Acetaminophen (Tylenol)

  • Acetaminophen is very helpful for fever and pain. Please do not use acetaminophen for infants under four months of age without talking to our office first.
  • Acetaminophen may be given every 4-6 hours
  • Infant drops and the children's syrup may have very different concentrations. Please only use the dropper provided with the infant drops to measure the infant dose.
  • Many over-the-counter cold and cough preparations also contain acetaminophen. Use of these products along with an acetaminophen preparation may result in a dangerous overdose.
  • Acetaminophen is also available as a rectal suppository for use in children who refuse to take medicine by mouth or who are vomiting. The brand name is Feverall, and it is available in most pharmacies. Please use rectal acetaminophen only on the recommendation of our office.

table
ADHD

Recommended reading:
ADHD: What Every Parent Needs to Know, American Academy of Pediatrics, 2011
Taking Charge of ADHD, Russell Barkley, 2013

Other Resources:
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD): http://www.chadd.org

www.ldonline.org

www.healthychildren.org/adhd

massfamilyties.org 800-905-TIES, can set up 1:1 Parent support match
Adolescence


Books About Puberty:
For Girls:
  • The Care and Keeping of You: The Body Book for Girls, by American Girls and Norma Bendell
  • A Girl's Guide to Becoming A Teen, by the American Medical Association


For Boys:
  • A Boy's Guide to Becoming A Teen, by the American Medical Association
  • It's Perfectly Normal: Changing Bodies, Growing Up, Sex, and Sexual Health, by Robie H. Harris and Michael Emberley


Books For Parents:
  • Getting to Calm: Cool-Headed Strategies for Parenting Tweens + Teens, by Laura S Kastner Ph.D. and Jennifer Wyatt
  • Positive Discipline for Teenagers, Revised 3rd Edition: Empowering Your Teens and Yourself Through Kind and Firm Parenting, by Jane Nelsen and Lynn Lott
  • Uncommon Sense for Parents with Teenagers, by Michael Riera
  • Parent’s Guide to Building Resilience in Children and Teens: Building Resilience, by K Ginsburg and M Jablow
  • Parent’s Guide to Understanding Teens’ and Tweens’ Digital World: Cybersafe, by Gwenn Schurgin O’Keeffe

Websites for Teens:

Websites for Parents:

Allergy

Food Allergy and Anaphylaxis Network (FAAN): http://www.foodallergy.org
Domestic Violence

National Domestic Violence/Abuse Hotline
1-800-799-SAFE, 1-800-787-3224 TDD.
Acetaminophen (Tylenol)

  • Acetaminophen is very helpful for fever and pain. Please do not use acetaminophen for infants under four months of age without talking to our office first.
  • Acetaminophen may be given every 4-6 hours
  • Infant drops and the children's syrup may have very different concentrations. Please only use the dropper provided with the infant drops to measure the infant dose.
  • Many over-the-counter cold and cough preparations also contain acetaminophen. Use of these products along with an acetaminophen preparation may result in a dangerous overdose.
  • Acetaminophen is also available as a rectal suppository for use in children who refuse to take medicine by mouth or who are vomiting. The brand name is Feverall, and it is available in most pharmacies. Please use rectal acetaminophen only on the recommendation of our office.

table



Ibuprofen (Motrin, Advil) dosing

  • Ibuprofen is very helpful for fever and for pain. It should not be used in infants under 6 months old.
  • Ibuprofen may be given every 6-8 hours
  • The most common side effects of ibuprofen are abdominal pain, nausea, and vomiting. Please give the medicine with food to try to prevent these side effects. If your child already has these symptoms, consider using acetaminophen instead.
  • Ibuprofen is available in a variety of dosage forms and concentrations. Please be sure to use the dose appropriate for the type of medication you are using. In addition, use only the dropper provided with the oral drops to measure the dosage. This dropper is a very different size than the dropper provided with acetaminophen drops and other droppers available, and improper use could result in over- or under-dosing.

table

Fish Consumption Recommendations

For Women Who Might Become Pregnant, Women Who are Pregnant, Nursing Mothers, and Young Children: 2004 FDA/EPA Consumer Advisory

Importance of seafood consumption:
  • Fish and shellfish are an important part of a healthy diet and have many nutritional benefits.
  • Fish and shellfish contain high quality protein and other essential nutrients, are low in saturated fat and contain omega-3 fatty acids.
  • A well balanced diet that includes a variety of fish and shellfish can contribute to heart health and children's proper growth and development. Thus, women and young children in particular should include fish or shellfish in their diets.
  • Follow these same recommendations when feeding fish and shellfish to your young child, but serve smaller portions.

