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• Bronchiolitis ( Respiratory Syncytial Virus )
• Chickenpox
• Colds
• Cough ( Viral Bronchitis )
• Croup
• Diarrhea ( Viral Gastroenteritis )
• Ear Infection ( Otitis Media )
• Eye Infection without pus ( Viral )
• Eye Infection with pus ( Bacterial )
• Frequent Infections
• Fifth Disease ( Erythema Infectiosum )
• Influenza
• Lyme Disease
• Measles
• Mumps
• Pneumonia
• Roseola
• Rubella ( German Measles )
• Scarlet Fever

• Wheezing (making a high-pitched whistling sound when breathing out)
• Breathing rapidly at a rate of over 40 breaths per minute
• Tight breathing (having to push the air out)
• Coughing (may cough up very sticky mucus)
• A fever and a runny nose that precede the breathing problems and cough.
• The average age of children who get bronchiolitis is 6 months. They are never older than 2 years.
• The symptoms are similar to asthma.

The wheezing is caused by a narrowing of the smallest airways in the lung (bronchioles). This narrowing results from inflammation (swelling) caused by a virus, usually the respiratory syncytial virus (RSV). RSV occurs in epidemics almost every winter. While infants with RSV develop bronchiolitis, children over age 2 years and adults just develop cold symptoms. The virus is found in nasal secretions of infected people. It is spread by an infected person who sneezes or coughs less than 6 feet away from someone else or by his or her hands after touching the nose or eyes. People do not develop permanent immunity to the virus, which means that they can be infected by it many times.

Wheezing and tight breathing (difficulty breathing out) become worse for 2 or 3 days and then begin to improve. Overall, the wheezing lasts approximately 7 days and the cough about 14 days. The most common complication of bronchiolitis is an ear infection, occurring in about 20% of infants. Bacterial pneumonia is an uncommon complication. Only 1% or 2% of children with bronchiolitis are hospitalized because they need oxygen or intravenous fluids. In the long run, approximately 30% of the children who develop bronchiolitis later develop asthma. Recurrences of wheezing (asthma) occur mainly in children who have close relatives with asthma. Asthma is easily treated with medications.

Medicines
About 1/3 of children with bronchiolitis are helped by asthma-type medicines. Your health care provider may prescribe medicine for you child.
Continue the medicine until your child's wheezing is gone for 24 hours.
In addition, you can give your child acetaminophen every 4 to 6 hours or ibuprofen every 6 to 8 hours if the fever is over 102°F (39°C).

Warm fluids for coughing spasms
Coughing spasms are often caused by sticky secretions in the back of the throat. Warm liquids usually relax the airway and loosen the secretions. Offer warm lemonade or apple juice if your child is over 4 months old.
In addition, breathing warm, moist air helps to loosen up the sticky mucus that may be choking your child. You can provide warm mist by placing a warm, wet washcloth loosely over your child's nose and mouth. Or you can fill a humidifier with warm water and have your child breathe in the warm mist it produces. Avoid steam vaporizers because they can cause burns.

Humidity
Dry air tends to make coughs worse. Use a humidifier in your child's bedroom.

Nasal washes for a blocked nose
If the nose is blocked, your child will not be able to drink from a bottle or to breast-feed. Most stuffy noses are blocked by dry or sticky mucus. Suction alone cannot remove dry secretions. Warm tap-water or saline nose drops are better than any medicine you can buy for loosening up mucus. Place three drops of warm water or saline in each nostril. After about one minute, use a soft rubber suction bulb to suck out the mucus. You can repeat this procedure several times until your child's breathing through the nose becomes quiet and easy.

Feedings
Encourage your child to drink enough fluids. Eating is often tiring, so offer your child formula, breast milk, or regular milk (if he is over 1 year old) in smaller amounts at more frequent intervals. If your child vomits during a coughing spasm, feed him or her again.

No smoking
Tobacco smoke aggravates coughing. Children who have an RSV infection and are much more likely to wheeze if they are exposed to tobacco smoke. Don't let anyone smoke around your child. In fact, try not to let anybody smoke inside your home.

IMMEDIATELY if:

• Breathing becomes labored or difficult.
• The wheezing becomes severe (tight).
• Breathing becomes faster than 60 breaths per minute (when your child is not crying).

Within 24 hours if:

• Any fever lasts more than 3 days.
• The cough lasts more than 3 weeks.
• You have other questions or concerns.

• Multiple small, red bumps that become thin-walled water blisters; then cloudy blisters or open sores; and finally dry, brown crusts (all within 24 hours) .
• Repeated crops of these sores for 4 to 5 days .
• Sores or crusts that are usually less than 1/4 inch across .
• Rash that is on all body surfaces, but usually starts on head and back .
• Some sores possibly in the mouth, eyelids, and genital area .
• Fever (unless the rash is mild).
• Exposure to a child with chickenpox 14 to 16 days earlier.

Chickenpox is a disease caused by exposure to a highly contagious virus. If your child has chickenpox, then your child was exposed to the virus 14 to 16 days earlier.

New sores will continue to crop up daily for 4 to 5 days.The fever is usually the highest on the third or fourth day. Children start to feel better and stop having a fever once they stop getting new bumps. The average child gets a total of 500 chickenpox sores.
Chickenpox rarely leaves any permanent scars unless the sores become badly infected with impetigo or your child repeatedly picks off the scabs. However, normal chickenpox can leave temporary marks on the skin that take 6 to 12 months to fade. Once a child has had chickenpox he will usually never get it again. Very rarely, a child may have a second mild attack of chickenpox.

Itching and Cool Baths
The best treatment for skin discomfort and itching is a cool bath every 3 to 4 hours for the first few days. Add 2 ounces (4 tablespoons) of baking soda per tub of water. Baths don't spread the chickenpox. Calamine lotion can be placed on the most itchy spots after the bath. You can also massage the itchy spots with an ice cube for 10 minutes. If the itching becomes severe or interferes with sleep, give your child a nonprescription antihistamine called Benadryl.

Fever
Acetaminophen may be given in the dose appropriate for your child's age for a few days if your child develops a fever over 102°F (39°C). Do not give ibuprofen products because of a possible link with severe Strep infections. Do not give aspirin to children and adolescents with chickenpox because of the link with Reyes' syndrome.

Sore mouth
Because chickenpox sores also occur in the mouth and throat, your child may be picky about eating. Encourage your child to drink cold fluids. For infants, use a cup rather than a bottle because the nipple can cause pain. Offer a soft, bland diet and avoid salty foods and citrus fruits. If mouth sores become troublesome and your child is over age 4, have him gargle or swallow 1 teaspoon of an antacid solution four times a day after meals.

Sore genital area
Sores also normally occur in the genital area. If urination becomes very painful, apply some 2.5% Xylocaine (no prescription needed) to the genital ulcers every 4 hours to relieve pain.

