A Quick Reference Guide

Abdominal Pain(Acute)
Cause: Abdominal pain may be the symptom of a great number of ailments from childhood disease, internal disorders or simply the result of overeating or eating the wrong foods. Other causes would include a twisted digestive organ, stomach ulcer, twisted testicle, viral or bacterial diarrhoea or food poisoning, pneumonia, hepatitis, chronic constipation and even pain caused by emotional problems.
Diagnosis: Diagnosis will vary according to the location of the pain, when it began, how long it has lasted, the age and sex of the child and whether there are other symptoms such as changes in bowel movements or urination, fever, nausea and vomiting.

Home Treatment: If you suspect constipation, avoid routine use of laxatives. They can complicate the situation. Give plenty of fluids, fresh fruits and vegetables.

Emergency Treatment: A physician should see your child if there is severe pain especially if there is vomiting. If a physician is unavailable, go direct to a hospital emergency room. If severe pain continues for more than an hour, consult a medical professional.

Important: Life threatening complications may develop if inappropriate treatment is begun at home or if diagnosis is delayed.

Acetaminophen Poisoning
Cause: Poisoning can result from swallowing an excessive amount of acetaminophen either in tablet form or as part of other medications. Young children are especially prone to poisoning. (Children should never be treated with adult acetaminophen children's acetaminophen is available in tablets as well as syrups and recommended dosage should be adhered to.) Acetaminophen may cause severe liver damage and occasionally kidney damage which can be fatal.

Diagnosis: Within a couple of hours, a child will be pale and nauseated and may perspire and vomit. There will be fluid loss if there has been vomiting. Symptoms may last up to 24 hours. Sometimes symptoms may occur as long as 48 hours after swallowing the acetaminophen and these symptoms may include mental confusion, abdominal swelling and tenderness over the liver area. Laboratory tests will determine the level of acetaminophen in a child's bloodstream.

Emergency Treatment: Treatment will focus on removal of the acetaminophen from the child's stomach. Vomiting may be induced or stomach washing may be appropriate. An oral or intravenous antidote may be given to neutralize the acetaminophen and to prevent organ damage. The sooner treatment is instituted, the better the outcome.

Call your doctor: If a parent has seen (or suspects) that a child has ingested pills or medications, a poison information centre or physician should be called immediately.

Caution: Keep medications out of your child's sight and reach. Use bottles with childproof caps.

Allergies
Cause: An allergy is present when your child's body over-reacts to something or perhaps many things that is eaten or breathed or touched or injected (such as medications). The most common childhood reactions are to foods, house dust, certain pollens, poison ivy, oak and sumac, stinging insects and some medications, such as antibiotics. Asthma often has an allergic component.

Symptoms: Swelling of the lips and mouth, hives, wheezing, and even shock are some of the more severe symptoms. The shock reaction (called anaphylaxis) may be fatal. A reaction to a stinging insect includes swelling and itching at the site of the sting, but if the reaction is severe it can cause anaphylaxis.

Whatever symptoms are evident in a small child may change as the child grows older. (A child with baby eczema may grow out of it but develop hay fever when older and, still later, asthma.)

Home Treatment: It is common sense to avoid substances that cause a reaction.

Medical Treatment: Symptoms of most allergic reactions can be reduced or eliminated with proper treatment your doctor may prescribe medication or a desensitization program.

Call your doctor: It is a medical emergency if a child has any associated breathing difficulty.

Food Allergy
Cause/Symptoms: Food allergies tend to be over-diagnosed. (About 5 percent of children have true food allergies.) The most allergenic food (the food most likely to produce a severe allergic reaction) is the peanut, although this is still very uncommon. In infants, egg and milk product allergies are relatively common. Symptoms can involve the mouth, (swelling), skin eruptions (hives), stuffy nose, and difficulty in breathing or swallowing. Symptoms usually appear within a very few minutes to an hour after eating. Some food allergies or intolerances may result in vomiting, diarrhoea, abdominal pain and bloating.

Home Treatment: The food that caused the reaction must be removed from the child's diet. Give the child plenty of clear liquids if the child has lost fluids through vomiting or diarrhoea. If the reaction includes itching from hives, antihistamines, calamine lotion, decongestants and cool compresses can help.

Medical Treatment: If asthma results, a physician can prescribe medication to help breathing difficulties. Children often outgrow food allergies by age 2 or 3.

Call your doctor: If the child shows signs of shock (rapid pulse, fast, shallow breathing, dizziness or fainting, clammy skin, thirst or anaphylaxis) get medical attention immediately. Epinephrine may be administered to control a severe allergic reaction. A kit may also be prescribed for home use.

Anaemia
Cause: Anaemia is a condition of the blood that results from a reduction in the number of red blood cells or in the amount of haemoglobin (which carries oxygen to the body tissues). It can develop from insufficient iron in the diet or from loss of blood. (Iron-deficiency anaemia is the most common type of anaemia.) In infants and toddlers, excessive amounts of cows milk may cause anaemia.

Symptoms/Treatment: Signs include weakness and shortness of breath, an excessively rapid heart rate, and pale skin. Iron and protein help formT haemoglobin so diet should include foods that are rich in protein and iron.

Appendicitis
Appendicitis is uncommon in children under 5. However, diagnosing appendicitis is difficult, so doctors take prompt action. Occasionally an appendix is removed that then is shown to be normal but this is far safer than facing life-threatening peritonitis, which will result if an inflamed appendix bursts.

Symptoms/Action: Consult a physician or take a child to an emergency room if the child complains of pain, tenderness or cramps in the stomach around the navel or in the lower right side of the abdomen and if the discomfort continues for 3 hours or more.

Medical Treatment: It is usual to remove the infected appendix often on the same day that the diagnosis is made.

Arthritis, Acute
This is an inflammation in one or more joints and can be due to many causes. Infectious arthritis most often affects children under 5 years of age. Children may also have bacterial arthritis. If it is untreated, permanent joint damage may occur.

Symptoms: Some symptoms of arthritis are pain, stiffness, warmth, redness, swelling and some loss of function in one or more joints.

Medical Treatment: Your doctor will treat a bacterial arthritis with a specific antibiotic, usually given intravenously. In some cases (for instance, if the hip is involved) pus that is present may be drained from the affected area. Treatment of other types of arthritis depends on the cause.

Call your doctor: Any child with joint pain and fever should be seen by a physician as soon as possible.

Asphyxia
Prolonged periods without breathing (apnea) can be a forerunner of Sudden Infant Death Syndrome (SIDS) especially if the infant turns blue or becomes limp. This is a life-threatening condition and premature infants are especially susceptible. (Breathing pauses of less than 6 seconds from birth to 3 months are normal.) Asphyxia may occur in an older child if the child chokes on food or a small object.

Symptoms/Action: If your baby is unconscious, if you cant find a heartbeat or if skin is discoloured, cardiopulmonary resuscitation (CPR) should be started immediately. See chapter on First Aid. Even if the child regains consciousness, go immediately to a hospital emergency room.

Important: CPR must be started immediately if a child is not breathing or if no heartbeat is present.

Aspirin Poisoning
Cause/Symptoms: A child who has swallowed just a few Aspirin tablets may breathe rapidly, vomit, and a fever may develop. Severe poisoning can include coma, seizures and death. Liver damage (Reyes Syndrome) has been associated with Aspirin ingestion during flu-like illness or chicken pox.

Medical Treatment: Prompt treatment is required which will include removing the Aspirin from the child's stomach by vomiting, stomach washing or binding with activated charcoal given by mouth. If a child is suspected to have swallowed more than a few tablets, the child should be taken to the closest hospital so that a blood level can be measured and treatment started.

