Table of contents on handouts from CPAC:
2)Treating your child's cold (including the truth about cough suppressants)
3)Losing weight - A healthful way that works.
your baby home from the hospital.
5)The Truth about RSV.
(scroll down to the information sheet that you wish to view)
What is fever?
is an elevation in temperature that is higher than normal. Therefore, fever is a temperature 100.5 or higher. Everyone’s
temperature varies normally through the day from 96 F through 100.4. If you measure all the temperatures taken throughout
the day, the AVERAGE of all these temperatures is 98.6. Fever is known to help fight infection. It fights both viral and bacterial
infections. Having a fever is a sign that the body is fighting infection so you do not want to prevent all fevers. Fever itself
is never dangerous. It is not possible for the body to produce a fever high enough to cause brain damage or death. However,
some types of infection CAN cause brain damage or death and the body produces a fever to fight these infections.
Mild fever............100.5 - 101.5 (too low to treat - many
sources state up to 102)
fever....101.5 - 104 (may treat for discomfort)
fever............over 104 (may treat for discomfort)
information does a fever provide?
lets us know that there is an infection going on. How high a fever is, may not be a good indication of how mild or severe
a disorder is. For example, Roseola (a completely harmless viral infection) is well known to cause fever up to 106, while
certain pneumonias may cause a very low-grade fever or no fever at all. Many cold or flu viruses may cause fever over 104.
If you do not know what is causing the fever, your child needs to be seen.
What about febrile seizures?
Febrile seizures are NOT caused by how high a fever gets but rather how rapidly fever
changes. A fever of 106 will not cause a febrile seizure if it goes up slowly enough but a fever of 101 CAN cause a seizure
if it gets there rapidly. Cool water and alcohol sponge baths actually TRIGGER febrile seizures since they cause RAPID change
in temperature. Febrile seizures CAN occur in children from six months of age to six years of age but are actually quite rare
in children over 4 years of age. Although frightening, febrile seizures are harmless if they last less than an hour. They
do not cause epilepsy, brain damage or death. Using ibuprofen, Tylenol, or other antifever medicines do NOT decrease the risk
of febrile seizures since they do not affect how rapidly the temperature changes. They only affect how high it goes.
What is the best way to take a temperature?
- a rectal thermometer in an infant or young child.
- an oral thermometer in an older child or teenager
- an ear thermometer, although not quite as accurate as the oral/rectal
thermometers is reasonable in children older than one year of age (sometimes the ear canal in babies is too small to get an
temperatures, forehead strips, and pacifier thermometers are so inaccurate that they should not be used (you don't add a degree
or take away a degree. They are so inaccurate, it is the same as not checking).
How do I use a thermometer?
Digital thermometers are best.
- Rectal - lubricate the thermometer with vasoline or cool water. Hold the child facedown
on your lap. Gently insert the thermometer about an inch into the rectum. Rest your hand on the buttocks, holding the thermometer
between the bases of two fingers to prevent the child from forcing the thermometer out. When the thermometer beeps (digital)
or the numbers stop changing (about 2-3 minutes usually) remove and read the thermometer.
- Oral (primarily for children over 4-5 years old if they will
let you. Otherwise do rectally)
10 minutes after the child has had something to eat or drink. Put the thermometer under your child’s tongue. Tell your
child to close his lips but not to bite. When the thermometer beeps or the numbers stop changing (2-3 minutes), remove and
read the thermometer.
I treat a fever?
