Headache is not as common in children as in adults. Any recurring headache or headache associated with vomiting, poor coordination or other symptoms should be evaluated by your physician. Mild infrequent headaches can be treated with acetaminophen or ibuprofen. Headaches associated with fever and a stiff neck are potentially serious and should be evaluated by your physician right away.

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Head Injury

Most head injuries in children are relatively minor and are seldom severe enough to justify the hours that parents spend worrying about them.


There are a variety of signs and symptoms to watch for following a head injury during the first 24 to 48 hours. You should observe your child for the following symptoms and report them to your doctor as instructed.

Severe Symptoms

  1. If your child loses consciousness, you should immediately contact the physician.
  2. Drowsiness. Most children will become drowsy after a head injury and sleep. It does no harm for your child to fall asleep. In fact, this is very common.It is important, however, to make sure that your child can be fully aroused. It is a good idea to awaken your child every three to four hours during the night after a bad blow to the head. If you have difficulty in waking your child, you should report this to your doctor.
  3. Any convulsion or seizure following head trauma should be reported to the doctor.
  4. Double vision or other visual problems should be reported to the physician.
  5. Unequal pupils should be reported to the doctor.
  6. Weakness in one arm or one leg should be reported to the doctor. Any limp or staggering which persists more than a few minutes after the head injury should be reported.
  7. Any abnormal leakage of fluid from the nose or ears should be reported.
  8. Vomiting. Vomiting is common following even minor head trauma. If it persists more than twice following the trauma, you should report this to the doctor.
  9. If your child develops slurred speech or is unable to speak, you should contact the doctor.
  10. Headache. This is a common symptom after head injury. If it persists or becomes increasingly severe, you should notify your doctor.

If your child exhibits none of the above, then it is very unlikely that your child has sustained a significant head injury. A hematoma (a collection of blood under the skin at the site of the head trauma) or “goose egg,” as some parents call them, is not serious unless they are huge (size of a baseball). This problem will resolve on its own.

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Circumcised boys will often get irritation and redness at the opening of the urethra (the small hole at the end of the penis) called meatitis. Chronic
meatitis can cause the opening of the penis to be scarred and too small. This is treated with an antibiotic ointment applied several times per day. Another problem with circumcised boys is adhesion of the skin to the head of the penis at the area of circumcision. This can be checked during a routine examination.

Uncircumcised boys can have problems with inflammation of the foreskin. If this occurs, contact your physician.

At the time of birth, the foreskin is attached to the underlying head of the penis. If your child remains uncircumcised, it should not be forcibly retracted. By the time your boy is three years old, the foreskin can usually be retracted. When the foreskin can be easily retracted, you should do this during each bath for hygiene purposes.

Testicular pain and swelling at anytime during a boy’s life is not normal. Contact your physician promptly if this occurs.


Vulvovaginitis: This is an irritation of the external genitalia usually occurring in young girls. It is sometimes caused by decreased attention to good hygiene. Bathing in bubble bath or soapy water can make this worse. Other causes of this are infections with yeast and certain types of bacteria. Treatment for this problem includes:

  1. Improved hygiene – teach your child to wipe from front to back and have her put on a clean pair of cotton underwear daily. In addition, a Sitz bath (shallow sit down bath) in warm tapwater for 10 to 15 minutes twice daily for four to five days is often helpful.
  2. If this is not helping the child, she should see her physician. A small amount of bleeding in this area with vulvovaginitis should not alarm you, but should prompt a call.


Any bulges in the groin area in both boys and girls should raise your concern about a possible hernia.

“What is a Hernia?”
A hernia is caused by a defect or small opening in the muscular abdominal wall which allows for a portion of the intestine to protrude through it, producing a bulge which is usually found in the groin area. Typically, the intestine will move easily back and forth through this opening and the bulge produced by the hernia will often appear when the intra-abdominal pressure is increased such as with crying. The bulge will often disappear when the abdomen is relaxed.

“What’s at risk?”
The danger of a hernia is that the intestine can protrude through the opening in the abdominal wall and somehow become twisted or swollen so that it is unable to return to its proper position within the abdominal cavity. When this happens, the hernia is said to be incarcerated and the bulge of a hernia becomes firm, and often red and painful. This results in intestinal obstruction and vomiting. An incarcerate hernia is a surgical emergency and the physician should be notified immediately.

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Stay calm, don’t panic! Fever is a sign of illness and not an illness in itself. Fever alone is not dangerous. Contrary to wide belief, fever does not cause brain damage, even high fevers of 105 to 106 degrees F.

What Causes It?

