Q & A


ADHD

What Is ADHD?

Lisa's son Jack had always been a handful. Even as a preschooler, he would tear through the house like a tornado, shouting, roughhousing, and climbing the furniture. No toy or activity ever held his interest for more than a few minutes and he would often dart off without warning, seemingly unaware of the dangers of a busy street or a crowded mall. It was exhausting to parent Jack, but Lisa hadn't been too concerned back then. Boys will be boys, she figured. He'll grow out of it. But here he was, now 8, and still no easier to handle. Every day it was a struggle to get Jack to settle down long enough to complete even the simplest tasks, from chores to homework. When his teacher's comments about his inattention and disruptive behavior in class became too frequent to ignore, Lisa took Jack to the doctor, who recommended an evaluation for attention deficit hyperactivity disorder (ADHD). ADHD is a common behavioral disorder that affects an estimated 8% to 10% of school-age children. Boys are about three times more likely than girls to be diagnosed with it, though it's not yet understood why. Children with ADHD act without thinking, are hyperactive, and have trouble focusing. They may understand what's expected of them but have trouble following through because they can't sit still, pay attention, or attend to details. Of course, all children (especially younger ones) act this way at times, particularly when they're anxious or excited. But the difference with ADHD is that symptoms are present over a longer period of time and occur in different settings. They impair a child's ability to function socially, academically, and at home. The good news is, with proper treatment, children with ADHD can learn to successfully live with and manage their symptoms.

What Are the Symptoms?

ADHD used to be known as attention deficit disorder, or ADD. In 1994, it was renamed ADHD and broken down into three subtypes, each with its own pattern of behaviors:
  • 1. an inattentive type, with signs that include:
    • inability to pay attention to details or a tendency to make careless errors in schoolwork or other activities
    • difficulty with sustained attention in tasks or play activities
    • apparent listening problems
    • difficulty following instructions
    • problems with organization
    • avoidance or dislike of tasks that require mental effort
    • tendency to lose things like toys, notebooks, or homework
    • distractibility
    • forgetfulness in daily activities
  • 2. a hyperactive-impulsive type, with signs that include:
    • fidgeting or squirming
    • difficulty remaining seated
    • excessive running or climbing
    • difficulty playing quietly
    • always seeming to be "on the go"
    • excessive talking
    • blurting out answers before hearing the full question
    • difficulty waiting for a turn or in line
    • problems with interrupting or intruding
  • 3. a combined type, which involves a combination of the other two types and is the most common
Although it can often be challenging to raise kids with ADHD, it's important to remember they aren't "bad," "acting out," or being difficult on purpose. And children who are diagnosed with ADHD have difficulty controlling their behavior without medication or behavioral therapy.

How Is It Diagnosed?

Most cases of ADHD are treated by primary care doctors. Because there's no test that can determine the presence of ADHD, a diagnosis depends on a complete evaluation. When the diagnosis is in doubt, or if there are other concerns, such as Tourette syndrome, a learning disability, or depression, a child may be referred to a neurologist, psychologist, or psychiatrist. Ultimately, though, the primary care doctor gathers the information, makes the diagnosis, and starts treatment.

To be considered for a diagnosis of ADHD:

  • A child must display behaviors from one of the three subtypes before age 7
  • these behaviors must be more severe than in other kids the same age
  • the behaviors must last for at least 6 months
  • the behaviors must occur in and negatively affect at least two areas of a child's life (such as school, home, day-care settings, or friendships)
  • The behaviors must also not be linked to stress at home. Children who have experienced a divorce, a move, an illness, a change in school, or other significant life event may suddenly begin to act out or become forgetful. To avoid a misdiagnosis, it's important to consider whether these factors played a role in the onset of symptoms
First, your child's doctor will perform a physical examination of your child and ask you about any concerns and symptoms, your child's past health, your family's health, any medications your child is taking, any allergies your child may have, and other issues. This is called the medical history, and it's important because research has shown that ADHD has a strong genetic link and often runs in families. Your child's doctor may also perform a physical exam as well as tests to check hearing and vision so other medical conditions can be ruled out. Because some emotional conditions, such as extreme stress, depression, and anxiety, can also look like ADHD, you'll probably be asked to fill out questionnaires that can help rule them out as well. You'll also likely be asked many questions about your child's development and his or her behaviors at home, at school, and among friends. Other adults who see your child regularly (like teachers, who are often the first to notice ADHD symptoms) will probably be consulted, too. An educational evaluation, which usually includes a school psychologist, may also be done. It's important for everyone involved to be as honest and thorough as possible about your child's strengths and weaknesses.

What Causes ADHD?

ADHD is not caused by poor parenting, too much sugar, or vaccines. ADHD has biological origins that aren't yet clearly understood. No single cause of ADHD has been identified, but researchers have been exploring a number of possible genetic and environmental links. Studies have shown that many children with ADHD have a close relative who also has the disorder. Although experts are unsure whether this is a cause of the disorder, they have found that certain areas of the brain are about 5% to 10% smaller in size and activity in children with ADHD. Chemical changes in the brain have been found as well. Recent research also links smoking during pregnancy to later ADHD in a child. Other risk factors may include premature delivery, very low birth weight, and injuries to the brain at birth. Some studies have even suggested a link between excessive early television watching and future attention problems. Parents should follow the American Academy of Pediatrics' (AAP) guidelines, which say that children under 2 years old should not have any "screen time" (TV, DVDs or videotapes, computers, or video games) and that kids 2 years and older should be limited to 1 to 2 hours per day, or less, of quality television programming.

What Are Some Related Problems?

One of the difficulties in diagnosing ADHD is that it's often found in conjunction with other problems. These are called coexisting conditions, and about two thirds of all children with ADHD have one. The most common coexisting conditions are:

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)

At least 35% of all children with ADHD also have oppositional defiant disorder, which is characterized by stubbornness, outbursts of temper, and acts of defiance and rule breaking. Conduct disorder is similar but features more severe hostility and aggression. Children who have conduct disorder are more likely get in trouble with authority figures and, later, possibly with the law. Oppositional defiant disorder and conduct disorder are seen most commonly with the hyperactive and combined subtypes of ADHD.

Mood Disorders (such as depression)

About 18% of children with ADHD, particularly the inattentive subtype, also experience depression. They may feel inadequate, isolated, frustrated by school failures and social problems, and have low self-esteem.

Anxiety Disorders

Anxiety disorders affect about 25% of children with ADHD. Symptoms include excessive worry, fear, or panic, which can also lead to physical symptoms such as a racing heart, sweating, stomach pains, and diarrhea. Other forms of anxiety that can accompany ADHD are obsessive-compulsive disorder and Tourette syndrome, as well as motor or vocal tics (movements or sounds that are repeated over and over). A child who has symptoms of these other conditions should be evaluated by a specialist.

