Pediatric Handbook
www.pbmc.org
Table of Contents Page Number
Topic
Table of Contents.......................................................................................1 Contact Information................................................................................... 2 About Pen Bay Pediatrics........................................................................... 3 Helpful Links............................................................................................ 4 After the Shots....................................................................................... 5-6 Infant Feeding Guide- tear this page out................................................... 8-9 Breast Milk Storage Guide- tear this page out............................................. 10 Sleep and Newborns-KidsHealth.org.....................................................12-13 Childproofing Your Home.......................................................................... 14 Learning Link.....................................................................................15-16 Essential Tummy Time Moves....................................................................17 Yeast Infections..................................................................................18-20 Circumcision Information-AAP............................................................. 21-22 Care of Uncircumcised Penis-AAP............................................................. 23 Lead................................................................................................. 24-25 Child Passenger Safety Program.......................................................... 26-27 Lice Information...................................................................................... 28 Lyme Disease ......................................................................................... 29 Poison Help- tear this page out............................................................ 31-32 Carbon Monoxide Poisoning and Prevention- tear this page out............... 33-34 Notes ............................................................................................... 35-38
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Pen Bay Pediatrics 7 Madelyn Lane, Suite B Rockport, ME 04856 Telephone 207.921.5600 | Fax 207.921.5360 www.pbmc.org Office Hours: Monday - Thursday 8:00 a.m. - 8:00 p.m. Friday 8:00 a.m. - 5 p.m. Saturday and Sunday* (acute sick visits) 10:00 a.m. - 1:00 p.m. *No Sunday hours between Mother’s Day and Labor Day Providers: Dana Goldsmith, MD William Stephenson, MD Peter Vickerman, MD Adda Winkes, MD Rachel Wilcox, PNP Scott McPherson, LCPC We Offer: Well child exams Sports physicals Vaccinations Same-day sick visits Consultations Care coordination Zing! program On-site counseling Extended hours 2
About Us Thank you for bringing your child to Pen Bay Pediatrics. Our goal is to provide excellent and timely care to all of our patients. The guidelines below will help answer any questions about what you can expect from us. 1. Well checkup appointments occur at:
1 week old
9 months
2 week old
12 months
1 month
15 months
2 months
18 months
4 months
24 months
6 months
30 months *
2. Physical exams are recommended every year starting at 3 years. When scheduling your child’s ! appointments for a physical, please know that we are usually scheduling 2 – 3 months in advance. 3. If you have a child who is acutely sick (earaches, vomiting, etc), we can see them on the day you call. 4. If you have urgent questions, after hours, that cannot wait until our office reopens, please call the office in order to have the doctor on-call paged. 5. Please give at least 24 hours notice when canceling or rescheduling appointments. This allows us to rebook that time slot with another family. 6. Please allow 2 business days for prescription refills. 7. Please allow 3 business days for all school and camp forms. 8. Medical records may be obtained after a parent or legal guardian signs a medical release form. We have these forms at our office. Insurance Information *Please note that not all insurance companies will cover a 30 month exam (from chart above). Important Notice Regarding Circumcision: Circumcision is not considered a medical necessity by most insurance companies. This includes MaineCare. If you choose to have a circumcision for your son, you will be responsible for payment if your insurance company does not cover the procedure. Telephone Policy: During office hours, phone calls are answered by the front office staff and directed to the nursing staff as needed. When calling, if you feel that there is an emergency, please state that when your call is answered and you will be directed to an available nurse immediately. Any messages left on the nursing line will be returned as soon as possible, after your child’s problem has been discussed with a doctor. After Hours: Please call the office number (921-5600), and the answering service will put you in touch with the doctor on-call. The answering service cannot answer medical questions. If you have not received a call back within an hour, please call again. Dr. Goldsmith, Dr. Stephenson, Dr. Vickerman and Dr. Winkes are the doctors who answer after hours calls. 3
Helpful Links Your Baby’s First Vaccine’s: What you Need to Know Center for Disease Control http://bit.ly/2qxSsGE
Safe Sleep and Your Baby American Acadamy of Pediatrics http://bit.ly/2qwdZ6M
Car Seats: Information for Families HealthyChildren.org http://bit.ly/2rATK81
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After the Shots... Your child may need extra love and care after getting vaccinated. Some vaccinations that protect children from serious diseases also can cause discomfort for a while. Here are answers to questions many parents have after their children have been vac cinated. If this sheet doesn’t answer your questions, call your healthcare provider.
What to do if your child has discomfort I think my child has a fever. What should I do? Check your child’s temperature to find out if there is a fever. An easy way to do this is by taking a temperature in the armpit using an electronic thermometer (or by using the method of temperature-taking your healthcare provider recommends). If your child has a temperature that your healthcare provider has told you to be concerned about or if you have questions, call your healthcare provider.
Here are some things you can do to help reduce fever: Give your child plenty to drink. Dress your child lightly. Do not cover or wrap your child tightly. n Give your child a fever- or pain-reducing medicine such as acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Advil, Motrin). The dose you give your child should be based on your child’s weight and your heathcare provider’s instructions. See the dose chart on page 2. Do not give aspirin. Recheck your child’s temperature after 1 hour. Call your healthcare provider if you have questions. n
Vaccinations may hurt a little . . . but disease can hurt a lot!
Call your healthcare provider right away if you answer “yes” to any of the following questions: Does your child have a temperature that your healthcare provider has told you to be concerned about? Is your child pale or limp? Has your child been crying for more than 3 hours and just won’t quit?
n
My child has been fussy since getting vaccinated. What should I do? After vaccination, children may be fussy because of pain or fever. To reduce discomfort, you may want to give your child a medicine such as acetamin ophen or ibuprofen. See the dose chart on page 2. Do not give aspirin. If your child is fussy for more than 24 hours, call your healthcare provider.
My child’s leg or arm is swollen, hot, and red. What should I do? Apply a clean, cool, wet washcloth over the sore area for comfort. For pain, give a medicine such as acetaminophen or ibuprofen. See the dose chart on page 2. Do not give aspirin. n If the redness or tenderness increases after 24 hours, call your healthcare provider. n n
Is your child’s body shaking, twitching, or jerking? Is your child very noticeably less active or responsive?
My child seems really sick. Should I call my healthcare provider? If you are worried at all about how your child looks or feels, call your healthcare provider!
s
Please see page 2 for information on the proper amount of medicine to give your child to reduce pain or fever.
immunization
IAC action coalition
healthcare provider: please fill in the information below.
[
If your child’s temperature is °F or or if you have questions, call your healthcare provider. Healthcare provider phone number:
°C or higher,
]
Technical content reviewed by the Centers for Disease Control and Prevention
Saint Paul, Minnesota • 651- 647- 9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4015.pdf • Item #P4015 (7/14)
immunize.org
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after the shots: what to do if your child has discomfort – page 2
Medicines and Dosages to Reduce Pain and Fever Choose the proper medicine, and measure the dose accurately. 1. Ask your healthcare provider or pharmacist which medicine is best for your child. 2. Give the dose based on your child’s weight. If you don’t know your child’s weight, give the dose based on your child’s age. Do not give more medicine than is recommended. 3. If you have questions about dosage amounts or any other concerns, call your healthcare provider. 4. Always use a proper measuring device. For example: ■ When giving acetaminophen liquid (e.g., Tylenol), use the device enclosed in the package. If you misplace the device, consult your healthcare provider or pharmacist for advice. Kitchen spoons are not accurate measures. ■ When giving ibuprofen liquid (e.g., Advil, Motrin), use the device enclosed in the package. Never use a kitchen spoon!
