TABLE OF CONTENTS
I.
Welcome to Emerald Pediatrics
1. Introduction
2. Hours of Operation
3. Calling the Office During Office Hours
4. Calling the Office After Office Hours
5. Policies
6. Schedule of Appointments
7. Screening Tests
8. Vaccines
II.
Welcome to Parenthood
1. Introduction
2. General Care of Your Newborn
3. Infant Medicine Chest
4. Development – The 2-4 Month Infant
5. Development – The 4-6 Month Infant
6. Development – The 6-9 Month Infant
7. Development – The 9-12 Month Infant
8. Development – The 12-15 Month Infant
9. Development – The 15-18 Month Infant
10. Development – The 18 Month-2 Year Child
11. Development – The 2-3 Year Child
12. Development – The 3-4 Year Child
13. Development – The 4-5 Year Child
III.
Common Illnesses
1. Introduction
2. Burns
3. Chickenpox
4. Colds
5. Constipation
6. Cough
7. Diaper Rash
8. Diarrhea
9. Earache
10. Fever
11. Head Injury
12. Nosebleeds
13. Vomiting
IV.
Acetaminophen/Ibuprofen Dosing Chart
WELCOME TO
EMERALD PEDIATRICS
INTRODUCTION
The Pediatricians and staff at Emerald Pediatrics feel it is our privilege to care for your
child. We wish to provide superior pediatric care in a friendly, accessible environment.
We respect the individuality of each family and are committed to assisting you in
providing the best environment for your child’s medical, developmental and emotional
well-being.
The Pediatricians have created the “Emerald Book” as a resource for families. Included in
the book is information regarding your child’s medical care and development, as well as
general office hours/policies and billing/insurance information.
HOURS OF OPERATION
Monday-Wednesday
Thursday-Friday
Sunday/Holiday
8:00am-6:00pm
8:00am-5:00pm
No routine hours
Walk-In Hours (ill only):
Monday-Saturday:
8:00am-9:00am
Walk-in hours are available all year for ACUTE illnesses only (illnesses arising
suddenly) for established patients only. We will not see patients for chronic
illnesses/problems during this time. Patients are seen on a first come, first serve basis.
New patients (patients who haven’t yet been seen in our office) require a scheduled
appointment with a physician for their first appointment.
Holidays observed
New Year’s Day, Memorial Day, July 4th, Labor Day,
Thanksgiving Day, Christmas Day
Limited morning hours
Good Friday, the Wednesday before and the Friday after
Thanksgiving, Christmas Eve and New Year’s Eve
CALLING THE OFFICE DURING OFFICE HOURS
We strive to provide our parents with efficient service when calling our office. For this
reason, when you call, there will be several options from which to choose to route your
call appropriately. Calls are received from 8:00am until 4:30pm Monday-Friday. If you
have a very urgent matter and need to speak to a doctor or nurse immediately, there is an
emergency option. For routine matters, please consult this book or our website:
www.emeraldpediatrics.com prior to calling the office as these references provide
useful information.
In order for the physician to have adequate time to address your concerns, it is crucial to
inform the receptionist or nurse the exact nature of your visit. We gladly provide more
time if we know ahead of time so that your doctor does not run behind and you do not
feel rushed.
Well Visits/Physicals: Well visits can be made with any physician in the practice. The
physicians share all of the patients. Therefore, you can choose which doctor your child
sees for each well visit. In general, the further in advance you call, the more likely you
are to get an appointment with the doctor and time of your choice. We have some
evening appointments available for well exams during the weekdays.
Ill Appointments: If your child is ill and you are certain an appointment is needed, let
the receptionist know and an appointment will be made. Please call as early as you can in
the day so that we can see all ill children in a timely fashion. We want you to be
reassured that all of our doctors practice similarly so that if your child’s doctor is
unavailable that day, you can feel comfortable seeing one of the other doctors.
Medical Advice: If you are unsure if an appointment is warranted or would just like to
talk to the nurse about a medical issue, you have the option of leaving a message for the
nurse. You will receive a call back from a qualified registered nurse (RN) in a timely
fashion, generally within a few hours. Complicated medical, developmental or
behavioral issues are best handled by the doctor and an appointment will be
recommended.
Prescription Refills: Refills of prescription medications should typically not be needed
as the doctor should give you enough refills to last until your follow up appointment.
Please discuss the appropriate interval of appointments with your doctor as this varies.
When you have no refills left, you should make another appointment. This appointment is
called a “medical evaluation” or a “med eval” and can be made by the receptionist. If
your child may need a change in a routine medication, you will need to speak to the nurse
for advice.
If you do need a prescription called in to the pharmacy, you will be routed to our
“prescription mailbox”. Follow the prompts and leave the appropriate information.
Please allow 48 hours.
Referrals: A referral is processed by our nurses/office staff at your request because your
insurance company requires it. It is then sent to your insurance company or specialist
prior to the date of your appointment. This can be a lengthy process so one is not done if
it is not needed. The only way to find out if one is needed is to call your insurance
company and inquire. If a referral has been pre-authorized by your doctor, please leave a
message for the nurse. Please allow at least 72 hours.
School/Sports/Immunization Forms: If any form is needed to verify shots or an exam,
fill out your portion and bring in/fax/send the form for us to fill out the rest. If these
forms are brought at the time of your child’s physical, we will do our best to complete
our part right then. For middle/high school forms, the teen must fill out their portion of
the form prior to the examination. Most schools or daycares accept these as “current” for
one year. Please allow 72 hours.
Billing/Insurance/Managerial Questions are routed directly to our billing department
and general practice comments/concerns are routed directly to our office manager.
Questions for the Doctor: If you have a specific question or concern you feel is only
appropriate for the doctor, leave your information with the nurse and the doctor will
contact you.
CALLING THE OFFICE AFTER HOURS/WEEKENDS
The philosophy of the Pediatricians at Emerald Pediatrics is to always be available to you
24 hours a day, 7 days a week, 365 days a year for urgent medical problems. We define
an “urgent medical problem” as a medical problem that requires immediate advice or
intervention. We expect you to contact us if you cannot find the answer to your question
on our website or in this book. It is NEVER an imposition to answer calls of this nature.
