"Moms on Call" respond to "What's Going Around?"

(Photo credits: Moms on Call, pediatric nurses and authors of The Moms On Call Guide to Basicl Baby Care, online toddler and baby seminar instructors at www.momsoncall.com)


If you could hang out at your pediatricians office all day every day - Well, maybe you actually do - you'd be able to determine what's going around in terms of pediatric illnesses. You'd hear some tips on what to do to combat respective symptoms. However, since most of us do NOT have time to hang out in the pediatricians office for more than an appointment warrants, the "Moms on Call" have kindly put together a response to "What's Going Around."

As they write on their web site, "You spoke, we listened." So, here it is. The Moms on Call, two pediatric nurses who answer basic baby care questions and authored The Moms on Call Guide to Basic Baby Care hope that this information will be helpful to you and your children.

This resource is not to be used to diagnose your child. Only a qualified pediatrician can accurately manage your child's care. This information is intended as a resource, not a replacement for medical care. Some of the materials that you will find here are excerpts from their book series, which also includes Moms on Call Basic Baby and Toddler Care Volume 2: 6-24 months.

The "Moms on Call" write:


"Here is what is going around:

FEVER
“My 14 month old has a fever of 103 rectally.”
We get so many calls about fever. This is a misunderstood symptom. Our bodies are designed to fight off infection. One way that the body does that is to turn up the heat when a virus or bacteria is detected, hoping the bacteria or virus will not want to stick around if it gets too hot. So, mild fevers in babies over 3 months old can be quite beneficial.

It is also imperative that you are able to take an accurate temperature. When taking the baby's temperature, we recommend taking rectal temperatures exclusively until the baby is over 18 months old. That is the most accurate way to take a temperature. The ear thermometers, forehead thermometers and pacifier thermometers are just not as accurate in infants. We recommend using a B-D Digital Thermometer®.

In babies over three months old, normal rectal temperatures are between 97-100.5 degrees Fahrenheit. In babies over 3 months old, we would not consider their temperature a “fever” unless it was over 100.5 rectally. Temperatures may vary according to several factors, including activity level and times of day.

How to take a Rectal Temperature
-Lubricate the thermometer with a pea-sized amount of Vaseline®
-Lay infant on back as if changing a diaper.
-Lift legs so rectum is easily seen.
-Press button on thermometer to turn it on.
-Insert thermometer into rectum about 1⁄4 inch or until you can no longer see the silver tip of the thermometer.
-Hold thermometer in place 3 minutes or until it beeps. (Most digital thermometers only take about one minute)
-Remove and read thermometer.

Daytime Treatment
If over 6 months old, if irritable or fussy and/or not resting well, may use Tylenol or Ibuprofen
If under 3 months old, a rectal temperature of 100.4 or higher is reason to seek medical care.

Give extra fluids.
Fevers generally subside during the day and spike in the late afternoon. No need to treat a fever under 102.5 rectally unless the child is uncomfortable.

Treat the child, not the numbers on the thermometer. We are much more worried about a child that has a mild fever but is lethargic (like a wet noodle all day) than we are a child with a 104 rectal temperature who is running around like nothing is wrong.

Nighttime Treatment

Put child to bed wearing cool cotton clothing. No fleece zip-ups or warm blankets. Temperature of the home should be between 68-72 degrees.

If he/she wakes up and feels very hot, undress the child down to the diaper/underwear and give whatever fever control medicine is due next. DO NOT TAKE THE TEMPERATURE FOR 10 MINUTES. (The temperature will spike right when the child awakens. If we give the child about 10 minutes of being undressed, the fever will generally come down 1-2 degrees all on its own. This helps us to avoid a big parental breakdown over a 105 rectal temp.)
There is normally a wait at the ER and by the time you have given a child fever control medicine and arrived at the ER, the fever is under control. However, high fevers that are accompanied by other symptoms may need to be evaluated such as:

Neck stiffness
Bright red or purple rash that does not blanch or lighten with pressure
Persistent vomiting (more than twice)
Severe abdominal pain
Inconsolable crying greater than one hour
Difficulty breathing (not increased breathing; respirations will be increased when they have a fever.)
Severe headache
Seizure activity – violent shaking

When to Seek Medical Care
If more than 6 months old, if the temperature >103.5 rectally, call your pediatrician
A baby under three months old with a rectal temperature over 100.4
A baby with any temperature that is lethargic (like a wet noodle) all day. Any child that is not having at least 20-30 minute periods of playfulness at any temperature can be a sign of illness.
Ask your pediatrician for a fever handout.
Fever accompanied by other symptoms such as, but not limited to: a rash, vomiting, decreased movement of a limb, difficulty breathing, inconsolable crying longer than an hour or an abdomen that is hard like a table when the baby is at rest.