Take these two steps to avoid causing a serious medication overdose in your child. 1. Don’t give your child a larger amount of acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Motrin, Advil) than is shown in the table below. Too much of any of these medicines can be extremely dangerous. 2. When you give your child acetaminophen or ibuprofen, don’t also give them over-the-counter cough or cold medicines. This can cause a medication overdose because cough and cold medicines often contain acetaminophen or ibuprofen. In fact, to be safe, don’t ever give over-the-counter cough and cold medicines to your child unless you talk to your child’s healthcare provider first.
Acetaminophen (Tylenol or another brand): How much to give? Give every 4 to 6 hours, as needed, no more than 5 times in 24 hours (unless directed to do otherwise by your healthcare provider). old formulations child’s infants’ drops child’s weight age 80 mg in each 0.8 mL or in each 1.0 mL
Infants’ New formulation or children’s liquid
children’s junior chewables strength
Kitchen spoons are not accurate measures.
80 mg in each tab
6–11 lbs (2.7–5 kg)
0–3 mos
Advised dose*
12–17 lbs (5.5–7.7 kg)
4–11 mos
18–23 lbs (8.2–10.5 kg)
12–23 mos
24–35 lbs (10.9–15.9 kg)
2–3 yrs
36–47 lbs (16.4–21.4 kg)
4–5 yrs
48–59 lbs (21.8–26.8 kg)
160 mg in each 5 mL (1 tsp)
1⁄ 2
No longer available for purchase in the U.S. Please discard old product.
160 mg in each tab
teaspoon or 2.5 mL
3⁄4 teaspoon
or 3.75 mL
1 teaspoon or 5 mL
2 tablets
1
1 ⁄2 teaspoon or 7.5 mL
3 tablets
6–8 yrs
2 teaspoons or 10 mL
4 tablets
2 tablets
60–71 lbs (27.3–32.3 kg)
9–10 yrs
1 2 ⁄2
5 tablets
2 ⁄2 tablets
72–95 lbs (32.7–43.2 kg)
11 yrs
3 teaspoons or 15 mL
6 tablets
3 tablets
teaspoons or 12.5 mL
1
Ibuprofen (Advil, Motrin, or another brand): How much to give? Give every 6 to 8 hours, as needed, no more than 4 times in 24 hours (unless directed to do otherwise by your healthcare provider). child’s infants’ drops child’s weight age 50 mg in each 1.25 mL
children’s liquid
old formulation
Kitchen spoons are not accurate measures.
50 mg in each tab
100 mg in each 5 mL (1 tsp)
children’s chewables
children’s chewables or junior tablets
100 mg in each tab
less than 11 lbs (5 kg)
0–5 mos
12–17 lbs (5.5–7.7 kg)
6–11 mos
1.25 mL
18–23 lbs (8.2–10.5 kg)
12–23 mos
1.875 mL
24–35 lbs (10.9–15.9 kg)
2–3 yrs
36–47 lbs (16.4–21.4 kg)
4–5 yrs
No longer available Advised dose* for purchase 1 teaspoon or 5 mL in the U.S. Please discard 1 1 ⁄2 teaspoon or 7.5 mL old product.
48–59 lbs (21.8–26.8 kg)
6–8 yrs
2 teaspoons or 10 mL
2 tablets
60–71 lbs (27.3–32.3 kg)
9–10 yrs
1 2 ⁄2
2 ⁄2 tablets
72–95 lbs (32.7–43.2 kg)
11 yrs
3 teaspoons or 15 mL
Advised dose*
* healthcare provider: please fill in the advised dose.
1 tablet 1
1 ⁄2 tablets 1
teaspoons or 12.5 mL
3 tablets
Immunization Action Coalition www.immunize.org/catg.d/p4015.pdf n
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Foods Breast milk or ironfortified formula
NONE
0-4 Months 5-10 feedings 24-32 ounces
4 – 6 Months 4-7 feedings 24-32 ounces
6 – 8 Months 3-4 feedings 24-32 ounces
10 – 12 Months 3-4 feedings 16-24 ounces (offer cup} -Infant or cooked cereals -Unsweetened cereals -Bread -Rice -Noodles and spaghetti
Peeled, soft fruit wedges: bananas, peaches, and pears
Cooked, mashed vegetables
-Small tender pieces of meat, fish, or chicken -Whole egg -Cheese, cottage cheese, and yogurt
-All fresh fruits peeled and seeded -Canned fruits, packed in water or fruit juice
Cooked vegetable pieces
NONE
-Lean meat, chicken and fish (strained, chopped, or small tender pieces) -Egg yolk, yogurt, cottage cheese, mild cheese
NONE
8 – 10 Months 3-4 feedings 16-32 ounces (offer cup) -Infant cereal -Toast, bagel or crackers
Infant Feeding Guide NONE
NONE
Cereals and Breads
NONE
All varieties of boxed infant cereal except cereal with fruit or honey. (Twice a day) Boxed rice, oatmeal or barley (spoon-fed). No sugar, fruit or honey added. Mix 2-3 teaspoons with breast milk, formula or water NONE
Fruit Juices
NONE
Strained or mashed: winter squash, sweet potatoes, peas, green beans, and, commercially prepared carrots, and spinach. ½- 1 jar or ¼ to ½ cup/day
NONE
NONE
NONE
NONE
NONE
Vegetables
Fruits
Protein Foods
Mashed fresh or cooked fruits: Banana, applesauce Strained fruits (avoid fruit desserts) ½ to 1 jar or ¼ to ½ cup/day May offer: -Lean meat, chicken, and fish (strained, chopped) -Egg yolk, yogurt, cottage cheese, mild cheese
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9
When your baby is a year old, offer whole milk.
Babies do better in the first year on breast milk or iron-fortified infant formula.
Feed your baby small amounts at first; make the food thin and smooth by mixing it with a little breast milk, formula or water. Use a baby spoon for feeding.
-Ask your nutritionist for more information on preparing your own baby foods.
-Avoid homemade carrots, spinach, & beets in the first year. -Mix meats and vegetables together if your baby prefers them that way.
You can make your own Buy plain meats, baby foods. vegetables, and fruits you get more for your money. -Do not add sugar, honey, corn syrup, butter, or salt to your homemade baby food.
A baby's bottle is for Try not to feel plain water and formula pressured to start solid only, not infant cereal. foods early. Babies get all they need in the first Avoid Kool-Aid, Hi-C, four to six months from soda and fruit punch breast milk or formula. which are made of mostly sugar.
(These foods are high in fat and sugar and contain few nutrients for your money).
• Bacon, luncheon meats, hot dogs • Creamed vegetables • Fruit desserts • Puddings • Cookies, candy, cakes and sweetened drinks
Foods to avoid:
-If your baby has a reaction, you know which foods to avoid.
-This will give time for your baby to adjust to the new food.
