Infant and Child Health

Childhood Rashes

2009-06-27T22:04:00.000-07:00

Childhood Rashes
Rashes that come with childhood illnesses are hard to tell apart. Review all symptoms before deciding what to do
Description	Possible Illness
Red, pimple-like spots that turn to blisters; fever	Chickenpox
Rash in diaper area only	Diaper Rash
Red rash on face that looks like slapped cheeks; pink rash on torso that comes and goes; possible fever	Fifth Disease
Red or pink dots on head, neck, shoulders; more common in infants	Prickly Heat
Sudden high fever for 2 3 days followed by rose-pink rash on torso, arms, and neck after fever goes down	Roseola
Fine pink rash; starts on face and covers whole body; swollen glands behind ears	Rubella (rare)
Fever, runny nose, hacking cough; red eyes 2 3 days before spotty red rash covers whole body	Rubeola (measles)(rare)
High fever, sore throat, and papery rash, and raspberry-textured tongue	Scarlet fever

Chickenpox

2009-06-27T21:52:00.000-07:00

Chickenpox

Chickenpox (varicella) is a relatively minor illness. Almost all children will get it. The first couple of days, your child will be in generally ill health, with a cold, cough, fever, and abdominal pain; then a rash of red, pimple-like spots appears. A child may have just one or two spots, or the rash may cover the entire body, including the throat, mouth, ears, groin, and scalp.

The spots turn into clear blisters that become cloudy, break open, and crust over. This rash itches a lot. Spots continue to appear for one to five days and subside over a week or two.

Chickenpox is very contagious. After exposure, symptoms occur in 10 days to 3 weeks. It is contagious for one to two days before the rash appears and for up to five days after the spots appear. Children can generally return to school or day care when all the spots have scabbed, or on the sixth day after the rash appeared. Encephalitis is a rare complication of chickenpox.

Prevention

The chickenpox vaccine can be given to children age 12 months and older, and to teens and adults who have not had the illness. It is especially important to immunize teens and adults who have not had chickenpox, because the disease is more severe in adulthood.

Adults who have not been vaccinated and who have not had chickenpox should avoid exposure to children who have it and avoid exposure to people who have shingles. Pregnant women who have never had chickenpox and have not been vaccinated should also avoid exposure, since the illness can harm the developing fetus. The vaccine cannot be given during pregnancy.

Home Treatment

Use acetaminophen to relieve fever. Do not give aspirin to children and teens under age 20 who may have chickenpox because aspirin use is related to Reye's syndrome.

Control the itching. Oral Benadryl and warm baths with some baking soda or Aveeno colloidal oatmeal added to the water will help. Avoid Benadryl creams because the medication can build up to toxic levels in the body.

Cut the child's fingernails to prevent scratching. If scabs are scratched off too early, the sores may become infected.

When to Call a Health Professional

If your child is at risk of complications from chickenpox (is taking steroid medications or cancer chemotherapy, or has a weakened immune system).

If a child age three months to three years has a fever of 103° or higher for 24 hours.

If severe itching cannot be controlled by Benadryl and warm baths.

If bruising appears without injury.

If sores appear in the eyes.

If you notice signs of encephalitis:

Fever, severe headache, and stiff neck
Unusual sleepiness or lethargy
Persistent vomiting

Bed-Wetting

2009-06-26T23:50:00.000-07:00

Bed-wetting (enuresis) in children who have never been dry is common, and most children will outgrow it by about age six to eight. In almost all cases, it is really not a disease, but rather a normal variation in development.

In some cases, a child who has been dry for several months or longer may begin bed-wetting again. This may happen without a clear cause, or may possibly be due to a urinary tract infection or to emotional problems.

Home Treatment

There are a number of ways to deal with bed-wetting that don't require medication. Ask your doctor for advice in managing bed-wetting until your child outgrows it.

Do not punish, embarrass, or blame the child.

