Common Pediatric Illnesses and Care

Pediatric Illnesses and Care:

JAUNDICE
This is a term that describes a condition that gives a yellowish color to the skin and sclera (whites) of the eyes.

In the first week of life, about 60% of term infants and even a higher number of premature infants may become jaundiced. It’s caused by the elevated bilirubin levels in the blood. The chemical bilirubin is a breakdown product of red blood cells, and the excess cells the infant no longer needs now that they are independent of their mother’s circulation. The extra bilirubin is handled by the liver. In the first few days of life, the liver is not up to full function which may cause the bilirubin to accumulate, making the infant appear yellow.

If there is no blood incompatibility between mother and infant, (usually determined by blood typing and a Coombs test) and the newborn shows no evidence of infection or liver disease (uncommon), time and normal feedings will handle most cases of physiologic jaundice. Should the bilirubin rise to worrisome levels, the physician usually orders the infant to be placed under a special light to reduce the level of jaundice. If this occurs, you will notice the infant’s eyes are patched to protect them from the constant light.  If the physician chooses to use bilirubin blankets, patches will not be required as they will not affect the baby’s eyes.

BLOOD TEST- NEWBORN METABOLIC SCREEN (NMS)                                                                                                      

Prior to discharge, your infant will have a blood test done by heel stick. It checks for several different types of rare inherited diseases, including PKU (a cause of mental retardation) and hypothyroidism (under-active thyroid). If the test is done prior to 24 hours of age it may not be completely accurate and will need repeated. Please obtain a collection slip from the hospital. Check with us for results at the two week visit.

FEEDING                                                                                                                                                                                                                

 Feeding is one of your baby’s first pleasant experiences. At feeding time, baby receives nourishment from his/her mother’s love. The food, correctly taken, helps your baby to grow healthy and strong. Mother’s love generously given, helps your baby to feel secure. Help your baby get both kinds of nourishment.

1. TECHNIQUE                                                                                                                                                                                                          

Both of you should be comfortable. You should be calm and relaxed, your baby should be dry and comfortable. Whether breast feeding or bottle feeding, hold your baby comfortably close to your breast, with the baby sitting in your lap and his/her head resting in the bend of  your elbow.

2. BREAST FEEDING

Provides the best nutrition for healthy babies with benefits including support of the immune system ad allergy avoidance. There are many books and support groups on the subject. the more you know, the more comfortable you will feel. We can also recommend a lactation consultant at your request.

3. BOTTLE FEEDING                                                                                                                                                                            

Your baby has a strong natural desire to suck. Sucking is a part of the pleasure of feeding time. Babies will keep sucking on nipples even after the have collapsed, so take the nipple out of your baby’s mouth occasionally to keep the nipple from collapsing. Hold the bottle so that the neck of the bottle and the nipple are always filled with formula. This helps your baby get formula instead of swallowing air. Air in the stomach may give a false sense of being full and make your baby uncomfortable or enhance the spitting of formula when burped.

Never prop the bottle and leave the baby to feed him/herself. Feeding is a time for you and your baby to relax and enjoy each other. Your baby needs the security and pleasure of being held at feeding time. Allowing your baby to sleep with a bottle of milk or juice may lead to extensive dental decay.

Most babies will thrive on virtually any type of formula. Most commercial formula comes in powder, concentrated liquid or Ready-to-Use forms which vary in price as well as convenience. All provide equal strength formulas when used according to directions. The use of the powdered or concentrated liquid preparations assures your baby of getting the necessary fluoride requirements, assuming the use of fluoridated water. Ask us about the need of fluoride supplements if you use private well water or bottled water. We recommend that that the formula contain iron for your baby’s ongoing requirements. Store that formula in the refrigerator. Make up only one day’s formula at a time.

After the first week of life it is not necessary to warm formulas, though most babies prefer it this way. The formula may be given directly from the refrigerator or at room temperature if acceptable to your baby. If warming the formula, do not use a microwave oven; this may cause either overheating or subsequent burns to your baby or explosion of the bottle in the oven. Carefully test the temperature oft the formula prior to giving it to your baby.

