Fevers are a normal part of the body’s immune system to fight off illness. Although they can look scary to a parent, they do not need to be feared. When a child has a fever, they will often look very sleepy, and have faster heart rates and faster breathing. Children often will have higher temperatures in the evenings and when they are sleeping (overnight and naps).
A rectal temperature of 100.4 degrees Fahrenheit or higher is considered a fever. It is not always necessary for a child with a fever to see their doctor and not all fevers need to be confirmed using a rectal thermometer, unless your child is under 2 months old. An infant under 2 months old should always have a fever confirmed using a rectal thermometer.
How to treat the fever depends on the child’s age:
0-2 months- A fever is considered an emergency, and the baby should be taken to an Emergency Room (not urgent care).
3-6 months- Tylenol is a very effective medication to help reduce fevers. See the dosing chart on our website. Dress your child in loose or light weight clothing and you can wipe them with cool towels if needed. Tylenol dose can be repeated every 4 hours if needed, and it is normal for the fever to start to come back around that 4 hour mark as the medicine is wearing off. Pushing fluids can be helpful as well. For a child 3-6 months of age, they can have pedialyte or their milk (breast or formula) to keep them hydrated. Water is not safe for babies to drink until 6 months of age.
6 months and older- Tylenol and/or Motrin can be used to help control the fever. Sometimes using both medications can be more effective than using one alone. First give either Tylenol or Motrin, and then wait 60-90 minutes to see the response. If the child still has a fever, then give the other medication. Again, wait 60-90 minutes. If the child still has a high fever after both doses of medication, call our on-call physician for advice.
Remember that Tylenol to Tylenol doses need to be 4 hours apart, and Motrin to Motrin doses need to be 6 hours apart. Once you get good control of the fever, using a “piggyback” approach can sometimes be helpful to keep the temperatures down and keep your child comfortable. This can be done by giving your child a dose of fever reducing medication every 3 hours, but alternating the medication each time. For example: Tylenol at noon, Motrin at 3pm, Tylenol at 6pm, and Motrin at 9pm (etc).
It is normal for children to have fevers for a few days when they are fighting off an illness. If they continue to respond to the medications and are acting well and drinking well when their fever is down, it is OK to watch them at home for a few days. When a fever lasts beyond 5 days, isn't responding well to medications, or the child is getting more ill after 3-5 days, it may be time to bring them into the office for a visit.
Croup is caused by a viral illness that leads to swelling of the airway near the voice box. This is most common in infants and young children, but can sometimes occur in older children as well.
It is characterized by a “barking” or “seal-like” cough, hoarse voice, and sometimes difficulty in breathing. If you think your child has croup and he or she does not seem to have a hard time breathing, you can take them into a steamy bathroom for 10-15 minutes, and then immediately follow that with breathing cool air (outside or garage in winter months, or opening the freezer in other seasons). Croup coughs usually are worse at night time, but if you can keep them comfortable with steam/cool air and they are breathing ok, you do not need to have them examined over night. Symptoms of croup can often be treated using steroids (oral or injection).
If your child is having frequent coughing that does not improve with steam/cool air, or a hard time breathing, take them to an ER for evaluation.
Vomiting & Diarrhea and Dehydration-
Vomiting can be a difficult thing for baby and parent, but as long as you can keep the child hydrated, it is OK to wait it out at home. Most cases of vomiting are viral in nature and will resolve on their own without treatment. Try to avoid feeding your child for at least 60 minutes after they had any vomiting. When offering them fluids, start with a clear liquid, like pedialyte, gatoraid or water (water is only ok if child is over 6 months old) and offer about 5 ml (one teaspoon) every 5-10 minutes. If your child can keep this down, continue this for a few hours. When they can tolerate larger volumes of clear liquid without vomiting, it is OK to progress to small amounts of bland foods. If they have persisting or worsening symptoms, are unable to tolerate any liquids at all, or showing signs of dehydration, this would warrant an office appointment, urgent care or ER visit. If your child is under 2 months old and is having forceful vomiting of all liquids, please call the office or on-call doctor.
The key to managing diarrhea at home is keeping the child hydrated. If over 6 months, they can have water, pedialyte, juice, or breast milk/formula. If the child is under 6 months old, they can have breast milk/formula, or pedialyte (no water). Avoidance of diary with lactose is key to slow down the diarrhea and keeping them comfortable. If your child is under 1 year old, give them lactose free formula (like Nutramigen or Alimentum) or have the breast feeding mom avoid dairy until the child has return of normal stools. If your child is over the age of 1, and is refusing liquids other than milk, get a lactose-free milk and water it down. Children will often get a diaper rash when they have diarrhea. See the diaper rash section for more information on how to combat that.
