acma10.gif (5905 bytes)        Your child's healthcare is your family's top priority. Your child's minor illness can cause tremendous stress.  Your child's mental and physical health is a prerequisite for their future successes. 
     In line with the major ACMA missions of improving health for all, the ACMA Medical Forum will publish a series of articles to address your needs related to children's health.  In the first article, Dr. Taosheng Huang of the Children's Hospital, Harvard Medical School, will address some frequently asked questions from parents of acutely ill children.  Dr. Huang is an attending physician at Winchester Hospital and a pediatric specialist at the Children's Hospital. In his article, Dr. Huang clarify some confusing medical issues concerning children.

 
 
Julian has a temperature of 100 F.  Is she running a fever?
How do you convert farenheit (F) to Celsius ( C )?
A fever for < 3-month-old child is considered a medical emergency
Fever caused by a viral infection
What is the dosage of Tylenol and Motrin?
How to convert kg. to lb?
WHEN a child with fever should seek medical care?

What is the "FLU"?
What should I do for my child if my child has the "FLU"?
When to seek medical care if a child has the "flu"?

WHAT is sore throat?
What can you do to help your child with sore throat?
When to seek medical care for sore throat?
My child has a cold; how can I make him or her feel better?
When to seek medical care for a child with upper respiratory infection (URI)?

Vomiting and diarrhea in infants
When an infant has diarrhea?
When an infant is vomiting (with or without diarrhea)?
What is dehydration?
What is the treatment  for a child with dehydration?
When to seek medical care for a child with vomiting and diarrhea?
 
 
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   Julian has a temperature of 100 F.  Is she running a fever?

Body temperature is influenced by various factors, such as age, sex, and environment temperature.  As a result, not everyone has the same body temperature. Even in the same individual, temperature can vary from time to time.

In pediatrics, we define a fever as a central temperature above 100.4 F.  In general, we refer to the rectal temperature as a central temperature.  If you take the temperature under your child's arm, you should add 2 F to your reading.  For sanitation purposes and the risk of infection, we generally don't recommend taking a temperature under your child's tongue, which is practiced very often in China.  There is also the chance of breaking the thermometer.
 
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  hot_white.gif (1853 bytes)How do you convert farenheit (F) to Celsius ( C )?

In China we tend to use oC; however, F is used more often in the United States.
The following is the equation to convert  F to C

               (F-32) x 5
        C=______________
                9
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   A fever for < 3-month-old child is considered a medical emergency

An infant is at risk of infection before and during delivery.  If your <3-month-old child has a fever, you must inform your pediatrician immediately.  Your pediatrician will examine your child.  If they cannot find the source of the infection, they might test your child's blood, urine or spinal fluid for clues.

In this case,  your pediatrician may tell you that your child is having a bacterial or virus infection.  A final answer generally takes between 24 - 48 hours.  However, based on the preliminary result, your pediatrician may admit your baby to the hospital for a possible bacterial infection or, if they feel your child's fever is more than likely caused by a viral infection, they could send you home and ask you call to follow-up on the results the next day.

In rare cases that the final tests show there is a bacterial infection, it will need to be treated further with an antibiotic.

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   Fever caused by a viral infection

If your child's fever is caused by a virus infection, the fever itself will not hurt your child, but it could last a few days.  For a temperature >101 F, you can give Tylenol.  If your child is older than 6 months, you can give Motrin (Advil, Iburopfen).  Usually, Motrin works better on a fever, but may upset your child's stomach a bit.

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 angel1a.GIF (1141 bytes)  What is the dosage of Tylenol and Motrin?

You can give your children 15 mg Tylenol per kg body weight; 10 mg Motrin per kg body weight
 
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   How to convert kg. to lb.

In the United States, people tend to use lb. instead of kg.  The following is the equation used to convert pounds to kilograms.

        1kg. = 2.2 lb.
        1lb. = 0.45kg.

For example,  a child weighing 10kgs is equal to 22lbs.
 A child weighing 40lbs is equal to 44/2.2 = 18.2 kg.