Learning Disabilities

About half of all children with ADHD also have a specific learning disability. The most common learning problems are with reading (dyslexia) and handwriting. Although ADHD isn't categorized as a learning disability, its interference with concentration and attention can make it even more difficult for a child to perform well in school. If your child has ADHD and a coexisting condition, the doctor will carefully consider that when developing a treatment plan. Some treatments are better than others at addressing specific combinations of symptoms.

How Is It Treated?

ADHD can't be cured, but it can be successfully managed. Your child's doctor will work with you to develop an individualized, long-term plan. The goal is to help your child learn to control his or her own behavior and to help families create an atmosphere in which this is most likely to happen. In most cases, ADHD is best treated with a combination of medication and behavior therapy. Any good treatment plan will require close follow-up and monitoring, and your child's doctor may make adjustments along the way. Because it's important for parents to actively participate in their child's treatment plan, parent education is also considered an important part of ADHD management.

Medications

Several different types of medications may be used to treat ADHD: Stimulants are the best-known treatments - they've been used for more than 50 years in the treatment of ADHD. Some require several doses per day, each lasting about 4 hours; some last up to 12 hours. Possible side effects include decreased appetite, stomachache, irritability, and insomnia. There's currently no evidence of any long-term side effects. Nonstimulants were approved for treating ADHD in 2003. These appear to have fewer side effects than stimulants and can last up to 24 hours. Antidepressants are sometimes a treatment option; however, in 2004 the FDA issued a warning that these drugs may lead to a rare increased risk of suicide in children and teens. If an antidepressant is recommended for your child, be sure to discuss these risks with your doctor. Medications can affect kids differently, and a child may respond well to one but not another. When determining the correct treatment for your child, the doctor might try various medications in various doses, especially if your child is being treated for ADHD along with another disorder.

Behavioral Therapy

Research has shown that medications used to help curb impulsive behavior and attention difficulties are more effective when they're combined with behavioral therapy. Behavioral therapy attempts to change behavior patterns by: reorganizing your child's home and school environment giving clear directions and commands setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate ones. Here are some examples of behavioral strategies that may help a child with ADHD: Create a routine. Try to follow the same schedule every day, from wake-up timeto bedtime. Post the schedule in a prominent place, so your child can see where he or she is expected to be throughout the day and when it's time for homework, play, and chores. Help your child organize. Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them. Avoid distractions. Turn off the TV, radio, and computer games, especially when your child is doing homework. Limit choices. Offer your child a choice between two things (this outfit, meal, toy, etc., or that one) so that he or she isn't overwhelmed and overstimulated. Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of his or her responsibilities. Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child's efforts. Be sure the goals are realistic (think baby steps rather than overnight success). Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior. Younger children may simply need to be distracted or ignored until they display better behavior. Help your child discover a talent. All kids need to experience success to feel good about themselves. Finding out what your child does well - whether it's sports, art, or music - can boost social skills and self-esteem. Alternative Treatments Currently, the only ADHD therapies that have been proven effective in scientific studies are medications and behavioral therapy. But your child's doctor may recommend additional treatments and interventions depending on your child's symptoms and needs. Some kids with ADHD, for example, may also need special educational interventions such as tutoring, occupational therapy, etc. Every child's needs are different. A number of other alternative therapies are promoted and tried by parents including: megavitamins, body treatments, diet manipulation, allergy treatment, chiropractic treatment, attention training, visual training, and traditional one-on-one "talking" psychotherapy. However, the scientific research that has been done on these therapies has not found them to be effective, and most of these treatments have not been studied carefully, if at all. Parents should always be wary of any therapy that promises an ADHD "cure," and if they're interested in trying something new, they should be sure to speak with their child's doctor first.

Parent Training

Parenting any child can be tough at times, but parenting a child with ADHD often brings special challenges. Children with ADHD may not respond well to typical parenting practices. Also, because ADHD tends to run in families, parents may also have some problems with organization and consistency themselves and need active coaching to help learn these skills. Experts recommend parent education and support groups to help family members accept the diagnosis and to teach them how to help their child organize his or her environment, develop problem-solving skills, and cope with frustrations. Parent training can also teach parents to respond appropriately to their child's most trying behaviors and to use calm disciplining techniques. Individual or family counseling may also be helpful.

ADHD in the Classroom

As your child's most important advocate, you should become familiar with your child's medical, legal, and educational rights. Children with ADHD are eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. Keep in touch with your child's teachers and school officials to monitor your child's progress and keep them informed about your child's needs. In addition to using routines and a clear system of rewards, here are some other tips to share with teachers for classroom success: Reduce seating distractions. Lessening distractions might be as simple as seating your child near the teacher instead of near the window. Use a homework folder for parent-teacher communications. The teacher can include assignments and progress notes, and you can check to make sure all work is completed on time. Break down assignments. Keep instructions clear and brief, breaking down larger tasks into smaller, more manageable pieces. Give positive reinforcement. Always be on the lookout for positive behaviors. Ask the teacher to offer praise when your child stays seated, doesn't call out, or waits his or her turn, instead of criticizing when he or she doesn't. Teach good study skills. Underlining, note taking, and reading out loud can help your child stay focused and retain information. Supervise. Check that your child goes and comes from school with the correct books and materials. Ask that your child be paired with a buddy who can help him or her stay on task. Be sensitive to self-esteem issues. Ask the teacher to provide feedback to your child in private, and avoid asking your child to perform a task in public that might be too difficult. Involve the school counselor or psychologist. He or she can help design behavioral programs to address specific problems in the classroom. Being Your Child's Biggest Supporter You're a stronger advocate for your child when you foster good partnerships with everyone involved in your child's treatment - that includes teachers, doctors, therapists, and even other family members. Take advantage of all the support and education that's available, and you'll be able to help your child with ADHD navigate his or her way to success. Reviewed by: W. Douglas Tynan, PhD