Fever should be viewed as the body’s normal response to fighting infection. Fever is caused by “pyrogens” which are substances released into the blood stream by the body’s white blood cells as they attack invading bacteria or viruses. Thus fever is a normal response of the body to infection. It is interesting that bacteria and viruses are killed more efficiently at higher temperatures. Chickenpox for instance is less severe if the fever is not treated (fewer lesions, less scarring, shorter duration of illness). In addition, with fever the degree of temperature elevation is frequently not related to the severity of the infection. Minor viral infections typically have quite high fevers and, of course, are not serious. Because of these considerations, fever alone should not cause alarm and is almost never an emergency. A much more important aspect of the management of fever is determining if your child has a serious infection as the cause of the fever.

If you feel your child has a fever, take the temperature. For children under three years of age, the rectal temperature is the most accurate and simplest to take. This is done by lubricating the thermometer with petroleum jelly (Vaseline) and inserting it into the child’s rectum approximately one inch. Remove the thermometer after two minutes. Fever is defined as a temperature above 100.5 degrees F taken rectally. The temperature may also be taken under the arm (Axillary) or under the tongue (Oral). The rectal temperature is usually one degree higher than an oral and two degrees higher than an axillary temperature. You should note the actual temperature and report the method used. If you use a tympanic (ear) thermometer and you suspect your child’s temperature is higher than the reading, re-take your child’s temperature either orally or rectally. It is not recommended to use the ear thermometer in children under 6 months of age due to their small ear canals.


  • Acetaminophen (Tempra, Tylenol), or Ibuprofen (Advil, Motrin, See Dosing Guide). It is not recommended that aspirin be routinely used for fever in children. Ibuprofen should not be given to children under the age of 6 months.
  • Keep Clothed – Dress your child in loose fitting clothing such as a T-shirt and underwear or a diaper. Do not bundle your child tightly or cover him/her with a blanket because this will only make the temperature rise further.
  • Sponge Bath – Give your child cool liquids to drink. If your child has a high fever which does not respond to the above measures within 30 to 60 minutes, you should lower his/her temperature by giving him/her a sponge bath with lukewarm water. To do this, place your child in a tub of lukewarm water and sponge him/her off thoroughly. Use a cup and pour water over his/her head. This will even be more effective in bringing the temperature down. You can expect your child to shiver very vigorously during the sponge bath. This is no cause for alarm.

Your Child Should See the Doctor When:

  1. Your child has a prolonged fever above 101 degrees F for more than 48 hours. Contact your physician during regular office hours for an appointment.
  2. Your child has fever plus any sign of minor infection such as sore throat, ear ache, pain on urination, cough or mild rash. Contact your physician during regular office hours for an appointment.
  3. More significant problems such as breathing problems, severe headaches, stiff neck, inconsolable irritability, lethargy, seizures, a bruise-like rash, etc., of course, demand prompt attention from your doctor when they occur.
  4. Fever above 100.5 degrees F taken rectally in infants younger than three months is significant even in the absence of other symptoms. This is the only instance of a true emergency with fever as the only sign of illness. The physician should be notified with any infant with fever.

The physician should be notified with any high fever above 104 degrees F which is unresponsive to acetaminophen and sponge baths. If you child’s fever comes down with the above measures, then there is not cause for alarm from the fever.

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Eye Problems


There are three minor problems with the eyes of newborn babies that parents should be aware of.

  1. The first is mildly swollen or irritated eyes appearing in the first few days of life which may be a reaction to antibiotic drops which are placed in the baby’s eyes at birth. The incidence of this problem has decreased due to a change in the medicine now used. Usually, the swelling and irritation will resolve without treatment in a few days. If the swelling increases, if the eyes drain a yellow or green discharge, or if the eyes themselves are red, then the child should be checked.
  2. Infants may also have a blocked tear duct. Blocked tear ducts in an infant or child causes the eyes to water excessively. The treatment for this is massaging the tear duct with the index finger at the inner corner of the eye. Pressure should be applied in a downward direction. This will help open the tear duct. You should discuss this problem with your physician during a routine office visit.
  3. Many young infants can have intermittent crossing of the eyes. This usually resolves spontaneously by six months of age. If it continues past this time, discuss this with your physician

Pink Eye

Pink eye or conjunctivitis is a mild inflammation of the outer lining of the eye manifested by redness and discharge from the eye. It is most often due to a mild infection although there are other causes including irritation from dust and allergy. Sometimes, conjunctivitis can be associated with infections in other parts of the body, especially ear or sinus infections. Some forms of pink eye are contagious and can be passed on by touch contact the way common colds are spread. Because pink eye has so many causes and is many times associated with other infections, it is difficult to evaluate this by telephone. If your child develops pinkeye, you should contact your physician to schedule an appointment.

Eye Trauma

Trauma to the eye that results in significant pain that does not go away in a few minutes should be evaluated on an emergency basis.

Eye Pain

Any severe eye pain, even if it is not associated with trauma, should be evaluated on an emergency basis.

