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

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

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.

Treatment

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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Cuts & Scratches

These should be treated in the following manner to prevent infection and to aid in healing with less scarring.

  1. If there is any possibility that stitches might be required, the child should be brought in for an evaluation. Stitches cannot be placed after 6 hours from the time of injury.
  2. Clean the area thoroughly with soap and water. Cover with an antibiotic ointment such as Polysporin. A clean bandage should be applied.
  3. A clean, minor wound should require no tetanus booster if your child is up to date on his/her immunizations. If the wound is dirty or deep, and it has been more than 5 years since the child’s last tetanus shot, then a booster is indicated within 24 hours of the injury. See immunization section for more details.
  4. Alcohol, Campho-Phenique, first aid cream, iodine, Mercurochrome and Merthiolate are not recommended, as they can injure the tissues.
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Crying

Crying

Continual crying in an infant, of course, is not normal. After the age of four months, the incidence of crying in a small child decreases dramatically. Many times, continuous crying can signify a medical problem. Please refer to the section on infant colic. If these measures are not helpful in calming your child and he/she has cried continuously for more than two hours, you should see your physician.

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Croup

 

What is Croup

Croup is a viral infection of the upper part of the airway and voice box. It is most common in younger children and is associated with low-grade fever, hoarseness and a loud barking cough. Although croup is usually not serious, occasionally a child with croup can have an attack with breathing difficulty especially at night. During these attacks, the child will have difficulty drawing his/her breath in.

Treatment of Croup:

Give the child plenty of clear liquids and use a vaporizer to keep the secretions moist (a cool mist is recommended). Treat the fever with acetaminophen (Tempra, Tylenol, see Dosing Guide). During an attack of breathing difficulty, place the child in the bathroom, turn the shower on hot and fill the room with steam. Fifteen to 20 minutes in this environment will often relieve the attack.  If these measures fail to help and he/she continues to have difficulty breathing, you should see your physician.

If your child develops an inability to swallow manifested by constant drooling and has the above symptoms of barky cough, fever (usually high), hoarse voice and difficulty breathing, he/she may have a serious bacterial infection of the throat called epiglottitis. Seek help immediately if this occurs.

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Cough

Coughing

The cough reflex is the body’s defense mechanism against mucus accumulation in the bronchial tubes.  Cough is very common and is usually not serious.  Coughs frequently accompany an ordinary cold.

Coughs which need to be evaluated further are those which:

  1. Are accompanied by high fever.
  2. Persist for more than seven days.
  3. Interfere significantly with sleep and daily activities.
  4. Are accompanied by difficulty in breathing.

Any of the before mentioned symptoms should prompt an appointment during regular office hours except coughs accompanied by difficulty in breathing which require immediate care.

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Contagious Disease

Your child will be exposed to a great number of minor, self limited contagious diseases on a daily basis through family, day care, school, and other social contacts.  These risks can be minimized by simple hygienic measures such as frequent handwashing.  Most illnesses do not represent a danger.  Rarely, however, exposure can occur to serious infectious illnesses such as measles, hepatitis, or spinal meningitis.  There are very specific recommendations for each of these, and your doctor’s office should be contacted.

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