Health Manual
Caring for Your Child’s Health
This information is for educational purposes only.
For specific advice, diagnosis, or treatment, talk to your child’s doctor.
November 2015
Fifth Edition: Shanley Chatham
The Health Manual’s contents were reviewed by two pediatricians for accuracy and
consistency with current American Academy of Pediatrics and other professional guidelines
and standards.
Fourth Edition: Binder, Edwards, Shanley (October 2011)
Third Edition: Binder, Lutzker, Izso (November 2007)
Second Edition: Baggett, Bigelow, Carta, Peterson, & Shore (May 2004)
First Edition: Adapted from Project SAFECARE (Taub, 1996)
2016 John R. Lutzker
All rights reserved.
Revised November 2015
Version 4.2.1 (May 2021)
TABLE OF CONTENTS
The purpose of the SafeCare® Health Manual is to help you keep your child well and to help
you when your child is sick or injured. This information is for educational purposes only
and not for specific advice, diagnosis, or treatment.
SICK OR INJURED CHILD 2
3
Forms 4-6
Phone Numbers and Child Information
Supplies Checklist
Health Recording Chart
Sick & Injured Child Chart-Parent (SICC-P) Steps 7
8
SICC-P Steps 9-10
Sick & Injured Child Chart-Parent (SICC-P) 11-13
Taking Your Child’s Temperature 14-18
19
Emergency 20
21
When to Call 911 or Go to ER 22-23
24-26
Doctor’s Appointment
When to Call the Doctor’s Office
Talking to the Doctor’s Office or Nurse Hotline about Your Child
Caring for Your Child at Home
How to Comfort Your Child
Planning for Sick Days
When to Keep Sick or Injured Children Home from School/Daycare
Giving Your Child Medicine
Prevention 28-31
32-35
Hygiene
Nutrition 36
Physical Activity 37-39
Regular Medical Checkups and Immunizations
Preventing Abusive Head Trauma 40
Safe Sleep 41-43
SYMPTOM & ILLNESS GUIDE 46
102
Table of Contents
A-Z Index
SICK OR INJURED
CHILD
1
Phone Numbers and Child Information
Emergency Numbers 911 Poison Control: 1-800-222-1222
Number:
Emergency Services:
24 Hour Nurse Hotline(s):
Name of Pharmacy:
Family Contact Information Caregiver 2’s Work:
Caregiver 2’s Cell:
Home Phone Number:
Caregiver 1’s Work: Number:
Caregiver 1’s Cell:
Emergency Contact:
Relationship:
Child Information
Name: Doctor:
Birth Date: Dentist:
Medications: Insurance Provider:
Allergies: Insurance Policy # & Plan Type:
Name: Doctor:
Birth Date: Dentist:
Medications: Insurance Provider:
Allergies: Insurance Policy # & Plan Type:
Name: Doctor:
Birth Date: Dentist:
Medications: Insurance Provider:
Allergies: Insurance Policy # & Plan Type:
Name: Doctor:
Birth Date: Dentist:
Medications: Insurance Provider:
Allergies: Insurance Policy # & Plan Type:
2
Forms
Supplies Checklist
Keep supplies on hand so you can care for minor illnesses and injuries at
home. Below is a list of recommended items that you may want to have.
Keep them stored in a safe place that your child cannot reach or open.
NEED HAVE SUPPLIES
______ ______ Digital thermometer
______ ______ Tweezers
______ ______ Medicine dropper for giving medicine
______ ______ Spoon tube for giving medicine
______ ______ Cotton swabs
______ ______ Bandages
______ ______ Petroleum jelly, like Vaseline® (for use with rectal temperatures when
______ ______ advised)
______ ______
______ ______ SKIN MEDICINES
______ ______
Diaper rash cream, like Desitin®
______ ______ Dry skin cream or lotion
______ ______ Aloe Vera cream (for sunburns)
______ ______ Calamine lotion (for rashes, poison ivy, minor grazes, etc.)
______ ______ Note: Do not put on face or genitals
______ ______ Antibiotic ointment (to keep out infections, germs)
Hydrocortisone cream (for itching)
Rubbing (Isopropyl) alcohol (to kill bad bacteria, germs)
MEDICINES
Children’s acetaminophen or ibuprofen, Tylenol® or Motrin®
Children’s antihistamine, like Benadryl®
Medication Cautions
Never give children medicines meant for adults
Never give medicines to a child under 2 unless instructed by your doctor or pharmacist
Never give aspirin to a child under 16 unless instructed by your doctor or pharmacist
Always check with your doctor or pharmacist before giving more than one kind of
medicine at a time
3
Health Recording Chart
On the next page, you will find a blank Health Recording Chart. The Health Recording Chart
helps you track what symptoms your child has, any recommendations you receive from
your child’s doctor, and what you have done to care for your child.
For emergency situations, fill out the chart after you take your child to the emergency. You
can use this form to make notes about the doctor’s recommendations. It also makes caring
for your child at home easier because it helps you have all the information you need in one
place, and helps you to know when to check back in with your child.
For non-emergency (doctor’s appointment and caring for your child at home), fill out the
chart after you decide your child’s symptoms are not an emergency. This chart helps with
giving important information to your doctor. Take this form with you to your child’s doctor
appointment to inform the doctor about what you have done to care for your child and to
make notes about the doctor’s recommendations. It also makes caring for your child at
home easier because it helps you have all the information you need in one place, and helps
you to know when to check back in with your child.
The chart has places for you to write:
General information about your child
Information about your child’s illness or injury
Medications or treatments you gave
Treatment suggestions from the Health Manual or from your nurse or doctor
Each time you check your child’s symptoms, you can complete a new follow-up box on the
Health Recording Chart, so you can better understand if your child is getting better or not.
By using this chart, you will have a good record of your child’s illnesses. Once the page is
filled out, put it in a notebook, so you can keep it as part of your child’s health records.
You can make extra copies of the chart or ask your provider for several copies. Keep these
charts where they will be easy to find if your child is ill.
You do not need to memorize what is on this chart. You just need to remember to use it.
4
Child’s Name: Health Recording Chart
Current Medications:
Allergies: Age: Approximate Weight:
First Check Date: __________________ Time: _______:_______ AM PM
Method (circle one): Mouth, armpit, ear,
Temperature: ___________________________ rectal, forehead ___________________
Fever? Yes / No
Symptoms: _____________________________ Medications (Dosage)/Treatment Given:
_______________________________________ ______________________________________
_______________________________________ ______________________________________
_______________________________________ ______________________________________
Checked Health Manual Symptom & Illness Guide? Yes / No
Notes: __________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Called health professional? Yes / No
Recommendations: _______________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
When calling the doctor,
1) Say your child’s name and age
2) Say all of your child’s symptoms
3) Say any treatments you have already given
4) Ask any questions you have so you know how to comfort and care for your child
5) Write down what the doctor tells you to do
First follow-up Date: __________________ Time: _______:_______ AM PM
Temperature: ___________________________ Method (circle one): Mouth, armpit, ear, rectal,
Fever? Yes / No forehead ___________________
Symptoms: _____________________________ Medications (Dosage)/Treatment Given:
_______________________________________ ______________________________________
_______________________________________ ______________________________________
Checked Health Manual Symptom & Illness Guide? Yes / No
Notes: __________________________________________________________________________
________________________________________________________________________________
Called health professional? Yes / No Visited health professional? Yes / No Date of visit_______
Recommendations: _____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Second follow-up Date: __________________ Time: _______:_______ AM PM
Temperature: ___________________________ Method (circle one): Mouth, armpit, ear, rectal,
Fever? Yes / No forehead ___________________
Symptoms: _____________________________ Medications (Dosage)/Treatment Given:
_______________________________________ ______________________________________
_______________________________________ ______________________________________
Checked Health Manual Symptom & Illness Guide? Yes / No
Notes: __________________________________________________________________________
________________________________________________________________________________
Called health professional? Yes / No Visited health professional? Yes / No Date of visit:______
Recommendations: _______________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
SICC-P Steps
SICC-P Steps
If your child seems very sick or is seriously injured, call 911 or go to ER
If the illness or injury is potentially life-threatening, call 911 for an ambulance
IMMEDIATELY
When your child seems sick or injured, follow these steps:
1. Identify your child’s symptoms
What do you notice is different about your child’s behavior and/or appearance?
2. Decide if this is an emergency
If it is an emergency, call 911 or go to the ER immediately
After the emergency visit, fill out the Health Recording Chart and make a follow-up
appointment with your doctor (see Step 4) and follow the ‘Care for your child at
home’ instructions in Step 5
3. Check your child for other symptoms (fill out the Health Recording Chart)
Check your child’s breathing (e.g., trouble breathing, fast breathing, sounds strange
like wheezing or barking)
Check your child’s temperature
Observe your child’s behavior (e.g., refusing to eat or drink, dry or persistent cough,
showing signs of discomfort—e.g., tugging at ear, decreased urination)
Check your child’s physical appearance (e.g., rash on body, cheeks look red)
Ask your child questions, if old enough (e.g., “What hurts?”)
