WHEN YOUR CHILD IS SICK

MAKING THE DECISION TO HAVE A CHILD IS MOMENTOUS. IT IS TO DECIDE FOREVER TO HAVE YOUR HEART GO WALKING AROUND OUTSIDE YOUR BODY.

Elizabeth Stone

“I don’t feel well!”

These words strike fear into the hearts of parents around the world. But— and this probably won’t be a surprise to you—infections and illnesses are a common part of childhood. It’s expected that healthy children will have as many as eight viral infections a year and even as many as 100 in their first 10 years of life. With this in mind, we’ve rounded up some helpful information to help you manage symptoms at home, tips for when to call the doc or seek out emergency medical care and a breakdown of some of the common illnesses your kids may face.

SYMPTOMS AND SIGNS

A symptom is what the patient notices and complains about. A sign is a physical change the doctor notes upon observation and examination. The signs are usually of more importance than the symptoms. It is what is observed that provides the most valuable information in determining just what kind of illness is present and whether or not is might be serious.

Three changes are often the first sign that something is wrong, although it may be many hours or even days before more evidence develops. 1. Activity: One of the most common indicators that a child is unwell is when there is no interest in doing something that is usually enjoyed. Of course, a child may not feel in the mood to be active or may just be sulking, but if the change in behaviour is a sign of a potential illness, other signs will develop. 2. Appetite: A child’s appetite can vary, so a loss of interest in food is not solid evidence of ill health, but it may be one of the early warnings. 3. Attitude: In many children, this is often the most reliable indicator. If a child who is usually cheerful and easy to get along with seems cranky for no obvious reason, something might be up.

FEVER

The presence of a fever almost always means an infection. The average fever isn’t dangerous or harmful—it’s the body’s normal reaction to the presence of foreign organisms. Parents should watch for the following complications: • A child’s behaviour is influenced by fever. In some children, the raised temperature makes them irritable. In others, it makes them drowsy. Irritability usually comes with moderate fever of about 38.5 C (101.5 F) to 39.5 C (103 F), and drowsiness with a fever of 39.5 C or over. Individual variations do occur. But it is likely the illness causing the irritability and drowsiness, rather than the fever. A fever in a baby under four months of age must always be regarded as potentially serious. Call your doctor.

HOW TO MANAGE A FEVER

A fever itself is not usually harmful. What counts is the cause. You don’t have to give your child anything for the fever just because it is there. A sick child’s fever is usually highest from about 6 p.m. until 3 a.m. If the fever is gone by the evening, your child will almost certainly not have a temperature the next day.

Indications for treating the fever: • If the child has had a previous febrile convulsion (a seizure due to fever) • If the fever is making the child irritable and uncomfortable If the fever makes the child sleepy and relaxed, no treatment is needed as long as they are taking adequate fluids.

What to do

• Try to keep the room cool and the humidity low. • Have a steady movement of air. • Keep your child undressed or in very light clothing. Remember that your child can lose heat only through the skin when the skin is hot and flushed. If your child’s body feels cool or is shivering, wrap them up in a blanket until the skin is hot again; otherwise none of these techniques will work.

CONVULSIONS DUE TO FEVER

About one child in 20 between the ages of six months and four years suffers from seizures that are triggered by fever. In most children, these seizures (called febrile seizures) don’t happen every time there is a fever. It seems to depend on a number of factors: 1. The temperature of the fever: Seizures are more common with temperatures higher than 39.5C 2. The speed with which the fever develops: A rapid rise in the child’s temperature is thought to increase the risk of seizure more than a gradual rise 3. The type of infection: Some viruses, such as roseola (baby measles), are associated with seizures more often than the common cold viruses Most children’s seizures are of the febrile type. They usually last a few minutes and the child may be sleepy after. A child outgrows them and will not be left with any brain damage or an increased risk of seizures in later life.

MEDICATION FOR TREATING FEVERS

Ibuprofen and acetaminophen are good options for treating fevers. Talk to your doctor about which medication to give your child. Aspirin

is no longer advisable for children’s viral illnesses because of the risk of Reye’s Syndrome.

Dosage

A general dosage outline for acetaminophen is provided by the manufacturer. Paediatricians prescribe a dose of 15 milligrams of the drug for each kilogram the child weighs. • A 10 kg baby would get 150 mg • A 15 kg 3 year old would get 225 mg Wait for one hour for the full effect. Do not repeat the dose for at least four hours. Repeat only if the indications for treating the fever have returned. If the fever persists for more than 72 hours, check with your doctor.

MEDICINE CABINET GO-TOS

To ensure you’re prepared for whatever ailments come your family’s way, keep these medications on hand. • Acetaminophen and ibuprofen are great for fever and relief of pain. (Ask your doctor which medication he or she recommends.) • Syrup of ipecac induces vomiting if a child swallows pills or anything potentially poisonous. Only give syrup on the advice of a doctor.

Never administer ipecac without advice from an emergency department or poison centre. It can be harmful if the poison is an irritating substance. • Auralgan ear drops are an effective method for relieving the pain of an inflamed ear drum, one of the most severe pains children will ever experience. • Anti-nausea medication is useful for motion sickness. Do not use anti-nausea medication for the vomiting of gastroenteritis unless your doctor says so. It makes some children drowsy and then it is more difficult to tell how sick the child is. As well, the child may become too sleepy to drink. Any medication can be dangerous to a child if taken in excess. Keep medications in childproof containers and store them in a safe area, locked up or out of reach.

