FHCS PHYSICIAN SERVICES
RUPPERSBERGER & MERCORA FAMILY MEDICINE
PEDIATRIC PREVENTIVE MEDICINE
Our goal is to help you keep your child healthy and safe. Working together we can do this. Listed below are
some preventive measures you should be aware of and follow. Please feel free to discuss these with us at any
time.
ALL CHILDREN DESERVE TO LIVE IN A SAFE ENVIRONMENT!
1. CAR SAFETY: Use of car seats should begin with the first ride home from the hospital. An appropriate
car seat is the right size for the child, fits the vehicle’s seats and seat belt system, and is easy to use. All
infants should be rear facing until they are 20 pounds and 1 years old. Children age 1 and above who are 20
to 40 pounds should be in forward facing car seat. We recommend that children age 4-8 (about 40-60
pounds) be in a booster seat. The safest place for a child is always in the backseat and children under 12
years old should not be allowed in the front. Remember, children learn by example so don’t forget to
buckle your own seat belt.
2. SPORTS SAFETY: Approved bicycle helmets should be worn by all children (and adults) on every bike
ride. Skateboards should not be used by children under 10 and nonpowered scooters should not be used for
children under 8, unless adult supervision is available. All skateboards and scooter-riders should wear a
helmet and other protective gear. All children and adolescents participating in organized sports should
make sure that they have and use the proper safety equipment and appropriate physical conditioning for that
sport.
3. BURN PREVENTION: Smoke detectors should be properly installed and maintained on every floor of
your home. You should check the battery at least twice a year. Carbon monoxide detectors should also be
installed in your home. Hot water temperatures should be set between 120-130 degrees Fahrenheit to avoid
scald burns. Never handle hot food or beverages while holding a child. Never leave a hot iron unattended.
4. POISON PREVENTION: Medicines and household products should be kept out of sight and reach of
children. These items should be purchased and kept in original childproof containers. Parents should have
a 2 ounce bottle of ipecac in the home for use as advised by your physician or poison control (215-3862100). Be sure to check the safety of other homes your child spends time in (i.e. grandparents, sitters, etc.)
5. FALL PREVENTION: Window and stairway guards / gates are necessary to prevent falls. We do not
recommend the use of infant walkers as their potential hazard outweighs any benefit.
6. WATER SAFETY: Young babies and toddlers most commonly drown in bathtubs and buckets. Make sure
to empty and properly store buckets after use. Never leave infants or young children in the bathtub without
constant adult supervision. All backyard swimming pools and spas need to be completely fenced to separate
them from the house and yard. Children under five should never swim unsupervised and no child of any age
should swim alone. Children under 5 years of age and older should be taught to swim and, at the same time,
taught appropriate rules for water play. Coast guard approved personal floatation devices should be worn
by every child engaged in any boating activity. No child should play near or swim in the ocean without
direct adult supervision or a trained lifeguard. Make sure to obey all current local warnings and rules while
at the beach.
7. FIREARM SAFETY: Firearms, especially handguns, are 43 times more likely to injure a family member
than an intruder. More than one-third of all accidental shootings of children occur in the homes of friends or
relatives. Explain to your children that guns are dangerous and that children should never touch guns. Also,
tell your children that gun violence on TV and the movies is not real and that in real life children are hurt
and killed with guns. If you choose to keep a firearm in your home, keep the gun unloaded and locked, and
lock and store bullets in a separate location. Make sure children do not have access to the keys. Check
grandparents homes for gun storage.
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FIRST AID
CALL 911 or an Emergency Number for any severely ill or injured child!
FEVER
Fever in children is usually caused by infection, too warm an environment,
or prolonged over activity. Take the child’s temperature to document a
fever. The height of fever is less important than the child’s appearance
and activity. If the child appears very ill with fever, or is less than 3
months old, call your doctor immediately. When the temperature reaches
102oF, undress the child to a diaper or underpants and a t-shirt, give fever
medications as recommended by your doctor or the package instructions,
and provide plenty of cool liquids to drink.
If the temperature remains over 104oF, sponge your child with lukewarm
water (slightly cooler than the child’s skin), and call your doctor. Do not
use cold water or rubbing alcohol to sponge your child. If you are
sponging your child in the tub, do not fill the tub with more than 2 inches
of water, and do not leave the child unattended.
BURNS AND SCALDS
General Treatment First stop the burning process by removing the child from
contact with the hot water or hot object (e.g. tar). If clothing is burning do not
remove. Smother the flames and wet the clothes immediately in order to stop
further burning and pain. Run cool water over burned skin until the pain stops. Do
not use ice or apply any medication or ointment.
