Stomach aches are common complaints in children. Most are due to relatively minor causes such as constipation or a stomach virus. Stomach aches often can occur during illnesses located in other parts of the body as well – such as a urinary tract infection (UTI).  Some people experience abdominal pain as a manifestation of stress or anxiety. Serious causes of abdominal pain include things like appendicitis or blockage in the intestines– though when things like this occur, they almost always come with severe pain and other symptoms such as fever or vomiting.

Most children with abdominal pain will recover without any specific treatment. Some remedies you can try at home include using pain relievers such as Tylenol, antacids such as TUMS, Miralax as a stool softener (especially if you suspect your child might have constipation), and comfort treatments such as a heating pad. All children with abdominal pain should be encouraged to drink plenty of fluids and eat lots of fresh, fiber rich foods such as fruits and vegetables.

A child with abdominal pain should be seen in the office if:

1. They have abdominal pain and vomiting to the point where you are worried about dehydration
2. They have abdominal pain and blood in the stool
3. They have abdominal pain and significant fevers for more than a few days
4. They have abdominal pain and urinary symptoms (pain with urination, increased frequency, having accidents, etc.)
5. They have abdominal pain and you suspect they might be losing weight
6. They have abdominal pain that starts near the middle of the abdomen but then migrates to the right lower side

Most people associate concussions with head injuries that occur while playing sports, though they also can occur with head trauma sustained during everyday life, such as during falls or car or bicycle accidents. A concussion is a brain injury that occurs after trauma and can have many symptoms. Physical symptoms can include headache, nausea, vision problems, or balance problems. Other symptoms include difficulty with sleep (either sleeping more or less than usual) and changes in emotions (being more sad or irritable than usual). Lastly, concussions can impact children in their ability to think, concentrate, or remember – this can be especially difficult as a child with a concussion tries to return to school. Sometimes symptoms show up shortly after the injury, but they can also start to occur as long as several days after the initial injury.

A child with a suspected concussion should be seen by their physician to confirm the diagnosis and to make sure there are no signs of more serious injury. Once a concussion is diagnosed, the physician will provide you with an outline for rest and gradual return to activity (both to school and to sports). The initial period of rest involves avoiding all physical activity and also avoiding activities that can be tiring for the brain such as reading, TV, cellphone use, or video games. Medicines for headache or nausea can also be used during the first few days of concussion symptoms, but sometimes overuse of these can lead to worsening symptoms, so it is best to talk about any medications with the doctor at the time the concussion is diagnosed.

It can be frustrating for children to be held back from school, sports, or other activities they might enjoy. It might seem like the concussion protocols are overly cautious or slow to get a child 100% back to the playing field. However, the biggest risk with a concussion is sustaining a second head injury before the brain has fully had a chance to recover. The concussion protocols are designed in such a way to minimize this risk and give the brain the best chance to recover without further injury.  Returning to school and activities too quickly may prolong the recovery from a concussion.

Children with concussions are often asked to return for additional visits with the doctor to assess their symptoms and clear them for full return to sports. Other reasons to return to the doctor include:

1. Worsening headache symptoms, especially if accompanied by vomiting.
2. New neurologic symptoms such as trouble with speech, weakness in the arms or legs, etc.
3. Symptoms not improving or worsening despite good adherence to the concussion protocol.
4. Trouble adjusting back to a normal amount of school work

Children are commonly seen by their pediatrician with complaints involving eye discharge or redness of the white part of the eye (sometimes called conjunctivitis or pink eye). Common causes of conjunctivitis include infections (viral or bacterial), allergies, or irritation from things like chlorine in swimming pools.

Eye discharge can often occur by itself WITHOUT redness in the white parts of the eye. Most commonly, this is due to the child having a cold. In this situation, the discharge will usually resolve as the cold symptoms improve. Newborns and young infants will often have eye discharge related to a blocked tear duct and can have symptoms intermittently over the first few months of life.  A child with eye discharge alone (without eye redness) usually does NOT need antibiotics and can attend Daycare or school.  If children are being treated with antibiotic drops they can return to Daycare/school as soon as the discharge improves.

It can sometimes be difficult to distinguish the different type of conjunctivitis. This is why we recommend that most children with redness in their eyes be evaluated by their pediatrician. In younger children especially, pinkeye can often be accompanied by an ear infection.

