‘Tis the Season to Catch the Flu

It’s all over the news: this is one of the worst flu seasons in several years. Influenza is still a dangerous disease that can take the lives of children and adults, especially if they are susceptible to infections because of asthma or a weakened immune system. But every year, previously healthy infants and children also die from influenza.  Here’s some advice on how to prevent, recognize, and treat influenza and when you need to call the doctor.

How can I prevent my child from getting the flu?

Get your children and yourselves vaccinated as soon as possible. Although it takes up to two weeks for all the protection to take hold, the flu outbreak may last till March, and you can still get protection for your family. This year’s vaccine is over 65% effective. Although difficult to prevent once an outbreak occurs in a community, the following steps are advised by the CDC:

  • Avoid close contact.
    Keep your children away from people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
  • Keep your child home.
    Keep your child home if he or she becomes sick or if there is a known outbreak in daycare or schools.
  • Cover your mouth and nose.
    Teach your child to cover his mouth and nose with a tissue when coughing or sneezing.
  • Clean your hands.
    Washing your hands and your children’s hands often will help protect you from germs.
  • Teach your child to avoid touching your eyes, nose or mouth.
    This is a hard one for parents. Germs are often spread when a child touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

How do I know if my child has the flu?

The symptoms are very specific and include high fever (usually lasting 4 – 6 days), sore aching muscles, generalized weakness, headache, pain behind the eyeballs, a sore throat and hacking cough.

How can I treat the flu?

The uncomplicated flu lasts 7 – 10 days and does not respond to antibiotics. Treatment includes plenty of fluids, bed rest and acetaminophen or ibuprofen for fever, headache and body aches. For cough, try a mixture of honey and lemon (if older than 1 year), non-caffeine teas or an over the counter (OTC) cough suppressant. Remember, to prevent Reye’s syndrome, a potentially fatal illness, never give aspirin to your child or adolescent with the flu.

When Do I Need to Call the doctor?

If the cough is worsening or your child is having difficulty breathing,

If you suspect your infant (under 1 years old) has the flu, especially if he/she has a high fever and cough which persists for more than 3 days. NOTE: Any infant under 2 months with a fever (rectal temperature of 101 or greater) must be seen.

If your older child has a high fever for more than 5 days, a worsening cough (with or without chest pain), a headache for more than 5 days or a headache which is getting worse or accompanied by a stiff neck.

Cold or Flu? How to tell if your child has a simple cold or the flu

girl blowing noseThe flu is still a serious illness, especially for small infants and anyone who has a weakened immune system or asthma. For most healthy kids who contract influenza, they will be very sick for a few days and then recover fully, but every year, a few healthy children and teens become seriously ill from influenza.  Vaccination is key to preventing widespread flu outbreaks, however, what if your child was not immunized this year.  You may begin to worry about every sniffle. wondering is this the flu or just a simple cold. Here are some guidelines to help you tell the difference.

The common cold lasts about 9-10 days and is sometimes described as three days coming, three days here and three days going. The first three days your child may have a fever. In infants and toddlers the temperature might reach 103-104, but after giving some acetaminophen or ibuprofen, the temperature will be lower and your baby will seem better. In older children there might be a low-grade fever or none at all.  But here comes the runny nose. A cold always causes a runny nose, but the flu usually does not.

During the middle phase of a cold, a child may develop a cough because of the congestion from the nose, however it will not be a deep or hacking cough as we see when a child has the flu, and usually there is no chest pain. During this time the fever is usually gone, and your child might be back to their activities, despite the runny nose and mild cough.

The final three days is when the mucous starts to thicken and become crusty. At this point it’s just wiping the nose and using humidifiers to help your child breathe easier at night.

The symptoms of flu are very specific and include high fever (usually lasting 4 – 6 days), sore aching muscles, generalized weakness, headache, pain behind the eyeballs, a sore throat and hacking cough.

