Treating Hard to Control Vomiting and Diarrhea

Even when they don’t linger, it can be frustrating for parents to treat their kids with vomiting and diarrhea. Get the latest treatment recommendations to help you get through these very common infections quickly.

Kids get vomiting and diarrhea for many reasons, but it is most often caused by a stomach virus.

Whatever the cause, even if it is something your child eat or food poisoning, you will want to know how to best manage your child’s symptoms to help them feel better quickly and prevent them from getting dehydrated.

Vomiting and Diarrhea

Although most people associate vomiting and diarrhea with the “stomach flu,” the flu virus doesn’t usually cause vomiting and diarrhea.

Instead, there are a number of other viruses, bacteria, and parasites that do, including:

  • rotavirus – a vaccine-preventable disease
  • norovirus – the “cruise ship virus,” but very common elsewhere too
  • Salmonella, Shigella, E. coli – food poisoning, animals
  • C. diff – associated with recent antibiotic use
  • Cryptosporidium – drinking contaminated water, swimming pools, water parks

If necessary, especially when diarrhea is associated with severe symptoms or is lingering, stool tests can be done to figure out the specific cause. Fortunately, diarrhea and vomiting often goes away on its own fairly quickly and these tests aren’t necessary. What will likely be necessary is keeping your child well hydrated until these symptoms stop.

Treating Vomiting and Diarrhea

For most kids with vomiting and diarrhea, you can:

  • continue breastfeeding on demand
  • continue their normal diet (feed through the diarrhea), including baby formula or milk, if they just have diarrhea and no vomiting or only occasional vomiting, giving extra fluids every time your child has diarrhea (about 3 ounces if your child is under 22 pounds and about 6 ounces if they are over 22 pounds)
  • forget about eating and concentrate on drinking if your child has a lot of vomiting, but start by offering very small amounts of fluid, perhaps starting with a teaspoon (5ml) every 5 or 10 minutes, and then slowly working your way up to a tablespoon (15ml) and than an ounce (30ml) or two over a few hours
  • take a break from drinking for 30 minutes if your child has a set back and begins vomiting again, and restart at 5ml, slowly working your way back up again as tolerated
  • watch closely for signs and symptoms of dehydration, including weight loss, decreased urine output (fewer wet diapers or going to the bathroom less often), no tears, or dry mouth with no saliva or spit, etc.

In general, when talking about fluids, we mean an oral rehydration solution, like Pedialyte. If your older child won’t drink Pedialyte, you can offer something like Gatorade, but keep in mind that sports drinks have more sugar, so can sometimes make diarrhea worse.

But do you really make your child eat and feed through the diarrhea if he doesn’t want to? Of course not. The idea is that you don’t restrict your child’s diet if they want to eat. If they are complaining of a stomach ache, just don’t feel good, or feeding them their regular diet makes the diarrhea or vomiting worse, then move to more bland food.

Treating Hard to Control Vomiting and Diarrhea

What if your child continues to have vomiting and diarrhea?

You should still avoid treating your younger child with over-the-counter remedies to stop diarrhea, including those with loperamine (Imodium) or bismuth subsalicylate (Kaopectate).

A prescription medication, Zofran (ondansetron), might be appropriate for some children with persistent vomiting who are at risk of getting dehydrated.

If your child has persistent vomiting and diarrhea, ask yourself these questions and share the answers with your pediatrician:

  • Does your child have any symptoms that might require immediate medical attention, such as high fever, bloody diarrhea, severe headache, severe abdominal pain, or signs of moderate to severe dehydration?
  • Has your child with chronic diarrhea (diarrhea for more than four weeks) been losing weight, had fever, or regular stomach pains?
  • Does your otherwise well toddler have chronic, watery diarrhea even though no one else has been sick, a possible sign of Toddler’s diarrhea?
  • Do you have any pets or contact with pets that could put your child at risk for a Salmonella infection, including turtles, lizards, snakes, and frogs?
  • Has your child visited a farm or petting zoo, which puts him at risk for a Salmonella or E. coli infection?
  • Did your child recently take an antibiotic, which puts him at risk for a C. diff infection?
  • Has your child been drinking raw milk or other high risk foods?
  • Has your child traveled recently, which puts him at risk for traveler’s diarrhea?
  • Did you put your child on the BRAT diet (bananas, rice, applesauce, and toast) even though they were eager to eat?
    Have you tried giving your child a probiotic?
  • Does your child now only have diarrhea after drinking milk, perhaps a sign of a temporary lactose deficiency?
  • Is your child better, with much less vomiting, but you are just frustrated that the diarrhea hasn’t gone away yet?
  • Is your child better, with much less vomiting, but you are just frustrated that she is still vomiting at least once each day?

While you should certainly call your pediatrician if your child’s symptoms are lingering, remember that almost everything about the idea of the “24 hour stomach flu” you have heard is probably wrong. In addition to the fact that it isn’t caused by the flu virus, the symptoms typically last more than 24 hours, at least in kids. The vomiting may get better in 24 hours, but diarrhea can easily linger for a week or two.

