«Common Triage Calls Newborn My newborn has a fever-do we need to be seen? A baby who is less than 2 months old with a fever over 100.5 needs to call ...»
Common Triage Calls
My newborn has a fever-do we need to be seen?
A baby who is less than 2 months old with a fever over 100.5 needs to call the ofﬁce 24 hours a day.
My newborn’s umbilical cord site is oozing-what should we do?
Clean the umbilical cord twice a day with hydrogen peroxide or alcohol. Be sure and get all the way
down to where the skin and cord connect. If the oozing continues then make an appointment to
be seen during ofﬁce hours. You need to call the ofﬁce if the cord develops a foul odor or redness around the belly button.
My newborn is very gassy/crying a lot. Is there something I can give him/her?
Generally all newborns are gassy. Babies tend to swallow a lot of air when they cry. This is something they tend to just outgrow as they get bigger. You can give your baby Mylicon drops (Simethicone drops) every 2 hours. Sometimes it seems to help and sometimes not, but it is safe to try. If you are breastfeeding your baby then try and decrease or eliminate dairy products from your diet to see if that helps. Be sure to burp your infant frequently during feeds. If your baby is crying a lot or has excessive gas, then call during ofﬁce hours to speak with one of the nurses.
My newborn vomited all of his/her feed a couple of times the last 2 days-Is this normal?
Yes, most newborns will occasionally throw up a whole feed. Either because an air bubble gets behind the milk or the infant overﬁlls. As long as it is not happening with every feed or several times a day, then it is likely normal. Try to burp your infant more frequently during feedings. If bottle feeding, try to feed slower. You can put the nipple on a little tighter and hold the bottle more horizontal to slow down a feed. You can also try to feed smaller amounts more frequently. If your infant vomits every feed, try to give 1 ounce of Pedialyte for 2 feeds. If he/she still vomits then call the ofﬁce. If tolerated then advance back to normal feeds.
My newborn gets the hiccups a lot-is this normal?
Most newborns hiccup frequently-often after feeds. If you noticed your baby got the hiccups a lot while you were pregnant, then that will probably persist. It can last for several weeks.
My newborns eyes look yellow. Does this mean he/she is jaundiced?
Jaundice in newborns starts to resolve after about 5 days of age. The eyes are often yellow longer than the skin. They can look that way for up to a month.
My newborn has not had a bowel movement in 24 hours. Is he/she constipated?
If you are breastfeeding it could indicate that your newborn is not getting enough to eat. A breastfed newborn should have at least 4 bowel movements in 24 hours. Call during normal ofﬁce hours if this happens. A formula fed baby may not go as frequently, but typically will go at least once a day. It is ok to wait a couple of days as long as your newborn’s belly is not round and ﬁrm. After one month of age infants tend to have less frequent bowel movements. It is not uncommon for some babies to only go once a week. Breastfed babies rarely get constipated. If your baby has hard, rocks of stool/strains a lot, then call the ofﬁce during normal hours.
My newborn has red bumps on chest/face-is there something we can put on it?
Newborns often get bumps/rashes as there skin adjusts to the environment. You do not have to put anything on them. This will resolve on its own. However, you can try some over the counter 1% Hydrocortisone cream on them twice a day.
My newborns eye/eyes are watery/has some yellow drainage, but are not red. Does that mean he/she has an eye infection?
It is very common for newborns to get clogged tear ducts. This causes the eye to water and mucous to back up. Usually this can be treated with just a warm compress several times a day. You can also try massaging up towards the inner corner of the eye. If the eyes are excessively matted or redness develops then call the ofﬁce during regular ofﬁce hours.
Baby My baby has white stuff in his mouth-is this thrush?
Sometimes you will see white on the tongue from just milk residue. However, Thrush is common in babies. You will usually see white plaques on the tongue, gums, and insides of cheeks. If your infant acts uncomfortable or has difﬁculty feeding then make an appointment during regular ofﬁce hours. If it does not seem to bother your infant then it is ok to just observe and see if it resolves on its own.
Breastfeeding moms should have it checked out if their nipples are tender along with seeing the white plaques in your baby’s mouth.
My baby is very congested all the time. What can I do?
