As parents we often see it coming – crankiness, sleepiness and loss of appetite followed by a fever. Here Dr. Jessica Long gives advice on when to call the pediatrician.

If there is one complaint or concern that pediatricians get called about the most, it’s fever.  They’re rough – kids are miserable with them, parents are worried about them, and there’s a lot of misinformation on the internet about them.  However, I’m here to calm your fever phobia and hopefully allow you and your child to sleep a little more soundly, even if her temperature isn’t 98.6 degrees Fahrenheit.

What is a fever?

Doctors consider a fever to be a temperature of 100.4 or higher., A fever is not an illness but instead a sign that your child’s body is fighting an infection – whether a virus or a bacteria – and is actually an important part of your child’s defense against these invaders. How high a fever is does not provide any clues as to what your child is fighting.  A common cold can cause a child to have a temperature of 104 while strep throat might raise it to only 100.8.  Don’t let a high number alarm you if your child is otherwise doing ok and likewise don’t ignore a slight fever in a child who looks ill.

What to do?

You actually don’t have to do anything.  If your child is comfortable, playful, and eating and drinking well despite his 101 temperature, it’s ok to just watch and wait.  However, if your child is miserable, then acetaminophen or ibuprofen (in children older than 6 months) is the way to go.  Some stubborn fevers may require that you use both of those medications and it is safe to alternate them if needed.  Be sure to reference a weight based dosing chart, like the one we have here at Spring Valley Pediatrics, to ensure your child is getting the correct amount of medicine.   Giving too small a dose will not reduce the fever as effectively.

When your child has a fever, he will lose fluids more quickly.  Be sure to encourage lots of drinking to avoid dehydration and call your doctor if he is crying without making tears, has a dry mouth or lips, or is not urinating frequently.

When to call your pediatrician

If your baby is under 3 months old and has a rectal temperature of 100.4 or higher, call your pediatrician right away.  Fever and illness can be more serious and progress faster in younger infants so do not hesitate to wake your physician in the middle of the night if your baby has a fever.

If your older child has fever as well as other symptoms – a stiff neck, severe headache or sore throat, rash, repeated vomiting or diarrhea, signs of dehydration – or is unusually drowsy or fussy, give your pediatrician a call.  If your child’s fever continues for 3 days, it’s worth chatting with your doctor about whether or not your child should be brought in for a visit.

The other time to call is when you’re worried, even if your child is not experiencing any of the symptoms above. We are always happy to talk our families through any concerns.  That’s what we are here for.

As parents we all know that immunizations, although necessary, can be a source of anxiety for little ones (and for us!). Here are  Dr. Jessica Long‘s tips on how to keep our children calm during immunization visits.

I always hoped that, since I’m a pediatrician, my children would have no qualms about anything that happens at the doctor’s office. I was wrong. My children get as upset about shots, as fearful of a blood draw, and as manic about opening their mouths for a strep swab as the next kid. But shots don’t have to be a horrible experience for kids and parents alike. There are simple things we can do to calm our child, no matter her age, to make everything go a bit smoother.

Leading up to the doctor’s visit, your toddler or school-aged child may ask if it will hurt. Honesty is the best policy. Let him know that yes, it will hurt for a second, but it won’t be bad and you’re right there with him. Some kids like to role play beforehand, pretending to be the doctor giving shots to their parent or stuffed animal, which can make them more confident for the real thing.

At the doctor’s office, the first step in calming your child is checking in on your own mood. If you are relaxed that will rub off on your little one; if you’re stressed, that will too. How would you feel about getting a shot yourself? Probably not exactly excited about it, but also not too worried or afraid. You should feel that way about your child getting a shot. And your child will notice how you feel, and will tend to feel that way herself. Children are perceptive – pretending won’t help.

At the time of the shot, distraction can be very helpful. An infant may want to nurse, suck on a pacifier, or be skin to skin on a parent, all of which have been shown to reduce the stress of painful procedures in babies. An older child may want to hugged or cuddled, read a book, or even watch a favorite video on your phone. Encouraging your child to cough loudly right before and right after the shot has also been shown to reduce painful reactions in school aged kids and even middle schoolers (yes, they get scared, too).