Conversely, it is not appropriate to call after hours for routine, non-urgent medical
questions, to make an appointment, or for over the counter medication dosing. Our
doctors and staff have worked hard to provide accurate, accessible information on our
website, in the Emerald Book and office handouts as well as provide phone service
availability to families during the day. We expect that parents utilize the resources
provided to answer routine concerns/questions or call the office during regular hours.
If your child has an urgent medical problem after hours, follow the prompts and leave a
message for the doctor on call. If you do not receive a call back within an hour or two,
please call again and remember to leave ONE unblocked phone # (a number that can
accept blocked calls) where you can be reached, your child’s name and date of birth and a
short description of your child’s symptoms. This option is NOT available from 9pm-8am,
as the on call doctor is only available for emergencies during those hours (see “doctor’s
line” option below).
If your child’s medical condition is so serious that you need to speak with a physician
immediately, you may leave a message on the “doctor’s line”. This is a line that is
typically reserved for hospitals or other doctors calling about our patients, but will be
available to parents for serious medical circumstances, such as a child with breathing
problems, seizures, severe accidents or other conditions of that magnitude. Follow the
appropriate prompts and the doctor will call you back immediately.
**If for some reason, you do not receive a call back after two calls, assume that we are
experiencing technical difficulties call 911or take your child to Nationwide Children’s
Hospital Emergency Room (Downtown).
POLICIES
Unscheduled Appointments: We do not see children without an appointment unless it is
an emergency. The doctors request that parents please refrain from asking the doctor
questions about another child or asking the doctor to check another child that was not
previously scheduled unless it is an emergency. This policy exists so the doctors do not
get behind. If a 5-minute question was asked only 3 times, 15 minutes are added to other
families’ wait time. Our staff is committed to respecting your busy schedule and running
on time. It is appreciated if you please respect the time of our staff and our other families.
Often we can work in an unscheduled child at a later time or with another doctor if
needed. Ask the receptionist upon arrival to discuss your options.
Missed Appointments: Patients are charged $25.00 if an appointment is missed. We
consider an appointment missed if you have not called the office to cancel the
appointment before the appointment time. We waive the first occurrence.
Arriving Late for an Appointment: If you arrive more than 10 minutes late, without
calling ahead, your appointment is missed. We will make every effort to reschedule you
that day. If that is not possible, you will be asked to reschedule on another day.
Fees: Extra fees are charged on weekends, holidays and after published weekday hours.
Emergency Room/Urgent Care Use: Unless you have an extreme emergency, call the
office or on call doctor before you take your child to Nationwide Children’s Hospital ER
or Urgent Care. We would like to save you the long wait and exposure to illness if
possible. Often we can advise you adequately over the phone until we can see your child
in the office. In addition, your insurance company may not pay for the visit if you have
not contacted us first. If an ER or Urgent Care visit is needed, we only recommend
Nationwide Children’s Hospital.
Adult Children Age 18 & Older: At the age of 18 patients become their own
responsibility. They will be required to complete their own financial responsibility and
health history forms. We can only release information to parents with the written
permission of the patient.
Resident and Medical Student Education: The Ohio State University College of
Medicine and Nationwide Children’s Hospital Residency Program are located in
Columbus and are among the nation’s top medical education programs. We feel very
fortunate to have these facilities so close. The doctors at Emerald Pediatrics are
committed to the betterment of these programs. One way we contribute is through
volunteering to educate medical students and pediatric residents about outpatient
pediatric care. Please welcome our young doctors and doctors-to-be. We advise them that
listening to parents/patients is one of the most important parts of practicing medicine.
SCHEDULE OF APPOINTMENTS
The following is a general schedule of our recommended well-child appointments. The
recommended vaccine/screening schedule changes frequently so you will be given an upto-date vaccine/screening schedule at the office.
The schedule of well child appointments is as follows:
Newborn Exam (2-7 Days after hospital discharge)
1 Month
2 Months
4 Months
6 Months
9 Months
12 Months
15 Months
18 Months
2 Years
Annually thereafter
We see newborns up through age 21.
SCREENING TESTS
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Hgb: Hemoglobin-a blood test by finger stick to check for anemia/low iron.
UA: Urinalysis-a test of the urine to check for diabetes, infection or signs of early
kidney disease.
PPD: A screen for the disease tuberculosis. The patient must return to the office
in 48-72 hours after receiving the PPD for the nurse or doctor to check the site.
Cholesterol Screen: Screens for hereditary high cholesterol which can be detected
as young as 6 years of age.
Vision: Distance vision is checked by asking your child to identify letters or
pictures through a vision screener.
Hearing: Hearing is checked using headphones and tone testing. Your child will
be asked to push a button when the tone is heard.
VACCINES - We follow the American Academy of Pediatrics Vaccination Schedule.
Vaccinating your child is important. The pediatricians at Emerald Pediatrics keep up to
date on all vaccine information and believe that the great benefits of vaccines far
outweigh the small risks. Therefore, the doctors feel very strongly that your child should
be vaccinated with all recommended vaccines. There is a lot of information (both good
and bad) on the Internet and in the news about vaccines that can be confusing. Please
talk with the doctor about any concerns or questions you may have about this very
important topic.
The following is a brief description of the vaccines we currently recommend for all
children. You will be given more detailed information in written form about each vaccine
at one of your child’s first visits, as well on the day the vaccines are given.
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DTaP: Diphtheria, Tetanus, Acellular Pertussis
Hepatitis A: Self-limited viral liver infection
Hepatitis B: Severe liver infection
Hib: Haemophilis Influenza type b (bacterial meningitis, blood infection,
epiglottitis)
HPV: Human Papilloma Virus – given to both sexes at age 11 years
Influenza: Available in late summer/early fall
IPV: Inactivated Polio Vaccine (not live)
Meningococcal: Neisseria Meningitis bacteria; fast acting, life-threatening
infection. This is most important for those children that do not have a functioning
spleen and those living in crowded conditions (i.e., college dorms)
MMR: Measles, Mumps, Rubella
Prevnar: S. Pneumococcal Bacteria (meningitis, ear/sinus/blood infection,
pneumonia)
Rotateq: Rotavirus
Tdap: Tetanus, Diptheria, Acellular Pertussis
Varivax: Chickenpox
WELCOME TO PARENTHOOD
INTRODUCTION
The following chapters of the Emerald Book have been prepared to assist you in caring
for your newborn and young child. For each age, the pediatricians have summarized the
most common nutritional, developmental and safety information questions asked by
parents at well child visits. The newborn section, for babies from birth to 2 months, is the
most detailed section because that is the age for which parents, understandably, tend to
have the most questions. Newborns, and the children they become, seem overwhelming
at first, but really just need your love and careful attention. Well-intended advice is often
offered to new parents from family members, friends and the media. This information
may be inaccurate, or may not be the best care for your baby. We hope you will use this
booklet to guide your efforts to provide the best care for your child, and ask us for
additional parenting information when the need arises. Our office has more detailed
information in handouts, including sample menus for various ages. We also have a
website which is regularly updated with medical news and articles you may find helpful.
