Care of Common Illnesses

Frequently Asked Question’s

Allergies and Environmental Control

If a child has allergies, the first and most important principle of therapy is avoidance.  Allergens are anything that makes sensitive individuals react in an abnormal way.  Inhaled allergens may cause wheezing, cough, watery eyes, sneezing, runny nose, sore throat, swollen glands, upset stomach, headache, sinus congestion, et cetera.  If a child’s air passages are sensitive and react to certain things, it is important to try to limit exposure to those things.  One should look at the child’s history to determine if the allergies are seasonal (hay fever, for example) or year-round, as well as make a list of everything that the child reacts to.  This list should include any noxious fumes such as cigarette smoke, wood smoke, paints, perfumes as well as the more common allergens such as pollen, dust, mold, grasses, trees, and pets.

The following measures may be taken to try to avoid allergens:

1. Pollen and Mold Spores

Keep windows and doors closed and use air conditioning during the spring, summer and fall.

Avoid being outside when pollen counts are highest.

Shower and change clothing immediately following outdoor activities.

Avoid grass cutting, leaf raking and other high exposure activities.

1. Dust

Vacuum carpets thoroughly and frequently, when child is not around, and then air the room

Ideally, there should be no carpets, only washable rugs or hardwood floors

Use damp or oiled cloth when dusting at least twice weekly

Before turning on the furnace for the first time each year, place a damp cheese cloth over the vents to filter dust

Wash or change furnace filters at least once monthly

Use synthetic- containing pillows and stuffed animals

Use allergen-proofed zippered plastic encasings for pillows, mattress and box springs

Use smooth washable blankets

Driers should be vented outside

Remove old books and stored clothes in the closet

Do not keep stuffed or upholstered furniture in the bedroom

Use light, washable cotton or synthetic-fiber curtains, not drapes or blinds

Keep closet doors closed

Do not store things under the child’s bed

Discourage children from rolling around on the rug or playing under the bed

1. Household products

Avoid breathing paint vapors or household sprays

Make sure there is ventilation when working with powders, sprays, cleaning agents, bleach or paint

Avoid cigarette, wood, or kerosene smoke

1. Pets

Keep bedroom doors closed to prevent pet from leaving dander in the rooms
HOME TREATMENT OF CHILDREN
Common cold

Every normal child catches colds.  A child can have 8-10 upper respiratory infections a year.  Antibiotics or cold medications will not stop or cure a cold.  However, you can help make your child feel more comfortable while he is recovering.  You may give Tylenol for fever.  Cool mist humidifiers are helpful for breathing problems.  Do not put any medicine in it, fill it with plain water.  Make sure you change the water daily as it can become a breeding ground for mold and bacteria.  It is not necessary to run the humidifier continuously since the room and the child may get very damp.  A few hours at a time may be sufficient.

Medicines for a dry and stuffy nose with only a little discharge:

Use salt water nose drops (½ tsp salt to a cup of water), made fresh daily, 1-2 dropperfuls as necessary in each nostril.  Then have the child blow his nose after waiting 1-2 minutes.

If the child is a baby who can’t blow his nose, use a soft, rubber bulb syringe to gently suction the loosened mucus.  Express the air out of the syringe, place in child’s nostrils and release the syringe.  Empty the contents into a tissue and repeat the procedure in the other nostril, starting with the saline.  If a soft rubber syringe was not sent home with you from the hospital, you can obtain a nasal aspirator at your local drug store.  Remember, a nasal aspirator can irritate the nose and make it worse, so be quite gentle and only insert it enough to make a seal.

Most of the OTC cough/cold medicines are of very little help and the side effects are generally worse than the cold itself.  Many of these products have been taken off the market and are not recommended for use in children.  Benadryl may be used at bedtime to suppress a cough and provide sedation to help with sleeping.  Symptoms should not be suppressed during the daytime hours.  The best treatment is saline as above, or taking the child into a steamy bathroom.  Usually a cold just takes time to resolve.
Call our office during regular hours if:

A:  A fever lasts for over three days in older children. B:  The nasal discharge lasts for over 10-14 days and is very thick and purulent. C:  Any suggestion of an earache. D:  In a baby, signs of an earache could include a change in temperament (fussy or cranky), decreased appetite, or waking at night when the baby has always slept through. E:  A fever recurs after a week of illness.  The skin under the openings of the nose becomes raw or cracked and will not heal. F:  Or, any symptom that concerns you.

