Ask a Nurse

Today's post will answer a question from one of our readers. Darbie in New Mexico asked:

What advice can you give for when to take your children to the doctor when they have a fever? My mother-in-law would take her children to the doctor if they were a bit warm, but I don't think that ONLY a fever with no other symptoms is a problem and wouldn't take my child to the doctor.

Unfortunately there is no exact formula for when you should take your sick child in to the pediatrician, but here are a few tips to help guide parents in determining if they should call the doctor:

* The best indicator of your child's health status is his/her behavior. Your child may have symptoms of a cold, but if he/she is running around and playing like normal, a doctor’s visit is probably not necessary. If, however, your child is not acting normally, is very sleepy, refuses to eat or drink, doesn't want to play, and is irritable, these are probably signs that the illness is a little more serious.

* Fever is a common response to infection and should always be monitored. But fever alone is not a reason to take your child into the doctor. Many fevers can be managed at home with antipyretics like Tylenol or Motrin. However, if your child is less than 3 months old and has a temperature greater than 100.4, you should call your pediatrician. An infant's immune system is less developed, and what would be considered a mild illness in a child or adult can be serious in a newborn. Also, if you are unable to manage your child's temperature with medication at home, you should call your doctor.

* If your child has a cough or cold that does not get better within a week, you should take him/her to the doctor.

* A child that will not eating or drinking for more than 12 hours or one that has severe vomiting or diarrhea should see a doctor. Dehydration is a major concern in these cases.

* Ear pain accompanied by a fever is usually indicative of an ear infection. This may be a bacterial infection, and your doctor will generally prescribe an antibiotic.

Remember, you as parents know your children best and are usually the best judge of their health status. If you are at all concerned, you should never hesitate to call your pediatrician's office.

How to Properly Take Your Child's Temperature

A digital thermometer is an essential item in every home with children. Fever is often one of the first signs of illness, and it is important to monitor and treat even a mild temperature. What most parents don't know is that in order to obtain an accurate reading, it is important to use the proper technique to take your child's temperature. Based on your child's age, the American Academy of Pediatrics (AAP) has given the following guidelines for checking your child's temperature:

Newborn to 3 months: rectal
3 months to 3 years: rectal
4 to 5 years: rectal or oral
5 years and older: oral

How to Take a Rectal Temperature
* Clean the end of the thermometer with soap and water.
* Put a small amount of vaseline on the tip to act as a lubricant.
* You can either 1) place your child tummy down across your lap with one hand on his/her lower back or 2) place your child face up across your lap and with one hand bring his/her knees to the chest.
* With the other hand, turn the thermometer on and insert it 1/2 inch to 1 inch into the anal opening. Be sure not to push the thermometer in too far. Hold the thermometer in place until it beeps (about one minute).
* Check the reading. Anything greater than 100.4 is considered a fever.

Note: Be sure to label the thermometer as rectal so it is not later used in someone’s mouth.

How to Take an Oral Temperature
* Clean the end of the thermometer with soap and water.
* Place the tip of the thermometer under the child's tongue and toward the back of the mouth.
* Hold the thermometer in place until it beeps (about one minute).

Note: To ensure accuracy, be sure the child has not anything hot or cold to drink for at least 15 minutes before taking the temperature.

Another Alternative
Although not as accurate, after your child is 3 months old, you can use the digital thermometer to check the axillary temperature (under the armpit). This may be a good option when you just need a ballpark idea of whether or not your child is getting sick. To check the axillary temperature, place the thermometer directly in the child's armpit and then hug his/her arm tightly against the thermometer. Hold in place for until it beeps (about one minute). Again, if your child has a fever, it is important to use either the rectal or oral method so you can accurately monitor his/her condition.

Even though there are other options available for checking your child's temperature (including ear thermometers), the AAP still recommends using a digital thermometer—it is the safest and most accurate method for home use.

