(763) 236-2700

When are antibiotics needed?

• Responsible for most coughs, congestions, sore throats, and runny noses (clear, yellow, or green mucous), cold symptoms may last up to two weeks. Antibiotics do not help in treatment or prevention.

• Colds or allergies may create fluid behind the eardrum which might become infected with bacteria, causing an ear infection. In most cases, antibiotics help cure the infection, but do not help remove the fluid present.

• Strep throat is the main sore throat that requires antibiotics. Most do not.

• Sinus infections are diagnosed by x-ray or when some coldlike symptoms seem to last longer than two weeks without improvement. Antibiotics often are helpful.

• Coughs can have viral, bacterial, allergic, or asthmatic causes. Antibiotics cure only bacterial kinds.

• Viral infections can weaken the body and lead to bacterial infections. If symptoms seem to last a long time or seem to change or worsen, please call us to arrange an office visit.

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What are the guidelines for car seats?

Minnesota state law requires that children under the age of four be restrained in an appropriate, federally approved car seat or booster seat. Car seats must be installed and used according to manufacturer's instructions. The law also requires that infants under one year of age and weighing less than 20 pounds must ride in a rear-facing car seat.

• A rear-facing car safety seat must not be placed in the front passenger seat of any vehicle equipped with a passenger-side front air bag.

• A convertible safety seat, which is positioned reclined and rear-facing for a child until at least 1 year of age and at least 20 pounds, as semi-upright and forward-facing for older children up to 40 pounds, should be used as long as the child fits well (ears below the top of the back of the seat and shoulders below the seat strap slots).

• A booster seat should be used when the child has outgrown a convertible safety seat but is too small to fit properly in a vehicle safety belt (60 to 80 pounds).

• The state of Minnesota suggests that compliance with car seat safety law is a minimum safety standard, and suggests that children remain in a booster seat to 80 pounds and remain in the back seat until age 13.

It is necessary to properly secure the child in the seat and the seat in the vehicle.

Tip

Check with your local fire department for dates and times of car seat safety clinics to have their child’s car seat inspected free of charge. A certified car seat safety technician inspects the child's safety seat and makes necessary adjustments so the seats are properly installed to protect children in the event of a crash. The technicians also answer parents’ questions or concerns about car seat safety.

For more information, check out Minnesota's Child Passenger Safety Program.

When should I worry about a cold/croup?

Normal colds

In their first year of life, children average 6 to 10 colds, with each illness lasting up to two weeks long. The symptoms of this viral infection include coughing, stuffy or runny nose, irritability, fever, poor appetite, and restless sleeping. Because "colds" are caused by a virus rather than bacteria, antibiotics are not effective against them. Antibiotics are given only for complications such as ear infections or pneumonia.

Home treatment includes measures to keep the increased mucus (phlegm) moist and loose and to keep the child as comfortable as possible. We encourage parents to give larger amounts of clear fluids (Infalyte^®, juices, Kool-aid, or water) if the child seems to gag on formula or breast milk.

We may recommend the use of cool vaporizers to increase humidity in the air for two or three days. These vaporizers should be used in the baby's room for naps and all night. Keeping the door partially closed will help the humidity stay in the room. Remember to empty and scrub the humidifier well every few days.

Coughing is a reflex measure to help the body rid itself of extra mucus, and therefore, can be helpful, unless the child coughs so hard that it results in vomiting or completely disrupts sleep. Coughing accompanied by a very runny nose may be caused by mucus dripping down the throat. (This is the type of cough that is frequently worse when the child lies down.) Older children and infants with this type of cough may benefit from the use of a decongestant and elevating the head of the bed/crib 20-30˚. A parent may also try 1 to 2 saline nose drops, then suctioning with a bulb syringe.

If you feel that your child might benefit by the use of a decongestant or expectorant, please call during clinic hours if you need further advice.

Croup

Croup can be caused by either a virus or by bacteria and can be very serious. This infection causes narrowing of the airways (tubes) leading to the lungs. Croup can come on very quickly.

Symptoms include very noisy breathing and a barking “seal-like” cough, usually with some fever.

The first line of treatment includes high humidity, which can be achieved in the bathroom with the door closed and a hot shower running or sitting next to the vaporizer. If this fails, sometimes several minutes of breathing cold, outside air is helpful.

Fever or pain relief can also be very important because they will ease the child’s breathing. Sometimes it is easiest for all to sleep if the child and parent sleep together in a comfortable chair with the cool mist humidifier blowing at their side.

When to call the doctor

Most colds and questions that arise can be handled during clinic hours. If your child is very ill, do not hesitate to call.