The uncomplicated flu lasts 7 – 10 days and does not respond to antibiotics.Your pediatrician can decide if an antiviral such as oseltamivir (Tamiflu) would be appropriate.  Treatment includes plenty of fluids, bed rest and acetaminophen or ibuprofen for fever, headache and body aches.  For cough, try a mixture of honey and lemon (if older than 1 year), non-caffeine teas. Some studies even suggest that chicken soup has some merit. Try to avoid OTC cold medicines, especially in children younger than 2 years of age. Remember, to prevent Reye’s syndrome, a potentially fatal illness, never give aspirin to your child or adolescent with the flu. Consult your pediatrician or family physician if your child has difficulty breathing, chest pain, a cough that is preventing them from sleeping, or a prolonged fever.


girl with feverHaving a baby or small child with a high fever is a common cause for anxiety in parents and a frequent reason to call the doctor for guidance.   Here are answers to some common questions and some advice on how to make your child more comfortable when they have a fever.

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.

Time Outs and Ins

timeoutChildren between the ages of three and five are learning to develop self- control. Developmentally they are capable of understanding basic rules like “No hitting or biting”.

In addition they should be developing a respect for property and can understand “You can not draw on the walls.” even if the impulse strikes them. But it’s important to remember that this takes time and that they are “learning.” When rules are broken time out provides a method of letting your child know that this behavior is unacceptable.

“Time-out” is the most effective method of discipline for young children. It has been researched extensively and is used by hundreds of day care centers and nursery schools. It is simple to carry out and allows both parent and child to cool off.

How to properly use Time-Out

  • Establish a time-out space in one particular room—the room where you spend the most time together is best. Use a chair, a step, or a playpen without toys. You can also create a time-out space wherever or whenever it is necessary. However, never put a toddler in a closed room, bathroom, or closet.
  • The recommended length of “time-out” is one minute for each year of age. A timer can be very helpful.
  • Establish what behaviors will result in time-out ahead of time. Have a “parent” meeting to decide what behaviors you wish to change. Never try to change more than two at a time.
  • Be consistent. That means each parent and childcare provider is consistent.
  • Remember the rule of using five words or less to tell your child what behavior you are putting them in time out for. Following the inappropriate behavior, say for example, “No hitting!” firmly and, without raising your voice and without further discussion, place the child in time-out.
  • If your child will not sit in the chair, hold him in it from behind the chair putting gentle pressure on the shoulders. For an older child, resetting the timer teaches him to sit until told to get up. The key to success is to not say a word or look at the child during this time.
  • Following a time-out, they can resume play. Do not bring up the incident again. Do not lecture and do not reprimand. Doing so has been shown to act as a positive reinforcement for the unwanted behavior by giving the child attention and could negate your disciplinary efforts.
  • Equally unhelpful is any attempt to assuage your “guilt” by giving extra hugs and kisses to show your child that you still love him. Love is demonstrated in many ways and helping your child learn to control his behavior is one of them.
  • The one exception to bringing up the subject is if they have injured someone or damaged someone’s property. You should ask them to apologize. A simple “I’m sorry ” will do. It’s never too early to teach them that art. But don’t expect miracles right away. If they refuse to apologize, don’t insist or make a fuss. Your facial expression will be enough to convey that you are disappointed. But over time, apologies will come, especially if your child has observed your behavior and heard you apologize.
  • The child should start with a clean slate after each time-out and should receive praise for the next positive behavior.

Time-out works best in a loving environment where the child has received adequate positive attention.


2month oldBabies are born with their own temperament and unique personalities. Every baby develops at his own pace. No one book on infant development will describe your child. I know it is difficult, but try not to compare your child with others! Your family practitioner or pediatrician will be following your infant’s development with you at each visit.

Two-month-olds are learning to smile. It is truly a wonderful moment when your baby responds to you after all your hard work. As your baby is rewarded with smiles in return, smiling will occur more often.

A daily change of environment is also good for everyone. Take your baby out to explore the world.

