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Q: What do I do if my newborn baby has a rash or marks on the skin?

A: Many rashes and marks are not harmful, and you can learn more about some common types below. However, you should contact your doctor if your baby:

starts to look or act sick
is less than 8 weeks old with a fever higher than 100.4 rectally
has true blisters (little bumps containing clear fluid)
has true pimples (little bumps containing pus) that are grouped together in a cluster, especially on the scalp
has an area that looks infected, or a rash that is painful to touch
has a rash that worsens over the course of the day
has a rash has a purplish color

In addition to the information below, you can visit the American Academy of Pediatrics to learn more about rashes here.

Baby Acne is a rash caused by the transfer of maternal hormones just prior to birth. It is located on the face and usually consists of small red bumps. The acne develops at 3-5 weeks of age and lasts until 4-6 months of age. No treatment is necessary, and baby oil or ointments make it worse.

Drooling Rash/Heat Rash is a rash located on the chin or cheeks which comes and goes. It is often caused by contact with food and acid that has been spit up from the stomach. Other temporary rashes on the face may be heat rashes. Rinse your child’s face with water after all feedings or spitting up. During hot weather, change the baby’s position more frequently and put a cool washcloth on the area.

Erythema Toxicum is a harmless rash that is located anywhere on the body surface and is composed of red blotches which are a half inch to one inch in size with a small white or yellow pustule in the center. Although this rash looks terrible, more than 50% of babies get this harmless rash on the second or third day of life. It will normally disappear by two weeks of age, and no treatment is necessary. It is necessary to bring the infant into the office to R/O herpes simplex which is a more serious condition.

Forceps or Birth Canal Trauma can occur from the pressure of forceps on the skin and can leave bruises, scrapes, or damaged fat tissue anywhere on the head or face. These bruises and scrapes will be noted on day 1 or day 2 and disappear by 1-2 weeks of age. For any breaks in the skin, apply an over-the-counter antibiotic ointment four times per day until healed. If the area becomes tender to touch, soft in the center, or looks infected, call your doctor.

Milias are harmless, tiny white bumps that are located on the faces (nose and cheeks, forehead and chin) of 40% of newborn babies. Although they look like pimples, they are much smaller and not infected. They are blocked off skin pores and will open up and disappear by 1-2 months of age. No treatment is necessary.

Mongolian Spots are a normal bluish-green or bluish-gray birthmarks that are found primarily on the back and buttocks, although they can be present any where on the body. Most fade away by 2-3 years of age and are harmless and do not have any relationship to disease.

Stork bites are flat pink birthmarks that occur over the bridge of the nose, eyelids, or the back of the neck of 50% of newborns. Those on the eyelids clear up by one year of age, although those on the bridge of the nose may persist for a few additional years. Those on the forehead that run from the bridge of the nose up to the hairline usually persist into adult life.

Q: What do I do if my newborn baby is spitting up?

A: Spitting up is the effortless spitting up or refluxing of one or two mouthfuls of stomach contents. Larger amounts can occur after overfeeding, and usually occur during or shortly after feedings. More than half of all infants have occasional spitting up which may be caused by poor closure of the valve at the upper end of the stomach, which is called reflux. Reflux typically improves with age, normally around 7 months.

You should contact your doctor if your baby:

spit ups blood
spits up bile (usually colored bright yellow or chartreuse green)
looks or acts sick in any way

In addition to the information below, you can visit the American Academy of Pediatrics to learn more about spit up click here and then click on "The Parents Take Home Guide to GERD." Go to the Emergency Room if your child is having difficulty breathing, turns bluish for more than 10 seconds after spitting up, has become limp after choking on milk, or appears sick/weak.

Tips for handling spit up:

Feed smaller amounts per feeding (at least 1 ounce less than you have been). Maintain the total feeding time at less than 20 minutes. For nursing mothers, try nursing on one side per feeding and pumping the other side, then alternate sides for next feeding.
Wait at least two and a half hours between feedings because it takes that long for the stomach to empty itself.
Avoid tight diapers because they add pressure on the stomach. Also, do not put pressure on the abdomen or play vigorously with your child right after meals.
After meals, try to hold your baby in an upright position. Use a front-pack, backpack, or swing for 30-60 minutes. Reduce time in a sitting position (eg. infant seats).
Constant sucking on a pacifier can inflate the stomach with swallowed air. In addition, sucking on a bottle with too small a nipple hole can also contribute to spitting up. If the formula does not drip out at a rate of one drop per second, clean the nipple better or enlarge the hole.
Burping is less important than giving smaller feedings. Burp the baby 2 or 3 times during each feeding. Do not interrupt the feeding rhythm to burp, wait until the baby pauses and looks around. Burp each time for less than a minute.

