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general health advice

Children's Dosage Chart:
Click here for a downloadable PDF.



Acne

Acne is a very common problem for teenagers; 85-90% of teens will have acne at some point.

Myths:

  1. Acne is caused by poor hygiene.
  2. No evidence has ever shown acne to be cause by excessive dirt or oily skin.  In fact, vigorous scrubbing can make acne worse.
  3. Certain foods make acne worse.
  4. Stress makes acne worse.

Tips for Treatment:

  1. BE PATIENT!!!  With all treatments for acne, it will take 8-12 weeks before any significant improvement is noted.
  2. Our goal is not to cure acne.  Our goal is to minimize symptoms and future scarring.
  3. Wash your face 2-3 times a day with mild soap.
  4. Use any medication prescribed as directed.

 


ADD/ADHD


Approximately 10-12% of all school age children have a problem which may interfere with their ability to stay focused in school.  This translates into 2-3 children per standard classroom.  Children with such issues may have ADD/ADHD, a Learning Disability, or a combination of both.  To provide the proper treatment for your child, I recommend that we evaluate both problems simultaneously. 


ADD/ADHD:


Contrary to what people think, ADD/ADHD is a medical problem like diabetes or thyroid problems.  It is not under the child’s control.  Just like diabetes this problem is controlled best with medication and education.  We will request that your family and the child’s teacher complete forms evaluating the possibility of ADD/ADHD.  These forms will help us determine if medication is needed or not.


Learning Disability:


First, let us establish that a Learning Disability (LD) is different from Special Education.  Special Education is for children with below normal IQs.  The goal for their education is to teach them skills fro daily living.  A child with an LD is a child with a normal to above normal IQ who simply has a problem with either learning the information or being able to report the learned information.  I recommend evaluation for an LD through the public schools so that if the child does have an LD, the proper interventions can be instituted.


For the evaluation, I recommend the following:

  1. Writing a letter (example below).  Sending copies of the certified letter to the following people:
    1. The superintendent of the school system.
    2. The principal of the school.
    3. The school psychologist.
    4. A file copy.
  2. Watching the PBS video, “How Difficult Can This Be?”


Example Letter:


To Whom It May Concern:
My child, _________________, attends __________________ School, and I think he/she has a learning disability. I would like to have this formally evaluated.
Yours, _______________________

Involuntary Bedwetting


Bedwetting is a frustrating, sometimes embarrassing, involuntary urination during the night that happens more than once a month.  We consider it to be a problem requiring treatment if a child is older than 7 years.  Thankfully, the incidence of bedwetting usually decreases with age; at age 5, 15% of children wet the bed, but by age 18 only 1% of people have this problem.


Over the years, several of the old myths about bed wetting have proven to be untrue.  Children wet the bed because their body is not yet releasing adequate amounts of a hormone called vasopressin, or dDAVP.  REMEMBER: THIS IS A MEDICAL PROBLEM! IT IS NOT UNDER THE CHILD’S CONTROL AND NOT SOMETHING THE CHILD IS DOING ON PURPOSE.  Parents should also know this problem tends to run in families.


Some helpful hints for dealing with bedwetting are:
-Limit fluids after 6 pm.
-Make sure the child empties the bladder before going to bed.
-Do not wake the child at night to go to the bathroom.
-Use protective devices for the mattress.
-Use diapers or pull-ups if okay with the child.
-Reward child for dry nights.
-NEVER PUNISH THE CHILD FOR WETTING.
-Remember this is the child’s problem; do not take it upon yourself.
-There are medications and/or alarms for bed wetting if a family is interested in using them.


Call the office if:
-The child has difficulty or pain with urination.
-New symptoms appear after a prescription medication is used.
-If the child had been dry at night for over 6 months and is now wetting the bed.
-You have any questions about bedwetting.

 


Biting


Biting is a common problem for children that is usually a learned behavior.  Like anything that is learned, it can be unlearned.  Realize it will take several weeks for us to extinguish this behavior.


Start in the morning.  Reward the child with a piece of candy or a cookie every 1-2 hours.  When giving the child the treat say, “Thank you for not biting.”


When the child bites, place something nasty tasting in their mouth (liquid soap, Tabasco, bitters, etc.) and place the child in time-out.  Do not scold or interact with the child during this phase.