Febrile Seizures
These are generally harmless and are a result of the fever going up too fast, not the fever getting too high. These may last 1-3 minutes. Usually febrile seizures begin at 6 months to 2 years old, with the first seizure occurring by the time the child is 2 years old. They normally stop by the time the child is 5-6 years old. Febrile seizures generally will occur in the first 24 hours of fever. Only a pediatrician or emergency room doctor can adequately diagnose this type of seizure.
Treatment
Keep area safe.
Do not try to restrain your child. Once started, it will run its course no matter what you do.
Once the seizure is over and your child is awake, give usual dose of medicine. (Tylenol® or Ibuprofen)
Do not over-dress your child. When the seizure has subsided, holding the child too close to your body can also cause the child to get overheated, so be careful with the cuddling at this time.
When to seek medical care:

This is the first febrile seizure:
Lasts longer than 5 minutes.
Neck stiffness.
Confused or delirious.
Difficulty awakening.
Any seizure activity in absence of a fever.
Note: Tylenol® and Motrin® do not cure the cause of the fever. It is for comfort only. Once these medications wear off, the fever will come back until they are no longer sick. Often the child's temperature will not come all the way back down to normal. It can hover between 101-102 rectally in an infant over 3 months even with fever control medicines.

VOMITING
“My kid just threw up and I don't know what to do.”
Vomiting: large amounts of vomit, with forceful emptying of stomach contents, more than 2-3 times. Although there are various causes of vomiting, we see it most often associated with a gastrointestinal virus. These types of viruses usually start with vomiting every 30-45 minutes for the first 6-8 hours then maybe an isolated episode of vomiting on day two or three. Diarrhea will often accompany these symptoms and it lasts for 5-7 days. (See diarrhea section.)
Treatment:
Try to wait about an hour after the child vomits. Then you can try one tsp of clear liquids (water, Pedialyte) every 10 minutes for the first 2-3 hours while awake, with an occasional teaspoon of heavy peach syrup. (Now you know why we mentioned the peaches in heavy syrup in the general shopping list! It coats the stomach and helps the baby keep the liquids down.) You can then begin to increase the amount of fluids by adding another teaspoon every ten minutes for the next 2-3 hours. (One teaspoon, wait ten minutes, two teaspoons, wait ten minutes, three teaspoons and so on.) Sucking on popsicles or a wet washcloth is a way of ensuring that they are not swallowing too much at one time. A teaspoon of jello would be good. You can sit on the couch and give sips of clear liquids from a medicine dropper if you need to as well.

If the child goes 6-8 hours without vomiting try to breastfeed a limited amount, increasing as tolerated or use 1-2 ounces of formula every 30 minutes for 2-3 hours as tolerated.

If no vomiting after 12 hours, begin returning to a normal diet slowly.

If the baby vomits during any of above, return to step one.

Avoid giving medicines for 8 hours (with the approval of the pediatrician). If running a fever of 102 or more rectally, then use Fever-All® suppositories if permitted by your pediatrician.
If older than a year, no milk for 24 hours from the last time that they vomit. After no vomiting for 6-8 hours try starchy foods such as toast or crackers and gradually return to a normal diet.

Common Errors
-Giving too much fluid at one time.
-Not waiting the hour before beginning fluids.
-Sometimes when a gastrointestinal virus is causing vomiting in a child, no matter what you feed them or how often you feed them, the vomiting will continue. If your child is crying for fluids and it has not been an hour after vomiting, it is okay to give it, just try to have them drink slowly. (We realize that you only have so much control over how quickly they drink.) When they are experiencing these symptoms, it is crucial to monitor for the following additional symptoms.

When to Seek Medical Care
Signs of dehydration:
Not urinating at least every 6 hours. (You may want to place toilet tissue in the diaper to check for wetness because the absorbent nature of today's diapers makes it hard to tell if the baby has urinated at all.)
When you run your pinky finger over the inside of their bottom lip it is dry and tacky as opposed to smooth and moist.
Tries to cry but cannot cry tears.
Marked lethargy.
Unable to hold down one tablespoon of fluid after 2-3 attempts. (Remember to wait 30 minutes to an hour after each vomiting episode.)
Vomits blood
Neck stiffness
Rash
Vomiting that continues > 24 hours
Fever
Vomiting bile - fluorescent yellow or green goo.
Abdomen hard and tender at rest (hard like a table top, as opposed to soft like a really full balloon).
Blood in stool (more than 1 tsp bright red blood)Call pediatrician if the child has a fever of 103.5 rectally or higher. (Or a baby under 3 months with a 100.4 or higher rectal temperature)

