- Kawasaki disease (KD) is a rare childhood illness that affects the blood vessels. The symptoms can be severe for several days and can look scary to parents. But then most children return to normal activities.
- KD is a systemic inflammatory disease, meaning that it is not localized to any particular organ but may have an inflammatory response involving anywhere with blood vessels, including the arteries of the heart.
- The most serious complications happen when the coronary arteries (arteries that carry blood to the heart) is involved, which may include heart failure, arrhythmia, or even sudden death. Infants are most susceptible to long term sequelae. However, most children who are treated recover from the disease without long-term problems. Continue to follow-up for a few weeks to a few months after treatment.
- The disease is most common in children under 5 years old. It is not contagious. Its etiology remains unknown.
- KD is also called mucocutaneous lymph node syndrome. Diagnosis is based upon evidence of systemic inflammation (fever) in association with any four of the following symptoms：
- Fever over 39 ºC for over 5 days
- Red eyes
- Swollen, red skin on the palms of the hands and soles of the feet
- Skin rash, often starting in the genital area. It can also be on the back, chest, belly, arms, and legs
- Cracked, red lips and tongue
- Swollen lymph nodes in the neck
- Fever management：
- Fever is when armpit temperature is over 37.5ºC or anal, forehead, or temporal temperature is over 38ºC.
- When your child has chills, keep him/her warm by adding another blanket or elevating the thermostat temperature. Do not give him/her an ice pillow.
- If your child has fever but the limbs are warm, give him/her a warm bath (water temperature 26~36ºC).
- Encourage your child to drink plenty of water to prevent dehydration. Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
- Fever medication (antipyretics) may be given when the child’s temperature is above 38.5℃. Repeat if necessary with at least 4 to 6 hours between the antipyretics. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to help prevent convulsion.
- Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
- IV (intravenous therapy) and IV pump care：
- Keep the dressing and injection cannula (the small plastic tube which is inserted into the vein) clean and dry.
- Periodically check that the the distal extremities (far end of the limb with the injection; ie. fingers or toes) that they are warm and pink.
- Keep the injected limb lowered to avoid IV fluid or blood refluxing into the tubes.
- Do not adjust the IV rate or touch the buttons of the pump by yourself. Inform the staff if you think adjustment is needed.
- The IV pump has a rechargeable battery. You may remove the electric the charging cable when walking around. Please keep the cable plugged in when possible.
- Gently compress the injection site for 1~3 minutes with a sterile cotton ball after the cannula has been removed. Remove the cotton balls if there is no more bleeding.
- If any of the following conditions occur, please inform the nursing staff：
- Pain, swelling, redness, or wetness at the injection site.
- Painful or reddening of the skin after the cannula was removed.
- You heard the sound of pump alarm.
- Your child needs a shower or change the clothes.
- Oral ulcer management：
- Make observation of the changes of the oral ulcers at least once everyday.
- Practice good oral hygiene. Use a soft toothbrush or a gauze wrapped on a popsicle stick and clean the mouth and teeth with normal saline or boiled water. This will help promote wound healing and prevent bad breath from bacterial growth.
- Drink or gurgle directly from a cup instead of a straw to avoid contact pain from the straw or wound irritation from sucking motion.
- Cool soft diet will reduce the painful sensation during swallowing. Try ice cream, yogurt, jelly, cold milk, or flan.
- Try lip balms or vaseline to moisten the lips.
- Eat frequent small meals. Do not force feed.
- Always practice good hygiene. Gently wipe off drool with wet towelette. Always wash your hands before and after touching your child.
- Avoid scratching or manipulating the skin rash to prevent secondary infection. Try gentle lotion on dry itchy skin.
- Inform our medical staff immediately if there are the following symptoms：
- Chest pain
- Shortness of breath
- Abnormal breathing sounds or signs of difficulty breathing
- Vomiting
- Skin turning blue or gray
- Abnormal irritability or odd behaviours
- Convulsion
- Loss or change of consciousness
- Follow-up regularly with your pediatrician or a pediatric cardiologist.