Within 15-30 minutes after that time-out, repeat the positive reward and again thank the child for not biting.


Repeat this for a week.  The second week, reward the child once in the morning and once in the afternoon.  The third week, reward the child in either the morning or the afternoon.  

 


Colic


Colic is a term applied to episodes of continuous crying (two or more hours) for no apparent reason.  During episodes of colic, baby’s face may turn red, legs may be drawn up, stomach may be distended, gas may be passed, and there may be some loose stools.  COLIC IS NEVER ACCOMPANIED BY FEVER, VOMITING, OR DIARHEA.  Colic is seen only in young infants, usually four months and under.  Attacks are most common in the evening hours. 


No one knows for sure what causes colic and no one has a cure for it.  Everyone agrees that colic is not a serious condition, that healthy babies have colic and that all babies outgrow it, usually by six months of age.  Colic is a term used after other illnesses have been excluded, so be sure you doctor is aware of the problem and agrees that your baby does have colic and not another problem.


Suspected Causes:


-An easily exited or tense baby and/or parent.
-Overeating/too rapid eating.
-Air swallowing.
-An immature or sensitive stomach or bowel.
-Sensitivity to carbohydrates &/or proteins.


It is hard on anyone to see a baby cry and cry and not be able to soothe the baby.  Many parents begin to feel that they are doing a bad job and feel guilty and inadequate, while others become annoyed.  If you are feeling frustrated, place the baby in a safe place and walk away.


Helpful Hints:


-Some babies like to suck a great deal and it comforts them.  A pacifier or sucking on a finger will often help a baby relieve his tension.
-Avoid over-stimulation and excitement.  Try soft music and low level lighting.
-If your baby is crying, swaddling and quiet will often help to quiet the baby.
-You should talk to your nurse or doctor about changing the formula if you thing this may help.
-Talk to someone that has been through colic with a baby.  It helps to talk and hear what has worked for another parent.
-Medications have not been found to be uniformly effective.  If all else fails, check with your doctor regarding the use of the drugs.
-If all else fails, place the infant in a safe place and walk away for twenty minutes, then recheck the baby.


Remember, Colic does not last forever!  It will go away in four to twelve weeks.


Constipation


Constipation occurs when a child has not had a spontaneous bowl movement in three days.  Although it can cause some discomfort, it is never life threatening and can wait until the office opens on the morning.


Constipation is cause by a combination of not drinking enough fluids and/or not eating enough fiber.  Therefore, the first step in treating constipation is to increase fluid intake and increase fiber in the diet.  You must also get the child to move their bowels to get rid of the stool in the rectum.  You can accomplish this by using a glycerine suppository or an enema*.


YOU SHOULD CALL THE OFFICE IF:

  1. The constipation continues despite increasing fluid and fiber.
  2. The constipation is associated with vomiting.
  3. The child has localized abdominal pain.


*Milk and Molasses Enema:
1.  Mix 3 oz. of milk with 3 oz. of Molasses
2.  Heat mixture on the stove to mix.
3.  LET MIXTURE COOL TO ROOM TEMPERATURE
4.  Give mixture as an enema.


Diet and Exercise


Your child has been determined to be too heavy for their size and age.  This is concerning because if we do not reverse this process your child is as risk for joint problems, early heart disease, diabetes, high blood pressure, and other medical problems which are preventable.  Children, like adults, become obese for the simple reason that THEY EAT MORE CALORIES THAN THEY BURN OFF.  This is not irreversible but it takes a very drastic change not only in your child’s life style, but your entire family’s life style.  The following are some suggestions for you and your child.

  1. Exercise:


The best exercise you can do to lose weight is walking.  Walk every day 30 minutes at a brisk pace (the pace a dog would set).  You can still bike, jog, play basketball, etc. but you need to also WALK!!!

  1. Diet Changes:
    1. No mindless eating.  That means you eat only at the dining room table.  NEVER eat in front of the TV, computer, Playstation, in your room, or while talking on the phone.
    2. Drink water!!! 4-6 8oz. glasses per day
    3. When going out to eat make better choices.  Avoid fried foods.  Eat more fresh fruits and vegetables.
    4. NO FRENCH FRIES
    5. Divide you plate as follows:
      1. ½ of your plate should be fiber
      2. ¼ of your plate should be protein
      3. ¼ of your plate should be starches

 


FIBER
= Fruits, vegetables, and salad
PROTEIN= meat, fish, poultry, eggs, nuts, peanut butter, lentils, and dairy
STARCH= bread, pasta, rice, potatoes, corn, soda pop, and sugary drinks


Head Lice


Head lice is a common problem.  There are 6-12 million cases per year.  It is not a sign of poor hygiene but rather exposure to the lice.


