COMMON SYMPTOMS

WE OFFER IMPORTANT INFORMATION ABOUT COMMON SYMPTOMS

ACNE

Acne is defined as blackheads, whiteheads (pimples), or red bumps on the face, neck and/or shoulders. Acne is caused by the plugging of oil glands due to the increased level of hormones produced during adolescence. Sometimes genetics or certain medications may be the cause.

Acne is not caused by diet, so it is unnecessary to restrict certain foods (e.g. chocolate)
Acne is most commonly noted on the face and back.
Poor hygiene is not a cause of acne, but excessive oils +/- rubbing can worsen acne
Acne usually lasts until 18 to 20 years of age (It can persist through adulthood).
It is rare, but possible for acne to cause scarring
Good skin care may keep acne under control and at a mild level

HOME TREATMENT

Soap: wash face twice daily and after exercise with mild soap (eg. Dove)
Hair: wash daily as it may make acne worse by contributing excess oil to the skin
Change pillow case 2-3 times weekly
AVOID picking and popping pimples as this may cause a secondary infection and/or scarring.
Use “non-comedogenic” make-up and moisturizers
Some over-the-counter products may be helpful:
Benzoyl peroxide lotions, gel, or washes: this helps to open pimples and unplug blackheads. It also kills bacteria and dries skin. The lotion causes less drying of the skin than the gel. Begin with the 5% lotion and apply a thin layer to the entire area where pimples occur; once nightly for a week, then twice a day. NOTE: often there is bleaching of sheets and clothing.
Medicated soaps (eg. Neutrogena)

PRESCRIPTION PRODUCTS:

When over-the-counter products are not helping to control acne or you feel the acne is not being controlled to your expectations, it may be time to try some prescription topical products or even consult a dermatologist if topical products are not helping.
Keratolytics: these medications help the skin layers to shed away quicker (eg. Differin, Retin-A, Tazorac).
Typically after 4 to 8 weeks of use, there may be a flare-up as underlying pimple are uncovered. It is important to be patient during this flare-up as it will not last. Always use a sunscreen, preferably between a rating of 15 and 30, on skin that has been treated with these medications.
Topical antibacterial agents(eg. Erythromycin, Clindamycin)
Combination products (eg. Benzamycin, Benzaclin, Duac, Epiduo)
Oral antibiotics (eg. Minocycline, Tetracycline, Erythromycin)

CALL BACK IF:

The acne appears to be infected: large, red, tender lump with possible oozing
Acne has not improved after treatment with benzoyl peroxide for 4-6 weeks
The face becomes itchy or swollen
Hives occur
Blackheads or scarring are noted.

ACNE

BRONCHIOLITIS

Adapted from Barton D. Schmitt, MD Instructions For Pediatric Patients 16th ed. 2018)

BRONCHIOLITIS IS THE NARROWING OF THE SMALLEST AIRWAYS IN THE LUNGS (BRONCHIOLES) AND EXCESSIVE MUCOUS PRODUCTION. THIS NARROWING RESULTS FROM INFLAMMATION (SWELLING) CAUSED BY ANY NUMBER OF VIRUSES, USUALLY THE RESPIRATORY SYNCYTIAL VIRUS (RSV). WITH RSV INFECTIONS,

INFANTS YOUNGER THAN 2 YEARS OF AGE OFTEN DEVELOP BRONCHIOLITIS, CHILDREN GREATER THAN 2 YEARS OLD AND ADULTS DEVELOP COLD SYMPTOMS.

* Primary symptoms of Bronchiolitis include wheezing (high-pitched whistling sound produced

when the child breathes out), rapid breathing, and a frequent, harsh cough.

* Other symptoms may include fever and a runny nose.

* Peak symptoms (wheezing and breathing difficulties) are seen on the 3rd and 4th day of the illness.

A more controlled cough may persist for 2 additional days with the cough lingering for up to 14 days.

* The fever usually resolves after the first 3 days.

HOME TREATMENT FOR BRONCHIOLITIS:

*Humidity

Dry air tends to make the cough worse. A cool mist humidifier in the child's room will help to soothe

the cough and congestion.