4. Decide if your child needs a doctor’s appointment
Look up the symptoms in the Symptom and Illness Guide
If your child does not need a doctor’s appointment, go to Step 5
If your child does need a doctor’s appointment, call your doctor’s office
If unsure, call your doctor’s office or nurse hotline for advice
o If an appointment is recommended, schedule as soon as possible
Remember to bring your completed Health Recording chart to doctor’s office
5. Care for your child at home
Always check your child regularly to make sure your child is not still sick or getting
worse
o The sicker or younger your child is, the more often you need to check in
o If your child gets worse or stays sick for more than a few days, your child may
need medical attention—use these steps again to decide what to do
Give your child comfort when your child is not feeling well
Follow the advice you receive from your doctor, nurse, or the health manual
Follow the advice of your doctor or pharmacist when giving medications
Fill out the Health Recording Chart each time you check-in on your child
7
SICC-P Steps
The Sick or Injured Child Chart – Parent
Steps to take when your child is sick or injured
SICC-P
1. Identify child’s symptoms
Call doctor or Unsure 2. Is this an emergency? YES
check Health
NO Call 911 or go to ER
Manual
RHMeevaiaenlwtuhal 3. Check other symptoms Fill out the
Health
Breathing, temperature, behavior,
appearance Recording
Chart
Ask your child questions
Fill out the Health Recording Chart
Call doctor or Unsure 4. Does your child need a YES
check Health doctor’s appointment?
Make a doctor’s
Manual appointment
NO
5. Care for your child at home
Watch for your child staying sick or
getting worse
Fill out the Health Recording Chart
8
Taking Your Child’s Temperature
Taking Your Child’s Temperature
Talk to your doctor about how best to take your child’s temperature. The best method for
taking a child’s temperature may change at different ages.
You should have a digital thermometer in your home. Read the directions before you use
the thermometer so you know which sound means that the thermometer is done. Turn the
thermometer on and make sure that the screen is clear of old readings. Set to Fahrenheit
(or Celsius). If your thermometer uses throwaway plastic sleeves or covers, place one on the
thermometer. Throw the sleeve away after each use. Whether you use a sleeve or not,
clean the thermometer with soap and water before putting it away.
There are several ways to take a temperature. Rectal (in the child’s bottom) temperatures
are the most accurate, but are most commonly only used for young infants. Temporal artery
(forehead) thermometers that touch the skin are an alternative to rectal temperatures in
children younger than 4, but are less accurate than rectal thermometers. Businesses and
schools may use no-contact (remote) forehead thermometers for screening; however, these
thermometers are expensive and less accurate. In children older than 4 years old, it may be
easier to take an oral (mouth) temperature. Axillary (in the armpit) and aural (ear)
temperatures are the least accurate. Ear thermometers cannot be used in children under 6
months old. Commonly recommended ways to take a child’s temperature include:
Age Recommended Method
0 to 3 months rectal or armpit
3 to 6 months rectal, forehead, or armpit
6 months to 4 years old rectal, forehead, ear, or armpit
4 years old or older mouth, forehead, ear, or armpit
Normal Rectal Ear Armpit Mouth (Oral) Forehead
temperature (Temporal, Contact)
Fever 99.6▫F 99.6▫F 98.2▫F 98.6▫F
temperature 37.6▫C 37.6▫C 36.8▫C 37.6▫C 98.2▫F
100.4▫F or 100.4▫F or 99.0▫F or higher 100▫F or higher 36.8▫C
higher higher 37.2▫C or higher 37.8▫C or 99.0▫F or higher
38▫C or higher 38▫C or higher higher 37.2▫C or higher
Taking a Temperature in the Bottom (a Rectal Temperature)
Ask your doctor or nurse to show you how to take a rectal temperature. If you need to take
your baby’s temperature and you do not have immediate access to a health professional,
you may want to have an experienced friend help you if you are unsure how to do it.
1. Lubricate the thermometer tip with a petroleum-based jelly, like Vaseline.
2. Place your baby face down across your lap while supporting the head or lay the child
down on a firm, flat surface, such as a changing table.
3. Place one hand firmly on your baby's lower back to hold your baby still.
Continue to next page
9
Taking Your Child’s Temperature
4. With your other hand, insert the lubricated thermometer through the anal opening,
about ½ inch (about 1.25 centimeters) into the rectum until the silver tip of the
thermometer is not visible. Stop if you feel any resistance.
5. Steady the thermometer between your second and third fingers as you cup your
hand against your baby's bottom. Soothe your baby and speak quietly as you hold
the thermometer in place.
6. Wait until you hear the appropriate number of beeps or other signal that the
temperature is ready to be read.
7. Write the temperature down on the Health Recording Chart.
Taking a Temperature in the Armpit (an Axillary Temperature)
1. Remove your child's shirt and undershirt (thermometer needs to touch skin only).
2. Insert the thermometer under your child's arm, in the armpit. Fold your child's arm
across the chest to hold the thermometer in place.
3. Wait until you hear the appropriate number of beeps or other signal that the
temperature is ready to be read.
4. Write the temperature down on the Health Recording Chart.
Taking an Ear Temperature (an Aural Temperature)
1. Put a cover on the thermometer.
2. Gently tug on the ear, pulling it back. This will help straighten the ear canal, and
make a clear path inside the ear to the eardrum.
3. Gently insert the thermometer until the ear canal is fully sealed off.
4. Squeeze and hold down the button for one second. Wait for a beep if devise has it.
5. Take out the thermometer and read the temperature.
6. Write the temperature down on the Health Recording Chart.
Taking a Temperature by Mouth (an Oral Temperature)
This is easy in an older, cooperative child.
1. Wait 20 to 30 minutes after your child finishes eating or drinking to take an oral
temperature and make sure there is no gum or candy in your child's mouth.
2. Place the tip of the thermometer under your child’s tongue and ask your child to
close the lips around it. Remind your child not to bite down or talk. Ask your child to
relax and breathe normally through the nose.
3. Wait until you hear the beeps or signal that the temperature is ready to be read.
4. Write the temperature down on the Health Recording Chart.
Taking a Forehead Temperature (a Temporal Artery Temperature)
Follow the manufacturer’s directions. Some devices take the temperature by running the
device over the forehead (contact) or without touching your child (non-contact).