General information about head lice:
-Humans are the only host.
-Lice must feed every 4-6 hours on human blood.
-Eggs hatch 7-12 days after being laid.
-Lice are spread by direct contact (sharing hats, combs, brushes, etc.)
-Diagnosis is made by seeing the lice or nits in the hair.


Treatments:

  1. Nix (permethrin 1%) Cream Rinse


Apply after hair is washed, leave on hair for 10-20 minutes, and rinse with luke warm water.

  1. Rid (pyrethrin) Shampoo


Apply to dry hair, leave on 10-20 minutes, and rinse with warm water.

  1. Kwell (lindane) Shampoo


Apply to dry hair, leave on 10-20 minutes, and rinse with warm water.
Due to side effects used only for recurrent lice.

  1. Ovide (malathion) Shampoo


Apply to dry hair to thoroughly wet hear, allow to dry, shampoo out after 8-12 hours.
THIS IS FLAMABLE! DO NOT SMOKE AROUND THIS PRODUCT.


After Initial Treatment:
-Comb Hair with a Nit comb.
-Reinspect the hair in 24-48 hours.  If lice are present repeat treatment.
-Repeat treatment in 7 days.


Prevention of Reinfestation:
-Place hats, bedding, and clothes in a hot dryer for 20 minutes.
-Seal stuffed animals in a plastic bag for 14 days.
-Vacuum rugs, mattresses, and furniture where hair follicles may have fallen.


DON’T TREAT CHILDREN WITHOUT LICE DUE TO THE RISK OF SIDE EFFECTS OF THE MEDICINES.


Head Trauma


Your child has had a significant trauma to the head.  Studies have shown there can be injury to the brain if the child either lost consciousness at the time of the trauma or if they start vomiting within 24 hours of the injury.


You do not have to wake the child or keep them up all night.


Your child will have a whopper of a headache for 3-5 days after the injury.  Do not hesitate to give the child an adequate dose of Tylenol or Motrin.  Do not give the child a narcotic for the headache, because it is necessary to know if there was a significant change in metal status or behavior.


IF YOUR CHILD LOST CONSCIOUSNESS WHEN THEY HIT THEIR HEAD, OR THEY BEGIN TO VOMIT WITHIN 24 HOURS, THEY NEED TO BE TAKEN TO THE CLOSEST ER FOR EVALUATION.

 


Usual Immunization Schedule


DaPT (Diphtheria, acellular pertussis, tetanus):
2 months
4 months
6 months
15-18 months (acellular pertussis vaccine is recommended)
4-6 years (acellular pertussis vaccine is recommended)


ADACEL (dTaP)
Every 5-10 years after age 5


HiB (Haemophilus B):
2 months
4 months
6 months
15 months


Polio:
2 months
4 months
6 months
4-6 years


MMR (measles, mumps, rubella):
12-15 months
4-6 years


Varicella:
12-15 months
Booster recommended at 4-6 years


Hepatitis B:
Birth
1 month
6 months


Prevanar (Pneumococcal vaccine)
2 months
4 months
6 months
12 months


Rotateq (recommended not required)
2 months
4 months
6 months


Hepatitis A (recommended not required)
12 months
18 months


Menactra (meningitis shot for college)
10-11 years


Gardasil (prevent cervical cancer)

Girls only
Starting age 10 years but anytime after age 10
#1 day 1
#2 two months after first immunization
#3 six months after first immunization

 


Replacing Fluids when Your Child is Vomiting


When a child is vomiting or has severe diarrhea they can dehydrate. It’s important to note that the older a child is the harder is for the child to become dehydrated.  You should become concerned if you see the following signs in your child:
-Loss of Saliva
-Decrease in Urine Production or the number of wet diapers
-Loss of Tears
-Sinking of the Soft Spot
-A Racing Heart Rate
-Vomiting Blood, Coffee Ground Looking Material, or Bile  


If a child has been vomiting, it is necessary to replace their fluids, but many parents make a common mistake.  PARENTS TRY TO REPLACE THE FLUID AS THE CHILD IS VOMITING.  You need to realize that just after a child has stopped vomiting his/her stomach is still upset and trying to give the child fluids will result in vomiting again.  Wait 2-3 hours after vomiting has stopped before offering the child anything.  When you do offer them fluids, start off with clear liquids (Pedialyte, Jello Water, 7 Up, Ginger Ale, Gatorade, Etc.) and start out slowly.


