Tongue-tie

     Tongue-tie (ankyloglossia) is a medical problem which was, for a time, routinely treated and then, for decades, was not treated and now is being treated again. It is evident immediately at birth. It occurs in 4 – 5 % of newborns. It is not a problem that causes any medical problems, but it does cause problems with breast-feeding. Breast-feeding is difficult enough in the newborn period. Mom is exhausted after delivery, the baby feeds at irregular intervals so mom has little chance to sleep and mom’s breasts are sore even in the best of cases. But when a baby has tongue-tie, breast-feeding is extremely painful. Mothers of infants with tongue-tie stop breast-feeding almost 3 times as often as those without tongue-tie.

     The procedure to clip a tongue-tie is simple and can be done in the nursery or office. Most mothers report that breast-feeding immediately becomes less painful and easier after the procedure. The infant can have some bleeding from the area under the tongue, but it soon stops.

     If your infant has tongue-tie and you are having any difficulty with breast-feeding, don’t hesitate to discuss clipping the tongue-tie as soon as possible.

Fever (2)

     Fever is the most common reason for parents to bring their child to the doctor.  Dr. Barton Schmitt coined the term “fever phobia” when describing the fear that most parents have about fever. The common misconception is that fever is a sign of a serious infection or that fever can cause damage. Fever caused by high external temperatures or as an unusual reaction to anesthesia can be dangerous. Fevers that children have with infections are never dangerous. Fevers can cause seizures (see “Fever Seizures”) which are frightening, but are not dangerous. Fever is not a disease; it is a symptom of a disease. The disease might be dangerous, but the fever is not.

     The key concern for parents is the reason for the fever. If the child has an obvious upper respiratory infection (runny nose, cough), the parent should watch the pattern of the fever (see “Fever (1)”). The daytime fever should go away in about 3 days and not return. The child should feel better when given fever/pain medication.

     If the child only has the fever and no other symptoms, the situation is more complicated. In the 1980s and 1990s, a child with a fever and no other symptoms would have blood work, a urine sample and, occasionally, a chest X-ray. Now, the vaccines for H. influenza (not “flu shots’) and Pneumococcus have eliminated the risk of these serious diseases.  Now, if a child has a fever, especially a fever over 102, and no other symptoms, it depends on how sick they are acting.  If they are acting well and seem to feel better with a dose of fever medication, the best thing to do is to check them again in about 24 hours. If the child is acting ill, they should have an examination and probably have lab work, especially an evaluation of their urine for a possible urinary tract infection. Although parents don’t like it, if a child is too young to give a good “catch” sample, the urine should be a catheterization sample. This is especially true if a male child under 2 years old is not circumcised – they have a high risk of urine infection.

     Fever with infection rarely goes above 106 and, as mentioned, is not dangerous. However, almost all parents surveyed felt that fever could harm their children. About half of all parents surveyed say they check their child’s temperature at intervals of about 1 hour and 85% of parents said they woke their child up at night just to give anti-fever medication. It was found that 14% of parents gave acetaminophen too frequently and 44% gave ibuprofen too frequently. 66% alternated acetaminophen and ibuprofen and most of them were told to do it by their doctor! Although combination therapy might lower the fever faster, it most certainly increases the risk of overdosing one or both of the fever medications. This is especially true if the child is also given a “cold medicine” which can also contain acetaminophen. Fever is part of the body’s normal defense mechanism and is necessary to fight the infection. The parent should focus more on the child’s symptoms than on the number on the thermometer.
     A helpful use of fever, however, is the "School Rule" for older children. If your child wakes up on a school morning and says " I don't feel good" or if they are recovering from an illness, take their temperature. If they have a fever, keep them home or you will get a call from the nurse to come and get them at school. If they do not have a fever (101 or above) send them to school. Many schools have a "24 hour fever-free" rule which is stupid.The fever from a viral infection can last an extra 2-3 days in the evening but these children are well during the day and can certainly go to school.