Wait at least 5 - 7 days before you try another new food.
Add one new food at a time.
Monday ! Monday
Infant Feeding Guide
• Hot Dogs • Berries • Peanut Butter • Popcorn • Nuts, raisins • Hard candies • Other firm chunks of foods
• Plain vegetables • Plain meats • Plain fruits • Egg yolk • 100% fruit juice • Unsalted crackers • Rice • Noodles • Whole wheat bread •Unsweetened cereals • Plain yogurt • Cottage cheese Foods that Cause Choking in Young Children
The Best Foods
Countertop
Location
Up to 39ºF (u to 4ºC)
Up to 77ºF (up to 25ºC)
Temperature
5 days
24 hours
6-8 hours
Duration
Store milk toward the back of the freezer where the temperature is most constant. At the longer durations, so lipids in the milk break down causing lower quality milk.!
Comments!
Comments Containers should be kept covered and as cool as possible Keep ice packs in contact with milk containers at all times. Limit opening cooler bag. Store milk in the back of the main body of the refrigerator (not on the door).
Breast Milk Storage Guide
Insulated Cooler Bag 39ºF (4ºC)
2 weeks
Duration
5ºF (-15ºC)
6-12 months
3-6 months
Less than 0ºF or (less than -17ºC) -4ºF (20ºC)
Temperature
Refrigerator
Freezer Freezer compartments inside a refrigerator
Freezer Section Chest or upright deep freezer
!
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KidsHealth.org “Sleep and Newborns” Newborns don’t yet have a sense of day and night. They sleep around the clock, and because their tiny stomachs don’t hold enough breast milk or formula to keep them satisfied for long, they wake often to eat — no matter what time of day or night it is.
How Long Will My Newborn Sleep?
A newborn may sleep up to 18 hours a day, waking every couple of hours to feed. Breastfed babies feed often, about 8 to 12 times a day. Bottle-fed babies tend to feed less often, about every 3 to 4 hours or so. Because the need for food is stronger than the need for sleep at this age, babies who sleep for longer stretches should be awakened to feed. Wake your baby every 3 to 4 hours to eat until he or she shows good weight gain, which usually happens within the first couple of weeks. After that, it’s OK to let your baby sleep for longer periods of time. Babies have different phases of sleep, just like everyone else. There’s drowsiness, REM (rapid eye movement) sleep, light sleep, deep sleep, and very deep sleep. The first months of a baby’s life can be the hardest for parents, who might get up many times at night to tend to the baby. Each baby has a different sleep pattern. Many babies start to sleep “through the night” (for 5-6 hours at a time) by 2 months of age, but not every baby does.
How Should Babies Sleep?
During the first weeks of a baby’s life, some parent choose to room-share. Room-sharing is when you place your baby’s crib, portable crib, or bassinet in your own bedroom instead of in a separate nursery. This allows your baby to be close enough to hear, smell, and sense you. This can help with baby’s feeding and sleep habits, and also helps new parents catch a bit more much-needed sleep. But room-sharing may not be for everyone; each family needs to decide what works best for them. While room-sharing is safe, putting your infant to sleep in bed with you is not. Although many cultures endorse bed-sharing, there is a risk that the baby can suffocate or strangle, and studies have shown that there’s a higher incidence of SIDS (sudden infant death syndrome) in households where the baby slept in the parents’ bed.
Follow these safety precautions with your little one:
Place your baby on his or her back to sleep, not on the stomach or side. The rate of SIDS has gone way down since the American Academy of Pediatrics (AAP) introduced this recommendation in 1992. Sleeping on the stomach with little-to-no ability to change head positions can block babies’ tiny airways and cause them to “rebreathe” their own carbon dioxide. In this position, babies also can get overheated (another risk factor for SIDS) and might have their mouths or noses blocked by bedding. Make sure your crib meets current safety standards. Use a firm crib mattress with a sheet that fits snugly. Do not put anything else in the crib or bassinet. Items that can touch a baby’s face — such as plush toys, pillows, blankets, and bumper pads — also can block breathing. 12
KidsHealth.org “Sleep and Newborns” continued Watch out for other hazards. Avoid items with cords, ties, or ribbons that can wrap around a baby’s neck, and objects with any kind of sharp edge or corner. Look around for things that your baby can touch from a seated or standing position in the crib. Hanging mobiles, wall hangings, pictures, draperies, and window blind cords could be harmful if they are within a baby’s reach.
Helping Your Newborn Sleep
Establishing a bedtime routine (bathing, reading, singing) will help your baby relax and sleep well. Even though your newborn may be too young to get the signals yet, setting up the bedtime drill now can keep you on track later. And putting your baby in the crib at night teaches your little one that it’s the place for sleep. If your newborn is fussy it’s OK to rock, cuddle, and sing as your baby settles down. For the first months of your baby’s life, “spoiling” is definitely not a problem. (In fact, newborns who are held or carried during the day tend to have less colic and fussiness.) It may take a few weeks for your baby’s brain to tell the difference between night and day. Unfortunately, there are no tricks to speed this up, but it helps to keep things quiet and calm during middle-of-the-night feedings and diaper changes. Try to keep the lights low and resist the urge to play or talk with your baby. This will reinforce the message that nighttime is for sleeping. Also, don’t try to keep your baby up during the day in the hopes that he or she will sleep better at night. Overly tired infants often have more trouble sleeping at night than those who’ve had enough sleep during the day.
When to Call the Doctor
While most parents can expect their newborn to sleep or catnap most of the day, the range of what is normal is quite wide. If you have questions about how much (or how little) your baby is sleeping, or your baby seems overly cranky and cannot be easily soothed, talk with your doctor. If it’s hard to wake your baby up from sleep and he or she is not interested in feeding in general, call your doctor immediately for reassurance or further medical advice. Reviewed by: Rupal Christine Gupta, MD Date reviewed: November 2014
Note: All information on KidsHealth® is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor. © 1995-2015 The Nemours Foundation. All rights reserved. Images provided by The Nemours Foundation, iStock, Getty Images, Corbis, Veer, Science Photo Library, Science Source Images, Shutterstock, and Clipart.com 13
Each year, children are injured by hazards in and around the home. The good news is that the risk of injury can be reduced or prevented by using child-safety devices and reminding older children in the house to re-secure safety devices after disabling them. Most of these safety devices are easy to find and are relatively inexpensive. You can buy them at hardware stores, baby equipment shops, supermarkets, drug stores, home improvement stores, on the Internet and through mail order catalogs. Safety devices should be sturdy enough to hinder access and yet easy for you to use. To be effective, they must be properly installed. Follow installation instructions carefully. Remember, too, that no device is completely childproof; determined youngsters have been known to overcome or disable them. Here are some child safety devices that can help reduce injuries to young children. The red numbers correspond to those on the image following the text.
Use Safety Latches and Locks 1 for cabinets and drawers in kitchens, bathrooms, and other areas to help prevent poisonings and other injuries. Safety latches and locks on cabinets and drawers can help prevent children from gaining access to medicines, household cleaners, matches, or cigarette lighters, as well as knives and other sharp objects. Even products with child-resistant packaging should be locked away and kept out of reach. This packaging is not childproof. Look for safety latches and locks that adults can easily install and use, but are sturdy enough to withstand pulls and tugs from children.
