As unpleasant as it is, it's usually harmless. But it needs to be managed properly. We are here to help; follow the advice of our pediatricians.

Vomiting and diarrhea can be particularly dangerous in infants and young children because they can easily become dehydrated. It can sometimes be difficult to tell whether an infant is vomiting or spitting up, or if they have diarrhea or just a loose stool. If you're unsure, call our doctor. We are here to help you gain confidence!

Spitting Up or Vomiting?

Babies often spit up a little breast milk or formula, sometimes with a burp, sometimes without. Spitting up can be regular, occurring almost after every feeding. It is not a health concern as long as the baby continues to grow well despite frequent spitting up. When a baby spits up, they simply burp and release the excess. In contrast, vomiting involves more effort from the baby, with retching and the forceful expulsion of a large amount of milk or formula. If a baby under six months vomits forcefully, contact a doctor immediately. Vomiting in summer is usually caused by bacterial infections, and in winter, it is typically due to viral infections. If multiple family members get sick at the same time after eating the same food, it is likely food poisoning. If vomiting is accompanied by headache, dizziness, or a tight, painful abdomen, call a doctor. If the child has hit their head beforehand and then feels nauseous or vomits, take them to the hospital to check for a concussion.

Is This Diarrhea?

During the first six months, a baby’s stool is naturally looser than that of older children. Breastfed babies usually have mustard-yellow stools with a seedy texture. It’s common for breastfed babies to have a bowel movement in almost every diaper, but after six weeks, they might go a week or more without one. Formula-fed or mixed-fed babies typically have one bowel movement per day, which is slightly firmer and brownish. Diarrhea is when the stool is very loose, almost soaking into the diaper, and occurs three or four times a day or more. If the baby’s stool is bloody or the diarrhea persists for days, call a doctor. It might be due to lactose intolerance or a food allergy. It is important to know that the rotavirus vaccine can cause diarrhea, vomiting, and loss of appetite in 10% of infants. Inform your doctor about this.

Preventing Dehydration

The most important task is to prevent dehydration. If the baby is still breastfeeding, frequent feedings are best. Breast milk should not be withheld from a sick child, as it provides fluids, nutrition, immune protection, and comfort. For babies who are not breastfeeding or only partially breastfeeding, give spoonfuls of cold water, which is likely to stay down. For prolonged fluid loss, it is best to give a rehydration solution, which can be bought at a pharmacy. In case of diarrhea, you will need a lot of diaper cream to protect the baby’s skin. It’s also worth applying cream to the anal area of older children who are no longer in diapers to prevent irritation. Do not use anti-vomiting or stool-binding medications without medical advice. What the child’s body wants to expel should be expelled!

If the child cannot drink or cannot keep fluids down, go to the hospital where they can receive fluids via an IV.

Diet?

Nowadays, we do not necessarily recommend a prolonged diet. The baby should be given light foods that they want as soon as they feel ready. However, do not force any food they do not want! Naturally, avoid heavy, very spicy, and fatty foods.

There are literally hundreds of types of viruses responsible for upper respiratory tract infections (URIs).  Unfortunately, we will never be fully immune to the common cold.  The first year children are enrolled in preschool, they are likely to be mildly ill every other week, between September and April. URI symptoms include cough, stuffy or runny nose, fever, headache, achy muscles, sneezing, and scratchy throat.

Transmission occurs via soiled hands, touching infected surfaces like toys or door handles, or through viral particles in the air after sneezing or coughing. Cold weather, drafts and being underdressed do not cause upper respiratory tract infections, (or pneumonia, for that matter).

A Parents’ Guide on How to Make a Child with a Cold More Comfortable

DO NOT

• Use antibiotics because they don’t work against viruses.
• Use aspirin containing medication in children under 16 years of age, due to the risk of a serious side effect called Reye syndrome.
• Use honey in children under 12 months of age because it could cause botulism.

DO

• Offer plenty of fluids, because good hydration is the mainstay of care. The fastest way to becoming hospitalized is refusing to drink.
• Remove mucus from the nose. For children who cannot blow, try a bulb syringe, or the nifty “snot-sucking device” available in Hungary called orrszívó porszívó. They are sold in pharmacies and electronics stores. Some can be connected to the vacuum cleaner, others are battery operated or plugged into a socket.
• Loosen sticky nasal secretions with saline nose drops ike Ocean, Ayre, Sterimar or Fluimare, or make your own by adding ¼ tsp of salt to 8 oz/240 ml of sterile water.
• Older children may find relief in daily saline washes, like sinurinse. Prepare the irrigation fluid with sterile or bottled water.
• Control pain and fever with acetaminophen/paracetamol ( Tylenol, Panadol), or ibuprofen products ( Nurofen, Motrin, Advil).
• Cool mist vaporizers are also a good idea. Hot water or steam may cause burns.
• Sleeping with the head of the bed elevated may help with post-nasal drip.