Newborns have very small nasal passages and just breathe through their nose, so it is common for breathing to sound congested. You can use saline and bulb suction to try and clear the nasal passages. Usually as long as your baby is eating ok then it is not a concern. If your infant has trouble eating or looks like he/she is working hard to breathe then they need to be seen.
What kind of formula should I supplement with?
Start with just regular Similac Advanced. If you have any problems then call during ofﬁce hours to discuss with the nurse.
How much formula should my baby drink per day?
Babies usually will eat just what they need. We do not get too concerned if the baby wants to eat more than the recommended amounts. You can call during ofﬁce hours to discuss with the nurse if you are concerned that your baby eats too much. Newborns usually take 1½-3oz every 3-4 hours. At 1 month of age 3-4oz per feed (18-32oz per day). 2-6 month 4-6oz per feed (23-32oz per day). After 6 month 6-8oz per feed (about 32oz per day).
When can I change my baby to whole milk?
At 12 months of age. And you can reduce to low fat milk at 24 months old.
My baby/child’s stools are green-is this normal?
Green stools are not a concern. If breastfeeding, it may just be related to something mom is eating or sometimes the stools just change colors for no explained reason.
Child/shots My child got shots yesterday and now the site is red/swollen-is this normal?
Local reactions to shots are very common. If the redness goes all the way around the leg or has red streaks coming off of it then your child should be seen in the ofﬁce. You can give Motrin for comfort and use an ice pack if tolerated.
My child got shots recently and there is a hard lump at the site-is this normal?
Yes, hard lumps are often felt at the site of the shot. Sometimes they persist for several weeks.
My child is getting shots tomorrow? When should I give him/her Tylenol?
Most of the time I recommend you can just give a dose of Tylenol or Motrin in the ofﬁce after we weight your child. That way we can give the correct dose. The medicine does not help with the pain of the shot itself, but help with leg pain/fever after the shots are given.
Child/teething/diarrhea What can I give my child for teething pain?
Motrin tends to work the best along with cold teethers/toys/frozen washcloths. Dr Raley does not like you to use Oragel. Teething tablets are ok.
Is fever/diarrhea normal with teething?
This is still debatable. There hasn’t been any real documented medical proof. However many parents do report these symptoms while their infant is teething. If fever is associated with teething it would be very low 99, anything above that is likely an illness. Some parents report looser stools with teething, but not actual diarrhea.
How long does diarrhea usually last?
Diarrhea from a virus can last 7-14 days. Do not feed the BRAT diet. Dr Raley recommends you feed your child a high protein, low carbohydrate diet. Avoid real fruit juice. Make sure your child is drinking enough to replace lost ﬂuids. You can try Lactobacillus. It helps to replace the good bacteria in the gut. You can purchase it at the drug store. Ask the pharmacist for dosing.
My child has a diaper rash from diarrhea. What can I put on it?
Often when kids get a diaper rash from diarrhea it is a yeast infection. This is typically a bumpy, red rash. You can try an over the counter antifungal like Lotrimin or Monistat 4 times a day. Then put a thick layer of Vaseline over it to help protect the skin from future stools. If it is not improving within a few days, is raw/bleeding, or has circular sores then your child needs to be seen during regular ofﬁce hours.
Can my child take Imodium for diarrhea?
We do not recommend Imodium for children under 6 years old.
Child/dog bite/swallowed coin/lumps My child got bit by a dog. Do we need to do anything?
Make sure the dog has been vaccinated for rabies. Wound can be cleaned with soap and water.
Apply Neosporin. If area develops swelling, redness or drainage, then your child should be seen during ofﬁce hours.
I think my child swallowed a coin-what do we need to do?
Usually coins will pass on their own within 3-7 days. You can come in and get an x-ray to see where the coin is, and then usually we will have you come back if it hasn’t passed after several days. Your child needs to be seen sooner if he/she has abdominal pain, vomiting, drooling or difﬁculty breathing.
My child has a pea size lump on his/her neck or back of head. Is this a concern?
Sometimes children get some swollen lymph nodes on their neck or head during an illness. If the lumps persist, become red, tender or are getting larger then schedule an appointment with Dr Raley.