Use Safety Gates 2 to help prevent falls down stairs and to keep children from entering rooms and other areas with possible dangers. Look for safety gates that children cannot dislodge easily, but that adults can open and close without difficulty. For the top of stairs, only use gates that screw to the wall. Use safety gates that meet current safety standards. Replace older safety gates that have “V” shapes that are large enough to entrap a child’s head and neck.
Use Door Knob Covers and Door Locks 3 to help prevent children from entering rooms and other areas with possible dangers. Door knob covers and door locks can help keep children away from places with hazards. Be sure the door knob cover is sturdy, and allows a door to be opened quickly by an adult in case of emergency.
Use Anti-Scald Devices 4 for faucets and shower heads and set your water heater temperature to 120 degrees Fahrenheit to help prevent burns from hot water. Anti-scald devices for regulating water temperature can help reduce the likelihood of burns.
Use Smoke Alarms 5 on every level of your home, inside each bedroom, and outside sleeping areas to alert you to fires. Smoke alarms are essential safety devices for protection against fire deaths and injuries.
Check smoke alarms once a month to make sure they’re working. Change batteries at least once a year or consider using 10-year batteries for alarms.
Use Window Guards and Safety Netting 6 to help prevent falls from windows, balconies, decks, and landings. Check these safety devices frequently to make sure they are secure and properly installed and maintained. Limit window openings to four inches or less, including the space between the window guard bars. If you have window guards, be sure at least one window in each room can be easily used for escape in a fire. Window screens are not effective for preventprevent ing children from falling out of windows.
Use Corner and Edge Bumpers 7 to help prevent injuries from falls against sharp edges of furniture and fireplaces. Be sure to look for bumpers that stay securely on furniture or hearth edges.
Use Outlet Covers and Outlet Plates 8 to help prevent electrocution. Outlet covers and outlet plates can help protect children from electrical shock and possible electrocution. Be sure outlet protectors cannot be easily removed by children and are large enough so that children cannot choke on them. If you are replacing receptacles, use a tamper-resistant type.
Use a Carbon Monoxide (CO) Alarm 9 to help prevent CO poisoning. All consumers should install CO alarms near sleeping areas in their homes. Change batteries at least once a year.
CPSC recommends using Cordless Window Coverings 10 in homes with young children, in order to help prevent strangulation. Children can wrap window covering cords around their necks or can pull cords that are not clearly visible but are accessible and become entangled in the loops. If you have window blinds from 2000 or earlier and you cannot afford new, cordless window coverings, call the Window Covering Safety Council at 800-506-4636 or visit WindowCoverings.org for a free repair kit. Window blinds that have an inner cord (for raising the slats of the blinds) can be pulled by a child and form a potentially deadly loop. Consumers should immediately repair these types of blinds. Consumers should know that WCSC’s retrofit kits do not address the dangling pull cord hazard associated with many common window blinds. Use Anchors to Avoid Furniture and Appliance Tip-Overs
11 . Furniture, TVs and ranges can tip over and crush young children. Deaths and injuries occur when children climb onto, fall against or pull
themselves up on television stands, shelves, bookcases, dressers, desks, chests and ranges. For added security, anchor these products to the floor or attach them to a wall. Free standing ranges and stoves should be installed with anti-tip brackets.
Use Layers of Protection with Pools and Spas 12 . A barrier completely surrounding the pool or spa including a 4-foot tall fence with self-closing, self-latching gates is essential. If the house serves as a side of the barrier, doors heading to the pool should have an alarm or the pool should have a power safety cover. Pool alarms can serve as an additional layer of protection. THIS BROCHURE BROUGHT TO YOU BY Sliding glass doors, with locks that must be re-secured after each use, are not an effective barrier to pools.
THIS BROCHURE BROUGHT TO YOU BY: U.S. CONSUMER PRODUCT SAFETY COMMISSION 4330 East West Highway, Bethesda, MD 20814 | Web site: www.cpsc.gov | Toll-free hotline: 1-800-638-2772 The U.S. Consumer Product Safety Commission (CPSC) is a federal agency that helps keep families and children safe in and around their homes. Go to www.cpsc.gov to check for recalled products and sign up for automatic e-mail recall notifications. 14
U.S. CONSUMER PRODUCT SAFETY CO 4330 East West Highway, Bethesda, MD 208 Web site: www.cpsc.gov Toll-free hotline: 1-800-638-2772
St. Elizabeth Healthcare
Learning Link
HELPING YOUR BABY LEARN TO TALK Babies learn an amazing number of things in their first two years, such as how to talk. Some start talking early, and other do not. Most late talkers are busy learning other things, but to be sure, ask a doctor, nurse, or other professional about it if your baby is not talking like other babies. This chart helps you decide when to ask.
Age
Talk with a professional...
3 months
Baby listens to your voice. He or she coos and gurgles and tries to make the same sounds you make.
3 If your 3-month-old does
8 months
Baby plays with sounds. Some of these sound like words, such as “baba” or “dada.” Baby smiles on hearing a happy voice, and cries or looks unhappy on hearing an angry voice.
3 If your 8-month-old is not
10 months
Baby understands simple words. She stops to look at you if you say “No-no.” If someone asks “Where’s Mommy?” Baby will look for you. Baby will point, cry, or do other things to “tell” you pick her up, or bring a toy.
12 months
First words! Baby says 1 or 2 words and understands 25 words or more. Baby will give you a toy if you ask for it. Even without words, baby can ask you for something - by pointing, reaching for it, or looking at it and babbling
18 months
Most children can say “thank you” and at least 30 other words, and can follow simple directions like “jump!”
20 months
Your child can put 2 words together in a sentence, such as “car go” or “want juice.” He can follow directions when you say things like “close the door.” He can copy you when you say several words together.
24 + months
#8842-1
What to look for in a growing, healthy baby
Your child adds endings to words, such as “running” or “played,” or “toys.” She likes hearing a simple children’s story. She understands 3 words about place, such as “in,” “on” or “at.”
8/01
15
not listen to your voice
making different sounds
3 If your 10-month-old does not look when people talk to him or her
3 If your 1-year-old is not
pointing at favorite toys or things he or she wants
3 If your 18-month-old cannot say more than 5 words
3 If your 20-month-old cannot follow simple commands, such as “come to Daddy.”
3 If your 2-year-old cannot say 50 words or does not use 2 words together
Ideas to Help Your Child Learn to Talk When to start
Birth
Do the first activities as long as your child enjoys them. Add new activities as he or she grows older Help your baby learn how nice voices can be. 3 Sing to your baby. You can do this even before your baby is born! Your baby will hear you. 3 Talk to your baby. Talk to others when baby is near. Baby won’t understand the words, but will like your voice and your smile. Baby will enjoy hearing and seeing other people too. 3 Plan for quiet time. Baby needs time to babble and play quietly without TV or radio or other noises.
3 months
Help your baby see how people talk to each other. 3 Hold your baby close so she or he will look in your eyes. Talk to baby and smile. 3 When your baby babbles, imitate the sounds. 3 If baby tries to make the same sound you do, say the word again.
