We include information about frequently encountered pediatric medical conditions. These are comprehensive but if you ever have a question about your child’s condition always feel free to call the practice.
At Premier Pediatrics, we are first and foremost looking out for the health and well-being of our patients, your infants and children. We believe that vaccines are safe and help protect your child from preventable illness. We follow the guidelines for vaccination scheduling as recommended by the American Academy of Pediatrics. With fundamental basis in the medical literature, the schedule recommends vaccines at times when infection from these serious illnesses could be most detrimental to your child’s health.
We get many questions about vaccines and recommend that parents start by reading the CDC (Center for Disease Control’s) leaflets, which contain the most up-to-date information about each vaccine.
We always have these leaflets available to you at the office to address important information about the vaccines. These include information about the disease that the vaccine protects your child from, when your child will need to receive the vaccine, as well as common side effects of the vaccine. In addition, your child’s doctor will review the common side effects to expect at every well child checkup during which your child receives vaccinations. There are some common side effects with vaccines. In infants, from the 2, 4, and 6 month vaccines, as well as with boosters at 12, 15 and 18 months, fussiness, tenderness and/or swelling at the site of injection, sleepiness and fever are most common. Side effects may last 1-3 days and are managed well with Acetaminophen. Click here for links to Vaccine Resources.
At the 12 and 15 month visits, the live vaccines, MMR (Measles, Mumps, Rubella) and Varicella (chickenpox) vaccines are administered. These vaccines may cause initial fever or local tenderness, but after MMR, about 5% of children may have fever and/or rash 1-2 weeks after the vaccine, and after Varicella vaccine, about 3% of children may get a mild rash, often near the injection site, about 1-3 weeks after the vaccine. After 4 year booster vaccines (DTaP, IPV (Polio), MMR and Varicella, the most common side effect is redness, swelling, and soreness at the injection sites. Acetaminophen or Ibuprofen and an ice pack are very effective at treating the side effects.
When to call your doctor:
This year New York City has risen from number 40 to number 13 for worst cities for allergies in the United States. For those who suffer from allergies this is going to be a rough season. Even if your child has not had seasonal allergies before they can develop at any age.
Below are some tips from Premier Pediatrics on how to get through allergy season.
1. Follow the pollen counts: The pollen count measures how much pollen is in the air and can help people with seasonal allergies determine how severe their symptoms may be on any given day. Visit the American Academy of Allergies and Asthma, and Immunology’s National Allergies Bureau for up to date pollen counts. http://www.aaaai.org/global/nab-pollen-counts/northeast-region.aspx
2. Reduce Exposure to allergens: During allergy season keep you windows closed. Have your child change clothing and wash hands (preferably shower) after playing outside to remove allergens from the outdoors. This helps to not spread the allergens all over your house.
3. There are no cures for allergens but there are medications that can help. If you think your child is suffering from seasonal allergies call the office to schedule an appointment to discuss what medications may be helpful for your child.
4. If your child has already been diagnosed with seasonal allergies treat early. Most medications work best if started before allergy symptoms start. Start your child’s recommended allergy medications before the allergy season starts. We generally recommend starting the medications at the end of March and continuing them through late June (check with one of our doctors if you are not sure when to start, since it can differ from child to child.)
5. Use high efficiency filters (HEPA filters for indoor air). These help keep indoor air clean by trapping pollen or other allergens.
Fever is any temperature greater than 100.4 degrees Fahrenheit or 38 degrees Celsius. In infants the temperature should be measured rectally in older children it is okay to use an oral or axillary (under the arm) temperature. temporal artery scanners are good as well, but we do not recommend ear or forehead strips as they are often inaccurate.
Fever is your child’s body using its natural response to fighting an infection. There are no “magic numbers” with fevers, it is no worse to have 104 temperature than 101 temperature what matters is how your child behaves once the fever is breaking.
Fever in itself, while it may seem scary (especially with your child’s first fever) is not usually dangerous. However, fevers can make children feel uncomfortable and therefore there are medications available to decrease the body’s temperature. The dosing of both ibuprofen and acetaminophen are weight based and the appropriate dose for your child can be found here http://www.premierpediatricsny.com/medical-info/dosing-charts/ Ibuprofen can be given every 6 hours and acetaminophen every four hours.