Caution: Children should not be given Aspirin because of the concern about Reyes Syndrome.

Important: Children are curious. Keep medications out of sight. Limit the number of tablets per package. Use bottles with childproof caps.

Asthma
Cause/Symptoms: Wheezing and difficulty in breathing in children is usually an indicator of asthma, but a doctor will check for alternate reasons, such as bronchiolitis, cystic fibrosis, congestive heart failure or foreign objects trapped in the air passage. A viral infection, such as a cold, may precipitate an attack. The good news is that many children outgrow asthma.

Medical Treatment: Mild asthma attacks may be treated with a prescription medication that relaxes smooth muscle in the breathing tubes. Medication usually continues for 2 to 7 days after the wheezing has stopped. A child with severe asthma usually requires hospitalization and children with recurrent attacks may need long-term therapy.

Memo: More children are hospitalized for asthma than any other illness.

Bites and Stings
See First Aid

Bleeding
See First Aid

Blisters
Cause/Symptoms: These are raised, red bumps filled with an almost clear fluid that forms when skin is damaged by being rubbed or injured. A blister also can result from an allergic reaction to plants or insects. The blister wont disappear until the skin underneath the blister has healed.

Home Treatment: Protect the area with a bandage or gauze to prevent infections. Don't break a blister, but if the blister should be accidentally broken, wash with soap and water, apply a mild antibiotic (a prescription medication isn't required) and cover.

Caution: Infection may result if a blister breaks. Red streaks that spread or redness at the base of the blister indicate infection and a physician should be seen.

Blood (In Stools or Vomit)
Symptoms: Vomiting a large amount of blood usually suggests that the bleeding originates in the esophagus or stomach. Blood in the stool is a sign that bleeding originates in the intestines. A black stool may also indicate internal bleeding. Significant blood loss can lead to shock. (Notice if the child is cool, clammy, weak, pale, thirsty, nauseous, dizzy, faint or has a rapid pulse.)

Medical Treatment: If there is a large amount of blood in vomit or rectal bleeding, the child must get medical attention immediately. If there is massive bleeding, intravenous fluids and salts may be administered to combat dehydration and shock. A blood transfusion may be started. Specific treatment depends on the cause.

Important: Comfort and reassure the child, who will be frightened. Fear and anxiety can complicate the problem.

Blood (In the Urine)
Cause: Blood in the urine may be due to bladder infections, inflammation, or kidney disease. It can be indicative of serious conditions, so it is wise to get an immediate medical evaluation.

Sometimes coloured foods, such as beets or red dyes, will cause red urine.

Call your doctor: All children with blood in the urine should be seen by a physician.

Boils
Symptoms: A boil is a skin infection resembling large pimples that eventually fill with pus, come to a head, break and drain. They most commonly appear on the face, neck, buttocks and upper back. The infection spreads easily so that boils can appear in a cluster, called a carbuncle, which can be very painful. A boil should come to a head within 2 or 3 days.

Home Treatment: Keep skin around the boil clean and dry. Soak it frequently with a saltwater solution. (Dissolve 1 teaspoon salt in 1 quart boiling water.) Cool liquid before applying. Apply with a piece of sterile gauze or cotton.

Medical Treatment: A child who gets multiple or recurrent boils should be evaluated by a physician.

Breathing
(Rescue Breathing, Choking, Hyperventilation)
See First Aid

Broken Bones
See First Aid

Burns
See First Aid

Canker Sores
Symptoms: These are painful ulcers (sores) that appear on the lining of the mouth usually the gums or inner sides of the lips or cheeks but also on the tongue, palate and throat. They are common and, for some reason, appear more frequently in females.

Home Treatment: There is no treatment but they will run their course in 1 to 2 weeks. Good oral hygiene may speed the healing. Don't give the child acidic foods such as tomatoes, because the sores will sting.

Chest Pain
Chest pain is common in children and usually not a cause for alarm.

Home Treatment: This will depend on the cause. A warm heating pad may help relax sore muscles.

Medical Treatment: If a child has serious chest pain accompanied by difficulty in breathing or fever, get medical attention immediately because there may be an injury or infection to the lung. Don't bind the chest in any way because it may interfere with breathing.

Call your doctor: A physician should be consulted if chest pain is caused by injury.

Chicken Pox
See Infectious Diseases

Chlamydia
Symptoms: About one third of babies born to women who have chlamydia develop an eye infection and as many as 10 percent of babies born to women with chlamydia get pneumonia. If a baby has chlamydial conjunctivitis (eye infection), the eyes become red and swollen (and perhaps have pus) 3 to 20 days after birth. Chlamydial pneumonia symptoms include a dry cough and may occur 3 to 20 weeks after birth.

Medical Treatment: A physician will usually prescribe antibiotic treatment which will continue for 2 to 3 weeks.

Colds
See Infectious Diseases

Cold Sores (Oral Herpes, Fever Blisters)
Cause: These are clusters of painful bumps or blisters on one side of the outer lip. The first bout follows contact with someone else with herpes and is transmitted in saliva. About 4 out of 10 people get small lip blisters by age 15. With the first infection, these blisters also appear inside the mouth (stomatitis) and are confused with canker sores. However, they are very painful and are associated with fever. The infections usually start before age 4. Cold sores (oral herpes) are associated with the herpes simplex virus, type 1.

Symptoms/Treatment: The blisters on the lip rupture, scab over and dry up in 10 to 14 days. They do not cause scars. After the blister heals, the virus is dormant and then, at a later time, will become active again. Cold sores heal by themselves and, although they are a nuisance, they are not serious. Young children with herpes stomatitis may refuse to eat or drink and therefore are at risk of becoming dehydrated.

Home Treatment: Warn your child not to touch the blisters or pick at the scabs. Phenol and camphor may give some relief if the blisters are sore and may also prevent bleeding of the scabs. Apply at the first sign of a cold sore.

Choking
See First Aid

Colic
Symptoms: A baby sometimes cries for long periods and yet the baby is not sick, in pain, or hungry, and is content between crying bouts. An episode usually doesn't end until the child is exhausted. The most common pattern is 3-month colic, when the baby sleeps during the day but cries long and hard at night. Colic usually starts when the baby is under 2 weeks of age. If it begins after 4 weeks of age, it is not colic. These babies feed well and grow normally.

Home Treatment: The cause is unknown, but cuddling, cooing and rocking may help the baby feel more secure. These infants often are inconsolable for long periods. Call a physician if it lasts more than 4 hours and also if it doesn't diminish after the baby is 4 months old.

Call your doctor: If the baby is not gaining weight or has other symptoms associated with crying, the diagnosis is unlikely to be colic and medical attention should be sought.

Croup
See Infectious Diseases

Dehydration
Symptoms: This is excessive loss of body fluids and it can develop very rapidly among newborns and infants who are vomiting or who have diarrhoea. Notice if your child has not urinated in more than 8 hours; if there are no tears when crying; if the mouth is dry; if there is decreased quantity or frequency in urinating; if the pulse is rapid; if the eyes seem to be sunken; and if the child is lethargic.

Home Treatment: Encourage the child to drink water, fruit juices or soft drinks such as ginger ale. Don't offer salty liquids, such as broth. If the child is nauseous and cant tolerate drinks, try offering chips of ice or frozen juice.

Medical Treatment: If hospitalization is necessary, the child may be given fluids and nutrients intravenously.

Caution: Shock can follow severe dehydration and this can be life-threatening if it is not treated promptly.

