Frequently Asked Questions

Children's Health

Here you will find answers to some of our most frequently asked questions. If you do not see the answer to your question here, check our topics through our additional educational information or call our office for assistance.

1. What dose of Acetaminophen (Tylenol) or Ibuprofen (Motrin/Advil) should I give my child?
2. How can I tell if a sore throat is a virus or a more serious infection?
3. My child has a virus (cold symptoms), how can I help them feel better?
4. My baby spits up a lot. Is this a sign of a problem?
5. What's the best way to treat vomiting?
6. What can I do if my baby gets diaper rash?
7. I think my child may be constipated. What should I do?

What dose of Acetaminophen (Tylenol) or Ibuprofen (Motrin/Advil) should I give my child?

The following charts are to help with dosing for these medications for your child. The ages given are for convenience only, the dosage should be based on your child's weight. If your child has fever and is less than two months old, call immediately. Your child will need to be evaluated right away. If your child is sick and is less than six months old, please call our office. Of note, aspirin should never be given to a child as it can cause serious illness.

Acetaminophen Dosage Chart

Dosages may be repeated every four to six hours, but should not be given more than five times in twenty-four hours. (Note: Milliliter is abbreviated as ml; 5 ml equals 1 teaspoon [tsp]. Don't use household teaspoons, which can vary in size.)
 

Ibuprofen Dosage Chart

Dosages may be repeated every six to eight hours, but should not be given more than four times in twenty-four hours. (Note: Milliliter is abbreviated as ml; 5 ml equals 1 teaspoon [tsp]. Don't use household teaspoons, which can vary in size.) Additionally, if there is any concern that your child is not well hydrated, speak to your pediatrician before giving ibuprofen.

back to top

How can I tell if a sore throat is a virus or a more serious infection?

There are many things that can give someone a sore throat. The most frequent cause of sore throat in children is a viral infection. Frequently with viral infections there are other symptoms such as congestion, runny nose, and cough. There may be a mild fever as well. The good thing about viral infections is that they usually resolve on their own with no medication, but the bad thing about viral infections is there is no medication to make the illness resolve more quickly.

One viral infection in particular, called Coxsackie virus, can cause a very sore throat with ulcers or blisters on the back of the throat. It is also known as hand-foot-mouth disease. It is most common in the summer and fall, and can cause a higher fever, more difficulty swallowing, and children feel sicker overall. Spots can sometimes be seen on the palms and soles as well.

Strep throat is a bacterial infection. Children may have fever, sore throat, swollen glands in the neck, mild headache, mild stomach ache, and they may have pus on the tonsils. It is important to diagnose strep throat as it must be treated with antibiotics.

When to call the pediatrician, and what to expect

If your child's sore throat persists through the day, you should call your pediatrician. Of course, if your child has any difficulty breathing, is not swallowing any fluids (or increased drooling), or seems extremely ill, you should call immediately. In the office, your pediatrician will examine your child and will determine if a throat swab is needed. This is done with a special cotton-tipped applicator. In the office, this swab may be used for a rapid strep test that gives results within minutes. If the result is negative for strep, your pediatrician may perform an additional swab test to send to the lab for a strep throat culture that may take 2 days for a result. If the result of the strep test is negative, the sore throat is usually presumed to be a viral infection.

Treatment

If your child's test for strep is positive your child will be treated with an antibiotic. Usually an antibiotic by mouth is given, though if your child is not able to tolerate this, he or she may be given an injection. It is very important when taking an oral antibiotic to take the entire 10-day course as prescribed, even if your child feels better after a few days, to prevent complications. If your child does not feel better in the 2-3 days after starting treatment, or if your child is having severe pain, it is important to let your pediatrician know.

For any sore throat, it is important to encourage fluids to prevent dehydration. Sometimes popsicles can help alleviate the sore throat pain. Acetaminophen and ibuprofen can also be helpful. If your child does have ulcers in the throat, it is helpful to avoid citrus, as well as very spicy foods, which may sting.

back to top

My child has a virus (cold symptoms), how can I help them feel better?

There are a few things that you can do to help your child feel better while a viral illness runs its course.

For fever:

You may treat fever with acetaminophen or ibuprofen. Refer to question #1 for the appropriate dosage. Aspirin is not safe to use for children because it has been associated with Reye syndrome, which can make children very ill.