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Allergies

Common Allergies

The causes of allergies are not fully understood. Your child can get allergies from coming into contact with allergens. Allergens can be inhaled, eaten, injected (from stings or medicine), or they can come into contact with the skin. Some of the more common allergens are:
  • pollens
  • molds
  • house dust mites
  • animal dander and saliva (cat, dog, horse, rabbit)
  • chemicals used in industry
  • some foods and medicines
  • venom from insect stings
The tendency to have allergies is often passed on in families. For example, if you as a parent have an allergy problem, there is a higher than normal chance that your child also will have allergies. This risk increases if both parents are allergic.
Common allergies
Condition Triggers Symptoms
Asthma A wide range of things can trigger an asthma attack. These include cigarette smoke, viral infections, pollen, dust mites, furry animals, cold air, changing weather conditions, exercise, and even stress. Coughing, wheezing, difficult breathing; coughing with activity or exertion; chest tightness.
Hay Fever Pollen from trees, grasses, or weeds. Stuffy nose, sneezing, and a runny nose; breathing through the mouth because of stuffy nose; rubbing or wrinkling the nose and facial grimacing to relieve nasal itch; watery, itchy eyes; redness or swelling in and under the eyes.
Food allergies Any foods, but the most common are eggs, peanuts, milk (see information on milk allergies), nuts, soy, fish, wheat, peas, and shellfish. Vomiting, diarrhea, hives, eczema, difficult breathing, and possibly a drop in blood pressure (shock).
Eczema (atopic dermatitis) Sometimes made worse by food allergies, contact with allergens (pollen, dust mites, furry animals), irritants, sweating. A patchy, dry, red, itchy rash that often occurs in the creases of the arms, legs, and neck; however, in infants it often starts on the cheeks, behind the ears, and on the thighs.
Hives Viral infections, food allergies, and drugs (such as aspirin, penicillin, or sulfa) but cause is often unknown. Itchy, mosquito-bite-like skin patches that are more red or pale than the surrounding skin. Hives may be found on different parts of the body and do not stay at the same spot for more than a few hours.
Contact dermatitis Contact with a plant substance such as poison ivy or oak, household detergents and cleansers, and chemicals in some cosmetics and perfumes. Itchy, red, raised patches that may blister if severe. Most of these patches are confined to the areas of direct contact with the allergen.
Copyright 2000 American Academy of Pediatrics

Asthma

Asthma

Asthma is an immunological condition that causes inflammation, excessive mucus secretion, and reversible constriction of the smooth muscle in the lung's airway. Asthma can produce wheezing, coughing and shortness of breath; these symptoms may vary in severity. An asthma attack may be triggered by a person's sensitivity to certain substances, exercise, dusts, viral infections and other conditions that produce inflammation of the airways.

Symptoms

A dry cough at night or during physical activity may be the only symptom of asthma. The initial symptoms of an asthma attack are generally shortness of breath, coughing or chest tightness. In children, an itching sensation on the chest or neck may be the first hint of an approaching attack. The attacks sometimes have a sudden onset that can rapidly progress to pronounced wheezing and shortness of breath. In other instances, the attack starts slowly and symptoms gradually increase in intensity. An asthma attack may last for several minutes, for several hours, or even for days at a time. Anxiety may accompany an asthma attack, especially if breathing becomes difficult. In very severe attacks, speaking is difficult and little air moves in or out of the lungs. If a person's air supply becomes seriously restricted, confusion and lethargy can occur, and the skin may turn blue. Emergency medical treatment is essential if these symptoms are present. Patients rarely die, even in cases of severe asthma attacks, if proper treatment is obtained early in the course of the attack.

Causes

The airway inflammation associated with asthma may be triggered by contact with an allergen to which a person is sensitive, by a viral infection, or by strenuous exercise. In some people with defined allergies, asthma may be triggered by an abnormal reaction of the airways to specific stimuli. These stimuli may include pollens, dust mites or animal dander, which certain cells in the airway recognize as allergens. The result is an immune response that causes certain cells to release substances such as histamine and leukotrienes that stimulate the smooth muscles in the airways to contract. Mucus secretion increases; white blood cells, which secrete chemicals that cause an inflammation response, are transported to the area; and the tissues lining the airways become swollen and inflamed. This produces a narrowing of the airways, a condition that is called bronchoconstriction. Bronchoconstriction, which can impede air movement and make breathing difficult, can vary in frequency, duration, and severity. Asthma also may occur in people who do not have defined allergies. Smoke, cold air, vigorous activity, stress, anxiety, a viral infection of the upper respiratory system, or any combination of these environmental conditions and events may produce similar changes that cause the narrowing of the airways in certain people. The resulting asthma attacks also vary in severity, frequency and duration.

Diagnosis

Asthma can be initially diagnosed on the basis of a description of characteristic symptoms. If a person has narrowed airways at the time he or she visits a doctor, the doctor may hear wheezing, in which case spirometry, a test that measures air movement in and out of the lungs, may confirm bronchoconstriction. Spirometry also may be used to determine the extent of airway obstruction and to monitor asthma treatment. If the diagnosis of asthma seems likely and spirometry results are normal, the doctor may recommend a trial of bronchodilators. If the symptoms resolve, then asthma is the probable diagnosis. In rare cases in which the diagnosis is uncertain, the doctor may give a small amount of a bronchoconstrictor to inhale. Inhalation at this dosage does not produce narrowing of the airways in a healthy person, but does result in bronchoconstriction in a person with asthma. Identifying and avoiding asthma triggers is the first line of defense against asthma attacks. In cases in which it is vital to identify the substance that triggers asthma attacks, allergy skin testing may be done. To diagnose exercise-induced asthma, a person is given spirometry tests before and following exercise on a treadmill or stationary bicycle.

