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About our office..................................................................................................4Routine Scheduling............................................................................................5

During office hours:.............................................................................................6After Office hours:...............................................................................................6Sick Visits............................................................................................................6

Fees, billing, insurance.......................................................................................7Section 1: “Wow” I look Pink, Warm, Healthy, and Happy.................................8

About your Baby..................................................................................................8In the Hospital.....................................................................................................9Office Visits.........................................................................................................9Normal care of the Newborn................................................................................9First day home..................................................................................................10Your baby’s vocabulary.....................................................................................10Thermometer....................................................................................................14Medicine spoon/dropper....................................................................................14Infant acetaminophen drops (Tylenol/Tempra)..................................................14Car seat.............................................................................................................14Poison Control...................................................................................................14Plug-in outlet adapters......................................................................................14Diapers..............................................................................................................15Clothing.............................................................................................................15Crib....................................................................................................................15Room Temperature...........................................................................................15Skin and Hair care.............................................................................................15Cradle Cap.........................................................................................................16Diaper Rash.......................................................................................................16Your baby’s appetite.........................................................................................16Breastfeeding....................................................................................................17Bottle Feeding...................................................................................................19Beginning Solid Foods.......................................................................................20Circumcision care..............................................................................................21Hernias..............................................................................................................22Spitting Up........................................................................................................22Teething............................................................................................................22Dental Care.......................................................................................................23Pacifiers.............................................................................................................23Thrush...............................................................................................................23Colic..................................................................................................................24Sun Exposure....................................................................................................24Travel................................................................................................................25Philosophy of Modern Pediatrics........................................................................25

Section 2: Crying, Fussy, Won’t Eat, So What’s wrong?...................................27Fever.................................................................................................................27Types of thermometers.....................................................................................28Diarrhea............................................................................................................31Vomiting............................................................................................................33Constipation......................................................................................................34Common Colds..................................................................................................34Cold Sores.........................................................................................................35Cough................................................................................................................35Sore Throat........................................................................................................36Conjunctivitis – “Pink Eye”.................................................................................36Chickenpox........................................................................................................36Lice....................................................................................................................37Poisoning...........................................................................................................38

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Cuts and scratches............................................................................................38Abrasions and scrapes.......................................................................................38Puncture wounds...............................................................................................39Animal bites......................................................................................................39Human Bites......................................................................................................39Nosebleeds........................................................................................................39Head injury........................................................................................................39Burns.................................................................................................................40Choking.............................................................................................................40More about car seats.........................................................................................43

SECTION 3: Epilogue & Index...........................................................................44Epilogue............................................................................................................44

Recommended reading....................................................................................44

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About our office

Mat-Su Community Pediatrics, P.C. (also known as MSCP) was formed in 2005 when Dr. Tamara M. Krimm M.D., F.A.A.P. saw a need for greater access to primary care practitioners in the growing Matanuska-Susitna Borough.

Dr. Krimm is Board Certified by the American Academy of Pediatrics.

Mat-Su Community Pediatrics, PC engages in the practice of Primary Care Pediatric & Adolescent Medicine. While providing direct services to individual clients or patients, the Practice's primary focus is to protect and promote the health and safety of the community as a whole.

The goal of The Practice is to provide primary pediatric care to children and adolescents, promoting healthy lifestyle habits and practices. We accomplish this goal by;

Providing high-quality pediatric & adolescent primary care. Prevent disease, disability, and to promote healthy lifestyles. Assure access to quality health care services. Promote and ensure a healthful environment.

Dr. Krimm M.D., F.A.A.P. normally sees her own patients for continuity of care. However if she should be out of town there is always someone with access to medical records to assume care for any patient when needed.

Nurses and medical assistants also work with the physician and are trained to assist patients and parents. Our goal is to provide quality patient care for your child.

Office Location:

We are located on East Country Field Circle in the Country Field Medical Plaza at 3750 E. Country Field Circle Suite C Wasilla, Alaska 99654, Alaska 99654. You can get a map from our website at: www.matsupeds.com

Our office Phone numbers are;Front Desk at 357-2955. Medical records fax at 907-357-9348E-Mail at: business@matsupeds.com

Office Hours are by appointment only, scheduled -- Monday, Tuesday, Thursday, Friday - 9:00 a.m. until 5:00 p.m. Please call 357-2955 for

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appointments and cancellations. These are the best times to make appointments and conduct other business, medication refills, routine questions, etc.

Every attempt is made to honor your appointment time. Occasionally, emergencies or unforeseen circumstances arise and your understanding in these situations it truly appreciated. Likewise, it is important for the doctor and other patients for you to be on time, or call if you anticipate a late arrival or are unable to keep a scheduled appointment.

No-Show PolicyWe request that you cancel your appointment 24 hrs before. We call all scheduled appointment holders the evening before to confirm, we have an answering service that will take a message and we can receive your e-mail through our website at www.matsupeds.com . If you do not cancel your appointment 24 hours before, you will be considered a “no show.” Three “no shows” per family and we may consider discharging you from our practice.

Routine SchedulingFollowing the birth of your child you will have an appointment at our office within the first week following your discharge. The following schedule of routine well child visits for physical examination is recommended by the American Academy of Pediatrics:

BirthTwo (2) WeeksOne (1) monthTwo (2) monthsFour (4) monthsSix (6) MonthsNine (9) monthsTwelve (12) monthsFifteen-eighteen (15-18) months2 - 6 years of age – yearly exam6 - 18 years of age – exams every 1 - 2 years

Some children may have a medical condition that could require more frequent visits and the above recommendations may be modified to fit the needs of your child. As children reach the middle school years they frequently participate in sports or other school related activities which may require an annual physical examination. If your child is current with yearly well child examinations, the required forms can usually be completed with a brief office visit. Please remember it is your responsibility to keep your child current with regular examinations.

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On occasion, certain problems arise that can’t be resolved during a “routine” visit. Extended visits or a second visit may be scheduled to more effectively take care of these situations.

Our goal is to work with you to provide the best possible care for your children. Please communicate any concerns that can help in make that goal attainable.

Telephone callsDuring office hours:The office phone number is 357-2955. If possible, call early in the day to schedule appointments for acute illnesses.

Please call for refills at this time at the office—NOT ON NIGHT AND WEEKENDS.

After Office hours:All non-emergency calls should be placed during regular clinic hours; at this time I have access to your child’s medical record.

On weekends, please only place calls that cannot wait until regular office hours. It becomes difficult to be available when the physician is paged with many non-urgent questions.

Before you call, write down your concerns, and take your child’s temperature if a fever seems to be present. The doctor’s advice will be more meaningful if you give as many facts as possible. You may want to be ready to write down any instructions.

When your calls is returned, please give us your child’s name, date of birth, age, and if your child is currently taking medications, has any medication allergies, or has any chronic illnesses.

FOR LIFE-THREATENING CONDITIONS, GO DIRECTLY TO THE NEAREST EMERGENCY ROOM or CALL 911.

Do not wait for the doctor to return your call. For all serious or potentially serious medical problems, I refer to the Emergency Room at MSRMC, phone number 861-6620.

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If preauthorization is required by your insurance carrier, it is important to call first before you go to the emergency room, except for life threatening situations.

Sick VisitsIf your child is sick, please try to call us at 8:30 a.m. We will always see you that same day if possible. If you are uncomfortable with any options given to you over the phone let us know and we will work you in that day. If your child has been seen for an illness and is not responding to treatment, please let us know. The only way for us to know of an arising complication is to stay in communication with each other.

It is important that if you have care providers for your children to make sure they keep you aware if your child is not feeling well and may need to be seen during regular office hours.

In case of Emergency & after hours care

If your child stops breathing, becomes blue or does not respond to stimulation

Call 911 immediatelyFor other acute problems you feel cannot wait until the morning. Several clinics are open after normal business hours include MSRMC ER or AIC You can call our office if you feel you must contact us at 357-2955. Please do not call after regular office hours for routine questions like, medication refills, formula changes, appointment scheduling, constipation, or to settle arguments with spouses or relatives.

Fees, billing, insurancePlease feel free to ask us about our fees before or after your visit. Our business office personnel are available during office hours to assist you with questions related to billing and insurance. A current insurance card is required at each appointment or you will need to reschedule or pay cash. Fees may include physician’s fees, immunization fees, and/or other office services. We ask that you pay for your medical services at the time of your visit. If your insurance requires a co-payment, it needs to be paid at each office visit. By doing this you help to cut down dramatically on the cost of billing services and the savings are ultimately passed on to you. We do recognize that not all medical expenses are budgeted. If needed, arrangements can be made to make monthly payments.

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Payment options if you do not have insurance: Self-pay patients are expected to pay at the time of service. Any other financial arrangements need to be made before your appointment.

Payment options if you have insurance: Insurance is a contract between you and your insurance carrier. We are not a party to this contract. Our goal is to help you get well and stay well.

As a courtesy to you, we will file charges with your primary and secondary insurances on your behalf. We cannot file your insurance if you do not have a copy of your insurance card. Without this information, your account will be treated as self-pay, (see above).

It is an insurance requirement that any co-payments must be made at the time of service.Charges not paid or denied by your insurance company within 90 days will become due and payable by you. If you receive Medicare, Denali Kid Care it is your responsibility to keep your eligibility up to date.

Methods of payment: We accept cash and personal checks for payment of services. Please be sure to bring one of these methods of payment with you to pay for any fees due at the time of service. Some insurance plans do not cover routine care or immunizations; a prompt pay discount of 10% applies when paid in full at the time of service.

We do not accept credit cards or debit cards as a method of payment . The cost of card services is too high to our practice this would result in an increase in fees to you the patient.

Statement: After your insurance responds to your claim, if you have a balance on your account, we will send you a statement. It will show any outstanding bills that are your responsibility. The balance on your statement is due and payable when the statement is issued, and is past due if not paid within 30 days of the statement date.

If your insurance determines a service to be “not covered” you will be responsible for payment. We try to inform patients when services may not be covered, however it is your responsibility to understand your policy limitations.

Past due accounts: We will be happy to arrange a reasonable payment plan for you to keep your account in good standing. This means that you must keep us informed of factors that affect your account. If your account becomes past due and all efforts to obtain payment have been exhausted, we will take the necessary steps to collect this debt.

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We shall have the right to cancel your privilege to make charges to your account at any time. Future visits would then need to be paid at the time of service.

Retrieval Fee: Copies of billing records are available without fee 30 days from the date of service. Requests beyond this limit will require a research fee, currently $20.00. This fee is not reimbursable by insurance and must be paid at the time of pick-up.

Divorce: The responsibility for payment of services rendered to dependant children whose parents are divorced rests with the person seeking treatment. Any court ordered responsibility judgment must be determined between the individuals involved and cannot be considered by this office. We will of course be happy to bill the appropriate parent’s insurance if we have that information.