If the bottle and nipples have been washed in hot soapy water rinse well, no sterilization is necessary. Those having a dishwasher need only run the bottles and nipples through the machine.

Water may be used directly from the tap and no boiling is required unless your home is serviced by private well water. If there is any question of the water quality, boiling water for 1 minute is recommended.

4. SCHEDULE 

Feeding schedules are usually most satisfactory if the hours are not rigidly set and the baby is allowed to eat when he/she becomes hungry in the first few weeks of life. After this you and your baby are likely to develop a more predictable pattern with some flexibility required to accommodate changing needs with growth. New babies usually need to be fed about every 2 to 4 hours, but may often go up to 5 hours between feedings. Should your baby consistently awake and cry less then 2 hours after feeding, check with our office. As he/she gains in weight, your baby will require larger feedings with, hopefully, longer intervals between feedings.

5. BURBING

Burping your baby removes swallowed air. Even if you fed properly, both bottle fed and breast fed babies usually swallow some air.

Hold your baby upright over your shoulder, pat or rub his/her back gently until he/she burps. Two alternative methods are: a) place the baby face down over your lap rub his/her back; b) hold the baby is a sitting position, leaning slightly forward, with your hand supporting his/hr chin pat the back until a burp occurs. Some babies require very frequent burping ; this is particularly true of babies who tend to “gulp their food down” or who are “spitters.” After you have fed and burped your baby, place him/her in bed on his/her back. If your baby tends to vomit milk, elevate the head of the mattress slightly since in this position the mile will naturally roll out of the mouth.

6. SOLID FOODS

Most babies will require nothing more than either formula or breast milk for the first 4 to 6 months of life. Their nutritional and fluid requirements are fully met by these feedings. However, since the timing selection of solid foods is an individualized decision, it will be discussed with you at the time of your baby’s routine visits to the office. Some basic rules can be given here: a) solids should be given by spoon only, never in a bottle; and b) new foods are to be introduced individually and slowly (a new food may be introduced every five to seven days).

7. VITAMINS 

Most commercial formulas contain the necessary vitamins for your baby For breast fed babies, supplementation with Vitamin D is recommended and available over the counter. Fluoride is not needed in babies less than 6 months.

8. WATER 

Supplemental water is not recommended for either breast or bottle fed infants until the age of six months.

GENERAL BABY CARE

Bathing

  • Until the baby’s naval heals, give soap and water sponge baths using a mild soap such as Dove© or Aveeno©.
  • After the navel has healed, the baby may be immersed in water.
  • You should wash the babies face using only water.
  • Their hair and scalp may be shampooed using baby shampoo twice weekly.
  • Daily baths are not necessary and can lead to dry skin; 2 to 3 times a week is sufficient.

Skin

  • The skin of most infants is normally moist and no special care is needed after bathing, avoid oils, lotions, and powder unless prescribed.
  • A fine peeling of the skin, especially on the hands and feet, is normal in the first few weeks.
  • Rashes resembling acne are quite common on the face during the first few months and usually subside without treatment.
  • The diaper area should be gently cleaned with each change. Disposable towelettes can con­tain irritants and may cause diaper rashes. If a rash occurs use plain water on cotton balls or disposable cloths in the first weeks of life.

Nails

  • Fingernails grow quickly and are very sharp, to prevent babies from scratching themselves, cover hands with socks, trim their nails with blunt scissors or file them with an emery board.

Eyes

  • Tears keep the eyes clean. If crusting on the eyelids occur, you may find it desirable to sponge them with warm water on a cotton ball, stroking gently from the inside corners outward. Do not try to force the eyes open to put the water inside. If a large amount of yellow or green drainage occurs from the eyes, or redness of the whites of the eyes occurs, call our office.

Ears

  • Clean only the area you can see. A Q-Tip© moistened in water can be used to clean the crevices. Do not push the cotton tip into the ear canal.