For stuffy nose:

Saline nose drops or nose spray can help in thinning mucus. To help clear a baby's nasal congestion, you can use a suction bulb. This can be particularly effective if you put one or two drops of the saline in your baby's nostril right before using the bulb suction in that nostril. To use the bulb, first squeeze the air out and put the rubber tip into one nostril and slowly release the bulb. Sometimes the use of a humidifier can also help with nasal congestion by helping keep the nasal passage moist and the mucus thin. It is important to frequently clean the humidifier according to the unit's instructions. A cool-mist type humidifier is the safest type.

To help prevent dehydration:

Encourage your child to drink fluids often. Even small sips taken frequently can help with keeping a child hydrated. Sometimes children prefer clear liquids, like Pedialyte, instead of milk or formula. Often, children have a decreased appetite while they are sick, which is to be expected. If your baby is eating poorly due to congestion, using the saline drops and bulb suction as above prior to a feeding can be helpful.

To prevent spread of infection:

One of the most helpful ways to prevent the spread of infection is frequent hand washing. Avoiding contact with persons with fever or cold symptoms. Avoid sharing utensils and towels, and avoiding eating or drinking after anyone that is sick. Wash dishes and cups in warm soapy water. For overall health don't smoke around your child.

But what about over the counter cough and cold medications?

Recently, after reviewing the safety and efficacy data of cough and cold medicines, the FDA recommended against using cough and cold medications for children less than two. This was due to lack of evidence showing that they are effective, and due to harmful side effects that can be seen, particularly if there is accidental misuse of the medication (ie giving doses of more than one type of cough and cold preparations that have similar medications in them). Please talk to your pediatrician about the use of cough and cold medications for your child.

back to top

My baby spits up a lot. Is this a sign of a problem?

Spitting up is a very common problem for babies. Spitting up, usually seen in babies under one year of age, is typically an easy flow out of the mouth of stomach contents. This frequently follows a burp, or when a baby has just fed and is placed on their belly. This is different from vomiting, which is usually more forceful.

Burping frequently and limiting your baby to gentle play right after meals can help with spitting up. The spitting up almost always improves a little every month, though some babies will continue to have some spitting up for their whole first year. With the typical spitting up, babies still gain weight well and are happy.

Some babies have spit up that worsens, or that causes them to be very fussy or not gain weight well. This can be a sign of GERD (gastroesophageal reflux disease). Your pediatrician will discuss options with you, such as possibly thickening the feedings, avoiding overfeeding, frequent burping, and keeping your baby upright for thirty minutes after a feeding.

Common illnesses in childhood can cause vomiting in your child. This vomiting is usually more forceful than spitting up, and if caused by a stomach virus may be accompanied by other symptoms such as a low grade fever and diarrhea. Sometimes other childhood illness can cause vomiting, like ear infections, for example.

When to call your pediatrician:

• if you see blood in the vomit, or if there is a green color to the vomit (bile)
• if your child is in severe pain
• if your child's abdomen seems swollen
• if the vomiting is very forceful or very frequent
• if your child is lethargic or very irritable
• if your child has signs of dehydration (such as dry mouth, no tears when they cry, sunken soft spot, decrease urination
• if your child is not drinking fluids
• if the vomiting is worsening or is not improving after 24 hours
• if your baby is less than four months old, call the office to discuss your baby's symptoms

back to top

What's the best way to treat vomiting?

In most cases, vomiting will resolve on its own without specific treatment. It is important during a vomiting illness to help keep your child from becoming dehydrated. Dehydration is when your body loses fluids and does not have enough to function properly. This can become serious and life-threatening if dehydration is severe. When vomiting, your child needs to take in extra fluids to replace the fluids that are lost when vomiting.

Solid foods are not usually well tolerated early in a vomiting illness. Your child can drink water, Popsicles, gelatin water (1 tsp of flavored gelatin in 4 oz of water), or an electrolyte solution, such as Pedialyte. The key to giving fluids to a child that has been vomiting is to go slowly and remember that small amounts of fluids are less likely to cause vomiting. Start with only 1-2 ounces of clear liquids every half an hour. When your child has done well with this for 4-6 feedings, you can try half-strength formula or milk. Slowly increase the amount at each feeding. After 12-24 hours of tolerating this well, begin reintroducing solid foods but continue to encourage fluids.