Immunization fees: We recognize that immunizations are quite costly. While we prefer to follow your child for well care and medical problems, if your insurance does not cover the cost of immunizations and you prefer to receive these at Public Health, we can provide you with their number they give immunizations for free. Public Health’s number is 352-6600.

Section 1: “Wow” I look Pink, Warm, Healthy, and Happy

About your BabyCongratulations! You have just given birth to a new, energetic, curious individual. In the next few days and weeks both of you must become accustomed to one another and adjustments by each will be necessary. To make this period easier for both of you, this booklet has been prepared. Many questions will not be answered, so we encourage you to ask them as situations arise.

In the HospitalThe immediate newborn period is a time of rapid transition for your baby. After birth, babies need to be observed closely to insure their breathing and temperature are stable. Your infant may have his/her blood sugar checked. Routinely, two medications are given to all newborns:

1. Erythromycin eye ointment to prevent an eye infection called ophthalmia neonatorum, and

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2. An injection of vitamin K to prevent a bleeding problem called hemorrhagic disease of newborn.

The Doctor will discuss with you your baby’s exam and any special problems or concerns that have arisen.

Your baby may have a blood test called a Bilirubin level for jaundice while in the hospital. Bilirubin levels usually peak on the second to fourth day of life in term infants. If you feel your baby looks more jaundice or yellow at home compared to the time of discharge from the hospital, you should call us immediately.

Prior to discharge from the hospital, a blood test will be obtained on your baby called a newborn screen. This test screens for rare but potentially serous illnesses called PKU, galactosemia, hypothyrodism, adrenal hyperplasia, hemoglobinopathies, biotinidase deficiency, and cystic fibrosis. This screen is done at the State Lab in Oregon and they notify the doctor of any abnormal screening results.

A vaccine to protect against Hepatitis B, a viral infection of the liver, is now recommended for all newborns, with the first vaccination typically given just after birth. This immunization would be given after your consent; the second shot of the series will be given at 2 months of age.

Nurses in the hospital will teach you about feeding techniques, taking your baby’s temperature, cord care, circumcision care, and bathing. Please ask your nurse or physician if you have any questions.

Office VisitsYour newborn should have his/her first office check-up within a few days after hospital discharge. If you feel he/she needs to be seen sooner, please call us!

With a new baby, we understand that you may have many questions, which you might forget to ask during the examination. Please feel free to write down your most important questions to address during the visit. This helps make the visit rewarding for all involved.

Normal care of the NewbornTake a good look at your new baby, look at the baby from head to toe, look for all the things that make this baby the most unique baby on Earth. Be aware that not much “friendly advice” is going to come from our office, but mostly from, grandma, grandpa, relatives, friends and others. Please use our office for “objective” advice and care!

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First day homeBabies tend to get hungry and more alert 24-48 hours after birth, just about the time you are arriving home. You may find this a challenging time. Your baby loves to be handled and you can use this time to become more acquainted with each other. They like to be snugly wrapped in a light blanket and be snuggled. They are comforted by gentle firm handling

This is Normal?Your baby’s vocabularyDuring the first few weeks the cry is about the only way babies have of expressing their needs. All babies have a vocabulary of several cries which you will soon relate to each specific need. The cry will vary in quality with: being hungry, too warm or cold or out of sorts; needing burped; a wet or soiled diaper; or an undiscovered pain; or just being plain angry.

It is very common for a baby to cry or fuss at about the same time each day, often evening, and this may go on for quite a while for no apparent reason. This period of fussiness often causes concern for new parents because they usually think their baby is still hungry and they often find that really this is not so. It’s tempting to keep offering more milk, but this seldom really helps for more than a short time. Sometimes motion or a warm bath at the fussy period will help relax your baby. Holding your baby may help. A reassuring fact about crying is that it causes no physical harm to the infant. For this reason you need not worry if your baby cries or fusses for a while before you respond. In fact, many new babies fuss for fifteen or twenty minutes after each feeding before going to sleep; its’ really pretty good exercise. As the child becomes older a new voice of happiness—cooing, laughing, smiling will be observed. At this time a pleasurable response will reward you for your diligent service of the first few weeks.

Babies are the strangest things, they sneeze, burp, belch, cross their eyes, grunt and make faces. They can turn the brightest shades of red while having a perfectly loose stool, and thus are not constipated! (Constipation is when the baby has small, hard stools that look like rabbit pellets. This is much more common in formula fed babies.)

Your baby’s head may be funny shaped, lopsided, flat in a spot or bruised. The skull bones may overlap a little. This is normal and will go away in a few days. At the top of the babies skull there is a soft spot where the skull bones come together. This area may pulsate and this is perfectly normal. The area is not tender and may be thoroughly washed.

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At birth the nurse/midwife put some antibiotic drops in the baby’s eyes. This means that they may look swollen or have some discharge from them. This discharge may be washed away with a warm soft cloth. Many babies have tear ducts that do not function for the first few months. They have mucus which collects until the tear duct start to drain. This is not an infection. Contact us if your baby has persistent eye drainage. This is usually treated conservatively by massaging the eyes and washing them with warm water. This can be demonstrated to you in the office if need be. Contact our office during regular hours if your infant has persistent eye drainage. We usually treat this problem conservatively and most of the time the drainage resolves by twelve (12) months of age.

After the first few days, your baby will begin to open his eyes more and look around. Babies can’t focus well or follow moving objects at birth. However, they can see short distances and like bright colors. Over the first two (2) months, they begin to focus better and begin to track moving objects. They may occasionally look cross-eyed and this is not a cause for concern unless it persists longer than six (6) months.

Your baby’s nose may become congested with mucus, particularly in the first few weeks after birth. Use a bulb syringe to clear this. If the congestion isn’t relieved with your baby spontaneously sneezing or use of the bulb syringe, you may use saline nose drops. These can be purchased over-the-counter at any pharmacy (Ocean Spray, Ayr, etc.) or you can make up your own by mixing ¼ teaspoon of table salt in 4 ounces of tap water. Use 2-3 drops in one nostril, then suction after a few seconds. Repeat on the other side. If the stuffiness doesn’t interfere with your child’s breathing or feeding, try not to let it bother you. Some babies sound stuffier than others. Simply propping up your baby in an infant seat may help. Persistent congestion is often related to exposure to smoke from cigarettes or wood stoves.

Many babies have nipples that appear raised and swollen. They may even have a milky discharge. This is due to hormonal changes and will normally subside in 3-4 months. Don’t squeeze or rub medication on the nipples as it will only irritate them.

The genitals of both boys and girls may be swollen at birth. Girls commonly have a white discharge with some blood streaks from the vagina for up to 1-2 weeks after delivery. Boys often have a swollen scrotum, which usually contains fluid (a hydrocele); this normally resolves on its own during the first few months of life. However, if the swelling comes and goes or worsens, it may indicate a hernia. Call the office if this occurs.

Most babies have bowed legs or feet after birth. This is not a cause for alarm and almost never requires treatment. It is usually due to how they were “packaged” while in the womb and straightens out in due time. If you are able to passively move your baby’s legs or feet into a neutral position, they will get there on their own eventually.

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Your baby’s umbilical cord will drop off at some point during the first 2 weeks of life. It is normal for there to be a few drops of blood when this happens and there may be some drainage on and off for several days. Clean the area by wiping with a washcloth. (No need to use alcohol or hydrogen peroxide) when you notice blood or discharge. If the area develops red streaks on the skin or a foul order, call the office. If your baby appears to have an “outie” or protruding umbilicus after the cord is off, no special treatment is needed. (See section on “umbilical hernias”).

Sudden movements, bumps and noises produce startle reflexes (jerky movements, throwing arms and legs wildly). Babies also jerk or twitch for no apparent reason, even while asleep. Gentle, firm handling and calm, reassuring voices are easily sensed by your baby. As your comfort and confidence levels increase day by day, your baby will also be calmer and will overreact less often.

Newborn babies often have a rather irregular breathing pattern while sleeping. You will notice breathing may vary over 10 to 20 seconds from being very shallow and quiet, increasing in intensity to being deep and strong. This is called periodic breathing. Babies also appear to “sigh” and “catch their breath”. They occasionally sound “rattly”, and this is due to mucous above their airway. They may sound more “rattly” during or after feedings. The babies will not act bothered by this. It will only bother us parents, as we would like to have them “clear their throats”, but they don’t! This is normal.

Newborn rashesStork bites – Flat, pink birthmarks may be present at the bridge of your baby’s nose, eyelids or the back of the neck. About half of all newborn babies have some form of these. You may notice the spots becoming more pronounced when the baby is crying and fainter when the baby is quiet. The spots on your baby’s eyelids (sometimes called “angel’s kisses”) will usually fade away in the first 3-4 months of life. Spots on the forehead or nose often take longer to fade and may not entirely fade away. Spots on the neck usually don’t fade but are covered up as the hair grows.

Mongolian spots – These are bluish flat birthmarks seen most commonly in dark skinned babies on the back and buttocks. They may be present on any part of the body and usually appear less noticeable after the first 2-3 years of life.

Milia – These are tiny white bumps seen on the face of about 40% of newborns. They are basically plugged skin pores and usually open up and disappear by 1-2 months of age. Nothing should be applied to them.

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Erythema toxicum – Over half of all newborn babies develop red blotches in the first week of life, some with a small white lump in the center. These can literally appear and disappear before your very eyes but they are NOT hives and do NOT mean your baby is allergic to anything in particular. You should not worry about this rash; it is normal and will go away by itself.

“Drooling rash” – A rash may often appear on the chin or cheeks due to excess drooling or contact with stomach contents after a baby spits up. The best thing to do is use a bib and gently wipe the face and neck with a rag or washcloth to keep the area as dry as possible. (Avoid using wet or diaper wipes)

JaundiceMost newborn babies develop some degree of jaundice (yellow/orange skin color). This is not present at birth but becomes noticeable at 2-3 days of age and usually peaks at 5-7 days. It is usually seen more with breastfed babies and may persist to some degree for 2-3 weeks. Notify our office during office hours if you notice jaundice and:

Excessive sleepiness

Poor feeding

Less than 1-2 bowel movements a day

Less than 3-4 wet diapers a day

Rectal temperature of greater than 100.4

Irritability

If your baby has jaundice but is feeding well, urinating and pooping, it is usually not a problem. Call us if you are concerned and we can see your baby and/or obtain a Bilirubin level. Treatment is usually simple observation and occasionally phototherapy (usually done at home).