Navel

  • Recent studies have shown that the best care for the umbilical cord is no care, other than keeping the cord clean and dry nothing special needs to be done.
  • Typically, the stump falls off before the second week and no dressing is needed.
  • If the skin around the navel becomes red, it may be an indication that an infec­tion is starting. At this time, you should contact our office.
  • Occasionally, when the umbilical cord drops off, slight bleeding may occur. This is usually not serious and can be stopped readily by applying pressure to the navel with a dry gauze. If the bleeding persists, you should notify us.

Circumcision

  • Complete healing will take one week after the procedure.
  • Sponge the area with water with each diaper change.
  • A small amount of Vaseline© to the top of the penis should be applied to prevent the penis from sticking to the diaper after the first 24 hours. Do not wrap gauze or any other material around the penis.
  • For uncircumcised male infants, retraction of the foreskin is not recom­mended. Do not force the foreskin back over the tip of the penis. It may normally take 3 to 4 years before the foreskin is fully retractable.

Bowel Movements

  • No two babies are alike. Bowel movements may vary in frequency, color, (yellow, green, brown), and consistency. If the abdomen is not distended and the movement is soft, it is probably normal. Frequency may be from every feeding to every 3 days or more and still be normal for a baby’s digestive system. It is normal for babies to appear to strain, draw their legs up, and get red in the face while having a bowel movement; this is not usually constipation. Under no circumstances should laxatives, supposi­tories, or enemas be used without a physicians advice. If the stools are excessively watery and frequent, you should notify us.

Sleep

  • The baby should be placed on their back. Recent studies have raised concerns regarding a higher incidence of Sudden Infant Death Syndrome (SIDS) in babies sleeping on their stomach. Unless your baby tends to regurgitate feedings excessively or has medical problems that place your baby at risk for choking, it is safe for the baby to sleep on their back.
  • There should not be any pillows or toys with loose or stretchable parts on the bed.
  • Do not tie a pacifier or any other toy around your baby’s neck.
  • Babies should not sleep in bed with you. Although some parents find it more con­venient to have newborns sleep in bassinets in the same room, there should be no concerns about the baby sleeping in their own room from the start; you will hear them when they need you.

Clothing

  • Your baby requires as much clothing as an adult. Never overclothe or underclothe your baby; dress them according to the temperature.
  • Keep the house temperature at a comfortable 68 to 74 degrees for the baby.

COMMON COLD’S
The major symptom of a common cold or upper respiratory infection (URI) is a runny or stuffy nose. A mild sore throat, cough, and fever are commonly associated with this viral infection. While over-the-counter cold medications may relieve some of the symptoms associated with a cold, they will not make the cold go away any sooner than usual, typically 7 to 10 days.

Colds can normally be treated by you at home; however, the following are symptoms that require a doctor’s visit:

  • Difficult or labored breathing (not due to nasal congestion)
    ***Any child with this condition should be seen immediately***
  • Earache
  • Nasal discharge greater than 10 days or becoming worse from the 7th to 10th day or beyond
  • Sinus headache and fever
  • Fever for more than 72 hours in duration
  • Bloody discharge

Home Treatment for  young infants with colds would include:
***We do not recommend over-the-counter cold medications for babies less than 6 months of age***

Treatment of young infants with colds would include elevating the head, instead of lying the baby flat on his/her back; saline drops and suctioning the nose with a short tip infant nasal aspirator; and a humidifier.

EAR PAIN                                                                                                                                                                                                                                                                                                        

In most circumstances ear pain can be treated symptomatically until the patient can be seen in the office. Ibuprofen or acetaminophen are the best for pain relief. In addition a warm heating pad or a few drops of olive oil can be very effective. Note: nothing should be instilled into an ear that is draining pus or has surgically placed P.E. tubes.

VOMITING
Vomiting is a common problem in children. While it can be serious, most often it is caused by a viral infection of the stomach or from eating something that disagrees with them. Vomiting can usually be managed by offering clear fluids (those you can see through). For babies, the best choice is Pedialyte©. Offer 1 teaspoon to 1 tablespoon (depending on their age) every 20 minutes, working up to every 10 minutes. If the vomiting continues despite this approach, give it a 1 hour rest then start again. Do the rest period only once, otherwise continue to push fluids in spite of continued vomiting.