Prevention of impetigo (infected sores)
To prevent the sores from becoming infected with bacteria, trim your child's fingernails short. Also, wash the hands with an antibacterial soap (such as Dial or Safeguard) frequently during the day. For young babies who are scratching badly, you may want to cover their hands with cotton socks.

Contagiousness and isolation
Children with chickenpox are contagious 5 days before the rash begins until all the sores have crusted over, usually about 5 to 7 days after the rash begins. To avoid exposing other children, try not to take your child to the physician's office. If you must, leave your child in the car with a sitter while you check in. Once all the sores have crusted over (after 5 to 7 days), your child does not have to stay home anymore even though he still has scabs. It may take 2 weeks for all of the scabs fall off.
Most adults who think they didn't have chickenpox as a child had a mild case. Only 4% of adults are not protected. If you lived in the same household with siblings who had chickenpox, consider yourself protected. Siblings will come down with chickenpox in 14 to 16 days. The second case in a family always has many more chickenpox sores than the first case.

IMMEDIATELY if:

• Some chickenpox sores look infected (yellow pus, spreading redness, red streaks).
• Your child develops a speckled, red rash.
• Your child starts acting very sick.

Within 24 hours if:

• The fever lasts over 4 days.
• The itching is severe and doesn't respond to treatment.
• You have other concerns or questions.

• Runny or stuffy nose.
• Usually associated with fever and sore throat.
• Sometimes associated with a cough, hoarseness, red eyes, and swollen lymph nodes in the neck.
• Also called an upper respiratory infection (URI).

1. Vasomotor rhinitis. Many children and adults have a profusely runny nose in the winter when they are breathing cold air. This usually clears within 15 minutes of coming indoors. It requires no treatment A cold or URI is a viral infection of the nose and throat. The cold viruses are spread from one person to another by hand contact, coughing, and sneezing - not by cold air or drafts. Since there are up to 200 cold viruses, most healthy children get at least six colds each year.

2. Chemical rhinitis. Chemical rhinitis is a dry stuffy nose from excessive and prolonged use of vasoconstrictor nose drops (more than 1 week). It will be better within a day or two of stopping the nose drops.

A cold or URL is a viral infection of the nosed and throat. The cold viruses are spread from one person to another by hand contact, coughing, and sneezing - not by cold air or drafts. Since there are up to 200 cold viruses, most healthy children get at least six colds each year.

EXPECTED COURSE

Usually the fever lasts less than 3 days, and all nose and throat symptoms are gone by 1 week. A cough may last 2 to 3 weeks. The main things to watch for are secondary bacterial infections such as ear infections, yellow drainage from the eyes, sinus pressure or pain (often indicating a sinus infection ), or difficulty breathing (often caused by pneumonia). In young infants, a blocked nose can interfere so much with the ability to suck that dehydration can occur.

Not much can be done to affect how long a cold lasts. However, we can relieve many of the symptoms. Keep in mind that the treatment for a runny nose is quite different from the treatment for a stuffy nose.

Treatment for a Runny Nose with Profuse Discharge

Suctioning or Blowing
The best treatment is clearing the nose for a day or two. Sniffing and swallowing the secretions are probably better than blowing because blowing the nose can force the infection into the ears and sinuses. For younger babies, use a soft rubber suction bulb to remove the secretions gently. Nasal discharge is the nose's way of eliminating viruses. Medicine is not helpful unless your child has a nasal allergy.

Warm-Water or Saline Nose Drops and Suctioning (Nasal Washes)
Most stuffy noses are blocked by dry mucus. Blowing the nose or suction alone cannot remove most dry secretions. Nose drops of warm tap water are better than any medicine you can buy for loosening mucus. If you prefer normal saline nose drops, mix 1/2 level teaspoon of table salt in 8 ounces of water. Make up a fresh solution everyday and keep it in a clean bottle. Use a clean dropper to insert drops. Water can also be dripped or splashed in using a wet cotton ball.

• For the younger child who cannot blow her nose: Place three drops of warm water or saline in each nostril. After 1 minute use a soft rubber suction bulb to suck out the loosened mucus gently. To remove secretions from the back of the nose, you will need to seal off both nasal openings completely with the tip of the suction bulb and your fingers. You can get a suction bulb at your drug store.
  
• For the older child who can blow her nose: Use three drops as necessary in each nostril while your child is lying on her back on a bed with the head hanging over the side. Wait 1 minute for the water or saline to soften and loosen the dried mucus. Then have your child blow her nose. This can be repeated several times in a row for complete clearing of the nasal passages.
  
• Errors in using nose drops: The main errors are not putting in enough water or saline, not waiting long enough for secretions to loosen up, and not repeating the procedure until the breathing is easy. The front of the nose can look open while the back of the nose is all gummed up with dried mucus. Obviously, putting in nose drops without suctioning or blowing the nose afterward is of little value.
  
• Use nasal washes at least 4 times per day or whenever your child can't breather through the nose.

• Fever: Use acetaminophen or ibuprofen for aches or mild fever
  (over 102 degrees F).
• Sore throat: Use hard candies for children over 4 years old and warm chicken broth for children over 1 year old.
• Cough: Use cough drops for children over 4 years old and corn syrup for younger children. Run a humidifier.
• Red eyes: Rinse frequently with wet cotton balls.
• Poor appetite: Encourage fluids of the child's choice.

IMMEDIATELY if :

• Breathing becomes difficult and no better after you clear the nose.
• Your child starts acting very sick.

Within 24 hours if :

• The nasal discharge lasts more than 10 days.
• A fever lasts more than 3 days.
• The eyes develop a yellow discharge .
• There is any suggestion of an earache or sinus pain.
• You have other questions or concerns.

Most coughs are caused by a viral infection. An infection of the trachea (windpipe) is called tracheitis. An infection of the bronchi (larger air passages in the lungs) is called bronchitis. Most children get such a viral infection a couple of times a year as part of a cold. These infections are usually not serious.

Usually bronchitis causes a dry tickly cough that lasts 2 to 3 weeks. Sometimes the cough becomes loose (wet) for a few days, and your child coughs up a lot of phlegm (mucus). This is usually a sign that the end of the illness is near.

Medicines to loosen the cough and thin the secretions

• Cough drops: Most coughs in children over age 4 years can be controlled by sucking on cough drops or hard candy. The cough drops or candy coat the irritated throat.
• Homemade cough syrup: For children 1 to 4 years old use 1/2 to 1 teaspoon of corn syrup instead of cough drops. The corn syrup thins the secretions and loosens the cough.
• Warm liquids for coughing spasms: Warm liquids usually relax the airway and loosen up the mucus. Start with warm lemonade, warm apple juice, or warm herbal tea. (Avoid this if your child is less than 4 months old.) Do not add liquor because it may aggravate the cough if your child inhales the fumes of alcohol into his lungs. Also, your child could become intoxicated from an unintentional overdose.

