Useful Medical Information

Hawaii Poison Control Center

Phone number to the Poison Control Center is 1-800-222-1222. It is helpful if you know the name of the poison, quantity ingested, concentration of the drug, and the time of ingestion.

 

Fever

Fever, which is defined as 100.4⁰ F (or 38⁰ C), is a cause of worry to many parents as it signifies that your child is ill. Fortunately, the great majority of children with fever have no serious infections or diseases due to immunizations. The most important thing to realize is that fever in and of itself does not cause brain damage (unless caused by heat stroke such as having a baby locked in a hot car alone). There is no need to bring down the temperature down to 98.6⁰. In fact, experts say that fever helps the body fight off the infection! Also, the age of the child makes a difference. Fever in babies less than 1 month of age is considered a medical emergency, and they need to go to the hospital right away. I still send babies less than 3 months of age to the emergency room to be on the safe side since their immune systems are still immature. Babies between 3 to 6 months of age is that "gray zone" where they probably can be checked out at the doctor's office rather than going to the emergency room. Children after 6 months of age have strong immune systems and should be fine with a fever. Generally for these older kids, they should see a doctor if their fever continues for over 3 to 5 days (since fevers caused by most viruses do not last this long). However, if they should have the following symptoms, they should go to the emergency room immediately.

  • Trouble breathing.
  • Fussiness and difficult to console (difficult to stop crying).
  • Very sleepy and difficult to arouse.
  • Trouble focusing with eyes (poor eye contact).
  • Parental anxiety (that maternal and paternal instinct that something is going very wrong with the child).

These are general recommendations, so in doubt, call your doctor. Make sure that the temperature is taken appropriately. In babies less than 3 months of age, rectal temperature is still the most accurate. So if you take the temperature and it is borderline, such as 99-100⁰ under the armpit, recheck it rectally. In babies over 3 months of age, the temporal artery thermometer can be used, and in babies over 6 months of age, the tympanic (ear) thermometer can be used. Oral thermometers can be used in children over 4 to 5 years of age. For dosing using acetaminophen (for example, Tylenol), or ibuprofen, see below. A good reference for more information regarding fever can be obtained through the American Academy of Pediatrics at healthychildren.org.

 

Acetaminophen Dosing Chart

This chart shows how much acetaminophen (for example, Tylenol) to give. I have not included the age, because the correct dose is based on weight, rather than age. Acetaminophen can be given every 4 to 6 hours, with a maximum of 5 doses in a 24 hour period. This is very important to avoid overdosing your child. Since some generic acetaminophen comes in the concentrated drops, I have included this; however, Tylenol is only in the suspension liquid to avoid confusion between the more concentrated and drops and the less concentrated suspension. So it is very important to know what concentration of acetaminophen you have! If you are not sure or have any questions regarding dosing, call your doctor.

Acetaminophen Dosing Chart.png
 

Ibuprofen Dosing Chart

This chart shows how much ibuprofen (for example, Motrin or Advil) to give. I have not included the age, because the correct dose is based on weight, rather than age. Ibuprofen can be given every 6 to 8 hours, with a maximum of 4 doses in a 24 hour period. If you have any questions regarding dosing, call your doctor.

 

The Snotsucker!

Parents have asked me what is good to suck out their baby's nose due to congestion. The bulb suctions from the hospital or store may not work too well. I was told by nurses at Kapiolani Medical Center that NoseFrida works very well. Essentially the parent is using his/her mouth to suck out the snot; however, rather than going into the parent's mouth (which is rather gross), it goes into a trap.

The gift shop at Kapiolani Medical Center for Women and Children is selling it for $17.50 plus tax. I heard they are also selling this at Babies "R" Us.

For gift shop hours, go to http://www.kapiolani.org/women-and-children/giftshop/.

For information regarding NoseFrida, the website is: http://www.fridababy.com/shop/nosefrida/.

 

Saline Nose Drops

You can either purchase saline nose drops, which works well to loosen up mucus in your baby's nose, or make it at home, and it's very easy.

The recipe is: 1/4 tsp salt into 8 oz of warm water.

Put 1 to 2 drops into each nostril, wait for 60 seconds then suck out. You can use a cotton ball or a dropper to drip the nose drops in. Popular brands for store bought ones are Ayr and Ocean.

To use the bulb suction, depress bulb first, then gently insert the tip into the nostril, and lastly release. Or you can use NoseFrida (see above).

