This handbook is designed to answer many common questions that parents ask. However, a handbook is not designed to be the answer to all of your questions. WHEN A PROBLEM ARISES WITH YOUR CHILD, PLEASE CONSULT THIS HANDBOOK FIRST. If any questions remain unanswered or you need further assistance, please call our office. As always, our first concern is your child’s health and wellbeing!

Please call the office to make an appointment for all office visits. Likewise, we would appreciate a call if you are unable to keep a regularly scheduled visit. This lets us know that you are OK and perhaps we can fill that vacancy. Urgent visits and emergencies will by necessity take preference over appointments. For your convenience and to aid in separating well children from those who may be contagious, we prefer to schedule only well children check-ups between 9:00 – 11:00 a.m. and 2:00 – 4:00 p.m. Tuesday - Thursday.

Check-ups or “Well-Child” visits are extremely important to the health and wellbeing of your child! At these visits, immunizations and some important tests to look for things like anemia, lead poisoning, or high blood pressure will be checked. This is also an important time to talk about safety, diet and nutrition, growth and development, and also a wonderful opportunity for parents and children to talk with the doctor about any problems or issues in their lives.

Ideally, check-ups should be scheduled at least 1- 3 weeks in advance. CROCKETT KIDS Pediatrics follows the guidelines set forth by the American Academy of Pediatrics for well-child visits:

Prenatal Visit: A chance for the doctor and the parents to get to know each other and to talk about risk factors, and getting the household ready for that new baby!

Nursery Visit: Dr. Benefield  will visit you and your baby while in the hospital. He will check on the baby and identify any problems before you get to go home. General infant care will be discussed like feeding/nursing, baby care, circumcision care, and more!

If a true emergency arises, transport your child immediately to the nearest hospital or emergency room, or call 911 immediately. Have the emergency room staff contact our office on arrival. For urgent problems that arise during office hours, call the office and explain the nature of your problem. Dr. Benefield,or the nurse will direct you to the office, emergency room, or instruct you over the telephone.

For your convenience, the office will take your calls during regular business hours. After-hours calls will be forwarded to Dr. Benefield or the on-call physician, should Dr. Benefield be away. Simply call 762-3341. Listen to the message and follow the voice mail message. Please understand that the doctor will return your call as soon as the opportunity presents.
If you are calling about a prescription refill, have your pharmacy phone number available.
FEEDING QUESTIONS AND GENERAL CHILD CARE QUESTIONS IDEALLY SHOULD BE ADDRESSED AT YOUR CHILD’S CHECK-UP APPOINTMENTS, OR DURING REGULAR OFFICE HOURS!
Most antibiotics, narcotics, and steroids cannot be prescribed without your child first being seen by a physician.

Iron deficiency anemia is the most common form of malnutrition in the United States! Beginning at your 12-Month Check-up, we will periodically check your child’s blood count as a screening for anemia. If your child’s blood count is low, the doctor may prescribe iron drops or pills to correct the iron-deficiency anemia. There are a few things you can do to assure your child gets enough iron:

Bedwetting seems to be more common in boys than in girls, and there is often a family history of the problem. The cause of this problem is unknown in many cases, and probably only represents a delay in the development of normal bladder control. A visit to CROCKETT KIDS is needed to rule out obvious anatomical or medical problems, such as a urinary tract, bladder, or kidney infection.

The treatment of bedwetting is often very frustrating for the child and for the family! Try to enlist your child’s cooperation to solve this problem, and motivate him or her with a reward system, such as stickers for “dry nights”. Dr. Benefield can tell you more, but here are some helpful hints:

Parents of small infants are concerned with the character and frequency of their child’s stools. This is an important concern, but seldom a cause for great worry. Keep in mind that all infants will not have the same stool pattern and that stools will vary depending on what the child eats. Note that breast fed babies can often have a bowel movement after EVERY feed…this can add up to a lot of diaper changes! This is NOT diarrhea and can be perfectly normal. It is normal for babies to grunt and strain to expel stools. If your child has extremely thick pasty stools, or has to grunt excessively to push out little firm balls, he or she is probably constipated. The stool can be softened by giving older children (greater than 4 – 6 months) apple juice or applesauce. Over-the-counter Mylicon Drops are also very useful.

