Resources

Illnesses - Ha-Lz

HEAD TRAUMA

General Information:

Head injuries can be extremely serious depending on the force involved.  Children are especially prone to this problem since they are daring, less coordinated than adults, and often involved in rough play. If the blow to your child's head is particularly severe such as in a car accident or an uncushioned fall of twice his body length, then he should be examined.

Children tolerate head injuries better than adults at least in the early years.  The soft spot in babies allows for some of the force to be dampened and so decreases the injury to the brain.  Children until the age of about 8 years have skull bones that are not fused and so also have decreased force applied to the brain with a head injury.

There are 2 major types of head injuries. First, direct force to the brain causes bruising and possibly a concussion.  Second, torn blood vessels from her injury can cause the formation of a large blood clot on her brain that increases the pressure inside her skull.

Symptoms that may occur with head injuries include headaches, sleepiness, repeated vomiting, disorientation, unsteady walking, amnesia, seizures, and unconsciousness.  Fortunately, with most injuries the symptoms are mild.

Treatment:

1. If he has had a hard blow to his head, then an initial physical exam is necessary.
   
2. You may give her acetaminophen (Tempra, Panadol, Tylenol, etc.) for expected headaches which may continue for several days.
   
3. Give him small, light meals for the next 12-24 hours since he will tend to be nauseated.
   
4. She may become sleepy. If she is otherwise acting normal, and her pupils constrict when a  light is shined in them, then she may sleep for 2-4 hours at a time.
   
5. In the middle of the night you should awaken him to see if he will wake normally.  Walk him around, talk with him, to make sure his response is normal. You should also check his pupils with a light again to make sure that they constrict.

Call Your Doctor If:

1.  She has repeated vomiting.
2.  He has an abnormal pupil response to light.
3.  If he has a seizure.
4.  She develops amnesia, lack of coordination, hallucinations, or other unusual behaviors.
5.  He has worsening headaches which might be a sign of a slowly enlarging blood clot.
6.  She has headaches that are lasting longer than 5 days.

 

HIVES
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General Information:

The hives are red, swollen, blotchy rashes associated with severe itching.  They are usually caused by the body's allergic reaction to a drug, food (especially nuts, dairy products, eggs, berries, and shellfish), insect bites, inhaled pollens, direct contact with irritants, but may also be a reaction to an infection.  Rarely, the cause may be stress, heat, cold, sunlight, pressure, hereditary factors, or certain systemic diseases. 

Hives may occur in up to 1/4 of all people at some point in their lives, and often the exact cause is unable to be determined, despite a careful search.  They are not contagious and are not spread by scratching, although scratching should be discouraged to prevent secondary infection.

Treatment:

1. If the reaction is to an insect sting, remove the stinger with a horizontal scraping motion.
   
2. If your child is taking any medications, stop it immediately and notify the doctor.
   
3. For itching, Benadryl elixir may be given by mouth every 4-6 hours, and cool compresses or baths may be helpful.

Call Your Doctor If:

1.  He develops hives while he is taking medication.
2.  She has fever, joint swelling or pain, or stomachache at the same time as the hives.
3.  He has hives which last longer than several days.
4.  She has hives associated with swelling of the mouth or difficulty breathing.
5.  He has a family history of recurrent hives.

 

IMPETIGO
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General Information:

Impetigo is a contagious, bacterial disease of your child's skin.  It is spread to other areas of his body by his scratching.  Impetigo can be transmitted to another person as long as his sores are open, but isolation or quarantine of your child is not necessary.  All family members with these skin sores must be treated.  It is important to treat his impetigo, as it rarely can result in serious complications such as kidney or heart problems.

Treatment:

1. Medication: if severe your doctor may give her antibiotics by injection, but this is unusual. Otherwise, your doctor will prescribe a 5-7 day course of antibiotics.  It is important to continue her medication for this period even if her skin has cleared.  A medication in a cream (Bactroban) is as good as oral medications if her infection is in one area only.
   
2. Cut his nails short and wash his hands often to prevent scratching and the spread of his infection.
   
3. Clean her infected skin four times a day with a mild soap.  Continue to do this until all of her sores are completely healed.  Use a clean cloth and towel every time you clean her skin or use disposable paper towels.
   
4. Do not use any creams or ointments unless your doctor has specifically prescribed them for him. Many of the nonprescription antibiotics can be irritating to him if used for a few days.

