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?
- Give a dose of Tylenol, bearing in mind that it will take 45-60min to take effect.
- 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?
My child is coughing and cannot sleep.
- Run a cool-mist humidifier in your child’s room for a few nights.
- If your child is over 12mo, give 1tsp of honey. This has been shown to be more effective than cough suppressants in children.
- Have your child sleep on an incline if they are 2 years or older.
- 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.
- Offer a little warm apple juice or hot tea.
- If your child has a history of asthma or wheezing, you may give an albuterol or Xopenex treatment up to every 4hrs.
- 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.
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?
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.
I’m out of town, and my child is ill. What should I do?
My child has started vomiting. What should I do?
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.
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?
- <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.
My child has developed a rash.
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?
I think my child might have a urinary tract infection (bladder or kidney infection).
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?
Can I give my young child this cough/cold medication? The bottle says it can be given down to age 2.
My child had vaccines recently and now is fussy and has a fever.
My child is teething. What should I do?
Can I take medication while 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?
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?
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?
My child has poison ivy. What can I do?
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:
- 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.
- Scratching poison ivy blisters does not spread the rash.
- 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.
- Any clothing, shoes, etc. that may have come into contact with poison ivy plant must be washed thoroughly to remove the uroshiol oil.
- 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.