If your baby goes 2 – 3 days without stooling and is uncomfortable, you may insert a sliver of glycerin suppository for relief. Keep in mind that suppositories or enemas should NOT be used routinely as they only relieve the problem temporarily and are NOT a solution. Increasing dietary fiber, using mineral oil, or giving Metamucil or Citrucel according to the package directions can treat constipation in older children.

Chicken Pox is an infection caused by a virus called Varicella. It occurs in most children by age ten. A characteristic rash is usually the first sign of the disease. The rash first appears on the chest or back and then spreads to the neck, face, arms, and legs. A tell tale sign of Chicken Pox is that the rash can even be found on the scalp! There are three types of bumps that you will see:

Children usually run fever for several days with chicken pox, and they can also have cold-like symptoms such as a runny nose, sore throat, or cough. The number one problem from chicken pox is itching! Since too much scratching can cause scarring or a superficial skin infection, it is important to:

Since Chicken Pox is contagious, your child can infect others from 24 hours BEFORE the rash appears, until all the bumps have crusted over! If your child has been exposed to someone with chicken pox, he/she can develop the rash in 10 – 21 days from when the illness was contracted. You may give your child Acetaminophen (Tylenol) for fever if he or she is uncomfortable. NEVER give Aspirin to a child who has been exposed to or already has Chicken Pox!

Recently, the Varicella vaccine has been developed which will hopefully one day eliminate Chicken Pox all together! So what’s the big deal about Chicken Pox anyway? Why does my child need it? Can’t he or she just “go ahead and get it!?”

True, in most cases, Chicken Pox is a relatively benign, short-lived and relatively harmless disease. However, there have been numerous cases in which skin lesions can get infected…to the point that serious antibiotics or skin grafts were required! Also, in rare cases, the chicken pox can affect the nervous tissue in the brain and high fevers can lead to seizures.

SO…just as smallpox, polio, and measles, mumps & rubella are diseases that we have been able to eliminate by widespread vaccination, so too may chicken pox! And besides, many states are now making the Varicella Vaccine mandatory for school or day-care attendance, including Tennessee!

Colic is a problem seen in some infants, usually under three months of age. Typical colic is manifested by:

All crying babies do not have colic! Excessive crying may be due to improper feeding techniques, tension in the family, or pain elsewhere in the baby (earache, urinary tract infection, virus, etc.) If you have questions about whether your child might have colic, consult your doctor or nurse. There are several things you can do to help your baby feel relaxed and restful:

Some “old-time” remedies for colic included such things as paregoric or herbal teas. These remedies are not always the safest for your baby! When in doubt, ask your doctor or nurse first, before trying! REMEMBER: colic does not harm your baby! Although it is very frustrating, it WILL pass! And take heart, colic is NOT a fault of bad parenting and no parent should be blamed or feel responsible for an infant’s colic!

Every baby and child at one time or another is going to catch a cold! In fact, many infants can average up to TEN colds in a year…that’s almost once a month! This is made worse if your child is exposed to those who smoke or goes to daycare. Colds are usually due to a virus caught by the child from the infected nose or throat of another person. Most colds begin with a runny nose, sneezing and watery eyes. Cough and sore throat, seen especially at nighttime or upon waking in the morning may accompany the cold. Children may run fever with the cold for 2 – 3 days. If the nasal discharge becomes really thick, your child may be bothered by a “stopped up” nose or an increased amount of coughing. Colds gradually run their course and disappear in 10 – 14 days unless complicated by another infection or other problem.

The treatment or management of a cold mainly is to treat the symptoms…to make your child (and you!) feel better. Medical science has yet to find a cure for the common cold! Below is a list of things you can do to help manage your child’s cold:

Conjunctivitis is an irritation or inflammation of the thin tissue that covers the eyeball. This is usually caused by a viral or bacterial infection, but can also be caused by allergy, trauma, or chemical irritation to the eye.

Treatment of most episodes of conjunctivitis includes eye drops or ointment. Place 2 – 3 drops or a thin ribbon of ointment in each eye 4 times per day for at least 5 days. If there is no improvement in 4 – 5 days or swelling or redness develops, call the office immediately.

Conjunctivitis is quite contagious! Keep other family members from touching the infected child’s eye drainage and do not share washcloths. Good hand washing is always a good idea!