StoolsNewborns can have any where from ten (10) loose stools per day to one (1) stool every ten (10) days. As long as your baby’s tummy feels soft and the stools aren’t rock hard or so watery they leave large water rings in the diaper, things are probably just fine. Again, many babies grunt and turn red in the face when having a stool. This does not mean your baby is constipated. Small babies should not be given enemas; always call the office during regular hours if you are concerned about your child’s stool pattern.

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SleepIt is normal for newborn babies to sleep much of the time. They often awaken only for feedings or diaper changes. As your baby gets older, he will sleep less and play more. If you happen to have a “good” baby who wants to sleep all day when first coming home form the hospital, be sure to awaken the baby every 4 hours at least during the day so the baby doesn’t sleep through too many feedings.

If at all possible, your baby should sleep in his/her own crib and own room. Babies normally are very noisy when they sleep. For your baby’s safety, under no circumstances should you sleep with him/her in your bed.

Babies should sleep on their backs or propped to the side. Crib death (Sudden Infant Death Syndrome) has been shown to occur only half as often when babies are positioned in this way. By 5-6 months, many babies can roll back to front and positioning is no longer an issue. Keep the crib free of pillows or items that could cause suffocation until 12 months of age.

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Some Things You’ll Need for a New Baby

ThermometerA glass or digital thermometer is fine. The “ear thermometers” currently in vogue are fine for babies over three (3) years of age but a rectal temperature with a glass or digital thermometer is more accurate and a more important issue in infants during the first two (2) months of life. The ear thermometers have the advantage of being very quick to take temperatures but can vary significantly. The thermometer strips available to be used on a child’s forehead are NOT RECOMMENDED! They’re okay for aquariums, but unreliable for children!

Medicine spoon/dropperKitchen teaspoons and tablespoons are not accurate for the measuring of medications so a medicine spoon or dropper, preferably one that measures in both teaspoons and milliliters, is needed. (Keep in mind that a child under the age of 4 months should not get any medication without checking with their medical provider first.)

Infant acetaminophen drops (Tylenol/Tempra)Call before giving these to a child under four (4) months of age. After four (4) months, feel free to use this as directed for fever, teething pain, etc.

Car seatThis is one of the most important items to obtain for your child. All seats are now safety tested to meet government standards.

All children under the age of 12 months and weighing less than 20 pounds should be in a car seat that is rear facing and in the back seat. We do not recommend the use of old (pre-used) car seats, or car seats that have been in an accident. You never know if they are safe for your newborn.

Poison ControlIf your child eats or drinks a potential toxin (plant, medication, etc) call Poison Control at 1-800-222-1222.

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Plug-in outlet adaptersSmall plastic adapters to plug into empty electrical outlets are important once your baby begins to explore!

DiapersEither cloth or name brand disposable diapers are fine. Generic brands or off brands of disposable diapers do tend to create more problems with diaper rash.

Have Patience and a sense of humor, Enjoy your baby!

The following topics address some questions frequently asked by new

parents:ClothingClothing should be loose-fitting and allow for easy movement. Don’t overdress your baby. Dress him as you would yourself. Your baby’s hand and feet may feel cool, but if his body is warm, he is fine. Cotton material is best. Wool may irritate your baby’s skin. Wash new clothing before putting it on your baby for the first time. Dreft detergent is a good choice for washing clothes and diapers. Softeners and anti-statics are best avoided for the first year, as they frequently cause skin irritation.

CribYour baby’s crib slats should be no more than 2 ¾ inches apart and the surface should be free of splinters and painted with a non-lead based paint. The mattress should be the appropriate size for the crib. Don’t permit hanging toys or window curtains within reach of your baby.

Room TemperatureIdeal room temperature for your baby is 65-70 degrees (no different than you probably keep it anyway!). Additional humidity during winter may be provided by central or room humidifiers.

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Skin and Hair careYour newborn’s umbilical cord should be kept clean and dry. To keep the cord dry, fold the top of the diaper below it. Once the umbilical cord is off and, if you have a circumcised boy, once the plastic ring is off the circumcision, the baby may be bathed in the tub (or sink). Until then, sponge your baby with warm water only or with a very mild soap with a fragrance and dye free soap for “real messy”. Babies don’t need to be bathed daily, just when dirty. (Once or twice a week is often enough during the winter). Again, plain water or a very mild soap are all that are needed. Baby oils and lotions can clog your baby’s pores, causing rashes, and should be used with caution, if at all. Hair should be washed with a mild baby shampoo. You may wash around the outside of your baby’s ears with a Q-tip or soft washcloth. Do not insert Q-tips or other objects into your baby’s ear canal.

Cradle CapIf your baby has oily, yellowish scales and crusts on his scalp, he probably has “cradle cap”, a common condition in young infants. Applying baby oil to the crusts before shampooing will help soften them so they are more easily removed. Use Selsun Blue shampoo and an old toothbrush to scrub the scales up and clear the problem fairly easily. Use the Selsun Blue 2-3 times weekly until the scales have cleared, then once or twice a week to keep the problem from flaring up again.

Diaper RashDiaper rash is a common problem among babies. You can help prevent it by keeping your baby’s diaper area clean and dry. At each diaper change, the area should be cleansed with water and a soft cloth or with diaper wipes that don’t contain alcohol, oils or perfumes. Once a day, wash the diaper area with warm water and soap. Allow your baby’s bottom to air dry before putting diapers back on.

If your baby develops a diaper rash around the rectal area, a barrier cream such as A&D, Desitin or Vaseline should be used. If the area is very red and “scalded” looking, your baby’s stools may be somewhat acidic. Applying Maalox (yes, like you drink!) and then covering with Vaseline will speed the clearing of the rash.

If your baby has recently been on antibiotics, diagnosed with thrush or has developed red bumps over the front of the diaper area, she/he may have a yeast diaper rash. Lotrimin or Monistat cream (Micozole) used twice daily should clear this. (Lotrimin is now available over-the-counter). If unsure, call the office during regular hours.

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Your baby’s appetiteFeeding time is one of the baby’s first pleasant experiences. It is a time made for closeness between mother and infant. Whether your baby is nursing or feeding from a bottle, this experience can be extremely gratifying to both parties. Both of you should be comfortable. Choose a chair that is comfortable for you. This will help you to be calm and relaxed as you feed your baby. Your baby should be warm and dry so that he/she is comfortable too.

Hold your baby in your lap, with his/her head slightly raised, and resting in the bend of your elbow. Whether Breastfeeding or bottle feeding, hold your baby comfortably close.

NEVER prop the bottle.

Babies eat more and sleep better afterwards if they are fed when they are really hungry. But just as adults, infants are not always hungry at the same time each day, nor are they hungry to the same degree at each feeding. And more important, each baby differs from other babies in timing the hungry periods. As it turns out, most babies are hungry from two to four hours after the last feeding, at least for the first few weeks. Understanding this, parents are wise to avoid the practice of offering a baby an ounce or two of formula, or five minutes at the breast every hour through the day and night or every time there’s crying. If this is done, it usually results in a baby who is never really hungry and never really satisfied and very tired parents at the end of about two days! To break this cycle it may be necessary to put off a feeding until at least two to three hours after the last one.

Sucking is a normal baby activity, even after a satisfying meal of milk. It is not always an indication of hunger. A pacifier nipple may also be used to help during “between-feeding” fussing. Pacifiers have helped many mothers and babies during the early months without becoming a necessary habit later on. DO NOT dip the pacifier in honey. Honey is not recommended for infants under 1 year of age.

Occasionally, babies want to eat more frequently for a day or two just before they change their feeding schedule, for example switching from six bottles or Breast feedings to five during 24 hours. This is just temporary and is more like “shifting gears” than establishing a new schedule.

BreastfeedingBreastfeeding is a very natural and beautiful way of feeding your baby. Breastfeeding your baby should be a comfortable and rewarding experience for both you and your baby. It is an active process that requires two participants. To successfully breastfeed, a mother must have her own personal motivation and should not be coerced into

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breastfeeding by a husband, doctor, nurse or friends. Successful nursing is dependent upon strong motivations, and a confident relaxed approach. A woman must not be made to feel guilty for not wanting to breastfeed or for some reason being unable to do so. As nurses and physicians we will encourage and support you and give you advice and helpful hints when necessary.

There are numerous advantages to breastfeeding. Mother’s milk is readily available, fresh, and warm, designed specifically for human infants. Infants who are breastfed have a lower risk of developing infections because breast milk contains antibodies, which are proteins that help prevent infection. There is also evidence that infants who are breastfed have less chance of developing asthma or food allergies.(Breastfed infants do need extra vitamin D because that vitamin is not transferred into the breastmilk. Vitamin D is available in an infant multivitamin that can be found in the grocery store or at All About Herbs (located in Wasilla) in a liquid form without the other vitamins. It is important that your infant get at least 400 international units of vitamin D daily.)

Because breast milk is a complete diet for young infants, there is usually no need to begin solids until 4-6 months of age. Breast milk contains a form of iron that is easily digested by babies.

While some babies are born instinctively knowing exactly how to breast feed, others are a bit more temperamental. Every infant, mother and delivery experience is different and while breastfeeding is sometimes effortless, it can take a great deal of work! If you discover your baby having difficulty with feedings when you arrive home, feel free to call the office or the birthing center where the infant was born.

In terms of general care, nursing mothers should wear a good bra day and night during the first few weeks of nursing to provide extra support for full breasts. Nipples should be washed occasionally with mild soap and water, although letting leftover milk or colostrum dry on the nipple will sometimes help form a protective film in case of sensitive nipples. Frequent nursing and drinking plenty of fluids, as well as getting plenty of REST will help ensure a good milk supply. Unless instructed otherwise, prenatal vitamins should be continued and diet should be continued as it was prior to delivery. Nursing mothers need about 500 calories per day more than usual while breastfeeding (i.e., the same amount of extra calories needed during late pregnancy). There are no specific dietary restrictions but if a certain food seems to upset your baby’s stomach, avoid it. Caffeine is one of the main offenders, so tea, coffee and sodas should be taken in moderation and discontinued if your baby seems to have any discomfort. Also, mothers who drink large amounts of cow’s milk may aggravate gas problems in an infant with lactose intolerance. Other things that make breastfed babies fussy (that Mom eats) are chocolate, onions, tomatoes, broccoli, and spicy foods. Alcoholic beverages in moderation are usually fine, i.e., an occasional glass of wine is fine, (Don’t

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drink any hot liquids while nursing your baby, as spills could cause accidental burns.) Lastly, please don’t smoke around your baby while nursing or any other time!

The first few days after delivery, you may notice a creamy white substance secreted from your breasts. This is colostrum and, while it is secreted in small amounts, it contains high concentrations of sugar, calories and antibodies (to prevent infection). Within 3-5 days after delivery, your breast milk will “come in”. This early breast milk is high in protein but contains less fat at first than it will later on. A mother who pumps her breast in the first 2-3 weeks after delivery may panic when she finds her milk looks about as satisfying as dishwater! Don’t worry. This is “transitional milk” and will gradually become more milk-like in appearance as the fat content increases in the first few weeks of nursing.