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Ear Problems


Ear Ache

Many times in children, an ear ache is due to an ear infection, although there are other possibilities. Most ear aches, especially when they are associated with fever, should be evaluated by your physician. Medications are not generally prescribed for an ear ache by telephone since it is difficult to determine the problem and prescribing antibiotics without a proper diagnosis is dangerous to your child (see section on antibiotics). Other problems, which can cause an ear ache, relate to an inability to equalize pressure in the ear following a cough, sneeze, or crying episode, etc. Many times, this can be relieved with a few minutes of rest. An antihistamine/decongestant preparation can help with this if the tubes in the ear are blocked.

To provide relief for your child at home prior to calling your physician, the following measures can be tried:

  1. Use Acetaminophen for pain (Tempra, Tylenol – see Dosing Guide).
  2. Rest your child’s head on a hot water bottle or heating pad. This may helprelieve the pain.
  3. If there is no drainage from the ear and if you have some Auralgan drops onhand, they may be placed in the ear to relieve the pain. Do not use Auralgan drops if there is drainage or if your child has pressure-equalizing tubes. Remember that an ear ache is usually worse at night and you should contact your physician the following day even if he/she seems better.
  4. If you have a cough/cold preparation containing codeine such as Phenergan with codeine, Tylenol with codeine or other codeine containing medicines, these can be given every few hours as needed (see Dosing Guide). If the ear ache is severe enough to require codeine to get the child through the night, then you should bring him/her into the physician the next day even if he/she seems fine. This medication, of course, does nothing for the infection, it only relieves the pain.
  5. Children who develop ear ache and fever should be seen by your doctor within 24 hours of the onset of their illness.
  6. Old prescriptions should not be given to a child with a new onset of an ear ache.

Draining Ear

If your child’s ear is draining pus, then the child should come in for an examination. It is possible that he/she may have a torn ear drum. This is not usually a serious condition and the ear drum will heal. The child should come in for an office visit during office hours. A cotton wick made from a cotton ball may be placed into the ear to absorb the drainage.

Hearing Problems

All hearing problems should be evaluated during regular office hours.

Object in the Ear

Rocks, seeds, beans and other small objects that are placed in the ear by a child should be removed during your physician’s regular office hours unless the child has pain or bleeding.

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Diarrhea & Dehydration



Diarrhea is characterized by frequent, loose, watery stools. It is most commonly caused by a viral infection in children, and is called gastroenteritis. This causes the stomach and intestine cells to become sick and to slow down and even stop their normal function (absorbing fluids and nutrients). Gastroenteritis often begins with vomiting and fever. Then, after several hours, the vomiting resolves and diarrhea follows. There are other more rare causes of diarrhea, including diarrhea due to bacteria (Salmonella and Shigella), parasitic infections and milk allergy. The vast majority of the cases of diarrhea are due to common viral infections.


Dehydration results when there are excessive fluid losses from the infant or child, usually a result of vomiting or diarrhea. Dehydration is serious and should be evaluated by a physician. Signs of dehydration include:

  • Dry mouth. Place your finger inside the child’s cheek and then rub your thumb and forefinger together. If it is wet, there is no need to worry about dehydration. If, however, it feels sticky, tacky or definitely dry, then dehydration may be present. A child that is drooling is not dehydrated.
  • Poor urine output. Infants and children usually urinate at least once every eight hours. Decreased urine output in the presence of diarrhea may mean that dehydration is present.
  • Tears. If your child is making tears when he/she cries, then there is little chance of dehydration. If there are no tears when your child cries, this could possibly indicate dehydration when taken with other symptoms outlined above.
  • Lethargy (drowsiness/unconsciousness). If your child or infant is not alert or shows little interest in his/her surroundings and normal activities such as eating and playing, this may be a sign of dehydration when taken into consideration with the above signs of dehydration.


The treatment approach to diarrhea is the same as the treatment outlined in the vomiting section. The main concern with diarrhea is that dehydration (lack of fluids) may result. The goal with treatment of diarrhea is to prevent this until the intestine can recover and begin its normal function.

The routine use of medications to stop diarrhea is not recommended unless specifically prescribed by your physician. Certain types of diarrhea can be dangerous to stop with an Anti-Diarrheal medication. These particular medications work by paralyzing the intestine and not by reversing the diarrhea process. The underlying cause of the diarrhea must be treated, not masked, and this is done by diet.

Call your doctor if:

  • Signs of dehydration are present.
  • The diarrhea is associated with high fever over 103 to 104 degrees F. and is unresponsive to acetaminophen (Tylenol, Tempra).
  • If pus or blood is noted in the stool.
  • If diarrhea persists for more than three days despite diet changes listed under the section on vomiting.
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