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The following information is intended as an aid for parents in caring for their children. None of the information included on the website is a substitute for the advice and care given directly by thier family physician. Please speak with your physician directly to discuss medical concerns pertaining to your individual child.

Fever
Colds
Infant Feeding Schedule
Vomiting and Diarrhea
Vaccines
Head Lice
spacer What is ADD/ADHD and how is it treated?
Why can’t an antibiotic be called in for my sick child?
Is your Child’s Cough Due to Allergies, a Cold, or Something Worse?
What Can I Do to Treat Constipation?
Lyme Disease: What Your Family Should Know

My child has a fever! What should I do? At what temperature should I panic?

While fever can be a sign that your child is coming down with an illness, it is not a reason to panic. Fever is a sign of a healthy immune system and usually indicates that the body is doing what it can to fight off an infection. Fevers due to infections do not cause brain damage and only a very small percentage of children will ever have a febrile seizure, even at very high temperatures. Many misconceptions exist regarding the dangers of fever, which lead to unnecessary stress for many parents.

Temperatures ranging between 98.6° and 100°F are not really considered fevers. Normal body temperature fluctuates throughout the day and peaks in the late afternoon and evening. Taken rectally, normal temperature ranges from 98.4° in the morning to 100.3° in the late afternoon. No medication is needed, unless your child has other symptoms, such as headache.

In a newborn baby under 2 months of age, any fever above 100.4° is considered an emergency and must be treated in an emergency room. For children over 2 months of age, temperatures ranging from 100° to 102° are considered low and are beneficial for fighting illnesses. How your child appears, such as whether they are in pain, are staying hydrated, or how they are acting, are better indicators of serious illness than height of fever. If your child is uncomfortable, analgesics such as Tylenol or ibuprofen (for children over 6 months of age) may be administered as needed. It is unnecessary to aggressively treat fever (such as by alternating Tylenol and Motrin or waking a sleeping child to make sure their fever is coming down), since the fever itself is not harmful. If your child is relatively comfortable, no medication is needed to treat the fever itself.

Temperatures above 102° may cause discomfort and should be treated with Tylenol or ibuprofen. Children with high fevers, such as above 105, should be seen by a doctor. A trip to the ER is probably unnecessary, unless the child is very ill-appearing or is dehydrated. In general, treatment of fever should be based on how the child looks, not the height of the fever. Fever itself is not dangerous, unless it rises above 108° (such as in a child locked inside of a hot car in the summer). In a normal person, the brain acts as a thermostat and prevents fever from rising above 106°; fever will not rise indefinitely if left untreated!

In general, fever is not dangerous nor is it a disease itself; it is simply a sign of illness, just like a rash or a headache. Keep your child comfortable by offering Tylenol or ibuprofen as needed, placing your child in a lukewarm bath (if desired), and offering plenty of fluids.

Please call your doctor for high fevers, fevers in infants, fevers lasting longer than 4 days, and fever accompanied by other symptoms, such as ear pain.

What is ADD/ADHD?

Attention deficit hyperactivity disorder is a neurologic disorder in which one has an inability to focus consistently that is disruptive to their daily life. This can occur with or without symptoms of hyperactivity and/or impulsivity. Symptoms occur in multiple settings,(at home and at play) not only in the classroom. The disorder has a genetic basis, meaning it tends to run in families. It is not the result of poor parenting, eating too much sugar, or the child being lazy or stupid. ADD is both overdiagnosed and underdiagnosed. Not every child with attention difficulties has ADD, as many other factors, such as illness, learning problems, stress at home, illicit drug use, poor vision, depression, or other psychiatric disorders may resemble this condition. On the other hand, many “daydreamers,” who have poor academic achievement due to inability to focus, or children who do well in elementary school but have problems in middle school or high school may be overlooked if they are not disruptive in the classroom.

How is ADD/ADHD Evaluated at WE CARE Pediatrics?
The evaluation of ADHD is a time consuming process and is not one that can be done on an ‘emergency’ basis. If a parent expresses concern that a child may have difficulty focusing, we initiate an evaluation using Connor’s forms, a standardized evaluation system. Several teachers, and each parent or other adults who are very familiar with the patient, and the patient himself (if over the age of 12 years) complete forms and we review them. If the results are suspicious for ADD/ADHD, we bring in the parents for a one hour consult to further discuss the symptoms. If ADD/ADHD is diagnosed and parents are interested in initiating a trial of medications, the patient is brought in to discuss the diagnosis and treatment. If further evaluation is indicated, or if either parent is uncomfortable with the diagnosis, referrals are made to a psychiatrist or a Developmental/ Behavioral specialist.

