VOMITING
Under 1 Year Old
If breastfeeding, continue to breastfeed, but offer smaller amounts more frequently; for example, nurse on only one side every 1-2 hours, or nurse for 5 minutes very 30-60min. If bottle feeding try small feedings of half-strength formula.

If your child continues to vomit, offer electrolyte solution (Pedialyte or various brands). Give small amounts every 5-10 minutes (try ½ ounce at a time; you may need to give as little as one teaspoon at a time). Using a timer will help you to remember. Although your child may be very thirsty, it is very important to offer small sips only! Larger amounts may lead to more vomiting.

Once your child is tolerating electrolyte solution for a few hours, you may slowly return to breastfeeding or formula as tolerated. Infants on solid foods that are tolerating breastfeeding or formula very well may restart bland foods such as rice cereal, strained bananas, etc. If your child can eat these foods without vomiting, a normal diet is okay in 24hrs.

Over 1 Year Old
Give small sips of clear liquids-electrolyte solution is best, but may also use gingerale, lemon-lime soda, or Gatorade. Avoid drinks with caffeine. Although your child may be very thirsty, it is very important to offer small sips only! Larger amounts may lead to more vomiting.

If tolerating small sips of clear liquids, you may offer bland foods such as saltine crackers, rice, etc. If your child can eat these foods without vomiting, a normal diet is okay in 24hrs.

Please call the office IMMEDIATELY for:

• Signs of dehydration-no urine for 8 hours in infants, 10-12 hours in older children; dry mouth, no tears,
  sunken eyes, acting lethargic or weak
• Vomiting green fluid (bile)
• Vomiting with painful or swollen abdomen

DIARRHEA
Under 1 Year Old
Continue breastfeeding or formula, but offer more frequently than usual. If stools are very frequent (>10 per day), continue breastfeeding or For infants on solids, continue feeding. Foods such as rice cereal, apple sauce, and strained bananas are best. Do not give juices; they may make the diarrhea worse.

Over 1 Year Old
Give lots of extra fluids-electrolye solution (Pedialyte) or milk are best. Avoid juices as they may make the diarrhea worse. Continue regular diet but starchy foods are best ( rice, bananas, bread, crackers, etc.)

Please call the office IMMEDIATELY for:

• Signs of dehydration-no urine for 8 hours in infants, 10-12 hours in older children; dry mouth, no tears, sunken eyes,
  acting lethargic or weak.

Please call during REGULAR HOURS for:

• Diarrhea with blood in it or diarrhea or fever.
• Over 101degrees for more than 3 days.

CONSTIPATION
Constipation means passing infrequent hard stools. Some children (esp. infants) may only have a bowel movement every few days but as long as the bowels are soft, there’s no need to worry or do anything. If bowels are hard, the following are things you can do to try to help:

Under 1 month old
Please call the office for an appointment

1-3 months old
Buy dark Karo syrup in any supermarket. Stir 1 tablespoon of Karo syrup into 2 ounces of water, breastmilk, or formula; give to the baby daily or every other day as needed. Mix prune juice with an equal amount of water; start with 2 ounces a day and increase gradually as needed (rapid increases may cause excessive gas).
AVOID rice cereal (use barley or oatmeal cereal instead), bananas, potatoes/sweet potatoes.
ENCOURAGE prunes, peaches, pears, squash, green beans, peas, Cheerios.

Toddlers/Young Children
AVOID too much milk (no more than 12-20 ounces per day), cheese, rice, white bread, bananas, potatoes.
ENCOURAGE high-fiber cereals, whole grain breads, fruits (except bananas), and vegetables.

Please call the office IMMEDIATELY for:

• Constipation associated with SEVERE abdominal pain.

Please call during REGULAR HOURS for:

• Constipation that doesn’t respond to the above measures.

FEVER
Fever is a body temp. above 100.4 degrees rectal. (Temp. measured orally or axillary will be about ½ to 1 degree lower than rectal temps.) Fever is the body’s normal response to infection or illness. It is sign of the body trying to fight off the illness. Fever is a good thing; it helps us recover from colds, flu and other illnesses faster. Fever does NOT lead to brain damage. Fever does NOT always need to be treated with medicine. However, if your child has a fever and feels miserable, isn’t drinking fluids well, fever medicines may help; at least for a few hours.

When Should I See the Dr. About My Child’s Fever?

Age: Any infant under 3 months should be seen for any temperature of 100.4 degrees or higher. For a child between 3 & 6 months, call the office for any fever of 101degrees or higher.
Associated Symptoms: If a child over 6 months has a fever and clearly has a cold or flu (runny nose, mild cough, body aches), is drinking fluids well, and doesn’t appear terribly ill, there is no need to rush to our office. However, if there is a fever without a clear reason, or the child is not drinking fluids well, you should contact our office.
Duration of Fever: Most fevers associated with colds, flu, and other viruses will resolve themselves in 2-5 days. If a fever last longer than 3 days, call our office.

Please call the office IMMEDIATELY for:

• Any fever of 100.4 degrees in a baby 3months or younger.

Please call during REGULAR HOURS for:

• Fever of 101degrees or higher >3 months old or fever that lasts more than 3 days.

COLDS
Colds are caused by viruses. Children catch more colds than adults because they are still building up their immune system. The average toddler will have 6 to 10 colds a year, mostly in the fall and winter, so they may seem to have a non-stop cold for months! Remember, colds are generally not dangerous and some simple home remedies will get your child through most of their colds.

Symptoms of a cold
Fever: There will often be a fever during the first 2 or 3 days.
Runny or Stuffy Nose: Runny or stuffy nose typically lasts 1 to 2 weeks. The mucus usually starts out clear then turns green or yellow as the cold progresses. Green or yellow mucus is a normal part of a cold and does not mean the child needs antibiotics.
Cough: Coughing is part of most colds and can often last for 3-4 weeks, even after the rest of the cold symptoms are gone.

Treatments for Colds:
Fluids: Give lots of fluids to drink to thin out mucus and avoid dehydration.
Acetaminophen (Tylenol) or Ibuprofen: (Advil). These medicines can relieve aches and pains and reduce fever.
Vaporizer: Run a cool mist humidifier in the child’s room.
Steam Treatments: Turn on the hot shower to steam up the bathroom; sit in the steamy bathroom with your child for 10-15min.
Saline Nose Drops: You can buy saline nose drops in any drug store. Place 1-2 drops in each nostril and use a bulb syringe to remove the mucus or have the child blow his/her nose.

Please call the office IMMEDIATELY for:

• Trouble Breathing

Please call during REGULAR HOURS for:

• Cold with an earache, runny nose more than 2 weeks or cough more than 4 weeks.

NON-EMERGENT QUESTIONS

If you have a general, non-emergent question for our nursing staff, please feel free to email them your question with a phone number for them to call you back with an answer. Please allow at least 1-2 business days to get back to you via phone.

If you are a Silver Spring patient, please email the patient’s name, telephone number, date of birth and question(s) to: nurseSS@childrenfirstpediatrics.com

If you are a Rockville patient, please email the patient’s name, telephone number, date of birth and question(s) to: nurseRV@childrenfirstpediatrics.com

We ask that you email the appropriate office for which you schedule your appointments in order for the nursing staff to have access to the patient’s chart when answering the question. This will allow the staff to answer your question in a more timely manner.

Thanks!