Family Medicine Cabinet Essentials

In addition to a first-aid kit, a well-stocked family medicine cabinet can help families contend with a variety of ailments that children of all ages – and adults alike – might experience.

Here, Dr. Jonathan Auth, a CHOC Children’s pediatrician, lists the essential elements of a family’s medicine cabinet.

Family Medicine Cabinet Essentials
Dr. Jonathan Auth, a CHOC Children’s pediatrician, offers tips on family medicine cabinet essentials.

Oral medications

Acetaminophen – Frequently known as Tylenol, this common over-the-counter medication is a first-line defense against fever and pain. He recommends that families stock children’s acetaminophen rather than anything labeled as for infants. Though they used to differ in concentration, formulas are now the same, and children’s versions are typically less expensive than those marketed to infants, Dr. Auth says. Download a parent’s guide to acetaminophen for children to ensure you’re giving your child the right dose.

Ibuprofen – Known in stores as Motrin or Advil, this medication also combats fever and pain. It can also help soothe swelling and other complaints associated with an injury, thanks to its anti-inflammatory properties. Ibuprofen’s effects also last longer than acetaminophen, though it can irritate some children’s stomachs, especially if taken on an empty stomach. Dr. Auth does not recommend it for children younger than 6 months old.

Diphenhydramine – Commonly known as Benadryl, this medication can have multiple purposes, Dr. Auth says. It can help children with mild allergic reactions, as well as those who have seasonal allergies and some cold symptoms. Dr. Auth cautions that it frequently has sedative side effects, and should not be given to children younger than 2 without first consulting a pediatrician.

Calcium carbonate – Known as Tums, these chews can help soothe upset stomachs. Dr. Auth recommends consulting your pediatrician before using them in children younger than 6, however.

Dimenhydrinate – Commonly sold in stores as Dramamine, this medication is good to have on hand for travel with children who are prone to motion sickness.

Topical treatments

Multipurpose antibiotic ointments – Commonly known under the brand names Neosporin or Bacitracin, these topical medications help reduce the risk of possible infections from scrapes and mild skin abrasions, Dr. Auth says.

Hydrocortisone, 1 percent – This low-potency topical steroid cream can help soothe itchy rashes or irritated skin.

Antifungal cream, 1 percent – Commonly known under the brand name Lotrimin, this cream is good for treating yeast diaper rashes, ringworm, and athlete’s foot, Dr. Auth says.

Sunblock – Dr. Auth recommends families keep plenty of sunblock on hand: Barrier forms, which contain compounds like zinc oxide or titanium dioxide and block out the sun are safe at any age. UV A and UV B light absorbers containing PABAs can be used in children after age 6 months old. Dr. Auth also recommends families choose SPFs around 40 or 50. Anything marked higher than that shows minimal additional benefit.

Diaper cream – For families with newborns and young infants, having a diaper cream on hand is valuable, says Dr. Auth, who also recommends choosing a cream containing zinc oxide.

Petroleum-based ointments – These treatments can be helpful as a barrier, Dr. Auth says. For example, they can protect a cut against infection or can lock in moisture on chapped lips or dry hands.

Miscellaneous

Nasal saline solution – Dr. Auth recommends these products to help relieve infants’ stuffy noses or older children’s congestion.

Thermometer – Dr. Auth generally suggests families have a very basic and inexpensive digital thermometer that can be used orally for toddlers and children and rectally for infants.

Nail clippers and files – These are a necessity to keep children’s fingers groomed. When it comes to trimming infants’ nails however, files are safer and less intimidating for new parents, Dr. Auth says.

Bulb suction devices – These products are helpful in removing mucus from newborns, as well as in children who can’t yet blow their noses.

Humidifier – This can be helpful for children suffering colds, Dr. Auth says. However, he cautions families to properly maintain humidifiers to prevent mold production or limescale build-up, which can worsen problems. Also, whether to use a warm or cold mist is generally a matter of preference, Dr. Auth says.

A word of caution

Safely store medications so that they are inaccessible to children.

With any medication, parents should pay special attention and adhere strictly to dosing instructions.

Every household should have the phone number for poison control readily available: 800-222-1222.

