General Guidelines for Positioning and Securing Child Safety Seats:
- Dress the child in clothing that allows access between the legs.
- The child's back/bottom should be flat against the seat.
- An infant seat should be at a semi-reclined 45-degree angle.
- No more than 1 adult-size finger should fit between the harness straps and the infant's collarbone.
- The harness clip should be level with the armpits.
- Never use a child safety seat in the front with an airbag that has not been turned off.
- Certified technicians are available to inspect your seat and assist with installation. Call 1-866-SEAT-CHECK or visit www.seatcheck.org.
Safety Tips for Infants:
- Never leave an infant unattended.
- Infants should not be in the seat for an extended period of time.
- Periodically reassess the infant's head and neck to make sure it is in a midline position.
- Do not hang toys from the carrying handle.
- Blanket rolls can be placed on either side of the infant's head for support.
- Generally, the carrying handle should be in the down position when traveling.
How to prevent diaper rash:
In order to prevent diaper rash, it is important to change your child's diapers frequently, clean them well, and make sure the skin is dry before putting the clean diaper on.
How to treat diaper rash:
To treat diaper rash, it is imperative to change your child's diaper as often as possible to keep moisture off their irritated skin. After removing the dirty diaper, wipe them well with a wet cloth. It can help to avoid wet wipes when their skin is raw, as the soap can burn and irritate their skin. After cleaning them well, use a blow dryer set on COOL to thoroughly dry the skin. After drying, liberally apply a diaper cream such as Desitin, Triple Paste, or Boudreaux's Butt Paste to the affected area before putting on the clean diaper. If the rash is persistent, worsening, or not responding to treatment, consult your health care provider.
Circumcision is a procedure typically performed within the first two weeks of life in which the skin covering the end of the penis is removed. Circumcision is a procedure that parents choose for cultural, social and religious reasons, but is not necessary for a child's health.
There are some studies that show that there may be some medical benefits to circumcision such as lower risk of urinary tract infection and penile cancer, slightly lower risk of STD's, prevention of foreskin infection, and easier hygiene.
Some of the reasons why parents choose not to have their child circumcised include possible risks associated with the procedure, the belief that the foreskin is necessary to protect the penis, and the belief that circumcision can make the penis less sensitive. There are some risks associated with the procedure, as there are with any invasive procedure, but complications are rare and usually minor. Proper hygiene can lower the risk of infections, cancer and STD's and therefore is important for parents to learn and to teach the child.
Please visit the AAP website for more information and to review frequently asked questions on circumcision.
After the procedure, the physician should talk to you about the recommended care. There are two main types of circumcisions that have different care for the healing foreskin. If your son was circumcised using the Plasti-bell procedure, there will be a ring over the head of his penis to help with healing. In terms of care, keep that ring area clean using standard wipes as needed. The ring should fall off on its own (sometimes in stages) over the next two weeks.
If your son was circumcised using the Gomco procedure, you will need to protect the freshly cut skin with a liberal amount of Vaseline and cover the Vaseline and the head of his penis with gauze with every diaper change. Typically, you will need to do this for the first week after the circumcision.
- We recommend waiting on cereal until 4 months of age (this should be given in a spoon not a bottle).
- We recommend starting baby food at 4 to 6 months of age.
- When introducing baby food, add a new food every 3 days. This gives you time to watch for potential allergies to a new food before adding another.
- It is appropriate to start giving water in a sippy cup at 6 months of age.
- Table foods should not be introduced before the baby is able to sit upright in a highchair and feed themselves with their fingers.
- All table foods should be cut into small pieces so as to prevent choking.
- More specific instruction will be discussed at your well check with your provider. Feel free to make a list of questions you may have and bring them with you to your visit.
Ways to help your child stop thumb sucking and pacifiers:
- Do not punish or tease them. Instead, reward good behavior with praise. Stressful events can cause a child to suck longer because it can be calming/soothing for them. Do not put pressure on the child creating more stress.
- Allow your child to keep a sticker/star chart to track their progress, give rewards for going a whole day or week without sucking their thumb/pacifier, and gently remind them when you see them starting to give in.
- Sit down with your child and make a list of "big kid" activities they want to be allowed to do and "little kid" activities they need to stop. Make their "big kid" activities contingent upon them stopping their "little kid" activities.
- Try putting a bandaid over the finger they suck to remind them when they start to put it in their mouth. Explain to them what this is for when you put it on.
- If their teeth are becoming affected you can talk to your dentist about getting a piece that prevents them from putting pressure on their teeth.
Nightmares are experienced by 20-39% of children between the ages of 5 and 12 and decrease in frequency as children get older. Children usually wake during the REM stage of sleep (typically between 4 and 6 am) and are sometimes able to describe the frightening episode in detail. The dreams are often vivid and have detailed plots. Children often have difficulty falling back asleep after waking. Helpful steps you can take include:
- Reassure and cuddle the child.
- Provide a night light.
- Talk about the dream during the day and come up with a happy ending.