- Aspirin may be prescribed for blood-thinning and anti-inflammation. It should not be discontinued or changed without the doctor’s orders. Continue to follow-up regularly when taking aspirin. If your child contracts the flu or chickenpox during aspirin treatment course, stop the medication and see your pediatrician as soon as possible.
Pediatric Illnesses
- Chickenpox (varicella) is a virus that causes an itchy rash and red spots or blisters (pox) all over the body. Although usually isn’t a serious problem in healthy children, it is highly contagious. An infected person can spread it onto others when sneezing, coughing, or sharing food or drinks. The fluid from a broken chickenpox blister is also contagious. A person who has chickenpox can spread the virus even before he or she has any symptoms. For most people, getting chickenpox provides immunity for life. At the same time, those who have never had the illness and have not had the chickenpox vaccine are at risk for chickenpox.
- The varicella-zoster virus is usually more active during late winter and early spring. It starts with fever, chills, poor appetite, sore throat, cough, muscle and joint soreness, and develops a blister-like rash with itching in 1-2 days. The rash starts from the trunk and the face, and can spread over the entire body. It usually takes about 1 or 2 days for the spot to go through all its stages: blistering, bursting, drying, and crusting over. New red spots will appear every day for up to 5 to 7 days. The first symptoms of chickenpox usually develop about 14 to 16 days after contact with a person infected with the virus.
- A person with chickenpox can spread the disease as soon as they have any symptoms, the 1 to 2 days before the rash have begun. They remain contagious until all their chickenpox blisters have scabbed, usually 5~10 days. After this, then the person with chickenpox can return to day care, school, or work.
- Chickenpox can be serious, especially in babies, people with weakened immune systems, and pregnant women. The best way to prevent chickenpox is to get the chickenpox vaccine.
- Fever management：
- Fever when armpit temperature is over 37.5ºC or anal, forehead, or temporal temperature is over 38ºC.
- When your child has chills, keep him/her warm by adding another blanket or elevating the thermostat temperature. Do not give him/her an ice pillow.
- If your child has fever but the limbs are warm, give him/her a warm bath (water temperature 26~36ºC).
- Encourage your child to drink plenty of water to prevent dehydration. Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
- Fever medication (antipyretics) may be given when the child’s temperature is above 38.5℃. Repeat if necessary with at least 4 to 6 hours between the antipyretics. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to help prevent convulsion.
- Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
- Take antipyretics as instructed. Do not take aspirin.
- IV (intravenous therapy) and IV pump care：
- Keep the dressing and injection cannula (the small plastic tube which is inserted into the vein) clean and dry.
- Periodically check that the the distal extremities (far end of the limb with the injection; ie. fingers or toes) that they are warm and pink.
- Keep the injected limb lowered to avoid IV fluid or blood refluxing into the tubes.
- Do not adjust the IV rate or touch the buttons of the pump by yourself. Inform the staff if you think adjustment is needed.
- The IV pump has a rechargeable battery. You may remove the electric the charging cable when walking around. Please keep the cable plugged in when possible.
- Gently compress the injection site for 1~3 minutes with a sterile cotton ball after the cannula has been removed. Remove the cotton balls if there is no more bleeding.
- If any of the following conditions occur, please inform the nursing staff：
- Pain, swelling, redness, or wetness at the injection site.
- Painful or reddening of the skin after the cannula was removed.
- You heard the sound of pump alarm.
- Your child needs a shower or change the clothes.
- Rash care：
- Clothing, bedding, towels, wound dressings, toys, utensils, or anything that might have come in contact with the patient’s body fluid should be cleaned separately. Do not share them with others.
- Wear loose clothing and keep the body clean and dry. Cool ambient temperature can help reduce the itching sensation.
- Do not break blisters as this may lead to infection and scarring.
- Keep the hands clean and trim nails regularly. Before going to bed, wear cotton gloves and socks to avoid scratching.
- Try skin calming lotion for the itch.
- Patients should stay at home and avoid public places. Do not come in contact with pregnant women or infants who have never had chickenpox.
