This is a season when many children contract gastroenteritis, causing vomiting, diarrhea or both. This is usually viral in origin and therefore the treatment is symptomatic. Our concern with vomiting and diarrhea, either alone or in combination, is dehydration. Signs of dehydration to watch for are dry mouth, no tears, no urine for 8-10 hours, listlessness or weight loss.

The key to treatment of vomiting is letting the stomach "rest." This means there should be no intake of liquids or solids for at least 2-3 hours after the child vomits. Then he or she may begin sucking on sweets or drinking sips of clear fluids (Pedialyte, Gatorade, white grape juice). If this stays down after 30-45 minutes, give one half to one ounce of fluid. Once several hours have passed, the amount may be gradually increased. Do not allow the child to drink quickly—this may begin the vomiting again. For most children, other than young infants, it is better to have no oral intake for several hours than to have the vomiting precipitated again. If the vomiting starts again, the whole process must start over. After your child has kept down clear fluids for 8-12 hours, you may start bland foods.

If an infant has projectile vomiting (forceful vomiting in which the stomach contents may be ejected a distance of several feet), there may be an intestinal blockage and you should call our office.

Diarrhea is frequent loose, watery stools (more than 6 stools in 24 hours). Unlike vomiting, diarrhea rarely causes dehydration. Also, unlike vomiting, the treatment is to "feed" the diarrhea. If the diarrhea has lasted for less than 2 days, children may continue their regular diet. Breast-fed babies should continue to nurse. Formula fed babies may be fed a soy formula if the diarrhea lasts more than 3-4 days. Older children should avoid milk, milk-based products, juice and highly sugared foods, as these may exacerbate the loose stools. They should have foods that are more binding , the so-called BRAT diet—bananas, rice and toast, or bread or pretzels. Usually it is unnecessary to give medications to stop the diarrhea and it can be dangerous. If your child has blood in the stool, fever greater than 101 degrees or looks dehydrated or "sick," please call our office.

Sometimes called "pink eye," conjunctivitis is a common problem in children. Symptoms are redness of the white of the eye and inner eyelid, and tearing or discharge.

There are many causes. The most common is a viral infection, often a cold. Viral conjunctivitis does not need specific treatment and will usually go away when the cold does.

A bacterial infection usually causes a yellow or green discharge. The eyelids may be "stuck together" after sleeping. Bacterial conjunctivitis requires antibiotic treatment, usually drops; call the office for directions and medications. The eye discharge can be cleaned with a cotton ball and warm water, which will help open the eyes and be soothing.

Irritants such as chlorine, smoke, dirt and soap can also cause conjunctivitis. Allergies might do the same, causing watery, itchy eyes, often associated with a runny nose. Allergic conjunctivitis is treated with avoidance of the allergen, oral antihistamines and allergy eye drops.

Call the office if your child’s eyelids are red and swollen, the eyes are painful, vision is blurred or your child seems ill.

We often get asked about fever in children. A fever is defined as a rectal temperature of 100.6 degrees F or higher (for practical purposes 101 or higher). A fever is a sign that the body is fighting an infection, which could be viral or bacterial. Fevers are not dangerous to your child unless it is 107 degrees F, rectally. Under that number, a fever is just uncomfortable to your child.

The treatment for fever is mostly home care. It is important to have your child drink extra fluids to replace the body fluids lost from sweating. You should also dress the child in light clothing, so that you are not increasing the body temperature. A light blanket is fine if your child is shivering or feels cold.

The medications used for fever reduction are acetaminophen (Tylenol) and ibuprofen (Motrin and Advil). Acetaminophen is usually our first line of therapy for children, but either can be given to make your child feel more comfortable. They are dosed by weight. Remember, they are not going to take the fever away altogether, since they are not treating the source of the fever; therefore dosing every 4 hours (for acetaminophen) or every 6-8 hours (for ibuprofen) may be necessary. We don’t recommend combining acetaminophen and ibuprofen for several reasons: there is no fever reducing benefit, combining them can cause dosing errors with possible overdosing, since the fever is not dangerous, it’s not necessary to control the fever that closely. We do not recommend using aspirin because of the risk of Reye’s syndrome. In general it is not necessary to do sponge baths. If you do, use only luke warm water, never cold water or alcohol, both of which cool the body too quickly. The alcohol can also be breathed in, which is unhealthy for your child.

You should call us if your child is less than 2-3 months old with a fever, has a fever over 104-105 degrees F, the fever persists or your child appears ill.

The recent media rush to inform us that our youth are overweight is new, but the problem is not. Weight gain, simply put, happens when the calories eaten exceed the calories burned.

This year we started plotting BMI or body mass index on children middle school and up as well as the occasional elementary student. Body mass is a single line measurement of height and weight for children 2 to 20. If you exceed a BMI of 23, you are considered "overfed," if you exceed 25 you are technically "obese" and may develop blood pressure, heart, or diabetes problems over the years.

We do find that there is a flaw in the system. That is, older adolescents in excellent condition often exceed BMI's of 23 due to weight lifting.

From parents, we often hear "she eats healthily" or "what else can we do since we already schedule sports, dance, karate etc. and there still is homework."

Lifestyles today often contribute to weight gain. First, many young students do not eat a healthy breakfast, if they eat one at all. Second, sports programs often schedule practice or games during the dinner hour, so students eat both before and after and/or eat quickly from fast food restaurants. Third, there is little fiber in the diets of students. The recommended daily amount is 20-25 grams (g). Most cereals (except All Bran, oatmeal, and Raisin Bran) have 3-5 g. Breads rarely exceed 3 g. Finally, TV, computer, and winter contribute to sedentary lifestyle.

What you can do is pay attention to what is really in the family’s diet—and be a model for your children. You can also walk—to school, to town, before or after dinner, even if it’s around the block. In general, children these days are driven too much.

Nothing is perfect when it comes to weight and we are aware and concerned about body image. Small changes in diet and exercise produce positive results that have lifelong benefits.

Physicals: Spring and summer are not far off and with them come the need for camp, school and sports physicals. To avoid the last minute summer time crunch, please think about making those appointments soon.

Flu vaccine: If anyone is interested in having their child receive the flu vaccine next year, either the injection or the intranasal, please let us know as soon as possible. We need to order the vaccines in February.

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