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Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. However, it can be dangerous for babies and toddlers [1].
For babies and toddlers the CDC recommends [1]:
Comments
 Published 9/17/2023 CDC Announcement [1]:
Staying Up to Date with Vaccines [2]:
Updated (Bivalent) COVID-19 Vaccines The updated vaccines are called “updated” because they protect against both the original virus that causes COVID-19 and the Omicron variant BA.4 and BA.5. Two COVID-19 vaccine manufacturers, Pfizer-BioNTech and Moderna, have developed updated COVID-19 vaccines. When Are You Up to Date? Everyone aged 6 years and older You are up to date when you get 1 updated Pfzer-BioNTech or Moderna COVID-19 vaccine. Children aged 6 months—5 years who got the Pfzer-BioNTech COVID-19 vaccine You are up to date if you are:
Children aged 6 months—5 years who got the Moderna COVID-19 vaccine You are up to date when you get 2 Moderna COVID-19 vaccine doses, including at least 1 updated COVID-19 vaccine dose. Sources: [1] https://www.cdc.gov/media/releases/2023/p0912-COVID-19-Vaccine.html [2] https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html  Milk Production After Delivery Mothers produce colostrum for the first few days after delivery (not breastmilk). Colostrum is a yellow fluid that contains all the essential nutrients and antibodies for the baby's first few days of life. Two to five days after delivery, milk production begins. At this time, the breast fluid will turn whitish and breasts may become heavy and tender, sometimes even lumpy. In order to produce milk it is necessary to:
 We are strong advocates of breastfeeding and will help you succeed at it.
Studies have confirmed that Babies who are breast-fed have fewer infections (SOURCE) and allergies during the first year of life than babies who are fed formula. Anecdotal evidence as experienced pediatric physicians confirms this first-hand over the past few decades and thousands of patients. Some advantages:
Note: Babies who are exclusively breastfed should take 1mL or 400IU of Vitamin D drops. Many mothers find breast-feeding one of the most rewarding aspects of baby care.  First Exam
Baby born at Sibley or George Washington (GWU) Hospital? We will usually see him/her at the hospital within the first 24 hours. Baby born someplace other than Sibley or GWU Hospital? We would like to see you in the office within 3-4 days after discharge. We usually schedule the first office visit anywhere from 3-5 days after birth to check the baby’s weight, presence of jaundice and to assist with any feeding issues. Next Exams Please bring the Discharge Summary papers from the hospital to your first visit in the office. In the beginning, check-ups will be relatively frequent while we are following the baby’s initial growth and development. We administer important immunizations during the early months in accordance with the American Academy of Pediatrics guidelines (see schedule of immunizations* link coming soon). Also, parents usually have the most questions during this period and we're here to support you too! Other Preparation You can also prepare in advance by stocking your medicine cabinet.  For Everyone
General tips to keep you feeling good.
Mental Health Mental health is important too! Here are some tips to keep you feeling good mentally as well.
For Babies For you parents of little ones, keep this in mind!
 Here are some helpful links you may wish to keep on hand:
 These downloadable school forms are provided as a courtesy for your convenience. Please check your school district requirements before submitting a school form for completion.
 Sooner or later, every child will fall and strike his or her head. Falls are especially common when your child is learning to walk. Most head injuries simply result in a scalp injury. Big bumps can occur with minor injuries because the blood supply to the scalp is so plentiful. For the same reason, small cuts on the scalp or face can bleed profusely.
Home Care Steps: 1) If there is a scrape, wash it off with soap and water. 2) Apply pressure with a clean cloth for 10 minutes to stop any bleeding. 3) For swelling, apply ice for 20 minutes. (Frozen vegetables such as peas work well or keep a wet sponge in a zippered bag in the freezer). For more serious head injuries, look for the following symptoms:
Call our office immediately if:
 A bump or bruise may cause damage to superficial blood vessels, resulting in a black and blue mark. Since the skin is not broken, there is no risk of infection. Bruises usually follow injury caused by blunt objects.
Unexplained bruises may indicate a bleeding tendency. However, unexplained bruises overlying the shins are usually not a sign of a bleeding tendency. Children often bump this area and then forget about it. Home Care Steps: 1) Apply ice to the bruised area for 20-30 minutes. 2) No other treatment should be necessary. Optional: Give acetaminophen (Tylenol) or Ibuprofen (Motrin) for pain relief. Avoid aspirin. Bruises usually resolve in about 2 weeks. During this time, the color will change from blue to green to yellow. Note: If a blood blister is present do not open it due to increased risk of infection. It will dry up and peel off in 1-2 weeks. Call our office immediately if:
 These wounds occur when the skin has been completely punctured by an object that is narrow and sharp, such as a nail. Since puncture wounds usually seal over quickly, there is a greater chance of wound infection.