Cough-suppressant medicines
Cough-suppressant drugs reduce the cough reflex. However, the cough reflex helps protect the lungs. Use cough-suppressant drugs only for dry coughs that interfere with sleep, school attendance, or work. They also help children who have chest pain from coughing spasms. Do not give them to infants less than 1 year old or for wet coughs.
Most nonprescription cough suppressants contain dextromethorphan (DM). You may want to give your child corn syrup during the day and DM at bedtime and during the night. DM is also available as a cough lozenge and as a long-acting liquid (effective for 12 hours).

Humidifiers
Dry air tends to make coughs worse. Dry coughs can be loosened up by encouraging your child to drink a lot and by using a humidifier in your child's bedroom.

Active and passive smoking
Don't let anyone smoke around your coughing child.

Common mistakes in treating cough
Antihistamines, decongestants, and antipyretics are found in many cough syrups. There is no proof that these ingredients will help your child's cough, and the antihistamines may make your child sleepy. Expectorants are of unproven value but harmless. Stay with the simple remedies mentioned above or use dextromethorphan (DM).Milk does not need to be eliminated from the diet. Restricting it improves the cough only if your child is allergic to milk.
Never stop breast-feeding because of a cough.

IMMEDIATELY if:

• Breathing becomes difficult and is not better after you clear the nose.
• Your child starts acting very sick.

During office hours if:

• A fever (over 100°F, or 37.8°C) lasts more than 3 days.
• The cough lasts more than 3 weeks.
• You have other concerns or questions.

• a tight, low-pitched "barking" cough
• a hoarse voice

You may hear a harsh, raspy, vibrating sound when your child breathes in. This is called stridor. Stridor is usually present only with crying or coughing. As the disease becomes worse, stridor also occurs when your child is sleeping or relaxed. With severe croup, breathing may be difficult.

Croup is usually part of a cold. Swelling of the vocal cords causes hoarseness. Stridor is caused by the opening between the vocal cords becoming more narrow.

Croup usually lasts for 5 to 6 days and generally gets worse at night. During this time, it can change from mild to severe and back many times. The worst symptoms are seen in children under 3 years of age.

If your child suddenly develops stridor or tight breathing, do the following:

Inhalation of warm mist
Warm moist air seems to work best to relax the vocal cords and break the stridor. The simplest way to provide this is to have your child breathe through a warm, wet washcloth placed loosely over his nose and mouth. Another good way, if you have a humidifier (not a hot vaporizer), is to fill it with warm water and have your child breathe deeply from the stream of humidity.

The foggy bathroom
In the meantime, have a hot shower running with the bathroom door closed. Once the room is all fogged up, take your child in there for at least 10 minutes. Try to help your child not be afraid by cuddling or reading a story.

Results of First Aid
Most children settle down with the above treatments and then sleep peacefully through the night. If your child continues to have stridor, call your child's health care provider IMMEDIATELY. If your child turns blue, passes out, or stops breathing, call the rescue squad (911).

Humidifier
Dry air usually makes a cough worse. Keep the child's bedroom humidified. Use a humidifier if you have one. Run it 24 hours a day. Otherwise, hang wet sheets or towels in your child's room.

Warm fluids for coughing spasms
Coughing spasms are often due to sticky mucus caught on the vocal cords. Warm fluids may help relax the vocal cords and loosen up the mucus. Use clear fluids (ones you can see through) such as apple juice, lemonade, or herbal tea. Give warm fluids only to children over 4 months old.

Cough medicines
Medicines are less helpful than either mist or drinking warm, clear fluids. Children over 4 years old can be given cough drops for the cough. Children over 1 year of age can be given 1/2 to 1 teaspoon of corn syrup as needed to thin the secretions. If your child has a fever (over 102°F, or 38.9°C), you may give him acetaminophen (Tylenol) or ibuprofen (Advil).

Avoid Smoke exposure
Never let anyone smoke around your child. Smoke can make croup worse.

Close observation
While your child is croupy, sleep in the same room with him. Croup can be a dangerous disease.

Contagiousness
The viruses that cause croup are quite contagious until the fever is gone or at least during the first 3 days of illness. Since spread of this infection can't be prevented, your child can return to school or child care once he feels better.

IMMEDIATELY if:

• Breathing becomes difficult (when your child is not coughing).
• Your child starts drooling or spitting, or starts having great difficulty swallowing.
• The warm mist fails to clear up the stridor in 20 minutes.
• Your child starts acting very sick.

Within 24 hours if:

• The attacks of stridor occur more than 3 times.
• A fever lasts more than 3 days.
• Croup lasts more than 10 days.
• You have other concerns or questions.

Antibiotics
Try not to forget any of the doses. If your child goes to school or a baby sitter, arrange for someone to give the afternoon dose. If the medicine is a liquid, store the antibiotic in the refrigerator and use a measuring spoon to be sure that you give the right amount. Give the medicine until the bottle is empty or all the pills are gone. (Do not save the antibiotic for the next illness because it loses its strength.) Even though your child will feel better in a few days, give the antibiotic until it is completely gone. Finishing the medicine will keep the ear infection from flaring up again.

Pain relief
Acetaminophen or ibuprofen can be used to help with the earache or fever over 102°F (39°C) for a few days until the antibiotic takes effect. These medications usually control the pain within 1 to 2 hours. Earaches tend to hurt more at bedtime.
To help ease the pain, you can put an ice bag or ice wrapped in a wet washcloth over the ear. This may decrease the swelling and pressure inside. Some physicians recommend a heating pad instead. Remove the cold or heat in 20 minutes to prevent frostbite or a burn.

Restrictions
Your child can go outside and does not need to cover the ears. Swimming is permitted as long as there is no perforation (tear) in the eardrum or drainage from the ear. Air travel or a trip to the mountains is safe; just have your child swallow fluids, suck on a pacifier, or chew gum during descent. Your child can return to school or day care when he or she is feeling better and the fever is gone. Ear infections are not contagious.

Follow-up Visits
Your physician will schedule a return appointment in 2 to 3 weeks for your child. At that visit, the eardrum will be looked at to be certain that the infection is cleared up and more treatment isn't needed. Your physician may also want to test your child's hearing. Follow-up exams are very important, particularly if the infection has caused a hole in the eardrum.

If your child has recurrent ear infections, it's time to look at how you can prevent some of them. The following list includes ways you can help your child prevent ear infections. If some of the following items apply to your child, try to use them or talk to your health care provider about them.

• Protect your child from second-hand tobacco smoke.
  Passive smoking increases the frequency and severity of infections. Be sure no one smokes in your home or at day care.
• Reduce your child's exposure to colds during the first year of life.
  Most ear infections start with a cold. Try to delay the use of large day care centers during the first year by using a sitter in your home or a small home-based day care.
• Breast-feed your baby during the first 6 to 12 months of life.
  Antibodies in breast milk reduce the rate of ear infections. If you're breast-feeding, continue. If you're not, consider it with your next child.
• Avoid bottle propping.
  If you bottle-feed, hold your baby at a 45° angle. Feeding in the horizontal position can cause formula and other fluids to flow back into the eustachian tube. Allowing an infant to hold his own bottle also can cause milk to drain into the middle ear. Weaning your baby from a bottle between 9 and 12 months of age will help stop this problem.
• Control allergies.
  If your infant has continuous nasal secretions, consider an allergy as a contributing factor to the ear infections, especially if your child has other allergies such as eczema. A milk protein allergy is most likely the problem.
• Check the adenoids.
  If your toddler constantly snores or breaths through his mouth, he may have large adenoids. Large adenoids can contribute to ear infections. Talk to your physician about this.