Your baby will love mobiles and cradle gyms. Most babies love brightly colored objects, high-contrast black and white designs with primary colors, big round shapes (especially faces) and mirrors.

Your baby’s hand becomes a new “toy” by about three months of age. Hands are loosening up and are less often held in a closed fist. Babies may stare at their hands for hours. Your baby can hold a rattle placed in the hand, but cannot yet reach for it.

You will notice increasing vocalization, with your baby making echoing sounds. Take time to cuddle and talk to your baby. By three months of age, your baby will turn in the direction of a sound. Babies love music and singing, as well as just “chatting.”

By this age, babies have increasing neck strength, but remain wobbly until four months of age. It is not dangerous to practice standing if you have a baby who wants to be in that position. However, most babies will not be able to support their own weight on their legs at this point.

Because babies are now placed on their backs to sleep, some babies have developed a flattening of the backs of their heads. To help avoid this, it is recommended to place the baby on his or her tummy for short periods, or to keep the baby held upright in order to counter the time spent on the back of their heads.

You Are Your Child’s Best Coach

family_walkingWhen was the last time you spent time with one or more of your children in an unplanned, unstructured activity? Do you feel anxious when you have time with your children alone? Do you feel that you should arrange play dates when your children “have nothing to do”? If you answered yes to any of these questions, you are not alone.

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 over-scheduling 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.

Sore Throats

The winter months are a time of sharing germs in the classroom and at home and the season of sore throats and runny noses. How can a parent tell if they need to bring their child to the pediatrician for a sore throat. Here are some of the basic facts you will need to know…

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 should 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, a rare complication of strep infections.

When to Call the Doctor

One of the hardest questions a parent faces is when to call the doctor. Here is a simple way to answer it — “Whenever you are concerned about your child’s health or well-being.”

This is a good rule to follow when deciding whether to call your pediatrician or family practitioner’s office. It is essential that you have a physician’s office that encourages your questions and provides an atmosphere for you to feel comfortable asking any question, no matter what the question is. You should never be made to feel badly for calling or asking any questions.

In this article, we will look in more detail at the issues surrounding how parents can better decide when it may be time to call the doctor. For a summary, click on the links below:

* When to call the Rescue Squad
* When to call Poison control
* When to call the doctor

Parents have to learn to be parents, and new mothers and fathers will feel particularly anxious about their new babies. They have to learn about the routine care of their infant, as well as how to handle common problems and illnesses. This is a learning process and part of the training is done through phone consultations with the staff at your pediatrician’s office. As a parent gains more experience and the confidence that goes with it, they will find that they need to call less.

Raising and caring for children is a process of education. Most parents do not have medical training. Some problems seem very serious to the parent, but the pediatrician knows that there is nothing to worry about. On the other side of the coin, parents may not always know when something that seems trivial is really an important sign of a problem.

Reading basic health information about children can help you become aware of what problems may arise and what you can do at home first. Take notes when your physician or their staff gives advice. Don’t be afraid or embarrassed to ask questions when you think of them in the office. If the doctor has left the room, tell the nurse you have one more question.

The age of the child is important as well in deciding when to call the doctor . A general rule is that the younger the child, the more urgent is the question. For example if a 3-year-old has a fever, this may not be as urgent as a 3-month-old with a fever is. Never underestimate your parental instincts. Parents know their children best. They often know that something is not right, even before it is obvious to someone else. If you are worried, we as physicians need to be concerned.

Parents sometimes wonder if they ask too many questions or if they are overanxious about a problem. An experienced and sensitive pediatrician or nurse will pick up on this and will discuss where this anxiety may be coming from. For example, a parent who expresses concern about frequent bruising or enlarged lymph nodes may really be concerned about the possibility of cancer. It is not until asked directly by a physician that they usually admit this. Once they have voiced their real concern, it can be addressed properly and hopefully, their mind set at ease.