Q: What do I do if my baby (under 3 months) is crying a lot?

A: Review our written material "Sleeping and Crying" and "Sleeping at About 2 Months." Another good resource for a fussy newborn is Dr. Weissbluth's book "Your Fussy Baby." You cannot spoil your baby so try everything you can to comfort your baby. Try things that once worked in the past but recently have not been very successful. Respond promptly to the fussiness that precedes the full blown crying and try to enlist help because soothing a lot and feeding often (especially breast feeding) is exhausting.

The basic strategies to soothe your baby are:

encourage sucking,
rhythmic rocking motions,
swaddling,
quiet sounds.

Try to encourage your baby to sleep within 1 to 2 hours of being awake to avoid becoming over tired. Call 911 if you think there is a life-threatening emergency. Go to the Emergency Room if you think your child is very sick or weak.

You should contact your doctor if:

your child is less than 1 month old and you suspect that your child might be ill in any way, including a low temperature (less than 96.8 rectally), vomiting, difficulty breathing, swollen scrotum, injury is suspected, or constant crying.
you think your baby has colic and you want advice and/or reassurance that your child is not sick.

Q: What do I do if my newborn baby is bleeding from the umbilical cord?

A: You might see a few drops of blood at the point of cord separation. This is normal and common. The bleeding may recur a few times from the friction of the diaper or normal movement against clothing. Apply direct pressure for ten minutes with sterile gauze to stop any bleeding. Clean the area beforehand, rather than afterwards, to prevent further bleeding. Prevent friction on the umbilical stump by folding the diaper down or cutting a wedge out of it. Most cords fall off between 10 and 14 days of age. Cords can also hang by a strand of tissue for 2 or 3 days. If the cord has small recurrent bleeding for more than 3 days make an appointment to be seen in the office.

You should contact your doctor if:

the spot of lost blood is greater than 2 inches or 5 cm
red streaks run from the navel
the red area spreads beyond navel
your baby has a fever higher than 100.4F rectally.

Go to the Emergency Room immediately if the bleeding does not stop after 10 minutes of direct pressure applied twice or if your child appears sick or weak.

Q: What do I do if my child has a fever?

We consider a fever a thermometer reading of 100.5 F or higher. Children older than 6 months of age usually do not need to be treated for fever unless their temperature is higher than 101 F. ALWAYS CALL IF YOUR CHILD HAS A FEVER AND IS UNDER 2 MONTHS OF AGE.

From “Fever and Your Child,” AAP 2001: A fever is most often a sign that your child is fighting an infection. It is actually a good sign that your child's body and immune system are working well as a fever is a natural response from the body towards bacteria and viruses. Your child may be acting perfectly fine all day and then suddenly out of the blue develop a fever. This most commonly occurs in the late afternoon or evening when our body temperatures are naturally higher. Many illnesses can cause a fever, including ear infections, common colds, urinary tract infections, viral infections, and pneumonia. Sometimes the only symptom of an illness is a fever which then several days later is followed by a rash.

The most accurate way to take a temperature in an infant or young child is with a digital thermometer in the rectum. Ear thermometers can be used over age 1 when the ear canals are big enough and older school age children can have their temperature taken orally. When children have a fever, or elevated body temperature, they often feel uncomfortable, and also their heart and breathing rates are faster. We treat fevers to help children feel more comfortable until the illness that caused the fever is treated or has run its course. Your child may also have other symptoms of the underlying illness such as an ear ache with an ear infection, a sore throat with strep throat, or a runny nose and cough with a cold.

We do NOT recommend using Aspirin in children because of the risks of developing a serious condition called Reye Syndrome. Children may feel better by dressing them in light clothing, encouraging them to drink fluids, making their room a comfortable temperature and also giving them a lukewarm bath to help their temperature come down as the water evaporates from their skin. Do not use cold water or try to bring the temperature down too fast. When the anti-fever medicine wears off it is common for the fever to return while the child still has the illness, also it takes 30 minutes to an hour for the medicines to take affect.

