More often than not, parents in today’s society have never learned how to “be” with their children or to “play” with their children. In fact, I believe that many of them are afraid to be with their children. They want to do what’s best for them, and yet they don’t trust that unstructured time with them can be what is best. They have simply lost that instinct.

Many experts have come out and told parents that overscheduling is not healthy for their children, but for many it is still a way of life for their family. They plan so many activities per child that a computerized scheduling system seems necessary to coordinate the carpools, coaching, games, dance recitals, etc. Some children are stressed; others seem to go with the flow. But I have never met a parent in this situation who is not stressed by the constant on the go schedule.

So why do parents get themselves and their children into this situation and seem unable and unwilling to change it? Somewhere over the past few decades, parents lost confidence in themselves as those that knew what was best for their children. At the same time, a proliferation of sports and activities for children developed along with the idea that early involvement was necessary for a child to be able to become competitive and successful when they were older.

A corresponding competitive spirit among parents emerged and seemed to match the growing industry of coaching, tutoring, and instructing young children in everything from soccer to computer science. Parents feared that their children would be at a disadvantage were they not included in these sorts of activities and so the idea that time spent with teachers, coaches, instructors and the like was “better” than time spent as a family arose. What’s more, for some parents, living vicariously through their children’s achievements, can become a powerful force of its own. With all of these competing factors, where does this leave the role of the family in a child’s life?

If you see signs of this kind of behavior in your own family and are tired of this lifestyle for yourself and for your child reflect on the following… Children do best when they are involved in sports or arts programs that stress enjoyment rather than intense competition. Children also avoid stress and the associated “burnout” when they have a variety of activities and are not pushed into “one” sport or activity to the exclusion of all others and of family time.

Children need time with you. Throwing a ball, shooting baskets, playing music, dancing in the living room – enjoying one another — are all very important ways to connect with your children. Sounds old fashion? Well it is! But try spending some unstructured time with your child and work through the anxiety you will feel that your child is “missing something”. Then follow some simple rules:

• One team in one sport per child per season, and one non-sport activity such as in music, art, dance, creative writing, theater or computers.
• Avoid very intense competitive leagues or traveling teams that require a child to practice more than one to two times a week or that demand play on holiday weekends and during vacation time.
• Avoid intensive dance, gymnastic or music programs that require rehearsals more than two times per week.

If you follow these rules there will be plenty of “off time” for both parent and child. And you will hopefully see your anxiety decrease and your confidence increase as you spend more time with your child.

Lastly, remember — the chances of a child becoming a professional ball player, an Olympic gymnast, or a professional singer are really very small. But the chances that they will become a parent themselves who will have children who need them is really much greater. Try focusing on life lessons and developing skills that will help them meet those challenges and become better human beings. You will likely find far greater reward and satisfaction in these pursuits – and so will they.

What causes a sore throat ?
There are a variety of causes. Most are caused by viral or bacterial infections that invade the throat and cause redness and swelling of the tonsils and surrounding tissue, causing pain. A sore throat can also be caused by allergies with an associated post-nasal drip that irritates the throat. A bacterial sinus infection also can cause similar problems, as infected mucous drips into the throat. Other potential causes include irritation from cigarette smoke or dry air in a home.

What is “strep” throat?
Although most sore throats are viral and not caused by bacteria, strep throat is the exception. It is caused by the streptococcus bacteria and is the most common bacterial infection of this area. It requires treatment with antibiotics.

How can I tell if my child has strep throat or just a cold?
The signs and symptoms of strep throat infection are a painful throat, usually accompanied by fever and swollen, enlarged tonsils and lymph nodes that you often can feel on the side of the child’s neck. Other symptoms can include headache, abdominal pain, vomiting, pain in the back of the neck, joint pain, muscle pain or a fine red rash. Other rashes that strep can cause are hives and a very red swelling of the groin area.

Why does the doctor do a throat culture?
The strep test or throat culture is needed because even to the best examiner, many illnesses can look similar to strep throat. Many viruses-especially mononucleosis or adenovirus-can produce a red throat with swollen tonsils covered with a white coat of infected pus. Many more viruses can produce a red throat and fever. Not all of these illnesses require treatment with antibiotics, and in fact antibiotics may make things worse.

My children hate strep tests. Isn’t there an easier way?
The only way to test for strep is to obtain a swab of the secretions on the tonsils. The only way doctors can do that at present is to use a long Q-tip to obtain the material. Even with the best technique it can still cause your child to gag or even vomit after the procedure. Your support during the procedure can really help a child tolerate the swab.

