Constipation

Infants

Parents of newborn and small infants are usually quite concerned about the character and frequency of their child’s stools.  Elimination is an important body function but is seldom a cause for great concern.  Frequency and character of bowel movements in infancy are quite variable.  Some infants may have a stool with almost every feeding, while others only have a stool every three to four days.  Both of these patterns are normal.  Most breast fed babies tend to have frequent, watery stools.  Formula fed infants may have thicker and less frequent stools.  This is especially true for the first three weeks of life, but may not be the case thereafter.

Parents are often concerned about constipation in their infant because of straining during a bowel movement.  Part of a newborn infant’s normal behavior is grunting and straining to pass stools.  The infant will often turn red in the face and seem to be having difficulty in passing his/her stools.  This behavior is normal.  As long as your baby is having a stool every three to four days and is not having an extreme amount of difficulty in passing the stool, his/her bowel habits are normal.  If, however, the stool is extremely hard or the child has to strain excessively to push out firm balls, he/she is probably constipated.

Treatment for Infants

Since constipation by definition is having hard stools which are difficult to pass, the treatment is aimed at softening the stools.  If your baby’s stools are soft, he/she needs no treatment for constipation.

The following measures are usually helpful for constipation.

  1. If your infant is crying in pain from a hard stool which is difficult for him/her to pass, one-half of a glycerin suppository can be inserted.  These can be obtained without a prescription, but should not be used often.
  2. To loosen the stool in older infants, give prune juice which is diluted half with water three times per day.  Other juices like apple juice can also be effective.
  3. If juice is not effective, or in younger infants, try Milk of Magnesia, starting at a dose of one-half teaspoon daily.  These can be mixed with the baby’s formula and given in a bottle.

Honey is no longer recommended in the treatment of constipation because of the potential for infant botulism poisoning.   

Constipation in Older Children

Occasional constipation in older children can be safely treated with a lubricant laxative like Milk of Magnesia, with a daily dose of one to three teaspoons until soft, non-painful bowel movements are achieved.  More chronic constipation may require a significant long term increase in dietary fiber and/or a bulk laxative such as Metamucil (one heaping tsp. in at least an 8oz beverage daily).  Unprocessed bran is an inexpensive, effective source of  fiber and can be added to many foods including cereal (one to two tsp.), hamburger, pancake batter, or any baked goods.

Less often, children can develop severe chronic constipation, sometimes with leaking of stool (encopresis).  This problem requires a more detailed evaluation and therapeutic plan, and your child’s physician should be consulted.

Colic

 

What is Colic?

The term of colic has been used in various ways by people over the years.  A common definition of colic is a condition in which babies, usually less than fou months of age, have periods of unexplained extreme fussiness, but are normal in every other way.  Typically, a regular pattern of crying develops in babies with colic.  The attacks of fussiness usually occur between the hours of 3:00 p.m. and midnight, when both the infant and parents are most likely to be fatigued.  The attacks are characterized by a sudden outburst of loud and more or less continuous crying.  The baby is usually sucking on its fist, wanting to eat every 15 to 30 minutes, passing gas, drawing its legs up to the abdomen, flailing the arms and legs about and turning red in the face.  The infant, however, is fine between these episodes of crying. Parents are usually convinced that the baby has a stomachache or even worse that something is dreadfully wrong with the infant.

The Cause of Colic

The cause for colic is not well understood.  Many people assume that the baby is experiencing cramping or abdominal pain because the infant is pulling its knees up to its chest.  However, babies will demonstrate this same pattern of movement with crying to anything in their environment that upsets them, such as being stuck with a safety pin or being startled by a loud noise.  For these reasons, colic is probably a much more complex issue than some abdominal pain.  Probably, colic is a response of the infant to many factors, including adjustments to feeding, the external environment, fatigue, perceived stress of the parents, among others.  With a problem as poorly understood as colic, you can imagine the treatment is quite varied.  In the past, sedatives have been used a lot, such as tincture of opium, (paregoric) and even ethyl alcohol.  Most doctors do not recommend these because they can be dangerous to the infant.

Colic is a condition that the infant will outgrow, usually by the age of four months. Infants with colic will develop normally and will have no long-lasting psychological or personality defects.  The following approaches may be helpful in treating your child’s colic.

Check your baby to make sure there is no obvious reason for crying.  Your baby should be well fed, adequately burped and appropriately dressed, including a clean, dry diaper.  Your infant should have a normal temperature with nothing obviously hurting him/her.  If your child has any other symptoms, consult the appropriate section of this booklet

If the baby is breast fed, you should consider any recent changes in your diet, which might be affecting your baby.  For both breast fed and bottle fed infants,attempts at frequent burping may have dramatic effects in decreasing the symptoms of colic.

