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Frequently Asked Questions:

CLICK ON ANY THUMBNAIL BELOW FOR A PRINTABLE VERSION OF THESE GUIDES:

About Your New Baby - Things to Remember

  1. A healthy baby cries several times a day.
  2. A healthy baby may sleep 18 - 20 hours a day.
  3. Puffy eyes with mucous in the first 2 - 4 days of life are the result of drops or ointment put into the eyes at birth to prevent eye infections. This is temporary and harmless.
  4. A red bruise on the cheeks of an infant delivered by forceps is normal. It may be followed by a lump under the skin in this area. The lump will shrink away in about one month.
  5. Occasional spitting up, straining to have bowel movements, hiccups, and sneezing are normal.
  6. Mild to moderately swollen baby breasts are normal. Do not massage or rub them. They will shrink by themselves.
  7. Occasional bloody mucous from the vaginal area the first month of life is normal. It is due to the effect of hormones from your body to which the baby was exposed during development. It will stop by itself in 2 - 4 days.
  8. There is no need to give your baby extra water. The water in breast milk or formula is plenty.
  9. A healthy newborn might lose up to 10% of his/her body weight during the first week of life.
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Accident and Poisoning Prevention

Accidents and poisonings are by far the most frequent causes of death and crippling among children. It is your responsibility to provide a safe environment for your child. Read the following instructions carefully. Do not wait until your child has already been hurt before you make your home safe.
 
  1. When traveling, a car seat (or safety belt for older children) must always be used. The younger your baby, the more he needs to be protected. A child is safest when riding rear-facing until 2 years of age. Secure the car seat properly into the car's seat belts and strap your child into the car seat. The AAP recommends that children remain in booster seats until they reach a height of 57 inches.
  2. The sides and ends of your baby's crib should be protected to prevent your baby from getting caught between the bars. The slats should be less than 2 3/8 inches apart. Corner posts should be less than 5/8 of an inch high. See that the sides of your crib are up and latched whenever you turn away from your baby. Mattresses should be firm and snugly fitted. There should be a minimum of 26 inches from the top rail to the mattress, with the mattress set at the lowest point. There should be no sharp edges or lead paint. The AAP advises against putting any objects in the crib including blankets, pillows, stuffed animals, bumpers, etc...
  3. Always stay with your baby when he/she is in the bath. Always grab a wrist or ankle firmly if you must turn away, even for a moment!
  4. Keep him away from faucet handles - babies have been burned by hot water. Turn your hot water heater down so that your hot water temperature is 120 to 125 degrees maximum.
  5. Hot coffee, either from a cup or a percolator, is the leading cause of burns. Immediate application of cold running water over the burn area is the best initial first aid you can give.
  6. Your baby should not be left alone in any location from which he might fall (table, counter, chair, bed, couch, etc...). Do not turn away, even for a moment, even at two weeks of age. This advice applies even to babies restrained in infant carriers or infant seats.
  7. Your baby should be given only safe toys. Rattles should be unbreakable. Toys should have no sharp points and no small parts which might break off and choke him.
  8. Keep plastic bags, safety pins, magnets, small batteries and other small objects out of your baby's reach.  If you suspect that your baby swallowed a battery, magnets, or a sharp object like a safety pin, go to the nearest pediatric emergency room. 
  9. Children should not have anything tied around their neck. Cords, pacifiers, and necklaces used in this fashion have been known to result in strangulation.
  10. Toddlers and early school age children are prone to the ingestion of poisons, either in the form of medicines, cleaning compounds, toxic plants, insecticides, or alcohol. If ingestion occurs, call Poison Control immediately at (202) 625-3333 or (800) 222-1222 or go straight to the nearest Emergency Room. 
  11. Head injury from bicycle accidents is a leading cause of serious injury in children. Small children riding in bicycle seats and older children and teenagers riding their own bicycles should wear an approved safety helmet. Helmets bearing a sticker from ANSI (American National Standards Institute) or the Snell Memorial Foundation indicates that strict safety standards have been met.
  12. To prevent unnecessary risks in bicycle riding, avoid buying a bike that a child must grow into. A beginning cyclist should have a standard or three gear bicycle with pedal brakes. The child should be able to place the balls of both feet on the ground when sitting on the seat, stand straddling the crossbar (if there is one) with one inch clearance between the crossbar and crotch, and apply pedal brakes or hand brakes without difficulty and with enough force to stop quickly.
  13. Falls are common in toddlers and active children. Let your doctor know if there is a deep cut or if your child has difficulty or pain in moving his arms or legs. Bumps on the head are frequent. If your child gets up right away and seems fine, there is probably nothing seriously wrong. If he is tired, let him go to sleep, but check him every 3 - 4 hours to make sure he stirs as in a normal sleep. If there is a loss of consciousness, vomiting, change in coordination or behavior, or he "just doesn't act right" call your doctor or go to the nearest emergency room.
  14. Knowledge of cardiopulmonary resuscitation (CPR) is highly recommended for parents and sitters. Contact the local Red Cross or your community hospital for class information.
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Baby Sitter Information

