Kid's Health A-Z -- August 13, 2012 -- Dr. Elizabeth Bailes - | Nashville News, Weather & Sports

Kid's Health A-Z -- August 13, 2012 -- Dr. Elizabeth Bailes

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Saint Thomas Health Medical Mondays
Monday, August 13, 2012
Topic: Kid's Health A-Z
Elizabeth Bailes, MD | pediatrician

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Whether you're a new or veteran parent, a sick child can leave you confused and afraid. Is the childs's fever dangerous? Should you call the doctor for a cough? Vomiting? Diarrhea?

It helps knowing that most common issues aren't an emergency. A touch of stomach flu, a minor diarrhea usually resolve in a few days. Yet sometimes these can be signs of something else -- or critical in their own right. So when should you talk to your doctor?

When to Call a Pediatrician: The Ironclad Rule

If you're worried, call your childs's doctor, period. That's the recommendation of Chris Tolcher, MD, a pediatrician in private practice and clinical assistant professor of pediatrics at the University of Southern California School of Medicine. "Trust your instincts," Tolcher stresses. If your child is weak, lethargic, or if you have any questions, always call.

"With so many of these illnesses, we go by the child, not by a number," Tolcher says, "so always pay attention to your child's energy level, how they're doing overall. ... Call your doctor when you're worried."

And when should you worry? The following are good guidelines for when to pick up the phone.

Fever: When to Call a Pediatrician

To get a handle on fevers, it helps to know your numbers: Generally, a low fever is under 102 degrees, a moderate fever is 102-104 degrees, and a high fever is 104 and over, says Tolcher.

Fevers aren't dangerous to the brain unless they're over 106, Tolcher tells WebMD. "The only thing a fever means is that the body is trying to fight an infection. So fevers aren't themselves bad, but we treat them because they make you feel miserable." Tolcher recommends that you call your child's doctor:

  • For any fever in an infant under 2 months, even a temperature as low as 100-101 degrees.
  • For babies older than 2 months, call your pediatrician for a low fever if your child is acting weak, sick, or if the fever lasts for more than three days.
  • For fevers 105 degrees and up, your child should see their pediatrician the same day or go to urgent care.

If the fever is also accompanied by an inability to drink, confusion, rash, trouble breathing, seizures, constant crying, difficulty waking, persistent vomiting, or diarrhea, call your doctor right away.

Stomach Flu and Other Intestinal Issues

Intestinal issues are a common cause of vomiting, diarrhea, and even cough and cold symptoms in kids. Usually caused by a virus, intestinal problems can happen no matter what age your baby is.

When should you call a pediatrician? Scott Cohen, MD, attending physician at Cedars Sinai Medical Center and author of Eat, Sleep, Poop: A Complete Common Sense Guide to Your Baby's First Year, recommends calling when there is:

  • Blood in your child's stool or vomit
  • Abdominal pain located in one spot
  • A fever for more than three days
  • If your child has diarrhea and pees fewer than three times in 24 hours

Dehydration, Diarrhea, and Vomiting

Dehydration can easily be caused by vomiting and diarrhea, especially in babies, so always call your pediatrician if you think your child is dehydrated, says Tolcher. Signs of dehydration include:

  • Parched lips
  • Lack of tears when baby cries
  • Wetting fewer diapers than normally
  • Going six hours or more with a dry diaper
  • Lethargy or weakness

Diarrhea is considered severe and worthy of a call to the doctor when:

  • There are more than eight stools a day
  • Stool has blood or mucus
  • Mild diarrhea warrants a call if it lasts more than two weeks

Vomiting is a pretty common part of childhood, but call your doctor if:

  • Vomiting lasts more than 24 hours
  • An infant throws up more than 8 or 10 times
  • An older child throws up 10 or 20 times
  • The vomiting seems unusually severe

"Again, if any illness ... is associated with a weak, lethargic, or dehydrated child, you should always call sooner," Tolcher tells WebMD.


It's all about the poop, writes pediatrician Tanya Altmann, MD, in her book Mommy Calls: Dr. Tanya Answers Parents' Top 101 Questions About Babies and Toddlers, who says questions about constipation are some of the most common a pediatricians hear.