IMMEDIATELY if:

• Your child develops a stiff neck.
• Your child acts very sick.

During office hours if:

• The fever or pain is not gone after your child has taken the antibiotic for 48 hours.
• You have other questions or concerns.

Diarrhea is usually caused by a viral infection of the lining of the intestines (gastroenteritis). Sometimes it is caused by bacteria or parasites. Occasionally a food allergy or drinking too much fruit juice may cause diarrhea. If your child has just one or two loose bowel movements, the cause is probably something unusual your child ate.

Diarrhea usually lasts several days to a week, regardless of the type of treatment. The main goal of treatment is to prevent dehydration. Your child needs to drink or receive enough fluids to replace the fluids lost in the diarrhea. Don't expect a quick return to solid bowel movements.

• Oral glucose-electrolyte solutions for 4 to 6 hours

  If your child has severe diarrhea and also has dark urine or not very much urine, buy Kao Lectrolyte or Pedialyte at your pharmacy or supermarket. (These special solutions are not needed for diarrhea that is not severe.) If your child doesn't like the flavor, add a bit of KOOL-Aid powder or 2 drops of Nutrasweet. Give as much of the special liquid as your baby wants (at least 10 ml for each pound your child weighs per hour). Diarrhea makes children thirsty, and your job is to satisfy that thirst and prevent dehydration. Never restrict fluids when your child has diarrhea.

  Until you get one of these special solutions, continue giving your baby full-strength formula in unlimited amounts. Avoid giving your baby Jell-O water mixtures or sports drinks (they do not contain enough sodium). Fruit juice will make the diarrhea worse.

  If you aren't able to get an oral glucose-electrolyte solution, ask your doctor about making a homemade solution as follows: Mix 1/2 cup of dry infant rice cereal with 2 cups (16 ounces) of water and 1/4 level teaspoon of salt. Be careful not to add too much salt (to avoid the risk of salt poisoning).

• Returning to formula

  After being given clear fluids for 4 to 6 hours, your baby will be hungry, so begin giving her full-strength formula. Offer it more frequently then you normally do. If the diarrhea continues to be severe, begin with a soy formula. If you give cow's milk formula and the diarrhea doesn't improve after 3 days, change to a lactose-free formula (a soy formula or milk-based Lactofree). If you start giving soy formula, plan to keep your baby on the soy formula until the diarrhea is gone for 3 days.

• Adding solids

  Foods that contain a lot of starch are more easily digested than other foods during diarrhea. If your baby is over 4 months old and has had diarrhea for over 24 hours, give her the following starchy foods until the diarrhea is gone: any cereal, applesauce, strained bananas, strained carrots, mashed potatoes, and other high-fiber foods.

BREAST-FED INFANTS

• Special considerations for breast-fed infants

  No matter how they look, the bowel movements of a breast-fed infant must be considered normal unless they contain mucus or blood or develop a bad odor. In fact, breast-fed babies may normally pass some green BM's or BM's with a water ring. The frequency of bowel movements is also not much help in deciding whether your breast-fed baby has diarrhea. During the first 2 or 3 months of life, the breast-fed baby may normally have one BM after each feeding. However, if your baby's BM's abruptly increase in number, your baby probably has diarrhea. Other clues are poor eating, acting sick, and a fever.

Treatment

• Continue breast-feeding but at more frequent intervals. Add solids as described below for formula-fed infants. Don't stop breast-feeding your baby because your baby has diarrhea. For severe (watery and frequent) diarrhea, offer Kao Lectrolyte or Pedialyte between breast-feedings for 6 to 24 hours only if your baby is urinating less frequently than normal.

  You may have to stop breast-feeding temporarily if your baby is too exhausted to nurse and needs intravenous (IV) fluids for severe diarrhea and dehydration. Pump your breasts to maintain milk flow until you can breast-feed again (usually within 12 hours).

OLDER CHILDREN (over 1 year old)

• Fluids

  Give your child only water to drink for the first 24 hours of watery diarrhea. (Most toddlers don't need oral glucose-electrolyte solutions such as Pedialyte unless they are dehydrated). On day 2, offer some milk as well as water. Avoid fruit juices because they all make the diarrhea worse.

  Caution: If your child refuses solids, give your child milk or formula rather than water.

• Table foods

  Keep giving your child table foods while he has diarrhea. The choice of food is important. Starchy foods are digested best. Examples of such foods are cereal (especially rice cereal), grains, bread, crackers, rice, noodles, mashed potatoes, carrots, applesauce, and bananas. Pretzels or salty crackers can help meet your child's need for sodium. On the second day of the diarrhea, if your child wants some protein, soft-boiled eggs are usually easily digested.

Common mistakes
Using boiled skim milk or any concentrated solution can cause serious complications for babies with diarrhea because it contains too much salt. KOOL-Aid, soda pop, or water should not be used as the only food because they contain little or no salt. Use only the fluids suggested here.
Clear fluids alone should be used for only 4 to 6 hours because the body needs more calories than clear fluids can provide. Likewise, a diluted formula is not needed because regular formula contains enough water.The most dangerous myth is that the intestine should be "put to rest." Restricting fluids can cause dehydration. There is no effective, safe drug for diarrhea. Extra fluids and diet therapy work best.

Prevention
Diarrhea is very contagious. Always wash your hands after changing diapers or using the toilet. This is crucial for keeping everyone in the family from getting diarrhea.

Diaper rash from diarrhea
The skin near your baby's anus can become irritated by the diarrhea. Wash the area near the anus after each bowel movement and then protect it with a thick layer of petroleum jelly or other ointment. This protection is especially needed during the night and during naps. Changing the diaper quickly after bowel movements also helps.

Overflow diarrhea in a child not toilet-trained
For children in diapers, diarrhea can be a mess. Place a cotton washcloth inside the diaper to trap some of the more watery BM. Use disposable super absorbent diapers to cut down on cleanup time. Use the diapers with snug leg bands or cover the diapers with a pair of plastic pants. Wash your child under running water in the bathtub.

IMMEDIATELY if:

• There are signs of dehydration (no urine in more than 8 hours, very dry mouth, no tears).
• Any blood appears in the diarrhea.
• The diarrhea is severe (more than 8 BM's in the last 8 hours).
• The diarrhea is watery and your child also vomits the clear fluids three or more times.
• Your child starts acting very sick.

During office hours if:

• A fever (over 100°F, or 37.8°C) lasts more than 3 days.
• Mild diarrhea lasts more than 2 weeks.
• You have other concerns or questions.