6 months
Help your baby understand words (even if he or she can’t say them yet). 3 Play games like Peek-a-Boo or Pat-a-Cake. Help baby move his hands to match the game. 3 When you give baby a toy, say something about it, like “Feel how fuzzy Teddy Bear is.” 3 Let your baby see himself in a mirror and ask, “Who’s that?” If he doesn’t answer, say his name. 3 Ask your baby questions like, “Where’s Doggie?” If he doesn’t answer, show him where.
9 months
Help your baby “talk” by pointing and using his or her hands. 3 Show baby how to wave “bye-bye.” Tell baby “Show me your nose.” Then point to your nose. She will soon point to her nose. Do this with toes, fingers, ears, eyes, knees and so on. 3 Hide a toy while baby is watching. Help baby find it. Share her delight at finding it. 3 When baby points at or gives you something, talk about the object with her.
12 months
Help your child to say the words she or he knows. 3 Talk about the things you use, like “cup,” “juice,” “doll.” Give your child time to name them. 3 Ask your child questions about the pictures in books. Give your child time to name things in picture. 3 Smile or clap your hands when your child names the thing that he sees. Say something about it.
15 months
Help your child talk with you. 3 Talk about what your child wants most to talk about. Give him time to tell you all about it. 3 Ask about things you do each day-“Which shirt will you pick today?” “Do you want milk or juice?” 3 When your child says just 1 word, like “ball” repeat it with a little extra-“That’s baby’s ball.” 3 Pretend your child’s favorite doll or toy animal can talk. Have conversations with the toy.
18 months
Help your child put words together and learn how to follow simple directions. 3 Ask your child to help you. For example, ask her to put her cup on the table. 3 Teach your child simple songs and nursery rhymes. Read to your child. 3 Encourage your child to talk to friends and family. A child can tell them about a new toy, for example. 3 Let your child “play telephone.” Have a pretend telephone conversation.
2 years
Help your child put more words together. Teach your child things that are important to know. 3 Teach your child to say his or her first and last name. 3 Ask about the number, size, and shape of things your child shows you. If it’s worms, you could say “What fat wiggly worms, how many are there?...“Where are they going?” Wait, watch, and listen to the answer. Suggest an answer if needed: “I see five...Are they going to the park or the store?” 3 Ask your child to tell you the story that goes with a favorite book. 3 Check your local library for programs for toddlers. Ask at your health clinic for other guides. 3 Don’t forget what worked earlier. For example, your child still needs quiet time. This is not just for naps. Turn off the TV and radio and let your child enjoy quiet play, singing, and talking.
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Essential Tummy Time Moves To Develop Your Baby’s Core
The American Academy of Pediatrics recommends placing babies on their backs to sleep and their tummies to play as part of a daily routine. Just a few minutes a day, a few times a day, can help your baby get used to Tummy Time and help prevent early motor delays. If you begin early (even from just a few days old) and maintain a consistent schedule, your baby will learn to love Tummy Time. This helps develop the muscles in their back, neck, and trunk, on their way to meeting all their infant development milestones. Here are the top five moves you can begin as soon as your baby is born: Tummy to Tummy~ Lie down on the floor or a bed, flat or propped up on pillows. Place your baby on your chest or tummy so that you’re face-to-face. Always hold firmly for safety. Eye-Level Smile~ Get down level with your baby to encourage eye contact. Roll up and place a blanket under the chest and upper arms for added support.
Lap Soothe~ Place your baby face-down across your lap to burp or soothe him. A hand on your baby’s bottom will help steady and calm.
Tummy-Down Carry~ Slide one hand under the tummy and between the legs when carrying baby tummy down. Nestle your baby close to your body.
Tummy Minute~ Place your baby on her tummy for one or two minutes every time you change her. Start a few minutes at a time and try to work up to an hour a day in short intervals by the end of three months. Don’t get discouraged. Every bit of Tummy Time makes a difference!
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(800)955-CHILD (2445)
Yeast Infection - Candida Albicans Information for Mothers To help make nursing less painful: • • • • •
Offer short, frequent feedings Nurse first on the least sore side Break the baby’s suction before taking him/her off the breast Ask your doctor about pain medication during the course of the treatment If the nipples are so painful that it hurts to wear clothing, breast shells may be worn while awake to provide comfort
• If your nipples are too sore to put the baby to breast, it may be necessary to express your milk, either by hand or pump, until you are able to nurse the breast again
Ways to cut down on the spread of yeast for the mother Take care to minimize yeast growth. Any items that are damp or come into contact with the baby’s saliva may harbor yeast. • Wash your nipples daily with soap and water • After feeding, rinse nipples with water or with a solution of one cup of water with 1 TBSP of white vinegar. Then dry nipples and apply the medication as directed. Keep breasts dry as possible Yeast thrives on milk and moisture • Change breast pads at each feeding or discontinue use • Clean bra every day. bras need to be washed in hot soapy water (above 122 F) and/or use 1 cup bleach or vinegar in the wash water. Items should be dried in a hot dryer or line dried in the sun. The heat of an iron can kill yeast on clothing • Good hand washing. Use warm soapy water for at least 15 seconds • Paper towels for hand drying, then discard. Yeast can thrive on a moist towel • Use a bath towel only once and wash it • “Air dry” nipples. if possible expose directly to the sun for a few minutes twice a day
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Yeast Infection Continued
For mother and baby • Boil all items that come in contact with the baby’s mouth or your nipples for 20 min each day. This includes all toys, pacifiers, bottle nipples, pump parts, breast shells, nipple shield, etc. Pacifiers and other rubber nipples need to be replaced weekly • A bleach solution of ¾ cups of bleach to 1 gal of water (or 2 TBSP bleach to 2 2/3 cups of water) will disinfect surfaces such as a diaper changing pad, baby furniture and toys • Because family members are in close contact, it is easy to spread yeast infections. All family members should be treated for yeast infections of any kind including: vaginal yeast, jock itch, finger/toenail yeast infections and diaper rash. Even pets can harbor yeast, so all members of the family should be examined for any unusual rashes or sores. Because yeast can be passed during any type of intimate contact, sexual partners may need to be treated. Use condoms during sex. Do not let your partner’s mouth come into contact with your breasts • Change toothbrushes frequently as they may also harbor yeast • Good hand washing is very important
Important points • Many mothers find that symptoms get worse for a short time immediately following the initiation of treatment. This is a normal response to anti-fungal treatment, however if your symptoms do not improve after 3-5 days of treatment, you should contact your doctor • The duration of treatment is very important. You and your baby should be symptom free for at least a week before stopping treatment, otherwise the infection may recur • Restrict consumption of alcohol, cheese, bread, wheat products, sugar and honey. Take acidophilus daily (40 million to 1 billion units) for 2 weeks beyond the disappearance of symptoms • The same ointment that is used on the mother’s nipples can also be used on the baby’s bottom • If the mother has symptoms and the baby never had obvious oral thrush, the baby is not considered particularly “susceptible” so the baby is not treated • If the baby has obvious thrush and the mother has symptoms, both are treated • If the baby has obvious thrush and the mother has no symptoms, either both are treated or the baby is treated and the mother is to call immediately if she develops symptoms
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Yeast Infection Continued
Your provider will prescribe one or more of the following for treatment: Nipple ointment Miconazole {Monistat) or Clotrimazole (Gyne-lotrimin) - apply sparingly after each feeding and wipe off gently before feeding again with a wet washcloth. If using more than one type of ointment you may mix 1/2” of each on a piece of waxed paper. Apply with a clean, new cotton swab for each application. Use until pain free for 1 week.