Spinach for Kids

Spinach is a super food—it is low in calories; rich in antioxidants; high in iron, calcium, and folic acid; and a good source of vitamins A, C, E, K, B2, and B6 as well as magnesium, potassium, copper, protein, phosphorus, zinc, niacin, selenium, and omega-3 fatty acids.

But if your kids are like most I know, getting them to eat spinach is practically impossible. Adding spinach to juices is a fun and easy solution to incorporating spinach into your child’s diet without altering the taste of their favorite drinks (although it does turn the juice green). Add a handful of fresh spinach leaves to orange juice, apple juice, or any other 100-percent fruit juice and blend it in the blender. You can even put the nutrient-rich juice into your toddler’s sippy cup.

Another alternative for your kids (or for you busy parents) is to make a spinach and fruit smoothie. You can use whatever fruit you want in the smoothie, but I typically use frozen strawberries and blueberries, part of a banana, spinach, and orange juice. The result is a perfectly healthy treat for your family!

Expected Stages of Play Development

As parents and health care professionals it is important for us to know normal child growth and development and what to expect of children in each age group. Play is such an important aspect of normal development because it is how children learn about the world around them. As they play, children pass through three distinct stages of development:

• Exploratory Stage (0–1 years old): Infants look around, hold objects, put objects in mouth, and begin interacting with the world around them.
• Imitation Stage (1–7 years old): Children use toys to imitate adult activities, e.g., playing with dolls, cars, cooking sets, or toy tool sets.
• Games and Hobbies Stage (8–12 years old): Children start developing their own interests and become involved in organized activities.

Play is also critical for the development of social skills in children. Experts have identified four stages of social play development.

• Solitary Play (infancy): Babies play alone but do enjoy the presence of others. They are interested in playing with body parts, sucking on fingers and toes, and smiling and squealing,
• Parallel Play (toddler): Toddlers play alongside but not with each other. An example of this is a child coloring at the table while the child next to him is playing with a toy car.
• Associative Play (preschool): Children in this stage begin playing together but often with no group goal and no rigid rules or organization. They often participate in imitative play.
• Cooperative Play (school-age): By this time children have learned to organize themselves in play activities. They establish rules and learn to conform. Leader/follower relationships develop in this play phase.

Parents should encourage age-appropriate play activities for their children.

Oral Health

You may be surprised to learn that the most common chronic childhood disease is tooth decay. According to the Centers for Disease Control and Prevention (CDC), more than 40 percent of children have tooth decay by the time they reach kindergarten, making dental cavities five times more common than asthma and seven times more common than hay fever in children. Health care professionals know, however, that this is one disease that is very preventable. Here are some tips for giving your child a healthy, happy smile:

• Start with good oral care habits early—Even before your baby’s teeth come in you should start cleaning his/her gums twice a day using a clean, soft cloth. Good times to do this are after a morning feeding and before bedtime. When the child’s first teeth come in, you should continue cleaning with a cloth or use a baby’s toothbrush and water. All baby teeth should be in by age two, and around this time, you can begin to use a pea-size amount of fluoride toothpaste on the brush. Don’t start using toothpaste until your child is able to spit instead of swallow after brushing. All children should brush at least twice a day and floss once a day.
• Avoid sugar—Sugar reacts with bacteria in the mouth to form acid, which then causes tooth decay. Limiting the amount of sugar your children consume and feeding them fresh fruits and vegetables instead of cookies, candy, and soda is much healthier for their bodies and smiles!
• No bottles to bed—Milk, formula, juice, and other sweet drinks have sugar in them, and when a child sucks on a bottle filled with these liquids right before bedtime or a naptime, the liquid pools in the mouth and the sugars react and destroy the front teeth (known as baby bottle tooth decay or BBTD). If you do need to put your baby to bed with a bottle, fill it with water.
• Fluoride—Fluoride is a mineral that is beneficial to oral health because it actually strengthens tooth enamel and works to prevent tooth decay. Fluoride is found naturally in many foods and is added to drinking water in most cities and towns. Fluoride is also added to toothpaste (however, to avoid fluoride toxicity in young children, it is recommended children don’t use toothpaste with fluoride until they are old enough to spit it out after brushing).
• Regular dentist visits—Your child’s pediatrician should check your child’s general oral health at every visit. It is also important that you take your child to see the dentist regularly starting around the first birthday or six months after the first teeth come in.