Tips
Never take a temperature right after a bath or if your child was bundled up for a while
Never leave your child alone while taking a temperature
10
Emergency
Emergency
When to Call 911 or Go to the Emergency Room
If your child seems very sick or is seriously injured, call 911 or go to ER
If the illness or injury is potentially life-threatening, call 911 for an ambulance
IMMEDIATELY
General Symptoms Needing Emergency Care
Call 911 or take your child to the nearest emergency room, if your child
Is unconscious—is limp, not moving, can't wake up
Has a high fever (rectal/ear temperature of 104°F, mouth (oral) temperature of 103°F,
or armpit/forehead temperature of 102.6°F or higher) in a child older than 3 months
and a very stiff neck
Is younger than 2 months old and has a rectal temperature of 100.4°F or an armpit
temperature of 99°F or higher
Is severely dehydrated (not enough water in the body)—has symptoms like very little
urine, sunken eyes and no tears, and wrinkly, dry skin
May have eaten something poisonous—possibility if the child is acting strange, is very
drowsy or very active, has passed out, is vomiting or having diarrhea, smells strange, or
has something odd on mouth or fingers
Is choking and can’t cough—the face or lips may be turning blue
Has stopped breathing or is having trouble breathing
Had a major injury and has serious symptoms
Has a fever with seizures or convulsions (uncontrollable harsh body jerks/movements)
Allergies
Call 911 or take your child to the nearest emergency room, if your child
Has been stung by an insect and has hives (round, raised areas over parts or all of the
body), trouble breathing, or swollen mouth, lips, tongue or throat
Has just eaten and has hives (round, raised areas over parts or all of the body), trouble
breathing, or swollen mouth, lips, tongue, or throat
Bites and Stings
Call 911 or take your child to the nearest emergency room, if your child
Has been badly bitten by any animal
Has been bitten (mild or severe) by a wild animal, stray animal, or animal acting
strangely
Has been stung by an insect and is having an allergic reaction. Your child has hives
(round, raised, red, itchy areas on the skin), or has trouble breathing, or has a swollen
mouth, lips, tongue, or throat
Has contact with a bat, like touched a bat, had a bat fly into them, or had a bat in their
room
11
Emergency
Breathing
Call 911 or take your child to the nearest emergency room, if your child
Has stopped breathing or is having a very hard time breathing. Has symptoms like
being too short of breath to talk or has bluish or gray lips or fingernails
Is making a loud noise when your child breathes in, and is struggling to breathe or is
drooling or having trouble swallowing saliva
Convulsions or Seizures
Call 911, or take your child to the nearest emergency room, if your child
Is having convulsions—falling to the ground with body jerking and shaking—and your
child has never had them before
o If your child has a known history of seizures and may have a seizure disorder, follow
doctor’s orders
Had a head injury and is having a convulsion or seizure
Eyes
Call 911, or take your child to the nearest emergency room, if your child
Has something stuck in the eyeball
Feels something is in the eye and will not open it
Has blood in the eye
Got a chemical in the eye
Had an injury and has serious symptoms:
o Can’t see well or has double vision
o Can’t move the eyes like usual
o The eyeball shape looks different
Headache
Call 911, or take your child to the nearest emergency room, if your child
Has other serious symptoms with the headache, like is less alert or having serious
vomiting or neck pain
Has had a serious injury to the head
Injuries
Call 911, or take your child to the nearest emergency room, if your child
Has a big burn or a burn that has turned the skin white or has charred the skin
Is burned on the face, scalp, hands, joint surfaces, or genitals
Has an electric or chemical burn
Has a body part that is partly or fully cut off
Is bleeding and it won't stop
Has a neck or back injury. Your child feels pain in the back or neck or is feeling "pins and
needles" below the injury. DO NOT MOVE YOUR CHILD. CALL 911
May have a broken bone. Your child can’t move the part that hurts, has a hurt part that
looks bent or is not shaped right, can’t walk on the hurt leg, or take only a few steps
Continue to next page
12
Emergency
May have a dislocation. Your child’s shoulder, elbow, wrist, hip, ankle, or knee looks
strange and swollen. The joint seems out of place and is painful and can't move
Has a head injury (see “Head Injury”) and
o Loses consciousness (DO NOT MOVE YOUR CHILD. Call 911 in case your child has a
neck injury. If your child is unconscious and vomiting, keep the neck straight while
you turn your child onto the side so that your child does not breathe in the vomit)
o Has lost consciousness (even for an instant) or is confused
o Is not breathing in the usual way
o Is hard to wake up
o Has blood or clear fluid coming from the nose, ear, or mouth
o Has a problem with talking or seeing
o Is weak or not able to move part of the body that is not injured
o Is dizzy
o Has neck pain or stiffness (DO NOT MOVE YOUR CHILD. Call 911 if you think your
child has a neck injury)
o Has a seizure
o Vomits more than 2 times
o Defecates or urinates when your child does not mean to
o Is an infant with a head injury and very fussy or not acting normally
Intestinal
Call 911, or take your child to the nearest emergency room, if your child
Has a fever and cannot stop vomiting
Has vomited blood
Is younger than 1 year old and vomits green fluid
Is younger than 6 months old, has a fever above 100.4°F and vomits
Has diarrhea (see “Diarrhea”) and severe abdominal pain (see “Stomachache”)
Has pain on the right side of the abdomen, especially with fever and nausea or vomiting
(see “Stomachache”)
Nosebleed
Call 911, or take your child to the nearest emergency room, if your child
Is gushing blood, or is weak or dizzy from losing blood
Is bleeding and you can’t stop it within 20 minutes with pressure
Skin
Call 911, or take your child to the nearest emergency room, if your child
Has a rash that came on suddenly and is having trouble breathing or swallowing
Has a purple or blood-colored rash and a fever
Has a painful rash with a fever
Is 2 months or younger and has blisters or pus-filled pimples
These are only some of the possible emergencies a child can have. If you think it is an
emergency, seek help immediately!
13
Doctor’s Appointment
Doctor’s Appointment
When to Call the Doctor or Nurse for an Appointment
Remember, if your child seems very sick or is having very bad health
problems, call 911 or go to ER
General Symptoms
Call the doctor’s office or the nurse hotline if your child
Is 2 month to 6 month old with a rectal (in the bottom) temperature of 100.4°F or
higher or an armpit/forehead temperature of 99°F or higher (see “Fever”)
Is 6 month or older with a rectal or ear temperature of 102°F or higher (mouth
temperature of 101°F, armpit/forehead temperature of 100.6°F) (see “Fever”)
Has signs of mild to moderate dehydration, like a dry mouth, dry eyes, and less urine
than usual (see “Dehydration”)
Started to get better from an illness, but then got sicker again
Has itching that keeps coming back or that lasts more than a few days without a clear
reason for it (see “Itching”)
Has itching that started after your child began a new medicine (see “Itching”)
Is sick for more than a few days
Is an infant and stops eating (see “Prevention: Nutrition”)
Is not growing normally (see “Prevention: Nutrition”)
Allergies (see “Allergies” and “Asthma”)
Call the doctor’s office or the nurse hotline if your child
Is wheezing
Has symptoms that keeps your child from participating in normal activities
Has symptoms that last more than a week
Animal Bites or Bug Bites and Stings (see “Animal Bites” and “Bug Bites and Stings”)
Call the doctor’s office or the nurse hotline if your child
Has been bitten by an animal that is a family pet whose shots are up to date and
o The skin is punctured, broken or bleeding
o The skin is getting worse instead of better
o Your child is not up to date with tetanus shots
Has a large rash or swelling in the area of a bug bite
Has a tick on them and
o Has a fever
o The tick has been there for 24 hours
o You cannot get all of the tick off your child
o Your child gets a rash, joint pain, or other symptoms within a month after the tick
14
Doctor’s Appointment
Breathing
Call the doctor’s office or the nurse hotline if your child
Is having a hard time breathing, like shortness of breath
Is wheezing, a whistling sound in the chest when your child breathes (see “Asthma” and
“Allergies”)
Is making a loud noise when breathing in (see “Croup”) and it doesn’t get better with
steam or cool air
Is coughing blood
Is having coughing fits that make it hard to catch the child’s breath
Convulsions or Seizures (see “Convulsions and Seizures”)
Call the doctor’s office or the nurse hotline if your child
Has had seizures before and this one seems like the ones in the past
Ears (see “Earache”)
Call the doctor’s office or the nurse hotline if your child
Has an earache that is mild and lasts for more than a day
Has a moderate earache that stays for more than a couple of hours
Has a very bad earache even for a short time
Has an earache and fever (see “Fever”)
Is a baby and is fussing and tugging at the ear
Is having trouble hearing
Has drainage from the ear (pus or blood)
Put something in the ear
Eyes
Call the doctor’s office or the nurse hotline if your child
Has symptoms of pink eye, such as redness and discharge from the eye (see “Pink Eye”)
Got something in the eye (see “Eye Injuries/Something in the Eye”)
o That does not come out with flushing
o That comes out with flushing but your child’s eye is still bothersome
Has a black eye that keeps getting redder, continues to hurt, or there is drainage from
the eye (see “Eye Injuries/Something in the Eye”)
You notice crossing or wandering eyes
Headache (see “Headaches”)
Call the doctor’s office or the nurse hotline if your child
Has headaches that happen once a month or more
Has headaches with other symptoms, like vomiting or weakness
Has headaches that keep your child from going to school or taking part in normal
activities
15
Doctor’s Appointment
Injuries
Call the doctor’s office or the nurse hotline if your child
Has a skin injury or burn that seems infected. Infected skin can be red, warm, and
painful, or with swelling or pus
Has not gotten all necessary immunizations, like tetanus, and has an injury that breaks
the skin
Has a burn that is blistered or is more than 2-3 inches each way (see “Burns”)
Has been bitten by a human and the skin is broken
Has a cut that (see “Cuts and Scrapes”) These cut injuries need
o Seems deep or the edges of the cut are far apart to be seen the same day.
o Is on the lip Go to the ER or urgent
o Keeps bleeding and oozing care if you cannot get an
o Comes from an animal appointment with your
o Can’t be cleaned doctor the same day.
o Has something in it that you cannot get out
Has something in the eye that you can’t get out, or keeps having pain after you get the
object out of your child’s eye (see “Eye Injuries/Something in the Eye”)
Has a head injury (see “Head Injury”) and
o Has signs of a concussion, like nausea, headaches, blurred vision, hard time thinking,
trouble with balance, being tired, and feeling anxious
o Has a lump on the head from the injury
o Had a head injury and has a headache
o Is an infant but is acting normally
Has a splinter (see “Splinters) that you cannot get out
Has an injured part, like an ankle or wrist, that hurts and that the child cannot rest it
Intestinal
Call the doctor’s office or the nurse hotline if your child
Has constipation (see “Constipation”)
o That won’t go away
o With blood in the stools
o With leaking of stool onto your child’s underwear
Has blood in the stools
Has a bad stomachache (see “Stomachache”)
Has diarrhea (see “Diarrhea”) and
o Mucus or blood
o Persistent, mild abdominal pain
o High fever
o Mild to moderate dehydration
o Dark, tarry stools or blood in the stools
o It lasts for more than 3 days
16
Doctor’s Appointment
Is vomiting (see “Vomiting”) and
o Is a baby under 1 month old
o Has forceful vomiting that gets worse over time
o Is a baby still vomiting after 24 hours of only getting breast milk or oral rehydration
solution
o Got better, but then starts vomiting again after starting a normal diet
o Has a head injury (See head injury)
o Has a high fever (see “Fever”)
o Has pain on the right side of the belly, especially with fever.