While newborns should poop daily, older babies can have a wide range of normal poop behavior. Call your doctor about constipation if your baby:

  • Is newborn (up to 4 weeks old) and hasn't pooped every day
  • Is more than 4 weeks old and has not pooped in a week
  • Has a distended or swollen belly
  • Starts vomiting
  • Has a fever
  • Is lethargic
  • Uninterested in feeding

Coughs, Colds and Other Respiratory Problems

Coughs are an expected part of having a cold and serve a purpose, Tolcher says, clearing mucus from the airways. Coughs are worrisome and rate a call to the pediatrician when they're severe, meaning:

  • When they're constant
  • Are associated with labored or noisy breathing
  • Are painful
  • Cause vomiting
  • Make a child uncomfortable
  • Keep a child up at night
  • Last more than two weeks

For colds, Cohen suggests calling your doctor if there is:

  • Problems with breathing
  • Fever for longer than three days
  • Signs of dehydration (see above)

Remember, no cough and cold medicines are recommended for infants and young children, Tolcher tells WebMD. "It's OK to treat fever and pain with acetaminophen or ibuprofen, but not with aspirin, which isn't recommended for children because of the risk of Reye's syndrome."


Lots of things cause rashes, says Altmann, such as infections, hormones, and irritations like soap, drool, and, of course, wet diapers. Call your doctor if your child:

  • Is bothered by the rash
  • Starts acting sick
  • If the rash doesn't improve within 2 or 3 days
  • The rash looks like bruises and does not blanch
  • The rash is associated with fever

Colic or Fussiness

Colic isn't really an illness, and you don't need to call your doctor for a colicky baby, yet "colic is one of the toughest things some parents will have to deal with," says Tolcher, and parents sometimes do need guidance through it.

"With colic (or anything else), if you don't know what to do, just call your doctor," he suggests. "Don't wait for a meltdown in yourself, ask for help, come in and have a meeting with your doctor, because one, you can make sure it is colic -- it could be a sensitivity, an allergy to formula, or GERD instead, for example -- and two, you can then find out what to do."

Luckily, colic happens only in 5%-10% of babies, and there are techniques that can help soothe a fussy, colicky infant, including:

  • Swaddling
  • Rocking
  • Humming
  • White noise
  • Putting them on their side (while they're awake only)
  • Home treatments

While most over-the-counter home remedies may not help all babies, "they generally won't hurt either," Tolcher says, adding that recent studies suggest probiotics may help with colic, too.

Whether it's colic, vomiting, tummy upsets, or just something that's worrying you, "just call your doctor and get some guidance and a plan of action," Tolcher says. Your pediatrician is there to help, so give them a call -- and let them help!

Childhood Weight Concerns

Childhood obesity is a difficult subject to tackle for parent and pediatrician alike. As a parent, you may feel embarrassed or guilty if your child is struggling with weight issues -- especially if you are overweight yourself. Or you assume that your kid's doctor will tell you if there is a concern.

Unfortunately, that may not happen. Studies show that sometimes pediatricians don't bring up weight issues. Some say they worry about insulting parents. Time concerns are also a factor, and some doctors just don't feel prepared to help.

Today, 17% of kids aged 2 through 19 are obese -- and those numbers keep growing at an alarming rate. While it may not be easy, talking with your kid's doctor may be an important first step toward protecting your child's health.

What You Need to Know About Childhood Obesity

Being overweight isn't something that your child can overcome on her own. She needs your guidance to help her overcome powerful social pressures to be sedentary and eat high-fat foods.

Being overweight tends to run in families. A child with two overweight parents is 80% more likely to be overweight herself. So if you are overweight, your child is also at risk.

Plus, being an overweight child can have serious consequences, even at a young age.

Being overweight sets kids up to be overweight adults. And when you're an overweight adult, extra pounds increase your risk for bone and joint problems, sleep problems, asthma, certain cancers, high cholesterol, high blood pressure, type 2 diabetes, and heart disease.

