On Call 24/7: 518-439-CARE (2273) 1220 New Scotland Rd. Suite 203, Slingerlands, NY 12159
Office Hours: Monday – Friday 8:30 A.M. to 5:00 P.M.      Saturday 9:30 A.M. to 12:00 P.M., resuming January      Sunday Hours Coming Soon

Medical Information
delmarpediatricspllc / Medical Information
Contact Information
Office Hours
  • Monday – Friday 8:30 A.M. to 5:00 P.M.

  • Saturday 9:30 A.M. to 12:00 P.M., resuming January

  • Sunday hours coming soon

Medical Information

+ Congratulations on your new arrival! You are about to begin one of life's great adventures, watching your infant grow and develop into a strong and healthy child.

+ Your child is an individual from the day he or she is born. We will be happy to give you guidance and answer your questions while you are in the hospital and later by phone and during your visits.




Breast Feeding:

The breast first produces colostrum, a yellow, watery fluid, rich in antibodies that protect against infectious diseases to which the mother has been exposed. Feeding every two to three hours stimulates abundant milk production by the third or fourth day. After Caesarean birth, this will take a few days longer.

Normally, babies feed fully in 30 minutes and can then go two hours before feedings. When breast-feeding, alternate which breast is offered first. Let your baby empty one breast before going to the other. A rigid schedule will not be necessary. Your baby will teach you his or her needs.

Continue your prenatal vitamins during breast-feeding, but consult us before taking any other medicines. Drink plenty of fluids. Eat any foods that do not seem to disagree with your baby.




Formula-Feeding:


Use only an iron-fortified formula. Premixed, concentrated, or powdered formulas are all equal in nutritional content.

Bottles prepared with formula mixed with tap water do not need to be sterilized. Well-water is discouraged for use in infant feeding. Most infants average an intake of two or more ounces per pound of body weight per day after the first week. After the first month, most babies take 24 ounces per day.


Weight:

Before establishing normal weight gain (usually one ounce per day in the first few months), some babies will lose a small percentage of their birth weight in the first few postnatal days. After a week, however, the birth weight is usually regained.




Vitamin D:

Your infant should begin taking 1 ml/day of vitamin D by the time he or she is two weeks old. Vitamin D is available without a prescription as D-vi-sol, Tri-vi-sol or Poly-vi-sol.




Newborn Screening:

New York State requires that a blood specimen from your infant be obtained before his or her discharge and sent to special labs to screen for disease. We receive prompt reports of any abnormality and will tell you immediately of any concerns about your baby.




Jaundice:

Some infants will look yellow during the first few days of life. This color change is called “jaundice”. We will explain the significance if it occurs. Usually, no intervention is necessary.




Umbilical-Cord Care:

The cord remaining after delivery will dry up and fall off within four weeks. Purple antiseptic dye applied in the nursery may stain the adjacent abdomen, causing it to look “bruised”. It is not. Keep the cord clean and dry. When it falls off, you may see a small amount of blood. You may basin-bathe your baby after the cord falls off.




Circumcision:

If you choose to have the procedure, an obstetrician can perform it in the hospital upon your consent. Keep the circumcised penis clean, applying an ointment to the site daily until it is healed, usually within one week.




Newborn Activities:

Infants may sleep up to 18 hours per day. This is normal. They also normally sneeze, burp, spit up, and startle after sudden movements or loud noises. They also cry. You will quickly learn what your baby is trying to tell you.




Going Out:

Avoid exposing your newborn to people who may be ill. Do not take your baby to crowded indoor environments and do not allow anyone who is sick to visit during the first two months, to reduce your infant’s exposure to disease.




Fever Under Three Months of Age:

If your baby has a rectal temperature over 100 degrees, call us immediately! Contact us before giving any fever-reducing medicine. An infant under three months of age who has a fever is presumed to have a possible serious infection and should be evaluated promptly.




Other Significant Signs:

Any change in normal activity such as: poor feeding, energy or sleep changes, increased irritability, decreased urination—if you are concerned, call us.




Immunizations:

The schedule for immunizations in childhood is made by the Center for Disease Control, and approved by the American Academy of Pediatrics. New vaccines replace old ones or are added as research and development creates a host of new protections against childhood and adult diseases. We adhere to this schedule. Vaccines save lives and prevent serious disease. The first one, against Hepatitis B, will be administered before your infant is discharged from the newborn nursery.




Clothing and Thermostat: Dress your infant in the same number of layers of clothing as you wear. A hat helps to keep your baby warm. Any temperature from 66 to 72 degrees is satisfactory for your home. Use a humidifier in the winter to keep things more comfortable as well.



Odd & Ends:

Nursing babies get sucking blisters on their lips that peel off and recur. This is normal.

Facial rashes resembling acne come and go and are normal. Greasy, scaling rashes on the scalp, forehead, or behind the ears are common. Red, pimply diaper-area rashes or white, patchy areas inside the mouth are not normal and need to be treated.

Breasts and genitals of newborn infants are commonly swollen from the effects of maternal hormones. This will subside. Both boys and girls may secrete milk from the swollen breasts. This is not a concern. Bloody mucoid vaginal discharge in female infants is also a normal finding.

Spitting up is a common event. Large regurgitated volumes should be reported. If you think your baby is not tolerating feedings, call us for advice before making any changes. You may file baby’s fingernails if long nails are scratching your baby’s face.




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Childhood development is a continuous process. Not all normally-developing children will demonstrate all of the following milestones at the stated ages. For children who have not achieved milestones, it is important to determine if progress is being made and to assess all areas of development: verbal-social, fine motor and gross motor. We routinely assess development at all well-visits and will discuss your child’s development with you at those visits as well as at other visits should concerns arise. Please notify our office if you are concerned about your child’s development.

The following milestones are typical emerging milestones for children of the ages noted. Children are expected to also demonstrate the milestones of younger children.

One Month

+ Babies can see close large objects and track movements from up to twenty feet. They are drawn to bright lights and contrasting black and white objects (like vertical blinds). They can not discriminate colors. They now smile and coo and can better control head movements but still need head and neck support when being held.

Two Months

+ Babies can see more detail. They track well, smile responsively and coo. Neck control is improving. Babies can lift and turn their heads from a stomach-lying position. They can tolerate “tummy time” better but should still sleep on their backs.
Four Months

+ Four month olds are more social. They will coo and laugh and smile. They reach for objects and bring them to their mouths. They roll over partly. From a stomach-lying position, babies can arch their backs.

Six Months

+ Babies explore making sounds. They make high and low-pitched sounds, make “raspberries,” and babble conversationally. They have nearly mastered rolling in both directions. They can lift their chests from a surface and extend their arms fully. They bring objects to the middle of their bodies and transfer items between hands. They notice their feet and bring them to their mouths. They can sit for a few seconds and may put their arms out to catch themselves when falling from a seated position.

Nine Months

+ Nine month olds babble in multi-syllables (da-da-da-da, ba-ba-ba-ba…). They laugh when you play peek-a-boo with them. They throw things from highchairs for you to pick up so they can be thrown again. They respond to their names and know familiar people. They may become anxious around strangers and when separated from caregivers. They easily sit without support and may crawl. They can pick up small items using their first finger and thumb in a “pincer grasp.” They finger feed and can hold and use a bottle or sippy cup.

One Year

+ One year olds have one-word vocabularies. They point to items of interest and look at items to which you point. They show others items they are excited by to engage people and view their responses. They wave hands and shake their heads sideways to indicate “no.” They pull to a standing position, walk holding onto stationary objects or hands, and stand (and may walk) unsupported. They finger feed and drink messily from a cup. (They may still choose to drink from bottles.) They put items in and take items out of containers.

Fifteen Months

+ These children speak three to ten words. They may follow simple instructions. They know some body parts. They can turn pages in board books, arrange two to three items horizontally (in a train), put rings on a cone and manipulate “shape sorting” toys. They can scribble and use utensils purposely (often messily). They can “help” brush their teeth. They may run and climb stairs and chairs.

Eighteen Months

+ Children use six to twenty words. They understand more than they can express and may get easily frustrated. Children at this age may bite and hit. They can eat with utensils more neatly and stack three or more items vertically. They begin to pretend play.

Two Years

+ Two year olds use fifty words, half of which are understandable, and combine two words to make sentences. They play next to other children, mimicking their actions. They jump, throw and kick balls. They try to catch balls. They can draw lines. They can assist with dressing and undressing and may be aware of when they need to pass urine and stool. They exhibit make believe play. Two year olds may follow two step directions, but are also becoming more independent and defiant.

Thirty Months

+ These children have a vocabulary of one hundred words, two-thirds of which are understandable, and speak in two to three word sentences. They engage other children in play and play with them. They may scribble circles and jump from chairs.

Three Years

+ Three year olds have a vocabulary of three hundred words, three-quarters of which are understandable, and speak in long sentences. They can say their names. They play creatively and point to items in books. They memorize favorite books and can make up their own stories to explain what a picture shows. They understand sharing, but may not choose to share, and can take turns in a game. They can draw a closed circle and build simple puzzles with a few pieces. They can stand on one foot for three seconds, pedal a tricycle, and walk up and down steps with one foot on each step.

Four Years

+ Four year olds have too many words to count, ninety percent of which are understandable. They tell long stories. They draw squares and crosses/ “x’s.” They can use scissors and ride bikes with training wheels.

Five Years

+ Five year olds are fully understandable (although articulation may not be fully mastered) when they choose to be understood. They draw triangles, people with multiple body parts and stick limbs, and write letters of their names. They can swing and balance better on a bike. They may enjoy singing, acting and dancing.

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Preventing disease is the greatest accomplishment of modern medical care. Pediatricians have always been the most active practitioners in this area.

VACCINATING YOUR CHILD PROMPTLY IS THE SINGLE BEST THING THAT A PARENT CAN DO TO INSURE THEIR CHILD'S GOOD HEALTH!

If you have questions about the risks and benefits of vaccines, contact us at 518 439-CARE (2273).


Birth - HEP - B
One Month - HEP - B
Two Months - PENTACEL (DtaP, IPV/Hib), RotaTeq, Prevnar
Four Months - PENTACEL (DtaP, IPV/Hib), RotaTeq, Prevnar
Six Months - PENTACEL (DtaP, IPV/Hib), RotaTeq, Prevnar
Nine Months - HEP - B
One Year - Prevnar, MMR
Fifteen Months - HIB, Varivax
Eighteen Months - HIB, DtaP, HEP A
Two Years
Two 1/2 Years / 30 Months - HEP A
Four Years - IPV, DtaP
Five Years - MMR, Varivax
Ten Years - Adacel
Eleven Years - Gardasil, Menactra
Twelve Years - Gardasil
Fifteen Years - Adacel
Sixteen Years - Menactra, Meningococcal B
Twenty Years - Adacel

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Adacel vaccine is a tetanus and pertussis booster, given after completion of the primary series.

Covid 19 is a more recent infection which caused a pandemic beginning in 2019. Available vaccines stimulate very high levels of protective antibody in vaccinated individuals and reduce serious disease and death.

DTaP is a combination against Diphtheria, Tetanus (Lockjaw) and Pertussis (Whooping Cough). Diphtheria causes significant inflammation in the respiratory tract and can cause heart inflammation and injury to the nervous system. This can be fatal.

Gardasil is a vaccine that protects against strains of HPV, Human Papillomavirus. HPV is an oncogenic virus, a virus that can cause cancer later in life. Forty strains of HPV are spread by sexual contact. HPV is now the most common sexually transmitted infection, with 20 million people infected in the United States and six million new infections occurring per year. Four of these strains cause the majority of genital warts and cancers of the throat, cervix, vagina, vulva, penis and anus. Vaccination can protect against infections from those strains, and is recommended for boys and girls as young as age nine. Vaccination can prevent 8,000 cases of cervical cancer and 4,000 cases of anal cancer per year alone.

Hepatitis A ​is a liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread ingesting contaminated food.

Hepatitis B is a disease spread by blood, body fluids, vaginal secretion, semen and is found even in saliva and tears. People who get Hepatitis B run the risk of cancer and chronic liver disease. The risk of death for disease acquired in early childhood is 25% with 90% of infants acquiring the disease before 1yr of age becoming chronically infected.

HIB stands for Hemophilus Influenza type B (not a flu bug, just a similar name). It is a serious invasive disease which can cause otitis media, sinusitis, pneumonia and meningitis. It was the leading cause of meningitis related brain damage and cognitive disability before the vaccine was used.

Influenza vaccine protects against “the flu”. Vaccines protect against the 3 or 4 strains that are expected to cause the most illness in any particular year. Flu vaccines are given yearly.

IPV is Polio vaccine made from dead polio virus which is injected. There is NO risk of acquiring Polio from this vaccine. Its use has replaced the oral vaccine which was live and carried a rare possibility of causing disease. Unfortunately, polio remains a cause of paralysis in many parts of the world.

Measles is an acute illness with temperature over 101 degrees, cough, runny nose, pink eye and a red blotchy rash. Complications include ear infections, pneumonia, upper airway inflammation, and diarrhea, especially in young children. Acute brain inflammation which frequently causes permanent brain damage, occurs in one of every thousand cases. Death due to respiratory and neurologic complications occurs in one to three of every one thousand cases reported in the United States.

Menactra & Meningococcal B Meningococcal disease is a serious illness caused by a type of bacteria called Neisseria meningitidis. lt can lead to meningitis (infection of the lining of the brain and spinal cord) and infections of the blood. Meningococcal disease often occurs without warning-even among people who are otherwise healthy. Meningococcal disease can spread from person to person through close contact (coughing or kissing) or lengthy contact, especially among people living in the same household. There are at least 12 types of N. meningitidis, called 'serogroups." Serogroups A, B, C, W, and Y cause most meningococcal disease. Anyone can get meningococcal disease but certain people are at increased risk, including:

• Infants younger than one year old

• Adolescents and young adults 16 through 23 years old

• People with certain medical conditions that affect the immune system

• People at risk because of an outbreak in their community

MMR Measles, Mumps and Rubella.


Mumps this disease causes swelling of the parotid salivary glands located at the angle of the jaw in front of the ears. Complications are rare. However, after puberty this disease can cause swelling of the testicles.


Pertussis is a disease that can become severe with a characteristic whooping type of cough which leaves the child exhausted. The cough can last for as long as ten weeks. Complications in infants and young children can include seizure, pneumonia, encephalopathy and death. Older children, adolescents and adults will generally only suffer from severe and protracted cough and the pain and sleep disruption that can result from it, but they may still infect susceptible infants.


Prevnar is a vaccine against many types of pneumoccal bacteria which cause infections of the upper respiratory tract and lungs. Pneumoccus is the most frequent cause of middle ear infections. It is also responsible for sinusitis, pneumonia and meningitis in infants and young children.


RotaTeq prevents development of rotavirus infection. Rotavirus is the most common cause of diarrhea and dehydration in infants and children; it remains a common cause of hospital admissions in young children.


Rubella The danger of this otherwise mild disease is to the fetus of pregnant women who contract the disease in the first three months of their pregnancy. The eyes, heart and brain are common organs affected by this infection. Infected infants often have stunted growth and can have blood disorders as well. If contracted later in childhood, Rubella is a mild illness with rash and swollen glands.


Tetanus is a neurologic disease which causes the inability to open the mouth due to an extreme spasm of the jaw muscles. Onset is gradual over a week and the disease subsides in a period of weeks for those who survive. Newborns can contract this disease through contamination of the umbilicus or because their mother is not vaccinated. This is rare in the United States due to the success of the vaccination program.


Varivax ​ protects against chickenpox. Although infrequent, the liver, brain and kidney can be damaged in this disease.



For Vaccine Information:

+ Children’s Hospital of Philadelphia

+ Vaccines for your Children

+ Vaccine Awareness and Research (CVAR)



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Infectious diseases are common problems in every family’s life. Antibiotics are used to treat bacterial infections. Here are some common infections we see.

Conjunctivitis (Pink Eye) is when the eye is red and has discharge. There are many different causes of pink eyes. Traumatic conjunctivitis follows trauma to the eye and tends to be painful. Allergic conjunctivitis is from pollens or other allergens causing a very itchy eye. Viral conjunctivitis is caused from viruses and tends to give a clear discharge. Viral conjunctivitis can be treated with a warm washcloth. Bacterial conjunctivitis usually gives a yellow-green discharge which will re-accumulate shortly after being wiped away. Only bacterial and some traumatic infections need to be treated with topical antibiotics.


Coxsackie Virus is a very common virus that effects the mouth and throat. Often children will present with fever, drooling and pain with swallowing. Children will often have blisters on their hands and feet, and small white ulcerations usually on the soft palate of the mouth (the back roof of the mouth). Hence the other name for this disease is Hand, Foot, Mouth disease. It is caused by a virus and antibiotics will not treat Coxsackie virus. Treatment is symptomatic. Treat pain with ibuprofen or acetaminophen and encourage fluids.

Ear Infections or Otitis Media are often secondary to upper respiratory infections. The fluid in the middle ear from the URI can become infected with bacteria. Often the symptoms of this will include ear pain, fever, waking at night and occasionally ear discharge. If your child has these symptoms, treat liberally with ibuprofen or acetaminophen and call us for an appointment.

Lyme Disease is a bacterial illness caused by the bite of an infected deer tick. If you find a tick in the skin, place some antibiotic ointment on the area and call our office the next day and we would gladly assist you in removal. If you believe the tick to be a deer tick, then you should monitor your child over the next three weeks for flu-like symptoms or a target-like rash. If your child does develop these symptoms, call our office during regular office hours and we will make an appointment. We will discuss obtaining labs. Keep in mind it is often beneficial to wait and get labs later because the body needs to develop an immune response for the lab result to be accurate. If necessary, we will start antibiotics at that time. Lyme is very easily treatable with the correct antibiotics.

Sinusitis is an infection in the sinuses. Often a cold can mimic some of the symptoms of sinusitis. Symptoms to watch for include facial or dental pain, headache behind the eyes and chronic runny nose lasting greater than 10-14 days. Please call for an appointment if you develop these symptoms.

Streptococcal Pharyngitits (Strep Throat) is a bacterial infection of the throat, usually affecting the tonsils. The most common symptoms are high fever, headache, sore throat, and belly ache. Sometimes you may notice white patches or exudates on the tonsils. Initial treatment includes ibuprofen, acetaminophen and fluids. Please call our office to be seen, tested and placed on antibiotics.

Upper Respiratory Infections (URI, Common Cold) are caused by viruses that infect the respiratory tract. They enter via the eyes, nose or mouth. They can cause viral conjunctivitis, sore throat, headaches and fever. Most of these symptoms last about 3-5 days. The virus will then work its way into the lungs and cause cough. The cough can last from 5-10 days. As these infections are viral, antibiotics are of no use. Symptomatic treatment is with ibuprofen or acetaminophen, cough and cold preparations. If fever is high, lasts greater than 5 days, or if your child appears very ill or dehydrated, she should be seen.

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Common Allergies:

The most common allergens are foods (nuts, milk, soy, egg, shellfish), seasonal environmental factors (pollen, trees, grasses), dust, pet dander and saliva, and medicines. Allergens cause histamine release resulting in flushing of the skin, eyes and nose. In the skin, this results in hives: raised areas surrounded by reddened skin that frequently itches. Hives can be treated with over-the-counter products: diphenhydramine (Benadryl) and oral antihistamines including cetirizine (Zyrtec) and loratadine (Claritin). Bathing with colloidal oatmeal soap and applying topical calamine, Benadryl and/or hydrocortisone can also help. In the nose and eyes, histamine causes swelling, redness, clear runny discharge and itch. Nasal sprays and eye drops can be used in addition to oral antihistamines if needed to control symptoms.

+ Medicine Dosing Sheet (pdf) Download

Food allergies require avoidance of the food. Testing and consultation with an allergist is often helpful to properly identify the food so that it can be avoided. It is important is the identity related foods that should be avoided or ingested with caution and those that are safe to consume. Environmental allergies do not have to be treated if they are mild and do not cause distress. Therefore, identification of the specific cause is not always relevant. Treatment for seasonal allergies is generally limited to the allergy season. Pollen, grass and tree allergies are worse in the Spring and Fall. Dust allergy can be controlled by reducing dust-trapping surfaces like carpets and drapes. Hard flooring surfaces are best. Floor coverings should be frequently vacuumed using a HEPA filtering vacuum. Pillows and blankets should be covered with allergen covers (generally plastic or tightly woven fibers) and bedding should be washed frequently. If pets are the culprit, they should initially be kept out of the allergy sufferer’s room.


Anaphylaxis:

A serious allergic reaction involving multiple organ systems is called anaphylaxis. The skin and respiratory, gastrointestinal, and nervous systems may all be involved. Symptoms include at least two of the following: hives, wheezing, shortness of breath, significant sudden vomiting and diarrhea, confusion, and reduced alertness levels. Anaphylaxis generally occurs within fifteen minutes of exposure and rarely occurs later than two hours after an exposure. ven if symptoms seem mild, anaphylaxis should be taken seriously, as it can become life-threatening.

The general rule is that reactions that only cause hives will only result in hives with future exposure and allergens that cause anaphylaxis the first time will always cause anaphylaxis. The important exception to this rule is peanut. Peanut ingestion may initially cause hives but with subsequent exposure result in anaphylaxis. For this reason, anyone with a peanut allergy should carry epinephrine, even if their reaction has never caused anaphylaxis.


Epinephrine:

Epinephrine is unstable in very hot and cold temperatures, so this medicine should never be left in car glove compartments and other areas subject to marked temperature shifts. If anaphylaxis occurs, administer epinephrine if it is available and call emergency services (9-1-1). If epinephrine is not available, immediately call 9-1-1. Repeat doses of epinephrine may be needed in anaphylaxis, so anyone needing epinephrine should be observed in an emergency setting for at least four hours.

Asthma refers to the reversible narrowing of the lower airway, from muscle constriction and inflammation caused by triggers, most commonly viral infections, weather changes, allergies and exercise. Symptoms of asthma include wheezing, shortness of breath, chest tightness and nighttime cough. Acute symptoms and signs are reversible with bronchodilator (rescue) medication. Frequent symptoms indicate poorly controlled asthma and require daily preventative medications (controllers).

Bug Spray:

Bug sprays are approved for use on those aged six months and older. The most common options are lemon/eucalyptus oils, picaridin and DEET. The American Academy of Pediatrics recommends only using products with a maximum of 10% picaridin or 30% DEET. Products can be applied directly to skin or clothing. Treated skin should be washed once indoors and treated clothing removed and washed before re-wearing.

Sunscreens:

Sunscreen can be used for infants six months old and older. Use products with SPF ratings of 30 or more that protect against UVA and UVB rays.

There are two categories of sunscreen - barriers and chemicals. Barriers (zinc oxide and titanium dioxide) coat the skin and limit penetration of the sun's rays. Barriers are not absorbed by the skin and are considered the safer choice. Chemical sunscreens, on the other hand, are absorbed by the skin. Many companies sell products that are barrier-only, chemical-only and combination products. We recommend barrier products.

Sunscreen should be applied fifteen minutes before sun going into the sun and reapplied every two hours, or sooner on wet skin. Be cautious when using spray sunscreens around the face, as they can irritate the eyes, nose, mouth and airway. Spray sunscreens can also provide uneven protection, so they should be rubbed into the skin after applying.

Diaper rashes are very common. Urine and stool acids can break down the skin and cause erosion that may bleed and cause pain. Irritant diaper rashes generally affect only the skin covered by the diaper. Treatment with a zinc-containing product will treat the rash. If babies are prone to diaper rashes, once the skin is healed, barriers (petroleum jelly, lanolin and Aquaphor) can be applied to insulate the skin from acid exposure.

Yeast or fungal infections are also common in infants. These rashes are identified by their intense red color and the presence of “satellite” spots, red bumps that spread away from the irritated skin. These rashes are treated with over-the-counter creams (clotrimazole and mycostatin), which are applied twice a day until the rash resolves and then for three additional days. At all other diaper changes, apply a zinc containing product.

Diaper rashes can also be due to bacterial infections, though this is less common than the other types. A bacterial diaper rash will cause multiple erosive areas that bleed, usually with the skin between them appearing to be normal. Apply topical antibiotic cream or ointment four times a day.

For most people, eczema is dry, scaly skin. It is generally worse in winter months since both cold air and home heating methods can cause dry air. Patients with eczema triggered by environmental allergies may have flares in their allergy seasons. Treatment of eczema entails increased hydration and moisturization and humidifying the air when needed. Frequent baths with gentle soaps help hydrate while not irritating.

There are two thoughts regarding whether more or less frequent bathing helps. Generally daily bathing, with the addition of a Baby or mineral oil to the water, greatly helps most people. Make sure to add the oil toward the end of the bath, after the child has gotten hydrated. The oil will lay on the water surface and coat the skin as the child exits the bath. Don’t add the oil before the child gets in. Doing so will coat the skin on entry and prevent hydration. Dry wet skin by blotting, not by rubbing, to reduce inflammation. Apply fragrance-free moisturizer after the bath and frequently throughout the day as needed. Moisturizers may need to be applied as often as four times a day. Since rubbing anything on dry skin, even a moisturizer, can sting, one trick is to wet affected skin mildly before applying moisturizer.

