It's flu season. When people talk about flu, they can be talking about either stomach flu or respiratory flu. Today, I'd like to discuss stomach flu. This is also known as gastroenteritis, or sometimes just enteritis. It is characterized by vomiting, diarrhea or both. It can sometimes be associated with fever, abdominal pain or cramping, but not always. Stomach flu in adults typically lasts 1-2 days. However, in children and teens, it frequently lasts 5-7 days. For this reason, I'd like to talk about what you can do to make your child more comfortable when this occurs.
Usually, the vomiting starts first. As parents, our natural tendency is to withold food and drink from a child who is vomiting. Nothing in, nothing out, right? Unfortunately, that's just not the case. Children can continue to vomit and have diarrhea for several days, even if they are not eating or drinking. Therefore, experts currently say to go ahead and try to feed your child through this phase, if possible. However, sometimes they just won't keep anything down. Or, whatever they take in comes right out the other end. When that happens, we have to try other measures.
I tell parents to give clear liquids for 24 hours, then a BRAT diet (which will be explained in detail) for the next 24 hours, then a bland diet for the next 4-5 days. Theses children should have no fried foods, no spicy foods and no dairy, except for yogurt with active cultures, for 1 week. This is the overview. The devil is in the details.
The first 24-48 hours is the hardest part. The clear liquids need to be given frequently and in small amounts. It is labor intensive and thankless. Not all clear liquids are good choices. For example, water doesn't seem to stay down well in most children. Clear soda or ginger ale works much better. Dark soda can also be given (but is not a first choice, it doesn't stay down as well), and the soda does not need to be flat or room temperature for most children. However, any child can be an exception. Soda provides sugar, which these children need, as they are not eating. Soup broth is another good choice. It provides potassium, an important electrolyte. Clear juices, such as white grape juice can also be given. Avoid apple and pear juice. The sugar in these juices is not well absorbed and can cause increased diarrhea. Gelatin that has not solidified is used by many people, and that's fine. Just keep in mind that it may change the color of your child's stools. Also, remember that if you cannot read through the liquid, it is not a clear liquid.
When you start your child on clear liquids, the amount and timing can be very important. I recommend 1 tablespoon (T) every 15 minutes for the first hour; 2T (1 oz) every 15 minutes for the second hour; 3T every 15-20 minutes the third hour, and 4T (2 oz) every 30 minutes the fourth hour. I don't recommend going over 2 oz at a time the first day. Keep in mind that this is not likely to go smoothly. Your child will most likely vomit long before you get to the fourth hour. When this happens, stop, wait 1-2 hours and start over at 1 tablespoon.
Your child is not going to be happy when you are restricting their fluids. They are probably going to throw temper tantrums and push your buttons. Try to remember that they would be much less happy if they were vomiting constantly. The second day, you can start them on a BRAT diet. You can do this even if the vomiting hasn't stopped completely. BRAT isn't a reflection on your child. It stands for Bananas, Rice, Applesauce, Toast and crackers. These are bland foods that are unlikely to trigger vomiting, but also bind up the stool and slow down diarrhea. Offer these foods in small amounts frequently throughout the day. If your child doesn't like all of these foods, then just offer the ones he or she likes. Hopefully, they will like some of them.
Over the next several days, add in more bland foods. Adding protein will help your child recover faster. As stated above, avoid fried foods, spicy foods and dairy for one week. The exception to that is yogurt with active cultures. Keep in mind that chicken nuggets are fried before they are frozen and placed in the freezer section.
If you are one of the lucky parents who is able to feed their child through the initial stages of stomach flu, start with the BRAT diet. Then add bland foods slowly over the next several days. You will still need to avoid fried foods, spicy foods and dairy, except for yogurt. Other comfort measures include comfortable clothing for the fever and warm baths for the abdominal pain and cramping.
Call your physician for vomiting that shoots 5' across the room, or for vomiting that is green or contains blood. If the vomit contains little particles that look like coffee grounds, that could be dried blood. That is another reason to contact your physician. Always call for abdominal pain that is limited to the right lower side of the abdomen, as this may be a sign of appendicitis. Consider talking to your healthcare provider in advance, as they may have specific guidelines for how soon to call based on your child's age, urine output and underlying conditions.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://PersonalMedicine.com
Thursday, March 24, 2011
Sunday, March 13, 2011
Fever
I hear a lot of concerns from families about fevers in children. Fortunately, most of these concerns are not based in fact and can easily be alleved with a little education. For example, fever does not make your child's brain melt and come out their ears. It does not cause deafness and rarely causes other neurologic problems. Children do not die from fever and fevers do not cause mental retardation. (However, infection can cause both death and mental retardation in exreme and rare cases. I don't want to dismiss these concerns, but I do want to try to put them in perspective).