DIARRHEA
Diarrhea can be caused by a gastrointestinal virus and can generally last 5-7 days. However, sometimes babies may have a day of diarrhea secondary to mild stomach irritation, and this will pass in one or two days.
Signs
More than 5 watery stools in a 24-hour period.
Relief measures
We do not like to give medication that claims to stop diarrhea for infants or kids under 2 years old. This is because most diarrhea is caused by a gastrointestinal virus that will run its course. We want the diarrhea to get out of the baby's system. This is the body's natural way of handling this kind of virus.
Infants
Formula Fed: May switch to Isomil DF® for a few days.
Breast-Fed: Continue to breastfeed. Breast milk is the gentlest thing for an infant's tummy.
Baby food for babies > 6 months old: Baby foods that are starchy are good choices, i.e., cereal, applesauce, bananas, carrots, mashed potatoes.
Children greater than one year old:
Water is the best fluid for your child with diarrhea, unless they are not eating well, then you may use Pedialyte®.
After 24 hours, you may give milk as well as water. Exception--if this is the only thing they will drink, you may give fruit juice to keep the baby hydrated.
AVOID fruit juices. Exception--if this is the only thing they will drink, you may give fruit juice to keep the baby hydrated.
Solids--starchy baby foods (i.e., rice cereal, bread, crackers, rice, noodles, potatoes, carrots, applesauce, and bananas). Fatty foods are good as well.
Note: Regardless of how you feed diarrhea, it will generally run its course. However, it's probably not the time to get Mexican for dinner.
When to seek medical care
8 or more watery stools a day for 5 days.
Blood or mucous in stool.
Fever (ask your pediatrician for a fever hand-out)
Abdominal tenderness/hard at rest.
Any signs of dehydration:
Longer than 6 hours without urinating.
No tears when crying.
Inside of lips feel dry when you swipe your pinky finger along the inside of bottom lip.
Increased lethargy.
Note: Diarrhea is very contagious. All family members need to wash hands well after changing diapers and/or using the toilet.

[Important Info
Moms On Call recommends seeking medical care when you are concerned.
Any time that you are concerned, or notice any symptoms, call your Pediatrician's office. Sometimes babies have discreet symptoms like a fever, and other times there is just something that you can't explain, call it mother's intuition or a nagging feeling that something may be wrong. Those are both valid reasons to seek medical attention. Many of the concepts addressed in this website vary from Pediatrician to Pediatrician. When it comes to your child's care, you are responsible for making the final decisions.

The Moms on Call web site, http://www.momsoncall.com/, is designed to provide information on infant and child care. This website is intended as a reference volume only, not as a medical manual. It is offered with the understanding that neither the author nor the publisher are engaged in rendering medical, health, or any other kind of personal professional services on this website. The reader should consult the services of a competent pediatrician, registered dietician or other medical professional. The author and publisher specifically disclaim all responsibility for any liability, loss, or risk, personal or otherwise, to any parent, person, or entity with respect to any illness, disability, injury, loss or damage to be caused, or alleged to be caused, directly or indirectly, of the use and/or application of any of the contents of this website.

The website should be used only as a supplement to your pediatrician's advice, not as a substitute for it. It is not the purpose of this website to replace the regular care of, or contradict the advice from, the American Academy of Pediatrics, or any pediatrician, nutritionist, registered dietician, or other professional person or organization. This text should be used only as a general guide and should not be considered an ultimate source of child care, child feeding, food preparation/storing, or as the ultimate source of any other information. You are urged to read other available information and learn as much as possible about child care and the nutrition and feeding of young children. Mention of specific companies, organizations, or authorities in this website does not imply endorsement by the publisher, nor does mention of specific companies, organizations, or authorities imply that they endorse this website.

Every reasonable effort has been made to make this website as complete and as accurate as possible. However, there may be mistakes both typographical and in content. Therefore, this text should be used as only a general guide. You should discuss with your pediatrician the information contained in this website before applying it. This book contains information only up to the copyright date. New information, or information contradicting that which is found in this book, should be actively sought from your child's competent medical professionals.]"

Moms on Call will be launching their first ever, online Basic Baby Care Seminar in September! Learn the basics of feeding, sleeping and settling into a daily routine. Their proven method has helped thousands of families become more confident while getting their baby to sleep earlier.Sign up to receive the newsletter so you can be notified once this exciting class is live! contact me if you're interested in receiving the newsletter: Shira Weiss, sweiss@weissmediagroup.com