Remind the child to get up during the night to urinate. Providing a bedside potty chair and night light may help.

Let children over age five take control of the problem. Help them learn to wake themselves at night to go to the bathroom. Set an alarm for three to four hours after bedtime, and make sure the child has to get out of bed to turn it off.

Do not force a child to wear diapers at night. However, some children may be more comfortable wearing adult diapers such as Attends or Depend. Waterproof, extra-absorbent underwear or thick pads to protect the mattress may also help avoid daily bed changes. Wash them with one-half cup of vinegar to eliminate odor.

When to Call a Health Professional

Your doctor can rule out or treat any physical causes of bed-wetting and help you and your child manage the problem.

If bed-wetting occurs with painful or burning urination or other signs of urinary tract infection.

If prevention and home treatment are not successful after four to six weeks in a child older than six.

If bed-wetting becomes more frequent or severe.

If bed-wetting occurs in a child who had previously been dry for several months.

If bed-wetting occurs with soiling of the underwear with bowel movements after age three.

If a child over age three has daytime bladder control problems.

Infant and Child Health

2009-06-21T13:09:00.000-07:00

My mother had a great deal of trouble with me, but I think she enjoyed it.

Mark Twain

When your child gets sick or hurt, you are usually the first person to provide care. Your calmness, confidence, and competence in caring for your children's health problems will help them enjoy healthy childhoods and learn the importance of self-care for their own use as they mature.

Facts About Infants and Young Children

The following brief notes are of particular concern to parents. This information may help dispel some unnecessary fears and give you some guidance.

Child Car Seats

Infant and child car seats save lives. Many states require them for all children
under age four and those weighing less than 40 pounds. Children who are not in car seats can be seriously injured or killed during crashes or even abrupt stops at low speeds. For maximum safety, follow the manufacturer's recommendations for
car seat use.

All children under age 12 should be in the back seat, especially if the car has
airbags.

Infants under 20 pounds: Use an infant car seat that reclines and faces the rear. Check the manufacturer's instructions.

Infants and children over 20 pounds: Use a toddler seat that faces the front and has a shield or harness. Some infant seats can be converted into toddler seats.

Children over age four and over 40 pounds: Use a booster seat that raises the
child so he or she can see out of the window. Use regular lap and shoulder belts. Adjust the shoulder belt to fit across the shoulder, not the neck.

Set a good example for your children by always wearing your own seat belt, and
always insist that they buckle up.

Umbilical Cords and Bellybuttons

Clean the bellybutton (navel) three or four times a day with a bit of cotton moistened with a little rubbing alcohol. Pull the cord up gently but firmly to clean the base (try to avoid getting alcohol on the skin around the navel). Swabbing the bellybutton with alcohol will help it to dry and prevent infection.Keep the cord dry and do not give a tub or pan bath until the umbilical cord has fallen off and the navel is healed. Fold diapers below and shirts above the cord
to promote drying.

The umbilical cord will drop off and the navel will heal in one to three weeks. After the cord comes off, there may be a moist or bloody oozing for a few days, less than the size of a quarter, between diaper changes. This does not need special treatment.

Call your doctor if there is redness or swelling around the navel or a large amount of foul-smelling discharge from the navel.

The appearance of the bellybutton is not affected by the way the cord is tied off. A small nodule of tissue sometimes remains after the cord falls off. If it is small, no treatment is usually needed. If it is larger or persists longer than two weeks, call your doctor.

Breast-Feeding

Breast milk is the ideal food for babies younger than four to six months. The American Academy of Pediatrics recommends that babies be breast-fed for the first year of life. Although breast-feeding is best, babies can also get good nutrition from formula.

Breast-feeding has many advantages for both baby and mother. Breast milk contains substances that help your baby resist infections and other diseases. It protects against allergies and asthma and also is easier to digest than formula. Breast-fed babies have fewer colds, ear infections, less diarrhea, and less vomiting.

