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Your Child's Health,9780553383690

Your Child's Health

by
Format: Trade Paper
Pub. Date: 11/29/2005
Publisher(s): Bantam
Availability: This title is currently not available.

Summary

Emergencies: --when to call your child's physician immediately -what to do in case of burns, bites, stings, poisoning, choking, and injuries Common Illnesses: -when it's safe to treat your child at home -step-by-step instructions on dealing with fever, infections, allergies, rashes, earaches, croup and other common ailments Behavior Problems: -proven strategies for colic, sleep disturbances, toilet training problems, thumbsucking, and the video game craze -no-nonsense discipline techniques for biting, temper tantrums, sibling fighting, and school refusal Health Promotion: From Birth Through Adolescence: -essential advice on newborn baby care, nutrition, cholesterol testing, immunizations, and sex education -ways of preventing spoiled children, picky eaters, overeating, tooth decay, accidents, and homework problems

Author Biography

Barton D. Schmitt, MD, FAAP, is Professor of Pediatrics at the University of Colorado School of Medicine, and Director of the Sleep Disorder Clinic and Encopresis-Enuresis clinic at The Children's Hospital of Denver. He has written more than one-hundred articles for fellow pediatricians, as well as the book Pediatric Telephone Protocols and the computer software program The Pediatric Advisor, used by over four-hundred-and-fifty hospitals nationwide.

Dr. Schmitt has received numerous awards for his work, including the American Academy of Pediatrics Education Award in 2004. He and his wife spend as much time as possible with their children and 6 grandchildren.

