Many people have a runny nose in the wintertime when they are breathing cold air that stops after coming indoors. This is called vasomotor rhinitis. It requires no treatment and has nothing to do with cold or an infection.

How long will it last?
Usually the fever lasts 2 or 3 days. The sore throat may last 5 days. Nasal discharge and congestion may last up to 2 weeks. A cough may last 3 weeks.

Colds are not serious. Between 5% and 10% of children develop a bacterial infection from a cold.
Watch for signs of bacterial infections such as prolonged fevers (more than 3 days), severe ear pain, yellow drainage from the eyes, prolonged (> 1 week) sinus pressure or pain, or rapid breathing (often a sign of pneumonia).
Suspect a sinus infection only if your child complains of pressure, pain or swelling over a sinus and it doesn't improve with nasal washes. Yellow or green nasal discharge is a normal part of the body's reaction to a cold. As an isolated symptom, they do not mean your child has a sinus infection.

How can I take care of my child?
Not much can be done to affect how long a cold lasts. However, the symptoms can be relieved.
Congested or runny nose:
Nasal discharge is the nose’s reaction to a virus. The best treatment is to clear the nose or by suction with a soft rubber suction bulb (especially for infants). Antihistamines are not helpful unless your child has a nasal allergy.
For dry secretions, over-the-counter saline nose drops or warm tap water can loosen the mucus to be more easily blown-out or suctioned.
• Infants may need their nose suctioned to breathe more easily while feeding and sleeping.
Over-the-counter decongestant medicines can decrease congestion and mucus.

Fever: Acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) for aches or mild fever.
Cough: A humidifier can make the air in the room less dry. Over-the-counter cough medicines are available to loosen mucus or suppress cough.
Poor appetite: Hydration is most important during a cold, appetite for food will return to normal in a few days. Encourage drinking fluids by letting the child choose what to drink. Water, juice, Gatorade, Pedialyte, and popsicles are all good choices. Dairy products will not worsen mucus.

Antibiotics for uncomplicated colds have no effect on viruses and could potentially be harmful.

When to call the Doctors’ office
Call IMMEDIATELY or seek IMMEDIATE medical attention if:
*Breathing becomes difficult AND no better after you clear the nose.
*Your child starts acting very sick.
*Fever over 105° F (40.6°C).

Call during office hours if:
*Your infant child is not feeding well.
*The fever lasts more than 3 days.
*The eyes develop a yellow discharge.
*The sore throat last more than 5 days.
*The cough or runny nose lasts more than 2 weeks.
*You have other questions or concerns.

What causes diarrhea?
Diarrhea is usually caused by a viral infection of the lining of the intestines (gastroenteritis). Sometimes it is caused by bacteria or parasites. Occasionally a food allergy or drinking too much fruit juice may cause diarrhea. If your child has just one or two loose bowel movements, the cause is probably something unusual your child ate.

How long will it last?
Diarrhea usually lasts several days to a week, regardless of the type of treatment. The main goal of treatment is to prevent dehydration. Your child needs to drink enough fluids to replace the fluids lost in the diarrhea. Don't expect a quick return to solid bowel movements.

What should I feed my child?
Hydration with fluids is most important during an illness, appetite for food will return to normal in a few days.
Dietary changes are the main treatment for diarrhea.
Note: One loose bowel movement can mean nothing. Don't start dietary changes until your child has had several loose bowel movements.
Fluids: Encourage your child to drink lots of fluids to prevent dehydration. Give your child water as the main fluid for the first 24 hours of watery diarrhea. Fruit juices and dairy products can make diarrhea worse.
Table foods: Keep giving your child table foods while he has diarrhea. Starchy foods (cereals, grains, bread, crackers, rice, noodles, mashed potatoes, carrots, applesauce and bananas) are digested best.

Prevention
Diarrhea is very contagious. Always wash your hands after changing diapers or using the toilet. This is crucial for keeping everyone in the family from getting diarrhea.

Diaper rash from diarrhea
The skin near your child's anus can become irritated by the diarrhea. Wash the area near the anus after each bowel movement and then protect it with a thick layer of diaper rash cream containing zinc oxide or petroleum jelly. This protection is especially needed during the night and during naps. Changing the diaper quickly after bowel movements also helps.
When to call the Doctors' office
Call IMMEDIATELY or seek IMMEDIATE medical attention if:
There are signs of dehydration (no urine in more than 8 hours, very dry mouth, no tears when crying, severely decreased energy level).
Any blood appears in the diarrhea.
The diarrhea is severe (more than 8 BMs in the last 8 hours).
The diarrhea is watery AND your child also vomits repeatedly.
Your child starts acting very sick.