HOW TO GIVE MEDICATIONS

Liquid Medications Most children prefer liquids in the provided dosing cup or a medicine syringe from the pharmacy. Taste the medication yourself first. Many medications, like penicillin, have an unpleasant aftertaste. Have something tasty on hand that the child likes and can pop in their mouth immediately afterwards.

Medications in Pill Form The easiest way to swallow a pill is to put it behind the bottom front teeth and then drink something quickly. The pill usually gets washed down with the first one or two swallows. Ear Drops If the drops are oily, stand the bottle in warm water for a few minutes. This will make the drops flow more easily. Lie your child on their side with the infected ear up. Put the correct dosage in the dropper. Pull the ear lobe toward the back of the head until you can see directly into the ear canal. Put the end of the dropper in the opening and squeeze the bulb. Keep your child on their side for five minutes. Eye Drops Let a drop of the medication hang down from the dropper, have the child look toward one side, and place the drop on the white of the eye in the outside corner. It will flow in easily.

Alternatively, you can have your child close their eyes, then put the drops in the inside corner of the eye. When the eyes are opened, the drops will flow in painlessly. Eye Ointments Squeeze out a strip of the ointment about one centimetre long and let it hang down from the tube. Then pull the lower lid down and lay the strand of ointment along the inside (the red part of the lower lid). Have your child open and close the eye a few times to spread the medication. Nose Drops Have the child lie down with his or her head back. Measure the right amount of nasal solution in the dropper. Place the dropper inside the nostril and gently squeeze the bulb. Try not to touch the lining of the nose or the child may jump or sneeze. Have him or her sniff hard a couple of times before sitting up again.

FOR INFANTS: Administer eye or nose drops when they are busy sucking or feeding.

TREATING COMMON SIGNS OF ILLNESS

Kids are prone to a few physical reactions to illness or injury, so it’s helpful to know how to handle them when they crop up, regardless of the root cause.

Rashes Most rashes are due to either skin reactions (allergies and dermatitis) or to infections in the skin. None of these skin eruptions make the child sick or cause a fever unless there are complications. Rashes often occur in the course of viral infections. The type of rash that accompanies the fever helps your doctor recognize illnesses.

The presence of a rash with an illness does not make the illness any more serious. If the rash is itchy, applications like calamine lotion, or a bath with baking soda or a commercial baby wash can help.

In the event that the spots look like blood under the skin and don’t blanch when you press them, the rash may be a sign of septicaemia (blood poisoning) and your child should be taken to the ER immediately. Cough and Congestion It is common for children’s infections to involve the respiratory system. The child develops a cough that at first is dry and irritating. After a day or two, the child’s nose begins to run and the cough begins to sound loose. At this stage, many parents say the child is “congested” and worry that there is some trouble in the lungs. The most common reason for a loose, moist cough is that the mucus from the back of the child’s nose is trickling down the back of the throat to the top part of the windpipe. This happens easily when the child is lying down.

When mucus trickles down the throat to the windpipe, adults automatically clear our throats, but children clear their throats by coughing. Suppressing the cough deprives the child of a mechanism for protecting the lungs. It is wiser to make sure that the air the child breathes is well-humidified so that the phlegm doesn’t dry out and become thick and sticky (and therefore harder to expel).

Signs that suggest that the infection is affecting the lungs and that the child should be examined are: • If the cough is not accompanied by any signs of a cold. • If the fever from the cold lasts more than three days. • If the child seems to be breathing rapidly or seems to have difficulty breathing, especially when the child’s temperature is below 38.5 C. • If there is any suggestion that the child’s colour is changing from pink or red to mauve or blue. • If the child looks unusually pale. Vomiting Vomiting is usually associated with problems directly involving the stomach or bowel, but can occur in children for other reasons. Some children will vomit from high fever, and others from emotional upset. Some children have very strong gag reflexes.

Stomach flu is a common virus infection in young children. Usually the child is listless, especially after vomiting. The vomiting is not caused by coughing, and often comes with little warning. At the beginning of a stomach flu (also known as viral gastroenteritis), the child may vomit repeatedly and be unable to keep anything down. After a delay of six to 24 hours, diarrhea usually occurs.

It is important to avoid dehydration. For most children who are healthy and well-nourished before the flu starts, the risk of serious dehydration depends on excessive loss of fluid rather than a failure to take in fluids. Any healthy child, even a baby, can safely go for up to 12 hours or more without drinking much, as long as there are no fluids

lost by vomiting, diarrhea or very heavy and continuous sweating. A child with gastroenteritis usually can’t keep very much down for the first 12 hours or so, but keep offering frequent small sips of flat ginger ale or diluted apple juice—start with a tablespoon every 15 minutes, then gradually increase the amount as tolerated. Paediatricians often recommend rehydration fluid for children. Things can change quickly with stomach flu, so if your child continues to have vomiting or loose bowel movements after a couple of days, check with your healthcare provider.