Please do not let a well meaning relative or friend convince you your milk is “too weak” in those first few weeks! If you have concerns, call the office. We can weigh the baby and talk with you about how feedings are going. If your baby is gaining weight well and having 4-6 wet diapers each day, your milk supply is probably just fine.

Many mothers experience breast engorgement soon after leaving the hospital. This is a sense of fullness in the breasts, caused early on by altered blood flow through the breasts and later on by overproduction of milk relative to what the baby needs. Applying hot packs and massaging the lumpy or tender areas of your breasts just prior to nursing will enhance the letdown reflex so milk is more easily emptied from the breasts. Sometimes using a breast pump to pump a small amount of milk out will soften the breast, making it easier for your baby to latch on. Also apply cool packs to breasts after feeds helps with swelling.

Babies should be fed on demand! Initially, she may need to be awakened every two (2) hours through the day to remind her to eat. Typically, though, by the fourth or fifth day of life, babies become quite good at “demanding” feedings as often as every 90 minutes around the clock! This can be quite exhausting for a new mother. The good news is that after a “growth spurt” in the second or third week of life, most babies settle down to a little more humane schedule (meaning every 2-4 hours). Remember, if your baby sleeps a longer stretch of time at night, don’t argue! Your baby may nurse anywhere from 5-20 minutes per breast, depending upon how vigorous her suck is and how hungry she is at the time. Every baby is different, so don’t worry if your baby is a “grazer” or a very quick feeder. Alternate the first breast offered each feeding.

Many parents ask about supplemental feedings for breast babies. This is an individual decision and is often based, in today’s society, more upon work obligations than mother’s preference. If you will be in a situation where you are unable to pump at work and need to substitute a bottle feeding for the

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times you will be away from your baby, this can be done. One good rule of thumb is to not offer your baby a bottle feeding at all during the first month of breastfeeding. The bottle is much easier for the baby to use and babies figure this out quickly, often deserting the breast in favor of this “quick fix”. On the other hand, if you breastfeed your baby exclusively for 3-4 months and then decide to try a bottle, often the baby won’t even attempt a bottle feeding. There is a window of opportunity during the fourth or fifth week of life when a baby can be offered a bottle feeding, just once every 3-4 days, without disrupting breastfeeding. Mothers returning to work should plan a 2 week transition period. During this time, a breastfeeding may be dropped every 4-5 hours with a bottle feeding substituted. This gives the mother a chance to gradually adjust to the new feeding schedule, minimizing breast discomfort, and also gradually introduces the new schedule to the baby. Some babies take bottle feedings better from their fathers or other caretakers than from Mom. Depending upon your individual situation, you may choose to use frozen (or refrigerated) breast milk that was pumped at an earlier time or a powdered commercial infant formula. If using pumped breast milk, remember it may take two pumping sessions to get enough milk for a single feeding. (A breast pump isn’t as efficient as a hungry baby!)

Breast milk may be refrigerated for 24 hours or frozen for up to 3 months. When thawing frozen milk, it is best to place the milk container in a bowl of warm water. Do not try to thaw milk in the microwave; this breaks down some of the components of the milk and can possibly be overheated, resulting in burns to your baby’s face or mouth.

Your baby does not need extra water during the first few months of nursing. Water is present in breast milk in adequate amounts for your infant.

Some over the counter medications are acceptable for use when nursing. So are some prescription medications. Always remind the physician prescribing any medication that you are breastfeeding. Birth control pills today have lower concentrations of hormones and may be taken while breastfeeding. You may notice some decrease in the volume of breast milk with these, however. Remember, breastfeeding alone is not an effective form of birth control!

Most women breastfeed about 9-12 months. This is a situation that is negotiated between each mother and child individually. Many mothers wean their infants from the breast directly to cup feedings.

Other questions about breastfeeding may come up. Feel free to call the office during office hours with any specific questions. We are eager to help make the nursing experience an enjoyable one for you and your baby.

Bottle Feeding

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For those of you who are unable or don’t desire to breastfeed, there is an alternative in infant formula. There are various types of good infant formulas available. We can discuss the best type for your particular situation if and when the need arises. Infant formula with iron is recommended for the first 12 months of life for infants who are not breastfed. Changing to cow’s milk at an early age can cause significant anemia; also, the cow’s milk has more salt, protein, cholesterol, and phosphorus than is recommended for infants.

Most infants will take 1-3 ounces every 3-4 hours in the first few weeks of life. During the “growth spurt” in the second to third week of life, your baby may want to eat every 90 minutes! Let the baby make the rules. Feed him as much as he wants as often as he wants, as long as feedings aren’t closer together than every 90 minutes. If you have a baby who sleeps most of the time, be sure to awaken her every 2-4 hours during the day to “remind” her to eat.

Bottles and nipples should be washed in hot, soapy water. If you have an automatic dishwasher, just run the bottles through a cycle in the top rack. There is no need to boil or sterilize nipples or bottles if your baby is doing well.

If you have city water, there is no need to boil the water prior to mixing your baby’s formula. If you have well water, you may boil it for the first few months or use bottled “nursery water” available at many area groceries for mixing formulas.

Most formulas come in powdered, liquid concentrate and ready-to-use formulations. The powdered form is least expensive and is handy for traveling. It is also most economical for breastfeeding mothers who only use an occasional formula feeding.

Most babies do not need extra water during the day until he/she is over 2 months of age and taking over 32 ounces of formula per day. Water is present in both breast milk and infant formula in adequate amounts and your baby will benefit most by drinking only milk during the first few months of life.

Some babies will need water to help treat constipation. If your formula fed baby has stools that are small and pellet like and the baby has a hard time getting it out, please add 1-2 ounces of warm water 1-2 times daily to her diet. This helps stimulates the intestines to move. If that does not help, add 1 teaspoon of dark Karo syrup per 1 ounce of water.

Never prop your baby’s bottle up with a blanket or other object. Propping the bottle leads to tooth decay (“bottle rot”) and increased risk of ear infections and choking. (Not to mention feeding time is time for bonding with your child!)

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Beginning Solid FoodsFor some reason, friends and relatives tend to fixate on when a baby has his first water bottle and first bowl of cereal! Any pediatric allergist will tell you, however, the most important factors in the development of food allergy (other than family history) are breastfeeding and delaying solid foods until 4-6 month of age. Breastfed babies are afforded some degree of protection from food allergies, and the longer a child is exclusively breastfed, the better. The sooner solid foods are introduced, the more chance there is of developing allergies over time.

Our goal is to delay solid foods until somewhere about 4-6 months of age. This will very from baby to baby, however.

If your baby is breastfeeding and sleeping through the night, don’t start solids! If, however, she has been sleeping 8 hours at night and is now waking for two additional night feedings, she may be ready for solids.

If your baby is bottle feeding and taking more than 32 ounces of formula in a 24-hour period, you may give a solid feeding supplement if she’s still hungry after the 32 ounces.

Rice cereal is a good choice for your baby’s first solid food. It may be mixed with breast milk or formula until quite thin, then fed to your baby with a spoon. Do not use an infant feeder! These lead to overeating, potential choking or aspiration and defeat the purpose of teaching your baby about eating solid foods.

After several days (5-6) on rice cereal, you can begin to slowly introduce your baby to different solid foods. A good rule of thumb is to introduce solids slowly, using one new food for 5-6 days before trying another. Most pediatricians recommend cereals first, green vegetables then yellow vegetables (no more than 2 ounces daily). Wait one (1) month before starting fruits because the children tend to like sweet things, but if they taste vegetables first, this is less common.

Some foods including peanut butter should not be given to children during the first year of life. (Peanut butter should not be given to any child under the age of 2.) These foods are considered “high risk” in terms of developing food allergies, especially if received early in life.

Honey should not be given to children during the first year of life because raw honey can contain spores causing botulism in young children. These foods can be discussed in more detail during office visits.

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Juice has no food value. It is purely sugar. A child actually never needs any juice. So do not feel you have to give your child juice. Juices should be diluted to half strength with water.

Milk should not be given in a bottle or a sippy cup until twelve (12) months of age. Milk can cause severe anemia if given instead of formula or breast milk. Other dairy products like yogurt and small pieces of cheese may be given after nine (9) months of age.

After nine (9) months, meats may be introduced.

Circumcision careAfter a circumcision has been performed, you must care for the skin underneath. Some boys have extra skin that sits over the head of the penis. This skin must be pulled back and gently wiped with a diaper wipe or wet washcloth. The goal is to keep the head of the penis, down to the purple line where the head of the penis meets the shaft, separate from the leftover skin. This gentle cleansing must be performed at least one time daily, but with every diaper change cannot hurt.

HerniasInguinal hernias appear as bulges or swollen areas in your child’s groin (or scrotum, in males). The bulges often change in size, becoming larger or smaller in the course of a day. They may be slightly tender. If you notice any swelling in your child’s groin (boy or girl), notify the office. Hernias appearing in the groin area do require surgical repair, although usually on an outpatient basis. It is only an emergency if the baby is very fussy, the area won’t reduce (become smaller) with mild pressure or if the area is discolored and the baby is not feeding or is vomiting.

Umbilical hernias occur when a weakness in the muscle around the “belly button” causes it to stick out. These are very common and usually cause no problems. When a child cries, the belly button will stick out more, but it won’t break! The hernia usually resolves on its own by school age without treatment. Taping a quarter over the area won’t make things go away any sooner and babies can develop allergic rashes from the tape.

Spitting UpThis is very common in newborn babies and is due to a weakness of the muscle at the upper end of the stomach. It improves with age and has usually cleared up by the time a baby starts walking. Most spitting up has nothing to do with what formula your baby is on so formula changes after leaving the

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hospital are rarely indicated. Please call the office before changing your baby’s formula.

Giving your baby slightly smaller feedings more frequently and avoiding tight diapers will help somewhat. Although burping during feedings is important, a baby should be burped when he or she pauses in feeding and sucking should not be interrupted. Burping is less important than giving smaller feedings. If your baby is still having a significant amount of vomiting despite these measures, call the office during office hours and we can discuss possibly thickening the feedings with cereal or other measures.

Most “spitters” start having problems during the first week of life.

If your baby has not had problems in the past but suddenly begins to vomit during the third or fourth week of life, be sure to call the office during regular office hours.

TeethingTeething may cause a baby to be fussy or have a low-grade fever (usually not over 100). Teething does not cause high fever.

