Although flu season is typically not observed during the summer, we want to remind you of the importance of staying vigilant year-round. At Pediatrics & Adolescents Clinic, we initiate our flu vaccine clinics shortly after Labor Day. We highly recommend the seasonal flu vaccine for all our patients and their families, especially those in high-risk groups.

For comprehensive information on influenza, we recommend visiting the following trusted sources:

1. HealthyChildren.org
2. Centers for Disease Control and Prevention (CDC)

At Pediatrics & Adolescents Clinic, we endorse the top five essential measures to safeguard your health and prevent the spread of illnesses. These key tips are universally recommended by organizations such as the World Health Organization and the U.S. Centers for Disease Control and Prevention, as well as other esteemed health experts.

1) Frequent Handwashing:

Proper and regular handwashing is one of the most effective ways to avoid illnesses such as flu. It is essential to use warm or hot water, lather up, and ensure thorough coverage including under your fingernails, around your wrists, and between your fingers. Aim to wash your hands for the duration of singing "Happy Birthday" twice or reciting the ABCs once. Rinse well. Handwashing should not be limited to before eating and after using the bathroom; it should also follow using a tissue or covering your mouth when sneezing or coughing, whether you are sick or not. This level of hand hygiene is crucial in preventing the spread of infectious agents.

2) Cough and Sneeze Etiquette:

When sneezing or coughing, ensure you cover your mouth and nose to prevent the spread of droplets. We recommend using the classic shoulder or the crook of your elbow to catch these droplets. After sneezing or coughing, it is vital to wash your hands to avoid contamination. Surgical face masks are an option for containing droplets, but they do not replace the need for hand hygiene. The use of face masks for everyday activities remains a topic of debate in the healthcare community due to issues related to proper use and effectiveness.

3) Stay Home When Sick:

If you are unwell, it is crucial to stay home. Rest and recovery are essential, and by doing so, you protect not only yourself but also those around you. Be sure to wash your hands frequently, especially after using tissues, to prevent recontamination.

4) Avoid Touching Your Face:

Strive to avoid touching your face, specifically your eyes, nose, and mouth. These areas are direct pathways for viruses to enter the body. Regular handwashing helps mitigate the risks associated with inadvertent face-touching.

5) Minimize Contact with Ill Individuals:

It is advisable to minimize close contact with individuals who are unwell. While flu viruses tend not to linger in the air, they can settle on surfaces, which can then transfer to your hands and potentially lead to infection. It is essential to avoid close interaction with sick individuals and maintain a clean environment.

At Pediatrics & Adolescents Clinic, we prioritize your health and well-being. These guidelines, recommended by esteemed health organizations, serve as crucial measures to ensure your protection during cold and flu season. We are dedicated to providing expert healthcare solutions for your child's well-being.

Vomiting can be your child's body's way of expelling the irritants it's encountering. Viral gastroenteritis, often referred to as the "stomach bug" or "stomach flu," is a common cause of vomiting in children. The primary concern during vomiting is maintaining proper hydration, as severe dehydration can significantly impact the body's functionality. However, in most cases, vomiting is an uncomfortable but temporary experience for both children and parents.

To promote adequate hydration and minimize vomiting, the following guidelines are recommended, depending on your child's age:

Infants Under 6 Months of Age:

1. Administer about ½ ounce of an oral electrolyte solution (e.g., Pedialyte) every 15 minutes. Avoid giving plain water as the salts in the electrolyte solution help replace lost fluids.
2. Gradually increase the solution amount if there's no recurrence of vomiting. For example, after two hours of tolerating ½ ounce, it's acceptable to try ½ to 1 ounce every 15 minutes and increase throughout the day.
3. If there's no vomiting after eight hours of this hydration process, you can consider returning to formula and/or breastfeeding, but start slowly. For breastfeeding, stick to 5-10 minute feeds every two hours, and for formula feeding, start with no more than an ounce at a time.
4. If vomiting occurs during rehydration, wait about 30-60 minutes before attempting the process again.
5. For infants under two months of age with repeated vomiting episodes, contact Boulevard Pediatrics for immediate care and instructions.