Specific recommendations:
  • Do not eat Shark, Swordfish, King Mackerel, or Tilefish because they contain high levels of mercury.
  • Eat up to 12 ounces (2 average meals) a week of a variety of fish and shellfish that are lower in mercury.
    • Five fish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish.
    • Albacore ("white") tuna has more mercury than canned light tuna. So, when choosing your two meals of fish and shellfish, you may eat up to 6 ounces (one average meal) of albacore tuna per week.
  • Check local advisories about the safety of fish caught by family and friends in your local waters. If no advice is available, eat up to 6 ounces (one average meal) per week of fish you catch from local waters, but don't consume any other fish during that week.

Mercury Levels in Commercial Fish and Shellfish (1990-2010)
Healthychildren.org

Medical website for parents, created by the American Academy of Pediatrics. Includes general information related to child health, parenting issues, etc.

image

Kidsdoc Symptom Checker
http://www.healthychildren.org/english/tips-tools/symptom-checker/Pages/default.aspx
Ibuprofen (Motrin, Advil) dosing

  • Ibuprofen is very helpful for fever and for pain. It should not be used in infants under 6 months old.
  • Ibuprofen may be given every 6-8 hours
  • The most common side effects of ibuprofen are abdominal pain, nausea, and vomiting. Please give the medicine with food to try to prevent these side effects. If your child already has these symptoms, consider using acetaminophen instead.
  • Ibuprofen is available in a variety of dosage forms and concentrations. Please be sure to use the dose appropriate for the type of medication you are using. In addition, use only the dropper provided with the oral drops to measure the dosage. This dropper is a very different size than the dropper provided with acetaminophen drops and other droppers available, and improper use could result in over- or under-dosing.

table

Insect Repellent

  • The repellents that are proven most effective are DEET and picaridin.
  • Sunscreen/insect repellent combinations are not advised. Repellents should be applied more sparingly and less often than sunscreen.
  • Apply sunscreen before insect repellent so that the sunscreen can bind to the skin.

  • DEET
    • Protects against mosquitoes, flies, chiggers, fleas, ticks
    • Safe for children 2 months and up, as well as pregnant women
    • Children 2 months and up can use DEET 10-30%, depending on duration of protection that is needed
    • Do not apply DEET more than 1 time per day in children
    • 10% products last approximately 2 hours
    • 24% lasts approximately 5 hours
    • 30% lasts approximately 6 hours
    • Apply to exposed skin, clothing, or both (but not under clothes)
    • To apply to face: apply to palms, rub hands together, then apply to face, wash palms after application
    • Do not apply over cuts, wounds, or irritated skin
    • Remove repellent with soap and water once it is no longer needed

  • Picaridin
    • Protects against mosquitoes and ticks
    • Doesn't irritate skin or damage plastic or clothing
    • Products with higher concentrations last longer than those with lower concentrations.
    • Choose a product with up to 20% picaridin for adults and 5% to 10% for children over six months.
    • Available as Cutter Advanced, Skin So Soft Bug Guard Plus
    • Probably similar effectiveness as low concentrations of DEET (2-4 hours)
    • No toxicity ever reported in humans (used in Europe/Australia for many years)
    • Manufacturer recommends reapplication every 3 to 4 hours

  • Lemon eucalyptus (also known as PMD)
    • Effective against mosquitoes, flies, gnats
    • Approved for children 3 years and up
    • Available as 65% PMD
    • Repel Lemon Eucalyptus Insect Repellent Lotion
    • Survivor Lemon Eucalyptus Insect Repellent
    • Available as 10% PMD
    • Off! Botanical Insect Repellent
    • PMD 65% is approximately equivalent to protection from 30% DEET, 10% equivalent to approximately 5% DEET

  • Citronella
    • Not recommended because needs to be reapplied every 1 hour
    • Impregnated arm bands have not been proven to work
Lead in Paint, Dust and Soil Resources

http://www.epa.gov/lead/
Learning Disorders

http://www.ldonline.org
LICE

Introduction
  • Head lice are tan to grayish-white, 2-3mm long (about the size of a sesame seed), and can be seen moving on the scalp.
  • The eggs (nits) are firmly attached to the hair shaft very close to the scalp. Nits vary in color from yellow to brown to white. Nits may be found anywhere on the head, but most commonly are found behind the ears, around the nape of the neck, and on the crown of the head.
  • Scalp itching is a result of sensitivity to lice saliva, it may take 4-6 weeks to develop after initial infection.

