FREQUENTLY ASKED QUESTIONS:
You can also look at the Handouts tab for more information.
You can also look at the Handouts tab for more information.
Q: MY CHIld has a fever, do i have to come in?
A: All patients with fevers should be checked for accurate diagnosis of their issues. Fevers above 105 degrees should be checked immediately in children above the age of 1 year. For infants under the age of 6 weeks - any fever above 100.4 should be checked immediately.
Remember, more importantly than fever is the way your baby or toddler acts. If your child acts LETHARGIC, they should be checked immediately.
***YOU SHOULD GIVE YOUR CHILD A FEVER REDUCER PRIOR TO COMING TO THE OFFICE***
don't worry - if your child acts better at the office or is afebrile, we still believe you that they had fever at home and will still check them thoroughly.
Remember, more importantly than fever is the way your baby or toddler acts. If your child acts LETHARGIC, they should be checked immediately.
***YOU SHOULD GIVE YOUR CHILD A FEVER REDUCER PRIOR TO COMING TO THE OFFICE***
don't worry - if your child acts better at the office or is afebrile, we still believe you that they had fever at home and will still check them thoroughly.
Q: My child fell and hit his head, do i have to bring him in?
A: We always recommend to be on the safe side and check any head trauma.
If you are reluctant to come in remember that the high risk factors with head trauma include -
If you are reluctant to come in remember that the high risk factors with head trauma include -
- Change of Mental Status - Not able to speak normally.
- Vomiting more than once.
- Swelling on the head that continues to grow.
- Deficit in balance
- Blood Coming out of the ear
Q: Do you recommend the flu shot?
A: Yes. I do recommend the flu vaccine. Even if the vaccine is not 100% effective, it is currently the best preventive measure we have for the Flu virus. I do vaccinate my own children as well. Year over year, the vast majority of patients with the Flu in our office are the ones who were NOT vaccinated.
If you decide not to vaccinate - remember that your child's flu may cause high fever (often 105 degrees) , cough and even respiratory distress. Rarely, the Flu can be fatal, even in healthy children. Annually, about 100 healthy children die from the flu EVERY YEAR in the U.S.
If you decide not to vaccinate - remember that your child's flu may cause high fever (often 105 degrees) , cough and even respiratory distress. Rarely, the Flu can be fatal, even in healthy children. Annually, about 100 healthy children die from the flu EVERY YEAR in the U.S.
Q:I don't want to come in, but my child isn't feeling well. What should I do?
A: Unfortunately, we can not diagnose your child's illness over the phone. It is risky for us to guess illnesses and we get a much better history in person. We can not guarantee your child's health. We also do not routinely provide diagnosis via emails for the same reason. If you have our cell phone and text/whatsapp/facebook message us for an illness - please know that we may never answer your question, and do not expect a rapid response.
Q: What to do with runny nose/congestion? Do you recommend cough medicine? My child has a bad cough, but is acting and feeling fine otherwise, should I be concerned?
See our handouts for Cough and Colds and our handout for Croup.
Q:When is my child not contagious anymore? When can I send my child back to school or Day Care?
A: Here are some illness specific answers:
Diarrhea - when your child's bowel movements are more formed and less frequent.
Strep - When your child's fever is gone or at least 12 hours on antibiotics.
Flu - until 24 hours after the fever is gone.
Pink Eye - 24 hours after you start antibiotics or once the discharge is gone.
Pneumonia - at least 1 week.
Coxsackie viral or Mouth blisters - Until all the blisters are gone - about 5-7 days.
Colds - when your child is fever free for 24 hrs and the cough is NOT persistent.
Asthma exacerbation - when your child does not need a nebulization for 12 hours (remember that running - tightens the lungs and causes more wheezing when your child is sick).
Skin infections including Impetigo, Cellulitis and Chicken Pox - until ALL the blisters are crusted over.
Ear Infections - until the child is fever free for 24 hours and with non persistent cough (the cold that produces the ear infection is contagious).
Diarrhea - when your child's bowel movements are more formed and less frequent.
Strep - When your child's fever is gone or at least 12 hours on antibiotics.
Flu - until 24 hours after the fever is gone.
Pink Eye - 24 hours after you start antibiotics or once the discharge is gone.