Call Your Doctor If:

1.  She has eye drainage.
2.  He has redness or pus around his navel (especially in infants).
3.  She has puffiness or swelling around her eyes, or on her arms and legs.
4.  He develops fever of 101 degrees F or higher.
5.  Her sores show no signs of clearing in 3-5 days.
6. He develops red or tea-colored urine.
7. She seems to be getting progressively sicker in any other way.

 

INFLUENZA (FLU)
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Influenza is a viral illness that can strike at any age but is especially serious in the very old or the very young.  It is most common in the winter, during which time epidemics of flu often occur. It is quite contagious so that frequently most or sometimes all members of your family will be sick at the same time. The flu is a particularly severe viral infection because of its tendency to go into secondary illnesses especially ear infections and pneumonia. Flu has the following signs and symptoms:

1. High fever and chills for 3 to 5 days but sometimes longer in the younger children.
   
2. Aching all over, especially in the back, neck and head.
   
3. A deep hacking cough for 2 weeks or longer.
   
4. Sore throat.
   
5. Sometimes upset stomach.

Prevention:
A yearly vaccine is especially important for children with asthma, heart disease, or chronic respiratory problems (premature lung, cystic fibrosis, or frequent pneumonia). This vaccine injection can be given to any child above 12 months and may cause fever, pain in the area of the vaccine, and the general aches usually seen with the flu. A new nasal spray vaccine may be more effective and is not painful, but is not available to all children.

Treatment:

1. Do not give her aspirin under any circumstances as this can cause Reye Syndrome.
   
2. Acetaminophen (Tempra, Panadol, Tylenol, or generic) is given for pain and fever.
   
3. Ibuprofen (Advil, Motrin, etc.) may also be given or alternated with acetaminophen.
   
4. Antibiotics do not help him unless a secondary, bacterial infection has occurred.
   
5. Rest is very important to speed recovery for her. Keeping up a regular routine will tend to keep her sick longer. However, complete bed rest is unnecessary. 
   
6. Give him a light diet before bed (no milk or dairy products) to prevent thickening of mucous.
   
7. Warm liquids, humidifiers, and showers may soothe her throat and keep her mucous moving.
   
8. The doctor may sometimes prescribe a cough suppressant with codeine for bedtime usage only to allow him to sleep.

Call Your Doctor If:

1.  She is complaining of a persistent earache.
2.  He has difficulty breathing from wheezing or severe coughing.
3.  She has pain in her chest which may imply she has pneumonia.  Rapid breathing, especially with her ribs showing, should cause you to return for a repeat examination.
4.  He has repeated vomiting or stiff neck.
5.  She has an ongoing high fever (102 degrees F. or greater) for more than 3 days.
6.  He has a recurrence of high fever after his temperature had returned to normal.

 

INGROWN TOENAIL
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General Information:

An ingrown toenail is a painful swelling of the corner of one of the large toes that is due to wearing tight shoes or cutting the toenails improperly. It most commonly occurs in teenagers who cut their toenails too short and cannot cut all the way across the nail. So they tear off the corner portion of the nail which leads to an irregular nail often with a barb on the end that grows into the fleshy portion of the corner of the toe. Picking at the toenails as a nervous habit can result in the same problem.

Treatment:

1. Soak the foot twice a day in warm, soapy water to help reduce the bacteria in the inflamed toe.
   
2. Antibiotic ointment is usually not very helpful, but if your child's toe is very swollen you may apply the ointment for a few days after soaking.
   
3. Have your child wear sandals or go barefoot as much as possible. When she has to wear closed shoes, she can place a little cotton on the side of the inflamed nail to reduce her pain.
   
4. If your child's toe has not improved substantially after doing the above, you will probably need to take him to your doctor who will have to cut off the corner of the nail. Although this is a painful procedure, it usually only takes a few seconds to perform.
   
5. Continue to soak the foot twice daily after your doctor has removed the corner of the nail. The swelling will usually go down dramatically in the days following the removal of the corner of the nail.
   
6. Occasionally a larger part of the nail needs to be removed if removal of the corner does not reduce the pain and swelling. This may be done by a surgeon or podiatrist.

Call Your Doctor If:

1. Your child's ingrown toenail is not improving with soaking.
2. The redness of your child's toe is enlarging noticeably over a day or two.
3. Your child develops fever or chills.