Parents worry that certain infections are associated with high fevers. This is true. Fortunately, most high fevers are associated with harmless viral illnesses that are shortlived. Occasionally a high fever can be a sign of a more serious infection. Because of this, it is important to have your child see a physician for any fever lasting more than 3 days, or fever associated with other worrisome symptoms. So, what constitutes worrisome symptoms? How about a mucousy cough, shortness of breath, hallucinations, severe headache or unexplained pain. If your child has any other symptom that really worries you, contact your physician.
It is important to note that certain antibiotics, especially at high doses, can cause deafness. High fevers used to be routinely treated with high doses of antibiotics. These doses are no longer used, and some of these antibiotics are no longer even available. I mention this primarily for historical reasons. Some of you may have older relatives who know someone who experienced this during their childhood. Very young infants, such as those under 2 months of age, can still be susceptible to hearing loss. If you have a young infant under 2 months of age who is treated with several days of intravenous antibiotics, your physician may recommend testing for hearing loss.
Here are a few other things we know. Fever is one of your body's defense mechanisms. It helps fight infections. Therefore, when your child develops a fever, it is a sign that they have an infection or inflammation, usually infection. The fever is going to help fight infection, and should be allowed to do so. There is now evidence that shows that children get over an infection faster if we do not treat their fever. Therefore, as parents and health care providers, we should not be treating fevers with acetominophen or ibuprofen on a routine basis. We should reserve these medications for fevers that are over 103 degrees farenheit, or fevers that last more than a couple of days.
The exception to this is fever in a child with a history of febrile seizure. A febrile seizure is a specific type of seizure that is not part of a seizure disorder. It is not harmful. It is simply that child's way of bringing down their body temperature.
I receive many calls during the night about what dose of acetaminophen or ibuprofen to give a child. This is especially true for children under the age of 2. Why, you ask? Because the dose for older children is available on the bottle. Therefore, parents of children under 2 years of age have no guideline concerning dosage. A general rule of thumb is to give 1 tsp of children's strength ibuprofen or acetaminophen for every 10kg or 22lbs of body weight. (See below). Acetaminophen is to be given every 3-4 hours, while ibuprofen needs to be given only every 6-8 hours. Acetaminophen is still one of the leading causes of poisoning in children in this country. For that reason, I suggest that you not keep several types or concentrations around the house if you don't need them. Also, consider getting rid of the "Infant Concentrate" once your child can take medications from a spoon or medicine cup. When using an Infant Concentrate, always measure it with the dropper provided with that particular bottle and no other dropper.
If you are treating your child's fever, and it is not responding to either acetaminophen or ibuprofen, there are other measures you can take. Some people alternate the two medications. If you are going to do this, please speak with your physician first. You may also use a tepid, or lukewarm bath. Your child should be placed in this bath for 30-45 minutes. Placing the child in the bath for less than 30 minutes will bring down the temperature of the skin, but will not bring down their core temperature. Sponge baths are ineffective for the same reason.
If, despite these measures, your child continues to have a fever for 3 or more days, please contact your Personal Medicine provider. Call sooner if your child is having additional problems.
Dosing:
Never give any medication to children under 8 weeks of age without your doctor's permission.
0-6lbs: Contact your physician.
6-11lbs: 1/2 droppers of Acetaminophen Infant Drops or 1/3
dropper Ibuprofen Infant Drops.
11-17lbs: 1/2 tsp of Acetaminophen or Ibuprofen. 1 dropper Acetaminophen Infant Drops. 2/3 dropper
Ibuprofen Infant Drops.
17-22lbs: 3/4 tsp of Acetaminophen or Ibuprofen. 1 1/2 droppers of Acetaminophen Infant Drops. 1
dropper Ibuprofen Infant Drops.
22-33lbs: 1 tsp of either Acetaminophen or Ibuprofen. May also use 2 Acetaminophen 80mg tablet, one
160mg tablet, 2 Ibuprofen 50mg tablets or one 100mg tablet.
33-44lbs: 1 1/2 tsp of either Acetaminophen or Ibuprofen. May also use 3 80mg Acetaminophen or 3
50mg Ibuprofen.
44-55lbs: 2 tsp of Acetaminophen or Ibuprofen. May also use 4 Acetaminophen 80mg tablets, two 160mg
tablets, 4 Ibuprofen 50mg tablets or two 100mg tablets.
55-66lbs: 2 1/2 tsp of Acetaminophen or Ibuprofen. May also use 5 Acetaminophen 80mg tablets or
five 50mg Ibuprofen.
66-77lbs: 2 1/2 tsp of Acetaminophen or Ibuprofen. May also use 3 Acetaminophen 160mg tablets or 3
100mg tablets of Ibuprofen.
