Advanced Pediatrics: Vision Values Health

Abdominal pain, or stomach ache, can:

Be mild and chronic
Occur suddenly and be so severe your child cannot stand up
Be somewhere in between.

Sudden severe stomach pain is the most likely kind to need immediate evaluation either here at the office or at the ER after hours.

The diseases and problems that cause stomach aches are many. To helps us figure out what is wrong, keep a log or journal about the stomach aches. Things to observe and include in this log are:

How often the pain occurs
Where the pain is located in the stomach
Note if the pain is worse or better on a full or empty stomach
Note any vomiting, diarrhea, constipation, or weight loss

To help you decide what to do lets first decide if it is chronic (longer than a week) or acute (sudden or less than a week)

chronic

A stomach ache that has been going on for a few months or more would be considered chronic. You may notice that the pain may be on and off or related to eating. The most common reasons for chronic pain are constipation, food intolerance, and heartburn or reflux. We can help with these problems and an office visit is a good idea.

acute

Acute pain is one that has started in the past few days or hours and is progressively worsening. There may be some vomiting and the pain clearly keeps your child from running around and being active as usual. At home you can push on their stomach and if it hurts a lot in any one spot or all over, you will want to call us or after hours, go TO THE ER for an evaluation.

Some possibilities that cause acute pain are

Appendicitis. Right-sided pain often with disinterest in eating, fever, and/or vomiting.
Bowel obstruction. Vomiting, no stool, severe pain.
Intussusception. Severe pain alternating with lethargy.

TO TRY AT HOME
For chronic abdominal pain, a trial off of dairy is helpful to determine if your child may have lactose intolerance. Also, if you keep track of their bowel habits, this could give us information about constipation. You would want to document how often your child has a bowel movement, if it is watery or hard, painful, or if there is any bleeding after stooling.

TO CALL US OR BRING TO THE OFFICE
Acute abdominal pain should be seen in the office. For chronic pain, an evaluation should be scheduled and we can try to determine the cause.

TO THE ER
Children with acute abdominal pain (sudden and severe) should be seen in the ER if the office is closed. You can call us to help you make a decision about where and when to go.

Allergies range from mild with nasal congestion and itchy eyes all the way to a serious anaphylactic reaction with difficulty breathing and throat constriction. Allergies are caused by foods, medications, pets, outdoor pollens, grasses, and many other things.

If your child has itchy eyes, congestion, or cough, they may have seasonal allergies to grass and pollens. These symptoms can also caused by allergies to pets, dust, and foods.

If your child develops a sudden allergic reaction with swelling of the eyes, lips, fingers, or any difficulty breathing or itchy throat, they need to be seen right away either at our office or at the ER after hours. This type of reaction is usually to foods, medications, or bee/wasp stings.

Food allergies may also be noticed in infancy with eczema (dry bumpy skin rash) or chronic congestion or chronic cough. The best way to improve these allergy symptoms is to identify and stop the offending food. We can allergy test in our office or we can refer to an allergy specialist to help identify which things your child may be allergic to.

TO TRY AT HOME
To decrease the exposure to the environmental allergens in the summer, keep windows closed at night and use the air conditioner to filter out allergens inside the house. Over the counter Claritin or Zyrtec are daily, non-drowsy allergy medications. Over the counter NaphconA is a topical antihistamine eyedrop that is usually quite successful in making itchy eyes better. Avoid pets or foods that are known to cause allergy symptoms.

TO CALL US OR BRING TO THE OFFICE
We can do allergy skin testing in our office to help identify what your child is allergic to. We can also prescribe other allergy meds such as eye drops, nasal sprays, or inhalers depending on the symptoms we are trying to treat.

TO THE ER
A severe allergic reaction is one in which the reaction goes beyond discomfort towards potential harm, such as a serious threat to breathing or blood pressure. This is suspected if you see serious lip or extremity swelling, tongue or throat swelling, or difficulty breathing. This could be in reaction to a food, bee sting, or medication. Immediately call 911 and while waiting for the ambulance, you can give Benadryl orally and use an epi-pen if you have one.

Asthma causes a cough that can be barky and dry and constant, or juicy and wheezy. This cough is usually triggered by colds or allergies which cause inflammation of the breathing tubes followed by their constriction.

TO TRY AT HOME
If your child has had these symptoms before and you have inhalers or a nebulizer at home, these are the 2 key treatments:

Pulmicort (or flovent) is an inhaled steroid. It is a preventative medication and is used twice a day when a cold and cough begin to help decrease asthma symptoms. It tackles the inflammation of the breathing tubes that starts the whole process.
Albuterol (or xopenex) is a bronchodilator. Use it as often as every 2-4 hours to help with the acute symptoms like cough and difficulty breathing.

