Dosage Chart

When giving your child medications, it's important to check the concentration (this means HOW MANY MILLIGRAMS PER UNIT OF MEASURE) of the medication you are using. Our chart lists medications by concentration. If you have any questions regarding which concentration you have and how to dose it, please speak with your pharmacist or call our office.

See package directions for older children.

We generally do not recommend use of multi-system cough or cold medications in children, particularly in children under the age of six.

Fever

What is it?

In the words of Professor Janet Serwint of Johns Hopkins, fever “actually is a part of the body's well-orchestrated response to infection.” Fever is an elevation of the body temperature caused by our immune system to help our bodies fight infection. The height of the fever tells us relatively little about the seriousness of the illness, except in an infant. Children can get fevers over 104 degrees with minor illnesses or can be very ill with little or no fever. There is no good evidence that fever can cause brain damage. When children have a fever, they breathe rapidly and may be fussy and tired. In general, your child's symptoms and how sick your child looks and acts is much more important than the actual temperature.

Seizures with fever occur in a small percentage of normal children, most commonly between six months to six years. While frightening to watch, they are generally harmless. There is little or no relationship between these seizures and the height of the fever. In fact, they often occur before the fever is noticeable. They appear to be genetic, and fever-reducing measures do not appear to prevent these seizures. Febrile seizures do require a discussion with your physician.

What you can do

Children under two months of age: In this age group, any fever is concerning and you should call immediately. Normal temperature in babies is up to 100.3 rectally, and a fever is any rectal temperature of 100.4 or more. All infants should have their temperature taken rectally only. Other methods are not accurate. Make sure that your baby is not overdressed, as this will sometimes raise the temperature. Do not give fever-reducers (i.e. Tylenol) to children under 2 months of age. Infants can be very ill with no fever. Judge your infant by his/her behavior and symptoms. Other concerning signs of infection in infants under 2 months of age include lethargy/sleepiness (i.e. you are unable to wake the baby for 2 feedings in a row) and irritability (i.e. you are unable to console your baby despite a variety of attempts). If in doubt, it's best to contact us or seek medical attention.

Children two months of age or older: Fever is best left alone. If your child is miserable or in pain, you may give Tylenol (acetaminophen). If your child is over six months of age, you may give Advil/Motrin (ibuprofen). These medications may or may not reduce the fever but will provide some relief from the discomfort of the illness. 

NOTE: NEVER USE ASPIRIN IN CHILDREN UNDER 18 YEARS!!!

When to call

Call the doctor immediately if your child:

• is irritable or lethargic and does not improve after Tylenol or Motrin and a tepid bath.
• has difficulty breathing.
• has a stiff (not sore) neck or a spreading purple rash.
• has a seizure (convulsion). If your child has a seizure that lasts more than 5 minutes, call 911.
• has a temperature over 105 taken rectally.

Call during office hours if your child:

• is not improving after 48 to 72 hours of fever.
• is becoming increasingly fussy.
• you are concerned.

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The Common Cold/Cough

What is it?

A cold is an infection caused by a virus that causes nasal congestion, runny nose, cough, and occasionally fever, sore throat and watery eyes. There are thousands of different viruses that cause the common cold, and young children can get a new cold as often as every 2-3 weeks in the winter. Colds usually get worse for 48-72 hours before they begin to improve. The runny nose often becomes yellow or green after the first few days and can last for up to two weeks (note: this happens with any infection - bacterial or viral). Antibiotics do not help or prevent colds. 

Cough lasting longer than two weeks is unusual for a typical viral illness. Sometimes chronic cough can be a sign of sinusitis or wheezing. Pay attention to the quality of the cough - is it worse after playing or laughing? Is it associated with changes in air temperature? Is it associated with fast breathing or working hard to breathe (look at your child's belly for this - in young kids this manifests as using abdominal muscles to pull air in and out of the lungs)? If you note these symptoms or your child is coughing so hard that he or she vomits, please call for appointment. 

