Parent Handbook

If your child suffers from recurrent ear infections or sinus infections, or if he seems to keep a cold all the time, he may be showing symptoms of allergies.  The following may help:

1. Avoid cigarette smoke.  Children of smokers have more colds and ear infections and more hospitalizations for asthma and pneumonia than do children of non-smokers.  Do not smoke around your child.  Smoking should be outside: even if you smoke in another room, that smoke gradually spreads throughout the house and is contained in your clothing.
2. Avoid exposure to other sick children when possible.  If arrangements can be made to have your child around only a few small children, your child will be exposed to fewer contagious illnesses.
3. Avoid house dust.  For the child with a confirmed or strongly suspected allergy to dust,  the child should not sleep with stuffed animals which cannot be washed.  Pillows should be featherless, washable, and enclosed in zippered, hypoallergenic covers.  The child’s bedroom should be dusted and vacuumed several times a week.  Curtains should be washed regularly and carpet should be removed if possible.  
4. If a child has a suspected allergy, dogs and cats should be kept out of the house and should never be allowed in the child’s room.
5. If you suspect food allergies, contact your physician to discuss possible evaluation.

Children with attention deficit hyperactivity disorder have problems with inattention, hyperactivity, and impulsivity.  Kids with ADHD may find it very difficult to sit still, concentrate on their schoolwork, focus their attention for long periods of time, and finish their work.  Because of these factors, they generally begin to have problems at school.  In addition to inattention and hyperactivity, kids with ADHD may have problems controlling their impulses. In their dealing with other people, some children with ADHD tend not to be sensitive to the feelings, desires, and reactions of others.  If left untreated, the disorder can have major complications of school failure, a sense of worthlessness and failure, and family chaos.

If you suspect your child may have attention deficit hyperactivity, you should schedule an appointment with your PCP to discuss these concerns.    It is very important for you to tell the receptionist that the appointment is for an ADHD evaluation for appropriate scheduling.  ADHD appointments are usually scheduled well in advance.

For children on ADHD medications, yearly physicals are required with weight checks scheduled every 3 months.  Renewals for ADHD prescriptions require a 72-hour notice to allow sufficient time to prepare the prescriptions and obtain your physician’s signature.  The prescriptions will be ready for pick-up at your child’s weight check appointment.  

Antibiotics are used for only certain kinds of bacterial infections and are not used to treat viruses.  Because of the potential dangers of the illnesses that require antibiotics and because of the potential side effects and overuse of antibiotics in general, we do not usually prescribe these medications over the phone. 

If you feel your child may need an antibiotic, an appointment should be scheduled.  

Colic is a poorly understood condition of young infants associated with crying spells usually in the evening.  Typically, an infant with colic has periods of extreme fussiness characterized by crying, sucking on fist, wanting to eat often, passing gas, flailing the arms and legs, turning red in the face, and pulling knees to the abdomen as if in severe pain.  The following approaches may be helpful:

1. Check your baby carefully to make sure there is no other reason for crying.  This should be done with the baby completely undressed.  If there is nothing obviously wrong, make sure your baby is well fed, adequately burped, and appropriately dressed, including a clean, dry diaper.
2. Swaddle the baby snugly in a blanket, holding the baby close to you with his head near your voice box as you hum quietly.
3. Rock baby gently or use an automatic swing.  Some babies are comforted by a ride in the car.
4. Burp the infant after every one to two ounces of formula and several times during breastfeeding.  Mylicon drops (simethicone) (0.3 ml every 2 hours) may help decrease gas and is available without prescription.
5. If your baby is bottle-fed, try changing the type of bottle and/or nipple.  We recommend that you call the office before changing formulas.

If the above measures are not helpful and your baby continues to scream, it is possible that your child has another problem besides colic.  Unusual screaming which is inconsolable and persists for more than two hours should probably be evaluated or prompt a call to our office.

If the above measures fail,  your child should be evaluated in the office.

The majority of coughs seen in children are productive coughs caused by mucus draining into the throat from the sinuses.  These coughs are not a sign that the cold has “moved into the chest” but simply the body’s way of clearing mucus that is blocking the airway.  A child needs to cough to clear his throat. 

Over-the-counter (OTC) cough and cold medications can be harmful to young children.   From ages 4-6 years, cough medicine should be used only if recommended by your child’s healthcare provider.  After age of 6 years, cough medications are safe to use, but follow the instructions on the package about the right dose of medication to give.

Non-medicinal cough treatments can be effective, for example:  

• For children over 1 years of age, use 2-5 mls of honey or corn syrup
• For children over 2 years of age, rub a layer of mentholated rub (Vick’s) on the chest and throat.

Another cause of cough is wheezing which may produce a frequent, harsh, nonproductive cough.  This condition should be examined by a doctor.  If the child is not in distress and an Albuterol inhaler has been prescribed before, Albuterol may be given until the child is seen by appointment.