COMMON AILMENTS: A QUICK REFERENCE GUIDE

ABDOMINAL PAIN, ACUTE

Abdominal pain may be the symptom of a number of ailments from childhood diseases, internal disorders or simply the result of overeating or eating the wrong foods. Other causes would include a twisted digestive organ, stomach ulcer, twisted testicle, viral or bacterial diarrhea or food poisoning, pneumonia, hepatitis, chronic constipation and even pain associated with emotions, such as high levels of worry. Diagnosis: Diagnosis will vary according to the location of the pain, when it began, how long it has lasted, the age and sex of the child and whether there are other symptoms such as changes in bowel movements or urination, fever, nausea or vomiting. Home Treatment: If you suspect constipation, avoid use of laxatives. Give plenty of fluids, fresh fruits and vegetables. Encourage your child to sit on the toilet regularly following meals, to increase opportunities for bowel movements to occur. Emergency Treatment: A physician should see your child if there is severe pain—especially if there is vomiting. If a physician is unavailable, go directly to a hospital emergency room.

ALLERGIES

An allergy is present when your child’s body overreacts to one or many things, including things that are eaten, breathed, touched or injected (such as medications). The most common childhood reactions are to foods, house dust, certain pollens, poison ivy, oak and sumac, stinging insects and some medications, such as antibiotics. Asthma often has an allergic component. Symptoms: Swelling of the lips and mouth, hives, wheezing and even shock are some of the more severe symptoms. The shock reaction (called anaphylaxis) may be fatal. A reaction to stinging insects includes swelling and itching at the site of the sting, but if the reaction is severe it can

cause anaphylaxis. Whatever symptoms are evident in a small child may change as the child grows older. Medical Treatment: The symptoms of most allergic reactions can be reduced or eliminated with proper treatment—your doctor may prescribe an antihistamine, or a desensitization program. It is a medical emergency if a child has associated breathing difficulty.

ALLERGIES, FOOD

Food allergies aren’t as common in children as you’d think. Still, the most allergenic food is the peanut, and in infants, it’s eggs and milk products. Symptoms can involve swelling of the mouth, hives, a stuffy nose and difficulty breathing or swallowing. Symptoms: Usually appear within a few minutes to an hour after eating. Some food allergies may result in vomiting, diarrhea, abdominal pain and bloating. Home Treatment: If you know what caused the allergic reaction, remove the food from your child’s diet. Give plenty of clear liquids if he or she has lost fluids through vomiting or diarrhea. If the reaction includes itching from hives, try antihistamines, calamine lotion, decongestants and cool compresses. Medical Treatment: If asthma results, a physician can prescribe medication to help breathing difficulties. Children often outgrow food allergies by age two or three.

If the child shows signs of shock (rapid pulse, fast shallow breaths, dizziness or fainting, clammy skin, thirst or anaphylaxis) get medical attention immediately. Epinephrine may be administered to control a severe allergic reaction. A kit may also be prescribed for home use.

APPENDICITIS

Appendicitis is uncommon in children younger than five. However, diagnosing appendicitis is difficult, so doctors take prompt action. Symptoms/Action: Consult your healthcare provider or take your child to an emergency room if he or she complains of pain, tenderness or cramps in the stomach around the navel or lower right side of the abdomen for three hours or more.

Medical Treatment: If it’s appendicitis, an appendectomy may be required following the diagnosis.

ASTHMA

Wheezing and difficulty in breathing in children is usually an indicator of asthma, but a doctor will check for alternate reasons. A viral infection, may precipitate an attack. Many children outgrow asthma.

Medical Treatment: Mild asthma attacks may be treated with a prescription medication that relaxes smooth muscles in the breathing tubes. Medication usually continues for two to seven days after the wheezing has stopped. A child with severe asthma may require hospitalization. BITES AND STINGS (See First Aid chapter) BLEEDING (See First Aid chapter)

BLISTERS

These are raised, red bumps filled with an almost-clear fluid that forms when skin is damaged by being rubbed or injured. A blister can also result from an allergic reaction to plants or insects. The blister won’t disappear until the skin underneath the blister has healed. Home Treatment: Protect the area with a bandage or gauze to prevent infections. Don’t break a blister, but if the blister should be accidentally broken, wash with soap and water, apply a mild antibiotic ointment (a prescription medication isn’t required) and cover.

Infection may result if a blister breaks. Red streaks that spread or redness at the base of the blister indicate infection and a physician should be seen.

BLOOD (IN STOOL OR VOMIT)

Symptoms: Vomiting a large amount of blood usually suggests that the bleeding originates in the esophagus or stomach. Blood in the stool is a sign that bleeding originates in the intestines. A black stool may also indicate internal bleeding. Significant blood loss can lead to shock. Medical Treatment: If there is a large amount of blood in vomit or rectal bleeding, get medical attention immediately. For massive bleeding, intravenous fluids and salts may be given to combat dehydration and shock. A blood transfusion may be started. Specific treatment depends on the cause. Comfort and reassure the child, who will be frightened. Fear and anxiety can complicate the problem.

BLOOD (IN THE URINE)

Blood in the urine may be due to bladder infections, inflammation or kidney disease. It can indicate serious conditions, so get an immediate medical evaluation. Sometimes coloured foods, such as beets or red dyes, can cause red urine. All children with blood in the urine should be seen by a physician.