Problems once only seen in adults are now seen in kids. Alarmingly, many of the weight-related health problems listed above for adults are also showing up in overweight children. For instance, 70% of obese children have at least one risk factor for heart disease.

Kids who are overweight are more at risk for being teased or bullied. This can lead to a realm of problems from social isolation to lower grades to a poor sense of self -- issues that can last into adulthood.

How to Bring Up Your Child's Weight: Questions to Ask

When you see your child's pediatrician, here are some questions you can ask to get the conversation started.

  • Is my child's weight in the right range for his age and height?
  • Should I be concerned about my child's size?

The pediatrician will assess your child's weight by using his height and weight to calculate his body mass index (BMI). The doctor will also calculate your child's BMI percentile, which compares him to other kids his age and gender. That BMI percentile places your child in a weight range: underweight, healthy weight, overweight, or obese.

But BMI is just a piece of the picture. The pediatrician will also ask you about your weight history as well your mate's, both parents' heights, your family health history, and your family eating and exercise habits. Your child's health care provider uses all this information to decide what to do next if your child's weight is outside the healthy range.

Help for Your Overweight Child: 2 to 5 Years Old

As a parent, it can be difficult to know the difference between overweight and healthy weight in a child this young. Many kids still have baby fat from their infant years, while others may appear thin. One study found that parents tend to underestimate their preschooler's weight. This means that your child could be overweight, and you may not even realize it.

The American Academy of Pediatrics recommends BMI screening starting at age 2, so it's a good idea to talk with your pediatrician about your child's weight at every visit.

Here are some questions you can ask the pediatrician about your 2- to 5-year-old.

  • What can I do to help my child develop healthy eating habits at this age?
  • How many meals a day should my child be eating?
  • What is a healthy snack?
  • What are appropriate portion sizes for my child?
  • How can our family change our eating habits to help our child?

Help for Your Overweight Child: 5 to 12 Years Old

If your grade-school child is overweight, her health care provider will likely recommend that you focus on maintaining her current weight as she gets taller so that she can grow into her weight.

Questions to ask your pediatrician about your overweight child in grade school:

  • How can I get my child to pick healthy foods without nagging her all the time?
  • How can I talk to my child about the food she sees on TV?
  • Can you recommend activities she might like? She stays indoors more and more these days.
  • How can I decrease TV and video game time for my child?
  • How will puberty affect my child's weight?

Help for Your Overweight Child: 13 to 18 years old

When your teen is overweight, one thing his health care provider will assess is how far along he is in his growth and physical maturity. Teens who still have a lot of growing to do still need calories and nutrients to fuel that growth, so as with younger kids, they may be advised to decrease weight gain or hold their weight steady for a while. If your teen is through puberty or is very overweight or obese, particularly if he has associated problems such as diabetes or signs of diabetes, medically supervised weight loss may be recommended.

  • These are great topics to discuss with your teen's health care provider.
    • How can I motivate my overweight teen to eat healthier without making him feel bad about himself?
    • Are some foods better than others when he goes out with his friends? What are some better choices in fast-food restaurants or malls?
    • My teenager always seems hungry. Is this normal?
    • How much physical activity should he get per day, and what will help him achieve that goal?
    • How much more growing do you think my teen will do? Will it be enough to help him grow into his weight?
    • Do we need to think about other ways to help make his weight healthier for his age?


9 Ways to Make a Child's Bedtime Easy

When it comes to sleeping, children are a bit like cats -- both do a lot of it. In fact, according to the National Sleep Foundation, by age 2, children have spent more time sleeping than awake. Throughout childhood, kids will spend about 40% of their time asleep. Sleep is vital for a child's mental and physical development.

Of course getting a child to bed -- and getting her to stay there -- can be difficult. And when kids don't get enough sleep, they have a harder time controlling their emotions, and they may be irritable or hyper, which is no fun for anyone. Kids who are chronically sleep-deprived are more likely to have behavior problems, have difficulty paying attention and learning, and be overweight. So although it's not easy, it's important to do all you can to help your child get the sleep she needs.

