Before Going to the Emergency Room

Abdominal Pain in 4-12 Year Old Children (6:55)

1. A significant number of children who go to the emergency room with concerns of appendicitis are in fact diagnosed with constipation. A child can be constipated despite having daily BM’s.
2. Constant pain or doubling over sweating or ear piercing scream requires immediate call. Abdominal pain that wakes a child at night and persists is also concerning
3. TO GET THE WHOLE STORY PLEASE WATCH THE VIDEO.

Ankle Injuries (4:55)

1. Swelling of the outer part of the ankle bone is rare,
• For older kids, if there is a fracture, x-rays are not always the most definitive determinate of a subtle fracture.
2. Remember R.I.C.E.
   • R. Rest: lie down
   • I. Ice: For at least 20 minutes 3 times a day (can use a bag of frozen peas)
   • C. Compress: Ace bandage wrap for about 7-10 days
   • E. Elevate
3. Crutches can be found at most pharmacies (with instructions on how to use and adjust)
• Recommended that you use crutches to keep weight off of injured ankle
• Within 48-72 hours you can trial using 1 crutch or no crutches – as pain allows.
4. CALL US:
• Any appearance of the ankle being angulated
• The inside of the ankle is painful or swollen
• If your child is worsening after 3-4 days or no better after 7-10 days
• With ANY concerns

TO GET THE WHOLE STORY PLEASE WATCH THE VIDEO.
Remember to look in advance, "Be like a scout, be prepared!"

Understanding Your Child's Asthma Plan (5:23)

How to use a Breathing Chamber (4:57)

The Importance of Holding (Breathing) Chambers in Exercise-Induced Asthma (4:36)

Facial Bug Bites (5:18)

Chest Pain in Children and Young Adults (6:49)

1. 98% of chest pain in children does not involve the heart.
2. Chest pain on exercise is more concerning.
3. Chest pain with significant shortness of breath can mean a collapsed lung.
4. TO GET THE WHOLE STORY PLEASE WATCH THE VIDEO.

Coughs - When to Worry (2:01)

Croup and Stridor - Demonstration (0:22)

Croup: the Fears

Is it a dog?
Is it a seal?
No, it’s my feverish child!
It makes my sleepy mind run wild!

Is it pneumonia, asthma, or bronchitis?
I did hear her with a little laryngitis!

Is that wheezing I hear?
Her throat could close up, I fear!
-Dr. Hartman

Nighttime Croup Attack Plan

Please follow this plan in the event that your child awakes in the night with a fever and a barky cough.

1. If your child is under 6 months old, call the office. If your child is drooling unusually, is difficult to wake up, or if his/her lips, hands or feet are blue, call 911 and then follow steps 2 and 3 below.
2. Take your child into a warm steamy bathroom for 10 minutes.
3. If the cough does not clear, take your child into the cold night air or open a freezer door to breathe the cold air for 10 minutes.
4. If the cough clears consider running a humidifier in the room or opening the bedroom window. If your child sleeps in a bed, you may want to prop him/her up on extra pillows.
5. If your child still has the barky cough or stridor (a wheezy sound made when they breathe in), give your child a dose of Orapred according to the dosing table. Continue to use the steamy bathroom or cold air therapy. The Orapred takes about two hours to work.
6. CALL THE OFFICE IMMEDIATELY IF THIS PLAN DOES NOT WORK.
7. CALL OR EMAIL THE OFFICE IN THE MORNING IF YOU USE THE ORAPRED.
1. We want to note this in your child’s chart.
2. For Westwood Patients the address is wnurse@wmpeds.com.
3. For Mansfield Patients the address is mnurse@wmpeds.com.
4. Please note that, while these email addresses are checked frequently, they should not be used for urgent questions.
8. AS ALWAYS, PLEASE CALL US AT ANYTIME WITH YOUR CONCERNS.