When a baby sitter cares for your children in your home, he or she should be provided with basic emergency information as well as information about your child: where you are going, what time to expect you back, and how to reach you by phone. Post the numbers for Poison Control (1-800-222-1222), 911 for Police, Fire or Rescue Squad, both parents' contact numbers, your pediatrician's office, and a nearby friend or relative. Post emergency instructions. Go over this list with your sitter before you leave.

If a child is to be given medication, go over the name, amount and time to be given. Tell the sitter where other medications and cleaning supplies are kept so that he or she can keep your child away from these things. Point out the location of smoke alarms, fire exits and children's bedrooms. 
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Colds/Upper Respiratory Infections

Colds, or viral upper respiratory infections, are extremely common in infants and children. The average number of colds per year is from 3-10, each lasting up to 14 days for a possible total of 140 days per year with cold symptoms.
Symptoms May Include:
  • Nasal discharge (often yellow or green)
  • Nasal congestion
  • Scratchy/sore throat
  • Tiredness and aches
  • Post nasal drip
  • Headache
  • Cough
  • Sneezing
  • Decreased appetite
  • Fever (greater than 100.5)
  • Irritability
  • Decreased sleep
  • Slight eye discharge without redness
  • Hoarseness 
COLDS ARE MOST COMMONLY SPREAD FROM NASAL SECRETIONS.
WASH YOUR HANDS OFTEN!!

The common cold completes its natural course in 10-14 days and management is focused on relief of symptoms.  Best therapies include humidified air, saline nasal drops (and bulb suctioning, if needed), positioning with the head elevated, and increased fluid intake.

In adolescents and adults, decongestants occasionally help symptoms; in infants and toddler, studies show cold preparations are no better than placebo. These products will not prevent ear infections.

If cold preparations are used, single ingredient products are recommended to decrease the risk of both adverse effects and overdose. (Data from the 2000 annual report of the American Association of Poison Control Centers indicate there were 61,034 overdoses in children younger than 6 years of age due to cough and cold preparations.) This includes not using cough/cold preparations that contain acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).  If your child has a fever or is uncomfortable, then give either acetaminophen or ibuprofen.
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Crying and Colic

All babies have periods of fussiness. The average two week old baby will cry about 1 3/4 hours a day. A six week old will cry 2 3/4 hours. After six weeks, the duration of crying steadily decreases. As a parent, you will develop an instinctive ability to "read" your baby's cries. You will learn the "hungry" cry, the "tired" cry, the "pick me up I want to play" cry, and the "something hurts" cry. Some babies cry for lack of anything better to do.

The most common cause for the "something hurts" cry in the first few months of life is the baby's normal sensitivity to his own gastrointestinal ("peristaltic") contractions. The intensity of these contractions vary from baby to baby, with the result that some babies tend to grunt and whimper only on occasion, while other babies appear to be in almost constant pain.

Because bowel contractions, a necessary part of the digestive process, are responsible for the baby's pain, most traditional remedies for this problem, while worth trying, often yield limited success: e.g. changing the mother's diet, changing the formula, "colic drops", chamomile tea, gripe water.

Some non-medical approaches to this problem: mild colic may be relieved by distraction such as carrying the baby, offering a pacifier, using an automatic rocker or the old fashioned rocking chair, taking a stroll, going for a ride in the car, taking a bath.  Gentle warmth to the baby's abdomen may help: use a warm water bottle or have the baby lie on your stomach.

If the baby is having constipation, relieving this problem will alleviate the intensity of the cramps.  If the baby is experiencing spitting up/reflux follow appropriate measures to address the issue.

If your interventions fail, an office visit for a complete evaluation may be warranted. 

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Fever

What is fever?