Another frequent situation that arises at the doctor’s office is when a parent appears to be worried about a variety of small problems. The reality is that there are often some major social problems occurring at home which the parent has difficulty discussing. Sometimes the question that is not asked is as important as the question that is asked. Physicians are trained to recognize these situations and in turn, do what they can to offer support and guidance.

Lastly, remember that nothing can replace a good relationship with the physicians and the nurses in your doctor’s office. As time goes on and you get to know and understand one another, knowing when to call the office will become a natural response.

When to call the Rescue Squad
There are some problems when it is best to call the Rescue Squad first. Make sure the phone number is posted near every phone in the house.

  • Severe difficulty breathing, especially with blue coloring, or after choking.
  • Serious injury (especially with massive bleeding, obvious broken bones, or severe head trauma with loss of consciousness.)
  • Electrical shock or burn
  • Allergic reaction (especially with difficulty breathing, airway swelling or wheezing, or any of the above with hives)

When to call Poison Control
AND REMEMBER TO CALL POISON CONTROL FIRST AFTER AN INGESTION. Then follow instructions on whether to call your doctor’s emergency line or go directly to the Emergency Room. Post the number for POISON CONTROL right near every phone. You can find this number in your local phone book or at The American Association of Poison Control Centers.

When to call the doctor
1. You should call your physician’s office or page the doctor on call immediately for the following problems:

  • Any infant under 3 months with fever. (100.5 or greater taken rectally)
  • Any infant who is acting very irritable and lethargic, or inconsolable. (no periods of alertness, no sucking, no eye contact.)
  • Any child with fever of 105 or greater.
  • Any child with a fever lower than 105, but who appears “toxic”. (unresponsive, lethargic, won’t smile, decreased eye contact.) or with redness and swelling of the eyelids, jaw, or any joint in the body.
  • Difficulty breathing (due to anything other than a stuffy nose)
  • Wheezing (with rapid respirations, cough, or deep movements of the chest & neck muscles with a breath, especially in an anxious child)
  • Croup (especially in an anxious child or if croup symptoms are unresponsive to steam or cool air)
  • Stridor (a noise made by an infant or child on inspiration)
  • Severe abdominal pain
  • Forceful vomiting (projectile or with blood, especially in an infant)
  • Explosive or bloody diarrhea
  • Signs of dehydration (decreased urination or wet diapers, dry mouth, no tears, sunken eyes.)
  • Head trauma (especially if there was any loss of consciousness or vomiting afterwards.)
  • Stiff neck (especially in an ill appearing child or child with fever.)
  • Severe headache (especially when accompanied by fever or with any visual changes, balance disturbances, or loss of the use of a limb or inability to walk)
  • Severe pain anywhere on the body.
  • Animal or human bites (especially if the skin is broken)
  • Hives over a large area of the body (especially if there are any swollen joints)

2. You should call the office within a day:

  • Asthma (known asthmatic with mild symptoms or those not responding to the usual treatments)
  • Cough (accompanied by chest pain, fever, or lasting more than a week)
  • Fever lasting more than 3 days
  • Sore throat with fever, pus on tonsils, swollen glands.
  • Earache in an older child, or concern that your infant may have an ear infection (cries whenever they are laid down, bats at ear, disrupted sleep)
  • Diarrhea (if you have not received instructions on what to do or if what you are doing is not working.)
  • Vomiting (for longer than 24 hours or if what you are doing is not working or your child seems to be getting worse.)
  • Eye infections.
  • Rashes or skin infections (including impetigo, ringworm, diaper rash)
  • Hives (without difficulty breathing or wheezing, or swelling of joints)
  • Poison ivy (with swelling of face, eyes, or covering large area of body)
  • Pain or burning on urination.
  • Abdominal pain
  • Chicken pox complications or questions
  • Lyme Disease (Lyme rash, fever, joint pain)

3. You should call the office to discuss the following non-urgent problems or to make an appointment:

  • Symptoms that have been going on for some time like frequent headaches, frequent abdominal pain, bedwetting, rashes, constipation.
  • Concerns regarding emotional or behavioral problems, or problems in school.
  • Concerns regarding your child’s growth or development.