-Give the child 1 tsp every 15 minutes for an hour.  If he/she tolerates this, then
-Give the child 2 tsp every 15 minutes for an hour.  If he/she tolerates this, then
-Give the child 3 tsp every 15 minutes for an hour.  If he/she tolerates this, then
-Give the child 1 oz. every 20 to 30 minutes.


Do not offer the child any solid food unless he/she asks for it.  When you do start solids, start with very bland foods (saltines, soft boiled eggs, toast, plain or vanilla yogurt, pudding, etc.)


If your child has had diarrhea but is not vomiting, we would like to help this with diet changes not medicines if we can.  I would recommend no milk products (milk, ice cream, cream, etc) for a few days.  For your child’s diet, I would recommend concentrating on the following in his/her diet but these do not have to be exclusive:
-Cheese
-Bananas
-Rice and Rice Cereal
-Apple Sauce
-Toast or Dry Cereal
-Yogurt with an active culture

 

RICE Therapy


RICE stands for the most important elements of treatment for many injuries: Rest, Ice, Compression, and Elevation.


Rest:

Stop using the injured part as soon as you realize that an injury has occurred.  Use crutches to avoid putting weight on the foot, ankle, knee, or leg.  Use splints for injuries of the hand, wrist, elbow, or arm.  Continued exercise or activity could cause further injury, increased pain, or a delay in healing.


Ice:

Ice helps stop bleeding from injured blood vessels and capillaries.  Sudden cold cause the small blood vessels to contract.  This contraction decreases the amount of blood that can collect around the wound.  The more blood that collects, the longer the healing time.  Ice can be safely applied in many ways:
-For injuries to small areas: such as a finger, toe, food, or wrist, immerse the injured area for 15 to 35 minutes in a bucket of ice water.  Use ice cubes to keep the water cold, adding more as the ice cubes dissolve.
-For injuries to larger areas: use ice packs.  Avoid placing the ice directly on the skin.  Before applying the ice, place a towel, cloth, or on or two layers of an elasticized compression bandage on the skin to be iced.  To make the ice pack, put ice chips or ice cubes on a plastic bag or wrap them in a thin towel or use a bag of frozen peas.  Place the ice pack over the cloth.  The pack may sit directly on the injured part, or it may be wrapped in place.
-Ice the injured area for about 30 minutes.
-Remove the ice to allow the skin to warm for 15 minutes.
-Reapply the ice.
-Repeat the icing and warming cycles for 3 hours.  Follow the instructions below for compression and elevation.  If pain and swelling persist after 3 hours, call our office.  You may need to change the icing schedule after the first 3 hours.  Regular ice treatment is often discontinued after 24 to 48 hours.  At that point, heat is sometimes more comfortable.


Compression:

Compression decreases swelling by slowing bleeding and limiting the accumulation of blood and plasma near the injured site.  Without compression, fluid from adjacent normal tissue seeps into the injured area.
To apply compression safely to an injury:
-Use an elasticized bandage (Ace bandage) for compression, if possible.  If you do not have one available, any kind of cloth with suffice for a short time.
-Wrap the injured part firmly, wrapping over the ice.  Begin wrapping below the injury site and extend above the injury site.
-Be careful not to compress the area so tightly that the blood supply is impaired.  Signs of deprivation of the blood supply include pain, numbness, cramping, and blue or dusky nails.  Remove the compression bandage immediately if any of these symptoms appear.  Leave the bandage off until all signs of impaired circulation disappear.  Then rewrap the area—less tightly this time.


Elevation:

Elevating the injured part above the level of the heart is another way to decrease swelling and pain at the injury site.  Elevate the iced, compressed area in whatever way is most convenient.  Prop an injured let on a solid object or pillows.  Elevate an injured arm by lying down and placing pillows under the arm or on the chest with the arm folded across.