How is ADD/ADHD Treated?
Not every child with a diagnosis of ADHD requires medication. . Practical measures, such as, ensuring that the child is getting sufficient sleep, a proper diet with protein at each meal, and limiting artificial coloring and preservatives in food, may be beneficial. In addition, many children benefit from a complete psycho educational evaluation through the school system. This can identify other educational problems that will respond to classroom accommodations. Public schools will create an individualized educational plan (IEP) or a 504 plan for children who qualify. When these measures are not sufficient, we do recommend medical treatment. It is important to remember that there are a number of different medications available to treat ADHD, and what works for one person may not work for another. We usually start patients at a low dose and gradually increase it until a dose is achieved that adequately treats the symptoms without significant adverse effects. While many patients do experience some loss of appetite or some difficulty falling asleep on these medicines, they usually find such side effects tolerable and many of these side effects decrease over time. If more significant side effects, such as moodiness, social withdrawal, or development of a tic occur, the medication is discontinued and another is started, if desired. Because of the complex nature of ADHD treatment, we see patients for 30 minute appointments every few months to monitor their response to medications. These appointments are essential for continued treatment, and frequently do need to take place during the day.

Where can I find additional information on ADD/ADHD?
www.chadd.org

Why Can’t An Antibiotic be Called in for my Sick Child?

Antibiotics are powerful medicines that can kill bacteria and treat bacterial infections. You may have seen your child respond quickly to antibiotics prescribed for these infections, such as ear infection or Strep pharyngitis, and desire antibiotics to be called in every time your child has a fever or does not feel well. While antibiotics are very effective against bacterial infections, they are not effective against viral illnesses. Most illnesses in children, including all colds, 99% of vomiting and diarrhea, croup, most coughs (99%), most fevers (95%), and most sore throats (90%), are caused by viruses, not bacteria. When a doctor examines a child in the office, she or he will determine whether their illness is more likely to be caused by a virus or bacteria. Since most sore throats are not caused by bacteria and most causes of ear pain or ear tugging are not actually ear infections, an antibiotic will not be beneficial for most patients.

Due to overuse of antibiotics, bacteria have started developing resistance to antibiotics. When resistance develops, the antibiotic will no longer be effective in treating illnesses caused by many types of bacteria. This causes us to use antibiotics that are more expensive or need to be administered via IV in a hospital setting. Even these newer, more expensive antibiotics are developing resistance. Doctors are therefore writing fewer prescriptions for antibiotics than in the past, in an attempt to try to combat resistance.

Antibiotics are also associated with many side effects, so it is not recommended to just “try an antibiotic” to see if an infection improves. Antibiotics can cause diarrhea, vomiting, stomachaches, and sometimes rashes. When a rash occurs, is difficult to tell if it is a side effect or an allergic reaction to an antibiotic. Sometimes children get mislabeled as allergic and cannot receive the antibiotic in the future when they really need it.

While we understand that you would like your child to feel better as quickly as possible and that you need to return to work and have your child return to school as soon as possible, pressuring your doctor for an antibiotic when it is not needed will not help you achieve these goals. If you think your child may have a bacterial infection, please call our office or the doctor on-call, and we will discuss with you whether an appointment is needed.

Colds

Your child has a cold (upper respiratory infection) without secondary bacterial infection. This does not mean that your child is not sick, miserable, and keeping you up all night. It does mean that an antibiotic will not help the problem. There are things that you can do to make your child more comfortable while their immune system fights off the infection.