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How RSV Changed the Way I Parent

By Alexandria Salahshour, CHOC parent and mom of Andre, four months

This story is about my son who got sick with Respiratory Syncytial Virus (RSV) at three weeks old and was hospitalized at six weeks. I’m sharing our story so other parents are aware of the dangers of RSV and know what to look for. It’s important to always follow your own instincts no matter what. YOU know what’s best for your child. You are your child’s voice.

RSV
Andre, diagnosed with RSV at three weeks old and hospitalized at six weeks, was treated at CHOC Children’s at Mission Hospital.

What is RSV?

RSV is a highly dangerous respiratory infection. It can be a potentially deadly virus if not taken care of in time. Most children will catch RSV by their second birthday, but the younger they are, the worse it can be. RSV is primarily spread through child care centers and preschools due to being in close proximity to many children. For most children, RSV will cause nothing more than common cold-type symptoms, but for some  children like my son Andre, it can lead to more serious life-threatening problems such as bronchiolitis, pneumonia, collapsed lungs, respiratory failure, airway inflammation and even death.

The early signs of RSV

This roller coaster started when Andre was three weeks old. Before Andre was born, I made everyone in my family get the whooping cough vaccine along with the flu shot if they planned on touching Andre. Paranoid? No. Proactive? Yes. When Andre came it was so exciting! It was the best day of our lives.

Though we allowed people to hold the baby, I would always say “Don’t forget to wash your hands first.” After Andre got sick, I realized that the REAL questions I should’ve been asking were “Are you sick? Have you recently had a cold? Are your children sick? Are people at your work sick? Are children you are around sick?”

When Andre got sick with RSV, it came as a shock. How did he get so sick so fast? I had a healthy pregnancy, and Andre was born healthy. At three weeks old, he became congested and his breathing sounded off. It wasn’t wheezing, but more like a grunting sound. The morning after he started showing symptoms, we brought him to his pediatrician. I brought recorded videos of Andre’s breathing so the doctor could hear the congestion and grunting.

Our pediatrician didn’t think there was anything going on. He advised us to run the humidifier and to use saline drops. He thought Andre would be just fine, but told us to come back if he got worse, or got a fever with wheezing. Andre never ran a fever. We did the saline drops and humidifier, but it didn’t seem to be getting any better.

That night after our first pediatrician appointment while Andre was sleeping, we had noticed that would choke on his phlegm, be uncomfortable and would occasionally stop breathing. We continued to follow our pediatrician’s recommendation of using the humidifier and saline drops, but it wasn’t helping. I knew that there was something more serious going on.

A few days later, Andre started to wheeze and have breathing problems in his sleep. We rushed him to the hospital where I had delivered him. It was scary to be there because we didn’t know what was wrong with our baby. I had never heard of RSV before, but when I researched his symptoms it kept coming up. The doctor tested Andre for RSV and it came back positive. We were discharged with the same instructions his pediatrician had given, and told to come back if it got worse.

A couple of days went by, and Andre wasn’t getting any better. We took him back to the pediatrician for an after-hours appointment. He was their first RSV patient of the season. The pediatrician let us know that RSV is like a roller coaster, especially in someone so young like Andre. We were once again told to use saline drops, a humidifier and aspirations, but Andre continued to get worse.

Caring for a sick baby during the holidays

At this point the holidays were right around the corner, and my family had arrived from Dubai. This vacation meant the world to me, but unfortunately, it was short-lived. As soon as my uncle held Andre for the first time, he could tell something was seriously wrong. He felt vibration sounds through Andre’s back, almost as if whatever he had was in his lungs.

Suddenly, Andre took a turn for the worse. He was starting to sleep a lot more and just seemed so “out of it.” We decided to take Andre back to the hospital. We took him to the closest hospital to where we were at the time. I told the nurse that Andre was diagnosed with RSV about a week ago, and we were told he would get better, but that he was getting worse. I told him that his retractions were so bad you could see his ribs, and that he was congested, looked like he couldn’t breathe, and had been choking on his phlegm. The doctor said he no longer had the virus and that he may have caught a different virus that was causing this to happen. Even though his retractions and wheezing were so bad, she didn’t see it as anything alarming. They did an X-ray to be sure to make sure it wasn’t pneumonia, and thank God it wasn’t

The next day I saw that Andre’s hands were pale and extremely clammy. Even his lips looked somewhat discolored. I didn’t want anyone to think I was crazy or a hypochondriac, especially because every time we went to the doctor for this virus, we were sent home and told it would get better.