A child with conjunctivitis or eye discharge should be evaluated in the office if:

1. They are under 2 years of age
2. They have eye redness and thick green or yellow discharge
3. They have fevers or other signs of illness
4. They wear contact lenses
5. The eye redness occurs after an injury or trauma to the face
6. They have visual complaints such as blurry vision

Different types of eye drops are available for the treatment of conjunctivitis. Ones containing antibiotics are available by prescription only. For conjunctivitis related to allergies there are some eye drops available over the counter.  If you think your child has eye redness due to allergies you can start Naphcon-A or Zaditor without coming in for a visit.

Diarrhea is a sudden increase in frequency and looseness of stools. The most common cause of diarrhea is a viral infection of the stomach and intestines. Many times children with viral illness will have both vomiting and diarrhea. These illnesses are typically highly contagious, so it is important to make sure that all caregivers for a child with diarrhea are diligent about washing their hands. Other less common causes of diarrhea include bacteria or parasites, food intolerance, or chronic GI issues such as Crohn’s disease.

The biggest risk with diarrhea is becoming dehydrated. This is especially true in younger, smaller children who are much more likely to become dehydrated faster. Signs of dehydration include decreased or no urine output, dry lips or tongue, and, when severe, extreme lethargy (being hard to awaken). The most important way to help a child with diarrhea is to make sure you encourage them to drink plenty of fluids. Breastfed infants should continue to breastfeed. Fluids may have to be offered in smaller amounts and more frequently, sometimes as often as every 10 to 15 minutes. Using a spoon or syringe to help you child take these smalls amounts can sometime be helpful. Pedialyte can be a good option in infants who are not tolerating breast milk or formula. Older children can drink sugar free sports drinks or water. Once a child is tolerating fluids, it is OK to offer them a regular diet and see how they do. Very sugary drinks such as juice should be avoided as this can often make diarrhea worse. If you change your child’s diet at the beginning of a diarrhea illness (the BRAT diet for example), resume the normal diet after 24-36 hours to provide the nutrition their system needs to recover.

Sometimes diarrhea can cause the skin around a child’s bottom to become irritated and sore, especially if the child is still in diapers. Liberal use of a zinc oxide containing diaper cream such as Desitin, Boudreaux’s, or triple paste can help in this situation. You can also give your child a probiotic such as Culturelle to help restore the balance of normal, healthy, gut bacteria in their system.

A child should be seen in the office for diarrhea if:

1. They have high fevers, severe abdominal pain, blood in the stool, or mucous in the stool
2. They have signs of dehydration (as detailed above)
3. They have diarrhea that lasts longer than 1-2 weeks

Ear pain is a common complaint in children, often due to ear infections. There are two main types of ear infections to know about.

Otitis media, or a middle ear infection, occurs when bacteria or viruses infect the space BEHIND the ear drum. This often occurs after a child has had a cold for a few days. A child with a middle ear infection will often complain of pain on the effected side and may have a fever. This type of ear infection is usually treated with oral antibiotics, though some ear infections resolve on their own and we may recommend delaying the antibiotics for 1-2 days to see if this will happen.

Otitis externa, also called “swimmer’s ear,” occurs when infection is in the ear canal IN FRONT of the ear drum. This often happens when water is trapped in the ear canal, often after swimming, allowing bacteria to multiply there. This type of ear infection usually does not have a fever. A child with a swimmer’s ear will often complain of pain that is worse when the earlobe is touched or moved. This type of ear infection is often treated with ear drops that contain an antibiotic and sometimes a steroid as well. Swimmer’s ear can be prevented by wearing a cap/ear plugs, shaking water out of ears immediately after swimming, and by using over the counter drops such as Swim-Ear to dry out the ears after swimming.

Children with ear pain should be seen by their doctor if:

1. Their pain doesn’t respond to pain relievers such as ibuprofen (Motrin) or acetaminophen (Tylenol) or lasts for more than a few days
2. They have drainage from their ears (unless they have ear tubes, see below)
3. They have significant fevers that last for more than a few days
4. They have ear pain or fever that is worsening while already on antibiotics for an ear infection, as this may be a sign that the antibiotic is not working
   

A little extra about ear tubes

Some children who get lots of middle ear infections will have surgery to put a small plastic tube in the ear drum. This allows any ear infection that develops to drain out on its own, eliminating the need for more rounds of antibiotics. If your child has ear tubes and develops ear drainage, it is generally OK to start using the ear drops given to you at the time of surgery without being seen by the pediatrician. However, if the drainage doesn’t resolve after a few days or your child has significant ear pain, they may still need to be seen by their doctor.

