Frequently Asked Questions

A. Well Child Care

Seeing children and parents at regular intervals is important in maintaining your child's health. Evaluating growth and development, discussing safety, nutrition, behavior and answering age related questions are the functions of well child/adolescent visits. We encourage the following schedule of visits; (the ages mentioned are approximate):

• Prenatal
• Newborn discharge exam (2-5 days of life)
• 2 weeks of age
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months
• 15 months
• 18 months
• 2 years
• Yearly visits ages 2-6 years
• After age 6, yearly, alternate years, or school or sport requirements. PLEASE CHECK YOUR INSURANCE COVERAGE.

During some of these visits, immunizations will be given and routine laboratory tests may be done.

Vision and hearing tests are also given regularly. We encourage advance scheduling of well childcare. For infants, please schedule your next check up at the end of your visit. Otherwise, we suggest you call 6-8 weeks ahead of the time you wish to be seen. We attempt to schedule older children (5 year and older) for their physicals in the summer to keep sufficient time available to see our sick children during the illness season. Generally, we see well children 9-11 a.m. and 1-3 p.m. and sick children later in the morning and afternoon to prevent the spread of illness.

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B. Sick Child Care

Please call us if you are bringing your child in, so that we can have both the chart and a time available. We will see sick children on the same day whenever possible. The best time to call is in the morning so that we can save an afternoon appointment time. If you suspect that your child has a highly contagious disease such as chicken pox, we will schedule your appointment for the latter part of the day.

The appointment time for sick children is shorter than for well child visits. If your child is already scheduled for a well child visit, but happens to be sick, we would recommend rescheduling the visit. If you have an additional sick sibling, please call ahead so that we can accommodate you.

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After Hours Care

When our office is closed, the after hours number (240) 605-3301 should be used. This will reach the doctor who will return your call. If you have an emergency call 911. Otherwise, you will always be able to reach a physician on weekends, evenings and holidays.

If possible, it is best to call before 8:00 p.m. If your child needs medication, it is difficult to get a prescription filled after 8:00p.m. Have the phone number of your pharmacy.

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C. The Common Cold

Colds last from three to seven days, usually with a gradual one to two day onset, followed by full-blown symptoms.

Young Children can normally get up to eight colds yearly or higher if your child is in Day Care; adolescents average two to four per year. Frequent colds in young children are important in building immunities. A cold may be caused by more than 100 different viruses^*. This explains why colds most frequently recur in winter.

Children's colds almost always seem worse at night. During the day time the child swallows secretions from his/her irritated nose easily. But in sleep, secretions accumulate in the throat causing a gag or cough. Coughing is a good reflex, for it guards against aspirating mucous into the lungs and clears the lower airways of germs.

Your child will be more comfortable if the obstruction of his/her nose is relieved. Encourage an increased intake of fluids. Use a cool mist humidifier or a vaporizer. Vaporizers help to moisten the air in the bedroom. It can be used if the child is not close enough or mobile enough to be burned by the steam.

Use a rubber bulb aspirator to suction the nose of a young infant. Salt water (saline) nose drops help loosen the mucus so it is easier to suction. Commercially prepared saline drops such as Ocean, Little Noses, etc. can be used. Use 2 drops in each nostril prior to suctioning. Do not overuse, as this can cause nasal irritation. Unless instructed by your doctor, never use decongestant nose drops or sprays in infants and toddlers.

Never use oral cold medicines in infants younger than 2 years unless directed by a physician due to side effects. For older children, follow the package instructions. Try not to use medications unless the child is really bothered by the symptoms. (Sometimes, they can cause drowsiness or excitability depending on the medication.)

Call the office if:

1. Your child develops a fever of greater than 100.5 degrees Fahrenheit 3 or more days after the onset of a cold.
2. Your child is coughing for longer than 7 days.
3. Your child develops any difficulty breathing more than is due to just a stuffy nose.
4. If you need reassurance.