  1. Make sure no one smokes in the house or car, even when the child is not there. The smoke will irritate the child’s nose and throat, make the cold last longer and increase the chances for an ear infection or bronchitis.
  2. For an infant, the nasal congestion will be noisy but if the child is drinking well it probably is not causing them any serious problems. If the infant is not drinking, try putting a drop or two of saline (Nasal or Ocean) nose drops in the nostril and then using a bulb suction to pull out the mucus.
  3. You can try filling the bathroom with steam from the shower and steaming their nose for 20 to 30 minutes, or using a humidifier or vaporizer in the bedroom.
  4. If they sleep better sitting up, you can let them sleep in an infant seat or car seat.
  5. If they don’t want to drink in the morning, try giving them an ounce or two of water (or Pedialyte for a child under six months) to wash down the mucus first.
  6. Congested infants may take fluid better from a cup because they don’t have to hold their breath, suck and swallow at the same time.
  7. Keep the heat in the house down. When it is too warm and dry, the mucus becomes thicker and more difficult for the infant to deal with. You do not need to “crank up” the heat when a child is sick.

Cold medications have been taken off the market for children under two because they were found to cause more harm than good. They are generally not recommended for children under six.

We need to hear from you if:

  1. Your child is refusing to drink, is not urinating every 6 to 8 hours or you think they are becoming dehydrated.
  2. Your child is having difficulty breathing and you think they have bronchitis or pneumonia.
  3. Your child complains of the severe persistent ear pain or sore throat.
  4. Your child is difficult to wake or looks very ill to you, and you think they may need to be in the hospital.

A preschool or school-age child may have between 6 and 12 colds a year, and each cold may last 10 days to two weeks. As the cold goes away, the mucus may become thick and green or yellow. This does not necessarily indicate a bacterial infection. As most of the colds occur in the winter it is possible for your child to be sick on and off all winter long without having a serious illness. We have no medicine to make the cold go away any faster than it will naturally. If you find something that works for your child, please tell us, we’d like to know!!

Schmitt, BD: Instructions for Pediatric Patients, 2nd Edition, WB Saunders Company, 1999

Infant Feeding Schedule

Newborns

  • Breast milk or formula only
  • For constipation, may have plain boiled water with 1 tsp sugar or 1 TBL apple juice or prune juice per 2 ounces of water. Give only 2 ounces per day.
  • Never give honey or Karo syrup to babies under one year of age.

4 to 6 months
Start solids – single foods, one at a time, each for 3-5 days in a row. Watch for signs of allergy. (Rash around the mouth, gassiness, vomiting, diarrhea, diaper rash)

  • Cereals – rice, oats, barley first, 1 to 3 TBS, once or twice a day. Wheat and mixed cereal later at nine months (higher allergic potential).
  • Vegetables (white – white, yellow, orange) – sweet potatoes, yams, squash, carrots (not home made), mashed potatoes, corn
  • Vegetables (dark – green) – peas, beans, zucchini, spinach
  • Fruits (light) – applesauce, bananas, pears, peaches, apricots.

6 months

  • Begin meat (chicken, turkey, veal, ground beef)
  • Juices(100% juice) in a cup only, limit to 2 ounces mixed with 2 ounces of water.

9 months

  • Dairy – plain or vanilla yogurt with active cultures, small curd cottage cheese or ricotta cheese
  • fruits (dark – berries) strawberry, blueberry, cherry
  • Can try table food cut into small pieces

One year

  • Begin whole milk in a cup and wean formula
  • Eggs three days in a row: first a hard boil and serve yolk only, next two days scramble whole egg.
  • Peanut butter, thin film on toast (if no family history of peanut allergy)

Vaccine Policy Statement

  • We firmly believe in the effectiveness of vaccines to prevent serious illness and to save lives.
  • We firmly believe in the safety of our vaccines.
  • We firmly believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and Prevention and the American Academy of Pediatrics.
  • We firmly believe, based on all available literature, evidence, and current studies, that vaccines do not cause autism or other developmental disabilities. We firmly believe that thimerosal, a preservative that has been in vaccines for decades and remains in some vaccines, does not cause autism or other developmental disabilities.
  • We firmly believe that vaccinating children and young adults may be the single most important health-promoting intervention we perform as health care providers, and that you can perform as parents/caregivers. The recommended vaccines and their schedule given are the results of years and years of scientific study and data gathering on millions of children by thousands of our brightest scientists and physicians.

These things being said, we recognize that there has always been and will likely always be controversy surrounding vaccination. Indeed, Benjamin Franklin, persuaded by his brother, was opposed to smallpox vaccine until scientific data convinced him otherwise. Tragically, he had delayed inoculating his favorite son Franky, who contracted smallpox and died at the age of 4, leaving Ben with a lifetime of guilt and remorse. Quoting Mr. Franklin’s autobiography:

“In 1736, I lost one of my sons, a fine boy of four years old, by the smallpox…I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it, my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.”