Call our office urgently if:

A:   Any temperature of 100.6F or 38.1C or above rectally in a baby three months or younger.                   B:   Any difficulty with breathing (difficulty drawing the air in or out of the lungs).
Constipation

A child is constipated if stool is hard or infrequent.  Therefore, large BM’s are not necessarily constipation.  Going seven or more days without a BM will be considered constipation even though this may cause no pain in some patients and even be normal for a few.  Many children normally go two or three days without a BM.  Constipation is often due to some temporary changes in the child’s diet or exercise level.  It usually is easy to help with dietary changes.  After he is better, be sure to keep him on a rather non-constipating diet so that it doesn’t happen again.

Treatment for babies:

For bottle fed babies, try ½ -1 tsp Karo syrup in each bottle.  Also give the baby strained apricots, prunes, peaches or pears twice a day.  Diluted pear juice or prune juice may also help.

If the baby is on solid food, some foods naturally bind:  rice, cereal, applesauce and bananas.  If constipation occurs with these foods, avoid them or just give loosening food with them, e.g. prunes or pears.  Rice cereal may be replaced with barley or mixed grain cereal.

Treatment for older children:

For children over 1 year old, at least three times a day, have your child eat fruits and vegetables (raw ones are the best, and skins are also helpful).  Some examples are:  prunes, figs, dates, raisins, peaches, pears, apricot, celery, lettuce, cabbage, etc.  Bran is an excellent natural laxative.  Have your child eat bran daily as a cereal, unmilled bran (¼ to ½ tsp twice daily) with applesauce or orange juice, bran flakes, bran muffins, shredded wheat, graham crackers, oatmeal, brown rice, whole wheat bread, Fig Newton cookies, etc.  Milk, cheese and ice cream are constipating and should be kept to moderate amounts.  Also be sure he/she drinks plenty of water.  There are also cookies called Fiber-Med, Fiberall, and Metamucil crackers that will help as well.

If this doesn’t work, a good natural laxative that you can buy at your pharmacy is Miralax.  Use as directed to promote a daily soft stool.  Once your child has a daily soft stool, continue to use Miralax on an ongoing basis to meet the goal of a daily stool.  Do not worry that your child will become “dependent” on the laxative.  Use it with dietary modifications to promote a healthy bowel regimen.  Call our office before using suppositories.

Call our office during regular hours if:

Your child gets cramps or pain that lasts over two hours. He/she goes three days on this dietary approach without a BM. Constipation is associated with toilet training. You see blood in the stool. Your child has other symptoms that concern you.

Cough

Most coughs are due to a virus infection of the bronchi (lung airways).  This is called bronchitis.  Most children get this a couple times a year.  Usually it’s a dry, ticklish cough that lasts from two to three weeks.  Sometimes it becomes loose and wet for a few days while the child coughs up a lot of phlegm (mucus).  Keep in mind that coughing protects the lungs from pneumonia.

Dry coughs are also loosened up by encouraging a good fluid intake plus using a cool-mist humidifier in the child’s bedroom.  Don’t add anything to the water in the vaporizer.  Also change the water daily.

A lot of coughs are due to post-nasal drip especially when the child is lying down.  You can bring the child into the bathroom with the shower on at bedtime or upon rising in the morning.  Saline mist is quite helpful as well.

Teenagers may find that gym and exercise trigger coughing spasms in bronchitis.  If so, avoid these temporarily.

Cough medicines containing dextromethorphan or codeine prevent the cough reflex.  Since the cough is usually a protective reflex, their uses should be limited to nights when the cough keeps the child awake.

Call our office during regular hours if:

Your child has a fever over 3-4 days with the cough. The cough lasts over two weeks. Your child is under three months old. The cough frequently awakens him from sleep. The cough causes vomiting.The cough interferes with more than two days of school attendance.

Call our office urgently if:

The cough changes to croup or wheezing. There is any difficulty in breathing. Your child has any coughing spasm that causes choking, passing out or a bluish color of the lips. There is blood in the phlegm. The child complains of chest pain with the cough.

