Metropolitan Pediatrics, LLC

After Hours Care and Advice

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URGENT MEDICAL ADVICE

A practitioner is always available by phone for any urgent issue you may encounter overnight. Should you wish to contact the doctor-on-call, simply call the main office number and follow the prompts.

IF YOU FEEL THAT YOUR CHILD HAS A LIFE-THREATENING EMERGENCY, DIAL 911 AND/OR GO TO THE NEAREST EMERGENCY ROOM.

BELOW YOU WILL FIND IMPORTANT INFORMATION TO ASSIST YOU IN DECISION-MAKING AFTER HOURS.

IMPORTANT ITEMS TO HAVE AT HOME

THERMOMETER (Preferably digital rectal)

NASAL SALINE

TYLENOL AND/OR MOTRIN/ADVIL

ANTIBIOTIC OINTMENT - Neosporin or Bacitracin

DOSING SYRINGES/DROPPERS OR CUPS (with both cc (or ml) and teaspoon markings

NASAL BULB SYRINGE - to be used sparingly in newborns and small infants

SUNSCREEN - SPF 15 or higher

IMPORTANT TELEPHONE NUMBERS

911 - In the event of a true EMERGENCY

1-800-222-1222 - Poison Control


COLDS AND COUGHS

The vast majority of colds, coughs and congestion are viral in nature. The illness may be accompanied by fever at the onset lasting up to 3-4 days, runny nose that may last for 7-10 days (of any color) and a cough that may persist for up to 2-3 weeks.

TREATMENT:

Increase your child’s fluid intake

Raise the head of the bed ~30-45 degrees

Steam treatments in the bathroom help moisturize airways and nasal passages

Nasal saline 4 times/day helps liquefy mucus and moisturize nasal passages

WARNING SIGNS - CALL IMMEDIATELY:

Any respiratory distress or increased work of breathing

Excess lethargy or irritability

Such nasal congestion that your child is unable to nurse or feed

A Word About CROUP: CROUP is caused by a virus that attacks the voice box. It often causes a cough that sounds like a seal barking and may cause a sound like wheezing called stridor. It typically worsens during the night and usually climaxes on day 2 or 3. It responds well to steam treatments and cold air. If you believe your child has croup and is in DISTRESS, attempt a 10 minute steam treatment. If this does not settle his/her cough or breathing effort, expose him/her to cold air either outside or from a freezer for approximately 10mins. If not improving, CALL or go to the nearest Emergency Room.


BURNS
Infants and children have skin that is much more likely to be burned or compromised.  It is exceedingly important to be careful around hot liquids and objects (including vaporizers and steam).
TREATMENT:· Run cold water over the burn· Try to keep the burn clean and wrapped to protect it from further trauma and infection· Apply an antibiotic cream to the area· Call in the morning for an appointmentWARNING SIGNS -  CALL IMMEDIATELY:· Large burns - bigger than 1-2 inches.· Signs of infection - Increasing redness, swelling or discharge

HEAD INJURIES

Children FALL.  The size of the bruise or contusion does not imply a more significant injury.  The most important factor in the severity of an injury is the mechanism: How far did he/she fall?

 

TREATMENT:· Periodic evaluation of the childWARNING SIGNS - CALL IMMEDIATELY:· Lost consciousness· Disorientation or imbalance· Vomiting more than once· Progressively worsening headache· Visual disturbances· Under 3 months of age TRAUMA (CUTS & SPRAINS)

Keep cuts and abrasions clean and apply antibiotic cream 3 times/day.Treatment for sprains or strains consists of 4 modalities: RICE - Rest, Ice, Compression (ace bandage, etc.) and elevation.