Infants 6 Months to 1 Year of Age:

1. Follow similar guidelines as for younger infants, but initial fluid volumes can be slightly higher.
2. Flavored popsicles from oral electrolyte solutions can be helpful.
3. After eight hours without vomiting, you can gradually reintroduce formula/breast milk as mentioned above. Start slowly. For infants on solids, you can introduce bland foods such as bananas, cereals, and soft crackers.

Children 1 Year of Age and Older:

1. Similar to the above instructions, larger initial volumes of clear fluids can be tolerated. Begin with ½ ounce every 15 minutes and increase gradually.
2. Clear liquids like ice chips/water, flavored oral electrolyte solutions (e.g., Pedialyte), or popsicles can be given.
3. After eight hours without vomiting, you can introduce mild, bland foods, including mashed potatoes, bland soups, and chicken broth.
4. In some cases, we may prescribe anti-vomiting medication, but this would only be after an in-office evaluation.
5. It's advisable to avoid milk products until a day or so after the vomiting stops.

Signs of Mild to Moderate Dehydration:

1. Dry mouth
2. Decreased tears
3. Decreased wet diapers or no urination in an older child for 6-8 hours
4. Slightly sunken soft spot on an infant's head
5. Increased fussiness

Signs of Severe Dehydration:

1. Extremely dry mouth, often appearing sticky inside
2. Wrinkled or doughy skin
3. Decreased alertness
4. Sunken eyes or a sunken soft spot in an infant
5. Increased sleepiness and appearing limp
6. No urination for eight hours in an infant and 12 hours in an older child

When to Seek Medical Attention: If your child refuses fluids or vomiting persists, it's important to seek medical attention. Other concerning signs include abdominal pain inconsistent with a viral stomach bug, projectile vomiting in an infant less than 3 months old, vomiting after a head injury, vomiting bright green fluid, vomiting blood or coffee ground emesis, or any other symptoms that raise concerns about your child's well-being. In such cases, please have your child seen immediately.

At Pediatrics & Adolescents Clinic, we prioritize your child's health and well-being, providing comprehensive guidance and care during challenging times.

Colds, also known as upper respiratory tract infections, are among the most prevalent illnesses that affect children. When your child begins daycare or preschool, it's common for them to experience an average of eight colds each year. Typically, these colds manifest 2-3 days after exposure and can last anywhere from a few days to a couple of weeks. Common cold symptoms include a runny or stuffy nose, a sore or scratchy throat, sneezing, coughing, and occasionally a low-grade fever. Nasal discharge can range from watery to thick yellow or green. It's important to note that colds are highly contagious, especially in the first few days after symptoms appear, and they can spread through person-to-person contact, airborne particles, or contact with contaminated surfaces.

What can you do to assist your child with a cold?

1) Elevate the Head During Sleep

Elevating your child's head while they sleep can help ease breathing difficulties.

2) Use Humidified Air:

Cool mist humidifiers are recommended to help loosen nasal secretions.

3) Maintain Hydration and Rest:

Ensure your child stays well-hydrated and gets adequate rest to support recovery.

4) Nasal Saline Drops and Bulb Suctioning:

Using nasal saline drops and periodic bulb suctioning can help clear nasal congestion.

5) Chicken Soup:

While research is limited, chicken soup contains cysteine, an amino acid known to have mucous-thinning properties. It's worth trying for relief.

6) Avoid OTC Cough and Cold Medications:

It's essential to follow the latest recommendations that advise against using over-the-counter cough and cold medications for children under 4 years of age due to potential ineffectiveness and the risk of overdosing.

When should you consider a visit to our clinic?

1) Shortness of Breath or Difficulty Breathing:

Seek medical attention if your child experiences breathing difficulties.

2) Worsening Cough:

If the cough intensifies, consult with us.

3) Increased Fatigue or Lethargy:

If your child becomes excessively tired and cannot maintain hydration, it's important to get medical guidance.

4) Sore Throat with Severe Pain When Swallowing:

A sore throat with significant pain during swallowing warrants evaluation.

5) Fever Lasting More Than Three Days:

If a fever persists for more than three days or doesn't respond to medical intervention and cooling measures, contact us.

6) Ear Pain:

Ear pain should be assessed by a healthcare professional.