To make your baby more comfortable during teething episodes, give acetaminophen just as you would for any other type of pain if over four (4) months of age. Children’s Motrin (ibuprofen is sometime more effective for teething pain for infants older than six (6) months. You can try one of the water-filled teething rings that can be placed in the refrigerator for cooling. Teething biscuits, raw carrots or other foods that can break off into chunks and choke your baby should be not used.

Some babies enjoy chewing on nipples (including Mom’s) or pacifiers while teething. Others actually begin refusing nipple feedings (even the breast). If this happens, try giving acetaminophen or ibuprofen about one (1) hour before feeding time or using a sipper cup for fluids.

Dental CareYour child’s gums should be massaged daily with a wet washcloth until the first tooth erupts. Please start brushing your child’s teeth with a soft toothbrush the minute you see them because that is when cavities start. Until twelve (12) months of age you may use a baby toothpaste without fluoride. Brush teeth twice times daily and do not give a bottle after night-time brushing. (Making this a part of your child’s daily routine at an early age helps make it a life long good habit). At twelve (12) months of age switch to a children’s toothpaste with fluoride and use a tiny amount like the tip of a match stick. Fluoride is important for preventing tooth decay but TOO MUCH fluoride can discolor your child’s teeth. Your child will need help with brushing until about school age. Younger children aren’t coordinated enough to maneuver the toothbrush everywhere it needs to go.

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Most dentists like to begin seeing children around the first birthday for routine dental care. Check with your family dentist as to his or her preference. If your family dentist does not see young children, we can refer you to a pediatric dentist who does.

Obviously, sugary treats or drinks in excess should be avoided. Juice (no more than 4 ounces daily). Juice and milk should be given at meal times only. Water should be given between meals. The leading cause of tooth decay in children under two (2) years of age is taking a bottle or breastfeeding in bed at night. This should be avoided.

PacifiersMost pediatricians don’t have strong objections to the use of pacifiers in infants who seem to have a strong need to suck. A properly shaped pacifier is less damaging to the developing mouth than sucking on a thumb or finger. Pacifiers should be of a one piece design to avoid the possibility of an infant swallowing or choking on a part of it. Pacifiers should not be placed on strings tied around a baby’s neck or any string used that is long enough for a baby to strangle on. Please wash the pacifier on a regular basis.

ThrushThrush appears as white spots coating the gums, tongue and sides of baby’s mouth. It can’t be washed away. Normally this is seen in young babies who are still nursing or on bottle feedings. Occasionally it is seen in an older child after a course of antibiotics. It is caused by a fungal (“yeast”) infection. If you think your child may have thrush, call the office during regular office hours.

On a daily basis, all bottle nipples and pacifiers should be washed in dishwasher or boiled while the baby is being treated for thrush. The medication prescribed should be continued for two (2) days after the thrush appears to be totally gone.

ColicColic is seen in 10% of healthy, well-fed babies and usually begins around the third or fourth week of life. It ends (hopefully) by the third month. These babies have an excessive amount of fussy crying and appear to be in pain. There may be multiple causes for what we presently term “colic,” but nobody is sure exactly what the causes are. It is seen in both breastfed and bottle fed babies. It is not the result of inadequate parenting so don’t blame yourself if your child has this problem!

There are several things to try to help the crying spells;

Rhythmic, soothing activities—try carrying your baby in a front pack or pouch. An automatic baby swing, rocking cradle or buggy

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ride may help. Sometimes a drive around the block in the car may help. Putting the baby in an infant seat on top of the clothes dryer and then running the dryer with some sneakers in it will sometimes soothe the baby. (Be sure the seat is secured so it won’t jiggle off onto the floor.)

Some babies are calmed by sucking a pacifier. If your baby has eaten in the past two (2) hours, don’t feel you must feed him. Colicky babies aren’t usually hungry.

Warming the baby with a warm water bottle or warm towel on her tummy or swaddling her may help.

Soft sounds may calm your baby. Soft music or a recording of sounds from mother’s womb may be used.

If your baby is dry and has been fed, it is perfectly all right to close the door to his room and let him cry for awhile. Check on him periodically, but try setting a timer for 20 minutes and use this time to do something YOU want to do! Colic can be very frustrating and exhausting for parents if you don’t take “time out” occasionally. New mothers in particular should try to take at least one nap each day. You can also try to increase the amount of time your baby sleeps at night by not allowing her to sleep more than 3-4 hours at a time during the day.

Sun ExposureIn the summer your baby’s skin will need to be protected when he is outdoors, even from indirect sunlight. Babies should be shielded from direct sun exposure when possible. For babies over 6 months of age PABA free sunscreen lotions of SPF 30 or greater are recommended routinely for any sun exposure to provide maximum sunburn protection. Skin cancer is on the rise. Studies have shown each case of sunburn increases the risk. Please reapply the sunscreen every couple of hours while outside.

TravelInfants generally travel very well. You should plan ahead to allow more than usual frequent stops for feeding and diaper changes. Infants should ALWAYS travel in APPROVED car seats.

For those babies taking airplane rides, the only precaution needed is to have the baby nursing or sucking on the pacifier during take offs and landings. This allows for equilibration of ear pressure during changes in altitude.

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DEET is okay to use in bug spray with 30% or less DEET. (Only apply one time daily and bathe child at end of day. DO NOT put on hands).

WELL CHILD CAREPhilosophy of Modern PediatricsThe role of the pediatrician is not only to see your child when they are sick but to also provide comprehensive well child care. During the first two years of life, your child will be seen frequently. Growth and development will be followed closely and immunizations will be given. A TB test may be given to check for exposure to tuberculosis and your child will be checked for anemia. In the first two (2) years checkups are scheduled every 2-3 months; we will also discuss proper nutrition and help you with other problems such as discipline or sleep problems, etc. so that you and your child can build a solid and healthy foundation for future growth and development.

Older children should have yearly checkups. During these visits, a physical examination will be done to catch any potential problems early in order to treat them early. Also, any problems with bedwetting, school or learning problems, nutrition, etc will be discussed.

ImmunizationsHEPATITIS B (HEP B) – This vaccine provides protection against the Hepatitis B virus, which can be transmitted across the placenta at birth or later in life via blood or sexual contact. The first injection is given at birth. Side effects are minimal, with usually just some tenderness at the injection site. The Hepatitis B series is now a required immunization for all children entering public schools.

POLIO VACCINE (IPV) – Polio is a disease that can paralyze. The vaccine is now an injectable killed virus and is given in four doses. There are very few side effects.

HEMOGLOBIN – These tests will be done at 12 months to screen for anemia.

PPD – A TB test is recommended in the event of a TB exposure. If any family member is diagnosed with TB or develops a positive skin test or any immune deficiency, it is important to let us know as this will change the schedule for your child’s testing. Testing will be done before your child goes to kindergarten.

VARIVAX (Chickenpox) – At 12 months or older, this vaccine is nearly 95% effective in preventing chickenpox. Side effects include some fever and pain at the injection site. Also, 2-4 weeks after receiving the vaccine a child may actually develop 4-5 spots like the chickenpox. No special precautions are

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needed in a child who develops these spots, as the odds of passing the virus on to otherwise healthy people is very slim. However, they should avoid people with known immune deficiencies or who are on chemotherapy. A second dose is now recommended before entering kindergarten.

MMR – The measles, mumps and rubella (German measles) vaccine is given in two doses. Reactions to this don’t occur until 1-2 weeks after the vaccine is given. There may be fever, rash and aching joints. During this time, your child is NOT contagious to others at all. Acetaminophen or ibuprofen will help make your child more comfortable. Getting MMR vaccine is much safer than getting any of these three diseases.

DTaP – This vaccine protects your child against diphtheria, pertussis, and tetanus. Each child receives five (5) doses. A tetanus booster is given every 10 years after entrance into school. Your child may experience fever, irritability and pain and swelling at the injection site in the 24-48 hours following this vaccine. Acetaminophen and cool compresses usually help any discomfort. There have also been rare reports of cases of encephalopathy (nerve and brain damage), usually temporary, in one of every 100,000 – 300,000 children following DTaP immunization. With the newer generation of acellular vaccine (DTaP) we rarely see any side effects at all. This is now Tdap for ages eleven (11) and up.

HIB – Each child receives three doses. This vaccine protects your child from infection with the bacteria Haemophilus Influenza type B, which is a bacterium that causes epiglottis and meningitis in childhood. Side effects are rare and include fever and redness at the injection site.

PREVNAR – This vaccine helps protect infants and toddlers from diseases caused by the streptococcus pneumoniae bacteria. These include meningitis, bacteremia, pneumonia and ear infections. Prevnar is given in a series of four doses and has side effects similar to those seen with other childhood vaccines.

FLU VACCINE – It is recommended any child six (6) months to five (5) years of age and any child with a chronic illness, like diabetes, asthma, heart disease, receive the influenza vaccine. This protects against infection with the influenza virus, which causes a 1-2 week long illness of headache, sore throat, fever, muscle aches and dry cough. Epidemics of influenza occur each winter and each year a flu vaccine is “custom made,” based on a prediction of which strains of virus will be making people sick in the coming winter months. The vaccine is best given in the fall months to allow time for the body to develop its defense against the “flu” bug before “flu season” hits.

Mat-Su Community PediatricsImmunization Schedule

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1 Month

2 Month

4 Month

6 Month

9 Month 12 Month

15 Month

18 Month

2 Year

4-6 Year 12 Year

******* Pediarix Pediarix Pediarix ********Pedvax Pedvax PedvaxPrevnar Prevnar Prevnar PrevnarRotateq Rotateq Rotateq

MMR MMRVaricella Varicella

DTaP DTaPHep A

#1Hep A

#2IPV Td or

TdapInfluenza-DURING INFLUENZA SEASON FOR 6M OR OLDER

******* = Developmental Check Only If UTD On Immunizations

We attempt to call in children who are considered at “high risk” for complications from influenza, including those with asthma and diabetes children with heart disease or other chronic lung diseases and children on aspirin therapy for medical problems. If your child has a medical history making him/her high risk and you haven’t heard from our office by mid-October, call us!

We give immunizations according to the current American Academy of Pediatrics guidelines. These may change as new vaccines become available or depending on when immunizations are started.

Section 2: Crying, Fussy, Won’t Eat, So What’s wrong?

Sick Days

FeverRepeat after me, “FEVER IS OUR FRIEND (unless my baby is under 2 months old, in which case I will call the doctor immediately!!)

Fever is present if the oral temperature is greater than 100 degrees Fahrenheit (37.8 degrees Centigrade) or the rectal temperature is 100.5 degrees Fahrenheit or greater. Axillary (under arm) temperatures are variable but usually a fever is present with an axillary temperature over 99-100 degrees Fahrenheit. A child may “feel hot” without having an actual increase in body temperature so if you think your child may have a fever and are concerned, use a thermometer to check the actual temperature.