Your child should be seen in the office if:

  • Less than 6 months old and vomiting beyond 12 hours
  • Age 6 months to 24 months and vomiting beyond 24 hours
  • More than 24 months and vomiting beyond 48 hours
  • Urine output is less than:
    • every 8 hours if under 1 year of age
    • less than every 12 hours if 1 year or greater

Vomiting is more serious if it is associated with any of the following conditions.
***These conditions require immediate medical attention and you should contact us for direction***

  • Abdominal pain that is greater than 2 hours in duration
  • Distended abdomen
  • Stiff neck
  • Difficulty in arousing
  • Swallowing a foreign object
  • Abdominal injury
  • Ingestion of a poisonous substance

DIARRHEA
Diarrhea is defined as frequent stooling. Most often it is viral and the stools that are caused by viral diarrhea are very watery.
***When diarrhea contains blood or mucous and is accompanied by a high fever, you should contact us***
The most important issue with diarrhea is to ensure that fluids are being replaced. Do not give water, the best replacement fluid for children is Pedialyte©. Offer 4 ounces of fluid for every large stool passed. In addition, your child should eat a regular diet if there is diarrhea without vomiting. You should also start giving a Probiotics product such as DanActiv, Baby Yo, or Yakult. New studies have revealed that Pribiotics help in strengthening the gut flora thus making the diarrhea episode shorter.
***Avoid concentrated sweets, fruit juices, rich foods, and fatty foods***

EYE DISCHARGE OR REDNESS
The most common cause of eye discharge and redness is a viral infection such as a cold or an allergy. In the case of a cold or an allergy, generally you will find that there is a small amount of yellow discharge in the corner of the eye or a small amount of crusting of the eyelids. If the discharge is heavier and persistent, the cause may be bacterial. Bacterial conjunctivitis requires treatment with topical antibiotics.

Here are some pink eye questions to answer in determining how to best treat your child:

  • Is there drainage from the eye?
  • Is the drainage green in color?
  • Is there matting noted on the eyes (i.e. the eyes are stuck shut upon waking up)?
  • Is the child less than 2 years old?
  • Is there fever?
  • Is there pain on or around the eye area?
  • Is there swelling around the eye?
  • Is there a history of recent injury or foreign body in the eye?
  • Is there blurring of vision or excessive tearing of the eye?

If you answered YES to questions 1, 2 and 3, please call our office for antibiotic eye drops.
If you answered YES to questions 4, 5, 6, 7, 8, or 9, please call the clinic for an appointment so the doctor can evaluate your child.
If you begin an antibiotic drop and the symptoms have not resolved in 72 hours, please call our office to schedule a follow-up appointment.

DIAPER RASH
Diaper rash occurs when there is prolonged contact of the skin with stool and/or urine. The skin will be raw and red and some babies start crying every time they soil their diaper because of the exposed and raw skin.

Common cases of diaper rash include:

  • Infants and newborns
    (because they have super sensitive skin and they have frequent bowel movements – normally every 3-4 hours)
  • Children with diarrhea
  • Children on antibiotics that are producing loose stools caused from the side effects of the antibiotics
  • Children that drink a lot of fruit juice

How do you prevent diaper rash?

  • Change the diaper as soon as it becomes soiled. For infants, usually this will be every time they feed. You want to lesson the time the skin comes in contact with the urine and feces in order to minimize the irritation. As the baby gets older, the frequency of diaper changes tapers off.
  • Wipe the baby’s bottom gently preferbly with just water. We like using the squirt bottle that the hospital usually gives to the moms after delivery or you can use a bulb syringe. The basic idea is that you want to minimize the friction on the baby’s skin.
  • Avoid using powder on the baby’s skin becuase it causes more irritation to the skin.
  • Use barrier therapy all the time especially during the newborn period and at night.
    • Barrier therapy means putting diaper cream on the baby’s bottom to prevent the skin and urine/feces from touching each other. There are many different types of diaper creams available in stores. We believe the thicker the cream the better it is and recommend Bordeaux Butt paste since it’s really thick and gooey or ask the pharmacist for Triple Paste. We recommend putting more on at night because the baby usually sleeps for longer periods, resulting in the baby not being changed as soon as they have a bowel movement or urinate.