Do not awaken
your child to check a temperature nor to treat. Fever is treated to decrease discomfort and if your child is comfortable enough
to sleep, it does not need treatment.
pain or fever over 101.5, you may give Tylenol every 3-4 hours. Ibuprofen may be given every 6 hours as needed for fever over
101.5 or pain. You may use them in combination but NOT AT THE SAME TIME. If you give ibuprofen every 6 hours, Tylenol may
be given right in between so that your child is getting one or the other every 3 hours if needed (only for pain or fever over
101.5). Do not use ibuprofen if there is nausea or vomiting since ibuprofen can worsen an irritated stomach. Your doctor can
discuss the dosages needed.
use aspirin for fever. If, after 45-60 minutes the temperature is over 104 F despite Ibuprofen and/or Tylenol, you may sponge
bath with lukewarm (never cool) water. The water ought to be warm enough that you would be comfortable in it. If your child
is shivering, the water is too cool. Never use cool water or alcohol to treat fever.
How long should a fever last?
Most fevers do not last over three days. Bring your child to be seen if the fever lasts
longer than three days.
there an age when fever should be a concern?
three months of age or younger are at higher risk for the dangerous bacterial infections. Any child this age or younger with
a fever needs to be seen as soon as possible.
2)Treating your child's cold
1. Chances are, your child will get at least one cold during the year. Many kids have
as many as eight or nine colds their first year alone. This trend is discouraging but not unusual so don’t get overly
worried. After the first year, children are exposed to more playmates and generally get eight - twelve colds per year (more,
if in day care or if smokers live in the household). Older children have built up some resistance and usually get fewer colds..
2. Signs of a cold include a runny or stuffy nose and possible
coughing. They may also have a fever usually during the first few days.
3.With a stuffed up nose, your child is breathing through the mouth so it is harder to
eat since they have to use the mouth to breathe as well. Additionally, things don’t taste the same with the nose clogged
up. Also, post-nasal drip causes the stomach to feel more full ...and may even cause nausea. Additionally, babies often have
increased spitting when they have a cold. Don’t worry about decreased appetite. If your child goes a week without eating,
they will be fine as long as they are drinking well. Push fluids!
4.FOR BABIES YOUNGER THAN 24 MONTHS: To help unclog your infant’s nose, use
a suction bulb. If the secretions are too thick to be easily suctioned, administer saline nose drops (at any pharmacy or you
may make your own with ½ tsp. salt in eight ounces of water). With the infant lying on his back administer two drops
in each nostril. Wait 45-60 seconds before suctioning to allow the saline drops to help break down the thick mucus. Studies
suggest that generally decongestants are not effective in children younger than two years of age (and may in fact, be
5.For children 2
yrs and older, decongestant/expectorant combinations may be used.
6.A humidifier is helpful in thinning out nasal mucus. A cool mist humidifier is recommended
since the hot vaporizers are more likely to be a burn/scald hazard.
7.Positioning may also decrease cough especially at night. When a person with a cold
lies down, the mucus drips back toward the throat and trachea (breathing tube) which induces cough. Propping children up such
as letting them sleep in a car seat, carrier, or recliner (depending on the age) helps decrease the drainage toward the lungs
and can help them sleep better. Extra pillows may also be used to prop them up.
8.If your child seems very weak and sick, has no energy, feeds very poorly, or doesn’t
wake up to be playful for even a short time, consult your doctor immediately. These indications may be signs your child has
more than just a cold. Colds do increase the risk of ear infections, bacterial sinus infections, and bronchiolitis/pneumonia.
If your child seems to be in pain (possible ear infection), has congestion for over two weeks nonstop-regardless of the color
of nasal discharge, (possible bacterial sinusitis) or coughs to the point of awakening or vomiting (possible pneumonia, croup,
or bronchiolitis), please bring your child to see the doctor.
9.Regardless of age, you generally need to avoid cough suppressants. Studies show that they do
NOT decrease cough enough to give comfort but do blunt the protective cough reflex enough to increase risk of pneumonia, bronchiolitis,
RAD and asthma.
10. Nasal allergies
are relatively rare in children younger than 5 yrs of age (it typically takes several years of exposure to develop allergies)
but become progressively more common in children as they get older. A simple blood test may be used to check for allergies
if you are concerned.
3)Losing Weight -A Healthful way that works.
