Home Care for Common Childhood Illnesses & When to Call the Doctor

The health information provided on this site is intended for the exclusive use of the established patients of North Seattle Pediatrics, as an adjunct to the services provided by telephone and in person by the physicians and staff of North Seattle Pediatrics. Use of the information on this site by anyone other than North Seattle Pediatrics patients is not intended to, and will not establish, a doctor-patient relationship between such unauthorized users and the physicians of North Seattle Pediatrics.

As part of our dedication to parent health education, the doctors at North Seattle Pediatrics have compiled information on common symptoms, illnesses and over the counter medications.  For the safety of your family, this information is intended for use by North Seattle Pediatrics patients exclusively.

If you have a non-urgent concern please call our office during office hours from 7:30 am-6:00 pm.  If you have an urgent concern and the information below does not answer your question please contact us by telephone at 206-368-6080.  During the day a North Seattle Pediatrics nurse will return your call, generally within 1 hour. After hours calls are answered by the answering service and your call will be returned by an on-call doctor or nurse depending on the time of day.

For life-threatening emergencies (severe difficulty breathing, unconciousness, seizures, or severe head or neck injury)  please call 911 immediately.

Conditions are listed in alphabetical order.  Read more by clicking on the link.

Abdominal pain

Acetaminophen (Tylenol) Medication for pain and fever — see dosing information.

Asthma or Wheezing

Cold Runny or stuffy nose often associated with fever, sore throat and cough.

Constipation Hard bowel movements that are difficult to pass.

Cough

Croup A barking cough, hoarseness, and sometimes a harsh sound when the child breathes in called stridor, which is associated with a hard time breathing.

Dehydration Excessive loss of body fluids through vomiting or diarrhea, combined with inadequate oral intake of fluids, can lead to dehydration in infants and small children.

Diarrhea Frequent loose or watery bowel movements.

Fever Temperature over 100.5° F or 38° celsius.

Ibuprofen (Motrin, Advil) Medication for pain and fever — see dosing information.

Sore throat

Urination, pain with

Vomiting

Acetaminophen (Tylenol) Medication for pain and fever. If your child is less than 3 months old, please call before giving this medication, unless immunizations have been administered within the last 2 days.

Suspension concentration (160mg per teaspoon):

  • 6 to 11 pounds: 1.25ml or 1/4 teaspoon (40mg) each 4-6 hours
  • 12 to 17 pounds: 2.5ml or 1/2 teaspoon (80mg) each 4-6 hours
  • 18 to 23 pounds: 3.75ml or 3/4 teaspoon (120mg) each 4-6 hours
  • 24 to 35 pounds: 5ml or 1 teaspoon (160mg) each 4-6 hours

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Abdominal pain: severe abdominal pain, especially if accompanied by fever or vomiting, may be a sign of more serious illness such as appendicitis or urinary infection.

Call us now at 206-368-6080 if your child

  • has severe abdominal pain that lasts longer than 4 hours
  • has severe pain and has fever or vomiting

Call us during office hours if your child:

  • has burning or pain with urinating
  • has reflux or heart burn symptoms
  • has pain that doesn’t go away in a few hours
  • has pain that is due to constipation (hard bowel movements) and you are not sure how to manage the constipation
  • has pain and you’re not sure what is causing it or how to manage it

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Asthma or Reactive Airway Disease : repeated attacks of wheezing, chest tightness, and difficulty breathing. This happens when the lower airways in the lungs are triggered by viruses, allergens, exercise, cold air, or irritants to tighten up. Viruses are the most common triggers for young children.
If your child has been given a prescription for an asthma inhaler or nebulizer in the past and you think your child needs it now, use it first and then call us as directed below.