The nightmare begins

Two days before Christmas, our nightmare really began. We woke up in the morning and it was as if Andre had somehow taken another turn for his worse. He seemed so out of it, wasn’t eating well, and had zero interest in breastfeeding. Andre stayed asleep a majority of the day, and didn’t have as many wet diapers as he normally did. By the end of the day he looked beyond lethargic, and almost lifeless.

I did more research about RSV and found that a baby should have 50-60 breaths per minute. Andre was only at 40 breaths per minute. We called the after-hours number for our pediatrician, which is initially probably what saved my son’s life. They immediately connected us with the on-call doctor: Dr. Barbara Petty, a CHOC Children’s pediatrician.

I didn’t know this pediatrician at the time, but I’ve told myself that one day I’ll make an appointment with her just to thank her. She got on the phone and was so kind and soft-spoken, she seemed so concerned and you could tell that she probably has the most incredible bed side manner. She was giving us the most information we have heard thus far. Luckily, while on the phone with Dr. Petty, she was able to listen to Andre, heard the way he sounded and listened to how much he was struggling.

She told us that we needed to get to the hospital right away. We let the doctor know that we’ve already gone to two different hospitals, and she told us that we should take him to CHOC Children’s at Mission Hospital. When we got off the phone with her we couldn’t thank her enough. That phone call will forever mean the world to me.

I remember it was raining that night. We quickly rushed out of the house and went to CHOC at Mission. It was a busy night in the emergency department and there were doctors and nurses everywhere. Our nurse checked Andre’s oxygen levels and found it was only at 70. A healthy, full-term baby’s level should be closer to 100!

RSV

The doctor came in looked at Andre and just kept saying everything was going to be alright and that they were going to take care of him. He told us that it was good we brought him in because his oxygen was so low. They gave Andre an IV, hooked him up to a heart monitor, and gave him oxygen. It was incredible how quickly a team can work to get a baby stable.

A diagnosis at last

He tested positive for RSV again, but he was also diagnosed with bronchiolitis, rhinovirus and respiratory failure. Finally, Andre was in a relaxing state hooked up to the monitors, oxygen, IV fluids and tons of steroids. When the doctor came in and let us know what was going on, he said that because Andre was so young he needed help breathing to fight off this virus. The doctor admitted Andre into the pediatric intensive care unit (PICU) so that they could keep a close  watch on him. When we got into our room, three nurses immediately came in to help care for our baby boy.

Celebrating Christmas at CHOC

The next day was Christmas Eve, our first Christmas as a family, and we were still in the hospital. It was sad being in the PICU and seeing our son struggle in the state that he was in, but we knew Andre was in the BEST place he could be and getting the best care.

Thankfully, Christmas Eve was special at CHOC. A dog named Piper from their pet therapy program visited all the children. We woke up in the PICU on Christmas morning and there was a big bag full of presents for Andre. The tag read “To: Andre, From: Santa.” It was the kindest thing I’ve ever seen.

RSV
Even though Andre and his parents spent his first Christmas at CHOC due to RSV, Santa still managed to find him.
RSV
Andre’s presents from Santa were delivered to his room in the pediatric intensive care unit despite his hospital stay due to RSV.

Though we were in the PICU, CHOC did an incredible job at making a not-so-normal Christmas feel normal. We were so thankful for CHOC and all of the wonderful donated presents from incredible people. Andre got so many toys for Christmas! Because of these kind people, this became a Christmas we will never forget and forever be SO thankful for. It still brings tears to my eyes every time I think about our experience at CHOC Children’s.

When the nurses came in on Christmas, they told us that Andre was doing better and we could start the process of slowly weaning him off the oxygen. His oxygen level was stable, his heart was stable and his retractions were better. It was so nice to see improvements on our little guy!

The next day he tolerated more weaning, and we got to leave the PICU for a room in the regular pediatrics unit. GREAT NEWS! He continued to improve as the days went by. A new doctor came in to give us a run down on what was going on and gave us so much helpful information.