Pneumonia - at least 1 week.
Coxsackie viral or Mouth blisters - Until all the blisters are gone - about 5-7 days.
Colds - when your child is fever free for 24 hrs and the cough is NOT persistent.
Asthma exacerbation - when your child does not need a nebulization for 12 hours (remember that running - tightens the lungs and causes more wheezing when your child is sick).
Skin infections including Impetigo, Cellulitis and Chicken Pox - until ALL the blisters are crusted over.
Ear Infections - until the child is fever free for 24 hours and with non persistent cough (the cold that produces the ear infection is contagious).
Q: is my child's overnight strep test positive or negative?
A:No news is good news! ONLY If your child's overnight had a surprise finding (a change from negative rapid test to positive overnight), we will call you.
Q: can you email immunization records?
A: Unfortunately, at this point we can not email any records. We can provide them for you for pick up. If you would like them faxed or mailed on your behalf, please call us to discuss the details - some charges may apply for these services.
Q:Can you call in a refill for my child's ADHD/ADD meds?
A: Dr. Simai DOES NOT INITIATE stimulant medicine without your child seen first by a trained specialist such as a pediatric developmental doctor or pediatric neurologist. If you already started on a stable dose and had a specific appointment to discuss the ADHD medicine with us in the past 3 months - we will gladly call in a refill.
If you would like the dosage changed, you will have to set up a new appointment at our office and discuss your concern so we can come up with a new plan or adjust the dosage.
If you would like the dosage changed, you will have to set up a new appointment at our office and discuss your concern so we can come up with a new plan or adjust the dosage.
Q:My sister/brother is in town visiting, and her child is sick, do you see one-time patients?
A: Yes, we do extend visits to our patients visiting family members - but remember that our office sees patients up to 21 years of age. A routine visit with or without strep testing is $100. Flu tests, Stitches, Injections and Vaccines may add to their bill.
q: my child has a hard time sleeping, do you recommend melatonin?
If you have tried to tackle the insomnia without success, you may try melatonin - there is no set amount but a toddler under 10 years should start with 1 mg and increase to 2mg if not successful. A teenager can start with 2mg and slowly increase to 10mg as needed.
We can not guarantee the safety of melatonin as we are not aware of long term studies showing Melatonin's safety. Try and taper your child's melatonin off after a few weeks. Once your child goes to bed nicely, make sure that you minimize any late nights.
- A: Not as a first line treatment. First, try and be sure that your child is not stressed, bullied, depressed.
- Make sure that your child does not read or play in their bed. If they like to read, allow them to read on the couch and only then, transfer to bed.
- Also, Make sure that your child does not consume sugary products before bedtime.
If you have tried to tackle the insomnia without success, you may try melatonin - there is no set amount but a toddler under 10 years should start with 1 mg and increase to 2mg if not successful. A teenager can start with 2mg and slowly increase to 10mg as needed.
We can not guarantee the safety of melatonin as we are not aware of long term studies showing Melatonin's safety. Try and taper your child's melatonin off after a few weeks. Once your child goes to bed nicely, make sure that you minimize any late nights.
q: i suspect my child has pinworms, what do i do?
See our handout on Pinworms
q: i suspect my child has mono, what do i do?
q: My child is vomiting/having diarrhea, what do i do? when can my child have dairy again?
See our handout on Vomiting and Diarrhea
Q: my child is constipated, what do i do?
- Infants - nursing babies rarely are truly constipated. They may defecate once a week - but as long as their bowel movements (BM) are soft/explosive - they are NOT constipated.
- Infants with Hard, Formed BM's - can have 3-6 ounces of prune juice, pear juice or white grape juice per day. You can give the juices straight or mixed in with their formula. For infants in extreme pain with a very hard BM stuck - ask your pharmacist for a Glycerin Suppository for Infants or use 1/2 of an adult suppository. You can also use Senna drops - they are safe in babies as well. BOTH SENNA AND SUPPOSITORIES DO NOT REQUIRE PRESCRIPTIONS. After the baby passes a hard BM with the help of a suppository or senna, start them daily on one of the juices to prevent these episodes from recurring. For infants that started on solids - try mixing 2 teaspoons of extra virgin olive oil into their bowels of food every day to prevent constipation. You may also accompany their meals with 4 ounces of water, prunes or pears.