If your child also has diarrhea, keep in mind that fluids that are high in sugar, such as juice, sodas, kool-aid, can make diarrhea worse. Caffeinated beverages are not helpful in keeping children hydrated. Do not give over-the-counter medications for vomiting or diarrhea unless specifically advised by your pediatrician.

When to call your pediatrician:

• if you see blood in the vomit, or if there is a green color to the vomit (bile)
• if your child is in severe pain
• if your child's abdomen seems swollen
• if the vomiting is very forceful or very frequent
• if your child is lethargic or very irritable
• if your child has signs of dehydration (such as dry mouth, no tears when they cry, sunken soft spot, decrease urination
• if your child is not drinking fluids
• if the vomiting is worsening or is not improving after 24 hours
• if your baby is less than four months old, call the office to discuss your baby's symptoms

back to top

What can I do if my baby gets diaper rash?

Most children will get diaper rashes during their first year. Diaper rashes can be caused by several different things. Some of the more common causes of diaper rash are: too much moisture against the skin, irritation from chafing from the diaper, irritation from urine or stool remaining in contact with the skin for a prolonged time, yeast infection, bacterial infection, or sensitivity to the diaper material.

Keeping your baby clean and dry can help in the treatment and prevention of diaper rashes. Changing diapers promptly after soiling is important. If your child has a rash, gently cleanse the diaper area with water and a soft washcloth. Use soap and water if the stool cannot be cleaned off with just the water and washcloth. With a severe rash, a squirt bottle with water can be helpful to avoiding rubbing the skin. Baby wipes can be irritating to skin if your child already has a diaper rash. Pat the skin dry, do not rub, and allow to air dry. Apply a thick layer of diaper cream or ointment (such as one with petroleum jelly or zinc oxide). These are usually very thick and do not have to be completely removed at the next diaper change. Do not fasten the diaper too tightly. A diaper that is slightly loose allows for less contact with the irritated skin.

Call your pediatrician if the rash does not go away within 2 or 3 days, if it is worsening or if it is severe, f it has blisters or pus-filled sores, if your child has fever, or if the rash is painful. Additionally, if your child is taking an antibiotic and the rash is bright red with red spots at the edge, call your pediatrician as this may be a yeast rash.

back to top

I think my child may be constipated. What should I do?

Constipation in a child is when they pass hard, dry, large stools. Frequently the stools are difficult or painful to pass. Typically, the child stools infrequently as well, though not always.

Constipation can be affected by your child's diet. Not drinking enough liquids contributes to constipation, as does a diet low in fiber. Foods that are good sources of fiber are cereals (like bran cereal or mini wheats), grains, fruits (prunes and prune juice in particular), and vegetables. A very large intake of dairy products can contribute to diarrhea as well. Sometimes constipation is seen when there is a change in the overall diet, such as when a baby starts solid foods or when switching to cow's milk from breast milk or from formula. Some children will have constipation after your child has been sick, or on some medications.

When constipation becomes a chronic problem (for more than two weeks), your child's body may ignore the urge to have a bowel movement. This makes the problem worse, as the stool becomes larger, harder, and more dry. This causes more pain with stooling and can make children want to avoid having a bowel movement. Sometimes when children get in this constipation cycle, they can even have accidents of soiling their underwear as some stool will leak out.

Things to do to help your child:

• Increase the fiber in the diet and increase the amount of fluids your child drinks every day.
• Help teach your child not to avoid bowel movements by establishing a regular habit of sitting on the toilet for at least 10 minutes, at about the same time each day, preferably after a meal. Making sure your child has something to rest his or her feet on is helpful, like a small footstool. Your child may read books or other such activities as well during this time.
• Your child may need a stool softener. There are safe options for stool softeners for children to discuss with your pediatrician.

When to call your pediatrician:

Call your pediatrician if your child's constipation is chronic, if it is not improving with the above measures, if your child is having soiling accidents, if your child is having loss of appetite or stomach pain, or if you see blood on your child's stool.

DISCLAIMER:

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

The American Academy of Pediatrics is an organization of 57,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults.

American Academy of Pediatrics
PO Box 747
Elk Grove Village, IL 60009-0747
http://www.aap.org