He explained that this virus usually comes from day cares, preschools, and school-aged children and then it’s quickly passed on to others. He let us know that this virus is a roller coaster; it gets bad and then gets better, it gets bad and then it gets better. There’s really no way of telling you when the virus will expel from the baby’s body, especially when they are so young. The doctor told us because he’s so young, the virus can last in his system up to a month!

Bring our boy home

Andre was still doing great and had life back in him. He even smiled for the first time! It was so special and it was the sweetest smile I’ve ever seen. I’ll never forget it. His care team was continuing to wean him off oxygen.

RSV
While he was hospitalized for RSV, Andre smiled for his parents for the very first time.

As they got closer to letting him breathe on his own, I was so nervous  since that would decide if we got to go home or not. The night went by and our little champion did amazing! I was scared to bring him home but the nurses and doctors knew best, and I knew I had to learn to trust their decision since they’re professionals Before we were discharged, the nurses came in and asked us if we had any questions. They let us know that if Andre started to decline, to come back right away. The hospital was great. They had an incredible staff and we were treated so well! When we left, they gave us a few extra pacifiers, a bunch of swaddles, a nice blanket with bears on it, and a pack of diapers. It was nice to have stuff to go home with in case we were out of anything.

Thankful for CHOC

I can never thank the staff at CHOC at Mission enough for taking care of Andre the way that they did. They made us feel like we were at home, even though we weren’t. Everyone was so comforting and understanding. If we ever have another emergency, which hopefully we will not, we’ll be returning to this hospital.

I hope that no one else’s child has to go through what our baby went through. But just in case, parents should know the symptoms of RSV, be prepared and trust your instincts.

RSV
Today, Andre is a happy and healthy three-month-old baby, after his bout with RSV.




Learn more about the CHOC RSV Program




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What Parents Need to Know About Hand, Foot and Mouth Disease

Hand, foot, and mouth disease (HFM) is a viral illness that usually affects infants and children younger than 10 years old, specifically those 1 to 5. We spoke to Dr. Jonathan Auth, a CHOC Children’s pediatrician on what to expect with this common condition.

hand foot and mouth disease
Dr. Jonathan Auth, a CHOC Children’s pediatrician, explains hand, foot and mouth disease

Q: Is HFM contagious?

A: Yes, it can be spread through contact with feces, saliva, or mucus. The virus is common year round but tends to cluster in the summer and fall.

Q: What are the symptoms?

A: A fever is usually the first sign of the virus, followed by a reduced appetite and sore throat, which can cause a child to feel achy and irritable. After a few days, painful sores (red-yellowish blisters) develop in the back of the roof of the mouth. A skin rash with red spots may appear in the palms of the hands and soles of the feet, as well as on the knees, elbows and buttocks area.

Q: What should a child with HFM eat?

A: Make sure your child drinks plenty of fluids, such as water or milk, to stay hydrated. How much water should your child drink? At CHOC Children’s, we recommend that children drink the amount of 8 ounce cups of water equal to their age, with a maximum of 64 ounces for children over the age of 8. Most children do not have much of an appetite during this time. Cold or soft foods, such as popsicles, ice cream, yogurt or jello, are the most soothing given the sores on the throat.

Q: How is HFM treated?  

A: HFM usually clears up within a week. While there is no medical cure or vaccination for HFM, your child’s pediatrician can recommend ways to make your child more comfortable while the illness runs its course. Acetaminophen or ibuprofen can be given to ease painful mouth sores or discomfort from the fever. Download a parent’s guide to acetaminophen for children.

Children with blisters on their hands, feet or rest of the body should keep the areas clean and uncovered. Wash the skin with lukewarm soap and water, and gently pat dry.

Everyone in the family should wash their hands often, especially after using the toilet or changing a diaper, and before preparing food. Shared toys should be cleaned often, as viruses can live on objects for a few days.

Call your child’s pediatrician if your child is sluggish, can’t be comforted or seems to be getting worse.

Q: Are there any complications?

A: Complications are rare. Occasionally, some complications could arise, such as dehydration, due to a child not eating well, or not being able to swallow enough liquids because of painful mouth sores. Sometimes the rash or sores on the body can be infected if there are breaks in the skin.