 

INSECT BITES AND STINGS
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General Information:

Insects bites and stings are a common part of human existence. While there are many different types of biting and stinging insects, they can generally be divided into just a few categories:

Stings from Bees, Wasps, Hornets, and Yellow Jackets

These insects use their stingers to protect themselves and especially their nests from intruders. If the person just receives one or two stings, no danger exists. He will have one or two red bumps with a burning sensation that usually lasts for 1-2 hours. The swelling may increase for 24 hours. Multiple stings of ten or more can cause vomiting, diarrhea, headache, and fever due to the large volume of venom injected. Stings in the tongue can cause severe swelling and breathing problems.

Honey bees can only sting once and leave the stinger in place. Since the stinger continues to pump venom into the child, it should be scraped out against the direction it is imbedded into the skin. Otherwise the stings can be treated similarly by placing a cotton ball soaked in meat tenderizer at the site for 15 minutes (to neutralize the venom), then placing a cool cloth over the site, and giving acetaminophen or ibuprophen for pain relief. Teach your child to stay away from dense bushes that often are homes of wasp nests during the summer. When you eat outside make sure to cover sugar-filled soft drinks and avoid clear glasses containing colorful drinks such as Kool-Aid because this attracts bees and wasps. You need to call your doctor if your child has respiratory problems, hives, more than 10 stings, or a sting inside the mouth.

Biting Insects

Mosquitoes, chiggers, fleas, bedbugs, fire ants, and other insects cause itchy, red bumps. Some variations exist among these insects. Mosquito bites occur in exposed areas anywhere on the body. Fleas, ants, and other nonflying insects are more likely to bite on the lower extremities and chiggers usually climb up under the clothing, especially around the elastic of underwear. None of these insects is prone to spreading other diseases.

Treat by applying calamine lotion or baking soda to the area. Use cold compresses in the areas that are especially itchy. Apply 1% hydrocortisone three times a day to reduce the itchiness and swelling. Using insect repellant can be helpful to keep mosquitoes at bay, but should not be used in babies less than 6 months old. Keep them covered and inside at dusk when mosquitoes are most likely to be out. When traveling through grassy fields, wear long pants to keep chiggers away from skin, then change the clothes immediately when arriving home. Treat animals for fleas and spray for crawling insects in the home with toxins that are safe for children.

Tick Bites

Ticks are biting arthropods that suck blood from warm-blooded hosts for 3-6 days. The bite is usually painless and causes little swelling unless it becomes secondarily infected. Ticks can spread diseases such as Rocky Mountain Spotted Fever by the wood or dog tick (up to ½ inch across) and Lyme disease by the deer tick which is only the size of a pinhead.

If a tick is discovered on your child slowly remove it with tweezers by gently pulling grasping the tick as close to the skin as possible. For very small ticks you may need to scrape the skin with a knife carefully to remove the tick. Applying a hot match, alcohol, or other caustic materials do not cause the tick to stop biting. Prevent tick bites by wearing long pants on hikes with the pant legs stuck into the top of the socks. Apply tick repellent to the shoes and check your shoes and pants every 2-3 hours. Shower after a hike to remove ticks that are not firmly attached. Check the skin of preschoolers and have older children check their bare skin for ticks. Also check in hair because this is a favorite place for ticks to go.

JAUNDICE IN NEWBORNS
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General Information:

Jaundice is caused by increasing levels of bilirubin (a blood by-product) in your baby's body. Up until the time of delivery the mother's liver metabolizes (breaks down) all the bilirubin in both the mother and baby.  Once the cord is clamped, the baby is forced to start breaking down the bilirubin on his own.  Since newborn livers are quite immature compared to adults, the bilirubin and thus the level of jaundice begins to rise.  Therefore, all newborns become jaundiced to a degree usually by the 3rd or 4th day of life.  This is not dangerous.

However, there are several situations that can cause the bilirubin to go very high which can result in irritability, poor feeding, permanent hearing loss, loss of coordination, or other forms of brain damage.  Infection in the baby, prematurity, interaction between the mother's and baby's blood, difficult deliveries with low Apgar scores, poor feeding, and extensive bruising can cause the bilirubin level to rise. Breast-fed infants will sometimes develop somewhat higher levels of jaundice due to small amounts of hormones in the mother's milk which interfere with the breakdown of bilirubin in the infant's liver.  This is not dangerous and does not lead to the above problems although it is difficult to distinguish breast milk jaundice from the other forms.

Treatment:

1. The physical exam can usually give an estimate of how high the bilirubin level is and also assess your baby's activity and the possibility of infection.
   