We wish our families the best experience possible with their new adventure in parenting.
GENERAL CARE OF YOUR NEWBORN
Hospital Stay: The earliest experience you will gain with your newborn is in the birth
hospital. We encourage you to stay as long as you are allowed, especially with a first
baby, to maximize rest and recuperation. Keeping your newborn close by (i.e. in your
room for the most part) is helpful in gaining knowledge about your new baby’s care and
needs from experienced hospital staff.
Once home, continue your rest and recuperation. Use pain medications offered by your
obstetrician and continue your prenatal vitamins if breastfeeding. Your newborn will not
need bathing, temperature measurements or any medical care prior to your first office
visit with us, unless her condition changes. We would like to see your newborn in the
office shortly after discharge. This is usually 2-7 days after discharge from the hospital. If
you have any concerns or questions prior to this first appointment, do hot hesitate to call.
Consider that many answers to your questions may be found in the following chapter of
this book.
Call our office immediately if you notice any of the following:
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Fever over 100.4 F rectal measurement in the first 6 weeks
Absence of stool or wet diapers for 24 hours
Increase jaundice (yellow skin)
Excessive (unrelenting) irritability, crying
Infant too sleepy to awaken for feedings at all
Infant Feeding: Hunger is the primary infant drive in the first weeks of life. We
recommend on demand feeding (NOT on a schedule), until the first few months are
behind her. Newborn infants need to eat often, up to every hour. Infants also require
nighttime feeding until closer to 4 months. Feed your baby whenever she cries in the first
few weeks, unless she was fed in the hour. Limit pacifier use, as suckling may indicate
her hunger. Be aware many newborns suckle for enjoyment, and may continue this
behavior after being fully fed. Limit a single feeding in time accordingly, usually 10-15
minutes per side if breastfeeding. Newborns lose up to 10% of their weight following
birth, and will regain this in the following week. Feeding your newborn can be frustrating
at first, but will quickly become a pleasurable time for you and your baby.
Breastfeeding: We strongly encourage mothers to breastfeed their infants when
possible. Advantages to the infant include protection from common viral illnesses
including colds and stomach flu, excellent digestion and optimal nutrition. Although
breastfeeding is the natural way to feed a baby, this skill requires patience, practice and
often hands-on help. We are very knowledgeable and supportive of breastfeeding, and
welcome your questions and concerns.
Breastfeeding begins immediately following birth in the hospital. Ask to feed your infant
when possible in the delivery room. Frequent feedings are recommended in the first few
days while your breasts are soft and staff is available to assist you. The frequency is on
demand, but wake your newborn for a feeding if she sleeps over 3 hours in the daytime.
Feeding duration should not exceed 10-15 minutes per breast to lessen nipple trauma.
Early milk production is a thick yellow liquid called colostrum, which is very beneficial
to your baby. Expect your milk to come in within 3-5 days. Twenty-four hours later, your
baby should be making wet diapers and stools frequently. If this is not the case, call your
doctor. Breast milk stool which follows the clearing of meconium, is yellow, watery and
seedy.
Breastfeeding can occur anywhere in your home where you are comfortable sitting, with
adequate pillows, a glass of water and some privacy. Be sure the baby holds your nipple
deep in her mouth to avoid nipple trauma. Limit feedings to 10-15 minutes per side, as
most breast milk is removed within this time. Ideally, if breastfeeding is going well, your
baby will not require any additional bottles of formula. Bottle feeding (or “supplements”)
a breastfed infant at this point is often confusing and counterproductive to the
breastfeeding process. In most instances, it is usually best not to introduce a bottle until
an infant is at least one month old. There may be cases where your doctor recommends
formula supplements for certain circumstances.
We will inquire about your breastfeeding experience at our first office visit, and will
measure your infant’s weight gain from birth. In many instances, breastfeeding can be a
challenge to new mothers. In most cases, this quickly improves and is followed by
months of mutual enjoyment. We encourage you to breastfeed as long as you are
enjoying this process with your baby.
Bottle-feeding: Again, on demand feedings are recommended for bottle-fed babies.
Most infants will work up to 2-4 ounces every 3-4 hours in the first weeks of life. We
recommend an iron rich cow’s milk formula, such as Enfamil LIPIL, or Similac
Advance as a first formula. Most infants will remain on the same formula for their first
year. Please contact us before switching to a special formula. Refrain from using low-iron
formulas as they are inadequate in nutrition for growing infants, and may adversely affect
neurologic development. Bottles require only dishwasher sterilization, and tap water (not
from a well source) is fine without boiling. Warm formula in a dish of warm water to
room temperature or slightly warmer (never microwave formula for infants). Most babies
will need to be burped once or twice during a feeding, and small amounts of regurgitation
are normal.
Water: Babies do not require additional feedings of water during the first few months.
All nutrition and fluid requirements are met in breast milk or formula feedings. Never
feed an infant honey prior to twelve months of age. Do not give newborns any other form
of solid or liquid feedings, until closer to four months of age.
Fluoride: Fluoride prevents formation of cavities. If your home water supply does not
contain fluoride (e.g. well source), your infant/child will need a supplement starting at six
months. Consider this when using bottled water to prepare formula, as many do not
contain fluoride. Tap water is usually perfectly fine.
Vitamins: Exclusively breastfed infants may benefit from a multivitamin drop daily,
starting at age two months. Ask your doctor at the two month check up.
Comfort Measures: Use your own comfort as a guide to room temperature, clothing
and activities for your newborn. Even newborn infants can overheat and should be kept
out of direct sun in warm weather. Avoid crowded indoor spaces in public areas until
your baby is at least one month of age. Visitors are okay from the start, as long as they do
not have any ill symptoms and they wash their hands prior to handling the infant.
