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Northeast

Pediatric Associates

Of Humble, P.A.

104 East Main Street, Humble, TX 77338-4513, (281) 548-7334

-Appointments


It is desirable to have an appointment to see your child. Everybody wins in this manner, because we see patients more efficiently, and waste less of your time. There are times when your sick child needs to be seen that day. Always call the office early in the morning if possible first, just in case the doctor is at the hospital, or in case your child needs to be referred immediately to the nearest Emergency Room. We will try our best to work your child into the schedule, there may be up to a one hour wait. We try not to interrupt our scheduled patient’s office visits.


Our office hours are Monday-Friday, 8:30am-5:00pm.

We will provide you with an appointment reminder card if an appointment is made while in our office. Please try not to forget your appointment, to be on time, and call early if you cannot come or need to reschedule. Any patient who is later than 15 minutes will be rescheduled. Ofan important situation arises that may delay the schedule, the office staff will notify you. We will try our best not to inconvenience anyone.


One of our doctors is on call at all times, and can be reached through the office number or through our answering service 281-548-2334.


Calls between 5pm-8am should be limited to urgent conditions like: life threatening conditions, respiratory distress, bleeding that cannot be stopped with application of pressure, obstructed breathing, poisoning or burns. These extreme emergencies may also be handled by priority call to an ambulance or Emergency Room. Any telephone call answered that would normally require and office visit will be charged to the patient.


Other emergencies such as continuous vomiting over 12 hours, no fluid intake over 12 hours, continuous diarrhea over 12 hours with no or little fluid intake, minimally arousable child, should be addressed by the Emergency Room after office hours.


Questions dealing with medication dosages can be referred to any 24 hours pharmacy. All refills on medication should be handled during regular business hours. Antibiotics will not be prescribed by telephone without an initial office visit to evaluate the patient.


The term “EMERGENCY” should be used only for life threatening conditions that must be treated immediately such as seizures, bleeding that cannot be stopped with application of pressure, obstructing breathing, or poisoning. Extreme emergencies can occur in which the priority (first) call should be to an ambulance and/or the child taken to the hospital emergency room. If this occurs, please have the ambulance service or the emergency room notify us at 281-548-7334.


-Well Child Checkups

Checkups are recommended frequently during the first two years of life, then yearly after that. The purpose of well checkups is to follow your child’s growth and development, to check for illnesses that may not have shown up until childhood progresses, to screen blood work, urine, vision, or hearing results (as indicated), to provide preventative or instructional discussions or literature, to provide immunization updates, etc. EPSDT examinations are considered a well child checkup time.


-Telephone Consultation

When you call our office, please give us as much information about the problem as possible, including temperature. For several reasons, we prefer to examine sick children at the office because:

We are more certain of the diagnoses when a physical exam is performed.

We can better choose the correct medicine. Use of prescription medication requires expertise and licensure.

We can determine how long to continue medication.

We can decide the follow-up plan.

Information on the website can help you decide about whether or not your child needs to see the doctor for illness. Please do not begin antibiotics on your own. If cultures on blood and urine are necessary, one dose will interfere with bacterial growth and thus prevent an accurate diagnosis.

Most behavior or school problems should be discussed at the office when extra appointment time can be allotted so that necessary details can be reviewed by the physician and detailed suggestions can be provided. Please let our office staff know your child will need extra time for these types of problems.


-Referrals

Referrals to specialists are based on your child’s need for more specialized care from a physician trained in the particular area of need. If your child needs a specialist, our physician will be happy to discuss this with you, provide recommendations, provide records needed by the specialist, continue to work with the specialist to provide ongoing care, lab work, or information.



COMMON ILLNESSES:


1) Fever- A fever is any elevation over 101.5 degrees Fahrenheit (100 F). Temperature can be taken three ways:

Orally or by mouth Auxiliary or under the arm (add one degree) Rectally or by rectum (subtract one degree)

Temperature is not necessarily an indication for calling the doctor immediately. Please observe your child for other symptoms indicating illness such as pulling at ears, cough, red throat,

presence of a skin rash, or if child appears very ill, etc., and schedule an appointment for your child to be examined by the doctor to determine the cause of the illness and make recommendations regarding treatment.