Cold vs. Flu

When your child is sick, it is often hard to tell the difference between the cold and flu. Here are a few easy tips:

Influenza
• Sudden onset of fever, chills, sore throat, cough, runny nose
• Child may also have headache, muscle aches, tiredness, nausea, vomiting

Cold
• Stuffy nose, sneezing, scratchy throat, hoarse voice, dry cough
• Child may have slight fever
• Child generally keeps up with usual activities

More important than the symptoms is how your child is acting. Take your child to the pediatrician if he/she is not acting normally (e.g., is very sleepy, has little energy to play, is irritable and cannot be comforted, is having trouble breathing, or is not drinking). Any child younger than three months who has a temperature greater than 100.4 should see a pediatrician.

Preventing the Common Cold

It’s called the common cold for a reason. Within the first two years of life, your child will probably have between eight and ten of them. Although most colds are uncomplicated and go away by themselves in about a week, there are steps you can take to keep your family healthy, especially during the winter months.

• If you know someone is sick, keep your child away from that person.
• If your baby is under 3 months old, take special precaution to limit exposure to the cold virus. Because infants’ immune systems are not as well developed, a virus that causes mild illness in a child or adult can be much more serious for an infant.
• Teach your children to wash their hands frequently! Wash with soap and water or use an alcohol-based hand sanitizer. This really is the best way to prevent the spreading of infection.
• Try to keep your kids from touching their eyes, nose, and mouth. The membranes of these areas are the easiest place for germs to enter the body.
• If your child has a cold, teach him/her to cough or sneeze away from others and to use a tissue. (If they don’t have a tissue, they can use their upper sleeve or elbow.) If children use their hands to cover their mouth, they risk spreading the virus to every surface they proceed to touch—a toy, a sibling, etc.

Baby, It's Cold Outside

It’s wintertime, and it’s cold outside. What is the best way to protect your baby from those extreme temperatures?

As a general rule of thumb, your baby should be dressed in one more layer than you are wearing. That means if you are going out in jeans, a sweater, and a coat, your baby will need one additional layer either under or over those clothes to stay warm.

And when it’s really cold out, remember your baby needs a hat. I always thought it was just an old wives’ tale, but it is true that most of a person’s body heat is lost through the head!

A Forum for Educating Families

I love children, and I love being a nurse. There are many reasons why I love my job, but one thing that most people don't realize about pediatric nurses is that their job is to take care of not only children but also the whole family. When a child is sick, it is a crisis, and in that moment I love knowing that people are counting on me and that I have the expertise to help. There is nothing more rewarding than having parents say, "Thank you for taking care of my baby!"

As a nurse, however, it is not just our knowledge of what to do in a crisis that is important. The best thing we can do as medical professionals is educate parents on how to keep their children healthy and, hopefully, prevent illnesses or accidents from happening in the first place.

Our children don't come with an owner's manual, and when it comes down to it, most of us are pretty clueless when it comes to their health. That's why I wanted to start this blog. I wanted a place where parents could find simple explanations to important health issues and where they could ask and receive answers to their questions. Questions like, "My child has a temperature, should I take him to the doctor?" or "My child isn't crawling yet, should I be concerned?" or "How do I know if my child is eating enough?" or “What’s all this news about the swine flu and how can I protect my family?”

I will be posting on this site several times a week, addressing a wide range of issues including questions from followers. So don’t be shy, send any of your health questions to healthyhappychildren@gmail.com. All of the information provided is in alignment with the standards set forth by the American Academy of Pediatrics.

While I love my job in the ICU, my hope is that through this blog I will be able to help parents everywhere gain the knowledge and confidence needed to properly care for their children and keep them healthy and happy!