Fever is the body’s normal way of fighting infection. Fever lets us know that something is going on and alerts us to keep an extra watch on how a child is acting. Normal temperature variation throughout the day is between 97 degrees and 100.4 degrees F. Your child has a fever if his or her temperature is greater than 38.5 C or 100.4 F with a rectal or ear thermometer. The best way to take a temperature of a child under 3 years of age is rectally. Using a digital thermometer is the quickest and safest. Mercury glass thermometers are NO LONGER recommended. Taking a temperature under the arm, with a forehead strip or with a pacifier thermometer is unreliable and NOT recommended. 
 
Putting the fever in perspective

Fevers between 100.5 and 105 F are common with many illnesses in children. The height of the fever does not necessarily correlate with severity of illness. We treat children with fever reducing medication to make them more comfortable. Do not wake your child just to take a temperature or to give fever reducing medication. Fevers are generally not dangerous until they are over 107-108 F. Children under 3 months of age with a temperature over 100.4 F should see a doctor. 
 
What to do?

If you think your child has a fever, dress him/her lightly and encourage fluid intake. Avoid bundling your child in heavy blankets. 

SPONGE AND COOL BATHS ARE USUALLY NOT NEEDED AND MAY MAKE YOUR CHILD MORE UNCOMFORTABLE. ALCOHOL BATHS OR RUBS ARE DEFINITELY NOT RECOMMENDED AND MAY BE HARMFUL.

If you choose to use a fever reducing medication, we recommend either acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). We do not recommend alternating these medications or giving them at the same time. These medications will reduce the temperature 1-2 degrees and last several hours. Reducing a temperature to normal is not necessary, because a little fever can be beneficial in helping your child fight infection. 
Contact your doctor's office if your child is:
  • Very irritable 
  • Not drinking or urinating 
  • Looking and acting very sick or seems confused 
  • Feverish for longer than 3 days 
  • Having difficulty breathing 
  • Unable to swallow 
  • Very sleepy and hard to wake up 
  • If you have any concerns

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Lice

Treatment for lice is recommended for persons diagnosed with an active infestation. 

All household members and other close contacts should be checked. Those persons with evidence of an active infestation should be treated. 

Using an Over-the-counter (OTC) or prescription medication:

Apply lice medicine, also called Pediculicide, according to the instructions contained in the box or printed on the label. If the infested person has very long hair (longer than shoulder length), it may be necessary to use a second bottle. 

WARNING: Do not use a combination shampoo/conditioner, or conditioner before using lice medicine. Do not re–wash the hair for 1–2 days after the lice medicine is removed.

If a few live lice are still found 8–12 hours after treatment, but are moving more slowly than before, do not retreat. The medicine may take longer to kill all the lice. Comb dead and any remaining live lice out of the hair using a fine–toothed nit comb.  If, after 8–12 hours of treatment, no dead lice are found and lice seem as active as before, the medicine may not be working. Do not retreat until speaking with your health care provider; a different pediculicide may be necessary. If your health care provider recommends a different pediculicide, carefully follow the treatment instructions contained in the box or printed on the label.

Nit (head lice egg) combs, often found in lice medicine packages, should be used to comb nits and lice from the hair shaft. Many flea combs made for cats and dogs are also effective.

After each treatment, checking the hair and combing with a nit comb to remove nits and lice every 2–3 days may decrease the chance of self–reinfestation. Continue to check for 2–3 weeks to be sure all lice and nits are gone. 

Retreatment is meant to kill any surviving hatched lice before they produce new eggs. For some drugs, retreatment is recommended routinely about a week after the first treatment (7–9 days, depending on the drug) and for others only if crawling lice are seen during this period. Retreatment with lindane shampoo is not recommended.

FOR MORE INFORMATION: 
http://www.cdc.gov/parasites/lice/head/treatment.html

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Lyme Disease / Tick Bites

The overall risk of infection with Lyme disease after a recognized deer tick bite in our area is 1-3%.  The risk is extremely low after a brief attachment of less than 18 hours (flat, non-engorged tick) and gets higher after 36 hours of attachment.

After reviewing the recent recommendations of the American Academy of Pediatrics, it was determined that analysis of a tick for Lyme disease is not helpful.  During the early stages of Lyme disease (first four weeks of infection), diagnosis is best made clinically by recognizing the rash around the site of a recent tick bite.

Other symptoms such as fever, fatigue, headache, mild neck stiffness, joint pain and muscle pain may accompany the rash.  During this phase, blood tests are insensitive and are not routinely recommended.  Preventive antibiotics after a deer tick bite are also not routinely recommended for children under 8 years.  Over 8 years of age, prophylactic treatment may be considered if it has been within 72 hours of tick removal and other criteria have been met.  Appointments are required for any consideration of such treatment.