Delirium
Cause/Symptoms: This is a change in mental alertness in which the child may be disoriented, have hallucinations, become frightened, cant sleep and is hyperactive. Diseases that produce fever that accompanies delirium are most often the cause, but a severe head injury or poisoning can also be responsible.

Medical Treatment: Treatment depends on the underlying cause, but a child may need to be hospitalized.

Diarrhea
See Infectious Diseases

Dizziness (Vertigo)
Symptoms: This involves a feeling of the world spinning a sensation that indicates that the balancing mechanism of the inner ear is disturbed. The feeling can be momentary, but if it persists nausea and vomiting are likely. A few children experience dizziness during their early years (ages 1 to 4) but it usually passes quickly and is not a cause for concern. Some children experience dizziness when they ride in a car.

Home Treatment: Most dizziness will pass quickly, especially if the child has been spinning during play, but if it persists for more than a few minutes, ask the child about other symptoms.

Medical Treatment: See a doctor if there is earache, buzzing in the ears, headache, fever or if the child is unable to stand or walk.

Ears (Object in Ear)
Cause: If a child has pushed a foreign object in the ear, pain and itching may be experienced. If you suspect that a live insect is in the child's ear, check with a flashlight.

Home Treatment: Don't stick anything in the child's ear to try to remove an object. If you can see it, grasp the top of the outer ear and pull up and out. This straightens the ear canal. Point the ear toward the floor while straightening the canal and have the child shake his or her head. The object may fall out. If it is a live insect, kill it by pouring in a little alcohol, then flush the canal with water to remove the insect.

Ear Infection
Symptoms: The peak ages for earaches are 6 months to 2 years, but they continue to be a problem until children are 8 or 10 and usually cause both pain and fever. An ear infection can be in the external ear, the middle ear or the inner ear. Young children are most affected by middle ear infections and this is the most common early childhood problem, next to colds. An external ear infection (often called swimmers ear) can ache, be tender and red, swell and have a discharge of pus that has an unpleasant odour. Itching and discomfort can last for a few days, even after treatment has started.

Home Treatment: Don't use folk remedies, such as warmed oil dropped in the ear. It is useless if the pain is in the middle ear and dangerous if the pain is in the outer ear. Don't plug the ear canal with cotton and don't use ear drops unless recommended by your physician. Heat held against the ear may increase the chances of an abscess bursting. To relieve pain, put an ice bag or ice in a wash cloth over the ear for 15 minutes. Cold provides better relief than warmth. Don't allow water near the ear.

If the pain is from water in the ears, get the child to lie with the affected ear downward so the water can drain.

Medical Treatment, External Ear: The physician will clean the ear canal and prescribe ear drops with antibiotics and cortisone.

Medical Treatment, Middle Ear Infection: Antibiotics are generally indicated to combat infection. Sometimes a small incision is made in the eardrum to admit a tube which allows fluid to drain from the middle ear. This is generally done if a child has multiple ear infections.

Medical Treatment, Inner Ear: Your physician will drain the accumulated fluid from the inner ear and start antibiotic therapy. Surgery is sometimes necessary.

Eczema
Symptoms: It is a skin eruption that, in infants, usually starts on the cheeks and is red and oozing. Thickening of the skin will occur in older children if the eczema is long-term. It is not contagious.

Infantile eczema tends to run in families. Usually a close relation to the child is susceptible to eczema or some other allergic complaint, such as hayfever or asthma.

Eczema usually starts in infants 2 to 3 months old and often clears when a child is between 3 to 5 years old. It may be associated with other allergic conditions such as hayfever. You will notice it first on your infants cheeks but then it will spread to the rest of the face, the neck, the wrists and the hands. Because it is so itchy, the child will rub against blankets and try to scratch. Then there will be oozing, followed by crusting and scaling. It may become infected.

Home Treatment: If the child scratches, eczema is very difficult to control. Apply cool, moist compresses these may help calm the itch. Keep the child's fingernails as short as possible but don't put the hands in mittens. It will be very hard on the child if they cant even rub the area to get some relief. Avoid harsh soaps and detergents. Apply oils or moisturizers to the skin. Let the child soak in warm water to relieve the dryness but after bathing, coat the skin with oil to seal in the moisture. Avoid rough or scratchy clothes.

If the cause is food-related, it can be treated by eliminating specific foods. During infancy, these may include milk products, eggs, tropical fruits, fish, shellfish, wheat flour products and chocolate. After the eczema has cleared up, introduce these foods one at a time, a week apart, so that the problem food can be identified.

Medical Treatment: A hydrocortisone ointment may be prescribed to help reduce inflammation. (A mild hydrocortisone would be used for infantile eczema.)

Bacterial infections will be treated by a physician with antibiotics.

Electric Shock
See First Aid

Emphysema
This includes several similar diseases of the lung, all of which are characterized by over-inflation of the lungs. Two diseases especially pertain to children: localized obstructive emphysema (when a child breathes in an object that becomes lodged) and congenital obstructive lobar emphysema (an uncommon condition that usually becomes evident in the first few weeks of life and which may be associated with breathing difficulty). In both instances, one of the large breathing tubes leading from the windpipe to the lungs is partially or completely blocked.

The most obvious sign that this has happened is coughing, wheezing or difficulty in breathing. If a large area of the airway is obstructed, the child may turn blue from lack of oxygen.

Emergency Treatment: If your child shows serious symptoms such as wheezing, difficulty in breathing, tightness in the chest or throat or seems about to pass out, act immediately. Call 911 or go to emergency.

Medical Treatment: If the child has inhaled a small object, it can be removed by bronchoscope or by surgery. Surgery is also required to remove the affected lobe if the child has congenital obstructive lobar emphysema. This surgery is almost always successful and there should be little or no impairment.

Important: If not treated promptly, both forms of emphysema in children become worse, making breathing difficult.

Caution:Do not give whole nuts to children under 6. And be careful about the size of toys and playthings because children like to put things in their mouths.

Eye Injuries
Causes: These range from a piece of matter in the eye or under the eyelid, a sharp object puncturing the eye or eyelid or a blow to the eye, to burns sustained from being exposed to chemical substances (cleaning agents, firecrackers) or overexposure to the sun. About one third of all blindness in children is caused by eye injuries.

Home Treatment: Blinking can usually force a piece of dust out of the eye. If you can see the culprit, moisten a cotton swab and gently flick it out.

Do not wash out the eye if the injury is from an explosive substance or if the eye has been penetrated.

Do wash out the eye if the eye has come into contact with a chemical substance. Flush the eye thoroughly with running water for at least 15 minutes (while protecting the other eye, so the chemical isn't washed into it). Then the child must be taken immediately to an emergency room.

Emergency Treatment: If the foreign matter is embedded, don't try to remove it. Go to an emergency room. After the object is removed, the physician may prescribe antibiotic ointment and pain relievers if the cornea is scratched. If the cornea has been burned by ultraviolet light, both eyes should be kept closed until healing occurs (1 or 2 days). A cut in the eyeball may require surgery.

Important: Teach your child to wear protective eye goggles when working with tools or chemistry sets. It should become an automatic habit.

Caution: Face masks and protective helmets should always be worn by your child when playing competitive games or riding bicycles.

Failure To Thrive (FTT)
Cause: This is a nutritional disorder of infants and young children in which the name of the ailment exactly describes the problem: A child doesn't thrive and either loses weight or fails to gain weight. FTT becomes evident before the child reaches 18 months and often as early as 6 months. There may be signs that the fetus was improperly nourished, perhaps because of the pregnant mothers poor diet, or her having a severe infection, or through her cigarette smoking or excessive use of alcohol. However, FTT also can result from diseases in the child such as cystic fibrosis, heart disorders, coeliac disease, and malabsorption. A physical problem, such as a cleft lip or palate, also can interfere with a child's eating and cause failure to thrive.