Sleep: Newborn infants spend the majority of their time sleeping (average of 16-22
hours/day). Your baby should sleep ONLY on her back, until 6 months of age or able to
roll. This has been shown to lessen the risk for Sudden Infant Death Syndrome (S.I.D.S.).
Use a firm mattress with no pillow or other objects in the crib. Consider sleep sacks or
pajama alternatives to blankets. Sleep positioners or wedges are unnecessary, and may
lead to the development of poor sleep habits.
Bathing:
The frequency of your baby’s bath depends on your schedule and wishes. It is only
necessary to bathe your infant once or twice a week. Your newborn’s first bath must wait
until the umbilical cord has fallen off. After this, bathe your infant head to toe in a warm
room with all equipment (soft cloth, hair brush, gentle soap) nearby. Avoid the eyes, nose
and mouth. Special basins are not required. Hold your baby at all times while in the
water.
Cord Care (Umbilicus): Keep your infant’s umbilical area clean and dry. The umbilical
cord will fall off in one to two weeks, and there may be spotting of blood on the clothing
when this occurs. This is normal. Call if you notice any redness at the skin around the
cord, or any unusual drainage.
Circumcision Care: If your baby boy was circumcised, apply Vaseline or Neosporin
ointment to the raw area until the skin of the glans looks the same as the skin on the shaft.
This prevents the skin from sticking to the diaper. The skin will appear normal in
approximately one week. As the circumcision heals, a soft yellow covering may develop
which is entirely normal. If you notice redness of the surrounding skin, bleeding or pus,
please call your doctor.
Jaundice: Many infants become jaundiced (yellow) following birth. Parents may notice
this color change in the first 2-5 days after hospital discharge (jaundice usually peaks on
the third-fourth day of life). If your baby appears to be yellow and is increasingly sleepy,
call us immediately. The treatment for jaundice is simple and can often be handled at
home. We may suggest a blood test or a change in her feeding.
Diapering: Newborn stools are frequent, yellow/brown/green and watery. They cannot
be distinguished from diarrhea. Bottle-fed infant’s stool may be firmer, and may pass
only once every 1-3 days. This is normal. In the first few days, many newborns produce
urine of salmon (pink-orange) color. This is attributed to urate crystals, and is considered
normal. Newborn girls may produce a bloody-mucus discharge from the vagina in the
first few weeks. This results from maternal hormones, and is normal. We recommend no
particular brand of diaper, but frequent changing to keep the skin intact and healthy. If
your newborn shows any signs of irritation in the diaper area, consider using only cotton
balls with warm water for changing, instead of baby wipes. Allow brief air drying before
replacing the diaper. If diaper rash develops, keep skin covered with a zinc oxide cream
(e.g. Desitin or A+D), Vaseline, or Aquaphor. If rash has not improved in 2-3 days,
call your doctor.
INFANT MEDICINE CHEST
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Bulb syringe for suctioning nose
Pedialyte
Tylenol/Acetaminophen (160mg/5ml)
Rectal thermometer
Saline nose drops
Vaseline
Non-scented baby wash
THE 2-4 MONTH INFANT
Nutrition: Generally, at this age, most babies develop somewhat of a feeding schedule
and a few are even sleeping through the night (6-8 hours). Often, when babies miss a
feeding at night, they make up for it during the day by eating more frequently or by
“cluster feeding” before bedtime. Usually, babies this age take between 25-40
ounces/day. If your baby is taking only breast milk, ask your doctor about giving a
vitamin supplement.
Development: Your baby should be able to smile, coo, turn to sounds, hold her head up
and become more alert to the surroundings. It is wise, for development of good sleeping
habits, to put your baby to sleep in her crib or bassinet when she is drowsy but awake.
Safety: Never leave babies unattended on surfaces like a bed, changing table or sofa as
they may roll off, and continue to have your baby sleep on her back. When your baby
rolls over on her own, you may leave her there.
THE 4-6 MONTH INFANT
Nutrition: Babies should start solids between 4-6 months of age. Your baby will let you
know when by giving you signs. Some signs a baby should start solids include: taking
more than 32 oz/day of formula or breast milk, eating more frequently, and waking at
night to eat (if was previously sleeping through). Cereals (on a spoon) are started first,
followed by fruits and vegetables, usually once or twice a day, increasing slowly as your
baby allows. Make sure to try a new food for 2-3 days before moving to the next new
food. There is nothing magical about baby food in a jar. Feel free to puree your own
fruits and vegetables, although homemade food is stronger than jarred food. If you make
your baby’s food at home, you may need to dilute it with a little formula or breast milk
initially. At this age, feeding your baby is more like an exercise in learning how to eat, so
relax about the amount or frequency per day and have fun! You will be fine if you follow
your baby’s cues. Also remember that solids are given in addition to bottle or breast
feedings and are not to replace them.
Development: Your baby should be able to roll over, sit with support, vocalize more
often, reach and grab objects to play with, and may begin teething.
A word about teething: The only thing we know that teething causes in infants is teeth. It
gets blamed for lots of symptoms, though, including runny nose, diarrhea, fussiness, and
fever. If your child has fever over 101 F, frequent diarrhea or severe irritability, this is
NOT due to teething. Everyone thinks their four month old is teething because they drool
a lot and put everything in their mouth. This is a normal developmental stage.
Safety: This is the time to start baby-proofing your house, focusing on the most harmful
things like stairways and poisons. It is a good idea to leave out a few non-dangerous, nonbreakable decorations that you want your baby to avoid purposefully so that your baby
starts to understand basic boundaries.
THE 6-9 MONTH INFANT
Nutrition: By 9 months, your baby should be taking solids 3 times a day. Usually
parents give cereal once/twice and both a fruit and vegetable each day. Most babies by 89 months can tolerate ground meats, cheese, yogurt, and eggs. Cheerio’s™ or other
similarly sized foods may be offered when your infant develops the “pincer grasp” over
“raking” food. Breast milk or formula is still the main nutrition source so don’t give less
than 16 oz/day. We recommend water (we do not recommend juice) if an additional
source of fluids is needed.
Sample Menu
Breakfast:
Lunch:
Dinner:
Cereal (1/3 –1/2 c.), fruit (1/4 – 1 jar)
Vegetable (1/4 – 1 jar), fruit
Cereal, vegetable and fruit
Development: Your baby should be able to sit without support, begin to form consonant
sounds, and transfer objects from hand to hand.