Acetaminophen (Tylenol, generic) can be used to bring fever down. Dosage is based on weight. Infant drops, liquid, chewable and non-chewable tables are available. Dosage of fever and medication may be given every 4 hours. Please use the following dosage chart:

[INSERT CHART]

If Acetaminophen is not effective for fever of 103 F or more, sponge the child with warm water in a bathtub until the temperature is less than 101 F. This usually takes 30-40 minutes. Do not use alcohol or cold/ice water to sponge child. PLEASE DO NOT GIVE ASPIRIN FOR FEVER.


2) Diaper Rash- This may be due to a number of things including moisture, irritants, diapers, yeast overgrowth, diarrhea, allergy, or caused by antibiotic use. Actions that aid healing are:

Bathing in warm water 3-4 times per day Being sure urine and stool are adequately removed Air drying of irritated area as much as possible Ointments such as Vaseline, A&D, Comfortene, Sratoga, Happy Hiney, or Desitin (ointments stay on better than creams or powders) Change brand of diapers Over the counter Lotrimin for diaper rashes

If these measures do not result in healing, please call our office.


3) Skin Rash- Mostly due to contact allergies, drug allergies, poison ivy, or a change in laundry detergent or fabric softener. Can be treated with over the counter Benadryl or Cortisone 10 Plus.


4) Teething- Erupting teeth do not cause high fever, severe diarrhea, or extreme irritability. Extreme symptoms and poor feeding in small infants warrant a doctor’s examination. Clean your child’s teeth with a soft cloth and water until age one, then being using a soft toothbrush and water. Your child should being seeing a dentist at age one. Children place objects in their mouths that have bacteria and viruses that cause fever, diarrhea, and irritability. Teething pain can be alleviated by rolling up a clean wet wash cloth into a cigar shape and tying it into a pretzel knot. Remove excess water and freeze. Try to avoid solutions that numb the gums such as Oral-gel.


5) Colds and Upper Respiratory Infections- These are nearly always due to viruses initially. Antibiotics are not needed to treat viral illnesses. Secondary bacterial infections can occur and can be treated by the doctor. Children with a cold lasting longer than 5-7 days, fever greater than 101 F for 36 hours, green nasal discharge, sore throat for longer than 2 days, or cough that persists all day, should be seen by appointment.


6) Infected Bites and Impetigo- First, clean thoroughly with warm soapy water to remove crusts. Then, clean with peroxide followed by application of antibiotic ointment three times a day. If these lesions do not clear up promptly, the child should be examined.


7) Vomiting- The most common cause is a stomach virus, though vomiting can be associated with many other illnesses. Without other symptoms, vomiting should be treated by not giving anything by mouth for 4 hours. Then, use Infalyte or Pedialyte for infants less than 12-15 months old, and Pediapops/Gatorade can be used in older children. Clear liquids should be given every 5 minutes, either by sips or tablespoons. Try not to use water, sodas, or red colored drinks. Clear soup, jello, or popsicles are also recommended. After 12 hours, if tolerated, you may begin bananas, white rice, apple sauce, toast, oatmeal, or crackers.

If vomiting continues, call the office nurse or doctor.


8) Diarrhea- Watery, frequent bowel movements are also most commonly caused by a stomach virus though other infections can be present. For babies liess than one year of age, please change feedings to only Infalyte or Pedialyte (instead of formula) for 24 hours. If your baby is breast-fed, please continue breast milk.

On the second day, give your baby “half-strength” formula. This is made as follows: If using powder- mix 1 scoop for 4 oz. water (instead of 2 0z.) If using concentrate- mix 1 can for 3 cans of water (instead of 1) If using ready-to-feed- mix 2 oz. with 2 oz. water (instead of straight from the can)

On the third day, you may give “full-strength” formula and resume baby foods. Please begin with bananas and rice.