Gentian Violet Gentian violet spreads quickly, stains and goes everywhere, so the baby should be undressed down to the diaper and the mother from the waist up. Take 4 clean cotton swabs, dip in to the solution, and paint the inside of the baby’s mouth. {Cheeks, gums, tongue and roof). Use a clean, new cotton swab for each part of the baby’s mouth. If you put a used swab back into the medicine bottle you can transfer the fungus from the baby’s mouth to the bottle. At the end of the feeding the baby’s mouth and the mother’s nipple will be purple. If her nipples are not purple, she should paint on some gentian violet with a clean, new cotton swab. Gentian violet may cause staining so take care to protect your clothing. Aerosol hairspray or bleach is effective in removing stains. Applying a thin layer of lanolin to the baby’s lips can minimize staining on the baby’s skin. Stains on the skin usually fade in 1-2 days.
Nystatin oral suspension Mycostatin, Nilsfat, Nystex oral suspension 100,000units/ml. Yeast cells reproduce in about one hour, so using nystatin oral suspension every 3 hrs may be helpful when the infection is not clearing up as quickly as anticipated. When treating with nystatin oral suspension, it is important to shake the bottle well before using. Put a small amount (1ml) into a small cup. Using a cotton swab, apply nystatin well to all surfaces inside the baby’s mouth between the cheeks and the gums, on the tongue, under the tongue, on the roof of the mouth, and between the lips and gums. Unlike other medicines that work when swallowed, nystatin has to come in direct contact with the yeast. The baby should drink the dose that remains after the topical application.
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Circumcision Information For Parents Circumcision
Are There Any Problems That Can Happen After Circumcision?
Circumcision is a surgical procedure in which the skin covering the end of the penis is removed. Scientific studies show a number of medical benefits of circumcision. Parents may also want their sons circumcised for religious, social, or cultural reasons. Because circumcision is not essential to a child’s health, parents should choose what is best for their child by looking at the benefits and risks. The following are answers to common questions about circumcision.
Problems after a circumcision are very rare. However, call your pediatrician right away if: • Your baby does not urinate normally within 6 to 8 hours after the circumcision.
• Bleeding doesn’t stop. • The redness around the tip of the penis gets worse after 3 to 5 days. • Yellow discharge lasts longer than a week. It is normal to have a little yellow discharge or coating around the head of the penis in the first week.
What is Circumcision?
At birth, boys have skin that covers the end of the penis, called the foreskin. Circumcision surgically removes the foreskin, exposing the tip of the penis. Circumcision is usually performed by a doctor in the first few days of life. An infant must be stable and healthy to safely be circumcised.
Reasons Parents May Choose Circumcision
There are a variety of reasons why parents choose circumcision.
Medical benefits, including:
Because circumcision may be more risky if done later in life, parents should decide before or soon after their son is born if they want it done.
• A markedly lower risk of acquiring HIV, the virus that causes AIDS • A significantly lower risk of acquiring a number of other sexually transmitted infections (STIs), including genital herpes (HSV), human papilloma virus (HPV), and syphilis. • A slightly lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised infant boy has about a 1 in 100 chance of developing a UTI in the first year of life. • A lower risk of getting cancer of the penis. However, this type of cancer is very rare in all males. • Prevention of foreskin infections. • Prevention of phimosis, a condition in uncircumcised males that makes foreskin retraction impossible. • Easier genital hygiene.
Is Circumcision Painful?
Yes. However, there are pain medicines that are safe and effective. The American Academy of Pediatrics recommends that they be used to reduce pain from circumcision.
What Should I Expect For My Son After Circumcision?
After the circumcision, the tip of the penis may seem raw or yellowish. If there is a bandage, it should be changed with each diapering to reduce the risk of infection. Use petroleum jelly to keep the bandage from sticking. Sometimes a plastic ring is used instead of a bandage. This should drop off within 5 to 8 days. The penis should be fully healed in about 1 week to 10 days after circumcision. 21
Circumcision Information Continued Social reasons:
Many parents choose to have it done because “all the other men in the family” had it done or because they do not want their sons to feel “different.”
Religious or cultural reasons:
Some groups, such as followers of the Jewish and Islamic faiths, practice circumcision for religious and cultural reasons.
Last Updated 11/21/2015 Source Circumcision: Information for Parents (Copyright © 2007 American Academy of Pediatrics, Updated 8/2012)
Reasons Parents May Choose Not to Circumcise
The following are reasons why parents may choose NOT to have their son circumcised: •
•
•
•
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
Fear of the risks. Complications are rare and usually minor but may include bleeding, infection, cutting the foreskin too short or too long, and improper healing. Belief that the foreskin is needed. Some people feel the foreskin is needed to protect the tip of the penis. Without it, the tip of the penis may become irritated and cause the opening of the penis to become too small. This can cause urination problems that may need to be surgically corrected. Belief it can affect sex. Some feel that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life. Belief that proper hygiene can lower health risks. Boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis, and STIs.
What If I Choose Not to Have My Son Circumcised?
If you choose not to have your son circumcised, talk with your pediatrician about how to keep your son’s penis clean. Keep in mind that the foreskin will not fully retract for several years and should never be forced. When your son is old enough, he can learn how to keep his penis clean just as he will learn to keep other parts of his body clean.
22
Care of the Uncircumcised Penis Our son is not circumcised. When will his foreskin retract?
In the first several years your son’s foreskin will separate from the tip of the penis. Some foreskins separate soon after birth or even before birth, but this is rare. When it happens is different for every child. It may take a few weeks, months, or years. Once this happens, the foreskin can be pulled back away from the tip of the penis. This is called foreskin retraction. Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teen years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until the foreskin fully separates, do not try to pull it back. Forcing the foreskin to retract before it is ready can cause severe pain, bleeding, and tears in the skin.
Smegma
When the foreskin separates from the head of the penis, skin cells are shed. These skin cells may look like white, pearl-like lumps under the foreskin. These are called smegma. Smegma is normal and nothing to worry about.
Cleaning
If your son’s foreskin separates before he reaches puberty, an occasional retraction with cleansing beneath will do. Once your son starts puberty, he should clean beneath his foreskin as part of his daily routine, just like washing his hair and brushing his teeth. Teach your son to clean his foreskin in the following way: Step 1: Gently pull the foreskin back away from the end of the penis. Step 2: Rinse underneath the foreskin with soap and warm water. Step 3: Pull the foreskin back over the penis
Last Updated 5/5/2015 Source Care of the Uncircumcised Penis (Copyright Š 2007 American Academy of Pediatrics, Updated 6/2007) The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. 23
Don’t take lead home from your job! Can lead from work harm my child? Yes. Your child can get lead poisoning if you or someone who lives in your home works with lead.
Some kinds of work make lead dust or fumes. You cannot see lead dust, but it can get on your hands, face, and clothes. You take lead dust from your job to your family when you wear your work clothes and shoes home. Lead dust can get in your car and even on your child's car seat. It can get on furniture, floors, and carpets. Your child can swallow this lead dust and be poisoned.