o Has signs of mild to moderate dehydration, like a dry mouth, dry eyes, and less urine
than usual (see “Dehydration”)
o The vomit looks like green or yellow-green fluid, or brownish stuff that looks like
coffee grounds
Nose
Call the doctor’s office or the nurse hotline if your child
Gets frequent nosebleeds
Puts something in the nose
Has a nosebleed and also has easy bruising or bleeding, especially from small cuts
Has a nosebleed after starting a new medicine
Still has a nosebleed after you put pressure on the nose for 20 minutes
Skin and Hair
Call the doctor’s office or the nurse hotline if your child
Has a rash and also has other serious symptoms you can’t explain (see “Rash”)
Has hives (raised, red, circular areas all over the body) that are not rapidly progressing
(see “Rash”)
Has itchy blisters or sores that grow larger day by day. They can burst and ooze. They
are usually on the face (around the nose and mouth), hands, or forearms (See
“Impetigo”)
Has little, flat, red spots on the body that do not go away when you press them. These
could mean a problem with bleeding
Has a rash that does not get better after 3 days of home treatment (see “Rash”)
Has a rash that starts out looking like small, red pimples or bug bites and then becomes
blistered (see “Chicken Pox”)
Has poison ivy that covers a lot of your child’s body, is on the face or genitals, or is
getting worse (see “Poison Ivy, Oak, and Sumac”)
Has signs of eczema, like itchy, dry, red skin, with small bumps (see “Eczema”)
Has signs of infection, like pus, blistering, increased redness, warmth, and pain
Has lice that do not go away with treatment (see “Lice”)
Has an itchy bottom or other signs of pinworm (see “Pinworm”)
17
Doctor’s Appointment
Has sunburn (see “Sunburn”) with
o Blisters or that covers a lot of your child’s body
o A fever or chills, headache, confusion, nausea, or feeling faint
o Eye pain, so that your child can’t look at bright lights
o A child younger than 1 year
Throat (see “Sore Throat”)
Call the doctor’s office or the nurse hotline if your child
Has a sore throat and
o A high fever
o Looking very ill
o Having a hard time swallowing
o Drooling
o Neck pain
o A rough red rash all over the body
o Signs of dehydration
o Contact with someone with Strep throat
These are only some of the times you should call the doctor’s office or the nurse hotline.
Even if your child’s problem is not listed here, call your doctor’s office or the nurse hotline
if you are worried.
Urgent Care Clinics
Your primary care doctor knows you and your child best. When possible, you should see
your own provider for all non-emergency situations. However, there will be times after
hours when your child’s doctor is not available. In these times, an urgent care clinic that is
comfortable seeing children is a good alternative. Urgent care clinics are typically open after
normal business hours, including evenings and weekends. In addition, these clinics can be a
less costly option than going to the emergency room for non-life-threatening symptoms.
Talk to your doctor about when to use an urgent care clinic. Locate the urgent care clinics
that are close to your home and what their hours are.
If your child’s symptoms are life threating, call 911 or go to ER!
Emergency rooms are the best place to take your child for severe and life-
threatening symptoms. They are open 24 hours a day, 7 days a week.
18
Doctor’s Appointment
Doctor’s Appointment
Talking to the Doctor or Nurse about Your Sick or Injured child
Most doctors’ offices want you to call with questions or concerns, so call them if you have
questions or are worried.
What to Tell the Nurse or Doctor
Whether you are taking your child for a regular checkup, calling a doctor’s office when your
child is ill, or taking your child for emergency treatment, it is helpful to provide the doctor
with as much information as possible. Be prepared to tell:
Your child's name
Your child’s age
Your child's approximate weight
Anything the child is allergic to
Any illnesses your child has had
Any medications your child is taking, whether prescription or over the counter
Any other treatment your child is getting
Which immunizations your child has had and when your child had them
Any illnesses your child was recently exposed to
Your child’s symptoms, including temperature
What to Ask the Nurse or Doctor
Basically, ask the doctor anything you want to know! Bring a pen and paper (Health
Recording Chart) when you go to the doctor to write down advice and instructions, as well
as the answers to your questions.
REMEMBER, there is no such thing as a silly question when it comes to your child’s health.
You have the right to ask your doctor questions until you get answers that make sense to
you.
19
Caring for Your Child at Home
Caring for Your Child At Home
How to Comfort Your Child
When children are sick or injured, they often need more attention than usual. A child may
become clingy, cry, or just want to be near you. Sometimes children do not understand why
they do not feel well and this makes them scared. Other children may become withdrawn.
They may not want to eat, play, or cuddle. Try to be cheerful around your sick or injured
child, and try to be especially patient with your child.
You do not need to keep a sick or injured child in bed. Let your child’s behavior be your
guide. If your child is very sick, your child may want to be still and will sleep a lot. However,
if your child wants to be out of bed and playing, let your child.
Sometimes your child’s illness can spread to other people. If you have questions about
whether your child could give the sickness to someone else, check with your doctor’s office.
In most cases, you do not need to keep your child away from other people, as long as you
take steps to keep the illness from spreading. These steps will be different depending on
what kind of sickness your child has.
Some illnesses are spread by coughing and sneezing. Teach your child to cough or sneeze
into their arm, and to wash hands a lot. Some illnesses can be spread by touch, and by
getting germs on washcloths and towels. Parents and caregivers should wash hands
frequently to avoid spreading illness. Wash washcloths and towels in hot water if your child
has a skin infection that can be spread.
Your child may not want to eat much when sick. Never force your child to eat. As long as
your child gets plenty of liquid, your child can do fine on very little food. When feeling
better, your child will make up for the food missed and may eat more than normal. If your
child is truly not eating any food, make sure that your child is drinking something with sugar
and salt for energy like Gatorade® or Pedialyte® instead of plain water only. Children who
are younger than 1 year old should drink diluted Gatorade® or Pedialyte®. It is very
important for a sick or injured child to drink as much as possible to replace the fluids lost
during sweating, vomiting, or diarrhea.
Try to be extra loving and understanding when your child is ill. Don't worry if your child
behaves like a baby again (like thumb sucking or bed-wetting or just wanting you to hold
them a lot). Don’t worry about making sure your child follows all the rules when your child
is sick or injured. Try to be patient and try not to scold or yell at your child. You can wait
until your child feels better before making sure your child follows all the rules.
20
Caring for Your Child at Home
Caring for Your Child At Home
Planning for Sick Days
Let's face it. No matter how clean, safe, and careful you are, your child may get sick or
injured. The time to plan is now, so that you don’t have a crisis when your child is sick.
Think ahead about what you will do.
How can you plan to stay home with your child?
___________________________________________________________________________
___________________________________________________________________________
Who do you know who can provide back-up if you need to work? For example, a
babysitter, family member or friend?
___________________________________________________________________________
___________________________________________________________________________
How can you plan for wages lost from missing work?
___________________________________________________________________________
___________________________________________________________________________
How will you pay if your child needs to go to the doctor or needs medication?
___________________________________________________________________________
___________________________________________________________________________
How can you put some money aside ahead of time so this won't be a problem?
___________________________________________________________________________
___________________________________________________________________________
What necessary medical supplies do you have on hand, and which ones do you need? (See
“Supplies Checklist”)
___________________________________________________________________________
___________________________________________________________________________
If you do not already have a doctor for your child, what can you do now to start looking
for a doctor before your child gets sick?
___________________________________________________________________________
___________________________________________________________________________
How will you get your child to the doctor? For example, taking the bus or taxi, asking for a
ride from a friend, family member, or neighbor, or using your own transportation.
___________________________________________________________________________
___________________________________________________________________________
21
Caring for Your Child at Home
Caring for Your Child At Home
When to Keep Sick or Injured Children Home from School/Daycare
In general, you should keep your child home from school if your child looks sick to you and
isn’t feeling well, is likely to disrupt the others in the class such as with lots of coughing and
sneezing, or has something that could be spread to others. Different places have different
rules about keeping children home. Check with your doctor or your child’s school or daycare
if you are not sure what to do. Below are some common rules.
