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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.

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.

 

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.