You should contact your doctor if:

If your child is 2 months of age or younger and has a fever of 100.5 F or higher rectally or an underarm temperature of 99.5 F
If your child looks very ill, unusually drowsy, or is very fussy
If your child has been in a very hot place such as an overheated car
If your child has a stiff neck, severe headache, unusual rash, or repeated vomiting and diarrhea and is unable to keep down fluids
If your child has a condition which suppresses their immune system such as cancer, sickle cell disease, or if they have been on steroids for more than one day
If your child has had a seizure
If the fever persists despite using appropriate anti-fever medicines
If your child has a fever for 72 hours with no other symptoms

Most of the time you can give your child an anti-fever medicine such as acetaminophen or ibuprofen to help them feel better. These medicines also have the properties of being anti-pain medicines. Below are guidelines for Fever & Pain Control:

Drops are more concentrated than elixir or suspension

Acetaminophen (e.g. Tylenol; not to exceed 5 doses per 24 hours)

Drops: 80 mg / 0.8 ml = 1 dropperful

Elixir or Suspension: 160 mg / 5 ml = 1 teaspoon

Chewable Tablets: 80 mg or 160 mg / tablet

Suppository: 80, 120, or 320 mg/suppository

12-14 pounds 80 mg every 4-6 hours

15-24 pounds 120 mg every 4-6 hours

25-32 pounds 160 mg every 4-6 hours

33-43 pounds 240 mg every 4-6 hours

44-55 pounds 320 mg every 4-6 hours

Ibuprofen (e.g. Motrin or Advil; Dosage for temperatures greater than 102.5;

Use half of dosage shown for lower temperatures)

Drops: 50 mg / 1.25 ml = 1 dropperful

Suspension: 100 mg / 5 ml = 1 teaspoon

Chewable tablets: 50 or 100 mg / tablet

22 pounds 100 mg every 6 -8 hours

33 pounds 150 mg every 6 -8 hours

44 pounds 200 mg every 6 -8 hours

Q: What do I do if my child has a common cold?

A: REMEMBER, COLD REMEDIES COMFORT YOUR CHILD BUT NOTHING CURES THE COLD. The common cold is a contagious upper respiratory tract infection caused by viruses. In the first 2 years of life, your child may have 8-10 colds a year, especially if your child is in daycare or has older siblings. The duration of a cold is usually 7-14 days. Viruses cause the common cold. These viruses are spread from person to person through oral and nasal secretions. The cold weather does not cause a cold but tends to keep people indoors, leading to more close contact with infected people.

Your child may have a runny nose (clear secretions changing to yellow or green secretions), congested nose, cough, sore throat, fever, fatigue and loss of appetite. Nasal secretions may become thicker and yellow or green as the cold progresses and does not indicate the need for antibiotics. Remember, colds are caused by viruses, not bacteria, and do not respond to antibiotics.

There is no cure for the common cold, however, treatment of symptoms and time are recommended. There are several cough and cold preparations available over the counter but should not be administered to a child under the age of 6 months. Suctioning of nasal secretions with a nasal aspirator and administering saline drops or spray are recommended if your young child /infant is having difficulty nursing or sucking from a bottle. Placing a cool mist humidifier in your child’s room helps thin nasal secretions, keeping him more comfortable. Fever medicines such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin), are recommended if your child has a fever. These medicines will also help to decrease discomfort of a sore throat. Generally, ibuprofen is not recommended a child under 6 months. Fever reducers are not recommended in a child 2 months of age or younger. Finally, encouraging your child to drink and rest will help prevent dehydration and facilitate recovery.

You should contact your doctor if:

Cough lasting more than 10 days
Nasal congestion and drainage lasting more than 2 weeks
Fever of 101 or higher lasting 3 days
Fever of 100.4 rectally or higher in an infant age 2 months or younger
Loss of appetite and refusal to eat
Difficulty breathing or swallowing
Very ill appearing, unusual listlessness
Chest pain

For additional information on the common cold, please click here and click on "The Common Cold" under the age group of your child.

Q: What do I do if my child is coughing?

A: Coughing is the sound made when the cough reflex suddenly expels air from the lungs. Coughs can be caused by a variety of things, the most common of which is a viral infection involving the respiratory system. It is not uncommon for a cough to be worse at night, or for a cough to last longer than 2 weeks. As long as your child is acting and drinking well and not having worrisome symptoms (see below), the cough will likely subside without intervention. Other less common causes for a persistent cough include: pneumonia, sinusitis, asthma, allergies, gastroesophageal reflux, and foreign body ingestion. If you suspect any of these conditions, your child should be evaluated by your doctor.