It is also important to keep in mind that most causes of vomiting and diarrhea are very contagious and can easily spread through the whole house if you aren’t careful. Remember to always wash hands, rinse fruits and vegetables, clean and disinfect contaminated surfaces, and don’t share food or drinks, etc. If you just do it when your kids are sick, it will be too late, as many illnesses are contagious even before you show symptoms.

What To Know About Treating Hard to Control Vomiting and Diarrhea

Even when they don’t linger, it can be frustrating for parents to treat their kids with vomiting and diarrhea. Get the latest treatment recommendations to help you get through these very common infections quickly.

More Information On Treating Hard to Control Vomiting and Diarrhea

Treating Hard To Control Asthma

Does your child have asthma?

Are his asthma symptoms easy to control or are they getting in the way of doing routine things, like sleeping through the night or playing outside with friends?

What Triggers Your Child’s Asthma?

As with many other childhood conditions, it is often better to avoid asthma flareups instead of trying to treat them.

That doesn’t necessarily mean it is easy though.

Still, you might try to avoid common asthma triggers, such as:

  • allergies – dust mites, pet dander, mold, pollen, etc.
  • exercise
  • infections
  • smoke
  • pollution
  • weather changes

Keep track of your child’s symptoms to see if you can identify any triggers.

Asthma Treatments for Kids

The most common treatment for asthma symptoms are the quick-relief medications, including albuterol (ProAir, Ventolin, Proventil) and levalbuterol (Xopenex). Either with a nebulizer, inhaler with a spacer, or inhaler alone, they can help when your child is coughing and wheezing.

If your child has severe or frequent asthma symptoms or attacks, the next treatment step is to use a long-term control medication, starting with an inhaled steroid (Alvesco, Asmanex, Flovent, Pulmicort, Qvar) and moving to a combined inhaled steroid and long acting beta-agonist (Advair, Dulera, Symbicort) if necessary.

Other asthma treatments can include:

  • oral steroids – often used short term for asthma flares with quick-relief medications
  • leukotriene modifiers – Singulair (montelukast) is a once-a-day pill that can be used to prevent both allergies and asthma in some kids

An asthma action plan can help make sure you know how and when to use your child’s asthma medications.

Treating Hard To Control Asthma

What do you do if your child’s asthma medicines aren’t working?

If your child continues to have regular asthma symptoms or attacks, ask yourself these questions and share the answers with your pediatrician:

  • Is your child really using his inhaler? Non-compliance is the most common reason for kids to have poorly controlled asthma. Remember, long-term control medications are used every day, even when your child doesn’t have any asthma symptoms. They prevent asthma attacks and asthma symptoms that can be treated with the as need use of your child’s quick-relief medications.
  • Is your child using his inhaler correctly? If not, his asthma medicine might not be making it to his lungs where it needs to go to work.
  • Is your child with exercise-induced asthma using his quick-relief inhaler before exercise?
  • Does your child need a step-up in therapy? Long-term control medications are available in a variety of strengths and your child may need a higher dosage if she is still having asthma symptoms. Or she may need to move from an inhaled steroid to a combined inhaled steroid and long acting beta-agonist inhaler.
  • Would allergy testing help you identify your child’s triggers?
  • Does your child have acid reflux?
  • Could stress be triggering your child’s asthma symptoms?
  • Does your child really have asthma? Both vocal cord dysfunction and exercise-induced laryngeal obstruction are asthma mimics that can be misdiagnosed as asthma.

A pediatric allergist and/or a pediatric pulmonologist can help your child with hard to control asthma.

What To Know About Treating Hard To Control Asthma

Asthma can be a life-threatening condition, so be sure to seek extra help if your child has difficult to control symptoms, especially if you have already tried many of these classic asthma treatments.

For More Information About Treating Hard To Control Asthma

Treating Hard to Control Reflux

Acid reflux isn’t just for babies, so it is important to learn to recognize GERD symptoms in older children and teens too.

Acid reflux is common, especially for newborns and infants.

Many parents are surprised to know that reflux can affect older kids too though. Fortunately, reflux is temporary for most of these kids and can be easily treated.

It can be even easier to treat younger kids, most of whom don’t need any treatment if they are just messy and don’t have true acid reflux disease.

Happy Spitters and Reflux Symptoms

Children who spit up have acid reflux or more specifically gastroesophageal reflux (GER).

Many babies spit up or have reflux.
Many babies spit up or have reflux, but most are just “happy spitters” and don’t need treatment. Photo by Ryan Dickey (CC BY 2.0)

They may not have acid reflux disease though (GERD), with other associated signs and symptoms, such as:

  • refusing to eat
  • recurrent vomiting
  • weight loss or poor weight gain (failure to thrive)
  • irritability or trouble sleeping
  • respiratory symptoms, such as a chronic cough, hoarse voice or cry, or hard to control asthma, etc.
  • Sandifer syndrome – reflux plus head tilting and back arching

Without any of these symptoms, your baby who spits up, even if it is very frequent and it seems like they spit up a large amount each time, is likely what is classically called a “happy spitter.” If they are just messy, they don’t need any treatment and you can wait until they outgrow their reflux.