- Infants should get a varicella vaccine once they are 12 months old.
- Please go to the hospital as soon as possible if there are following symptoms：
- Persistent vomiting or severe headache
- Difficulty walking or unsteady gait
- Severe coughing
- Difficulty breathing
- Chest pain
- Severe abdominal pain
- Fever over 39 degree Celsius or fever lasting longer than 24 hours
- Confusion, agitation, drowsiness, coma
- Stiff neck and back pain
- Signs of wound infection (skin redness, pain, swelling, pus)
- Evident new blister formation after 7 days or rash that lasts for over 2 weeks
- Chickenpox on the eyeball
- Urinary tract infection (UTI) is the infection of the urinary system (kidneys, ureters, bladder and urethra). It can cause symptoms of fever, abdominal pain, vomiting, painful or burning sensation during urination, frequent bathroom calls with only small amount of urine, difficulty holding urine, foul stench of urine, flank pain, back pain or even blood in the urine. If not treated immediately, UTI can have serious complications including sepsis, seizure, and kidney or bladder damage. Urinary tract infections are common in infants and children. 3~5% of girls and 1% of boys under 2 years old with unexplained fever have UTI.
- Fever management：
- Fever is when armpit temperature is over 37.5ºC or anal, forehead, or temporal temperature is over 38ºC.
- When your child has chills, keep him/her warm by adding another blanket or elevating the thermostat temperature. Do not give him/her an ice pillow.
- If your child has fever but the limbs are warm, give him/her a warm bath (water temperature 26~36ºC).
- Encourage your child to drink plenty of water to prevent dehydration. Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
- Fever medication (antipyretics) may be given when the child’s temperature is above 38.5℃. Repeat if necessary with at least 4 to 6 hours between the antipyretics. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to help prevent convulsion.
- Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
- Take antipyretics as instructed. Do not take aspirin.
- IV (intravenous therapy) and IV pump care：
- Keep the dressing and injection cannula (the small plastic tube which is inserted into the vein) clean and dry.
- Periodically check that the the distal extremities (far end of the limb with the injection; ie. fingers or toes) that they are warm and pink.
- Keep the injected limb lowered to avoid IV fluid or blood refluxing into the tubes.
- Do not adjust the IV rate or touch the buttons of the pump by yourself. Inform the staff if you think adjustment is needed.
- The IV pump has a rechargeable battery. You may remove the electric the charging cable when walking around. Please keep the cable plugged in when possible.
- Gently compress the injection site for 1~3 minutes with a sterile cotton ball after the cannula has been removed. Remove the cotton balls if there is no more bleeding.
- If any of the following conditions occur, please inform the nursing staff：
- Pain, swelling, redness, or wetness at the injection site.
- Painful or reddening of the skin after the cannula was removed.
- You heard the sound of pump alarm.
- Your child needs a shower or change the clothes.
- Avoid putting on diapers too tightly. Change diapers at least every two hours, as urine and feces that have been sitting too long may breed bacteria which may increase the risk of urinary tract infection.
- Older children should wear underwear with 100% cotton material. To reduce bacteria growth, underwear should also be changed when damp from water or sweat.
- Encouraged your child to drink plenty of water. 100% juice without sugar additives such as cranberry, citrus juice, or guava juice are also recommended.
- Do not hold the urge of urination. Remind your child to the go to the toilet between play time. Tell your child to not rush during voiding to allow complete emptying of the bladder.
- Cleaning up and hygiene：
- Girls should wipe from front to back (ie. from the urethra towards the anus)
- Boys should gently push the foreskin down to wash the glans everyday.
- Take showers instead of baths.
- Call your pediatrician or go to the emergency department if there are following symptoms：
- Fever over 38 ℃ with poor appetite (anorexia) or decreased activity.
- Voiding difficulty or pain causing your child to cry or scream.
- Decreased urine amount or foul smelling urine.
- Purulent secretions on diapers.
- HFMD and herpangina are infections of the enterovirus which usually occur during the summer (May~June) and autumn (Septmber~October) periods. It is highly contagious and often breaks out within a community.