BREATHING (RESCUE BREATHING, CHOKING, HYPERVENTILATION)

(See First Aid chapter) BROKEN BONES (See First Aid chapter) BURNS (See First Aid chapter)

CHICKEN POX

Chicken pox (varicella) is a viral infection. It is common in childhood in children who haven’t been vaccinated against it, and the infection is usually mild. Chicken pox usually begins with a fever, followed by a rash after one or two days. The rash usually starts as red spots, and then turns into blisters filled with fluid. Within a few days, crusts form over the blisters. New spots may also appear over the following days. The rash may be very itchy. If your child gets chicken pox, they should develop immunity and will likely not get the infection again. Treatment: You can try to control your child’s fever by giving him acetaminophen. Do not give your child aspirin or any products that contain aspirin. Aspirin increases the risk of getting Reye’s Syndrome, a severe illness that can damage the liver and the brain. Treat the itchy rash with calamine lotion and/or baking soda baths. Transmission/Prevention: The virus that causes chicken pox spreads through the air, or spreads through direct contact with the blister(s) of an infected person. Chicken pox is infectious five days after the rash first appears, or until a crust has formed over the last blister. If your child isn’t vaccinated and has been around another child who has chicken pox, watch them for signs of the infection over the following two weeks.

If your child gets chicken pox and attends a daycare centre or school, it is important to tell the centre staff or teacher.

COMMON COLD AND FLU-LIKE ILLNESSES

Symptoms of a common cold or head cold are usually a stuffed-up nose, lessened appetite, headache and mild fatigue. A sore throat or mild cough are somewhat common. Sometimes there is a mild fever. With a flu, symptoms are more severe, and may include fever, cough, fatigue and achiness. There may also be a sore throat, hoarseness and the swollen glands in the neck. Loss of appetite, vomiting and diarrhea are also common with flu-like illnesses.

The common cold is actually caused by a virus that can infect the nose and throat. Flu-like illnesses are also often caused by a virus and usually infects the head and chest. Treatment: Give your child plenty of fluids and urge him to rest. You can give your child acetaminophen for pain, aches or a fever higher than 38.5. Do not give your child Aspirin or products containing Aspirin because of the risk of Reye’s Syndrome. If your child has a dry, hacking cough and is older than age six, you can give your child a cough syrup that contains dextromethorphan (DM).

Contact your physician if your child shows any of the following signs: earache, fever higher than 39C (102F), excessive sleepiness,

excessive crankiness or fussiness, skin rash, rapid breathing or difficulty in breathing. Common colds usually get better after five to seven days. Bad colds or flu-like illnesses may take a few days longer. A cough can linger for a few weeks. If your baby has breathing trouble, fever, poor appetite, or vomiting, make sure they are checked by their doctor. Sometimes a cold can lead to complications such as a middle ear infection, in which case your child needs to see a doctor. Signs of an ear infection are a high fever, earache, vomiting, irritability and especially pus draining from the ear. Your child should also see a doctor if they get an eye infection with a cold, a symptom of which is dried yellow pus in and around the eye. Transmission/Prevention: The virus is carried in the saliva and nasal secretions and spreads through the air when people cough, sneeze or blow their noses. Teach your child to cover their mouth and nose when sneezing or coughing.

COLD SORES (ORAL HERPES, FEVER BLISTERS)

These are clusters of painful bumps or blisters on one side of the outer lip. Kids usually get infected by coming in contact with the open lesions or saliva of someone who’s infected. (If adults around your child are prone to cold sores, they should avoid close contact when experiencing a flare up.) With the first infection these blisters also appear inside the mouth (stomatitis) and are confused with canker sores. However, they are very painful and are associated with fever. The infections usually start before age four. Cold sores (oral herpes) are associated with the herpes simplex virus, type 1. Symptoms/Treatment: The blisters on the lip rupture, scab over and dry up in 10 to 14 days. They do not cause scars. After the blister heals, the virus is dormant and then, at a later time, can become active again. Cold sores heal by themselves and although they are a nuisance, they are not serious.

Home treatment: Warn your child not to touch the blisters or pick at the resulting scabs. Phenol and camphor may give some relief if the blisters are sore, and may also prevent bleeding of the scabs. Apply at the first sign of a cold sore.

CHOKING (See First Aid chapter)

CROUP

Croup often begins like a common cold. Later, there is fever, cough and difficulty breathing. The lining of the throat and larynx gets red and swollen, and a barking cough develops. The voice gets hoarse and breathing can get rapid and noisy. Croup usually sounds worse than it is. Cause: Croup is a viral infection of the throat and vocal cords (larynx). In an older child or adult it is call laryngitis.

Treatment: Croup is a viral infection so antibiotics, which are used to treat bacterial infections, do not help. Call your child’s doctor right away if he gets a fever higher than 39C (102F), has rapid or difficult breathing, has a severe sore throat, starts to drool or has more drool or if he refuses to swallow or is uncomfortable when lying down. Transmission/Prevention: As with a cold, the virus is carried in the saliva and nasal secretions and spreads through the air when people cough, sneeze or blow their noses.

DEHYDRATION

This is an excessive loss of body fluids, and it can develop very rapidly among newborns and infants who are vomiting or have diarrhea. Notice if your child: has not urinated in more than eight hours; if there are no tears when crying; if the mouth is dry; if there is decreased quantity or frequency in urinating if the pulse is rapid; if the eyes seem to be sunken; and if your child is lethargic. Home Treatment: Encourage him or her to drink water, fruit juices or soft drinks such as ginger ale. Don’t offer salty liquids such as broth. If the child is nauseous and can’t tolerate drinks, try offering chips of ice or frozen juice. Medical Treatment: If hospitalization is necessary, the child may be given fluids and nutrients intravenously.

