Welcome to our Helpful Hints Handout!

 

Poison Control TN 1-800-288-9999   GA 1-800-282-5846

 

Many problems that occur with children unfortunately occur after regular business hours.  We provide you this handout to cover most of the routine problems that can easily be handled without our intervention. Please remember that after hours calls should be for urgent and emergent conditions only.  Routine advice on formula, sleep habits, social problems, medication refills, head lice, pinworms, and minor colds are not emergencies and may delay us from getting to the truly ill child with a real emergency.  If you need answers but know that your call is not an emergency, your insurance company has a nurse line that will be able to answer your non-urgent questions.  We will, of course, be glad to help you with these issues during regular business hours.

 

Tummy viruses (nausea, vomiting, diarrhea)

The onset of a tummy virus is usually abrupt and almost always in the wee morning hours.  When your child begins to throw up repeatedly, stop any intake for about 1-1/2 hours.  When no vomiting has occurred for about 1 hour, start with ½ ounce of Pedialyte or Gatorade every 15 minutes for about 6 hours or so.  If your child is handling this volume well, you may advance the diet to 1-2 ounces every 30 minutes.  Again do this for about 6 hours.  If no further vomiting has occurred, you may start very small amounts of milk or formula, again every 15 minutes for 6 hours.  Your older child may then have toast or crackers and a broth diet.  Aim toward getting your child back to their normal diet in 48 hours.  Your child needs to be seen in the office, or if after hours, the emergency room at TCThompson’s Childrens’ Hospital if he/she continues to vomit repeatedly despite this protocol or if your child has severe abdominal pain.  Diarrhea is often frightening to parents.  However, it is rarely dangerous.  Diarrhea frequently lasts 7-10 days.  You need to call for an appointment if your child has more than 10-15 stools a day, is having severe diarrhea but refusing to drink for several hours, or if you see blood in your child’s stool.    We need to evaluate your child if he/she has had diarrhea for more than 10 days.  Signs of dehydration are cracked lips, decreased urination, marked decrease in activity, and excessive sleepiness. If you see these signs your child needs urgent evaluation in the office or the emergency department.  A playful child who is eating and drinking well does not need any intervention except avoiding juices that will make the diarrhea worse.  Sometimes adding lactobacillus (available at drug stores) to his/her food will slow down diarrhea.  The Academy of Pediatrics does not recommend the use of any anti-diarrheal products like Pepto-Bismal and Kaopectate.

 

Fever

Fever under 3 months of age with a rectal temp of 100.5 or greater is potentially very sick.  You need to call and come in immediately or proceed to the emergency room.  For children over 6 months of age, temperatures less than 103 can easily be managed at home by alternating Tylenol with Motrin every 3-4 hours.  This regimen should keep the fever less than 103 and the child relatively well appearing and playful.  You should contact us for any fever greater than 103 despite Tylenol and Motrin use, temperatures lasting more than three days, or if your child is still very ill appearing despite the use of Tylenol and Motrin.  Please refer to the dosing charts we have given you or the medication bottle for correct dosing of Tylenol and Motrin( ibuprofen).

 

Colds, Coughs, Sneezing, Runny noses

Colds and coughs drive parents crazy and make children miserable.  When do you as a parent need to worry about these symptoms?  When a child less than 3 months old gets a stuffy nose and a mild cough, mixing ¼ tsp salt in 1 cup sterile water will serve as a saline solution to help clear your child’s nasal passages.  Place 2 drops in one nostril and suction that nostril, compressing the other nostril to clean the airway.  Repeat on the other side.  You can repeat this process before feeds and before naps.  Small children with really horribly stuffy or runny noses may have RSV, a bad cold virus that can have serious consequences for your small baby.  If your child is less than 4 months and has a very stuffy or runny nose, please call for an appointment that day.  A child who has a runny nose for several days and no other symptoms usually has a simple cold that only time will cure.  Green nasal discharge, despite popular belief, does not mean your child has a sinus infection.  You should call during regular office hours for a thick runny nose that has lasted more than 10-14 days.  Cough that is severely interrupting your child’s sleep or eating patterns needs to be evaluated by us.  You will need to call for children who are having difficulty breathing, have difficult to control fever, and/or for ill appearing children.  For persistent coughing in children who do not have these concerns, call during regular business hours.  Unfortunately the AAP does not recommend any cold and cough medications for children under the age of six.  Relief of the symptoms and watching for signs of worsening or complications is the best we can do as parents.

 

Head Injury, Goose Eggs

Children frequently fall and bump their heads.  It usually takes a pretty significant blow to the head to hurt the brain.  Children who bump their heads and cry immediately are usually ok.  The child who loses consciousness needs to be evaluated in the emergency room.  For simple head injuries without loss of consciousness, you will need to observe for increasing lethargy (a child who is unable to wake up), huge changes in personality or irritability, or vomiting more than twice in the 24 hours following a head injury.  A child who bumps his head, cries immediately, takes a little nap and then wakes and plays normally the rest of the day is very unlikely to have a serious injury.  You will still need to wake the child with a head injury several times during the night to assure they awaken easily, recognize you quickly and act appropriately.  If you have any concerns about your child as listed above, please call the office immediately.