• Redness of the white part of the eye (sclera)
• Redness of the inner eyelids
• Puffy eyelids
• A watery eye.

Red eyes are usually caused by a viral infection and they often occur when a child has a cold. If a bacterial infection occurs, discharge from the eyes becomes yellow and the eyelids are often matted together after sleeping. If this happens, your child needs antibiotic eye drops even if the eyes are not red.

Viral conjunctivitis usually lasts as long as the cold (4 to 7 days).

Rinse out with water
Rinse the eyes with warm water as often as possible, at least every 1 or 2 hours while your child is awake. Use a fresh, wet cotton ball each time. This rinsing usually will keep a bacterial infection from occurring.

No eye drops
A viral infection is not helped by eye drops.

Contagiousness
Pink eye is harmless and mildly contagious. Children with viral conjunctivitis can attend day care or school.

IMMEDIATELY if:

• The eyelids become very red or swollen.
• Eye pain occurs.
• Your child develops blurred vision or eye pain.

Within 24 hours if:

• A yellow discharge develops.
• The redness lasts more than 7 days.
• You have other concerns or questions.

• Yellow discharge in the eye
• Eyelids stuck together with pus, especially after sleeping
• Some redness in the white part of the eyes
• Puffy eyelids.

Eye infections with pus are caused by bacteria and can be a complication of a cold. Pink eyes without a yellow discharge, however, are more common and are due to a virus.

With proper treatment the yellow discharge should clear up in 72 hours. The red eyes (which are due to the cold) may continue for several more days.

Cleaning the eye
Before putting in any medicines, remove all the pus from the eye with warm water and wet cotton balls. Unless this is done, the medicine will not have a chance to work.

Antibiotic eye drops or ointments
Putting eye drops or ointment in the eyes of young children can be a real battle. Ideally it's done with two adults. One person can hold the child still while the other person opens the eyelids with one hand and puts in the medicine with the other. One person can do it alone if she sits on the floor holding the child's head (face up) between the knees to free both hands to put in the medication.

Eye drops:
If your physician has prescribed antibiotic eye drops, put 1 drop in each eye every 2 hours while your child is awake. Do this by gently pulling down on the lower lid and placing the drops there. As soon as the eye drops have been put in the eyes, have your child close them for 2 minutes so the eye drops will stay inside. If it is difficult to separate your child's eyelids, put the eye drops over the inner corner of the eye while he is lying down. When your child opens his eye and blinks, the eye drops will flow in. Continue the eye drops until your child has awakened 2 mornings in a row without any pus in the eyes.

Ointment:
If your physician has prescribed antibiotic eye ointment, the ointment needs to be used just 4 times a day because it can remain in the eyes longer than eye drops. Separate the eyelids and put in a ribbon of ointment along the lower eyelid from one corner of the eye to the other. If it is very difficult to separate your child's eyelids, put the ointment on the edges of the eyelids. As the ointment melts from body heat, it will flow onto the eyeball. Continue until 2 mornings have passed without any pus in the eye.

Contact lenses
Children with contact lenses need to switch to glasses temporarily. This will prevent damage to the cornea.

Contagiousness
The pus from the eyes can cause eye infections in other people if they get some of it on their eyes. Therefore, it is very important for the sick child to have his own washcloth and towel. He should be encouraged not to touch or rub his eyes because it can make his infection last longer. Touching his eyes also puts a lot of germs on his fingers. Your child's hands should be washed often to prevent spreading the infection.
After using eye drops for 24 hours, and if the pus is minimal, children can return to day care or school.

IMMEDIATELY if:

• The outer eyelids become very red or swollen.
• The vision becomes blurred.
• Your child starts acting very sick.

Within 24 hours if:

• The infection isn't cleared up after 3 days of treatment.
• Your child develops an earache.
• You have other concerns or questions.

Similar Condition:

Allergies
If your child is over age 3 years, sneezes a lot, has a clear nasal discharge that lasts over a month, doesn't have a fever, and especially if these symptoms occur during pollen season, your child probably has a nasal allergy (hay fever). Allergies are much easier to treat than frequent colds because medicines are effective at controlling symptoms.

The main reason your child is getting all these infections is that he or she is being exposed to new viruses. There are at least 200 different cold viruses. The younger the child, the less the previous exposure and subsequent protection. Your child is exposed more if he or she attends day care, play group, a church nursery, or a preschool. Your child has more indirect exposures if he has older siblings in school. Therefore, colds are more common in large families. The rate of colds triples in the winter when people spend more time crowded together indoors breathing re circulated air. In addition, smoking in the home increases your child's susceptibility to colds, coughs, ear infections, sinus infections, croup, wheezing, and asthma. Colds are not caused by poor diet or lack of vitamins. They are not caused by bad weather, air conditioners, or wet feet.

Many parents are worried that their repeatedly ill child has some serious underlying disease. A child with immune system disease (inadequate antibody or white blood cell production) doesn't experience any more colds than the average child. Instead, the child has 2 or more bouts per year of pneumonia, sinus infection, draining lymph nodes, or boils and heals slowly from these infections. In addition, a child with a serious disease does not gain weight adequately nor appear well between bouts of infection.

Look at your child's general health.
If your child is vigorous and gaining weight, you don't have to worry about his or her basic health. Your child is no sicker than the average child of her age. Children get over colds by themselves. Although you can reduce the symptoms, you can't shorten the course of each cold. Your child will muddle through like every other child. The long-term outlook is good. The number of colds will decrease over the years as your child's body builds up a good antibody supply to the various viruses. For perspective, note the findings of a recent survey: On any given day 10% of children have colds, 8% have fevers, 5% have diarrhea, and 3% have ear infections.

Send your child back to school as soon as possible.
The main requirement for returning your child to day care or school is that the fever is gone and the symptoms are not excessively noisy or distracting to classmates. It doesn't make sense to keep a child home until we can guarantee that he or she is no longer shedding any viruses because this could take 2 or 3 weeks. If isolation for respiratory infections were taken seriously, insufficient days would remain to educate children.
Also the "germ warfare" that normally occurs in schools is fairly uncontrollable. Most children shed germs during the first days of their illness before they even look sick or have symptoms. In other words, contact with respiratory infections is unavoidable in group settings such as schools or day care.
Also, as long as your child's fever has cleared, there is no reason he or she cannot attend parties, play with friends after school, and go on scheduled trips. Gym and team sports may need to be postponed for a few days.

Try not to miss work.
When both parents work, these repeated colds are extremely inconvenient and costly. Since the complication rate is low and the improvement rate is slow, don't hesitate to leave your child with someone else at these times. Perhaps you have a baby sitter who is willing to care for a child with a fever. Because there are so many working mothers these days, "sick child" day care programs are starting to spring up around the country and can be another alternative to staying home with your child.
If your child goes to day care or preschool, he or she can go back once the fever is gone. There is no reason to prolong the recovery at home if you need to return to work. Early return of a child with a respiratory illness won't increase the complication rate for your child or the exposure rate for other children. Likewise, you don't need to cancel an important social engagement because your child has a minor acute illness. In addition, you don't need to take your child out of preschool or day care permanently because of these repeated illnesses. Consider switching to a small home-based day care if your child is less than 2 years old. Also find another day care if someone on the day care staff smokes on-site.