The cause of obesity
Lack of will power is not the problem. Too much insulin production
is the ultimate cause of obesity. Although insulin is required to process sugars and starches (carbohydrates), too much insulin
production can wreak havoc with activity levels and appetite. One person may eat a slice of bread and produce just the right
amount of insulin. That person remains slim. Another person may eat an identical slice of bread but produce three times the
amount of insulin needed. Producing too much insulin induces low blood sugar (which causes fatigue), and increases the appetite
-specifically causing cravings for more high carbohydrate foods. Decreased activity stemming from fatigue in addition to increased
appetite is a recipe for obesity.
Insulin is produced
in response to ingestion of carbohydrates. By decreasing carbohydrate consumption, less insulin is produced. Since blood sugar
does not drop, there is no fatigue. Additionally, there is no insulin-induced cravings for more food. Increasing activity
(from eliminating fatigue) and decreasing the appetite will induce weight loss. As an added benefit, since the appetite decreases,
the body burns fat. Ketones, produced as a side product of burning fat, further suppress the appetite. In fact, too much ketones
can even cause some nausea. That rarely happens but if it does, a very small amount of carbohydrates can alleviate this problem.
Putting the solution in practice:
Foods can be divided into three groups
1)Food you can eat all you want - eggs/meat/cheese. Trying to
starve yourself does not work. When you are hungry, you should eat. However choose foods primarily from this category.
2) Foods you should avoid completely - sugar/flour/starches.
Starches include foods such as rice, corn, bread and most beans (green beans are low carb however). If you cheat, it generally
takes at least a week to get the carbohydrates out of your system so the body can start breaking down fats. Even a little
starch (such as the breading on fried chicken) can completely ruin the effect of this diet
3)Foods you can eat in moderation - You just have to know how
many grams of carbohydrates are in the food. These foods include most vegetables. A whole 3 inch diameter tomato has about
5 grams of carbohydrates for instance. Cucumbers, lettuce, and cabbage have essentially none. The Doctor Atkins book (among
others) can give the carb count for most common foods. For most people, losing weight will occur easily when eating 20 grams
or less of carbohydrate / day. After a few weeks, you may be able to add some more carbs and still lose weight. Some people
may produce just a little too much insulin. They may be able to lose weight while eating more than 20 gram. Other people produce
way too much insulin and will have to restrict their carbohydrate consumption more aggressively.
An excellent book on losing weight using this method is "Dr
Atkins New Diet Revolution.*" Obviously it goes into much more detail than this handout. I suggest you read the book
twice before embarking on this diet.
all the bacon, eggs and hamburger meat cause my cholesterol to go up?
Typically the opposite occurs if you are following the diet correctly. Insulin is required
to absorb cholesterol. If you are restricting carbohydrates sufficiently, you can eat all the eggs, meat, cheese and bacon
you desire but your blood cholesterol will drop since the cholesterol will not be absorbed.
2)Can this diet injure my kidneys?
No. However, if you already have kidney problems from diabetes
or other causes, the high ketones caused by burning fat may be problematic.
*To order the book,
you may call Barnes and Nobles at 1 800 THE-BOOK. They have versions both in English and in Spanish.
4) Taking your baby home from the hospital
Feeding - Once you leave the hospital, your
baby should not be on a schedule of feeds. Your baby should decide how much to eat and how often. New parents are often surprised
at how much babies eat. Eating much or frequently is NOT an indication that your baby is ready for solids. That is just an
indication that they need MORE formula or breastmilk. Most babies lose about 10% of their birth weight normally by discharge.
We will need to check your baby in two to four days. At that time, if your baby is not doing well, then scheduled
feeds may be necessary. Otherwise, as long as your baby is eating, urinating and stooling well, you should continue to feed
on demand. If you are breast feeding, you may need scheduled feeds just until your breastmilk supply is well established.
Once the breastmilk supply is well established (usually about three days), go to feeding on demand instead of scheduled feeds.