 

Diaper rash

Diaper rash can be quite painful for children.  Any diaper rash that does not clear quickly may need special attention.  Swish your baby’s bottom thru some lukewarm water to clean as opposed to wiping across the irritated skin.  Pat or blow dry the area, and then apply Lotrimin AF (found in the fungal foot section of the drug store) and cover it with a thick, thick coating of Desitin.  Reapply the Desitin as needed.  The trick here is to treat the rash as you would a burn….don’t rub over the healing skin, clean and protect it with medications.  Repeat this process 3-4 times during the day.  It is not uncommon for diaper rashes to have a small amount of bleeding but the diaper rash will resolve if you stick to this routine.  Call the office during routine office hours if this formula doesn’t work for you.

 

Sprains and Strains

Injuries are common in children.  A twisted ankle or wrist may just need some good basic first aid.  Ice the area 10 minutes on and 10 minutes off for the first few hours.  Elevate the injured area.  Start an anti-inflammatory agent (Motrin) to help with swelling and pain.  Check to make sure that your child can still feel fingers and toes, and that the area feels warm to touch and has a good blood supply.  This should keep your child very comfortable.  If pain persists and your child is very uncomfortable despite these measures, if the bone is obviously unnaturally bent or obviously deformed, he/she will need to be evaluated in the emergency room.  If your child is comfortable with these measures, call during routine office hours for an appointment.

 

Tick bites, Bug Bites, Stings, Poison Ivy

Parents frequently worry about tick bites.  The best medicine is clearly prevention with an approved bug repellent marked “family” or “kids.”  Once you find a tick on your child, remove it by pulling the skin as far apart as possible and using a pair of tweezers to pull the whole tick off.  The area can frequently be red right around the bite area for a few days, and frequently will itch.  You need to come in for a visit if your child develops a fever, a scattered rash, and appears quite ill the next few days after a tick bite.  You will need to be seen if your child develops a large red ring around the tick bite area at the site of a previous tick bite.

Bug bites frequently can cause large local reactions in children.  These areas occur almost immediately and are frequently characteristic of your child’s reaction to bites.  Oral Benadryl every 6 hours will help with the itching (1 tsp for 20 lb, 1 ½ tsp for 30 lb, and 2 tsp for 40 lb).  A topical anti itch medicine will frequently help, such as Cortaid.   If any of these areas look particularly red and angry, increase in size and redness and are accompanied by ill appearance or/a fever, your child needs to be evaluated.  Hornet, wasp and bee stings are also common during the summer months.  As long as your child  isn’t known to be allergic to the insect, simple application of a baking soda paste to the area will help take the “sting” out of a sting.  If your child is known to be allergic to the insect that stung him/her, administer your EpiPen and proceed to the emergency room or our office.  If your child has a huge local reaction (whole arm or leg swells), then please call for an appointment the next working day and avoid insects until that appointment.  Any respiratory distress in a non allergic child is very unlikely after a sting, but certainly requires emergency evaluation if it occurs.

Poison ivy is very common at different times of the year.  Any rash that may have been caused by something touching the skin will usually respond to the use of hydrocortisone cream applied several times a day.  Oral Benadryl will help with itching.  Repeated applications over several days may be necessary.  Occasionally your child may have a significant reaction that involves the face or that causes a large area of the body to weep and ooze.  Call during regular office hours for an appointment ion these cases.

 

Constipation

Children occasionally get constipated. If your child has not had a bowel movement in 3-4 days, has hard little balls of stool, or seems to strain all the time, you can give him a glycerin suppository (available at any drugstore behind the counter).  This will frequently solve the problem.  You may also want to add pear or apple juice for a short time to loosen the stools. If these remedies don’t solve the problem or if the problem keeps recurring, we need to evaluate your child.   If your child is in severe pain, having bloody stools, or has a more complicated picture than simple constipation, please let us know.

 

Web Addresses

Parents get a lot of advice, whether you want it or not.  Our website contains links that can assist you with your health questions  We follow the American Academy of Pediatrics guidelines.  Other websites that provide reliable information are www.aap.org, www.cdc.gov, www.erlanger.org/housecalls. 

                                                    

After Hours Calls

Due to the large volume of after hour phone calls of a non-urgent and non-emergency nature, we ask that you limit your after hours calls to urgent and emergency situations only.  We will no longer be able to refill medications after hours except emergency rescue inhalers.  We will no longer be able to call in medications after hours for routine, non urgent problems like head lice, pinworms, earaches, swimmers ear, low grade fevers in non ill appearing children, etc.  Please call during regular business hours to discuss discipline, sleep problems, feeding/formula problems, etc.  Please use this handout and the listed website, and/or your insurance company’s nurse line for non urgent or non emergency calls.  Please check the back of your insurance card or try these numbers for non urgent/emergency questions.

 

AETNA:  800-238-6299

BLUECROSS/BLUESHIELD:  866-904-7477

BLUECARE(BCBS):  800-262-2873

CIGNA

HUMANA:  800-622-9529

JOHN DEERE HEALTH:  800-237-4936

 

Parents get a lot of advice, whether you want it or not.  Our website contains links that can assist you with your health questions  We follow the American Academy of Pediatrics guidelines.  Other websites that provide reliable information are www.aap.org, www.cdc.gov, www.erlanger.org/housecalls. 

 

 


 



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