The vaccine campaign is truly a victim of its own success. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many of you have never seen a child with polio, tetanus, whooping cough, bacterial meningitis, or even chickenpox, or known a friend or family member whose child died of one of these diseases. Such success can make us complacent or even lazy about vaccinating. But such an attitude, if it becomes widespread, can only lead to tragic results.

Over the past several years, many people in Europe have chosen not to vaccinate their children with the MMR vaccine after publication of an unfounded suspicion (later retracted) that the vaccine caused autism. As a result of underimmunization, there have been small outbreaks of measles and several deaths from complications of measles in Europe over the past several years.

Furthermore, by not vaccinating your child you are taking selfish advantage of thousands of others who do vaccinate their children, which decreases the likelihood that your child will contract one of these diseases. We feel such an attitude to be self-centered and unacceptable.

We are making you aware of these facts not to scare you or coerce you, but to emphasize the importance of vaccinating your child. We recognize that the choice may be a very emotional one for some parents. We will do everything we can to convince you that vaccinating according to the schedule is the right thing to do. However, should you have doubts, please discuss these with your health care provider in advance of your visit. In some cases, we may alter the schedule to accommodate parental concerns or reservations. Please be advised, however, that delaying or “breaking up the vaccines” to give one or two at a time over two or more visits goes against expert recommendations, and can put your child at risk for serious illness (or even death) and goes against our medical advice as providers at We Care Pediatrics. Such additional visits will require additional co-pays on your part. Furthermore, please realize that you will be required to sign a “Refusal to Vaccinate” acknowledgement in the event of lengthy delays.

Please recognize that by not vaccinating you are putting your child at unnecessary risk for life-threatening illness and disability, and even death. As medical professionals, we feel very strongly that vaccinating children on schedule with currently available vaccines is absolutely the right thing to do for all children and young adults. Thank you for your time in reading this policy, and please feel free to discuss any questions or concerns you may have about vaccines with any one of us

Vomiting and Diarrhea

What are your recommendations for vomiting and diarrhea?
If your child is vomiting (forceful ejection of large amounts of stomach contents, not just spitting up small amounts of formula or breastmilk in an infant) and/or diarrhea (frequent, watery or mucousy stools), keeping them hydrated (keeping enough fluid in their system) is of utmost importance

You should go directly to the Emergency Room if your child has the following symptoms. Your child may need IV fluids or further evaluation.

• No urine for over eight hours
• Dry lips and mouth
• Sunken eyes or sunken fontanelle (the soft spot on an infant’s head)
• Unable to wake up and talk to you
• Vomiting with severe abdominal pain

For young children with vomiting and diarrhea who are able to hold down fluids, give them small amounts of fluids at a time, even as little as a teaspoon every 10 minutes. Electrolyte solutions, such as Pedialyte, are good choices, but you can also give breastmilk, or formula. Don’t give your child just clear liquids for more that 24 hours. Gatorade is not the best option, but it can be diluted and given to older children. Popsicles are also good choices to keep children hydrated, since they dissolve slowly, soothe the throat, and may be more eagerly accepted by ill children. Avoid juice as it contains a lot of sugar and will make diarrhea worse. If your child wants solid food, you can give small amounts of most foods. You may want to avoid milk and anything greasy for the first 24 hours. If they are not interested in eating, focus on keeping them hydrated and don’t worry about the solid food; they will regain their appetite as they recover.

We do not recommend medications to stop vomiting and diarrhea because they can prolong the illness. We do not call-in medications to treat these illnesses because there are no medications that are safe and effective in children and infants. Usually, vomiting and diarrhea is caused by viruses and does not respond to antibiotics. In fact, antibiotics can cause vomiting and diarrhea as side effects! There is some research that suggests that probiotics, such as acidophilis, may shorten the duration of stomach viruses. These are available over-the-counter in most pharmacies (Culturelle, Biogaia, and Florastor Kids are some brands available for children and infants.)