Orapred (prednisolone) dosing table for croup

Child's weight (pounds)	Dose (teaspoons)
15 lbs	1/2 teaspoon twice a day for one day
20 lbs	1/2 teaspoon twice a day for one day
25 lbs	3/4 teaspoon twice a day for one day
30 lbs	1 teaspoon twice a day for one day
35 lbs	1 teaspoon twice a day for one day
40 lbs	1 1/4 teaspoons twice a day for one day
45 lbs	1 1/4 teaspoons twice a day for one day
50 lbs	1 1/2 teaspoons twice a day for one day
55 lbs	1 1/2 teaspoons twice a day for one day
60 lbs	1 3/4 teaspoons twice a day for one day

This dose should be given twice a day for one day.
Please call or email in the morning so we know you have started your child on Orapred (prednisolone).

Croup: the Fears

Is it a dog?
Is it a seal?
No, it’s my feverish child!
It makes my sleepy mind run wild!

Is it pneumonia, asthma, or bronchitis?
I did hear her with a little laryngitis!

Is that wheezing I hear?
Her throat could close up, I fear!
-Dr. Hartman

Croup: the facts

Croup is caused by a virus that inflames the windpipe. It is most common in children under the age of five. The symptoms of croup include fever and barky cough. Croup is almost always worse in the middle of the night.

Although the symptoms of croup can be frightening, it is almost always a mild illness. While about 6% of children under age five will contract croup, only .4% of children will be hospitalized. Croup is a self-resolving illness. The nighttime cough and fever can last for 1-3 days, and a mild daytime cough may last for up to 10 days.

Croup: the plan

Croup can often be treated at home without medications. If the croupy cough is persistent, croup can be treated with a one day course of Orapred (prednisolone), an oral steroid. Orapred decreases the swelling in the windpipe and quiets the barky cough of croup. If your child should come down with croup this season please refer to our “Nighttime Croup Attack Plan”. Please read the plan through now and post it on your refrigerator. As always please contact us with any questions!

Concussion Basics (4:15)

Concussions - Prognosis (4:05)

Cuts/Lacerations (3:51)

To stitch, or not to stitch

Middle Ear Infections (9:30)

1. 80% of ear infections resolve with no antibiotic within 48 hours. Often just pain control with proper dosing of ibuprofen will work.
2. Ear infections do not cause permanent hearing loss except in extremely rare cases.
3. TO GET THE WHOLE STORY PLEASE WATCH THE VIDEO.

Swimmer's Ear (7:37)

Fevers (5:58)

Finger Injuries (4:05)

• There are three types of common finger injuries: crush injuries (for example when the tip of a finger gets slammed in a door or window), hyperextension injuries (when a finger is “jammed”) or fractures.
• Very rarely there may be significant angulation and disfigurement of the finger (not just swelling) or there may be a piece of the bone sticking out of the skin. In these two circumstances, emergency room evaluation and treatment may be necessary.
• The vast majority of finger injuries, however, does not fall into this limited subset and can be safely managed at home (or evaluated in the office during regular hours).
• Well over 75% of such injuries will heal on their own with minimal intervention. Home treatment should include giving Ibuprofen, icing the injured digit and taping the finger to the neighbor finger (“Buddy taping”) or applying a splint (which can be purchased at a local pharmacy).
• If your child has suffered a finger injury and you are not sure whether an Emergency Room visit is warranted PLEASE CALL OUR OFFICE FIRST so we can guide you appropriately.
• TO GET THE WHOLE STORY PLEASE WATCH THE VIDEO.

Tick Bites and Lyme Disease (9:34)

Poison Ivy (4:31)

1. Poison ivy (if the diagnosis is correct) will not get into the eye and cause damage even when the skin around the eyes swells to the point of closing the eye.
2. Poison ivy is not contagious when the rash comes out.
3. Call us before going to the ER we may be able to help and prevent an expensive ER visit.
4. TO GET THE WHOLE STORY PLEASE WATCH THE VIDEO.

How to Perform a Rapid Strep Test (3:25)

When A Sore Throat Is Not A Sore Throat (6:34)