DIARRHEA/DEHYDRATION

Diarrhea is most often caused by a virus. Sometimes it is caused by bacteria. Your child has diarrhea if he is having more bowel movements than usual and his stools are loose and watery. Your child may also have a fever, nausea, vomiting, pains in the stomach, cramps, blood and/or mucus in the stool and may not want to eat. Diarrhea can be dangerous if it causes dehydration. Signs of dehydration are less urination, lack of tears, dry skin, mouth and tongue, sunken eyes and a sunken fontanelle in babies. Dehydration can be very dangerous, especially for babies and young children. Treatment: At the start of diarrhea in your baby, continue breastfeeding on demand. If you do not breastfeed, continue to offer your baby food and drink. Whether you breastfeed or not, offer oral rehydration solution (ORS) following this schedule.

For the first six hours: • For a child less than six months old, give 30 to 90 ml of ORS every hour. • For a child six to 24 months old, give 90 to 125 ml of ORS every hour. • For a child over two years old, give 125 to 250 ml ORS every hour. If your child vomits in addition to having diarrhea, you may need to stop food and drink. Continue to give ORS. Give your child 15 ml (1 tbsp)

every 10 to 15 minutes until the vomiting stops. Then go back to the schedule above. If vomiting doesn’t stop after four to six hours, take your child to the hospital. • From six to 24 hours, keep giving ORS until the diarrhea happens less often. When the vomiting happens less often, have your child drink small amounts of milk or formula often. • After 24 to 48 hours, most children can eat and drink normally. It can take seven to 10 days for stools to return to the normal form. Transmission/Prevention: The germs that cause diarrhea are spread easily from person to person, especially among children who haven’t learned to use the toilet. Wash your hands and your child’s hands well after changing a diaper and going to the toilet and before preparing food and eating.

Call your child’s doctor if he has diarrhea and is younger than six months, if he has bloody or black stools, if he is still vomiting after four to six hours, if he has a temperature greater than 38.5C (101.5 F) or if he has signs of dehydration.

DIZZINESS (VERTIGO)

This involves a feeling of the world spinning—a sensation that indicates the balancing mechanism of the inner ear is disturbed. The feeling can be momentary, but if it persists, nausea and vomiting are likely. A few children experience dizziness during their early years but it usually isn’t a cause for concern. Some children experience dizziness in the car. Home Treatment: Most dizziness will pass quickly, especially if the child has been spinning during play. If it persists for more than a few minutes, ask your child about other symptoms. Medical Treatment: See a doctor if there is earache, buzzing in the ears, headache, fever or if the child is unable to stand or walk.

EAR INFECTION

The peak ages for earaches are six months to two years, but they continue to be a problem until children are eight or 10 and usually cause both pain and fever. An ear infection can be in the external ear, the middle ear or the inner ear. Young children are most affected by middle ear infections—it’s the most common early childhood problem next to colds. An external ear infection (often called swimmer’s ear) can ache, be tender and red, swell and have a discharge of pus that has an unpleasant odour. Itching and discomfort can last for a few days, even after treatment has started.

Home Treatment: Don’t use folk remedies, such as warmed oil dropped in the ear, and don’t plug the ear canal with cotton. To relieve pain,

put an ice bag or ice in a washcloth over the ear for 15 minutes. Cold provides better relief than warmth. Don’t allow water near the ear. If the pain is from water in the ears, get the child to lie with the affected ear downward so the water can drain.

Medical Treatment (External Ear): The physician will clean the ear canal and prescribe ear drops with antibiotics and cortisone. Medical treatment (Middle Ear Infection): Antibiotics are generally indicated to combat infection. Sometimes a small incision is made in the eardrum to admit a tube that allows fluid to drain from the middle ear. This is generally done if a child has multiple ear infections. Medical Treatment (Inner Ear): Your healthcare provider will drain the accumulated fluid from the inner ear and start antibiotic therapy. Surgery is sometimes necessary.

ECZEMA

Eczema is a skin eruption that, in infants, usually starts on the cheeks and is red and oozing. Thickening of the skin will occur in older children if the eczema is long-term. It is not contagious. Infantile eczema tends to run in families. Usually a close relation to the child is susceptible to eczema or some other allergic complaint, such as hay fever or asthma.

Eczema usually starts in infants two to three months old and often clears when a child is between three to five years old. It may be associated with other allergic conditions such as hay fever. You will notice it first on your infant’s cheeks, but it will probably spread to the rest of the face, the neck, the wrists and the hands. Because it is so itchy, the child will rub against blankets and try to scratch. Then there will be oozing, followed by crusting and scaling. It may become infected. Home Treatment: If a child scratches, eczema is very difficult to control. Apply cool, moist compresses to calm the itch. Keep your child’s fingernails as short as possible. Avoid harsh soaps and detergents. Let the child soak in warm water to relieve the dryness, but after bathing coat the skin in oil to seal in moisture. Avoid rough or scratchy clothes. If the cause is food-related, it can be treated by eliminating specific foods. These triggers may include milk products, eggs, tropical fruits, fish, shellfish, wheat flour products and chocolate. After the eczema has cleared up introduced these foods one at a time, a week apart, so that the problem food can be identified. If you’re having trouble get a handle on your child’s eczema, make an appointment with their doctor. Medical Treatment: A hydrocortisone ointment may be prescribed to help reduce inflammation. (A mild hydrocortisone would be used for infantile eczema.)

