptoms. Cool mist vaporizers used when the child is sleeping will allow the secretions to be loose so that the child may cough or sneeze them out more easily. Increased fluid intake will also make the secretions looser. If fever is present, more fluids are required. Fever and discomfort may be treated with ibuprofen or acetaminophen as outlined above for fever.

In infants, a nasal bulb syringe can be used to clear secretions from the nose. Cold medicines are not recommended under 6 years of age. Saltwater nose drops (1/4 teaspoon salt in 8 ounces of water) may help to alleviate stuffy noses by placing 2 to 3 drops in each nostril every 2 to 4 hours as needed. Wait a minute after placing the drops in the nostrils, and then use the bulb syringe to suck out secretions.

Antihistamines dry up secretions and are good for allergies, and they sometimes help with very watery nasal drainage. Side effects of antihistamines can include sleepiness, fatigue or irritability; the medication should be stopped if these are a problem.

Decongestants open up nasal passages to allow better drainage and are good for stuffiness, congestion, and sinus infection. Side effects of decongestants are nervousness, irritability, and poor sleeping.

For allergic reactions and itching, try giving Benadryl.

	6 mo.-2 yr.	2-5 yr.	5-12 yr.	Over 12 yr.
Liquid	¼- ½ tsp. (1.5 – 2.5 ml)	½-1 tsp. (2.5 – 5.0 ml)	1-2 tsp. (5.0 – 10.0 ml)	2-4 tsp. (10.0 – 20.0 ml)
25mg Tablet	-	-	1	1-2

Coughs and sore throats

For coughs, in patients over 1 year of age, 1 teaspoon of honey can be helpful. Humidifiers and elevating the head will also help. Sore throats often accompany viral “colds.” However, if a sore throat persists for over 24 hours and is accompanied by fever, tender swollen glands in the neck, or a rash, this may represent strep throat. If this is the case, call the office and the nurse will determine whether the child needs to see the doctor or come in for a strep test only. If the test confirms strep, an antibiotic will be given. Most other sore throats are caused by viruses and can be relieved by Chloraseptic spray, throat lozenges (not to be used in children younger than 4 years old as they could be a choking hazard), and other symptomatic measures. If sore throat is extremely severe, the child should see a doctor.

Ear infections

Ear infections are a frequent consequence of colds. If during the course of a cold your child suddenly develops a fever or ear pain, this may mean that the ears have become infected. Small children will often not tell you that their ears hurt but if infected, children will often be very fussy, especially at night or when lying down. They may even pull or dig at their ears. If ear infection is suspected, the child should be treated for fever or pain and a call made to the office so that the ears may be checked by a doctor. If an ear infection is diagnosed by examination, the doctor may prescribe an antibiotic. If a child shows no improvement after at least 3 full days of treatment, the child should be re-examined.

Croup

During the fall and winter, many young children develop an illness marked by hoarseness and a dry, “barky” cough (like a seal), with a low to moderate fever. Croup is caused by a viral infection of air passages and vocal cords. Coughing is generally worse at night and can persist for up to 1 week. A cool-mist humidifier and/or vaporizers can increase the humidity in the child’s bedroom, soothing the irritation and offering relief. During particularly bad coughing spells, sitting with your child in a steamy bathroom or in the cool night air for 15 to 20 minutes offers added relief. Croup is generally well-tolerated, but occasionally inflammation and swelling may cause mild blockage of the air passage, requiring treatment. If your child does not get better with the humidity and the cold air, call the office.

Vomiting and diarrhea

Vomiting and diarrhea are most often associated with a viral illness and usually can be resolved with diet restriction and fluid control. Medications are generally not necessary and should be avoided in most circumstances. Antibiotics usually make nausea and diarrhea worse, unless they are symptoms associated with a bacterial infection.

Dehydration is the biggest concern when your child has vomiting and diarrhea. This is especially true when your child is younger than 18 months old. Parents may notice signs of dehydration including dry mouth, sunken eyes, decreased or lack of urination, and weight loss. If a child has moist lips and mouth and is urinating normally, then they are not significantly dehydrated.

Vomiting is initially treated by restricting liquids and solid foods from the diet. It is often wise to give the child nothing by mouth 1 to 2 hours after vomiting starts. After this initial period, give only Pedialyte or another commercially available fluid and electrolyte solution. Other options include Pedialyte popsicles, Gatorade, or clear broth. Start with small volumes of these liquids (½ to 1 ounce) every 30 minutes and advance to larger volumes if the child tolerates it. Remember to give SMALL, FREQUENT QUANTITIES.