You will find that over time, babies develop their own schedule.
Gas -Gas is caused by the body breaking down the carbohydrates in breast milk and/or
formula. It is not caused by anything you are doing wrong. As the diet gets more varied at 6 months of age, the gas decreases.
Gas drops, though harmless have been shown in multiple studies to have no effect.
Water -There is no reason to boil water to make formula. If the water is safe for you
to drink, it is safe for the babies. Boiling water is only needed in third world countries where there is not a safe water
supply. Babies should not be given water to drink until starting solids at about six months of age. They get all the water
they need from the formula/breastmilk. There is no advantage to buying the so-called "nursery water."
Sterilization -There is no advantage to boiling bottles, nipples
or pacifiers for healthy babies. Normal washing is adequate.
Formula - Formula may be used unless kept out of the refrigerator for over two hours. It is good
in the refrigerator for up to 24 hours. There is no medical reason to warm formula before feeding it to a baby. Straight out
of the refrigerator is perfectly fine and will not cause stomach upset or any other problem. If you do decide to warm formula
for personal preference, avoid using the microwave as this practice can cause hot spots in the formula and lead to burns.
Follow-up - As stated above, babies usually lose about 10% of
their birth weight in the first few days. Then they start to regain. If they lose too much weight, we may need to schedule
feeds. Therefore your infant will need to be seen 2-4 days after hospital discharge for us to evaluate. We do
not expect them to be at birth weight until two weeks of age. We will need to see your baby at that time as well to asses
their weight and do a careful physical. Certainly if you have any concerns, please call our office for an earlier appointment.
5) What is RSV?
RSV (respiratory syncitial virus) is the name of a virus that causes colds. It is not
the name of a disease. When people say "my child had RSV," they often mean that the child had bronchiolitis, which
can be caused by any number of cold viruses. However, the great majority of people, when infected by the RSV, only get a cold
which resolves in 10 - 14 days. In fact, by two years of age, almost 100% of all children have been infected by RSV. In only
a small percentage do these colds lead to bronchiolitis.
What is bronchiolitis?
is the inflammation of a part of the lung called the bronchioles by any cold virus. In bronchiolitis, the viral inflammation
has spread beyond the area of nose/throat/sinuses that is normally affected by a cold. Although, depending on the season,
RSV may cause 60-80% of bronchiolitis, many other cold viruses can cause it. Typically bronchiolitis occurs in children 2
years of age or younger. Children who get bronchiolitis have a 50% chance of developing asthma as they get older. There is
no lab test or x-ray to diagnose bronchiolitis. The diagnosis is based on the physical exam.
How do you treat a cold caused by RSV?
Treat it the same way you treat any other cold: lots of fluids,
humidifier, decongestant ( if age-appropriate), and time. Antibiotics do not treat colds whether caused by RSV or not.
How do I treat RSV bronchiolitis?
Treat it the same way you treat any other bronchiolitis caused
by any other cold virus: generally bronchiolitis is treated with a medicine given in mist form by a nebulizer. Most bronchiolitis
can be treated at home but it sometimes requires hospitalization. Antibiotics do not treat bronchiolitis whether caused by
RSV or not.
Should my child
be tested for RSV?
the answer is "no." The treatments for a cold or for bronchiolitis remain unchanged whether they are caused by RSV
or any other cold virus. The one possible exception may be if a child has bronchiolitis so severe that they are on a ventilator
(this situation is exceedingly rare). There is a medication called Ribavirin that can be administered using the ventilator
but only if the bronchiolitis is caused by RSV. There is much controversy about whether or not Ribavirin helps even then.
Most hospitals do not use Ribavirin (even on ventilator patients).
Are certain children at higher risk for bronchiolitis?