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D. Does My Child Have Constipation?

Constipation is the passing of hard, dry, and sometimes painful stools.

Constipation: What a Parent Should Do

• Do not dilute the formula.
• Do not reduce the amount of breast feeding or formula.
• Do not use honey with infants (<1 year old) due to the risk of botulism.

For babies 0-6 months of age (and not eating solids):

• Add extra water to the diet (about 1-3 oz each day).
• Mix 2 oz. of water and 1 oz. of prune juice and use in one day.
• Increase physical activity (for example: playing, rocking, moving legs or gently massaging the infant.)

For babies 4-12 moths of age (and eating solids) or children:

First Step

• Encourage your child to drink plenty of fluids. Offer juice or water frequently.
• Give 2 oz. of water (or fruit juice) with 1 oz. of prune juice each day. Do this for 3 days.
• Increase physical activity (tummy time). For example, allow plenty of floor time for play and movement.
• Add high fiber to the daily diet, such as fruits, vegetables, prunes, cooked beans, apricots, plums, peas, broccoli, whole grain breads, whole grain cereal, graham crackers, and bran muffins. Strained foods have little fiber and won't help with constipation.

Second Step

• Add 1 teaspoon (tsp.) of bran to moist foods such as mashed potatoes, cereals, applesauce, casseroles, or ground meats. Give an extra 2-4 ounces of fluid for each teaspoon of bran you add to the diet.
• If your child needs more, add 1 more teaspoon every 2-3 days. Make sure you give an extra 2-4 ounces of fluid for each teaspoon of bran.

Third Step

• If the above doesn't work within 3-5 days, call the child's doctor.

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E. Fever

Definition:

^*Fever is part of the body's normal response to infection. Most infections are caused by viruses, but occasionally a bacterial infection may be present. Fevers due to viral infections usually last 2-3 days. Most children with fever will be tired, irritable, have loss of appetite, and loss of desire to play or maintain normal activities. Fevers usually increase in the evening and at night. This increase does not necessarily mean that the infection is becoming more serious. The height of the fever does not bear any direct relationship to the seriousness of the illness. High fever of itself is not dangerous and does not cause brain damage. The appearance and overall functioning of your child are of more significance than the actual height of the fever. 3% of children are predisposed to having febrile seizures - this is a seizure that occurs with any degree of a temperature rise. These kids should be treated with antipyretics, as soon as possible.

An Approach to Fever:

1. If fever develops (<102 degrees) in a child greater than 3 months old who has no other symptoms and acts well, it is safe to wait and see what happens. Fever is a common symptom of colds and flu like illnesses.
2. Fever in infants less than 3 months of age should never be taken casually. It may represent a serious infection, and such infants should almost always be seen by a physician.

Always call the office if:

1. Fever persists for over 72 hours.
2. Fever develops after the onset of a cold or flu, as this frequently indicates a complication.
3. The fever will not come down below 103 after 24 hours of treatment.
4. The child has a convulsion.
5. The child has labored or difficult breathing.
6. The child has poor fluid intake, especially if there is associated vomiting and diarrhea.
7. There is a marked behavior or personality change or the child is difficult to arouse or is confused or is very lethargic.
8. The child has frequent, painful urination.
9. Any symptom that alarms you.

Treatment of Fever:

Treating fever does not treat the underlying disease, although it can help the child feel more comfortable. It is not necessary to treat low-grade fever, but the following are suggested for temperatures 102 degrees or higher:

1. Dress the child lightly.
2. Increase the fluid intake to make up the increased loss of fluid through the skin and increased breathing rate.
3. Place the child in a bathtub with lukewarm water. No cold baths.
4. Do not use rubbing alcohol. (Toxic Fumes)
5. Acetaminophen can be given every 4 hours or Ibuprofen (Motrin/Advil) can be given every 6-8 hours (if your child is tolerating liquids/solids).
6. DO NOT give aspirin of any kind.

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