We do not usually bring in patients with vomiting and diarrhea to be seen in the office, since there is not much we can do to treat these illnesses. There are some important exceptions: diarrhea or vomiting that is bloody or lasts more than one week, vomiting accompanied by other symptoms, such as fever, headaches, significant abdominal pain, sore throat, or rash, or signs of dehydration. Please call the office if your child is experiencing any of these symptoms or if you are unsure if your child may be dehydrated! Also, make sure all family members are washing their hands frequently because these illnesses are very contagious! Children can return to school or daycare when they have not vomited or had diarrhea in 24 hours.

Head Lice: AAP Official Statement on Proper Treatment

According to an official statement put forth by the American Academy of Pediatrics (Pediatrics Aug 2010), head lice should initially be treated with Nix (Permethrin 1%). Nix should be applied to damp hair after the hair is shampooed with a nonconditioning shampoo and towel-dried. (Use of conditioner will decrease efficacy). It is left on for 10 minutes, then rinsed off. Treatment should be repeated in nine days. All other family members should be examined for live lice and nits and treated accordingly.

If Nix is not successful in irradicating lice, Cetaphil facial cleanser may be used to suffocate the lice. Cetaphil is applied to a dry scalp until the scalp is soaked, then the hair is blow-dried. Cetaphil is left on overnight, then rinsed in the morning. Treatment should be repeated once a week for at least 2-3 weeks.

It is a good idea to wash pillowcases and sheets used by the affected individual, as well as cleaning combs, brushes, and hats. It is unnecessary to extensively clean the entire home, however, as head lice cannot survive off a human scalp for over 24 hours and are very unlikely to live in rugs or on furniture.

If neither Nix nor Cetaphil are effective after proper use, a doctor can call in a prescription treatment, such as Ulesfia or Ovide. These are very effective, but are considered second-line therapies and may be expensive. Ovide (malathion 0.5%) is extremely flammable; if prescribed, no one should smoke or use a hair drier or curling iron near the affected individual until it is completely rinsed out. Lindane is no longer prescribed because it can cause seizures.

Medications that are used to treat head lice can cause itching or mild burning of the scalp that can persist for many days after lice are killed. Continued itching is not proof that treatment has failed and is not a reason to repeat treatments. Oral antihistamines (Benadryl) can be used to control itching until this side effect resolves.

According to the American Academy of Pediatrics, “No healthy child should be excluded from or allowed to miss school time because of head lice. No-nit policies should be abandoned.” (Pediatrics, Vol 126, No.2, Aug 2010, p.400). Many children miss an unnecessary number of school days due to head lice and this can affect their school performance, not to mention days of work missed by their parents!
Head lice are not a sign of poor hygiene or poor parenting! They affect all socioeconomic groups and do not cause illness beyond an itchy scalp.

Is your Child’s Cough Due to Allergies, a Cold, or Something Worse?

Fall is the time of year we see an increase in colds, allergy symptoms, and asthma flares. As a parent, it can be difficult to tell which of these your child is experiencing. Here are some ways to tell the difference between them and to help determine if your child needs a doctor visit or if he or she can be treated at home.

Allergies: We see an increase in allergy symptoms in the fall due to ragweed season. Symptoms of allergies include clear runny nose, itchy and/or watery eyes, and sneezing. Allergies can last weeks, months, or sometimes all year round, depending on what the individual is allergic to. Allergy symptoms are very annoying, but people who suffer from allergies don’t feel ill or run high fevers. Infants and toddlers do not usually develop seasonal allergies until age 2 years, so if your infant has a runny nose, it is more likely a cold. Allergies usually respond well to antihistamines like Claritin, Zyrtec, and Allegra, all of which are now over-the counter. In some cases, antihistamines are not enough and a prescription may be needed.

Colds: Upper respiratory infections, or colds, are also increased in the fall due to children returning to school. Symptoms of a cold can be similar to allergies in that they include runny nose and sneezing. Colds, unlike allergies, may be accompanied by fever that can last up to 4 days, coughing, sore throat, and headache. Mucus from the nose will usually turn yellow-green after 2 days, which is a sign that the body is fighting back, not a sign that it has become a sinus infection. If yellow-green mucus comes from the nose, the same color mucus can be coughed up, as well, which does not mean the child has pneumonia, but means there is post-nasal drip. Colds are caused by viruses, so antibiotics do not help. Usually supportive care, such as chicken soup, increasing fluid intake, honey for children over 1 year of age, and sometimes over-the-counter cough and cold medicines for children over 6 years of age, are all that are needed.

