For a poison emergency in the U.S. call
American Association of Poison Control Centers
Call 9-1-1, or go to the nearest emergency room immediately for any of the following:
- Your child is lethargic, hard to awaken, inconsolable
- Your child has had an ongoing illness and has voided fewer than 4 times in 24 hours
- Fever and severe headache, stiff neck, and/or rapidly spreading rash
- Difficulty breathing
- Excessive bleeding
- Broken bone that is protruding through the skin
- Sexual assault
Fever: 0 - 8 weeks old
In this age group, a fever is a temperature of 100.4 degrees or higher. Newborns are susceptible to many different infections and can become ill very quickly. If your infant has a fever, it is best to have your infant evaluated in a pediatric emergency department as soon as possible.
Fever: 2 months or older
In this age group, a fever is a temperature of 101 degrees or higher. Fevers are a symptom of an underlying illness, and can actually help your child fight the illness. It is safe to alternate tylenol and motrin to help keep fevers down when needed, but if your child is tolerating a fever up to 102 degrees without seeming lethargic or irritable, it is okay for your child to have the fever. If a child’s temperature is higher than 103, or if they are irritable and uncomfortable, they should be given medicine to bring their fever down.
Your child should be taken to an emergency department for a fever if they are lethargic, difficult to arouse, irritable and will not be consoled, have a severe headache, or if the fever is accompanied by a rapidly spreading rash. Otherwise, please call the clinic during business hours to schedule an appointment for your child.
Coughs are one of the most common symptoms of various childhood illnesses. Although a cough can sound terrible, it isn’t usually a sign of a serious condition. In fact, coughing is a healthy reflex that helps protect our airways.
Lots of coughs get worse at night. When your child has a cold or allergies, the mucus from the nose and sinuses can drain down the throat and trigger a cough during sleep. Asthma also can trigger nighttime coughing because the airways tend to be more sensitive and irritable at night. A child who has a cough, mild fever, and runny nose probably has a common cold.
Coughs caused by colds due to viruses can last weeks, especially if your child has one cold right after another. Asthma, allergies, or a chronic infection in the sinuses or airways also might cause persistent coughing. If your child’s cough lasts for 3 weeks or if it is accompanied by a fever of 102.2 or higher (if older than 2 months of age), you should take your child in to be seen by their doctor. Because most coughs are caused by viruses, antibiotics are usually not prescribed. A cough caused by a virus needs to run its course.
If your child’s breathing is noisy when they are not crying, or if your child is showing signs of respiratory distress such as rapid breathing or retractions (the inward movement of the skin of the chest wall or the inward movement of the breastbone (sternum) during inspiration), seek medical attention. Retractions mean that the child is using chest muscles and/or neck muscles to get air into the lungs. Grunting or nasal flaring are also signs of respiratory distress.
Call 911 if your child’s respiratory distress is more than mild or if they have a blue or dusky color to the lips, face, or tongue.
If your child’s cough starts rapidly without any other symptoms you should check to see if they are choking.
Kids often cough so much that it triggers their gag reflex, making them vomit. Children might also throw up if a lot of mucus drains into the stomach and causes nausea. Usually, this is not cause for alarm unless the vomiting doesn’t stop.
Here are some ways to make your child with a cough feel better:
- Use a cool mist humidifier in their room at night.
- If over 12 months of age, you can give Benadryl prior to bedtime to decrease their post nasal drip (see dosing chart). You can also give a teaspoon of honey, alone or in warm tea, before bed.
- If over two years old, apply Vick’s VapoRub to their chest. Children 2-23 months of age can use Vick’s Baby Rub instead.
- Cough drops are OK for older kids, but kids younger than 3 years old can choke on them. It’s better to avoid cough drops unless your doctor says that they’re safe for your child.
- If under 12 months of age, saline in the nose followed by the use of bulb suction can help clear some of their upper airway congestion.
It is not recommended to give over the counter cough syrups to children under 6 years of age.