• Any infant or child who has a difficult time breathing should be seen by a doctor immediately. Symptoms include rapid breathing, blueness of the lips or fingernails, or abnormally hard rise and fall of chest as the child breathes (retractions).

• Infants under three months who have a fever higher than 101°F (rectal)

• Older infants who have a fever for longer than 48 hours

• Coughing hard enough to produce vomiting more than once

• Babies who are very irritable, restless, and cannot be comforted

• Babies who are too tired to eat and want to sleep continuously

• Babies who are wheezing (whistling, musical sound to the chest)

• Babies in whom you suspect an ear infection (crying when sucking, ear drainage, pulling or rubbing ears)

• Babies under 1 year with a "cold" or cough

Acetaminophen should be given only for fever or generalized discomfort. It is not helpful for coughing or runny noses and should not be given routinely during the duration of the cold.

What should I know about constipation?

Constipation in infants is usually due to the cow’s milk or soy in the formula, not the iron. Thus, low iron formulas will likely not help the problem.

For infants not taking solids yet, we recommend using one ounce twice a day of pear, prune, or apple juice. This may be fed directly diluted with water or put in morning and evening bottles. The amount necessary to keep the stools loose will need to be adjusted up or down depending on how loose the stools are. Give less if too loose and more if too firm.

In the toddlers and older children, constipation and the abdominal complaints that it often leads to are extremely common. Make sure the child does not consume excessive amounts of dairy products and maintain a high-fiber/low-fat diet.

Regular schedules of bathroom attempts in toilet-trained children are also important.

If you have further concerns about your child with constipation, it is best to schedule a 30-minute consult visit with a physician to allow enough time to address the complexity of this problem.

What should I know about diarrhea and/or vomiting?

Though very common, diarrhea and/or vomiting only infrequently leads to dehydration because of fluid loss. A few small loose stools or vomiting episodes are of no danger to a child.

Continuous vomiting or frequent large liquid stools (more than ten a day) may lead to dehydration, especially in infants.

These symptoms are generally caused by viral illnesses and are not helped by antibiotics. Treatment includes encouraging fluids or solids in smaller, more frequent amounts.

Signs of dehydration:

• Dryness of the usually moist tongue and mouth

• Dry, sunken appearance of the skin and eyes

• Significantly longer times between wet diapers or urination

• Infant/child is very tired, has little desire to eat or be up and about

• Infant/child may be quite irritable

We do not recommend the use of nonprescription medications for diarrhea and vomiting before checking with the clinic.

Dehydration following diarrhea and vomiting, especially in infants, can occur very rapidly and be dangerous. Therefore, please notify the clinic for all infants under 6 months of age with diarrhea.

If your toddler has been experiencing frequent loose but not watery stools without seeming to act too sick, this may be due to excessive juice or even total fluid intake. Thirty ounces of fluid in a day is plenty for an average toddler. Cutting back the juices and increasing greasy or fatty foods in the diet while limiting total fluid intake to around 30 ounces will generally help with this cause of diarrhea, commonly called “toddler’s diarrhea.”

When should I worry about a fever?

Normal body temperature is about 98.6°F when taken orally (by mouth). Temperatures taken rectally usually run about 1° higher. A fever is defined as an oral temperature above 99.4°F or a rectal temperature above 100.4°F.

A fevers is a sign that the body is fighting an infection, so you may want to avoid giving medicine if your child is running a low-grade (up to 100.2°F) fever.

Treat a fever

• Give your child plenty of fluids to drink to prevent dehydration (not enough fluid in the body) and help the body cool itself.

• Dress your child in light cotton pajamas so that body heat can escape.

• Avoid piling on blankets. This only serves to raise the temperature higher.

• Sponge with lukewarm water.

• A child may have a maximum of 80 mg acetaminophen for every 10 pounds weight every four hours.
  
  80 mg acetaminophen = 1 dropper infant drops or
                                             1 children's chewable (80 mg tab) or
                                             1⁄2 teaspoon children's liquid (160 mg/tsp) or
                                             1⁄2 junior chewable (160 mg tab)

•  For more severe fever or pain, a child may have a maximum 100 mg ibuprofen for every 22 pounds weight every six hours.

100 mg ibuprofen = 1 teaspoon liquid (100 mg/tsp) or
                                   1 100 mg chewable or
                                   1⁄2 of 200 mg adult tablet

Tips on giving medicine

• Don't give more than 5 doses in one day.
• Don't give a baby younger than 3 months medicine unless instructed by your doctor.
• If using drops, fill the dropper to the line.
• For liquids, use a liquid measuring device, not a household spoon to make sure you give the right dose.
• Acetaminophen suppositories are great to use if a child vomits oral fever medication.