What are the treatments for diaper rash?

  • Let the area dry out to aid in healing. If you can, remove the diaper and allow the baby  to be in their birthday suit for one hour or so.
  • Warm sitz baths. Let the baby relax in a warm tub of water for 5-10 minutes. Once they are done soaking, gently wipe the baby’s bottom and ensure the area is completely dry before putting on a new diaper.
  • Try using an over the counter (OTC) anti-fungal cream such as Clotrimazole (Lotrimin AF) in addition to the diaper cream that you’re using. Put the anti-fungal cream on first, and then top it off with the diaper cream.
  • If you’re baby is 6 months or older, give them  a small amount of probiotic yogurt such as Baby Yo or Dan-Activ. Probiotics have the good bacteria that makes the diarrhea better.
  • Some foods can be harsher on your baby’s bottom such as apple juice. When there is a diaper rash present, try removing them from your baby’s diet.

When to call the clinic?

  • If the baby has fever
  • If the rash lasts more than 3 days despite home treatment with Lotrimin
  • If the rash is spreading to other body parts and not just limited to the diaper area

FEVER
Fever is the body’s normal response to infection. By itself fever is not harmful until it reaches 106°F or 107°F. Generally, the body cannot reach a temperature this high without unfavorable environmental conditions such as being left in a hot car in the summer. How sick your child looks, is much more important than how high the fever is.

Definition of fever in different age groups:

  • Infants (0 – 3 months old)
    • 100. 4°F (38°C) taken rectally only
  • Older children
    • Oral temperature above 100°F (37.8°C)
    • Axillary (armpit) temperature above 99.0°F (37.2°C)
    • Rectal temperature above 101°F (38.4°C)
    • Ear (tympanic) temperature above 100.4°F(38.0° C)
      (Note: Not reliable for babies under 6 months old)
    • Temporal artery (TA) temperature above 100.4°F(38.0° C)
      (Note: more reliable than tympanic thermometers, but not to be used for children under 6 months old)

If the temperature is between 100.o°F  and 101.o°F, re-check the temperature again in an hour before calling it a fever. Mild fevers can be caused by too much clothing, recent exercise or a hot environment. Oral temperatures can be raised by eating warm foods within half an hour.

If any of the  following conditions are present along with a fever, you should call us right away so we can deteremine if your child needs immediate care: 

  • Less than 2 months of age
  • Constant crying
  • Temperature more than 105.o°F at any age
  • Accompanied by a stiff neck or bruise-like rash
  • Difficulty in arousing (can’t wake from sleep)
  • Difficulty breathing (labored breathing not due to a stuffy nose)
  • Dysuria (frequent or painful urination)

If your child’s fever is high, they will usually breathe faster and more shallow than normal. As long as their color is normal, (pink rather that pale, blue or mottled), you can give them medicine for the fever and observe for improvement over the next hour. Typically, you can expect that the temperature will come down 1 or 2 degrees and that the breathing will appear more normal within this period of time.

Guidelines we use to determine if you child needs a to be seen at a scheduled appointment in the next 16 hours are:

  • Age 2 to 6 months with fever
  •  Duration more than 72 hours at any age
  • Fever gone for 24 hours, then recurs
  • Fever for 24 hours without other symptoms

CONSTIPATION
What is constipation?

  • Passage of firm, dry pebbly poop
  • Crying and pain during bowel movement which can result in anal bleeding, abdominal pain and decreased appetite

Note: Constipation is not defined by the frequency of bowel movements or the straining involved when attempting to pass a stool.