Most parents can identify dehydration in their children based on how often they urinate. If the child is in diapers, they should have a void at least every 8 hrs. If the child is out of diapers, they should have a void at least every 8-10 hrs. If the child has not urinated during that time span, and you try to get them to go and are unsuccessful, they should be seen. Parents can also watch for additional signs of dehydration including dry lips or tongue, sunken soft spot in an infant, or no tears when crying.
If your child has been exposed to covid and they are vaccinated and have no symptoms, have them wear a mask in public places for at least 10 days and avoid any unnecessary gatherings. If they develop symptoms, call our office for an appointment to get tested.
If your child is unvaccinated, please have them quarantine for 10 days and observe for symptoms.
If they develop symptoms (vaccinated or unvaccinated), call our office for an appointment for a test, or go to an Urgent care or ER to be evaluated if the child is having difficulty in breathing or any other reason they need to be seen outside our regular office hours.
If your child tests positive for covid, they should quarantine for 10 days. There are a few circumstances they could quarantine for 5 days then continue to wear a mask for an additional 5 days, but please discuss this with the doctor. You can keep them comfortable by treating fevers, and giving over the counter medications for the common cold. Have them drink extra fluids while they are ill and get lots of rest. If they develop difficulty in breathing, high fever that cannot be controlled with tylenol or motrin, or are not acting appropriately, please call the on-call doctor or proceed to the Emergency Room.
Most diaper rashes can be taken care of at home. Try to air out the diaper area as much as possible, and clean with running water or a damp cloth and pat dry. Avoid diaper wipes if possible, and you can use a zinc containing diaper barrier cream (like Desitin or Aquaphor healing paste) with each diaper change. Sometimes mixing in over the counter hydrocortisone cream 2-3 times per day can be helpful as well. If this is not improving rash in a few days, please call our office for an appointment.
Toddlers and children fall and hit their heads quite often, and most of the time they do not need to be seen. It is normal for them to cry or be upset for a few minutes after the fall, but most children will be back to normal activity level (playful and happy) within 10-20 minutes or so. If your child is not acting appropriately after a short fall, takes a larger fall (like down stairs) or starts vomiting after hitting their head, you should call for an appointment, call the on-call doctor or take them to an emergency room to be examined.
Hand, Foot, and Mouth Disease (HFM)-
Hand, foot and mouth is a common childhood virus that leads to a characteristic rash, sore throat, and often a fever. The rash is usually found on the palms and soles of the feet, and also around the mouth and sometimes on the buttocks or arms/legs. This rash is usually red and splotchy, but often will look more like blisters. The spots can be itchy or painful for the child. Most children will also get a sore throat or pain from ulcers in the back of their mouth or throat. It is also common for them to have other signs of viral illness, like aches, chills, and runny nose or cough.
Treatment for HFM is symptomatic. Because it is a viral illness, there is no medication we can give your child to make them improve more quickly. We recommend alternating tylenol and motrin (if greater than 6 months) to treat pain or fevers. You can see how to alternate the medication in the section above on “Fever”.
HFM spreads by contact with an infected persons saliva, nasal secretions, stool, or fluid from their blisters. It is very contagious, and usually affects young children, but can also make older children and adults sick too.
Most children recover from this illness within about a week. They are considered contagious until they have been fever free for at least 24 hours, and have had no spreading of their rash in over 24 hours. Also, if any area of their rash appears to be blistered, it needs to be scabbed or crusted over. Most children will take about 7 days for all of these criteria to be met. It is not uncommon for a child’s fingers or toes to peel after having HFM, and sometimes the fingernails or toenails can looks soft or peel as well.
If your child has a fever that does not resolve in 5 days, or does not improve with Tylenol and/or Motrin, or if your child is refusing to drink and you are concerned about them becoming dehydrated, that would be the time to call our office for an appointment or take them to the ER.
Strep throat is one illness that will not get better without treatment with antibiotics. In older children and adults, strep usually presents as severe sore throat, often with fever. When you look at the throat, it will appear very red over the tonsils and roof of the mouth. Sometimes there will be "white patches" in the back of the throat, but more commonly it is just very bright red. Younger children usually present with fever and complaints of headache or belly ache. They do not always complain of sore throat, but their throats will still look red. Children under the age of 3 rarely get strep throat, and usually we do not need to test for it. In order to diagnose Strep, the child has to be tested using a swab in the back of their mouth. We cannot treat with antibiotics until we have the test to confirm if they have strep. If you think your child has strep and the office is closed, we recommend you proceed to an Urgent Care clinic to have them tested. If the office is reopening soon, you could keep them comfortable with tylenol and motrin and call us when we are open and we can test for strep in our office.