TO CALL US OR BRING TO THE OFFICE
If you do not have these medications yet and you believe your child is having a bad cough, wheezing, or difficulty breathing, we can listen in the office to the chest and help decide if these medications would be beneficial. We can also rule out other serious cough related illnesses like pneumonia.

TO THE ER
One of the signs of breathing problems with asthma is retractions. This is when the skin seems to suck in and out of the ribs or in the neck. This means that your child is using their muscles to help them breathe. Another sign of breathing problems is a fast breathing rate. You can count their rate for 1 minute and if it is greater than 60 breaths/minute that is too fast. So, if your child's cough has been getting worse and you see these symptoms, it may be time to go TO THE ER for an evaluation. There, they can receive more breathing treatments, steroids, and if necessary, oxygen. Again, call us to help you make a good decision.

One of the scariest things is to see your child having difficulty breathing. Breathing difficulties range from a bad cough to shortness of breath and could be caused by a number of reasons, usually stemming from a cold or a virus.

Statistically speaking, most breathing problems - while uncomfortable for your child and painful for you to watch - are not particularly dangerous in the long term. In time they will end. In the short term, treating the symptoms may be the most that can be done. Over the counter cough medications have not been proven to be helpful and we don't recommend their use. To help decrease the nighttime cough, try a cool-mist humidifier. For children over age 1, honey will soothe the throat. It can be mixed with warm milk or tea.

But all breathing problems have the potential to be serious and should always be observed closely. The time to worry is if your child is struggling to breathe. Some signs of this are:

A breathing rate greater than 60 times/minute. It is best to measure when they are at rest and not crying.
Using their chest wall to help them breathe and you see the skin tugging in at the ribcage (retractions).
If they seem out of breath and gasping.
If they have persistent vomiting with their cough.

If any of these symptoms occur, it is time to call us. Or if worrisome enough and it is after hours, you may call 911.

A common childhood virus is croup (parainfluenza virus). This virus causes swelling of the vocal cords and can produce difficulty breathing, especially in infants and young children. This can begin suddenly as a barky cough that is usually worse at night or in the early hours of the morning. It sounds like a seal barking or a foghorn; or as a loud whistling sound (known as stridor) that occurs during inspiration and/or expiration.

TO TRY AT HOME
The quickest fix is to take your child either outside into cold air or into a steamy bathroom. This shrinks the swelling of the vocal cords and improves the stridor and cough.

TO CALL US OR BRING TO THE OFFICE
We can prescribe steroids for croup. This can be done at night if you call and have an open pharmacy to use. In the office we will listen to your child breathing to rule out more serious lung problems, like pneumonia.

TO THE ER
If you think your child is having a lot of trouble getting air in and out of their chest, you may need to take your child to an ER where they may receive steroids and a breathing treatment of racemic epinephrine. Of course, call us to help make a good decision. Infrequently, a child may need to spend the night in the hospital if their croup symptoms are severe.

Vomiting, diarrhea, and/or fever are symptoms of gastroenteritis, or stomach flu. In a typical stomach flu virus, your child may throw up off and on for 1 to 3 days.

TO TRY AT HOME
During this time, encourage small sips of liquid - 1 tsp every 5 minutes - until the vomiting has improved. This is a very powerful strategy since 1 tsp of liquid is absorbed before it hits the retching stomach. One tsp every 5 minutes puts 16 ounces every 8 hours into the system, which is more than enough to prevent many bouts of dehydration. Once the vomiting has stopped (none in 12 hours), you can offer bland foods such as rice, cereals, toast, bananas, noodles. If vomiting resumes, restart a liquid diet and try food again the next day.

TO CALL US OR BRING TO THE OFFICE
Diarrhea can last up to 10 days and at first can be many times per day, but will start to decrease in frequency. If diarrhea is bloody or lasts more than 10 days, we may need to check the stool for bacterial or parasitic infections.

TO THE ER
Dehydration can occur with stomach flu. The key indicators of dehydration are a sharp decrease in urination and a wilted look to your child, such as sunken eyes, dry cracked lips, or a limp look. In the ER, your child can receive fluids through an i.v. to rehydrate them.

Ear pain is one of the most common childhood problems. It may be hard to tell in a baby that their ear hurts but an older child may be able to tell you about their ear pain.