Is there a way to prevent colds?

While cold prevention may seem challenging, several measures can help:

1) Avoid Contact with Infected Individuals:

Steer clear of individuals with colds and objects they may have touched, such as utensils, cups, and tissues.

2) Practice Good Hand Hygiene:

Regular and thorough handwashing is crucial.

3) Cover Nose and Mouth When Sneezing/Coughing:

Teach your child to cough into their elbow, not their hand.

For those curious about the use of zinc, vitamin C, and Echinacea, it's important to note that there is no substantial research supporting their effectiveness in preventing colds in children.

At Pediatrics & Adolescents Clinic, we are dedicated to providing guidance and care to support your child's well-being during colds and various illnesses.

A cough serves as a vital reflex safeguarding your child's airway, and various underlying factors can trigger it. We have previously discussed distinct cough types, such as the seal bark-like cough of croup, the wheezing-related whistling cough, or the common cold-associated cough.

However, other reasons for your child's cough can include allergies, allergic rhinitis (which stems from post-nasal drip), gastroesophageal reflux disease (GERD) (sometimes presenting subtly with no other accompanying symptoms), and sinus infections (manifested in prolonged colds exacerbated as nasal passages accumulate mucus). Pertussis (whooping cough) is characterized by severe coughing spells culminating in the distinctive "whoop" sound, typically affecting infants. Fortunately, we administer a pertussis vaccine from the age of 2 months as part of the DTaP vaccine, which also includes diphtheria and tetanus. Additionally, there is now a pertussis booster vaccine available for adolescents and adults.

Most coughs tend to worsen at night, often due to the horizontal sleeping position, while others may intensify during the day in response to factors like cold air or exercise-induced asthma or wheezing.

Although some coughs may not necessitate immediate medical attention, please schedule a visit to our clinic if any of the following occur:

1. Your child experiences difficulty breathing or is working harder than usual to breathe.
2. Shortness of breath or stridor, characterized by a harmonical breath sound during inhalation.
3. The cough is accompanied by a high fever.
4. You observe any change in color, particularly blue around the mouth.
5. If there's any presence of blood in the cough.
6. Wheezing is noticed, and there's no existing asthma care plan provided by your physician.
7. The classic "whoop" associated with pertussis.
8. Infants who have been coughing for an extended period.

What can you do at home to alleviate your child's cough?

1. If your child has asthma, initiate the care plan discussed with your pediatrician. If there's no established plan, seek immediate evaluation.
2. As mentioned in the croup section, if a seal bark-like cough emerges, take your child into the bathroom after a hot shower, allowing the steam to surround them, aiding relaxation. If there's no improvement, bring your child in for immediate evaluation.
3. Invest in a cool-mist humidifier for your child's room, as added moisture can be beneficial.
4. Ensure your child stays well-hydrated and gets sufficient rest.
5. Use saline nasal sprays to address nasal congestion.
6. Based on research supporting its use, consider administering 2 teaspoons of honey before bedtime for children aged 2 years and older. Never give honey to children under 1 year of age due to the risk of infantile botulism.
7. Comply with the latest recommendations regarding over-the-counter (OTC) cough and cold medications, which discourage their use for children under 4 years of age, as their effectiveness lacks robust data, and there are concerns related to overdosing.

At Pediatrics & Adolescents Clinic, we prioritize your child's health and comfort, providing comprehensive guidance and care during cough-related challenges and various health concerns.

Remarkably, croup, also known as laryngotracheobronchitis, is not attributed to a specific virus but rather characterizes a distinct medical condition. It is characterized by a distinctive, harsh cough, often resembling a seal's bark. Croup can be triggered by a variety of pathogens, including parainfluenza, human metapneumovirus, adenovirus, and even influenza. The root cause of the croup's characteristic cough, sometimes accompanied by stridor (a high-pitched sound during inhalation), is the inflammation that occurs around the larynx (vocal cords) and trachea (windpipe). Younger children, due to their narrower airways, are more vulnerable to this condition. Croup symptoms typically worsen at night, which can be a distressing experience for both the child and parents.