Let the Children Play

 “Play is the work of children” is a quote from a famous turn of the century psychologist. I use that phrase a lot when describing how vital play is for a child’s development. From the moment they can reach for an object, play and the exploration of the world become one. Just watch a six month old reach for an object, shake it, transfer it from hand to hand and then put that object in their mouth for further exploration. As the child grows, exploration of the world becomes more complex and we see this as we watch toddlers manipulate objects and watch the joy on their face when they bang two objects together, put puzzle pieces in place or get the circle in the circle hole in a shape sorter.

Play is also how children work through strong feelings such as anxiety . Peek a boo is a perfect example of this. As soon as a nine month old starts worrying about separation from parents, they also begin loving the game of peek-a boo. It starts with mom or dad pulling a blanket over their head and watching the delight on the baby’s face when they pull it off and say “peek-a-boo”.  They will do it over and over again, even starting to pull the blanket down them selves,  “mommy is gone, mommy is back. As they get older, imaginative play takes over and children will imitate everything they see in the adult world. And to help them overcome feelings of being small and powerless, suddenly a four year old becomes his favorite super hero, with super strength and able to fly.

For school-aged children, play helps them learn self control. A game like Simon Says, for example, teaches kids impulse control. And board games teach them organization and how to follow rules and take turns. Playground games help kids learn negotiation as rules are often changed to fit the situation and kids have to compete in a “child created” hierarchy.

 Play helps children at every age , but something is happening now when children reach age five and enter school. Suddenly the time allowed for free play starts to disappear. Playtime is replaced with playdates, often structured by parents. And what happens on a playdate has changed. By this age imaginative free play has too often been replaced by video and computer games. In school, recess used to be a time of free play with kids learning how to navigate the playground games with rules set by the kids themselves. But now schools have cut down on recess time because of fears of liability and the need to increase time for academics. After school used to be a time of neighborhood play with kids of all ages engaged in pretend and pick up games. But now many parents do not let their children play outside without supervision because of fear for their safety.

Another factor is parents feeling pressure to help children achieve academic and athletic success. Parents fear that if they do not start lessons in sports or other activities at a very young age, their children will have a disadvantage as they grow. So kids are enrolled in ice skating classes and soccer teams at very young ages. This has replaced the free unstructured play time that kids used to have.


3.Talk about the movement to bring play back for children.  

 Many specialists are warning parents about the dangers of “play deficit”. Depriving children of free imaginative play as they grow may have harmful effects on their growth and development. The experts are saying that most of the social and intellectual skills one needs to succeed in life and work are first developed through childhood play. Children need child centered unstructured imaginative play- time. This is play that does not involve electronics and computers, X boxes, and iPads. It’s play that puts the child in charge of what happens. As soon as parents impose the rules, it becomes “parent play”.


4. What can parents do to help their children have more time for play?  

 Make a commitment to play. Whatever the age of your child, think about how they spend their free time. If you have small children, remove the electronics and unplug their play: look for toys like blocks, legos, dress up, pretend kitchens and tea sets. And avoid toys that are marketed to promote movies and TV shows. Look for toys without a story, ones that a child can impose their imagination on and can create their own stories.Take a look at your children’s schedules. Is there enough time for free play. Are all those classes necessary for an eight year old? Ask your kids what they really enjoy doing.


Create a fun room for play that other kids will like to come and play in. Make it safe, but adult free. Learn to tolerate mess. Making forts out of furniture cushions is messy, but very creative. Look at your backyard. Make it play friendly. Take some trips to the park with other parents.  Let the kids play by themselves. They need to create the rules. Advocate for recess time in schools. Connect with other parents or local advocates like your pediatrician who may feel the same way about the need for exercise as well as play during the school day. Most importantly, get out and play with your child. Play is fun for all ages!