General
Keep your child home from school if your child
Has a fever of 100.4°F or higher by mouth (101.4oF by rectal/ear or 99oF by
armpit/forehead). Most childcare centers and schools will send children home if they
have a temperature of 100°F or higher. Keep your child home until your child has not
had a fever for 24 hours (see “Fever”)
Has a fever below 100.4°F by mouth but is tired and cranky and doesn’t feel well
o If a temperature is above normal (98.6°F) but less than 100°F and your child is not
very tired and doesn’t seem very sick, most centers and schools will allow your child
to stay (see “Fever”)
Breathing
Keep your child home from school if your child
Is having trouble breathing (call the doctor’s office or the nurse hotline). If your child is
having a very hard time breathing, call 911 or go to the emergency room
Is wheezing, a whistling sound in the chest when the child breathes (call the doctor’s
office or the nurse hotline)
Has a cold with a very runny nose or a cough that will disturb other children
o You don’t need to keep your child out of school with a cold. But if your child feels
very tired and sick, is coughing in a way that will disturb the other children, or has a
very runny nose, you probably should keep your child at home
Has a cough that is likely to disturb other children
o You can send your child to school with a mild cough. But if your child has a bad
cough, keep your child at home and call your doctor’s office (see “Cough”)
Eyes
Keep your child home from school if your child
Has conjunctivitis (pink eye). Conjunctivitis is very easy to spread to others. Keep your
child home until your doctor says your child can go back (see “Pink Eye”)
22
Caring for Your Child at Home
Intestinal
Keep your child home from school if your child
Has diarrhea. Keep your child at home until the symptoms go away and your child can
eat regular food again (see “Diarrhea”)
Is vomiting. Keep your child home until your child has not vomited for 24 hours (see
“Vomiting”)
Skin
Keep your child home from school if your child
Has chicken pox. Keep your child home while your child is contagious. This means
keeping your child home from the time the rash first shows up until all of the sores have
crusted over. This usually takes 7 to 10 days, but make sure that all of the sores have
crusted over and they look like scabs, NOT blisters (see “Chicken Pox”)
Has impetigo (skin infection). Keep your child home until the infection crusts over (see
“Impetigo”)
Has lice and the school policy says your child needs to stay home until your child is
treated and the lice are gone. Many schools and daycare centers will not let your child
stay in school. If the school says it is okay for your child to be there, you can send your
child (see “Lice”)
Sore Throat/Strep
Keep your child home from school if your child
Has Strep throat. Keep your child home until your child has been taking antibiotics for at
least 24 hours
23
Caring for Your Child at Home
Caring for Your Child At Home
Giving Your Child Medicine
Over-the-Counter and Prescription Medicines
The Symptom and Illness Guide describes when to use some over-the-counter medicines.
These are medicines you can buy in a drugstore or supermarket without a prescription.
Check with your doctor’s office before giving over-the-counter medicine to a child under
2 years old
Check with your doctor’s office before giving more than one medicine to your child at a
time
Never give aspirin to your child unless the doctor says to because it may cause a serious
disease called Reye Syndrome (a serious condition that causes swelling in the brain and
liver damage)
Sometimes when you take your child to the doctor, the doctor may prescribe special
medicine for your child. Whenever your child’s doctor prescribes medicine, follow the
directions carefully. Give the medicine until it is gone, even if your child feels better before
all the doses are given.
How to Give Medicine
Never give a child medicine if you are not sure how much or how to give
Carefully read the instructions for the medicine and administer it to the right place. If you
have questions about how much medicine to give, it is better to be safe and call the
doctor’s office for instructions. Wash your hands before giving any medicine. Check to make
sure you are giving the right medicine, the right dose, at the right time. Read the medicine
label carefully. If you don’t understand the instructions, have somebody help you or call the
doctor’s office or pharmacy. Also, make sure you know whether or not you should
refrigerate your child’s medicine.
Giving babies and children medicine by mouth
For a liquid medicine, always use a measuring spoon, a spoon tube, a medicine cup, or a
medicine dropper. For a baby, sometimes you will need to measure the right dose and
then use your finger to give the medicine
Always give medicine with your baby or child’s head in a slightly raised position. If your
child is lying flat, your child may choke on the medicine
If your baby or child spits up a lot of the medicine, do not give another dose right away.
Wait until the next dose is due or call your doctor’s office for advice
If it is hard to give the medicine, get someone to help
24
Caring for Your Child at Home
For babies
Only put a little of the medicine in your baby’s mouth at a time
Give the medicine to the side of your baby’s mouth, never towards the back, so your
baby doesn’t choke
To use a measuring spoon or spoon tube
1. Put the right amount of medicine in the spoon
2. Hold your baby in the crook of your arm
3. Gently open your baby’s mouth by pulling down the chin
4. Place the tip of the spoon on your baby’s lower lip
5. Raise the angle of the spoon and let the medicine run into your baby’s mouth
6. Write the medicine and dose you gave on the Health Recording Chart
To use a dropper
1. Put the right amount of medicine in the dropper
2. Hold your baby in the crook of your arm
3. Place the dropper in the corner of your baby's mouth and release the medicine
gently
4. Write the medicine and dose you gave on the Health Recording Chart
To use your finger (if your baby will not take medicine from a spoon or a dropper)
1. Wash your hands thoroughly
2. Measure the right amount of medicine into a container
3. Dip your little finger into the medicine and let the baby suck it off your finger
4. Repeat this step until all the medicine is gone
5. Write the medicine and dose you gave on the Health Recording Chart
For older children
Check with your doctor’s office before giving more than one medicine to your child at a
time
Never give aspirin to your child unless the doctor says to
If your child does not like the taste of the medicine
o Have your child suck on a popsicle before taking medicine to numb your child’s
taste buds
o Refrigerate the medicine to reduce the taste
o Let your child have their favorite drink ready for right after your child takes the
medicine
o Some medicines can be mixed with Kool-Aid®, syrup, ice cream, or other sweet
flavors. Check with the pharmacist before mixing the medicine with something else.
o Check with the pharmacist before crushing a tablet or capsule. Some medicines will
not work right if you crush them
25
Caring for Your Child at Home
Giving children medicines in the ears, eyes, or nose
Never let the dropper touch the eye, ear, or nose, or you may get germs in the bottle
when you put the dropper away. If it does touch, wash it very well before putting it back
Do not use over-the-counter drops for more than 3 days without checking with your
doctor‘s office
If the bottle has been in the refrigerator, you can warm it by holding it in your hands or
putting it in warm (not hot) water for a few minutes. Do not microwave the medicine
Ear drops
1. Lay your child on your child’s side and turn your child’s head so the hurting ear is up
2. Let the drops fall into the center of the ear
3. Hold your child steady until the drops have run into the ear canal and you can’t see
the medicine any more
4. Write the medicine and dose you gave on the Health Recording Chart
Eye drops
1. Make sure you or someone else can hold the child very still
2. Tilt the child's head slightly so that the infected eye is lower than the other eye. This
way no drops run into the healthy eye
3. Gently pull the lower eyelid down and let the drops fall between the eye and the
lower lid
4. Write the medicine and dose you gave on the Health Recording Chart
Nose drops
1. Tilt the child's head back slightly
2. Gently drop liquid into each nostril
3. Count the number of drops as you put them in. Two or three drops at a time is
usually enough. More might run down the throat and cause the child to cough
4. Write the medicine and dose you gave on the Health Recording Chart
Nose sprays
1. Clear your child’s nose. Have your child blow it if the child can. Use a nasal aspirator
(bulb syringe) to remove sticky nasal fluids if your child is too young to blow their
own nose
2. Tilt the child's head back slightly so the medicine does not go into your child’s throat
3. Ask your child to sniff gently while you squeeze the bottle
4. Follow the instructions about how many puffs of spray you should give on each side
5. Write the medicine and dose you gave on the Health Recording Chart
Inhaled Medicine
Talk to your doctor or pharmacist for instructions
26
Prevention
27
Hygiene
Prevention
Hygiene
Hygiene is about keeping clean and stopping the spread of germs.
Hand washing
Hand washing is the #1 way to stop the spread of germs. The chance of getting the
common cold and many illnesses that are more serious can be decreased by washing your
hands.
When to wash your hands After playing with an animal
Before eating and cooking After riding public transportation, like
After using the toilet
After cleaning a child who has used the the bus, taxi, or subway
After changing cat litter or cleaning a
toilet
After changing a baby’s diaper pet cage
Before caring for a toddler or infant After coughing, sneezing, or blowing the
After coming in from outside
After visiting or caring for a sick person nose
After taking out the trash
How to wash your hands the right way
Step 1. Turn on the water and Step 2. Have your child wet Step 3. Use enough soap to
put your hand in to make sure it the hands. make good suds.
isn’t too hot for your child.