Sinusitis: Sinus infections are secondary infections that can develop in someone who already has a cold. Typically, the child has a cold for over a week, then suddenly gets worse, rather than better. Symptoms include facial pain in the cheeks and forehead, which are much worse with bending forwards, nasal congestion, sore throat, fever, and foul odor to breath. Yellow mucus does not automatically mean sinus infection! If you suspect your child has a sinus infection, they should be seen by their doctor.

Pneumonia: Another secondary infection that can follow a cold is pneumonia. The child will have a cold that suddenly gets significantly worse, with significant coughing, rapid breathing, chest pain, and/or fever. Any cold with a fever lasting over 4 days without improvement, a fever that goes away and then returns after several days, a cough that persists over 2 weeks without improvement, or any trouble breathing could be a sign of pneumonia and would indicate a need for a doctor visit.

ANY SYMPTOM OF RESPIRATORY DISTRESS, SUCH AS BREATHING EXTREMELY FAST, GASPING FOR AIR, OR SIGNIFICANT SHORTNESS OF BREATH IS A MEDICAL EMERGENCY – CALL YOUR DOCTOR OR GO TO THE ER FOR FURTHER EVALUATION!

Asthma or Reactive Airway Disease: Due to the change in weather and increase in viral colds, both of which can trigger wheezing in children who are prone to it, we see an increase in wheezing episodes in the fall. Signs of wheezing include a whistling sound with breathing, a feeling of chest tightness, a cough with a tight quality, breathing quickly, or a cough that lasts over two weeks without improvement. Sometimes mucus in the back of the throat from post-nasal drip can also cause a whistling sound with breathing or a “rattling” in the chest, but this would be associated with any difficulty breathing. If your child does not have a history of wheezing, but you suspect your child may be wheezing now, it is important to call for a doctor visit. As mentioned previously, any signs of respiratory distress are a medical emergency and warrant a call to your doctor or a visit to the ER. A single episode of wheezing does not mean your child has asthma; it can be triggered by pneumonia or viral illnesses.

As you can see, there are many reasons why your child may be coughing during the fall season, most of which do not require an antibiotic. When in doubt, call for an appointment so we can listen to your child’s chest and determine what treatment, if any, would be most helpful.

What Can I Do to Treat Constipation?

A child who is constipated will have stools that are hard, unusually large, and infrequent. In severe cases, children may go 4-5 days or longer without having a bowel movement and blood can sometimes be seen in the stool. Not every child needs to have a bowel movement every day, as long as stools are soft and easy to pass. Newborns are born with a reflex that gives them an urge to stool every time they eat; this resolves when they are one month of age. It is normal for a one-month-old to sometimes have a day in which they do not poop; this simply means they have outgrown this reflex and is not a cause for alarm.

For infants, children, and teens, the first step in treating constipation is to increase fluid intake. Many people get constipated from not drinking enough water. Babies and children 4 months and older can also be given prune juice, pear, or peach nectar. Babies 2 months and older can have one ounce of prune juice diluted with one ounce of water up to twice a day or can have 1-2 ounces of sugar water up to twice a day.

A high fiber diet is also important in treating constipation. For infants over 4 months of age, rice cereal can be replaced with oatmeal, which is less binding. Fruits and vegetables that start with “P” also help, including peaches, pears, prunes, plums, and peas. For older children, high fiber foods include beans, blueberries, popcorn (over age 3 years), Double Fiber bread, Fiber One bars, and Thomas’s Light Multigrain English Muffins (or Fiber Goodness or Triple Health).

Children over one year of age can also take Benefiber or Metamucil Clear and Natural, 1-2 tsp in 6-8 oz any drink, up to 3 times a day. These are colorless, tasteless powders that dissolve completely in drinks and are safe to use long-term. Metamucil wafers can be given to children over the age of one; one a day for children under 12 years, two a day for older than 12 years.
When very constipated, give Miralax ½ to 1 capful dissolved in 8 oz of any drink daily, up to two weeks; this is also a colorless, tasteless powder. The dose should be adjusted so that the child is having soft BMs daily, but not diarrhea. After two weeks, slowly wean off Miralax over several weeks or longer, so that he or she continues to have soft BMs daily. Restart if constipation recurs. Miralax produces a BM within 24 hours.