What’s the difference between the short and long strep tests?
The quick strep or rapid strep test is a screening test. Using a reaction between the antigens taken from the throat swab and the antibodies for strep in the kit, we can find a positive strep infection 85% of the time. However, this method is not fool proof and must always be backed up by an overnight culture of the throat swab material.

How do I know if I need to bring my child in for a throat culture?
If your child has a sore throat with a fever and any of the symptoms listed above, she or he should be tested for strep. If your child has a cold, cough, laryngitis or hoarse voice, it is less likely that he or she has strep. However, if your child continues to complain for more than 3-4 days about the throat please call your doctor to discuss whether or not your child needs to be seen.

If it’s so obvious, why do we have to bring our children in for a strep test?
The strep test or throat culture is needed because even to the best examiner, many illnesses can look similar to strep throat. Many viruses-especially mononucleosis or adenovirus-can produce a red throat with swollen tonsils covered with a white coat of infected pus. Many more viruses can produce a red throat and fever. Not all of these illnesses require treatment with antibiotics, and in fact antibiotics may make things worse.

I have heard that babies can’t get strep. Is this true?
For unexplained reasons, babies and young toddlers rarely get strep. No one is exactly sure why this is so, however, there may be age differences in our immune systems. It is not impossible for infants to get strep infections, however, and your doctor may test for it, especially if there is a close family member with a strep infection or an outbreak in a day care center.

If my one child has strep, why not treat all my children?
It is not thought to be a good idea to treat asymptomatic children for strep. For one thing it may be unnecessary use of antibiotics, as not all children exposed will get the strep infection.

Why does my child get repeated strep infections?
The strep bacteria remain sensitive to most penicillin or erythromycin antibiotics. True resistance is rare. If treatment failures occur, it may not be that the antibiotics aren’t working, but rather because, after a strep infection is treated, the enlargement of the tonsils continues for some time. These enlarged tonsils are like “catcher’s mitts” for whenever the next child in class coughs the strep bacteria nearby. Some researchers also believe that other bacteria that live in our throats may act to decrease the strength of the antibiotic. If your child is having repeated strep infections, your pediatrician will discuss the treatment options with you.

What can I do to make my child feel better?
Regardless of the cause of the sore throat, the pain can be treated with acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). Depending on the age of the child, lozenges or ice pops can also be helpful to ease the pain. Providing a humidifier or cool mist vaporizer in your child’s bedroom is also helpful in reducing the dry air which can aggravate any sore throat. If the doctor prescribes antibiotics, follow the directions completely. It’s important to treat strep infections for a full ten days to prevent rheumatic fever.

What is an allergy?
Why do some people sneeze, wheeze, cough, itch and get rashes in reaction to things in their world? Allergies are a mistake our bodies make. This occurs when the immune system, designed to protect us from infection, wrongly identifies an otherwise harmless substance like pollen, and then overreacts as it tries to protect the body. As part of this overreaction, the body releases the chemical histamine which then sets off a series of reactions. Allergies are responsible for asthma, hay fever, food allergies, eczema, hives, and-in rare cases-life threatening shock or swelling of an airway. They can occur in reaction to a wide variety of “allergens” such as pollen, ragweed, dust mites, molds, and animals as well as foods and drugs. Allergies can be seasonal or can last all year long depending on the person’s sensitivity and exposure.

What are seasonal allergies?
The seasonal allergies occur mainly in the Spring and Fall months as the trees, grasses, weeds and flowers release pollen. Allergic rhinitis or Hay Fever is the most common reaction to the seasonal allergies. It affects mainly the nasal passages resulting in a stuffy, itchy or runny nose; mouth breathing which results from the stuffy nose, discoloration and swelling under the eyes; rubbing or wrinkling the nose (the allergic salute); and watery eyes.

What’s allergic “pink eye” or conjunctivitis?
Allergic conjunctivitis is the reaction of the eye to these “allergens.” The conjunctiva or white of the eye becomes red and there may be swelling of the eyelids. The eyes will have a watery discharge and feel intensely itchy. Bacterial conjunctivitis (pink eye) can occur as a secondary infection. If this occurs, the mucous of the eye will be thick or yellow-green and an antibiotic ointment would be required.