Congratulate your child on being cooperative and brave, but don’t make too big a deal out of it Give her a high five, a hug or a cuddle to let her know you’re proud of her and then head out for a small reward. In our house we go for cake pops, and knowing there is a special treat waiting for my girls (and me!) at the end of a tough doctor’s visit puts everyone a little more at ease.

Once your baby is mobile, it’s time to start making some changes around the house to protect your curious little one. Read on for tips from Dr. Jessica Long on best practices for baby-proofing.

There are a lot of ways parenthood changes us but one I did not expect was how drastically different our house would look. Never mind the scooters on the front porch, the chalk drawings on the sidewalk, or the toys strewn everywhere inside and out. There are more subtle differences I never would have guessed like covers on the outlets, gates on the stairs, and not a loose coin to be found. Baby-proofing your home is a huge but important endeavor and it involves changing habits and routines you never really knew you had.

How do you even start making your home safe for your little one who, at a very young age, can (and will) start reaching for things and sticking them in her mouth? Suddenly a benign water bottle lid becomes a potential choking hazard. The dog food bowl becomes your child’s most desired possession. And don’t get me started on how every electric cord in the house suddenly becomes a beacon of fun.

As you prepare to baby-proof, I recommend looking in each room in your house, ideally from the much lower viewpoint of your child, to see what potential dangers there are. There are obvious things like installing baby gates at the top and bottom of all stairs but also more subtle hazards like window blind cords that should be tucked out of reach. In bedrooms and living rooms, make sure furniture is secured to the wall so that your curious child does not accidentally topple it over when trying to pull up on it. The same goes for TVs, which are notorious for causing injuries to young children.

In kitchens and bathrooms, invest in strong cabinet and drawer locks so that curious hands do not find medications or cleaners. When possible, store toxic or poisonous substances up high as well as locked away to minimize the chances of your little one accidentally getting ahold of them. Outlets should be covered and electrical cords should be taped down or hidden behind furniture so as not tempt curious babies.

One of the big changes that needs to be made, and maintained over time, is keeping choking hazards out of your child’s reach. Gone are the days where you can toss loose change on the table without thinking or absent-mindedly leave batteries on the counter – both pose serious threats to your child. When ridding your space of choking hazards, use the toilet paper roll rule. If an item is small enough to fit through the cardboard tube, it should be placed out of reach of your child. While this is a routine that can take time to master, it will soon become second nature and ensures your child can crawl, walk, climb and explore in a safe space.

Once you’ve seemingly covered your house in bubble wrap, the next step is seeing what your child gets into. All the baby-proofing in the world doesn’t replace good adult supervision, and watching your child will reveal new hazards to abate Plus, every child is different, so while your first may never have looked at an outlet, your second may be found licking one (true story). You will likely continue to update and change your safety precautions as needed and as your child grows.

 

Most parents, even brand new ones, expect a lot of vaccines in their children’s first few years of life. There are many diseases that we can protect children from – including whooping cough (pertussis), chicken pox (varicella), and the flu – and most well-child visits include at least one shot. But as our kids grow, the shots are fewer and further between until it seems like they’re only getting a flu vaccine each year (speaking of – now’s the time to get yours!).

However, there are many important vaccines that teenagers should get as well. The Centers for Disease Control (CDC) recommends that children between 11-12 get a Tdap booster and a meningitis vaccine, as well as start the HPV series. When your high schooler is 16 years old, a meningitis booster is needed and many pediatricians also start the Meningitis B vaccine series at that age as well.

What in the world are all these diseases and acronyms? Let’s break it down so that you and your child know what to expect and understand the importance of each of these vaccines.

Tdap vaccine

In the first four years of your child’s life, she likely received 5 DTaP shots that protected her from diphtheria, tetanus and pertussis (whooping cough). However, over time the protection the vaccines provide slowly decreases so when kids are 11 years old we give them a booster, confusingly called Tdap instead of DTaP, which provides further immunity against the same diseases. All of these diseases are caused by bacteria. Diphtheria, which causes a very serious throat infection, and pertussis can both spread person to person through sneezing or coughing; we see pertussis outbreaks even in local schools in DC. Tetanus is caused by a toxin made by bacteria in soil and enters the body through cuts, scrapes or puncture wounds to the skin. It can cause muscle spasms and even breathing problems or paralysis. All good reasons to make sure you are up to date with your booster shot!