Remember – “Spit Happens.”

Older children with acid reflux might complain of heartburn, chest pain, or say that they have a sour taste in their mouth (sour burps).

Lifestyle Changes for Reflux

Once you recognize that your child has GERD and needs to be treated, you might start with these lifestyle changes:

  • avoiding milk and dairy products for two to four weeks if you are breastfeeding an infant with GERD
  • changing baby formula to an extensively hydrolyzed protein (Nutramigen, Gerber Extensive HA, Alimentum) or amino acid–based infant formula if your formula fed baby has GERD
  • thickening your baby’s formula (typically about one tablespoon of rice cereal per every one to two ounces of formula) vs switching to a baby formula for reflux (Enfamil AR or Similac Sensitive R.S.)
  • making sure you aren’t overfeeding your baby, including that you don’t re-feed your baby right after they spit up
  • avoiding seated and supine (on his back) positions after feedings, although you shouldn’t put your baby down prone (on his stomach) if he is going to fall asleep (risk factor for SIDS)
  • helping older children with acid reflux lose weight if they are overweight and making sure they don’t smoke or drink alcohol
  • encouraging older children to avoid acid reflux triggers, especially caffeine, chocolate, foods with acid, and spicy foods

When can you expect your infant’s reflux to go away? In most babies, reflux symptoms peak at about 4 months and go away by the time they are 12 to 18 months old. In older children, reflux symptoms generally go away after a few months of appropriate treatment.

Acid Reflux Medicines

If lifestyle changes aren’t working, your child with reflux likely needs medicine to treat his reflux.

These acid reflux medications include:

  • antacids – may be okay in older children with very rare symptoms, but not for routine use
  • histamine-2 receptor antagonists (H2RAs) – such as Zantac (ranitidine) – works quickly, but may stop working over time (tachyphylaxis)
  • proton pump inhibitors (PPIs) – such as Prevacid (over-the-counter for adults) and Nexium (Nexium packets are FDA approved for infants) – considered more potent and superior to H2RAs but may take up to four days to start working
  • prokinetic agents – rarely used because of side-effects

In general, if your child’s symptoms improve or go away within two weeks of taking an acid reflux medication, then you should likely continue it for at least two to three months.

Treating Hard to Control Reflux

What do you do when lifestyle changes and reflux medicines don’t work or symptoms return after you stop your child’s reflux medicine?

First, make sure you are giving the right medicine, the right dosage of medicine, and are giving it at the right time, keeping in mind that PPIs should be giving 30 minutes before a meal.

Next, consider if there are any other lifestyle changes that you can try. For example, you might encourage your older child with persistent reflux to eat smaller meals more frequently, avoid a bedtime snack, and you may even elevate the head of his bed by about 30 degrees.

Lastly, you might make sure that your child really does have reflux.

Just because your baby is fussy and wakes up a lot at night, it doesn’t automatically mean that he has reflux. It could instead be colic, or be related to a food intolerance or allergy, with breastfeeding mothers needing to go on a more restrictive diet or infants drinking a hydrolyzed formula might need to switch to an elemental formula (Elecare, Neocate, or PurAmino).

Older kids with difficulty swallowing (dysphagia), which is often blamed on acid reflux, might have post-nasal drip caused by allergies or a sinus infection, etc.

And even if truly spitting up, instead of GERD, a child might have any number of other conditions instead of GERD, from an intestinal obstruction to a metabolic disorder.

It is usually at this point, when classic acid reflux treatments aren’t working, that a referral to a pediatric gastroenterologist would be a good idea.

What To Know About Acid Reflux

Acid reflux in kids is usually temporary and can often be controlled with lifestyle changes and medications, but unfortunately, acid reflux symptoms are not always caused by reflux, leading to some treatment failures.

For More Information on Acid Reflux

Treating Hard to Control Bedwetting

Although bedwetting can be hard to control, it is easier if your child understands that it is not their fault and that they will almost certainly eventually outgrow it and stay dry at night.

All kids wet the bed when they are younger.

When do they stop?

Bedwetting Basics

Although parents typically understand that their kids will become potty trained sometime around age three years, they often have unrealistic expectations for when they will stop wetting at night.

So the first thing to understand about bedwetting (nocturnal enuresis) is that it is consider a normal part of development to continue to wet the bed up until about age six years. That’s the age when most kids can stay dry all night.

But even after age six years, many kids still wet the bed. In fact, at age eight years, up to eight percent of kids still wet the bed. Fortunately, there is a 15% chance that these kids will outgrow their bedwetting each year.