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Types of thermometersThere are many types of thermometers available. Acceptable choices include glass thermometers and digital thermometers. Thermoscans (thermometers which take the temperature in the ear) are not very accurate and we do not recommend their use. If a child under 2 months of age is felt to have a fever, we request you check a rectal temperature using a glass or digital thermometer before calling us. The thermometer strips available for use on a child’s forehead are notoriously inaccurate and not recommended.

Mild fevers may be caused by too much clothing, recent exercise, hot weather or hot foods. A fever is expected after certain immunization and is a normal reaction of the immune system to the vaccine.

Pediatricians as a group are very concerned about fever in infants under 2 months of age. This is because their immune systems are still developing and they often don’t give physical signs of severe illness other than fever at a young age. If you have a child less than 2 months of age and he/she had a rectal temperature of greater than 100.4 you should call the office immediately. This temperature means your child might be seriously ill and should be seen immediately.

After 2 months of age, we consider fever a normal response to infection. It should be treated only if your child is uncomfortable or the fever is fairly high (over 104-105◦).

Either an acetaminophen product or ibuprofen may be used to treat fever. The ibuprofen products are particularly effective but may cause stomach upset in some children and should not be given to children who are vomiting, having severe diarrhea or are not eating.

Never, ever give your child aspirin. (It can cause a life threatening illness).

CALL IMMEDIATELY If your child has fever associated with any of the following;

Age under 2 months.

Constant crying as if in pain

Fever of 105 or higher NOT responding to medication

Stiff neck

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Purple spots on the skin

Difficulty breathing (other than a stuffy nose)

Your child becoming difficult to arouse, confused or delirious

Your child appear extremely ill or has other signs that worry you

Call the office during regular hours if:

You child complains of sore throat or ear pain

Your child complains of pain with urination or is peeing more than usual or wetting the bed

Your child has a bad cough or any other symptoms along with fever lasting more than 48 hours.

As discussed previously, fever may be treated with medication such as acetaminophen (Tylenol) or ibuprofen (Motrin). Having your child drink lots of cold liquids will help. Sponging in a bath with lukewarm water for 20-30 minutes will generally reduce a fever by 2-3 degrees. If this causes more “fighting” than help, try a popsicle!

Note: Fevers are normal the first 24-48 hours after a DTap vaccine and 5-15 days after MMR.

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Dosage ChartTYLENOL Every 4-6 Hours 

WeightInfant Drops Liquid Chewable Jr. Strength

  80mg/0.8cc 160mg/5cc 80mg tablet  6-11 Lbs Consult Doctor  12-17 Lbs 0.8ml 1/2 tsp. N/A N/A18-23 Lbs 1.2ml 3/4 tsp N/A N/A24-35 Lbs 1.6ml 1tsp 2 N/A36-47 Lbs N/A 1&1/2 tsp 3 N/A48-59 Lbs N/A 2 tsp. 4 2 Tablets60-71 Lbs N/A 2&1/2 tsp. 5 2 1/2 Tablets72-95 Lbs N/A 3 tsp. 6 3 Tablets96 Lbs & over N/A N/A N/A 4 TabletsTYLENOL: Do not give Tylenol to children younger than 4 months

unless instructed by your physician

IBUPROFEN (Advil or Mortin) Every 6- 8 Hours Weight Infant Drops Children Liquid Chewable Jr. Chewable Jr. Coated Tabs Childrens Advil

50mg/0.8cc 100mg/5ml 50mg 100mg 100mg  < 12 Lbs. Consult Doctor N/A N/A N/A N/A N/A12-17 Lbs 1.25 ml 1/2 tsp. N/A N/A N/A N/A18-23 Lbs 1.875 ml 3/4 tsp. N/A N/A N/A N/A24-35 Lbs N/A 1 tsp. 2 Tablets N/A N/A 1 tsp.36-47 Lbs N/A 1 1/2 tsp. 3 Tablets N/A N/A 1 tsp.48-59 Lbs N/A 2 tsp. 4 Tablets 2 Tablets 2 Tablets 2 tsp.60-71 Lbs N/A 2 1/2 tsp. 5 Tablets 2 1/2 Tablets 2 Tablets 2 tsp.72-95 Lbs N/A 3 tsp. 6 Tablets 3 Tablets 3 Tablets 2 tsp.MOTRIN: **NOT FOR CHILDREN UNDER 6 MONTHS OF AGE*** 

BENADRYL Every 4-6 Hours 

Weight Liquid Chewable Tab.Tablet 25 mg.

  12.5mg/5ml    11-16 Lbs 1/2 tsp. Use Liquid Use Liquid17-21 Lbs 3/4 tsp. Use Liquid Use Liquid

22-32 Lbs 1 tsp. 1 TabletUse Liquid or Chews

33-42 Lbs 1 1/2 tsp. 1 1/2 TabletUse Liquid or Chews

43-53 Lbs 2 tsp. 2 Tablets 1 Tablet54-64 Lbs 2 1/2 tsp. 2 1/2 Tabs  65-75 Lbs 3 tsp. 3 Tablets  76-86 Lbs 3 1/2 tsp. 3 1/2 Tabs  >86 Lbs + 4 tsp. 4 Tabs 2 Tablets

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DiarrheaBabies usually have mushy, somewhat loose stools. Diarrhea is defined as a sudden increase in the number of stools and looseness of stools compared to your baby’s normal pattern. Breastfed babies may have anywhere from 10 loose stools per day to one stool per ten days and practically any consistency is normal for a breastfed baby. (They usually resemble mustard water with a little cottage cheese curd thrown in!) However, if your breastfed baby has a sudden increase in the number of stools, acts sick, has vomiting, fever or weight loss, then there is a reason for concern. While bottle-fed babies tend to have some more formed and less frequent stools, the same basic rules apply.

Diarrhea is usually caused by a viral infection or occasionally a bacterial infection. It usually lasts several days, sometimes as long as 1-2 weeks. Infections cause diarrhea by causing temporary injury to the intestines which causes food to not to be digested or absorbed.

Children who are otherwise alert and active and having only mild diarrhea do NOT necessarily require any changes in the diet other than limiting juices and sugar-containing fluids. It may help to limit milk and other dairy products like cheese while your child has diarrhea.

If your child is becoming listless and having moderate to severe diarrhea call the office.

Here are some simple dietary changes may be helpful: Probiotics (Acidophilus/Lactobacillus) are a dietary supplement shown to decrease the time children have diarrhea. You may add this to their formula or food. Probiotics can be found at All About Herbs (located in Wasilla, Alaska or in the refrigerated section of the health food sections at Fred Meyers or Carr’s.

Breastfed babies continue to nurse. Nursing on only one breast but more frequently will supply smaller volume feedings and may be retained better than a full nursing if your baby has any vomiting associated with diarrhea. An electrolyte-containing supplement (such as Pedialyte or Enfalyte) should be given in small amounts between nursing to replace the electrolytes lost in the diarrhea stools. These supplements can be found near the infant formulas in groceries and pharmacies. As long as your baby is having wet diapers (at least one wet diaper every eight 8 hours), a few additional fluids should be all that is needed. Once stools have begun to improve, solids may be added back if your baby had been taking them prior to the diarrhea. Stick with the “ABC diet” – applesauce, bananas, and rice cereal – for a few days.

Good choices for electrolyte supplementation include:

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Pedialyte Enfalyte or a similar commercially prepared electrolyte drink. These are available near the infant formulas in groceries and are usually in ready-to-feed form.

Gatorade may be diluted to half strength with water and used until you are able to get to the store for a premade electrolyte drink. Any flavor is fine-whatever color stool you want to clean up from the diaper! Many children over 12-18 months find this better tasting than the pedialyte.

Bad choices for a “clear liquid” diet for diarrhea include:

Boiled skim milk – boiling milk is dangerous because it causes an elevated salt content in the milk.

Kool-Aid and juices. These contain too much sugar, which can worsen diarrhea. They also don’t contain the appropriate electrolytes.

Soda pop – carbonated beverages often make diarrhea worse, particularly if they contain caffeine. The electrolytes needed to replace losses from diarrhea are not present, once again.

Water – water alone can alter a child’s electrolyte status and make salt and electrolyte depletion worse.

Remember when we say “clear liquids,” we don’t mean every liquid that is clear!

After 24 hours on a “clear liquid diet,” your child should be advanced to small amounts of formula. Mix his formulas as usual.

After your child is tolerating formula, the “ABC diet” may be resumed if he has been taking solid feedings in the past. (Applesauce, bananas, rice cereal, yogurt, crackers, dry cereal and toast.) During this time stools may temporarily seem to worsen but should begin to thicken and decrease in frequency over the next few days.

If your child’s diarrhea worsens as the diet is advanced, call the office during regular hours for advice.

Older children follow basically the same plan; that is, clear liquids for 24 hours, followed by an ABC diet and avoiding juices or milk for a few days. Raw fruits, vegetables, bran products, beans and spices may aggravate the diarrhea as well. If your child continues with diarrhea after several days without milk, you may want to resume his milk intake but with Lactaid drops (available over the counter) added to the milk or with a lactose-free milk.

Medications are rarely recommended to slow diarrhea; these usually just prolong the symptoms. If your child has had prolonged or severe diarrhea,

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this may be an option but always check with the office before using any anti-diarrheal medication.

You should call the office if:

Diarrhea is severe (e.g., bowel movement every hour for over 24 hours)

Stools don’t improve after 3-4 days on the special diet

Mild diarrhea lasts over 2 weeks

You see blood or mucus in more than one (1) stool

Your child develops signs of dehydration (less than one (1) wet diaper every eight (8) hours, dry tongue and mouth, increasing lethargy or refusal to drink)

Your child’s breathing becomes fast or labored

Your child has severe abdominal pain

We should see your child if he or she has:

Bloody diarrhea

Persistent abdominal pain for more than two (2) hours

Less than three (3) wet diapers in a 24 hour period

Stools every hour for over 24 hours

See within 24 hours if:

Diarrhea for more than two (2) weeks

Fever for more than three (3) days

VomitingThe most common cause of vomiting is a viral infection of the GI tract. Vomiting usually stops within 12-24 hours. It is best treated with clear liquids in small amounts. Wait 1-2 hours after your child’s last episode of vomiting, then begin with just 1-2 tablespoons (1/2 – 1 ounce) at a time and gradually increase the amount every 20-30 minutes. Refer to the list of acceptable “clear liquids” listed in the diarrhea section for examples. There are also electrolyte popsicles available now, usually in the formula section near the electrolyte drinks (e.g., Pedialyte, Freezer Pops).

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After eight (8) hours without vomiting, your child may begin the “ABC diet” as discussed in the diarrhea section, and then gradually resume a regular diet.