Everybody is different and each person has their own schedule for passing stools. Some children go once a day, others go twice a day, some every other day, and for some it’s every 3rd day and so on. As long as the defecation process is pain-free and there’s no crying involved, most likely that is just the normal defecation pattern for that child.

Grunting and straining while trying to poop is normal, especially for young infants. Small babies can start drawing their legs up, grunt and turn beet red when they are pooping. Straining is usually observed during the first 2-4 weeks of life when the baby is becoming more aware of their body and the signals that it’s giving to the baby. It is difficult to poop even when you’re sitting down so imagine these poor babies trying to poop when they’re on their backs, especially with no gravity helping them. The straining process helps move the stool and this is a sign that they are learning to control their body. During the initial stages, they are still learning the mechanics of defecation so they might be exerting effort during the early phases but they will eventually learn to coordinate the process better later on.

Home remedies for constipation include:

  • Babies under 6 months of age
    (Note: Corn syrup and sugar attracts more fluid into the intestine making stools softer)

    • Give them sugar (1 tsp in 1 ounce of water)
  • Babies between 6 months and 12 months of age:
    • Give mixed grains of cereal:
      • Bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread
    • Give more fruits and vegetables:
      • Pureed prunes, peas, beans, broccoli, banans, figs, dates, apricots, prunes, peaches, pears, plums have high fiber content
    • Add fruit juices and water:
      • Prune, apple, apricot, cherry, and grape juice are rich in sorbitol, a nondigestible sugar that absorbs more water with it when it passes through the body to the colon
    • Give them Karo Light syrup (1 tsp added to bottle 2-3 times per day)
  • Babies older than 12 months of age:
    • Encourage more fluid intak such as water and fruit juices
    • For those who are in the process of toilet training, encourage more sitting time and on a regular schedule:
      • Usually after meals to take advantage of the gastrocolic reflex
      • Reassure them that their poops won’t hurt when they come out
      • Praise them for the release of bowel movements
      • Avoid any pressure, punishment or power struggles about holding back poops, sitting on the potty or resistance to training
    • Warm Water for Rectal Pain
      • Warmth helps many children relax the anal sphincter and aids them in releasing a bowel movement. For prolonged straining, have your child sit in warm water or apply a warm wet cotton ball to the anus.

Call our office if constipation persists despite these measures and if the child is having other symptoms such as vomiting, decreased urine output and fever.

FLU VACCINE AND THIMEROSAL
We have received some questions from concerned parents about thimerosal or ethylmercury in the flu vaccine. Below is information regarding these topics for your reference:

What is Thimerosal?

  • Thimerosal is an effective preservative that has been used in multi-dosed vials to prevent bacterial and fungal contamination of the vaccines. It has been used for several years but due to safety concerns and the possible association with autism, (which has not been clearly linked and several studies have not documented the direct relationship), vaccine manufacturers had voluntarily stopped using thimerosal with their products. The majority of the vaccines recommended by AAP are thimerosal free with the exception of SOME types of flu vaccines.

What is ethylmercury?

  • Ethylmercury is a type of mercury, but is different from methylmercury that is normally found in fish and seafood. Methylmercury at high levels can be toxic to people so we avoid giving fish with high methylmercury content  (swordfish, king mackerels, sharks and toothed whales) to pregnant and young children because of the affects it can have on the brain development of these children. It’s important to understand that promblems don’t occur from single exposure to these fish, it’s the prolonged and continuous exposure that causes problems. Problems occur when there is a cumulative effect of methylmercury in the body because it takes a while for the body to excrete it. So if you’re eating these fish constantly, the mercury in your body will start accumulating, causing some toxic affects to the body. Once you stop consuming these fish, your body will eventually excrete the mercury.

Ethylmercury has not been known to cause equal effects compared to methylmercury. It’s the process of methylation which makes it more toxic to the body. I would loosely compare ethylmercury to ethanol (drinking alcohol) and methylmercury to methanol (anti-freeze) just to say that the process of methylation makes the substance more powerful and more toxic.