Safety: Make sure not to use a mobile baby walker, as they are very dangerous. Babies
over 20 lbs. may need to get a larger car seat. Make sure the larger car seat is both front
and rear facing as your baby needs to be rear facing until 2 years of age, regardless of
weight.
THE 9-12 MONTH INFANT
Nutrition: At 1 year of age, it is recommended that bottles and formula are stopped and
replaced by “sippy” cups and whole (vitamin D) milk. For this reason, it is important to
encourage food each time and try to offer milk after meals. Do not offer cow’s milk
regularly until the age of 1 year.
Sample Menu
Breakfast:
Lunch:
Dinner:
Snacks:
Cereal (1/2 c.) or egg (1), fruit (1/2 – 1 jar), formula (3-4 oz.)
Yogurt (1/2 c.), vegetable or fruit (1/2 – 1 jar), formula (3-4 oz.)
Meat (1/2 c.), vegetable or fruit, bread (1/4 adult serving),
formula (3-4 oz.)
Cheerios™, cheese slices cut to Cheerios™ size, fruit (1/4 c.),
formula (3-4 oz.)
Development: Your baby should be able to: crawl, pull to stand, start babbling, and
understand simple commands.
Safety: Choking is a worry at this age so be very careful about their surroundings and
keep the size of their bites of food very small.
THE 12-15 MONTH INFANT
Nutrition: Whole milk, rather than formula, should be your child’s primary source of
dairy. Limit your child’s consumption of milk to 16 oz/day to prevent malnutrition and
anemia. Make sure your child gets 3 meals a day plus 2 snacks, as many with the family
as possible. Ideally, you should offer snacks that are healthy like yogurt and fruit rather
than crackers or cereals. It is also best, to help expand taste buds, to give your child small
pieces of foods that you make for your meals (assuming it is healthy) and to only give
sweets on occasion. It is also best to hold the cup until after your child eats so he/she
doesn’t fill up on fluids before eating. Your child should be weaned from the bottle as
well to prevent excess or inappropriate fluid consumption and tooth “baby bottle” decay.
Unless your child has specific food allergies, you do not need to restrict any food at this
age. Do continue to limit the size of bites to very small to prevent choking.
Recommended Food Intake
Food Group
Milk (milk products, yogurt or cheese)
Fruits & Vegetables
Bread & Cereals
Meat, Poultry, Fish, Eggs
Daily Servings and Service Size
3-4 servings; fluid servings each 4 oz.
4 servings; each 1-2 Tbsp.
4 servings; each 1/4-1/3 adult serving size
2 servings, each about 1/2 oz.
Development: Most children at this age will begin to walk independently, say several
words appropriately, and may make animal noises or point to body parts, throw balls,
stack blocks and undress themselves.
Safety: Continue to be diligent about keeping dangerous areas gated or locked. Make
sure to lower the crib to the lowest level.
THE 15-18 MONTH INFANT
Nutrition: Many toddlers start to get very picky at this age because they are growing at
a slower rate than in the first year of life. They are also busy doing other, more
interesting, things. Please remember that your child will eat the amount of food that they
need to grow. Your job is not to create bad habits with the types of food you offer your
toddler to eat. Refrain from the following and your chances of having a good eater
dramatically improve:



Letting your child “drink himself full”. The maximum milk intake is 16 oz/day,
the rest water. Offer fluids only after eating if this is a problem.
Letting your child eat junk if they refuse healthy foods “so he eats something”. If
he does not want his healthy food, he is not hungry. Save it for later or even the
next meal, he will eat it then.
Making your toddler special “toddler” food often (chicken nuggets, mac &
cheese, hot dogs). Feed your child smaller amounts of what you make (assuming
it’s healthy).



Being the “short order chef”. If your child doesn’t want what you’ve made, he’s
not that hungry.
Arguing with your toddler about eating. If he doesn’t eat, throws his food or has a
tantrum, take the food away.
You control what goes on the plate; your child controls what goes in his mouth.
Recommended Food Intake
Food Group
Milk (whole milk & milk products)
Fruits & Vegetables
Breads & Cereals
Meats, Poultry, Fish, Eggs, Beans
Daily Servings and Service Size
3-4 servings; fluid servings each 4 oz.
4 servings; each 1-2 Tbsp. or 1/4 piece
of fruit
4 servings, each about 1/4-1/3 adult
serving size
2 servings, each about 1/2 oz.
Development: Most children at this age are walking well and may be starting to run and
climb. Their vocabulary is expanding and they can follow simple commands. They are
often trying to assert their independence and want to do more on their own.
Safety: Now that your toddler is walking well, be sure to look around your home for
dangers at her level. Toilets, buckets and standing water in the yard pose a danger to topheavy toddlers. Also, lock up dangerous things that may smell good to a toddler like baby
oil, lamp oil and gasoline as well as colored vitamins or medicines. If they are climbing,
it is a good idea to anchor furniture to the wall to avoid “tip-over” injuries.
THE 18 MONTH-2 YEAR CHILD
Nutrition: Continue to be diligent about your toddler’s eating as discussed in the 15-18
month section. A children’s general purpose over the counter multi-vitamin (liquid or
chewable) may be added if your child is not eating a well-rounded diet. Get creative with
foods your toddler likes that are similar colors. Offer vegetables raw, canned or frozen.
Let your child dip vegetables in ketchup, cheese or ranch dressing. Offer melon or raisins
and yogurt for snacks in place of handfuls of crackers or cereals. Your effort will pay off
in the long run.
Development: Most children at this age can say 20+ words, and follow multiple step
commands. Your toddler’s favorite words are likely “no” and “mine” and she is probably
having tantrums if she is mad. This behavior is normal, but will escalate if she is allowed
to get her way. It is very important to ignore the tantrum entirely so she will learn that
tantrums don’t work. Encourage her to “use her words” to tell you what she wants.
Safety: Transfer your toddler to a toddler bed or a mattress on the floor if he can climb
out of the crib or if he is very tall. Make sure to baby proof his room and put a gate up at
the door. Also make sure your toddler can’t open the doors to get out of your house. You
may change to a forward facing car seat at age 2 years.