How much sexual activity is going on in middle school? There is some, but not as much as you would think if you only listened to news reports and the scores of rumors that make the rounds among parents. But the truth is that there really is no hard data on sexual activity in this age group. Some studies estimate that 20% of young teens (under the age of 14) have engaged in some form of sexual activity. But according to Dr. Elizabeth Rose, an adolescent medicine specialist practicing in New Jersey, the studies are anything but conclusive or accurate. Reliable large-scale studies have just not been done. In her own experience in her suburban practice, “All the kids are talking about it, but very few are actually doing it.”

So as a parent of a middle school student, what should you do? You want to discuss this with your child, but you don’t know how? And should you bring this subject up at all?

The answer, according to Dr. Rose is yes. Throughout their school they are hearing about it and many kids are very anxious about it. Many of them are not ready for physically or emotionally for any sexual activity. We may call them Tweens, but developmentally, kids in this age group are more like children, than teenagers. And remember, even in the studies that have been done, 80% of middle school students are not sexually active in any way. So this is frightening for many young teens especially those aged 9-12 many of whom have barely hit puberty. The most important thing that parents, doctors, and health educators can do is to help dispel the myths and relieve these fears.

Remember, the media has saturated your young teens world with sexual images and references. Television, Movies, and Music have had increasing levels of sexual content for some time, but it is the Internet and social media that has brought this content even closer to your children on their computers, their iPads, and their smart phones. They are constantly exposed to a culture with a level of sexuality that is unprecedented. And they are not ready for it. I remember my daughter at the age of 12 coming to me and complaining with a sigh, “Mom, why is everything about sex?” I couldn’t give her an answer, but I remember it led to a good talk.

So how do you begin the conversation?

Pick the right moment,
While driving in the car, you have a captive audience, and even if a child doesn’t look at you he or she may be listening. Or while watching TV with your child (which I highly recommend) look for examples on TV to bring a subject up. (There will be plenty of opportunities if you watch programming for teens)

How do you start the conversation?
Always start by asking about other kids, it’s a safer starting point. For example, “I read something today that bothered me and I want to get your opinion.” Or “I was wondering do kids in your class actually date?” or “Do any of your friends have (girlfriends or boyfriends)?”

How do you get into the tricky stuff?
Once the conversation has started, be direct. Start with something like: “Do you know what sexting is?” “Do you know if this is something that some kids are doing in your school?” Then you can move into other areas such as questioning them about their knowledge of oral sex or intercourse. When I asked patients in my practice these questions, as pediatricians and adolescent medicine doctors are trained to do, the answers were very similar. “Yeah I heard some rumors but I don’t know anyone who was really doing it.” When I would ask how do you feel about this? Often the answers were, “It makes me nervous” “I don’t want to go out with boys because I don’t want to do that” “I think it is gross. “These kids needed to vent their anxiety and were relieved if I told them they were in good company.

Then what do you do?
First of all, make sure they have all the correct information. It’s very common for kids to get the facts all wrong. For example, according to Dr. Rose, many teens do not believe that oral sex is a form of sex or that they can get sexually transmitted diseases if they engage in this. Once you are sure they have all the facts, ask their opinion about the issues. Be sure to listen, and then express your own opinion. Allow room for discussion. Reassure your child that not everyone is doing this. If the talk leads to other issues about sexuality, consider yourself lucky. If your child doesn’t respond, just give them some time to digest the information.

What role can your doctor play?
Most pediatricians are trained to discuss these issues with your child beginning at age eleven or twelve. You will probably not be in the room. Your pediatrician will discuss these issues in a responsible and age appropriate way with your young teen. If you know that your child has been engaging in early sexual behavior or if you are having more serious problems, your pediatrician can refer you to an adolescent medicine specialist, like Dr. Rose, who has even more extensive training with adolescents.

But having a pediatrician or adolescent specialist speak to your child is not a replacement for a parent conversation. Statistics do show that kids, who are involved with their families, are less likely to engage in early sexual activity. It may be a conversation that’s hard to start, but the unspoken message to your child will be: that you understand, you care, and you are there.