Step 4. Have your child rub the Step 5. Rinse your child’s Step 6. Dry well with a
soapy hands together for 20 hands. clean towel and turn off the
seconds (amount of time to say faucet with the towel.
the alphabet), including in
between the fingers, under the
nails, and up to the wrists.
28
Hygiene
Using hand sanitizer
You can also use an alcohol-based hand sanitizer like Purell®. Hand sanitizers work best when
there is not a lot of dirt that can be seen on the hands. If the hands look dirty, soap and water
are best. Only let your child use a hand sanitizer if you are watching. Make sure that your child
does not touch the eyes, nose, or mouth while sanitizer is on hands. Keep hand sanitizer out of
the reach of children to avoid ingestion. Do not use sanitizer if your child has cuts on hands
because it will sting.
Step 1. Put enough hand sanitizer on your child’s Step 2. Have your child rub your child’s
hands so they stay wet for about 10-15 seconds. hands together, including in between
Depending on the size of your child’s hands, this fingers, under nails, and up to wrists
might be about the size of a quarter or less
Bathing
Bathe your infant 2-3 times a week. Older children should bathe as often as needed to
maintain good hygiene
Children like routines, even when they say they do not. Make bathing a routine by having
baths at the same time every day—usually either in the morning or the evening
Give a 5-minute warning to let children know that it is almost bath time
Get all of the bath supplies, including bath toys, before bringing children into the bath
Never leave your child alone in a bath and watch your child the entire time your child is in
the bathroom
Test the water with your elbow before placing your child in a bath to avoid burning your
child’s skin
Consider using lotions or cream after the bath to keep your child’s skin moist
During bath time
Wash your child’s face. Young children don’t need soap on their faces because their
faces do not get oily. Use water to clean off food and dirt
Wash your child’s arms, armpits, fingers, and fingernails
Wash your child’s legs, feet, toenails, and between toes
Use a washcloth to clean the outside parts of your child’s ears and behind the child’s
ears
Wash your child’s genital area and bottom (If your child is an uncircumcised boy, show
your child how to keep the foreskin area clean. Talk to your doctor if you do not know
how)
29
Hygiene
Wash your child’s hair around 1 to 2 times a week, more if your child sweats a lot, gets
dirt in hair, or has cradle cap (see “Cradle Cap”). Do not wash your child’s hair too often
because the scalp may get dry and itchy
o Use mild shampoos that are made specifically for children
o If your child has long hair, use a detangling shampoo or rinse to make the hair
smoother and easier to brush
o Lather the shampoo in your child’s hair, and then rinse it well. Never rub your child’s
scalp hard
Nails
Use a pair of special scissors with rounded edges to clip your child’s nails
A good time to clip your child’s nails is after a bath when your child’s nails are soft or when
the child is napping
Be careful not to clip the nails too short—just enough so your child does not scratch
themselves
Teeth
Start caring for your child's teeth as soon as you see the first baby tooth. You should stop
night feedings once your baby’s first tooth erupts
Teeth should be brushed at least twice a day, especially after the last feeding of the day
(do not send your child to bed with a bottle)
Clean your baby's first teeth with a clean piece of gauze, a terry cloth washcloth, or a soft-
bristled baby toothbrush
Use a smear of fluoride toothpaste (size of a grain of rice) for children younger than 3 years
old and pea size amount starting at age 3 years old. Until your child can spit out the extra
toothpaste, you may want to use a baby toothpaste that does not have fluoride. When
your child is old enough, teach your child to spit the toothpaste out after the child’s teeth
are brushed
Your child can learn how to brush their own teeth at about 3 years old and should be
brushing their own teeth morning and night by age 7. You should watch your child brush to
check for proper cleaning and spitting out of the extra toothpaste until age 7
Always use a soft-bristle brush that is small enough to fit comfortably in the child’s mouth
Flossing is an important part of good dental health. Start flossing your child's teeth when
your child has teeth that touch each other. Talk with your dentist about when and how to
floss your child's teeth and teach your child to floss
Do not have your child use mouthwash until after your child is 12 years old, unless your
dentist says to
See a dentist by the time your child is about 1 year old, even if the child is not having
problems, to start preventive care and make sure your child’s teeth stay healthy
30
Hygiene
Clothes
Try to have your child wear clean clothes every day. Body odor in small children usually isn't
coming from them but from bacteria growing on the sweat and dirt on their clothes.
Sometimes children want to wear the same clothes every day. Keep several pairs of favorite
underwear or other clothes so that you and your child don’t fight when you want your child to
change clothes.
Socks and Shoes
Smelly feet happen because bacteria grow on sweat in the socks and shoes. Air out shoes after
they get sweaty. If your child sweats a lot, put odor eater insoles or charcoal insoles into shoes,
or sprinkle non-caking baby powder, cornstarch or baking soda inside socks to help absorb
sweat. Wearing clean, dry cotton socks helps prevent foot odor.
31
Nutrition
Prevention
Nutrition
Feeding your baby: Birth to 4 months old
During the first 4 months, infants do not need anything to eat but breast milk or formula.
Breast milk is the best, but a fortified formula is also good. You do not need to give your
baby water, juice, or other foods for the first 6 months. In fact, too much water can make
an infant sick.
A breastfeeding newborn may nurse 8 - 12 times per day (every 2 - 4 hours). Most babies
cut back to 4 - 6 times per day by 4 months.
A baby who is taking formula will start out eating about 6 - 8 times per day, with 2 - 5
ounces of formula per feeding (for a total of 16 - 35 ounces per day). As the infant gets
older, the number of feedings will decrease, but each feeding will be around 6 - 8 ounces.
All babies (even formula fed babies) should get vitamin D drops starting within the 1st
week of life. They need vitamin D drops every day until 1 year of age.
Have your baby checked regularly by your doctor to make sure your baby is growing at a
good rate. Your doctor will tell you if you need to feed the baby more or wake your baby at
night to feed. If your baby is not eating as much as usual, or your baby starts to lose
weight, call the doctor. Your doctor can see if there is anything wrong and can give you
advice. Do not become angry with your baby if the baby does not eat well, but do call the
doctor.
Keep your baby safe
Do not give your baby younger than 4 months water to drink because too much water
can make your baby sick
Never give honey to a baby younger than 1 year because infants may not be able to get
rid of bacteria that are sometimes found in honey
Do not prop the bottle while feeding your baby
Feeding your baby: 4 to 6 months old
At 4 - 6 months, most babies take in about 28-32 ounces of breast milk or formula a day and
are eating 3-5 times a day. At this age, an infant is often ready to start the transition to solid
foods. You will know your baby is ready when:
Weighs twice as much as when your baby was born
Can control head and neck
Can sit up with support
Can show your baby is full by keeping the mouth closed or turning their head away from
the breast or a bottle
Seems interested in food
32
Nutrition
Your baby’s first solid food can be iron-fortified baby rice cereal mixed with breast milk or
formula to a thin consistency. The cereal may be mixed thicker as your baby gets used to
eating it. Start by offering cereal 2 times per day. Start with a little bit—1 or 2 tablespoons
dry cereal mixed with breast milk or formula. Over time, increase to 3 or 4 tablespoons of
cereal. Feed the cereal to your baby with a spoon. Do not give cereal in a bottle unless your
doctor tells you to.
Once your baby is eating rice cereal easily, you can try other iron-fortified instant cereals.
Do not add more than one kind of cereal every few days so that you can make sure that the
new food agrees with your baby.
Never put a baby to bed with a bottle, since this can cause tooth decay. Use plain water if a
bottle is necessary, but do not give a lot of water because too much water can make your
baby sick.
If your baby is not eating as much as usual, or starts to lose weight, call the doctor. Your
doctor can see if there is anything wrong and can give you advice. Do not become angry
with your baby if your baby does not eat well, but do call the doctor.
Keep your baby safe
Do not give your baby water to drink, or only give a small amount
Do not feed cereal in a bottle
Never give honey to a baby younger than 1 year
Do not put your baby to bed with a bottle, since this can cause tooth decay
Feeding your baby: 6 to 12 months
Offer your baby breast milk or formula 3 to 5 times per day. By about 8 months of age,
more of your baby’s nutrition will come from other sources, and the number of breast milk
or formula feedings will begin to decrease. The primary source of nutrition until age 1 is
breast milk or formula.
Once your baby is 6 months of age, you can talk to your doctor about how best to introduce
allergens.
In addition to the breast milk or formula, by 8 months try to offer about 2 servings of fruit
and 2 servings of vegetables each day. Each serving should be about 2 to 3 tablespoons at
first. Give your baby bigger servings as your baby gets used to eating fruits and vegetables
and as your baby grows bigger.