Barky coughs are usually caused by a swelling in the upper part of the airway. Most of the time, a barky cough comes from croup, a swelling of the larynx (voice box) and trachea (windpipe). Croup usually is the result of a virus. Younger children have smaller airways that, if swollen, can make it hard to breathe. Kids younger than 3 years old are more at risk for developing croup because their airways are so narrow. A cough from croup can start suddenly and in the middle of the night. Sometimes a child with croup will also develop stridor, which is a noisy, harsh breathing (often described as a coarse, musical sound) that occurs when a child inhales. If your child has a bark-like cough you should take them in to be seen as steroids are usually prescribed to decrease upper airway swelling/inflammation and hopefully prevent stridor from developing. Any stridor at rest or when your child is calm warrants a trip to the emergency room. For a “barky” or “croupy” cough, turn on the hot water in the shower in your bathroom and close the door so the room will steam up. Then, sit in the bathroom with your child for about 20 minutes. The steam should help your child breathe more easily. Sometimes a brief exposure to the cool air of the outdoors can relieve the cough as well.
Another name for pertussis, an infection of the airways caused by the bacteria Bordetella pertussis. Kids with pertussis will have spells of back-to-back coughs without breathing in between. At the end of the coughing, they’ll take a deep breath in that makes a “whooping” sound. Other symptoms of pertussis are a runny nose, sneezing, mild cough, and a low-grade fever. Although pertussis can happen at any age, it’s most severe in infants under 1 year old who did not get the pertussis vaccine. Pertussis can be life-threatening for infants because their airways are so small. If you think your infant may have pertussis take them in to be seen or call 911 immediately if showing any sign or symptom of respiratory distress.
Mixing Medications Safely
It is safe to give tylenol (acetaminophen), motrin (ibuprofen), benadryl, and antibiotics together. Tylenol is considered safe at any age but when using for fevers, please see the section below regarding fevers. Motrin is considered safe after 6 months of age, and benadryl is considered safe after 12 months of age.
Medication Dosage Charts
|Tylenol / Acetaminophen
(every 4-6 hours)
|80mg / 0.8ml
|160mg / 5ml
|Chewable Tabs (80 mg)
|1 1/2 tab
|5 ml (1tsp)
|Motrin / Ibuprofin /
Advil (every 6-8 hours)
Must be greater than 6 months old
|40mg / 1 ml
|100mg / 5ml
|Chewable Tabs (50 mg)
|Benadryl (every 6-8 hours)
Must be greater than 12 months old
|Children’s Liquid (12.5 mg / 5 ml)
When children are vomiting, the biggest challenge they face is to avoid dehydration. It is best to allow an upset stomach to rest as much as possible, while keeping enough fluid in your child’s body to allow it to function properly. If your child has been vomiting repeatedly for 2-3 days, appears dehydrated, is lethargic, difficult to arouse, or just looks very sick, please seek medical attention.
However, if your child is not very ill, we recommend following the instructions below:
- Encourage your child to take small sips of Pedialyte about every 10 minutes over 3-4 hours.
- If your child tolerates this without vomiting, give 2 to 3 ounces of Pedialyte at a time in a cup or bottle. Allow your child to drink at their own pace with some encouragement to take frequent sips.
- If your child is able to take another 8-12 ounces of Pedialyte without vomiting, then offer small amounts of bland foods. Slowly increase fluids and foods over the next 24 hours.
- If your child vomits, wait 30 minutes without giving anything and start over.
- If you have to start over 3 times and your child is still vomiting, or if your child does not urinate at least 4 times in 24 hours, please seek medical attention.
If you know, or suspect, your child has swallowed or eaten something that could be dangerous, call Poison Control immediately at 626-6016. This includes batteries, coins, foods, medications, plants, etc. Do not use medicine or other means to induce vomiting.