Croup is usually caused by a viral infection. It causes a loud, dry, almost “barky- like” cough. Sometimes there is also difficulty getting air in, causing a “wheezy” noise on inspiration called stridor.

You can help your child by using a cool mist vaporizer or humidifier in the child’s bedroom. If your child develops stridor or difficulty breathing, which usually occurs at night, you can often relieve the distress by letting your child breathe the steam created by running the shower with hot water in the bathroom. If no relief is given in 10 – 15 minutes, you may find that breathing cool dry air may help your child. In winter months you can simply go outside (bundle up so you don’t chill!). In summer months, let your child breathe the cool mist from the refrigerator or freezer air. If these ideas fail to relieve your child’s distress, call the doctor or seek help in the emergency room. Remember to also try to keep your child as calm as possible and with as little stimulation as possible. “Let a sleeping child lie!”

Dermatitis simply refers to inflammation of the skin due to contact irritants, allergies, heat, etc. If your child’s skin becomes excessively reddened, swollen, crusty, and scaly or has open sores, contact the doctor. Otherwise, most rashes can be treated by:

Keep in mind that infants will acquire a variety of rashes during the first few months, and these rashes seldom require any treatment. For most rashes, it is most important to remove the causative irritant from your child’s environment.

Unfortunately, all babies wearing diapers are prone to developing some degree of diaper rash or skin irritation at some time. Diaper rashes can result from wet baby skin, from allergic reactions to commercial diapers or diaper wipes, or from a fungal infection. The doctor can prescribe the best treatment once the cause has been determined. For any diaper rash, the following will help the rash:

If the rash persists or spreads, call the office.

Most bouts of diarrhea in young children are caused by “stomach viruses”, such as Rotavirus. It is very contagious and often runs through day-care and families. Good hand washing is key in controlling the spread of this virus.

When your child has diarrhea, it is important to encourage liquids to prevent dehydration. The old adage of “putting more in than what is coming out” holds true! Signs of dehydration are:

If your child can make urine or cry tears or make spit, he or she is probably not dehydrated. For infants under a year of age:

Solids are very important if the child is not vomiting. If only liquids are going in, then only liquids are going to come out! As the diarrhea improves, advance the diet emphasizing starchy foods, such as potatoes, bananas, and macaroni.

Over-the-counter drugs like Imodium AD sometimes may be used, but keep in mind that most episodes resolve after 2 – 3 days. Pepto- Bismol is NOT recommended when diarrhea is associated with a flu-like illness because it may contain aspirin, which has been known to cause a rare disease called Rye Syndrome in some patients.

Most cases of diarrhea can be managed without seeing a doctor. However, if the diarrhea is accompanied by abdominal pain or lasts longer than a week, or if there are bloody/red stools, let Dr. Benefield know!

“Breast fed babies are the best babies!” This saying holds true. Breast fed babies have fewer ear infections, gain important protective antibodies from mom, and tend to be bigger! If you cannot breast-feed or choose to formula feed, choose a commercially prepared milk formula with iron (such as Enfamil or Similac with Iron), rather than a homemade preparation. Breast milk and infant formula provide all the calories, water, and nutrients that your baby will require during the first four months of life. For various reasons, some babies may need to begin solids before or later than four months of age. You should always discuss starting solids with the doctor. Likewise, formula switching is not a good idea. If you think your child is “allergic” or not tolerating the formula, let the doctor know so this can be discussed. True milk allergies are rare and formula switching randomly can cause more problems than not!

The goal of introducing solid foods is to provide your child with a more balanced diet. Iron-fortified infant cereal is recommended as your baby’s first solid food. Dry cereal can be mixed with water, breast milk or formula to a pleasant consistency (not too runny or gummy). Start with rice cereal, and over a several week period you should try oat and barley cereals. Since different foods may cause allergies in certain individuals, it is recommended that you introduce only one new food at a time to your baby’s diet. You should then continue that food 4 – 5 days before introducing the next new food. Each feeding should be followed by formula. The amount your child eats depends on his or her desire.

The next food group to introduce is usually vegetables. You may desire to give fruits first, but your baby may grow accustomed to the sweet taste. Begin with the “yellow” vegetables (squash, carrots, and sweet potatoes). Then move to the green ones, still introducing one new food every 4 – 5 days. When beginning fruits, feed individual fruits, not mixed-fruits. Fruit juices, baby or adult, may be introduced after fruits are added to the diet. They are NOT essential to the diet and you want to watch out for too much sugar!