Treating Bedwetting

In addition to waiting it out, classic treatments for bedwetting often include:

  • protecting the mattress from getting wet by using a plastic cover under the sheets
  • make wearing pull-ups seem routine and not a punishment
  • limiting the amount of fluids your child drinks in the evening
  • severely limiting the amount of fluids your child drinks right before bed
  • making sure your child goes to the bathroom right before going to bed
  • sticking to a good bedtime routine

Most importantly, make sure that your child knows that it is not his or her fault that they wet at night. Staying dry at night is just another developmental milestone that kids have to reach. Unfortunately, like many milestones, you will likely have to wait until your child reaches this one and stops wetting at night.

Usually bedwetting stops by puberty.

American Academy of Child and Adolescent Psychiatry

If your child is getting older and is tired of waiting, especially if he is approaching the age of sleepovers or overnight camping trips, there are  other options to treat bedwetting, including the use of bedwetting alarms and prescription medicines, like DDAVP (desmopressin) tablets.

DDAVP can be an especially good option for sleepovers, etc., as it only works to stop wetting on the nights your child takes it. It is a synthetic version of a natural hormone, antidiuretic hormone (ADH), that normally reduces urine volume at night in our bodies.

Treating Hard to Control Bedwetting

Why is your child continuing to wet the bed at night?

Maybe he is just a deep sleeper. Maybe he has a small bladder. Maybe bedwetting runs in the family and she will just have to outgrow it, like other family members have.

Although most children eventually outgrow wetting the bed, if you think your child’s bedwetting should have already stopped, you should ask yourself these questions and share the answers with your pediatrician:

  • Has your child ever been dry at night for more than a few weeks or months or has he always wet the bed?
  • If the bedwetting is a new issue, have there been any changes in your child’s life?
  • Is your child constipated?
  • Is your child losing weight?
  • Does your child wet during the day?
  • Does your child avoid going to the bathroom during the day, holding their urine for long periods of time (voiding dysfunction)?
  • Is your child drinking any caffeine during the day?
  • Does your child snore very loudly at night? Some people think that bedwetting can be associated with sleep apnea.
  • Have you tried waking your child an hour or two after he has gone to sleep and having him go to the bathroom?
  • Are you relying on alternative treatments for bedwetting, such as hypnosis, psychotherapy, acupuncture, chiropractic, or medicinal herbs, which have been proven to not work?
  • Have your tried using a star chart to encourage and reward nights that she stays dry?
  • Although they only work half the time, did you try using a bedwetting alarm?
  • Did you try DDAVP (desmopressin), thinking it would cure your child’s bedwetting, but not understanding your child would likely wet again once they stopped taking it?

A pediatric urologist can also be helpful for your child with hard to control bedwetting.

What To Know About Treating Hard to Control Bedwetting

Although bedwetting can be hard to control, it is easier if your child understands that it is not their fault and that they will almost certainly eventually outgrow it and stay dry at night.

More Information About Treating Hard to Control Bedwetting

Treating Hard to Control Warts

Although multiple wart treatments are available, warts are not easy to treat and so it is not unreasonable to just leave them alone if they aren’t bothering your child.

Unfortunately, there are no quick and easy ways to treat warts.

In fact, because there are no quick and easy ways to treat warts, many pediatricians suggest that parents simply wait it out, and let the warts go away on their own.

Common Wart Treatments

If you don’t have the patience to wait for a wart to go away on its own, which can take months to years, you can try:

  • OTC topical liquid or gel wart remover treatments with salicylic acid
  • OTC wart remover treatments with salicylic acid on a pad
  • OTC wart remover treatments that freeze warts
  • duct tape

Your pediatrician might also try:

  • cryotherapy – “prescription strength” wart freezing, which may have to be repeated multiple times
  • cantharidin – not FDA approved in the US, but this blistering agent is often applied to warts to induce them to go away

And of course, your pediatrician might also simply recommend that you wait it out for a few more months or years, as the warts should eventually just go away.

But why not treat the warts if treatments are available? Many experts say that at best, standard wart treatments only work half of the time. And they can be painful or leave scars.

Treating Hard to Control Warts

Again, treating warts is often hard, even in the best of circumstances. Warts can be even harder to treat if they are around your child’s nails (periungal warts) or on the bottom of their feet (plantar warts).

Plantar warts can be hard to treat.
Plantar warts can be hard to treat. Photo by happyfeet34 (CC BY 2.0)

Still, if you are not getting anywhere, you should ask yourself these questions and share the answers with your pediatrician:

  • Does your child really have warts?
  • Did you follow the directions on the label carefully?
  • Are you gently rubbing away hard skin from the surface of the wart with a pumice stone or emery board each week?
  • Are you softening the skin on and around the wart by soaking the area in warm water for at least 5 minutes before your wart treatments?
  • Did your child’s wart mostly go away and then come right back in the same spot?
  • Did your child’s wart completely go away, but new warts came up in different places?
  • Did your child get a much bigger wart around the site of a previously treated wart (a ring wart)?

A dermatologist can treat your child’s truly resistant warts with cryotherapy, cantharidin, higher strength salicylic acid paste than is available OTC, yeast injections, electrosurgery, or pulsed dye laser therapy, etc.