Call during office hours if:
Mucus or pus appears in the BMs.
A fever lasts more than 3 days.
Mild diarrhea lasts more than 2 weeks.
You have other concerns or questions.

(See also Vomiting section)

What is a fever?
A fever means the body temperature is above normal.
The body's average oral temperature is 98.6°F (37°C), but fluctuates during the day. Mildly increased ("low-grade") temperature (100.4 to 101.3°F or 38 to 38.5°C) can be caused by exercise, excessive clothing, a hot bath, or hot weather. Warm food or drink can also raise the oral temperature. If you suspect such an effect, recheck the temperature in 30 minutes.
Fever is over 101.5°F (38.5°C) or 100.4°F (38.0°C) if under 2 months old.
Ear (tympanic) temperatures are not reliable for babies under 6 months old. Rectal temperatures are recommended for babies.

What is the cause?
Fever is a symptom, usually the body's normal response to infections. Fever helps fight infections by activating the immune system. The majority of fevers (100 to 104°F or 37.8 to 40°C) are not harmful. Most are caused by viral illnesses; some are caused by bacterial illnesses. Teething does not cause fever.

How long will it last?
Most fevers due to viral illnesses range from 101°F to 104°F (38.3°C to 40°C) and last for 2 to 3 days. The height of the fever doesn't necessarily relate to the seriousness of the illness. How sick your child acts is what counts. Fevers cause no permanent harm, unless the body temperature is over 108°F (42°C). The brain's thermostat keeps fevers well below this level.

How can I take care of my child?
Extra fluids and less clothing. Clothing should be kept to a minimum because most heat is lost through the skin. Allow the excessive body heat to dissipate by avoiding bundling during a fever. During the time your child feels cold or is shivering (the chills), give him a light blanket. Body fluids are lost during fevers, so encourage your child to drink extra fluids, but do not force him to drink. Popsicles and iced drinks are helpful. These are often the only treatments needed for fevers.

Medicines to reduce fever
Medicines may assist in relieving a fever.
Acetaminophen (Tylenol): Children older than 2 months of age can be given acetaminophen. Give the correct dosage for your child's weight every 4 to 6 hours. Ibuprofen (Advil, Motrin): Ibuprofen is similar to acetaminophen in its ability to lower fever and often lasts 6-8 hours (compared to 4-6 hrs for Tylenol). The FDA has approved it for infants over 6 months of age. Give the correct dosage for your child's weight every 6 to 8 hours. CAUTION: The dropper that comes with one product should not be used with other brands.
Avoid aspirin: Children should not take aspirin. Aspirin taken during a viral infection has been linked to a severe illness called Reye's syndrome.

When to call the doctor's office for fever?
Call IMMEDIATELY or seek IMMEDIATE medical attention if:
Your child is less than 3 months old.
The fever is over 105°F (40.6°C).
Your child looks or acts very sick (regardless of temperature).

Call during office hours if:
Your child is 3 to 6 months old.
The fever is between 104°F and 105°F (40°C and 40.6°C).
Your child has had a fever more than 24 hours without an obvious cause or location of infection AND your child is less than 2 years old.
Your child has had a fever for more than 3 days.
The fever went away for over 24 hours and then returned.
You have other concerns or questions.

(See also Medication Dosage section)

What is vomiting?
Vomiting is the forceful emptying ("throwing up") of a large portion of the stomach's contents through the mouth. Strong stomach contractions against a closed stomach outlet result in vomiting. In contrast, reflux is the effortless spitting up of one or two mouthfuls of stomach contents commonly seem in infants.

What causes vomiting?
Most vomiting is caused by a viral infection of the lining of the stomach or if your child eats something that disagrees with him. Often, a child whose vomiting is caused by a virus also has diarrhea.

How long will it last?
The vomiting usually stops in 6 to 24 hours. Changes in the diet can prevent excessive vomiting and dehydration. Diarrhea usually continues for several days.