2. A bilirubin blood test might be necessary if your baby appears on the physical exam to be in the high range. 
   
3. Frequent nursing or formula will help eliminate a source of the bilirubin in the stool.  It might be helpful to supplement with glucose water or Pedialyte if your child is nursing.
   
4. Occasionally it will be necessary to stop nursing for 24 hours to decrease the jaundice from the breast milk.  The mother should pump her milk during that time so that she can restart nursing without difficulty.
   
5. If the baby's bilirubin continues to rise, it might be necessary to begin phototherapy in the hospital. While sunlight can lower the bilirubin level at home, the small degree to which it is lowered is probably not worth the risk of sunburn, overheating, dehydration, or damage to the baby's eyes which are also exposed.

Call Your Doctor If:

1.  Your baby is feeding less and less.
2.  Your baby has become very irritable and he has a high-pitched cry.
3.  Your baby has suddenly become much more yellow.
4.  Your baby is sleeping more and more.
5.  Your baby develops fever or rashes all over her body.

 

LICE
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General Information:

Pediculosis is the disease produced by infestation with sucking lice.  There are 4 places where lice can cause problems.  Infestation may involve the scalp hair, axillary hair, pubic hair, or the skin surface, especially in the skin creases or at the waist. Most cases are in the scalp.

Lice are transmitted by close contact or from infested clothing, bedclothes, etc.  Your school-age child will be excluded from school until the lice are eliminated so that other children can be protected from the infestation.  The condition is inconvenient and uncomfortable but not serious.

Treatment:

1. All family members should be closely examined for lice.  It is usually recommend to treat everyone in the family unless younger than 1 year of age or pregnant, but consult your doctor.
   
2. Wash all bedclothes, towels, wash cloths, hats and clothes in hot water, or dry clean if necessary. Sweep mattresses, pillows, box-springs, floors, and rugs.
   
3. A prescription for lindane (Kwell) or Nix will be prescribed. Nix shampoo tends to be better in that it remains in the hair roots for up to 2 weeks killing new lice that may emerge from ones originally missed. However, since it has been available without a prescription for several years, resistance may have developed in some lice.

For head and/or pubic lice: Kwell or Nix Shampoo

1. Have each family member take a hot, soapy bath or shower.
   
2. Pour 2 tablespoons of Kwell or Nix shampoo onto the hair.
   
3. Shampoo vigorously being sure to wet all the hair at the base with the shampoo.
   
4. Wet hair with a little warm water and work into a full lather for a full 15 minutes.
   
5. Rinse completely and dry with a clean towel.
   
6. Comb vigorously with a fine-toothed comb as necessary to remove the nits (larval stage). You may have to remove some of them with tweezers. 
   
7. Combs and brushes should be washed with Kwell or Nix shampoo before being used again.
   
8. A second shampoo is seldom needed, but may be used once again within 7 days if needed.
   
9. Examine dogs and cats for lice.  Consult a veterinarian if found.

 

LYMPH  GLANDS THAT ARE SWOLLEN
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General Information:

Lymph glands are present throughout the body, especially the neck, armpit, and groin areas. They can often be easily felt, particularly in slim individuals. They are normally smaller than a pea, movable, and not tender.  Lymph glands act to filter harmful substances and thus are part of the body's defense against infection.  Lymph glands often swell in response to a nearby infection (for example, a cold or tonsillitis) in their attempt to control the infection.  This swelling may persist for some time, even weeks.

When glands are marble-sized or larger, associated with redness, tenderness, or fever, there may be more serious causes.  The most common of these is adenitis, a bacterial infection of the gland itself.  Other causes for abnormally swollen glands include tuberculosis and related infections, the so-called "cat-scratch disease," some cancers, and several viruses and fungi. In addition, some unrelated lumps may be mistaken for swollen glands.

Treatment:

1. Usually swollen glands, if small and not associated with other symptoms, require only observation, making sure that they do not continue to enlarge or become tender.
   
2. An infection of the gland itself may be treated with oral antibiotics.  Warm compresses for 15 minutes three times daily may be helpful.
   
3. Occasionally drainage of the gland, antibiotic injections, or further testing is required.

Call Your Doctor If:

1.  Your child has glands swollen for more than 3 days, enlarging rapidly, or red and tender.
2.  Your child's infected glands have not responded to antibiotic treatment within 3-5 days.
3.  Swollen glands are present in several places or associated with fever, weight loss, or other serious symptoms.