Potty Training

     It is physically impossible for one human being to force another human being to eat, fall asleep or go to the bathroom. That is why we parents are in trouble when we tell our children to do one of these things - because we can’t make them do it and they will prove that to us.

     Although potty training often creates a great amount of parental concern, it really doesn’t need to. It is more comfortable and convenient to use toilets than to sit around in a soiled diaper. Sooner or later, every child will realize that. No one goes to Senior Prom in diapers.

     Training is education. A young child learns by observing and imitating his parents. He learns that Mommies and Daddies pee and poop in the toilet by watching – just try to go to the bathroom without your 2 year-old following you. The most important incentive for a child is his parent’s encouragement and approval, so forget charts, stars and (even worse) treats. Children soon get bored with artificial rewards. The next most important way to help mold behavior is to act as if you expect the child to behave properly – don’t nag, argue or act like there is any option. Once your toddler understands what toilets are for, gentle encouragement with appropriate praise will usually do the rest. Don’t fight, force him to sit on the toilet, punish him for not using the toilet or create any kind of negative experience.  Without any big announcements, start using pull-ups as diapers. The good thing about pull-ups is that you can pull them down and back up again. It gives the child more control of the situation. The parent can say, “Do you need any help?” (Even if they say “no”, keep the door open – at first, they’ll need help and you don’t want them getting frustrated with the process.) As the pull-ups stay dry longer and longer, the parent can start the day by asking “Is today a pull-up day or a underpants day?” If the child chooses underpants and then soils them, the parent says (without anger), “ We made a mistake – it was a pull-up day” and puts the child in pull-ups for the rest of the day.  Don’t follow your toddler around the house changing soiled underpants because “he doesn’t like pull-ups”. Use pull-ups during the night even when days are dry.

     You can improve your success rate by eliminating the milk and juice between meals and before bed. This gives parents one more reason to have the “One glass of milk with meals and only water between meals” rule. Your child will eat better at meals, have less risk for obesity, have healthier teeth AND potty train more easily.

Food Allergies (1)

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     About 12% of children are reported to have food allergies. If you test the children who are reported to be allergic, that number drops to about 3%. Food allergy is a specific immunologic reaction rather than just an inability to tolerate some foods (for example, lactose intolerance is not food allergy).

     The most common foods for children to be allergic to are: cow’s milk, soy, egg, wheat, nuts (particularly peanuts) and fish (particularly shellfish). It is rare for children to be allergic to fruits or vegetables, but it can happen.

     Food allergy occurs most often in families with a strong history of asthma, seasonal allergies, eczema or other allergic diseases. Not surprisingly, children with food allergies are 2 to 4 times more likely to have asthma, eczema or respiratory allergies. Children who have true food allergy and asthma are at the greatest risk for a severe, life-threatening reaction when exposed to that food. This is especially true with peanut allergy.

     Any child who has allergic symptoms (hives/rash, vomiting, coughing/wheezing, swelling) after eating a certain food or who has chronic eczema should be evaluated for food allergy. However, there are many phony tests for allergy such as placing substances under the tongue or testing muscle weakness after exposure. Even tests that are accepted as accurate have common false-positive results, so any allergy testing has to be carefully evaluated.

     It is common for children with allergy to milk, eggs, wheat and soy to “grow out” of these allergies and be able to tolerate these foods later in life. It is less common for allergies to nuts and shellfish.
     If the child has true food allergy and has had a severe reaction in the past, it is important to have an epinephrine pen and to use it immediately. Don't wait to see if a reaction is going to occur. Delay in giving epinephrine can result in death from severe allergic reaction. After giving the injection, call 911. If the child is having more symptoms, don't hesitate to give a repeat injection.

     Because there is so much misinformation and confusion about allergy, parents need to speak with their child’s caregiver before simply eliminating a food from their child’s diet.

