Note: This information is intended as an overview and provides typical advice for common medical problems. As all children and situations are different, please call your doctor or seek medical care if you are concerned that your child may have a serious condition.
Abdominal pain occurs in children for many reasons including stress, gastrointestinal problems such as constipation, infections such as gastroenteritis and appendicitis, reproductive tract problems such as ovarian cysts, and urinary tract problems such as kidney stones. Many times abdominal pain will resolve on its own without a clear cause. Reasons to seek urgent medical care include severe pain, constant pain lasting more than a few hours without any improvement, episodic pain in a toddler (the child cries from severe pain then abruptly feels better until the next episode occurs an hour or so later), pain that worsens with movement (particularly if associated with a fever), and pain associated with bloody stool or urinary symptoms.
Breathing Concerns / Respiratory Infections
Upper respiratory infections (URI), also known as “colds”, are a leading cause of illness in children and a common reason for health care visits. It is very likely that your child will come down with a URI at some point in his/her early childhood. Young children have, on average, six to ten URIs per year. Viruses cause almost all of these infections so antibiotics are rarely helpful; the most typical viruses are rhinoviruses, RSV, adenovirus, influenza, and parainfluenza. Symptoms generally last 4-14 days, and go away without treatment or complications. Fever, runny nose and cough are the most common symptoms. Fevers can be quite high among younger children whereas older children typically have lower-grade fevers. Nasal discharge can be clear, yellow or green; a common myth is that green mucus requires treatment with antibiotics. Cough will most likely be the last symptom to go away and may persist for 2-3 weeks. Other possible symptoms include chills, fussiness, decreased appetite, decreased activity, mouth breathing, dry irritated nasal passages (that can lead to nosebleeds), eye discharge, and sneezing.
Signs your child needs to be seen by a health care provider:
Constipation is common in children and a frequent concern for parents. Constipation should be suspected when there are hard, rabbit-pellet-like, large, or painful bowel movements. A decrease in stool frequency is not considered constipation as long as the stool is still soft (this is particularly true for breastfed infants as many go several days without needing to have a bowel movement). Constipation is commonly seen when breastfed infants are switched to formula, when baby foods are first introduced, and when there is insufficient water or fiber in the diet of older children.
A trip to the emergency room is not needed for constipation. It can be treated at home with undiluted juice (prune often works best, maximum 1 oz per day for young infants), or with pediatric glycerin suppositories that are available over the counter at pharmacies. Glycerin suppositories are only intended to be used infrequently; if you are using more than 1-2 per month then you should talk to your child’s primary care provider. For an older child, you should also increase water intake and fiber in the diet. In infants, diluting formula to treat constipation can cause life-threatening problems and is not recommended. Reasons to see your child’s primary care provider include chronic constipation, frequent over the counter suppository or laxative use, stool soiling in underwear, and constipation with bloody stool. Untreated long-standing constipation in older children can lead to encopresis; this is a significant problem that results in stool soiling or incontinence, and can take months or years to correct.
Ear infections are often a complication of another condition such as an upper respiratory infection or allergic rhinitis. Ear pain can also be caused by reasons other than ear infections such as sinus pressure, nasal congestion, or a foreign object in the ear. Unfortunately, many ear infections are caused by viruses that will not respond to antibiotics, and unnecessary use of antibiotics can lead to drug resistance. Pain management with ibuprofen (Motrin) or acetaminophen (Tylenol) is the most important step. Antibiotics are most commonly needed for ear infections in children < 2 years old, and ear infections that develop after cold symptoms have already been present for several days (this is a possible sign of a bacterial, rather than a viral, ear infection). If your child is acting very sick or has ear pain that does not go away with pain medication, then you should have him seen by a medical provider. Yellow or bloody discharge from the ear canal does not require a visit to the emergency room. Usually when you see pus, the pain is already gone because the pressure has been relieved. If this happens, avoid getting water in the ear, continue oral antibiotics if already started, and call for an appointment the next day if your child is not already on antibiotics for an ear infection.
Fevers are common in children and are often caused by viral infections. A fever is defined medically as a temperature greater than 100.4°F (38°C) rectally (temperatures of 99 or even 100.3 are not considered a fever). Some people believe that one degree should be added for temperatures taken under the arm but this is not very accurate – if you are concerned then a rectal temperature is best. Click here for information on how to take a rectal temperature (scroll down to the section on rectal temperatures).