*Nasal Saline & Suction

If the nose is blocked up, your child will not be able to nurse or drink from a bottle. Most stuffy noses are blocked by dry or sticky mucous. Nasal saline (and a bulb syringe) is often helpful. You may do this as often as needed. 3 to 4 times per day is recommended.

*Feedings

It is important to push fluids. Eating is often tiring for the child, so offer smaller, more frequent feedings. Thinning the formula with extra water or electrolyte solution, for example Pedialyte, will help to thin nasal secretions.

*Medications

Some children with Bronchiolitis respond to asthma medications. However, some do not.

Your medication is:

Directions:

For children greater than 6 months old, nasal decongestants and Dextromethorphan are sometimes helpful in relieving symptoms for a short time. Check with your doctor before giving.

CALL BACK IF:

* Cough becomes more frequent or repetitive and the child is unable to drink or talk

* Breathing becomes labored or difficult

* Lips turn blue

* Any signs of dehydration (No urination in 12 hours, no tears, dry mouth, sunken eyes, lethargy)

* Fever > 3 days or > 103 for 4 hours or > 102 for 6 hours

* Your child is acting VERY sick!

* Any questions or concerns

Updated 2020

BRONCHIOLITIS

CONSTIPATION

Constipation = HARD, FORMED, CLAY-LIKE poops, associated with painful or difficult passage. If poops are infrequent but soft, this is NOT constipation; it is obstipation. A baby may poop as many as 5 to 8 times a day or as little as every 3 days. It is normal for a baby to turn red and grunt while they are pooping. Ages 8-12 years old commonly get constipated.

TREATMENT IN INFANTS/TODDLERS

(0 to 18 months of age)

Offer 1 to 2 oues of water or preferably Pedialyte (electrolyte solution) in between normal feeds once or twice daily.
Do not significantly decrease the amount of usual feedings.
½ tsp of Karo syrup to every bottle. For breastfed babies: mix ½ to 1 tsp in 1 to 2 ounces of water 2 to 3 times/day.
White grape juice or prune juice daily in between feeds.
In babies older than 4 mos.: oatmeal cereal tends to soften the stools. Rice cereal makes stools firmer.

TREATMENT IN TODDLERS/PRE-SCHOOLERS

(18 mos. to 3 ½ years old)

May be a toilet training issue: (may want to discuss with MD/NP)
Do not force child to sit on potty!
Offer diaper to poop.
Ask child where they would prefer to poop (clear choices)
It is not uncommon for children to hold their poops for days to resist potty training.
Encourage child to drink lots of fluids other than milk.
Maple syrup or Karo syrup (1teaspoon to 1 tablespoon 2 to 3 times/day). Ask MD/NP re: other stool softeners.
Mineral oil 1 tsp, 2 times/day (may titrate up or down after speaking with MD/NP) for maximum 5 days.

*** See list of foods to increase/avoid.

PRE-SCHOOLERS/SCHOOL-AGED KIDS

(ages 3 ½ and up)

Encourage child to drink plenty of fluids other than milk
Mineral oil 1 tbsp/day (may titrate up or down after speaking with MD/NP) for a maximum of 5-10 days.
May need to speak with MD/NP re: additional stool softeners (fiber, Miralax)
No laxatives

***See list of foods to increase and list of foods to avoid.

FOODS TO INCREASE

Fruits and Veggies: 5 to 6 servings per day recommended; raw and unpeeled best.
Prunes, figs, dates.
Peaches, pears, apricots, raisins, grapes.
Leafy green veggies, cauliflower, cabbage.
Broccoli, potato skins, beans, peas.
Grains: bran is a high fiber food and acts as a natural stool softener.
Whole grain breads, muffins, waffles, wheat and oat bran, whole grain.
cereals (shredded wheat, bran flakes, oatmeal), whole wheat pasta, brown rice, granola,
Popcorn (only for children > 4 years due to choking risk).

FOODS TO AVOID OR DECREASE

It is important to decrease the intake of constipating foods:

Maximum milk intake=16 oz/day.
Dairy products (milk & cheese!!), Yogurt would be best dairy.
Cooked carrots, potatoes, white rice, bananas, apples, peanut butter, chocolate, white pasta, white bread/crackers.