Meats and eggs are usually delayed until 6 months of age. After your baby has tried all of the individual foods above, mixtures may be fed for the sake of variety and convenience.

Baby foods can be very costly and many parents want to know if it is OK to make their own baby food. The answer is YES and NO. It’s OK to make your own baby food, but the most common mistake that parents make is that they make the food to thick (it needs to be very soft and easy to swallow) and it needs to be seasoned according to the baby’s taste…NOT the parents! It is very common for parents to make their own baby food far too sweet or too salty for baby!

Whole cow’s milk (NOT skim milk) can be started at 12 months of age. Children should have 16 – 24 ounces per day. After age two, 2% or skim is OK.

Your child’s appetite will vary from month to month, and even from meal to meal. Do not be concerned by a temporary loss of appetite. Very likely it will be offset by a temporary increase in food consumption. We are more interested in long term slow weight gain than we are by short-term changes in appetite.

Offer your child foods from all food groups each day. Encourage your child to at least try each food on his or her plate, but do not let meal time become a battle ground of strong wills. We do not encourage “grazing”, which allows a child to fill up on snack foods between meals and might decrease appetite at meal times. However, young children do benefit from a limited snack in the morning and afternoon between meals. It is helpful to have meal times on a regular schedule each day.

Foods such as hot dogs, peanuts, grapes, raisins, apples or popcorn are a very real choking hazard for small children!

Fevers are one of the most misunderstood pediatric symptoms! Fevers are not harmful to children, only to the viruses and bacteria children get, and sometimes to their parents’ peace of mind! Fever, in fact, causes more needless worry than any other common childhood symptom. Many parents have false ideas about whether fevers are dangerous, and how and when they should be treated.

Fever can be defined as any temperature above 100.4 degrees Fahrenheit in infants less than 2 months of age and greater than 101 degrees in older children. Children are very susceptible to fever and even a healthy child’s temperature may rise after strenuous activity or on a hot summer day. Most of the time, however, fever develops as the result of viral or bacterial infections. This rise in temperature is actually a normal response. Fever is the body’s attempt to fight off infection and trying to keep a child’s temperature at 98.6 degrees will not only be frustrating, but may actually slow the healing process.

The best advice for treating fever is whatever measures it takes to make your child comfortable. Some children with fevers of 101 degrees lie about the house listless, while others with fevers to 104 degrees continue to laugh and play as if nothing was wrong. The most important step in treating fever is to dress your child in as little as possible, such as a T-shirt. Piling blankets on your child in an attempt to “sweat out” the fever will actually cause more heat to be retained. The only exception is the child with chills, in which case an extra blanket may reduce shivering. Cool liquids will feel good to a feverish child. Your child should be encouraged, but not forced, to drink plenty of fluids during times of fever. One of the most pleasant and effective ways to cool your child is with lukewarm bath water. You should bathe your child thoroughly for 10 – 15 minutes involving the entire body, including the head and shoulders. Never plunge your child into icy water or sponge a feverish child with alcohol, as these measures can actually be harmful!

Whether to use medication to reduce fever depends more on how the child feels than how high the fever is. If your child has a 103-degree temperature but is laughing and playing, you needn’t give him or her anything! If the feverish child is complaining or appears miserable, a dose of fever-reducing medicine is a good idea. Acetaminophen (Tylenol, Tempra, Panadol to name a few) is the medicine of choice and is usually recommended in drop form for infants, as a liquid for toddlers, and in chewable tablets for older children. Acetaminophen is as effective as aspirin for pain and fever, but does not cause side effects like aspirin. Also, the child with flu or chicken pox, who is given aspirin, is at an increased risk for Rye’s Syndrome, a rare but potentially fatal liver disorder.

Newborns or neonates (infants less than 2 months of age) are a different story. A fever in this age group is defined as a RECTAL temperature that is 100.4 degrees or higher. Once again, most fevers are the body’s reaction to a virus. However, newborn’s defense system is not as fully developed as older children and this makes them more susceptible to certain types of infections like pneumonia, urinary tract infections, blood infections (“sepsis”) and an infection called meningitis. It helps that newborns get some protection from mother’s antibodies and breast-feeding helps even more. If your newborn has a fever, let the doctor know immediately!