Medical Treatment: Both short-term and long-term care are almost always required. It starts with a complete physical and emotional evaluation which should be done by your physician. Physical causes will be identified, a program to stimulate the child may be recommended and social intervention may be required.

Memo: Treating the whole family is often crucial to help parents with children who have chronic illnesses.

Fever
Cause: Most parents use fever to judge whether their child is ill but small rises in temperature can be caused by strenuous play or warm air. In fact, your baby may have a high temperature with a mild illness or have a serious illness with no fever.

Home Treatment: You can take a small child's temperature with a fever-tester or a mercury or digital thermometer used under the arm. For older children, use a non-glass, non-mercury thermometer. Ibuprofen or acetaminophen should be given according to the dosage chart sup-plied by the manufacturer, if needed. Dress the child in light-weight clothing and keep the room cool.

Medical Treatment: A physician should be called if a child under 2 months has a high fever and for any high fever in a child who is otherwise unwell, with no improvement following the taking of ibuprofen or acetaminophen. A physician also should be consulted if there are worrying features, such as an altered state of consciousness (confusion or lethargy), neck stiffness, difficulty in breathing or joint pain or swelling.

Fifth Disease
See Infectious Diseases

German Measles
See rubella in Infectious Diseases

Giardia
See Infectious Diseases

Growing Pains
Cause: They are misnamed because they are not caused by growth. They are normal aches and pains in a child's limbs and joints and they are experienced by most children, ages 6 to 12, to some degree. The pains are both temporary and harmless. The pains most often are felt in the child's calves, thighs and feet. The pains are more likely to occur when the child is at rest and they most commonly occur at night. The cause is unknown.

Home Treatment: A warm water bath may help as well as gently massaging and stretching the sore muscles. You might massage the sore muscles with ice for 20 to 30 minutes several times on the first day.

Medical Treatment: If there is persistent pain which does not improve after a couple of days, if it gets worse or if there is a limp, swelling of a joint or fever, this is not growing pains and a physician should be consulted.

Gums
Cause/Symptoms: Most children will have at least one problem at some time during childhood, but almost all problems can be put right. In infants, gums may be sore from teething. Thrush, a fungal infection, is also common in young infants. This results in white spots on the gums and lining of the mouth.

Changes in the colour of your child's gums suggests a problem. Gingivitis is the most common, which is caused by plaque buildup. Bacteria and components of saliva form as a result of particles of food remaining between the teeth. Gums may swell and become red and tender.

Viral gum infection affects the gums, the tongue, the roof and sides of the mouth and the inside of the lips and often afflicts children under the age of 5. It can be the first stage of oral herpes. As well as red, swollen, sore gums, headache and fever, blisters develop on the gums and, in a few days, rupture to form painful sores. The infection may stay, inactive, in the child's body for years, occasionally erupting in oral herpes or cold sores.

Home Treatment: For sore gums caused by teething, the best treatment involves letting the infant chew on smooth, firm, cool, unbreakable objects. Older children should be taught good oral hygiene at home. Young children with severe mouth infections may refuse to eat or drink due to pain. Fluids should be encouraged.

Medical Treatment: Take your child to the dentist regularly. Mild gingivitis may be treated with antibiotics, but if it is severe, the child may be referred to a periodontist (a specialist in treatment of gums). There is no cure available for the herpes infection, but proper nutrition, regular oral hygiene and numbing preparations combine to ease symptoms. Thrush is treated with an oral anti-fungal medication.

Hair Loss
Cause: Most of the newborn hair will fall out and be replaced and the colour of the new hair may be quite different. Many infants who sleep on their backs will develop a temporary bald spot on the back of the head. Later, hair loss can occur at any time during childhood because of the infant rubbing against the end of the crib, by pulling at the hair, or by having it pulled too tightly into ponytails or braids. Spot balding may result from the child being emotionally upset. Severe illness can cause baldness.

Home Treatment: Hair loss often corrects itself, so treatment may not be recommended. However, if there are sores from an infection, after medical treatment they can be soaked with warm water compresses several times a day to reduce crusting.

Medical Treatment: A physician may diagnose a fungal or bacterial infection which can lead to permanent baldness if it is not treated early. Impetigo and fungal infection usually require oral medication.

Caution: Don't allow your child to share hair brushes and hats and see that the hair is shampooed frequently.

Hand, Foot and Mouth Disease
See Infectious Diseases

Handedness
You can't anticipate which hand your child will favour because babies start out ambidextrous. Toddlers go through a period of using a particular hand for particular activities. Which hand your child will use will not be determined until the third year. About 10 percent of children are left handed.

Cause: Hand selection is controlled by the part of the brain that deals with speech, reading and writing.

Home: Parents who try to change their child's handedness can cause major problems. If a child is left handed, offer help. For instance, get left handed scissors and set the table with the place-setting placed the right way for your child.

Hayfever
Symptoms: This is an allergic reaction of the nose and sinuses that results in sneezing, nasal congestion, itchy nose, clogged sinuses, sometimes itching at the back of the throat, teary, red, itchy eyes and perhaps clogged ears. There is no fever.

Causes, Seasonal Hayfever: Sensitivity to pollen (trees, grasses, weeds and especially ragweed).

Causes, Perennial Hayfever: Year-round substances (dust, animal dander, feathers).

Home Treatment: Keep windows closed to shut out pollen. Filter air through air conditioners or air filters. Avoid furnishings in the child's bedroom that collect dust. Dust and vacuum the home frequently. If the child has a mold allergy, avoid damp areas. The child may be given an oral antihistamine and decongestant to relieve the symptoms.

Medical Treatment: Your physician may prescribe a short treatment of corticosteroids in nasal spray form if the symptoms are severe and, after the problem substances are clearly identified, may also recommend a series of injections to produce an immunity to the substances.

Headache
Most headaches are of short duration, don't require treatment and are almost as common among children as adults.

Causes: There may be numerous causes, such as a blow to the head, a viral illness, a high fever, hunger, tension (prolonged use of video games etc.) or stress (perhaps concern about school or relationships). Broadly speaking, there are three types of headache: migraine; disease or injury-related; tension.

Home Treatment: Have your child relax in a dimly-lit room. Offer a light meal. A cool washcloth on the forehead may help. You may want to give a pain-relieving medicine such as children's ibuprofen or children's acetaminophen. An older child can learn to recognize the onset of an attack and use relaxation techniques to help forestall the problem.

Medical Treatment: If your child suffers from migraine, your physician may suggest regular medication that may prevent attacks.

Emergency Treatment: Treat it as an emergency if (1) the pain is so severe that the child clutches the head; (2) the pain is so severe that it interferes with normal activity for more than an hour; (3) the pain is accompanied by fever, vomiting, a stiff neck; (4) the child is confused, disoriented or delirious.

Head Banging
Symptoms: It is quite common starting at about 6 months of age, for a child to rhythmically head-bang against a crib mattress or headboard. The habit is three times more common among boys than girls. It seems to comfort children, especially at bedtime when they are left alone.

Cause: If it is the rhythmic sound and banging the child needs, there is no cause for concern. The habit usually stops without intervention before the child is 3. Rarely, children have a need to hurt themselves and then the habit is more disturbing.

