Advice

What is a fever?

While fevers can be scary, they are actually a good sign that your child's body is trying to fight an infection.  A fever is considered over 100.4F (38.0C).  It's important to make sure your child stays hydrated, and keep them comfortable by giving them either Tylenol or Motrin (Tylenol/Motrin dosing chart).  You can always call us if you have concerns about your child's fever.

We ask that you call us if:

• Your child acts sick even when the temperature is back to normal
• The fever persists for more than 24 hours in a child less than 2 years of age
• The fever persists for more than 3 days in a child over 2 years of age 

Please call us right away if your child:

• Looks very ill, is unusually sleepy or is very fussy (irritable)
• Has been in a very hot place
• Has symptoms of a stiff neck, headache, severe sore throat or ear pain, unexplained rash or severe vomiting or diarrhea
• Has signs of dehydration (dry mouth, cracked lips, no tears when crying, sunken eyes, sunken fontanel in babies, no wet diapers/urine)
• Has an immune deficiency, cancer, or is taking steroids
• Has had a seizure
• Is younger than 10 weeks (2.5 months)
• Is unimmunized

How to take your child's temperature

There are several ways to take your child's temperature if you are concerned he or she has a fever.  There is no right way, it depends on your comfort level and the comfort level and age of your child.   

• Rectally - considered the most accurate way of taking a temperature.  If your baby comes in for a sick visit under the age of 8 weeks, our medical assistants will check your baby's temperature rectally. 
• Orally - Generally performed in children older than 4 years of age.  Oral temperatures are typically one degree Farenheit lower than rectal temperatures. 
• Temporal artery (forehead) - can be used in infants and children 3 months and older.    
• Tympanic membrane (ear) - can be used in patients 6 months and older.  Too much ear wax can contribute to a false reading.   
• Axillary (underarm) - This is the least reliable way to take a temperature, but it's a good screening tool for a fever.  Axillary temperatures are also usually considered lower than a rectal temperature, but no standard conversion is available.

Important resources

Poison Control Center Hotline 1-800-222-1222

• Please keep this number handy (program it into your cell phone!) especially if you are a parent of young children.  It's very important to have all medications and cleaning supplies up and away from reach of small, curious hands or in a locked cupboard. 

Centers for Disease Control

• The CDC's website has information about many diseases, vaccines, and what precautions need to be taken with international travel.  

HealthyChildren.org

• This website is a wealth of information put out by the American Academy of Pediatrics (AAP) with advice and information about a wide range of topics related to the health and well-being of your child. 

American Academy of Pediatrics

• This website is dedicated to the health and well-being of infants, children, adolescents and young adults.  Check here for all the latest research and updates on what's new and important for your kids. 

LactMed

• A website from the National Institutes of Health with information about levels of medications that are excreted in breast milk and possible effects in the breastfeeding infant.  Alternatives are provided where appropriate. 

Consumer Product Safety Commission

• The Consumer Product Safety Commission's website contains all the latest consumer product recalls.  Visit frequently to ensure the products your child is using have not been recalled by their manufacturer or the federal government.

HealthyChildren.org Car Seat Safety Guide

• Check out this great guide for everything you need to know about car seats.

Choosing a Child Care Center

Choosing who will watch your children while you are at work can be a challenging and stressful decision.  Thankfully, HealthyChildren.org has come up with a list of questions and resources to help make that decision a bit easier.  Click here to find out more: https://healthychildren.org/English/family-life/work-and-child-care/Pages/choosing-a-child-care-center.aspx

Supplements

We at Pediatricenter get lots of questions about vitamins and supplements.  Supplements contain a “dietary ingredient” such as vitamins, minerals, herbs, amino acids, probiotics, enzymes, antioxidants or other nutrients.  The Food and Drug Administration (FDA) does not evaluate the safety, effectiveness or quality of dietary supplements or their ingredients, so there is no guarantee that the supplement contains what it claims.  However, some manufacturers voluntarily choose to undergo third party testing of their supplements to show their commitment to producing high quality products.  Examples of these include CL, NSF, USP or UL (so these initials on the label indicate this third party testing).  Most products certified by one of these third party companies have been tested for one or more of the following:

• The supplement contains what’s stated on the label and the amount listed
• Products are standardized from batch to batch
• The supplement is free of harmful levels of contaminants
• The product does not contain any undeclared ingredients

Athletes should look for products with the NSF Certified for Sport certification, which ensures the product is free of more than 270 substances that are banned from most major sport organizations.  The term “dietary supplement” should also be on the label, and the bottle should contain a dietary supplement facts panel that includes amounts of all dietary ingredients.  As always, if you have further questions, please do not hesitate to call the office!

Sleep

As pediatricians, it's our job to keep your child healthy and safe.  When newborns and infants are not placed in a proper sleep environment, they are at an increased risk for SIDS (Sudden Infant Death Syndrome).  The AAP recently updated their recommendations and developed new guidelines to help lower the risk of SIDS.  Please ask your pediatrician if you have any questions about the most current guidelines below.   