Starting Solid Feedings

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     There are many “rules” about how to start your infant on solids, but few of them have any real scientific basis. Until 4-6 months of age, infants grow well on breast milk or formula. Most physicians recommend waiting until 6 months to introduce solid foods on the basis that it decreases the risk of allergies, but recent studies have shown that this isn't true. At 4-6 months, your baby will begin to chew on anything that comes near his mouth and will be ready for solids. Although it is universally done, there is no need to begin with infant cereal. By six months, your baby’s intestine is normally developed and can digest almost any food.  Rather than giving your infant the extra sugar and salt that can come with processed baby foods, consider making your own baby food. Use whatever you are having for dinner. It is never too soon to have your child eating what you are eating and, from the beginning, it is good to avoid making special meals for your child. Another common recommendation is to start one food at a time to know if the baby will "react" to a given food but this, too, has little basis in fact. Start by blending foods to a smooth consistency and, as the baby gets used to solids, give the food more consistency. Don’t worry about giving “vegetables before fruits”, because your child has lots of sweet taste buds, and, like most of us, will prefer the taste sensation of “sweet” his whole life long. Give him vegetables when you are eating vegetables. You teach your child healthy feeding habits by giving him fresh fruits and vegetables and not feeding him juices, “fruit snacks” and other processed foods. If your child closes his mouth and shakes his head, it may be time to put the food on the tray and allow him to start feeding himself. When more food hits the floor than hits the mouth, the meal is over. Mealtime should always be a happy, family time and should never be a fight or struggle. Don't worry about how much or how little your child eats at any given meal.

Gas and Reflux

     All infants have periods of time when they are fussy. The most common reason for a fed, dry infant to be fussy is that he is tired. When an infant is fussy or has loud, grumbling bowel sounds, it is commonly said that he has “gas” as if it is a medical problem. It is normal for the gastrointestinal tract to have air in it and the grumbling is the normal movement of the bowel heard before and after feedings. When an infant cries, even more air is pulled into the stomach, so the tummy can get even more distended. The crying is causing the “gas” – the “gas” is not causing the crying. Far too much concern and energy is put into burping, changing formulas, changing nipples and worrying about diet – all in the name of preventing “gas”. Air comes up and food goes down through the gastrointestinal tract and parents don’t really need to do anything to help that process.

     When an infant spits up frequently, it is now common to diagnose him as having reflux. True gastroesophageal reflux (GERD) is rare in infants, but spitty infants are frequently given medications called proton pump inhibitors (PPI) just on the history without a real evaluation. A large study of prescribing practices in the US showed a 16-fold increased use of one of the popular forms of PPI from 1994 to 2004. The FDA has not approved PPIs for children younger than a year of age, but most infants on these medications are much younger. There is no good scientific evidence that PPIs relieve distress in infants better than placebo, and there are definite side effects that can result from using PPIs. Before automatically asking that their infant be placed on reflux medication, it would be better if parents look at other causes

Moles

     Moles cause a lot of concern. Moles in children cause much less problem than in adults, but parents still need to know what to watch for when their child develops a mole. There are three main characteristics to observe in a mole. First, color. Whether it is tan, brown or black, an innocent mole is usually all the same color. If a mole has red, brown, black, blue - different colored areas on the same mole, it needs to be checked. Next, look at the boarder. An innocent mole usually has a sharp, distinct boarder separating it from the skin. Bad moles have indistinct boarders that sometime seem to fade into the surrounding skin. Finally, check surface. Whether a mole is raised or flat, smooth-surfaced or bumpy, the innocent moles will have a uniform surface. If some of the mole is flat and some is raised or irregular, the mole needs to be checked.

     Other moles that are worrisome are moles that are growing or changing rapidly and moles that are on areas of the body that cause the mole to be repeatedly rubbed and irritated. There is also a lesion on the skin that is called a mole but it is not. This is a reddish, raised lesion that appears and grows rapidly and bleeds profusely when it is irritated.  This is called a pyogenic granuloma and needs to be removed because it will continue to bleed whenever it is touched. Finally, children frequently get little, ivory-colored masses anywhere on their bodies. These little “moles” have a small amount of white mucous-like material in them and they have a little depression in the center of them that looks like a tiny belly button. These are molluscum contagiosum and are caused by a virus. There are many treatments recommended for molluscum, but the best advice I can give parents is to ignore them. The more doctors try to treat molluscum, the more risk for scars and infection. After weeks, they go away by themselves and do not need any treatment.