Treatment

The most commonly used medications to relieve asthma symptoms are bronchodilators, which stimulate certain receptors in the airway to relax the smooth muscle and dilate (widen) the airways. Bronchodilators may be taken by mouth, by injection or by inhalation. Inhaling devices deposit the medication directly into the airways during an attack and immediately dilate the airways, but in cases of severe bronchoconstriction they may not transport the medication to all the affected airways. Oral bronchodilators can reach all the obstructed airways but act more slowly than inhaled forms and usually have more side effects than inhaled bronchodilators; oral agents must be taken on a regular basis to prevent asthma attacks. They may be taken orally via short-acting tablets, sustained-release capsules, or in syrup form. Bronchodilators can be given by injection, but these are usually used to treat severe asthma attacks. Inhaled, oral or injected corticosteroids can counteract the inflammatory response and are very effective at controlling symptoms. Inhaled corticosteroids are used most often in those with moderate or severe asthma. When taken over time, these medications gradually act to prevent attacks by reducing inflammation and blocking the sensitivity of the airways to allergens and other stimuli. When severe asthma does not respond to other treatments, long-term oral corticosteroids may be prescribed to control symptoms. Long-term use of oral corticosteroids is limited to the most severely affected people because of the potential for serious side effects, including inhibited wound healing, weakening of the bones, slowed growth in children, bleeding from the stomach, cataracts, increased blood sugar level, weight gain, and mental disturbances. Inhaled corticosteroids used over the long-term do not have these same side effects. Other medications that may be prescribed to prevent or control asthma include cromolyn sodium and nedocromil, which inhibit the release of inflammatory substances and help prevent airway constriction. The newest medications used to control asthma are leukotriene modifiers (for example, montelukast, zafirlukast and zileuton), which prevent the action of chemicals that cause the inflammation associated with asthma attacks. Persons diagnosed with asthma are generally prescribed a handheld, metered-dose inhaler that uses pressurized gas to propel the bronchodilator medication, which is inhaled through the mouth into the airways. Inhaled bronchodilators work rapidly to relieve shortness of breath and wheezing by relaxing the smooth muscles of the airways. For people with frequent asthma attacks (more than two to three asthma attacks a week), cromolyn or inhaled corticosteroids may be added as daily medications. Another group of oral medications called leukotriene receptor antagonists is also used to control symptoms. Oral theophylline is prescribed less commonly but can be useful for treating persistent symptoms, particularly nighttime symptoms. An acute asthma attack should be treated immediately using additional medications or higher doses or different forms of the medications used on an ongoing basis to control or prevent asthma. A handheld inhaler may be used by a person during an asthma attack, or a nebulizer may be used to direct pressurized air through a solution of the medication. The nebulizer produces a continuous mist that can be inhaled. Intravenous asthma medications, including epinephrine or corticosteriods, are sometimes used to treat severe asthma attacks. Oxygen and intravenous fluids also may need to be given, and antibiotics may be necessary if an underlying infection is present. Excerpted from: Complete Medical Encyclopedia, American Medical Association, 2003. If you would like information about purchasing the Complete Medical Encyclopedia, click here. Copyright 2003 American Medical Association All rights reserved.


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Bedwetting

How can I keep my child from wetting the bed?

Keep the following tips in mind when dealing with bedwetting: Be honest with your child about what is going on. Let your child know it's not his fault and that he will eventually be able to stay dry all night. Let your child know lots of kids go through this, but no one goes to school and talks about it. Be sensitive to your child's feelings. If you don't make a big issue out of bedwetting, chances are your child won't, either. Protect the bed. Until your child stays dry at night, put a plastic cover under the sheets. This protects the mattress from getting wet and smelling like urine. Let your child help. Encourage your child to help change the wet sheets and covers. This teaches responsibility. It can also keep your child from feeling embarrassed if the rest of the family knows he wet the bed. However, if your child sees this as punishment, it is not recommended. Set a no-teasing rule in your family. Do not let family members, especially siblings, tease your child. Let them know that it's not his fault. Take steps before bedtime. Have your child use the toilet and avoid drinking large amounts of fluid just before bedtime. Try to wake him up to use the toilet (1-2 hours after going to sleep) to help him stay dry through the night. Reward him for dry nights, but do not punish him for wet ones.

Bedwetting alarms

If your child is still not able to stay dry during the night after using these steps for 1 to 3 months, your pediatrician may recommend using a bedwetting alarm. When a bedwetting alarm senses urine, it sets off an alarm so the child can wake up to use the toilet. When used correctly, it will detect wetness right away and sound the alarm. Be sure your child resets the alarm before going back to sleep. Bedwetting alarms are successful 50% to 75% of the time. They tend to be most helpful for children who have some dry nights and some bladder control on their own. Ask your pediatrician which type of alarm would be best for your child.

Medicines

Different medicines are available to treat bedwetting. They rarely cure bedwetting, but may help your child, especially in social situations such as sleepovers. However, they are usually a last resort and are not recommended for children younger than 5 years. Also, some of these medicines have side effects. Your pediatrician can tell you more about these medicines and if they are right for your child.

Beware of "cures"

There are many treatment programs and devices that claim they can "cure" bedwetting. Be careful; many of these products make false claims and promises and may be very expensive. Your pediatrician is the best source for advice about bedwetting. Talk with your pediatrician before your child starts any treatment program. Published online: 2/07 Source: Bedwetting (Copyright © 2006 American Academy of Pediatrics, Updated 12/05)


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Breastfeeding

Breastfeeding Your Baby

One of the most special times in a mother's life is when she is breastfeeding her baby. Experts agree that breastfeeding is best.

Benefits

Breast milk is nature's perfect baby food. Your milk has just the right nutrients, in just the right amounts, to nourish your baby fully.

Baby

There are many reasons why breastfeeding is best for your baby:
  • The colostrums a yellow, watery pre-milk that your breasts make for the first few days after birth helps your newborn's digestive system grow and function.
  • Breast milk has antibodies that help your baby's immune system fight off sickness.
  • The protein and fat in breast milk are better used by the baby's body than the protein and fat in formula.
  • Babies who are breastfed have less gas, fewer feeding problems, and often less constipation than those given formulas.
  • Breastfed babies are at lower risk for sudden infant death syndrome (SIDS).

Mothers

Breastfeeding isn't just good for babies. It's good for mothers, too. Breastfeeding:
  • Is convenient.
  • Releases the hormone oxytocin. This makes the uterus contract and helps it return to its normal size more quickly.
  • May lower your risk of osteoporosis and some forms of cancer.
  • Burns calories.
  • Is cheaper than bottle feeding.
  • Creates a special bond between you and your baby.

Facts About Breastfeeding

During pregnancy, your nipples may start to drip a little colostrum. After you give birth, your body sends a signal to your breasts to start making milk. Within a few days, colostrum is replaced by milk. Once feeding is established, the first milk that flows out of your breasts is watery and sweet. This quenches the baby's thirst and provides sugar, proteins, minerals and fluid. As the feeding goes on, the milk becomes thick and creamy. This milk will give your baby the nutrients he or she needs to grow.

Getting Started

Although breastfeeding is a natural process, it may take some practice and patience to master. Mothers and babies have to learn together. To help give you a good start, during pregnancy tell your doctor that you plan to breastfeed. During labor, remind the doctor and nurses that you plan to breastfeed. They can help you get started right after delivery.

How to Breastfeed

Babies are born with the instincts they need to nurse, such as the rooting reflex. Cup your breast in your hand and stroke your baby's lower lip with your nipple. The baby will open his or her mouth wide (like a yawn). Quickly center your nipple in the baby's mouth, making sure the tongue is down, and pull the baby close to you. Bring your baby to your breast ? not your breast to your baby. Let your baby set his or her own nursing pattern. Many newborns nurse for 10 to 15 minutes on each breast. Nurse on demand. When babies are hungry, they will nuzzle against your breast, make sucking motions, or put their hands to their mouth. Crying is a late sign of hunger. When your baby empties one breast, offer the other. Don't worry if your baby doesn't continue to nurse, though.