CONSTIPATION

CROUP

CROUP is a narrowing of the “windpipe”, usualy as the result of a viral infection. The hoarseness is due to the swelling just below the vocal cords. STRIDOR occurs as the opening between the vocal cords becomes narrowed, due to the swelling around them.

STRIDOR is a harsh, raspy, vibrating sound or “honk” that can be heard when a child breathes in.

Stridor is most often present when the child is crying or coughing. If the disease becomes worse, stridor may be heard when the child is sleeping or relaxed.

Croup usually lasts for 4 or 5 days, and generally gets worse at night. The worst symptoms are classically seen on the 2nd and 3rd nights of the illness
Primary symptoms of croup include a tight metallic cough (like a barking seal), a hoarse voice, and fever can be high early in the illness
Other associated symptoms my include a runny nose and sore throat

HOME TREATMENT FOR CROUP

Mist

Dry air usually makes the cough worse, so keep the child’s room humidified.
Cool, moist air is best (cool mist humidifier or open the window).
On a cool night it is recommended to open the window, or for increased coughing TAKE CHILD OUTSIDE for at least 20 to 30 minutes! (air conditioning in room or car, or a car ride with open windows is also effective).

If this does not help try:

Steam bathroom-close the door and run the shower on hot; when bathroom is steamy take your child in for 10-15 minutes. Stay calm, cuddle child to keep him comfortable.

Remember that these treatments will help the breathing, but the cough will still be barky.

Avoid exposure to smoke-this can make croup worse.

Cold Liquids

Constant cold, thin drinks may help to decrease the swelling in the throat and help to keep the child hydrated!

Over-the-counter medications may decrease symptoms, but will not shorten the illness.

Ibuprofen (Not recommended for < 6months old) For discomfort due to fever or for increasing “honking” sound.

Benadryl: (Not recommended for children < 4 years old) May use for increasing “honking” sound.

Dextromethorphan:(DM present in cough medicines) Not recommended unless directed by provider.

CALL BACK IF:

Stridor at rest (with every breath)!
Breathing becomes difficult
Lips turn blue or dusky
Child develops excessive drooling, spitting, or difficulty swallowing
Any signs of dehydration, no urination in 12 hrs, no tears, dry mouth,

CROUP

DIARRHEA

DIARRHEA is the sudden increase in the frequency and looseness of bowel movements. Diarrhea is usually caused by a viral infection of the intestines (viral gastroenteritis). Diarrhea can also be due to excessive fruit juice or to a food allergy. Occasionally, diarrhea can be due to abnormal bacteria as well. Diarrhea may last from several days to a week, regardless of treatment. The main goal of therapy is to prevent dehydration. (Barton D. Schmitt, MD, 1999)

TREATMENT FOR DIARRHEA

Pedialyte in frequent small amounts.
A lactose free diet may be helpful in reducing diarrhea, but may delay full recovery. Dairy products contain lactose; yogurt (probiotic) best to try first, to help with recovery
For babies soy formula or diluting formula with extra Pedialyte for 2 days may reduce diarrhea.
Dilute juices (white grape) are acceptable to start, but can advance to other foods if not vomiting.
If not vomiting can start starchy foods to help firm up the stools (pasta, rice, cereal, crackers, toast, pretzels, bananas, white potatoes)
Avoid spicy and fatty foods for 2-4 days

CALL BACK IF:

Bloody stools
Severe abdominal pain
Fever is present for longer than 3 days
Any signs of dehydration, which include: lethargy, no urination for 12 hours, no tears, dry mouth, sunken eyes, and dry lips and tongue
The diarrhea does not slow down after 5 to 7

DIARRHEA

FEVER

FEVER is a symptom, not a disease. Fever is the body's normal response to infections and plays a role in fighting them. Most fevers that children get are not harmful. Many are caused by viral illnesses, some are caused by bacterial infections. Some fevers can be caused by an autoimmune diseases as well.