At 9 months, offer solids three times a day. Your baby can eat finger foods, in small
amounts at first, and in larger amounts as the baby gets older. Soft cooked vegetables,
washed and peeled fruits, graham crackers, Melba toast, and noodles are good finger foods.
You can also give your baby teething foods, unsalted crackers, and teething biscuits. Stay
away from salted or sugary foods.
33
Nutrition
Starting at 8 months of age, you can give your baby strained or finely chopped meats. For
breastfed infants, start meats at 8 months of age, since they’ll need to get more iron than
they get from breast milk. You can also give your 8-month-old baby egg yolks. As with other
foods, add only 1 new food every few days. You can give your baby small amounts of
cheese, cottage cheese, and yogurt, but do not give the baby milk. If you’re unsure about
what foods to give your baby, make sure to talk to your doctor.
Begin to offer a sippy cup with water at 9 months for practice. By the age of 1 year, you
should wean your baby off the bottle, though some infants may still be breastfeeding. You
can breastfeed your baby for as long as you want. There is no evidence of harm to a child
for breastfeeding into the third year of life or longer.
If your baby is not eating as much as usual, or starts to lose weight, call the doctor. Your
doctor can see if there is anything wrong and can give you advice. Do not become angry
with your baby if your baby does not eat well, but do call the doctor.
Keep your baby safe
Do not feed cereal in a bottle
Do not give foods that can make your baby choke, like apple chunks or slices, grapes,
hot dogs, sausages, peanut butter, popcorn, nuts, seeds, round candies, and hard
chunks of uncooked vegetables
Never give honey to a baby younger than 1 year
If you feed out of a baby food jar, you must toss it after 2 hours, but if you pour part into
a bowl and the spoon does not touch the remainder, it can be stored for 2 days in the
refrigerator
Feeding your child: 1 year old and older
After your child is 1 year old, they can probably eat most of the foods your family eats.
Make sure to serve your baby in ways that are safe. At 1 year, your baby should start
drinking whole milk. Do not give your 1-year-old baby skim/non-fat or 1%/low-fat milk
because your baby needs the calories from the milk fat to grow. At age 2, your toddler
should drink skim/non-fat milk or 1%/low fat milk. Give your toddler many different kinds of
foods, including lots of fruits and vegetables. Young children eat small amounts at a time,
but they eat more often than adults do, around 4-6 times a day, and they need to snack.
Sometimes toddlers lose interest in food for a few days or weeks. It is not uncommon for
children 1 to 5 to have times when they do not want to eat. This is normal, but if they often
don’t eat or are not growing normally, talk to their doctor. Children go through many stages
as they grow. Eating habits can be affected by these stages. Do not force your child to eat or
become angry at your child for not eating. Children sometime have a small or no appetite. If
children are active and growing, a small appetite is probably okay, but it can be a warning
that your child is sick, upset, or worried. Call your doctor’s office if you are worried about
your child’s eating or your child does not grow for several months.
34
Nutrition
Mealtime and Healthy Snacks. Offering regular meal and snack times every 2-3 hours at
about the same time each day lets your child know when your child can expect food. Also,
consider offering a wide variety of foods at the different meal and snack times. Mealtime is
an opportunity to be together as a family. At least one meal a day should be as a family.
Find a place where everyone can sit together. Engage in a positive conversation with your
child during meal and snack times. Turn off the TV during snack and meals times as this
promotes healthy eating habits.
For children, especially those who are physically active, snacks can provide important
nutrition and energy. Snacks should be healthy, for example, milk, fruit, vegetables, whole-
wheat baked crackers, peanut butter, cheese, or yogurt. Snacks should not be eaten right
before meals. Children should learn to get hungry for meals, rather than eating to feel full
all the time.
Children learn healthy eating habits by watching others. Model appropriate eating
behaviors and eat healthy foods. Give your child food choices (“Do you want to eat an apple
or a cheese stick for your snack?”). This can give your child a sense of control over what
they eat. Always include fruits, vegetables, whole grains, and a protein source with each
meal. It is best to limit highly processed foods, and sugared foods and beverages.
Feeding tips
Share responsibility with your children’s eating:
o Parents are responsible for when and how food is prepared and what to eat
o Children are responsible for if they eat and how much to eat
During meal and snack times, encourage your child to eat. Avoid forcing your child
to eat or taste foods, as your child may not be hungry or ready to try a food
Children are often more willing to eat foods they help to prepare. Give your child a
simple task (e.g., “Can you get the apple from the refrigerator?”) while you are
preparing a snack or meal
Keep your child safe
Do not give foods that can make your child choke. Do not give your child any round, firm
food that is more than ½ inch big. Cut foods like grapes and hot dogs into small pieces
before feeding them to your child
Do not let your child eat while running around
Check the temperature of food to make sure it is not too hot
35
Nutrition
Prevention
Physical Activity
Older babies and children need physical activity. Infants can’t really exercise, but gently
helping your baby stretch and move is a great way to practice your interaction skills.
Infants and babies need to be able to move as much as possible. Do not keep a child in a car
seat, stroller, rocker, portable bouncer/vibrating seat, or pushchair for over an hour. In
addition to not allowing movement, this may cause them to have a flat head. Supervise your
child carefully when your child is playing and remember to be gentle.
Infants and Pre-Crawling Babies
For older infants, gentle baby games can help in developing motor skills. Examples include:
Stretch to play “How Big?”, ask, “How big is the baby?” Then gently lift the arms up and
say, “Sooooo big”
Gently pull the baby up to sitting position by your baby’s arms and then slowly lower the
baby down
Encourage your baby to kick a toy. Lay the baby on the back. Touch your baby’s foot
with a toy. If the baby kicks it, make a happy fuss and lift the object high in the air. Do
this with the other foot
Hold toys or other objects your baby likes where the baby can get them by reaching.
This will help your baby’s eye-hand coordination
Encourage tummy time while your baby is awake with your supervision
Crawling Baby
At this age, your child should be encouraged to explore. Careful supervision is critical.
Sample activities include:
Encourage crawling by placing toys just beyond your child’s reach
Create obstacle courses using pillows, boxes, and sofa cushions to improve your baby’s
confidence. Make sure to pay attention when your baby is in the obstacle course to
ensure that your baby does not get stuck and that the baby is not in danger of
suffocating in pillows or other obstacles
Help your baby crawl up the stairs
Keep choking hazards off the floor and out of reach
Walking Children
The focus of physical activity at this age should be fun, not an organized routine. Examples
of activities are:
Roll a ball to your child and get them to kick it
Help a toddler walk up the stairs
Play jumping games
Roll on the floor
Get your child to run to an object, touch it, and run back
Work in the garden. Your child can help dig a hole or fill in dirt
Take a walk
36
Immunizations
Prevention
Regular Medical Checkups and Immunizations
Well-Child Checkups
Your child's doctor will want to see your child on a regular basis. The doctor will ask you
questions about the child's development, mood, and behavior, and will do a physical
examination. The doctor will tell you what immunizations your child needs and may even
give the immunizations in the office. You will also get advice about diet, exercise, and other
ways that you can keep your child healthy.
At first, your doctor will want to see your baby a lot, like once a month for the first 6
months. This is because your child needs lots of immunizations during that time (see table
on next page) and so the doctor can check your child for problems. As your child gets older,
there will be more time between visits, unless your child needs extra care.
Immunization Schedule
Immunizations are very important! They protect your child and others from infectious
diseases that can be prevented. Many hospitals and clinics offer free immunizations if you
cannot afford them. State law requires immunizations for your child to go to school.
The immunization schedule on the following page was last updated in 2021. The
immunization schedule is updated regularly. Check with your doctor to make sure that your
child gets the necessary shots using the most up-to-date schedule.
37
Immunizations
Vaccine ▼ Birth 1 2 4 6 9 12 15 18 19-23 2-3 4-6
Age► 1st month months months months months months months months months years years
dose
Hepatitis B (HepB) 2nd dose 3rd dose
Rotavirus (RV) 1st 2nd 3rd
dose dose dose
Diptheria, tetanus, 4th dose See
acellular pertussis (DTaP) 1st 2nd 3rd dose 3rd or 4th dose notes**
dose dose
Haemophilus influenza See See notes* See
type b (Hib) 1st 2nd notes 4th dose notes**
dose dose 4th dose
Pneumococcal * 3rd dose
conjugate (PCV13) 1st 2nd 3rd Annual vaccination
Inactivated poliovirus dose dose dose Start yearly vaccine 1 or 2 doses
(IPV ) 1st 2nd
Influenza (IIV) dose dose 2nd dose
OR 2nd dose
Influenza (LAIV4) See notes** 1st dose
Measles, mumps, 1st dose
rubella (MMR)
Varicella (VAR)
Hepatitis A (HepA) See notes** 2-dose series***
Meningococcal See notes**
Pneumococcal See notes**
polysaccharide (PPSV23)
*Administration of Hib will depend on when the doses are received. Speak to your pediatrician about your child’s specific
needs.