You should be able to handle most fevers yourself, but some will require special attention. Call Dr. Benefield:

Fever will be one of the most common symptoms during the winter cold and flu season and often most frustrating for parents. The approach to treating your child’s fever should always be directed toward making your child the most comfortable. If you ever have any questions regarding your child and fever, please consult the doctor.

One child in twenty will have a convulsion with fever. Whether or not one occurs has really nothing to do with how high a fever is or how effectively parents are keeping it down. Although the episode can be quite frightening to all involved, simple fever convulsions have no consequences. Ninety percent of these occur in children younger than 3 and they rarely occur after age 5. The seizure may begin with your child appearing dazed or with abnormal eye movements. The child then may shake all over for what may seem forever, but usually only lasts 1 – 5 minutes. If a convulsion begins, DO NOT attempt to restrain your child. You should remove any dangerous objects nearby, check to make sure the airway is clear, then turn your child’s head to one side so that any secretions or vomitus will drain from the mouth. Within a few moments your child should be back to normal or a little sleepy. While everyone recovers, call the doctor.

Head injuries are common during childhood and seldom are severe. Children bounce! There are a variety of signs and symptoms to watch for following head trauma for the first 48 hours. Check your child every 2 hours for the first 24 hours following a head injury. Call the doctor or take your child to the nearest emergency room if any of the following signs or symptoms develop:

Immunizations are an important means of preventing serious childhood diseases. When was the last time you heard of someone having polio, smallpox, or measles? Thanks to immunizations, diseases like these are diseases of the past. Most states, including Tennessee require immunizations prior to school or day-care admission.

Crockett Kids Pediatrics follows the guidelines set forth by the American Academy of Pediatrics, when administering immunizations. These guidelines are updated yearly. As of this printing, the current recommendations are:

Crockett Kids Pediatrics would like to stress the importance of parents keeping their own up-to-date record of their child’s immunizations. Your child’s shot record will be necessary many times throughout his or her childhood, adolescence, and even in adulthood as most high schools and colleges now require proof of immunization for admission. A handy form or card will be given to record all of your child’s immunizations and check-up information. This card will be filled out by the nurses after shots are given. Please bring this form to every well-child check-up! At the completion of the shot series, it is wise to store this record with your child’s birth certificate and other important papers.

If you get your child’s immunizations at the Health Department, please bring your record with you so that we can update our records from time to time and make sure nothing is missed. We cannot complete school forms or physicals without written proof of immunization.

Impetigo refers to a superficial infection of the skin. It is most commonly seen during the summer months and is characterized by yellow, crusty, weeping sores usually located on the arms and legs. Impetigo usually results from Strep or staph infections introduced into the skin by scratching cuts or insect bites. Treatment of impetigo consists of:

Return to the office if the sores are not improving in 5 days, or sooner if the sores spread to other areas of the body or if redness or swelling develops around the sores.

Lice infestation of the scalp is very common in children. Lice are caused by a tiny insect that lays its eggs on the hair shaft. Treatment includes use of a medicated shampoo such as Nix or RID, that may be purchased over the counter. Follow the directions on the bottle. Wash all bedclothes and clothing in hot water. Discard combs and brushes. Check all family members for infestation and treat accordingly.

Nosebleeds are common in children when the air is dry. Running a humidifier in the home can often reduce wintertime nosebleeds. The best way to treat nosebleeds is:

This is an infection of the outer ear canal. It most commonly occurs during the summer months associated with swimming. Since these infections are limited to the external ear canal, the treatment consists of antibiotic drops placed in the ear. Occasionally pain drops for the ear will further provide relief and are also indicated. Any time your child complains of an earache, give him/her Tylenol, Ibuprofen, and/or pain drops and see the doctor if it persists.

Swimmer’s Ear may be prevented in a child who has normal eardrums and no tubes by using an equal mixture of hydrogen peroxide and water, after swimming. (1/2 – 1 cup of peroxide + ½ - 1 cup of water.)

This refers to infection behind the eardrum. It most commonly occurs in children under age 6 and usually follows a cold or sore throat. The infected germs travel up the short tube connecting the ear to the throat (the Eustachian tube) with fluid or pus. This presses on the eardrum causing pain, fullness, and occasionally changes in hearing or equilibrium. Often children will pick or pull at their ears secondary to this fullness.