There are no instant cures for recurrent colds and other viral illnesses. Antibiotics are not helpful unless your child develops complications such as an ear infection, sinus infection, or pneumonia. Having your child's tonsils removed is not helpful because colds are not caused by bad tonsils. Again, the best time to have these infections and develop immunity is during childhood.

• Your child has a bright red or rosy rash on both cheeks for 1 to 3 days ("slapped cheek" appearance).
• The rash on the cheeks is followed by a pink lacelike or netlike rash on the arms and legs (mainly on the thighs and upper arms).
• The "lacy" rash comes and goes several times for 1 to 3 weeks.
• Your child has a low-grade fever (less than 101°F, or 38.4°C) or no fever at all.

SIMILAR CONDITIONS

Fifth disease was so named because it was the fifth pink-red infectious rash to be described by doctors. The other four are

1. Scarlet fever
2. Measles
3. Rubella
4. Roseola ( controversial )

Fifth disease is caused by a virus called human parvovirus B19.

This is a very mild disease with either no symptoms or a slight runny nose and sore throat. The lacelike rash may come and go for 5 weeks, especially after warm baths, exercise, and sun exposure.

Treatment
No treatment is necessary. This distinctive rash is harmless and causes no symptoms that need treatment.

Contagiousness
Children will come down with the rash 10 to 14 days after they have been exposed to the virus. The disease is contagious during the week before the rash begins. Therefore, exposed children should try to avoid contact with pregnant women, but that can be difficult. Once a child has the bright red or lacy rash, he is no longer considered contagious and does not need to stay home from day care or school.

Adults with Fifth Disease
Most adults who get Fifth disease develop just a mild pinkness of the cheeks or no rash at all. Adults develop joint pains, especially in the knees, more often than a rash. These pains may last 1 to 3 months. Taking ibuprofen usually relieves these symptoms. An arthritis workup is not necessary for joint pains that occur after exposure to Fifth disease.

Refer Pregnant Women Exposed to Fifth Disease to Their Obstetrician
Yes. If a pregnant woman is exposed to a child with Fifth disease, she should see her obstetrician. An antibody test will be done to see if the mother already had the disease and is therefore protected. If she does not have antibodies against the disease, the pregnancy will need to be monitored closely. Some babies develop complications if they were infected with Fifth disease before birth. 10% develop severe anemia and 2% may die. Birth defects, however, are never a result of this virus.

During office hours if:

• Your child develops a fever over 102° F (38.9° C).
• You have other concerns or questions.

The treatment of flu depends on a child's main symptoms and is no different from the treatment for other viral respiratory infections. Bed rest is not necessary.

Fever or aches
Use acetaminophen (Tylenol) every 6 hours or ibuprofen (Advil) every 8 hours for fever over 102°F (39°C). Children and adolescents who may have influenza should never take aspirin because it may cause Reyes' syndrome.

Cough or hoarseness
For children over age 4 give cough drops. If your child is 1 to 4 years old, give corn syrup (1/2 to 1 teaspoon as needed).

Sore throat
Use hard candy for children over 4 years old. Warm chicken broth may also help children over 1 year old.

Stuffy nose
Warm-water or saline nose drops and suction (or nose blowing) will open most blocked noses. Use nasal washes at least four times a day or whenever your child can't breathe through the nose. Saline nose drops are made by adding 1/2 teaspoon of salt to 1 cup of warm water.

Contagiousness
Influenza spreads rapidly because the incubation period is only 24 to 36 hours and the virus is very contagious.Your child may return to day care or school after the fever is gone and he feels up to it.

IMMEDIATELY if:

• Your child is having difficulty breathing.
• Your child starts to act very sick.

During office hours if:

• Your child develops any complications such as an earache, sinus pain or pressure, or a fever lasting over 3 days.
• You have other questions or concerns.

Influenza vaccine gives protection for only 1 or 2 years. In addition, the vaccine itself can cause fever in 20% of the people who get the shots and a sore injection site in 10%. Therefore, the vaccine is not recommended for healthy children (unless an especially severe form of influenza comes along). Only children with chronic diseases (for example, asthma) need to come in for yearly influenza boosters. Talk with your health care provider if you think your child should have flu shots.

Stage I: 3 to 30 days after the tick bite

• A unique rash develops in 80% of infected people. The rash (called erythema migrans) looks like a large red ring or bull's-eye that starts where the person was bitten and expands in size.
• The rash at the bite becomes larger than 2 inches (5 cm) across. A rash the size of a dime or quarter is not Lyme disease.
• The rash is neither painful nor itchy.
• It lasts 2 weeks to 2 months.
• Many children develop smaller spots of rash at several locations.
• Some children develop a flu like illness including fever, chills, sore throat, and headache that lasts for several days.

Stage II: 2 to 12 weeks after the tick bite

• It develops in only 15% of the people who have not received treatment for the disease.
• The main symptoms are related to the nervous system; for example, stiff neck (aseptic meningitis), weak facial muscles (7th nerve paralysis), and weakness or numbness of the extremities (polyneuritis).
• A few children develop some abnormalities of heart rhythm (myocarditis).

Stage III: 6 weeks to 2 years after the tick bite

• It develops in about 60% of the people who have not gotten treatment for the disease.
• Often these people have had no stage-II symptoms.
• The main symptom of this stage is recurrent attacks of painful, swollen joints (arthritis). It usually affects the knees. The arthritis becomes chronic in 10% of children.

Lyme disease is caused by a type of corkscrew-shaped bacteria called spirochetes. The bacteria are transmitted by little deer ticks the size of a pinhead, dark brown, and hard to see. Lyme disease is not carried by the more common wood tick, which is bigger (1/4 to 1/2 inch in size). In most states only 2% of deer ticks carry Lyme disease. In the New England states, Wisconsin, and Minnesota, however, up to 50% of deer ticks are infected with Lyme disease. But even in these high-risk areas, only 1% of children bitten by a deer tick develop Lyme disease. If not disturbed, a tick will remain attached to a person's skin and feed there for 3 to 6 days. The longer a tick is attached to a person, the greater the chance a person has of being infected by the tick. For Lyme disease to be transmitted, the tick needs to be attached for at least 18 to 24 hours. You are more likely to get the infection if the tick remains attached for more than 48 hours.