Never use aspirin for children under 18 years of age. In rare cases, aspirin causes Reye's syndrome in children. This is a serious illness that can lead to death.

When to call the doctor

• Under 3 months old: Call your doctor right away if your baby's temperature goes over 100.4°F rectally, even if he or she doesn't seem sick. Babies this young can get very sick very quickly.

• 3 to 6 months old: Call your doctor if your baby has a temperature of 101°F or higher (even if your baby doesn't seem sick) or a temperature of 99.5°F that has lasted more than 24 hours.

• 6 months and older: If your child has a fever of 101.4°F, call the doctor if the fever rises or lasts for more than three days. In children 3 months to 2 years of age, if the temperature is 103°F, call your doctor even if your child seems to feel fine.

• Fever is accompanied by any of the following symptoms:

• Constant vomiting or diarrhea

• Difficulty breathing

• Earache, tugging on ears

• High-pitched crying

• Loss of consciousness

• No appetite

• Pale

• Seizures

• Skin rash

• Sore throat

• Stiff neck

• Stomach pain

• Swelling of the soft spot on the head

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What should I know about head injuries?

Children often fall and bump their heads. Fortunately, most childhood falls or blows to the head result in injury to the scalp only, which is more frightening than dangerous.

External injuries

The scalp has many blood vessels, so even a minor cut may bleed a lot. A "goose egg" or swelling that often appears after a head blow is the result of the scalp's veins leaking fluid or blood under the scalp. It may take days or even weeks to disappear.

Apply a cold pack to the injured area for 20 minutes.

If the injury occurred close to naptime or bedtime and the child falls asleep soon afterward, check every few hours for disturbances in color or breathing.

Possible internal Injuries

The brain is cushioned by fluid, but a severe blow to the head may push the brain into the side of the skull and/or tear blood vessels. Any head injury can be very serious. It's difficult to determine the level of injury, so it's always wise to discuss a head injury with your doctor.

If any of the following occur, notify us immediately:

• Any loss of consciousness or inability to wake up

• Vomiting more than once

• Pupils are different sizes

• Complains of a severe headache, neck pain, dizziness, or trouble with vision

• Won't stop crying

•  Inability to move arms and legs normally, difficulty walking

• Convulsions, seizures

• Blood or clear fluid leaking from the ears, nose, or mouth

• Abnormal breathing

• Slurred speech

• Loss of bladder/bowel control

What should I know about my newborn?

Weight

All newborn babies lose weight  (normally up to 10% of birth weight) during the first few days of life. Birth weight is usually regained by two weeks of age. Weighing your baby at home is unnecessary. Your baby will let you know if he/she is hungry. If you have any concerns about your child’s weight, please call us.

Noises and movement

 Hiccups, sneezes, mild coughs, noisy breathing, brief jerky movements, eye crossing, and chin quivering are frequently seen in young infants and are of no medical significance.

Crying is your baby's earliest method of communicating. It may signal a need for food, warmth, affection, or relief from discomfort. Babies cry an average of two to four hours a day. Some babies make life easy for parents and spread out the crying. Others do it all at once. A tired baby may cry 20 to 30 minutes simply settling down to go to sleep.

Don't overreact to your baby's crying. Soothers such as pacifiers, rhythmic movements, continuous sounds, or music may help.

If you cannot determine a reason for the crying and the baby seems to be crying excessively, please give us a call.

Spitting up

 Spitting up occurs to some degree in all babies and is not a problem unless the baby fails to gain weight normally. Frequently, a small mouthful of formula will ride up with a burp. Some babies spit up more as they become older and increasingly active.

 If you become concerned with the amount of spitting up, try these measures:

• Place the baby upright in an infant seat for 30 to 45 minutes after feeding.

• Give your baby smaller but more frequent feeds.

• Be sure your baby is burped well during and after each feeding.

• Try laying your baby on his/her tummy in a sling with the head of the mattress elevated for 30 to 60 minutes after each feeding.

Actual vomiting is not a natural process, but rather a symptom. This consists of forceful, rapid emptying of all stomach contents. If your child vomits more than one feeding, he or she may require a checkup or a change in diet. Please call the clinic for further advice.

Diapers                 

Diapers may be cloth or disposable (paper with plastic backing). Disposable diapers are more frequently associated with diaper rashes than are well-laundered, well-rinsed cloth diapers (without plastic pants); but disposable diapers are undeniably more convenient, and problems with them can be minimized if you change them often enough.