Table of Contents

Essential Topics for Each Age xix
Introduction xxi
Acknowledgments xxv
The Reader's Responsibility xxix
I. Emergencies
Emergency Telephone Calls
3(1)
Emergency Transportation
4(1)
Life-Threatening 911 Symptoms
5(1)
Emergency Symptoms
6(3)
Resuscitation (Mouth-to-Mouth Breathing)
9(1)
Choking
10(3)
Allergic Reaction, Severe (Anaphylactic Reaction)
13(2)
Bites: Animal or Human
15(4)
Bites: Insect, Bee, or Tick
19(6)
Bites, Marine Animal
25(3)
Bites, Snake
28(2)
Bites, Spider or Scorpion
30(3)
Bleeding, Severe
33(45)
Bleeding, Minor---See Skin Trauma
78
Breathing Difficulty, Severe
36(1)
Burns, Chemical
37(1)
Burns, Thermal
38(2)
Coma
40(1)
Convulsions with Fever (Febrile Seizures)
41(3)
Convulsions Without Fever
44(1)
Delirium
45(1)
Drowning
46(2)
Electric Shock or Lightning Injury
48(1)
Eye, Chemical in
49(1)
Eye, Foreign Body in
50(13)
Fracture---See Bone, Joint, and Muscle Trauma
63
Frostbite
52(1)
Heat Reactions
53(2)
Poisoning
55(3)
Suffocation
58(5)
II. Trauma (Injuries)
Bone, Joint, and Muscle Trauma
63(3)
Ear Trauma
66(1)
Eye Trauma
66(2)
Finger and Toe Trauma
68(3)
Genital Trauma
71(1)
Head Trauma
72(3)
Mouth Trauma
75(2)
Nose Trauma
77(1)
Skin Trauma
78(5)
Tailbone Trauma
83(1)
Teeth Trauma
84(1)
Tetanus Booster Following Skin Trauma
85(1)
Sutured Wound Care
86(1)
Wound Infections
87(6)
III. New Baby Care
Normal Newborns
93(37)
First Days in the Hospital: Getting Acquainted
93(4)
First Weeks at Home: Getting Help
97(5)
Normal Newborn's Reflexes and Behavior
102(1)
Normal Newborn's Appearance
103(5)
Newborn Rashes and Birthmarks
108(3)
Newborn Skin Care and Bathing
111(2)
Circumcision Decision: Pros and Cons
113(2)
Circumcision Care and Problems
115(1)
Foreskin Care and Problems
116(2)
Newborn Equipment and Supplies
118(7)
Sleep Position for Young Infants: Preventing SIDS
125(1)
Sibling Rivalry Toward a Newborn
126(4)
Newborn Problems
130(19)
Sick Newborn: Subtle Symptoms
130(1)
Sick Infant: Judging the Severity of Illness
131(1)
Cradle Cap
132(1)
Diaper Rash
133(2)
Jaundice of the Newborn
135(3)
Spitting Up (Reflux)
138(2)
Tear Duct, Blocked
140(1)
Thrush
141(2)
Umbilical Cord, Bleeding
143(1)
Umbilical Cord, Delayed Separation
144(1)
Umbilical Cord, Oozing
144(2)
Umbilical Hernia
146(3)
IV. Health Promotion: Keeping Your Child Healthy
Feeding, Eating, and Growth
149(62)
Normal Growth
149(1)
Breast-Feeding
150(6)
Formula-Feeding
156(5)
Nighttime Feedings
161
Spitting Up (Regurgitation)---See Under Newborn Problems
138(24)
Weaning, Normal
162(2)
Weaning Problems
164(3)
Solid (Strained) Foods
167(4)
Appetite Slump in Toddlers
171(4)
Picky Eaters
175(3)
A Healthy Diet
178(5)
Cholesterol Screening or Testing
183(3)
Treating High Cholesterol Levels
186(3)
Sugar and Sweets
189(3)
Baby Bottle Tooth Decay: Prevention
192(2)
Tooth Decay Prevention
194(3)
Food Allergies
197(4)
Overeating: Prevention of
201(2)
Overweight: A Weight-Reduction Program
203(5)
Eating Problems: Other Strategies
208(3)
Development and Safety
211(1)
Developmental Stimulation
211(11)
Injury Prevention
215(1)
Car Safety Seats
216(4)
Shoes
220(2)
Preventing Infections
222(1)
The Prevention of Infections
222(16)
Immunizations for Prevention
225(1)
Immunization Reactions
226(3)
Passive (Involuntary) Smoking
229(2)
Contagious Diseases and Incubation Periods
231(3)
Frequent Colds and Other Infections
234(4)
Medicines
238(15)
Nonprescription Drug Dosage Tables
238(2)
Medicines: Overuse
240(1)
Antibiotics: Preventing Unnecessary Use
241(2)
Medicines: Safe Use
243(1)
Medicines: Helping Children Swallow Them
244(4)
First Aid Kit
248(1)
Home Medicine Chest (Nonprescription Medicines)
248(2)
Antibiotics, Failure to Improve on
250(3)
V. Behavior: Preventing and Solving Problems
Sleep Problems
253(33)
Crying Baby (Colic)
253(4)
Prevention of Sleep Problems: Birth to 6 Months
257(4)
Prevention of Sleep Problems: 6 Months to 2 Years
261(2)
Trained Night Feeder (Night Awakenings from Feeding Until Asleep)