Call us right away at 206-368-6080 if your child is

  • having difficulty breathing
  • using their stomach or chest muscles to breathe
  • having a hard time walking or talking because of difficulty breathing
  • having chest pain or vomiting
  • needing to use their inhaler or nebulizer more than every 4 hours
  • Call 911 if your child is having severe trouble breathing or is looking very sick

Call us during business hours if your child looks well and is eating and active but is

  • having new onset wheezing
  • having worsening wheezing
  • having wheezing for more than 5 days
  • having a cough lasting more than 4 weeks

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Colds or Upper Respiratory Viruses are common and usually involve a congested or runny nose, a cough and a low grade fever.  Sore throats are also common as are mild headaches and decreased energy.  A fever with a cold usually starts within 2 days of the onset of cold symptoms, usually spikes 2 or 3 times a day, and usually lasts 2-4 days.

Helpful home care for colds includes

  • offering small amounts of liquids frequently to keep your child well hydrated
  • using a cool mist humidifier (without medication added)
  • letting your child breathe in a steamy bathroom before bed
  • if your child is over 3 months old and has low grade fever or mild discomfort you may give them Tylenol (acetaminophen) by this dosing and schedule.
  • if they are over 6 months you may use Ibuprofen (advil, motrin) for fever or mild discomfort with this dosing and schedule.
  • an infant may need occasional nasal saline drops to help open a stuffy nose. Mix 1/2 teaspoon of table salt in 1 cup of warm water. Use a dropper to put one drop of salt water in one nostril. Wait a few seconds. Your child may sneeze the salt water and mucous out or you may gently suction with a bulb syringe.  Repeat on the other nostril.
  • we do not recommend cold or cough medicine for children under the age of 4 years because of the risks of side effects and because they usually don’t help very much

Call us right away at 206-368-6080 if your child

  • is having a severe problem breathing (call 911 if they are unresponsive or look bluish )
  • is under 2 months old and has a fever over 100.4° F rectal

Call us during office hours if your child

  • has a relapse of fever after they were fever free for more than 24 hours
  • has a fever that is getting steadily higher or lasts more than 5 days
  • has ear pain or wakes with sudden screaming during the night (treat the pain with tylenol or ibuprofen until we see the child)
  • has a wheezy cough (see more on cough)

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Constipation in infants and children refers to hard, painful bowel movements. Stools that are soft are normal. In infants between the ages of 1 month and the time they start solid food, bowel movements as infrequently as every 3-5 days are normal as long as they are soft and the baby is eating well, seems healthy, and is having lots of wet diapers.  In toddlers and older children, constipation can usually be relieved by increased amounts of liquids in the diet, especially apple juice and prune juice, and by increased amounts of fruits and vegetables.

Call us now at 206-368-6080 if your child

  • has severe pain that is constant and persists for more than 2 hours

Call us during office hours if your child

  • does  not improve with a change of diet
  • is an infant under 4 months who has hard stools

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Cough: A cough with a respiratory virus will often last 2-4 weeks.  The cough is a reflex that helps protect the lungs and keep them clear.  Coughs may sound dry or wet.

Although medicines to control the cough reflex don’t really work and can have harmful side effects, there are ways to help soothe the airway and throat to help your child be more comfortable.

  • try a cool mist humidifier in the bedroom
  • try letting your child breathe in steam from a steamy bathroom before bed
  • try letting your child over age 4 suck on sugar free cough drops.
  • try giving your child over age 1 one teaspoon of honey. You may mix it with one teaspoon of warm water.

Call us right away at 206-368-6080 if your child

  • is having to work with their muscles to breathe
  • is acting very sick
  • is making a grunting sound when they breathe
  • is breathing very rapidly

Call us during office hours if your child

  • is wheezing but otherwise comfortable and not acting very sick
  • is coughing for longer than 4 weeks
  • is coughing frequently at night or with exercise (several times a week for more than 4 weeks)

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Croup is a viral respiratory infection that in young children can cause a barking, hoarse cough. Sometimes, especially during the night, the child will have a harsh sound when breathing in called stridor which is associated with difficulty breathing.  This is caused by swelling of the tissue that lines the wind pipe at the level of the vocal cords. Stridor and  difficulty breathing can often be relieved quickly by wrapping the child in a blanket and taking the child outside to breathe in cool air.