Bowel movements may normally vary in frequency from one per feeding to one per week or less. Color will vary with diet – yellow, orange, brown, and green all may be normal variations. Stools of breast-fed babies are usually soft, mushy, or even watery. If your baby's stools are hard or pass as small pellets, this may indicate constipation. If this develops, please let us know.

Diaper rash is most commonly caused by exposure to irritants such as urine, stool, soaps, and powders. It's a rare baby that escapes them during the first few months. Effective treatment consists of removing the irritant and exposing the diaper area to open air for 20 to 30 minutes three or four times a day and application of ointment with each diaper change. Plastic pants should not be used until the rash clears. If your baby has a diaper rash that persists in spite of these measures, please let us know.

Cleaning

Cleaning should involve nothing more than gently wiping the face and body with a warm damp cloth. A mild soap may be used. Daily bathing is fine if your baby enjoys it; if not, twice a week is adequate.

Keep your bathing supplies together and never leave the baby unattended.

• Eyes: Clean around the eyes with warm moist washcloth without soap.

• Ears and nose: Clean outer areas only with a moist washcloth. Do not use cotton-tipped applicators.

• Scalp: Use mild soap or baby shampoo with each bath.

• Skin: Use only soap and water. Oils, lotions, and creams tend to clog the baby's pores and increase the tendency to develop rashes.

• Navel: Keep it clean and dry and open to the air whenever possible. Clean the navel three times a day with cotton balls or Q-tips soaked in alcohol. Just before and after the cord falls off there may be some oozing or bleeding for three or four days. This is normal – just continue cleaning with alcohol.

• Penis: It is not necessary to retract the foreskin of an uncircumcised infant for at least the first three years. For circumcised boys, gently clean between the folds of the remaining foreskin. A small amount of thick white matter is common and should be washed away. After circumcision, the penis will look very red and swollen. Use petroleum jelly and gauze to cover the tip of the penis for 3 days or more. Change with each diaper change.

• Vagina: Newborn girls have a milky white discharge from the vagina which is occasionally blood-stained. This is due to maternal hormones. When cleaning the baby's bottom, always wipe from front to back. It is important to clean around the labia as well as the vaginal opening. A wet cotton ball or soft washcloth can be used.

Sleep

Babies vary as much as adults in their sleep requirements. It may take you a while to understand your child's sleep patterns.

Most babies will have one period during the day when they are awake for a longer period of time. For newborns this often occurs in the early evening and the baby may be more fretful than usual. The sleeping patterns of a fussy baby are much more irregular than those of a relaxed baby and will require special understanding. Please talk with us if your baby's sleep schedule is very irregular.

The norms for sleep in infants are:

• Newborn: 17 to 20 hours a day for the first few weeks. Some babies sleep as little as 10 to 12 hours a day for 2 months, an average of 15 hours with longer hours of deep sleep, especially at night. Two or three naps daily is common.

• 3 to 9 months: 10 to 12 hours at night with approximately two naps daily.

• 9 to 12 months: 10 to 12 hours at night; may have only one nap daily.

The American Academy of Pediatrics recommends that all healthy, term babies without gastroesophageal reflux or lung problems that are less than 6 months of age should be placed to sleep on their backs or either side instead of on their stomachs as a measure of sudden infant death syndrome prevention. Babies are not born with sleeping position preferences. They will likely end up preferring the positions that they are placed in by their caretakers. They also should be placed on soft but firm mattresses without pillows to allow them to breathe without chance of suffocation.

If you have any questions, please talk to us.

Rashes

• Erythema toxicum (newborn rash): Many babies develop a rash within the first two days of life which appears primarily on the trunk. This appears as small red pimples and is of no significance. It generally lasts one week and no treatment is necessary.

• Prickly heat: This rash is caused by blockage of the baby's sweat glands. The face, neck, trunk and diaper area are most commonly affected. It appears as groups of small red pimples, which occasionally form tiny blisters. It is most common during the summer months or when the baby is overdressed. It seldom bothers the baby and is best treated by not overdressing the baby and keeping him in a cool environment.

• Facial rashes: Babies develop a variety of mild facial rashes in the first few months. The most common is one in which tiny white pimples appear on the face. This is due to plugging of the oil glands of the skin. None of these rashes require treatment and they generally disappear in a few weeks.

• Cradle cap: This is an accumulation of white to yellow scaly material on the scalp. The treatment consists of shampooing with a mild soap two or three times a week. In stubborn cases, shampooing with anti-dandruff shampoo will eradicate the condition. Firm scrubbing with the fingertips followed by a thorough drying is also helpful.