EYE INJURIES

Eye injuries can be caused by a piece of matter in the eye or under the eyelid; a sharp object puncturing the eye or eyelid; a blow to the eye; burns sustained from being exposed to chemical substances (cleaning agents, firecrackers); or overexposure to the sun. Home Treatment: Blinking can usually force dust out of the eye. If you can see the culprit, moisten a cotton swab and gently flick it out, or flush the eye thoroughly with running water for at least 15 minutes. If the injury is from an explosive substance, if the eye has been penetrated or if it has come into contact with a chemical substance, do not wash out the eye. Call your healthcare provider for actions to take. Emergency Treatment: If the foreign matter is embedded, don’t try to remove it. Go to an emergency room. After the object is removed, the physician may prescribe antibiotic ointment and pain relievers if the cornea is scratched. If the cornea has been burned by ultraviolet light, both eyes should be kept closed until healing occurs (one or two days). A cut in the eyeball may require surgery. Teach your child to wear protective eye goggles when working with tools or chemistry sets. It should become an automatic habit.

GIARDIA

Giardia is a parasite that causes a bowel infection. It is common in children in childcare centres, especially if there are children in diapers. Some children have no symptoms. Others have diarrhea, bowel movements with a very bad smell, stomach cramps, gas, loss of appetite and weight. Treatment: There are medications to treat giardia. A doctor may have to take three stool samples on three days to confirm the diagnosis. Transmission/Prevention: Giardia may spread on the hands of someone who has changed a diaper or used a toilet. The spread can be prevented by careful hand-washing after changing the diaper or going to the toilet, and before preparing food and eating.

If your child has been diagnosed with giardia and is ill, he should not attend daycare or school until the diarrhea has stopped.

GROWING PAINS

We say “growing pains,” but these aches aren’t really caused by growth. Instead, these are normal aches and pains in limbs and joints, and they are experienced by most children ages 3 to 12, at some point. Luckily, these pains are both temporary and harmless. The pains most often are felt in the child’s calves, thighs and feet, and they’re more likely to occur when kids are at rest and at night. The cause is unknown, although it seems to have a family tendency.

Home Treatment: A warm bath may help, as well as gently massaging and stretching the sore muscles. There is no need to stop regular activities. Medical Treatment: If there is persistent pain that does not improve after a couple of days, if it gets worse or if there is a limp, joint swelling or fever, you should contact your healthcare provider.

HAND, FOOT AND MOUTH DISEASE

This infection is found in saliva and can cause fever, headache, sore throat, loss of appetite, lack of energy, a skin rash and small, painful ulcers in the mouth. The rash usually appears on the hands and feet, but may also be on other parts of the body. Treatment: If symptoms appear, call your doctor to confirm the diagnosis. There’s no treatment; the infection will go away after seven to 10 days. Outbreaks are more common in the summer and fall. Transmission/Prevention: It spreads from person to person through the air or by touch. The incubation period is about 10 to 14 days. Children may remain infectious for one to two weeks.

HEADACHE

Most headaches are of short duration and don’t require treatment. They’re almost as common in children as they are in adults. There may be numerous causes such as a blow to the head, a viral illness, a high fever, hunger, tension or stress. Broadly speaking, there are three types of headaches: migraine, disease or injury-related and tension. Home Treatment: Let your child relax in a dimly lit room. Encourage other relaxation strategies, like taking deep breaths or imagery. Offer a few snacks. A cool washcloth on the forehead may help, too. You can also give a painrelieving medicine such as children’s acetaminophen or children’s ibuprofen. Encourage your child to get back to regular activities as soon as they’re able. Medical Treatment: If headaches are diagnosed as migraines, your healthcare provider may suggest regular medication that may prevent attacks. Emergency Treatment: Treat a headache as an emergency if the pain is so severe that it interferes with normal activity for more than an hour; the pain is accompanied by fever, vomiting and a stiff neck; or if he or she is confused, disoriented or delirious.

HIVES

This is a general term for an allergic skin reaction that affects children who are allergic to specific substances. In some cases, the cause of hives is never found.

Acute hives may appear on a child face and chest or anywhere on the body. They are very itchy and may erupt suddenly after a bee sting or

specific foods. Hives generally disappear in a few days without receiving treatment. Cold hives are exactly what the name implies: a reaction to cold air, cold water and cold drinks. They are itchy and painful. Home Treatment: Itching and pain may be relieved with calamine lotion or by soaking the affected skin in cool water with two tablespoons of sodium bicarbonate. Medical Treatment: An oral antihistamine may be prescribed. If hives are associated with difficulty in breathing or wheezing, medical help should be sought immediately. HYPERVENTILATION (See First Aid chapter)

INFLUENZA

The flu is a viral infection of the nose, throat, trachea and bronchi. Every autumn and winter you can bet on a widespread epidemic of whichever bug is present. There are many types of viruses and they change constantly, so it is possible to have influenza annually. Symptoms: Primary symptoms are stuffy nose, sore throat and nagging cough, as well as muscle pain, headache, fever and chills that are usually identified with the common cold. Because it is so widespread, healthcare providers can readily identify the symptoms. Home Treatment: Influenza is almost always treated at home, but not with antibiotics, because it is a viral infection. It can sometimes develop into a bacterial infection (pneumonia), at which time antibiotics will be required.

