General Information

This page is for patient education. The topics discussed below, while not exhaustive, are often areas of concerns for parents and their children. Should you need an appointment or speak to Dr. Raley afterhours, please call 398-7170.

Usually defined as a temperature of 100.5 or greater. ( I recommend taking the temperature either rectally or using a temporal scanner thermometer in babies under 12months, then either the temporal or ear thermometer for kids over a year.)

In most cases, fever is usually caused by a viral or bacterial illness and is the body's "appropriate" response to the infection. While this causes fear in many parents, unless your child is under 2 months of age, a fever can be treated at home with Tylenol for babies under 6 months, and Ibuprofen for babies and children 6 months and older. (See dosage chart)

For all babies under 2months, any temperature of 100.5 or greater deserves a call to our office 24 hours a day.

For kids 2 to 6 months, temp of 102 or greater, please call the office. For kids over 6months, unless your child is lethargic, most fevers can be treated with Ibuprofen and see how your child responds. If the fever persists more than 24 hours or there are other symptoms present, please call for appointment.

As many of my patients have heard in the past, I am more concerned about how the child looks with a fever, rather than the height of the temperature itself. There is not necessarily a maximum height that needs to have immediate attention-unless your child is under 2 months.

Many parents think that a high temperature will cause "brain damage." This is not true. It is possible to have brain injury from "environmental heat stroke-very hot days with strenuous activity, but not from a temperature associated with an illness. About .5-1 % of all children may have a seizure associated with a high fever, but this cannot be predicted based upon the height of the fever and is often thought to be related to the rapid rise in the fever and if there is a family history of seizures with fever.

Almost all cases of vomiting and diarrhea are caused by virus and are usually self limiting in duration. However, some kids may become dehydrated and the following is a guideline to help parents deal with both.

Vomiting with out diarrhea: It is unusual for children to become severely dehydrated from vomiting alone. However, it is very stressful for the parents and child. It is important to let the stomach "rest" and after each episode of vomiting to not allow your child anything by mouth for a least one hour (no matter how thirsty they look or how much they beg). After they have had one hour without vomiting, you can begin to give them small amount of fluid. Use the following guideline depending on the age of your child:

Less than 12 months: 1 tsp of Pedialyte every 5- 10 minutes. If tolerated for 1 hour can double the amount. If your child continues to do well you can resume ½ strength formula feeds or breast feeding every 3-4 hours. Gradually increase the amount as tolerates. I would suggest holding off on food until the following day.

Over 12 months: ½ ounce of either water, pedialyte or Gatorade every 5 to 10 minutes. May slowly increase the amount as tolerated. Same guideline as above on foods.

Diarrhea only: If your child has diarrhea without vomiting, you can feed them as your normally would. I would avoid all juice products and fruits and try and increase the amount of protein in the diet. The traditional BRAT diet is high in carbohydrates and can actually increase the volume of diarrhea. If your child has a high fever or blood in the stool, you need to call the office. Also it is much easier to become dehydrated from diarrhea-please try and monitor the amount or urine your child has, as this is a good indicator for hydration status.

Most coughs are either caused by viral illness or allergy symptoms. Coughs tend to worsen when your child is lying down due to the drainage from the upper airway. OTC meds such as benadryl and dextromethorphan may provide some symptomatic relief-see dosage of common medications.

If the cough lasts longer than 3-4 days or is associated with difficulty breathing and/or fever, I need to see your child.

Croup is a type of cough that often affect children of all ages usually in the early fall and spring. The cough is a characteristic bark that sounds like a walrus or goose. It is often associated with an inspiratory sound that is frightening to both child and parents. You can be reassured that your child is not going to stop breathing or that the airway is going to close off-it just sounds that way!. Unfortunately croup usually occurs in the middle of then night. The best things to do are to comfort your child, then to "steam" up the bathroom and place your child in the bathroom for 5- 10 minutes then go outside in the cool night air. Usually after steam and cool, your child will calm down and be ok for the rest of the night. You should call the office in the am for an update. If they continue to be "croupy" despite steam/cool, please call the office immediately.

Most children will have a decent reaction to mosquito bites. The area will be red, hard and vary in size from pinpoint to a dime/quarter size. This is usually just a local reaction and will respond well to OTC hydrocortisone cream 1%, motrin and cool compresses. If you notice red streaks, rapidly enlarging lesions, or fever, you should call the office for appointments. Insect stings will have a more significant local reaction, and your child may need benadryl for the itching. If your child begins to swell on other parts of the body not close to the sting site, please call the office.

These little disgusting creatures sure provoke anxiety for both parent and physician alike. MOST of the time tick exposure is nothing but a nuisance. Grab the ticket at its base with tweezers and with firm gentle traction, slowly pull the tick off. It may take a little while for the tick to release, so be patient. After the tick is gone, apply Neosporin to the site. There may be a small red bump at the site for a few days.

It is important to check your child each night, including their hair, for ticks. Very rarely children will develop a fever after a tick exposure. Most of the time this is related to another viral illness instead of the tick exposure, however, you should call the office for an appointment if the fever is greater than 101 and/or associated with a rash, headache or body aches.

Ear infections either middle ear infections (Otitis media) or outer ear infections, ie: swimmer's ear, (Otitis Externa) are the most common causes of ear pain in children.

Otitis media is usually associated with low grade fever, runny nose, cough and congestion. Typically your child will be fussy and may pull on their ear.

Otitis externa or swimmer's ear is mainly in kid 5or 6 and above. This is from spending a lot of time in either the swimming pool or lake. The child will have severe pain, especially when touching the ear. The other symptoms associated with Otitis Media are usually absent. Parents can help prevent swimmer's ear by flushing out their child's ear (AS LONG AS YOUR CHILD DOES NOT HAVE EAR TUBES!) with a solution of ½ rubbing alcohol and ½ white vinegar after swimming.

WARTS

There are two common types of warts found in kids. Typical warts on hands, knees, feet, and very small little bumps/warts on trunk of younger children called Molluscum Contagiosum. Both of these types of warts will usually spontaneously resolve, however this may take up to a year. Some OTC meds will help but are not usually very effective. Some parents have had luck with using "duct tape". The areas of the warts are soaked in water and the tape is applied and left on over night. The family can then try and file or trim down the wart (pain allowing), each day. This needs to be done for at least 1 month.

There are multiple different causes of diaper rash, however most are either yeast or irritation from having stool or urine in contact with the skin. To help prevent both, try changing the diapers as often as possible and using a barrier protectant of either Vaseline or aquaphor every time the diaper is changed. Allowing the skin to air dry-while can be messy!- is often effective.

This the greasy, white, yellowish flaky stuff on the scalp. It is similar to adult dandruff. OTC 1%hydrocortisone applied to scalp after the bath and/or selsun blue (do not get into eyes) a couple of times a week may help. This type of rash may also be found under the neck, in the axilla and in the diaper creases of really fat babies.

This is a poorly understood behavior found if babies usually around 2 weeks to about 4 months. Babies tend to be very fussy usually at clearly defined times. Most often will be in early evening. There is usually a lot of crying and parents will report that their babies are inconsolable. Colic is often associated with gas pains and changing formulas or trying OTC mylicon (gas) drops does occasionally help. Other comforting measures like the swing, singing to your babies, a sound machine or driving in the car will also help to soothe some babies.

This can be very frustrating for some families. Please call the office if you feel you baby is excessively fussy.