***** ALWAYS PUT MEDICATIONS AWAY, OUT OF REACH OF CHILDREN. *****

Croup is a viral infection of the upper part of the airway near the voice box.  It is common in younger children and is associated with low grade fever, hoarseness, a loud barking-type cough, and occasionally breathing difficulty.  Though it is usually not serious, croup frequently occurs in the night time and can be alarming.  During these attacks, you will notice the child having difficulty drawing his breath in and some breathing movements will be noted above the collar bone and over the stomach.  

Treatment for croup is as follows:

1. Encourage fluids
2. Use a cool mist humidifier in the room where the child sleeps
3. Treat fever with acetaminophen if needed (Click Here for dosing information)
4. During an attack of breathing difficulty, go to the bathroom with the child and put the shower on hot to produce a steamy mist.  15 to 20 minutes in this environment will often relieve the attack.  If this doesn’t work, wrap the child up and take him out into the cool night air for a few minutes.  If these measures fail and you believe your child is in distress with rapid and labored breathing, the child will need to be seen in the office or in the emergency room.

Earaches can be caused by several things including increased pressure, bacterial infection, and viral illness and teething.  A sudden earache following a cough, sneeze, crying, or yelling is probably caused by pressure and will likely resolve spontaneously after a short time.  Earaches may occur when a child has a cold: the Eustachian tube connecting the throat and the middle ear is blocked, causing increased pressure and pain, but there is not necessarily middle ear infection.  Finally, earaches may be caused by bacterial infection which will likely require antibiotic therapy. 

Most earaches, especially when associated with fever, should be evaluated in the office during regular hours.  To provide relief at home prior to the office visit, the following things can be tried:

1. Acetaminophen of Ibuprofen for pain (Click the links for dosing information)
2. Resting the head on a hot water bottle.
3. If there is not drainage and the child does not have ear tubes and you have some numbing drops on hand, these may be warmed and placed in the ear to relieve pain.
4. Earache pain is usually worse at night and the child should be brought in the following day even if he seems better.  Earaches are not generally treated over the phone as an accurate diagnosis is important.

 Most insect bites are not serious unless the child is severely allergic. Treatment includes:

1. Removing the stinger if present with horizontal scraping motion.
2. Placing cool, wet compresses on the area.
3. Benadryl elixir (Click Here for dosing guide) for severe itching.
4. Apply 0.5% or 1 % hydrocortisone cream for itching.
5. Acetaminophen for pain (Click Here for dosing guide).
6. Go to the nearest emergency room if your child develops difficulty breathing, a sensation of fullness of tongue or throat, passes out, or becomes very pale.

Any symptoms suspicious for urinary tract infection including painful urination, urinary frequency, and urgency should be evaluated in the office.  A urine sample will be collected during the visit to check for infection.  If your child needs to urinate prior to being called back to see the doctor, please notify a member of our staff.

Nose bleeds can be caused by dryness of the lining of the nose or by picking the nose.  Allergies or upper respiratory infections may aggravate the problem.  Having the child sleep with a cool mist humidifier can decrease the dryness of the air, which may help.  Polysporin ointment or Vaseline applied into the nose with a Q-tip may also be of benefit.

To stop active bleeding, have the child sit up, tilt his head forward, and pinch the entire nose together for at least 5 to 10 minutes or use an ice pack.  After the bleeding stops, do not remove the clot from the nostril.  Chronic nose bleeds should be evaluated by appointment during regular office hours.

If your child swallows a potentially dangerous substance, call Poison Control immediately.  

Poison Control #:   501-686-6161 or 1-800-376-4766 (1-800-3POISON).

Diaper Rash: Diaper rashes are usually due to either irritation from a wet diaper or to yeast which grows on the skin in moist areas.  The following treatments are recommended:

1. Change wet or soiled diapers frequently
2. Use a washcloth with water only; avoid wipes and soaps that will sting the inflamed skin
3. Apply zinc oxide (Desitin) or other diaper ointment (A&D; Diaper Goop; Vaseline)
4. Allow exposure to air by leaving diaper off; this is most convenient during naps when the child can be laid on a towel

If the rash is red and bumpy and fails to respond to the above measures, try an over-the-counter yeast cream such as Monistat or Gyne-Lotrimin applied to diaper area three or four times per day.  If rash does not respond, call office for an appointment (501-847-2500).

Poison Ivy: If your child has come in contact with poison ivy or another irritant, it is important to wash the involved area thoroughly with soap and water to remove the poison ivy toxin.  Benadryl elixir (Click Here for dosing guide) can be used to control itching.  Calamine lotion and Aveeno baths may also be helpful for itching (trim fingernails to prevent scratching).  ½% to 1% Hydrocortisone cream applied to the area can decrease inflammation.  If the rash is particularly severe, you should call for an appointment during regular business hours.

Viral Rashes: A red rash over the whole body in a child with a low grade fever, who otherwise feels well, is probably due to a virus.  If the rash causes no symptoms, then no treatment is required.  Itching can be treated with Benadryl (Click Here for dosing guide). A rash in an ill-appearing child should be evaluated by the doctor.

Rashes due to drugs: If a rash develops while a child is taking a drug, that medication should be stopped and the doctor notified during office hours.