How much is the acceptable mercury exposure? Listed below are the varying recommendations from different organizations of acceptable exposure to mercury:

  • EPA – 0.1 microgram/kg/day
  • Agency for Toxic Substances Registry – 0.3 microgram/kg/day
  • FDA – 0.4 microgram/kg/day
  • WHO, FAO (Food and Agricultural Organization) – 0.23 microgram/kg/day

The bottom line is, the ethylmercury in the flu shot is a small amount and not the form, (methylmercury), known to be toxic if it starts accumulating in the body.

For further information, please take a look at the article “General Questions and Answers on Thimerosal” provided by the Center for Disease Control. If you still have questions or concerns please call our office and we will be happy to assist you.

AUTOMOTIVE SAFETY

  • Somewhere between the security of the hospital nursery and the loving home of their parents, your baby may encounter a serious threat to their young life if leaving the hospital on your lap in the family car instead of in a safe restraint. What almost all of us forget is that no mother’s arms can protect her young one from the tremendous force of even a 15 m.p.h. automobile accident. Motor vehicle accidents are a major cause of death in children from ages 1 to 4.
  • Even on the very first car ride, the drive home from the hospital, and visits to the office, friends, family, and stores, your baby should be transported in an effective safety carrier. It is a Virginia state law that all children under 6 years of age must ride in an approved safety seat.
  • Various models of infant and child safety seats exist. They can be obtained at most major stores that carry infant and child supplies. It is critical that all devices be used and installed according to the manufac­turer’s instructions. Installation in the center of the seat is safer than the sides, and the back seat is safer than the front. Never use an infant rear facing car seat in a seat with an air bag. We recommend locating a safety check point through your community’s fire and rescue or the police to have the carseat checked for installation.
  • A car seat and seat belts are the best investment you will ever make for your child to have a long and safe life. The law now requires car seats or boosters for children 6 years and under.  The National Safety Transportation Board recommends child safety restraints until eight years of age and 80 pounds or over four feet nine inches tall. For further information please take a look at the article titled “Car Safety Seats: Information for Families for 2012″ by the American Academy of Pediatrics.

GENERAL SAFETY PRECAUTIONS

  • Always keep one hand on your baby when bathing them. Never leave them alone in the bath or in the pool. If the phone or doorbell interrupts their bath – disregard the call, take your baby with you,  or place them in a safe place such as their crib.
  • Always check the water temperature before placing a baby in it. Turn down the maximum temperature of the hot water heater to 120°F.
  • Keep safety pins closed, and small objects such as scissors, nail files, but­tons, small toys, etc. away from their reach.
  • Keep toys free from splinters and sharp edges. Be sure to remove all loose parts which may be swallowed.
  • Keep the baby away from hot stoves, radiators, pipes, open fires, ciga­rettes, irons, curling irons, and hot foods.
  • Do not use soft heavy pillows which might interfere with breathing.
  • Keep electric sockets covered and cords out of reach.
  • Furniture and lamps should be placed so they cannot be pulled over onto the baby.
  • Keep all medications in a locked cabinet/drawer or in a high, out of reach place. The same is true for household poisons such as insecticides, cleaning agents, solvents, dishwasher soap etc. Always have the Poison Control Center phone number handy.***Ask our front desk for a magnet with the Poison Control Center phone number***

MEDICAL SUPERVISION

To ensure good health care, we suggest regular periodic “checkups.” Your child’s growth, development, and feedings will be discussed. You will receive anticipatory guidance for the subsequent interval of time. During the first year, we advise examinations at a minimum of two weeks, 2 months, 4 months, 6 months, 9 months, and one year. immunizations are very important; they help protect your baby from hepatitis, diphtheria, whooping cough, tetanus, polio, measles, mumps, German measles and certain types of meningitis. Your baby will receive these immunizations at the time of their regular checkups. In addition, urine and blood test as well as skin tests for tuberculosis (TB), will be done periodically. We will discuss with you the benefits and risks of any procedure or medication at these checkups.

 

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