- No scary movies/TV before bed. (No scary movies before age 13.)
- Provide a safe sleep environment by moving any objects the child could hurt themselves on should they wake and get out of bed during the night.
Night terrors are experienced by 1-4% of children and are most common between four and 12 years of age. Night terrors occur during deep sleep early in the sleep cycle and are characterized by blood curdling screams and an inability to recall the incident after the fact. Your child may be difficult to arouse and seem confused during such an episode. Children typically "outgrow" night terrors before adolescence and usually only need comfort and reassurance after an episode. It is important to provide your child with a safe sleep environment to prevent them from harming themselves if they were to get out of bed while disoriented.
Sunscreen should not be used in children under 6 months of age. Babies should be kept out of the sun altogether if possible. Children 6 months of age and older should have a broad-spectrum sunscreen applied to exposed surfaces but trying to keep skin covered is the best protection. For those sun exposed areas, a Zinc oxide or titanium dioxide-based sunscreen is best. Spread a small amount of lotion evenly over exposed areas avoiding eyes and palms of hands. At least SPF 15 to SPF 30 is recommended and should be reapplied after swimming, sweating, towel drying, or exposure to sun for > 2 hours.
Bug spray should not be used in babies less than 2 months of age. A bug spray containing DEET is best for protecting against insect bites. The concentration of DEET in products ranges from around 10% to over 30% and should be listed on the bottle. The maximum concentration recommended in infants and children is 30%.
Common Childhood Illnesses
Middle ear infections are common in infants and toddlers. They are often preceded by a cold and most commonly manifest with ear pain, fussiness, fever, waking from sleep, or decreased appetite. Children can have symptoms ranging from asymptomatic (no symptoms) to all of the symptoms mentioned above. There is no way to know whether your child truly an infection has (pus behind the ear drum) without looking in the ear and visualizing the ear drum. An infection is not the only cause of ear pain; therefore, it is important for a provider to examine your child's ears if you are concerned. A true infection requires treatment with antibiotics, while clear fluid in the ears, eustachian tube dysfunction, or cerumen (wax) impaction does not.
Strep throat is a bacterial infection that can lead to serious side effects if left untreated. We strongly recommend bringing your child in to be examined if they are experiencing a sore throat, fever, headache, or stomachache as these can be signs of this infection.
If left to its own, Strep can be dangerous, leading to heart and kidney problems. For this reason, we run a quick test in the office and if negative, run a culture to confirm. We also examine the child for signs of complications including heart murmurs, "scarlet" rashes, and throat abscesses. If a child is tested positive, we always treat with an antibiotic.
A fever is defined as a temperature >100.4 . in neonates and 101 in older kids the most common causes of fevers are colds and other viral infections. The cause of a fever often cannot be determined during the first 24 hours due to the fact that many illness present with fever before any other symptoms are present.
Reasons to call right away:
- ANY infant less than 2 months of age with a temperature >100.4
- Fever >104
- Fever with additional, alarming symptoms such as neck pain, rapid breathing, poor responsiveness
Reasons for office visits:
- Any of the above
- Fever more than two days
- Fever with sore throat, vomiting, rash, ear pain, wheezing, insect bite, urinary discomfort, or any other concerning symptoms
Home care advice:
- Increase fluids and dress in 1 layer of lightweight clothing
- Temperatures greater than 102 may be treated with Acetaminophen (Tylenol) or Ibuprofen (Advil or Motrin) for comfort
- See Common Medication Dosages. Children should not be given Aspirin.
- Sponge baths can be helpful for fevers >104 that do not come down with medication. Use lukewarm water (not cold) and sponge for 15-20 mins.
- Do not put the child in a cold bath. It is important to note that dabbing the child's skin with a cool rag may help to evaporate away some heat while waiting for the Tylenol to kick in, but putting a child with fever in bath water could be shocking and could even make the body try harder at making a fever.
Is fever dangerous?
- Some infections can be dangerous, but fever itself is not (even 105°).
- While it is true that some families carry a tendency for brief seizures during a rapidly rising fever, even these "febrile seizures" cause no permanent damage.
- Therefore, comfort is the only true goal of fever reducers.
The most common cause of vomiting and diarrhea is viral gastroenteritis. Usually this illness will start with vomiting, and diarrhea will follow within 12-24 hours. Other more serious illnesses can cause vomiting as an isolated symptom and your provider should be contacted if vomiting persists.
Your child should be brought into the office for:
- Symptoms of dehydration including decreased urine output (less than every 8-10 hours), lethargy, dry mucous membranes, & lack of tears.
- Blood in vomit that is not from a nose bleed
- Bile in vomit
- Continued abdominal pain
- Persistent symptoms or any other concerns
Home care advice for children >1 year old:
- For vomiting > 2 times, do not give the child anything by mouth for 3-4 hours
- After 3-4 hours reintroduce fluids by giving ice chips, a popsicle, or spoon/dropper feed 1-2 teaspoons of water/Pedialyte/half-strength Gatorade every 5 mins for 30 minutes
- Slowly increase the volume of fluids over the course of 4-5 hours as tolerated
- If fluids are tolerated for 8 hours without vomiting, solids may be reintroduced. Limit solids to bland food such as bananas, rice, toast, crackers, ect.