You should contact your doctor:

if your child is younger than one month with a persistent cough
if your child has coughing spasms (more than 5 minutes of continuous, nonstop coughing)
if the cough is associated with fever >101 for 3 or more days
if any blood has been coughed up
if the cough sounds croupy (sound similar to seal barking)
if the cough lasts longer than 14 days and is interfering with his daily activities
if your child has chest pain

Remedies for home use:

warm fluids to decrease sticky mucus caught near vocal cords
increased humidity
cool mist humidifier
sitting in steamy bathroom for 10-15 minutes especially for croupy coughs
cough drops or hard candy to coat irritated throat for older kids

Bring your child to the nearest ER if there is marked difficulty breathing (ie: grunting noises with each breath, difficulty speaking or crying, bluish discoloration around lips, and retractions (spaces between the ribs are being pulled in with each breath).

For additional information on coughing, please click here and click on coughing.

Q: What do I do if my child has a cough that sounds like the bark of a seal?

A: This tight, low-pitched, barky cough is known as croup. Croup is a viral infection; therefore antibiotics will not help to cure this cough. However, there are several things that you can do to help alleviate your child's cough. If the air is dry, run a humidifier. Dry air can make croup worse. For coughing spasms, you may give your child warm fluids to relax the airway if the child is older than 4 months. If your child develops stridor, a harsh, raspy sound heard with breathing in, then have your child inhale warm mist. Have the hot shower running with the bathroom door closed. Once the room is all fogged up, take your child in there for at least 10 minutes. If this does not help, then have your child inhale cool air by breathing near an open refrigerator for a few minutes or by taking him/her outside for several minutes. Croup usually lasts 5-6 days and becomes worse at night.

Contact our office if the above treatment does not help or if the cough gets worse.

Q: What do I do if my child has rash?

A: Rashes can result from a variety of causes. The most common causes include a contact irritant, an infection, and possibly an allergy. Many times the cause of the rash will remain unknown.

Generalize Rash: If a rash is all over the body, it is more likely to be from an infection or an allergy. A common viral infection can often cause a generalized rash. This rash might be flat or raised, it is usually somewhat red and not very itchy. If the rash is purplish and not reddish, call the office immediately because that can be a sign of a serious infection. If the rash has fluid filled blisters, that might be from chicken pox. Treatment for this rash is symptomatic. You can use oatmeal baths for itching, an antihistamine like benadryl by mouth, also for itching and anti pain medication such as acetaminophen or ibuprofen for pain and/or fever.

Hives: These look like welts or somewhat like big mosquito bites. They can come and go quickly. Hives can be from an allergy to something that was eaten by mouth, or from something that came into contact with the skin, such as a new detergent. Frequently hives appear without a known trigger. They can even result from a viral infection. Treatment is an antihistamine such as benadryl.

Localized Rash: If a rash is more localized, it could be from something coming into contact with the skin. This could be due to dermatitis/eczema or sensitivity to something touching the skin such as wool or nickel. For minor rashes, lubrication alone with Vaseline, Aquaphor or Eucerin Cream (all available over the counter) will often help. If lubrication alone does not help, over the counter hydrocortisone (0.5 or 1 %) will help. It should be used 2-3 times each day, along with the lubrication.

You should contact your doctor if:

there are other worrisome symptoms such as a high fever, vomiting, sore throat, lethargy, irritability
there has been a significant change in appetite/activity level or behavior
the rash is getting worse over the course of the day
the rash has a purplish color

For additional information on rashes, please click here and click on the related topic.

Q: What do I do if my child has a mild headache?

A: Give acetaminophen or ibuprofen for pain relief. Offer food or juice if your child has not recently eaten. Encourage resting or extra sleep. Apply local cold or ice pack to the forehead for 20 minutes. Massage any tight neck muscles.

Call 911 if the headache is severe and your child is difficult to awaken or there are neurological symptoms (confused thinking, blurred or double vision, slurred speech, unsteady walking, weakness, loss of consciousness). Go to the Emergency Room if the headache is severe and your child has vomited 2 or more times or the temperature is over 105 rectally or orally.

Come to the office today if your child has a sore throat, sinus pain, headache not improved with pain medicine or if the headache lasts more than 24 hours.

Make an appointment or come to the office if the headaches recur.

For more information on headaches, please click here and click on Headaches in Children.

Q: What do I do if my child suffered minor head trauma?

A : Usually after minor head trauma (cut, scrape, bruise, or swelling), you can care for your child at home. If there is a scrape or cut in the scalp, wash it off with soap and water. Apply pressure with sterile gauze for 10 minutes to stop bleeding. Apply ice in a wet washcloth or a cold pack for 20 minutes to any swelling. Observe your child closely during the next 2 hours; mild headache, mild dizziness, and nausea are common. Allow your child to sleep but awaken him after 2 hours to check his ability to walk and talk.

