Pediatrician, East Bay Pediatric & Adolescent Medicine Association, Barrington, Rhode Island
"Babies are very good teachers, and new parents are incredibly fast learners," says Jane Dennison, M.D., a pediatrician who has been treating children (and educating parents) for 30 years. Still, parents young and old have many questions when it comes to the health of their children. Dr. Dennison provides some answers below that will help you keep your child happy and healthy.
Q: What can parents do to prevent their children from getting common illnesses?
A: One of the most important things is to make sure they get enough sleep. Families by nature are staying up later, so the kids are getting less sleep than they used to. In the old days, kids were often getting the 10 to 12 hours of sleep they need. Families should try to get kids to bed at pretty much the same time every night. The kids will do better. They will be healthier, happier, and more settled, no matter what age.
Of course, children should also eat a variety of fruits and vegetables—your grandmother was right—and make sure they wash their hands with soap and water.
Q: When should you call your pediatrician?
A: Parents are encouraged to call any time they are concerned or their child is sicker than they're comfortable with. During the day, you may be able to get the answer you need from a staff member. If they don't have the answer, they can determine if the child should be seen, or if a return phone call from the doctor will be enough.
At night, all physicians have an answering service you can call. The standard is to be called back within an hour. When it's more urgent than that, you can ask the service to page the physician. If you don't receive a return call in the timeframe you expect, call back.
If you feel you don't have time to wait for a return phone call, you should call 911. On the other hand, if you think you may need to go to the emergency room, but feel you have some time, call your pediatrician first so you won't have to wait several hours to be seen. We can call ahead to let them know the child is coming and what the symptoms are so he or she can be treated faster.
Q: When is a fever a concern?
A: For a child who is 2 months old or younger, a rectal temperature of 100.4 or higher should be brought to the physician's attention right away. For older children, the actual reading is not always as important as how the child is acting. With these kids, we also want to know if something out of the ordinary is happening. We want to know the background. As a rule of thumb, though, if your child is between 3 and 6 months, call if his or her temperature reaches 101. For kids older than 6 months, call for a temperature of 103 or higher.
When you take your child's temperature, get an oral or rectal reading. Don't put it under the armpit. It's not as reliable. Forehead thermometers are not recommended either. An ear thermometer is OK if you use it correctly, but that's not always easy. For kids under 2, a rectal temperature is preferred.
Q: What other information should parents be prepared to provide when they call about a sick child?
A: There are a few things we'd like to know. One is whether the child is drinking and eating. Sick kids don't often eat, but most kids will drink enough to stay hydrated. We'll also want to know when the last two times were that they urinated. Even if they just urinated, but hadn't in 12 hours, that's a risk factor. You want them to urinate three to four times in 24 hours, minimum.
If they have a rash, it's important to let us know if it fades briefly or stays there if you stroke it. If you touch it and it goes white for a moment and then comes back, that's called blanching, which is normal. Nonblanching rashes, when a dark color remains, are not good. We don't want to wait on those types of rashes.
If the child is complaining about a sore throat or neck, we want to know if the neck is stiff or the child can't bend it. It's more likely that child will be sent to the hospital in the middle of the night. On the other hand, if it's just a sore throat, but the child is otherwise looking pretty good, that can be dealt with in the morning.
Q: What are some of the basic medications you should have in your medicine cabinet?
A: Acetaminophen (such as Tylenol®), ibuprofen (such as Advil® or Motrin®), and diphenhydramine (such as Benadryl®) are all good to have. Loratadine (such as Claritin®) is a little less sedating than diphenhydramine, and some people think cetirizine (such as Zyrtec®) works better for little kids. I also suggest some cortisone cream for things like bug bites when they're older, and an antibiotic ointment like bacitracin.
Parents should know that it's OK to use ibuprofen for children over 6 months. However, under 6 months, we use acetaminophen for pain and fever. If parents have any questions, especially if the child is under two, they should call their physician or pharmacist.
Q: What suggestions for day-to-day living do you have for parents to keep their kids healthy?
A: Kids need to get outdoors more and get away from computers and TV and being harassed by cell phones. Unfortunately, the days of digging to China are gone and creative play is becoming less and less common. People have lost sight of some of the health benefits of outdoor and creative play.
Today, parents ask their children what they want to do more often than they were asked by their own parents. Kids need some time to be alone, to play, to be with other kids and not with grown-ups telling them what to do all the time. What kids remember are not the 400 soccer games they played, but the hike they took one day because along the way they kicked over a mushroom or found a dragonfly or tried to catch a frog.
There's so much that happens so fast these days that kids don't have a chance to play and create a world and alter it and change it. For example, having a bunch of 7-year-olds sitting around having a tea party or kids making a tent out of a blanket is more unusual today. That shows creativity on the kids' part, that's healthy play, and we have to encourage more of that. Kids grow so well with that kind of freedom.
