• Colds are caused by viral infections of the nose and throat.
• The average healthy child will experience between 6-10 colds a year.
• While colds are not serious, about 5-10 % of children will develop a bacterial complication (e.g. ear infection).

Typical Cold Symptoms

• Runny or congested nose—it’s okay for mucus to be clear, cloudy, yellow or even green!
• Fever of 100° F or greater that lasts for up to three days (72 hours)
• Sore throat or hoarseness
• Red, watery eyes
• Coughs that last up to three weeks

From Cold to Worse (When symptoms require a trip to GetzWell)

• Earache or discharge from the ear
• Fever that lasts more than three days
• Fever that went away for 24 hours and then returns
• Sore throat that lasts more than five days
• Coughs that last more than three weeks or a worsening cough
• Respiratory distress or wheezing

Treatment and Immune Support

• Comfort measures
  • Humidity—Try a cool-mist humidifier in the room and nasal saline drops to help moisten mucus membranes.  Suctioning mucus with a “nose frida” is often helpful.
  • Elevate the head while sleeping to reduce post-nasal drip stimulated coughs.  Fold blankets or towels under the crib mattress to elevate.
  • Increase fluids to help reduce congestion and prevent dehydration (milk counts too as it’s NOT linked to increased phlegm production).
• Immune Boosting Products and Treatments
  • Oscillococcinum: A homeopathic remedy that can safely be used at any age at both onset of cold symptoms and as weekly prevention during cold season.
  • Cold Calm: Another homeopathic medication that can be used at onset of cold symptoms at any age.
  • Echinacea/Eyebright: An herbal tincture that can be given daily during cold and flu season as a daily immune system booster.
  • Echinacea/Astragalus: An herbal tincture that can be given at the onset of a cold for deep immune support.
  • Probiotics: A daily supplement that helps to boost both the innate and acquired immune responses.
  • Chestal: A homeopathic cough medication that can be used to reduce cough (contains honey and shouldn’t be given to children less than one year due to risk of botulism).
  • Honey: A simple natural product found to be effective at suppressing cough (not for infants under one due to botulism).
• Over-the-Counter Products
  • There are NO cold and cough formulations approved by the FDA for use in children under four years old and in general they are ineffective at curing the common cold.
  • Ibuprofen can be given to reduce fever.  Please contact us for correct dosing as dosage should be based on a child’s weight, not age.

The Mayo Clinic defines chronic constipation as a two week period marked by several days between bowel movements that are accompanied by hard, dry and difficult-to-pass bowel movements and abdominal pain, irritability, nausea, poor appetite, or bright red blood on the surface of hard stools. Parents should also seek medical advice if they notice symptoms like abdominal bloating, forceful straining with bowel movements, and/or lumpy, hard or small pellet-like stools along with a feeling lingering fullness. Children with serious constipation often refuse to go to the toilet, hide in order to maintain privacy, soil their underwear and/or wet their beds.

While the quality and frequency of bowel movements varies from one child to another, it is important not to ignore symptoms of constipation. Chronic sufferers may experience encopresis (the involuntary leakage of feces that occurs in 60% of children with chronic constipation) which invariably results in shame, guilt, isolation and social stigma, and they may also distend their bowels causing nerve damage to their GI tracts and even experience rectal prolapse.

What to consider if your child begins to show signs of constipation:

• increasing fluids and exercise
• decreasing all dairy consumption
• teaching relaxation techniques (particularly deep, slow breaths while relaxing the pelvic muscles)
• regular abdominal massage
• supplementing with magnesium
• introducing a multi-species probiotic that contains Lactobacilli and Bifidobacteria
• adding age-appropriate fermented foods like sauerkraut, tempeh, or miso
• increasing dietary fiber (A good measure is 5-6 grams of fiber plus your child’s age. For instance, a 5 year old should have 10-11 grams of fiber per day.)

Raw fruits and vegetables have the most fiber, but cooked ones are also beneficial. Remember that the harder a vegetable is, the more fiber it has. Keep in mind that in order to reap the benefits of fiber, it is very important to drink adequate amounts of water (a minimum of 3 glasses) to help with the passage of stool in the intestines. If your child requires more than these general lifestyle and dietary changes to manage his/her constipation, please contact us for a consultation:  415.826.1701.

Fevers are part the body’s effort to activate the immune system, so they are one of our innate protective mechanisms. Most fevers are good for children because fevers help them to fight infection.

The body’s temperature normally fluctuates throughout the day and peaks in the late afternoon and evening. For instance, an oral or axillary (under the arm) temperature can be 97.6° F  (36.5° C) in the morning and go to a high of 99.5° F (37.5° C) in the evening. Similarly, a rectal temperature can be as low as 98.4° F (36.9° C) in the morning and become as high as 100.3° F (38° C) in the late afternoon.

If your child has a fever, remember to stay calm and use the following definitions to put your child’s fever into perspective (If your child is less than 6 months old, then you should immediately call your doctor.):

• 100-102 F (37.8-38.9 C)  Low grade fevers are beneficial (Try to keep temps here*)
• 102-104 F (38.9-40.0 C)  Moderate grade fevers are beneficial*
• > 104 F (>40.0 C)       High fevers cause discomfort but are harmless
• > 105 F (>40.6 C)       Higher risk of bacterial infection
• > 108 F (>42.2 C)       The fever itself can be harmful

Many people mistakenly believe that fevers cause brain damage and that temperatures above 104° F (>40° C) are dangerous. However, fevers caused by infection do not produce brain damage. Only body temperatures over 108° F (42.2° C) can cause brain damage, and body temperature only climbs to this level with very high environmental temperatures. (Example:  being inside a closed car on a hot day.)