What To Know About Treating Hard to Control Warts

Although multiple wart treatments are available, warts are not easy to treat and so it is not unreasonable to just leave them alone if they aren’t bothering your child.

More Information About Treating Hard to Control Warts

Treating Hard To Control Head Lice

Treating your child’s head lice doesn’t have to be a nightmare, even when it seems like the lice are resistant to routine treatments.

Treating head lice probably never seems easy.

Washing your child’s hair with a head lice shampoo, washing things that had contact with your child’s hair, removing nits, and retreating your child in a week can be a hassle.

As you can imagine, it can be incredibly more frustrating when you can’t seem to get rid of the lice or they keep coming back.

Treatments for Head Lice

Although you could just manually remove all of the live lice on your child’s head and new lice as they hatch, most people choose to treat their kids with an over-the-counter head lice shampoo, such as:

  • Permethrin 1% lotion – Nix
  • Pyrethrins – Rid

If your community has a lot of problems with resistance to Nix or Rid (they don’t work), your pediatrician might recommend that your first choice be a prescription head lice treatment instead, such as Ovide (malathion), Natroba (spinosad), Sklice (ivermectin), or Ulesfia (benzyl alcohol).

Never initiate treatment unless there is a clear diagnosis with living lice.

AAP Clinical Report on Head Lice

While all of the prescription head lice treatments work well, Sklice has the added benefit that it should only require one treatment, and like Natroba and Ulesfia, can be used on infants as young as six months old.

Ovide works well, but is flammable because of its high alcohol content, can only be used on kids who are at least two years old, and some lice are already resistant to it.

Unfortunately, these prescription head lice treatments are much more expensive than Nix or Rid, although coupons can help with some of that expense. Of course, even Nix or Rid can quickly get expensive if you have to keep buying them over and over and over again because they aren’t really working.

Buying all of the things that parents sometimes do to prevent head lice, most of it not proven to work, can get expensive too.

Treating Hard To Control Head Lice

What do you do if your kids still have lice after they have been treated?

Ask yourself these questions and discuss the answers with your pediatrician:

  • Does your child really have lice?
  • Do you really see live lice moving around in the hours or days after you treated your child with an OTC head lice shampoo?
  • Do you just see dead or dying lice on your child’s head? Can you easily remove them?
  • Do you just see old nits on your child’s head?
  • Are you relying on natural or other home remedies to treat your child’s lice, such as essential oils, mayonnaise, or olive oil?
  • Do you see live lice about a week after you had treated your kids with an OTC head lice shampoo? Did you remember to do a second treatment to kill hatching eggs?
  • Are the live lice that you are seeing in the days after treatment very small and about the size of a pin head? These may be newly hatched lice. You can pick them off manually and know that any that remain will be killed when you do your second treatment. Ideally, any residue of the treatment left on your child’s head would have killed these newly hatched lice though.
  • Do you see live lice several weeks to months after you had treated your kids with an OTC head lice shampoo?
  • Are your kids continuing to share brushes or combs with other children?
  • Did you closely follow the instructions on the medication’s label?
  • Did you check other family members for head lice?
  • Have other infested children that are around your kids been checked and treated?
  • Are you at the point that you are considering shaving your child’s head?

While your kids may still have head lice after they have been properly treated with an OTC head lice shampoo, it is also possible that they don’t have an active head lice infestation anymore or that they simply got lice again. Getting reinfested is even more likely if you went weeks and weeks without seeing live lice and you don’t see many new nits yet. In that case, it is not that the OTC treatments are failing to work, it is that your kids keep getting new lice on their head.

Most importantly, remember that seeing live lice is the main sign to look for as to whether or not your kids need to be treated for an active head lice infestation. Simply having nits alone does not mean that your kids still have lice.

What To Know About Treating Hard To Control Head Lice

Treating your child’s head lice doesn’t have to be a nightmare, even when it seems like superlice are resistant to routine treatments.

For More Information On Treating Hard To Control Head Lice

Treating Hard To Control Eczema

While eczema can usually be controlled and most kids eventually outgrow having eczema, you may need some help to really understand how to really manage your child’s eczema effectively.

Eczema or atopic dermatitis very commonly affects kids.

Few conditions are as frustrating for parents and pediatricians, because even when properly treated, you can expect eczema to flare up from time to time after it gets better. Eczema is even worse when it isn’t properly treated though.

What Triggers Your Child’s Eczema?

Like other things that are supposed to have triggers, like asthma and migraines, it is often hard to figure out what triggers a child’s eczema.

Dress in soft, breathable clothing and avoid itchy fabrics like wool, that can further irritate your eczema.

National Eczema Association

Common eczema triggers to avoid might include:

  • harsh soaps and cleansers, shampoos, and body washes, including those with fragrances
  • food allergy triggers – milk and eggs
  • environmental allergy triggers – dust mites and animal dander
  • low humidity
  • temperature extremes – either getting too hot or too cold
  • skin infections

And anything else that might make your child’s skin dry and itchy.