THE 2-3 YEAR CHILD
Nutrition: Children this age are still very picky. We encourage you to “stay the course”
with the previous advice in the 15-18 months and 18-24 months sections. Take advantage
of your child’s hungry times by feeding them fruits and vegetables first and allowing
them to eat more than normal while slipping in a few things they don’t usually like.
Development: Give positive feedback when your child uses the potty. Clapping or
dancing around smiling is enough. Don’t pester your child to use the toilet or punish them
if they have an accident. Toilet training is as much of a milestone as walking or talking.
You can’t “make it happen”. Your child will use the toilet when she can if you are
relaxed about this issue. Discipline is often an issue at this age. Discipline should be age
appropriate, consistent and immediate at this age to be effective. Your child should not be
in charge! Don’t let your child con you into reasoning with her. Her verbal skills are far
beyond her reasoning skills at this age. Reasoning with a 2 year old is attention and thus,
positive reinforcement. Also, don’t give her choices when there are none.
Safety: Watch your child closely outside as well as inside the home. Children this age
often get away from their parents in public places. Your child should be taught his first
and last name and to go to another “mommy or daddy with kids” if he gets lost. Teach
your child his private parts, along with their proper name, and that no one, except
mommy or daddy, can see them and even the doctor can’t check without mommy or
daddy there.
THE 3-4 YEAR CHILD
Nutrition: Most 3 year olds are much better eaters. Continue to offer a variety of fruits
and vegetables and limit desserts to once or twice a week. It is important to eat as a
family, and to keep the TV off and limit interruptions at meal times.
Development: Most children at this age can speak in sentences and most of what they
say should be discernible to an adult that doesn’t know them well. Three year olds should
know their colors and how to count to 5. They can use a fork well and pedal a tricycle. It
is beneficial for the development of socialization skills to have your child in some type of
group setting such as a mom’s day out program, preschool or daycare. One or two half
days per week is sufficient.
Safety: Make sure your child learns her street name and if possible, her full address and
phone number. Teach your child to NEVER talk to strangers—even if they offer candy or
have a puppy or kitten to pet. They should be taught to run away and tell a parent or
teacher if this occurs.
THE 4-5 YEAR CHILD
Nutrition: At this age, encouraging activity is just as important as eating healthy.
Encourage your child to play actively with friends and siblings. Riding bikes and playing
sports are good ways of accomplishing this important goal. Limit television, computer
and video games to no more than 1 hour/day total.
Development: Children at this age can recognize letters and numbers and may be able to
write their name. Many learn to ride a bike and start playing organized sports.
Kindergarten readiness is often a question and we recommend taking all factors –
developmental, social, academic and behavioral into consideration when making your
decision.
Safety: Make sure your child always wears a helmet when riding a bike or scooter. Your
child can stay in most booster chairs up to 85 pounds. Make sure the shoulder harness fits
your child properly. We do not recommend guns in any home with children. If you do
own a gun, make sure it is locked separately from ammunition and a parent have the only
key at all times. Teach your child to never touch any gun and to get an adult immediately
if one is found.
COMMON ILLNESS
INTRODUCTION
The following is general information regarding common pediatric medical problems.
Our website and office handouts provide expanded and additional information for
virtually any pediatric illness. We are happy to provide you with handouts at your
request.
BURNS
Treatment: Immediately immerse area of burn in cool water at least 10 minutes. Do not
use ice. Cool smoldering clothing by also soaking in water. Remove clothing from
burned area unless it is stuck to the burn. Cover burns with a sterile gauze pad. If blisters
form, do not break.
Call the office if you notice:
 Blistering develops
 Any increase in redness or swelling
 Any discharge
 Other concerns or questions
CHICKENPOX
Chickenpox is a very contagious viral illness that causes an itchy, blistering rash. After
exposure, it takes 10 to 21 days for the rash to appear. A child is contagious 2 days prior
to the appearance of the rash until the lesions are crusted (about 6-10 days). Children
should be isolated from others until all lesions are crusted. Children should be
encouraged to avoid scratching the lesions. Other symptoms often accompanied with
chickenpox are: a low-grade fever, upper respiratory infection, decreased appetite, and
headache. We do not recommend that you intentionally expose your child to chickenpox.
In some cases, it is not a benign disease and actually kills as many as 100 children in the
US per year.
Treatment: Acetaminophen (Tylenol) is helpful for the fever and discomfort associated
with chickenpox. An antihistamine, such as Benadryl, can help decrease itching.
Oatmeal baths and calamine lotion are also useful for itching. Occasionally, lesions can
get infected. An antibiotic ointment like Neosporin can be applied four times daily. To
prevent infection, keep fingernails clean and trimmed, provide a daily bath, and
discourage itching. DO NOT GIVE YOUR CHILD ASPIRIN OR IBUPROFEN. We do
not need to see your child in the office for routine care of chickenpox.
Call the office if you notice:
 Any lesions appears to be infected
 A persistent and severe cough



Difficulty breathing or chest pain
High fever, stiff neck, headache, or listlessness
Other concerns or questions
COLDS
A cold, or upper respiratory infection, is the most common medical problem in children.
Since viruses cause colds, there is no specific treatment. Normal, healthy children can
have 6 to 8 colds per year or more if your child is in a daycare setting. A cold typically
produces a runny nose, cough, sore throat, and a slight fever. Yellow or green nasal
drainage is a normal part of a cold. Colds usually last 7 to 14 days.
Treatment: The treatment for viral illnesses is through primarily supportive measures.
Extra fluids are important to help keep mucus thin and children well hydrated.
Humidifiers and vaporizers are effective in keeping secretions thin. Holding your child in
a steamy bathroom may also be helpful. Since infants breathe primarily through their
noses, saline nose drops are useful for thinning mucus and decreasing swelling of the
nasal mucosa. Use a nasal aspirator alone or following saline drops to help clear
secretions.
Medications such as acetaminophen and ibuprofen (for infants older than 6 months) are
very helpful to relieve fever and discomfort. We do not recommend other cold
medications as they often have side effects such as irritability, sleeplessness and
jitteriness and can only temporarily relieve symptoms. Remember, your child needs time,
fluids, rest and extra love to fight viral infections and no medication will shorten the
course of a cold.