Fevers only need to be treated if they cause discomfort, and these are usually fevers over 102 or 103° F (38.9 or 39.5° C). The exact number of your child’s temperature or fever is not as important as how your child looks and feels. Is he/she alert, interactive, curious despite the fever? Is he/she drinking and urinating?  Is he/she complaining of pain or very uncomfortable?  These are the questions that should be asked to determine if you should seek out a doctor’s care (* unless your child is less than 6 months of age, then you should call your doctor immediately).

If you treat a fever, temperatures don’t always normalize. With treatment (removal of clothing, cool bath, ibuprofen), temperatures often drop 2 or 3 degrees Fahrenheit (1-1.5° C), usually enough to allow your child to feel a little better. And if the fever “doesn’t break,” this isn’t cause for alarm. There is no greater risk that a fever that doesn’t come down is caused by a serious infection. Fevers that don’t respond to fever medicine (usually ibuprofen or acetaminophen) can be caused by viruses or bacteria.  And there are no medicines that kill viruses.

Fevers will not continue to climb higher and higher if not treated. Fevers from infection usually stop rising at about 105-106° F (40.6 or 41.1° C) or lower, because the brain’s thermostat keeps body temperatures lower than this.

Not every child with a fever is at risk for a febrile seizure. Only about 4% of all children will ever have a febrile seizure. If your child has a febrile seizure, though it is scary to watch, they cause no permanent harm and usually last less than 5 minutes. Children who experience febrile seizures have no increased risk of developmental delay, learning disability, or epilepsy.

PR: wait… I: wait… L: wait… LD: wait… I: wait… wait… Rank: wait… Traffic: wait… Price: wait… CY: wait… I: wait… YCat: wait… C: wait…

A:  After the first few days of life when your baby has meconium bowel movements that are very dark and sticky, it’s normal for your newborn’s poop to begin to be very watery and seem like diarrhea.  Breast fed infants, in particular, have BMs that are loose and seedy and range in color from brown to mustard yellow to green.  A typical newborn’s poop looks a lot like grainy mustard–think Grey Poupon country style!

Q:  My newborn must have a cold because he keeps sneezing.

A:  It’s very unlikely that your baby is sick.  Newborns often sneeze quite a bit and we think of it as nature’s way of allowing your baby to blow his nose.  New babies have very small nasal passages and usually make a little bit of mucus which can produce some degree of nasal congestion.  This usually isn’t a problem, but because newborns don’t know they can breathe through their mouths, you may hear your newborn’s breathing and think it means he is having difficulty.  As long as your baby is feeding well, is content, doesn’t seem to be struggling to breathe or crying a lot (which forces babies to mouth breathe) he is likely just fine.

Q: We want to take our baby girl to a party but she is only 2 weeks old.  Is this OK?

A:  The immune system of a newborn is immature and the more people she is exposed to the greater the likelihood she may catch something which could cause her to become quite sick.  We generally stress being very careful regarding hand hygiene and potential exposure to germs for the first 60-90 days of life, when pediatricians consider a fever a sign that an infection may be serious.  Hand washing is the best way to prevent introducing illness-causing germs to your newborn; proper cleaning of your hands involves rubbing them together for 15 seconds (or 3 rounds of “Row Row Row Your Boat”) with good old soap and warm water or the use of an alcohol based hand sanitizer.

Q:  Which hand sanitizers are best?

A:  Generally we recommend an alcohol based product which is rated 0-2 on the Environmental Working Group (EWG) cosmetics database toxicity scale (http://www.cosmeticsdatabase.com) so that you’re sure to purchase something effective while avoiding highly toxic ingredients.  This is an important factor when considering what to buy for you and your baby.  EWG is a tremendous resource available to guide purchasing decisions.  Babies and small children have very thin skin and immature detoxification systems, and thus are vulnerable not only to what we feed them but also to what we use on their skin, what we clothe them in, and what they breathe.

Q:   Do I need to give my 2 month old baby Vitamin D drops?  There is not much sun in our San Francisco neighborhood and we spend most of our time indoors.

A:  Vitamin D is important to our health and many of us have insufficient levels due to lack of adequate sunlight exposure or supplementation.  The American Academy of Pediatrics (AAP) recommends all children receive a vitamin D supplement starting in the first few days of life because evidence has shown this could have life-long benefits.  Furthermore, because of the growing body of evidence that a pregnant woman’s vitamin D status is important to her developing fetus, the AAP has recommended that physicians caring for pregnant women consider vitamin D testing during pregnancy.

At GetzWell we test all new mothers’ vitamin D levels and often find they are lacking.  This is critical both for mothers’ health and directly impacts the breast feeding baby.  Once we have these results, we can tailor our recommendations to each mother and baby as part of our effort to optimize the health of our patients and families.

Before refrigeration, people throughout the world ate fermented foods rich in probiotics on a daily basis.  In contrast, our modern diet often lacks such foods (except yogurt, miso and kimchi, for instance).  Some experts say we can make up for the dearth of dietary sources of probiotics by taking a daily supplement (in addition to eating fermented foods and a high fiber diet on a regular basis).  There are reputable companies making probiotic supplements that are available for purchase at Whole Foods, Rainbow Grocery, and other health oriented stores.  At GetzWell Pediatrics we carry pharmaceutical grade probiotic supplements manufactured by Klaire and Pharmax.  We believe the universe in our bellies needs careful tending, just like a garden.

For more information and scientific references on probiotics go to the National Center for Complimentary and Alternative Medicine at the NIH: www.nccam.nih.gov.