Colic

Colic is an unknown condition consisting of prolonged episodes of agonized crying. It generally begins during the first few weeks and subsides by three to four months. During these episodes, the baby turns red, flexes his legs, passes excessive amounts of gas and makes strong sucking movements.

There is a general tendency to want to feed your baby during these episodes. This tends to worsen the episode by increasing the amount of air in the intestinal tract.

If your baby seems colicky, rest assured that it is nothing you are doing wrong. Changing formula or medication is rarely of any benefit. Soothing techniques like continuous sounds, an infant swing, soft music, gentle rocking or swaddling (pinning arms across the chest and wrapping snugly in a blanket) may be helpful. If your methods for handling the colic are ineffective, please give us a call.

Remember, the problem disappears by three to four months; it does not harm the baby and whatever you do, maintain your cool!

What should I know about pink eye?

Pink eye (conjunctivitis) is common in children. It's when the white part of the eye (sclera) and inside the eyelids becomes red. It's just a symptom and not itself a disease, however. There are many causes of conjunctivitis in children, most commonly by cold viruses. Just like the cold, it needs and has no effective treatments. This form of pink eye will run a few days and resolve itself as the cold subsides.

Other causes, including bacteria, allergies, trauma, and irritation do have specific treatments.

Because conjunctivitis is frequently associated with an ear infection or is not treatable by antibiotic eye drops, our staff will generally ask that the child be seen in the office to determine proper treatment. Please do not be offended if we ask to see the child rather than prescribing antibiotic eye drops over the phone.

As with a cold, a child should not be in school when the symptoms are most severe.

Keep the eyes clear of matter by cleaning with water on a cotton ball at least four times a day; clean from the nose outward. Use a new cotton ball for each eye. Dispose of the secretions and keep the child's washcloths and towels separate from other family members'.

If the eye continues to increase in redness, or swelling and pain occurs, call the clinic.

Conjunctivitis is highly contagious, whether caused by a virus or bacteria. Antibiotics decrease the contagiousness of bacterial conjunctivitis, but not viral conjunctivitis. The contagiousness of viral conjunctivitis decreases as the symptoms decrease.

What should I know about sore throats?

Sore throats can be caused by:

• Viruses: Unfortunately, antibiotics are not effective against viral sore throats. Children having viral sore throats can be ill for several days with a fever and swollen glands. The only treatment of viral sore throats is to help alleviate the soreness with acetaminophen and encourage liquid intake.  

• Postnasal drip: This is caused by irritating mucus from a stuffy nose that constantly drains down the throat. This type of sore throat may be accompanied by a head cold, cough, (mostly at night), and sore throat upon waking in the morning. Postnasal drip sore throats may be severe and short-lasting such as with the common cold, or may be a chronic problem due to dryness in the air during the winter months, or due to nasal allergies. Symptoms of postnasal drip may be helped by use of a decongestant.

• Streptococcus bacteria (strep): These are larger germs that can be killed by antibiotics. Symptoms of strep throat are the same as for a viral sore throat, but also may include headache, vomiting, abdominal pain, and a rash. Strep throat is most common during late fall and winter. If not adequately treated with proper antibiotics, it can lead to heart damage and kidney disease.

Does my child have strep?

• Strep can only be diagnosed with a throat culture or strep latex test

• A fever is very common with strep throat (viruses can also cause a fever). A fever over 101°F for more than three days is likely to be caused by strep throat.

• Recent exposure to someone with strep throat

• It is uncommon for a child under the age of 3 to get strep throat

• Pain on swallowing or while pressing on the neck glands, or pain during coughing is usually not strep throat.

• Strep is sometimes accompanied by a high fever and a characteristic rash (scarlet fever) that appears as fine, red pimples all over the chest, abdomen and back. It feels rough, like sandpaper, and may look like a sunburn. This rash is not serious like it used to be. It's the result of the body reacting to a toxin produced by the strep.

Strep is contagious until antibiotics have been used for at least 24 hours. It spreads by touching and via respiratory droplets (sneezing and coughing). We recommend throat cultures on all family members who have sore throats or symptoms of head cold.

Rarely, a child may have strep throat in spite of a negative culture. We recommend repeat throat cultures and/or a visit with the doctor if symptoms persist longer than 48 to 72 hours or if a rash appears.

Please feel free to call the clinic anytime during office hours if you have further questions.

When should I get my child vaccinated?

Call our office or see the Well-Check Schedule for exam and vaccination intervals.