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    phone2.gif (573 bytes)When a child with fever should seek medical care again

- is too lethargic to drink or refuses milk
- has difficulty breathing
- has bloody stools
- has signs of dehydration such as
- no tears with crying;
- sunken eyes;
- dry lips and mouth;
- no urine in 8-12 hours or small amounts of dark urine.
- appears sicker than when seen by you pediatrician
 

Call an ambulance if your baby:
- develops deep red or purple spots on the skin
- is struggling to breath
- skin is blue or gray around his/her lips, face or fingernails
- you have difficulty waking your baby
- if your baby's condition becomes suddenly worse and you are unable to contact your physician
 
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   WHAT IS THE "FLU"?

Influenza or "flu" is a viral infection that affects the respiratory tract and is commonly seen in the winter.  Symptoms such as chills, fever, headache, aches and pains, and fatigue appear first.  Signs of an upper respiratory infection such as sore throat, runny nose, congestion, and cough soon follow.  Younger children often develop vomiting and/or diarrhea. The flu usually lasts 3-4 days or longer.

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   What should I do for my child if my child has the "FLU"

Acetaminophen will help control fever and relieve headache, aches and pains, and sore throat.  Do not give aspirin or products that contain aspirin to your child unless prescribed by your
healthcare provider.  Acetaminophen may be given every 4-6 hours as needed for fever or pain.

Encourage the child to drink plenty of fluids to prevent dehydration:

- expect the appetite to be decreased.  A child who refuses to take fluids
is more worrisome than a child who doesn't want to take solid foods for
several days
- give more than the usual amounts of fluid than the child would take in a day
- foods such as popsicles, jello, ice cream, and applesauce also help
provide fluids

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   phone2.gif (573 bytes)  When to seek medical care if a child has the "flu" ?

- severe headache
- neck pain, back pain, or neck stiffness
- excessive crying, irritability, or difficulty calming your child
- increased sleeping or not waking up for feedings as expected
- unexplained changes in behavior
- purplish or unusual rash
- vomiting of blood or bile (yellow/green liquid)
- difficulty in swallowing
- difficulty in breathing or wheezing
- pulling on ears or complaints of ear pain
- no urine in over 8 hours or small amounts of dark urine
- dry mouth and lips
- fever that lasts longer than 3-4 days
- if your child appears sicker than when evaluated last, you should bring your child to your pediatrician or a local hospital
 
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  What is sore throat?

Throat infections can be caused by either a virus or bacterium.  Viral infections resolve on their own over time.  Antibiotics will not work against them.  Bacterial infections, such as strep throat, require antibiotic medications for treatment.

A throat culture is a test that detects a specific bacterial infections.  Rapid laboratory analysis takes about 15 minutes.  If a rapid test is positive for strep, your child needs antibiotics.  If the test is negative, the results then need to be proven via throat culture which requires an additional one to three days.  If the final throat culture results are positive and your child has not already been treated with the proper medication, you must call your pediatrician.
 
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What can you do to help your child with sore throat?

- encourage the child to drink plenty of liquids.  Cold fluids, popsicles, and ice cream will soothe the throat
- run a cool mist vaporizer at the child's bedside while asleep
- for children older than 3 years: Children's Chloraseptic Throat Spray, available at most drugstores, may provide some relief by numbing the throat
- if an antibiotic is prescribed and the throat culture is positive, finish all the medication,
even if the sore throat has eased after a few days of treatment.

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   phone2.gif (573 bytes)  When to seek medical care for sore throat:

Call your Doctor if your child:
- is drooling excessively or cannot swallow
- has difficulty breathing
- has stiff neck or neck pain (as opposed to throat)
- has pain or difficulty opening the mouth
- has signs of dehydration
- no tears with crying;
- sunken eyes;
- dry lips and mouth;
- no urine in 8-12 hours or small amounts of dark urine
- symptoms appear worse.

If your child's condition becomes suddenly worse and you are unable to contact your physician, go to a local hospital.

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  angel2a.GIF (7883 bytes)My child has a cold; how can I make him or her feel better?

- nasal congestion in infants can be relieved using saline (salt water)
nose drops and bulb suction. Your pediatrician will show you how to the procedure works.