263(4)
Trained Night Crier (Night Awakenings from Holding Until Asleep)
267(4)
Bedtime Resistance
271(4)
Sleeping with the Parents (Bed-Sharing)
275(2)
Nightmares
277(1)
Night Terrors
278(2)
Sleepwalking
280(2)
Early-Morning Riser
282(1)
Sleep Problems: Other Strategies
283(3)
Toilet-Training Problems and Bedwetting
286(23)
Toilet-Training Your Child: The Basics
286(4)
Toilet-Training Resistance (Encopresis and Daytime Wetting)
290(3)
Incentives for Motivating Children
293(2)
Encopresis from Stool-Holding
295(3)
Encopresis and Constipation: How to Get Better (Note to the School-Age Child)
298(1)
Daytime Frequency of Urination
299(3)
Bedwetting (Enuresis)
302(4)
Bedwetting Alarms
306(3)
Discipline Problems
309(54)
Discipline Basics
309(9)
Physical Punishment and Spanking
318(2)
Time-out Technique for Discipline
320(4)
Time-out: When It Doesn't Seem to Be Working
324(3)
Spoiled Children, Prevention of
327(4)
The Terrible Twos and Stubborn Toddlers
331(2)
Temper Tantrums
333(7)
Biting
340(2)
Hurting Another Child
342(2)
Sibling Arguing and Quarreling
344(3)
Discipline Problems: Other Strategies
347
Sibling Rivalry---See Under Normal Newborns
126(237)
Infants, Toddlers, and Preschoolers
363(16)
Thumbsucking
363(4)
Pacifiers
367(3)
Breath-Holding Spells
370
Appetite Slump in Toddlers---See Under Feeding, Eating, and Growth
171(201)
Sex Education for Preschoolers
372(2)
Masturbation in Preschoolers
374(2)
Speech Problems: Normal Versus Stuttering
376(3)
School-Age Children
379(28)
School Phobia or Avoidance
379(4)
Attention-Deficit/Hyperactivity Disorder (ADHD)
383(5)
Schoolwork Responsibility: How to Instill It
388(3)
Homework Problems (School Underachiever)
391(3)
Television: Reducing the Negative Impact
394(5)
Video Games
399(2)
R-Rated Movies: Protecting Your Child
401(3)
Tics (Twitches)
404(2)
Nail-Biting Habit
406(1)
Family Issues
407(20)
The Working Mother: Juggling Children, Home, and Career
407(9)
Divorce's Impact on Children
416(3)
Adolescents: Dealing with Normal Rebellion
419(8)
VI. Common Symptoms and Illnesses
General Symptoms of Illnesses
427(14)
Fever
427(4)
Fever: Myths and Facts
431(2)
Temperature: How to Measure It
433(5)
Decreased Appetite with Illness
438(1)
Increased Sleep with Illness
439(1)
Decreased Activity with Illness
440(1)
Skin: Widespread Pink or Red Rashes
441(24)
Rashes, Unknown Cause (Widespread)
441(1)
Itching, Unknown Cause (Widespread)
442(2)
Rashes While on Drugs
444(1)
Amoxicillin Rash
445(1)
Chicken Pox (Varicella)
446(3)
Dry Skin
449(1)
Eczema (Atopic Dermatitis)
450(3)
Fifth Disease (Erythema Infectiosum)
453(2)
Heat Rash (Miliaria)
455(1)
Hives (Urticaria)
456(2)
Measles (Rubeola)
458(2)
Measles Vaccine Rash
460(1)
Purple Spots or Dots
460(1)
Roseola (Roseola Infantum)
461(1)
Rubella (German Measles)
462(1)
Scarlet Fever
463(2)
Skin: Localized Pink or Red Rashes
465(24)
Rashes, Unknown Cause (Localized)
465(2)
Itching, Unknown Cause (Localized)
467(1)
Acne
468(3)
Athlete's Foot
471(2)
Boils (Abscesses)
473
Cradle Cap---See Under Newborn Problems
132(1)
Diaper Rash---See Under Newborn Problems
133(342)
Hand, Foot, and Mouth Disease
475(1)
Impetigo (Infected Sores)
476(3)
Jock Itch
479(1)
Lice (Pediculosis)
480
Newborn Rashes and Birthmarks---See Under Normal Newborns
108(374)
Poison Ivy
482(2)
Ringworm
484(1)
Shingles (Zoster)
485(2)
Sores
487(1)
Tinea Versicolor
487(2)
Skin: Conditions Without a Rash
489(23)
Blisters, Foot or Hand
489(1)
Bluish Lips (Cyanosis)
490
Burns, Chemical---See Under Emergencies
37(1)
Burns, Thermal---See Under Emergencies
38(452)
Calluses, Corns, and Bunions
490(1)
Cracked Skin
491(1)
Dandruff
492(1)
Fingernail Infection (Paronychia)
493(1)
Slivers or Splinters (Foreign Body in Skin)
494(2)
Freckles
496(1)
Hair Loss
496
Injury (Bruises, Cuts, Puncture Wounds, and Scrapes)---See Skin Trauma
78(419)
Jaundice
497(1)
Lymph Nodes (or Glands), Swollen
498(2)
Moles (Nevi)
500(1)
Pale Skin
501(1)
Pimples
502(1)
Sunburn
503(4)