Offer only clear fluids if he vomits. If the pain is so bad you are considering pain medicines, then your child needs to be examined. At night, awaken your child at your bedtime and again 4 hours later for 2 nights to check his ability to walk and talk. Sleep in the same room as your child for 2 nights.

You should contact your doctor if your child has:

Blood in the vomit.
If the pain becomes severe or if neurological symptoms develop during the next 3 days
If your child's symptoms are getting worse.

Call 911 for severe head trauma that causes confused thinking and talking, loss of consciousness, amnesia or altered mental state following trauma, difficult to awaken, slurred speech, weakness of arms, unsteady walking, or any acute neurological symptom.

Go to the Emergency Room if your child has bleeding that cannot be stopped after 10 minutes of pressure.

For additional information on minor head trauma, please click here under the First Aid section and click on "Minor Head Injuries in Children".

Q: What do I do if my child has a sore throat?

A: The term sore throat refers to pain or extreme discomfort in the throat. The tonsils and surrounding area will appear red and inflamed. A sore throat is generally caused by a virus, but sometimes can be caused by bacteria, including the bacterium which causes strep throat. Your child may have a sore throat if he has a cold or allergies.

Your child will have pain, extreme discomfort and/or feeling of fullness in his throat. The tonsils and the area surrounding the tonsils, including the roof of the mouth may be red and inflamed. There may be white spots on the tonsils and the glands in the neck may feel swollen. Your child may have a fever and feel sick. With strep throat (generally age 3 years and older), your child may have a headache, abdominal pain, nausea, vomiting, fever and/or rash.

One particular virus may cause blisters in the throat. This virus is called Coxsackie virus and is seen mainly during the spring and summer months. These blisters may also be seen on the hands and feet (called hand, foot and mouth).

Treatment of a sore throat is usually symptomatic treatment, unless your child has strep throat. Cool fluids and pain relievers such as acetaminophen (Tylenol) and ibuprofen (Advil/ Motrin) are helpful in relieving pain and reducing fever. Antiotics can be used to treat strep throat. If you are suspicious of strep throat, your child will need to be seen in the office and have a strep test performed. Antibiotics will not be prescribed over the telephone for suspected strep throat.

You should contact your doctor if your child has:

Sore throat lasting longer than three days
Severe sore throat
Fever, headache and/or vomiting accompanying sore throat
Known exposure to strep throat

For additional information on a sore throat, please click here and click on "sore throat".

Q: What do I do if my child has an ear ache?

A: The anatomy and shape of the inside of a child's ear (middle ear) is different of that of an adult, thus lending to more ear aches and ear infections in children, especially between the ages of 6 months and 2 years.

Middle ear infections (otitis media) and external ear infections (otitis externa or swimmer's ear) are the two major causes of earaches in children. Otitis media is often preceded by colds. Mucous from colds may congest and block the eustachian tubes in the middle ear, which can provide a breeding ground for viruses and /or bacteria to grow, causing infection. Children who are at highest risk for otitis media are those between 6 months and 2 years of age. Risk factors include daycare attendance, exposure to second hand smoke, formula fed infants, bottles in bed, bottle use after 18 months of age and family history of otitis media.

Otitis externa or swimmer's ear is and infection of the ear canal. Sometimes water from bathing but more commonly from swimming can get in the ear where bacteria can grow and irritate the lining of the ear canal. Many times it is difficult to know if your child has an earache. Until your child is at a developmental stage where he can verbalize his ear pain, he may exhibit symptoms that could indicate a possible earache. Tugging of the ears alone in an otherwise health child is usually NOT a symptom of an earache. Increased waking during naps and nighttime, increased fussiness, decreased appetite, child wincing or crying when his ear is touched, drainage from ear and/or fever are common symptoms of an earache. Vomiting and dizziness are less common symptoms. An older child may tell you his ear feels full, clogged or “popping.” He may also tell you his ear hurts. Infants may have trouble nursing or sucking from a bottle but continue to eat solids without difficulty.

Treating an earache depends on the cause of the earache. You may treat the symptoms of an earache with pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil/Motrin). Middle ear infections (otitis media) historically have been treated with antibiotics given orally. Approximately two thirds of middle ear infections are caused by bacteria and one third are caused by viruses. Your health care provider will need to examine your child's ear to determine the need for antibiotics. External ear infections (otitis externa) are usually treated with antibacterial eardrops. These drops may also contain an anti-inflammatory medication to reduce swelling of the ear canal. Your health care provider cannot determine an ear infection over the phone, so your child will need to come to the office to have his ear examined.

