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Newborn Handout

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Insect Bites

• Itch X or Pramosone topically for itching
• Benadryl or other antihistamine orally

Tick Bites

• Grab the tick close to the head and pull with constant tension
• If the head does not come out, cleanse the area well, get the child's skin  nice and soft and see if you can prick out the remainder with a pin.  If you cannot get the head out observe for signs of infection
• With any tick bite watch for :
  • Fever, headache and rash 3-7 days later seen in rocky Mountain Spotted Fever and Erhlichiosis
  • A persisting spot at the tick bite for several days to weeks then a slowly expanding rash around the bite site as seen in Lyme Disease
  • Tender swollen lymph nodes suggestive of infection near the bite site

Stings

• Place ice on site
• Give Tylenol or Motrin for pain
• Use Itch X or Pramosone for itching
• Benadryl  orally for itching

Animal Bites

• Dog Bites generally are not sutured unless gapping or on a cosmetically important place like the face. Cleanse the area well. Observe  for signs of infection: redness, tenderness or drainage.
• Cat Bites are almost never sutured and very frequently become infected.  If a cat bite is very deep or significantly breaks the skin call your doctor.  Your child might be placed on antibiotics to prevent infection.
• Human Bites that are significant--not bites by a toddler but bites like those occurring during a fight should be placed on antibiotics and there may be concerns about viral transmitted diseases (Hepatitis B etc)

Bumps and Lumps

• Newborns frequently have harmless bumps in the scalp that are lymph nodes.
• Children may have bumps in scalp from bites or lymph nodes in scalp or behind ear.  These are harmless unless tender
• Children may have small bumps that stick out from the neck when the head is turned.  These may be a valve in a vein or more likely a lymph node.  If these are tender or increasing in size they should be seen during regular office hours.
• Children of all ages may have small pea size lumps in the groin region and in the arm pits.
• Lumps in the neck, under the arms, and in the groin that are red, very tender or nickel size or bigger  need to be seen in the office because they may be infected.
• Infants may have lumps under the nipple that are in response to hormones.  These go away with time and are not important unless suddenly much bigger and tender with overlying redness.
• Both boys and girls in the pre-pubertal and pubertal  years may get a temporary breast bud on one or both sides.  Often this is mildly tender and first notice when the area is hit.  This is harmless.
• Hernias will be a lump in the groin  near the base of the penis.  There is usually a lump that appears when the child stands up or strains and disappears at other times.  Sometimes the hernia will poke down into the scrotum.  A hernia that disappears or can be made to disappear can be observe until seen in the office.   A hernia that is hard, very tender, and cannot be made to disappear may be incarcerated and needs to be seen in the ER.

Head Trauma

Goose Eggs in the forehead are are seldom associated with serious head trauma.  Ice can be applied and the child observed. 

 The following are some suggestions that will help you decide whether your child needs to be seen and examined after minor trauma:

            1)  Age of the child.  The younger the infant, the more likely is the possibility of significant injury.  An infant under nine months of age whom has head trauma resulting from a fall of 3 or more feet or who develops swelling from a fall should  prompt a call to the doctor and may need to be seen and examined.

            2)  Loss of consciousness or persistent alteration of conscious-ness in any child.  Often following a fall a child may seem briefly stunned, then cry and then continue to appear normal once settled down--this child needs only home observation. However, one with true loss of consciousness should be seen.  Often following mild head trauma a child may appear sleepy, either from the fall or from crying hard and long immediately after the fall.  This child may be allowed to sleep 15 or 20 minutes.  However, persisting drowsiness necessitates an evaluation as does any child with difficulty walking, talking or performing normal activities after a fall.

            3)  Vomiting.  Sometimes from hard crying immediately after trauma a child may become so upset that he vomits once or twice.  A child with persistent vomiting 4 or 5 times or who has vomiting several hours after head trauma should be seen.

            4)  Seizure or obvious neurologic signs.  An ambulance should be called immediately by dialing 911.  The child should not be transported by car.  Roll the child to his side.  DO NOT ATTEMPT TO PLACE ANYTHING IN HIS MOUTH.

             In observing children after head trauma, first offer sips of clear fluids until it is apparent that no nausea or vomiting is occurring.  Keep him relatively quiet.  Check the child frequently to see if he responds appropriately.  Watch for difficulty following orders or performing routine activities. Tylenol may be given for pain.

          SEAT BELTS AND BICYCLE HELMETS ARE THE TWO MOST EFFECTIVE MEANS OF PROTECTING YOUR CHILD FROM SERIOUS HEAD TRAUMA

Could It Be Broken?

• An extremity that is misshapen or has obvious swelling may be broken and needs to be seen on an  emergent basis.  Other extremities can be observed after ice and pain medicines have been given.
• Elbow injuries that have swelling and pain need to be seen.
• Fractured clavicles will give pain in the shoulder.  There will also be pain if you pick a child up by his arms.  Children with suspected broken clavicles can be placed in a sling  until office hours.
• Nursemaid’s elbow most often results from a pulling injury on the arm which pops a tendon out of place. The arms hangs limply at the side or the child holds the arm at the wrist and will not move it. If your are sure this is the problem, then holding the affect arm straight out with the palm up and thumb out then turning the arm all the way around so that the thumb points out again will fix most nursemaid’s elbows
• A child who injures his ankle and immediately is unable to bear any weight or walk may have broken his ankle and needs to be seen.  This not very common.  Most ankle injuries are sprains.
• Most knee injuries do not need to be seen in the emergency room unless the knee cap is dislocated and will not go back in place.

Sprained Ankles

Sprains result from rolling or twisting of the ankle inward that stretch ligaments.  Sometimes a pop can    There is usually tenderness and swelling below and in front of the outside ankle bone.  Sprains do not need to be seen in the emergency room

Treatment of Sprains - think of RICE.

• R - Rest
• I -  Ice applied 20 minutes at a time.  A  bag of frozen vegetables works well.
• C - Compression.  This is important to limit bleeding into the tissues and swelling.
• E - Elevation also helps with swelling.

Does it need stitches?

Stitches may be needed if a cut gapes over 1/8 th inch wide, if yellow fat is evident in the wound stitches may be needed and the child should be seen in the emergency room.