Kids with the flu need plenty of bed rest and lots of fluids. Acetaminophen or ibuprofen help reduce muscle aches and fever.

LARYNGITIS

Laryngitis in infants is often called croup and may be associated with a hoarse cry and breathing difficulties. In older children, breathing problems are unusual, because the airway is much bigger. Their hoarseness is caused by a cold or overuse of the vocal cords through shouting or screaming, which cause an inflammation of the voice box (larynx). An older child with laryngitis may not be able to speak above a whisper and may have a dry cough and a scratchy and sore throat. Home Treatment: Have your child gargle with warm saltwater or suck on a hard candy several times a day. Younger children can sip warm liquid, like apple juice. Encourage the child to talk as little as possible for a few days. If he or she has a fever, offer acetaminophen or ibuprofen. You can also put a cool-mist humidifier in the bedroom. Medical Treatment: Call your healthcare provider if the hoarseness is

present for more than two weeks or if the hoarseness gets worse. If there is difficulty in breathing or a high fever develops, call a physician immediately.

NOSE BLEEDS

Nosebleeds are common in childhood and almost never dangerous. The actual blood loss is usually insignificant. You can blame a blow to the nose, scratching or blowing the nose very hard, hay fever, other allergies and colds. A nosebleed can also result from bleeding disorders like hemophilia. Home Treatment: A nosebleed usually stops by itself. If it doesn’t, have your child sit up and lean slightly forward so as not to swallow the blood. Then squeeze his or her nose firmly between your thumb and forefinger. Apply this pressure for a few minutes, then release. This allows the body’s clotting mechanism to go to work. After the bleeding has stopped, tell your child not to wipe or blow his or her nose and sit still for a few minutes. If bleeding doesn’t stop after home treatment and after 20 minutes of constant pressure, consult your physician.

PINK EYE

Pink eye is an infection of the covering of the eyeball, usually caused by a virus, but sometimes caused by a bacteria. It can also be caused by allergy, exposure to chemicals and other irritants around your child. There will be pus coming from the eye if the pink eye is caused by bacteria. If it is caused by a virus, the discharge will be more watery. The pus may make the eyelids stick together. There is a scratchy or painful feeling in the eyes, and the whites of the eyes turn pink or red. Your child should see a doctor if they have these symptoms. Treatment: If caused by bacteria, it is treated with antibiotics and warm water compresses. If caused by a virus, treat with warm water compresses only.

PINWORMS

Pinworms are tiny, white thread-like worms that live in the intestines. The worms crawl out of the anus at night and lay their eggs on the nearby skin. Pinworms are a nuisance, not a disease. They spread when an uninfected person picks up pinworm eggs from an infected person or their belongings. There may be no symptoms, or there may be itchiness around the anus or vagina. Treatment: If a doctor determines that a child has pinworms, it can be treated with medication.

Transmission/Prevention: When an infected person scratches the itchy area, they get pinworms on their fingers or under their fingernails. It’s also spread when an uninfected person picks up pinworm eggs from an infected person’s belongings (eggs can live for several weeks outside the body). To prevent repeated infections, hand-washing is important.

PNEUMONIA AND BRONCHITIS

Pneumonia is an inflammation or infection of the lungs. It can be caused by bacteria or viruses. Bronchitis is an inflammation of the bronchi— the air passages connecting the windpipe (trachea) with the lung sacs (alveoli) where oxygen is taken up by the blood. It can be caused by complications from a cough due to a severe cold. These infections are much more severe than colds. Symptoms include breathing trouble and a strong cough, which may produce yellow or green phlegm, and/or that is so severe it causes vomiting or turning red in the face. Fever may also be present. Treatment: Your doctor will decide on a course of treatment, depending on the condition, how severe it is and what caused it. Transmission/Prevention: With viral pneumonia, it is spread from person to person in the form of droplets expelled by an infected person when talking, coughing or sneezing, through touching infected secretions and through touching contaminated hands, objects and surfaces.

ROSEOLA

Caused by a virus, the infection is rare for children younger than four months or older than four years; it’s common in children aged six to 24 months. It starts out with a fever that disappears in a few days and is replaced with a rash on the face and body. The rash has small red spots and lasts for one or two days. Most children are not very sick during the fever stage, although some children have a very high fever that causes febrile seizures (convulsions). Treatment: Talk to your doctor if your child gets a persistent fever or feels unwell. Transmission/Prevention: It is not known how roseola spreads from person to person. Tell your child’s daycare or school if he is diagnosed with the infection.

SINUSITIS

The sinuses are a group of air-filled hollows that connect to the nasal passages. Sinusitis can be caused by colds, other viral infections, allergies, injury to the nose, infected adenoids, polyps in the nose or foreign objects in the nose. Infection of the sinus tissue is often caused by bacteria. Chronic sinusitis is also associated with the inhaling of cigarette smoke. Symptoms: There is a sensation of pressure or pain above the eyebrow, behind the eye or over the cheekbone. The child may complain of headaches. There may be a thick nasal discharge and it may be necessary to breathe through the mouth.