Croup

Croup is a viral infection of the vocal cords, trachea,and bronchial passages.  It usually is part of a cold.  It causes hoarseness and a tight, seal-like, barky, hacking cough.  When croup becomes bad, it causes a crowing noise (stridor) every time your child breathes in.  Croup usually lasts for five to six days.  During that time, it can change from mild to severe many times.  It usually is worse at night and better in the daytime.  After a few days of the tight barky cough it will change over to a regular cough and runny nose that you see with a common cold.

Home treatment

Mist:  Keep the child’s room humidified using a cool mist humidifier 24 hours a day.  Another option is to hang some wet sheets or towels in his/her room.  As they dry, the air in the room will become humidified.

Increase fluid intake:  Encourage your child to drink clear fluids especially during the day when their breathing is easier.   He/she should drink 4-8 ounces every hour while awake.

Medicines:  Medicines are less helpful than either mist or increased fluid intake.  During the day, older children can try cough drops for their hoarseness.  Occasionally, severe croup will be treated with a steroid to decrease the inflammation.

Treatment for attacks of croup

If your child suddenly awakens with stridor (the crowing noise), do the following:

Take the child outside for 5-10 minutes.  Sometimes the cold night air will break the stridor. In the meantime, have the hot shower running full blast with the bathroom door closed.   Once the room is all fogged up, take him/her in there for 10-15 minutes.  Cuddle him/her and read a story.  Fear and crying make croup worse. If this doesn’t work, dress the child, go out in the car and drive around the block with the windows down for 15-20 minutes. Most children settle down with one of the above treatments and then sleep peacefully through the night.  If the stridor is still present after all this, you will need to be seen in the Emergency Department for evaluation and treatment.

Call our office during regular hours if:

The croupy cough persists past seven days. The child is stridorous (making noise while breathing in) during the day, or at rest.

Call our office urgently if:

Your child’s lips and skin start turning blue. Your child is having difficulty breathing in. Your child is drooling heavily or has a high fever.Your child has stridor even when sitting quietly without coughing.

Diaper rash

Almost every child gets diaper rash.  Most of them are due to a combination of overheating, wetness, and irritation.  With proper treatment, they are usually much better in a few days.

Treatment

Leave the baby’s bottom exposed to the air as long as possible several times each day.  Practical times are during naps or after BM’s.  Check the diapers- about every hour and if they are wet or soiled, change them immediately.  Wash the area gently with water and a mild soap.  The soap will remove the film of bacteria left on the skin by BM’s.  After using a soap, rinse and dry your baby carefully.  Then apply some protective ointment with each diaper change.

Diapers:  Some diapers have a pink or blue liner that may cause a contact rash in some babies.  Try a different brand of diaper.

Call our office during regular hours if:

The rash isn’t much better in four days. The child has any fever or is ill. There are any big blisters. The child is in pain from the rash. The color is bright red. There is thrush or white spots in the mouth. There are any pimples, boils, pus, or yellow crusts.  Also, if the child is a male and circumcised call if there is a sore or scab on the tip of the penis. Don’t use powder with talc because it can be injurious to the baby’s lungs.

Diarrhea

Diarrhea is a watery stool that occurs many times a day in copious amounts.  Diarrhea is usually caused by a viral infection of the intestines.  The diarrhea often lasts from several days to weeks.  Dietary changes usually speed recovery and prevent dehydration.

Treatment for older children:

For the child who is toilet trained for BM’s, the approach is the same as what any adult would do- regular diet with the following simple changes.  Avoid raw fruits and vegetables, bran products, and any other foods that can cause loose BM’s.  Drink at least four glasses of clear fluids.  Occasionally, the appetite decreases.  A normal diet can usually be continued.  You want to feed your child through the illness.  He will recover faster.

Treatment for babies:
Most of the following recommendations apply to the infant who is not yet toilet trained.  Have the baby take just clear fluid or Pedialyte for the first 6-8 hours.  Within 8-12 hours you can resume formula.  If the baby is old enough, also add constipating foods like strained carrots, strained bananas, rice cereal, applesauce and rice.  The above approach is not necessary for breast fed babies.  Breastfeeding can be continued.  It may take 1-2 weeks for the stools to be back to normal.
If the skin near the baby’s anus is getting sore, wash gently and then protect it with diaper ointment.
Call our office during regular hours if:

Your child is less than six months old. The diarrhea is severe. Your child has no urine for 12 hours. Mild diarrhea lasts for over two weeks. Your child is less than 2 months old and has a fever. Your child’s tongue and mouth are dry. There are no tears when he/she cries.There is blood, pus, or mucus in the stool.Your child has other symptoms that concern you.