Fever is not a disease; rather a response to an infection or other underlying condition. Parents are often concerned by how high the fever is, but we are more concerned about the underlying cause and how the child looks than the degree of the fever (a common myth is that a 104-105°F fever can cause brain damage). Fever may increase a child’s risk of becoming dehydrated so drinking fluids should be encouraged. Keep the room comfortable and cool, and dress your child in light clothing or pajamas. Tylenol and Motrin won’t fix the underlying illness, but they can reduce the fever for a few hours and help your child feel better.
In general fevers do not need to be evaluated by a doctor. However, the following exceptions warrant an appointment or visit to the emergency room as the fever could be a sign of a serious illness:
Go to an emergency room immediately if your child hits his head and loses consciousness. If a child hits his head and then cries right after falling without loss of consciousness, you can usually monitor at home. However, if he vomits more than once, seems sleepy or disoriented, or has clear fluid draining from his nose or ear, call your doctor or go to an emergency room for evaluation. Research is also indicating that repetitive concussions are associated with increased risk for long-term brain injury. This is particularly true when a concussion occurs before a previous head injury has fully healed. Please call your child’s clinic to discuss when it is safe to return to sports after head injuries, even mild ones.
Overdoses / Poisonings
Unintended exposure to medications and household chemicals are a leading cause of injury in children. The best treatment is prevention – keep medicines and chemicals out of reach, use child-proof containers, and never let young children take medicine by themselves. This is true even for “safe” medications such as vitamins and Tylenol as they can be lethal at the wrong dose. If you suspect an overdose or poison exposure occurred, call Poison Control at (800) 222-1222 immediately even if your child is acting well. (The one exception would be an overdose or poisoning that is causing difficulty breathing, loss of consciousness or other serious symptoms – in that case call 911 and take the container of the suspected medication or poison with you to the emergency room.) Poison Control is available 24/7 and so useful that even doctors call for advice about patients! If possible, have the container of the suspected medication or poison in hand when you call. Other details such as the time of suspected ingestion and amount ingested are also helpful. Ipecac and other methods of inducing vomiting are no longer recommended – do not give your child any antidotes unless advised by Poison Control.
Sore throat (pharyngitis) is a common problem in pediatrics, and usually does not require a visit to the doctor. The vast majority of sore throats are caused by viral infections that improve with time and do not require antibiotics. Sore throats from a virus are often associated with a runny nose, cough, pink eye, hoarse voice or diarrhea. On the other hand, “strep throat” is a bacterial infection caused by Group A Streptococcus and antibiotics are needed. It is more common in children 3 years or older who have a fever, sore throat and swollen lymph nodes in the neck, but no other symptoms. The American Academy of Pediatrics (AAP) recommends that “strep throat” should not be diagnosed or treated with antibiotics unless a throat culture or other lab test is positive for Group A strep infection. This is because antibiotics do not work for viral infections and may even make things worse by causing drug resistance or a drug reaction. Non-infectious causes of sore throat include allergies, dry air, pollution, smoking and exposure to second-hand smoke.
Home treatment recommendations for sore throat include increasing fluids, giving hot or soothing drinks, and acetaminophen (e.g. Tylenol) or ibuprofen (e.g. Motrin) for pain. Prevention of sore throat includes good hand washing, avoiding contact with people who are sick, and avoiding smoking and second-hand smoke.Your child should be evaluated by a medical provider if the throat pain is severe enough to cause dehydration from inadequate oral fluid intake (decreased urine output is a good marker of dehydration), if the pain is associated with difficulty breathing or excessive drooling, if the pain is associated with difficulty (not just painful) swallowing, or if the pain persists longer than 3-4 days (especially if there is a fever but no other cold symptoms).
Vomiting and Dehydration
Vomiting is usually caused by a viral infection or eating something that disagrees with your stomach. When a viral infection causes vomiting, it usually lasts 6-48 hours and is accompanied by fever and/ or diarrhea.
Home care for breast fed infants <1 year old:
Home care for bottle fed infants <1 year old:
Home care for children >1 year old:
Call your child’s clinic immediately for additional advice if:
Call for a clinic visit within 24 hours if: