Sorry, sometimes this page doesn't work on mobile devices. Use a desktop to access help with common medical problems.
Common Medical Problems
How to assess and treat common illnesses/urgent problems and decide whether or not to call us for an urgent sick visit.
This information is intended as general educational information, not specific medical advice, and is only for patients registered with our office. Contact our office if you have any medical concerns about your child. Call 911 for any life-threatening medical emergency. This information is for our registered patients only, and is only to be used in consultation with us. Do not use this guide if you are not a patient.
***Important note: This information offers general educational guidelines as to whether or not your child should be evaluated by us in our office. It is not actual medical advice. If you ever determine that your child should be seen by us, and this guide suggests it may not be necessary, please follow your own judgement and contact us to be seen.
INDEX OF ILLNESSES AND URGENT PROBLEMS
Natural remedies and support for colds and coughs
NEW RSV VACCINE
Natural treatments and supplements for immune boosting
Sudden difficulty breathing
Fever medication dosing
Rashes (emergency rashes, hives, viral rashes, ringworm and impetigo (bacterial skin rash), eczema, drool rashes, baby acne)
Eye discharge in infants
Abdominal pain - acute and chronic
Tetanus shots and wounds
Bee stings and spider/insect bites
Warts and Molluscum
Bites - animal and human bites
IF YOU DON'T SEE YOUR MEDICAL PROBLEM LISTED HERE, SEARCH FOR IT ON www.AskDrSears.com
NATURAL REMEDIES AND SUPPORT FOR COUGH, COLDS, AND FLU
Sinupret. This herbal liquid is available at our office or online. You take it by mouth three times daily and it helps support sinus and nasal problems during an illness (not for allergies though). Follow the dose on the package. For babies from 6 months to 23 months, give about 3/4 of the 2-year-old dose.
Zarbee's. You can find a whole variety of natural remedies for colds and coughs for all ages from this company online or in natural stores. Use as directed (follow dosing on the package). You can take these WITH the Sinupret above.
Zinc, Vitamin C, Vitamin D, Echinacea, and Elderberry are also useful. See our guide to these supplements during illness or even when not sick further down in this guide under COUGHS, COLDS, and FLU. I particularly like sodium ascorbate form of vitamin C powder (online or some stores) for coughs and colds. Follow suggested dosing below in the COVID section or on the package.
COUGH, COLDS, FLU, AND NASAL CONGESTION
Here are situations that likely do NOT warrant an evaluation by us:
Newborns or young infants with nasal congestion. Virtually all newborns go through a few months of nasal congestion as their airway adjusts to life. If there is no dripping runny nose or cough, then this is not an illness. Saline drops or breastmilk in the nose can relieve this.
Anyone with a runny nose and general cough who has no fever or in whom a fever has now resolved, and has no rapid labored breathing, likely has a common cold or mild respiratory illness that will resolve without medical intervention.
RSV is going around, as it does every late Fall and Winter. Pfizer is in the process of having the FDA approve a new RSV vaccine for pregnant women so newborns will be born with some protection, so RSV is all over the news this year. However, RSV is mild and harmless in most cases. More info below on when to worry.
Even junky coughs with mucus (bronchitis) likely don’t need to be seen if there is no persistent fever (more than a few days) and no rapid labored breathing as antibiotics are rarely necessary in such circumstances. Normal coughs from cold viruses can normally last from 1 to 4 weeks, then go away.
Green runny noses generally do not need antibiotics, as most common colds have a “green” phase, and even most sinus infections will go away without antibiotics (see sinus infection below).
Coughs with some wheezing are usually caused by RSV (a winter-time cold virus). You may notice a tight cough and may be able to hear wheezing when your child breathes deeply. There is generally no medical treatment that helps other than the same measures you would use for a common cold. If your child is having labored, asthmatic breathing, a doctor's visit is warranted (or the ER if severe).
Common colds and coughs can typically last from 1 to 3 weeks, and likely don’t need to be seen.
Here are scenarios that may require an evaluation by us:
NOTE: Before you call us, consider taking a short video (about 10 seconds) of your child's breathing bare-chested so we can see any distress. Then also take a short video of the cough. Send these to us with a message in your Chart Portal.
CHRONIC COUGHS: If you are bringing your child in for an appointment for chronic coughing fits, please bring some video examples of these, as most kids won't cough once they are at our office, and seeing the nature of the coughing fits will help in our evaluation. Most chronic coughs do not need antibiotics or prescription medical treatment, and there is often nothing we need to do for your child unless he or she fits one of the severe descriptions below. The most common causes of chronic coughs are RSV (see above), allergies, and residual bronchitis from a cold. These generally don't need antibiotics or prescription medical treatment. We can see your child for an appointment if you need reassurance.
RSV. Like most other respiratory viruses like Covid and Flu, most cases of RSV are harmless and don't require treatment. You likely won't even know if your newborn, infant, or child even has it, and there's no reason to test for it unless in an ER. Please do not contact us in a panic because you think your child might have RSV because there's nothing we'll need to do (unless severe), and there's nothing we can do to keep it from being severe if it is going to go that way. Simply treat this like any other cold, and try your best to keep your newborns and infants away from sick older children for the 10-day contagious period.
RSV: when to be seen. Rarely RSV can cause a more severe infection. If your child has rapid labored breathing or chest retractions (caving in with each breath) that lasts for hours, and doesn't improve with steaming and suction, then go to an ER if it's after hours or call our office for an appointment during the day. There isn't anything we can do over the phone as far as treatment goes. An ER will stabilize the breathing with some inhaled medications and then decide what more needs to be done, if anything.
Croupy coughs (cough sounds like a seal barking, your child has lost her voice or has a raspy voice or cry): Croup is a viral illness and doesn’t require antibiotics. Most mild cases don’t need to be seen by us. Search croup on our web site AskDrSears.com for more information. If your child has labored breathing and stridor (see our web page on croup) – not just while coughing, but persistently for hours – she should be evaluated by us. 20 minutes of cold, humid night air or in a bathroom with steamy shower running often settles down croupy coughs and stridor. Go to an ER if your child is blue or acting like she isn’t getting enough air.
Cough and/or runny nose with fever for more than 3 days. Since most Flus and many colds (including RSV) can cause fever for 3 to 5 days, there still may be nothing medical for us to do. But we can generally see you to just make sure if fever lasts more than 72 hours.
Rapid labored breathing that persists for hours.
Ear pain with fever and cold/cough symptoms (see Ear Infection section below). Ear pain does NOT simply mean touching or grabbing the ears as an infant, as babies are prone to doing that due to teething or for no reason.
Wheezing, chest retractions (chest caving in with each breath).
Any infant 3 months and younger with a fever of 101 or higher should be seen.
Sinus infection: most of these don’t need antibiotics. If sinus headaches and pain, green nose, and fever persists for 5 or more days, we should see your child to discuss antibiotics.
Prolonged, severe coughing fits that last 20 or more seconds that make the face turn red, with “whooping” gasps between fits of coughing in which it seems your child has some difficulty inhaling, often ending in gagging or throwing up. This may be whooping cough – search for this on our AskDrSears.com website for more info.
What about Pneumonia? Kids with pneumonia typically have 3 or more days of fever, severe cough, possible chest pains, and rapid labored breathing even when fever is down. These scenarios are listed above as reasons to be seen. If your child does not fit this scenario, then being seen just to rule out pneumonia is likely not necessary.
Treating colds and coughs. Search our “medications to treat coughs and colds” guide on AskDrSears.com for guidelines on this for kids 4 years and older. For infants and toddlers, use steam (hot shower steam or humidifier), suction out the nose, sleep a bit upright (with a pillow under the mattress), and try natural sinus remedies like Sinupret liquid (find online – follow dose on bottle for kids 2 and older; give half dose for kids under 2) and cough remedies like Zarbees, or any other natural remedy.
Supplements to take:
Take Zinc, Vit D, and Vit C as described below in the Covid section, plus the following supplements to help reduce flu symptoms and severity:
Echinacea – dose the same mg as Vit C (not during Covid though)
Elderberry extract – follow dosing on the package, twice daily.
How long are colds contagious? At least as long as there is fever, and a day or 2 after fever is gone. Colds are generally contagious for about 10 days though. They are possibly contagious longer if cough remains moderate to severe and as long as the runny nose persists.
NEW RSV VACCINE
NEW RSV VACCINE GIVEN DIRECTLY TO NEWBORNS AND INFANTS
The FDA has just granted fast-track approval for a new version of this already-existing vaccine. The Product Insert is now available here.
This new product, however, isn't actually a vaccine. Vaccines technically are the germ components that stimulate an immune response (antibodies) in the body to provide protection from infection. Nirsevimab contains the actual antibodies genetically engineered then injected to provide some artificial immunity in a baby. An older version of this preventive treatment, called Synagis, has been around for decades and has been recommended mainly for premature babies (in whom RSV can be much more severe). This new version is recommended for ALL newborns to help reduce the severity of RSV during their first winter. It can also be given to infants with severe heart and lung disease for their second winter as well.
The injection is given as a single one-time dose before the start of RSV season (around October).
How it is made/ingredients: This is a genetically-engineered monoclonal antibody produced in a laboratory using hamster ovary cells to generate batches of these proteins. The antibodies are then mixed with two amino acids, some sucrose, polysorbate 80 and water.
Side effects: The main side effect of concern is allergic reaction. The exact risk of this rare reaction is not yet known.
I have not yet given any patients this injection, but will begin discussing it with them. If I experience any problems with it, I will update this information here.
Cost: It will cost about $620 for this one-time injection.
IF YOU KNOW YOUR CHILD HAS COVID, such as exposure to a family member who tested positive, your child was seen somewhere and tested positive, you did a home test and it was positive, we can evaluate your child if necessary. Please continue reading the guidelines below, however, as most cases in children under 12 years of age do not require medical evaluation.
Kids under 12 years of age:
If you are worried that your child has Covid, realize that virtually all cases in children under 12 are mild and don’t require evaluation or prescription medical care. Please refer to www.CDC.gov for more information.
If you feel your child should be tested, you can do a test at home, or we can do a rapid nasal antigen swab test (not deep nasal, just about one inch into the nose) and get an immediate result. We can also swab the mouth and throat for a send-out PCR test that takes about 2 to 3 days to get back (likely more accurate). All positive results (nasal or oral swabs) are reported to the California Department of Public Health so that they can contact you to assist you in quarantining your family.
You can also elect to not seek testing and simply keep your child at home for 10 days from the onset of symptoms.
If your child has respiratory distress (rapid labored breathing, wheezing, chest retractions, blue color around the mouth, feels like not getting enough air) then you should NOT wait for your phone appointment, and just go to an emergency room as we are not equipped to handle serious Covid emergencies like this.
If your child is acting very ill (high fever, severe flu-like symptoms), but does not have respiratory distress, we can evaluate your child by phone to discuss testing and prescription treatment, and decide during the phone appointment whether or not you should be seen by us in person the following day.
Children 12 years and older:
California law AB 2098 dictates that all physicians must comply with instructions from the California Department of Public Health and the CDC when it comes to Covid information. In compliance with this, if your child is 12 years and older, we adivse you to either go to urgent care, an ER, or call us for an appointment if you think or know your child has Covid. We can test your child and discuss prescription medication to help.
How long is Covid contagious? Generally the same as discussed for colds above. Current policy, however, is that you can return to public after 5 days have passed since symptoms began as long as fever is gone and your symptoms are improving. Waiting a 10 day period is more of a guarantee that you are no longer contagious.
SUPPLEMENTS TO TAKE DURING COVID:
Here is what may be helpful to take when you are sick with Covid and/or are exposed to someone with COVID. Only take this high dosing for 10 days, then you can still take the supplements but at the regular dosing for age. Note: most people believe you should not take echinacea during Covid (something many would normally take during most illnesses), as it might have the potential to increase inflammation.
Zinc 2-6 yr old: 5 mg/day,
7-12 yr old: 10 mg/day
Adults 20 mg/day
Vit D 2-6 yr old: 2000iu/day
7-12 yr old 5000iu/day
Vit C 2-6 yr old 250mg 3x/day
7-12 yr old 500mg 3x/day
adults 1000mg 3x/day
I like Sodium Ascorbate version of Vit C - a powder you mix into juice or water.
Quercetin: Follow the dosing on the bottle
NAC: Follow the dosing on the bottle (but it’s generally 1/2 of the vitamin C dose for the above ages 2x/day)
SUDDEN DIFFICULTY BREATHING
This scenario is often concerning for parents. The causes are usually one of the respiratory illnesses described above (croup, RSV, or whooping cough). If you think your child is actually choking on something, please begin CPR and call 911. If you child is blue or can't get any air, call 911.
If this is not a sudden choking emergency and your child's color is good, then here are some guidelines you can follow to decide if you should go to an ER or work through the illness until we can see you in the office:
Croup - see above for full info. This cold virus can cause sudden raspy loud breathing, raspy voice and cry, and a cough that sounds like a seal barking. The fastest way to relieve this is to go outside in the cold, humid night air. Within a few minutes the breathing should clear. If it doesn't improve, go to an ER (drive with the windows rolled down for cool air). Read more above.
RSV - instead of croupy breathing, this cold virus can cause wheezing and retractions of the chest. Steaming your child may bring some relief. If having wheezing that is too severe, go to and ER. Otherwise, contact us when we next open.
Whooping cough - this should only cause labored breathing while a coughing child is struggling to get air in during a severe fit of coughing. If you child's color is good, don't need to go to an ER. Call us to be seen that day. If you child is diagnosed with whooping cough, he or she is contagious for about 3 weeks from when cold symptoms first began, OR once the five-day course of antibiotics are complete.
Pneumonia - see description above under respiratory illnesses.
Fever in and of itself isn’t dangerous. It’s the body’s natural way to respond to infection and helps the immune system fight infection. Most such infections are viral and don’t require antibiotics. Even many bacterial infections won’t require antibiotics as our immune systems are equipped to fight most things. We expect kids to have a faster heart rate and feel worse when fevers are higher, then improve when a fever comes down.
Don’t treat a fever with Tylenol (acetaminophen) or Motrin/Advil (ibuprofen) unless a child is miserable. Use cooling measures (luke-warm baths) as needed. Use medication if a child is in significant pain or is miserable from the fever. Otherwise, allow the fever to run as it will help the body respond to infection. We prefer ibuprofen over acetaminophen if you do need to give a medication. It's our opinion that it is safer and works better. Search ibuprofen on AskDrSears.com for our dosing chart. You will also find a Tylenol dosing chart there, if needed.
Beware that some fever-reducers are labeled as "natural," but their main ingredient is still acetaminophen (Tylenol). They simply don't have as many artificial ingredients. If you can find a dye-free ibuprofen, that may be the best choice.
Any infant younger than 3 months with a fever of 101 or higher should be seen that day.
Any child who has a fever of 101 or higher for more than 3 days (72 hours) should be seen.
Any child with fever and signs of meningitis should be seen: painful stiff back of the neck such that your child won’t look down at her belly button without pain, severe headache, lights hurt the eyes, and nausea or vomiting.
Any child who is lethargic with a fever should be seen. Lethargic means limp, won’t open eyes and focus on you, semi-conscious, and not moving much. Simply being less active and more quiet than usual, or wanting to be held more and not wanting to play, are NOT lethargy, but are normal responses to fever.
Any child with a petechiae rash should be seen. These are small red spots on the skin that don’t disappear (don’t blanch) when you stretch the skin around them. There usually would be several dozen on an area of the body. They look as if someone wrote small red dots on the skin with a red felt tip pen. If you stretch the skin around the spot (pulling away in two directions away from the spot) and the spot disappears, then these are NOT petechiae and likely not an emergency. If they are on the face or neck, they are likely just from the pressure of coughing or vomiting and likely not an emergency. If your child has fever and petechiae anywhere else on the body, it’s possibly a bleeding disorder or serious bacterial infection and you should call us to be seen if during the day or go to an ER if after hours.
Likely causes of fever and when to be seen:
Roseola: This is the most common cause of fever in young children 6 months to 2 years of age when there are no other symptoms besides fever. This harmless virus causes 3 days of moderate to high fever and fussiness, then a rash. Search it on AskDrSears.com for details. If an infant reaches 4 days of fever, with no rash yet, we recommend being seen.
Common colds and coughs: These are expected to cause 1 to 3 days of fever. See guidelines above about whether or not to be seen.
Flu: if it’s flu season, and your child has flu symptoms and fever, then it’s likely the flu. Search Flu on AskDrSears.com for several articles on treatment, prevention, and when to be seen. Also, see our “Natural Supplements During Illnesses” handout above.
Fever and sore throat: For kids under 4 years old, sore throat infections are usually viruses and don’t need antibiotics, especially if the throat/tonsils don’t look red and there is no pus on the tonsils. We likely don’t need to see a young child for this. Kids four and older with fever, sore throat, swollen lymph glands in the neck, and a red throat and/or tonsils with or without pus means it could be Strep throat. We can see your child to test for this. Sore throats that do not look red and are accompanied by cold and cough symptoms are likely not Strep and is likely to just be a common cold virus. If you see what look like canker sores (white blisters surrounded by red) in the back of the mouth and on the throat, this is a viral sore throat that likely doesn’t need to be seen. Therefore, most simple sore throats that don't look like strep usually don't need to be seen.
Hand/foot/and mouth disease. If your child has several days of fever, canker sores in the mouth or on the back of the throat, and/or blisters on the hands or feet, this is likely HFM disease. This is ultimately harmless, requires no medical treatment, and usually isn’t contagious to teens and adults. We usually don’t need to see this. See more (with pictures) by searching it on AskDrSears.com. This illness is contagious for 1 to 3 weeks, depending on your strain of virus (which you won't know and there isn't a test for). You are most contagious for the first week, as long as there is fever (and a couple days after), and as long as the mouth sores hurt. You will have to decide whether to quarantine until these signs are gone or for a whole 3 weeks.
Ear infection. If a baby is just pulling on his ears, but doesn’t have a runny nose and fever, then it’s likely not an ear infection and doesn’t need to be seen. Infants pull on their ears because of teething or simply curiosity. If sick with runny nose, fever, and ear pain or extreme fussiness, see the Ear Infection section below for info on home treatment and whether or not to be seen.
If your child is having an allergic reaction to food, insect bites, bee stings, medication, or to something unknown, here is some preliminary information on what to do:
For HIVES, swelling, or any type of itchy skin rash, you can give a dose of Benadryl (diphenhydramine) to minimize the reaction. You will find a dosing chart by searching Benadryl on AskDrSears.com for kids two years and older. For infants and toddlers, you must ask your doctor for the dosing. Do not give an infant benadryl without asking your doctor. The dose I tell my own patients is 2.5 ml (equal to 6.25 mg) for infants who are about 6 to 11 months old and weigh 14 to 19 pounds. Toddlers who are 12 to 24 months old and weight 20 to 25 pounds the dose would be 3.75 ml (equal to about 10 mg). Kids who are 2 years and older, and who weight 27 pounds or more would get 5 ml (12.5 mg). Never give this medication to an infant or toddler without asking a medical professional. See dosing chart on AskDrSears.com for more dosing info.
If this helps, then you don't need to rush to an ER. Read more about how to solve the cause of hives on AskDrSears.com.
ANAPHYLACTIC REACTION. If you have an epinephrine prescription, have been trained in how to use it, and your child is having severe anaphylaxis, go ahead and use this and call 911. If you don't have this medication, call 911 and seek emergency help as quickly as possible. Signs of anaphylaxis include throat closing, difficulty getting air, and severe sudden wheezing. Other signs including uncontrolled vomiting, severe drooling, inability to swallow, severe lethargy, or shock, especially if also having difficulty breathing. Simple facial swelling or hives around the head, neck, or chest WITHOUT any of the above anaphylactic signs is likely NOT anaphylaxis and can be treated with Benadryl.
For information on how to track down the causes of and how to eliminate the sources of nasal allergies, excessive sneezing, and chronic allergic coughs, see the allergy section here on AskDrSears.com . For information on other aspects of allergies, food allergies, and understanding what situations are likely NOT allergies, see here.
For a complete guide to understanding and solving every aspect of allergic disorders, check out The Allergy Book here (Dr. Bob sends you a signed copy himself).
Children can get many different types of rashes, and most don’t need to be seen in our office. The best place to go to read about your child’s rash is AskDrSears.com – search rash and read our article on “Common Rashes.” You will likely find your child’s rash among the 15 common rashes we describe in this article, along with guidelines on home treatment and when to be seen by us.
The main rash emergency is Petechiae. Any child with a petechiae rash should be seen. These are small red spots on the skin that don’t disappear (don’t blanch) when you stretch the skin around them. There usually would be several dozen on an area of the body. They look as if someone wrote small red dots on the skin with a permanent red felt tip pen. If you stretch the skin around the spot (pulling in two opposite directions away from the spot) and the spot disappears, then these are NOT petechiae and likely not an emergency. Petechiae spots will stay visible even when you stretch the skin. If they are on the face or neck, they are likely just burst capillaries in the skin from the pressure of coughing or vomiting and likely not an emergency. If your child has fever and petechiae anywhere else on the body, it’s possibly a bleeding disorder or serious bacterial infection and you should call us to be seen if during the day or go to an ER if after hours.
Hives can be another type of urgent rash as part of an allergic reaction, but these can often just be treated at home and don’t need to be seen (unless a severe allergic reaction is progressing). Don't panic if hives are on the head, neck, or chest. Our hives page on AskDrSears.com will give you guidance on how to track down the cause (often simply part of a viral illness, or possibly a food allergy) and gives you a dosing chart for Benadryl if you child is uncomfortable. See us if hives keep coming back for a few days.
Eczema. You will see this rash explained on the AskDrSears.com rash page highlighted above. Here is a link directly to our eczema page that will help you solve this.
Viral rashes. Rashes with fevers or cold symptoms are usually just part of the viral illness and not a reason to panic. Check out our rash page on AskDrSears.com to track down the culprit. Fever with blisters on the hands, feet, around the mouth, and canker sores inside the mouth are likely hand/foot/mouth disease (see above under Fevers).
Ringworm. This harmless rash is caused by a mild fungus (not a worm). This is probably the most common rash we get sent pictures of. It's very hard to distinguish between ringworm and round eczema patches, but in general ringworm patches are rings that are clear in the middle and eczema patches are not clear in the middle. You do not need to ask us for help with this rash unless you just want to make an appointment for us to take a closer in-person look. We rarely can tell just by pictures, so sending us pictures isn't necessary. You can simply try treating the ring rash with an OTC clotrimazole 1% cream twice daily. It takes a few weeks to work. If you think it is an eczema patch, OTC hydrocortisone 1% cream twice daily works within a few days or sooner. Even if you put on the wrong cream, it won't hurt the rash. If one treatment doesn't work, try the others. If it persists, THEN see us for an in-person appointment or go to a dermatologist.
Impetigo. This is a bacterial skin infection. It usually resolves with OTC treatments. It looks like clusters of red pimples and may have a honey-colored crusty ooze on them. It usually occurs on the face, under the nose, and around the mouth. You can search online for pictures to see if your child's rash matches this. Here is a very detailed page on AskDrSears.com that you can use to guide you through treatment. If your child doesn't respond to the washing, diluted peroxide, and OTC antibiotic ointment, you can try the diluted betadine as suggested, or wash once daily with OTC Hibicleanse liquid soap (from any drugstore). If it still worsens, call our office for a prescription of mupirocin antibiotic ointment (message appt, phone appt or in-person appt).
Baby Acne. This nuisance rash hits virtually every baby when they are around 2 weeks old. It peaks around 4 to 6 weeks of age then goes away by 2 or 3 months. No one really knows the cause or how to prevent it from happening. The main remedy is to dab breast milk on the rash a few days daily to reduce the inflammation. It's likely NOT related to food allergies.
Drool rashes. These are an inevitable part of teething drool and messy eating. Expect these red areas to come and go for many months until teething subsides and eating becomes more neat. You can try applying lanolin (Lansinoh) ointment to the face or chin. For the redness in the neck folds, open the area twice daily, dab it clean with a warm washcloth, blow it dry, then apply any clear diaper ointment.
See our diaper rash page on AskDrSears.com (click here) for a full discussion on identifying what is causing your baby's diaper rash. Here are some first steps you can take with any diaper rash:
Realize that babies are supposed to have some diaper rash. So don't panic. Every baby will get a diaper rash from time to time.
Applying a zinc-based white diaper cream (I don't have a favorite brand) to any diaper rash will often solve the rash so you don't even have to figure out why the rash happened.
Almost all toddlers will have dry, raised patches of diaper rash on the buttocks or the rear waste-line due to chaffing from crawling and walking. So will older kids who use pull-ups at night. You likely won't get this to go away until baby is done with diapers, so just minimize it with a clear-type diaper ointment as best you can.
For yeast diaper rashes (see AskDrSears.com) try dabbing on a solution of 1/2 ounce white vinegar in 8 ounces water a few times daily, air it out for as many hours a day as you can have baby diaper-free, and apply zinc diaper cream when you put a diaper on. If this doesn't help, try OTC clotrimazole cream twice daily instead of the vinegar.
If you see red pimples or boils that have white heads or blisters with crusty ooze, this may be bacterial. Call our office for an appointment for a prescription antibiotic ointment called mupirocin.
BLADDER INFECTIONS (UTIs)
Symptoms of bladder infection include burning with urination, frequent urination, and a feeling of extreme urgency to need to go. Virtually all kids will have burning and at least one other symptom. The urine may smell strong or foul, and there may also be blood in the urine.
If you think your child may have a bladder infection, and he is vomiting or has a high fever, he should be seen that day or at an urgent care after hours.
If no fever or vomiting, and no severe back pain (which indicates a possible kidney infection), then evaluation can wait until our office next opens. Here's what you can do meanwhile:
Do a home test from a drug store to see if it's a bladder infection.
Start Vitamin C (see above), D-mannose (follow dose on bottle), and cranberry juice or chewables.
If symptoms persist despite these natural remedies, then call us for an appointment. Most simple bladder infections will, however, resolve with these measures and don't even need to be seen or given antibiotics.
EYE DISCHARGE IN YOUNG BABIES
Most young babies will have eye discharge in the early weeks. This is caused by plugged tear ducts. These ducts drain the tears from the inner corners of the eyes into the nose. These get clogged in some babies, and mucus drains back out into the eyes.
You can help this resolve by rubbing the inner corners of the eyes while pushing inward toward the nose for a few seconds several times each day. Then put a few drops of breastmilk in the eyes. You do NOT need to call the office for this harmless and common situation unless the whites of the eyes are also very red. And don't worry if you skipped the newborn eye ointment. You don't need to call us to check in about this - simply let the doctor know at your next visit and he will discuss it further with you.
Most cases of pink eye are viral or allergic and don’t need to be seen by us. Search “pink eye” on AskDrSears.com and read about the various causes of pink eye and home treatments. Even many cases of bacterial pink eye will resolve without antibiotic eye drops.
Here are some additional guidelines that are not on the website:
Many cases of pink eye, either viral, allergic, or bacterial, can resolve with time and by soothing the eyes with homeopathic eye drops (like Optique One, by Boiron, or Similasan eye drops). And there's no hurry to make it go away. These may take 3 to 7 days to resolve.
If the eye is red and itchy, with no pus, then it’s likely allergic. If homeopathic drops don’t help, oral Benadryl may help, or OTC antihistamine eye drops (like Naphcon A or Opcon A) may bring relief.
If the eye is red and painless, or mildly irritated but not itchy, and no pus throughout the day (just some upon waking), it’s likely viral. Viral may have some mild pus upon waking and maybe a little bit during the day. This should resolved within a week.
If the eye is red and has pus draining out throughout the day, it’s likely bacterial. But, again, even bacterial pink eye will usually go away with natural Optique 1 by Boiron eye drops. Give this natural treatment about 48 hours to kick in. If no better, call us.
It’s not too critical to diagnose whether your child’s pink eye is viral, bacterial, or allergic – natural OTC treatment may address it regardless. If the condition doesn’t improve after 48 hours, call us. Viral and bacterial are contagious until the redness has subsided and discharge is gone.
THE MAIN REASON TO WORRY is if the eyelid becomes red and swollen as well, in addition to pus draining from the eye. This could mean a bacterial infection of the eyelid that needs oral or IV antibiotics. This redness would be very red (not just mildly pink like allergic swelling would be).
INCONSOLABLE CRYING IN AN INFANT
This is a common scenario for almost every baby at least once but rarely needs to be seen.
Here are the common causes that usually do not require a visit:
Teething pain - usually starts between 4 and 6 months, and baby will be drooling and gnawing a lot, and possibly tugging on her ears. If not sick with fever and runny nose, then it's likely just teething.
Food sensitivity - something in Mom's diet is irritating baby.
Colic - usually starting in the first few weeks of life, you won't know right away if it's colic. Consider these other causes, but if all else is normal it may be colic.
Sick with fever, runny nose, and inconsolable - see above under these illnesses for advice.
See these page on AskDrSears.com for advice on how to treat each of these.
Here are some causes that do require a visit:
Scratched eye - if baby's eye is red and she's closing it or rubbing it a lot, she may have scratched it, which can be somewhat painful for a day or so.
Hair tourniquet - look at baby's fingers and toes to make sure a hair hasn't wrapped around one, causing it to turn red and swell painfully.
Intussusception - this complicated term refers to a type of intestinal blockage. Baby may vomit, have an extremely tense abdomen, and pull his legs up to his tummy. But this can also mimic plain gas or colic. But intussusception will also usually result in passing a dark bloody and runny stool (called "currant jelly sign"), and the severe painful episodes will last for 30 to 60 minutes, followed by lethargy for a while as the blockage relaxes, then recurs. This problem is rare.
You should go to an ER if you suspect one of these problems, or see us urgently.
Most cases of abdominal pain do not need to be seen by us urgently. You can likely figure it out by searching “Abdominal Pain” on AskDrSears.com and reading about the 20 causes we discuss there.
The main reason to see us urgently on the same day is if you think your child has appendicitis. Here is how to tell:
Most cases or appendicitis occur in children over five years of age.
Pain is focused in the lower right front of the belly, or may start around the belly button then move down to the lower right.
Pain is severe, likely stays almost constant, and gradually worsens.
Pain gets worse with movement, especially with coughing or sneezing, or when you press in on the lower right side of the belly. Ask your child to jump up and down. If pain gets much worse with this, then that’s a concern. If your child is in too much pain to even stand and try to jump, that’s a concern.
Fever, loss of appetite, nausea and/or vomiting, along with the pain characteristics above.
Children who complain of sharp abdominal pain, even severe, but who then can run around and play a few minutes later, and don’t have many of the above signs, likely don’t have appendicitis.
Chronic Abdominal Pain is a common problem in children, and usually takes a long appointment with us to figure out (not a same-day quick urgent appointment). In most cases, constipation is the culprit. Read about this and other chronic causes in our website article and follow the guidelines there before calling for an appointment.
Most cases can be solved without seeing us.
For infants younger than 4 months, taking cow’s milk products out of a breastfeeding mom’s diet can help. Insert a rectal thermometer into your child's anus while she is straining to go, and this should help pass the next hard stool. If this doesn't help, use a children’s suppository from any drug store (cut in half lengthwise for infants 6 months and younger).
If your infant just started solids, pause this process for a week or two until stools return to soft again. Don't give rice cereal and minimize bananas when you resume.
If stools don't soften after these changes, and your baby is 4 months or older, start diluted prune juice (2 to 4 ounces daily mixed into any liquid) or pureed baby food prunes or peaches every day to keep the stools softer and moving. Avoid rice cereal and bananas for a couple months.
For babies 9 months and older, and for children, here is a list of more effective remedies:
Fiber foods – search online
Magnesium – Vitality Natural Calm brand online – 100 mg daily for toddlers and 200 mg daily for kids 2 and older.
Aloe Juice – George’s brand is good if you can find it. ¼ cup daily mixed into juice for toddlers, and ½ cup daily in juice for kids 4 and older.
Benefiber powder – from any drug store. Follow dose on bottle.
Fruit-Eze – a jelly to eat daily. Find online or in some stores.
Probiotics – any brand. Follow dose on bottle.
Start 1 or 2 of these daily, or alternate between 3 or 4 of these. Give everyday to keep the stools moving well for 2 to 3 months, then wean off. If problems persist, make an appointment with us.
Search this on AskDrSears.com for a complete discussion.
If your infant is simply pulling on her ears, but does not have a fever and runny nose, then it’s not an ear infection. Infants need to have cold symptoms and moderate nasal congestion in order for an ear infection to develop. Babies who are not sick, but are just pulling on the ears, are likely just doing so out of curiosity or because of teething.
Children who are sick AND complaining of ear pain or pulling on the ears may have an ear infection. Infants (too young to tell you they have ear pain) who have nasal congestion, fever, and fussiness may have an ear infection, especially if these symptoms have persisted for more than a day. If there is no pus, mucus, or liquid draining out of the ear, then you may find that using mullein garlic oil ear drops (like Herb Pharm brand) from any health store may provide enough relief that you don’t even have to be seen for the suspected ear infection.
How to use garlic oil ear drops. Warm the dropper in your hands so the drops aren't cold, then put 3 drops in each affected ear and let sit for several minutes, 3 to 4 times daily. Infants only need 1 or 2 drops (ears are smaller).
If pain and/or fever persist for more than a day or two, or drainage comes out of the ear, we should see you. If there is severe redness and pain behind the ear, or the ear is sticking out more than usual, or severe tenderness when you press behind the ear, we should see you.
You can read more about evaluating ear infections by searching it on AskDrSears.com
Swimmer’s Ear is different than an ear infection. This is caused by water getting stuck in the ear after swimming. You can tell by the fact that there will be moderate to severe ear pain when you press in on the ear or move the ear. There may or may not be drainage coming from the ear. We can see your child and can prescribe antibiotic ear drops. AskDrSears.com has a good page on how to evaluate swimmer’s ear.
Most cases of this don’t need to be seen by us. The main reason to be seen urgently the same day or next day is if there is blood in the diarrhea. This can indicate an infection that may require medical treatment. Virtually all other causes of diarrhea in kids don’t need medical treatment. Search “diarrhea” on AskDrSears.com for a very detailed discussion on how to solve this without seeing us. If diarrhea persists for a few weeks, and you’ve tried the steps on our website, call us to be seen.
On AskDrSears.com (click here) we have a complete guide on how to assess and treat this as well as dehydration. Most cases of acute vomiting are caused by intestinal viruses, do not require medical treatment, and do not need to come into the office. If your child is getting moderately to severely dehydrated, or has severe abdominal pain (as discussed above), we should see you that day.
These almost never need a doctor's appointment and can be solved at home. Have your child sit leaning slightly forward and plug the nose holding a kleenex or cloth for about 5 minutes. It also helps to gently squeeze the bridge of the nose at the same time. This should stop the bleeding. After another 5 minutes or so your child can gently snort the clotted blood back into the throat and spit it out. If bleeding resumes, repeat this process. If bleeding doesn't stop after 2 or 3 rounds of this, go to an urgent care.
Recurrent nose bleeds. These are usually due to irritated lining of the nasal septum near the front of the nose which bleeds easily. Apply vaseline twice daily inside each nostril and gently rub the nostrils to distribute the ointment inside to coat the sore nasal septum. Doing this for a week should heal it enough to stop the recurrent bleeding. If not, try an OTC antibiotic ointment instead. Repeat this process if bleeding returns (which it might after several months of a break). If these steps don't help, make an appointment for us to look inside and discuss more treatment options.
TETANUS SHOT AFTER AN INJURY
Many people worry about getting tetanus after an injury if they haven't had their tetanus shots (usually given 6 times over childhood in the DTaP vaccine). Here are some things to know as you decide with your health care provider if you should get a shot:
Fortunately, only about 1 child five years and under catches tetanus every year in the U.S. It is a rare condition. Between 1 and 5 older kids/teens catch it each year.
Tetanus can happen without even having a known source of injury, but again this is rare.
Clean cuts that can be washed out and even may need a few stitches are very low risk wounds. A minor poke or scrape by a metal dirty object is also low risk.
Even though most ERs will advise you to get a tetanus shot after most wounds or animal bites, you can also ask the doctor there how risky your child's particular wound is as you decide with them whether or not to get a tetanus shot.
The highest risk wounds are when someone is impaled by rusty metal that is dirty with animal feces-contaminated soil, such as on farms, and the wound cannot be adequately cleaned out. Any cut from a dirty or rusty object that is open and can be thoroughly cleaned is lower risk.
If you are unvaccinated and suffer a high-risk wound, realize that getting the first tetanus shot at this time won't do much to protect your child from this injury, as it takes some weeks for the shot to be effective. If you already have had some tetanus shots, getting a booster at this time may help. However, you can get an immediate-acting tetanus immune globulin shot (called TIG) that works right away to neutralize any tetanus from that current wound.
Call us for an appointment if you would like to discuss this further.
BEE STINGS AND INSECT BITES
For most kids, these are simple stings/bites and can be soothed with cold packs applied to the area for 10 minutes once an hour until the swelling, itching and pain have subsided. Don't put ice cold packs directly on the skin.
Bee stings. For some kids, the area around the sting will swell considerably, such as an entire hand or foot, possibly extending up part of the arm or leg. Give a dose of diphenhyrdamine (Search "Benadryl" on AskDrSears.com for dosing for all ages) and continue to cool the area. Facial swelling may also occur and diphenhydramine should help. If swelling continues to worsen despite these treatments, call us for an appointment -- prescription steroids may help.
Anaphylaxis is rare. Signs include difficulty breathing or throat closing, and may possibly include fainting and vomiting. Call 911, and use an epinephrine injection if you have access to one according to your doctor's advice.
Should you get an epinephrine prescription if you've had some swelling after a bee sting? In general, no. We don't prescribe these over the phone. We can discuss this at your next appointment.
Spider and insect bites. You don't really need to distinguish what exactly caused the bite. The initial treatment is the same as above for bee stings. After about 48 hours, if redness and pain persist, switch over to warm soaking for 20 minutes every hour to reduce infection. You can also mix epsom salt into the warm soaking water twice daily. If the bite is open, apply antibiotics twice daily after a soak. If the infected skin continues to worsen and spread, call us for an appointment (might need antibiotics).
There are two types of warts, and you rarely need to come see us for either of these:
Regular warts. These are the classic rough-topped wart that you can treat with OTC salicylic acid liquid (I like the liquid better than the band-aid type). They are caused by a virus. Simply apply the liquid on every night at bedtime, let it dry, and it works overnight while your child sleeps. It takes about 1 to 3 months for the acid to dissolve enough skin around the wart for you to them peel the wart out of its crater. You can also try duct tape (reason online for directions) or homeopathic remedies (I don't have any experience with these, however).
These may start as firm lumps under the skin and may be slightly painful at this stage, especially if on the foot (plantar wart). I suggest waiting until the wart surfaces before starting treatment. Your child will likely get a few more warts during the months of treatment and that's fine.
I can see you for an appointment to freeze off the warts if your child only has a few. If you have more than five, OR if the warts are on a cosmetically important area, I'd suggest a dermatologist instead. There's no reason to see me to help you confirm the warts - just look online for pictures if you aren't sure.
Molluscum warts. These are a different type of wart caused by a difference virus. Look online for pictures as these have a very distinctive appearance. They are smaller than regular warts, varying in size from a pin head to half a pencil eraser head. They have a smooth dome-shaped top with a dimple in the middle, are slightly white-ish and skin-colored, and seem to be filled with a thick gel. They may also itch (relieve this with Benadryl or any anti-itch cream). They can occur as a single wart, but more often form clusters in any area of the body. They can also spread around and form a few dozen warts.
These will persist for about 12 to 18 months, then the immune system will eliminate the virus and the warts will fade away (it takes that long for our immune system to recognize the virus as foreign and attack it). New ones will crop up during this time, but will usually fade no longer than 18 months from when the first ones started.
I feel it's best to just leave these alone and let them run their course, especially if they don't bother your child and are covered by clothing. Treating them may cause irritation and more spread. If they irritate your child or occur on a part of the body that is visible to others and your child is embarrassed, you can try treating them.
OTC homeopathic remedies (like Naturasil) may work. OTC wart acid isn't recommended for these. A dermatologist can use a product made from the saliva of a beetle that irritates each wart and causes them to fall off (but these can cause some considerable irritation and then spread). I only recommend such treatment when a child really needs them taken care of. Otherwise, just wait out the 18 months.
They are contagious, so avoid sharing bath-time with your child. They aren't contagious enough to avoid school or normal daily contact with family and friends.
Thrush appears as a white coating of yeast inside baby's mouth. If it is ONLY on the tongue, then it's unlikely to be thrush and is probably just left over milk. If you also see patches of white coating the inside of the lips and cheeks, then it likely IS yeast (thrush). Thrush is harmless to a baby but can cause an uncomfortable yeast infection on mom's nipples and inside her breasts. Thrush is more likely is mom had antibiotics during labor or after baby was born, or baby had antibiotics.
Start with a diluted white vinegar solution (1 Tablespoon mixed into 8 ounces of water) dabbed into baby's mouth with a cotton ball 3 times daily. You can also dab this onto any yeast diaper rash baby has. Also, dab this onto mom's nipples and areola after each nursing session to kill any yeast on mom's nipples.
If the problem persists, contact our office and I can prescribe Nystatin liquid to kill the yeast in baby's mouth. Mom can also apply OTC clotrimazole 1% anti-fungal cream to her nipples twice daily after a nursing session.
Mom can also take probiotics and eat probiotic foods. You can also make a paste out of breastmilk and probiotics (any infant brand) and wipe this in baby's mouth twice daily.
If mom has severe breast pain, she can ask her midwife or OB to prescribe an oral anti-fungal medication Diflucan (ok to take while breastfeeding). Mom can also go on a yeast-free low-carb grain-free diet for a few months to help rid her body of yeast (read more about this by searching it online).
Call our office for an appointment if these measures aren't enough.
These common worms can seem scary and gross, but they are actually very harmless. So don't freak out.
Symptoms include anal itching during the day that is usually much worse at night. Your child may wake during the night crying from itching and burning discomfort because the worms tend to crawl out onto the outer anus during the night to lay their eggs, then go back inside during the day.
You can diagnosis these worms by using a flashlight to look at your child's anus in the middle of the night (between 1 and 4 am). You will see the worms squirming around on the anus. They look like white threads about one inch long (maybe about the width of two threads woven together). You may also see these in your child's stools. It's useful to try to see these to confirm them before treating. If you don't see them, but highly suspect them, the doctor can order a stool test to try to detect them.
Here are your treatment options:
Natural treatments: there are some herbal and natural remedies you can investigate, but I am not well-versed in these.
OTC medication called Pyrantel Pamoate (under various brand names) is the first line of medical treatment. Follow the single one-time dose on the bottle, and REPEAT this dose after two weeks.
Repeating the dose is very important because the first dose only kills the adult worms. The second dose kills any new ones that hatched and grew up during the two weeks after the first dose.
Consider treating the whole family, especially if sharing a bed with the child as these can be fairly contagious from the child spreading the eggs from his anus.
Read online how to clean everything in your child's room to eliminate all the eggs laid by the worms that your child may have transferred from his anus to his clothes, towels, bedding, etc.
You should be able to manage all of this without needing an appointment with us.
Prescription meds can be used if these recur. The main one is mebendazole, but it's very expensive in some cases depending on your insurance. A slightly stronger version is called albendazole, which is much cheaper and can be used instead for cost reasons OR if the worms persist despite using mebendazole. Call or message us for an appointment if you need a prescription.
BITES - Animal and Human Bites
Most animal and human bites don't require emergency treatment, so no need to panic. On AskDrSears.com we have an excellent page that describes what to do for every possibly type of animal or human bite. Follow the cleaning and care instructions there, and if you need medical help contact us after hours if your bite is an emergency or during normal office hours if it is not. Click here to go to the AskDrSears.com page.