Sweating, Excessive
507(1)
Toenail, Ingrown
508(2)
Warts
510(2)
Brain
512(10)
Altitude Sickness
512
Breath-Holding Spells---See Under Behavior Problems
370
Coma---See Under Emergencies
40(1)
Convulsions---See Under Emergencies
41(4)
Delirium---See Under Emergencies
45(469)
Dizziness
514(1)
Fainting
515(2)
Headache
517
Injury, Head---See Head Trauma
72(447)
Motion Sickness
519(1)
Soft Spot, Bulging
520(1)
Soft-Spot Closure
520(2)
Eyes
522(10)
Allergies of the Eyes
522
Chemical in Eye---See Under Emergencies
49(474)
Dark Circles Under the Eyes
523
Foreign Body in Eye---See Under Emergencies
50(16)
Injury---See Eye Trauma
66(458)
Itchy Eye
524(1)
Red or Pinkeye Without Pus
524(3)
Red or Pinkeye with Pus
527(2)
Swelling of Eyelid
529(1)
Stye
530
Tear Duct, Blocked---See Under Newborn Problems
140(387)
Yellow Discharge---See Red or Pinkeye with Pus
527(5)
Ears
532(18)
Earache
532(3)
Ear Congestion
535(1)
Ear Discharge
536(1)
Earwax, Packed
537(1)
Foreign Body in Ear
538
Injury---See Ear Trauma
66(473)
Itchy Ear
539(1)
Mumps
540(2)
Pierced Ear Infections
542(2)
Pulling at Ear
544(1)
Swimmer's Ear (Otitis Externa)
545(2)
Ventilation Tubes Surgery
547(3)
Nose
550(14)
Colds
550(5)
Foreign Body in the Nose
555(1)
Hay Fever (Allergic Rhinitis)
556
Injury---See Nose Trauma
77(482)
Nosebleed
559
Runny Nose---See Colds
550(11)
Sinus Congestion
561(3)
Mouth and Throat
564(17)
Bad Breath (Halitosis)
564(1)
Canker Sores (Mouth Ulcers)
565(2)
Cold Sores (Fever Blisters)
567(1)
Geographic Tongue
568
Injury, Mouth---See Mouth Trauma
75(9)
Injury, Teeth---See Teeth Trauma
84(485)
Lip, Swollen
569
Neck, Swollen---See Lymph Nodes (or Glands), Swollen
498(72)
Sore Throat (Pharyngitis)
570(2)
Swallowing Difficulty
572(1)
Teething
573
Thrush---See Under Newborn Problems
141(434)
Tongue-Tie
575(1)
Tonsil and Adenoid Surgery
576(2)
Toothache
578
Tooth Decay Prevention---See Under Feeding, Eating, and Growth
194(387)
Lungs (Respiratory)
581(15)
Allergic Reaction, Severe---See Under Emergencies
13(23)
Breathing Difficulty, Severe---See Under Emergencies
36(545)
Breathing, Noisy
581(1)
Chest Pain
582
Choking---See Under Emergencies
10(574)
Congestion, Respiratory
584(1)
Cough
584(4)
Croup (Croupy Cough and Stridor)
588(3)
Hoarseness
591(1)
Influenza (Flu)
592(2)
Wheezing
594(2)
Abdomen (Gastrointestinal)
596(28)
Abdominal Pain
596(2)
Amoxicillin Diarrhea
598(1)
Constipation
599(4)
Diarrhea
603(5)
Foreign Body, Swallowed
608(2)
Gas, Excessive
610(2)
Hiccups
612(1)
Nausea
613(1)
Pinworms
613
Spitting Up (Reflux)---See Under Newborn Problems
138(478)
Stools, Blood in
616(1)
Anal Fissure
617(1)
Stools, Unusual Color of
618
Umbilical Hernia---See Under Newborn Problems
146(473)
Vomiting
619(3)
Vomiting of Blood
622(2)
Bladder (Urinary)
624(5)
Bedwetting (Enuresis)---See Under Toilet Training Problems and Bedwetting
302
Toilet Training---See Toilet-Training Your Child: The Basics
286(338)
Urination, Pain with
624(3)
Urine, Blood in
627(1)
Urine, Strong Odor
627(2)
Genitals
629(6)
Circumcision Decision: Pros and Cons---See Under Normal Newborns
113(2)
Circumcision Care and Problems---See Under Normal Newborns
115(1)
Foreskin Care and Problems---See Under Normal Newborns
116(513)
Foreign Body in Vagina
629
Injury---See Genital Trauma
71(559)
Menstrual Cramps (Dysmenorrhea)
630(2)
Swelling, Groin or Scrotum
632(1)
Vaginal Irritation or Itching
633(2)
Bones, Joints, and Muscles
635(10)
Backache, Acute
635
Injury, Bone, Joint, and Muscle---See Bone, Joint, and Muscle Trauma
63(5)
Injury, Finger and Toe---See Finger and Toe Trauma
68(15)
Injury, Tailbone---See Tailbone Trauma
83(554)
Limb Pain
637(1)
Limp
638(1)
Neck Pain, Acute
639(6)
VII. Glossary
A Glossary of Children's Diseases Requiring Physician Consultation
645(20)
Chronic Diseases or Conditions
645(9)
Acute Illnesses Usually Requiring Admission to the Hospital
654(5)
Acute Illnesses Usually Treatable at Home but Requiring a Physician for Diagnosis
659(6)
Index 665