Can allergies make you wheeze or cough?
Very definitely — yes. Reactive Airways, or what we used to call asthma, is a term that now refers to the irritation of the upper airway all the way down to the lower airways. Although in children, viruses are the most common trigger of the coughs and wheezes that occur, allergies are the next most common cause. The symptoms can be a cough, or a croup-like cough, as well as the better-known symptoms of asthma such as chest tightness, shortness of breath and wheezing.

How can I tell an allergy from a cold?
A cold begins with clear mucous from the nose that changes over the next 7-10 days, first thickening and changing to a white, yellow or green color before drying up. There may be fever and other symptoms such as sore throat or cough. An allergy such as hay fever is more constant and lasts longer than the average cold. Another important difference is that patients with hay fever experience itching, which is rare in the simple cold.

Can my baby have allergies?
Although infants can experience food allergies from early infancy, it is rare for an infant or toddler to have seasonal allergies. You have to live through the seasons a few times before your body will react to the pollen. Most children develop seasonal allergies during the school years.

How can I treat these allergies?
There are several OTC (Over The Counter) products and prescription medications available for allergy treatment. ( see related article-Treating Seasonal Allergies). Your pediatrician is the best person to help find the right treatment for your child’s allergies.

Does my child need to see an allergist?
Although skin testing in older children can provide a parent with a detailed list of the child’s allergies, most children do not need to see a specialist. A parent and pediatrician working together and using some simple detective work can usually figure out the source of the allergies. And if a simple treatment plan does not work, your pediatrician will refer you to an allergist.

Will allergy shots help?
Older children with chronic allergies that do not respond well to medical treatment may be treated with “allergy shots” that contain small but gradually increasing amounts of the pollens or molds which the child is allergic to. This treatment gradually makes a person less sensitive by “fooling” the immune system into reacting less. It is most effective against hay fever and household allergies. It is not useful for food allergies.

What else can we do?
Although it’s impossible to avoid the air and the allergens in the atmosphere around us, you can limit your child’s exposure on the worst days. Keeping windows closed and using air conditioning when available can keep pollen outside. The use of air filters has a questionable benefit, but some patients report good results. Limiting outdoor activities during heavy pollen days is helpful but can limit your child’s exercise and social interactions. Using preventative medications prior to exposure will help minimize the allergy symptoms but still allow your child to engage in his or her normal activities.

It’s important to reduce some of the stress that families go through at the beginning of the school year, as activities and school responsibilities begin again. With multiple children, come multiple schedules of sports and other activities that require masterful juggling acts. And too often it is mothers who become what I call “PARENT CENTRAL”. From play dates to car pools, everything that happens to every child in the family goes through this parent. It is an important role, but it can be very stressful on that parent if they take on everything themselves. Raising responsible and independent children means that kids need to take more responsibility for their school and extra curricular lives. So here are some tips to make this happen.

Have a series of family meetings.

1) The schedule meeting: Reduce stress by being prepared and organized, and a family meeting to review schedules is an important first step. Especially if more than one child has a sport or after school activity. Create a large “family calendar” to put all events in place. Have a meeting at the beginning of each semester. This will help head off conflicts and car pool confusion about who is picking up who and when. Put down family events, like weddings or of town family gatherings that are important and require children to be present, or when a parent knows they will be out of town. One family cut out small pictures of family members and taped them on their birthdays, so even the youngest could see when Grandma’s birthday was. Involve the kids in solving schedule conflicts.

2) The finance meeting: almost as important as the schedule meeting, talking about finances, allowances, and chores that should be done during the school year is another way to encourage responsibility. If a family is on a budget, then everyone needs to know how much money can be spent on activity fees, sports equipment, or dance shoes. Allowances should be discussed and parents should make it clear what they will pay for, ie. Clothes for school, fees for sports, tuition for dance class; and what they will not pay for, ie. video games, downloaded music, or trendy fashions. Encourage children to both save part of their allowance for the future and to consider donating part of their allowance to a charity of their choice.

3) The responsibility meeting: This is the meeting where you place all the issues on the table. Let your kids clearly know what you expect of them during the school year. Discuss what household chores are required of each child. Make sure they know that they are responsible for completing homework and assignments, and remembering project dates. If a child works after school, it should be clear that the job should not interfere with school work. Discuss religious responsibilities and commitments, especially for bar and bat mitzvahs and confirmations. Go over house rules when you are not home after school. For middle school and high school kids discuss your rules about smoking, drinking and drugs. This is a good time to let your children know how you feel and what consequences will occur if they break the rules. (Although discussions about sexuality and sexual activity are equally important, these are best discussed one on one and in private.)