What you can do

Elevate your child's head. You may put a few drops of saline in one nostril, wait a few seconds, and then suction with a bulb syringe or a Nose Frida or have the child gently blow her nose. In general, cough and cold medicines are not recommended under the age of six. Unless your child is also experiencing allergy problems, do not give antihistamines for colds. In children over one year of age, honey frequently helps to relieve cough and sore throat. Do not use honey in infants under 12 months of age.

When to call

Call the doctor immediately if your child has difficulty breathing that is not improved with nasal suctioning and elevating the head.

Call during office hours if your child has:

• green or yellow nasal discharge that lasts more than two weeks.
• congestion or cough lasting more than two to three weeks.
• cough that is associated with fast breathing or working hard to breathe.

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Influenza ("the flu")

What is it?

The flu (typically, influenza A or B) is a viral respiratory infection that begins with the very sudden onset of severe sleepiness and weakness accompanied by a high fever. Influenza is the opposite of subtle; you can't miss it! It is characterized by its sudden onset and its severity, whereas colds tend to have a more gradual onset. The first 48 hrs are usually spent sleeping, with headache, muscle aches and weakness. The fevers are usually quite high and are part of the immune response. Over the next 36 to 48 hrs, the fever continues but the child is less sleepy. He or she will develop increasing congestion and coughing with persistent muscle aches, exhaustion and weakness. Many patients develop wheezing (whistling exhalation). The congestion, cough and weakness slowly resolve over the next couple of weeks. For some, it may take up to a month to fully return to normal energy and strength levels.

What the flu is NOT

Influenza is not a cold with a fever. It does not come on gradually. It is not a vomiting and diarrhea illness (i.e. “stomach flu”), although vomiting may occur.

What you can do

Call the office for an evaluation. We can test for influenza using a nasal swab, and medicines may help if initiated in the first 24 to 48 hours.

• REST! Rest! Rest!
• Try to give plenty of fluids, including water, Gatorade and chicken soup.
• The fever is not harmful. However, giving acetaminophen (Tylenol) or ibuprofen (Advil/Motrin) can help relieve aches and pain. It is not recommended to give fever reducers around the clock, as the fever may help the illness resolve.
• Elevating the head may help if your child cannot sleep at night due to nasal congestion.
• Try to get your child to sit up periodically to help open up the lungs to help prevent a secondary pneumonia. If he/she is old enough, encourage deep breaths. Having your child blow bubbles or blow a pinwheel can help encourage deep breaths.
• Next year, consider getting a flu shot. While not always effective at preventing the flu, it can give your immune system a running start at fighting it.

When to call

Call immediately if your child:

• has difficult or rapid breathing. Note: Rapid heartbeat and rapid breathing are common with fever, so recheck when the fever is reduced.
• has chest pain.
• stops urinating for 8 or more hours.
• is not arousable, extremely weak, or is delirious.
• cannot keep down liquids or will not drink fluids.
• you suspect your child has the flu and you are worried that your child is extremely ill.

Call during office hours if:

• you suspect your child has the flu and it's in the first 48h of symptoms.
• the fever is not going away in 72-96 hrs or if the fever recurs after a day or two without fever.
• the cough keeps getting worse after the first few days.

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Sore Throat

What causes it?

Many conditions cause sore throats, including viruses, strep, sinus infections and allergies. Viruses, by far, cause most sore throats. If your child has an associated cough, he or she likely has a virus. Strep throat is a throat infection caused by bacteria called Streptococcus pyogenes and can only be diagnosed by a throat swab done in our office. It does not appear to occur in infants. White or red spots on the throat do not necessarily mean it is strep. It is important to treat strep throat with antibiotics to help prevent rheumatic fever.

What you can do

• Sore throat is not generally an emergency, except as noted below. However, if you suspect strep throat, please call during office hours for an appointment. Otherwise, treatment is designed to relieve discomfort.
• Encourage liquids. Often children find relief with popsicles, cold milky drinks (milkshakes), or other cold foods to help with the pain.
• Try a pain reliever such as ibuprofen or acetaminophen. If your child does not mind, you can also try Chloraseptic spray or Sucrets Maximum Strength Lozenges (in older children) for temporary relief.
• Older children can also try gargling with warm salt water.