**Range of recommended ages for certain high-risk groups. Ask your pediatrician about your child’s specific needs.
***Separate by 6 to 18 months in between dose 1 and dose 2
Adapted from CDC (2021) website https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-
schedule.pdf Note that many vaccine schedules/dosages depend on which vaccine product is used
From birth until your child is 6 months old
From the time a child is born until 6 months of age, your child needs a lot of immunizations.
By the time your baby is around 6 months old, your baby should have had:
2 hepatitis B shots. This protects your baby against hepatitis, a kind of liver infection.
Your baby will get the third (and last) hepatitis B shot when your baby is at 6 to 18
months old
3 DTaP shots. This protects your baby against diphtheria, tetanus, and whooping cough.
Your baby will get the fourth DTaP shot when your baby is 15 to 18 months, the fifth
shot when your child is 4 to 6 years, and the sixth shot when your child is 11 or 12
3 Hib shots. This protects against an infection of the lining of the brain and other
problems. Your baby will get the fourth (and last) Hib shot when your baby is 12 -15
months
2 polio shots. This protects what was once a leading cause of nerve damage, resulting in
children who could not walk or even lost the ability to breathe. Your baby will get the
third polio vaccination when the baby is 6 to 18 months old and the fourth when your
child is 4 to 6 years old
Continue to next page
38
Immunizations
3 pneumococcal shots. This protects against a bacteria that causes pneumonia,
earaches, infection of the lining of the brain, and other illnesses. Your baby will get the
fourth (and last) dose when your baby is 12 to 15 months old
3 rotavirus shots. Rotavirus causes diarrhea. After the third dose, your child does not
need any more rotavirus vaccines
When your child is older than 6 months, but less than 2 years old
When your child is older than 6 months, but less than 2 years old, the frequency of
immunizations is less. Your child will need:
The first MMR and varicella shots when your baby is 12 to 15 months. MMR protects
against measles, mumps, and German measles (Rubella). Varicella vaccine protects
against chicken pox. Your child will get the second (and last) MMR and varicella shots
when your child is 4 to 6 years old
The first hepatitis A shot when your toddler is 12 to 23 months and the second (and last)
hepatitis A shot 6 months after the first. This protects against a liver infection
The last hepatitis B shot when your baby is between 6 and 18 months old
The third polio shot when your baby is between 6 and 18 months old and the fourth
polio shot when your child is 4 to 6 years old
Your child should get a flu (influenza) vaccine every year before flu season starting when
your child is 6 months old. The first year that your baby gets flu vaccine, the baby will
need 2 shots, separated by about a month, but in the years after that, your child will
only need one shot. You can also ask your doctor about LAIV4, which is administered as
a nasal spray instead of an injection
Your child should get the last Hib and pneumococcal shots when your baby is 12 to 15
months
The fourth DTaP shot when your baby is 15 to 18 months old
When your child is older than 2 years
When your child is older than 2 years, the child still needs immunizations. Your child will
need:
The fifth DTaP, fourth (and last) polio, second (and last) MMR, and second (and last)
varicella shots when your child is 4 to 6 years old
Booster shots for some diseases when your child reaches 11 or 12 years old and 16
years old
39
Preventing Abusive Head Trauma
Prevention
Preventing Abusive Head Trauma
Shaken Baby Syndrome is a form of abusive head trauma that can kill. It is considered child
abuse. It happens when someone shakes a baby hard. A baby has a heavy head and a weak
neck, so when the head is shaken a little, it moves fast and hard. The shaking hurts the
baby’s brain. Never shake an infant or child.
Normal playing with a child, like bouncing the baby on a knee, will not cause Shaken Baby
Syndrome. Shaken Baby Syndrome usually happens when the caregiver is angry or
frustrated and shakes the baby, for example, because the baby will not stop crying.
Prevention
If you feel your baby is crying too much and you cannot cope with it, get help right
away. Have a friend take over for you, or call your doctor’s office or 911 if you think you
might hurt your baby
If you have a fussy baby, make sure that anybody who cares for your child knows this
and knows to never shake a baby
Many babies who die from Shaken Baby Syndrome have been abused. If you think
somebody you know may be abusing their child, make a report to authorities
If you know a caregiver who is very stressed and can’t seem to cope with their child, see
if you can get help for them
Symptoms in a baby who has been shaken too hard include:
Overall tiredness and hard to wake the Difficulty breathing
baby
Hard time lifting the head
Vomiting
Can’t focus the eyes or follow you with
Poor sucking or swallowing their eyes as you walk around
Decreased appetite Unconscious
Not smiling Fussiness
Not making noises Irritability
Stiffness Increased crying
Seizures
** Some babies show no symptoms
If you think a child has Shaken Baby Syndrome, call 911
or take the child to the emergency room right away
40
Safe Sleep
Prevention
Safe Sleep
Just as you keep your infant safe when your infant is awake, you need to keep your baby
safe when sleeping by making sure that the place your infant sleeps and how your infant
sleeps is good for a baby.
Sudden unexpected infant deaths (SUID) is the sudden and unexpected death of an infant
who is younger than 1 year old. After a full investigation, these deaths may be diagnosed as
suffocation, entrapment, infection, ingestion/choking, metabolic diseases, cardiac
arrhythmias, trauma (accidental or non-accidental), or SIDS. Sudden Infant Death
Syndrome (SIDS) is the sudden, unexplained death of a baby younger than 1 year that does
not have a known cause even after an investigation that includes a complete autopsy,
examination of the death scene, and review of the clinical history. It is scary because it can
strike without warning, even in a baby who seems healthy. SIDS/SUID is the leading cause of
death among infants who are 1 month to 1 year old.
There are 6 safety measures you can do to help reduce the risk of SIDS/SUID and prevent
other sleep-related causes of death.
1. Sleeping Position
Always put your baby on your baby’s back while they sleep but your baby can be on the
stomach when your baby is awake with you supervising (see ‘Tummy Time’ on the next
page). A baby sleeping on their back is not more likely to choke. When your baby is old
enough to roll over, it is okay to let your baby choose in what position they sleep.
2. Sleeping Environment
Your baby’s crib and play yard (safety-approved) should have a firm sleep surface for
your baby to lie on (visit http://www.cpsc.gov/safety-education/safety-education-
centers/cribs/ for more information on safety-approved baby sleep areas)
o Put your baby on a firm sleep surface, never on a pillow, couch or other soft surface
o The mattress should fit tightly in the crib so your baby will not get stuck between
the mattress and the rails. Use a fitted sheet to cover the mattress
o The crib should have no broken or missing rails and the rails should be no more
than 2 3/8 inches apart (about as wide as a soda can)
o Make sure there are no gaps or holes that allow your baby’s head or other body
parts to get trapped
Put your baby in a sleep outfit (e.g., one-piece sleeper) instead of using a blanket, and
be sure your baby does not overheat while sleeping
Do not put soft toys, stuffed animals, pillows, blankets, bumpers, loose bedding,
clothing not on your infant, or other soft objects in crib with your baby
41
Until 6 months old, it is safest for your baby to sleep in the same room as you but in
your baby’s own bed (do not bed share with your baby because this increases your
baby’s risk of suffocation)
3. Use a Pacifier
Consider giving your baby a pacifier when your baby is sleeping but do not force it (Note: If
breastfeeding, wait until the baby is used to breastfeeding first). A pacifier may decrease
risk of SUID/SIDS.
4. Room Temperature
Keep the room at a comfortable temperature while your baby sleeps that is good for an
adult in a short-sleeve shirt. A room thermometer is useful and can be purchased from
many pharmacists. An ideal room temperature is 65°F to 70°F.
5. Never smoke around your infant
It is important that you never smoke around your infant or child. Babies exposed to
smoke are at increased risk for SIDS/SUID. Nobody should ever smoke in the house, even
people visiting. If you or someone needs to smoke, it is necessary to smoke outside of the
house. Also, change your shirt after smoking in order to not expose your infant to the
smoke on your clothes. Prenatal exposure to smoking is linked to SIDS.
6. Tummy Time
When your baby is awake and being supervised, place your baby on the stomach for
tummy time. This will help with the development and strengthening of your baby’s head,
neck, and shoulders. Also, minimize the time the baby spends in a car seat, bouncer, or
carrier. This also will reduce the chance of flat spots on your baby’s head.
How do I make my baby’s crib safe?
42
Safe Sleep
What should my baby’s sleeping space look like?
Crib in caregiver’s room:
Bassinet in caregiver’s room:
For more information on safe sleep for babies, visit
http://safetosleep.nichd.nih.gov
43
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