These meetings take time and effort, but the results will be an organized family, more responsible kids, and hopefully less stress on Parent Central, otherwise known as MOM, who will be monitoring everyone’s role, instead of doing it all herself.

Another study performed by the American Speech-Language-Hearing Association (ASHA) found two disturbing pieces of information: teens listen to their iPods and MP3 players at volumes considerably louder than adults and, no surprise, the same teens are experiencing symptoms of hearing loss.

The surveys, done by telephone, asked 1,000 adults and 301 high school students across the U.S. about their listening habits. More than half (59 percent) of students reported playing their MP3 players “loudly,” compared with only 34 percent of adults.

The surveyed teens and adults were also asked if they suffered from the common symptoms of hearing loss including:

• The need to continually turn up the volume while listening to music (28 percent of students and 26 percent of adults)
• Regularly asking people to repeat themselves during normal conversation (29 percent of students and 21 percent of adults)
• Suffering from ringing in the ears (17 percent of students and 12 percent of adults)

The researchers in the Vanderbilt study hypothesized that the increase in hearing loss was a result of increased sound volume that teens were exposed to, but admit the data has not confirmed the source of the problem. Experts have been concerned because improved headphones (buds deliver sound in a very directed and concentrated way)  be another factor. The ASHA survey concluded that it’s the combination of length of time and volume at which the teens are listening to music through headphones that is responsible for the damage.

Thankfully, teenagers seem to have some understanding of this. The ASHA’s survey shows that nearly 70 percent of students say that they are “likely” to turn down the volume of music when listening to it through earphones. However, 58 percent said they weren’t likely to cut down on the time they spent listening to music with earphones on. “Louder and longer is definitely not the way to use these products,” says Brenda Lonsbury-Martin, PhD, ASHA’s chief staff officer for science and research. Dr Eavey has also advised that any sound over 85 decibels exceeds what hearing experts consider to be a safe level and some MP3 players can reach levels of 120 decibels.

The National Institute on Deafness and Other Communication Disorders (NIDCD) offers three basic rules for limiting the damage done to your children’s ears by listening to iPods and MP3 players:

1. Make sure that he or she can hear normal conversation voices while listening to music through headphones

2. Limit the amount of time he or she spends listening to any type of music through headphones to one hour a day

3. Set the volume of their music player no higher than 60 percent of the maximum

Some children show readiness for toilet training between 18 and 24 months.  This should not be confused with the achievement of toilet training, which may not occur until the child is between two-and-a-half to four years of age.  You may already have a potty in the bathroom and you both may have names for urine and stools.  Your toddler may let you know he is dirty or wet, indicating a desire to have his diaper changed.  Toilet training requires a combination of physical and mental developmental skills, which must be mastered before training can be successful.  Here are some tips to get you and your toddler started:

How Do I Know if My Child Is Ready?

Your child should be able to walk well and be able to climb up and down from the potty unassisted.  Your child must also be able to recognize when he has the urge to urinate or defecate (“signaling abilities.”)  Your child then must be able to verbalize that urge.

Other signs of readiness include dry nap periods, grunting or straining after meals, asking to have diapers changed after a bowel movement, or telling you she has had a bowel movement.  This is a sign that she can recognize the signals. You may start noticing these signs when your child is 18 to 24 months of age. However, it is not uncommon for a child to still be in diapers at 2 and a half to 3 years of age.

When Is a Bad Time to Start?

Try not to start toilet training during any type of upheaval in the child’s world – for example, the move to a new home, the birth of a new baby, divorce or illness.

When is a Good Time to Start?

Remember, toilet training requires a combination of physical and mental developmental skills, which must be acquired before training can be successful.  Your child must have the physical ability to hold urine and stool and must be able to recognize the urge to go.  He should be able to pull his pants down and sit on the potty by himself.  He should be able to verbalize when he needs to use the potty.

What Do I Do Next?

You should buy a small potty or a potty seat that fits over your regular toilet and begin to discuss the topic with your child.  You should begin using simple words (such as “pee-pee,” “wee-wee” and “poop”) to describe what is happening.  Have your child sit on the potty in his diapers or clothes to feel comfortable.  Remember — this is the early stage of training.  Avoid putting pressure on your child before he is ready.

What about books and videos?