- Toddlers - with hard, painful bowel movements. Can be given 1 CAPFUL of Miralax or 5 ml of Senna syrup per day. if the BM is literally STUCK/IMPACTED - you can give a Saline Enema for children rectally. Usually a large BM will come in 30 minutes.
- Teenagers - above 100 Lb - you can use an adult Saline Enema for a IMPACTED BM or give a TRIPLE DOSE of Miralax for a patient that had no BM for a few days.
- ALWAYS REMEMBER THAT IF YOUR CHILD HAS APPENDICITIS - THEIR STOMACH ACHE WILL USUALLY BE PERSISTENT, SEVERE AND RADIATE TO THEIR LOWER RIGHT SIDE OF THE ABDOMEN. THEY WILL HAVE A FEVER AND VERY POOR APPETITE.
- CONSTIPATION PAINS - On the other hand are INTERMITTENT - they come and go, sometimes lasting a few minutes and sometimes lasting close to 1 hour.
Q: when can i start giving my child motrin?
A: Motrin is for children 6 months and older.
Motrin is preferred for:
Motrin is preferred for:
- High fevers - above 103
- Tooth Pain
- Joint Pain or Swelling
- Ear Aches
- Muscle Pains
Q: is there a problem to fly with my newborn baby?
A: Flying with infants and children ALWAYS poses a risk of getting sick. Due to lack of fresh air during the flight, your body is exposed to many germs. Infants under 6 weeks have a weak immune system which makes them more prone to contract dangerous illnesses such as meningitis. If you are able to postpone your flight to a later date, postpone your flight. If you have a major trip - i.e. relocating to a new state or country, you may choose to take a small chance. If you are flying for leisure - vacation, wedding, bar mitzvah - we strongly discourage you to fly with an infant under 6 weeks.
For infants over 6 weeks - even though the risk of meningitis is much lower, you should still avoid flying to prevent your child from contracting other illnesses such as Respiratory Syncytial Virus (RSV), Influenza, and other colds. RSV is a major cause of mortality in young infants, especially ones with a history of prematurity and heart or lung disease.
For infants over 6 weeks - even though the risk of meningitis is much lower, you should still avoid flying to prevent your child from contracting other illnesses such as Respiratory Syncytial Virus (RSV), Influenza, and other colds. RSV is a major cause of mortality in young infants, especially ones with a history of prematurity and heart or lung disease.
q: what can i do to prevent myself or my kids from getting sick while flying?
A: 1. Some articles suggest to use a saline nose spray. The saline keeps the mucus membranes i our noses intact, so the dry air on the plane does not damage this important barrier and allow germs to enter our body.
2. Make sure that you drink plenty of fluids and rest as much as possible before and after the flight.
3. For babies, nurse or bottle feed the baby on take off and landing to equalize the pressure in the ears.
2. Make sure that you drink plenty of fluids and rest as much as possible before and after the flight.
3. For babies, nurse or bottle feed the baby on take off and landing to equalize the pressure in the ears.
q: do you recommend that i give my child benadryl or melatonin or other medicines when flying?
A: Not at all. I am a fan of going natural and start the flight without medicine. But if your child has PROVEN to be a major menace and a disaster to fly with, you might want to try these medicines. Try the medicine first at home before the flight - some patients will become HYPER, not sedated from Benadryl, and you do not want to find our that your child is one of those children.
In my opinion, its a smart to have tylenol or motrin aboard the flight in case your child appears to be in pain or with fever, and if your child gets croupy easily, have the prednisone on board as the dry air on the plane may bring another croup attack.
Also, don't forget to print out a tylenol, motrin and benadryl dosing sheet from our website and bring it along on your trip.
If you did not bring any medicine with you, please do not panic. Chances are that if your child really needs these medicines, someone else has them on board and will be glad to share them with you. Enjoy your trip, and stay calm and relaxed!!!
In my opinion, its a smart to have tylenol or motrin aboard the flight in case your child appears to be in pain or with fever, and if your child gets croupy easily, have the prednisone on board as the dry air on the plane may bring another croup attack.
Also, don't forget to print out a tylenol, motrin and benadryl dosing sheet from our website and bring it along on your trip.