How can I take care of my child?
Hydration with fluids is most important during an illness, appetite for food will return to normal in a few days.
Offer small amounts of clear fluids (no solid food) until the vomiting has stopped for 2-4 hours. Examples of clear fluids are: Pedialyte, Rehydralyte, Gatorade, popsicles, and juice. Since the stomach is irritated, start with small amounts of clear fluids (1-2 tsp every 5-10 min for infants, 2-4 ounces every 5-10 min for older children). Drinking too much, too fast will almost always result in a recurrence of the vomiting. Gradually increase the amounts over the next few hours if there is no vomiting. If the vomiting returns, rest the stomach completely for 1 hour and then start over but with smaller amounts.
Offer bland foods after 2-4 hours without vomiting. After 8 hours without vomiting, your child can gradually return to a normal diet. Infants can start with bland foods such as cereal. Older children can start with such foods as saltine crackers, cereals, white bread, bland soups like "chicken with stars," rice, and mashed potatoes. Usually your child can be back on a normal diet within 24 hours after recovery from vomiting.

Medicines
There is no safe, effective medication for vomiting in young children. Occasionally, prescription medications can be used in older children.

When to call the Doctors' office
Call IMMEDIATELY or seek IMMEDIATE medical attention if:
There are signs of dehydration (no urine in more than 8 hours, very dry mouth, no tears when crying, severely decreased energy level).
Your child vomits up blood.
Your child vomits repeatedly over several hours.
Your child starts acting very sick.

Call during office hours if:
The vomiting continues for more than 24 hours if your child is under age 2 years or 48 hours if over age 2.
You have other concerns or questions.

(See also Diarrhea section)

What is conjunctivitis?
Conjunctivitis is inflammation of the conjunctiva. The conjunctiva is the clear membrane that lines the eyelids and covers the white of the eye. Conjunctivitis is sometimes called pink eye (though the white part of the eye, the cornea, often is not pink).

How does it occur?
Conjunctivitis can be caused by many things, including infection by viruses or bacteria. Viruses that cause colds may lead to conjunctivitis. Some bacteria that cause conjunctivitis are chlamydia, staphylococci, and streptococci. Severe conjunctivitis, such as that caused by gonococci, is rare and can cause blindness.
Viral and bacterial forms of conjunctivitis can be spread easily from person to person. They can be spread by coughing or sneezing. Bacteria or viruses can get in your eyes through contact with contaminated objects, including:
" hands
" washcloths or towels
" cosmetics
" false eyelashes
" soft contact lenses

What are the symptoms?
Symptoms may include:
" itchy or scratchy eyes
" redness
" sensitivity to light
" swelling of eyelids
" watery discharge
" discharge of pus

How is it treated?
" Rinse out with water: Rinse the eyes with warm water as often as possible, at least every 1 or 2 hours while your child is awake. Use a fresh, wet cotton ball each time.
" Like a cold, viral conjunctivitis will usually go away on its own, even without treatment.
" Bacterial conjunctivitis requires antibiotic eyedrops or ointment. You can also help your eyes get better by washing them gently to remove any pus or crusts. Then dry them gently with a clean towel.
" Antibiotic Eyedrops: If prescribed antibiotic eyedrops, follow as directed by prescription (usually 2 drops in each eye 2-4 times per day for 5 days). Do this by gently pulling down on the lower lid and placing the drops there. As soon as the eyedrops have been put in the eyes, have your child close them for 2 minutes so the eyedrops will stay inside. If it is difficult to separate your child's eyelids, put the eyedrops over the inner corner of the eye while he is lying down. When your child opens his eye and blinks, the eyedrops will flow in.
" Antibiotic Ointment: If prescribed antibiotic eye ointment, follow as directed by prescription (usually applying 2-4 times per day for 5 days). Separate the eyelids and put in a ribbon of ointment along the lower eyelid from one corner of the eye to the other. If it is very difficult to separate your child's eyelids, put the ointment on the edges of the eyelids. As the ointment melts from body heat, it will flow onto the eyeball.
" For very severe forms of conjunctivitis, antibiotics may need to be given with a shot or an IV (intravenous).
" If you wear contact lenses, you will need to stop wearing them until your eyes are healed. The combination of contacts and conjunctivitis may damage your cornea (the clear outer layer on the front of your eye) and cause severe vision problems

How long will the effects last?
Viral conjunctivitis usually lasts as long as the cold (4 to 7 days).
Bacterial conjunctivitis should improve within 2 days after you begin using antibiotics. If your eyes are not better after 3 days of antibiotics, call your health care provider