Believe it or not, most cases of Otitis Media will resolve on their own, WITHOUT antibiotics. In fact, many countries in the world DO NOT use antibiotics so that resistance stays low. The decision to use antibiotics in the United States is to prevent possible side effects from persistent ear infections, such as hearing loss or infection of the bones and other structures around the ear. Most ear infections are caused by viruses, which usually go away in 5 – 7 days. However, many times a child’s resistance is lowered as a result of this viral infection, allowing germs and bacteria to grow and cause further infection. In that case, antibiotics are often prescribed. There are many different kinds of antibiotics, including ones that can be taken by mouth, drops, or even a shot. It is important to always take the ENTIRE PRESCRIPTION the doctor has ordered and have the ear rechecked 10 – 14 days after an episode to assure that the infection has completely resolved.

Pharyngitis refers to red throat and/or tonsils. It can be secondary to viral or bacterial infections (like Strep. Throat), or simply due to sinus drainage. During the winter months, your child may complain of sore throat every few weeks. Viral and Strep. infections are often very similar, and may include sore throat, headache, difficulty swallowing, cough, vomiting, stomachache, fever, or rash. If your child has several of these symptoms and they persist for a few days, let Dr. Benefield know and we can check for Strep. Throat.

Up to 85% of all sore throats are viral in origin. These infections do not benefit from taking antibiotics. If your child does have Strep Throat, he or she will require 10 full days of antibiotics by mouth or a shot of Penicillin. Your child will remain contagious for 24 – 48 hours. Never share a child’s antibiotic with siblings, even if they develop similar symptoms. The need for antibiotics should be evaluated for each child!

Here are some things you can do for sore throats:

Pinworms look like tiny white threads. Usually at night they travel to the rectal opening and lay eggs on the outside skin. This will make a child’s bottom itch and often cause restless sleep and rectal scratching. Since this infection is spread by passage of eggs from fingers to mouth, other family members are also at risk. Pinworms usually require treatment with oral medicine. Frequent hand- washing, keeping nails clean and cut short, and changing underwear and bed linens are important.

Ringworm is a fungus infection that can be caught from a dog, cat, or another person. Ringworm infection on the skin usually has ring-shaped sores with raised and sometimes scaly edges. The center of the ring usually remains clear. Treatment of ringworm on the skin consists of a 7 – 10 day course of anti-fungal medication, such as Lotrimin AF, or Tinactin (both available without a prescription). Come to the office if there is no improvement in several weeks. Other family members should also be checked.

Fungal infection between the toes is commonly termed “athlete’s foot.” Treatment for “athlete’s foot” includes medicated powder or spray or ointment, such as Desenex, Tinactin, or Micatin. Keep the feet as clean and dry as possible, and use cotton socks. Come to the office if blisters develop, or if there is no improvement in several weeks.

Fungal infection of the scalp is a different problem! The fungus gets into the root of the hair and topical creams will not be of benefit. Fungal infection of the scalp may cause flaking or bumps on the scalp and even hair loss. The only effective treatment is a prescription medication taken by mouth for 1 – 2 months. Make an appointment if the affected area becomes red or swollen of if sores develop.

Scabies is a very itchy red rash caused by a small insect that burrows into the skin. It is spread by close contact with other infected persons. Treatment consists of:

Even after adequate treatment, the rash and itching may persist for weeks. Do not over treat. Call the doctor if there is no improvement in 2 weeks.

Seizures (or “fits” or “convulsions”) can occur at any age. If your child has a seizure, stay calm! Remove your child from any danger. Do NOT attempt to force open the mouth and do not offer any fluids by mouth. A doctor must evaluate any child who has a seizure immediately.

Seizures caused by high fever are most common in children ages 6 months to 6 years of age. While they are frightening for the parents, they do not cause any harm to the child.

Sleep patterns, habits, and the need for sleep varies from individual to individual and changes with aging. Most newborns average 20 or more hours of sleep in the first two weeks of life. Thereafter, they usually average 12 – 16 hours per day throughout the first year of life. Since your baby will come home from the nursery without a set day/night schedule, it is important to encourage your child’s waking moments during the day and avoid stimulation at night. The key word is stimulation! Most babies respond to talking, touching, rocking, etc. by trying to stay awake. Throughout daytime feedings you should maximize stimulation of your newborn. At night, limit stimulation as much as possible. Most babies can be expected to sleep through the night by 4 months of age.