Some instruction helps ensure that you can breast-feed successfully. Try to take a breast-feeding class. The La Leche League and the Nursing Mother's Council are other good sources of breast-feeding information, advice, and support.

Nursing mothers need 500 calories per day more than they needed before becoming pregnant. Although you don't need to drink milk to make milk, extra calcium and protein are important, and your doctor may prescribe a vitamin supplement. Avoid smoking and drinking alcohol, and limit caffeine to one or two
beverages per day. Do not take any medication while breast-feeding unless it was prescribed by a health professional.

Circumcision

Circumcision is surgery to remove the foreskin of a newborn boy's penis. About 60 percent of boys in the U.S. are circumcised, down from over 80 percent in the late 1970s.

There are both benefits and risks associated with circumcision. Discuss the risks and benefits with your doctor. The decision is entirely up to you.

The major benefit is that circumcision makes it easier to keep the penis clean. Cleanliness reduces the risk of developing urinary tract infections.

The risks of circumcision are slight. Complications of local infection or bleeding occur in about one in every 250 cases. Local anesthetic will reduce the pain of circumcision. Generally, circumcision is not recommended for a sick infant.

After circumcision, apply petroleum jelly liberally to the head of the penis at each diaper change to prevent the scab from sticking to the diaper. Wash the penis by dripping warm water over it (do not use alcohol or baby wipes). Pat dry with a soft towel.

If the circumcision site is red, apply an antibiotic ointment (Bacitracin or Polysporin). Call your doctor if the redness extends down the shaft of the penis.

If you choose not to have your son circumcised, clean the exposed foreskin gently during the first four years. Starting around age four, gently begin to retract the foreskin. Do not forcibly retract the foreskin; it may not be fully retractable until puberty. Teach your son to wash his penis well at every bath and to gently retract the foreskin when possible and clean beneath it.

Toilet Training

Every child has a unique timetable for becoming toilet-trained. Most children are ready to begin toilet training between age 18 and 36 months. Look for these other signs of readiness in your child:

Understands words referring to bowel movements and urination.

Recognizes the sensation of a full bladder and the urge to have a bowel movement.

Knows what the toilet is for and has watched others use it.

Prefers clean, dry diapers to soiled ones.

Understands that using the potty means having a dry diaper.

If you think your child is ready to begin toilet training, the following tips may make it go more smoothly:

Get the child a potty chair. Make sure the child's feet can rest on the floor or on a footrest. Encourage the child to sit on the chair at least once a day at about the same time each day. Let the child use the chair for looking at books or watching TV.

After the child has had a bowel movement in a diaper, put him or her on the chair, and put the contents of the diaper in the pot.

Once the child is interested, let the child play for short periods without a diaper and have the chair nearby. Encourage the child to use the chair if he or she needs to "go potty."

Reward every success with hugs and words of praise. Relapses are common in the first few weeks, but don't scold or punish when the child forgets. Keep a casual attitude.

Bladder control may take longer than bowel control. If the child is aware of a full bladder, try putting him or her on the potty every 30 to 60 minutes. Praise the child for success and give gentle encouragement when the child wets his or her pants.

Sleep Habits

Babies have both deep and light sleep cycles. In each sleep cycle, there are 60 minutes of light sleep, 60 to 90 minutes of deep sleep, and another 30 minutes of light sleep. At the end of this cycle, the baby is semi-alert and can be wakened easily.

Parents can help the baby sleep through the night by helping the baby learn to soothe him- or herself back to sleep during the light sleep cycles.

For infants (birth to 2 months):

Put the baby in the crib when he or she is drowsy but awake.

Make middle-of-the-night feedings short and boring.

As the baby gets older, delay the middle-of-the-night feeding, and discontinue it sometime after age four months.

It appears that it is safer for a baby to sleep on his or her back or side to prevent sudden infant death syndrome (SIDS). Do not force a baby into a sleeping position. Babies are capable of moving themselves.