Fever, defined in young children as a rectal temperature of100.5 F or higher, is a symptom of illness and not a disease unto itself. It is the body’s normal response to infection and is itself not dangerous or harmful.  Most fevers are due to mild viral infections and will resolve within a day or two. Less commonly, fevers can be signs of more serious bacterial infections that will require treatment.

Though not dangerous, fever can be uncomfortable. Medicines to treat fever, such as acetaminophen (Tylenol) or ibuprofen (Motrin), are used for relieving the discomfort associated with fever but will not treat the underlying cause. Dosing guidelines for these medicines are on our website at OTC Medications Dosing

There is no particular temperature (such a 103 F or 104 F) that should prompt an immediate need for treatment or evaluation (except in very young infants and other special circumstances, see below). Rather, it is important to consider how a child is doing overall with the fever, with particular attention on their comfort, ability to stay hydrated, and their demeanor and energy throughout the illness.

Children with fever should be seen in the office if:

1. They are under the age of three months and have a rectal temperature >100.5
2. They have fever that lasts more than 5 consecutive days
3. The fever does not come down with an appropriate dose of medication or the child does not feel better when the fever comes down
4. They have persistent fevers for more than 48-72 hours after being started on antibiotics for a bacterial infection (ear infection, strep throat, UTI, etc.)

Some children with chronic conditions such as sickle cell disease or who have weak immune systems (such as children on chemotherapy for cancer) need to be seen immediately in an ER if they have fever. Your doctor should let you know well ahead of time if your child falls into one of these special categories.

Almost everyone gets a headache from time to time. Usually they occur when we are stressed out, dehydrated, or haven’t gotten enough sleep. Headaches can also occur with almost any type of minor acute illness, such as a cold, especially when the child has a fever. There are other types of headaches, such as migraines, that are more chronic or recurrent. Migraines headaches are typically sharp or throbbing and are often accompanied by other symptoms such as nausea, dizziness, or light and sound sensitivity. Sometimes pain from migraines is so severe it causes people to miss work or school.

Most headaches will improve with sleep and hydration. Using acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can also help ease the pain of a headache. Children SHOULD NOT take aspirin for headaches, as this can put them at risk for developing a serious illness called Reye syndrome. People who have been diagnosed with migraines are often told to avoid certain triggers, such as caffeine, in order to prevent a migraine from starting.

In general, medicine is most effective when taken at the beginning of a headache, rather than waiting until it is more severe.  It can also be helpful to keep a diary of the headaches for a few weeks, tracking when they occur and seeing if triggers can be identified in diet, sleep, stress, etc.

A child with a headache should be evaluated in the office if:

1. They are frequently missing school for headaches
2. They are taking pain medication for headaches more than once or twice a week
3. They have a headache AND fever, vomiting or a stiff neck
4. They have abnormal neurologic complaints such as changes in vision (blurry vision or seeing double), weakness, slurred speech, trouble swallowing, etc.

They have headache following an injury to the head, as this may indicate a possible concussion.

Typical symptoms of Flu are high fevers, muscle aches and fatigue. Kids tend to feel lousy with the Flu. Infants may be fussy or lethargic. Most kids with Flu can be managed at home with fever reducers and good hydration. While we are happy to see your child if you are concerned, it is not necessary if your child has typical Flu symptoms and can be kept comfortable. Flu testing and treatment is NOT indicated for most healthy children. If your child is at high risk (under age 2 or chronic conditions like Asthma), please call to schedule an appointment so that we can assess them for Flu.

Don’t let the hysteria about Flu cause you to mistrust your parental instincts. We are happy to provide advice and help you react appropriately to your child’s condition.

Children are active and often sustain minor injuries. A sprain is when ligaments, which hold bones together, are overstretched and/or partially torn. A strain is when a muscle is overstretched or torn. After an injury, signs of a sprain or strain include swelling, pain, or bruising around the affected area. While most sprains and strains will improve with conservative treatment at home, occasionally an injury is more severe or may involve a fracture (broken bone). In these cases, often the injured body part will have decreased movement, unnatural movement, obvious deformity from the surface, or will be extremely painful even to light touch. If you suspect a possible fracture in your child, please call the office for further instructions.