Burns with Blisters Do not break the blisters. Call our doctor for advice on how
to cover the burn and about any large burns or burns on the face, hands, feet or
genitals.
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Large or Deep Burns Call 911 or an emergency number. After stopping and
cooling the burn, keep the child warm with a clean sheet covered with a blanket
until help arrives.
Electrical Burns Disconnect electrical power. Do Not touch the victim with bare
hands. Pull the victim away from the power source with wood or a thick, dry cloth.
All electrical burns need to be seen by a doctor.
SKINS WOUNDS
Make sure your child is immunized for tetanus. Puncture wounds or lacerations
may require a tetanus booster even when your child is currently immunized.
Bruises Apply cold compresses. Call your doctor for a crush injury, large bruises,
continued pain or swelling.
Cuts Wash small cuts with water until clean; topical antiseptics can be used. Use
direct pressure with a clean cloth to stop bleeding. Apply a topical antibiotic
ointment, and then cover the cut with clean dressing. Call your doctor for large and
deep cuts since stitches should be placed without delay. Apply pressure directly to
the wound for major bleeding with a clean cloth and call for help (911). Continue
pressure until help arrives.
Scrapes Irrigate with water to remove dirt and germs. Do not use detergent,
alcohol or peroxide. Use topical antiseptic. Apply an antibiotic ointment and a
non-adherent dressing.
Splinters Remove small splinters with tweezers, then wash and apply topical
antiseptic. If you are unable to remove the splinter completely call your doctor.
Puncture wounds Do not remove large objects such as a knife or stick from a
wound. Call for emergency medical assistance (911). A doctor must remove such
objects. Call your doctor for all puncture wounds. Your child may need a tetanus
booster.
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STINGS AND WOUNDS
Stinging insects Remove the stinger as quickly as possible with the scraping
motion of a fingernail. Put a cold compress on the bite to relieve the pain. If hives,
nausea, vomiting, trouble breathing or fainting occurs, call your doctor or 911. For
spider bites call your doctor or Poison Center and describe the spider.
Animal or human Bites Wash wound thoroughly with soap and water. Call your
doctor.
Ticks Place tweezers as close as possible to the head of the tick and slowly pull the tick away
from the point of attachment. Call your doctor if any part of the tick remains under the skin or if
the child develops symptoms such as a rash or fever.
Snake Bites Keep the child at rest. Call the Poison Center. Do not apply ice. Loosely
splint the injured extremity. Take the child to an emergency department. Keep the extremity at
rest, positioned at, or slightly below the level of the heart.
HEAD INJURIES
DO NOT MOVE A CHILD WHO MAY HAVE A SERIOUS HEAD AND /OR
NECK OR BACK INJURY. THIS MAY CAUSE FURTHER HARM.
Call 911 or an emergency number for a child with a head injury and any of the
following:
-Any loss of consciousness or drowsiness
-Persistent headache or vomiting
-Clumsiness or inability to move any body part.
-Oozing of blood or watery fluid from the ears or nose.
-Convulsions (Seizures)
-Abnormal speech or behavior
For any questions about less serious injuries call your doctor.
CONVULSIONS/SEIZURES
Protect the child from injury. Put nothing in the child’s mouth. Loosen any
restrictive clothing. Perform rescue breathing if the child is blue or not breathing.
If breathing, lay the child on his or her side to prevent choking. Call 911 or an
emergency number.
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FAINTING
Lay the child on his or her back with the head to the side. Do Not give the child
anything to drink. If the child does not wake up right away, call your doctor, or dial
911 or your emergency number. If the child is not breathing, begin CPR.
POISONS
If the child has been exposed to or ingested a poison, call your Poison Center.
Swallowed Poisons Any non-food substance is a potential poison. Call the Poison
Center immediately. Do not induce vomiting except on professional advice. The
Poison Center will give you further instructions.
Fumes, Gasses or Smoke Call 911 or the fire department and get the victim into
fresh air. If the child is not breathing start CPR and continue until help arrives.
Skin Exposure If acids, lye, pesticides, chemicals poisonous plants, or any
potentially poisonous substance comes in contact with a child’s skin, eyes or hair,
brush off any residual material while wearing rubber gloves, if possible. Remove
contaminated clothing. Wash skin, eyes or hair with large quantities of water or
mild soap and water. Call the Poison Center for further advice.