Home Treatment: The best treatment is probably no treatment. Parents should avoid expressing any concern because making an issue of the habit in front of the child will likely make the self-comforting more necessary. However, if you are concerned, you might mount severals sheets of cardboard at the head of the bed. (A crib bumper won't do because you will deprive the child of the noise) If the child accepts this, there is no need to be concerned. However, if the child transfers the head banging to unpadded side-bars, you will need to find out why there is a need to be hurt. This may be an unhappy child.

Medical Treatment: It should be pointed out that a few children with severe developmental problems may hit their heads so hard that an injury may result. In this event, talk to your physician who may recommend you to a behavioural psychologist.

Head Lice
Symptoms: Be assured that head lice is a very common condition in children and it is not caused by lack of cleanliness. These are tiny insects that live on the scalp and they lay eggs called nits that stick to the shaft of the hair very near the scalp. They appear as whitish-grey or tan specks, about the size of a grain of sand. There are often no symptoms. Some children may have itching of the scalp. Head lice do not spread any diseases.

Prevention: They spread from child to child by direct contact or items such as hats, combs or hair brushes. Head lice cannot jump or fly.

Home Treatment: Special shampoos or cream rinses all contain an insecticide which kills the insect. Carefully follow the directions on the bottle and ensure it is appropriate for the age of the child. Vacuum carpets, rugs and upholstery thoroughly. It may be necessary to treat all members of the household at the same time. Do not treat anyone with a head lice product unless you find lice or nits in their hair. If your child has head lice, treatment must be given before your child returns to school or a childcare centre.

Hearing Loss
Cause: Hearing loss may be traced to infection, disease, or injury. Often, the cause can't be identified.

Some types of hearing loss involve middle-ear inflammation, but accumulation of wax in the ear canal or an obstruction of the canal by a foreign object in the ear can also be factors. Other types of hearing loss indicate that part of the internal ear, the nervous system or the brain is malfunctioning.

Medical Treatment: Treatment will depend on the cause. If hearing loss is due to middle ear infection, it is usually treated with antibiotics. If a child is partly deaf after a middle ear infection or a cold and still seems deaf after a week, see your doctor again. Repeated middle ear infection can sometimes cause permanent damage.

One type of partial deafness is caused by Glue Ear, which is thought to be a result of frequent and not always completed courses of antibiotics for middle-ear infections, leaving an accumulation of matter in the middle ear that prevents the ear drum from vibrating as it should. Many causes of hearing loss cannot be cured.

Post Treatment: If the child's hearing is permanently impaired, and the hearing impairment is mild to moderate, there should be support treatment with an audiologist or speech pathologist. Most children with permanent hearing loss benefit from hearing aids. If you suspect that your child cannot hear, a proper audiologic assessment should be done as soon as possible.

Height Problems
Cause: A child's pattern of growth is usually determined by the height of the parents. Average growth: double birth length at 4 years. Triple birth length at 13 years. To predict adult height: Boys reach 1/2 their adult height at about 27 months, girls at about 20 months - multiply by 2.

Height also can be affected by hormonal disorders, chronic disease and environmental factors. Height problems caused by skeletal abnormalities can't usually be corrected but height problems caused by disorders that disturb normal bone growth may be reversible if treated in time.

Home Treatment: Give a balanced diet - and lots of affection and approval. (Check the chapter on Milestones.) If your child doesn't fall into the `normal' range, have the child evaluated.

Medical Treatment: It is important that a growth-delay problem caused by a long-term illness, nutritional deprivation, emotional deprivation or hormonal problem be treated quickly so that normal growth can resume. If becoming too tall is the problem, treatment may involve high doses of estrogen to accelerate puberty and complete skeletal growth. In a girl, treatment should begin before the onset of the menstrual cycle, usually between 10 and 12 years of age. If treatment is delayed (and the problem is reversible) the problem may become permanent.

Hepatitis
Symptoms: This is a viral infection of the liver leading to jaundice. It can be recognized by yellow-appearing skin, light-coloured bowel movements and dark-coloured urine.There are three types of Viral Hepatitis:

• Hepatitis A is most common among children and adolescents and usually is a mild infection. There is no cure, but most children recover fully. Very occasionally, liver damage is so severe that death may result.
• Hepatitis B is more severe than hepatitis A. It usually is transmitted by blood or sexual contact. A cure does not exist but most children recover fully. High-risk children or babies whose mothers are hepatitis B carriers should be immunized.
• Hepatitis C is usually a mild disease, but often results in chronic liver disease.
• Chronic hepatitis exists when hepatitis persists for more than 6 months. A child with chronic hepatitis may carry the virus for years and may result in cirrhosis. Hepatitis A does not cause chronic disease, although both B and C may.
  

Home treatment: There is no cure, but bed rest at home is essential. If the child has no appetite, offer broth and juice. When the appetite returns, see that the diet is nutritionally well balanced. For hepatitis A, strict hand-washing is important to prevent spread. Children with hepatitis A should not go to school or daycare for a week after the onset of illness or until the jaundice has disappeared.

Medical treatment: Hospitalization may be required.

Hernia
Symptoms: Inguinal hernia is a small swelling or bulge in the area where the abdomen meets the legs. The bulge consists of abdominal tissue, fluid or organs (such as bowel) which can protrude through the hole. Straining during bowel movements, coughing or sneezing may aggravate the condition. Boys are affected 10 times more often than girls.

Medical Treatment: Have the child seen by a doctor because without treatment the blood supply to the bowel can be squeezed off and the tissue can deteriorate. If the the contents of the hernia (usually bowel) become obstructed, emergency surgery is necessary. In most cases, non-urgent surgery will correct the problem.

Umbilical hernia is a weakness of the abdominal wall at the navel. This type of hernia most often occurs in children with an African heritage.

Medical treatment: A mild umbilical hernia may not require surgery unless the hernia gets larger after the child is about age

Diaphragmatic hernia: The diaphragm is a large muscle positioned between the chest and abdominal cavities. A diaphragmatic hernia occurs when
one of the organs found in the abdomen (usually stomach, spleen, small or large intestine) protrudes up into the chest cavity through a hole in the diaphragm. It appears most often on the left side, severely interferes with breathing and so can be life-threatening to a newborn. It can be present at birth or result from an injury.

Medical treatment: The only successful treatment is surgery - and the surgery is usually required within the first few hours of life because the lung is compressed and cannot expand. Do not try to hold in a hernia with a band or belt. This is a dangerous practice as well as ineffective.

Hives
Cause/symptoms: This is a general term for an allergic skin reaction that affects children who are allergic to specific substances. In some cases, the cause of hives is never found.

• Acute hives may appear on a child's face and chest or anywhere on the body. They are very itchy and may erupt suddenly after a bee sting or specific foods. Hives disappear in a few days without receiving treatment.
• Cold hives are exactly what the name implies: a reaction to cold air, cold water and cold drinks. They are itchy and painful.

Home treatment: Itching and pain may be relieved with calamine lotion or by soaking the affected skin in cool water with 2 tablespoons of sodium bicarbonate.
Medical treatment: An oral antihistamine may be prescribed.

If hives are associated with difficulty in breathing or wheezing, medical help should be sought immediately.

Hyperventilation
See First Aid

Hypothermia
See First Aid

Impetigo
See Infectious Diseases

Influenza
Cause: This is a viral infection of the nose, throat, trachea and bronchi that occurs in epidemics every 3 or 4 years. Widespread epidemics almost always occur in autumn and winter. There are many types of viruses and they change constantly so it is possible to have influenza almost annually.