Transmission
  • Lice don’t hop or fly, they can only crawl.
  • Transmission usually occurs from direct head-to-head contact or sharing personal items such as combs, brushes, hats, scarves, or coats.
  • Lice DO NOT transmit disease.
  • Head lice is not caused by poor hygiene/being unclean.

Treatment
A visit to the doctor’s office is usually not necessary First choice of treatment is over-the-counter Nix (permethrin), Rid is another product but Nix is preferable.
  • Shampoo hair with regular shampoo, towel dry, apply Nix to damp hair
  • Leave in for 10min, then rinse over sink with water that’s not too hot
  • Do not use conditioner.
  • Use a nit comb after treatment.
    • Divide hair into small sections and comb through each one.
    • Continue to check hair every 2-3 days for 2-3 weeks to be sure all lice and nits are gone.
    • There are professional (but expensive) “nit pickers” who will do this for you if you prefer.
  • Repeat application of Nix on day 9
  • Scalp itching may persist for a few weeks, even after successful treatment
  • If a few live lice are found 8-12 hours after treatment but are moving more slowly than before, do not re-treat. If after 8-12 hours, no dead lice are found and lice seem as active as before, a different treatment should be used.
  • These treatments are insecticides, so do not overuse. Please call the office if your child is not responding.

"Natural products"
Some evidence of effectiveness but evidence not as robust as other approved treatments
  • Cetaphil Gentle Skin Cleanser
    • Apply to hair for 2 minutes then comb through
    • Dry with blow-dryer
    • Wash out next morning
    • Repeat once per week for 3 weeks
  • LiceGuard Robi-Comb - should not be used in children with a seizure disorder
  • Hair-Clean 1-2-3

Household decontamination
  • Clean all items that were in contact with infected person within 24-48 hours before treatment
  • Check all family members for live lice or nits close to the scalp.
  • Place combs in dishwasher
  • Clothes, pillowcases, and other items should be cleaned in HOT water (>140 deg) or machine dried on hot cycle.
  • Furniture, carpets, carseats, and fabric can be vacuumed
  • Use of insecticides or fumigants on upholstered furniture/carpets/bedding is not necessary and not recommended.
  • Items that can't be washed can be bagged in plastic for 2 weeks
Lyme Disease and Tick Image Gallery

Lyme disease is a tick-borne illness caused by the bacteria Borrelia burgdorferi. There are many types of ticks in the United States. However, only deer ticks can transmit Lyme disease. Deer ticks are very tiny, approximately the size of a poppy seed.

Transmission
  • Finding a tick on your child does not mean he or she will develop Lyme disease.
  • A tick must be attached to a person for at least 36-48 hrs to transmit Lyme disease.
  • Even if attached for 36-48 hours, the risk of developing Lyme disease is less than 3%.

Signs of Lyme disease may include
  • Fever (usually 3-14 days after bite)
  • Expanding red rash (usually within 1 wk, but should be within 1 month of bite). Rash may have a bulls-eye appearance.
  • Headache
  • Joint aches or swelling

Prevention
  • You can prevent some tick bites by wearing light-colored clothes and tucking pants into socks when going into tall grass. As many ticks fall from trees, be especially watchful after going through the woods.
  • Apply insect repellent such as DEET to the body. The repellent permethrin can be applied to clothes.
  • Please check your children daily for ticks. Deer ticks are no bigger than a poppy or sesame seed. They are most commonly found around the hairline, especially at the nape of the neck and behind the ears. Other common locations are the underarms and groin.
  • Pets may bring ticks into the house and should be inspected if they have been outdoors. Treatments to prevent ticks on pets can be obtained from your veterinarian

Tick removal
  • If there is a tick attached to your child, pull it straight off with a pair of tweezers. Do not use a twisting motion and try not to squeeze the tick’s body.
  • Please do not apply agents to the skin to help remove the tick such as petroleum jelly, rubbing alcohol, nail polish, or soap. Touching the tick with a hot or cold object is not helpful either.
  • There will usually be a small black spot left under the skin after the tick is successfully removed.
  • Cleanse your child’s bite with alcohol and then apply a first-aid ointment.
  • Be sure the tick is dead before you dispose of it.
  • Please call our office within 72 hrs for further instructions after removing a tick from your child.
  • Most children will not require antibiotics after a tick bite.