Natural Remedies

Menthol, camphor and eucalyptus oils inhaled or as a vapor rub have not been proven to work, but carry minimal risk. They should not be used on infants. Mild skin irritation is a frequent side effect.

Oral zinc decreases the duration of URI symptoms in adults, but results are inconclusive in children. Unpleasant taste and nausea also limits its usefulness. Zinc NASAL products should be avoided, as they are associated with permanent loss of sense of smell. 

Vitamin C may reduce the duration of colds when taken preventatively, but does not alter the course when taken as treatment. Avoid doses over 200 mg a day.

Ecchinacea is no better than placebo. Avoid in those who are ragweed allergic, as it may cause a cross reaction.

Vitamin D does not reduce the duration, incidence or severity of colds. Please do take your regular maintenance dose.

Over the counter medication for colds

Many medicines for cold symptom relief available in the pharmacy without a prescription have never been proven safe or effective in children.  If you choose to use them, please select single ingredient remedies instead of combinations.  This lessons the risk of overdose and allows for a more targeted approach.

Nasal decongestants reduce congestion topically. They should not be used for more than 5 to 7 days, as rebound increase in stuffiness can occur.  Examples:  oxymetazoline, xymetazoline, phenylephrine, nasivin.  Steroid sprays help children with allergic rhinitis, not those with colds.

Oral decongestants are blood vessel constrictors. Side effects: increased blood pressure, headaches, nausea, nervousness, irritability. Examples:  Rhinathiol cold, coldrex, rhinopront, pseudoephedrine, phenlypropanolamine, calciphedrine.

Antihistamines have precious little impact on cough and runny nose caused by viruses. They are to be used in allergic disease. Possible side effects: sedation, paradoxical excitability, blurred vision, dry mouth, hallucinations and respiratory depression. Examples of first generation antihistamines:  fenistil, bronpheniramine, diphenhydramine-benadryl, chlorpheniramine, hydroxyzine.

Mucolytics thin secretions and also can cause upset stomach, spasm of the lung and fever. Examples:  ACC, carbocisteine, ambroxol.

Cough is a protective reflex and should only be suppressed if it prevents sleep. Those who suffer from asthma, recurrent croup, recurrent obstructive bronchitis and reactive airway disease should only take cough suppressants after consulting a doctor. They usually need bronchodilators or anti-inflammatories rather than suppressive medication.

For children over 12 months of age, honey is a safe, mild cough suppressant. A teaspoon 3x a day, especially before bed, can alleviate cough. Tussirex junior is a honey based over the counter medicine.

Hard candy and lozenges may be helpful in those over 5 years of age, but are a choking hazard in toddlers.

Infrequently, the physician may choose to prescribe a narcotic (erigon) or non-narcotic (sinecod) cough suppressant. These can cause serious side effects like sedation, respiratory depression, and even death, if overdosed.

Tips for a sore throat

Use panadol/Tylenol and/or ibuprofen for pain.

Keep your oral cavity moist by drinking lots of liquids and sucking on hard candies. There is no evidence that medicated lozenges or sprays work better than simple hard candy.

Avoid cigarette smoke, including second-hand smoke.

Offer a soft diet (cream soups, oatmeal, yoghurt) and don’t give foods or beverages that contain lemons, grapefruit, and oranges if they sting being swallowed.

If you choose options that contain pharmaceuticals, know what you are giving your child:

Anesthetics/nonsteroidal anti-inflammatories: benzocaine, phenol, benzydamine

Antiseptics: chlorhexidine, hexyresorcinol

Cooling agents: menthol

Tantum verde, lolisept: benzadymine

Herbal hot Swiss drink, herbalsept lollipop, Dr Weiss Anginex: herbal preparations

Strepsils: phenol/benzyl alcohol

Strepfen: flurbiprofen anti-inflammatory

Please see a doctor if:

• You are concerned your child could have an ear infection, a sinus infection, pneumonia or an asthma attack
• If your child has a fever over 39C ( 102 F) for more than 48 hours
• If your baby is younger than 2 months and has a fever over 38 C ( 100,4 F)
• If your child has labored or fast breathing
• If your child has an earache
• If your child is unable to drink enough to urinate normally ( at least 4x/day)
• If your child is irritable or lethargic
• If the cough is not significantly better after 2 weeks
• If the cold symptoms last longer than ten days
• If you are worried for any other reason

We would very much appreciate it if you performed a rapid covid test ( and flu and RSV in the winter months) before you came for your visit. This saves you time and money, and helps us make a more specific diagnosis.