Sprains and strains can generally be treated at home. A useful mnemonic for the treatment of these injuries is RICE, which involves:

1. Resting the affected body part
2. Ice – use a cold compress or icepack wrapped in a towel and apply to the injured body part several times a day for the first few days after the injury
3. Compression – use an elastic bandage or ace wrap to support the injured body part
4. Elevation – keep the injured body part above the level of the heart to help reduce swelling

In addition to RICE, children can take ibuprofen to help with pain associated with sprains or strains.

A child with a musculoskeletal injury should be evaluated in the office if:

1. You suspect a broken bone of any kind
2. They are having trouble walking/bearing weight after an injury to the legs
3. Their symptoms of a sprain or strain are not improving with treatment as outlined above

Occasionally children with injuries require evaluation by Orthopedists, Sports Medicine Specialists, and Physical Therapists. We can provide referrals to qualified providers in all of these disciplines.

If your child has swallowed a poison, call the office or Poison Control Center (800-222-1222) immediately. Most poisonings can be prevented by the proper storage of drugs and household cleaners and chemicals. Request that all your prescriptions be dispensed in child-proof containers.

Seasonal allergies (called “hay fever” by some) occur in children who are sensitive to pollens from trees, grass, and weeds. They occur predictably during certain seasons depending on which type of pollen a person is allergic to. Symptoms include sneezing, coughing, nasal congestion, a clear runny nose, or a scratchy feeling in the nose or throat. Some people with seasonal allergies will also get itchy, watery, or even red eyes. Children with underlying asthma may have wheezing triggered by exposure to these allergens as well.

If a child has seasonal allergies, it is important to try to minimize their exposure to allergens. This can be accomplished by keeping windows closed, using air conditioning, and, when the pollen counts are especially high, considering limiting outdoor activities. It is also a good idea to make sure that children with allergies are washing their hands after playing outside and changing out of clothes that may be covered with pollen. When allergy symptoms are bothersome enough, medications are used to try to reduce the symptoms. Generally, over the counter anti-histamines such as Claritin or Zyrtec are safe and effective treatment for allergies in children. These medications can cause some sleepiness, so it is best to try them out on a weekend or at night before sending a child to school after having taken them. For significant nasal symptoms, nasal steroid sprays such as Flonase tend to work best. Occasionally, when allergies are very severe, there are other prescription medications or even allergy shots (immunotherapy) that can be used to desensitize a person to allergens.

A child with suspected seasonal allergies should be seen in the office if:

1. They have fever that lasts for more than a few days in conjunction with allergy symptoms. This may be more of a sign of an acute illness and not allergies.
2. They have been taking medication consistently for allergies and are not getting any relief.

They have asthma and are having wheezing or using rescue inhalers more frequently due to allergies

Vomiting is a common symptom with many different illnesses. It is most commonly caused by viral infections affecting the stomach and intestines. When viruses are the cause of a vomiting illness, it is not unusual for a child to develop diarrhea in the days following the start of vomiting. Other causes, such as bacterial infections, food poisoning, or blockage in the intestines, are possible but much less common. Vomiting that has dark green bile color in it or blood can also be a sign of something more serious.

The biggest risk with vomiting is becoming dehydrated. This is especially true in younger, smaller children who are much more likely to become dehydrated faster. Signs of dehydration include decreased or no urine output, dry lips or tongue, and, when severe, extreme lethargy (being hard to awaken). The most important way to help a child with vomiting is to make sure you encourage them to drink plenty of fluids. Breastfed infants should continue to breastfeed. Fluids may have to be offered in smaller amounts and more frequently, sometimes as often as every 10 to 15 minutes. Using a spoon or syringe to help your child take these smalls amounts can sometime be helpful. Pedialyte can be a good option in infants who are not tolerating breastmilk or formula. Older children can drink sugar free sports drinks or water. Once a child is tolerating fluids, it is OK to offer them a regular diet and see how they do.  Vomiting does not hurt your child, so don’t worry if they throw up after you give them more food.

A child with vomiting should be evaluated in the office if:

1. They are not able to keep down any liquids
2. They show signs of dehydration as listed above
3. They have vomiting AND severe abdominal pain, headache, or a stiff neck
4. They have vomiting AND have significant other medical problems such as diabetes or heart disease
5. They have dark green bile or blood in their vomit

Most children with vomiting will recover on their own as long as they stay sufficiently hydrated. Occasionally they will be treated with anti-nausea medication (i.e. Zofran) at the discretion of their doctor. As a general policy, we feel that any child who is sick enough to require medication is sick enough be seen by a doctor.  As such, we will not routinely prescribe Zofran without seeing the patient in the office first.