Treatment

Simethicone drops (Mylicon and Phazyme) are sometimes helpful in decreasing the amount of gas in the stomach.  The dose is one dropperful (0.6 ml) every six hours.  Again, the best way to prevent intestinal gas is frequent burping.

It sometimes helps to swaddle your baby snugly in a blanket and the rhythmic motion of a rocking chair can have a calming effect.  If late at night, and holding and rocking do not help, allowing the infant to be alone in his/her crib with the room darkened for several minutes will often encourage badly needed sleep.

If the above measures are not helpful and your infant continues to cry excessively, it is possible that he/she has another problem besides colic. Consult your doctor.  Unusual screaming which can not be explained or comforted and persists for more than two hours should prompt a visit to your physician.

Colds

 

At some time or another, every baby and child is going to catch cold.  Colds are caused by viruses and are usually spread person-to-person from the infected nose or throat.  Colds usually begin with a watery discharge from the nose accompanied by sneezing and watery eyes.  The child can also develop fever, cough and a sore throat.  Usually, the cough and sore throat are not particularly severe.  The child may run fever for two or three days.  As a cold progresses the nasal drainage often becomes thicker and may turn yellow or green.  This may be the final stage in the resolution of a cold and no additional treatment is needed for several days if your child is otherwise doing well.  So far, there is no cure for the common cold.  Since the infection is due to a virus, antibiotics are not helpful.  Treatment of colds is aimed at relieving symptoms and keeping the body well hydrated and nourished so that it can fight off the infection.

Treatment

  1. Get plenty of rest.
  2. Encourage plenty of fluids, especially clear liquids.  This will keep the mucus thin and prevent dehydration.
  3. Encourage your child to eat nutritious foods.
  4. Use Acetaminophen (Tempra, Tylenol) for fever and/or aches (see Dosing Guide).
  5. Saline nose drops (AYR, Salinex, Ocean) are quite helpful when placed in the nose to loosen the mucus.  You should put two or three drops in each nostril, wait a minute or so and then suction the nose with a nasal aspirator (bulb syringe) as often as needed.  Saline nose drops are particularly helpful for very small children who are unable to blow their noses.
  6. Sometimes for older infants and children, nasal decongestants and cough/cold preparations can be helpful.  If your child is less than 6 months of age, consult your doctor before using these.

You Should Make an Appointment With Your Doctor…

  • If the nasal drainage persists after the usual 7-10 days of a cold and seems to become thicker and greenish in color.
  • If the cough becomes particularly severe and is associated with a high fever above 102 degrees F.
  • If your child seems to “keep a cold” year around, your child may be allergic and should be checked.
  • If your child’s temperature persists over 101 degrees F for more than three days.
  • If your child’s sore throat is particularly severe.
  • If your child develops ear pain.

Do not start any left-over antibiotic prescriptions, as these drugs do not cure the common cold and can cause more harm than good.

Chickenpox (Varicella)

 

Symptoms

Chickenpox is a common viral infection of childhood. After an incubation period of 10 to 21 days, a child will break out with a rash which begins as small red bumps and which very quickly form clear blisters. The clear blisters then rupture and form dark crusts. These three lesions occur in sequence. Lesions generally begin on the chest or back and then spread to the face, neck, arms, and legs. Children usually run fever for several days. In addition to this, they may have a runny nose, sore throat and/or cough. Chickenpox is highly contagious. The child is contagious one day to two days prior to breaking out with the rash and remains contagious until all lesions have completely crusted over and there are no blisters or fever. This generally takes five to seven days from the onset of the rash. You can usually expect the child will break out with new lesions for two or three days after the first lesion is seen.

Complications

Chickenpox is generally a mild illness with no complications.  If complications do occur, the most common one is secondary bacterial infection of the lesions manifested by redness and/or discharge of pus.  You treat these as you would treat impetigo (see section on impetigo).  Serious chickenpox complications are very rare. These involve pneumonia and encephalitis. Signs of encephalitis include headache, stiff neck, vomiting and lethargy (drowsiness to unconsciousness).  If your child should become lethargic and begin vomiting, contact your doctor right away.