Return to activities?

Please stay home until there is no fever for at least 24 hours, the child is sleeping well, and has a normal energy level

Tick bites are commonplace between spring and autumn in all of Hungary and much of Europe north to Sweden and west to Germany.  These arthropods can carry dozens of diseases that may be transmitted to humans. Tick-borne encephalitis is one such illness, which causes a two-phased sickness. About a week after the tick bite there is onset of fever, joint aches, headaches and fatigue. The second phase consists of more severe symptoms like confusion, weakness and paralysis. Most importantly, trouble with balance, weakness, hearing, headache and cognition may persist long-term, especially in adults.

There is no treatment for this infection of the nervous system caused by a virus. Fortunately, a vaccine for prevention is available. Please note the FSME and Encepur vaccines do not prevent Lyme disease, they prevent tick-borne encephalitis.

The tick shot is approved for individuals over 12 months of age. The junior version is appropriate for one to 15  year olds( FSME)  one to 12 year olds ( Encepur). The series consists of 3 jabs: the second dosed 1-3 months after the first, and the third 5-12 months after the second.  If rapid immunity is necessary, then the second dose may be given as early as two weeks after the first.  A booster dose is recommended after 3 years if you remain in the area, and every 5 years thereafter.  The two brands of tick-borne encephalitis vaccine are not interchangeable.

After vaccination, minor redness, swelling or tenderness may occur at the site of the injection for a day or two. Cold packs and Panadol/Tylenol can offer relief of symptoms. Less frequently, joint pain, headaches, muscle aches, fever and rash may occur. Serious reactions, like inflammation of the nerves, are exceedingly rare.

A concomitant illness with fever is a reason to postpone immunizing.

These vaccines have not been tested in pregnant or nursing women.

They are contraindicated for those allergic to any of its components, which would be obvious if there was an allergic reaction to a previous dose. 

Those who suffer from autoimmune diseases like iridocyclitis or multiple sclerosis may experience a flare of their condition, and should consult a specialist before vaccinating.

Immunizing is especially important for those who spend a lot of time in the great outdoors, but transmission is possible even in the heart of a big city.

The best time to start the series is right away, so as to achieve protection by the warm season when ticks are most active.

Stomatitis is a common contagious illness that can be caused by hand, foot and mouth disease and herpangina. This benign, yet bothersome ailment, produces inflammation of the inside of the mouth, with tiny painful blisters. The lesions appear on the tongue, gums, the inner surface of the cheeks and sometimes even the roof of the mouth and tonsils. Initially, they are filled with clear or turbid fluid, then pop, and become gray ulcerations, until they finally heal over about a week later.  In hand, foot, and mouth disease, fluid filled spots develop on the hands and feet, and possibly the buttocks and other areas as well. In herpangina, the eruption is limited to the inside of the mouth. In sharp contrast to chicken pox, the blisters do not itch.  Runny nose and fever are not uncommon. Weeks later, peeling of the skin of the hands and feet, and shedding of the nails may occur, but this is a short-lived and trivial cosmetic issue.

The usual causative agents of hand foot mouth disease and herpangina are coxsackievirus A16, A6 and enterovirus 71. Children under 5 years of age are most commonly infected, although adolescents and adults are occasionally affected, too.

The illness is transmitted from person to person via inadequate hygiene during toileting and diapering (the fecal-oral route), and contact with the drool and open skin lesions. The incubation period is generally 3 to 5 days.

Stomatitis can be very unpleasant, making it difficult to eat and drink. A child who refuses fluids can become dehydrated and wind up on an IV infusion in the hospital.

Since this infection is viral, antibiotics do not hasten recovery.  The goal of treatment is to keep the child comfortable and drinking. For pain and/or fever, give nurofen (ibuprofen) and panadol ( paracetamol). To prevent dehydration, more fluids need to be ingested than lost from fever and drooling. Water, non-acidic juices, caffeine free tea, milk and formula should be encouraged in large amounts. Good choices for food would be mild, soft foods like apple sauce, yoghurt, cream soups, noodles and ice cream. Avoid sharp (potato chips), spicy, and citrus containing items (lemonade, oranges, grapefruit). Numbing gels and solutions can be used, but their effect is temporary. They do not cure the disease, but can lessen the symptoms to allow for eating and drinking.  Safe choices for topical anesthetics are: dologel and nurodent, which are herbal remedies. Lidocaine suspensions, like suspension anestheticum, are also available, but can cause significant side effects if swallowed.

If a child is not drinking or urinating well, or if she is very irritable, she should be rechecked by a doctor.

Most children are able to return to their usual activities within a week, when they no longer have fever, or new blisters in the mouth, they are not drooling more than normal, and are back to their lively selves.