For older children with diarrhea, please give clear liquids such as Gatorade, white grape juice, clear soup, soft jello, or popsicles. After 12 hours, if tolerated, you may begin crackers, bananas, oatmeal, grits, toast, noodles, baked potatoes, etc. Do not give milk, cheese, ice cream, or other milk products while the diarrheal illness is resolving. Gradually resume other normal diet items.

Even though your child may not seem very hungry, please encourage plenty of fluid intake so that dehydration can be avoided. Signs of dehydration include dry or sticky mouth, cracked/peeling lips, extreme thirst, not urinating, skin with doughy feel, sunken (tired) eyes, loss of weight, fretfulness, anxiety, or disorientation.

If diarrhea continues or you think your child is becoming dehydrated, call the office nurse or doctor. Please do not use any products to treat diarrhea.


9) Diarrhea from Taking Antibiotics- is treated differently than that from infections. Please start feeding yogurt 2-3 times per day and/or giving your child fresh bananas. Rice is also a good food for a child with diarrhea. Avoid foods that aggravate diarrhea such as apples, pears, and prunes. Milk, cheese, and ice cream are Ok during diarrhea from antibiotics. If necessary give Lactinex Granules (over the counter packets, as pharmacist), one packet three times a day, stirred into yogurt or other soft food. You may apply Maalox or Mylanta to diaper area to prevent diaper rash.



INJURIES AND ACCIDENTS:


1) Life Threatening Injuries- Take your child immediately to a hospital emergency room.


2) Household Accidents- The most common is POISONING. The best treatment is prevention by using safety locks on cabinet doors, childproof caps, and storing items known to be toxic well away from a child’s reach in a locked area (i.e. paints, cleaning agents, insecticides, lye, etc). Never mix or store toxic agents in cups or glasses (not even paper or plastic) because a child recognizes a glass to be used for drinking. Items that are colorful or pretty may be mistaken as Koolaid, etc. Even vitamins, Tylenol, and medicines can be toxic if taken in excess. Every family should have a bottle of “Syrup of Ipecac” to induce vomiting after a child has ingested a poison. The dose of Ipecac depends of the child’s weight and is usually 1-2 tablespoons followed by at least 8-16 oz. of water (1-2 tall glasses). If no vomiting occurs in 15 minutes, the dose can be repeated. DO NOT use Ipecac if the ingested substance is oily, i.e. gasoline, turpentine, furniture polish, or is acid or alkali, i.e. lye.

In any ingestion, call Poison Control (1-800-764-7661 or 1-800-POISON1) or the Emergency Room prior to giving treatment. Try to have this information available: name of product, amount ingested, manufacturer, instructions on the label in case of ingestion. It is important that you ask for help as soon as you know that the ingestion has occurred- time makes a significant difference in removing toxin adequately.


3) Burns- Keep pan handles, hot coffee cups, and other hot objects OUT OF REACH AT ALL TIMES. Set hot water heater on 120 degrees. In case of burn, flood the burned area with ice cold water. DO NOT APPLY ointments, and call the office or Emergency Room.


4) Internal Injuries- Blood in urine, stool, or vomit, or severe pain or tenderness in any area warrants an examination. Pallor and/or weakness can also be signs of severe injury.


5) Fractures- Swelling, pain especially on movement, or an obvious (crooked) deviation of the part from the normal position are signs of fracture. The child needs to see a physician.


6) Head Injury- The size of a lump is not as important as other symptoms such as: Loss of consciousness, “knocked out” Unusual drowsiness or stupor Dizziness

Pallor Nausea/vomiting Unusual behavior/personality change Unequal pupils or eye movements Drainage of clear fluid or blood from nose or ear Stiff neck

If any of these symptoms develop, call immediately. It is important that the child be observed closely for the next 72 hours. Arouse the child several times during the night and ask him/her to identify familiar persons or toys, etc.


7) Scratches and Abrasions- Initially, wash well with warm water and soap. Rinse with clear water, pat dry. Clean with peroxide. Apply Bactracin or another triple antibiotic ointment three times a day.