There are times when the fever may return prior to the allotted time. In these cases it is okay to alternate using the acetaminophen and ibuprofen. These medications work differently and there is no specific amount of time needed between giving the two. For example: if your child has a fever at 6am and you give the appropriate dose of ibuprofen you may not give a second dose until 12pm. However, if your child’s fever returns at 10am you may give the appropriate dose of acetaminophen. The key is to have 4 hours between each dose of acetaminophen and 6 hours between each dose of ibuprofen. you may also put your child in a tepid bath to help bring down the temperature. Do not put your child in cold water or ice.
When to call MD/seek further medical attention
It is not uncommon for children to have episodes that may include; vomiting, diarrhea or both. Most of the time these episodes are self-limited and require only supportive care.
If your child is vomiting:
When your child has diarrhea try and stick to a bland diet, there is no need to be terribly restrictive, unless your child is vomiting (see above), but if you find that certain foods make it worse then stay off those foods for a few days. The BRAT (Bananas, Rice, Applesauce and Toast) diet alone isn’t recommended anymore because it does not provide enough nutrition for a child with Gastroenteritis and does not make the symptoms go away any faster.
If the diarrhea has lasted >3-4 days you can introduce a probiotic (Culturelle or Florastor kids) and remove dairy from the diet for a week.
Warning: Do not use anti-diarrhea medications unless directed by your doctor.
When to call/seek further medical attention
Your child will likely face multiple episodes of cough and congestion during their early years. Most of these episodes are caused by viruses and are self-limited. While there is no medicine for a virus there are things you can do to make your child more comfortable.
Often cough and congestion will be accompanied by fever (temperature greater than 100.4 with link to fever blurb) if this is the case you can give your child acetaminophen or ibuprofen (link to dosing chart.) It is also okay to give your child these medicines if they are fever free but uncomfortable. These medications work as both fever reducers and pain relievers. We do not recommend over the counter cough or cold medications. They have not been proven to be effective and can have harmful side effects.
For the congestion and cough, there are several was to alleviate some symptoms. You can use nasal saline drops 4-5 times a day. In infants, you may use the bulb suction following the administration of the saline drops. Do not suction greater than 3 times a day as over suctioning can lead to irritated nasal mucosa and worsening congestion.
For cough steam showers can be extremely helpful. To accomplish this, turn on the shower as hot as it goes. Once the room is steamy, sit in there for fifteen minutes. This may need to be repeated multiple times before the illness has run its course. You can also put a humidifier in your child’s room. For children over one a teaspoon of honey at bed time can be helpful as well.
When to seek further medical attention :
How is wheezing treated? Even if your child does not have asthma, they can still be treated for wheezing. We might prescribe inhaled medications, called bronchodilators to see if the symptoms improve. Bronchodilators work by relaxing the smooth muscle in the airways allowing tight airways to relax and increase air entry. These medicines are safe in infants and can often improve your child’s breathing. Often we will trial these medications in the office to see if they help your child. If they do, then we will provide you with a prescription for at home use.
How do I give my child these medications? Medications for wheezing work by going directly into the airway. These medications can be delivered via nebulizer or via an inhaler. If your child uses an inhaler they must always use a spacer to ensure the medication gets into the lungs and not just in the mouth.
Check out these helpful videos about use of mask and spacer in children
What is bronchiolitis? Bronchiolitis is an inflammation of the small airways that results from a viral infection. Many viruses can cause bronchiolitis. The infection affects the tiny airways called bronchioles. The airways swell, making breathing difficult. Infants are often affected because their airways are small and can become more easily blocked.
Does my child have asthma? It’s important to remember that one instance of wheezing isn’t enough to diagnose asthma. It must happen on multiple occasions. Less than one third of all infants who wheeze on a recurring basis during their first 3 years continue to wheeze. Most kids who wheeze as infants outgrow it and don’t have asthma when they get older. A child’s risk of asthma is higher if he or she has an allergy, such as a food allergy or hay fever, or one or both parents have asthma, allergies or eczema.