Home Care Steps: 1) Soak the wound in warm water and soap for 15 minutes. 2) Scrub the wound with a washcloth to remove any debris. 3) Cut off any flaps of loose skin that cover the wound and interfere with drainage or removing debris. 4) Apply an antibiotic ointment and a bandaid to reduce the risk of infection. 5) Re-soak the area and reapply antibiotic ointment every 12 hours for 2 days. 6) Give acetaminophen (Tylenol) or Ibuprofen (Motrin) for pain relief. Call our office immediately if:
 An abrasion is an area of superficial skin that has been scraped off during a fall, such as a skinned knee. Wash the wound for at least 5 minutes with warm water and soap. The area will probably need to be gently scrubbed several times to get out all the dirt. You may have to remove some dirt particles with a pair of tweezers. Pieces of loose skin may be cut off with clean scissors. Apply an antibiotic ointment and cover the scrape with a bandaid or gauze dressing. Cleanse the area once a day with warm water and then reapply the ointment and dressing until the scrape is healed. Give acetaminophen (Tylenol) or Ibuprofen (Motrin) for pain relief.
Call our office immediately if:
 Small, superficial lacerations (cuts) simply should be cleaned with plenty of soap and water. Apply direct pressure for 10 minutes to stop any bleeding. Apply an over-the-counter antibiotic ointment and cover it with a bandaid or gauze. Wash the wound, apply the ointment, and change the bandaid daily. Do not kiss the wound or use alcohol on the wound. Let the scab fall off by itself. If suturing the wound is necessary, it must be done as soon as possible after the skin is cut. After 4 hours for bite wounds and 18 hours for other wounds, suturing is no longer an option due to risk of infection. If the laceration is deep and the edges are more than one millimeter apart, then the wound should probably be sutured. A deep laceration is more likely to scar if it is not sutured. If you can bring the edges together and keep them together with a “butterfly” bandaid, then suturing may not be necessary. Depending on their location and depth, some lacerations can be repaired at our office using a special “glue” called Dermabond.
Additionally, be sure to check the date of your child’s last tetanus shot. If Dtap [DO NOT USE ABBREVIATIONS] or Td [DO NOT USE ABBREVIATIONS] have not been given within 5 years of the injury, your child might need a booster. Call our office immediately if:
 Be careful with pots, warm air humidifiers, cooking on the stove, hot cups of coffee and soup on the table, matches, fireplaces and of course electrical outlets. Be aware that exposed surfaces of ovens and radiators are sometimes hot enough to cause burns.
First-degree burns are mild and result in redness, slight swelling, and pain. Sunburns are usually first-degree burns. Second-degree burns cause blistering and more intense swelling and pain. Third-degree burns are serious and life threatening, causing charring and destruction of all the skin layers. Usually you can treat a first-degree burn yourself by soaking the burned area in cool water for 10 minutes. Keep it clean, dry and free from sun exposure until it heals. Second-degree burns require our attention, particularly if they occur on the face, hands or feet. First, soak the burned area in cold water. When you bring your child to the office, cover the burn with sterile gauze or a clean cloth (not absorbent cotton). Try not to pop the blisters. Give acetaminophen (Tylenol) or ibuprofen (Motrin) for pain relief. Third-degree (full-thickness) burns require emergency treatment at the nearest hospital. Call 911 immediately. [HOW DO YOU KNOW IF IT'S 1st/2nd/3rd DEGREE?]  Most rashes need to be evaluated in the office. There are many different types and causes of rashes.
Call our office immediately if:
Call our office during regular hours if:
 Babies commonly grunt, push, strain, draw up their legs and become flushed in the face during passage of BMs. However, these behaviors are normal as long as their stool is soft. The painful passage of hard stools is the most reliable sign of constipation in infants and in older children. These children feel a desperate urge to have a bowel movement (BM) but are unable to pass a BM after straining and pushing for more than 10 minutes.
Some children begin to retain stool in order to avoid the pain of passing a hard BM. These children may start to soil themselves as the watery stool in the upper intestines leaks around the impaction. Constipation is often due to a diet that does not include enough fiber or fluids or due to drinking or eating too many dairy products or starchy foods. It is also caused by repeatedly waiting too long to move the bowels. If constipation begins during toilet training, too much pressure may be being placed on the child. Changes in the diet frequently relieve constipation. After your child is better, be sure to keep him on a non-constipating diet so that it doesn’t happen again. Diet treatment for infants less than 1 year of age include:
Diet treatment for infants older than 1 year of age:
Call our office immediately if:
Call our office during regular hours if:
 Diarrhea consists in frequent, loose bowel movements. The best indicator of the severity of the diarrhea is its frequency. The main complication of diarrhea is dehydration from excessive loss of body fluids. Symptoms of dehydration include a dry mouth, the absence of tears, a reduction in urine production (i.e., none in 12 hours), and a darker, concentrated urine. It is the dehydration you need to worry about, not the presence of diarrhea.