Eczema Treatments for Kids

Although there is no cure for eczema, it is usually possible to control your child’s eczema, including getting rid of all or most of her eczema rash and decreasing how often your child has eczema flares.

These basic treatments include:

  • using lukewarm water for daily baths and showers
  • using a soap substitute or cleanser that is unscented, fragrance-free, and dye-free – Cetaphil, Dove, Aveeno
  • using a tar-based shampoo if your child’s scalp is red and itchy – T-Gel
  • daily use of moisturizers, especially within a few minutes of taking a bath or shower (soak and seal therapy)
  • prompt use of a moderate strength prescription topical steroid (like traimcinolone acetonide 0.1% cream) as soon as your child has a flare, with red, rough itchy skin
  • as needed use of oral antihistamines to help control itching during flares – Benadryl
  • keeping your child’s finger nails short to minimize damage from scratching

A written eczema action plan can make sure that you understand how and when to do each of these treatments.

Best Moisturizers for Eczema

Everyone seems to have their favorite eczema moisturizer.

Which is best?

The best moisturizer is probably the one that your child will use and which works to keep his skin from getting dry. In general though, ointments are better than creams, which are better than lotions.

Some favorites include Aquaphor (too thick and greasy for some people), Vanicream Moisturizing Skin Cream, CeraVe Moisturizing Cream, Eucerin Original, and Cetaphil Moisturizing Cream.

Whichever moisturizer you use, be sure to apply it to your child’s skin within three minutes of his soaking in a bath or shower so that you can seal in the moisture (soak and seal therapy).

Treating Hard To Control Eczema

What to do you do when basic treatments aren’t working?

Although a pediatric dermatologist can evaluate your child to see if she needs a systemic medication, phototherapy, or other treatment, most kids with hard to control eczema simply need more education to make sure they are using standard treatments correctly.

  • Is your child bathing correctly?
  • Are you putting on the right moisturizer, using enough moisturizer, and using it often enough?
  • Is your soap too harsh?
  • Are you afraid to use a topical steroid?
  • Are you applying a steroid over a moisturizer, which can make it less effective?
  • Could you be doing more to avoid triggers?
  • Could stress be triggering your child’s eczema?

What’s next?

A Staph skin infection might be a problem. In addition to oral antibiotics, weekly dilute bleach baths might help if this is an issue for your child.

Your child with hard to control eczema might also benefit from:

  • using more moisturizer over his entire body – don’t spot treat the areas that you think are a problem
  • using a thicker moisturizer – put your jar of Aquaphor in the freezer or refrigerator if your child doesn’t typically like using a moisturizer or complains that it stings or burns
  • a prescription barrier cream to control itching – Atopiclair, MimyX
  • a prescription topical Clacineurin Inhibitors – Elidel, Protopic
  • a 504 school plan
  • changing your laundry routine – wash new clothes, use mild, dye free laundry detergent and rinse twice after washing
  • using sunscreen and rinsing after swimming in a pool or excessive sweating, applying a moisturizing quickly afterwards
  • allergy testing to better identify triggers

You might also talk to your pediatrician about wet wrap therapy. With this treatment, you have your child take a bath or shower, applying a topical steroid to the affected areas and a generous amount of moisturizer to the rest of your child’s skin. Next, cover the area in wet cotton clothing or a wet dressing, and lastly, dress your child in dry cotton clothing, removing them all once the clothing dries out. You can then repeat the whole process or start again the next night, continuing until your child’s eczema is under better control.

Wrap therapy can be done with wet pajamas if you have to cover a big area, tube socks with the end cut off if you just have to do his arms, or cotton gloves for hard to control hand eczema. Some experts even recommend using a chilled wet dressing, putting the wet clothes in the refrigerator for a short time before using them on your child.

If you are at the point of considering wet wrap therapy, seeing a pediatric dermatologist might also be a good idea.

What To Know About Treating Hard To Control Eczema

While eczema can usually be controlled and most kids eventually outgrow having eczema, you may need some help to really understand how to really manage your child’s eczema effectively.

More Information About Treating Hard To Control Eczema

Treating Hard To Control Constipation in Kids

Learn how to treat kids with hard to control constipation.

Constipation is very common for kids.

Since your kids will almost certainly become constipated, at least briefly, at some point in their lives, it is important to understand how to recognize the symptoms of constipation.

Symptoms of Constipation

How do you know if your child is constipated?

In addition to grunting and stomach pain, more traditional signs and symptoms of constipation include having:

  • fewer than two bowel movements in a week
  • bowel movements that are small, hard, and like little balls
  • bowel movements that are very big and hard and which may frequently clog the toilet

Most importantly, your constipated child will have bowel movements that are painful and difficult to pass. Very big bowel movements might also lead to small rectal tears and bleeding (usually some bright red blood on the toilet paper when wiping, not blood that fills the toilet bowl).

Not surprisingly, large painful bowel movements commonly lead kids to avoid going to the bathroom, creating a viscous cycle of worsening constipation that can become chronic. Your child with chronic constipation may eventually develop encopresis, having soiling accidents that you mistake for diarrhea. Or because they are holding their stool, they might also hold their urine and develop multiple urinary tract infections or just have urine accidents.

What about grunting and straining? If your baby grunts, strains and even cries briefly, but then passes a soft bowel movement each day, then she probably isn’t constipated (Infant Dyschezia).

Young Children with Constipation

It is often most obvious when young children get constipated, as you are still changing diapers or helping them use the potty.

Keep in mind that:

  • you should talk to your pediatrician if you think that your newborn baby is constipated (not pooping can be a sign that newborn babies aren’t eating enough) or if your child has had constipation problems since he was born (sign of Hirschsprung disease) or is constipated and isn’t gaining weight (Celiac disease)
  • exclusively breastfeeding infants, especially before they start solid foods, once they are gaining weight well, are unlikely to get constipated, but they may only have their soft bowel movements every few days or weeks
  • infants sometimes get constipated when they start rice cereal or other baby foods
  • toddlers sometimes get constipated when they start potty training – this is an especially important time to make sure your child doesn’t get or stay constipated, or it will interfere with potty training

Again, be aggressive if your child becomes constipated when potty training. It is easy to imagine that your toddler is not going to want to have regular bowel movements on the potty if he associated them with pain.

Children with Constipation

Although it is typically harder to recognize, because you likely don’t know how often they are going to the bathroom, constipation is common in older children too.

Common times to develop constipation might include:

  • when they start kindergarten, especially if they don’t feel comfortable going to the bathroom at school
  • after going to camp, on a trip, or any other situation where their diet and routine might have changed
  • after a brief illness, especially if they took or are taking a medication that might have constipation as a side effect
  • during a period of stress, such as starting a new school, moving to a new house, bullying, or social changes (divorce, death in the family, etc.) at home

It is so common, you might even want to watch for constipation at those times, especially if your child has had issues with constipation in the past.

Hard To Control Constipation

Most parents know how to treat simple constipation – more fluids, more fiber, stool softeners, and the occasional glycerin suppository or pediatric enema (the last treatments should likely only be used when nothing else is working and your child is uncomfortable).

But what do you do when that’s not enough?

To help treat kids with hard to control constipation, it usually helps to:

  • make long term changes to your child’s diet, including more fluids (especially water), less fat,  and more fiber, as kids with constipation may have a diet high in fat and low in fluids and fiber
  • make long term changes to your child’s behavior, encouraging him to sit and try to go to the bathroom after breakfast and dinner, but not making him sit until he goes
  • encourage your child to be physically active
  • continue your child’s daily maintenance constipation medicine (usually polyethylene glycol (PEG), lactulose, Milk of Magnesia (magnesium hydroxide), or mineral oil) until he is having a soft stool each day for several months and continues having a daily soft stool as you gradually decrease (over several months) and then stop the medicine (stopping a laxative as soon as kids begin having regular bowel movements is the biggest mistake that parents typically make when their kids are constipated)
  • consider a clean out regimen over a few days if your child is very constipated, using high dose polyethylene glycol or magnesium citrate, which unfortunately might cause some diarrhea as a side effect of getting a lot of hard stool out

What do you do if your child relapses? You usually just start over, especially if the relapse is because you stopped one or more of your child’s constipation treatments.

If your child relapses even though you had been consistent and had been continuing all of his previous treatments that had been working well, you might consider:

  • switching to an alternative to cow’s milk, like almond or soy milk, as some people think constipation can be due to a cow’s milk protein allergy, plus they will likely be lower in fat than cow’s milk
  • increasing the dose of stool softeners and make sure that you don’t stop them too soon
  • avoiding treatments that have not been found to be helpful, including very high fiber diets, prebiotics or probiotics, biofeedback and other alternative treatments
  • avoiding suppositories and enemas, as oral constipation medicines are just as effective and will be better tolerated by your child

Your pediatrician and/or a pediatric gastroenterologist can be helpful if your child has hard to control constipation. In fact, up to 25% of the visits to a pediatric gastroenterologist are for constipation.

For More Information on Constipation

The Numbers Behind Keeping Food Safe

Learn the numbers behind food safety to help keep your kids safe from poisoning.

Learn the four basic steps to keep your food safe from germs.
Learn the four basic steps to keep your food safe from germs.

There is no safe food when it comes to food poisoning. Eggs, fruits, meats, vegetables and even organic sprouts can all become contaminated.

That makes it important to learn how to keep your food safe.

Although many things are being done to reduce contamination before food gets to us, it is just as important to prepare, cook and store food properly so that our kids don’t get sick.

Food Safety Numbers

There are some numbers related to food safety that you might be all too familiar with – about 48 million people get sick from food poisoning each year, sending 100,000 people to the hospital, and causing about 3,000 deaths

Reducing food poisoning is a “winnable battle” though, according to the federal Centers for Disease Control and Prevention. But of course, safe food doesn’t just happen. It takes a little work, starting with understanding some of the other numbers associated with food safety, such as:

  • 4 – the number of steps to proper food safety – clean, separate, cook, chill
  • 0˚F – the temperature to set your freezer (0˚F or below)
  • 40˚F – the temperature to set your refrigerator (between 40˚F and 32˚F)
  • 140˚F – the temperature you should keep food after cooking
  • 145˚F – the minimum internal temperature to cook pork, fresh ham, steaks, roasts, chops and other whole meats (cook to the right temperature)
  • 160˚F – the minimum internal temperature to cook egg dishes and ground meat (cook to the right temperature)
  • 165˚F – the minimum internal temperature to cook poultry and reheat leftovers (cook to the right temperature)
  • 3 minutes – the amount of “rest time” you should wait to make sure harmful germs are killed after cooking food, which is especially important after cooking steaks, roasts, chops, fresh pork and fresh ham. Don’t just heat and eat your food.
  • 2 hours – the maximum about of time that perishable food should be left out before you put it in the refrigerator
  • 90˚F – the outside temperature that should alert you that you need to refrigerate perishable food after just one hour, instead of the usual two hours
  • 20 seconds – how long you should wash your hands before, during and after preparing food and before eating.
  • 4 hours – the amount of time that a refrigerator will usually keep food cold if the power goes out and the refrigerator door is not opened. After that time, throw out perishable food that has been above 40˚F for two hours or more.
  • 3 to 4 days – how long most leftovers can be safely stored in the refrigerator
  • 15 to 20 – the number of Salmonella cells in undercooked food that can cause food poisoning
  • Less than 5 minutes – how long it takes to report a case of food poisoning to your local health department so that you can help to prevent a larger outbreak.

How can you tell the internal temperature of foods that you are cooking? Use a food thermometer, as you can’t tell when foods are safely cooked by simply looking at them.

And be on the alert for food recalls, to make sure that you don’t have contaminated foods in your home.

What To Know About Keeping Food Safe

Do all of these numbers sound too hard to do or keep up with, especially when you are trying to have fun at a cook out or family dinner?

Remember, it is better than the alternative, 2 to 10 days of vomiting and diarrhea because your family developed symptoms of food poisoning…

For More Information on Food Safety Numbers:

Save

Fire Ant Bites

Learn how to treat and avoid fire ant bites and stings.

A classic fire ant mound popping out of a nice green lawn.
A classic fire ant mound popping out of a nice green lawn. Photo by Bart Drees.

Are you worried about your kids getting bit by fire ants?

If not, then you don’t live in Alabama, Florida, Georgia, Louisiana, Mississippi, or Texas, where they have been around for a while.

Fire Ants

Fire ants are thought to have been imported on ships into Mobile, Alabama from South America. They have continued to spread ever since, lately making it as far as eastern New Mexico, the southern half of Oklahoma, and parts of California.

Like imported killer bees, fire ants are more aggressive than native ants.

Many of us get annoyed when we see large fire ant mounds pop up in our yards after it rains, but it can be really concerning one or more fire ants bite or sting your child.

Symptoms of Fire Ant Bites

While many insects bite, it is the classic behavior of fire ants that can make their bites so much worse.

When disturbed, fire ants emerge aggressively, crawling up vertical surfaces, biting and stinging “all at once”.

Texas Imported Fire Ant Research and Management Project

In a typical situation, a toddler or preschooler steps on a fire ant mound in the yard, and before you know it, dozens of fire ants are covering their feet and legs. Or they fall onto the mound, with the fire ants all over their hands and arms.

As you scramble to move your child and get the ants off (quickly rub them off with a cloth or your own hand), they will likely all start stinging.

Multiple fire ant bites on a child's hand.
Multiple fire ant bites on a child’s hand. Photo by the Texas Department of Agriculture.

Fortunately, very few people are allergic to fire ant stings, which might trigger a whole body reaction, with dizziness, shortness of breath, and hives, etc.. The redness, swelling, and white-yellow pustule at the site of the bite are usually the normal symptoms of a local reaction to the fire ant venom.

The pustules go away over a few days to weeks. There is no need to pop or try to drain them. In fact, popping them might lead to their getting infected. It’s better to leave them alone.

After you are bit, it is going to hurt or burn for a few minutes too – that’s why they are called fire ants.

How do you treat fire ant bites?

After you remove the ants, basic first aid and treatment for fire ant bites might include washing the area with soap and then using a cool compress, oral antihistamines, and topical steroids to treat itching.

And of course, seek immediate medical attention if your child is having an allergic reaction to the bites or if it appears that the bites are later getting infected, with increased pain and swelling when you would think that they should be improving.

What To Know About Fire Ant Bites

Although fire ant bites are rarely dangerous or life-threatening, your best bet in protecting your kids is to get rid of any fire ants in your yard and in other places that they play. You might also encourage your kids to wear shoes (not sandals or Crocs) and socks when walking or playing outside.

For More Information on Fire Ant Bites