Call the office if you notice:
 Extreme irritability
 Yellow-green eye drainage for more than 72 hours
 Very puffy or swollen eyelids
 Ear pain or ear drainage
 Symptoms that persist more than 10-14 days
 Fever for more than 72 hours
 Difficulty breathing, especially if ribs are visible with each breath
 Sore throat accompanied by fever, headache or vomiting without runny nose and
cough
 Other concerns or questions
CONSTIPATION
All infants and children occasionally become constipated. Many infants do not have
bowel movements daily. Usually, this is not constipation. Constipation means hard stools,
not infrequent stools. For infants under the age of four months, discuss treatment with
the nurse or doctor.
Treatment: For infants over four months offer pear or prune juice (2-4 oz. mixed with
equal amount of water). For those six months and older, increase foods such as green
beans, peas, pears, peaches, and bran products. Avoid bananas and rice cereal. We do not
recommend the routine use of suppositories or enemas unless we direct you to do so.
Call our office if you notice:
 The above suggestions are not helping
 This is a recurring problem
 Severe pain or bleeding
 Other concerns or questions
COUGH
Cough is one of the most common pediatric symptoms. It can be associated with a cold,
allergy, croup, pneumonia, asthma, and a variety of other conditions.
Treatment: Treatment of a cough depends on the particular cause of the cough, but
basic comfort measures include: extra fluids, a cool mist humidifier, and elevating the
head of the bed. For children over 1 year of age, honey on a teaspoon can be used.
Call our office if you notice:
 Cough persists for more than 1 week
 Your child has a difficult time breathing
 The cough is painful, persistent, and accompanied by vomiting or turning blue
 The cough develops after choking on food or any other object
 Other concerns or questions
DIAPER RASH
Treatment: The best treatment for diaper rash is to simply remove the diaper and leave
the area exposed to the air. However, this is often impractical. At the first sign of
irritation, air dry the skin, then apply Desitin, Aquaphor, or other recommended
ointments. Try not to use wipes when your child has a diaper rash. It is better to use a
warm, soft washcloth, or just to rinse their bottom with warm water. To prevent diaper
rash, change your baby’s diaper frequently and wash the diaper area well following
bowel movements.
Call our office if you notice:
 Any blisters or pustules develop
 The rash is not better in 3 days
 The rash is spreading quickly
 A high fever or ill symptoms with the rash
 Other concerns or questions
DIARRHEA
Diarrhea is a common problem in childhood. It is most often caused by a viral infection.
True diarrhea is watery bowel movements with marked increase in frequency and
volume. The main concern with a diarrhea illness is that your child may become
dehydrated. Increasing the amount of fluid your child drinks can prevent dehydration.
Signs of dehydration include:






Less than 2 wet diapers/urine out in 12 hours
Sunken eyes/dark circles under eyes
Dry, cracked lips
Dry, sticky tongue or cheeks
Lethargy (hard to arouse/interact with)
Weakness (won’t sit up, crawl or play)
Treatment: For infants: If breast-fed, continue breastfeeding and offer additional fluid
in the form of Pedialyte. Formula fed infants may benefit from a soy formula, like
Isomil or Prosobee if the diarrhea is prolonged. Pedialyte should also be offered for
additional fluid.
For older infants and toddlers: Offer a variety of clear liquids at the first signs of a
diarrhea illness. Pedialyte solution or Pedialyte popsicles are a good choice. You can
still offer your child milk, but cut down on the normal intake. Avoid juices as these can
make diarrhea worse. Yogurt is a good food to offer to children with diarrhea.
Older children: Older children are not at risk as much as infants for dehydration.
Encourage more fluids as mentioned above and offer a bland diet.
Call the office if you notice:
 Diarrhea persists more than 2 weeks
 Vomiting and diarrhea last more than 48 hours and is accompanied with
decreased urine output
 Any signs of dehydration as noted above
 Blood is present in the stool
 Other concerns or questions
EARACHE
Ear pain can be caused by a variety of conditions, including a middle ear infection, an
outer ear infection (swimmer’s ear), a sore throat, trauma or eustachian tube dysfunction.
A middle ear infection is a common problem in childhood and often associated with a
cold.
Treatment: The doctor will prescribe medication if an infection exists only after seeing
your child in the office. Until your child can be seen in the office, the best way to provide
pain relief is to give acetaminophen or ibuprofen. You may also use a heating pad set at a
low setting.
Call the office if you notice:
 Persistent ear pain or irritability
 A high fever with ear pain
 Drainage from the ear
 Other concerns or questions
FEVER
A fever means the body temperature is above normal. After the age of 2 months, A
FEVER IS NOT A MEDICAL EMERGENCY. The body’s average temperature when
it is measured orally is 98.6 F (37 C), but it normally fluctuates during the day. Mildly
increased temperatures (100.4-101.3 F of 38-38.5 C) may be caused by exercise,
excessive clothing, a hot bath, or hot weather. Warm food or drink can also raise the oral
temperature. If you suspect such an effect on the temperature of your child, take it again
in a half hour.
Fever is a symptom, not a disease. It is the body’s normal response to infections. Fever
helps fight infections by turning on the body’s immune system. The usual fevers (100104 F, or 37.8-40 C), which all children get, are not harmful. Most are caused by viral
illnesses; some are caused by bacterial illnesses. Teething does not cause a high fever.
Most fevers with viral illnesses range from 101-104 F (38.3-40 C) and last for 2 to 3
days. It is normal for fevers, with or without the use of anti-fever medicine, to come and
go throughout a 24 period. Your child should be “fever free” for 24 hours before he can
be considered not contagious. In general, the height of the fever does not relate to the
seriousness of the illness. How sick your child acts is what counts. Fever causes no
permanent harm until it reaches 107 F (41.7 C). Fortunately, the brain’s thermostat keeps
untreated fevers below this level.
Treatment:
Medications: Remember that fever is helping your child fight the infections. Use fever-reducing
medication, such as acetaminophen or ibuprofen, only if the fever is over 102 F (39 C) and
preferably only if your child is also uncomfortable. Give the correct dosage for your child’s
weight as directed.
Two hours after they are given, these medications will reduce the fever 2 to 3
degrees F (1 to 2 degrees C). Medicine does not bring the temperature down to
normal unless the temperature was not very elevated before the medicine was
given. Repeated dosages of the medication will be necessary because the fever
will go up and down until the illness runs its course. If your child is sleeping, do
not awaken him/her for medicine.
