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Common Preschool Problems

Appendicitis

            Appendicitis is most common in children over six year of age. Symptoms usually begin with pain that is centered on the belly button. The pain then moves to the lower right side of the abdomen and becomes worse. Vomiting usually begins a few hours after the pain. This is an important way to tell the difference between a typical stomach virus, which usually causes vomiting and then pain. Other symptoms can include a low grade fever, loss of appetite, and abdominal pain that is worse after your child moves his leg or tries to walk.

Asthma

            Asthma or reactive airway disease (RAD) is a common problem in infants and children. The most common symptoms include coughing, wheezing and difficulty breathing. Inflammation and tightness in the breathing tubes of the lungs cause these symptoms.

Bedtime Problems

            Preschool age children may have sleep problems, including trouble getting to sleep; frequent night waking in the middle of the night and having irregular sleep patterns. Remember that there are no definite rights or wrong ways to put your child to sleep and that if you and your child are happy with your current routine then you should stick to it. However, it is not good if it is a struggle to put your child to bed, if she gets overly frustrated in the process, strongly resists being put to bed or if she is waking up so much that she or other family members end up not getting adequate sleep.

Bedwetting

            While most children are potty trained by the time they are three to four years old, wetting the bed at night (nocturnal enuresis) is still a common problem for many six to eight year old children (affecting about 8% of eight year olds). It is more common in boys and in families in which one or both parents wet the bed as a child.

Bowed Legs

            Most young children's legs are bowed (genu varum) and usually straighten out by the time they are two to three years old without any treatment. You should discuss it with you doctor if the bowing is severe or only involves one of his legs.

Constipation

            Constipation is a very common and frustrating problem in children. It is usually defined as the passage of painful hard stools or going four or more days without a bowel movement. It is most commonly caused by a diet that is low in fiber, but can also be caused by drinking too much milk (more than 12-16oz/d), not drinking enough water or waiting too long to go to the bathroom.

Crossed Eyes

            It can be normal for your newborn's eyes to occasionally cross or not move in the same direction. However, by the time he is six to eight weeks old; his eyes should no longer cross and should move together.

Flat Feet

            Many toddlers appear to have flat feet (pes planus) when they are standing. If you are able to see an arch develop when you have him stand on his tip toes, then he has a condition called flexible flat feet. This is a very common and normal condition and does not require any treatment. Flexible flat feet are painless and will disappear by the time your child is six to seven years old. In older children you can try using soft arch supports for comfort. You will not need corrective shoes, bracing, or foot exercises.

Intoeing/Outtoeing

            It is common for young children's toes to turn inward, and it usually corrects itself without treatment. One cause of intoeing that does require aggressive therapy is a club foot. In this condition, the foot is rigidly turned inward and can't be easily returned to a normal position. Your doctor will be able to easily tell if your child has a club foot, so that serial casting of the feet can begin to return them to a normal position.

Knock Knees

            Children aged three to four sometimes walk with their knees held very close together, a condition called genu valgum. These children with knock knees are usually normal and their legs will straighten out by the time they are five to eight years old without any medical treatment.

Labial Adhesions

            Labial adhesions occur when the labial skin around the vagina becomes irritated and sticks together. It is most common in young girls between the ages of 3 months and six years and is usually not a cause of concern. The adhesions may be mild, in which only part of the vaginal opening is closed, or they can cover the complete vaginal opening.

Nosebleeds

            It is common for children to have occasional nose bleeds. Some may even have as many as two or three each week and while they may be frightening, they very rarely cause serious problems. Nosebleeds usually occur when your child's nasal passages are dry or irritated from allergies or an upper respiratory tract infection. Rarely, a blood clotting disorder can cause frequent nosebleeds, but your child will usually have other bleeding problems or easy bruising and other family members will have similar problems.