Diarrhea is usually caused by a viral infection of the intestines. Occasionally, it is caused by bacteria or parasites. It also can be due to drinking too much fruit juice or to a food allergy. Diarrhea usually lasts from several days to a week, regardless of the treatment. The main goal of therapy is to prevent dehydration. Don’t expect a quick return to solid stools. Since one loose stool can mean nothing, don’t start dietary changes until there have been at least two. Infectious diarrhea is very contagious. Good hand washing is essential for preventing everyone in the family from getting diarrhea. For a child of any age with mild diarrhea (a few loose or mushy stools), continue a regular diet with a few simple changes:
For bottle-fed infants with frequent, watery diarrhea:
For breast-fed infants with frequent, watery diarrhea:
For children over 1 year of age with frequent, watery diarrhea:
Call our office during regular hours if your child has:
 Most vomiting is caused by a viral infection of the stomach (viral gastroenteritis) or eating something that is tainted. It can occur with diarrhea or by itself. In infants, it is important to distinguish between normal amounts of spitting up and vomiting. Many normal infants may have mild reflux and may spit up small amounts of undigested milk soon after feeding. Often, the viral type is associated with diarrhea. The expected course is usually 12 to 24 hours Dietary changes usually speed recovery. If diarrhea is present, it usually continues for several days to a week.
Home care for vomiting includes special dietary changes according to age and normal diet. For bottle-fed infants less than 1 year of age, offer oral rehydration solutions (ORS), such as Infalyte or Pedialyte, for 8 hours. Offer small amounts (1 teaspoon) every 5 minutes for the first hour, then 2 teaspoons every 10 minutes, then 3 teaspoons every 15 minutes. You should aim for total of about 2 ounces per hour, After 4 hours without vomiting, increase the amount. After 6-8 hours without vomiting, return to formula. For infants more than 4 months of age, also return to cereal, bananas, etc. A normal diet is okay in 24 to 48 hours. If your child refuses the Pedialyte, you may give Gatorade, herbal tea, chicken broth or flat sodas. Coca cola syrup is particularly effective in “settling” the stomach.” Try to avoid diet sodas and plain water since they lack any sugar and electrolytes. Once your child has managed to tolerate fluids for at least four hours, you may offer mild foods as tolerated. For breast-fed infants, reduce the amount or feeding and feed more frequently. Your goal is to avoid filling the stomach. Nurse for 5 minutes every 1-2 hours. After 6-8 hours without vomiting, return to regular breast-feeding. For children over 1 year of age, offer clear fluids (water, Pedialyte, or Gatorade) in small amounts for 8 hours. Give small amounts (1 tablespoon) every 10 minutes. After 4 hours without vomiting, increase the amount. For severe vomiting, rest the stomach completely for 1 hour, then start over with smaller amounts. Add bland foods after 6 hours without vomiting. Stay on bland, starchy foods (saltine crackers, white bread, rice, mashed potatoes, etc.) for 24 hours. Call our office immediately if:
 Most sore throats are caused by viruses and are part of a cold. However, about 30% are due to the strep bacteria.
A throat culture or rapid strep test is the only way to distinguish strep throat from viral infection. To provide local pain relief, children over 8 years of age can gargle with warm salt water (1/4 teaspoon of salt per 6-8 oz water). Children over 4 years of age can suck on hard candy, like butterscotch or lollipops, as often as necessary. Children over 1 year can sip on warm chicken broth.  The common cold involves an array of symptoms including runny or stuffy nose, congestion, fever, sore throat, cough, hoarseness, red eyes, and swollen lymph nodes in the neck. A cold or URI is a viral infection of the nose and throat.
Cold viruses are spread from one person to another by droplets through hand contact, coughing, and sneezing, not by cold air or drafts. Since there are up to 200 different cold viruses, healthy children still commonly contract six to ten colds each year. A typical course of cold symptoms may include a fever that lasts 3 days, nose and throat symptoms that last 1- 2 weeks, and a cough that may linger for 2 to 3 weeks. The main things to watch for are secondary bacterial infections such as ear infections, yellow drainage from the eyes, sinus pressure or pain, or difficulty breathing. Home care remedies usually do not impact how long a cold lasts, but can relieve many of the symptoms. Examples of home treatment for associated symptoms include:
The older child should try to gently blow his nose after instilling the saline drops. Use nasal washes 2-4 times per day or whenever your child is having trouble breathing through his nose. When your child sleeps you may use a cool mist humidifier in his or her room. The most effective steam room, however, is your smallest bathroom with the shower running on hot. Sit in the steamy room with your child for 20 minutes three or more times a day. |
AuthorThe staff of Panda Pediatrics, located in Washington, D.C. Categories
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