Roseola:  This is a viral infection of small children.  It begins with a high fever of 2 to 4 days duration.  About the time the fever breaks, a red rash over the whole body appears.  The rash disappears after 1 to 2 days and requires no treatment.

Impetigo: This is a bacterial infection of the skin and is mildly contagious.  Impetigo is characterized by weeping, honey-colored drainage which dries and forms crusts around the lesion.  Mild impetigo can be managed with the following measures:

1. Wash well with soap and water
2. Apply antibiotic ointment (Polysporin) two or three times daily
3. Keep fingernails clean and short to reduce spread of infection
4. Place freshly laundered clothes on the child each day.  Repeated wearing of unwashed clothes will spread infection
5. Benadryl may be used for itching (Click Here for dosing guide)

If your child has more than one area of skin involved or if the infection seems especially bad, call the office for an appointment, occasionally antibiotics by mouth may be indicated.

Hives and allergic rashes: 

Hives is a red, raised rash in various sizes which is usually due to an allergic reaction.  The rash seems to move to different areas of the child’s body and is often associated with itching and sometimes with swelling of the hands and feet.  The rash is usually not dangerous, but can be uncomfortable.  Hives can be caused by anything the child has eaten, breathed, or come in contact with.  Benadryl (Click Here for dosing guide) may help resolve the rash and control the itching.

Foods are the most prevalent trigger for allergic reactions.  Stinging insects and medications can also cause reactions.

Head Lice:

Head lice are an insect infestation of the hair which are identifiable by the oval, yellow/white ‘nits’ (lice eggs) which adhere to the hair close to the scalp, particularly just above the hairline on the back of the neck.  Lice can be treated with over-the-counter Rid or Nix and careful removal of the nits. 

If this treatment is ineffective, apply a liberal coat of Vaseline, mayonnaise, or olive oil to the entire scalp and sleep with a shower cap on to suffocate the lice.  The next morning, thoroughly wash the hair with dishwashing detergent (such as Dawn) to clean the hair and remove all the oil.  Next, remove ALL nits using a nit removal comb (fine-tooth comb).  This may be very time-consuming so be sure to allow enough time to thoroughly go through your child’s hair to remove ALL nits. If you cannot get rid of the problem with the above measures, call the office during regular hours.

Scabies:

Scabies is another skin infestation caused by a tiny mite which causes an extremely uncomfortable rash due to itching.  The rash is common on the trunk, groin, and between the fingers.  Sometimes ‘tracks’ can be identified where the mite has burrowed underneath the skin.  Call the clinic during office hours to schedule an appointment if you believe your child has scabies.

A mild sore throat without fever can be treated with warm liquids, salt water gargles, throat lozenges or hard candy, and/or Chloraseptic spray.  If the sore throat persists over four days, even without fever, the child should have an appointment to be seen. If fever is present with a sore throat, the child should be evaluated in the office for strep throat.   

Stomach ache is very common in children and is somewhat comparable to headaches in adults.  Often it is caused by stress or fatigue and no other cause can be identified.  Another common and often unsuspected cause of abdominal pain in children is constipation.  If your child complains frequently of stomach ache, pay careful attention to the child’s bowel habits for a few days and refer to the section on constipation, page 12.  Rarely, abdominal pain is caused by appendicitis or other serious illness.  If any symptoms below are present, consult the physician:

• Severe and persistent pain
• Persistent vomiting
• Pain localized in the right lower portion of the abdomen
• Persistent fever
• Painful urination
• Bloody stools or black and tarry stools

The first teeth usually erupt around 6 months of age, but may erupt anywhere from 4 to 15 months of age.  It is not clear whether or not teething actually causes illness in children.  Drooling and chewing are also normal around 6 months of age and may be in part due to discomfort in teething. 

In general, it is not recommended that you put salve or lotion (Oragel) or teething tablets on the baby’s gums for teething symptoms as these can potentially be harmful.  Acetaminophen (Click Here for dosing guide) can be given for teething pain.  Chewing on cold objects (teething rings, wet washcloths) may be provided for comfort.  Frozen objects are not recommended.  Certainly, any severe symptoms such as high fever, prolonged vomiting, etc., should never be assumed to be due to teething, but rather treated as you would any illness in your baby.

Other Dental Problems: Young children take many falls and often injure their mouths in the process.  Bleeding after such a fall can be due to a tear of the frenulum, which is a small web of skin between the lip and gum.  Applying pressure to the lip will stop bleeding in a few minutes.  No other treatment is needed.  If teeth are loosened or knocked out, (if found, keep the tooth in milk) consult your dentist. Some teeth can be replaced.

Wheezing is caused by congestion deep in the lungs and is associated with a squeaking or whistling sound when the child breathes out.  Audible nasal congestion is sometimes confused with wheezing.  Wheezing can be caused by an infection or by asthma.  A child with wheezing should be evaluated promptly unless the child has had wheezing treated repeatedly in the past and parents are very comfortable with its management.  If the wheezing is accompanied by breathing difficulty, the child should be taken to the ER.  For severe or life threatening breathing difficulty, call 911.