77-88lbs: 3 tsp of Acetaminophen or Ibuprofen. May also use 4 tablets of 100mg Ibuprofen, or two (adult)
200mg Ibuprofen.
88-100lbs: 3 1/2 tsp of Acetaminophen or Ibuprofen.
Over 100lbs: Use adult doses.
Please note these doses are only a guideline, and that your personal physician may recommend somewhat different doses. However, these guidelines should be helpful in those "middle of the night" instances when you may feel hesitant to call your physician.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://PersonalMedicine.com
Parents worry that certain infections are associated with high fevers. This is true. Fortunately, most high fevers are associated with harmless viral illnesses that are shortlived. Occasionally a high fever can be a sign of a more serious infection. Because of this, it is important to have your child see a physician for any fever lasting more than 3 days, or fever associated with other worrisome symptoms. So, what constitutes worrisome symptoms? How about a mucousy cough, shortness of breath, hallucinations, severe headache or unexplained pain. If your child has any other symptom that really worries you, contact your physician.
It is important to note that certain antibiotics, especially at high doses, can cause deafness. High fevers used to be routinely treated with high doses of antibiotics. These doses are no longer used, and some of these antibiotics are no longer even available. I mention this primarily for historical reasons. Some of you may have older relatives who know someone who experienced this during their childhood. Very young infants, such as those under 2 months of age, can still be susceptible to hearing loss. If you have a young infant under 2 months of age who is treated with several days of intravenous antibiotics, your physician may recommend testing for hearing loss.
Here are a few other things we know. Fever is one of your body's defense mechanisms. It helps fight infections. Therefore, when your child develops a fever, it is a sign that they have an infection or inflammation, usually infection. The fever is going to help fight infection, and should be allowed to do so. There is now evidence that shows that children get over an infection faster if we do not treat their fever. Therefore, as parents and health care providers, we should not be treating fevers with acetominophen or ibuprofen on a routine basis. We should reserve these medications for fevers that are over 103 degrees farenheit, or fevers that last more than a couple of days.
The exception to this is fever in a child with a history of febrile seizure. A febrile seizure is a specific type of seizure that is not part of a seizure disorder. It is not harmful. It is simply that child's way of bringing down their body temperature.
I receive many calls during the night about what dose of acetaminophen or ibuprofen to give a child. This is especially true for children under the age of 2. Why, you ask? Because the dose for older children is available on the bottle. Therefore, parents of children under 2 years of age have no guideline concerning dosage. A general rule of thumb is to give 1 tsp of children's strength ibuprofen or acetaminophen for every 10kg or 22lbs of body weight. (See below). Acetaminophen is to be given every 3-4 hours, while ibuprofen needs to be given only every 6-8 hours. Acetaminophen is still one of the leading causes of poisoning in children in this country. For that reason, I suggest that you not keep several types or concentrations around the house if you don't need them. Also, consider getting rid of the "Infant Concentrate" once your child can take medications from a spoon or medicine cup. When using an Infant Concentrate, always measure it with the dropper provided with that particular bottle and no other dropper.
If you are treating your child's fever, and it is not responding to either acetaminophen or ibuprofen, there are other measures you can take. Some people alternate the two medications. If you are going to do this, please speak with your physician first. You may also use a tepid, or lukewarm bath. Your child should be placed in this bath for 30-45 minutes. Placing the child in the bath for less than 30 minutes will bring down the temperature of the skin, but will not bring down their core temperature. Sponge baths are ineffective for the same reason.
If, despite these measures, your child continues to have a fever for 3 or more days, please contact your Personal Medicine provider. Call sooner if your child is having additional problems.
Dosing:
Never give any medication to children under 8 weeks of age without your doctor's permission.
0-6lbs: Contact your physician.
6-11lbs: 1/2 droppers of Acetaminophen Infant Drops or 1/3
dropper Ibuprofen Infant Drops.
11-17lbs: 1/2 tsp of Acetaminophen or Ibuprofen. 1 dropper Acetaminophen Infant Drops. 2/3 dropper
Ibuprofen Infant Drops.
17-22lbs: 3/4 tsp of Acetaminophen or Ibuprofen. 1 1/2 droppers of Acetaminophen Infant Drops. 1
dropper Ibuprofen Infant Drops.
22-33lbs: 1 tsp of either Acetaminophen or Ibuprofen. May also use 2 Acetaminophen 80mg tablet, one
160mg tablet, 2 Ibuprofen 50mg tablets or one 100mg tablet.
33-44lbs: 1 1/2 tsp of either Acetaminophen or Ibuprofen. May also use 3 80mg Acetaminophen or 3
50mg Ibuprofen.
44-55lbs: 2 tsp of Acetaminophen or Ibuprofen. May also use 4 Acetaminophen 80mg tablets, two 160mg
tablets, 4 Ibuprofen 50mg tablets or two 100mg tablets.