Excerpts

EMERGENCY TELEPHONE CALLS

Life-Threatening Emergencies

Dial 911 (Emergency Medical Services). In larger cities, this call will dispatch an emergency vehicle staffed by a rescue squad and based at the nearest fire department. In smaller towns and counties, the operator will connect you with an emergency ambulance service. The direct number for this service is usually found on the first page of your telephone directory. In areas that use 911, children should be taught to dial this number for crises. Increasingly, 911 is being linked to a computer system (“enhanced 911”) that can determine the address of the incoming call even if the caller can’t speak.

Non-Life-Threatening Emergencies

Call Your Child’s Physician. If you don’t have a physician, call the near- est emergency room. Always call in first, rather than simply going to an emergency room. Your physician may provide you with critical first aid instructions by phone (e.g., for burns, animal bites, or fractures). Your physician also can help you decide whether a rescue squad should be sent out or if it is safe for you to drive in. In addition, your physician can also tell you if it’s safe to be seen in the office or where to take your child for the best emergency care.

Poisoning

If you know the phone number of the nearest Poison Center, call them now. If not, call the National Poison Center hotline at 1-800-222-1222. They will automatically connect you with your local Poison Center.

How to Cut Through Red Tape

When you call in, always state assertively, “This is an emergency.” Do not let the answering service or receptionist put you on hold before talking with you. If you are put on hold, hang up and call back immediately.

EMERGENCY TRANSPORTATION

Life-Threatening or Major Emergencies

Call your rescue squad (911) or ambulance service.

Definition of a Life-Threatening Emergency—Children who may need resuscitation en route (for instance, those with severe breathing difficulty, severe choking, or not breathing) require a 911 call. Other potentially life-threatening emergencies are persistent loss of consciousness (coma), continuing seizure, or bleeding that can’t be stopped by direct pressure. Children with major trauma or possible neck injury need splinting before transportation.

The Staff of Emergency Vehicles—Emergency vehicles are staffed by EMTs (Emergency Medical Technicians) or Paramedics. EMTs are trained in Basic Life Support: cardiopulmonary resuscitation (CPR), splinting, bandaging, and so on. Paramedics are EMTs with additional training in Advanced Life Support: drawing blood, starting IVs, intubation, recording EKGs, and so on. EMTs receive 160 hours of training and Paramedics receive 1,200 hours. These pre-hospital care specialists are certified by their national associations. While providing emergency care, they are linked by two-way radio to an emergency room physician at their base hospital.

Rescue Squads Versus Ambulance Services—In larger cities, rescue squads are often available through local fire departments. Usually rescue squads can respond more rapidly than ambulances, and their service is free. After the patient’s condition has been stabilized, they will often call an ambulance company for transport to the hospital if it is warranted. In general the police do not transport sick people, so don’t call them for medical emergencies.

Non-Life-Threatening Emergencies

Go to the nearest hospital offering emergency services. Try to call your child’s physician first.

Definition of Less Severe Emergencies—These concern children who need to be seen as quickly as possible but whose condition is currently stable or at least does not pose a danger of suddenly needing resuscitation. Examples are poisonings, slow bleeding controlled by pressure, severe pain, and seizures that have stopped.

Advantage of Car over an Ambulance—A private car is quicker and less expensive than an ambulance. Another option is to call a taxi.

Driving in to Seek Emergency Care—If you are going by private car, don’t leave until you know the exact location of the emergency room you will be going to. It is a good idea to rehearse the drive by the fast- est route before an emergency occurs. Keep your sick child in a car safety seat. Try to have a friend or neighbor accompany you and do the driving. Some parents are too shaken by their child’s injury to drive safely.

What to Bring with You to the Emergency Room

•Your health insurance card

•Your child’s immunization record

•Your pharmacy’s telephone number

•Any medicines your child is taking (or a list of drugs and dosages)

•If your child has been poisoned, bring the container.