You should contact your doctor if your child has:

Mild ear pain lasting longer than 24 hours
Severe ear pain not responding to pain medicine
Fever lasting 3 days
Ear drainage
Redness of the outer ear

For additional information on an ear ache, please click here.

Q: What do I do if my child is vomiting?

A: Vomiting is the forceful throwing up of stomach contents through the mouth. Vomiting is different from spitting up, which is usually more of a trickle of stomach contents, often accompanying a burp. Spitting up is very common in newborns and infants, who may spit up with most feedings. Babies who spit up usually do not appear uncomfortable. Spit up may look like milk or like curdled milk, and may occur just after a feeding or hours after a feeding, but should not be bright yellow or green, and should not be consistently forceful (also known as “projectile”), although most healthy babies will occasionally have an episode of projectile vomiting.

Vomiting occurs when the abdominal muscles and diaphragm contract while the stomach is relaxed. Vomiting is a reflex that is triggered by a “vomiting center” in the brain. Nerves from the stomach and intestine activate this center when they are either blocked or irritated by infection. After the first few months of life, the most common cause of vomiting by far is a viral infection of the gastrointestinal system. Bacteria can also cause vomiting, although it is difficult to tell the difference from vomiting caused by bacteria and vomiting caused by viruses, and the treatment is generally the same. Antibiotics are very rarely used to treat either vomiting or diarrhea. The same infections that cause vomiting often also cause diarrhea, fever, nausea, and abdominal pain. Other infections can cause vomiting as well, including urinary tract infections, pneumonia, and meningitis. These other infections are often accompanied by other symptoms. Children with urinary tract infections may complain of burning with urination, those with pneumonia usually have a cough and trouble breathing, and children with meningitis usually appear quite ill and often have neck stiffness, headache, and are bothered by light.

Q: I think my child has the stomach flu. What can I do to help her?

A: Most vomiting resolves naturally within twelve to twenty-four hours, although your child may occasionally vomit for several days after developing a stomach virus. Diarrhea often follows vomiting by a day or so. We do not recommend that you give your child any medication to stop vomiting. At the beginning of a stomach virus, it is best to let your child rest, and not to force fluids intake. Once the vomiting begins to resolve, you should begin to give fluids in small amounts, avoiding solid foods at first.

Q: Which liquids can I give my child once his vomiting slows down?

A: For most babies with vomiting, you can use either breast milk or formula when re-introducing liquids into the diet. You may also give your child or baby Pedialyte or Infalyte, especially if they are showing signs of dehydration (see below). Pedialyte and Infalyte are oral rehydration solutions containing special mixtures of water, sugar, and electrolytes to replenish what your child loses when he vomits. They are available at most grocery stores. They come in several different flavors, and also as Popsicles for older children. Oral rehydration solutions and water are of more benefit than juice, tea, flat soda or ginger ale, or other drinks.

When re-introducing liquids, start with small amounts (an ounce at a time), and wait several minutes before giving another ounce. Although your child may want to drink a whole bottle or cup at once, this may lead to more vomiting. As it becomes clear that your child is able to hold down some fluid, you may gradually increase the amount of liquid that you are giving.

Q: I am worried that my child is becoming dehydrated. How can I tell?

A: Most cases of vomiting do not result in dehydration. However, if your child has a particularly severe stomach virus, she may become dehydrated. Signs of dehydration include decrease in urine output (having less wet diapers), lack of tears when crying, sunken appearing eyes, a sunken-in soft spot in babies (a late sign of dehydration), dry mouth and lips, and complete lack of activity. Babies less than six months old should have a wet diaper at least every six to eight hours. Infants and children over six months should urinate at least once every eight to twelve hours.

You should contact your doctor if your child has:

Blood in the vomit
Severe abdominal pain
Swelling of the abdomen
Lethargy or severe irritability
Signs of dehydration
Vomiting that is not improving after twenty-four hours
Bile in the vomit (bile is a green-colored liquid)
Signs of urinary tract infection (burning with urination, frequent urination)
Signs of meningitis (stiff neck, severe headache, very ill-appearing)

For additional information on vomiting:

Click here and click on "vomiting".

Q: What do I do if my child has diarrhea?