Remember that nearly all children will have an RSV- caused cold
in their first two years and will recover from it in 10 - 14 days as from all their other colds. Certain children are at much
higher risk for severe RSV- caused bronchiolitis. These are primarily children younger than two years of age who were born
very prematurely and/or have chronic heart or lung disease. These children need a monthly injection of a medication called
Synagis throughout RSV season (October through April most years). Since these monthly injections are very expensive, insurances
will only pay if you meet very strict risk criteria.
can I prevent bronchiolitis?
bronchiolitis is inflammation caused by a regular cold virus that then spreads to the lungs. Almost everyone who develops
bronchiolitis starts out with just a regular cold. Careful handwashing will minimize the risk of transmitting colds which
can later lead to bronchiolitis. Children who live in smoking households are MUCH more likely to have their colds lead to
bronchiolitis. STOP SMOKING! Keep your child away from crowds and from people with colds. Wash your baby’s toys often.
6) Routine immunizations
Birth - Hep B
2mo - Pediarix*, Pneumococcal, Hib, oral rotavirus 1
4mo - Pediarix*, Pneumococcal, Hib, oral rotavirus 2
6mo - Pediarix*, Pneumococcal, Hib, oral rotavirus 3(depending
on type available, 2 or three may be needed), flu**
mo- catch up any missed vaccines and well check
mo - MMRV (preferably given as combination if available), Pneumococcal, Hib
15 mo - Hep A 1
18 mo - Dtap
2 yrs - Hep A 2 (must be at least 6 mos after Hep A 1)
4 yrs - DtaP,IPV (often given combined as Pediarix - the
extra Hep B is no problem), MMRV (preferably given as combination if available).
9 - 12yrs and older - HPV at 0, 2, 6 months (given
routinely at age 12 but may be given as early as 9 yrs of age if high risk/desired)
11 yrs - TdaP (Give later if missed)
12 yrs - meningococcal #1/Start HPV series routinely
16 yrs - meningococcal #2
*Pediarix contains DtaP, IPV, Hep B in one shot
**Given Aug - April if 6mo - 18 years old or any other risk factor - ONE
year given must repeat in one month for children younger than 9. Entire family needs if any high risk person (high
risk includes if anyone in household is younger than age 18, older than age 65, has a chronic heart or lung disease such as
asthma, is immunocompromised or has any other significant chronic health condition, such as Cerebral palsy, diabetes, etc.)
7) Flu vaccines
INFLUENZA (FLU) VACCINE INFORMATION
If your child or anyone in the household meets ANY one or more of the criteria below,
EVERYONE in the household (six months of age and older) needs to get the flu vaccine as soon in the season as possible.
The best time is Aug/Sept.
- Has asthma
or any other chronic lung disease (COPD, emphysema)
Has any cardiac (heart) disease
- Is 18
years of age or younger; or older than 65
Has any chronic condition (diabetes, sickle cell, cerebral palsy, spherocytosis, etc.)
- Is immunocompromised
your child is younger than 9 years old, ONE year they get two vaccinations, in the same season, at least one month apart (even
if they had a single vaccine in a previous season). From then on, only one/yr is needed.
The BEST time to get the flu vaccine is Aug/Sept but it may be given as late as April.
For children requiring two flu vaccines, the first may be given as late as March and finished in April. The earlier
you get the vaccine, the better. It takes a couple of weeks for the antibodies induced by the vaccine to be effective.
Two types of vaccine are available.
- shot - Not quite as effective as nasal spray but cheaper so pretty much all insurances pay.
- nasal spray - More effective and NOT a shot. Your child must
be two years or older to recieve this vaccine. Not currently FDA approved for asthmatics although multiple studies demonstrate
that it is safe and effective for asthmatics as well. (insurances may not pay for the nasal spray form if your child is asthmatic
although they pretty much always pay for the shot form).
we order our vaccines as early as a year in advance, we never know when they will arrive. You may call the office starting
early August to see if they have arrived before coming for the vaccine. 642-2642
Interesting fact: In the history of medicine, not ONE person has ever gotten the flu from the