Shingles

Shingles is a reactivation of chickenpox infection and is usually seen in adults. People with active shingles are contagious and can spread the chickenpox virus to others who have not had chickenpox.  You can catch chickenpox from someone with shingles, but you cannot catch shingles from someone else. Shingles only occurs in someone who has had chickenpox at an earlier time in their life.  Parents and grandparents do not need to worry about catching shingles from their children with chickenpox.  Shingles is treated the same as chickenpox unless the child develops painful shingles which should prompt a physician contact.  Shingles is spread by direct contact with the lesions.  Keeping them covered with clothing or a gauze pad will help to prevent spread of the disease.

Treatment

  1. Keep your child away from other children or adults who haven’t had chickenpox and from pregnant patients or patients receiving chemotherapy. Although chickenpox is usually a mild illness in children, it can be quite severe in adults.  If you are unsure as to whether you have had chickenpox and your child catches the disease or has been exposed to someone with the disease, you need to let your physician know.
  2. Use an antihistamine such as Benadryl for itching and trim the child’s fingernails.  If itching is quite severe, even with Benadryl, try Aveeno baths and an emollient lotion (Do not use Benadryl Cream).
  3. For fever and the discomfort of chickenpox you may use acetaminophen (Tempra, Tylenol; see Dosing Guide) if your child is uncomfortable.  Aspirin should be avoided because of the potential for Reye’s syndrome.  Fever is actually beneficial in chickenpox and should not be treated if your child is comfortable.
  4. The child is contagious for about a week after the onset of the rash or until all sores have crusted over and have begun to dry.
  5. It is not recommended that you expose your child to chickenpox in order to get the disease.
  6. It is not recommended that aspirin be routinely used for chicken pox or fever in children.

Prevention

Varivax (live attenuated chickenpox vaccine) is now available and recommended for all children 12 months or older who have not yet had chickenpox. More details about this immunization are presented in the immunization section of this handbook. Your child’s physician can also discuss Varivax with you.

 

Burns

Burns

Burns severe enough to cause blisters, breaks in the skin and all electrical burns should be evaluated right away by a physician. Burns to the hands, face and genitals are more serious than burns in other locations. Burns that merely cause redness of the skin and do not cause blisters or breaks in the skin are generally minor and require only watchful care. The following steps can be taken at home immediately after a burn to both minimize further burning and to begin treatment.

Treatment

  1. Hold the burned area under cool water for several minutes.
  2. Use Acetaminophen (Tempra, Tylenol) for pain (see Dosing Guide).
  3. An antibiotic ointment such as Polysporin can be applied and the area covered with a dressing. Clean white socks are good for protecting burns on the hands or feet. If your child has an extensive burn, clean sheets can be used for protection while on the way to the doctor or hospital.
  4. If the burn results in blistering or breaks in the skin, a tetanus booster will be needed if one has not been given during the last five years.

Bruises

Bruises are usually normal in active, playful children. Bruises, which are particularly common, include bruises along the shin and elbows in young children. Any unusual amount of bruises or bruising noted in uncommon areas should be evaluated by your doctor

Bleeding

 

Bleeding From the Navel

Many times in newborns, a small amount of blood is noted on the navel after the cord falls off. As long as the bleeding does not make a spot on clothing larger than a quarter, it is of no significance. The navel should be kept clean with alcohol and the bleeding will usually stop on its own. If after two or three days the bleeding continues to be a problem, contact your physician. Significant bleeding from the navel of an infant is extremely rare. If your child loses enough blood to soak a cloth diaper the size of a quarter, there is redness of the skin surrounding the navel or pus draining from the navel, contact your physician.

Bleeding From a Superficial Wound

Bleeding from an accidental cut or scrape can usually be managed by holding steady pressure over the site with a clean dry cloth. In the case of a deeper cut, the wound should receive immediate medical attention and pressure should be held on the area during transport.

Vaginal Bleeding in the Newborn

Occasionally, because of the effect of the mother’s hormones, infant girls will have a small amount of vaginal bleeding the first few days of life. This will stop spontaneously and requires no treatment.

Nose Bleeds

Nose bleeds can be caused by dryness of the lining of the nose or by picking or rubbing the nose too vigorously. Allergies or upper respiratory infections may aggravate the problem.

Moisturization of the nasal passages with saline (salt-water) nasal spray on a regular basis can help. Additionally, a child with recurrent nose bleeds can benefit from antibiotic ointment (Polysporin or Vasolene) applied to the inside of the nose with a Q-tip daily for several days.

To stop active nose bleeds, have the child sit up, and pinch the nose together or use an ice pack. After the bleeding stops, do not remove the clot from the nostril, as this may cause the bleeding to start up again. If the bleeding continues for more than ten minutes despite the above measures or if your child suffers chronic nose bleeds, contact your physician.