Eczema can also become inflamed or infected. Inflamed eczema will look like red, thickened skin that is more intensely itchy and is occasionally painful. Inflamed eczema should be treated as above but may also require topical steroids. When it comes to topical steroids, weaker is better, since too potent a steroid applied too often or for too long can cause thinning of that skin and change its color. The weakest steroid is hydrocortisone 1%, available over the counter. Steroids should be used only for inflamed eczema, and for the shortest duration necessary to reduce the inflammation, generally twice a day for less than two weeks.

Eczema of the hands is very common in the winter. Dry air coupled with washing hands in water and not drying well is the cause. To prevent hand eczema, thoroughly dry wet hands, or avoid water by using sanitizer (with aloe or a moisturizer added is best). To speed healing, add a thick moisturizer (petroleum jelly or lanolin) at night and cover the hands in cotton gloves when sleeping (in addition to frequent daytime moisturizer use).

Fever is a normal response to inflammation and infection. It is a sign of an underlying process and generally not itself a problem. In general (other than as noted below for infants), notify us if fever is higher than 103, or it lasts more than four days, is associated with pain, respiratory distress or dehydration. In many cases, the non-fever symptoms are the ones that determine the timing and type of evaluation that is needed.



Treating Fever:

Acetaminophen ( Tylenol ) is approved for treatment of fever and pain in infants two months of age and older. It can be given every four hours as needed. Ibuprofen ( Motrin, Advil ) is approved for infants six months of age and older for pain, fever and swelling, and can be given every six hours as needed. Ibuprofen is preferred over acetaminophen for higher fever ( 102F, 39C ), injury with swelling and for nighttime use, when a longer duration of fever control is helpful. The two products are metabolized by different organ systems and have different adverse effects. Therefore, they can be given together, though that is rarely helpful. However, if one product does not adequately control symptoms until it can be given again, acetaminophen and ibuprofen can be alternated. Specifically, acetaminophen can be given, and ibuprofen given three hours later. After another three hours, acetaminophen could be given again, continuing to alternate as needed. Given this way, each acetaminophen dose is given at least four hours apart and each ibuprofen dose is given at least six hours apart.

See our medicine dosing sheet for weight-based dosing suggestions.

Febrile Seizures:

Around three percent of children from six months to five years of age may develop a seizure due to a very high (around 104F/40C) or rapidly increasing fever. Only half of infants who "have a fever related seizure" (febrile seizure) will have a second febrile seizure, and only one-quarter will have a third. In a simple febrile seizure, a child's eyes will roll back, the body will stiffen and then rhythmically contract. After it is over, a child will be drowsy. Although scary, febrile seizures are rarely dangerous. If a febrile seizure occurs, place the child on his/her side, ensure that airway is protected and call emergency services (9-1-1).



Fever in an Infant Under Three Months Old:

Fever is an infant younger than three months of age is approached differently. Since these infants have limited social-developmental skills, it is difficult to differentiate ill from well infants without additional tests. Therefore, we have a lower fever threshold in this age range (100.4F/38C). For infants with a fever over 100.4F/38C, a comprehensive evaluation, possible empiric antibiotic treatment and admission to the hospital may be indicated. Do not treat infants in this age range without first notifying our office.
Babies as young as four months of age can be spoon-fed foods, although food is not necessary for growth until six months. There are two feeding rules to follow.

The first rule is to ensure the food is the right texture. First foods should be very thin purees, which can be thickened as tolerated. Teeth most commonly break through the gums between six and nine months of age. Teeth enable infants to mash firmer foods. Around nine months of age, infants can finger feed. Great finger foods include small pieces of fruit and softened vegetables, cheerios and puffs. Toddlers begin to (messily) use utensils at around fifteen months and can handle some bigger and firmer foods, such as chunky peanut butter and pieces of grapes. Large, round and hard foods, such as whole nuts and grapes, continue to pose choking risks until age two and should not be given until then.