Meningococcal Vaccines

Most parents have heard of meningitis or seen the very emotional commercials on TV encouraging them to vaccinate their children. This vaccine protects children from any illness caused by a bacteria called Neisseria meningitides, which can lead to an infection of the fluid and lining around the brain and spinal cord or an infection in the blood. Meningococcal disease passes from person to person through saliva – through things like kissing or sharing a drink – and easily spreads when people live in close quarters such as college dorms. This is why we make sure children are fully vaccinated against this disease before they head off to college. Infections caused by Neisseria meningitides are very serious – the CDC estimates that even with treatment about 10 to 15 out of 100 people will die from it.

The meningitis vaccine that children get at 11 years old protects against four types of the bacteria – A, C, W, and Y. In recent years there have been outbreaks of a fifth kind, Meningitis B, on college campuses with some deaths attributed to it. Therefore, the CDC recommends that teenagers also receive a vaccination against Meningitis B. There are two forms of the vaccine available (one is a three shot series and one is a two shot series) so talk with your pediatrician to see if this is a good choice for your teenager.

HPV Vaccine

Infection with the Human Papilloma Virus (HPV) causes 31,000 cases of cancer in women and men a year according to the CDC. While there are over 150 different strains of HPV, they do not all cause cancer. Thankfully we now have a vaccine that protects against the nine strains of HPV that are most likely to cause cancer.

With the HPV vaccine, starting early is best! Studies have shown that kids 11-15 years who complete the HPV vaccine series show such a good response that only two vaccines total are needed. For older teens who are unvaccinated against HPV, three shots total are needed. Therefore your pediatrician will likely recommend your child receive his or her first HPV vaccine at the 11-year old appointment.   Hopefully more cancer preventing vaccines, like the HPV vaccine, are in our future!

The first few months at home with a newborn can be especially stressful, especially when it comes to sleep. Here are Dr. Jessica Long‘s  tips on how to keep your sleeping baby safe.

I am expecting my third daughter in the Spring and the thought of going back to sleepless nights is sort of terrifying. Nothing plagues parents of small children like sleep – or lack thereof – and you would be hard pressed to find a new parent who can get through a conversation without mentioning their baby’s horrible sleep patterns. While I worry about the late night awakenings, I at least do not have to stress about how I put my baby down at night to keep her as safe as possible. With these simple tips you don’t have to either.

Back in the day when we were all babies, most parents placed their little ones on their bellies to sleep. In the 1990s, as studies showed that belly sleeping increased baby’s risks of Sudden Infant Death Syndrome (SIDS), the Back To Sleep Campaign championed a safer sleep position. Since then, the number of SIDS deaths has dropped precipitously – by more than 40% – and we now know of other simple steps you can take to keep your child safe at night.

Babies should sleep in their own space – not in the bed with their parents but ideally in the same room. The American Academy of Pediatrics (AAP) recommends keeping your child in a crib or bassinet in your room for ideally the first year but definitely the first six months. Your little one should have a flat, firm mattress with no pillows, blankets, bumper pads or stuffed animals. Instead of loose blankets that can be wiggled around to accidentally cover a child’s face, you can place your baby in a sleep sack. While they are adorable, baby crib bumpers should be avoided due to cases of babies smothering in them. Yes, a bare crib looks boring but boring is safe when it comes to a baby who cannot move to protect her breathing.

There are many products out there that promise to provide further protection against SIDS. Everything from heart monitors that link to your smart phone to bassinets with build in fans is available for purchase. The AAP does not endorse any of these devices as they have not been shown to actually reduce the risk of SIDS. Unless your child was sent home from the hospital with additional medical monitoring of breathing or heart rate, save your money and your sanity and skip these unnecessary gimmicks.

While following the ABCs (Alone, on her Back, in a bare Crib) of baby sleep positions may not get you any additional hours of sleep, it will at least let you rest easy that your child is as safe as possible while you both catch some hard earned zzz’s. Happy dreaming!