Regular schedules and bedtime rituals greatly impact a child's ability to get sound sleep and function at his best. Establishing and maintaining good sleep habits helps your child fall asleep, stay asleep, and awake rested and refreshed. Good sleep habits can also help take the stress out of bedtime.

There are no hard-and-fast rules for bedtime, and every child is different based on his or her temperament. What's important is to develop a routine that works for your family -- and to stick with it. The following suggestions are a good place to start.

1. Make sleep a family priority.

Set regular go-to-bed and wake-up times for the entire family and be sure to follow them -- even on weekends. You can tell that children are getting enough sleep when they fall asleep within 15 to 30 minutes of going to bed, wake up easily in the morning, and don't fall asleep during the day.

2. Deal with sleep difficulties.

Signs of sleep struggles include difficulty falling asleep, nighttime awakenings, snoring, stalling and resisting going to bed, having trouble breathing during sleep, and loud or heavy breathing while sleeping. Sleep difficulties can be seen in daytime behavior as well. If your child seems overtired, sleepy, or cranky during the day, tell your child's health care provider. Causes of sleep difficulties may be as simple as large tonsils and adenoids, which can be determined during a routine examination.

3. Work as a team.

It's important to discuss and agree on a sleep strategy for your child with your spouse or partner beforehand and work together as a team to carry it out consistently. Otherwise, you can't expect your child to learn or change her behavior.

If you are starting a new sleep routine for your child, make her part of the team by explaining the new plan to her if she is old enough to understand. For a young child, try using a picture chart to help your child learn the new routine. Changing clothes, brushing teeth, and reading a book can easily be shown through pictures.

4. Routine, routine, routine.

Kids love it, they thrive on it, and it works. In fact, a 2009 article in the journal Sleep found that a consistent nighttime routine improved sleep in children who had mild to moderate sleep problems. A nightly bedtime routine helps your child learn to be sleepy, just like reading in bed often puts adults to sleep. The structure of bedtime routines also associates the bedroom with good feelings and provides a sense of security and control. Routines can take the stress out of bedtime and help make it a special time.

There is no one right routine for everyone, but in general, your routine should include all the things that your child needs to do before going to sleep, including brushing teeth, washing up, putting on PJs, and having a snack or drink of water. Your child may want to be read to, talk about the day, or be told a story. Whatever you choose to do, keep the routine short (30 minutes or less, not including a bath) and be firm about ending it when it's time to sleep.

5. Bedtime snacks.

Children need more than three meals a day to keep them going, so a small snack before bedtime can help their bodies stay fueled through the night. Healthy options include whole-grain cereal with milk, graham crackers, or a piece of fruit. Avoid large snacks too close to bed, especially with older kids, because a full stomach can interfere with sleep.

6. Dress and room temperature.

Everyone sleeps better in a room that is cool, but not cold. For optimal comfort, a good rule of thumb is to dress your child basically as you dress yourself, keeping in mind that younger children often kick off the covers at night and are unable to cover themselves.

7. Sleep environment.

Make sure the bedroom is dark and quiet and the noise level in the house is low. If your child does not like a totally dark room, turn on a small night light, or leave the hall light on and the door to the bedroom open.

8. Security object.

Bedtime means separation, and that can be made easier with a personal object, like a doll, teddy bear, blanket, or other comfort item. This kind of object can provide a sense of security and control that comforts and reassures your child before falling asleep.

9. One last thing.

Kids will always ask for that one last thing -- kisses, hugs, a drink of water, using the bathroom, just one more book. They can be quite inventive. Do your best to anticipate all this by incorporating these small rituals into the bedtime routine. That way you can get it all done before putting your child to bed. And let your child know that once he is in bed, he has to stay in bed.

If he gets up, don't react -- simply take him by the hand and walk him back to bed. If you argue or give in to requests, you are giving your child the extra attention -- and delayed bedtime -- he is seeking. And don't give into the "just this one time" pitfall. If you read one more story or let them stay up longer "just this time," you risk that the bedtime routine you've worked so hard to establish will come undone.


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