An earache can wait until the morning unless your child is in unbearable pain that cannot be adequately controlled. Here are a few measures that can help get you through the night:

1. Give a dose of Tylenol, bearing in mind that it will take 45-60min to take effect.
2. Apply a heating pad to the outer ear.

If your child is still in extreme pain after these measures have been tried and you think you may need to go the ER, do call us first.

One note, if your child has ear tubes in place or if pus is draining from your child’s ear, do not use any type of over-the-counter ear drops or oil.

Sore throats, including strep throat, can be managed at home for the night. Tylenol OR ibuprofen can be given for discomfort or fever. Other things that can help with sore throat include warm tea, popsicles, ice cream, and 1tsp of honey (if your child is over 12mo.).  If your child is having trouble breathing because of the severity of the sore throat, please call us.

Cough is one of the most frustrating symptoms for families because it can interrupt everyone’s rest! Things you can try to get through the night:

1. Run a cool-mist humidifier in your child’s room for a few nights.
2. If your child is over 12mo, give 1tsp of honey. This has been shown to be more effective than cough suppressants in children.
3. Have your child sleep on an incline if they are 2 years or older.
4. Turn the shower on hot, close the bathroom door, and sit in the bathroom with your child for 10-15min, breathing in the steamy air.
5. Offer a little warm apple juice or hot tea.
6. If your child has a history of asthma or wheezing, you may give an albuterol or Xopenex treatment up to every 4hrs.
7. If your child is at least 6yrs old and does not have asthma, you may try an over-the-counter cough suppressant, such as Delsym and/or Benadryl. We do not recommend any cough or cold medications under age 6, regardless of the ages stated on the medication packaging.

If your child’s cough sounds like a seal barking, if your child is having difficulty breathing, if your child is turning blue with coughing (turning red is okay), or if your child is obviously wheezing, please call us or go to the ER.

If your child is >90 days old and does not have any complicating medical conditions (metabolic disorder, immune system disorder, etc.), it is okay to not treat the fever and just monitor. If your child is feeling poorly with the fever, Tylenol OR ibuprofen may be given to bring the fever down and help your child feel better. Never put your child in a cool bath or sponge with alcohol to treat fever. If fever is > 102.5, your child should probably be seen the following day for evaluation, even if no other symptoms are present. If fever is > or = 105.0, call us promptly, and we will determine whether your child needs to be seen before morning. If your child is <90 days old and has a temperature of > or = 100.5 rectally, call us immediately.

If your child is < 90 days old, you must call immediately for temperature > or = 100.5 rectally. If your child is older than this, how your child feels is much more important than the height of the fever. If your child has fever of 104 but overall seems to feel okay, this is much less concerning than a child with fever of 101 who is lethargic. If your child’s fever reaches 105.0, call us for advice on bringing it down and for assistance in determining whether your child needs to be evaluated before the morning. If your child has fever > 102.5, we should probably evaluate your child in the office the following day, even if symptoms seem mild.

In regard to seizures and brain damage, before the advent of the vaccines we benefit from now, high fever was often an indication of bacterial meningitis so it really was very scary for parents. It was the bacterial meningitis infection, not the fever itself, that caused seizures and brain damage. Nowadays, most fevers — even high ones — are secondary to viral illnesses that the body is able to fight off on its own. In fact, fever is one of our body’s protective mechanisms for fighting infection, as many viruses and bacteria do not grow as well at higher temperatures. Because of this, some physicians advocate not treating fever at all!

Here in the US, however, we typically recommend treating fever simply to help the child feel better.
There is a condition called “febrile seizures” that certain children have. These seizures (like all seizures) are scary to see, but they are harmless and do not cause any long-term damage. Only certain children have febrile seizures and there is no way to predict which child will and which won’t. However, for children who do have febrile seizures, it is not the height of the fever that causes the seizure anyway, and interestingly anti-fever medications do not prevent febrile seizures.
Fever will not increase infinitely. Your child’s body will top out a fever at 105-106, unless something else is already seriously, seriously wrong. The higher the fever, the higher the risk of an underlying bacterial infection though, so higher fevers do warrant evaluation more frequently than lower fevers.

We usually do not recommend alternating Tylenol and ibuprofen. Studies have shown that alternating is not more effective than giving both medication alone, and it significantly increases the risk of medication error. Keep in mind that fever will probably only decrease 1.5-2 degrees after a dose of Tylenol or ibuprofen, so do not expect temperature to return completely to normal if your child’s fever is high. Also keep in mind, that it takes 45-60min for either medication to take effect. If fever does not decrease all the way to normal or if fever recurs before it is time for the next dose of anti-fever medication, simply wait. Do not repeat Tylenol more frequently than every 4-6hrs or ibuprofen more frequently than every 6-8hrs.

Diaper rash can wait until the morning, even if it is blistery or bleeding a little. Good over-the-counter products to try include: Maximum Strength Desitin, Aquaphor Healing Ointment, and Boudreaux’s Butt Paste. Be sure to change diapers very frequently, as urine and stool will further irritate the rash. A dose of Tylenol.