Symptoms: Primary symptoms are stuffy nose, sore throat and nagging cough as well as more muscle pain, headache, fever and chills than are usually identified with the common cold. Because it is so widespread, your physician will readily identify the symptoms.

Home Treatment: Influenza is almost always treated at home - but not with antibiotics, because it is a viral infection. It can sometimes develop into a bacterial infection (pneumonia), at which time antibiotics will come into play.

Give bed rest and a balanced diet plenty of fluids. Children's acetaminophen or ibuprofen help reduce muscle aches and fever.

Aspirin should never be given to any child with influenza.

Jaundice
Cause/symptoms: Jaundice is a symptom that the liver is functioning abnormally and usually can be recognized by the yellow discolouration of the skin and the whites of the eyes. Signs may also include loss of appetite, a bitter taste in the mouth, tenderness in the upper right portion of the abdomen and urine may appear dark. The most common time for children to be jaundiced is when they are newborn, however, it is most likely to be physiologic jaundice, a type that is transient and harmless. Premature infants are more likely to have severe complications.

Medical treatment: No treatment is usually required for physiologic jaundice, but consult your physician if the baby isn't nursing well, seems excessively drowsy and has a fever. If the child has true jaundice, treatment will depend on the underlying cause.

Knee Injuries
Cause: Knee injuries are most likely to occur when the child is playing vigorously with abrupt stops and starts, twists, jumps, and sudden changes in direction. The result can be a sprained knee (often when jumping) or a fractured knee (often from a blow to the side of the knee).

Symptoms: There may be intense pain, inflammation, swelling and tenderness in the entire area.

Home Treatment: Most sports injuries are treated with rest, ice, compression and elevation for the first 24 to 48 hours. Raise the injured knee and support it with a cushion. Apply a snug, wet elastic bandage. Be very careful not to wrap too tightly - it could interfere with blood circulation. Apply crushed ice in a plastic bag for 20 minutes out of every hour (except sleep hours). Keep up this alternating therapy for a few hours until the swelling begins to decrease. A child with a sprain may need to use crutches. If pain has not substantially subsided in 2 days, talk to your physician.

Medical Treatment: If it is a fracture, prompt care by a physician is required when the bones are in place, they will be immobilized with a cast.

Have your child do stretching exercises before a demanding physical activity.

Don't allow your child to wear cleated sport shoes. They hold the leg too immobile so that the foot will be held stationery but the knee will twist.

Knock Knees
Symptoms: When standing, if your child's knees touch but the ankles don't, the child may have knock knees. It is very common in children age 2 to 6 years.

Medical Treatment: Knock knees often self-corrects by the age of 8. However, your physician may recommend the help of orthopaedic appliances if the condition is severe. Both a night brace and orthopaedic shoes may be helpful. If the condition persists, surgery may be necessary.

Surgery won't be rushed. You will want to allow time for the bones to straighten naturally. The best age for surgery seems to be when a girl is about 10 years of age and a boy is about 11.

Laryngitis
Cause/Symptoms: Laryngitis in infants is often called croup and may be associated with a hoarse cry and breathing difficulties. In older children, breathing problems are unusual, because the airway is much bigger. Their hoarseness usually is caused by a cold or overuse of the vocal cords through shouting or screaming which cause an inflammation of the voice box (larynx). An older child with laryngitis may not be able to speak above a whisper and may have a dry cough, scratchy throat - and perhaps a sore throat.

Home Treatment: Have the child gargle with warm salt water or suck on a hard candy several times a day. Younger children can sip warm liquids, like apple juice. Encourage the child to talk as little as possible for a few days. If there is a temperature, give a fever-reducing medication such as ibuprofen or acetaminophen. You might put a cool-mist vaporizer in the bedroom.

Medical Treatment: Call your physician if the hoarseness is present for more than 2 weeks or if the hoarseness gets worse.

If there is difficulty in breathing or a high fever develops, call a physician immediately.

Leukemia
Leukemias are forms of cancer that involve the white blood cells. It is a rare childhood disease (about 40 cases per million children per year) and, with modern treatment, well over half of children can be completely cured.

Symptoms: They may include swollen lymph nodes in the neck and armpits, sore throat, fever, listlessness, lack of appetite, loss of weight, bone or joint aches and perhaps a tendency to bruise easily or suffer spontaneous bleeding (which appear as small bruises).

Diagnosis: Your physician will make a diagnosis through tests of blood and bone marrow.

Medical Treatment: Treatment should begin as soon as a diagnosis is made. Chemotherapy will be administered along with a combination of medications that can achieve remission (elimination of all signs of the disease) in about 95 percent of cases.

Environmental factors (radiation, toxic chemicals, some medications) may increase the incidence of leukemia. Be alert to environmental hazards.

Malabsorption
This is an intestinal condition that interferes with the absorption of fat, protein or sugar. The problem is sometimes present at birth but won't be apparent until certain foods are introduced. The most common form is intolerance of sugar found in milk (lactose). This is known as lactose intolerance. The severity varies. There also may be a sensitivity to gluten (in wheat, rye or barley) which damages the bowel wall and results in malabsorption. Cystic fibrosis also causes malabsorption, often associated with recurrent pneumonia.

Symptoms: Include watery, loose stools that are foul-smelling, abdominal bloating, gas, nausea, gurgling and sometimes vomiting. These children do not gain weight adequately.

Home treatment: Offending foods may be removed from the child's diet. If a child is lactose intolerant, milk and foods with milk may be eliminated, or a yeast lactase enzyme added to milk to break down lactose. (Available without prescription.) Specific therapy is required for the other disorders.

Malnutrition
Cause: This is the result of eating (or absorbing) too little food or having an imbalanced diet. It is one of the leading causes of death in children around the world. It results in stunted growth and body processes that don't function properly because insufficient food intake causes the body to use existing muscle and fat to supply energy and protein.

Symptoms: The first symptom is inadequate weight gain. Children also willbecome listless and, over time, the condition will interfere with the child's development.

Home Treatment: If the condition is mild, you can begin treatment at home by developing a diet plan to ensure a completely balanced daily intake of food. Get help from your physician, a nutritionist, or Canada's Food Guide for Healthy Eating. (See chapter on Nutrition.)

Medical Treatment: Hospitalization may be required for treatment of severe malnutrition.

Emergency Treatment: If a child becomes dehydrated, is in shock or body temperature falls (hypothermia), he or she should be encouraged to drink fluids and be wrapped in blankets. A physician must be seen immediately because these are life-threatening symptoms.

Measles
See Infectious Diseases

Meningitis
See Infectious Diseases

Moles
Symptoms: Moles are raised tan, brown or black spots on the skin - and they tend to be an inherited trait. Most adults have 20 to 30 moles. They first appear around 1 year of age and will continue to appear through adolescence. They don't fade and they last throughout our lives. They are usually harmless and treatment isn't necessary. There are exceptions: A mole rarely becomes cancerous but a very large birth mole, a very dark mole or one that is irregularly pigmented should be watched.

Medical Treatment: A physician may recommend removal of a giant pigmented birth mole before a child is 3..

If a mole changes in shape, colour or depth or if it bleeds or forms a crust, see a physician.

Motion Sickness
Cause/symptoms: This is caused by a disturbance of the body's balance fluids, located in the inner ear. It is the feeling of nausea and dizziness that can affect children riding in anything that moves (a car, merry-go-round, garden swing, boat, bus, train).

Children are more likely to be sensitive to motion than are adults. Strangely, infants are not susceptible to motion sickness.

Parents will notice their child becoming pale, anxious, dizzy and perhaps perspiring. Then the child may vomit.