If you did not bring any medicine with you, please do not panic. Chances are that if your child really needs these medicines, someone else has them on board and will be glad to share them with you. Enjoy your trip, and stay calm and relaxed!!!
q: my baby had shots last week and has a fever now, do you think that the vaccines caused the fever?
A: Almost all the vaccines we give can cause fever in the first 24 hours after the administration.
The only vaccines that have a delayed reaction are the MMR and Varicella (chickenpox) Vaccines - they can cause fever after 7-10 days.
The only vaccines that have a delayed reaction are the MMR and Varicella (chickenpox) Vaccines - they can cause fever after 7-10 days.
Q: my child has a bad diaper rash, at what point should i bring him in?
A: Some diaper rashes are caused by fungus and need prescription strength creams.
If your baby's diaper rash is not improving with the use of a zinc containing cream such as Desitin, Balmax or Triple Paste - please bring your child in for a visit.
If your baby's diaper rash is not improving with the use of a zinc containing cream such as Desitin, Balmax or Triple Paste - please bring your child in for a visit.
Q: How much formula can my baby have/how much milk should my baby be drinking?
A: Each baby has a different appetite so general numbers may not be right for your baby.
Here are average intake for the average baby:
Baby Weight Amount of Formula if Fed every 3 hours
4-5 Lb 30 - 45 cc / 1 -1.5 ounces
6-7 Lb 60 - 90 cc/ 2 - 2.5 ounces
8-9 Lb 90 cc / 3 ounces
10-12 Lb 120 cc / 4 ounces
12-14 Lb 150 cc / 5 ounces
16 -18 Lb 180 cc / 6 ounces
Remember that when babies are born, their stomachs are very small. As each day passes, the stomach inflates and can handle much more fluids. By day 2-3 most full term babies should be able to drink the amounts written above for their weights.
Here are average intake for the average baby:
Baby Weight Amount of Formula if Fed every 3 hours
4-5 Lb 30 - 45 cc / 1 -1.5 ounces
6-7 Lb 60 - 90 cc/ 2 - 2.5 ounces
8-9 Lb 90 cc / 3 ounces
10-12 Lb 120 cc / 4 ounces
12-14 Lb 150 cc / 5 ounces
16 -18 Lb 180 cc / 6 ounces
Remember that when babies are born, their stomachs are very small. As each day passes, the stomach inflates and can handle much more fluids. By day 2-3 most full term babies should be able to drink the amounts written above for their weights.
Q: My child's ear is draining PUS and/or BLOOD, what should I do?
A: Each child heals differently from perforations of their Ear Drum (a.k.a Tympanic Membrane).
Some children perforate their Ear Drums after having severe, excruciating ear pains - most of the pain is relieved once the pus drains out of the ear.
You should have your child checked at the office to determine what is the best treatment choice for them.
In the meantime, do NOT allow anything to go into their ear until you are certain that the Ear Drum has closed up.
Some children perforate their Ear Drums after having severe, excruciating ear pains - most of the pain is relieved once the pus drains out of the ear.
- Some heal without any interventions.
- Some heal with prescription ear drops alone.
- Some heal with oral antibiotics.
- Some children do not have a perforation and what you saw may be some wax that fell out.
You should have your child checked at the office to determine what is the best treatment choice for them.
In the meantime, do NOT allow anything to go into their ear until you are certain that the Ear Drum has closed up.
Q: my baby keeps spitting up, should i be concerned? Does He/she have REFLUX (GERD)?
A: Most babies spit up and to a certain extent we consider it normal. Most infants spit up when their stomachs are full (dry babies and dehydrated babies almost never spit up). Here are a few things you should know about spit up:
- Spit up gets better with time - the esophageal sphincter which keeps our food down when we stand on our heads is loose at birth but tightens nicely at 12 months of age.
- Spit up spells trouble when your infant seems to be in a lot of pain during or after the feedings or if your child has poor weight gain.
- Vomiting is preceded by stomach pains for a while (think about how sick you felt before you last vomited), while spit up happens really quickly, just as a burp happens.
- Hold your baby more upright during the feeding.
- Try NOT TO MOVE your baby after the feeding, pay close attention not to press on the belly.
- Keep your baby upright for 30 - 40 minutes after the feeding.