Acute (less than 1 week) Diarrhea mostly tends to be related to a viral infection that occurs with vomiting as well. In infants, diarrhea is a bit more concerning as they can become dehydrated and lethargic quickly. When your child has diarrhea, you should keep them hydrated with plenty of fluids such as Pedialyte, or for older children, Gatorade mixed ½ and ½ with water. It is best to stay away from juices, most fruit and cows milk until the diarrhea is resolved. If your child wants to eat, foods such as bread, potatoes, rice, bananas, and applesauce can help decrease the amount of diarrhea.
Diarrhea also can be caused by eating foods that produce looser stools, such as fruit juice and fruits. If your child seems well and is having diarrhea, it may be their diet.
Your child should be seen immediately if they are having bloody or mucusy stools, high fevers, the diarrhea is going on for more than 1 week or they are becoming dehydrated. Signs of dehydration include no tears when they cry, a dry mouth and/or less than four wet diapers per 24 hours.
This is a whistling sound produced by the airways while breathing out. For wheezing to occur, some part of the respiratory tree must be narrowed or obstructed. Narrowing of the airways can be caused by inflammation of the airways from a viral illnesses or asthma.
A chronic inflammatory disease of the airways. Common symptoms include wheezing, coughing, chest tightness, and shortness of breath. If these symptoms occur and your child has albuterol (breathing treatment or inhaler), give your child albuterol immediately. If your child has been diagnosed with asthma and has an asthma action plan – follow it. If your child’s wheezing is mild and there are no signs of respiratory distress, schedule an appointment to see your child’s doctor. If however, the wheezing is significant or if he or she is showing some signs of respiratory distress, take your child in to be seen right away. If the wheezing or respiratory distress is severe call 911/take your child to the emergency room immediately.
Allergies and upper respiratory infections often cause significant congestion and runny nose.
The following strategies can help keep your child comfortable through their illness:
- Suctioning the nose: For infants, applying saline drops to the nose and using a bulb suction device to remove mucus from the nose helps your baby eat, sleep, and breathe better.
- Humidifier: Using a cool mist humidifier in your child’s room during sleep can help ease coughing and congestion. This is appropriate for all ages.
- Vick’s Baby Rub: This can be applied to the chest of children 3-23 months of age to help ease congestion.
- Vick’s VapoRub: This can be applied to the chest and under the nose of children 2 years or older to help with coughing and congestion.
- Elevating the head of the bed: Positioning your child’s sleep area to place them on a gentle incline can help the congestion drain from their nose or throat through the night, thereby allowing them to breathe more easily and cough less. For young infants, elevate the head of the bed by placing a rolled up towel under the head of the mattress. Make sure all mattress edges are still snug fitting with the sides of the crib. Never place your infant on a pillow or other soft sleeping surface. For older children, place 2-3 pillows under the head, or allow them to sleep leaning against the arm of a couch.
- Benadryl: For children >12 months, giving your child a dose of Benadryl 30-60 minutes prior to bedtime can help decrease mucus production through the night so your child can breathe more comfortably. See dosage chart above for weight-based dosing.
Falls & Head Injuries
Many children take falls and hit their heads during infancy and childhood. Although rare, these can result in significant head trauma. If your child has had a significant bump on the head, try to console your child and thoroughly examine their head. If there are any deep lacerations or large areas with rapidly increasing swelling, your child should be seen at an emergency department as soon as possible. If neither of these is present, the most critical time to monitor a child after such a fall is for the following six hours. Try to distract your child with things he or she enjoys, and when your child is calm, offer a small snack or drink. If it is bedtime, allow your child to go to sleep but check on your child frequently, waking him or her up once or twice to make sure they can come to full alertness and normal behavior. During this six hour period, if your child is crying inconsolably, irritable, overly tired, vomiting, difficult to arouse, or has any abnormal movements, they should be seen in an emergency department as soon as possible.
Most rashes on the body, other than diaper rashes, are the result of an allergy or a viral illness, such as a common cold.
In order to differentiate between the different causes of rashes on the body you should call our office during business hours to schedule an appointment. Most rashes, with the exception of those below, do not require an after-hours call to the doctor.