Ticks like to hide in underbrush and shrubbery, especially during spring and early summer. Children and adults who are hiking, picnicking, or playing in tick-infested areas should wear long pants and tuck the ends of the pants into their socks. Apply an insect repellent to shoes and socks. While you are outside look for ticks on each other every 2 to 3 hours and remove any ticks on the clothing or exposed skin. Because a tick's bite is painless and doesn't itch, a person usually does not know that he or she has been bitten by a tick. Immediately after being outside or at least once a day, check the bare skin. Ticks like hair and dark places, so carefully check the scalp, neck, armpit, and groin. A brisk shower will remove any tick that isn't firmly attached. If you find any ticks, remove them immediately. Removing ticks promptly may prevent infection because the tick must be attached to the skin at least 18 to 24 hours before it can transmit Lyme disease. Also, a tick is easier to remove before it becomes firmly attached. To prevent the spread of Lyme disease by your dog, wash him with an anti-tick soap during the spring and summer months. Check for ticks on him if he goes with you on a hike. Pull off any ticks that you find.

The simplest and quickest way to remove a tick is to pull it off. Use tweezers to grasp the tick as close to the skin as possible (try to get a grip on its head). Pull gently and steadily upward until the tick releases its grip. Do not twist the tick or jerk it suddenly. Such maneuvers can break off the tick's head or mouth parts. Do not squeeze the tweezers to the point of crushing the tick because the secretions released may spread disease.
If you don't have tweezers, pull the tick off in the same way using your fingers, a loop of thread around the tick's jaws, or a needle. Some tiny ticks need to be scraped off with a knife blade or the edge of a credit card.
Sometimes the tick's body comes off but the head stays in the skin. You must remove the head also. Use a sterile needle to remove the head just as you would to remove a sliver.
Dispose of the tick by returning it to nature or flushing it down the toilet. You don't need to save the tick for positive identification. Don't crush ticks with your fingers because crushing increases your chance of getting a disease.
Wash the area of the tick bite and your hands with soap and water after you remove the tick.
A recent study showed that attached ticks do not back out when covered with petroleum jelly, fingernail polish, or rubbing alcohol. It was thought that this would block the tick's breathing pores and take its mind off eating. Unfortunately, ticks breathe only a few times per hour. The study also found that touching the tick with a hot match did not make the tick detach. In fact the hot match could make the tick vomit infected secretions into the wound.

IMMEDIATELY if:

• You can't remove the tick or the tick's head.
• Fever or widespread rash occurs in the 2 weeks after a tick bite.
• Your child starts acting very sick.

During office hours if:

• You think your child might have Lyme disease.
• You have other questions or concerns.

• Blotchy red rash starting on the face and spreading downward over the entire body in 3 days .
• 3 or 4 days of red eyes, cough, runny nose and fever before the rash begins .
• White specks on the lining of the mouth (Koplik's spots).
• Exposure to another child with measles 10 to 12 days earlier.
• Your health care provider needs to see your child to confirm that he or she has measles.

The measles virus.

Measles can be a miserable illness. The rash usually lasts 7 days. Your child will usually begin to feel a lot better by the fourth day of the rash. Ear and eye infections are common complications.

Treatment

• Fever: Use acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) in the usual dosage for your child's age.
• Cough: Use corn syrup for children less than 1 year old, honey for children 1 to 4 years old, or cough drops for children over 4 years old. If the cough interferes with sleep, give a cough suppressant such as dextromethorphan (DM). Also, use a humidifier.
• Red eyes: Wipe your child's eyes frequently with a clean, wet cotton ball. The eyes are usually sensitive to bright light, so your child probably won't want to go outside for several days unless he wears sunglasses.
• Rash: The rash requires no treatment.

Contagiousness
The disease is no longer contagious after the rash is gone. This usually takes 7 days.

Measles exposure
Any child or adult who has been exposed to your child and who has not had measles or the measles vaccine should call his physician. If given early, a measles vaccine is often protective.

IMMEDIATELY if:

• Breathing becomes labored and no better after you clear the nose.
• Your child becomes confused or difficult to awaken.
• Your child develops a severe headache.
• Your child starts acting very sick.

Within 24 hours if:

• Your child develops an earache.
• The eyes develop a yellow discharge.
• Your child develops sinus pain or pressure.
• The fever is still present on the fourth day of the rash.
• Fever returns after the temperature has been normal for more than 24 hours.
• You have other concerns or questions.

• A swollen parotid gland in front of the ear and crossing the corner of the jaw (both parotid glands are swollen in 70% of children)
• Tenderness of the swollen gland
• Increased pain when chewing
• Fever over 100°F (37.8°C).
• Exposure to another person with mumps 16 to 18 days earlier.

Mumps is a viral infection of the parotid gland, a gland which produces saliva and is located in front of and below each ear.

The fever is usually gone in 3 to 4 days. The swelling and pain are gone in 7 days.

Pain and fever relief
Give acetaminophen (Tylenol) or ibuprofen (Advil). Cold compresses applied to the swollen area may also relieve pain.

Diet

• Avoid sour foods or citrus fruits that increase saliva production and parotid swelling.
• Avoid foods that require lots of chewing.
• Consider a liquid diet if chewing is very painful.

Contagiousness
The disease is contagious until the swelling is gone (usually 6 or 7 days). Your child should be kept out of school and away from other children who have not had mumps or mumps vaccine.

Mumps vaccine
If your child or teen has not received the mumps vaccine and has not had mumps, he or she needs to get the vaccine. Only 10% of adults who have no record of mumps are really susceptible. Adults who as children lived in the same household with siblings who had mumps can be considered protected.
Those who are not protected should call their physician during office hours to see if the mumps vaccine would be helpful. Adult and teen males who get mumps have a 25% chance of having a swollen testicle along with the other symptoms of mumps. Usually only one testicle is affected. Damage to one testicle rarely causes infertility.

IMMEDIATELY if:

• Your child develops a stiff neck or severe headache.
• Your child vomits repeatedly.
• Your child starts acting very sick.

During office hours if:

• The swelling lasts more than 7 days.
• The fever lasts more than 4 days.
• The skin over the mumps gland becomes reddened.
• Your child is an adolescent male and his testicle becomes painful.
• You have other concerns or questions.

• labored breathing (respiratory distress)
• rapid breathing
• occasionally painful breathing
• coughing
• fever, sometimes with chills
• abnormal patch (infiltrate) on a chest x-ray.
• Your child needs to see a health care provider to confirm that he or she has pneumonia.

Pneumonia is an infection of the lung that causes fluid to collect in the air sacs (alveoli). About 80% of pneumonia cases are caused by viruses and 20% by bacteria. Viral pneumonia is usually milder than bacterial pneumonia. Bacterial pneumonia tends to occur more suddenly and cause higher fevers (often over 104°F, or 40°C). Pneumonia is usually a complication of a cold. Although colds can be passed from person to person, bacterial pneumonia is not considered contagious.

Before antibiotics were available, bacterial pneumonia was dangerous. With antibiotics it improves within 24 to 48 hours. On the other hand, viral pneumonia can continue for 2 to 4 weeks. Recovery from viral pneumonia is gradual but complete. Most children with pneumonia can be cared for at home. Admission to the hospital for oxygen or intravenous fluids is required in less than 10% of cases.
Most children admitted to the hospital are young infants or children who have extensive involvement of the lungs (as determined by an x-ray). Recurrences of pneumonia are rare.