What exactly is asthma? Asthma is a disorder caused by inflammation in the airways that lead to the lungs. This inflammation causes airways to tighten and narrow, making it difficult to breathe. Symptoms include wheezing, breathlessness, chest tightness, and cough particularly at night or after exercise/activity. The inflammation may be completely or partially reversed with medicines.
Is there a test to determine if my child has asthma? There is no single test for asthma; however, we can diagnosis it by taking a patient’s history, performing a physical examination and conducting pulmonary function tests. Pulmonary function tests can be used to aid in the diagnosis, but are unreliable in children under 5 years old. In the office we can perform breathing tests using a spirometer, a machine that measures the amount of air that flows in and out of the lungs. It can detect whether the airflow is less than normal, and it can also detect if the airway obstruction is involving only small airways or larger airways too. After the spirometer reading, we may give your child an inhaled medication that opens the airways and then take another reading to see if breathing improves with medication. If the medication reverses airway obstruction, as indicated by improved airflow, then there’s a stronger possibility that the child has asthma.
Are there triggers for asthma? Asthma triggers can differ from person to person. Some common triggers are exercise, allergies, viral infections, and smoke. When a child with asthma is exposed to a trigger, their already sensitive airways become inflamed, swell up, and fill with mucus. In addition, the muscles lining the swollen airways tighten and cause difficulty breathing.
My child has been diagnosed with asthma what are the different types of medications available?
The goal of asthma therapy is to prevent your child from having chronic symptoms. This includes: maintaining your child’s lung function as close to normal as possible, allowing your child to maintain normal physical activity levels, and preventing recurrent asthma attacks and/or emergency department visits and hospitalizations. We also want your child to be on a medication that gives the best results with the least side effects. In general, we will start with a high level of therapy following an asthma attack and then decrease treatment to the lowest possible level while still prevents asthma attacks and allowing your child to have a normal life.
There are two types of medications used primarily to treat asthma. 1. Rescue medications: these medications are used when your child has an acute asthma attack. These medications are called bronchodilators and have the trade names albuterol, ventolin or xopenex. These medications relax the smooth muscle in the small airways improving your child’s ability to breathe. These medications are meant to be used for short periods of times. If your child is requiring rescue medications multiple times per month they may need a controller medication. 2. Controller Medications: The underlying problem in asthma involves a chronic inflammation of the small airways. Some children require a daily medication to help prevent multiple asthma attacks. Typically, these medications are an inhaled steroid. These medications work by attacking the underlying chronic inflammation. They are inhaled so they act at the levels of the airway and are not absorbed into the body in large quantities.
This is all so new and confusing, how can I determine if my child’s asthma is well controlled?
The good news is that in most children asthma can be well controlled with the appropriate medications. For most families, the learning process is the hardest part of asthma management. Asthma can take a little time and energy to manage so don’t be discouraged if your child has some flare ups along the way.
Every child with asthma needs an individualized asthma management plan to control symptoms and flares. We will work closely with you to help manage your child’s asthma.
This includes: 1. Identifying and controlling triggers: Triggers are things that exacerbate your child’s asthma. Each child can have unique set of triggers. Some common triggers are allergens, viral infections, irritants, exercise, breathing cold air, and weather changes. It can take some time to figure out what your child’s triggers are. Keep a record of your child’s breathing and night time cough. This can help us to identify and try and prevent some of your child’s asthmatriggers.
2. Medications: It is important for your child to take their medications as prescribed. Asthma medications can be confusing, if you are not sure what your child should be taking please ask us to review the medications with you. It may take a little trial and error in the beginning to determine what the best medication for long term asthma control is in your child.
3. Review and reassessment of control: We will closely follow your child to determine whether their asthma is well controlled. This may include office visits and/or the use of breathing tests (spirometry). As always we are here to help and guide you through this process. Please call us with questions or concerns.
Remember that any child with asthma can still have an occasional asthma attack particularly during the period right after diagnosis or after exposure to a very strong or new trigger.