Alternative Vaccination Schedules

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            More than 1 in 10 parents do not follow the recommended schedule for childhood vaccinations. They delay some vaccines or refuse some vaccinations altogether. There are many reasons that these parents give for their decisions. They feel that it is safer to wait to give vaccinations until the child is older, they distrust the pharmaceutical companies that produce the vaccines or they feel that the risk of side effects from the vaccines is too great. These fears have been well documented to be groundless, but once a rumor like this gets started, it continues to circulate in various forms.. A good example is the belief that measles vaccine caused autism. Even though the Englishman who originated this myth has been totally discredited and multiple studies involving hundreds of thousands of children have proven that there is absolutely no relationship between autism and measles, parents still have different variations of this fear.

            No medical procedure is without risk. One must always balance the risk of a procedure or medication against the risk of the disease With vaccines, the risk of the disease is worse than the risk of the vaccine. In the time before vaccines, diphtheria or pertussis (whooping cough) could infect an entire family and kill all of the children in that family within a couple of weeks. These diseases have not disappeared. Skipping or delaying vaccines has been proven to significantly increase both the risk of getting and the risk of spreading the diseases that can be prevented by vaccines. Unvaccinated children are 22 times more likely to get measles and 6 times more likely to get pertussis. Unvaccinated children also pose a risk to the vaccinated children in a community. A Colorado study showed that for every 1% increase of under-immunized children in a community, the vaccinated children in that community had twice the risk of developing pertussis.

Autism is an emotional disaster for parents that turns their life upside down because their hopes and expectations for their previously normal child have to be readjusted. Whenever this kind of tragedy happens in our lives, it is human nature to want to know why it happened. Modern medicine cannot give these parents a reason for autism and the parents become desperate to know what caused this total change in their life and their child’s life. Unfortunately, other people can use that desperation to promote their own agendas. They are always willing to give reasons and “cures” when scientific medicine cannot. They also give parents the false sense that they can prevent autism if they avoid vaccines or alter the vaccine schedule. Most of us would do anything if we were convinced that it would keep our children safer. The reality is that giving the recommended vaccines on the recommended schedule makes our children safer. Altering those schedules puts our children at greater risk.

Constipation - Tummy Pain

            “Mommy, my tummy hurts” is a complaint that parents hear frequently. If the tummy pain is a new symptom or is associated with other symptoms such as fever or vomiting, the child needs to be seen by his caregiver right away. If the child has had the pain off and on for a longer time and is otherwise healthy, the most common cause for tummy pain is constipation. Parents will often say: “My child couldn’t be constipated! He goes to the bathroom every day!” or “ He has runny stools”. But any child can be constipated no matter how often they stool or what their stool looks like.  There are certain signs that signal constipation. Constipation pain can occur anytime, but commonly occurs during or immediately after a meal. Food in the stomach causes the colon to contract and if the colon has a lot of stool in it, that contraction causes pain. The child may say, “I’m full” after just a few bites. The child may have dull pain off-and-on through the day or severe cramps. The stools may be large and hard (often clogging up the toilet), or the stool could be liquid – the hard, large stool stays in the colon and the contraction of the colon only moves liquid stool around it. The child may go to the toilet often but complain that he “can’t poop”. The stool can be uncontrollable causing the child to soil his underwear. This is called encopresis. The child has held back the stool so long that the muscle of the rectum stretches and becomes weak. The child may be unaware that he has stooled. Sometimes these children get mistakenly sent to psychiatrists thinking that they are lying or being stubborn.