Diet

When you are pregnant, your body stores extra nutrients and fat to prepare you for breastfeeding. When you are nursing:
  • Eat a well-balanced diet.
  • Make sure you get 1,000 mg of calcium a day.
  • Avoid foods that bother the baby.
  • Drink at least eight glasses of liquid a day.

Sex and Birth Control

When you are ready to resume having sex, think about birth control. Even though you may not have menstrual periods while you are breastfeeding, you can still get pregnant. Talk with your doctor about what form of birth control is right for you. Barrier methods such as latex condoms or a copper intrauterine device (IUD) are good options because they do not affect your milk supply.

Work

Many mothers keep nursing their babies after they return to work. If you want to breastfeed when you go back to work, you may want to look into buying or renting a breast pump. Any breast milk is better than no breast milk. Try to breastfeed without supplementation for at least the first 6 months of your baby's life if you can.

Breast Health

As they start to breastfeed, some women may have a few minor problems. Problems that may occur include:
  • Engorgement
  • Sore nipples
  • Blocked ducts
  • Mastitis (an infection of the breast caused by bacteria in the milk ducts)
Most often problems are easy to treat. If you have any of these signs of a problem, contact your doctor:
  • Fever
  • Pain
  • Bleeding
  • Rash
  • Lumps
  • Redness
To keep your breasts healthy and to increase the chances of breastfeeding success, try these tips:
  • Learn proper nursing technique.
  • Use your finger to break the suction before you remove your breast from your baby's mouth.
  • Gently pat your nipples dry with a clean cloth after feedings.
  • Use only cotton bra pads.
  • Apply 100 percent pure lanolin to your nipples after feeding.
  • Don't wash your nipples with harsh soaps or use perfumed creams.
  • If one nipple is tender, offer the other breast first.

Finally ?

Breastfeeding is a special gift of love and health only you can give your baby. Breastfeeding is natural, but it takes practice. You and your baby can learn together.


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Bronchiolitis

What is Bronchiolitis?

Bronchiolitis is infection and inflammation (swelling and blocking) of the very smallest breathing tubes in your child's lungs, called the bronchioles. It is caused by infection with a virus, most often the very common respiratory syncytial virus (RSV). As the small airways become narrowed or blocked, you may hear wheezing (high pitched sounds coming from the lungs) as your child breathes. If bronchiolitis becomes severe, your child may have difficulty getting enough air. If this happens, he or she may need to be admitted to the hospital for oxygen and other treatments.

What does it look like?

Bronchiolitis starts off with the symptoms of a typical cold, with sneezing and a runny nose. Your child may recently have been exposed to an older child with a cold. He or she may also have a fever. After a few days, your child may develop more severe breathing-related problems, such as:
  • Coughing or wheezing (high pitched sounds coming from the chest, especially when your child is breathing out).
  • Shortness of breath (as if your infant is having trouble getting enough air).
  • Fast breathing, which may make it difficult for your infant to nurse or feed.
  • Dehydration (not drinking enough fluid), which may result from feeding difficulties. Symptoms of dehydration include:
    • Decreased urination
    • Dryness inside the mouth
  • Agitation or irritability may be a sign that your child is not getting enough oxygen. Get medical help as soon as possible.
More severe signs of difficulty breathing (respiratory distress). Take your child to the emergency room immediately if any of the following symptoms occur:
  • Chest caves in, ribs stick out, belly goes up and down, and nostrils flare (called retractions)
  • Skin turns blue (called cyanosis). This is an emergency - call 911.

What causes bronchiolitis?

Bronchiolitis in infants is caused by viruses, most commonly RSV. Nearly all infants have been exposed to RSV by age 2. In older children and adults, RSV usually causes a cold. Only in infants and toddlers does the infection get into the small breathing tubes, causing bronchiolitis. Bronchiolitis is not caused by infection with bacteria, so antibiotic treatment probably will not will not be prescribed. Antibiotics may be recommended if your doctor suspects a bacterial infection is present in addition to bronchiolitis.

What puts your child at risk of bronchiolitis?

  • Bronchiolitis usually occurs in infants under 2 years of age. Severe bronchiolitis requiring hospitalization is more likely in infants under 6 months old.
  • It often occurs after exposure of your infant to older children with colds.
  • It mainly occurs during "cold season," that is, late fall and winter.
  • Premature infants and those with other lung diseases are more likely to develop severe bronchiolitis.

Can bronchiolitis be prevented?

The best prevention for bronchiolitis is taking whatever steps you can to avoid spreading colds. Avoid exposing your infant to older children with colds if possible. Wash your hands frequently, especially during cold season. Premature infants and those with certain lung diseases may be treated with infection-fighting bodies called immunoglobulins to prevent RSV disease.

What are some possible complications of bronchiolitis?

Even when bronchiolitis is severe enough to require hospitalization, most children recover completely. However, it may take a couple of weeks before all of your child's symptoms clear up.


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Car Seat Safety

Car Safety Seats: A Guide for Families 2006

Each year thousands of young children are killed or injured in car crashes. You can help prevent this from happening to your child by always using car safety seats and seat belts correctly. The information below explains how.

Which car safety seat is the best?

No one seat is the "best" or "safest." The best seat is the one that fits your child's size, is correctly installed, and is used properly every time you drive. When shopping for a car safety seat, keep the following in mind: Don't base your decision on price alone. Higher prices can mean added features that may or may not make the seat safer or easier to use. All car safety seats available for purchase in the United States must meet very strict safety standards established and maintained by the federal government. When you find a seat you like, try it out. Put your child in it and adjust the harnesses and buckles. Make sure it fits properly and securely in your car. Keep in mind that pictures or displays of car safety seats in stores may not show them being used the right way.

Important safety rules

  • Always use a car safety seat. You can start with your baby's first ride home from the hospital.
  • Never place a child in a rear-facing car safety seat in the front seat of a vehicle that has a passenger air bag.
  • The safest place for all children to ride is in the back seat.
  • Set a good example - always wear your seat belt. Help your child form a lifelong habit of buckling up.
  • Remember that each car safety seat is different. Read and keep the instructions that came with your seat handy, and follow the manufacturer's instructions at all times.
  • Read the owner's manual that came with your car on how to correctly install car safety seats.
  • If you need help installing your car safety seat, contact a certified Child Passenger Safety (CPS) Technician. To locate and set up an appointment, call toll-free at 866/SEATCHECK (866/732-8243) or visit www.seatcheck.org.

Rear-facing seats

All infants should ride rear-facing until they have reached at least 1 year of age and weigh at least 20 pounds. That means that if your baby reaches 20 pounds before her first birthday, she should remain rear-facing until she turns 1. There are 2 types of rear-facing seats: infant-only seats and convertible seats. Convertible seats can be used rear-facing for infants, and then converted to a forward-facing position once the child is old enough and big enough to do so safely.

