How many times have you returned with your child from the pediatrician’s office, only to realize that you remember little of what was said to you during the visit? Perhaps it was because your mind was numb from staying up late taking care of your sick child, or possibly you were so worried about your child’s illness that you could only focus on a few things that were discussed during the visit. Maybe you just accept that your doctor is knowledgeable, and the only issue of concern to you now is that your child gets better.In reality, the questions in this content and the reference answers provided are meant to complement the office visit and will only enhance the effectiveness of what the doctor is trying to accomplish. Most pediatricians want parents to leave with as much knowledge about the child’s illness as possible. Indeed, it is my sincere hope that this content will enhance the relationship between you and your child’s doctor and that you have many productive and healthy visits down the road for years to come.
HAY FEVER (Allergic Rhinitis) 289 asthma, dental misalignment necessitating braces, and sleep disturbance leading to learning and/or behavioral problems. 7. Is this an allergic condition, and, if so, how long should we wait to see an allergist? The symptoms of allergic rhinitis may be difficult to distinguish from those of viral URIs in very young children. If your child has other allergic features (such as infantile eczema) or a strong family history of allergies, chances are better than not that the chronic nasal symptoms are allergic. Regardless of the childs age, if the rhinitis symptoms do not respond satisfactorily to a trial of allergy medications or are complicated by recurrent infections or asthma, referral to an allergist is recommended for additional evaluation and management.
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8. When do I call you back regarding my childs progress? You should call if the allergy symptoms are not clearly improving within one week after starting medications, sooner if your childs condition is worsening or you observe medication side effects. 9. Will you need to see my child again regarding this condition? If the allergy symptoms are manageable with medications, the problem and its treatment will be reviewed at your childs annual wellness visit. If the allergies are complicated by recurrent infections or asthma, follow-up visits should be scheduled twice a year to review the childs progress and consider additional interventions. ROBERT W. SUGERMAN, MD Allergy and Immunology 1001HealthyBabyAns.qxd:Layout 1 4/11/08 9:25 AM Page 290
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HEADACHES Authors Comment: This is a very common complaint among children. It is important that you consult your childs doctor to rule out any serious underlying condition if the headaches persist or occur with significant frequency. 1. What is the cause of my childs headaches? There are multiple causes of headachesmost are benign. A thorough history, physical examination, neurological examination, and headache examination is necessary to make sure the headaches are not serious. The most common recurrent headache is migraine. Sinus headaches are usually at the nasal bridge and not associated with classic symptoms of migraine, which are light and noise sensitivity and abdominal discomfort. 2. Are we sure that they are not a symptom of something more serious going on in the head?
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We become concerned if the patient has early morning vomiting with headaches. There is no classical history that definitely identifies a brain tumor or other space-occupying lesions, but early morning headaches with vomiting are often suspicious. Keep records of 1001HealthyBabyAns.qxd:Layout 1 4/11/08 9:25 AM Page 291 HEADACHES 291 headaches and avoid excessive intake of caffeine, establish good sleeping habits (eight to nine hours per night), and ensure that your child is eating appropriately without skipping meals, as well as drinking lots of fluids, especially when it is excessively hot. These simple procedures can often prevent routine headaches. 3. Are there more tests that need to be performed to better define the cause of this disorder? If the patient does not respond to treatment or has abnormalities on neurological examination, your doctor may want to obtain an MRI scan of the brain. 4. What medicine(s) should we use to treat the headaches?
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