Call our office urgently if:

There is fast or heavy breathing.

Any abdominal pain lasts more than two hours.

Ear infections

An ear infection is an infection of the middle ear (the space behind the ear drum).  It usually is a complication of a cold.  If the following treatment is carried out, there should be no damage to the ear or hearing.

Treatment:

Some ear infections are due to a virus and will clear on their own.  Sometimes antibiotics may be prescribed for the treatment of your child’s ear infection.  After a few days, your child should begin to feel better, even though all the germs have not been killed.  To prevent the ear infection from flaring up again, it is important that your child take EVERY dose.

Do not forget any doses.  If the antibiotic is liquid, it may need to be stored in the refrigerator.  Shake the bottle each time.  Use a measuring spoon so that you give the right amount.  Give all the medicine until it is finished.

Motrin/Tylenol can be taken in regular doses for the earache and fever.  The antibiotic will often take two or three days to bring these symptoms under control.  These medicines are the best ones for helping your child get to sleep.  See dosage chart in “Fever” section.

There are no restrictions for ear infections.  The child can return to school as soon as the fever is gone and the pain is mild (this usually means after one day).  The child can go outside and need not cover his/her ears.  Swimming is permitted as long as there is no perforation (hole) in the eardrum.  A draining ear means there is a perforation.

Antibiotics are not prescribed over the phone.  If you suspect an ear infection, then we need to see the child.

Call our office during regular hours if:

The fever or pain is not gone by 48 hours with treatment, or any new symptoms develop that concern you. If you suspect your child has an ear infection in the evening or at night, manage the overnight symptoms with appropriately dosed Tylenol or Motrin. Call the office in the morning even if the symptoms have resolved and we will help you decide if the child needs to be seen for evaluation.

Eye Infections (Conjunctivitis)

An eye infection (pink eye) causes redness of the sclera (white part of the eyeball).  Often the eyelids are stuck together with dried pus when the child awakens in the morning.  Such an eye infection is caused by bacteria or virus, and will clear up in a few days using warm soaks with a cotton ball or tissue.

Before putting in any medicines, remove all the dry and liquid pus from the eye with warm water and wet cotton balls.  Pull down the lower lid of the affected eye and place a ribbon of medicine or drops as directed.  Continue the medication until the child has awakened for two mornings in a row without any pus in his/her eyes.  Generally this is about five days.  If stopped sooner, the infection will probably come back.

Conjunctivitis is contagious.  Therefore, it is important for the child to have his own washcloth and towel, and should be encouraged not to touch or rub his/her eyes.  Hands should also be washed often to prevent spread of infection.

Call our office during regular hours if:

The infection has not begun to clear by 72 hours. Any fever develops. Any sores develop on the eyeball. Your child’s vision changes. Any symptoms concern you.

Call our office urgently if:

Your child develops a fever and redness spreads onto the skin surrounding the eye.

Fever

Fever is the most common reason that parents call pediatricians.   Fever is not harmful, and is a sign that the body is fighting an illness.  If your child is not bothered by the fever, is acting normally, and sleeping and eating well, there is no need to treat a fever.  If your child is uncomfortable, or acting sick, a fever may be treated with Tylenol or Ibuprofen.  The proper dose is determined by the child’s weight (see table below).

ACETOMINOPHEN DOSING

(Tylenol every 4 hours as needed)

Use infant preparations for children under 2 years of age (drops-80mg/0.8 ml dropperful)
6-11 lbs———- ½ dropperful
12-17 lbs———1 dropperful
18-23 lbs———1  ½ dropperfuls
24-35 lbs———2 dropperfuls
Children 2 years old and at least 24 lbs- follow instructions on label for either Children’s Tylenol Suspension -160mg/5ml(tsp) or Children’s Chewables (80mg tablets).

IBUPROFEN DOSING

(Advil or Motrin every 6-8 hours as needed)

Use infant preparations for children under 2 years of age (drops- 40mg/ml preparations).  Use only for infants at least 6 months of age.
12-17 lbs———–1 dropperful
18-23 lbs———–1 ½ dropperfuls
24-35 lbs———–2 dropperfuls
Children 2 years old and at least 24 lbs- follow the instructions on the label for Children’s  Suspension (100mg/5cc), Children’s Chewables (50mg/tablet), or Children’s Junior Strength Caplets (100mg/tablet). Dress your child lightly to allow the warmth from his body to escape.  Do not bundle.Parents may rely on the degree of fever or the response to medications to gauge the degree of illness in their child.   If your child with a high fever looks and acts fine, then don’t worry about the fever. However, if there is only a low grade fever, yet your child acts and looks very sick, he/she is really more ill than the fever indicates.  Trust your instincts!
Call our office during regular hours if:

Your child is two to six months old. The fever has been present over 72 hours. The fever goes away for 24 hours and then returns. If no reason is apparent to explain the fever and it has lasted for over 24 hours in children six -24 months old. There is burning or pain with urination.

Call our office urgently if:

Your child is less than three months old. Your child seems very sick to you or is not responding to you appropriately after fever reducing medicine is tried. \Your child’s neck is stiff. Your child is confused or delirious. Your child is having difficulty with his/her breathing.Your child has any purple spots on his/her skin. Any symptoms concern you.

Head Injury

Every child sooner or later strikes his head, and usually the damage is only to the scalp.  Big lumps can occur with these minor injuries, but injury to the brain is rare.  However, extra caution for 48 hours can pick up any possible serious complications early. Most important in the treatment of head injury is for a responsible person to stay with the patient and watch carefully for the appearance of possible serious symptoms.

If there is a scrape, wash it off with soap and water, and apply pressure with a clean cloth (sterile gauze if you have it) for 10 minutes to stop any bleeding.  Then, put some ice in a wash cloth and apply it to the wound.  Apply the ice for 20 minutes, then remove for 20 minutes.  This can be repeated as needed.

Children tend to react more than adults to bumps on the head.  Acetaminophen may be given for pain.  Avoid narcotics or sedatives.  Restrict the child to a light diet.  For the first 24 hours following an injury, waken your child every four hours, ask him to name familiar persons or toys and check the pupils (black center of the eye) to be sure they are equal in size.

Call our office urgently if:

The accident was a serious one such as a fall down a flight of stairs. The crying lasted over 15 minutes after the injury. Your child has a headache that becomes more severe. Your child vomits more than twice.Any cut in the skin is deep and may need to be sutured. Your child is confused or not acting like himself. Your child has any difficulty speaking. Your child complains of vision changes. Your child is walking unsteadily. Your child has difficulty using his arms. Your child complains of neck pain. There is blood or watery fluids from the nose or ears. Your child is stunned or unconscious from the injury. Your child has a seizure. The pupils are unequal. Any other symptom concerns you.

Head Lice

Head lice are tiny (1/16  inch) bugs that only live on human beings.  Their favorite place is in the hair.  Therefore, they usually cause itching and sores in the scalp, especially at the back of the neck.  They are grey and move quickly, they do not fly, but they can be seen.  Smaller yet are the eggs (called nits), which are attached near the base of hairs and look like white lint.  They hatch in a week.

Treatment

If you suspect that your child has lice, buy and OTC cream rinse (Nix) or Rid shampoo and use as directed.  Never use hair conditioners while using Nix.  Combing through the hair is very important to make sure the hair is free of nits.  You can separate the hair into sections and work through with a fine tooth comb (included in the lice treatment kits).  You may need to check the hair every day for the next 4-5 weeks.

Since lice are only passed from person to person, they can’t live for over 72 hours outside the human body.  However, the child’s room should be vacuumed or wet-mopped.   Sheets, blankets and pillow cases should be washed in hot water.  Also wash combs and brushes.  Coats, hats, headbands, hoods, bed quilts, stuffed animals and dolls should be washed or set aside and not used for at least two weeks.

Check the heads of everyone else in the home.  If anyone has scalp rashes, sores, or itching, they should be treated even if lice are not seen.  The child can return to school after one treatment.  There are no long-term consequences of head lice.

Jaundice

Jaundice refers to the yellowish discoloration of the skin.  Many babies, soon after birth, experience this condition which usually clears up by itself in a few days.  Jaundice is usually a normal thing, not an illness in a newborn.

Newborns have a larger number of red blood cells than older people.  These red blood cells live for a shorter period of time than in older children.  As the red blood cells break down and die, a normal waste product called bilirubin results.   Bilirubin is removed from the bloodstream by the liver. However, a newborn’s liver is immature; therefore the bilirubin builds up causing the baby’s skin and the whites of the eyes to turn slightly yellow.