• Always place your baby on his or her back for every sleep time.
• Use a firm sleep surface.  Car seats and other sitting devices are not recommended for routine sleep.
• Breastfeeding, if not contraindicated, is recommended for at least the first 6 months of life. 
• It is recommended that infants sleep in the parents' room, close to the parents' bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first 6 months (room-sharing but not bed-sharing).
• Keep soft objects and loose bedding out of the infant's sleep area.  This includes pillows, stuffed animals, blankets, and bumper pads.
• Consider offering a pacifier at nap time and bedtime.
• Avoid smoke exposure, alcohol and illicit drug use during pregnancy and after birth.
• Avoid overheating and head covering in infants.
• Pregnant women should receive regular prenatal care.
• Infants should receive all recommended vaccinations.
• Avoid the use of commercial devices that are inconsistent with safe sleep recommendations.  These include infant positioners and wedges.
• Avoid the use home monitors or commercial devices marketed to reduce the risk of SIDS.
• Supervised, awake tummy time is recommended daily to facilitate development and minimize the occurrence of positional plagiocephaly (flat heads).

In addition to making sure your baby is safely sleeping at night, it's equally important as he or she grows to make sure your child is getting enough sleep.  Adequate sleep is incredibly important for your child.  Insufficient sleep is associated with behavior issues, poor school performance, and obesity, among others.  Here is a summary of how much sleep your child needs depending on age:

• Newborns: 16-18 hours
• Toddlers/Preschool-aged children: 11-12 hours
• School-aged children: At least 10 hours
• Teenagers: 9-10 hours 
• Adults: 7-8 hours

It's important to create a good sleep environment for your child, and start early.  Bedtime routines can start as early as infancy, with the same routine every night (ex: bath, bedtime story, same song every night, etc). Good sleep hygiene habits are also an important part of making sure your child gets a good night's sleep.  These include:

• Getting to bed around the same time each night, and getting up around the same time every morning 
• Sleeping in a dark, cool environment
• Remove all TVs, computers, and other electronic equipment in the room.  Your child's bed should only be for sleep, not for other activities (reading, watching TV, listening to music, etc)  

Screen Time Recommendations

Our kids are growing with a constant presence of electronics, and as a parent it's hard to know how much is too much.  Research has shown that excessive use of electronics can lead to obesity, sleep disturbances, and can negatively impact a child's development.  No matter what age, media use is best if it is shared with a parent, as studies have shown there is more benefit to your child if there is interaction and discussion about what they are seeing and hearing. 

Here are some guidelines from the latest policy statement on media use from the AAP for younger children: 

• Avoid digital media use (except video-chatting) in children younger than 18 to 24 months.
• For children ages 18 to 24 months of age choose high-quality programming and use media together with your child. Avoid solo media use in this age group.
• Do not feel pressured to introduce technology early; interfaces are so intuitive that children will figure them out quickly once they start using them at home or in school.
• For children 2 to 5 years of age, limit screen use to 1 hour per day of high-quality programming, co-view with your children, help children understand what they are seeing, and help them apply what they learn to the world around them.
• Avoid fast-paced programs (young children do not understand them as well), apps with lots of distracting content, and any violent content.
• Turn off televisions and other devices when not in use.
• Avoid using media as the only way to calm your child. Although there are intermittent times (ex: medical procedures, airplane flights) when media is useful as a soothing strategy, there is concern that using media as strategy to calm could lead to problems with limit setting or the inability of children to develop their own emotion regulation.
• Monitor children's media content and what apps are used or downloaded. Test apps before the child uses them, play together, and ask the child what he or she thinks about the app.
• Keep bedrooms, mealtimes, and parent-child playtimes screen free for children and parents. Parents can set a "do not disturb" option on their phones during these times
• No screens 1 hour before bedtime, and remove devices from bedrooms before bed.

To see if your child or teen is ready for a cell phone, take this quick 10 minute survey developed by AT&T and the AAP: https://screenready.att.com/digital-parenting/

Consult the American Academy of Pediatrics Family Media Use Plan, available at: healthychildren.org/mediauseplan.

Here are some guidelines from the latest policy statement on media use from the AAP for older children and adolescents: 

• Develop, consistently follow, and routinely revisit a Family Media Use plan (see the plan from the American Academy of Pediatrics at healthychildren.org/mediauseplan).
• Address what type of and how much media are used and what media behaviors are appropriate for each child or teenager, and for parents. Place consistent limits on hours per day of media use as well as types of media used.
• Promote that children and adolescents get the recommended amount of daily physical activity (1 hour) and adequate sleep (8-12 hours, depending on age).
• Recommend that children not sleep with devices in their bedrooms, including TVs, computers, and smartphones. Avoid exposure to devices or screens for 1 hour before bedtime.
• Discourage entertainment media while doing homework.
• Designate media-free times together (ex: family dinner) and media-free locations (ex: bedrooms) in homes. Promote activities that are likely to facilitate development and health, including positive parenting activities, such as reading, teaching, talking, and playing together.
• Communicate guidelines to other caregivers, such as babysitters or grandparents, so that media rules are followed consistently.
• Engage in selecting and co-viewing media with your child, through which your child can use media to learn and be creative, and share these experiences with your family and your community.
• Have ongoing communication with children about online citizenship and safety, including treating others with respect online and offline, avoiding cyberbullying and sexting, being wary of online solicitation, and avoiding communications that can compromise personal privacy and safety.
• Actively develop a network of trusted adults (eg, aunts, uncles, coaches, etc) who can engage with children through social media and to whom children can turn when they encounter challenges.