HELPFUL HINTS (REGARDLESS OF CAUSE):

Encourage your child to drink plenty of fluids

Dressing your child in thin, light layers is best, avoid cooling or sweating

"Sponging and cooling of the skin are NOT indicated and may cause seizures"

Alcohol rubs are NOT indicated and may be harmful

Tell us how the temperature was taken. Rectal is the most accurate for infants. Under the arm is okay if done correctly. Oral for older children is appropriate. Ear temps may be inaccurate if not placed in the ear properly, if eardrum is blocked by wax, if there is a tube in the eardrum or the eardrum is inflamed. Pacifier and forehead strips often not accurate.

MEDICATIONS (FOR DISCOMFORT DUE DUE TO A FEVER AND/OR ACHES)

Do not give more than 3 days in a row without calling our office.

ACETAMINOPHEN (Tylenol) is easier on the stomach, shorter lasting, and can be given every 4-6 hours. Maximum of 5 doses within a 24-hour period. Don't use under 2 months of age unless directed by provider. Also available as a suppository

IBUPROFEN (Motrin & Advil) is longer lasting but should not be given if child is less than 6 months old, or is not eating well, or if has any nausea or vomiting. Ibuprofen can be given every 6-8 hours

Occasionally Acetaminophen and Ibuprofen can be alternated; this can be done after discussing with a provider.

CALL BACK IF:

The fever lasts longer than 3 days

The fever is remaining over 102.5 for 4 hours or longer, or over 101.5 for 6 hours or longer, whether medication is given or not

The child has a specific complaint such as ear pain, sore throat, swollen or tender joint, pinpoint purple rash, bloody stools, painful urination or severe back and/or neck pain

CALL IMMEDIATELY IF:

A baby less than 8 weeks old has a rectal temperature == 100.3 or greater (99.8 if not taken rectally)

FEBRILE SEIZURES OCCUR IN 3% OF CHILDREN BETWEEN THE AGES OF 6 MONTHS TO 5 YEARS OLD (MOST OFTEN 1 TO 3 YEARS OLD). THESE ARE NOT HARMFUL TO THE CHILD AND NOT NECESSARILY RELATED TO THE HEIGHT OF THE FEVER. THE ABOVE ADVICE REGARDING "COOLING" MAY HELP TO PREVENT THESE SEIZURES.

FEVER

LACTOSE INTOLERANCE

LACTOSE INTOLERANCE is the inability of the small intestine to digest the milk sugar, lactose, due to the lack of the enzyme, lactase. This is NOT a milk allergy; rather it is a digestive intolerance. This is a very common problem. If lactose proceeds undigested through the gastrointestinal tract it leads to abdominal bloating, gas, abdominal pain, and/or diarrhea.

Primary Intolerance: The permanent, inherited inability of the small intestine to produce some or any lactase enzyme.

Secondary Intolerance: The short-term inability to produce lactase. This is common during and after viral intestinal infections and can last days to months. Eventually, the small intestine recovers the ability to produce lactase.

WHAT TO DO:

AVOID consuming foods which contain lactose – milk, cheese, ice cream. (yogurt is NOT a problem because the active bacterial cultures digest the lactose)

Take lactase enzyme supplements before or during consumption of these products. Lactase is available in drops and tablets from your pharmac ywithout a prescription. The amount of lactase needed is variable from one person to the next and needs to be adjusted as needed. It is safe at any age.

Lactose-free and lactose-reduced dairy products are readily available at grocery stores.

Brand names = Lactaid, DairyEase
Soy based products (milk, cheese, frozen creams) are also RECOMMENDED.

LACTOSE INTOLERANCE

MUSCULOSKELETAL INJURIES

SPRAIN: The stretching of a ligament with the possibility of some degree of tissue tearing.

STRAIN: The stretching of a muscle or tendon with the possibility of some degree of tissue tearing.

CONTUSION: Due to tissue compression which causes damage to blood vessels within the tissue and the formation of a hematoma (bruise).

X-ray for significant injury or if not improving days 4-5 after injury

Physical Therapy if significant swelling or need to return to competitive athletics

A = Analgesia

Pain relief
Acetaminophen or Ibuprofen

A = Anti-inflammatory

Ibuprofen (Advil, Motrin, store brand)
Dosed every 6 to 8 hours and must be given with food or milk to avoid upset stomach

P = Protection/support

Extra padding
Ace bandage
Splints or braces for certain injuries
Neoprene or spandex joint support for all activity for several weeks!!