- control your child's fever with Acetaminophen (Tylenol/Tempra/Panadol) or
Motrin.

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   phone2.gif (573 bytes)   When to seek medical care for a child with upper respiratory infection (URI)?

Call your Doctor if your child has symptoms you don't know how to manage.

Call your doctor immediately if your child:
- develops high fever;
- is having trouble breathing;
- develops signs of dehydration:
- no tears with crying;
- sunken eyes;
- dry lips and mouth;
- no urine in 8 -12 hours or small amounts of dark urine
- complains of severe headache
- becomes extremely irritable or excessively sleepy.
 
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    VOMITING AND DIARRHEA IN INFANTS:

Vomiting and diarrhea are common symptoms of many childhood illnesses.  At times your baby may have both vomiting and diarrhea; at other times, only one of these symptoms may occur.  Diarrhea sometimes is slow to improve and the most important aspect of care is to give fluids to make up for the fluids lost in stools.
 
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   WHEN AN INFANT HAS DIARRHEA:

- give the infant more liquids to prevent dehydration
- acceptable fluids for infants are Rehydralyte, Ricelyte, Pedialyte (which can be bought at drugstores or grocery stores), milk formula supplemented with plain water or breast milk
- give 1/2 to 1 ounce of fluids for every episode of liquid stools; give it slowly (every 10-15 minutes)
- to prevent vomiting try to avoid using a bottle; instead use a spoon or small cup
- avoid fluids too high in sugar (undiluted bottled fruit juices, undiluted Kool-aid, jello, sodas).  Also avoid tea or plain water without some solids
- usually it is not necessary to eliminate milk or milk-based formulas or change to a soy formula, unless advised by your healthcare provider
- keep your baby on his/her regular diet to prevent under nutrition and speed up his/her recovery
- good solid foods are those that are easily absorbed like cooked mashed vegetables, cereals, rice, toast, crackers, yogurt, bananas or other fresh fruits
- give small frequent feedings (at least 6 times a day) for 2-3 days
- avoid over-the-counter medications to control diarrhea unless prescribed by your healthcare provider.
 
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   WHEN AN INFANT IS VOMITING (with or without diarrhea):

- give liquids in small volumes (1 teaspoon) every 1-2 minutes
- try not to use the bottle
- if tolerated, advance to 1/2 to 1 ounce every 10-15 minutes
- small, frequent feedings are the key to control vomiting
- if the infant vomits, wait 10 minutes and start again more slowly
- use acceptable fluids for infants as described above
- as soon as vomiting has eased, slowly reintroduce your baby to his/her
regular diet.
 
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    What is dehydration?

Dehydration occurs when the body hasn't had enough to drink, is sick with fever, has breathing problems, vomiting, diarrhea, or when sweating due to hot weather.

What are the signs of dehydration for a child with vomiting and diarrhea:
- no tears with crying;
- sunken eyes;
- dry lips and mouth;
- no urine in 8 -12 hours or small amounts of dark urine.

Other worrisome symptoms:
- vomiting of blood or bile (green/yellow)
- bloody stools
- distended belly
- irritability
- weakness or lethargy
- high or persistent fever

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   What is the treatment for a child with dehydration:

- Fluids with the appropriate balance of salts and sugars are necessary.  If your child is less than one year of age, try Pedialyte, Ricelyte (both of which can be bought at most grocery stores).  Given small amounts of these fluids frequently.
- If your child is older than one year of age, Pedialyte, Rehydralyte, Ricelyte as well as fresh fruit juices, Gatorade and plain water with crackers may be given.

Once again, provide small amounts frequently.
- If fever is present, Tylenol every four hours or Ibuprofen every six hours as directed by your physician here today.
 
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 phone2.gif (573 bytes)   When to seek medical care for a child with vomiting and diarrhea:

Call your physician if the signs of dehydration described above are present.  In addition, call  your pediatrician or go to a local emergency room if your child is too sleepy or if their behavior is abnormal.
 

Author: Taosheng Huang, M.D., Ph.D.

Webpage Design: Hong Gao, M.D.