How do I know if I work with lead? You may work with lead if you: remove old paint tear down or remodel houses, buildings, tanks or bridges work at a shooting range solder pipes make or fix radiators or batteries melt, cast, or grind lead, brass, or bronze recycle or work with scrap metal The law says that your employer must tell you about anything at work which is dangerous, including lead. Your employer is responsible for your health and safety. Talk to your employer about lead, or call the Maine Occupational Disease Registry Program at 207-287-5378. Protect your family. • Check this website: www.maine.gov/healthyhomes • Call for advice: 1-866-292-3474 • TTY: Call Maine Relay 711 24
How can I protect my family from lead poisoning?
Change into clean clothes and shoes at work before you get into your car or go home. Put dirty work clothes and shoes in a plastic bag.
Wash your face and hands with soap and warm water before leaving work.
Take a shower and wash your hair as soon as you get home. (It is better to shower at work if you can).
Wash work clothes separately from all other clothes. Empty your work clothes directly from the plastic bag into the washing machine and wash them. Run the empty washing machine again to rinse out the lead. (It is better if your employer washes the work clothes).
If you have any questions, call the Healthy Homes & Lead Poisoning Prevention Program toll free in Maine. 1-866-292-3474 The Department of Health and Human Services (DHHS) does not discriminate on the basis of disability, race, color, creed, gender, age, sexual orientation, or national origin, in admission to, access to or operation of its programs, services, activities or its hiring or employment practices. This notice is provided as required by Title II of the Americans with Disabilities Act of 1990 and in accordance with the Civil Rights Acts of 1964 as amended, Section 504 of the Rehabilitation Act of 1973 as amended, the Age Discrimination Act of 1975, Title IX of the Education Amendments of 1972 and the Maine Human Rights Act. Questions, concerns, complaints, or requests for additional information regarding civil rights may be forwarded to the DHHS’ ADA Compliance/ EEO Coordinator, State House Station #11, Augusta, Maine 04333, 207-287-4289 (V) or 207-287 3488 (V), TTY: 800-606-0215. Individuals who need auxiliary aids for effective communication in programs and services of DHHS are invited to make their needs and preferences known to the ADA Compliance/EEO Coordinator. This notice is available in alternate formats, upon request.
25
Adapted from: The California Occupational Lead Poisoning Prevention Program and the California Childhood Lead Poisoning Prevention Branch.
June 2013
The Maine Law – M.R.S.A. 29-A § 2081
Maine’s Child Passenger Safety (CPS) law is one of the strongest in the country. The law requires that:
• Children who weigh less than 40 lbs. must ride properly secured in a child safety seat;
and who are less than 8 yrs. old, must ride • Children who weigh between 40 lbs. and 79 lbs. properly secured in a federally approved child restraint system;
• Children who are taller than 4 feet 9 inches in height and who are no longer using a child restraint system, must be properly secured with a seat belt and;
• Children who are under 12 yrs. old and who weigh less than 100 lbs. must be properly secured in the back seat of the vehicle, if possible.
26
Child Passenger Safety Continued
Newest Federal Recommendations The National Highway Traffic Safety Administration (NHTSA) recently released recommendations for children including: • BIRTH – 12 MONTHS. Your child under age 1 should always ride in a rear facing seat. There are different types of rear-facing car seats: Infant-only seats can only be used rear facing. Convertible and 3-in-1 car seats typically have higher height and weight limits for the rearfacing position, allowing you to keep your child rear-facing for a longer period of time. • 1 – 3 YEARS. Keep your child rear-facing as long as possible. It’s the best way to keep him or her safe. Your child should remain in a rearfacing car seat until he or she reaches the top height or weight limit allowed by your car seat’s manufacturer. Once your child outgrows the rear-facing car seat, your child is ready to travel in a forward-facing car seat with a harness. • 4 – 7 YEARS. Keep your child in a forwardfacing car seat with a harness until he or she reaches the top height or weight limit allowed by your car seat’s manufacturer. Once your child outgrows the forward-facing car seat with a harness, it’s time to travel in a booster seat, but still in the back seat. • 8 – 12 YEARS. Keep your child in a booster seat until he or she is big enough to fit in a seat belt properly. For a seat belt to fit properly the lap belt must lie snugly across the upper thighs, not the stomach. The shoulder belt should lie snug across the shoulder and chest and not cross the neck or face. Remember: your child should still ride in the back seat because it’s safer there.
Maine Child Passenger Safety Program Distribution sites:
Located throughout the State of Maine, certified site technicians provide parents/caregivers with car seat education and car seats. Car seats are issued when eligibility criteria can be provided. One-on-one lessons are offered explaining the correct use and installation of car seats and seat belts.
Inspection stations:
Located throughout the State of Maine, certified station technicians provide parents/caregivers with car seat education. One-on-one lessons are offered explaining the correct use and installation of car seats and seat belts. For a location near you, visit: http://www.maine.gov/dps/bhs/child-passengersafety/cps-general/cps-intro.html
27
Lice Treatment Children are commonly exposed to lice which are transmitted by head to head contact. They are pests, but do not carry diseases and often leave sores on the scalp from scratching and are sometimes hard to get rid of. We recommend beginning treatment for head lice with a one time application of permethrin, available over the counter. This treatment is to be applied to the head, left on for approximately 10 min, then washed off with a warm water shampoo. This treatment can be repeated in one week if new live lice are seen or if the child has persistent itching. We would also recommend washing bed linens, car seat covers, and other items your child’s head has been in contact with, in the hot water cycle in the washer. Consider running toys and other objects that may have been snuggling with your child through a hot cycle in the dryer (if they cannot be washed) or sealing them in plastic for one week to assure all lice are eradicated from the toys. Sometimes the medication is not completely effective in killing the eggs or nits. We also recommend combing wet hair - after the permethrin treatment - with a fine tooth nit comb to remove the eggs. Your child’s head should be checked daily for any new live lice or new eggs (nits). If these appear, we would recommend a repeat treatment with permethrin. It is possible to have lice resistant to treatment with permethrin. If you feel you have lice resistant to treatment, please call our office for advice and a prescription for a different medication against lice.
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Lyme Disease The incidence of Lyme disease in Maine in 2015 was 75 confirmed cases per 100,000 people. It is a common problem in our area, and our office receives many calls with concerns about tick bites. As an office, we follow the recommendations of the American Academy of Pediatrics Committee on Infectious Diseases (Red Book 2015) for diagnostic evaluations and treatment.
Tick bite prevention • • • •
Be aware of tick risks in brushy/wooded areas Use DEET (20-30%) insect repellents on skin and consider permethrin-treated clothing to repel ticks Wear clothing that covers exposed skin and remove after potential exposures Check for ticks daily and remove as soon as possible if found
*Ticks attached for less than 36 hours carry little risk of transmitting disease Signs and symptoms of early Lyme disease •
Distinctive rash with central clearing, fatigue, headache, muscle and joint aches
Testing • •
Lyme disease can be a clinical diagnosis in the early stages If signs in the clinical diagnosis are not clear, diagnostic testing is available, though the effectiveness of diagnostic testing is limited in the first weeks of infection. Our office uses a ‘tick panel’ which has a ‘two-tiered’ test for Lyme disease as well as tests for babesiosis and anaplasmosis.