A: Diarrhea is the passage of frequent, watery stools. The quality of stool in babies and children varies greatly, and can differ from one day to the next. Newborns can get diarrhea, but it is not very common. Newborns (especially those who are breastfed) often have frequent loose stools, which may be anywhere from pale yellow to dark green in color. They may have several stools with each feeding. This is normal, and is not diarrhea. If your baby is feeding well and making at least four wet diapers per day, he most likely does not have diarrhea. As is the case with vomiting, viruses usually cause diarrhea. The same viruses that cause diarrhea also often cause vomiting, fever, nausea, and mild abdominal pain. Vomiting and fever often develop before the onset of diarrhea. Bacteria may also cause diarrhea, although most cases of bacterial diarrhea are NOT treated with antibiotics.

Certain parasites can also cause bacteria. These are sometimes treated with medicine, but your child's stool needs to be tested before treatment starts. Other diseases that affect the body may also cause diarrhea, but this is usually not the case if vomiting, diarrhea, and fever are the only symptoms.

Q: Does my child need to have her stool tested to see why she has diarrhea?

A: Usually, a stool test is not necessary. We will often request a stool sample if your child has had diarrhea for longer than one week, if there is blood in the diarrhea, or if you have recently traveled out of the country or gone camping.

Q: What can I do to treat diarrhea?

A: Unlike adults, medicines such as Imodium and Pepto-Bismol should not be used in children. These medicines can be dangerous for babies and children. Watch for signs of diarrhea (discussed above), and if those signs should occur, you should rehydrate your child as discussed previously. If your child has diarrhea but does not appear to be dehydrated, we recommend a bland diet until the diarrhea is improving.

Q: What is a bland diet?

A: For babies with diarrhea, breastfeeding should continue. Breast milk is very good for the infant gastrointestinal system. Formula-fed babies may continue on formula, but if the diarrhea is severe or persistent, it may help to switch to a soymilk based formula such as Isomil or Prosobee until the diarrhea is resolving. Regular formula may then be gradually re-introduced into the diet. When infants have significant diarrhea, solids foods should be limited initially, and then gradually re-introduced. Bananas and apples are good foods to re-introduce first, as babies with diarrhea easily tolerate them. Older children may continue to drink milk and water when they have diarrhea. Juice and sodas should be avoided. A bland diet for older children includes bananas, applesauce, toast, rice, crackers, and bread. Other foods may be given as tolerated.

Q: I'm worried that my child is dehydrated - how can I tell?

You should contact your doctor if your child has:

Signs of dehydration
Bloody diarrhea
No improvement in the diarrhea after a week
Severe abdominal pain
Recent camping or travel outside the United States
Lethargy or severe irritability

For additional information on diarrhea, please click here and click on "diarrhea".

Q: What do I do if my child has abdominal pain?

A: Abdominal pain is a frequent complaint in childhood. Common causes include: constipation, indigestion, gas pains, overeating, the onset of a vomiting or diarrhea illness, menstrual cramps, and stress-related issues (e.g. school avoidance). Other less common causes include: appendicitis, pneumonia, intestinal/ovarian/testicular problems, urinary tract infections, and child abuse/trauma. With harmless causes, abdominal pain usually resolves within 2 hours. Offer your child only clear fluids such as water, ginger ale, or 1/2 strength fruit juice. Encourage rest and sitting on the toilet to relieve any constipation or impending diarrhea. Be prepared for vomiting. Do not give any medications for diarrhea, or that could upset the stomach (e.g. ibuprofen).

You should contact your doctor if:

your child is younger than 2, or has a fever of 105 degrees F or higher
your child has constant pain for more than 2 hours, or intermittent pain for more than 24 hours
your child walks bent over holding the abdomen or is unable to walk
there is blood in the bowel movements
your young child (usually younger than 3) has intermittent attacks of severe pain/crying that suddenly switch to periods of normal activity (usually 2-10 min. of quiet)
your child is pregnant or could be pregnant
your child becomes worse

Bring your child to the nearest ER:

if the pain is located on the lower right side of the abdomen, scrotum or testicle
if your child is vomiting blood or bile (yellow or green)
if there has been recent injury to the abdomen

Call 911if the pain could be a result of poisoning from a plant, medicine, or chemical or if there are any signs of shock: your child is very weak, limp, not moving, has pale skin, etc.

Q: What do I do if my child has eye discharge?

