Preschool Health

The well-child checkup 

Making and keeping well-child checkup appointments with your child’s doctor every year will help keep your child healthy and happy.

The well-child checkup includes:

  • Getting a health history and developmental assessment.
  • A complete physical exam.
  • Vision and hearing checkups.
  • Lab tests.
  • Immunizations for his age.
  • Health education.
  • A dental referral.

Immunizations/vaccinations

At your child’s annual well-child checkup, ask what immunizations he needs and get your child a flu shot.

Click here for the “Well Child Check Up and  Immunization” chart.

Healthy hearing

Most children who are born with a hearing loss can be diagnosed through a hearing test. But in some cases, the hearing loss is caused by things like infections, trauma and damaging noise levels, and the problem doesn’t emerge until later in childhood. So it’s important to have your child’s hearing evaluated regularly as they grow.

Kids who seem to have normal hearing should continue to have their hearing tested at regular doctor’s appointments. Hearing tests are usually done at ages 4, 5, 6, 8, 10, 12, 15 and 18, and any other time if there’s a concern.

If your child seems to have trouble hearing, if speech development seems abnormal or if your child’s speech is difficult to understand, talk with your child’s doctor.

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Young girl getting an eye examHealthy vision

Healthy eyes and vision are a critical part of your child’s development. His eyes should be examined regularly, as many vision problems and eye diseases can be detected and treated early.

Routine medical exams for kids’ vision include:

  • In the first year of life, all infants should be routinely screened for eye health during checkups with their doctors.
  • Around age 3, children should undergo eye health screenings and tests that measure sharpness of vision with their doctors.
  • After age 5, further routine screenings should be done at school or at the doctor’s office, or after the appearance of symptoms such as squinting or frequent headaches. (Many times, a teacher will realize the child isn’t seeing well in class.)
  • Kids who wear prescription glasses or contacts should have annual checkups to screen for vision changes.

Resource

Fever

In healthy children, fevers are usually not serious and are often the body’s way of fighting infections. And not all fevers need to be treated. High fever, however, can make a child uncomfortable and worsen problems such as dehydration.

Your child has a fever if his body temperature is above:

  • 100.4°F measured rectally (in the bottom).
  • 99.5°F measured orally (in the mouth).
  • 99°F measured under the arm.

Causes of fever

It’s important to remember that fever by itself is not an illness – it’s usually a symptom of another problem. Fever is usually due to infection, overdressing or an immunization.

  • Children at this age with temperatures at or above 102.2°F require medical attention. 

The illness is probably not serious if your child has normal skin color; is still interested in playing and is urinating and drinking well; and looks well when the temperature comes down.

Resource

When to call the doctor

In general, contact your child’s doctor if your child:

  • Isn’t urinating as often as usual.
  • Has a temperature higher than 102.2°F for one day.
  • Has a temperature higher than 100°F for more than three days.
  • Seems to have ear or sinus pain.
  • Has yellow eye discharge.
  • Has a cough for longer than one week.
  • Has thick, green nasal discharge.

Seek medical help immediately if your child:

  • Has trouble drinking.
  • Coughs hard enough to cause vomiting or changes in skin color.
  • Coughs up bloody mucus.
  • Has difficulty breathing or is bluish around the lips and mouth.

When to keep your sick child at home

Sick Child with thermometer in her mouthCheck with your child care provider for a list of their rules on when to keep sick children home, but you should probably keep a child home if he has any of the following:

  • Fever, irritability, lethargy, persistent crying or difficulty breathing.
  • An upper respiratory illness such as bronchiolitis or influenza.
  • Diarrhea that can’t be contained by diapers or by using the toilet regularly.
  • Bloody stools or stools containing mucus. (Give your doctor a call!)
  • Vomiting.
  • A rash – if it is not linked to a fever or other symptoms, he may be able to go if your daycare’s rules allow it.
  • Chicken pox – your child is no longer contagious once all the sores have dried and crusted over.
  • Impetigo during the first 24 hours of antibiotics.
  • Scabies – until it is treated with a topical insecticide as recommended by your child’s doctor or pharmacist; prior to treatment, it is contagious.
  • Bacterial conjunctivitis (pinkeye) and yellow discharge from the eye – not contagious after 24 hours of antibiotics.
  • Strep throat – is usually not contagious after 24 hours of antibiotics. Mouth sores that cause excessive drooling; wait until your doctor says they’re not infectious.
  • Head lice – your child can return to daycare after he’s been thoroughly treated.

 

Girl washing her handsGerm prevention 

Hand washing is the best way to prevent illness. Teach your child to wash his hands thoroughly. 

  • Teach everyone in the household to cough or sneeze into a tissue or the crook of their arm.
  • Avoid sharing utensils, drinking glasses, washcloths, towels and other items that may harbor germs.
  • Avoid anyone who’s sick. This is especially important during the first few days of a viral illness, when the person who’s sick may be most contagious.

 

 

Over-the-counter medicines

Pharmacist with over the counter medicineOver-the-counter (OTC) means you can buy the medicine without a prescription.

You should check with your child’s doctor or a pharmacist before giving your child any medicine, especially for the first time. Your child may or may not have side effects with any drug. Be sure to tell the doctor if your child has any side effects, throws up or gets a rash after taking a medicine. 

All OTC medicines have the same kind of label. The label gives important information about the medicine. It says what it is for, how to use it, what is in it and what to watch out for. Look on the box or bottle to:

  • Check the chart on the label to see how much medicine to give. If you know your child’s weight, use that first. If not, go by age. 
  • Check the label to make sure it is safe for infants and toddlers younger than 2 years. If you are not sure, ask your child’s doctor.

 

First aid 

Eye injuries

Any injured or painful eye should be seen by a doctor. Cover the painful or injured eye until you can get medical help. If anything is splashed in the eye, flush gently with water for at least 15 minutes. Call the Poison Center or the pediatrician for further advice. Do not touch or rub an injured eye. Do not apply medicine. Do not remove objects stuck in the eye. 

Fractures and sprains

If an injured area is painful, swollen or deformed, or if motion causes pain, call your child’s doctor or seek emergency care. Apply ice or a cold compress wrapped in thin cloth for no more than 20 minutes. 

If there is a break in the skin near the fracture or if you can see the bone, call 911 or an emergency number in your area. Then cover the area with a clean bandage. Do not move the child unless instructed to do so.

Fainting

Make sure the child is breathing. If not, call 911 and begin rescue breathing and CPR. If vomiting has occurred, turn the child onto one side to prevent choking. Elevate the feet above the level of the heart (about 12 inches). Do not give the child anything to drink.

Head injuries

Do not move a child who may have a serious head, neck and/or back injury. Call 911 or an emergency number right away if the child loses consciousness or has a convulsion (seizure).

Call the pediatrician for a child with a head injury that includes any of the following:

  • Drowsiness
  • Difficulty being awakened
  • Persistent headache or vomiting
  • Clumsiness or inability to move any body part
  • Oozing of blood or watery fluid from ears or nose
  • Abnormal speech or behavior

Poisons

If the child has been exposed to or ingested a poison, call the Poison Center at 1-800-222-1222. A poison expert in your area is available 24 hours a day, seven days a week.

  • Swallowed poisons. Do not give anything by mouth or induce vomiting. Call the Poison Center right away. Do not delay, but try to have the substance label or name available when you call.
  • Fumes, gases or smoke. Get the child into fresh air and call 911 or the fire department. If the child is not breathing, start CPR and continue until help arrives.
  • Skin exposure. If acids, lye, pesticides, chemicals, poisonous plants or any other 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 a large amount of water or mild soap and water. Do not scrub. 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. Apply 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 the pediatrician or seek emergency care.

Teeth

  • Baby teeth. If knocked out or broken, apply clean gauze to control bleeding and call a pediatric dentist.
  • Permanent teeth. If knocked out, call or go directly to the pediatric dentist or an emergency department. Do not touch the root of the tooth (the part that would be in the gum). If dirty, rinse gently with cold running water or milk. Do not scrub. Do not use any cleansers. Place the tooth in clean water or milk, and take it along with the child when seeking emergency care. 

Convulsions, seizures

Call 911 or an emergency number for a prolonged seizure (more than five minutes). If the child is breathing, lay him on his side to prevent choking. Make sure the child is safe from objects that could injure him. Be sure to protect his head. Do not put anything in the child’s mouth. Loosen any tight clothing, and start rescue breathing if the child is blue or not breathing. 

Stings, bites and allergies

  • Stinging insects. Remove the stinger as soon as possible. Put a cold compress on the bite to relieve the pain. If the child has trouble breathing or if fainting or extreme swelling occur, call 911 or an emergency number right away. If hives, nausea or vomiting occur, call the pediatrician. 
  • Spider bites. Call the pediatrician or Poison Center (1-800-222-1222) and describe the spider. Have the pediatrician check any bites that become infected.
  • Animal or human bites. Wash wound well with soap and water. Call the pediatrician. The child may need a tetanus or rabies shot.
  • Ticks. Use tweezers or your fingers to grasp as close as possible to the head of the tick and briskly pull the tick away from where it is attached. Put the tick in a plastic baggie, and keep the tick in the freezer until you are sure the bite is fully healed. Call the pediatrician if your child develops symptoms such as a rash or fever. Wash your hands well after handling a tick.
  • Snake bites. Take the child to an emergency department if you are unsure of the type of snake or if you are concerned that the snake may be poisonous. Keep the child at rest. Do not apply ice. Loosely splint the injured area, and keep it at rest, positioned at or slightly below the level of the heart. 
  • Allergies. Swelling, problems breathing and paleness may be signs of severe allergy. See your doctor to determine if your child has allergies. If the child has trouble breathing or if fainting or extreme swelling occur, call 911 or an emergency number right away.

Burns and scalds

First remove the child from contact with hot water or a hot object (for example, oil). If clothing is burning, smother flames and cool clothing by soaking with water. Remove clothing unless it is firmly stuck to the skin. Run tap water over burned skin until the pain eases. Do not apply ice, butter, grease, medicine or ointment.

  • Burns with blisters. Do not break the blisters. Call your pediatrician to determine how to cover the burn and to ask about burns on the face, hands, feet or genitals.
  • Large or deep burns. Call 911 or an emergency number. After stopping and cooling the burn, keep the child warm with a clean sheet or covered with a blanket until help arrives.
  • Electrical burns. Disconnect electrical power immediately, if possible. If the child is still in contact with the live electrical source, do not touch the child with bare hands. Pull the child away from the power source with an object that does not conduct electricity (such as a wooden pole) only after the power is turned off. All electrical burns need to be seen by a doctor.

Sunburn 

  • Regular sunburn. Apply cool compresses to the burned areas or bathe the child in cool water. You also can give acetaminophen to help relieve the pain. (Check the package for appropriate dosage for his age and weight.)
  • Severe sunburn. If the sunburn causes blisters, fever, chills, headache or a general feeling of illness, call your pediatrician. Severe sunburn must be treated like any other serious burn, and if it’s very extensive, hospitalization sometimes is required. 

Skin wounds

Make sure the child is up to date for tetanus vaccination. Any open wound may require a tetanus booster even when the child is currently immunized. If the child has an open wound, ask the pediatrician if the child needs a tetanus booster.

Bruises

Apply cold compresses. Call the pediatrician if the child has a crush injury, large bruises, continued pain or swelling. The pediatrician may recommend acetaminophen for pain.

Cuts

Rinse small cuts with water until clean. Use direct pressure with a clean cloth to stop bleeding. If the cut is not deep, apply an antibiotic ointment, and then cover the cut with a clean bandage. Call the pediatrician or seek emergency care for large, deep or gaping cuts. Continue direct pressure with a clean cloth until help arrives.

Scrapes

Rinse with clean, running tap water for at least five minutes. Do not use detergents, alcohol or peroxide. Apply a triple antibiotic ointment and a bandage that will not stick to the wound.

Puncture wounds

Do not remove large objects (such as a knife or stick) from a wound. Call for help (911 or an emergency number). Large objects must be removed by a doctor. Call the pediatrician for all puncture wounds. The child may need a tetanus booster.

Bleeding

Apply pressure using a gauze pad or cloth over the bleeding area. If still bleeding, add more gauze or cloth, and apply pressure. If bleeding continues, call the pediatrician or seek emergency care.

Preventing bites

Insect bites

It is impossible to prevent all insect bites, but you can minimize the number your child receives by:

  • Avoiding areas where insects nest or congregate, such as garbage cans, stagnant pools of water, uncovered food, and orchards and gardens where flowers are in bloom.
  • When you know your child will be exposed to insects, dress him in long pants and a lightweight, long-sleeved shirt.
  • Avoid clothing with bright or dark colors or flowery prints. They seem to attract insects.
  • Don’t use scented soaps, perfumes or hair sprays on your child, because they also are inviting to insects.

Insect repellents

Insect repellents come in many forms including aerosols, sprays, liquids, creams and sticks. Some are made from chemicals, and some have natural ingredients. Keep in mind that insect repellents prevent bites from biting insects but not stinging insects. Ask your doctor or pharmacist to recommend a good insect repellent for your child. 

The following types of repellents are not effective:

  • Wristbands soaked in chemical repellents
  • Garlic or vitamin B1 taken by mouth
  • Ultrasonic devices that give off sound waves designed to keep insects away
  • Backyard bug zappers (insects may actually be attracted to your yard) 

Preventing animal bite wounds 

Child walking next to a dogThere are about 4.5 million dog bites, 400,000 cat bites and 250,000 human bites reported annually. Although many bites are minor, others cause serious infections. Most bites come from domesticated animals that have been vaccinated, so the risk of rabies or other diseases is low. The greatest risk for rabies comes from wild animals such as bats, raccoons, foxes, skunks and coyotes. Rabies is a very serious viral infection that affects the central nervous system and brain, causing a high fever, swallowing difficulties, convulsions and eventually death. If your child is bitten by an animal, contact animal control officials. 

Even when rabies isn’t present, an infection can develop at the site of the bite. 

Contact your pediatrician if any of the following signs of an infection are present:

  • Pus or drainage from the bite wound
  • Swelling and tenderness in the area around the bite
  • Red streaks that extend from the bite
  • Swollen glands that occur above the bite

To prevent bites and the infections associated with them:

  • Teach your child to avoid all contact with strange animals. 
  • Never leave a young child alone with an animal. Even playful interactions can lead to an unexpected bite.
  • Teach your child to play nicely with pets and respect them while they are eating.
  • Educate your youngster never to place his face close to an animal nor to awaken a pet from sleep.
  • Teach your child not to run from a dog or make any aggressive movements but instead face the dog, allow the dog to sniff him and then back away slowly.
  • Instruct older children to recognize the signs of a potentially unsafe dog, including a rigid body, a stiff tail at half-mast, a staring expression, hysterical barking or a crouched position.

 

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