8) Puncture Wounds- Soak in warm soapy water (or betadine) solution three times a day. Apply antibiotic ointment. If the foreign object is still embedded, or if there is persistent swelling, redness, tenderness, oozing or bleeding, or it has been longer than 5 years since a tetanus shot, the child should be seen by a physician within 24 hours of injury.


9) Foreign Body in Eye- Wash with copious amounts of clear water or sterile saline. If child will not let you, if the object will not come out, or if the eye continues to tear or hurt after washing, the child needs to see an Emergency Room Doctor.

Foreign Body in Ear- Usually requires physician removal to prevent injury to eardrum

Foreign Body in Nose- Try to get child to blow nose, this often will dislodge the object. If unsuccessful, the child needs to see a physician.

Foreign Body in Skin- Splinters can sometimes be removed at home if a large enough piece is protruding. However, some require special or small utensils and/or incision and removal by physician. Please sanitize any utensils used at home with alcohol or betadine. Please do not wait longer than 24 hours to remove or have or have the object removed so that an infection will not begin. Clean afterward with peroxide and apply antibiotic ointment.


10) Electric Shock- If severe, call ambulance or Emergency Room. If burned but not otherwise affected, flood burn with cold water, and call physician. Prevention is best accomplished by using plastic plugs in all unused receptacles, eliminating frayed cords, keeping small hands away from electrical cords or appliances, etc.


11) Cuts (Lacerations)- Bleeding should be stopped by promptly applying direct pressure over the cut with a small clean cloth or handkerchief. Cuts that stand open or appear deep usually require sutures (stitches). Cuts in the mouth usually do not require stitches unless bleeding cannot be controlled or it is a very large wound. Cold applied to any cut after bleeding stops, reduces the pain and swelling.


12) Insect Stings- Swelling, redness, itching at the site can be reduced with Benadryl cream or spray and cold compress. Rarely, severe reactions such as fainting, difficulty breathing, severe abdominal pain, hives, vomiting, pallor, and lethargy can occur. This is an emergency and the child should be seen by the physician or an ambulance immediately.


13) Choking or Aspiration- Help the child clear the object by firmly patting his/her upper back or sweeping mouth or suctioning with a bulb syringe. If the child collapses, is unable to breathe (gasping for air) or turns blue, call an ambulance and continue to try to help the child regain an airway. Perform mouth to mouth resuscitation, if possible. Basic Life Support training can be obtained through the American Red Cross. Prevention of choking is best accomplished by close observation and not providing access to small objects that can be aspirated (“gotten down the windpipe”). Nuts, popcorn, raisins should not be given to children less than 3 years old. Pieces of balloons that burst can also be aspirated.


14) Car Safety- Use an approved child auto safety seat (or seat belts if old enough) every time your child rides in the car. IT’S THE LAW.



ROUTINE BABY CARE:


1) Feeding – Human milk is best! If you have any concerns regarding breastfeeding, please contact physician before discontinuing breastfeeding your baby. If breastfeeding is not possible, please discuss which formula to use with the pediatrician. At first, please feed your baby on demand- when he/she is hungry. As time goes along, your baby and your family will develop a schedule of feeding that suits your household. Babies need to eat at least six times in 24 hours, but more times is ok. Breastfed babies should nurse 10-15 minutes on each breast every 2-4

hours. Formula babies usually take 2-4 ounces every 3-4 hours at first and this gradually increases up to 6-8 ounces every 3-4 hours. If your baby is growing, is satisfied, is wetting 6-7 diapers per day and is stooling, your baby is getting enough to eat/drink. At checkups we will measure your baby’s growth.


2) Burping- Air swallowing during feedings or during crying can be relieved by burping your baby between breasts (halfway through a feeding) and after completion of feeding. Try for about 5 minutes to get your baby to burp; if he/she does not, it is ok.


3) Pacifiers- There is no universal pacifier. Different babies have different mouth shapes that do better with different pacifier shapes and bottle nipple shapes. It makes sense that something which simulates a natural breast nipple would be a good thing to try. “Orthodontic” is marketing, not a medical theory, when it comes to nipples and pacifiers. And yes, sometimes even a thumb will pacify a fretful baby. After your child is one year old, use of pacifiers should be discontinued.