Home treatment: The best treatment is prevention. A child can be given medications such as antihistamines before a trip that may help prevent motion sickness. Crackers and a flat carbonated beverage may help settle the stomach during the trip. Keep a child occupied with games and conversation.

If the child does get motion sickness, have the child lie down with eyes open and keep a vomiting pan handy. Give only sips of clear fluids until the stomach settles down. It is helpful if the child can get to sleep. Most children vomit only once and the symptoms will disappear in about 4 hours.

Mumps
See Infectious Diseases

Muscle Pain
Cause/Symptoms: Most tears and stretches of muscles are caused by overexertion and can be treated at home. However, muscle pain can also be caused by muscle inflammation associated with viral illnesses like influenza. This often occurs as a dull ache in the large muscles of the body - the back, shoulders, neck and arms.

Home Treatment: Muscle pain from overexertion: Start by raising the muscle to slow the flow of blood through damaged blood vessels. Apply an ice bag or massage the area with ice for about 20 minutes. Repeat this several times throughout the day. Use the muscle as little as possible. The pain will lessen as the swelling subsides. Give children's ibuprofen or acetaminophen for pain.

After 48 hours there may be some persistent stiffness. Have your child soak in a hot bath and lightly massage the sore muscles.

Treatment of inflammation also centres around reducing the swelling. Again, after the swelling has been reduced, use warm soaks or compresses to relax the muscle, followed by gentle massaging.

Cramped calf muscles can be gently squeezed while the front of the foot is pushed upward. An arm muscle that is cramped should be squeezed while the elbow is straightened very slowly. Teach your child stretching exercises and return to exercise gradually. Don'tallow the child to resume vigorous activity for a week, even if the pain disappears. If muscle pain persists after 48 hours and a muscle can't be used, see your physician.

Neck Lumps
Cause/Symptoms: Lumps on a child's neck are almost always harmless (benign). Sometimes a lump is present when a baby is born but a lump can develop anywhere on the neck, any time and can be any size. Most lumps are made up of lymph glands which enlarge due to throat infections or colds. This is normal. An infection of the tonsils may result in swelling of lymph nodes in the neck. Very occasionally, neck lumps are cancerous (the most common is Hodgkin's disease).

Medical Treatment: All lumps should be seen by your physician. Treatment will vary depending on the cause of the lump. Sometimes a lymph node becomes infected and antibiotic treatment is needed.

• Antibiotics will be effective for most infected lumps.
• Surgical removal is appropriate for most congenital lumps and non-inflammatory benign lumps
• Surgery, chemotherapy and radiation are required treatment for cancerous lumps.

If a neck lump is very hard, or enlarging rapidly, see your -physician.

Nosebleeds
Nosebleeds are common in childhood and almost never dangerous. The actual blood loss usually is insignificant.

Cause: Includes a blow to the nose, scratching or blowing the nose very hard, hayfever, other allergies and colds. A nosebleed also can result from bleeding disorders like haemophilia or conditions like leukaemia.

Home Treatment: A nosebleed usually stops by itself. If it doesn't, have the child sit up and lean slightly forward so as not to swallow the blood. Then, squeeze the child's nose firmly between thumb and forefinger. Apply this pressure for a few minutes, then release. This allows the body's clotting mechanism to go to work. After the bleeding has stopped, tell the child not to wipe or blow the nose and to sit still for a few minutes.

If bleeding doesn't stop after home treatment and after 20 minutes of constant pressure, consult your physician.

Nose Problems
Causes: Nose problems can range from a nose fracture or disfigurement to bruises caused by a blow to the nose to tiny objects being pushed up the nose by young children. (It is not at all unusual for children to push objects up their noses or vaginas or in their ears.) A nose bruises very easily, so bruises tend to look worse than they are.

Home Treatment: If an object pushed up the nose cannot be easily removed, don't try to remove it at home. You could push it even further up the nostril. This is especially true with smooth, hard objects, like peanuts. To remove an object that can be seen and looks as if it can be easily removed, have the child blow its nose vigorously. Hold the unaffected nostril closed to increase the force of the child's blowing. Alternately, if the object is lodged near the end of the nostril and the child can be persuaded to stay very still, you can carefully attempt to remove it with tweezers.

If the problem is an injured nose, apply an ice pack immediately to reduce both the swelling and bleeding. (Wrap ice in a towel. Never set ice directly on the skin.)

Medical Treatment: When you see a physician, it is helpful if you know what the object is because non-metallic objects, for instance, don't show up on an X-ray. Your physician will numb the area or perhaps use a general anaesthetic because the child must stay absolutely still.

For bruises, your physician need only be called if pain, discolouration and swelling last longer than 3 days.

If the nose is fractured, it may need to be repositioned and taped by a physician. After an injured septum heals, a child may have trouble breathing and may need corrective surgery.

See that your child wears protective gear when playing contact sports.

Keep small objects out of reach of small children. Teach children, when they are very young, not to put things up their noses.

Pigeon Toes
Cause/Symptoms: This is the toeing-in of all or part of the child's foot. It is caused by the inward turn of the bone of the thigh, lower leg, ankle or foot. It often results from a child's position in the uterus. It can also be caused by bone malformations and certain serious diseases such as cerebral palsy. It affects about 70 percent of infants at birth. It is often outgrown and usually disappears by the time the child is 5 years of age, but sometimes appliances, special shoes or surgery are required.

Home Treatment: Teach your child to sit and sleep with toes pointed outward. Encourage physical activities that will strengthen leg and thigh muscles. If pigeon toes don't correct themselves, orthopaedic shoes, separated by a bar, may be worn at night.

Medical Treatment: A physical therapist may suggest exercises to stretch and strengthen the legs.

For structural malformations, a plaster cast in a corrected position may be helpful or a physician may suggest surgery. In general, however, the defect is cosmetic only and does not affect running or walking.

Pink Eye (Conjunctivitis)
See Infectious Diseases

Pinworms
See Infectious Diseases

Pneumonia and Bronchitis
See Infectious Diseases

Poison Ivy, Oak, Sumac
Causes: Poison ivy, poison oak and poison sumac are all allergic reactions to the oils of their plants. The child may get it by direct contact with the plant, but the oils also can be carried by pets, clothing and smoke from the burning of the plants.

Symptoms: Redness, swelling and weeping blisters erupt on exposed body surfaces such as the arms, legs and face. They appear in streaks or patches and are extremely itchy but not contagious. The initial redness and itching may appear within 1, 2 or 3days after the child has played in the field or woods.

Home Treatment: Cool baths or massaging the area with an ice cube and letting the skin air-dry may help - and so may calamine lotion or oral antihistamines. Cortisone creams are not very effective. Keep the child's nails short to discourage sharp scratching. The rash should not be itchy longer than 10 to 14 days.

Medical Treatment: If the rash is severe, see your physician who may prescribe cortisone tablets.

Poisons
See First Aid

Polio
See Infectious Diseases

Polyps
Intestinal polyps can occur anywhere along the length of the stomach and intestines. They usually are harmless, painless and disappear without treatment. They never become cancers.

They most often appear between ages 3 to 6, rarely appearing before the first birthday or after age 15.

Nasal polyps are tear-drop shaped when developing and, when mature, resemble peeled seedless grapes. They may be due to inflammation of the
nasal membranes caused by long-term hayfever or asthma. They are harmless, although they may recur if the underlying cause isn't eliminated.

Medical Treatment: Most polyps disappear without treatment, but they should be examined periodically by your physician. Intestinal polyps should be removed if they cause an intestinal obstruction or rectal bleeding. Nasal polyps should be removed if they obstruct breathing. Nasal decongestants don't help eliminate nasal polyps.