- A normal diet may be resumed after 24 hours without vomiting
Viral infection is the most common cause of diarrhea. It is often accompanied by vomiting but may occur in isolation. Viral diarrhea usually lasts 5-7 days and is almost always worse on the first two days of the illness.
Your child needs to be seen for:
- Signs of dehydration including decreased urine output (less than every 8-10 hours), dry mucous membranes, lack of tears, or lethargy
- Blood in stool
- Diarrhea persisting for > 1 week without complications
- Profuse diarrhea or any other concerns
Home care advice for children > 1 year old:
- Start Pedialyte or diluted Gatorade. Offer unlimited amounts unless the child is also vomiting (See section on Vomiting).
- Avoid fruit juices and soft drinks as this can make the diarrhea worse.
- Starchy foods are best: bread, noodles, potatoes, rice, oatmeal, crackers, etc.
- 2-6 ounces of yogurt twice a day can help restore healthy bacteria to the GI tract
Croup is a condition that causes a swelling of the voice box (larynx) and windpipe (trachea). The swelling causes the airway below the vocal cords to become narrow and makes breathing noisy and difficult. It is most caused by a viral infection.
Children are most likely to get croup between 3 months and 5 years of age. As they get older, it is not as common because the windpipe is larger, and swelling is less likely to get in the way of breathing. Croup can occur at any time of the year, but it is more common in the fall and winter months.
Stridor (working hard to breath) is common with mild croup, especially when a child is crying or active. But if a child has stridor while resting, it can be a sign of more severe croup. As your child's effort to breathe increases, she may stop eating and drinking. She also may become too tired to cough, and you may hear the stridor more with each breath.
Can try breathing in steam from a steamy shower and can try cool night air to see if croupy cough improves. If no improvement call Harpeth Pediatrics at 615.771.2656 or if difficulty breathing call 911.
As kids get older, too much screen time can interfere with activities like being physically active, doing homework, playing with friends, and spending time with family. Too much screen time also can contribute to obesity, attention problems, sleep disorders, problems at school, anxiety, and depression.
For teens, screen time can include things like researching a school project, creating music or art, or interacting with friends via social media. But it also can include less productive and potentially harmful activities, like watching inappropriate TV shows, visiting unsafe websites, or playing violent video games.
Some studies show that teens spend almost 9 hours a day online, on the phone, watching TV, or playing games – so what’s a parent to do?
Parents should continue to set limits on screen time, preview all shows and games to make sure they are OK, and stay aware of what their teens are doing online.
How Much is Too Much?
The American Academy of Pediatrics (AAP) recommends that parents of kids and teens 5 to 18 years old still limit screen time to ≤ 2 hours per day.
In today’s world, limiting teens to 2 hours may be impossible. What’s not impossible is making teens aware of how much time they are spending on their phone, computer, etc.
For teens (and kids of all ages), screen time should not replace time needed for sleeping, eating, being active, studying, and interacting with family and friends.
Not all screen time is created equal. It’s up to parents to decide how (and how often) their teens use screens and whether screen time is positive or negative; for instance, time spent on homework or other educational activities might not need to be as restricted as time spent playing video games or watching Netflix.
Screen Time Tips:
The same parenting rules apply to screen time as to anything else – set a good example, establish limits, and talk with your child about it.
To make your teen’s screen time more productive:
- Research video and computer games before letting your teen get them.
- Preview games and even play them with your teen to see what they are like.
- Encourage teens to have a variety of free-time activities.
- Cultivate interests that do not involve a screen, like art, books, musical instruments, puzzles, photography, etc.
- Turn off all screens during family meals and at bedtime.
- Treat screen time as a privilege that teens need to earn.
- Spend screen time together.
- Use screening tools.
- Teach your teen about internet safety and social media smarts.
- Keep the computer in a common area and use parental controls.
In 2016, US Preventative Services Task Force began recommending a screening for depression in children ages 12-18. Depression is a leading cause of disability in the U.S. Children and adolescents with depression may have trouble in their performance at school, interactions with friends and family and with basic daily activities.
If the patient is 18 or older, they legally must give us the authorization to allow a parent access to their medical record.
Starting at 14, we offer teens a chance to see the doctor alone without a parent in the room. Adolescents are encouraged to take charge of their basic medical care, i.e. knowing what medicines they take or are allergic to. Usually the teen will do a better job of answering their own medical questions if the parent is not in the room. We also find that a teen may ask more personal questions when not in front of a parent. However, we will not exclude a parent from the room if the parent wishes to be there, or the child requests that they stay.
Have questions about vaccines?
At Harpeth Pediatrics, our providers know that keeping your child safe is top priority. Click to learn more about our vaccine policy