In occasional instances, a medicine for vomiting may be prescribed but these don’t always work and can have significant side effects. For the most part, small amounts of clear fluids by mouth are the most effective and safest treatment of vomiting.

What about food poisoning?Vomiting, abdominal cramps and diarrhea occurring 2-4 hours after eating unrefrigerated meat, dressings, pastry or cream sauces may be due to food poisoning. Treatment is supportive with clear liquids and symptoms usually resolve in about 6-12 hours.

You should call the office if:

Your infant (12 month and under) vomits for more than 24 hours or your child (over 12 months of age) vomits for more than 48 hours.

Your child develops signs of dehydration (less than one (1) wet diaper in 8 hours, decreased number of wet diapers/voids, dry mouth, increasing lethargy, refusal to drink).

Your child becomes confused or difficult to wake up

Blood appears in the vomit

The vomit becomes dark green in color

Your child develops SEVERE abdominal pain or mild abdominal pain for more than 24 hours.

Any other symptoms appear which bother you

ConstipationConstipation is never an emergency and should not be a reason for after hours calls.(Please see the information on normal stool descriptions in “well days” section.)

Babies often grunt; strain; grimace; and exhibit great effort in working up to a good bowel movement. A breastfed baby may actually seem to be

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uncomfortable for 1-2 days before his/her “explosion” of a weekly bowel movement.

Apple juice or prune juice may help soften hard stools. Usually 1-2 ounces a day in young infants will do the trick.

If your child has chronic constipation, please contact the office during regular office hours.

Common ColdsMost children get around 6-12 colds per year. Colds (upper respiratory tract infections) are caused by direct contact with a person who has one. They aren’t caused by cold air or drafts. Usually, fever last 2-3 days and the runny nose, sore throat, etc last for about 7-14 days.

Over-the-counter cold medications are not particularly effective as a rule, especially in young infants. The FDA recently recommended that no over-the-counter cold remedies be used for children under the age of two (2). (There have been several child deaths due to the misuse of these medications.) In the first few months of life, use a bulb syringe to suction mucus from the nose and sitting in the bathroom while the hot shower is running may help to “break up” any mucus in your baby’s nose so it drains more easily. You can also use saline drops to help loose secretions in your baby’s nose. These are available over-the-counter (Ayr or Ocean Spray drops, etc.) or can be made at home by mixing ¼ teaspoon of table salt with 4 ounces of warm water. Place 2-3 drops in one nostril at a time, then suction with a bulb syringe. This is most effective if done before feedings and at bedtime and naptime.

Left over antibiotics should NOT be used for colds. Decongestants may be tried and sometimes help slightly for “stuffy noses” in older children (e.g., Pediacare/Sudafed/Dimetapp). However, these medications can cause excitability or irritability in some children. A cool mist vaporizer may be helpful, particularly in the winter.

Your child should drink lots of fluids. Believe it or not, even chicken soup has been shown to have some beneficial effect on the common cold. (Grandma was right!)

While antibiotics do NOT help the common cold, if cold symptoms have lasted more than 14 days and/or any of the following signs appear, you should call the office.

You should call the office if:

Your child’s fever lasts more than 3 days.

Your child’s eyes become matted- 39 -

Your child complains of ear pain

Your child’s breathing becomes labored.

Cold SoresHerpes virus of the lip (“cold sores”) is transmittable to infants and children and can cause serious disease. Do not let anyone with a cold sore kiss or handle your baby.

CoughCoughing is a normal reflex to clear the lungs of mucus and protect them from pneumonia. During the winter months, viral respiratory infections of the trachea (windpipe) or bronchial tubes can result in a dry cough which persists for 2-3 weeks. Some children develop “cough variant asthma” with a persistent dry cough instead of wheezing. Chronic, loose night time coughs are often present with sinus infections in older children or may be seen in children with allergies. There are several things you can do to make your child more comfortable during these cough episodes.

1. Humidity – dry air tends to make coughs worse. Your child should drink plenty of fluids. A hot shower in the bathroom at bedtime will humidify the air somewhat and may help coughing.

2. No Smoking – No one should smoke in the house or car. This means no smoking indoors, even in another room of the house or in the car when the child isn’t present. The smoke still gets into the air space in the house and car and eventually finds its way into the child’s lungs! Multiple studies have shown that passive smoking aggravates chronic cough, asthma, respiratory infections and ear infections in children. If you would like a handout specifically addressing passive smoking and children, ask at the office and we will gladly provide you with one.

3. Medications – During the day, it is best not to suppress the cough as it helps protect against developing infection in the lungs. However, in some children a bronchodilator (e.g., albuterol or xoponex) may be prescribed for use during the day. This won’t suppress the cough but will make it more effective in clearing any secretions from the lungs.

Sore ThroatSore throats may be caused by viruses or bacteria (e.g., strep throat). Hot salt water gargles, cool foods, humidified air, acetaminophen or ibuprofen and lozenges for older children will help the pain.

Your child should be seen during regular office hours if:

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Sore throat has been present more than 2-3 days

Swollen or tender lymph nodes are present in the neck along with abdominal pain or a rash

There has been recent exposure to strep throat or impetigo

White spots are present in the back of the throat

Please do not use leftover antibiotics if your child has a sore throat. The antibiotics may be too old to do any good. Also, they don’t help viruses. If we diagnose strep throat in your child, we will treat with an antibiotic at that time. After 24 hours of medication, your child may return to school or day care.

Conjunctivitis – “Pink Eye”Conjunctivitis is inflammation of the white part of the eye and membranes lining it, with or without pus from the eye. Bacterial conjunctivitis (“pink eye”) usually presents with no other symptoms. Viral conjunctivitis usually presents with more mucus, runny nose, cough and possibly fever. Initial treatment at home should be washing the eye with warm water and a washcloth to remove the mucus. (Don’t forget to wash everyone’s hands as well).

If your child is complaining of ear pain or showing signs of bacterial conjunctivitis, call the office during regular office hours and we will help you decide if your child should be seen.

ChickenpoxEpidemics of chickenpox occur frequently. These appear first as small, red bumps resembling bug bites. Within 24-48 hours, they change to thin-walled blisters, then open sores and finally dry crusts. Repeated bunches of these sores occur for 4-5 days and they may be present on any skin surface, even in the mouth. Your child will probably have a fever with the chickenpox. This illness usually develops 2-3 weeks after exposure to a contagious person. A child may catch chickenpox from an older person with shingles, as shingles represent basically a reactivation of the chickenpox virus.

Chickenpox can often be diagnosed by an experienced parent or grandparent so an office visit isn’t needed. If unsure whether your child has the chickenpox, call the office and we will arrange to see him or her outside of the regular office area to avoid exposing other children in the office.

Please call immediately if your child becomes difficult to arose, confused or delirious, or complains of a stiff neck or severe headache. Otherwise, your child can be watched at home. Cool baths will help the itching and WON’T spread the pox. Oatmeal soap is soothing and helps itching. Calamine lotion applied to the pox will also help the itching. Keeping the Calamine cool in the refrigerator seems to make it more soothing. Please note: CALADRYL is not

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recommended in children with chickenpox!! The Benadryl in that particular product is absorbed through the broken skin in children with pox and can result in toxic levels of Benadryl in the system. For the same reason, Benadryl sprays or any topical form of Benadryl is not recommended. If your child has severe itching, Benadryl MAY be given by mouth. If your child develops sores in the mouth, popsicles, milk shakes and cool liquids are tolerated best. Acidic and salty foods (soda pop, juices, pretzels, etc) should be avoided until the sores have healed. Your child’s fingernails should be kept trimmed and hands washed often to decrease the risk of infecting the pox from scratching. If you suspect the pox may be infected (if they become soft and golden and drain pus), call the office.

Fever may be treated with acetaminophen. Never treat fever with aspirin. Aspirin can cause a life threatening disease called Reyes Syndrome.

Your child will no longer be contagious after the pox have scabbed over (i.e., about 6-7 days). He or she may return to school or day care after a week and needn’t wait until the scabs have all fallen off.

LiceNits are pearly white in color and attach firmly to the hair shaft and are not easily removed like dandruff. Lice bugs are 1/16 inches long are and are difficult to see. Lice crawl; they do not jump or fly. They are often found around ears and the back of the neck.

Treatment recommendations:

1. Nix cream rise. Shampoo with any shampoo, then apply Nix and leave in for 10 minutes. Rinse. If the nits are strong, you can use a ½ vinegar/ ½ water solution to help loosen them. Then, comb out with a fine tooth comb that comes in the Nix package.

2. Mayonnaise (not fat free). Apply to entire head and sleep in a shower cap all night. This will smother the lice. Olive oil works too, but is more expensive and harder to get out of your child’s hair.

General measures:1. Combs and brushes should be rinsed in Nix.2. Combs and brushes should be placed in the freezer overnight.3. Sheets, pillowcases, hats should be run through the hot water

wash.4. Items unable to be washed should be tied up in a plastic sack for

three weeks.

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PoisoningPoisoning is one of the most common medical emergencies. Each year about 500 children in the United States die from poisoning. Most, if not all, poisonings are preventable.

Children are naturally inquisitive and curious and will open drawers and doors to find things that will make them sick if they eat them. Make sure that anything potentially dangerous is locked up and away from your child. They’re especially bad about getting into Grandma’s purse, too! Make sure purses are empty or unavailable.

Children most commonly eat/drink medicines, gasoline and other petroleum products, furniture polish, household washing products, and Drano-like products. All of these items can kill your child and should be safety stored high and away from children. Don’t store dangerous material in “friendly containers” (i.e., gasoline in coke bottles.)

If an ingestion of a non-food material occurs, take the following steps :

1. Identify the drug or chemical that was ingested. Have the bottle next to you when you call and estimate the amount taken.

2. Call the Poison Control Center at 1-800-222-1222 or the Hospital Emergency Room: MSRMC 861-6620.

MINOR ACCIDENTSCuts and scratchesWash for 5 minutes with soap and water. Cover with a band aid or gauze. Don’t use alcohol, hydrogen peroxide or Methiolate on open wounds, they sting and can cause tissue damage. If bleeding hasn’t stopped after 10 minutes of continuous pressure with gauze or cloth or if the wound edges are gaping and you think the child may need stitches, call for advice. If the wound begins to appear infected, with pus or red streaks around it, call for advice. If your child’s immunizations are up to date, no tetanus booster will be needed. If your child hasn’t had a tetanus booster within the past 10 years, call the office during regular office hours to arrange for a booster. This should be done within 24 hours.

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Abrasions and scrapesWash for 5 minutes with soap and water. Remove any dirty particles from the wound with tweezers. If there is tar in the wound, it can be removed with Vaseline. Cut any loose pieces of dirty skin away with sterile scissors. If the wound is small, leave it open to air. If large, cover with a Telfa pad for 24 hours. Acetaminophen or ibuprofen may be given for pain. If a very large area of your child’s body is involved, call the office.