R = Rest!

Avoid sports and activities that will aggravate or re-injure the body
Do not resume activities until pain-free when walking

I = Ice

Apply to the injury as often as needed, especially during the first 24-48 hours; and continue 3-4 times daily until swelling is gone; then switch to heat. Be sure to have towel/cloth between heat/ice and skin.

C = Compression

Wrap with ace bandage or other elastic braces

E = Elevation

Keep injured area elevated on pillow when sitting or laying down whenever possible until swelling is gone (24-72hours)

CALL BACK IF:

Any numbness, tingling, or weakness of extremities
For ankles: Extreme tenderness to ankle bone
Child not able to bear weight or still with significant limping after 2 to 3 days
Significant swelling, tenderness, and pain with movement after 2 to 3 days
Not showing some improvement daily

MUSCULOSKELETAL INJURIES

NASAL CONGESTION

TREATMENTS FOR NASAL CONGESTION

1. Increase fluids

May give frequent breast feeds or dilute prepared formula with pedialyte for 1 to 2 days
May offer Pedialyte for feeds or between feeds

2. Cool, moist air

Crack window
Cool mist humidifier or warm steam vaporizer (clean daily/use fresh water daily)

3. Avoid irritants and allergens

Avoid smoke from cigarettes or fireplaces/wood burning stoves
Avoid animal hair and dust (furniture, clothing, rugs, mattress, pillow)

4. Elevate Head of Bed

Approximately 30 degrees
Do not prop on pillows; elevate by object under mattress

5. Nasal Saline drops or spray

Use as often as needed (at least am, afternoon, pm and before each feed in baby)
Store bought brands: Nasal, Ayr, Ocean, Salinex
Homemade: 1/2 cup boiling water + 1/4 tsp salt; let cool

6. Antibiotics : Per MD/NP

7. Decongestants: Per MD/NP (not recommended for child <2 yrs) (provider directed for <6 years)

CALL OUR OFFICE IF:

Fever > 100.3 in infants <8 wks old
Worse on the 5th day or no better on the 10th day
Increased irritability
Increasing frequency of cough
Inconsolable > 30 minutes
Poor Feeding

ADMINISTRATION OF NASAL SALINE DROPS TO A CHILD

For infants: hold baby supporting the neck and head, with head tilted back slightly; In older children, have the child lie down on his/her back. A pillow placed under the neck may provide additional support
Drop 2 or 3 drops in each nostril and have child remain for 30-60 seconds before rising. Excess nasal secretions should be removed by having the child blow the nose or use a bulb syringe to gentley aspirate.
To remove excess nasal secretions in infants: gently wipe the nose with a disposable tissue and use

NASAL CONGESTION

NASAL SPRAYS

OVER-COUNTER NASAL SPRAYS

Nasal Saline (Ayr, Ocean, Salinex, store brand)

Non-medicated
Lubricant/moisturizer
Helps to thin, loosen, and moisturize nasal secretions so they may be evacuated easier
Flushes and irrigates nasal passages
May use as often as needed
Recommended use for congestion: at least 3x/day before food and sleep Nasal decongestants (Afrin, Neosynephrine, store brand)

CALL THE OFFICE BEFORE USING ANY OF THESE PRODUCTS!

Important to dose as directed, after consulting with the office staff
DO NOT use under 6 years of age
These products may cause “rebound congestion” which means dilated blood vessels
Used to relieve SEVERE congestion associated with upper respiratory infections or allergies

PRESCRIPTION NASAL SPRAYS

Nasal Steroids (many available)

Used to control seasonal allergy symptoms = Allergic rhinitis Also used for inflamed nasal passages= Non allergic rhinitis
To achieve maximum effect, need to use several days in a row, as instructed by MD/NP
Prolonged use may result in mild bleeding from the nose
Antihistamine Nasal Sprays
Non-steroidal
Used to control symptoms of allergic and non-allergic rhinitis
Relieves runny nose, congestion, and possibly itchy/watery eyes

NASAL SPRAYS

OVER -THE-COUNTER MEDICATION

Viral respiratory illnesses are self-limiting and the best treatment is time and supportive care. Therefore, it is not essential to use most over-the-counter products. These products are used for comfort Purposes and they do not treat the underlying infection or shorten the duration of the illness (with the exception of antihistamines for hives or allergies). Some of the liquid preparations may contain small amounts of alcohol. There are many products sold over the counter that have combinations of various medications below. Effect of these medications is not established and packaging can be confusing or misleading as to the purpose of the medication(s). We suggest you review any combination medicine with our providers, in addition to guidelines below.