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6 Things Your Pediatrician Wants You to Remember in 2017

The new year is a great time to kick start healthy habits with your children that can be practiced all year long. We spoke to Dr. Reshmi Basu, a CHOC Children’s pediatrician, who offered the following tips:

pediatrician
Dr. Reshmi Basu discusses 6 things your pediatrician wants you to know this year.
1. Get your flu shot

If you haven’t received your flu shot this season, it’s not too late. Remember, the nasal flu vaccine is not recommended this season. The flu can make you much more sick than a regular cold and can have more complications, like pneumonia, so it’s important that everyone in the household over 6 months old receives it. If there is a new baby in the family, you can protect the baby by making sure anyone in contact with the baby has received the flu vaccine.

2. Wash hands often to keep germs away

Proper handwashing is especially important during cold and flu season. And remember to wash for at least 15-20 seconds and make sure to scrub between fingers and under nails.

3. Protect your child’s skin

During the winter it’s important to moisturize frequently throughout the day, especially after baths or showers, to treat and prevent dry skin. And, if you’ll be out in the sun, don’t forget the sunscreen. It’s best to apply it 15-30 minutes before sun exposure and reapply often.

4. Make well-child appointments and stay up-to-date on vaccinations.

 When children are young, there are frequent well checks with the pediatrician and these appointments usually include vaccines. As children get older (after 5 years old) and vaccines are not a part of every visit, it is easy to forget the well checks. They are still important, however, to see how your child is growing, how she is doing in school, and discuss any concerns. It’s also a good opportunity to get the flu shot (depending on the time of year) and make sure all other vaccines are up to date. Download CHOC’s  guide to making shots less stressful for kids.

5. Stay active.

The American Academy of Pediatrics recently lifted their rule on no screen time for kids under 2, with some limitations. Find time to be active. Make it a family activity– go on a hike, ride bikes together, or play in the park.

6. Read aloud to young children, starting at birth.

Try to read together for at least 15 minutes every day. Reading to your kids from a young age can help them with their speech development, communication skills, and even academic performance. And it’s a fun way to spend time together!

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Choosing the Right Pediatrician for your Child

During open enrollment, parents may evaluate their family’s healthcare plan, which can mean searching for new doctors and specialists for their children. Choosing your child’s primary care doctor is important. We spoke to Dr. Dan Mackey, a CHOC Children’s pediatrician, who offered tips to help parents make the right decision for their child.

Importance of a Pediatrician

It’s important for children to see a pediatrician, rather than a family practitioner who may treat older members of the family. A pediatrician is specially trained to care for infants, children and teens.   A pediatrician has graduated from medical school and completed a three-year residency program in pediatrics.  A board-certified pediatrician has passed rigorous exams administered by the American Board of Pediatrics.

Kids are not “little adults.” Different ages can present different illnesses and behavioral problems, which pediatricians are trained to recognize, diagnose and treat. Teens need pediatric care, too. Their bodies are still young and growing, their brains are still developing, and they are not yet ready for adult care, says Mackey.

A pediatrician’s office is generally designed with kids in mind, with waiting areas and exam rooms geared toward making children feel comfortable and engaged. Pediatricians’ office schedules are usually created to accommodate same-day and sick appointments.

In addition to choosing a pediatrician who is in-network with the family’s insurance plan, parents want to make sure the pediatrician is aligned with good pediatric subspecialists and their local children’s hospital.  Other factors to consider include:

  • Bedside manner
  • Interaction with office staff
  • Office hours and ease of scheduling an appointment
  • Medical records: paper or electronic
  • Method of communication with doctor: many offices offer phone, email and an online patient portal

Part of the Family

Having an open dialogue with your child’s pediatrician is important.  Parents shouldn’t shy away from asking questions.

“Being available for questions is important to families,” says Mackey. “A lot of teaching and education goes on over the years as the child grows up. It starts with educating the parent about nursing and nutrition, and continues with discussions about child safety, including issues like discipline and behavior.”

In addition to being a trusted resource on parenting, your child’s pediatrician is someone with whom you will spend a lot of time as your children grow up.

“Hopefully the relationship the family has with the pediatrician becomes a very long and pleasant one that lasts many years,” says Mackey. “Eventually, the pediatrician almost becomes part of the family, and a trusted member to turn to for help and advice. The best part of the job is getting to watch the child grow up.”

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