Books and videos about this topic are helpful, but always remember to read the book or watch the tape first so you are familiar with the contents.  Make sure the method demonstrated is compatible with your own ideas and appropriate for your child’s developmental level.  And never just put a video on and not explain things to your child – they can get some pretty wild ideas about this subject!

Did you know that 20% of obese pre adolescents are pre-diabetic? The incidence of type 2 diabetes has increased in adolescents from 5% in 1982 to 40% in 2003. And this rise is directly related to obesity.

So we have a serious crisis on our hands in this country. And parents hold the solution in their hands.

How do you know if your child is overweight?
Your pediatrician can tell you. If your child’s weight is 15 lbs greater than expected for his or her age and height, they are considered overweight. Pediatricians use something called the Body Mass Index (an equation that takes all factors into account) to determine how overweight or obese a child is. If your child is already overweight or obese, discuss treatment options with your doctor. Reversing obesity at an early age is the key to avoiding serious health complications such as Type II diabetes and heart disease.

What causes obesity?
The simple answer is overeating. But it is more complicated than that. Some factors are genetic. If a parent is overweight, there is a 30% chance that his or her child will be overweight. But genetics alone cannot account for the sudden rise in obesity numbers. Children today have a more sedentary lifestyle. Despite all their scheduled athletics, many children still spend more time sitting while they watch TV or play video games. Television viewing, as well as hours spent with all forms of media, has been directly linked to obesity in children. Too little sleep at night, especially in toddlers and preschoolers has also been linked to obesity which can develop as early as five years old and continue throughout childhood. And naps don’t seem to make up for poor sleep at night which can cause a serious imbalance in the hormones that regulate our metabolism.

What health problems can obesity cause, as my child gets older?

The serious and often irreversible health complications of obesity:

• An obese child or adolescent will have an elevated cholesterol level, which in turn causes cardiovascular disease with the potential for stroke and heart attack.
• Obesity also causes insulin resistance resulting in Type 2 diabetes and all its associated complications.
• Hypertension is often associated with obesity.
• Other complications of obesity include liver disease, gallstones, orthopedic problems such as hip joint abnormalities, sleep apnea, and several other problems.

Obesity also creates a potential for psychological problems such as low self-esteem, distorted body image, eating disorders, and depression.

What can I do as a parent?

Controlling what your children eat is a parent’s responsibility. Educating your children on the dangers of obesity is also important. As a family discuss a change to a more healthy diet for everyone. Learn the new food pyramid that has been designed by the experts to promote overall health and lower the risk of chronic disease. (See below.) Discuss limits on TV viewing and video games. Encourage outdoor play. Get your children into good sleep habits as early as possible.

What is the new food pyramid?

The US Dept of Agriculture has established a very helpful and user friendly website at http:/mypyramid.gov

(To access- don’t put in www) For all members of the family, you can individualize a nutrition plan for healthy eating.

What else can I do?

• Examine the family eating habits.
• Get your children to sleep for the recommended hours per night.
• Have scheduled mealtimes as often as possible with busy family and work schedules. Have more home cooked meals and less fast food.
• Have your children eat at the table instead of in front of the TV.
• Have fruits and vegetables readily available for snacks.
• Eliminate all sugar drinks, including sport drinks, which are high in sugar and salt.

Many parents – particularly in those parts of the country where ticks are prevalent and children thus frequently exposed to them – have questions and concerns about their children contracting Lyme Disease. Let’s take a closer look at the truth about tick bites and Lyme Disease.

If my child has a tick bite, does that mean they have Lyme Disease?

Lyme disease, which is caused by a type of bacteria called a spirochete, can only be spread by the very tiny tick with the exotic name of “ixodes dammini.” The bad news is that these ticks are very hard to see. The good news is that only about 40% of these ticks are thought to be infected. Lyme disease is not spread by the larger wood ticks. Not every bite, even with an infected tick will result in infection.

How long does the tick have to be on the skin?

The duration of attachment is important and most experts feel that a tick has to be imbedded in the skin for more than 48 hours in order for the Lyme spirochete to be transmitted. If you are doing daily tick checks on your children, and you know that you have removed a tick within two days of attachment, it is unlikely that your child would contract Lyme disease from that tick bite.
The tick is swollen, what does that mean?

Degree of engorgement is another factor to consider. If the tick sac is engorged (swollen and visible to the eye) it is more likely that the spirochete has been transmitted. This engorgement takes a few days of being imbedded.