Rabies
Cause: Rabies is an infection of the central nervous system that primarily affects the brain - and nearly every untreated victim dies. If a child is scratched or bitten by a rabid animal, or an animal even suspected of being rabid, the child must receive a life-saving series of injections. Animals can transmit rabies even if they have no symptoms. Especially dangerous are raccoon, fox, skunk, bat, coyote or any large wild animal. In Canada, most dogs are vaccinated so the greatest threat is from wild animals.

Symptoms: The closer the bite to the brain, the shorter the time until symptoms appear. (The illness can begin 9 days following the bite but symptoms are delayed for 30 to 60 days.) Once the symptoms appear, nothing can be done to save the victim.

Home Treatment: Immediately wash the wound with soap and water for 10 to 15 minutes. If possible, flush the wound under a faucet. Call the police to alert them and to try to capture the animal. Don't touch it, alive or dead. Its saliva can cause rabies by getting into a cut.

Medical Treatment: Get medical attention immediately. A series of injections must begin before the first symptoms appear. Many injections are required over a period of 2 to 8 weeks (depending on the age of the child).

Reye's Syndrome
Reye's syndrome was first recognized in 1963, but the cause remains unknown. It is a serious illness that may develop as a child recovers from a viral infection and it can be fatal. Liver function deteriorates and brain disease (encephalopathy) develops, leading to bizarre behaviour and coma.

Symptoms: If your child has influenza or chicken pox (or another viral infection) and, a few days after becoming ill, experiences drowsiness, nausea, vomiting, hallucinations, delirium - get immediate medical attention. The illness develops quickly and early treatment is vital.

Medical Treatment: The child must be diagnosed quickly and then hospitalized. Treatment will focus on keeping the symptoms as mild as possible while the illness runs its course.

Never give Aspirin or Pepto-Bismol (which contains Aspirin) to a child under 18 years of age except when specified by your physician.

Roseola
See Infectious Diseases

Rubella (German Measles)
See Infectious Diseases

Scabies
Cause/Symptoms: Scabies is caused by mites (tiny, spiny, four-legged insects) which infest soft skin areas such as the webbing between the toes and fingers, the genitals, buttocks, wrist, armpit. Infants become infested on the face, scalp, soles of the feet and palms of the hands. These mites burrow under the skin to lay eggs. The result is a very itchy rash consisting of small red bumps, pimples and tunnels.

Home Treatment: Wash all clothing and bed linen in very hot water.

Medical Treatment: An anti-mite preparation will kill both the adult mites and eggs; ask your doctor which one to use. It is a non-prescription preparation that you apply to affected areas. Medications should not be used on young children and infants without consultation with your doctor. The incubation period is 30 days and the contagious period is from the onset of the rash until after one treatment. Don't allow your child to pet wild animals or pets that have mange.

Sinusitis
Cause: The sinuses are a group of air-filled hollows that connect to the nasal passages. Sinusitis can be caused by colds, other viral infections, allergies, injury to the nose, infected adenoids, polyps in the nose or foreign objects in the nose. Infection of the sinus tissue is often caused by bacteria. Chronic sinusitis is also associated with the inhaling of cigarette smoke.

Symptoms: There is a sensation of pressure or pain above the eyebrow, behind the eye or over the cheekbone. The child may complain of headaches. There may be a thick nasal discharge and it may be necessary to breathe through the mouth.

Home Treatment: It is necessary to clear the sinuses and passageways so the fluid drains away and inflammation can be reduced. Decongestants may help. You might use a vaporizer in the child's bedroom. See that the child drinks plenty of fluids. If the child is a swimmer and diver, see that goggles and nose plugs are worn. Without treatment, the sinuses usually open after about a week.

Medical Treatment: Antibiotics may be prescribed if the infection is bacterial. The sinuses may be drained, using suction, if other treatment fails.

Slivers
See First Aid

Strep Throat
See Infectious Diseases

Styes
These are bacterial infections in the hair follicles at the base of eyelashes on either the upper or lower eyelids. The eye will be red, swollen and sore or have red, sore bumps. The stye forms a white head, bursts and then drains spontaneously. They tend to recur.

Home Treatment: Place a warm, moist wash cloth or cotton ball over the stye for 10 minutes, 3 or 4 times a day. This hot compress helps increase the blood flow to the area, bringing in extra white blood cells to engulf the bacteria and bring the stye to a head. A physician's help shouldn't be needed unless the styes persist.

Keep the child's towel and wash cloth separate from the rest of the family and see that hands are washed frequently.

Sudden Infant Death Syndrome (SIDS)
Sudden Infant Death Syndrome (also known as crib death) is the sudden, unexplained death of a healthy infant under one year of age. It is the major cause of death of infants during the first year of life (after the first month). It usually occurs when the baby is sleeping. Premature babies are at higher risk for SIDS.

Home Treatment: Put your baby to sleep on its back. Make your home a smoke and drug-free environment. Avoid over-dressing your baby for sleep. Breastfeeding your baby may give some protection against SIDS.

Post-SIDS Treatment: After the tragic loss of a baby due to SIDS, parents and siblings may need help in coping with the pain, guilt and shock - and to accept that the death is not their fault.

Put your baby to sleep on its back. SIDS is less common in babies who sleep on their back.

Sunburn
Cause: Rays are strongest between late morning and early afternoon and burning is more likely in areas with high elevation, on sand, snow and water. Most at risk are infants and children with fair skin.

Symptoms: Chills, fever and nausea as well as tender, red, warm skin. As healing begins, the upper layer of the skin (the epidermis) will dry and peel.

Home Treatment: Prevention is best - use lotions with a high SPF (sun protection factor) and reapply frequently - especially if a child is swimming outdoors. Children should wear waterproof sunscreens with an SPF of at least 15 on all exposed skin when they play outdoors, winter and summer.

Soak burned areas in tepid water and baking soda. Give the child a tepid bath to relieve pain. Petroleum jelly helps soothe and protect the burned skin. If blisters form, do not open them. Allow them to heal by themselves.

Medical Treatment: If blisters should open, they may become infected. See your physician.

Severe sunburn in childhood may predispose to later malignancy.

Teething
Don't blame irritable behaviour and excessive crying on teething. You may be overlooking symtoms of illness. Teething usually does not cause fever, diarrhea, vomitting, loss of appetite or convulsion. Teething may cause tender and sore gums as the teeth come in. A child will often drool, which can result in red, chafed cheeks.

Home Treatment: Freeze a teething ring before giving it to the child to numb the gums and relieve soreness. A parent may also rub the gums with a finger.

Tetanus (Lockjaw)
See Infectious Diseases

Thrush and Candida Diaper Rash
See Infectious Diseases

Unconciousness
See First Aid

Undescended Testicles
Testicles (the male reproductive glands) descend into the scrotum of the fetus in the mother's 32nd to 36th week of pregnancy. If the testicle does not descend, it is referred to as an undescended testicle. The testicles do not descend in about 4 percent of full-term male newborns and in 20 percent of premature male births. The condition usually corrects itself.

Medical Treatment: The condition should be surgically corrected before the child is age 2. (If it remains in the abdominal cavity after puberty, it will not produce sperm, even if it is corrected.) Surgery is almost always successful.

Whooping Cough (Pertussis)
See Infectious Diseases. BCCE

Edited by Sheila Jacobson mbbch frcp(c) . The Hospital for Sick Children. University of Toronto. Faculty of Medicine, Department of Paediatrics

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