Infant-only seats

  • Small and have carrying handles (sometimes come as part of a stroller system).
  • Have a built-in harness that covers the child's upper torso.
  • Can only be used for infants from birth up to 20 to 30 pounds, depending on model.
  • Many come with a detachable base, which can be left in the car. The seat clicks into and out of the base, which means you don't have to install it each time you use it.

Convertible seats (used rear-facing)

  • Are used rear-facing for infants from birth to at least 1 year of age and at least 20 to 22 pounds. Can also be used forward-facing by older children.
  • Have higher rear-facing weight limits than infant-only seats. These are ideal for bigger babies.
  • Have the following 3 types of harnesses:
    • 5-point harness - 5 points of attachment: 2 at the shoulders, 2 at the hips, 1 at the crotch
    • Overhead shield - A padded tray-like shield that swings down over the child
    • T-shield - A padded t-shaped or triangle-shaped shield attached to the shoulder straps

Features to look for in rear-facing seats

Harness slots. Look for seats that come with more than one harness slot to give your baby room to grow. The harnesses should be in the slots at or below your baby's shoulders. Adjustable buckles and shields. Many rear facing seats have 2 or more buckle positions for growing babies. Many overhead shields can be adjusted as well. Other features. Angle indicators (built-in angle adjusters that help you get the proper recline) and head support systems are other features that can help you install the seat the right way. Once your child is at least 1 year of age and at least 20 pounds, he can ride forward-facing. However, it is best for him to ride rear-facing until he reaches the highest weight or height limit allowed by the car safety seat. There are many types of seats that can be used forward-facing including convertible seats, built in seats, combination forward-facing/booster seats, and travel vests.

Convertible seats (used forward-facing)

As mentioned previously, convertible seats can also be used forward-facing by children who are at least 1 year of age and weigh at least 20 pounds. However, if you have used your convertible seat rear-facing, you need to make the following 3 adjustments before using it forward-facing:
  1. Move the shoulder straps to the slots that are at or above your child's shoulders. On many convertible seats, the top harness slots must be used when the seat is in the forward-facing position. Check the instructions to be sure.
  2. Move the seat from the reclined to the upright position if required by the manufacturer of the seat.
  3. Make sure the seat belt runs through the forward-facing belt path.
When converting your seat from rear-facing to forward-facing, carefully follow the car safety seat manufacturer's instructions.

Built-in seats

Built-in seats are available in some cars and vans. Weight and height limits vary. Read your vehicle owner's manual or contact the manufacturer for details about how these seats are used. Combination forward-facing/booster seats Some car safety seats combine the features of a forward-facing seat and a booster seat. These seats come with harness straps for children who weigh up to 40 to 65 pounds (depending on the model). Once your child reaches the weight or height limit, you can use the seat as a booster by removing the harness and using your vehicle's lap and shoulder seat belts. Keep in mind that when using the harness straps, the seat can be secured with a lap and shoulder belt or a lap-only belt. However, once you remove the harness, you must use a lap and shoulder seat belt. Children must never ride in a booster seat using a lap belt only because serious injury can result.

Travel vests

If your car only has lap belts, a travel vest may be an option. These can also be used for a child who has outgrown his seat with a harness but is not yet ready for a booster seat.

Booster seats

Booster seats do not come with harness straps but are used with the lap and shoulder seat belts in your vehicle, the same way an adult rides. Your child should stay in a car safety seat with a harness as long as possible before being allowed to ride in a booster seat. You can tell when your child is ready for a booster seat when one of the following is true: She reaches the top weight or height allowed for her seat with a harness. (These measurements are listed on labels on the seat and are also included in the instruction booklet that is provided with the car safety seat.) Booster seats are designed to raise your child so that the lap and shoulder seat belts fit properly. This means the lap belt lies low across your child's thighs and the shoulder belt crosses the middle of your child's chest and shoulder. Correct belt fit helps protect the stomach, spine, and head from injury in case of a crash. Both high-back and backless booster seats are available. Booster seats should be used until your child can correctly fit in lap and shoulder seat belts.

Seat belts

Your child is ready to use lap and shoulder seat belts when the belts fit properly. This means:
  • The shoulder belt lies across the middle of the chest and shoulder, not the neck or throat.
  • The lap belt is low and snug across the thighs, not the stomach.
  • The child is tall enough to sit against the vehicle seat back with her legs bent without slouching and can stay in this position comfortably throughout the trip.
Remember, seat belts are made for adults. If the seat belt does not fit your child correctly, he should stay in a booster seat until the adult seat belts fit him correctly. This is usually when the child reaches about 4' 9" in height and is between 8 and 12 years of age.

Other points to keep in mind when using seat belts

  • Never tuck the shoulder belt under the child's arm or behind the back.
  • If there's only a lap belt, make sure it's snug and low on the child's thighs, not across the stomach. Try to get a lap and shoulder belt installed in your car by a dealer.
  • Never allow children or anyone else to "share" seat belts. All passengers must have their own car safety seats or seat belts.

A warning about seat belt adjusters

There are products on the market that claim to make seat belts fit better. They attach to the seat belt but are not a part of the original belt. These products may actually interfere with proper lap and shoulder belt fit by causing the lap belt to ride too high on the stomach and making the shoulder belt too loose, and may even damage the seat belt itself. No federal standard ensuring the effectiveness and safety of these after-market products has been developed. In addition, most vehicle and car safety seat manufacturers do not recommend their use. Until the National Highway Traffic Safety Administration develops safety standards for these products, the American Academy of Pediatrics (AAP) recommends they not be used. As long as children are riding in the correct car safety seat for their size and age, they do not need to use any additional devices.

Installing a car safety seat

There are 2 main things to remember when installing a car safety seat.
  • Your child must be buckled snugly into the seat.
  • The seat must be buckled tightly into your vehicle.
Ask yourself the following questions to make sure both are done correctly. If you are not sure, check the instructions that came with your car safety seat, or contact a certified CPS Technician for help.

Is the child buckled into the car safety seat correctly?

  • Are you using the correct harness slots?
  • Are the harnesses snug?
  • Have you placed the plastic harness clip (if your seat comes with one) at armpit level to hold the shoulder straps in place?
  • Do the harness straps lie flat?
  • Is your baby dressed in clothes that allow the straps to go between the legs? It's OK to adjust the straps to allow for thicker clothes, but make sure the harness still holds the child snugly. Also, remember to tighten the straps again after the thicker clothes are no longer needed.
  • Is anything under your baby? Tuck blankets around your baby after adjusting the harness straps snugly. Never place them under your baby.
  • Is your child slouching down or to the side? If so, pad the sides of the seat and between the crotch with rolled up diapers or blankets.