How can I prevent conjunctivitis?
To keep from getting conjunctivitis from someone who has it, or to keep from spreading it to others, follow these guidelines:
" Wash your hands frequently. Do not touch or rub your eyes.
" Never share eye makeup or cosmetics with anyone. Throw out eye makeup you have been using.
" Never use eye medicine that has been prescribed for someone else.
" Do not share towels, washcloths, or sheets with anyone with conjunctivitis. If one of your eyes is affected but not the other, use a separate towel for each eye.
" Avoid swimming in swimming pools if you have conjunctivitis.
" Avoid close contact with people until your symptoms improve

Contagiousness
The pus from the eyes can cause eye infections in other people if they get some of it on their eyes. Therefore, it is very important for the sick child to have his own washcloth and towel. He should be encouraged not to touch or rub his eyes because it can make his infection last longer. Touching his eyes also puts a lot of germs on his fingers. Your child's hands should be washed often to prevent spreading the infection.
After using eyedrops for 24 hours, and if the pus is minimal, children can return to day care or school.

When to call the Doctors' office
Call IMMEDIATELY or seek IMMEDIATE medical attention if:
" There is severe eye pain
" The outer eyelids become very red or swollen
" Vision is affected
In the absence of the above situations, conjunctivitis is rarely an on-call emergency and can be treated the next business day.
Antibiotics require a prescription in part because the problem should be evaluated by a doctor before starting treatment. We would prefer NOT to call in antibiotics by phone without having evaluated your child in person. Though most conjunctivitis is routine, serious eye damage can occur if not treated appropriately.

Call during office hours if:
" The symptoms do not improve after using antibiotics medicine for 3 days (bacterial conjunctivitis).
" The symptoms do not improve after 2 weeks (viral conjunctivitis).
" You have other questions or concerns.

What is spitting up?
Spitting up (also called regurgitation or reflux) is the effortless spitting up of small amounts of stomach contents. Formula or breast milk just rolls out of the mouth (occasionally nose) often with a burp. It usually happens during or shortly after feedings. It begins in the first weeks of life.
Spitting up is harmless as long as your infant doesn't spit up large amounts that interfere with normal weight gain.
This condition is also called gastroesophageal reflux (GE reflux).

What is the cause?
Spitting up results from poor closure of the valve (ring of muscle) at the upper end of the stomach.
Spitting up is normal and harmless for most babies.
Spitting up is messy, but it is a normal occurrence during your baby's early months. It rarely involves choking, coughing or pain.
It is a problem if it causes poor weight gain (from spitting up large amounts), choking, or pain from acid damage to the lower esophagus (esophagitis).

How long does it last?
Spitting up improves with age. By 7 months of age, most reflux has decreased or is gone. The reasons for this are probably because the baby is old enough to sit up or is eating solid foods. By the time your baby has been walking for 3 months, even severe reflux should be totally cleared up.

How can be done to improve reflux?
Feed smaller amounts. Overfeeding usually makes spitting up worse. If the stomach is filled to capacity, spitting up is more likely. Give your baby smaller amounts (at least ½ ounce less than you have been giving). Your baby doesn't have to finish a bottle. Wait at least 2 and 1/2 hours between feedings because it takes that long for the stomach to empty itself.
Avoid pressure on your child's abdomen. Don't put pressure on the stomach or play vigorously with him right after meals.
Burp well to reduce spitting up. Burp your baby two or three times during each feeding.
Keep your child in a vertical position after meals. After meals, try to keep your baby in an upright position using a frontpack, backpack, car seat, or swing for 30 minutes. When your infant is in an infant seat, keep him from getting scrunched up by putting a pad under his buttocks so he's more stretched out. After 6 months old, a jumpy seat or infant activity station can be helpful for maintaining an upright posture after meals.
Most infants with spitting up problems should still sleep on their backs, the position recommended by the American Academy of Pediatrics to reduce the risk of SIDS (regardless of reflux). Try to elevate the head of the bed a bit.

Other possible treatments to be discussed with the doctor
Add rice cereal to formula. If your infant still spits up large amounts after all the previous treatments have been tried, you can try thickening the formula with rice cereal. Add ½ teaspoon of rice cereal to each ounce of formula. You may also need to make the nipple opening bigger.
Medications: Children with severe reflux or symptoms of heartburn may need temporary reduction of stomach acid. There are a variety of medications to consider.

When to call the doctor's office for reflux?
Call IMMEDIATELY or seek IMMEDIATE medical attention if:
You see blood in the spit-up material.
The spitting up causes your child to choke or cough.

Call during office hours if:
Your baby is uncomfortable during or shortly after feedings and doesn't improve with the measures listed above.
Your baby does not gain weight normally.
You have other concerns or questions.