1. Abdominal pain:
Mild abdominal pain in children is very common, and may be caused by viral illness, overeating, over-stimulation, or constipation. More severe abdominal pain, especially if accompanied by fever or vomiting, may be a sign of more serious illness such as appendicitis or urinary infection. Call the office for advice at 206-783-9300 if your child’s abdominal pain is severe and has persisted for longer than four hours, or fever/vomiting are present.

2. Acetaminophen: (Tylenol, paracetamol, APAP)—see Medications, dosages

3. Advil: (ibuprofen)—see Medications, dosages

4. Constipation:
Constipation in infants and children refers to hard, painful bowel movements. Stools that are soft are normal, and may be as infrequent as every 2 or 3 days in normal, healthy infants and children. In toddlers and older children, constipation can usually be relieved by increased amounts of liquids in the diet, especially pear juice and prune juice, and by increased amounts of fruits and vegetables. For infants who have hard, painful stools, or in older children who do not improve with a change in diet, please call during office hours to talk with one of the nurses for further advice at 206-783-9300.

5. Dehydration:
Excessive loss of body fluids through vomiting or diarrhea, combined with inadequate oral intake of fluids, can lead to dehydration in infants and small children. Signs of dehydration include infrequent urination (fewer than 3 times in 24 hours), dry lips and tongue, sunken eyes, and skin that has a “doughy” feel, or which remains tented up when gently squeezed between your thumb and forefinger. Lack of tears or saliva are also signs of dehydration. If your child appears to be dehydrated, please call the office for advice, at 206-783-9300.

6. Diarrhea:
Diarrhea is a common childhood condition usually caused by an intestinal virus. Frequent loose or watery stools may occur, accompanied by low-grade fever. If your child is otherwise well, taking fluids without vomiting, and urinating at least once every eight hours, it is acceptable practice to continue feeding the child’s usual diet and expect the diarrhea to resolve in 3-4 days. In the toddler or older child it may be helpful to eliminate milk and other dairy products (which contain lactose) from the diet for a day or two. If diarrhea is accompanied by severe abdominal pain, high fever, or blood in the stool, please call the office for advice at 206-783-9300.
If diarrhea is accompanied by vomiting, please consult that topic on this site. If you are concerned that your child may be dehydrated, please consult that topic or call our office.

7. Fever:
Fever (rectal temperature above 100.5 degrees F) is usually a sign that your child’s immune system is responding to an infection of some kind. Most of these infections are caused by viruses and involve only mild signs of illness or discomfort. Most of these viral infections subside in 3-4 days, and for infants over six months of age and older children, only comfort care is necessary, which includes fever-reducing medications.

If fever is accompanied by severe sore throat, headache, vomiting, diarrhea, rash, difficulty breathing, pain with urination, abdominal pain, or confusion, please consult those specific topics on this site or call to talk with the consulting nurse at 206-783-9300.
Fever in an infant less than three months old may represent a serious infection. Call us immediately at 206-783-9300 for an urgent appointment. Infants over three months old may have a mild fever accompanying a cold. If the infant is otherwise well, except for cold symptoms, only careful observation is necessary. Fever that appears after several days of cold symptoms may indicate a secondary bacterial infection—call the office for advice. If your infant has a high fever not accompanied by signs of a cold, or if the infant appears ill or very fussy, call us at 206-783-9300 to discuss your child’s symptoms and to decide whether a visit to the office, after-hours clinic, or emergency room may be necessary.

8. Headache:
Children often have headaches associated with viral infections, overheating, or mild dehydration. These headaches are usually brief and respond to comfort measures such as rest, fluids, and medications such as acetaminophen or ibuprofen. Headaches may also follow minor head injury and also respond to comfort measures.
If headache is severe, or accompanied by vomiting, fever, confusion, or stiff neck, call our office immediately at 206-783-9300 for advice.
If your child develops a pattern of frequent or severe headaches, especially if they interfere with normal activities or occur first thing in the morning, call the office to arrange for an evaluation.