Is the car safety seat buckled into the vehicle correctly?

  • Is the car safety seat facing the right direction for your child's age and weight?
  • Is the seat belt routed through the correct belt path?
  • Is the seat belt buckled tight? If you can move the seat more than an inch side to side or toward the front of the car, it's not tight enough.
  • Is your rear-facing seat reclined enough? Your infant's head should not flop forward. If it does, tilt the car safety seat back a little. Your car safety seat may have a built-in recline adjuster for this purpose. If not, wedge firm padding, such as a rolled towel, under the base.
  • Do you need a locking clip? They come with all new car safety seats. If the seat belts in your car move freely even when buckled, you need a locking clip. If you're not sure, check the manual that came with your car. Locking clips are not needed in most newer vehicles and in vehicles with LATCH. (See "Installation made safer and easier" below for more information.)
Some lap belts (especially those found in older vehicles) need a special heavy-duty locking clip. These are only available from the vehicle manufacturer. Check the manual that came with your car for more information.

Installation made safer and easier

Child passenger safety experts have developed several ways to make car safety seat installation safer and easier, including the following:
  • LATCH (Lower Anchors and Tethers for Children) is an attachment system that makes installing a car safety seat easier by eliminating the need to use seat belts to secure the car safety seat. It includes 2 sets of small bars, called anchors, located in the back seat where the cushions meet. Car safety seats that come with LATCH have a set of attachments that fasten to these vehicle anchors. Nearly all passenger vehicles and all car safety seats made on or after September 1, 2002, come with LATCH. However, unless both your vehicle and the car safety seat have this anchor system, you will still need to use seat belts to secure the car safety seat.
  • A tether is a strap that attaches a car safety seat to an anchor located on the rear window ledge, the back of the vehicle seat, or on the floor or ceiling of the vehicle. Tethers give extra protection by keeping the car safety seat and the child's head from moving too far forward in a crash or sudden stop. Tethers should not be confused with LATCH attachments; the tether is a longer strap at the top of the seat and LATCH attachments are located at or near the base of the seat. All new cars, minivans, and light trucks have been required to have tether anchors since September 2000. Most new forward-facing car safety seats and a few rear-facing car safety seats come with tethers. For older car safety seats, tether kits are available. It is highly recommended that tethers be used because they greatly improve the protection of your child in the event of a crash. Check with the car safety seat manufacturer to find out how you can get a tether for your seat if yours does not have one.
  • Child Passenger Safety (CPS) Technicians can help you. If you have more questions about installing your car safety seat, a certified CPS Technician may be able to help. A list of certified CPS Technicians is available by state or ZIP code on the National Highway Traffic Safety Administration (NHTSA) Web site at www.nhtsa.dot.gov/people/injury/childps/contacts/. A list of inspection stations- where you can go for help with installation-is available in both English and Spanish at www.seatcheck.org or toll-free at 866/SEATCHECK (866/732-8243). You can also get this information by calling the toll-free NHTSA Auto Safety Hot Line at 888/DASH-2-DOT (888/327-4236), from 8:00 am to 10:00 pm ET, Monday through Friday.

Common questions about car safety seats

Q: What if my baby is born prematurely?

A: Use a car safety seat without a shield harness. Shields often are too high and too far from the body to fit correctly. A small baby's face could hit a shield in a crash. Premature infants should be observed in their car safety seats while still in the hospital to make sure the reclined position does not cause low heart rate, low oxygen, or breathing problems. If your baby needs to lie flat during travel, use a crash-tested car bed. If possible, an adult should ride in the back seat next to your baby to watch him closely.

Q: What if my baby weighs more than 20 pounds but is not 1 year old yet?

A: Many babies reach 20 pounds well before their first birthday. However, just because your baby weighs more than 20 pounds does not make him ready to ride forward facing. Look for a convertible seat that can be used rear-facing by children who weigh more than 20 pounds.

Q: What if my child has special health care needs?

A: Children with special health problems may need other restraint systems. Talk about this with your pediatrician. Easter Seals, Inc has car safety seat programs for children with special health care needs. More information is available from Easter Seals, Inc at 800/221-6827. You also can learn more about transporting children with special needs by calling the Automotive Safety Program at 317/274-2977 or by visiting its Web site at www.preventinjury.org. For more information and a list of car safety seats available for children with special needs, see the AAP brochure, Safe Transportation of Children With Special Needs: A Guide for Families.

Q: What if my car has air bags?

A: All new cars come equipped with air bags. When used with seat belts, air bags work very well to protect older children and adults. However, air bags are very dangerous to children riding in rear-facing car safety seats and to child passengers who are not properly positioned. If your car has a passenger air bag, infants in rear-facing seats must ride in the back seat. Even in a low-speed crash, the air bag can inflate, strike the car safety seat, and cause serious brain and neck injury and death. Toddlers who ride in forward-facing car safety seats also are at risk from air bag injuries. All children up to age 13 years are safest in the back seat. If you must put an older child in the front seat, slide the vehicle seat back as far as it will go. Make sure your child is properly restrained for his age and size and stays in the proper position at all times. This will help prevent the air bag from striking your child. Air bag on/off switches are available in the few cases in which an infant must ride in the front seat. Most families don't need to use the air bag on/off switch. Air bags that are turned off cannot protect other passengers riding in the front seat. Air bag on/off switches only should be used if all of the following are true:
  • Your child has special heath care needs.
  • Your pediatrician recommends constant supervision of your child during travel.
  • No other adult can ride in the back seat with your child.
  • On/off switches also must be used if you have a vehicle with no back seat or a back seat that is not made for passengers.

Q: What if my car has side air bags?

A: Side air bags improve safety for adults in side impact crashes. However, children who are seated near a side air bag may be at risk for serious injury. Read your vehicle owner's manual for recommendations that apply to your vehicle.

Q: What if my car only has lap belts in the back seat?

A: Lap belts work fine with infant-only, convertible, and forward-facing car safety seats. They cannot be used with booster seats, and they are not the safest way to buckle older children. If your car only has lap belts, use a forward-facing car safety seat with a harness and higher weight limits. Other options are
  • Check with a car dealer or the manufacturer of your car to see if shoulder belts can be installed.
  • Use a travel vest (some can be used with lap belts).
  • Consider buying another car with lap and shoulder belts in the back seat.

Q. What if I drive more children than can be buckled safely in the back seat?

A: Avoid having to drive more children than can be buckled safely in the back seat, especially if your car has passenger air bags. However, if necessary, a child in a forward facing car safety seat with a harness may be the best choice to ride in the front seat. This is because a child who is in a booster seat or using a regular seat belt can easily move out of position and be at greater risk for injuries from the air bag.