It is recommended that babies sleep in their own cribs or beds, in a room separate from the parents. Newborns should be placed on their backs or sides to sleep. Newborns should NOT be placed on their tummies, as they are unable to turn over and can easily suffocate. Avoid placing a lot of pillows or bedding around your baby as well.

Babies should be placed in their cribs or beds while they are still awake, so that they can learn to get themselves to sleep. That way, if they awaken at night, they can get themselves back to sleep. The use of a transitional object, such as a blanket or stuffed animal, may help.

Even when everything is done properly, sleep problems frequently develop late in the first year of life. These problems are manifested by awakening and by crying out in the night. If this occurs, your child should be checked with as little stimulation as possible (gentle words and gentle patting). Reassure your child that you will be nearby, but that you expect your child to go back to sleep. You may want to check your child again every 5 – 15 minutes, but only with minimal stimulation. It is not recommended that your child be fed, rocked, or taken into the parent room as this will reinforce waking and aggravate the problem! Change the diaper if it is wet or dirty.

After the first year of life, family schedules will affect the sleep habits of children. Some families go to bed early and get up early, while others arrive home late and spend their night with the children. Prior to bedtime it is wise not to over excite your child with rough play, exciting TV, etc. Instead, the time prior to bedtime should be spent in a quiet, calming environment. Warm baths, light snacks, and bedtime stories will help relax your child. As your child gets older, we find that bedtime is a good time just to listen to what your child has to say. All parents should take time each day, uninterrupted, and just to listen to their children.

Your child’s first teeth will arrive any time between 2 months and one year of age. Infants react differently to teething: some are fussy and irritable and some have a little diarrhea or runny nose. High fever is not a normal symptom or teething. The best treatment for teething is to give your child a cold pacifier or teething ring to bite on or a rough washcloth soaked in ice water. Massaging the gums with your fingers may also help. You can also try numbing gels like Baby Orajel.

Thrush is a yeast infection of the mouth commonly seen in infants following colds or a course of antibiotics. The first symptom may be reluctance to feed, because the mouth hurts. You may see patchy white spots on your baby’s lips, tongue, gums, palate, and inside the cheeks. The white patches may look like milk but fail to scrape off easily. If you notice thrush in your baby, let us know and we can prescribe the appropriate treatment.

Sucking is a normal and essential function in infants. It is the primary method by which infants get nourishment and a way for them to pacify, occupy and comfort themselves. Thumb sucking and pacifier use in infancy and childhood help to give children a feeling of comfort and help to eliminate discomfort.

It is recommended that pacifier use stop by age 2. After age 4 or so, persistence of thumb sucking can lead to malocclusion or other dental problems. Behavioral problems and impaired peer relationships can be caused by persistence of this habit.

The optimal plan for stopping thumb sucking consists of aversive tastes with a concurrent reward system. Your pharmacist can sell you a foul tasting but otherwise harmless substance to apply to your child’s thumb each morning and evening (and any other time that sucking is observed). Create a grab bag of small rewards or use stickers to reward suck-free days. Fade the aversive taste treatment after the child lasts one week without sucking. Instruct siblings and adults not to nag the child about thumb sucking.

With vomiting, it is important that your child keep from getting dehydrated. Although your child may not feel like eating, try to encourage cool drinks, Pedialyte or Infalyte solution, or pop-sickles. Solid foods may be added once your child feels better or has gone several hours without further vomiting. If vomiting and diarrhea occur simultaneously, treat the vomiting first and then deal with the diarrhea.

You should call the office if the vomiting does not resolve after 24 – 48 hours or the vomiting is accompanied by severe abdominal pain or bloating. Also call if the vomiting produces bloody or black material or if there are any concerns about dehydration. Signs of dehydration include no urine output for 12 hours, sunken eyes, decreased tears or a sunken soft spot in babies.

Once your child is feeling better, try the B.R.A.T. Diet (Bananas, Rice, Apples, Toast, and ‘Taters). Don’t change formulas without discussing with the doctor first!