Antibiotics
Children with bacterial pneumonia need an antibiotic.
Only bacterial pneumonia is helped by antibiotics. Because it's difficult to distinguish bacterial from viral pneumonia in all cases, sometimes antibiotics are prescribed for children who have viral pneumonia.

Medicines for fever
Use acetaminophen (Tylenol) or ibuprofen (Advil) for fever (over 102°F, or 38.9°C). This can be repeated every 4 to 6 hours. These medicines can also help chest pain.

Warm fluids for coughing spasms
Coughing spasms are often caused by sticky secretions in the back of the throat. Warm liquids usually relax the airway and loosen the secretions. Offer your child warm lemonade, apple juice, or herbal tea. Children over 1 year old can sip warm chicken broth. Encourage your child to drink a lot of fluids.
In addition, breathing warm moist air helps to loosen up the sticky mucus that may be choking your child. You can provide warm mist by placing a warm wet washcloth loosely over your child's nose and mouth. Or you can fill a humidifier with warm water and have your child breathe in the warm mist it produces. Avoid steam vaporizers because they can cause burns.
Don't give cough suppressant medicines (such as those containing dextromethorphan) to children with pneumonia. The infectious secretions need to be coughed up.

Humidity
Dry air tends to make coughs worse. Use a humidifier in your child's bedroom.

No smoking
Tobacco smoke aggravates coughing and makes coughs last longer. Don't let anyone smoke around your child. In fact, try not to let anybody smoke inside your home. Remind a teenager with pneumonia that if he or she smokes, the cough will last weeks longer.

IMMEDIATELY if:

• Breathing becomes more labored or difficult.
• Your child starts acting very sick.

Within 24 hours if:

• The fever lasts over 48 hours after your child starts taking the antibiotic.
• The cough lasts over 3 weeks.
• You have other questions or concerns.

• Age 6 months and 3 years old.
• Your child has a fine pink rash, mostly on middle part of the body.
• Your child had a high fever 2 to 4 days before the rash appeared. When the rash appeared, your child's fever went away.
• Your child was only a little sick during the time with fever and acts fine now.

Roseola is a rash caused by the human herpesvirus-6.

The rash lasts 1 or 2 days, followed by complete recovery. Some children have 3 days of fever without a rash.

No particular treatment is necessary. Roseola can be spread to another child until the rash is gone. Other children of this age who have been with your child may come down with roseola in about 12 days.

IMMEDIATELY if:

• The spots become purple or blood colored.
• Your child starts to act very sick.

During office hours if:

• The rash lasts more than 3 days.
• The fever lasts more than 4 days.
• You have other questions or concerns.

• A rash of widespread pink-red spots that starts on the face and moves rapidly downward, covering the body in 24 hours.
• Enlarged lymph nodes at the back of the neck.
• A mild fever.
• The rash is not distinctive. Many other viral rashes look like it.

Rubella is caused by a virus. The incubation period (time between exposure to someone with the disease and the beginning of symptoms) is 14 to 21 days.

The disease is mild. The rash will be gone and your child should be completely recovered in 3 or 4 days. Complications in general are very rare. However, pregnant women should avoid anyone who may have rubella. Complications to the unborn child of a pregnant woman with rubella are disastrous and include deafness, cataracts, heart defects, growth retardation, and encephalitis.

If your health care provider has determined that your child probably has rubella, the following may be helpful:

Treatment
No treatment is usually necessary. Give acetaminophen (Tylenol) or ibuprofen (Advil) for fever over 102°F (38.9°C), sore throat, or other pains.

Avoid pregnant women
If your child might have rubella, keep him away from any pregnant women. He is contagious for 5 days after the start of the rash.

Exposure of adult women to rubella
A non pregnant woman exposed to rubella should avoid getting pregnant during the next 3 months.
A pregnant woman exposed to rubella should see her obstetrician. If she has already received the rubella vaccine, she and her unborn child are probably protected. Even if she thinks she had German measles as a child and the recent exposure was minor or brief, she should have a blood test to determine her immunity against rubella.

Rubella vaccine
Get your children immunized against rubella at 12 to 15 months of age so we won't have to worry about pregnant women getting exposed to rubella when a child gets a pink or red rash. It's safe to immunize a child who has a pregnant mother.

IMMEDIATELY if:

• The rash becomes purple spots or dots.
• Your child starts acting very sick.

During office hours if:

• The rash becomes itchy.
• The fever lasts more than 3 days.
• You have other concerns or questions.

• A rash that will cover all areas within 24 hours.
• Your child will have a sore throat and fever before the rash
  (usually 18 to 24 hours before).
• Reddened, sunburned-looking skin (especially on the chest and abdomen) that feels rough, somewhat like sandpaper. On close inspection, the redness is speckled
  (tiny pink dots).
• Increased redness in skin folds (especially the groin, armpits, and elbow creases).
• Flushed face with paleness around the mouth.

Scarlet fever is caused by the strep bacteria. The rash is caused by a toxin that is produced by some strep bacteria. The complication rate is no different than the complication rate for strep throat alone.

The red rash usually clears in 4 or 5 days. Sometimes the skin peels in 1 to 2 weeks where the rash was most prominent (for example, the groin). The skin on the fingertips also commonly peels. Your child will stop having a sore throat and fever after taking an antibiotic for 1 or 2 days.

Antibiotics
Try not to forget any of the doses. Give the medicine until all the pills are gone or the bottle is empty. Even though your child will feel better in a few days, give the antibiotic for 10 days to keep the strep throat from flaring up again. If the medicine is a liquid, store it in the refrigerator. Use a measuring spoon to be sure that you give the right amount.
A long-acting penicillin (Bicillin) injection can be given if your child will not take oral medicines or if it will be impossible for you to give the medicine regularly.
(Note: If given correctly, the oral antibiotic works just as rapidly and effectively as a shot.)

Relief of sore throat or fever
Acetaminophen or ibuprofen is very helpful for throat pain. Children over 1 year old can sip warm chicken broth or apple juice. Children over 4 years old can suck on hard candy or lollipops. Also give acetaminophen (Tylenol) or ibuprofen (Advil) for fevers over 102°F (39°F).

The Rash
The rash itself needs no treatment. It generally clears in 4 to 5 days.

Contagiousness
Your child is no longer contagious after he or she has been on an antibiotic for 24 hours. Therefore, your child can return to school after 1 day if he or she is feeling better. The rash itself is not contagious.

Recurrent strep throat and re cultures

Usually repeat throat cultures are not necessary if your child takes all of the antibiotic. However, about 10% of children with strep throat don't respond to initial antibiotic treatment. Therefore, if your child continues to have a sore throat or mild fever after treatment is completed, return for a second throat culture. If it is positive, your child will be retreated with a different antibiotic.

IMMEDIATELY if:

• Your child develops drooling or great difficult in swallowing.
• Your child starts acting very sick.

During office hours if:

• The fever lasts over 48 hours after your child starts taking the antibiotic.
• You have other concerns or questions.