4)Colic- For many years the cause of relentless crying in some babies less than three months old was elusive. Now most pediatricians believe that colicky crying is associated with indigestion- like pain in babies caused when stomach contents, including stomach refluxes, come back up from the stomach. Treatment includes: preventing reflux with measures such as a small frequent feedings, diligent burping, prevention of air swallowing (including crying), thickening feedings with rice cereal, using gravity to keep feedings in the stomach by keeping the head up for 45 minutes after feedings use of antacids (Gaviscon, Maalox Plus, Mylanta) to decrease acidity and irritation, use of anti-gas medications (Mylicon or Simethicone) to reduce flatus (gas) and cramping, providing comforting measures such as rocking, holding baby where abdomen is under no pressure, using infant swing, riding in car, placing infant in seat or on top of dryer, and devices which attach to bed and cause vibration. The physician can help you determine to what extent you must go t help you baby with colic symptoms, and remember, most babies outgrow “colic” by three months of age.


5) Sleeping Position- Based on careful evaluation existing data indicating an association between Sudden Infant Death Syndrome (SIDS) and prone (on tummy) sleeping position for infants, the American Academy of Pediatricians recommends that normal infants, when being put down for sleep, be positioned on their back. Sleeping patterns vary among babies. Most babies sleep 1-2 hour naps during the day and at least one 5 hour nap during the night. Adding cereal or other foods to their diet does not necessarily make a baby “sleep through the night”. Be patient and try to establish a schedule for your baby that fits your home schedule comfortably. Leaving lights on during the daytime naps, and making the room dark at night helps a baby set his/her internal clock.


6) Umbilical Cord Care- Cleanse umbilicus with generous amount of isopropyl alcohol at each diaper change. Lift the cord and clean the base, leaving some extra alcohol if possible. Do not be alarmed if a few drops of blood appear. Do not submerge the infant until the cord is off, use a sponge bath instead. Report redness around the naval, oozing of mucous, foul odor, or large

amounts of bleeding to our office. Most cords fall of between 2-3 weeks of age. If it does not occur, the physician can apply silver nitrate to help remove the umbilical stump.


7) Foreskin Care- If your baby boy is not circumcise, do not try to pull back (retract) the extra skin. It is normal for it to take several years for the foreskin to become stretched enough to be retracted. If white waxy material builds up under foreskin, gently clean it at bath time.


8) Circumcision Care- At each diaper change, apply triple antibiotic or Vaseline ointment to the circumcised area for the first week, to allow for healing. The tip of the penis may be reddened or have thick yellow crusts in spots, but these will heal in several weeks.


9) Vaginal Discharge- Many girl infants have whitish discharge from their vagina. This is caused by mother’s hormones that the baby was exposed to before birth. Gently spread the labia (lips) during diaper changes and wipe off urine or stool. This will also gradually remove whitish discharge over time. It is not necessary to try to remove the discharge completely at a diaper change.


10) Nipples- Enlargement during the first months of life is common in many babies and is no need for alarm unless reddened or painful.


11) Soft Spot- The areas on your baby’s head will allow for growth of the brain. We will observe your baby’s head growth at checkups. You may also notice ridges where the skull bones touch.


12) Cradle Cap- Commonly, the scalp of babies begins to have white or golden flakes, or scales. This is caused by the skin replacing itself with new cells and shedding the old cells. It becomes worse if oils, lotions, or ointments are rubbed on the scalp. Simply shampoo your baby’s scalp daily and use a soft brush to remove the scales over several weeks.


13) Earwax- The ear canal makes wax to protect the ear structures. It can be removed by wiping the outer ear at bath time. It is not necessary to remove it from inside the ear canal.


14) Crossed Eyes- Mild crossing during the first months of life is common. It usually corrects itself. Your baby sees only light and dark (20/200) for several weeks, then gradually is able to see eyes and mouths of caregivers and begins to smile. By one year, your baby should be able to see 20/60 (still fairly blurry vision compared to the 20/20 that most older children and adults can see).