Treatment •
For early localized disease, a two week prescription of antibiotics is sufficient treatment. Antibiotic prescriptions for a longer amount of time are recommended for disseminated disease or late presentations with Lyme disease and are prescribed on a case by case basis.
image: https://www.cdc.gov/ticks/symptoms.html 29
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NORTHERN NEW ENGLAND POISON CENTER Call FAST to treat a poisoning! Call FIRST to prevent a poisoning!
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24 hours a day • 7 days a week
How Your Poison Center Helps You In the United States, poison centers provide
We Help People of All Ages — in All Types of Situations
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TREATING CHEMICAL EXPOSURES ON THE JOB.
POISON
WHEN THEY TAKE TOO MUCH OR THE WRONG MEDICINE.
POISON
POISON CENTER EXPERTS ARE JUST ONE CALL AWAY.
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emergencies. They also provide information about poisons and poison prevention, 24 hours a day, 7 days a week.
eat them, breathe them, or get them in your eyes or
Poisons can hurt you — or even kill you — if you on your skin. The poison center can help you with questions about: • household products • chemicals at work or in the environment • drugs (prescription, over-the-counter, herbal, illegal, or animal medicines) bites, and scorpion
• snake bites, spider stings. For life-saving treatment advice about any kind of poison, call 1-800-222-1222. A specially trained nurse, pharmacist or doctor at your poison center will help. All services are free and confidential. Poison center services are available for people with hearing problems and for non-English speakers. When health care providers need information about treating poisonings, they also call their local poison center.
1-800-222-1222
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immediate treatment advice for poison
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Children learn by imitation. Take your
•
drinking anything.
children to ask an adult before eating or
Poisons can look like food or drink. Teach
1-800-222-1222.
If you think someone has been poisoned, call your poison center right away —
!
© American Association of Poison Control Centers 2003 www.1-800-222-1222.info
The Northern New England Poison Center is supported by funds received through grant # H4BHS00078 awarded by the Department of Health and Human Services, Health Resources and Services Administration. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Health Resources and Services Administration, Division of Healthcare Preparedness, Healthcare Systems Bureau.
Maine Medical Center, a member of the MaineHealth Family; Maine Center for Disease Control and Prevention, Department of Health and Human Services: The United Way; New Hampshire Department of Safety; Vermont Department of Health; Fletcher Allen Health Care.
The NNEPC is supported by:
Swallowed something that’s not food or medicine? Drink a small amount of milk or water. Call 1-800-222-1222.
For more tips, log on to www.1-800-222-1222.info
•
Swallowed the wrong medicine or too much medicine? Call 1-800-222-1222.
Inhaled poison? Get to fresh air right away. Call 1-800-222-1222.
Teach Children to Ask First
medicines where children can’t watch.
Is it medicine? Call it medicine, not candy.
•
using them.
Poison on the skin? Take off any clothing that the poison touched. Rinse skin with running water for 15 to 20 minutes. Call 1-800-222-1222.
the phone.
medicine with you to answer the door or
Are children around? Take the product or
medicines and products.
Read the label. Follow the directions on
•
•
•
Use Poisons Safely
Poison in the eyes? Rinse eyes with running water for 15 to 20 minutes. Call 1-800-222-1222.
Has the person collapsed or stopped breathing? Call 911 or your local emergency number right away.
First Aid for Poisoning
1-800-222-1222
Use child-resistant packaging. But remember —
• nothing is child-proof!
Store poisons in their original containers.
reach them.
locked up, where children cannot see or
Store medicines and household products
•
•
Store Poisons Safely
Poison Prevention Tips
Have a question? All questions about poisons are smart questions. Ask FIRST to prevent a poisoning!
the wrong person.
used the wrong way, in the wrong amount, or by
Products and medicines can hurt you if they are
You Can Prevent Poisonings at Home
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Carbon Monoxide Poisoning and Prevention
Carbon monoxide prevents oxygen from being carried in the blood.
The “Invisible” Killer You cannot see or smell carbon monoxide -but at high levels it can kill you in minutes.
Carbon monoxide is a colorless, odorless, poisonous gas. It enters the body through the lungs, and is delivered to the blood. It prevents the blood from carrying and using oxygen properly, and harms the brain and other organs. Carbon monoxide is made when fuels burn improperly. Many fuels can produce carbon monoxide, such as: • Wood • Oil • Natural gas • Gasoline • Kerosene • Propane • Coal Symptoms Carbon monoxide poisoning begins with flu-like symptoms They include: • Headache • Fatigue • Shortness of breath • Nausea • Dizziness
Risk of Poisoning
• When appliances, equipment, or heating systems burn fuel, there is risk of carbon monoxide poisoning if they are not working properly. (Electric appliances and electric heating systems do not produce carbon monoxide.)
• If the appliances and equipment do not function as they should, have worn parts, or are vented improperly, there is great risk for carbon monoxide poisoning.
Carbon Monoxide Emergency
If you suspect that you have been exposed to carbon monoxide:
• Get to fresh air right away.
• Call 911 or local fire department.
• Call the Northern New England Poison Center at 1-800-222-1222.
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cleaned by professionals once a year before heating season.
• Have your furnace and chimney
• Never leave a car running in a garage, even with the garage door open.
• Never burn charcoal inside a home, garage, closed-in porch, vehicle or tent unless properly vented to the outside.
• Never run a portable generator under windows or indoors, including garages, basements and crawlspaces.
• Check battery-operated carbon monoxide alarms monthly and replace batteries according to the manufacturer’s instructions or when batteries are low.
• Place carbon monoxide alarms close to sleeping areas. Place extra alarms on every level and in every bedroom of a home for more protection.
• Have appliances and heating systems installed by a professional.
Prevention Tips
Call the Consumer Product Safety Commission’s toll-free hotline at 1-800-638-2772 (TTY available at 1-800-638-8270) or e-mail at info@cpcs.gov.
To report a dangerous product or a product-related injury:
The NNEPC is supported by: Maine Medical Center, a member of the MaineHealth Family; Maine Center for Disease Control and Prevention, Department of Health and Human Services; The United Way; New Hampshire Department of Safety; Vermont Department of Health; Fletcher Allen Health Care. The NNEPC is also supported by funds received through grant # H4BHS00078 awarded by the Department of Health and Human Services, Health Resources and Services Administration. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Health Resources and Services Administration, Division of Healthcare Preparedness, Healthcare Systems Bureau.
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Poison Emergencies Prevention Questions Medication Safety
• Diving from or swimming near houseboat platforms while motor is running. • An improperly installed or poorly functioning gas- or keroseneburning appliance.
Relay Service: 7-1-1
Interpretation Services Available
Voice/TTY/
1-800-222-1222
Call the Northern New England Poison Center
• “Teak surfing” or pulling “skiers” from a boat’s diving platform.
• Gas-fueled lanterns and stoves used inside a small, sealed area like a tent, trailer, or boat cabin.
• Gas-powered tools (lawn mower, generator, chain saw) run in a home, garage, or under a tarp.
• Gas or charcoal grill used inside an enclosed area.
Warm Weather Carbon Monoxide Hazards
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