Rashes

• Atopic dermatitis (eczema): the childhood form of eczema usually has its onset between 4-10 years with the development of itchy red areas on the wrists and ankles and on the flexural surfaces of the arms and legs (elbows and knees). The skin may be thickened, shiny and oozing and is usually very dry. Treatment is with daily use of moisturizers and topical steroid creams during breakouts. This is usually a chronic problem that will continue to improve and get worse for many years. See the Eczema Treatment Guide for more information.
• Contact dermatitis: many agents can cause rashes in infants from direct irritation of the skin. These can include harsh soaps and detergents, saliva from excessive drooling, and bubble baths. This type of rash usually has mild redness and itchiness and improves with the use of a moisturizer or lubricant to protect the skin. Many agents can also cause an allergic contact dermatitis with a more intense reaction in the skin 7-10 days after being exposed to it. Common things that can cause allergic skin reactions include poison ivy, cosmetics, and metals. The rash usually is very red, itchy, with oozing, crusting and swelling and will improve with a mild potency hydrocortisone cream.
• Impetigo: a skin infection caused by bacteria that begins as a tiny red bump and quickly turns into a honey colored crusted plaque. It is most commonly found around the nose, but can occur on any area of skin that has been damaged. Impetigo is treated with antibiotics. For minor infections a topical antibiotic cream can be used, but more extensive cases will require an oral antibiotic.
• infections: rashes are commonly associated with many different types of viral infections, including roseola (causes high fever for 3-5 days and then once the fever goes away, small red bumps appear on the trunk that spread all over the body), fifth disease (causes red cheeks and then a fine lace-like red or pink rash on the arms), and chickenpox (causes small red bumps that turn into vesicles that crust over). See the Guide to Common Infections for more information on infections that can cause skin rashes.
• keratosis pilaris: causes small pinpoint size red bumps and rough and dry skin on the cheeks and the back of the upper arms and legs. It is a chronic condition that is difficult to treat, but may improve with lubricants or topical keratolytic creams, such as Eucerin Plus or LacHydrin.
• molluscum contagiosum: this is a type of wart caused by a virus. The rash consists of small flesh colored, dome shaped bumps with a crater in the center. They can be grouped on any skin surface, but are usually located on the head, neck and diaper area. Treatment is not required and this type of wart will go away on its own over several months to years. Treatment for more extensive or persistent warts can be treated with cryotherapy. An antiviral cream called Aldara is currently being tested in children to help with this common problem.
• Ringworm (tinea corporis): a fungal infection that causes circular or annular shaped, red scaly patches with clear centers. It is usually found on non-hairy areas of the face, trunk, arms and legs and is easily treated with an OTC antifungal cream applied twice a day for two to four weeks.
• Scabies: caused by a tiny mite that infects only humans. The mites burrow under the skin and lay their eggs, which hatch in 10-14 days. Scabies usually appear as itchy red bumps on the hands (especially in the finger webs), wrists, and elbows, in the genital and underarm area and on the trunk. You may also see small S-shaped burrows on the skin where the mites are traveling and crusted nodules. Scabies are very contagious and usually affect everyone in the household. This condition can be treated with a single application of a prescription cream for 8-12 hours, although your child may continue to itch for one to two weeks as the skin heals.
• seborrheic dermatitis: causes yellow or salmon colored greasy scales and patchy redness on the scalp (cradle cap), face, behind the ears and in skin folds. Most children clear up without treatment in three to four weeks, but more severe or persistent forms can be treated with and anti-seborrheic shampoo with selenium sulfide or a low potency topical steroid cream.
• Warts: appear as irregular and rough bumps, most commonly on the arms and legs, but can occur on any skin surface. Warts are caused by an infection with the human papillomavirus, and usually do not cause any symptoms unless they are on the bottom of the feet or around the nails. Warts will go away on their own, but it may take one to two years for the process to be complete. Warts can be treated with cryotherapy, which uses liquid nitrogen to freeze the wart and surrounding skin to kill the virus, or by use of topical medicines that contain salicylic acid.

Sibling Rivalry

            Your preschool age child may have a hard time sharing your attention with other siblings, especially a new baby. Children at this age are normally self-centered and may not understand why they have to share your attention. They may feel neglected or jealous and may regress in many of their behaviors.

Sleep Problems

            Like adults, children have dreams when they are in REM sleep. This occurs 4-5 times each night, and while most dreams aren't remembered, some are frightening enough to wake the child and make them summon their parents. Nightmares usually begin when a child is about three years old, they are most common between the ages of three and eight (when their fantasy life is more active) and they are most likely to occur later in the night. Unlike night terrors, your child will be wide awake and responsive after the nightmare and she may be able to recall the details of the nightmare the next morning.

Stuffy Nose/Sneezing

            Having a stuffy nose or occasionally sneezing is very common in preschool children and is usually caused by irritation from dry air, smoke, or dust. Try to eliminate common irritants. You can also try using a humidifier.

Stuttering

            Many preschool children stutter as they are learning to talk, but most of them will grow out of it. As children learn to talk, they may repeat certain sounds, stumble on or mispronounce words, hesitate between words; substitute sounds for each other, and is unable to say some sounds.

Toilet Training Resistance

            While most children show signs of physical readiness to begin using the toilet as toddlers, usually between 18 months and 3 years of age, not all children have the intellectual and/or psychological readiness to be potty trained at this age.

Upper Respiratory Infections

            The common cold is a type of upper respiratory tract infection that is probably the most frequent type of infection in children. It is caused by a few hundred different strains of different viruses, including strains of rhinovirus, parainfluenza virus, coronavirus, respiratory syncytial virus, adenovirus, and influenza virus. It is because there are so many different strains of these different viruses that you do not develop immunity to the common cold and why it is difficult to develop a vaccine against it. Most children have three to eight colds each year, and children in daycare can have even more, so it may seem like your child is always sick.