Acetaminophen (examples: Tylenol or store brand):

Not recommended less than 2 months of age unless directed by MD/PNP
Fever reducer/Pain reliever (for comfort)
Gentle on belly, try first before Ibuprofen
Dosed every 4 to 6 hours: reassess after 2-3 days
No significant side effects unless overdosed
Available as a suppository

Ibuprofen (examples: Advil or Motrin or store brand):

Not recommended less than 6 months of age unless directed by MD/PNP
Fever reducer/Pain reliever/Inflammation reducer (for comfort) Dosed every 6 to 8 hours: reassess after 2-3 days
Side effects: Stomach upset or gastritis (not recommend if vomiting/belly pain)
Antihistamines (examples: Benadryl, Claritin or store brand):
Not recommended for children < 2 years old (unless directed by MD/NP)
Label ingredient: brompheniramine, diphenhydramine, chlorpheniramine, Loratadine
Allergy reliever primarily (runny nose, itchy/watery eyes); not as effective for viral illnesses
Anti-itch medication or to treat hives
Dosed per active ingredient every 6 to 24 hours
Side effects: drowsiness, but occasionally can cause hyperactivity or irritability. Side effects are less so with Loratadine (Claritin)

Decongestants (examples: Sudafed or store brand):

Not recommended less than 6 years of age unless directed by MD/PNP
Label ingredient: pseudoephedrine, phenylephrine, phenylpropanolanine
Congestion/stuffy nose reliever by shrinking blood vessels in nose/nasopharynx
May relieve headaches and sinus pressure associated with congestion
Side effects: fast heart rate, hyperactivity, insomnia, occasional abuse by teens

Cough Suppressants (examples: Robitussin DM; Delsym = long acting cough suppressant or store brand with “DM”suffix):

Not recommended less than 6 years of age unless directed by MD/PNP
Label ingredient: dextromethorphan
May help quiet/reduce cough frequency
Dosed per brand every 6 to 12 hours
No significant side effects, unless on psychiatric meds, occasional abuse by teens

Expectorants (examples: Robitussin, Mucinex, or store brand with NO additional suffix or letters):

Not recommended less than 2-6 years of age unless directed by MD/PNP/PA
Label ingredient: guaifenesin, helps break up mucous so it may be coughed up or blown out
Dosed per brand every 6 to 12 hours

OVER -THE-COUNTER MEDICATION

UPPER RESPIRATORY INFECTIONS

A Cold or an Upper Respiratory Infection is a VIRAL infection of the nose and throat. The cold viruses are spread from one person to another by hand contact, coughing and/or sneezing. The fever part of a cold usually lasts 3 days and all nose and throat symptoms including cough should be gone by 10-14 days. (Barton D. Schmitt, MD, 1999)

HELPFUL HINTS:

Over-the-counter cold medications might relieve some symptoms, but they DO NOT
shorten the length of the cold or fight the infection. Using these products in children
under 6 years old is not routinely recommended, therefore should be directed by provider.
Cool moist air (humidifier or fresh air), head elevation and frequent fluids to drink are very helpful.
Yellow to green nasal drainage CAN BE COMMON during the second half of a cold, usually improving between 5 and 10 days after illness begins.
A bacterial SINUS INFECTION might be considered if symptoms worsen on or after the 5th day or if the child is not improving by the 10th day.
For sore throats: cold drinks, popsicles, ice chips, and pain medications (Acetaminophen & Ibuprofen) can be helpful
For babies and toddlers: nasal saline drops/ gel, followed by a nasal aspirator or a drink, may help relieve congestion /discomfort.