Please talk to your doctor if you have any additional questions.

https://www.cdc.gov/lyme
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Spitting Up/Reflux

Babies seldom "spit up" in the first few days of life because the milk intake at each feeding is small. 

It's typical for the baby to begin "spitting up" at two to four weeks of age. Effortless regurgitation of small amounts of milk is normal. 

Forceful vomiting ("projectile vomiting") and vomit containing bile (yellow-green) are abnormal and require a call to the pediatrician and possibly further evaluation.

Some babies raise milk from the stomach to the esophagus or the throat and then reswallow the milk. This is referred to as "gastroesophageal reflux". Mild reflux is normal and of no concern. Reflux which appears to pain the baby or causes frequent gagging requires a medical evaluation and possibly medical treatment.   

Some simple measures that can be used to help reduce reflux include:

  • feeding your baby on an incline
  • burping your baby frequently
  • keeping your baby's head elevated for 15-20 minutes after each feed
  • elevating the head of your baby's bassinet about 10-15% so that the baby sleeps on a small incline
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Teething

Babies generally begin to drool and chew from teething around age two to four months, although the teeth do not usually erupt before four to seven months of age. For several weeks before a tooth breaks through the gums, the baby may experience discomfort. Irritability, poor sleep, reluctance to suck, and an increase in the frequency of bowel movements are symptoms associated with dental eruption. Teething rings (especially cold ones) could be used for relief.  The FDA advises against using topical anesthetics (like Orajel or Ambesol) on children under 2 years old.  The FDA also recommends avoiding homeopathic products due to potential side effects.  You may occasionally give acetaminophen drops every four hours as needed for temporary relief. 

If the baby's symptoms are disturbing, call the doctor's office to discuss the problem. We are careful not to attribute symptoms to teething which might be due to other problems.
The time to start cleaning a baby's mouth is shortly after birth. The gums can be gently wiped daily with a soft cloth. This routine gets the child used to having the mouth touched by the parent's fingers. When the first teeth do erupt, the cloth may be used to clean them. A toothbrush is generally introduced when the baby has about 8 teeth (no later than age 2 years old).
Baby Teeth Usually Erupt as Follows:
  • Central incisors 6 - 12 months
  • Lateral incisors 9 -14 months
  • Canines 16 - 22 months
  • First year molars 13 - 17 months
  • Second year molars 24 - 30 months

Vomiting and Diarrhea: Gastroenteritis

Vomiting and diarrheal illnesses are very common in children but are usually managed at home with no medications needed. These illnesses infect the intestines.    
Symptoms May Include:
  • Watery non-bloody diarrhea
  • Abdominal cramps and pain
  • Nausea, vomiting, or both
  • Occasional muscle aches or headache
  • Fever
Depending on the cause of the illness, the infection can range from mild to severe, lasting a day or 2, or as long as 10 days. There’s often no specific medical treatment for gastroenteritis because antibiotics are not effective against viruses. 

To keep your child more comfortable and prevent dehydration:

  • Let the stomach settle and wait 1 hour after vomiting before trying liquids
  • Older children may suck on ice chips or take small sips of clear liquids
  • Pedialyte is the drink of choice in small children
  • Pedialyte popsicles for small children and popsicles for older children also deliver fluids slowly
  • Ease back into eating solids
  • Do not use Ibuprofen,  and use Tylenol sparingly
  • Avoid Aspirin
  • If no vomiting, you may offer a regular diet (including milk products)
 
Call the doctor's office if any of the following are present:

  • Temperature higher than 104 degrees
  • Is unusually sleepy, difficult to arouse, or irritable
  • Has bloody diarrhea
  • Bloody or bile-colored vomiting
  • Has a dry mouth or cries without tears
  • No urine output for 8-12 hours
  • Is in a lot of discomfort or pain
  • Any  other worrisome symptoms
 
REMEMBER: THE BEST DEFENSE AGAINST THE SPREAD OF INTESTINAL INFECTION IS FREQUENT AND THOROUGH HAND WASHING.     
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CHILDREN'S MEDICAL ASSOCIATES OF NORTHERN VIRGINIA, P.C.
6303 Little River Turnpike, #300, Alexandria, Virginia 22312   (703) 914-8989   Fax (703) 914-5494
10615 Braddock Road, #200, Fairfax, Virginia 22032   (703) 691-4700   Fax (703) 691-4791
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