In most cases, croup is not severe and can be managed at home. Home remedies include exposure to humidified air, which can be achieved through a humidifier or by taking your child into a steam-filled bathroom. Additionally, a brief exposure to cool night air (ensuring your child is adequately wrapped up) and ensuring your child consumes plenty of fluids can be beneficial. However, if symptoms fail to improve with these measures, it is imperative to seek immediate evaluation by a physician. Medications may be necessary, including steroids and/or epinephrine, which is administered in a mist-like form.

Instances that warrant immediate medical attention, either at our clinic or, if it occurs at night, at a local emergency department or urgent care facility, include:

1. The presence of pronounced stridor, characterized by high-pitched inspiratory breathing sounds.
2. Difficulty swallowing or excessive drooling.
3. Any signs of extreme irritability or agitation.
4. Significant breathing difficulties.
5. A bluish hue around the mouth or nose (perioral cyanosis).
6. A fever approaching 104°F.

At Pediatrics & Adolescents Clinic, we are committed to addressing croup and various pediatric health concerns with expertise and compassion, ensuring your child receives the best care and guidance.

A normal core body temperature, most accurately measured rectally, is approximately 98.6°F. However, several factors, such as age and overall health, can influence an individual's baseline temperature. It is common for temperature to slightly dip in the morning and rise later in the afternoon. Additionally, strenuous physical activity can lead to a mild increase in core body temperature. When a child's core body temperature surpasses 100.4°F, it is considered a fever. Nonetheless, lower values may also indicate a fever depending on the child's age.

When a fever arises as a response to an illness, it is a positive sign, as it signifies the body's effort to combat the infection. During a fever, the body increases the production of white blood cells, antibodies, and other agents, aiding in the fight against infections. Therefore, a fever should not necessarily be treated if the child remains playful and in good spirits. The following guidelines provide further information based on the child's age and actual temperature.

Methods to Measure a Child's Fever Accurately:

1. Rectal: The most precise method, suitable for infants up to 3 months of age.
2. Oral: Best utilized from around 4-5 years of age.
3. Ear: Typically used for older infants and children, offering a slightly lower reading than rectal temperature.
4. Axillary: An acceptable method for children older than 3 months, although less accurate than rectal measurement.
5. Temporal: Measuring across the forehead is employed for infants older than 3 months.

Approach to a Child with a Fever by Age Group:

1. 0-4 weeks of age: Any rectal temperature exceeding 100.4°F requires immediate evaluation, with the possibility of hospital admission for further diagnostic tests.
2. 4 weeks-3 months of age: For a temperature surpassing 100.4°F, an immediate evaluation is necessary, with the subsequent course of care depending on the evaluation and diagnostic tests.
3. 3 months-6 months of age: Seek an evaluation for a fever exceeding 102°F, a fever lasting more than three days, or if the child exhibits irritability, a late-onset fever following an illness, or a rash not present before the fever.
4. 6 months-2 years: An evaluation is warranted for a fever exceeding 104°F, a fever lasting more than three days, a fever occurring post-illness, or when there are no concurrent viral symptoms (e.g., runny nose, cough, vomiting, diarrhea).

Treatment of Fever in Older Children:

In older children, a fever does not necessarily require treatment. If the child is cheerful, playful, and well-hydrated, it may not be essential to lower the fever. However, when a child has a fever and is feeling unwell, it is acceptable to take measures to reduce the fever, aiming to bring the temperature closer to the 100-101°F range.

Non-Medication Approaches to Reduce Fever:

• Removing excess clothing
• Applying cool compresses to the forehead, armpits, or groin
• Providing lukewarm baths

Medication Options:

1. Acetaminophen (Tylenol): Administer every four hours but not exceeding five doses in 24 hours. It should not be given to children under 3 months of age unless directed by a healthcare provider.
2. Ibuprofen (Advil/Motrin): Administer every six hours, typically suitable for children older than 6 months, often closer to one year of age. It is preferable not to switch between these medications unless advised by a healthcare professional.

Notably, aspirin should never be used to manage a child's fever due to its association with Reye's Syndrome, a serious condition that can affect children with viral infections. Aspirin use can lead to severe outcomes, including liver failure and death.

At Pediatrics & Adolescents Clinic, we prioritize comprehensive care and guidance for children with fevers, ensuring their health and well-being.