If your child is less than 2 months old, do not give these medications until you
have discussed it with your child’s doctor. CAUTION: The dropper that comes
with one product should not be used with other brands.
Acetaminophen: Children older than 2 months of age can be given
acetaminophen. Please do not use any combination products (i.e. Tylenol
Cold)
Ibuprofen: Children older than 6 months of age can be given ibuprofen. Ibuprofen
is similar to acetaminophen in its ability to lower fever. Its safety record is also
similar. One advantage ibuprofen has over acetaminophen is a longer lasting
effect (6 to 8 hours instead of 4 to 6 hours). Children with special problems
requiring a longer period of fever control may do better with ibuprofen. Give the
correct dose for your child’s weight every 6 to 8 hours.
Extra fluids: Encourage your child to drink extra fluids. Popsicles and iced drinks are
helpful. Body fluids are lost during fevers because of sweating.
Less clothing: Bundling can be dangerous. Clothing should be kept to a minimum
because most heat is lost through the skin. Do not bundle up your child; it will cause a
higher fever. During the time your child feels cold or is shivering (the chills), give
him/her a light blanket.
Call our office IMMEDIATELY if:
 Your child is less than 3 months old
 Your child looks or acts very sick
Call our office WITHIN 24 HOURS if:
 Your child is 3 to 6 months old (unless the fever is due to the DTaP shot)
 Your child has had a fever more than 24 hours without an obvious cause or
location of infection
 Your child has had a fever for more than 3 days
 The fever went away for over 24 hours and then returned
 You have other concerns or questions
HEAD INJURY
Head injuries are almost inevitable. Most head injuries are minor and cause no serious
problems. If your child hits his head, you should be alert to the following: Observe how
your child is acting for the next 24-48 hours. You do not need to wake your child through
the night if you have observed at least four hours of normal behavior while awake. Make
sure your child is talking and moving his arms and legs normally.
Treatment: DO NOT PANIC! Place wrapped ice or a bag of frozen vegetables on the
site to minimize swelling if possible. If there is any bleeding, apply firm direct pressure
to the area. Remember, even minor head lacerations may bleed profusely.
Call our office immediately if your child:
 Will not wake up or is more sleepy than usual
 Vomits more than two times
 Has a headache that gets worse or lasts more than a day
 Has a seizure
 Has neck pain
 Bleeds or has drainage from ear or has a nosebleed
 Has trouble with vision, hearing or speaking
 Has trouble walking or weakness of an arm or leg
 Has unusual behavior, such as inconsolable crying, confusion or dizziness
 Has a laceration that may need stitches
 Lost consciousness with the head injury
NOSEBLEEDS
Nosebleeds are common in childhood. They are usually caused by colds, allergies,
trauma (especially picking) and low humidity. The bleeding usually comes from a small
vessel on the septum of the nose.
Treatment: To stop bleeding, squeeze the nostrils together and keep head tilted forward.
Continue to apply pressure for at least 15 MINUTES. Do not release the nose during this
time to see if it is still bleeding. Use of a humidifier and Vaseline may help decrease
recurrent bleeding.
Call our office if you notice:
 Bleeding persists for more than 15 minutes
 Bleeding recurs in the same location
 Bleeding gums or excessive bleeding from cuts or a rash
 Other concerns or questions
VOMITING
Vomiting (throwing up) is most often caused by a viral infection in the stomach or by
eating something that has irritated the stomach lining. It is often associated with diarrhea
and generally can last 12-48 hours. Like diarrhea the main concern is that your child stays
well hydrated.
Treatment: Wait 30 minutes from the time your child last vomited before offering any
fluids. After 30 minutes, give 5-10 milliliters of water or Pedialyte. If no vomiting
occurs after 10 minutes, another 5-10 milliliters. If successful, continue in this manner
until you reach 1oz/10 minutes. You may then try breast milk or formula (for an infant)
or Gatorade or Propel (for older children) in 1 oz increments. If no more vomiting
occurs after 6-8 hours of clear fluids, if your child is taking solids, you may try cereals or
crackers. If that is tolerated, the following day you may offer bland foods such as
bananas, toast or applesauce adding others slowly as your child can tolerate. It is normal
for your child’s appetite to be decreased for up to a week after a vomiting illness. It is
also normal for you child to lose weight during this period. Do not worry as infants and
children eat more than normal in the weeks to follow to regain lost weight. If vomiting
recurs at any time, wait 30 minutes and start over.
In general, we do not recommend medicines to treat vomiting. Fevers often occur with
these illnesses; therefore it is appropriate to use acetaminophen as needed. However, if
vomiting is persistent, you may want to use the suppository form.
Call our office if you notice:
 Vomit containing blood or bile (which is dark green)
 No improvement in 24 hours
 Persistent vomiting accompanied by fever and significant abdominal pain
 Lethargy (hard to arouse/interact with)
 Weakness (won’t sit up, crawl or play)
 Signs of dehydration (see diarrhea section)
 Other concerns or questions
ACETAMINOPHEN / IBUPROFEN
DOSING CHART
Weight
Acetaminophen
(160mg/5mL)
Ibuprofen
(50mg/1.25mL)
Ibuprofen
(100mg/5mL)
10 lbs
15 lbs
20 lbs
25 lbs
30 lbs
35 lbs
40 lbs
50 lbs
60 lbs
70 lbs
80 lbs
90 lbs
100 lbs
125 lbs
150 lbs
175 lbs
2 mL
3 mL
4.25 mL
5 mL
6.5 mL
7.5 mL
8.5 mL
10 mL
12.5 mL
15 mL
15 mL
15 mL
15 mL
15 mL
15 mL
15 mL
1.25 mL
1.75 mL
2.25 mL
2.75 mL
3.5 mL
4 mL
4.5 mL
2.5 mL
3.5 mL
4.5 mL
5.5 mL
7 mL
8 mL
9 mL
10 mL
14 mL
15 mL
18 mL
20 mL
22.5 mL
30 mL
35 mL
40 mL
If your child is less than 2 months old, do not give these medications until you have
discussed it with your child’s doctor.
Children older than 2 months of age can be given acetaminophen. Please do not use any
combination products (i.e. Tylenol Cold).
Children older than 6 months of age can be given ibuprofen.
Use this chart as a general guide. If your child’s weight falls between the weight
categories listed above, give your child the lower dose of medication.