•If your child has passed blood in the urine, stool, or vomited material, bring a sample for testing.

•Your child’s security object or favorite toy

LIFE-THREATENING 911 SYMPTOMS

Every parent should learn how to identify life-threatening symptoms. You need to know in advance when to call 911 rather than trying to reach your doctor, and when it’s not safe to try to drive to the hospital. Then you will not make the tragic mistake of attempting to drive your seriously ill child to an emergency room only to have him/her stop breathing or go into shock on the way. If your child ever has any of the following symptoms, call Emergency Medical Services (911) immediately.

Severe Breathing Problems

•Breathing has stopped.

•Your child is choking and unable to breathe or is turning blue.

•Difficulty breathing follows a medicine, food, or bee sting (the concern is for severe allergic reaction or anaphylaxis).

Severe Bleeding

•Blood is pumping or spurting from the wound.

•Blood is pouring out and can’t be stopped with direct pressure.

Severe Neck Injury

Try not to move your child until EMS arrives.

Seizure or Convulsion Now (hasn’t stopped)

Can’t Wake Up

Your child is unconscious (in a coma).

EMERGENCY SYMPTOMS

All the conditions discussed in this chapter are emergencies. The following emergency symptoms, however, are highlighted because they are either difficult to recognize or not considered serious by some parents. If your child has any of the following symptoms, contact your child’s physician immediately.

Sick Newborn

If your baby is less than one month old and looks or acts sick in any way, the problem could be serious (e.g., vomiting, cough, poor color).

Severe Lethargy

To be tired during an illness is normal, but if your child stares off into space, won’t smile, has no interest in playing, is too weak to cry, is floppy, or is hard to awaken, these are serious symptoms.

Severe Pain

If your child cries when you touch him or move him, this can be a symptom of meningitis. Such children also don’t want to be held. Constant screaming or the inability to sleep also points to severe pain.

Can’t Walk

If your child has learned to walk and then loses the ability to stand or walk, the most likely reason is that he or she has a serious injury to the legs or an acute problem with balance. If your child walks bent over, holding his abdomen, he probably has a serious abdominal problem such as appendicitis.

Tender Abdomen

Press on your child’s belly while he or she is sitting up in your lap and looking at a book. Normally you should be able to press an inch or so in with your fingers in all parts of the belly without resistance. If he pushes your hand away or screams, this is an important finding. If the belly is also bloated and hard, the condition is even more worrisome. (See Abdominal Pain, page 596.)

Tender Testicle or Scrotum

The sudden onset of pain in the groin area can be due to twisting (torsion) of the testicle. This requires surgery within 8 hours to save the testicle.

Labored Breathing

You should assess your child’s breathing after cleaning out the nose and when he is not coughing. If your child is working hard at breathing, has tight croup, or has obvious wheezing, he or she needs to be seen immediately. Other signs of respiratory distress are a rapid breathing rate, bluish lips, or retractions (pulling in between the ribs). (See Breathing Difficulty, Severe, page 36.)

Bluish Lips

Bluish lips, gums, or tongue (cyanosis) can indicate a reduced amount of oxygen in the bloodstream. (See Bluish Lips, page 490.)

Drooling

The sudden onset of drooling or spitting, especially associated with difficulty in swallowing, can mean that your child has a serious infection of the tonsils, throat, or epiglottis (top part of the windpipe).

Dehydration

Dehydration means that your child’s body fluids are at a low level. Dehydration usually follows severe vomiting and/or diarrhea. Suspect dehydration if your child has not urinated in 8 hours (12 hours if over 1 year old), crying produces no tears, the inside of the mouth is dry rather than moist, or the soft spot in the skull is sunken. Dehydrated children are also tired and weak. If your child is alert and active but not making much urine, he isn’t dehydrated. Dehydration requires immediate fluid replacement by mouth or intravenously.

Bulging Soft Spot

If the anterior fontanel is tense and bulging, the brain is under pressure. (See Soft Spot, Bulging, page 520.) Since the fontanel normally bulges slightly with crying, assess it when your child is quiet and in an upright position.

Stiff Neck

To test for a stiff neck: With your child lying down, lift his head until the chin touches the middle of the chest. If he is resistant to this, place a toy or other object of interest on his belly so he will have to look down in order to see it. Older children can simply be asked to look at their belly button. A stiff neck can be an early sign of meningitis.