Antibiotics do NOT treat the common cold.Some health care providers, in an effort to please patients, use antibiotics prematurely. This is often unnecessary and contributes to the overuse of antibiotics and can cause antibiotic resistance in future illnesses.

CALL BACK ANYTIME If:

The child complains of ear pain, shortness of breath or frequent repetitive cough.
For babies and toddlers: waking up at night, with crying , difficulty returning to sleep and/or not feeding well
The child has had a fever into the 4th day
Symptoms are not improving by the 10th day or are worsening on or after the 5th day

UPPER RESPIRATORY INFECTIONS

VOMITING

VOMITING is the forceful ejection of a large portion of the stomach’s contents through the mouth. Most vomiting is caused by a viral infection (viral gastritis) or eating something that disagrees with your child. The vomiting usually stops in 6 to 24 hours (Barton D. Schmitt, MD 1999)

SUGGESTIONS FOR VOMITING

Begin with NOTHING by mouth for 20 TO 30 minutes after the vomiting episode.
Begin with only SIPS of clear (see through) liquids, for example, electrolyte solution like Pedialyte or Gatorade, white grape juice, chicken broth, decaf tea.
If tolerated,then increase to 2 oz at a time (wait 20-30 minutes before taking more).
Advance the diet slowly if the child is tolerating the fluids. Try starchy foods (pasta, rice, cereal without milk, crackers, toast, baked white potato etc.), then try banana, yogurt and applesauce. Begin with frequent, small amounts.
If the child vomits again, START OVER.
Dairy products, other than yogurt, and fatty or fried foods should be last to add back to diet.

CALL BACK IF:

Any vomiting associated with head trauma or poison/medication ingestion
Severe abdominal pain, especially between vomiting
Fever is present for longer than 3 days
Any signs of dehydration which include: lethargy, no urination for 12 hours, no tears, dry mouth, dry lips, dry tongue, and sunken eyes
Blood in vomit or bowel movement
Increase frequency of vomiting or with diarrhea

WARTS

A WART is a raised, round, rough-surfaced growth on the skin. Thye are most commonly found on the hands and feet. Warts are usually painless unless they are located on the bottom of the foot (plantar warts). Brown dots are often seen within the wart (unlike a callous) and it will have a clear boundary with the normal skin.

(Barton Schmitt, MD, 1999)

Warts are caused by papillomaviruses
The word “plantar” refers to the bottom of the foot.
Left untreated, most warts will resolve within 2 years, but can spread within this time.
With proper treatment, warts usually resolve in 2 months, but may spread by rubbing during this time.

HOME TREATMENT

Topical wart medication: Salicylic acid (e.g. Compound W, DuoFilm, multiple store brands)
Home treatment will not be successful unless it is done on a daily basis, first thing in the AM or at bedtime or both
SOAK the wart in warm water for 3 to 5 minutes. This will soften the skin.
SCRAPE the wart with an emery board to remove old, dead skin and expose the root of the wart. If done without pressure, this should not be painful.
Use a circular corn pad exposing the wart in the center. This will enable the medication to stay centered on the wart not the surrounding skin.
APPLY an over-the-counter WART MEDICATION (liquid) on the wart and cover with a loose band-aid.
Repeat cycle (steps 1-4) every 12-24 hours until gone (often 4-6 weeks).

Encourage the child to avoid picking at the wart, as this may cause it to spread.
For plantar warts: child may participate in swimming with swim shoes.
If there are only a few warts and painful then we may be able to remove (scrape) them in our office, followed by above treatment for about one week.
The DUCT TAPE method has been shown to be effective; replace steps 3&4 with application of duct tape overnight and pull off aggressively in the morning.

The role of the Dermatologist or Podiatrist is reserved for those patients who have failed home treatment for 2 months or pain that is not subsiding with home treatment or office treatment. Cryotherapy (freeezing off the wart) or oral medications are used by these specialists to remove warts. These are not one-time treatments. Cryotherapy reqires mulitple visits to a specialist. There are new home versions of this therapy that can be discussed.

WARTS

For more information, or to schedule an appointment, call us at 716-893-7337.