            The only cure for constipation is to get the colon cleaned out and to keep it cleaned out. By the time the child is having tummy pain or cramping, simply increasing the fiber in the diet with either liquid fiber products or eating more fruits and vegetables isn’t going to resolve the problem. There are powders available in the pharmacy containing a compound called polyethylene glycol. These powders are available without a prescription. They are mixed with water to create a laxative solution.  When the child drinks this solution, the polyethylene glycol brings more water into the colon and makes the stool liquid. If the stool is not liquid in a day or so on the laxative, the parent can increase the dosage until the stools are liquid.  If constipation was the reason for the child’s tummy pain, the pain should go away totally when the stools are liquid and the child is stooling frequently. If the child has been taking the laxative and having loose stools for a few days and still has tummy pain, the child needs to see his caregiver. There are many other causes of tummy pain and they need to be investigated.

      If the constipation was caused by a single episode of stool-withholding (for instance, after a camping trip) one bowel clean-out should be all that’s necessary. If the constipation is the result of a long-term stool-holding habit, it needs a long-term solution. The child needs to stay on the daily medication until the stool habits change. If the child has had no tummy pain while taking the polyethylene glycol solution but starts to have large stools and tummy pain again a few days after he stops taking the medication, he wasn’t on it long enough to eliminate the holding habit and he needs to start taking the laxative again.

Infant Sleeping

Infants need to be fed, dry, warm and they need enough sleep. A newborn spends most of the day sleeping. Newborns wake up, eat and go back to sleep for 2 to 3 hours and repeat that pattern all day and night. As infants get older, they eat more actively, stay awake longer, and get into their own sleep pattern. Some babies need more sleep and some need less, but they all need more than what most parents think.

            An infant wakes up in the morning hungry and wet. After a quick change and a full feeding (don’t limit the amount you feed - feed him until he stops eating), your baby should be awake and happy. However, even a happy baby will occasionally just scream or cry for no apparent reason. Don’t worry. He is just practicing different forms of communication.  He’ll soon be smiling again without you doing anything. This is a wonderful time to interact with your baby.

            After a few hours of being awake, your infant will start to get crabby. He might also rub his eyes and face. He is getting tired. Some infants like to have a little more feeding at this time, but, because they aren’t really hungry, they might just push the bottle away or suck a few times and start to fall asleep. If a fussy baby is not hungry or wet and he has been awake for a few hours, he is tired. Quiet rocking in a darkened room with a pacifier might help your baby fall asleep but be sure to lay him in his crib before he is completely asleep. Often, parents will carry and walk a fussy baby. The baby will keep waking up with the bouncing or, if he falls asleep, he will almost certainly wake up again when he is laid down in the crib. As he gets more and more tired, he will cry harder and harder. Often, what is called “gas” or “colic” is exhaustion. As hard as it is for parents, the infant who doesn’t fall asleep with quiet rocking should be placed in his crib and allowed to cry until he goes to sleep. Don’t allow him to fall asleep in your bed with you. Co-sleeping is dangerous. Falling asleep in swings or car seats is also not good for infants.

            Most infants require at least a morning and an afternoon nap. From birth to 3 months of age, most infants will wake up about two times during the night to eat. From 3 to 6 months of age, they usually need a feeding at least once in the night. Most infants don’t sleep through the night without feeding until 6 months of age.

            Babies can need 12 hours a day of sleep or more up to 1 year of age. If you learn the clues that tell you when your baby is tired and allow the baby to go to sleep when he needs to, you both will be a lot happier.

Fever Seizures

       Seizures that occur with fever (febrile seizures) are common in childhood. Under 5 years of age, 2-3 % of children with fever will have a seizure. These seizures are true, grand-mal seizures that cause the child’s arms and legs to jerk. The child will breathe irregularly and lose consciousness. They usually only last 1-2 minutes, but they are extremely frightening for parents.

        Doctors do not know what causes these seizures. They often occur in the first few days of a fever, when a child’s temperature may change rapidly up and down. It is possible that the brain cannot adjust to these rapid changes. But it is important for parents to know that seizures do not occur simply because the fever gets “too high”. Children can have a seizure at any temperature, low or high.