15) Eye Color- Most babies have blue eyes at birth and by four months old, they will have the eye color that they will keep for life.


16) Eye Drainage- During the first week, yellow drainage and swelling is usually a result of medication given at birth. After this resolves, other causes could be infection or blockage of the tear duct. Please discuss this with one of our office doctors.


17) Sneezing/Stuffy Nose- Sneezing is a reflex and usually is not a result of a cold or wrong temperature in babies. If, however, your baby develops mucous from his/her nose, please suction it away with a bulb syringe (pump). You may use saline nose spray to help soften the

mucous so it will come out without suctioning. If the mucous is yellow or greenish, please take your baby’s temperature and call our office.


18) Lips- Many babies have a blister on their upper lip from sucking. They do not need treatment for this.


19) Mouth- White patches inside your baby’s cheek, on tongue, or gums is Candida (thrush). This is an overgrowth of yeast and can be treated with prescription medication; you will need to call our office. Do not try to wipe it off. Your baby’s mouth may be sore, and he/she may resist feeding. Sometimes these white patches on the tongue can be milk plaque, and nothing needs to be done.


20) Teeth- Most babies begin extra drooling at about three months old and begin teething at about four months. You can give acetaminophen or ibuprofen which will give four to eight house of relief. Teething toys are short-term helpers. High fever usually is not from teething; please call our office.


21) Legs/Feet- Bowed legs and curved feet usually correct themselves when your baby begins bearing weight and learning to walk. This will be checked at office visits.


22) Skin- After birth white spots may appear on your baby’s nose. These will go away on their own. Bruises caused at the time of birth resolve over one or two weeks. Red dots with small bumps in the center that come and go are “Erythema Toxicum”; they (and pimples) resolve over the first month of life with usual washing of the skin. Peeling or dry skin is common because old layers of skin are shedding. Oil, lotions, creams, or ointments make these worse. Babies with very dry scaly skin may have eczema. The patient should be bathed with Dove unscented soap only. Bathe every other day for 5 months. Dry off and immediately coat skin with plain Vaseline (Petroleum Jelly).


23) Yellow Jaundice- In most cases, the yellow discoloration of a newborn baby’s skin is a minor problem. It is caused by extra bilirubin that is present because of the breakdown of extra blood cells and the immature (slow) liver of the baby. This type of jaundice is physiological jaundice. It improves as the liver beings to work better and as light on the baby’s skin causes the breakdown of the extra bilirubin. This type of jaundice stays slightly longer in a breastfed baby.

Jaundice needs specific treatment when the level becomes high. Your baby’s doctor will decide if special treatment is needed. Some severe conditions such as blood group incompatibilities or infections cause jaundice requiring more intense treatment.


24) Crying- This is your baby’s way of communicating to you his/her needs since babies cannot talk. Sometimes it means hunger, diaper change needed, too cold/hot/bored, needing to be held, or need of a pacifier. Crying could be from tummy gas, sickness, teething, change in schedule, family crisis, etc. Provide for the obvious needs/check into the possible needs, including taking your baby’s temperature. If the baby has inconsolable crying call for an appointment.


25) Stools- Breastfed baby stools are usually yellow and watery with curd0like or mustard-like consistency. The stools occur after each feeding until several months old when they become less frequent. A baby may even go one week without stooling. Breast milk stools have much less odor than formula stools.

Formula fed babies stool 1-3 times a day. The stool is dark brown and pasty or formed, at first, but this changes to a tan, formed stool.

Color changes in stools are not of much concern, except if you notice blood in the stool. Please report this to a doctor.

Constipation occurs when stools become hard and pebble-like and cause your baby pain when they are passed. Giving more formula (or water) is the first step in relieving constipation. If this is not enough relief, you may use a Pediatric Glycerin Suppository (over-the-counter) or give your baby sugar water (2 ounces of water with one tsp of sugar). If constipation persists, please call our office for further advice on treatment.

Babies frequently grunt and strain when stooling, but this is present even when your baby is not constipated. Remember, your baby is lying down and trying to have a bowel movement.