Injured Neck

Any injury to the neck, regardless of symptoms, should be discussed with your physician because of the risk of damage to the spinal cord.

Purple Spots or Dots

Purple or blood-red spots or dots on the skin can be a sign of a serious bloodstream infection. Explained bruises don’t count. (See Purple Spots, page 460.)

Fever Over 105°F

All the preceding symptoms are stronger indicators of serious illness than is the level of fever. All of them can occur with low fevers as well as high ones. Serious infections become a special concern only when the temperature rises above 105ºF (40.6ºC). In infants a rectal temperature less than 96.8ºF (36.0ºC) can also be serious.

Suicide Concerns

Because of the marked increase in suicide attempts in adolescence, parents should be alert to any of the following warning signs: preoccupation with thoughts of death or suicide, themes of death in writing or conversation, abrupt withdrawal from friends and family, abrupt loss of interest in favorite pastimes, abrupt decline in schoolwork, reckless risk-taking behavior, depressed mood. Call either the suicide hotline or your child’s physician.

Child Abuse Concerns

Call your child’s physician or the child abuse hotline if you are afraid you might hurt your child, if someone has injured your child, or if someone has shaken your child. Child abuse has a tendency to escalate, so protect your child by seeking help early. Infants are at the greatest risk for a serious reinjury.

Related Topics

Sick Newborn: Subtle Symptoms (see page 130)

Sick Infant: Judging the Severity of Illness (see page 131)

RESUSCITATION (Mouth-to-Mouth Breathing)

If your child has stopped breathing or is gasping for breath (e.g., from choking, croup, carbon monoxide poisoning, drowning, or head trauma), you won’t have time to read these guidelines. So read them now. And take an approved CPR (cardiopulmonary resuscitation) or first aid course. You can’t learn external cardiac massage purely from reading. Fortunately, more than 90 percent of children who stop breathing still have a pulse and heartbeat (unlike heart attack victims) and they need only artificial respiration to revive them. The steps in mouth-to-mouth breathing are as follows.

Preparation

Rescue Squad—Have someone call a rescue squad (911) immediately. You’re going to need help.

Clear the Mouth—Look for any gum, food, foreign object, or loose orthodontic retainer. If present, remove them with your fingers or a Heimlich maneuver (see Choking, page 11). If any liquid is in the mouth, remove it by turning your child on one side and using gravity.

Position the Head—With your child lying faceup, put a folded blanket or towel (1?2 inch to 2 inches thick) directly under the back of your child’s head. Do not put anything under the shoulders or neck. This “sniffing,” head-forward position opens the airway and closes the esophagus (thereby keeping air out of the stomach). The jaw and chin can also be pulled forward to open the airway more. (Note: Some adolescents and adults may require slight extension of the neck for optimal breathing.)

Mouth-to-Mouth Breathing

Pinch your child’s nostrils closed with one hand and seal the mouth with yours. (In small children, an adult can often seal both the child’s nostrils and mouth with his mouth.) Blow air with a steady pressure into your child’s lungs until you see the chest rise (the smaller the child, the smaller the volume of your puff). Then remove your mouth and your child will automatically blow the air out without any help (normal recoil of the lungs). During this time, take a breath and refill your lungs. Repeat this at the following rates:

•Under 2 years old: 20 times per minute (once every 3 seconds)

•2 to 12 years old: 15 times per minute (once every 4 seconds)

•Over 12 years old: 12 times per minute (once every 5 seconds)

Occasionally, take several quite deep breaths to bring plenty of oxy- gen into your lungs. (Note: If it is impossible to open the victim’s mouth, cover the mouth and give mouth-to-nose breathing.) If 4 or 5 breaths don’t move the chest, assume the airway is blocked and perform a Heimlich maneuver 10 times in rapid succession (see Choking, p. 11).

If the heartbeat and carotid pulse are absent, also perform external cardiac massage if you know how to do it. In general, give 5 heart compressions for every 1 breath (i.e., 1-2-3-4-5-breathe, then repeat).

Excerpted from Your Child's Health: The Parents' One-Stop Reference Guide to: Symptoms, Emergencies, Common Illnesses, Behavior Problems, and Healthy Development by Barton D. Schmitt
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

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