  • If your child is having severe difficulty breathing even outside, call 911.
  • If your child still has trouble breathing or significant stridor after being outside for 10 -15 minutes your child may need steroid or other treatment and should go to the closest emergency room. If your child’s stridor resolved outside, keep the air cool and moist with a humidifier or an open window and call our office in the morning at 206-368-6080.

Call now at 206-368-6080 if your child

  • is still having difficulty breathing after breathing cool outside air for 10-15 minutes

Call during office hours if your child:

  • had stridor that resolved with cool air.
  • we may need to give your child medication to help prevent a recurrence the following night.

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Dehydration. Excessive loss of body fluids through vomiting or diarrhea, combined with inadequate oral intake of fluids, can lead to dehydration in infants and small children. If your child has vomiting or diarrhea it is important to give them small sips of clear liquids every few minutes (1 teaspoon every 5 minutes to start).

Call the office for advice at 206-368-6080 if your child

  • can’t keep sips of fluids down after 5-6 hours
  • is extremely tired or lethargic; not smiling or interacting
  • has dry lips and tongue or sunken eyes
  • isn’t urinating at least a little bit every 8-12 hours

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Diarrhea is a common childhood condition usually caused by an intestinal virus. Frequent loose or watery stools may occur, accompanied by low-grade fever. If your child is otherwise well, taking fluids without vomiting, and urinating at least once every eight hours, it is acceptable practice to continue feeding the child’s usual diet and expect the diarrhea to resolve in 3-4 days. In the toddler or older child it may be helpful to eliminate milk and other dairy products (which contain lactose) from the diet for a day or two. Keep in mind that there is no effective safe medicine to treat diarrhea in children. Extra fluids and diet therapy work best.

If diarrhea is accompanied by vomiting, please consult that topic on this site. If you are concerned that your child may be dehydrated please consult that topic or call our office at 206-368-6080.

Call us now at 206-368-6080 if your child

  • has severe abdominal pain
  • has blood in the stool
  • appears very ill or dehydrated

Call during office hours if your child

  • has loss of bowel control
  • has a fever above 102° F or chills

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Fever is usually a sign that your child’s immune system is responding to an infection of some kind. Unless your child is under three months, you may take the temperature with any thermometer.  A digital thermometer under the arm is fine and will have a result within one half a degree of the core temperature.  Ear thermometers can read several degrees higher than your child’s actual temperature and so are the least accurate.

Fever in an infant under 3 months may represent a serious infection, so it is important to have an accurate temperature for these babies.  Use a rectal thermometer for infants under 3 months.  For an infant under 3 months with a fever (100.4° F rectal or 38° Celsius) call us immediately at 206-368-6080.

Most infections causing fever are caused by viruses and involve only mild signs of illness or discomfort. The fever is part of the body’s response to fight off the virus and is not harmful.  Children will often have fever up to 104° F (40° C) with a viral illness.  Typically fevers due to a virus will spike up and down 2 or 3 times a day for 3-5 days.  Fever can make children not feel well and not look well. If your child is uncomfortable we recommend that you use a fever reducing medication (Tylenol or ibuprofen).

Call us at 206-368-6080 now if your child

  • is less than 3 months old and has a fever above 100.4° F (38° C)
  • has purple or blood-red spots on the skin
  • has sudden onset of drooling or spitting or difficulty swallowing
  • has difficulty breathing (see croup, cough, asthma)
  • has severe abdominal pain
  • has lethargy – more than the usual tiredness from fever and illness – to the point of not smiling or playing, being too weak to cry, being floppy or hard to awaken
  • has a fever over 105° F taken by a thermometer other than an ear thermometer

Call us during office hours if your child

  • has a sore throat with fever but does not have a cold or cough
  • has vomiting with fever over 102° F
  • has a fever return after being gone for more than 24 hours

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Ibuprofen (Advil, Motrin)  Age 6 months and up.
Infant concentrated drops (50mg per 1.25ml); use only the dropper provided.