When to call

Call immediately if your child:

• one side of the throat is swollen and painful and the other side is normal.
• he or she cannot open their mouth fully.
• difficulty breathing.

Call during office hours if your child:

• lasts more than 24 hours and is not associated with a cough.
• is accompanied by a rash.
• is very painful. In a young child, this can manifest as excessive drooling in an attempt not to swallow.
• is accompanied by vomiting or abdominal pain.

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Earache

What is it?

Many earaches are not due to ear infections but rather to conditions such as sore throats, colds and sinus infections. Ear pulling in children less than 24 months of age is not typically a sign of ear infection, and most children with ear infections do not pull on their ears. In younger children, the main signs of an ear infection are fussiness, sleeplessness and fever.

What causes it?

There are two basic types of ear infections. The most common is the middle ear infection, which usually starts during a cold, sinus infection or when allergies act up. There may be drainage from the ear if the eardrum ruptures, which is not an uncommon event with ear infections. The other type of ear infection is an outer ear infection called swimmer’s ear. This infection usually occurs after swimming and results in an ear that is tender to touch or gentle pulling.

What you can do

Most earaches begin in the middle of the night. Antibiotics will not relieve the pain immediately. Ear pain generally does not improve much faster with antibiotics. If your child has pain, you can take the following steps:

• Give ibuprofen (Motrin or Advil) or acetaminophen (Tylenol).
• Try a warm towel over the ear.
• Elevate the head to reduce ear pain.

When to call

Call during office hours if your child:

• has an earache. Note: we cannot prescribe antibiotics over the phone. Diagnosis requires a proper ear exam.
• has ear discharge. 
• is having an accompanying fever.

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Croup

What is it?

Croup is a response to an infection that results in noisy inspiration (breathing in) and a cough that sounds like the bark of a seal. Croup is usually caused by a virus that causes swelling near the vocal cords. This occurs mostly during the night in children under six years of age. Most children with croup feel well during the day and at bedtime except for a mild cold and possibly a hoarse voice. They awaken suddenly during the night with very noisy breathing, painful barking cough and are often frightened. After the croup resolves, your child may have cold symptoms for several days to a week.

What you can do

Take the following steps if your child develops croup:

• Keep him or her calm to help them slow down their breathing. (If you are feeling worried, do your best to ACT calm for your child's sake.)
• Go out into the cool night air for 5-10 minutes to help breathing. An alternative to this is to run a hot shower and breathe in the steam with the door closed.
• If he or she is having a very difficult time with breathing, take a drive in the car with the windows down towards the nearest emergency room (dress appropriately).
• IF THERE IS NO IMPROVEMENT, GO INTO THE EMERGENCY ROOM.

After you have settled your child down:

• Keep the room cool and humid (a humidifier will help).
• Elevate the head.
• You may find that sleeping in the same room with your child is easier so you can detect any changes in breathing.

When to call

Call immediately if your child:

• has croup so severe and you cannot control the symptoms.
• your child is sitting up, leaning forward, drooling, has his or her chin jutting out, and looks quiet. This may be a very rare condition called epiglottitis, which is an extreme emergency. You may need to call 911 in this circumstance.

Call during office hours if your child:

• has had a difficult first night.
• is still having noisy, honking breathing in the day.
• has croup that is not improving after a few nights.
• has croup that comes on after a week of a cold.

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Vomiting

The following advice pertains to children over two months of age. If your child begins to vomit, DON'T PANIC. Don’t rush to give him or her fluids. Wait until the vomiting has stopped for at least an hour. Your goal is to try to get as much fluid to stay in your child’s body. If you give a lot of fluid too quickly or at once, your child is likely to vomit more. If you give small, frequent amounts of fluid, your child will have a chance to absorb the fluid without triggering the vomit reflex. Your child may complain of thirst, but it is very important to give small, frequent amounts of fluids or you may ultimately make your child more dehydrated. Begin to give fluids as follows:

• Give one teaspoon of Pedialyte or similar electrolyte solution every ten minutes for small babies and every five minutes for older children. If this provokes continued vomiting, you should wait until the vomiting has completely stopped for one hour before restarting Pedialyte. If the vomiting will not stop after a few hours, go ahead and give one teaspoonful (5 ml or cc) every 5 to 10 minutes. If the vomiting still will not stop, go to an Emergency Room.
• If you have a breastfeeding infant who will not take the Pedialyte, you may also give small amounts of breast milk, either by bottle, syringe, spoon or breast. Feed a small amount every 5-10 minutes and slowly advance. If the baby vomits, wait until the vomiting has stopped for 30-60 minutes before trying again. Keep an eye on urine output, as fewer wet diapers can be a sign of dehydration.
• After he or she holds down one teaspoonful 8 to 10 times, you may begin to give one tablespoonful every 25-30 minutes for infants and every 15-20 minutes for older children.
• After he or she holds this down four times, very gradually give larger amounts of liquid. Don’t give more than two ounces at a time for the first day.

Start a bland and starchy diet slowly, such as described in the “Diarrhea” section. Gradually return to a normal diet over the next several days. Please note that sometimes vomiting will recur intermittently over the next few days, especially if your child has had a larger or heavier meal or dairy.

When to call

Call immediately if your child:

• appears to be dehydrated, with signs such as decreased urination, glassy eyes, lethargy, dry mouth, no tears or sunken eyes and/or soft spot.
• cannot stop vomiting or will not hold down even very small amounts of liquid at a time.
• has severe diarrhea (see “When to call” in the Diarrhea section).

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Diarrhea

What is it?

Diarrhea is a condition in which our bodies make many watery bowel movements per day. Most cases are caused by viruses, can last from one day to two weeks and may be accompanied by vomiting. If diarrhea and vomiting occur together, it is important to treat the vomiting first (see instructions on vomiting above). Some cases of diarrhea are caused by dietary choices, such as excess juice, fruit, or sugar-free product consumption. Please note that newborn breastmilk stools are normally very liquidy. Diarrhea in a breastfed infant is a change from baseline in the consistency of the stool such that it is watery and does not leave residual in the diaper.

What you can do

Infants

If your infant develops diarrhea, he or she will need extra fluids, preferably Pedialyte or a similar electrolyte replacement solution. If the diarrhea is not severe, give 2 ounces for every diarrheal stool in addition to his or her normal formula or breast milk.
For severe diarrhea:

• Give only Pedialyte or similar fluid for 12 hours. Infants may prefer plain Pedialyte.
• Babies on cow's milk-based formulas (such as Enfamil, Similac or Gerber Good Start) may need to switch to a lactose-free or soy formula for a week.
• If he or she is on solid food, offer plain rice cereal with water, boiled potatoes, pasta or bananas.
• Probiotics (eg. Gerber Soothe, Culturelle) may reduce the severity and duration of diarrhea.
• Gradually return to a normal diet.

Older Children and Adolescents

• Give Pedialyte or similar solution for 12-24 hours. Older children tend to prefer grape, cherry or apple-flavored Pedialyte or Gerber electrolyte solution. Pedialyte popsicles are another available form.
• Choose foods such as chicken broth with noodles, potatoes, crackers, bread, bananas and cooked carrots. Probiotics (eg. Gerber Soothe, Culturelle) may reduce diarrhea.
• Lean meats provide the proteins needed to repair the bowel.
• Avoid greasy or spicy foods, juices, milk and soda.
• After a severe bout of diarrhea, some children will develop a temporary lactose intolerance and may benefit from a switch to a lactose-free milk for a couple of weeks.

The diarrhea may last for days. As long as you are able to keep up with the fluid losses and the stools are gradually improving, don’t worry.

When to call

Call immediately if your child:

• appears to be dehydrated, with signs such as decreased urination, glassy eyes, lethargy, dry mouth, no tears or sunken eyes and/or soft spot.
• has stools are bloody or very mucousy.
• has diarrhea that lasts longer than one week.
• has over ten large liquid stools per day.

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Constipation

What is it?

Constipation means hard bowel movements. Children and infants do not have to have bowel movements every day, though most should. The consistency of the stool and the effort required to pass the stool is more important than the frequency of the bowel movements. Some breast-fed infants may suddenly start having bowel movements as little as every 3-10 days around six weeks of life, which is normal as long as the stools are still loose and liquidy in consistency.