        If a child’s parent or sibling or the child himself has a history of fever seizures, the child has an increased risk to have a seizure with fever. The first time a child has a seizure, parents should contact their child’s caregiver because there are other problems that can cause a seizure and they need to be investigated. If a seizure lasts longer than 10 minutes, the irregular breathing can be dangerous and the parent should call 911.

        Parents of a child who has a fever seizure are frequently told to alternate fever medications such as acetaminophen or ibuprofen, to sponge the child or to use other means to “keep the fever down”. This advice is bad in two ways: first, it is simply wrong. There is no evidence that any kind of “fever control” prevents fever seizures. Second, it gives the parents the false sense that they can do something to prevent fever seizures. The parent can mistakenly feel guilty if the child has a seizure because they think that they “failed to keep the fever down”. A child’s fever is usually the result of an infection. Fever serves as an important part of the child’s immune defense and is necessary to fight the infection. Fever medications can lower the fever somewhat and make the child more comfortable, but they cannot eliminate the fever or the risk of fever seizures. Fortunately, even though fever seizures are very frightening for parents, they are not dangerous for the child. By the time the frightened parent has called 911, the seizure is usually over and the child is asleep.

        If a child has a fever seizure, the parent should not try to restrain the child but allow them to lie gently on the floor. Do not try to force anything into the child’s mouth. The child will not “swallow their tongue”. When the seizure is over, check the mouth to be sure nothing is in it and that the child’s airway is clear. The child will be sleepy for about an hour after the seizure. Have your child examined after the first fever seizure, if more than one seizure occurs within 24 hours or if the seizure occurs with other symptoms such as confusion, lethargy or dehydration.     

Teaching Healthy Eating Habits

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     Up to 4 months of age, breast milk or formula is the only food that an infant needs. From 4 months on, begin practicing with baby foods, but breast milk or formula is still the main source of nutrition. After 9 months, the infant won’t want to eat baby foods, so begin feeding the infant what the family is eating (as long as it does not have a choking risk).  Allow him to feed himself and give him a lidded cup of milk or water with meals. Up to 1 year of age, baby is still allowed to have a breast milk or formula between meals, but, at mealtime, feed him real food. There is never a reason to give juice. No matter how healthy the juice package makes the juice seem, it is simply sugar water and doesn’t need to be in the baby’s diet. Don’t give apple juice; give an apple. The next step to healthy eating is that, after 1 year, all bottles become water.  Not milk, not juice - just water. The toddler who drinks juice and milk all day long or snacks on “fruit snacks” or crackers between meals learns that he always needs to have something sweet going into his mouth. Instead, feed your toddler three meals a day when the family eats and give him what the family eats.  Allow one glass of milk with meals. If you want to give a snack between meals, stop your activities, go to the kitchen and have a snack of fresh fruit or fresh vegetables and a glass of water. You can give a bottle at nap or night time to help the baby sleep, but only put water in it – not juice or milk. Giving your toddler milk or juice in the bottle after 1 year of age not only teaches the child to keep taking in sweet calories all day, but it also ruins the teeth – especially bottles at or before sleeping.  A healthy diet for a 1-to-2 year old is to eat what the family eats, when the family eats, drink milk with meals and have minimal snacks of fresh fruit or vegetables along with water between meals. If you don’t teach your child to snack (and sip) on sweet foods all day long, you will eliminate one of the major causes of obesity – too many calories.

Excessive Newborn /Infant Tears

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     Eyes constantly produce tears to keep them moisturized. The tears are produced in the upper, outer corner of the eye, wash across the eye and collect in the inner, lower corner of the eye. They go into a small tube called the tear duct and drain into the nose to be absorbed. If you look closely at the lower eyelid in the inner corner of the eye, you can see the tiny opening of this tube.

     In the first few months of life, an infant can develop excessive tearing in one or both eyes. This is commonly the result of blockage of the tear duct. This causes the tears to collect in the eye and run down the infant’s face. This blockage can often be relieved by the parent, using the pad of their fingertip to do a massage of the area between the inner corner of the eye and the nose. The massage should start just inside where the parent sees the opening of the tear duct and go down to the nose at about a 45-degree angle. The massage should be firm but gentle. Absolutely no pressure should be put on the eye – only the area between the eye and the nose where there is nothing but skin, muscle and bone.