- Enterovirus is transmitted from person to person via the fecal-oral route; that is, when the caretaker changes a diaper without washing his/her hands afterwards or when a young child gets stool on his/her hands and then touches objects that other children put in their mouths. The virus also spreads easily through direct contact with oral and respiratory secretions such as droplets from coughing and sneezing, as well as touching the vesicle fluids in HFMD.
- Enteroviral infection often causes fever, sores in or on the mouth, and skin rash. In some cases, there are no symptoms at all or the symptoms are very mild that parents also catch the disease without any realization. Symptoms usually occur 3~6 days after being exposed to the virus.
- The most commonly occurring types in Taiwan are herpangina and HFMD which in addition to the aforementioned symptoms, results in sores or vesicles usually 1~5mm in diameter on the hands, soles of the feet, knees, buttocks or legs. The sores may be painful. Infected children often complain of mouth or throat pain, and in children who have yet to speak often show refusal to eat. There may also be unexplainable fussiness, abdominal pain, vomiting, and diarrhea.
- The illness usually doesn’t last more than a week or so. At first your child may feel tired, get a sore throat, or have a fever of around 38~39°C. Then in a day or two, sores or blisters may appear and they quickly rupture and crust over.
- Enterovirus is infamous and often feared by parents because of how quickly and easily it spreads and its potential serious complications. Type A71 enterovirus has been associated with complications of the central nervous system (encephalitis, paralysis, meningitis), lung edema and hemorrhage, and heart failure.
- There are more than 60 types of viruses in the group of enteroviruses. There is long-lasting immunity once infected, but only for that specific type of enterovirus. As there are so many types of enterovirus, it is possible to contract enterovirus again in the same year or possibly even the same season. Different types of enterovirus may cause similar symptoms. Therefore, the same patient may seem like he/she has gotten hand-foot-and-mouth disease or herpangina more than once. There is no specific antiviral therapy available for the treatment of the enteroviruses nor is there vaccines. Management is symptom relief, and most patients will be fully recovered within one week. However, children with complications may require hospitalization.
- Fever management：
- Fever is when armpit temperature is over 37.5ºC or anal, forehead, or temporal temperature is over 38ºC.
- When your child has chills, keep him/her warm by adding another blanket or elevating the thermostat temperature. Do not give him/her an ice pillow.
- If your child has fever but the limbs are warm, give him/her a warm bath (water temperature 26~36ºC).
- Encourage your child to drink plenty of water to prevent dehydration. Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
- Fever medication (antipyretics) may be given when the child’s temperature is above 38.5℃. Repeat if necessary with at least 4 to 6 hours between the antipyretics. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to help prevent convulsion.
- Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
- Take antipyretics as instructed. Do not take aspirin.
- IV (intravenous therapy) and IV pump care：
- Keep the dressing and injection cannula (the small plastic tube which is inserted into the vein) clean and dry.
- Periodically check that the the distal extremities (far end of the limb with the injection; ie. fingers or toes) that they are warm and pink.
- Keep the injected limb lowered to avoid IV fluid or blood refluxing into the tubes.
- Do not adjust the IV rate or touch the buttons of the pump by yourself. Inform the staff if you think adjustment is needed.
- The IV pump has a rechargeable battery. You may remove the electric the charging cable when walking around. Please keep the cable plugged in when possible.
- Gently compress the injection site for 1~3 minutes with a sterile cotton ball after the cannula has been removed. Remove the cotton balls if there is no more bleeding.
- If any of the following conditions occur, please inform the nursing staff：
- Pain, swelling, redness, or wetness at the injection site.
- Painful or reddening of the skin after the cannula was removed.
- You heard the sound of pump alarm.
- Your child needs a shower or change the clothes.
- Oral ulcer management：
- Make observation of the changes of the oral ulcers at least once everyday.
- Practice good oral hygiene. Use a soft toothbrush or a gauze wrapped on a popsicle stick and clean the mouth and teeth with normal saline or boiled water. This will help promote wound healing and prevent bad breath from bacterial growth.