For your child’s safety, we strictly do not call in antibiotics without seeing your child, even if you are out of town. If you feel your child may require an antibiotic or physician evaluation, we recommend utilizing a local urgent treatment center or ER. If you are unsure whether your child’s condition warrants such a visit, we can consult with you by phone.

If your child does not suffer from any chronic medical illnesses (metabolic disorders, diabetes, etc.), mild stomach viruses can often be handled at home. Stomach viruses will frequently include some diarrhea or fever, in addition to vomiting. For the vomiting child, we recommend giving Pedialyte (This is a rehydrating solution that is much preferable to plain water, Gatorade, juices, sodas, etc. It is readily available at pharmacies, Walmart, Target, and some grocery stores.), starting with 1tsp every 3min and continuing this even if your child continues to vomit. Once your child is starting to keep down the Pedialyte, you may gradually increase the amount you offer.

Do not offer any solid foods until your child is tolerating Pedialyte well. If repetitive vomiting persists for more than a few hours or if your child develops signs of dehydration (see below), please call.  Note: If your child is breastfeeding, breastmilk is excellent for upset stomachs, and it is should be given instead of Pedialyte.

Mild-to-moderate diarrhea can often be handled at home. As long as your child is not vomiting, it is not necessary to restrict your child’s diet, except for avoiding excessive juice or other sugary beverages, which can sometimes worsen diarrhea. Encourage your child to drink extra fluids to remain hydrated; Pedialyte can be offered on top of your child’s regular milk intake.

Keep in mind that it requires more than just a few episodes of vomiting or diarrhea for an otherwise-healthy child to become truly dehydated. Signs of dehydration to monitor for: dry or sticky mouth, lack of tears with crying, sunken “soft spot” in babies, not having any urine output for > 6-8hrs, lethargy. Bear in mind that if your child is <6mo, dehydration can occur more quickly. If either vomit or diarrhea has any blood, call for an appointment.

Please note that the following advice is intended just to get you through the night. Constipation is often a chronic problem, and if this is the case, please call in the morning to schedule an appointment to discuss this issue further.

• <1mo: First of all, keep in mind that it is sometimes normal for babies not to pass a stool for up to 3 days. As long as the stools are soft and not small, hard balls, this is nothing to worry about it. If your baby is passing hard stools, then you may give 1oz prune juice mixed with 1oz water. You may do this 1-2x/day for 2-3 days. You may also give over-the-counter simethicone drops to help with gas. A warm bath can also be helpful.
• 1mo – 2yrs: You may give your child 2-4oz (limit to 2oz if under 6mo of age) of juice to help. The most effective juices (in decreasing order of effectiveness) are: prune, prune/apple, apple, dark grape, and pear. If no results with juice alone, you may administer a small piece of an over-the-counter glycerin suppository. You may also give over-the-counter simethicone drops to help with gas.
• 2yrs – 5yrs: You may give your child 4-6oz of juice to help. The most effective juices (in decreasing order of effectiveness) are: prune, prune/apple, apple, dark grape, and pear. You may also give one dose of over-the-counter milk of magnesia 1/2 – 2tsp. Over-the-counter simethicone drops can be given to help with gas.
• 6yrs – 11yrs: You may give your child 6-8oz of juice to help. The most effective juices (in decreasing order of effectiveness) are: prune, prune/apple, apple, dark grape, and pear. You may also give one dose of over-the-counter milk of magnesia 1tbsp. Over-the-counter simethicone drops or capsules can be given to help with gas.
• 12yrs – young adult: You may give 8oz of juice to help. The most effective juices (in decreasing order of effectiveness) are: prune, prune/apple, apple, dark grape, and pear. You may also give one dose of over-the-counter Miralax or milk of magnesia 2tbsp. Over-the-counter simethicone capsules can be given to help with gas.

Most formula switches should wait until the morning when a nurse can review your child’s chart and offer more accurate advice. If you are extremely worried and feel you need to make some switch before morning, it would be reasonable to purchase one can of Enfamil Nutramigen or Similac Alimentum formula and give this until discussion with our office. These are hypoallergenic, very easily-digestible (and quite expensive!) formulas, which are effective for the vast majority of formula allergies or intolerances.

Most rashes in children are harmless. However, if your child has a rash that looks like tiny popped blood vessels or bruises beneath the skin, and the spots do not disappear briefly when you press on them, this could represent a serious bacterial infection requiring immediate medical evaluation, especially if the rash is accompanied by fever. Please call us immediately.

If your child is on an antibiotic and has developed a raised, itchy rash that looks like mosquito bites and seems to be “moving around” (i.e. spots coming and going), this could represent an allergic reaction. Do not give any further antibiotic doses. Take a photo of the rash. Give a dose of Benadryl and a lukewarm Aveeno oatmeal bath. Benadryl may be given every 6hrs as needed. Contact our office in the morning to schedule an appointment, and bring the photo with you. If your child develops any swelling of the mouth/tongue/face, difficulty breathing, throat itching or tightness, wheezing, or vomiting, please call us and/or EMS, depending on the severity of your child’s immediate condition.

Call us in the morning. This includes exposure to MRSA, strep, RSV, rotavirus, pink eye, and meningitis.