Constipation needs treatment if:

• the stools are very firm, hard or pellet-like.
• your child has difficulty passing the stools.
• he or she is bloated or having abdominal pain due to the constipation.
• you see blood in the stool.
• your child is trying to hold stools in secondary to pain or discomfort.

What you can do

Infants under one month

• Increase feedings. Do not give water.
• If appears to be gassy or to be pushing, try bicycle leg exercises or tummy massage.
• May stimulate rectum by using Q-tip or thermometer with Vaseline or Aquaphor on tip and gently insert into rectum and do 3-4 circles.
• Call for appointment if any bloating or if your baby has not had a stool in 24 hours.

Infants 1 month to 6 months

• It may be normal to not have stool up to 7 days, but needs medical attention if belly is distended or baby is in pain.
• Do not give water.
• If appears gassy or to be pushing, try bicycle leg exercises or tummy massage.
• Try an infant probiotic, such as Gerber Soothe or Culturelle.
• May stimulate rectum by using Q-tip or thermometer with Vaseline or Aquaphor on Qtip and gently insert into rectum and do 3-4 circles.
• Add one teaspoon of sugar to four ounces of formula or expressed breast milk.
• Used a 1/2 dose of Pedialax liquid glycerin suppository (over the counter).  Note: This should only be done in very rare circumstances.
• Babies over four months of age can take 2 oz prune, plum or pear juice diluted with 2 oz water per day. You can also try offering puréed prunes. 
• Changing to a different formula may help (consider Enfamil Reguline).
• Call for an appointment if stools continue to be hard, pellet or clay-like or cause any bleeding.

Older infants and children

• Prune, plum or pear juice diluted with water may help.
• Increase water intake.
• Increase intake of high fiber fruits and vegetables, such as stone fruits (plums, peaches, mangos, apricots), pears, and green leafy vegetables. Consider making a simple smoothie with a higher-fiber fruit, fresh spinach and milk.
• High-fiber cereals with 8 to 10 or more grams of fiber per serving will help as long as they're given with plenty of liquids.
• Avoid starches (pasta, potatoes, crackers, rice, etc), bananas, cheese and excess milk – these foods can be constipating.
• For toddlers in acute distress, give a Pedia-lax liquid glycerin suppository. If this fails, try a Pedia-lax enema. Note: These should only be done in very rare circumstances.
• In older children with distress, give one Pedia-lax enema. If a bowel movement does not occur within two hours, repeat the enema. Note: These should only be done in very rare circumstances. Do not give more than two enemas without consulting your pediatrician.

When to call

Call immediately if your child:

• has severe pain and the above measures give no relief, or if you see blood in the stool.

Call during office hours if your child:

• has recurrent constipation.

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Diaper Rash

What causes it?

There are many causes of diaper rash. The most common is irritation from stool or urine, which results in some areas of redness or raw skin. This rash will often spare the folds of the skin. For this rash:

• Protect the skin with large amounts of petroleum jelly (Vaseline), Aquaphor, Original Desitin (40% zinc oxide in a “purple container”), or other barrier ointment containing at least 25% zinc oxide. 
• Do not wipe the skin if it is very raw.  Rinse off the urine and stool and apply very large amounts of the barrier ointment.
• Try to give the child “air time” without the diaper as much as you can to help the rash heal.

Another common cause of diaper rash is yeast diaper rash. This rash typically thrives in the folds of the skin. Yeast usually begins a few days after diaper rash caused by irritation and it is typically redder, angrier and has small red dots and bumps spreading out from the main rash. For this rash:

• Apply miconazole vaginal yeast cream (100 mg/application) three times a day until the rash clears for at least two days.
• If the skin is raw, cover the fungal cream with a thick layer of diaper ointment.
• Try to give the child “air time” without the diaper as much as possible.

When to call

Call during office hours if none of these measures work.

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Teething

What is it?