When immediate relief is needed, Fleet’s enema can be given once daily, up to 3 days in a row. This is available in pediatric strength and usually lead to immediate passage of stool. For infants, glycerin suppository can be given (1/3 to ½ a suppository, depending on age of baby.)

Children with chronic constipation should have bowel-training to encourage regular stooling. Have child sit on toilet for 10 minutes after breakfast and dinner daily to attempt to have BM; it is okay to have them bring a book to help them relax.

If your child has blood in the stool, if an older child who is already potty-trained is now having stool accidents, if your child’s abdomen is hard and distended, or if you have already tried the methods discussed here and are not seeing an improvement, it is important to call your doctor to schedule a visit for further evaluation.

Lyme Disease: What Your Family Should Know

Now that summer is here, it is important for families to take measures to protect themselves against Lyme disease. Lyme disease is spread by the black-legged deer tick, which is found commonly in Pennsylvania and in the northeastern United States. When Lyme disease is diagnosed and treated early in the course of infection, late complications can be avoided.

When your child plays outdoors, especially in wooded areas, it is important to perform a tick check afterwards, even in your own backyard. When checking your child or yourself for ticks, be sure to check the scalp, around the ears, inside the belly button, around the waist, behind knees, and under the arms. When hiking or playing in wooded areas, use an insect repellant with 20% DEET; this can safely be applied to skin and clothing, but avoid applying it to hands, eyes, and mouth. Clothing and pets should also be checked for ticks.

If a tick is found, it should be removed immediately. Using fine-tipped tweezers, grasp the tick as close to the skin as possible and pull upwards with steady, even pressure. Do not twist or jerk the tick because this can lead to mouthparts being left in the skin. IF TICK PARTS ARE LEFT IN THE SKIN, THIS IS NOT DANGEROUS AND NOT A NEED FOR AN ER VISIT OR ANTIBIOTICS! Simply attempt to remove the mouthparts with tweezers; if you cannot remove them, let the skin heal; the mouthparts themselves do not transmit Lyme Disease and are no more dangerous than a splinter. It is also NOT recommended to douse the tick with alcohol or petroleum jelly or to try to burn the tick with a lighter; these are not effective methods of removing the tick!

Symptoms of early Lyme disease include a “bull’s eye” rash, and sometimes fever, body aches, headache, and joint pain. The rash will appear as a red spot that gradually increases in size over a few days and forms a ring-like lesion, up to 5cm in diameter, often with central clearing. The rash is not itchy or painful. If you see a “bull’s eye” rash, it is important to have a doctor look at it to determine if antibiotics are needed. This does not need to be confirmed with a blood test; often the blood test is negative for the first few weeks until the body has a chance to build up antibodies to the infection. A two to three week course of antibiotics will be prescribed for suspected Lyme disease and it is important to complete the full course to avoid late complications of this illness. As long as the full course of antibiotics are given, late effects of Lyme disease are highly unlikely.

Sometimes the rash is not seen and late complications develop. These can include arthritis of a joint, usually the knee, with redness and significant swelling; Bell’s Palsy, which is a palsy of the facial nerve, and less commonly, chronic joint pain, heart problems, and neurologic symptoms. These symptoms are also indications to seek immediate medical evaluation and most complications can be treated with a three to four week course of antibiotics. Vague symptoms such as fatigue are not usually an indication to be tested for Lyme disease, especially since the blood test has a high rate of false positive results.

While it is important to recognize and treat Lyme disease promptly, this does not mean that finding a tick on your child or yourself is a reason to panic! Only black-legged deer ticks transmit Lyme disease; large ticks, such as dog ticks, do not transmit this infection. The tick needs to be in place for over 24 hours to transmit Lyme disease; if a tick is pulled off following a hike or following outdoor play, the risk of Lyme disease is extremely small. Even if the tick is a deer tick, the risk of infection is about 1% to 3%. Therefore, it is not recommended that everyone who has been bit by a tick take antibiotics! It is also not necessary to send every tick you find to the lab to see if it is a deer tick, as this is also not an indication to start an antibiotic. If a tick is found, remove it promptly and monitor for signs of infection, especially a “bull’s eye” rash. If such a rash develops, call your doctor for further evaluation.

For further information, please visit the CDC’s website at www.cdc.gov/lyme