How do I remove the tick?

Using blunt curved forceps or tweezers, grasp the tick as close to the skin surface as possible and pull upward with steady pressure. Try not to twist the tick so that only part is removed. Do not use bare hands to remove a tick. Clean the area with alcohol or antiseptic. Do not use Vaseline, nail polish, rubbing alcohol or matches to kill the tick.

“I didn’t get it all out!”

This is a common concern of parents. Do the best you can, but even if tiny tick parts remain imbedded, it is unlikely that infection will spread. There is no need to panic and rush a child to the Emergency Room for tick removal. The staff at your doctor’s office will advise you on what to do.

Does my child need antibiotics right away?

Although this area is somewhat controversial, most infectious disease experts do not advocate putting all children on antibiotics who have had a tick bite. The evidence is not conclusive that early treatment will prevent Lyme disease. The vast majority of children who contract Lyme disease probably acquired it from a tick that was never seen. Moreover, most children will have either the ECM rash or some symptoms consistent with Lyme disease in the early stages. If you find an engorged deer tick and are not sure if it has been attached for less than 48 hours, call your doctor’s office for a consult.

How can I prevent tick bites?

If you live in a Lyme-endemic area and it can be hard to avoid tick-infested areas as they are everywhere that your children live and play. And it is hard to have the kids in long pants tucked into socks in the hot summer. The advice is to cover as much as possible and spray clothing with permithin. This is marketed as Permanone Tick Repellent and can be found in lawn and garden stores and sporting goods stores, and some pharmacies.
Note: This is to be used as a clothing spray only and is not to be applied directly to the skin.

Insect repellent sprays, liquids and ointments (e.g. Off, Cutters, Repel) contain the ingredient DEET which is very effective against mosquitoes and ticks, but it can also be dangerous especially to small infants and children. Products with 10% or less of DEET can be used sparingly on ankles and wrists. Skedadle has a low concentration of DEET which is “time-released.”
Note: Products containing 50 to 100% DEET are available and are especially dangerous and should never be used on children. Ingestion of DEET can be fatal.
Avon Skin So Soft is safe and available as a lotion. It has been found to only protect for 10-30 minutes, however, and frequent reapplication is necessary. With no safe and effective repellent available yet, our best weapon is daily and compulsive tick checks at bath time. This, followed by prompt removal, is the best prevention we have against this difficult disease.

Is Fever Dangerous?
Fever is a person’s normal response to infection and is often the very first sign that an illness is starting.The first thing to remember is that fever, in and of itself, is not dangerous. It is the body’s way of fighting an infection. High fever caused by illness does not cause brain damage. For children with temperatures less than 105, the degree of the fever is not always related to the seriousness of the illness. Temperatures of 103-105 are quite common in children. This means that you can have very high fevers with a simple cold or stomach virus and low temperatures for more serious illnesses. It also means that it is unnecessary to record the exact numbers of temperature, i.e., 104.2. An approximate range is more useful to the doctor and for you to determine a response to medication. Hallucinations occur in some children with high fevers (usually greater than 104). The child may say they see things which aren’t there, or may sing or act strangely. These symptoms should resolve quickly as the fever responds to treatment and the temperature is brought down.

If fever (T100.8 or greater) occurs in infants younger than 3 months, call your doctor immediately for the baby to be seen.

How Do I Take my Child’s Temperature?

Many products are marketed today to measure an infant or child’s temperature, but the gold standard is a digital thermometer.  In small infants, the only reliable method for taking a baby’s temperature is to use a digital rectal thermometer. It is safe and accurate. Color strips for the forehead, or ear thermometers do not work well in small infants.  For older children, the oral thermometer or one placed under the armpit works well and is an economical option, but you can also use thermometers which measure the temperature of the inner ear. Placing your hand on a forehead will work as well as strips that change color.

How Do I Know If a Fever Is Serious?
The best way to tell is by observing how the child looks and acts, especially after the fever is brought down by medicine. No one looks great with a high fever, but after treatment with acetaminophen, ibuprofen, or a lukewarm bath, the child should look a bit brighter. If a baby can suck on a bottle, or nurse, make eye contact, or maybe even smile at a familiar face, then the illness is probably nothing serious at that time. If the baby is very lethargic, avoids eye contact, has no moments of playfulness or interest in faces or objects, then the illness may be more serious. For older children the same guidelines apply. However, once a child can talk, he or she can describe how he or she is feeling and what hurts. If your child has a severe headache or stiff neck, severe abdominal pain, an unusual rash, severe sore throat or drooling, severe cough, chest pain, earache, or pain with urination, you should call your doctor’s office regardless of the child’s temperature.