Teething is a natural process that all infants go through. Most babies get their first teeth somewhere between 6-12 months of life, although some get them earlier and some get them later. By the age of 2-3 years, babies should have developed all 20 of their primary teeth. Most 4-month olds look like they're teething because they have their hands in the mouth and love to chew on things - this is a normal developmental stage and not necessarily a sign of teething.

Every child reacts differently to teething. For some infants, teething can be quite painful and for others, it can be quite pain-free. Some children can become more fussy, irritable, have sleeping difficulty during teething times. Other kids experience more drooling, biting and swollen gums. It is not common for fever to be caused by teething.

What can you do

If your child is fussy, give him or her a safe teething toy to chew on. If your baby is old enough to eat solids, you can also try a safe, solid food to chew on (or a peice of cold fruit placed into a “mesh” bag). You can also freeze wet washcloths and give them to your baby suck and chew on. Sometimes rubbing your clean finger gently but firmly onto the baby’s gums can also provide pain relief. If your baby is extremely fussy, you may administer the appropriate dose of ibuprofen (for children 6 months and older) or acetaminophen (see our dosing guide). We do not recommend other pain relief medications such as Orajel, as they may be harmful in large amounts. Also, there have been FDA concerns about homeopathic teething tablets containing variable amounts of a possibly unsafe medication.

Call during office hours if your child:

is extremely fussy from teething and the pain relief measures mentioned above do not seem to be helping.

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Bloody Noses

Bloody noses are common. They occur frequently when the weather is hot and dry, the heater is on, or during colds or allergy attacks.

What you can do if your child has a nosebleed:

• Have him or her sit up and lean forward. Squeeze the lower half of the nose together (the entire nose below the nasal bone that can be squeezed flat, not just the tip or the ends of the nostrils). Continue to apply pressure for 5 minutes.
• If the bleeding does not stop, hold it for ten minutes.
• One or two hours after the nosebleed, push a small amount of antibiotic ointment, nasal saline gel, or Vaseline into each nostril, then gently squeeze the nostrils and wipe off the excess ointment.

When to call

Call the doctor on call if the bloody nose does not stop after ten minutes with the above measures. Make an appointment if the bloody noses are frequent.

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Pink Eye (Conjunctivitis)

What is it?

Pink eye is an inflammation of the eye caused by viruses, bacteria, allergies or irritants. Bacterial conjunctivitis usually has copious pus-like discharge that returns very quickly after you wipe it away. It usually resolves in 7-10 days, but improves faster with antibiotic eye drops. Viral pink eye usually exhibits a mucusy or watery drainage. The white of the eye is usually pink or red. It is very contagious and antibiotic drops do not help. It runs its course in 2-10 days.

What you can do

If this occurs in the evening, you can wipe it out with a damp cotton ball or soft cloth. If the eye is very itchy, an over-the-counter allergy eye drop may help. Do NOT use Visine or other eye drop to treat the redness.

When to call

Call immediately if your child:

• has a very painful eye. Pink eye is not an emergency unless the eye is very painful. 

Call during office hours if your child:

• does not have a very painful eye. Wipe the eye when needed and call the office in the morning. Note: we generally do not prescribe antibiotics over the phone.

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Hives

What is it?

Hives are a type of rash that is blotchy, red, irregular, and itchy. They are commonly referred to as welts, and they tend to move around. Hives can last from hours to weeks. Hives are often the result of an allergic reaction to food, medication, dyes or other allergens. They can be the first sign of a more severe allergic reaction. Hives in children also are commonly associated with viral infections.

What you can do

• Oral diphenhydramine (Benadryl) will usually stop the itch and diminish or clear the rash temporarily. This can be repeated every 6 hours.
• Make note of and stop any new or possibly offending foods or medicines.

When to call

Call immediately if your child:

• has hives associated with hoarseness, difficulty breathing, profuse vomiting, pale color, generalized swelling or weakness.
• has water-filled blisters with them (not hives).

Call during the day, preferably in the morning, if:

• your child is on an antibiotic or other prescription medication that you stopped because of the development of hives.

Call during office hours if your child:

• has hives lasting for days or associated with other worrisome symptoms.

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Burns

What are they?