9. Ibuprofen: (Motrin, Advil)—see Medications, dosages

10. Medications, dosages:
The most useful medications for pain and fever in infants and children are acetaminophen (Tylenol, paracetamol, APAP) and ibuprofen (Motrin, Advil). The main difference between them is that acetaminophen should be given every 4-6 hours, and ibuprofen every 6-8 hours, which is more convenient at night. There is no evidence that giving these medications together is any more effective in reducing pain or fever—we recommend you use one or the other, NOT both at the same time Aspirin (acetylsalicylic acid)# should never be used in children because of the risk of Reyes Syndrome, a rare and dangerous liver disease.

Acetaminophen and Ibuprofen are generally considered safe medicines after two months of age.  Any fever prior to 3 months of age please call Ballard Pediatrics to discuss with the nurse (only exception being evening after 2 month vaccines).
 
- Acetaminophen (Tylenol, paracetamol, APAP)
Infant drops (80mg per 0.8ml):     6 to 9 pounds: 0.4ml (40mg) each 4-6 hours
                                                    9 to 12 pounds: 0.6ml (60mg) each 4-6 hours
                                                    12 to 18 pounds: 0.8ml (80mg) each 4-6 hours
                                                    18 to 24 pounds: 1.2ml (120mg) each 4-6 hours
                                                    24 to 30 pounds: 1.6ml (160mg) each 4-6 hours
 
Elixir (160mg per teaspoon):       24 to 30 pounds: 5ml or 1 teaspoon (160mg) each 4-6 hours
 
- Ibuprofen (Advil, Motrin) suspension (100mg per teaspoon):
                11 to 17 pounds: 2.5ml = 1/2 teaspoon (50mg) each 6-8 hours
                17 to 22 pounds: 3.8ml = 3/4 teaspoon (75mg) each 6-8 hours
                22 to 30 pounds: 5ml = 1 teaspoon (100 mg) each 6-8 hours

11. Motrin (ibuprofen): see Medications, dosages.

12. Rash:
Most rashes in infants and children accompany mild viral infections and look like scattered red dots and bumps that are not itchy or painful. Rashes occasionally are a sign of a serious infection—specifically rashes that are purplish, do not disappear with pressure from a finger, and are accompanied by fever and/or headache. Call our office immediately (206-783-9300) if you observe a purplish rash. Some rashes can be diagnosed over the telephone—if a rash persists for a week or more, please call the office. If a rash occurs while your child is taking an antibiotic or other prescription medication, call the office for advice.

13. Sore throat:
Most sore throats in children are mild and are caused by viruses that last 3-4 days before resolving on their own. Comfort measures include cool liquids, bland foods, and appropriate doses of pain medication such as acetaminophen or ibuprofen. More severe infections in children over 18 months can be caused by the Streptococcus bacteria (“strep throat”). Clues that your child’s sore throat might be due to strep are sudden onset, headache and abdominal pain, enlarged tonsils (which may be red or show white patches), and enlarged, tender lymph nodes on either side of the neck (“swollen glands”). Typical cold symptoms such as runny nose or cough are often absent. Occasionally a fine red “sandpapery”-feeling rash may occur under the arms or in the groin. If you suspect your child may have a sore throat due to strep, please call the office for an appointment. If laboratory tests indicate that a strep infection is present, an antibiotic is the appropriate treatment.

14. Tylenol (acetaminophen): see Medications, dosages.

15. Urination, pain with:
Pain with urination is commonly accompanied by fever, frequent urination, and abdominal or back pain. These symptoms often indicate a urinary tract infection, and should be evaluated in the office within 24 hours. Call 206-783-9300 for an appointment. In the meantime, comfort measures such as acetaminophen or ibuprofen may be used. Increased intake of oral liquids, especially cranberry juice, may also be helpful.