My child is complaining of ear pain. What should we do?
Give your child some Motrin every 6-8 hours for comfort, then schedule an appointment during regular ofﬁce hours.
Child/ear concerns There is pus/blood draining from my child’s ear-what do we need to do?
Likely the ear membrane has ruptured and the infection is draining out. Call during regular ofﬁce hours to schedule an appointment.
Can my child swim if she/he has an ear infection?
Yes, the infection is on the inside of the ear.
When can my child swim if he/she had a ruptured ear drum?
Generally ok to return to swimming 48 hours after starting treatment.
I think my child has swimmer’s ear. Can Dr Raley just call in some drops?
No, he needs to look in the ear. If the canal is very swollen then he will need to put a wick (like a string that expands) in the ear to help the drops get down to the affected area. Motrin can be given for pain management. Make an appointment during regular ofﬁce hours.
What can I put in my child’s ear to help prevent swimmer’s ear?
½ vinegar / ½ alcohol mixture–ﬁll ear canal after swimming. Do not use if your child has ear tubes or recently had a ruptured ear drum.
Does a child always run a fever with an ear infection?
Not always, but some kids do.
How can I tell if my child has an ear infection?
You can not tell for sure without having the doctor look. However, common signs include runny nose, wet cough, tugging at ears, infant not wanting to be laid ﬂat or suck on a bottle.
Child/cough/stomach pains My child coughs until he/ she throws up-what should we do?
Your child probably has a lot of drainage. If he/she has repeated episodes of coughing/ gagging on mucous, then he/she needs to be seen during ofﬁce hours.
My child has a cough only at night for several weeks- do we need to do anything?
Your child should be seen during regular ofﬁce hours to assess the cause of his/her cough.
My child has complained of some general stomach pain off and on for a while-should we come in?
The most common causes of this are constipation and occasionally reﬂux. Your child should be seen during regular ofﬁce hours to determine the cause.
My child has been getting bloody noses recently. Is there anything we can do to help this?
This is usually caused by a dry nose, seen with lots of nasal drainage, and sometimes due to a scratch. Use nasal saline and Vaseline in the nose as often as possible. You can put the Vaseline on a Q-tip and apply inside the nose. If nose bleeds take a long time to stop or are frequent, then your child should be seen during ofﬁce hours.
My child has a cough and fever. Do we need to be seen?
Yes, you can treat fever with Tylenol or Motrin and make an appointment during regular ofﬁce hours.
My child started coughing, but does not have fever. Do we need to do anything?
If the cough last more than 3-4 days then he/she should be seen during ofﬁce hours.
My child has itchy eyes, runny nose, and congestion. I think it is allergies-is there an over the counter medication we can try?
Claritin or Zyrtec are available in the drug store. You can call during regular ofﬁce hours to check dosing if unsure. If allergy sypmptoms persist then schedule an appointment with Dr Raley.
Child/bug bites My child was bit by a tick-what do we need to watch for?
Observe for a rash around the site of the bite or a generalized rash or fever within 2 weeks of the tick bite. If this develops then schedule an appointment during regular ofﬁce hours. Area can be cleaned with soap and water. Apply Neosporin.
My child has mosquito bites that are really swollen, itchy-what can we put on it?
Try some over the counter 1% Hydrocortisone cream twice a day.
My child was bit by a mosquito-will he get West Nile Virus?
It is unlikely that your child will come down with West Nile. The people most often affected by this are the elderly or immune compromised.
Child/skin conditions My child has poison ivy-what can we put on it?
Mild reactions can be treated with over the counter 1% hydrocortisone cream. If reaction is more severe and/or involves the face then your child should be seen during regular ofﬁce hours.
I think my child has ringworm. What can we put on it?
Ringworm is a fungal infection of the skin (not actually worms). You can try some over the counter antifungal like Lotrimin or Monistat (generic is ok). Apply 4 times a day. It does not usually clear up very fast. If there is not any improvement in 1-2 weeks, then you need to schedule an appointment with Dr Raley.
Child/antibiotic My child is on an antibiotic. Can he/she still take Ibuprofen or Tylenol? Yes My child is on an antibiotic and now has a rash. Is he/she allergic to the antibiotics?