55-66lbs: 2 1/2 tsp of Acetaminophen or Ibuprofen. May also use 5 Acetaminophen 80mg tablets or
five 50mg Ibuprofen.
66-77lbs: 2 1/2 tsp of Acetaminophen or Ibuprofen. May also use 3 Acetaminophen 160mg tablets or 3
100mg tablets of Ibuprofen.
77-88lbs: 3 tsp of Acetaminophen or Ibuprofen. May also use 4 tablets of 100mg Ibuprofen, or two (adult)
200mg Ibuprofen.
88-100lbs: 3 1/2 tsp of Acetaminophen or Ibuprofen.
Over 100lbs: Use adult doses.
Please note these doses are only a guideline, and that your personal physician may recommend somewhat different doses. However, these guidelines should be helpful in those "middle of the night" instances when you may feel hesitant to call your physician.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://PersonalMedicine.com
Saturday, March 12, 2011
Cold Symptoms
Over the counter cold symptoms are no longer available for children under the age of 4. Most Pediatricians don't want you to give them to children under the age of 6. Prescription cold medications are also now under fire. What is a parent to do for their sick child?
My advice to parents hasn't changed over 20 years. The first line of defense is to increase fluids. This primarily means giving water. Fluids with vitamin C are also helpful, such as fruit juice. Chicken, beef or vegetable broth, and occasionally soda, are also good choices. However, fruit drink is not. Also, this advice, does not mean using soda pop as a primary fluid. Friut drink, sport drinks and soda pop have excessive amounts of sugar and should be avoided. I use soda pop in limited amounts for the child who refuses all other liquids. Diet sodas offer no advantage over water, and I see little reason to offer them.
A second line of defense is to run a humidifier. Several types are available. I usually recommend a cool mist vaporizer. Several studies have shown that they improve pulmonary function in children with asthma better than warm mist vaporizers. In all children, cool mist vaporizers have a lower risk of scald injuries, if overturned. Recently, there have been some adverse reports concerning use of ultrasonic vaporizers. If you are concerned about this, don't use an ultrasonic vaporizer. Always clean your vaporizer daily while in use.
Mentholated rubs have been shown to reduce the severity and length of cold symptoms. These may be applied to either the chest or feet of affected children. If you are applying this to your child's feet, please put socks on afterward. This rub is hard to get out of carpet or off of hardwood floors. (Not to mention it can increase your child's risk for a fall). Do not apply to the nose, or ingest the rub at any time.
Fever reducers should not be used routinely, and are addressed in a seperate post.
Please keep in mind that most children get 10-12 colds a year, 6 of which require a physicians attention. Most colds last 2-3 weeks, the worst part being the first 5-7 days. For a cold that is lasting longer than 2 weeks, or is getting worse after 2 weeks, please contact your Personal Medicine provider.
Dr Nan N
House Call Pediatrician, Overland Park, KS
http://FiresidePediatrics.com
http://PersonalMedicine.com
My advice to parents hasn't changed over 20 years. The first line of defense is to increase fluids. This primarily means giving water. Fluids with vitamin C are also helpful, such as fruit juice. Chicken, beef or vegetable broth, and occasionally soda, are also good choices. However, fruit drink is not. Also, this advice, does not mean using soda pop as a primary fluid. Friut drink, sport drinks and soda pop have excessive amounts of sugar and should be avoided. I use soda pop in limited amounts for the child who refuses all other liquids. Diet sodas offer no advantage over water, and I see little reason to offer them.
A second line of defense is to run a humidifier. Several types are available. I usually recommend a cool mist vaporizer. Several studies have shown that they improve pulmonary function in children with asthma better than warm mist vaporizers. In all children, cool mist vaporizers have a lower risk of scald injuries, if overturned. Recently, there have been some adverse reports concerning use of ultrasonic vaporizers. If you are concerned about this, don't use an ultrasonic vaporizer. Always clean your vaporizer daily while in use.
Mentholated rubs have been shown to reduce the severity and length of cold symptoms. These may be applied to either the chest or feet of affected children. If you are applying this to your child's feet, please put socks on afterward. This rub is hard to get out of carpet or off of hardwood floors. (Not to mention it can increase your child's risk for a fall). Do not apply to the nose, or ingest the rub at any time.
Fever reducers should not be used routinely, and are addressed in a seperate post.
Please keep in mind that most children get 10-12 colds a year, 6 of which require a physicians attention. Most colds last 2-3 weeks, the worst part being the first 5-7 days. For a cold that is lasting longer than 2 weeks, or is getting worse after 2 weeks, please contact your Personal Medicine provider.
Dr Nan N
House Call Pediatrician, Overland Park, KS
http://FiresidePediatrics.com
http://PersonalMedicine.com
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