The second rule is to limit the frequency at which new foods are offered. Breast milk or formula can also be offered at mealtime, but should be offered after the food. A baby may consume a few ounces at a time. Only one new food should be introduced per week at this age. Eating solids will result in your baby drinking less. Babies who are offered food at four months of age should be offered one to two feedings a day. Only one new food should be offered per week. At six months of age, two to three feedings per day can be offered and new foods can be introduced every three days. At nine months, babies may eat three large meals a day. New foods no longer need to be separated at this age.

What to feed a baby is a common question. It is easier to answer what not to feed a baby. Babies under one year should not drink milk or consume raw honey. Introducing milk before one year can cause the baby to develop food allergies. This is not the case with other dairy products, such as cheese and yogurt, which can be given in the first year. Raw honey can contain botulism spores which can paralyze an infant. Baked or cooked honey that is in other food is safe to give your baby after six months. New data supports the introduction of peanut to infants by six months of age in order to prevent peanut allergy. Peanut powder or creamy peanut butter can be mixed with breast milk, formula or water to get the proper texture. Other common allergenic foods can be introduced at any time, but can be delayed if there is a strong family history of allergy to those foods. Although many people follow the traditional path of starting with cereals and then move on to vegetables before fruits, any order is acceptable provided these two rules are followed.

It is normal for babies to be hungry at night. They will waken and need to feed. In fact, two-thirds of babies won't sleep six hours at a time until they are one year old. Sleep training is not about expecting babies to sleep through the night. It is about helping babies who too frequently waken out of habit to develop new sleep associations (to replace being fed or rocked by a caregiver) so that they can get more sleep and get themselves back to sleep without parental intervention.

The trick with sleep training is to know when it is appropriate. In other words, to know when the infant is waking because of hunger and when it is a habit (due to caregiver-dependent sleep associations). A hungry infant will have a good feeding (similar duration and/or volume as a day feeding) and return to sleep. A hungry child may waken three or four times at night. If those frequent feedings are good feedings, and the infant returns to sleep easily after the feeding, then sleep training is not indicated. A baby that is waking out of habit will generally have frequent smaller feedings ("snacks") and may not settle back to sleep easily. If these infants are growing well, they do not need these snacks. Sleep training for these infants is appropriate and can be started in infants as young as four months old.

To sleep train, put babies down to sleep when tired but not asleep. If they fall asleep during a feeding, rouse them gently when putting them down, so they are sleepy but not asleep. This way the baby will learn to fall to sleep on its own. If they waken, and you know they are safe, overtired and not hungry, you can let them cry for up to one hour. Many parents are unable to let their infants cry for very long because the parental instinct is to tend to them or because a crying infant may disrupt a sibling's sleep. Letting an over-tired infant cry for a while is not neglect. Letting them cry gives them the chance to successfully return to sleep and create new associations that don't involve the parent. Generally, within a week many of these infants can sleep longer at night, waken for fewer snacks and return to sleep more easily. Infrequently, some infants become more agitated and don't easily settle down. Sleep training may not work as well for these infants.

A normal stooling regimen is one that results in the painless passage of soft stool. A child who passes such stools but only every few days is not constipated. A child who passes wide, distended stools that cause pain and withholding behaviors is constipated, independent of the frequency. Dietary treatment for constipation involves increasing the amount of fiber (fruits and vegetables - especially prunes) in the diet. Juice, which is mostly sugar, can also help, as both fiber and sugar pull water into the colon to soften the forming stool. Increasing water intake will not treat constipation, since water is absorbed out of the intestine and excess water is excreted through the urinary tract. Medications may be needed to treat constipation when diet alone is insufficient.

Many toddlers will be ready to toilet train around age two years. Awareness that they have urinated or stooled is the first step. The second step is awareness of the need to urinate or stool. Toddlers may go to a certain part of the house to do this in private. At this stage, toddlers who have been introduced to the potty and are receptive to it can be successfully toilet trained.

Training involves a lot of positive reinforcement, initially just for sitting on the potty and eventually for successes. Be aware that there are very few things in life that your toddler can control, but toileting is one of them. Just because your toddler can toilet doesn't mean he or she will choose to. Battles over toileting are discouraged. Children may be anxious about toileting, and conflict will only make the anxiety worse. If there is too much anxiety over toileting, it is sometimes best to hold off training for a while.

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