Before You Call

Please review these frequently asked questions that we receive in our after hours phone calls:

My child has an earache. What should I do?
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.

My child has a sore throat. It might be strep. What should I do?
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.
My child is coughing and cannot sleep.
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.

My child has developed a fever, but I don’t see any other significant symptoms yet.
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.
What fever level do I need to call for? Won’t fever cause my child to have a seizure or brain damage? Will my child’s fever just keep going up if I don’t do something? Should I alternate Tylenol and ibuprofen if my child’s fever continues?
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.

My child has a diaper rash.
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.
I’m out of town, and my child is ill. What should I do?
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.
My child has started vomiting. What should I do?
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.

My child has developed diarrhea.
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.

My child is constipated. What can I do?
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.
I think my baby might need to switch formulas.
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.
My child has developed a rash.
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.

My child has been exposed to (blank) at daycare. He/she seems okay. What should I do?
Call us in the morning. This includes exposure to MRSA, strep, RSV, rotavirus, pink eye, and meningitis.
I think my child might have a urinary tract infection (bladder or kidney infection).
UTIs can become miserable quickly, so we do recommend prompt evaluation, even if symptoms are mild. However, if your child is not in too much discomfort and doesn’t have any fever or vomiting, you can probably manage at home until morning. You may give Tylenol OR ibuprofen for discomfort. Cranberry juice and increasing fluid intake can be helpful. Over-the-counter phenazopyridine can be very helpful for urinary pain if your child is at least 12yrs old. If your child becomes very uncomfortable, develops fever > 101, or has vomiting, he/she should be taken to an ER.
One of my children was recently diagnosed with strep throat, and now my other child has developed a sore throat. Can you call in antibiotics?
We do not call in antibiotics for strep throat without evaluating the child in the office, and we do not make exceptions to this policy. This is a very common scenario, and surprisingly a great deal of the time, it does not turn out to be strep throat! At any rate, strep throat can almost always wait until the following morning. You may treat sore throat and fever with Tylenol OR ibuprofen through the night.
Can I give my young child this cough/cold medication? The bottle says it can be given down to age 2.
We do not recommend any cough or cold medications under age 6, regardless of the medication label. These medications have been shown in repeated studies not to be beneficial, and they can have side effects.
My child had vaccines recently and now is fussy and has a fever.
You may treat the fever and fussiness with Tylenol, as long as the fever is within 48hrs of vaccines, the fever is < 103, the child is consolable, and there are no other significant symptoms present. If the fever starts >48hrs after vaccines, then the fever is not related to the vaccines.
My child is teething. What should I do?
A dose of Tylenol OR ibuprofen may be given for teething discomfort. Bear in mind that teething does NOT cause fever > 100, ear infections, moderate-to-severe diarrhea, or moderate-to-severe nasal congestion or runny nose. If any of these things are present, there is probably something besides teething going on.
Can I take medication while breastfeeding?
In general, we recommend avoiding any medications that aren’t absolutely necessary while breastfeeding. However, if there is a medication you must take, visit for the most accurate information about safety with breastfeeding.
Oh, no! My child has head lice!

Don’t panic! Anyone can catch head lice, and it is not due to poor personal hygiene. Most children catch it at school or daycare. Children over age 2 should be treated with over-the-counter Nix and can return to daycare/school the following day. We do not recommend treating other family members unless head lice are seen. If your child has not responded to over-the-counter treatment (Don’t worry — this is rare!), an office visit is required for prescription treatment, so please call in the morning to schedule an appointment.

Is it okay to use sunscreen on my baby?
The most important thing is avoiding sun exposure for baby’s tender skin, as even one blistering sunburn significantly increases a person’s lifetime risk of melanoma. And keep in mind that sunscreen can help avoid sunburn, but the studies remain unclear as to whether sunscreen actually prevents skin cancers. Try to stay in the shade, cover baby’s head with a hat, cover baby’s eyes with sunglasses, and keep arms and legs covered with light cotton clothing.

If exposure to the sun is unavoidable, then it is acceptable to use a hypoallergenic sunscreen, even down to 2mo of age. We recommend Neutrogena with Helioplex, at least SPF 50. Try the product on a small area first to be sure there is no reaction. Apply the sunscreen at least 30min before sun exposure to increase effectiveness, and reapply every 2hrs (sooner if swimming). Don’t forget the top of baby’s head and ears. Do not apply to baby’s hands, as these go into the mouth so frequently. Do give baby a bath to wash off the sunscreen after you come back inside.

Is it okay to use insect repellent on my baby?
Insect repellent can be used as young as 2mo of age, if exposure to insects is unavoidable. We recommend Deep Woods Off, which is available in a spray form or in towelettes. The towelettes are especially helpful for babies and young children, as they allow more direct application and less inhalation of the product. Do not apply the product to the hands, as these so frequently go into the mouth. Avoid the eye and mouth areas. Apply as sparingly as possible, but do apply enough to be effective. Be sure to wash the product off promptly, once exposure is over.

Bear in mind that lower concentrations of DEET than that found in Deep Woods Off are less effective and last only 30min, which is inadequate for most situations. Other “natural” forms of insect repellent are much less effective than DEET, so we do not recommend the more “natural” products for this particular use.

My child has itchy mosquito bites. What can I do?
Apply over-the-counter hydrocortisone 1% cream 2-3x/day as needed. Apply cool compresses. Call for signs of infection, including red streaks, drainage of pus, or increasing redness.
My child has poison ivy. What can I do?
Poison ivy rash is caused by exposure to uroshiol oil from poison ivy, oak, and sumac plants. It is typically a red, bumpy, very itchy rash, sometimes with oozing or small blisters. The most helpful product for poison ivy is probably over-the-counter Zanfel, which is a scrub cream that helps to remove residual uroshiol oil from the poison ivy rash, which allows healing. Zanfel is available at local pharmacies, and it typically costs $35-40 for a tube. Large outbreaks may require more than one tube.

Itching can also sometimes be helped with over-the-counter hydrocortisone 1% cream, applied 2-3x/day for a maximum of 1wk. Cool compresses can help decrease itching as well. Keep in mind that heat exposure (hot bath, etc.) will increase itchiness.

Things to know about Poison Ivy:

  1. The rash is not contagious from one person to another. However, if there is residual uroshiol oil on clothing, shoes, pets, etc., this can “spread” the rash from person to person.
  2. Scratching poison ivy blisters does not spread the rash.
  3. There is no danger of damage to the eyes with poison ivy. If the rash is present near the eye area, however, it can cause significant swelling, and we will sometimes treat this with oral steroid medication, if it is severe. Please call to schedule an appointment in the morning if you are concerned. Application of cool compresses can be helpful for swelling. Keep in mind that eye swelling is going to be worst in the morning, after having been lying down all night, and it decreases through the day.
  4. Any clothing, shoes, etc. that may have come into contact with poison ivy plant must be washed thoroughly to remove the uroshiol oil.
  5. Antihistamine medications, such as Zyrtec and Benadryl, have not been shown in studies to be effective at decreasing itching from poison ivy.

If the poison ivy outbreak is severe, please call in the morning to schedule an appointment, as oral steroid medication can sometimes be helpful.