  • 12-17 pounds: 1st line on dropper = (1.25ml)  up to every 6 to 8 hours
  • 18-23 pounds: 2nd line on dropper = (1.875ml)  up to every 6-8 hours
  • 23-35 pounds: (1.25ml plus 1.25ml = 100mg) up to every 6-8 hours

Suspension (100mg per teaspoon)

  • 11 to 17 pounds: 2.5ml = 1/2 teaspoon (50mg) up to every 6-8 hours
  • 17 to 22 pounds: 3.8ml = 3/4 teaspoon (75mg) up to every 6-8 hours
  • 22 to 35 pounds: 5ml = 1 teaspoon (100mg) up to every 6-8 hours

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Sore Throat. Most sore throats in children are mild and are caused by viruses that last 3-7 days before resolving on their own. Comfort measures include cool liquids, bland foods, and appropriate doses of pain medication (ibuprofen or Tylenol).

More severe infections in children over 18 months can be caused by the Streptococcus bacteria (‘strep throat’). Clues that your child’s sore throat might be due to strep are sudden onset, headache and abdominal pain, fever, enlarged tonsils (which may be red or show white patches), red palate (roof of the mouth) and enlarged, tender lymph nodes on either side of the neck (‘swollen glands’). Typical cold symptoms such as runny nose or cough are often absent. Occasionally a fine red ‘sandpapery’-feeling rash may occur under the arms or in the groin.

Call the office during office hours if

  • you suspect your child may have a sore throat due to strep. If laboratory tests indicate that a strep infection is present, an antibiotic is the appropriate treatment.

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Pain with Urination. Pain due to a urinary tract infection is commonly accompanied by fever, frequent urination, accidents and abdominal or back pain.  Young girls who are feeling well but complain of burning with urination may have irritation of the skin that contacts the urine.  If the child looks well call our office at 206-368-6080 within 24 hours. If the child is vomiting or has a high fever call our office right away. Increased intake of oral liquids, especially cranberry juice, may also be helpful.

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Vomiting in children commonly occurs in the early stages of an intestinal viral infection (‘stomach flu’) and more rarely may be a sign of food poisoning. Vomiting may also be a sign of rare but serious conditions such as intestinal obstruction or appendicitis. If your child is NOT vomiting green material (bile) and does NOT have a high fever or severe abdominal pain, it is safe to try very slow clear fluids as decribed below. The child may initially vomit several times close together as the stomach empties.

Instructions for giving clear liquids (oral rehydration):

After the child’s initial vomiting has stopped for about an hour, begin rehydration using small amounts (1 to 2 teaspoons) of clear liquids such as Pedialyte (our first choice for infants), or 1/2-strength Gatorade, or water. Offer these every 5 to 10 minutes while your child is awake. Continue giving a teaspoon every five minutes even if your child still vomits every couple of hours or less. If your child is breastfeeding you may resume nursing, but try limiting the duration and increasing the frequency of nursing.

When vomiting has stopped for eight hours and your child is tolerating 2 ounces of clear liquids at a time, it should be safe to begin feeding your child small amounts of food. Foods that are well-tolerated include carbohydrates such as rice, white bread, white potato, pasta (except whole wheat), jello, rice milk, soy milk, or soy formula. Observe this diet for 24-36 hours, and then resume your child’s regular foods.

Call us now at 206-368-6080 if your child

  • has severe abdominal pain and vomiting
  • has bright lime green bile-colored vomiting
  • is not keeping even small sips of fluids down after several hours of the slow rehydration described above
  • has fever above 104° F with vomiting
  • has difficulty or pain with urination and vomiting

Call us during office hours if your child

  • is still on clear liquids after 48 hours

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