Treatment
  • Blood tests for Lyme disease are not usually performed or recommended immediately after a tick bite. This is because the body’s immune system hasn’t produced enough antibodies to detect an infection in the first few weeks.
  • We will prescribe oral antibiotics if your child has Lyme disease. We most commonly use doxycyline in children 8 years and older. Children younger than 8 years are usually prescribed amoxicillin. Antibiotics are typically given for a course of 14 to 21 days.
  • Lyme disease is completely curable when treated in the early stages.

Additional Resources:
www.cdc.gov/lyme
www.idsociety.org/lyme
http://www.ent.iastate.edu/imagegal/ticks/
Safety (Car and Bicycle)

Car safety
  • Keep your infant/toddler in a rear-facing seat until 2 years of age.
  • Use a forward-facing carseat until 4-5 years old.
  • Your child should ride in a booster seat after exceeding the weight or height limit on the forward-facing carseat.
    • Continue to use a booster seat until at least 8 years old and 55 inches tall.
  • Never leave your child alone in a car. Children can die from heat stroke because temperatures can reach deadly levels within minutes.


If you need installation help: If you have questions or need help installing your car seat, find a certified CPS technician. Lists of certified CPS technicians and child seat fitting stations are available on the following Web sites:
  • NHTSA (or call NHTSA Vehicle Safety Hotline at 888/327-4236)
  • SeatCheck (or call 866/SEATCHECK [866/732-8243])
  • National Child Passenger Safety Certified Technicians (or call 877/366-8154) This site provides information in Spanish and also provides a list of CPS technicians with enhanced training in protection of children with special needs


For more information:
Healthychildren.org
Bicycle helmet safety institute - http://www.bhsi.org/
Travel

If you are planning to travel internationally (to anywhere other than Canada or Western Europe), please call our office AT LEAST 4 WEEKS PRIOR TO YOUR TRIP to discuss the need for vaccines or medications.

When calling the office please leave a message with the country (including the province) you are traveling to, your departure date, and the number of days you will be away. The sooner you call before your departure, the better we will be able to meet your travel needs.

Also, you may visit www.cdc.gov/travel for recommendations on international travel.
Vaccine Schedule

Our practice follows the standardized vaccine schedule published by the ACIP.

The Advisory Committee on Immunization Practices (ACIP) consists of 15 experts in fields associated with immunization, who have been selected by the Secretary of the U.S. Department of Health and Human Services to provide advice and guidance to the Secretary, the Assistant Secretary for Health, and the Centers for Disease Control and Prevention (CDC) on the control of vaccine-preventable diseases.

http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm

http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf


Vaccine Information Statements (VIS)

Information statements from the CDC:
http://www.cdc.gov/vaccines/pubs/vis/default.htm


Books

Vaccines and Your Child: Separating Fact from Fiction - Paul Offit, MD and Charlotte Moser

Vaccine Safety

http://www.healthychildren.org/English/safety-prevention/immunizations/pages/Vaccine-Studies-Examine-the-Evidence.aspx

http://www.healthychildren.org/English/safety-prevention/immunizations/pages/Child-Immunization-Schedule-Why-Is-It-Like-That.aspx

Fever
Fever is a body temperature that is higher than 98.6-100°F. Temperatures below normal are usually not worrisome unless they occur in very young babies.
Fever itself is not an illness, but usually indicates that the body is fighting an infection. Fever is the body’s natural response to infection. In general, an elevated temperature is NOT dangerous. The infection that is causing the fever may or may not be concerning. Fever alone never causes brain damage unless the fever is very high (over 106-107°F).

How to take a temperature
  • Always check temperature with a thermometer. Feeling your child’s forehead is not reliable.
  • For infants, the most accurate way is to take a rectal temperature.
  • Oral (“mouth”) temperatures are also reliable when done in children who are least 4 years old.
  • Armpit, ear, and forehead temperatures are not as accurate as rectal or oral temperatures but are convenient for young children (over 3 months).

What to do if your child has a fever
  • In infants less than 3 months of age please call us immediately if your baby’s rectal temperature exceeds 100.4°F (38.0°C). Do not give any medication to lower fever in babies less than 3 months of age before talking to us.
  • From 3 months to 3 years of age, with temperature of
    • 100-102.1°F (37.8 – 39°C). This is often not serious. Most important is your child’s behavior. If your child seems well, that is reassuring. If your child seems ill, does s/he improve when the fever is reduced? Your child is less likely to have a serious illness if his/her overall condition improves when you bring down the temperature.
    • Greater than 102.2°F (39°C). Please call the office to determine whether your child needs to be evaluated. If your child is acting well, you can wait to call us during regular office hours.
    • Call us at any time if your child appears very ill or if you are unable to lower the temperature.
  • For children over 3 years of age
    • You may watch for 24 to 48 hours to determine if the fever decreases with treatment and behavior improves when temperature is reduced. If your preschooler or school-aged child with a high fever is eating, sleeping and acting well, s/he is less likely to have a serious illness.
    • Please call the office if the fever persists for 3 or more days or spikes after 3 or more days of illness.