If a child is unconscious, becoming drowsy, having convulsions, or having trouble
breathing, call 911 or an emergency number. Bring the poisonous substance (safely
contained) with you to the hospital.
NOSEBLEEDS
Keep the child in a sitting position with the head tilted slightly forward. Applying
firm steady pressure to both nostrils by squeezing them between your thumb and
index finger for 10 minutes. If bleeding continues or is very heavy, call your doctor
or seek emergency care.
EYE INJURIES
If anything is splashed in the eye, flush gently with water for at least 15 minutes.
Call the Poison Center or your doctor for further advice. The doctor should see any
injured or painful eye. Do NOT touch or rub an injured eye. Do NOT apply
medication. Do Not remove objects stuck in the eye. Cover the painful or injured
eye with a paper cup or eye shield until you can get medical help.
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FRACTURES AND SPRAINS
DO NOT MOVE A CHILD WHO MAY HAVE A NECK OR BACK INJURY as
this may cause serious harm. Call 911 or an emergency number.
If an injured area is painful, swollen, deformed, or if motion causes pain, wrap it
with a towel or soft cloth and make a splint to immobilize the arm or leg with a
cardboard or another rigid material. Apply ice or a cold compress, call your doctor,
or seek emergency care. If there is a break in the skin near the fracture, or if your
can see the bone, cover the area with a clean dressing and make a splint as
described above.
If the food or hand below the injured part is cold or discolored, seek immediate
emergency care.
TEETH
Baby Teeth if knocked out or broken, apply clean gauze to control bleeding and
call your dentist.
Permanent Teeth If knocked out, find the tooth and, if dirty, rinse gently without
scrubbing or touching the root. Do not use chemical cleansers. Use mild or cold
running water. Place the tooth in clean water or milk and transport the tooth with
the child when seeking emergency care. Call ad go directly to your dentist or an
emergency department. If the tooth is broken, save the pieces in milk and call your
dentist immediately.
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NUTRITION FOR CHILDREN
General Principles
 Infants and children will eat when they are hungry. You do not need to force
them to eat.
 Make mealtimes happy and pleasant. Call your provider if you are having
feeding problems (this holds true right through adolescence).
 Children will eat what they see others eating. If you don’t eat vegetables or
try new foods there is a good chance your kids won’t either (on the other
hand, if you don’t make negative comments about foods, your child is more
likely to accept them.
 Juice is nutritionally not very important. Children are likely to drink too much
rather than too little. Juice should be diluted half and half with water until
about age five and your child should never get more than 54 – 6 ounces of
juice per day (water is fine if they are thirsty).
 When children are sick, they will not eat well for several days. Offer fluids
and watch to see how much they eat when they feel better.
Feeding your 1 year old
 Now you can start milk (either 2% or whole milk). You do not need to mix it
with formula – just offer 1 bottle the 1st day 2 the second day and then stop
the formula if there is no problem. If your child has been on soy formula,
introduce milk a little more slowly.
General Principle’s for the toddler and school age child
 Eating habits for life are being formed now. Make sure they are good habits.
 Offer plenty of fresh fruits and vegetables. Offer raw vegetables as snacks.
 Avoid fried foods, fast foods and sweets, except as an occasional treat.
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 Remember that the young child has a small appetite. A rough rule is that a
portion of any food is about the size of the child’s fist. One quarter of a
sandwich is often plenty for the young child.
 Try to use whole grain breads and cereals as much as possible.
 Do not use foods as a reward. Do not fill-up a poor eater with desserts and
cookies just so “they’ll eat something.”
 As your child gets older, let him/her help with shopping and cooking. This
will often help to spur an interest in trying new foods.
 If you have a picky eater, do not offer to cook special meals. Find some
healthy, no or little preparation food (cottage cheese, peanut butter, yogurt,
vegetable soup, etc.) to have on hand for those family meals that your child
won’t eat. If you are concerned about your child, talk to your doctor.
 Mealtime should be family time. Try to get everyone to sit down together for
at least one meal per day. Remember not to let mealtime become fight time.
Teens
 You have much less control over your child’s intake now. If you have offered
a good diet and healthy habits have developed, a few years of lots of pizza and
hamburgers will probably be okay.
 Try to make sure that everybody in the house has breakfast. Leftovers, soup,
yogurt, a glass of milk are fine. Children need breakfast to perform well in
school.
 Adolescent girls need to be sure they get lots of calcium and plenty of iron
(red meat, dark green leafy vegetables, fortified cereals). Athletes need an
especially good, well balanced diet.
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