A Quick Reference Guide
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.
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.
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.
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.
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 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.
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.
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.
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.
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
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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.
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.
(Rescue Breathing, Choking, Hyperventilation)
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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 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.
See Infectious Diseases
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.
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.
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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.
See Infectious Diseases
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.
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.
See Infectious Diseases
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.
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.
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.
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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.