I’m Afraid My Child Will Have a Convulsion!
Convulsions ( or seizures) occur with rapidly rising fevers in about five percent (5%) of children between the ages of 6 months to 6 years. Watching your child have a convulsion is very frightening for parents.  The child, however, will have no memory of the convulsion and if there are no other complications, no long term effects or brain damage. These “febrile convulsions” occur as the fever rises rapidly within a few minutes to a height usually close to 105. The child becomes stiff and may turn blue around the mouth, as arms and legs begin to jerk. The eyes are usually turned to one side of the body. The convulsion usually only lasts about five minutes and the child will be sleepy for a while after awakening. If your child should have a convulsion, the local rescue squad should be notified after you have removed the child from any dangerous surroundings. Usually the convulsion is over by the time help arrives, but the rescue squad can be helpful by communicating with your doctor or the nearest hospital.

How Long Does a Fever Last?
Fevers that accompany most viral illnesses last 3-4 days. There are exceptions to this rule and some viruses, like influenza or mononucleosis, can cause fever for up to 10 days. If there is a bacterial infection present-i.e., ear infection, Strep throat, pneumonia, urinary tract infection-the fever may be present for more than the usual 3 days. So the presence of fever and the number of days your child has had the fever is important to relay to the doctor. Also, it is normal for temperatures to increase late in the day. The child who seems better in the morning may be looking and feeling worse by late afternoon.

Why Do We Treat a Fever?
If fever is the body’s way of responding to (and possibly fighting) infection by raising the temperature of the body, then why do we treat fever? The answer is that regardless of the cause of the fever, fever makes an infant or child uncomfortable. So doctors will treat fever to make the infant or child more comfortable.

Should We Always Treat a Fever?
If the temperature is greater than 101 and your infant or child seems uncomfortable, then treating the fever is indicated. If your child is “running around” and playing with a 103 temperature, you may not need to treat the fever at that time.

How Do We Treat a Fever?
Doctors treat fever in two ways: by treating the underlying illness when possible, and by treating the fever directly. Our role as physicians is to diagnose and treat the underlying illness which is causing the fever. Viral illnesses do not respond to antibiotics, so those illnesses need time and supportive care.

Your role as parent is to treat the fever directly. There are three common ways to treat fever:

1. Acetaminophen (Tylenol, as well as generic forms) is the most common medicine used to treat fever today. It is very useful in reducing fever and relieving pain. It does not work as well as aspirin or ibuprofen for inflammation and muscle and joint aches; however, it is a safe drug to use, and has minimal side effects. Aspirin should never be used in children and adolescents because of the risk of Reye’s syndrome.

Acetaminophen comes in a variety of forms, including infant drops, children’s elixir and suspension, chewables, swallowable tablets, and caplets. It also is available in suppository form. This can be useful when a child is vomiting or refusing to take the drug by mouth.

2. Ibuprofen (Children’s Advil, Children’s Motrin), available in liquid form, chewable and swallowable tabs, is another useful treatment for fever in infants and children. As an anti-inflammatory, it is also useful for pain. The advantages to using ibuprofen over acetaminophen are less frequent dosing (every 6 hours, as compared to every 4 hours) and perhaps a better response for treating very high temperatures (over 104).

3. Non-medical treatments include bathing the child in a lukewarm bath. The trick is to lightly rub the water over the child’s body to help evaporate the heat. It is best to do this 30 minutes after giving acetaminophen or ibuprofen to avoid chilling. Drinking lots of cool fluids will help bring down body temperature. Increasing the amount of fluids is also necessary in infants and children with fever because they can become dehydrated more quickly. Dressing the child in light cotton underwear and pajamas and the infant in a t-shirt or onesie over a diaper will help prevent the temperature from rising higher.

What Shouldn’t I Do?
Avoid heavy layering of clothing. Avoid high room temperatures indoors in winter and high temperatures outdoors in summer. Avoid space heaters. Avoid alcohol rubs or baths with alcohol. (Children have had convulsions from alcohol toxicity absorbed through the skin.) Avoid aspirin (and products which contain aspirin/salicylates, such as Pepto-Bismol) to avoid Reye’s Syndrome.