 


Sleep and Children


The first and most important thing to remember is that sleep is a learned pattern of behavior.  Like any pattern of learned behavior it can be unlearned.  The second thing to remember is that children thrive on routines and predicable patterns of behavior.  Lastly, I encourage parents to place children in bed awake so they can learn to comfort themselves and fall asleep.


Common Causes of Sleep Disturbance in Children:

  1. Sleeping with Parents.


Children should sleep in their own beds, in their own room, by themselves from the night they come home from the hospital.  If a child learns to fall asleep with a parent in the same room, he/she will always need the parent in the room to be able to sleep.  Avoid the problem by never starting this behavior.  Usage of a nursery monitor will allow you to monitor your child but avoids this potential problem.

  1. A recent illness.


When a child wakes from sleep in pain or has difficulty maintaining sleep because of an illness, it is of course important to comfort the child.  However, some children will continue to desire the snuggling with the parents after the illness has been resolved.  This is called a trained night crier.  Please refer to the steps below to solve this problem.

  1. A recent vacation or disruption of the child’s bedtime routine.


Whenever a child gets off their bedtime routine, they may react by not falling asleep or maintaining a full night’s sleep.  If this occurs, reestablish your bed time routine ASAP.

  1. An erratic bedtime or bedtime routing.


Since children thrive on routines, a child without a bedtime routine will have problems with sleep.  You are the adult.  Select a bedtime which you feel is appropriate and a bed time routine.  Please keep the routine very simple, and remember to place the child in bed awake so they can learn to go to sleep.


Assuming you have established your child’s bedtime and routing and you have followed it, what do you do now when he/she is lying in bed crying?
Step 1: Do not go back into your child’s room for 20 minutes.  This is long enough to allow our child to calm themselves but is not so long that your child will feel abandoned.
Step 2: Make sure you check the basics.  Does your child feel hot or feverish?  Has he/she soiled their diaper?  Is there a tag or a zipper scratching his/her skin? Has he/she developed a rash?  Does he/she have a string wrapped about a finger or toe cutting off circulation? Etc…
Step 3: If everything is fine, give your child a kiss on the forehead and leave for another 20 minutes.


Repeat the above process until your child falls asleep.  Be patient!  It may take 2-6 hours the first night for your child to fall asleep.  It may also take 3-5 nights for the problem to resolve.


Starting Solids


The feeding of solid foods tends to be a social/cultural decision, rather than a medical decision.  Most children are ready to start solids at about 4 to 6 months of age.  Note that breast milk and formula contain all of the nutrients that infants need for the first year of life.


-The process of switching to solids is usually begun with cereals because they are the easies on the infants system.  If the child has a history of constipation, consider starting with something other than cereal.
-When the infant is taking cereal well, start vegetables.  Offer the child the vegetable for 3 days before introducing the next vegetable.
-Work your way through all the vegetables before introducing fruits.
-Follow the same directions for fruits as vegetables.


Starting Cows Milk:
After the baby is 1 year old, introduce milk.  Whole or 2% is fine.  When the baby is off of formula, it will be necessary to start a vitamin supplement.


Weaning from the bottle:
The key to weaning the baby from the bottle is to keep the content of the bottle bland, while making the cup great tasting.  In the bottle, place water or plain milk while in the cup put juice, chocolate milk, Gatorade, etc… (the better tasting the better it will work).  If within a few weeks the child does not give up the bottle, make the bottle undesirable.   At bedtime first give the child the cup with their favorite drink in it.  Let them drink ½ of the cup.  Then give the child the bottle with Tonic water in it.  After the child takes a drink, they will usually pull the bottle away due to the nasty flavor.  Instantly give the child the cup to drink.  It usually takes 2 to 3 nights before the child will no longer take the bottle.

 


Wound Care Instructions

  1. Clean the area with soap and warm water three times a day.
  1. Daily, after the wound is cleaned, apply a thin coat of antibiotic.
  1. Change the dressing daily and keep the area covered with an adhesive bandage for 48-72 hours.
  1. Notify the office if you have an increasing wound pain, or any evidence of infection (redness, swelling, drainage, or red streaks from the wound edges).
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