The one rash that requires immediate medical evaluation is a rash called petechiae or purpura. Petechiae appear as red, flat spots. They look as if someone used a red pen to put little dots on the skin. Purpura is similar, but is larger and can be more purple or blue in color.
The two most important signs that you can use to distinguish these spots from other rashes are:
- They don’t blanch when you press on them. Many other kinds of rashes, when pressed, will turn white or skin colored for 1 or 2 seconds, and then turn red again. Petechiae and purpura will stay red or purple. They won’t blanch at all when pressed.
- They are completely flat. Because they occur under the skin, you won’t be able to feel any bump.
IF YOU SUSPECT THIS RASH YOU SHOULD BE EVALUATED IMMEDIATELY IN THE OFFICE OR IN AN ER AFTER HOURS.
For prescription refills, please contact your pharmacy.
If there are no refills available on your prescription, the pharmacy will contact the prescriber to authorize refills.
It is best to request refills 3-5 days prior to when your supply of medication will run out.
Bites & Stings
Desert regions are full of spiders, insects and reptiles that can bite or sting. Most of these are not harmful, just irritating. But, there are things you can do to help, and there are times your child may need medical attention for these.
These tend to be very itchy. As children scratch, they can cause further inflammation that can lead to scarring or infection. We recommend using 1% hydrocortisone ointment two to three times per day on itchy bites as needed to keep your child from scratching these. Oatmeal baths can be soothing to irritated skin if there are many bites. If your child is very itchy or the areas around the bites are a bit raised and puffy, Benadryl taken orally can also be helpful. To help prevent insect bites, wear protective clothing outdoors when possible, and use insect repellant containing up to 30% DEET (this is safe for 2 month olds and older).
Seek medical attention for your child if bites begin to show signs of infection. These include oozing, pain, large increase in size, streaking (red line running up the arm or leg from the bite) or an area of spreading redness around the wound. Your child may also run a fever if his or her bites have become infected.
Two types of spiders found locally can cause significant illness if one of them bites your child. These are the brown recluse and black widow. If you think your child has a spider bite:
- Wash the area with soap and water.
- Elevate the area if possible to prevent spread of the venom.
- If your child is in pain, give an age-appropriate dose of Tylenol or Motrin. (See medication dosage charts). Apply an ice pack or cold compress to the area as well.
- If you can safely capture the spider that bit your child, do so, in order to identify the type of spider. If you are unsure of the type of the spider and think it may be poisonous, call poison control at 1-800-222-1222.
- Seek emergency treatment if you believe your child was bitten by a brown recluse or black widow spider, or if your child begins to have an allergic reaction to the bite, seems ill, or develops a rash. If possible, bring the spider with you for identification to help the medical team better treat your child.
Bee & Wasp Strings
Many people are allergic to stings and can have severe reactions. If your child has a known allergy and has been stung, use your Epi-pen as directed and seek emergency medical care. Even if your child is not known to be allergic to bee or wasp stings, it is still important to watch for a serious allergic reaction which might include the following: lip, tongue or face swelling, cough, hives, trouble breathing, lethargy, or vomiting. If one or more of these occur, seek emergency medical attention. If you are able to quickly do so, you may give your child a dose of Benadryl.
If your child does not have an allergic reaction, treat symptomatically. Remove the stinger as soon as possible by scraping it out with a fingernail or the edge of a credit card, or gently pulling with tweezers. You may apply 1% hydrocortisone ointment to the sting to help decrease swelling and inflammation. You may also give your child oral Benadryl to help decrease irritation and give Tylenol or Motrin for pain as needed. Seek medical attention if severe swelling, pain, or signs of infection occur, such as spreading redness, streaking away from the sting area, or oozing.
Snake Bites & Scorpion Strings
Arizona is home to multiple types of snakes and scorpions with varying degrees of toxicity. If your child is stung by a scorpion or bitten by a snake and you are able to safely locate or identify the snake or scorpion, call poison control at 1-800-222-1222. Otherwise, seek emergency medical attention immediately.