A: A small amount of whitish discharge in the inner corner of the eye after sleeping is normal. The majority of eye infections are caused by viruses and do not need antibiotics. Eye discharge is often accompanied by cold symptoms. If your child has eye discharge wipe it away gently with a cottonball or tissue. Apply a warm compress for 10-15 minutes 3 to 4 times a day. Viral conjunctivitis can last as long as the cold symptoms (4 to 7 days). Eye discharge that does not improve with compresses and time can signify a bacterial conjunctivitis which needs to be treated with antibiotics. Signs and symptoms of "pink eye" or bacterial conjunctivitis are yellow discharge in the eye, eyelids stuck together due to discharge, and sclera (white part of the eye) red or pink. If your child has these symptoms, antibiotics may be necessary.

You should contact your doctor if:

If your child has eye discharge as above, please call our office. Often if your child is over 1 year of age, this can be treated over the telephone during office hours
If your child is younger than 1 year of age with eye discharge

Q: What do I do if my child has lice?

A: Lice are small (about the size of a piece of rice) grey or brown bugs which can be spread by using the hat, comb, or brush of an infected person or simply by close contact. They tend to be found on the scalp especially behind the ears or nape of the neck. However, they can live on any part of the body. Anyone can get lice and being infected is not a sign of poor hygiene. The nits (eggs) of the lice are often mistaken for dandruff. However, unlike dandruff they can not be brushed away and are cemented to the hairshaft. They are usually white or brown in color and hatch in about 1 week. The closer the nits are to the scalp, the newer they are.

To treat lice and nits, if your child is over 2 years of age, their hair should be shampooed with an anti-lice shampoo, such as Nix or Rid, which can be purchased at most pharmacies. Since new lice can hatch in about 7 days, repeat the shampooing in one week. To remove the nits (eggs) comb the hair with a fine tooth comb or pull them off individually. Lice cannot live off the body for more than 72 hours. Vacuum your house especially your child's room. Soak combs and brushes in a solution made from anti-lice shampoo for about one hour. Wash your child's bedding or any clothing that may have touched their hair in hot water. Items which can't be washed such as a stuffed toy should be sealed in a plastic bag for 3 weeks before using. Check the heads of anyone else living in the home and shampoo their hair if needed.

For additional information on head lice, please click here and click on "Head Lice".

Q: What do I do if my child has a diaper rash?

A: Most diaper rashes are due to prolonged contact with urine and/or stool, so frequent diaper changes are recommended to prevent skin contact with these irritants. Avoid using diaper wipes. Rinse the child's skin with warm water during each diaper change. A mild soap, such as Dove, may be used to cleanse the skin after bowel movements. Exposing the child's bottom to air as much as possible will also help to heal the skin and reduce the risk of yeast infections. A protective ointment such as petroleum jelly, A&D, or Desitin, may be used if your child has diarrhea or a severe rash. With proper treatment, diaper rashes are usually better in 3 days. Contact the office if the rash does not improve or becomes worse.

For additional information on the topic of diaper rash, please click here and click on "diaper rash".

Q: What do I do if my child has constipation?

A: Most constipation is due to a recent change in the diet or waiting too long to use the bathroom.

Diet for Infants 1 year old or younger:

For infants older than 1month: only on breast milk or formula, add fruit juices. 1 ounce/month of age, twice a day. Pear or apple juice is okay.

For infants older than 4months: also add baby foods with high fiber content twice a day (peas, beans, apricots, prunes, peaches, pears, plums, spinach)

Diet for Children 1 year old or older:

Increase fruit juice (apple, pear, grape, and prune). Citrus juices are not helpful.
Add fruits and vegetables high in fiber content 3 times a day (peas, beans, broccoli, bananas, peaches, pears, prunes, apricots)
Increase whole grain foods (bran flakes, bran muffins, graham crackers, oatmeal, brown rice, whole wheat bread)
Decrease milk products to 3 servings/day

Rectal stimulation may help to release the stool. This can be done by inserting a lubricated rectal thermometer into the anus for about 1 minute. If your child is potty-trained, establish a regular pattern by sitting on the toilet for 10 minutes after meals, especially breakfast. If your child is resisting toilet training by holding back, temporarily stop training, and put him back in diapers. If your child has acute rectal pain due to constipation, give your child a 20 minute sitz bath in warm water (2 ounces of backing soda per tub). This may help your child to relax the anal sphincter and release the stool. If the sitz bath does not work, use a glycerin suppository to smooth the way. The suppository is inserted past the anal sphincter while the child is lying on his stomach.

Dosage is based on age:

< 1year: 1/2 pediatric suppository

1-6 years: 1 pediatric suppository

6-12 years: 1 adult suppository

>12 years: 2 adult suppositories

For additional information on constipation, please click here and click on "The section on Gastroenterology and Nutrition".