In the nursery, your baby will be closely observed.  A blood test to measure the amount of bilirubin in the blood stream may be performed if we become concerned about whether your baby’s skin is too yellow (jaundiced).  We will notify you of any concerns if your baby’s color indicates jaundice.

You may be asked to evaluate your baby’s color at home after discharge from the hospital.  Undress the baby and place him near a window in the natural daylight.  This is the best way to observe your baby’s color.  If you think the whites of your baby’s eyes (sclera) or his/her skin is more yellow than it should be, please call us in the office.

If you call regarding jaundice, you will be asked about the baby’s recent feeding and elimination.  Typically, if a child is urinating frequently, stooling well, and eating well, less intervention is required.

In some cases, if the jaundice worsens, treatment is necessary to prevent complications.  The baby is placed under fluorescent lights which help to lower the amount of bilirubin.  This is called phototherapy.  The baby’s eyes are covered to protect them from the light.

Sore Throat

Most sore throats result from a viral infection of the throat.  These usually last a few days.  There are several things you can do to help.

Gargle with warm salt water if old enough (1 tsp salt per glass) six times a day.  Suck on hard candy every hour.  Take Acetaminophen as necessary to help the discomfort. Small children often refuse to eat if they have a sore throat.  Cold liquids and popsicles help, too.  Chloroseptic spray may also be used in older children.

Call our office during regular hours if:

Your child has severe pain lasting more than two days. Your child has a fever with the sore throat. The sore throat lasts over 72 hours even if there is no fever. There is any recent contact with people with strep throat. Your child has big, swollen lymph glands in the neck. Your child has abdominal pain or vomiting. A rash develops.

Call our office urgently if:

Your child is drooling. The pain becomes severe. Your child is having difficulty breathing.

Vomiting

Most vomiting is caused by a viral infection of the stomach or by food that disagrees with the child.  The vomiting usually stops in 6-12 hours.  Regurgitation or spitting up one or two mouthfuls is found in many normal babies and goes away by itself by six or nine months of age.

For the first few hours, give clear liquids such as Pedialyte, decarbonated 7-Up, ginger ale or cola, Gatorade or Kool-Aid, or diluted white grape juice.  Start with 1-2 tsp every 5-10 minutes and slowly increase the amount every 30 minutes.

After 8 hours with no vomiting, a child can gradually return to a normal diet.  For babies, start with foods like applesauce, strained bananas or bland soups.  It may take two days to fully return to a normal diet.  When milk, dairy products and fatty foods are reintroduced, go slowly, as they may upset the stomach.

A common error is to give too much fluid too quickly.  This almost always leads to continued vomiting.  The key is to give small amounts of fluid at frequent intervals.  With this method, even if your child continues to vomit, enough fluid is absorbed to hopefully prevent dehydration.

The signs of dehydration:

Dry mouth and tongue. No tears, sunken eyes. No urine for 12 hours.

Call our office during regular hours if:

The vomiting continues for more than 12 hours. Your child is under six months old. The vomiting could be caused by a prescription medicine your child is taking. Any other symptom concerns you.

Call our office urgently if:

There is any blood in the vomitus or it is green in color. Your child complains of abdominal pain for over two hours, or has distention (swelling) of the abdomen.  There is any possibility of poisoning with a plant, medicine, or bad food.  The phone number for Poison Control is 1-800-222-1222.

Childproof Safety Checklist

Car Seats or Seat Belts used for all car rides.

Poison Control phone number (1-800-222-1222) on all phones.

Poisons, medicines, cleaning products and chemical locked out of children’s reach.

Doors and cabinets locked with safety latch.

Never leave baby unattended on table or bed.

Stairways blocked by gates.

Guards over low windows.

Keep matches, sharp objects and small objects out of children’s reach.

Always supervise child when swimming or bathing.

Caution around hot items like irons, curling irons, stove, barbecue, etc.

Cover or insulate hot pipes or radiators.

Hot water temperature at 120 degrees.

Use flame resistant fabrics.

Smoke alarm in home.

Teach older children fire drills.

Lock up firearms and tools.  Use trigger locks.

Plugs in electric outlets.

Keep electrical cords in good repair and away from children.

Teach older children emergency phone number 911.

Carbon monoxide detector in home