Home Treatment: It’s necessary to clear the sinuses and passageways so the fluid drains away and inflammation can be reduced. Decongestants may help. You might use a vaporizer in your child’s bedroom. See that they drink plenty of fluids. For kids who are swimmers, see that goggles and nose plugs are worn. Medical Treatment: Antibiotics may be prescribed if the infection is bacterial. The sinus may be drained, using suction, if other treatment fails.

STREP THROAT

Caused by a bacteria called streptococcus pyogenes (strep) Group A, strep throat is characterized by fever, severe sore throat, headache and stomachache. Neck glands may be swollen and tender, or sores around the nose may appear. Treatment: See your child’s doctor for diagnosis and treatment, which will likely involve antibiotics. Transmission/Prevention: Spread through the air when an infected person talks, coughs or sneezes. Hand-washing is important to prevent spread. Teach your child to cover his mouth when sneezing or coughing. Your child should not go back to daycare or school until antibiotics have been taken for at least 24 hours.

STYES

Styes are bacterial infections that develop when the glands along the eyelids are clogged, much like when a skin glad is clogged and a pimple forms. Home Treatment: Place a warm, wet washcloth or cotton ball over the stye for 10 minutes, three or four times a day. This hot compress helps increase the blood flow to the area. A physician’s help shouldn’t be needed unless the styes persist. Keep the child’s towel and washcloth separate from the rest of the family (and replace with clean ones often). See that hands are washed frequently.

VIRAL MENINGITIS

This is a virus that causes swelling of the lining of the brain and is diagnosed by analyzing spinal fluid taken during a procedure called a spinal tap. The doctor will confirm whether the infection was caused by a virus or bacteria (bacterial meningitis is much more serious). Fever, headache, neck pain, or stiffness, pain when looking at bright lights, nausea, vomiting, poor appetite, tiredness and sleepiness. It may infect other parts of the body and cause skin rash, runny nose, sore throat, earache, cough, difficulty breathing and diarrhea.

If your child develops these symptoms, see your child’s doctor immediately.

Treatment: There is no treatment to cure viral meningitis, and children recover on their own in approximately one to two weeks. The doctor will only hospitalize your child if they are quite sick from the infection. Transmission/prevention: The germs are in the saliva and secretions of the nose. Close contact between children is required for the spread of these germs. It occurs most often in children under two.

VACCINATION SCHEDULE

Vaccinations are scheduled differently in every province (turn the page for the cross-country table) but there is a general consensus that the standard vaccines are spread out at intervals from two months of age to age 11. Booster shots to update vaccines may occur throughout adolescence and adulthood. Keep an eye on the calendar to ensure your child’s vaccinations are up to date (especially when kids go to school—you may be asked to show proof of vaccination depending on your region). Vaccinations are a contentious topic for some families; any concerns can be discussed with your child’s doctor.

For more information, and to view and print your own copy of the Provincial and Territorial Routine and Catch-up Vaccination Schedule for Infants and Children in Canada, visit canada.ca. (You can also search “Canadian vaccination schedule” for easier access.)

CANADA’S PROVINCIAL AND TERRITORIAL ROUTINE (AND CATCH-UP) VACCINATION SCHEDULE FOR INFANTS AND CHILDREN*

This table summarizes the current routine vaccination schedule for infants and children in all provinces and territories accross Canada. Changes to this schedule are updated regularly in collaboration with the Canadian

VACCINES PROVINCIAL AND TERRITORIAL VACCINATION SCHEDULE

* last updated: December 2020. ABBREVIATIONS: yrs = Years (age); mos = Months (age) Vaccine is not publicly funded in this province/territory

A specific catch-up program is currently underway. A catch-up program is defined as a time-limited measure to implement a new vaccine program to a certain age cohort (e.g. an additional dose of a vaccine is recommended and a targeted program is put in place). It can also be used when a vaccine is added at a younger age (e.g. in infancy) and the existing program continues until that infancy age cohort “catches up” to the current age cohort (e.g. hepatitis b vaccine is added to the infancy program, but the school immunization program continues until those infants reach school aged immunization). With that said, a province or territory can still provide catch-up vaccine at the individual level even if there’s no specific program in place.

Nursing Coalition for Immunization (CNCI) and the Canadian Immunization Committee (CIC) schedules for each province or territory can be found on Canada.ca/vaccines.

PROVINCIAL AND TERRITORIAL VACCINATION SCHEDULE

1 If attending post-secondary school out-of territory 2 Females only 3 Males only 4 The schedule applies to children born after June 1, 2019. Children born before this date will follow the vaccination schedule that was recommended at the time. For more information please visit https:// www.quebec.ca/en/health/advice-and-prevention/ vaccination/quebec-immunisation-program/ 5 Students are provided with a combination vaccine that protects against hepatitis A and B 6 A catch-up program in the 3rd year of high-school evaluates student’s vaccination history. Students will be provided any missed vaccination to protect against the following diseases: diphtheria, pertussis, tetanus, polio, measles, mumps, rubella, varicella, meningoccal serogroup C infections, hepattis

A and B, and human papilloma virus. 7 DTaP-IPV-Hib may be substituted for DTaP-IPV in times of shortage