Burns are heat or friction injuries of the skin. The injury can range from mild (redness) to severe injuries that injure all layers of the skin. The full extent of the burn is not known at the time of the injury. The burn can begin as just a red spot and develop blisters minutes to several hours later.

What you can do

Thermal burns

• Immediately run cold tap water on burn and quickly remove any overlying clothing including diapers to prevent continued contact of a hot substance with the skin.
• Cool the burn with cold tap water immediately for 15-30 minutes continuously. This can decrease the pain as well as the depth of the burn. Even if the burn looks terrible, start the cooling process first prior to making a decision about if you need to call us or 911.
• Put washcloths or gauze into ice water and use those cloths to rotate onto the burn over and over for a very long time.
• After the cooling, if blisters are not broken, gently wash them and apply bacitracin or double antibiotic ointment and a dressing to protect the blisters.
• If the blisters are open, wash the area gently, carefully remove the cover of the broken blister and apply bacitracin or double antibiotic ointment and a sterile non-stick gauze and covering. Re-dress every day or sooner if the dressing becomes contaminated. If the burn was dirty, please see below.

Friction Burns (aka ‘road rash’)

• If you are able, gently clean out all of the dirt, gravel and sand to avoid a “tattoo” effect when it heals. If you cannot do this, please call us. We can help.
• Apply bacitracin or double antibiotic ointment and cover with a plain non-stick gauze (eg. Telfa dressing).
• Re-dress daily for two days and then every 2-3 days, or sooner if the dressing becomes contaminated.

When to call

Call 911 if your child:

• has a burn as a result of a large fire, has had smoke inhalation, or is associated with coughing and/or breathing difficulty.
• has a burn that covers a large area of the body.
• has other generalized symptoms, such as weakness or altered level of consciousness.

Call immediately if your child:

• has a large burn and you are unsure if you need to call 911 or go to the hospital.
• your child is still in considerable pain despite 40-60 minutes of cooling and a dose of ibuprofen.

Call during office hours if your child:

• has a burn is that is moderate in size with either open or intact blisters.
• has increasing redness or tenderness spreading around a burn area.
• has a burn that is not healing.
• cannot tolerate dressing the wound or if you are having a difficult time dressing the wound.

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Head Injuries

What is it?

Minor head injuries are frequent and common. Most only require close parental observation.

What you can do

• Observe your child.
• Use cool packs to reduce swelling.
• Wake your child every 2 to 2 ½ hours for the next 24 hours and see if they react normally to you (as normal as possible in the middle of the night).

Call 911 or head immediately to a nearby emergency department if your child:

• loses consciousness.
• is persistently dazed, falling asleep more than normal, or seems off-balance.
• has vomiting.
• is persistently crying or irritable.
• if the skull is dented in (not a bump).

Call during office hours if:

• you are concerned that your child may have signs or symptoms of concussion, such as headache, nausea or vomiting, fatigue, or fuzzy or slow thinking.

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Painful Urination

What is it?

It is pain with peeing. It may be due to irritation of the genitalia caused by bubble baths, wiping too hard, sand or tight pants. It can also be due to a bladder infection, which is commonly associated with more frequent and urgent urination. Urinary infections are more likely if your child generally uses the bathroom less frequently or has constipation.

What you can do

You can encourage more liquids, including cranberry juice. Clear water baths (no soap or shampoo) daily.  Avoid bubble baths and encourage your child to use the bathroom more frequently to prevent infections. If the genitalia are red, use Vaseline to protect the skin from irritation from urine.

When to call

Call immediately or if your child:

• has painful urination associated with fever, backache, vomiting or if she looks ill.

Call during office hours if your child:

• has symptoms of painful urination.

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Testicular Pain

What is it?

It is pain in the testicle, usually of sudden onset and may present with redness, swelling and a fever. It may be caused by a viral infection or it may be due to a twist in the base (root) of the testicle (testicular torsion). This is an emergency and it needs to be seen right away by a doctor and corrected; otherwise, it may cause permanent harm to the testicle.

When to call

CALL RIGHT AWAY. This is an emergency and needs to be checked out within hours and may need surgery to correct the problem.