 

WARNING SIGNS - CALL IMMEDIATELY:· Laceration will not stop bleeding· Deviation of the normal direction of an extremity

RASHES
Rashes are generally not reason for concern.  They are usually caused by contact with a foreign substance or article of clothing, virus or fungus, and uncommonly by allergy or bacteria.In order to diagnose a rash properly, it must be examined by a doctor.  Please call for an appointment.
WARNING SIGNS - CALL IMMEDIATELY:· If accompanied by facial swelling or difficulty breathing· If the rash will not blanche - it does not fade when pressed with your fingers

SORE THROATS & EARACHESCommon childhood problems.  Call in AM for an appt.TREATMENT:· Give pain control meds and increase fluid intake.· Warm compress to the ear for comfort. A few drops of warmed up Extra Virgin Olive Oil. WARNING SIGNS - CALL IMMEDIATELY:· Drooling or signs of respiratory difficulty

FEVER

Fever is defined as a temperature higher than 100.5º in an infant under 3 months and a temperature higher 101.3º in all other children.  Fever represents a defense mechanism and actually serves to fight off the offending infection.  One does not need to treat a fever with medication for the fever’s sake.  Only treat the fever if the child is uncomfortable or the temperature is higher than 103º.  Many children are content even with very high fevers.  A warm bath will also serve to lower a fever.  Do not give a cold water or alcohol bath.  The child will shiver elevating the temperature.  Do not over dress your child.

 

WARNING SIGNS - CALL IMMEDIATELY:· If seizure occurs· If your child is under 3 months old· If fever is above 104º· If your child is extremely lethargic or irritable· If fever is not coming down with medication VOMITING / DIARRHEA

The vast majority of vomiting/diarrhea is due to viral infection.  Other causes include reflux, food reactions (excess intake of fruit juices, intolerances and allergy), side effects to antibiotics, food poisoning and rarely, bacterial infections.  Infants may seem on occasion to vomit/spit up quite a large amount.  This is often due to gagging or burping after a large feeding.  Vomiting and diarrhea are the body’s way of expelling an offending “agent”.  This is a defense mechanism.  The vomiting is often worse initially, during the first 24 hrs. and then subsides.  The diarrhea then ensues lasting often for up to 10 days.  Diarrhea is defined as an increase in the number of stools and a decrease in the solidity of the stools.  Diarrhea often begets diarrhea washing away enzymes that metabolize food.

 

TREATMENT - VOMITING: · Give 1/2 hour stomach rest after each vomiting episode and then offer frequent sips of clear fluids like Pedialyte or white grape juice or watered down juice.  Be as deliberate as possible; i.e: 1 tsp of fluid every 5 minutes.  Too much volume may upset the stomach.  Popsicles and ice chips work well also.  As the vomiting diminishes, increase the volume of fluid given.TREATMENT - DIARRHEA:       BRAT Diet:  Bananas, Rice, Apple Sauce (not juice) and Toast.· Protein:  Chicken Soup or other protein containing fluid.· Increase fluids and try to stay away from fruit juices and milk.  Soy products (Isomil DF formula in infants) tend to firm up the stools.WARNING SIGNS - CALL IMMEDIATELY:· Decreased urine output or number of wet diapers
MOTRIN/ADVIL/IBUPROFEN DOSING (10MG/2.2LBS)
(GIVE ~ 50MG FOR EVERY 12 LBS) EVERY 6 HOURS

Weight
Infants (50mg/1.25ml)
Children's (100mg/5ml or 1tsp)
12-17 lbs.
1.25ml
1/2 tsp
18-23 lbs.
1.875ml
3/4 tsp
24-35 lbs.
2.5ml
1 tsp
36-43 lbs.
 
1 1/2 tsp
44-54 lbs.
 
2 tsp
55-65 lbs.
 
2 1/2 tsp
66-76 lbs.
 
3 tsp
77-87 lbs.
 
3 1/2 tsp
88 lbs. & up
 
Adult Dosing Applies
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TYLENOL (Acetaminophen) Dosing (15mg/2.2 lbs)
(Give ~ 50mg for every 13 LBS.) every 4 hrs.

Weight

Children's (160mg/5ml or 1 tsp)

6-11 LBS 0-3 Months

1.25 ML

12-17 LBS 4-11 Months

2.5 ML

18-23 LBS 12-23 Months

3.75 ML

24-35 LBS 12-23 Months

5ML (1TSP)

36-43 lbs.

1 1/2 tsp

44-54 lbs.

2 tsp

55-65 lbs.

2 1/2 tsp

66-76 lbs.

3 tsp

77-87 lbs.

3 1/2 tsp

88 lbs. & up

Adult Dosing Applies

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Metropolitan Pediatrics, LLC
11300 Rockville Pike
Suite #404
North Bethesda, MD 20852

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