Puncture woundsIt may be helpful to make the wound re-bleed initially. Then soak it in hot, soapy water for 15 minutes. These soapy water soaks should be continued twice daily until healing occurs. A sterile dressing should be applied between soaks. If the wound begins to look infected (red, tender or drains pus) call the office. If your child is up to date on immunizations, an additional tetanus booster is NOT needed, as it is present in the Dtap/Tdap vaccine. If your child is 15 years of age or older and hasn’t had a recent tetanus booster, it may be time for one. Call the office during regular office hours to arrange for a booster within 24 hours of injury.

Animal bitesThe wound should be washed immediately with an antibacterial soap. Watch for signs of infection (such as red streaks or drainage at the site of the bite). If your child is not up to date on immunizations he should come in within 24 hours for a tetanus booster. The wound may be left open to air or a loose dressing applied. Call animal control. Animals most likely to transmit rabies are: bats, skunks, raccoons, foxes or large wild animals. Mice, rats, gerbils, hamsters, gophers, chipmunks and rabbits are usually considered free of rabies. Rarely, squirrels have carried rabies so if a squirrel was the culprit and seemed sick, further investigation is needed. You must also call the Health Department to report the attack Antibiotics are needed only if the wound is very large or requires sutures, or if the bite is from a dog or cat. Any wound involving the hands or face or by a dog or cat should be seen by a physician, due to the high rate of infection. If any other concerns exist, call the office.

Human BitesThe wound should be washed immediately with an antibacterial soap. Watch for signs of infection (such as red streaks or drainage at the site of the bite). Because human bites are actually more likely to become infected, antibiotics are more often prescribed. Call the office for advice.

NosebleedsThese are common with trauma and during the winter when the air is dry. During a nosebleed, pinch your child’s nose shut for 10 minutes by the clock. (Have him breathe through his mouth). This may be repeated once if the

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bleeding hasn’t totally stopped following the first ten minutes. If bleeding still hasn’t stopped after a second attempt, call the office.

If you think the bleeding may be due to dryness, put some Vaseline on the tip of a Q-tip and apply it to the inner nose membranes. This helps keep them moist and stop them from bleeding.

Head injuryIf your child doesn’t lose consciousness, chances are no major harm was done. Your child should be kept awake for one hour after significant head trauma; after this, he or she may nap. Your child should be aroused every 2 hours during the night following a significant blow to the head to be sure his or her pupils are equal in size and that no unusual signs (listed below) are present.

Call immediately if your child develops:

1. Persistent vomiting (more than twice), stiff neck or fever

2. Unequal sized pupils or a pupil that doesn’t get smaller when you shine a flashlight on it

3. Confusion or unusual drowsiness

4. Seizures or loss of consciousness

5. Stumbling, problems talking or using the arms and legs

6. Significant bleeding or leakage of fluid from the nose

7. Headaches not relieved by acetaminophen or ibuprofen

8. If in doubt, call-especially in children under 6 months of age.

BurnsVery large burns, burns of the face, neck or genitals or burns encircling an arm or leg should be seen as soon as possible by a physician. Any electrical burns should also be seen as soon as possible. Other burns can often be managed at home. Call the office with any questions.

The burned area should be rinsed immediately (don’t take time to remove clothing) with cold water for 10 minutes. No butter, ointment or creams should be applied. Extensive burns should be wrapped in a wet sheet or Saran Wrap and brought to the office or emergency room.

Minor burns (red with only a few blisters) may be managed at home. They should be washed with antibacterial soap twice daily. Blisters should NOT be opened; the outer skin protects against infection. Small burns need not be

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covered. Acetaminophen may be given for pain. Cold compresses may also be used. If your child is unable to sleep because of pain, call for advice. If several blisters are present, we will probably want to see the burn in the office and will probably recommend an antibiotic cream.

ChokingAny object in the airway may be life-threatening. If your child is choking but can make noise and speak, do NOT pound on his back, but do seek immediate medical attention. If the choking child is unable to breathe or make a sound, turn her face down over your knees and forcefully give 4-5 back blows with your open hand. If this fails, deliver rapid thrusts to the chest. Repeat en route to an emergency facility if there has been no response. If you can actually see the object, you may try to remove it with your fingers, but only if you can actually SEE it! If you are comfortable performing the Heimlich maneuver, this is very effective in older children.

ACCIDENT PREVENTIONAccidents are the number one cause of death in children between the ages of 1 and 16. Most accidents are preventable. Start “child-proofing” at 4 months.

REMEMBER: PREVENTION IS EASIER AND BETTER THAN TREATMENT.

Do’s and Don’ts for Prevention of Accidents1. Keep crib sides securely fastened.

2. Use restraints in baby feeder, carriage, stroller, car seats, etc.

3. Never prop baby bottles

4. Do not hang or tie toys to the crib (your baby may become entangled in the string).

5. Avoid use of pillows

6. High chairs should have a broad base to prevent tipping, a safety strap, and a latch on the tray.

7. Teach your child the meaning of the word “HOT”

8. Use gates on stairways to prevent falls

9. Windows should open from the top or have guards attached

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10. In the kitchen area, be alert for spattering grease, keep pot handles turned inward, and keep hot containers in the middle of the table at mealtime.

11. Always check bath water temperature; never run hot water first, as child may fall in.

12. Be alert for small objects – peas, buttons, popcorn, beads, and nuts. Avoid nuts and popcorn until your child is 4-5 years old; raisins and gum until 3.

13. Be sure broken glass and razor blades are safely disposed of.

14. Use safety plugs in unused wall sockets; be sure electric cords are not frayed and secure electrical cords so lamps cannot be pulled over.

15. Be careful when using plastic bags, especially dry-cleaner bags. DO not leave then lying around the house for the child to play with. They can suffocate your child.

16. Make sure that your child can’t get into the Drano, dish soap, oven cleaner, furniture polish, medicines, alcohol or any other harmful substance. Keep them locked up, preferably above the reach of he child. If you are using one of these items, put it away in a secure place before answering the phone or doorbell.

17. Always use a car seat or seat belts, even when in someone else’s car.

18. Turn water heater temperature down lower than 120 degrees so even the hottest faucet water won’t burn as much.

19. Don’t use a lawn mower when children are playing nearby.

20. No peanuts or popcorn in the house until your youngest child is 4-5 years old.

21. Don’t turn your back on our baby when he’s on the bed or table. Never leave the baby alone in the bath, even for a few seconds.

22. Keep your baby away from loose cords (Venetian blind cords). Make sure no cord hangs in or near your baby’s crib.

23. Never tie a pacifier around your baby’s neck.

24. Consider a smoke alarm near the children’s sleeping area. Develop and practice escape routes with children in case of fire.

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25. Discourage your child from running with food in his mouth.

26. Teach road safety, i.e., never run into the street, look both ways before crossing, etc.

27. Teach bicycle safety. Require bicycle helmet use.

28. Teach water safety. Never consider a child “water-safe.”

29. Never leave your baby alone in a room with pets, no matter how gentle.

30. Put plants up and out of reach.

31. Use safety latches for cabinets

32. Wood stoves are a leading cause of burns. Use safety screens.

33. Curling irons are a leading cause of burns. Keep them out of reach of your child.

Never give a child under the age of three (3), a toy that can fit though the inside of a toilet paper roll. It is too small and they can choke on it.

More about car seatsAutomobile accidents are the leading cause of accidental death in children. For this reason, utilization of a car seat each time your child rides in the car is a must. Unrestrained babies and children become flying missiles during a collision. They will hit the dashboard or car window. Don’t bring your child to our office unless he/she is properly restrained!

Use of the car seat should start on your baby’s first ride home from the hospital. You will find that children accept car seats very well. Car rides are much more enjoyable and relaxing when children know they must be in a car seat when riding in a car.Car seats must be approved by the National Highway Traffic Safety Administration and must be used as directed. If you have questions about a particular car seat, please contact the manufacturers.

Infant Safety SeatsFor children up to 20 pounds and one year oldAlways face rearwardAlways follow manufacturer’s instructions

Convertible Child Safety SeatsFor infants and children up to 40 pounds and 4 years of ageFor infants, recline and face rearwardFor toddlers, upright and forward facing

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Always follow manufacturer’s instructions Check to see that you have the vehicle safety belt in the right place

Booster seatsFor toddlers who have outgrown convertible safety seats and weigh more than 40 pounds and are over 4 years of age.

Always follow manufacturer’s instructions for use with shoulder harness or with lap belt only. Use until child is 8 years and 80 pounds.

Remember;Do NOT wear safety belts:

Under armAcross neckOver faceLoose or floppyOver bulky clothingChildrenWear lap belt low and snugAdjust shoulder belt properly across chestDon’t let child sit on pillowIf correct fit is impossible, use an approved boosterShould stay in booster seats until 8 years and 80 pounds

If your belt is too short, consult your auto dealer or service station for safety belt extender. Child should be secured in the back seat until they are at least 12 years old, 125 pounds and 4’ 9”

SECTION 3: Epilogue & Index

EpilogueWe don’t receive training to become parents. This is unfortunate because our first child is always our “experiment.” As parents, we must be willing to adjust to our children and learn from them while teaching them what we can. Children thrive and excel when they are brought up in a positive atmosphere of acceptance, happiness and approval. All children are different and need to

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be treated as individuals. No two are alike! This makes parenthood extremely interesting, challenging and, at times, frustrating.

Please make use of every opportunity to talk to and be with your child, read to your child and play with your child. The greatest gifts we can give our children as parents are our love, our acceptance, and our time. They will then grow up to be more confident and loving.

Most behavioral problems that children manifest are simple attempts at getting attention. If we parents spent more time giving positive attention, children would have less motivation to seek the negative attention they usually get. Make efforts to read parenting books and special topic books that relate to your particular concerns. You will find your unique problems are actually universal problems. This helps us parents realize we are not alone in our parenting endeavors.

Finally, parenting is much easier when both parents are on the same wavelength. Effective parenting requires, to a large degree, effective communication between spouses.

REMEMBER – take time to have fun with your baby along with way !!

Recommended readingTouchpoints: Your child’s emotional and behavioral development; by T. Berry Brazelton: Addison Wesley, 1992

Caring for your baby and young child: Birth to age 5; American Academy of Pediatrics: Editor-in-Chief, Steven P. Shelov: Bantam Books, 1991, 1993, 1998

Recommended Web SitesAmerican Academy of Pediatrics www.aap.org

Centers for Disease Control www.cdc.gov

Immunization Information www.vaccineinformation.org

State of Alaska Epidemiology www.epi.hss.state.ak.us

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