When vomiting ceases (even if there is still diarrhea), begin to advance the child’s diet to include crackers, toast, applesauce, bananas, and clear broth. Transition to a full diet when solids are tolerated without difficulty for a day. Hunger is a good sign that the illness is getting better. However, often after a child improves, he or she will eat a large quantity before the gastrointestinal tract has recovered, and vomiting may return. If this occurs, return to more bland foods in smaller volumes.

Treatment for diarrhea depends on the severity of illness. Mild diarrhea (3 to 5 loose stools per day) may not require any specific treatment or dietary change. Moderate and severe diarrhea (8 or more loose stools per day) may require more active treatment. Fluids high in sugar (soda and juice) and fruit should be limited during severe diarrhea. Some pediatricians will also recommend reducing or discontinuing milk intake when diarrhea is severe or prolonged. However, in most diarrheal illnesses, a normal diet (limiting juice and fruit) should be maintained. Breast-feeding mothers should continue to nurse even when baby has severe diarrhea. In most cases, diarrhea will improve or resolve within 5 to 7 days. Do not give your child an anti-diarrheal medicine unless directed by your pediatrician. A child should be seen in clinic if they have signs of dehydration, a high fever (greater than 102 degrees F), bloody stools, or severe abdominal pain that continues even after vomiting or stooling. Call our clinic if loose stools persist more than 14 days as your pediatrician may recommend performing tests for bacteria or parasites in the stool.

Rashes

Diaper rashes can have many causes, including sitting in urine or stool too long, yeast infections, burning of skin from diarrheal stools, skin infections, or certain foods irritating the skin. Home treatment could include changing diapers more frequently (especially if diarrhea is burning the skin), dietary changes to decrease diarrheal stools, eliminating certain offending foods (such as pears or other fruits), using diaper ointment, or treating for yeast infection with Lotrimin. If there is no improvement, call the office for advice.

Other rashes of the body may be a reaction to infections (such as strep throat or viruses), medicines, contact irritants, or foods. The rash itself needs no specific treatment. If itching is a problem, it may be relieved by Aveeno Bath or baking soda baths, Benadryl, or prescription medication obtained by calling the office.

Poisoning

Prevention is the best treatment. Keep all medications, cleaning compounds, and other toxic substances out of the reach of children. NEVER call medicine “candy.”

In case of accidental ingestion, call the office or Poison Control (1-800-222-1222) immediately for advice. DO NOT MAKE THE CHILD VOMIT UNLESS YOU ARE INSTRUCTED TO DO SO. With certain substances, vomiting is the wrong thing to do.

If you are asked to bring the child to the office or emergency room, also bring the container, the remaining contents, and any information about the ingested substance.

Head trauma

Any head injury patient may become sleepy, and vomiting once or twice is common. The following symptoms can indicate more serious injury and a need for further examination:

• Nausea and/or vomiting more than twice, especially vomiting not preceded by nausea, or more than 1 hour after the injury.
• Excessive sleepiness.
• Difficulty being woken from sleep (awaken the patient every 3 hours for the first 24 to 48 hours after the injury).
• Unequal pupils (black parts [in center] of the eye are unequal); sensitivity to light; double vision; loss of vision in certain fields; deviation of eyes to one side; unusual movement of eyes.
• Loss of strength, numbness, tingling in arms or legs, difficulty walking.
• Confusion; lack of orientation to time, place, or person.
• Personality change.
• Seizures with either full loss of consciousness or with only twitching of parts of the body.
• Severe or prolonged headaches. Acetaminophen may be given for headache.

Burns

Burns require immediate attention and can often be treated entirely at home. Most burns occur when a child touches a hot object (stove, barbecue, curling iron) or has hot liquid spilled on him or her. The immediate concern for a burn is to apply cold compresses to the area. In minor burns, this may be all the treatment that is required. Blistered areas may require more treatment, such as antibiotic ointment or dressings. Blisters should be left intact; opening them may increase the chance of the burn becoming infected. If there are large blisters or open areas, the burn may need treatment at the office or emergency room. Call the office if you think the burn needs to be treated professionally.