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A word about antibiotics

We get many questions about prescribing antibiotics over the phone. With rare exceptions, it is against our office policy to do so. We generally consider prescribing antibiotics over the phone without examining your child poor medical practice. Many illnesses are caused by viruses, and antibiotics have no effect on such illnesses. Furthermore, your child may have an illness that is more serious than you suspect and giving an oral antibiotic may not be adequate treatment. Giving an antibiotic from a previous illness or from someone else’s prescription may mask serious symptoms and signs and can affect test results.

When you receive an antibiotic for your child, give it for the entire prescribed time. If you run out before the recommended time, call the office during the day for a refill. If your child develops a potential allergic reaction to an antibiotic, stop the medication and call. If severe diarrhea develops, stop the medicine and call the office during the day. Eating yogurt or taking probiotics may lessen antibiotic-associated diarrhea.

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Lice

What is it?

A lice infestation is a scalp infection caused by tiny gray bugs called lice. Lice are 1/16th inch long and move quickly. They are extremely difficult to see when looking through someone's hair. They lay eggs that are firmly attached to hair shafts near the skin. The eggs are called nits. They look like specks of dandruff or grains of sand, but they do not shake off easily. Itching of the scalp is the main symptom, but not all people actually itch from lice. A scalp rash, often noted at the nape of the neck, may also be present. The empty nits are white, the unhatched nits are dull and usually found closer to the scalp. Nits are best found on the back of the head.

What you can do

In California, most lice have become resistant to over the counter products like Nix and Rid.  

Here are some other options:

Cetaphil Method

Purchase Cetaphil Gentle Skin Cleanser. This is a soapless cleanser usually found in the soap department at most drug stores.
Apply an ample amount and work into scalp, making sure the cleanser covers the entire scalp and hair. After hair is soaked through, wait 2 minutes.
Comb out excess cleanser with a fine-toothed comb.
Blow-dry your child’s hair. It must be completely dry to the scalp to suffocate the lice. Note: hair will take about 2-3x longer than usual to dry.
Leave dried Cetaphil in hair for at least 8 hours.
Wash off with regular shampoo and comb out nits (see below section for comb information).
Repeat twice in 1 and 2 weeks.

Don't forget to simultaneously wash all bedding/towels/hats/worn clothing in hot water and dry on high heat for at least 20 minutes.

Combing

Use a comb such as NIt-Free Terminator Lice Comb ©. The Nit Free © company also has several products, such as shampoo, conditioner, and spray that can help repel and prevent lice from attaching to hair. You will need to comb through your child's hair multiple times per day over at least 2-3 weeks.

Nit Picking Option

Aggressive picking of nits can eliminate the mites, but every single nit needs to be removed. There are nit picking shops in the community that perform this, as well. We have a list of community resources available should you need this. Call our office for more information. 

Cleaning

Any items that have been in contact with your child’s head within 24-48 hours prior to treatment will need to be cleaned, such as bedding, jackets, hats and stuffed animals. Lice die within two days without a blood meal. Nits take 8-10 days to hatch and then it takes about 9+ days for the lice to become adults and lay eggs. Since it is possible for nits or lice to be on items used by the child prior to treatment, clothing and bedding should be washed in hot water and dried using a high heat cycle for at least 20 minutes. Items that are not washable should be dry-cleaned or put into a sealed plastic bag for two weeks to prevent hatched lice from getting a blood meal. Soak combs, brushes, hair bands, and barrettes in soapy hot water for at minimum one hour (or boil for five minutes). Carpets and furniture can be vacuumed daily. THERE IS NO NEED TO APPLY PESTICIDES.

When to call

Call during office hours if your child:

• continues to have lice despite above measures.
• has redness, pus, soft scabs or open sores on the scalp.
• is less than 2 months old.
• has scalp rash or itch lasting more than a week after treatment.

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What if I need a refill of a prescription?

If you need a medication refilled, please call us during regular office hours. Please give us at least 24 hours notice for regular medication refills and at least 3 business days for triplicate medication refills. Please note that we do not refill prescriptions after office hours.

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