- Drink or gurgle directly from a cup instead of a straw to avoid contact pain from the straw or wound irritation from sucking motion.
- Cool soft diet will reduce the painful sensation during swallowing. Try ice cream, yogurt, jelly, cold milk, or flan.
- Try lip balms or vaseline to moisten the lips.
- Eat frequent small meals. Do not force feed.
- Always practice good hygiene. Gently wipe off drool with wet towelette. Always wash your hands before and after touching your child.
- Avoid scratching or manipulating the skin rash to prevent secondary infection. Try gentle lotion on dry itchy skin.
- Personal hygiene is the most important factor in disease prevention and outbreak control. Children younger than 3 years old are at most risk for complications and should be encouraged and helped with practicing good hand washing technique.
- How should you wash your hands：
- Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
- Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
- Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
- Rinse your hands well under clean, running water.
- Dry your hands using a clean towel or air dry them.
- When to wash your hands：
- Before, during, and after preparing food
- Before eating food
- Before and after caring for someone who is sick or going to the hospital
- Before and after treating a cut or wound
- Before touching or making direct contact with a child
- After using the toilet
- After changing diapers or cleaning up a child who has used the toilet
- After blowing your nose, coughing, or sneezing
- After touching an animal, animal feed, or animal waste
- After handling pet food or pet treats
- After touching garbage
- Disinfect common areas. Get in the habit of cleaning high-traffic areas and surfaces first with soap and water, then with a diluted solution of chlorine bleach and water. Child care centers should follow a strict schedule of cleaning and disinfecting all common areas, including shared items such as toys, as the virus can live on these objects for days. Clean your baby’s pacifiers often.
- Children are most likely to spread the disease during the first week of the illness. But the virus can stay in the stool for several months and may spread to others. To help prevent the disease from spreading, isolate infected children at home, avoid close contact with other children including siblings, and don’t let your child share toys or give kisses.
- Always have a balanced diet, regular exercise, and adequate sleep to help boost immunity.
- Go to a hospital or inform our medical staff immediately if there are the following symptoms：
- Extreme sleepiness
- Myoclonic jerks (repeated jerk-like movements similar to a startling response involving muscle contractions of the whole body)
- Persistent vomiting
- Persistent fever
- Decreased activity or generalized weakness
- Irritable behaviour or crying
- Loss or change of consciousness
- Neck stiffness
- Paralysis
- Shortness of breath
- Increased heart rate or irregular pulse
*special attention should be paid to young infants within the first 5 days of illness.
- Sterilizing at home：
- Aldehydes and halogen-based disinfectants (such as commercially available chlorine bleach) can deactivate enterovirus activity. Try adding bleach into your laundry loads.
- Making disinfecting spray：
mix 1 tbsp / 15~20mL household bleach (usually sold in 6% to 7% concentrations) in 5 L tap water and divide into appropriate size spray bottles - Dry heat weakens and shortens the lifespan of the virus. Cook food thoroughly. Wash clothes with hot water and put the dryer on highest heat setting.
- UV (ultraviolet) light diminishes viral activity. Try drying cleaned objects in the sun.
- Cellulitis is a common but potentially serious bacterial infection of the skin and the deeper tissues beneath. It is most common in the lower legs although it can occur anywhere on the body or the face. It may also extend directly from a wound or somewhere near a wound.
- Cellulitis appears as a swollen, red area of skin that feels hot and tender. Sometimes, pus or blisters may develop causing localize pain. It might cause fever, chills, malaise, or joint pain. Left untreated, the spreading infection can rapidly turn life-threatening.
- Fever management：
- Fever when armpit temperature is over 37.5ºC or anal, forehead, or temporal temperature is over 38ºC.
- When your child has chills, keep him/her warm by adding another blanket or elevating the thermostat temperature. Do not give him/her an ice pillow.
- If your child has fever but the limbs are warm, give him/her a warm bath (water temperature 26~36ºC).
- Encourage your child to drink plenty of water to prevent dehydration. Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
- Fever medication (antipyretics) may be given when the child’s temperature is above 38.5℃. Repeat if necessary with at least 4 to 6 hours between the antipyretics. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to help prevent convulsion.
- Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
- Take antipyretics as instructed. Do not take aspirin.
- IV (intravenous therapy) and IV pump care：
- Keep the dressing and injection cannula (the small plastic tube which is inserted into the vein) clean and dry.
- Periodically check that the the distal extremities (far end of the limb with the injection; ie. fingers or toes) that they are warm and pink.
- Keep the injected limb lowered to avoid IV fluid or blood refluxing into the tubes.
- Do not adjust the IV rate or touch the buttons of the pump by yourself. Inform the staff if you think adjustment is needed.
- The IV pump has a rechargeable battery. You may remove the electric the charging cable when walking around. Please keep the cable plugged in when possible.
- Gently compress the injection site for 1~3 minutes with a sterile cotton ball after the cannula has been removed. Remove the cotton balls if there is no more bleeding.
- If any of the following conditions occur, please inform the nursing staff：
- Pain, swelling, redness, or wetness at the injection site.
- Painful or reddening of the skin after the cannula was removed.
- You heard the sound of pump alarm.
- Your child needs a shower or change the clothes.
- Always wash your hands before and after touching a sick child to prevent spreading the disease.
- Keep the infected limb elevated to help reduce swelling.
- Ice packing the site may mediate the pain and swelling.
- Check the infected area for changes in wound healing, redness, swelling, or discharge.
- Wound Care：
- In a circular motion starting from the center working outwards, clean the wound with a swab soaked with sterilized saline or water to remove any debris or discharge.
- Using a different swab, apply non-alcoholic Betadine over the wound in the same motion; wait about 30 seconds to dry and disinfect.
- Use a different swab again soaked in in sterilized saline to remove the Betadine.
- Cover the wound with sterile gauze.
- Take a sponge baths to avoid getting the wound wet.
- Practice good personal hygiene to prevent further damage to the skin. Avoid scratching which may cause skin breaks furthering skin infection.
- All wounds no matter how small may lead to infection if not treated properly.
- If no restrictions, consider a high protein diet to improve immunity and promote wound healing.
- See a doctor as soon as possible if there is persistent high fever, progressive swelling of the infected area, or appearance of purulent secretions.
- A febrile seizure or febrile convulsion, is a seizure associated with fever which occur in children between the ages of 6 months and 5 years. The seizure may be over the whole body or may be only on a single limb and the child loses awareness during the episode. Most seizures occurs within 24 hours of the fever, are less than five minutes in duration, and the child is completely back to normal within sixty minutes of the event.
- Febrile convulsion seldom result in any short or long term neurological problems or epilepsy. Parents or caretakers should not panic during an episode. Place the child in a safe place (bed or on flat ground) and rotate the child onto his/her side. Clear out his/her mouth if there is vomiting. Do NOT put anything in the child’s mouth. Give rectal suppository fever medications.
- Seek immediate medical if there is the following conditions：
- Seizure continues for more than 5 minutes
- Patient remains unarousable for a long time after seizure subsides
- Persistent vomiting
- Complaints of severe headache
- Neck stiffness
- Fever unresponsive to medications
- Weakness or numbness of a limb after seizure episode
- Reduce food intake during acute stage (the first few days of the illness when symptoms are prominent) but do allow your child to eat in small frequent meals as long as symptoms are not worsening.
- Withhold antidiarrheal medications when diarrhea subsides.
- Make sure your child is taking enough fluids. Give water, sports drinks, or clear broths. Juice and soft drinks should be avoided.
- Avoid drinking milk and soy product. Stay away from fried, greasy, or strong flavored foods.
- The best foods for your child are easily digestible foods, such as rice cereal, pasta, breads, cooked beans, mashed potatoes, cooked carrots, applesauce, and bananas.
- Stop feeding if there is vomiting. Rest for a few hours then try again.
- To prevent catching or spreading the virus, always wash hands thoroughly especially when eating and handling food, use separate personal items around your home, disinfect hard surfaces such as counters, doorknobs, faucets, separate raw food and from, practice good kitchen hygiene and separate raw from cooked food.
- Mild diarrhea may persist for a few days. Allow your child rest and continue to observe for symptom changes. Please return to the hospital as soon as possible if there are following symptoms：
- Worsening vomiting or diarrhea
- Signs of dehydration (e.g. decreased urine output, dry sticky tongue)
- Shock or loss of consioucness
- Persistent abdominal pain
- Irritable unconsolable crying
- Abdominal pain shifting to the right lower abdomen
- Decreased activity, very poor appetite, or complaints of weakness and fatigue
- More than 200 different viruses can cause this infection, but the rhinovirus is the most common culprit. Antibiotics, which fight bacteria, won’t treat your child’s cold. Except in newborns, colds in healthy children aren’t dangerous. They usually go away in 4 to 10 days without treatment.
- Sometimes, there may be intermittent fever for 3-5 days. Try an ice pillow when the temperature is over 38℃ and there is no chills. You may give fever medications when the temperature is over 38.5℃.
- Drink lots of warm water. Avoid eating iced, cold or sweet food and beverages. Hold off oranges and grapefruit temporarily.
- Wear masks that cover the nose and mouth area to prevent spreading the disease and also to help minimize symptom exacerbation from cold air, dust, or cigarette smoke.
- To allow your child’s immune system to fight off the virus, let your child get plenty of rest and give him/her more vegetables and fruits for a vitamin boost.
- Call your pediatrician if your child doesn’t get better after a few days. Follow-up at the outpatient clinic.
- Please call or return to the hospital as soon as possible if there are following symptoms：
- Persistent high fever
- Poor activity or extreme fatigue or poor appetite
- Hacking cough
- Too much thick yellow or green sputum
- Oral ulcers may occur at all ages, and there are multitudes of causes：oral trauma, recurrent stomatitis, vesicular stomatitis, chickenpox, hand foot and mouth disease (enterovirus), bacteria, fungi, gastrointestinal diseases, autoimmune disease, etc… Oral ulcers may easily relapse but will usually heal within 5-10 days without leaving a scar.
- Oral ulcer care：
- Make observation of the changes of the oral ulcers at least once everyday.
- Practice good oral hygiene. Use a soft toothbrush or a gauze wrapped on a popsicle stick and clean the mouth and teeth with normal saline or boiled water. This will help promote wound healing and prevent bad breath from bacterial growth.
- Drink or gurgle directly from a cup instead of a straw to avoid contact pain from the straw or wound irritation from sucking motion.
- Cool soft diet will reduce the painful sensation during swallowing. Try ice cream, yogurt, jelly, cold milk, or flan. Avoid strong flavored or stimulating foods that are sour, spicy, bitter, or too sweet.
- Try lip balms or vaseline to moisten the lips.
- Eat frequent small meals. Do not force feed.
- Always practice good hygiene. Gently wipe off drool with wet towelette. Always wash your hands before and after touching your child.
- Oral drug application：
- If prescribed, use the oral anti-inflammatory spray 30 minutes before eating.
- When applying oral cream, gently dab a small amount of the cream with a small spatula or Q-tip on the affected areas. Do not rub as it may cause painful irritation.
- Drink warm water to help relieve itchy throat. Take small slow sips to avoid coughing.
- Avoid eating iced, cold or sweet food and beverages. Hold off oranges and grapefruit temporarily.
- Wear masks that cover the nose and mouth area to prevent spreading the disease and also to help minimize symptom exacerbation from cold air, dust, or cigarette smoke.
- Take medicine as instructed and follow up at the outpatient department as scheduled.
- See a doctor as soon as possible if there are the following symptoms：
- High or persistent fever unresponsive to medication
- Wheezing
- Large amounts of purulent yellowish sputums
- Severe dry cough
- Lips or nails turning blue or gray
- Coughing blood
- Coughing with diarrhea
- Traveling to areas with known active epidemics
- Symptoms continues to worsen despite having seen a doctor