1. Middle ear infections

This infection usually follows nasal congestion from a cold or allergy. Middle ear infections are small boils in the eardrum that sometimes come to a head and drain. When this happens, you will notice fluid coming out of the ear. Bursting and draining usually relieve the pain from the fluid pressure. The hole heals on its own in about a month. When bursting and draining occur, we like to treat the ear infection with eardrops and if need be, oral antibiotics.

TO TRY AT HOME
If you suspect your child has an ear infection, you can give them pain relievers like Motrin or Tylenol until they can be seen in the office.

TO CALL US OR BRING TO THE OFFICE

If your child has ear tubes, an ear infection will often look like ear drainage without the usual pain and fever. If this occurs, we will prescribe ear drops and, if need be, oral antibiotics.
If your child has had a cold or congestion and then seems very fussy or complains of an earache we can look at their ears in the office.
If you see any pus or discharge from the ear, you can call us and we can prescribe eardrops that evening and then see your child in the office to fully evaluate the ear.

TO THE ER
Ear infections do not need an emergency evaluation unless you are out of town and cannot be seen by us. Motrin and Tylenol will help the pain until we can see your child in the office in the morning.

2. Outer ear infection

Also known as swimmer's ear, outer ear infection occurs from bacteria growing in the outer ear canal. The bacteria can come from any water source, pool, lake, or ocean. This ear pain is usually sudden and it may hurt to pull on the outside of the ear.

TO TRY AT HOME
Pain relief with Motrin and Tylenol can help until your child can be seen in the office.

TO CALL US OR BRING TO THE OFFICE
Swimmer's ear is diagnosed by looking in the ear canal. We can prescribe antibiotic ear drops in the ear canal is infected.

TO THE ER
Swimmer's ear infections do not need and emergency room evaluation unless you are out of town and cannot be seen by us.

Lice is a very common childhood problem and is caused by a parasite. It spreads easily from person to person and often goes around a classroom or daycare. Having lice does not imply poor hygiene or a dirty environment. It can happen to anyone. Lice like to live on the scalp; they cause no serious disease.

Lice look like tiny black bugs in your hair and lay eggs that look like sticky dandruff. The way you can tell the difference is that the eggs stick to the hair shaft and are not only on the scalp; dandruff is flaky and does not stick to the hair.

TO TRY AT HOME
There are many treatments available for lice but the one we prefer is with Cetaphil cleanser. Please see the link below for a detailed description of how to use the Cetaphil. After you treat your child you can clean their sheets in hot water. For stuffed animals or things that you cannot wash, enclosing them in a plastic bag for 3 days is sufficient to kill lice on them. You can repeat this procedure in 1 week to be sure you have killed any new lice that may have hatched from eggs that remained.

http://www.nuvoforheadlice.com/method_explained.htm

TO CALL US OR BRING TO THE OFFICE
If you are not sure your child has lice, we can look at the scalp in the office to help diagnose it. Also, if your child has bald patches in the scalp or additional scalp problems, we can evaluate in the office.

TO THE ER
There is no need for ER evaluation of lice. You can call us any time and we can explain the treatment to you.

The symptoms of pinkeye are itchy red eyes, with or without pus or discharge. This is a common childhood problem and schools and daycares will often not let children back until they are treated. Pinkeye is a minor illness and does not cause eye damage or have any long term consequences. In fact, most pinkeye will go away on its own in a week even if left untreated.

There are 3 types of conjunctivitis and only one benefits from antibiotic eye drops:

1. Bacterial pinkeye. Looks like red, itchy eyes with pus and crusty drainage seen especially in the am with waking. This type of infection responds well to antibiotic eye drops and we can prescribe those for your child.
2. Viral conjunctivitis. Has red eyes without any drainage or crust and often is associated with a cold or viral illness. This type of pink eye does not require eyedrops and will resolve when the cold does.
3. Allergic conjunctivitis. Has red, itchy eyes often associated with other allergy symptoms like congestion and cough. There are 2 allergy eyedrops (Patanol and Zaditor) we can prescribe for your child.

TO TRY AT HOME
For any itchy pinkeye you could try over the counter rewetting drops for the eyes or cool compresses on the eye for comfort.

TO CALL US OR BRING TO THE OFFICE
If your child's eye is red and has crust and discharge it is probably bacterial pinkeye and we can prescribe antibiotic eye drops. If your child's eye is red and itchy and associated with allergy symptoms, we can prescribe antihistamine eye drops like Patanol or Zaditor.

TO THE ER
Conjunctivitis does not need ER treatment since you can always call us for treatment. However if your child's eye would suddenly become very painful and your child is unable to look into normal light (photophobia) or has excessive tearing, they may need to be seen by an eye doctor. If this occurs after hours or on a weekend, call us first and we can help you decide if the ER would be a good option.