- Avoid placing your baby in a swing after the feeding.
- Place a small towel under your baby's mattress to elevate their head slightly.
- If your baby drinks formula or pumped milk, you can add rice or oatmeal cereal to thicken the feeding - this works nicely and helps us minimize using medicine for reflux. You can add UP TO 1 teaspoon of cereal per 2 ounces of formula. Just make sure that the bottle nipple is not clogged. Start by adding 1 teaspoon per bottle and slowly increase. Cereals sometimes cause constipation, but most babies tolerate cereal very well.
q: WHich sunscreen do you RECOMMEND?
Any sunscreen is okay as long as it is unscented.
q: wHEN CAN I START PUTTING SUNSCREEN ON MY BABY?
You can start using unscented sunscreen when your baby is six months old. Before six months, keep your baby in white or light colored long sleeve clothing and try to keep your baby is a shaded area. Burns can occur after 10 minutes of sun exposure.
Q: IN LIGHT OF THE OUTBREAK, Does MY CHILD NEED TO GET AN MMR VACCINE TODAY?
ANSWER: WE DISCUSSED THIS QUESTION WITH PEDIATRIC INFECTIOUS DISEASE SPECIALISTS AND RECEIVED THESE RECOMMENDATIONS:
1. IF YOUR CHILD RECEIVED 2 MMR VACCINES AFTER THEIR FIRST BIRTHDAY - NO FURTHER ACTION IS NECESSARY.
2. IF YOU ARE PLANNING TO SPEND A DAY IN AN AREA AFFECTED BY THE OUTBREAK (I.E. MONSEY, LAKEWOOD, WILLIAMSBURG, BORO-PARK)
INFANTS UNDER 6 MONTHS - NO VACCINE
INFANTS 6 MONTHS - 1 YEAR - SHOULD RECEIVE AN MMR VACCINE
TODDLERS ABOVE 1 YEAR - SHOULD RECEIVE AN MMR BOOSTER, WHICH WILL BE COUNTED AS THEIR BOOSTER
KIDS ABOVE 4 YEARS OLD WHO RECEIVED 2 MMR VACCINES - NEED NO FURTHER SHOTS AT THIS POINT
1. IF YOUR CHILD RECEIVED 2 MMR VACCINES AFTER THEIR FIRST BIRTHDAY - NO FURTHER ACTION IS NECESSARY.
2. IF YOU ARE PLANNING TO SPEND A DAY IN AN AREA AFFECTED BY THE OUTBREAK (I.E. MONSEY, LAKEWOOD, WILLIAMSBURG, BORO-PARK)
INFANTS UNDER 6 MONTHS - NO VACCINE
INFANTS 6 MONTHS - 1 YEAR - SHOULD RECEIVE AN MMR VACCINE
TODDLERS ABOVE 1 YEAR - SHOULD RECEIVE AN MMR BOOSTER, WHICH WILL BE COUNTED AS THEIR BOOSTER
KIDS ABOVE 4 YEARS OLD WHO RECEIVED 2 MMR VACCINES - NEED NO FURTHER SHOTS AT THIS POINT
What is your office ADHD Medicine policy?
Our providers DO NOT start patients on ADHD medicines. We can recommend a developmental doctor or neurologist who could diagnose your child with ADHD and start them off on medical treatment. If your child is on a stable dose and is doing well, with permission of your specialist and barring any complicating factors, we may be comfortable with refilling the medicine.
In order to comply with medical standard and ensure that your child grows nicely and monitor any adverse effects of the medicine we require:
1. A refill medicine visit at our office once a month. (e.i. we will see your child, send a refill AND YOU WILL NEED TO COME BACK IN A MONTH.
2. A consultation for any request to change the medicine or change the dosage - this option is not done over the phone but at our office.
3. Prescription refills should be requested 72 hours in advance - please do not wait until the last day.
In order to comply with medical standard and ensure that your child grows nicely and monitor any adverse effects of the medicine we require:
1. A refill medicine visit at our office once a month. (e.i. we will see your child, send a refill AND YOU WILL NEED TO COME BACK IN A MONTH.
2. A consultation for any request to change the medicine or change the dosage - this option is not done over the phone but at our office.
3. Prescription refills should be requested 72 hours in advance - please do not wait until the last day.