Fever treatment
Many children do not need any treatment at all. Fever does not need to be lowered in a well-appearing, comfortable child. For instance, a child older than 3 months who has a temperature of less than 102°F (38.9°C), and who is otherwise healthy and acting normally, does not need a fever reducer.
  • Call us if you are not sure how best to handle your child’s fever.
  • NEVER give aspirin to a child younger than 18 years old. Aspirin can cause a dangerous condition called Reye syndrome.
  • Give a fever reducer to any child over 3 months of age with a fever who seems uncomfortable or won’t feed well.
  • Children often have poor appetites when they are sick. It is important to prevent dehydration. Offer your child plenty of fluids to drink. Call us if your child won’t or can’t drink fluids.
  • Encourage your child to rest as much as he or she wants but don’t force your child to sleep or rest.
  • Your child can return to school or regular activities when he/she is feeling better and has had no fever over 100°F for 24 hours.

Other fever facts
  • Children breathe more quickly as their temperature increases and slower as their temperature falls.
  • Most fevers fluctuate during the day, typically peaking in the afternoon/early evening.
  • 3% of children between 6 months old and five years of age may have a seizure (convulsions) from a fever. This is unavoidable, even with the best fever medications. Febrile seizures do look scary but are usually benign. If your child has a seizure, s/he needs evaluation. Call us immediately if your child has a seizure.

Occasionally a fever may be caused by a serious condition.
Please call us if
  • You are unsure about your child’s illness or have questions about this information.
  • Your child seems too sleepy
  • Your child is inconsolable/irritable
  • Your child is working hard to breathe
  • Your child has a stiff neck or seizure
  • Your child has a fever and new skin rash
  • Your child or has other extreme symptoms
  • Your child seems dehydrated. Signs of dehydration can include:
    • Decreased urination/dark yellow urine
    • Dry mouth
    • No tears from eyes when crying
    • Your child may feel thirsty, tired, dizzy, or confused.
  • Temperature is over 104°F
  • Your child has an underlying medical problem, such as heart disease, cancer, a seizure disorder, etc
  • Your child has not received all of the recommended childhood vaccines
Vaccine Policy

Dear Parents and Guardians,

Recent outbreaks of measles, mumps, and whooping cough reinforce the ongoing need for childhood vaccinations. Vaccines are important for your child. Vaccines save lives.

Our practice uses the standard vaccine schedule recommended by the U.S. Centers for Disease Control (CDC), the American Academy of Pediatrics, and the Massachusetts Department of Public Health. Millions of children worldwide receive the same vaccines we give in our office. The vaccines have been extensively studied for safety and effectiveness. Not vaccinating your child and alternative vaccine schedules increase your child’s risk of disease and medical errors. Chestnut Hill Pediatrics hopes to create a relationship of trust and mutual understanding with each family in our practice. We also have a duty to provide the best evidence-based care for your child, and to protect all of our patients from exposure to preventable diseases. We strongly believe in the importance of vaccines.

Families that choose not to vaccinate their children or do not adhere to a mutually acceptable vaccine schedule may be asked to leave our practice.

We are happy to answer your questions you may have about this policy, please do not hesitate to reach out to us.


Sincerely,
The Team at Chestnut Hill Pediatrics
Index*

Acetaminophen (Tylenol)
ADHD
Advil (see ibuprofen)
Adolescence

Allergy

Bullying

DEET (see insect repellent)
Domestic violence

Fever Facts
Fever/Pain medication
Fish consumption

Healthychildren.org
(AAP medical reference website)


Ibuprofen (Motrin, Advil)
Insect repellent

Lead in Paint, Dust and Soil
Learning Disorders
Lice
Lyme disease and Tick gallery

Motrin (see ibuprofen)

Safety (Car and Bicycle)

Travel
Tylenol (see acetaminophen)

Vaccine schedule (ACIP)
Vaccine information statements (VIS)


Vaccine Policy

* We have reviewed the material and websites listed above, but due to the dynamic nature of the internet, we cannot guarantee or endorse all of the content. This information must also be evaluated carefully by you. It is not intended to replace the advice or recommendations of your pediatrician.