     With a blocked tear duct, the drainage from the eye should be clear tears. If the drainage from the eye is cloudy or looks like pus, the infant should be seen by his caregiver. If the white of the eye becomes red or bloodshot or the eyelids become swollen, the infant should also be seen. Finally, excessive tearing can be a sign of glaucoma. If the tearing continues even with massage, if the child squints in light or if the eye seems to be enlarging, the infant needs to be examined by an eye doctor.

Fever (1)

            There are many things that can cause a child to have a fever. By knowing some basic facts about fever, the parent can save themselves a lot of worry and perhaps a doctor visit. The most common cause of fever is a viral infection such as a cold. Fever is often the first thing that happens when a child gets ill.  It usually starts in the late afternoon or evening, about the time you pick the child up from day-care. The child looks and acts sick and feels hot. Feeling the child is an inaccurate way to judge how high the fever is (101, 102, etc.) but feeling the child is an accurate way to judge whether the child has a fever or not. With most viral illnesses, the fever is up and down for the first three days and always higher at night. After the third day, the daytime fever drops. The child still will have a nighttime fever for another night or two and then the night fever goes away. During those first few days of fever, you can give the child a fever-reducing medication (acetaminophen or ibuprofen) to help him feel better. In fact, your child's response to the medication can sometimes let you know whether the fever is caused by a simple viral infection or a more serious infection. The temperature may not go down much with the medication, but the purpose of the medication is not to lower the fever, it is to make the child more comfortable. If the child seems to feel better an hour after a dose of the medication, the illness is less worrisome. If the child seems to be more sick or feels worse after the medication, it is more worrisome and the child should be seen by his caregiver.
     Fever is not dangerous and does not cause brain damage. Children can have seizures with fever, but the seizures are not caused because the fever got “too high”(See the article on “Fever Seizures”). Once the fever is gone, the child should feel much better, even though the symptoms that came along with the viral illness (runny nose, cough, diarrhea, etc.) may continue for another week or two. After the daytime fever resolves, it does not return even though the fever can still be up at night. If a daytime fever lasts more than 3 days or if the daytime fever returns after having been gone for a day or two, the child needs to see the doctor. If your child does not slowly improve over a week or two,  develops new or more serious symptoms or seems to be acting more ill, the child needs to see the doctor.

Pacifiers

     Pacifiers can be very helpful for parents with young infants and they won’t become a problem if they are used correctly. Babies love to suck and, along with being the way babies obtain food, sucking is a normal, self-quieting behavior. Between birth and six months of age, parents can allow the baby to have a pacifier anytime he wants to have it, day or night. Don’t worry about pacifier size or shape and don’t worry about the baby’s teeth – there aren’t many. The first six months of life is a very difficult time of life for infants and parents so anything that gives a little comfort and quiet is good. Use the pacifier as much as you want to.  In fact, there is some evidence that infants who use pacifiers have a slightly decreased risk of Sudden Infant Death, although we don’t know why. At six months of age, the infant is chewing on anything that comes within a foot of his mouth.  This is the time to start only using the pacifier when the baby is tired and trying to go to sleep.  The simple rule is that, after six months of age, the pacifier never comes out of the crib. The baby can use it for naps or nighttime to fall asleep, but never during the day.  Parents can use the pacifier strap to attach a small teething ring to the baby’s shirt during the day (but remove it when the baby sleeps).  The child will happily chew on the teething ring, his fingers and everything else and never miss the pacifier.  The pacifier can stay in the crib for as long as the child wants to use it. It falls out of the infant’s mouth soon after falling asleep and will never cause a problem. Never taking the pacifier out of the crib is also an effective way to break a child of the pacifier habit if he has been allowed to use it during the day, but why get into trouble in the first place? After six months of age, when the baby comes out of the crib, the pacifier disappears and to do all pacifier problems.