Rectal Bleeding

Rectal bleeding can be a more serious type of bleeding. Although it can be due to something as simple as a small tear around the rectum, children with any type of rectal bleeding should be checked by your doctor.

Other types of bleeding such as blood in the urine, coughing up blood, wounds that fail to stop bleeding, etc., of course are potentially serious and your doctor should be notified.

Bites

Dogs or Other Domestic Animal Bites

Any animal bite that breaks the skin requires two types of management. The first is local wound care. If the wound is minor, it should be thoroughly cleansed with soap and water, and then Neosporin ointment applied. The wound should be carefully watched for signs of secondary infection (pain, swelling, redness, red streaks, fever, discharge). If these symptoms should occur or if the wound is more extensive, then contact your physician.

The second part of management of animal bites involves the prevention of rabies from the bite exposure. If the animal is well known and has been vaccinated against rabies, there is little chance that your child will catch this disease. The offending animal should be kept confined ten days and observed. If the animal is healthy at the end of ten days, the child has no need for rabies prevention. If, however, your child is bitten by a stray or wild animal, an animal which cannot be found or an animal that subsequently dies, it is very important to bring this to your physician’s attention immediately. As with any other wound, it is important that the child be up-to-date with their immunization to tetanus. After an animal bite or other dirty wound, a tetanus immunization is required if the child has not had one in the past five years. If your child is not up-to-date and they suffer a wound, you should contact your physician during regular office hours.

Human Bites

Human bites should be treated like domestic animal bites.

Insect Bites and Stings

Most insect bites and stings are not dangerous unless the child is severely allergic to a particular bite or sting.

Treatment

  • If the stinger is present, remove it with a horizontal scraping motion.
  • Place a cold compress on the bite for several minutes to reduce swelling and redness of the bite or sting. Some redness and swelling are to be expected. You should contact your doctor if this becomes severe.
  • Treat with Benadryl elixir (per package instructions; for dosing for children less than 6 years of age please contact physician for dosing instructions.) and/or a paste of baking soda and water to relieve the symptoms.
  • Apply 0.5% Hydrocortisone ointment or cream to the area to help with further itching. This is available without prescription.
  • Call your physician for any difficulty in breathing.
  • Use Acetaminophen (Tempra, Tylenol) for pain. (see Dosing Guide).

Snake Bites

Non-poisonous snake bites are the same as bites from a dog or other domestic animal. Reptile bites do not cause rabies. If a child has been bitten by a poisonous snake, they should be taken immediately to the nearest hospital. You should make no effort to treat this yourself. Cutting the wound, oral suction, suction from snake bite kits, compresses, tourniquets, etc., are no longer recommended for poisonous snake bites.

Tick Bites

Most tick bites are harmless, but ticks are potential carriers for three serious diseases: Rocky Mountain Spotted Fever, Ehrlichia, Tularemia, and Lyme Disease. All three infections involve a 5 to 10 day incubation period followed by fever, muscle aches and headache. Tularemia (rabbit fever) causes swollen tender lymph nodes in areas near the tick bite. Rocky Mountain Spotted Fever and Lyme Disease can involve characteristic rashes over the entire body, but these vary greatly. If your child has a history of tick bites with any of these symptoms, it is important that they be seen by their physician. If a tick is found, it can be removed with tweezers, grasping the tick nearest the mouth and pulling it straight out with steady pressure, followed by a soap and water scrub. It is common for a small crusty sore to remain at the site for several days. This is not an indicator of severe disease. The tick-borne diseases are much less likely to occur if a tick is removed within 24 hours of imbedding.

Bed Wetting

Bed Wetting

Despite what you may hear from other parents, up to 50% of children will continue to wet the bed at three years of age. Many children are much older than this before they achieve nighttime bladder control. Usually children who continue to be enuretic (bed wetters) after five years of age have a parent who was late in obtaining bladder control also.

For those children who have never achieved bladder control by the age of five years, consultation with your physician is probably warranted, as there are treatment options available to them.

Children who have been dry in the past and who develop bed wetting or even daytime wetting (enuresis) need to be examined. Urinary tract infections and emotional stress are the most common causes of this.

Arms & Legs

Arms and Legs

If the child refuses to use an arm or leg completely, you should contact your physician.  If the child is limping without much pain, they should stay around the house with as little activity as possible.  If the limp is not gone in 24 to 48 hours, contact your physician.  A child should never be lifted by an arm or leg.

If the child suddenly begins falling a lot when he/she hasn’t in the past or you notice swelling, redness or pain in the joint you should contact your physician.