 

Fish and Mercury

Eating fish is very popular in Hawaii and it can be a part of a healthy meal. However, certains types of fish can have mercury which can be harmful to the developing brain. The following chart from the State of Hawaii's Department of Health has guidelines on eating fish for women who are pregnant or are breastfeeding, and children younger than 8 years of age.

  • Eat anytime: Akule, awa (milk fish), moi, mullet, opelu, salmon, fish small enough to fit in a frying pan whole, ika (squid), tako (octopus), scallops, shrimp.
  • Only once a week: Aku (skipjack tuna), canned tuna, cod (butterfish), grouper, halibut, mahimahi, nairagi (striped marlin), orange roughy, pollock.
  • Only once every 2 weeks: Ahi (bigeye/rombo/yellowfin tuna), ono (wahoo), opah (moonfish).
  • Do not eat: Kajiki (Pacific blue marlin), shark, swordfish (shutome).
 

Mineral Content of Foods

The following table are foods that is high or low in a particular mineral if you are interested. This table is from an old reference of mine from New Orleans (which explains why there are Southern foods on the list).

  • High potassium: Lima beans (canned), mustard greens, spinach, broccoli (frozen), tomatoes (raw, canned, juice), banana, apricot, milk, prunes (raw, cooked, juice), and orange juice.
  • Low potassium: Carrots, peas, green beans, corn (canned), apples (raw, sauce), pears, cranberries (raw, juice, sauce), ginger ale, and Kool-Aid.
  • High calcium: Cream of Wheat, All-Bran; spinach, mustard greens, green peas, broccoli; figs, dates; egg yolk; milk, and milk products.
  • Low calcium: Cornflakes, oatmeal, macaroni, noodles, rice, grits; corn, potatoes, tomatoes, lettuce, carrots; canned and fresh fruit; beef, chicken, pork; butter, and egg white.
  • High phosphorus: All-Bran, Cream of Wheat; greens, peas, dried lima beans, okra; dates, raisins; turkey, beef heart and kidney; fish; egg yolk; milk, milk products, and cheese.
  • Low phosphorus: White bread, grits; carrots, beets, green beans, celery, lettuc, onions, parsley; stewed chicken, wieners, sausage, Vienna sausage; peaches, pears, apple, grapefruit, apricot; raw egg white, and butter.
  • High iron: All-Bran, Cream of Wheat, enriched macaroni, spaghetti, oatmeal; American cheddar cheese, egg yolk; clams, oysters; dried apricots, dates, prunes, peaches; dried beef, fried chicken beef heart and kidney, liver, roast turkey; asparagus, green beans, green peas, spinach, greens, broccoli, and dried lima beans.

Why are these minerals important? Let's go through each of these.

Potassium is needed to maintain the electrical activity in cells, and low potassium (hypokalemia) can cause changes in the electrical activity of the heart, which can be seen in an EKG. Fortunately, it is impossible to have low potassium from diet alone. It would occur from loss of potassium through the GI tract (such as with vomiting, diarrhea, laxative use, or an ileostomy) or from the kidneys (through some types of medications). Symptoms of low potassium are muscle weakness, aches, cramps, and irregular heart beats with very low levels.

Calcium as we were taught in school is important for strong bones and teeth. A lifetime of low calcium can increase the risk of osteoporosis. Calcium requirements change depending on the age of the person. Children who are growing very fast (such as the growth spurt that happens in adolescents) need more calcium than other age groups, which amounts to 1300 mg/day.  There's another condition called hypocalcemia which is where the blood is low in calcium and this can lead to muscle spasms. However, this is not caused by a faulty diet, but commonly due to hypoparathyroidism.

Phosphorus is important is bone metabolism and is an important component of ATP (which is the energy molecule of the cell). As such, calcium and phosphorus are both important is strong bones. As long as you eat a well balanced diet, you don't have to worry about this, as low phosphorus levels in the blood is pretty rare in healthy individuals.

Iron is an important component of red blood cells, which is the oxygen containing cells of the body. Deficiency of iron can cause anemia, and this can be commonly seen in a diet low in iron although it can also happen from chronic blood loss. As our body needs oxygen to function, anemia can lead to feeling weak and tired, trouble concentrating, and headaches.

So, in summary, if you are a healthy individual, you only need to worry about two things on this list, calcium and iron. A diet low in calcium can lead to osteoporosis or weak bones when you are older, and a diet low in iron can lead to anemia.