Q: Can I use a car safety seat on an airplane?

A: The Federal Aviation Administration (FAA) and the AAP recommend that when flying, children should be securely fastened in car safety seats until 4 years of age, and then should be secured with the airplane seat belts. This will help keep them safe during takeoff and landing or in case of turbulence. Most infant, convertible, and forward-facing seats are certified to be used on airplanes. Booster seats and travel vests are not certified to be used on airplanes. Check the label on your car safety seat and call the car safety seat manufacturer before you travel to be sure your seat meets current FAA regulations.

Q: Can I use a car safety seat that was in a crash?

A: If the car safety seat was in a moderate or severe crash, it needs to be replaced. If the crash was minor, the seat does not automatically need to be replaced. A crash is considered minor if all of the following are true:
  • The vehicle could be driven away from the crash.
  • The vehicle door closest to the car safety seat was not damaged.
  • No one in the vehicle was injured.
  • The air bags did not go off.
  • You can't see any damage to the car safety seat.
If you are unsure, call the manufacturer of the seat. See the resource section for manufacturer names and phone numbers.

Q: What about using a used car safety seat?

A: Avoid using used car safety seats, especially if obtained from a yard sale or secondhand (consignment) shop because there is no way to know the seat's history. Also never use a car safety seat that
  • Is too old. Look on the label for the date it was made. Do not use seats that are more than 10 years old. Many manufacturers recommend that car safety seats only be used for 5 to 6 years from the date of manufacture. Check with the manufacturer to find out how long the company recommends using its seat.
  • Has any visible cracks in the frame of the seat.
  • Does not have a label with the date of manufacture and model number. Without these, you cannot check to see if the seat has been recalled.
  • Does not come with instructions. You need them to know how to use the seat. You can get a copy of the instruction manual by contacting the manufacturer.
  • Is missing parts. Used car safety seats often come without important parts. Check with the manufacturer to make sure you can get the right parts.
  • Is a shield booster. Although shield boosters are still around, the AAP recommends against their use. Major injuries have occurred to children in shield boosters. The only time shield boosters should be used is if the shield is removed and the seat is used with a lap and shoulder belt.
  • Was recalled. You can find out by calling the manufacturer or by contacting the following:
    • Auto Safety Hot Line: Toll-free: 888/DASH-2-DOT (888/327-4236), from 8:00 am to 10:00 pm ET, Monday through Friday.
    • National Highway Traffic Safety Administration (NHTSA) www-odi.nhtsa.dot.gov/cars/problems/recalls/childseat.cfm
If the seat has been recalled, be sure to follow the instructions to fix it or to get the parts you need. You also may get a registration card for future recall notices from the hotline.


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Constipation

How do I know if my child is constipated?

Your child is constipated if one or more of the following are true:
  • He or she has fewer than 3 bowel movements a week.
  • The stools are hard, dry and unusually large.
  • The stools are difficult to pass.

What causes constipation?

Constipation is likely to happen when your child doesn't drink enough water, milk or fruit juices, or if your child doesn't eat a healthy diet that includes enough fiber. Fiber is found in foods such as cereals, grains, fruits and vegetables. If your child eats a diet high in fat and refined sugars (candy and desserts), he or she is probably not getting fiber, which may result in constipation. Constipation may also begin when you change your baby from breast milk or baby formula to whole cow's milk, and when your switch from baby food to solid food. Young children often ignore the urge to have a bowel movement and may become constipated. Your child may not want to interrupt play, ask a teacher or use a public restroom. Sometimes constipation happens after your child has been sick or has taken certain medicines. You should not be concerned if your child becomes constipated. Constipation is common in children and usually goes away on its own.

What can I do if my child is constipated?

There are 3 things you can do to help your child:
  1. Diet--You can start by increasing the amount of fluid your child drinks every day. It may also help to give your baby a bottle of prune juice every day, or add corn syrup or brown sugar to your baby's formula until his or her bowel movements become regular. Check with your doctor about how much corn syrup or brown sugar to add. You can give an older child large quantities of fluids every day, as well as prune juice, bran cereal, and fruits and vegetables that are high in fiber.
  2. Bowel habit training--Your child should be taught not to wait to have a bowel movement. To establish a regular bowel habit, ask your child to sit on the toilet for at least 10 minutes at about the same time each day, preferably after a meal. Make sure your child can place his or her feet firmly on the floor while sitting on the toilet. If this is not possible, put a footstool in front of the toilet. While your child is sitting on the toilet, you might let your child read a story book or listen to the radio.
  3. Medicine--Many laxatives are available to treat constipation in children. The choice of laxative depends on the age of your child and how serious the constipation is. Ask your family doctor to suggest a brand name and tell you how much to use.
If the constipation doesn't get better, take your child to see your family doctor. Constipation can sometimes be a sign of a more serious problem.

CHILDREN'S DIET FOR CONSTIPATION

Children with constipation need more bulky foods and more fluids. Use more of these bulky foods: Raw Vegetables - Carrots, cabbage, tomatoes, celery, lettuce, cauliflower Raw Fruits - Apples and pears (with peeling), oranges, grapes Dried Fruits - As is or cooked: Prunes, raisins, apricots Leafy Green Vegetables - Spinach, broccoli, turnip greens Bulky Grain Products - Whole Wheat bread, 40% Bran flakes, Bran buds, All bran, Shredded wheat, Graham crackers A child needs 2 cups of milk daily but no more when constipated. Increase fluids by using: Water - 4 to 5 extra small glasses daily Fruit Juices - (Not fruit drinks or fruit aides) Prune, orange and apple juices are good

Eliminate these concentrated foods:

  • Cheese
  • Sweets (such as candy, puddings, rich fillings like pecan pie or custard)
  • Bananas
  • Peanut Butter


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Cronobacter

Symptoms of Cronobacter

Sicknesses from Cronobacter look different depending on the person.

Babies (less than 1 year old): In babies, especially babies less than 2 months old, Cronobacter germs usually get in the blood or make the lining of the brain and spine swell (meningitis). Sickness from Cronobacter in babies will usually start with a fever and poor feeding, crying, or very low energy. Some babies may also have seizures. Babies with meningitis may develop serious, long-lasting problems in their brains. Up to 4 out of 10 babies with meningitis from Cronobacter can die.

People of all ages: Cronobacter can cause problems in cuts, scrapes, or places where people have had operations. Cronobacter can also get into your urinary tract. Older people and people with weakened immune systems (for example, people being treated with immune-suppressing drugs for cancer, organ transplants, or other illnesses, or those with HIV infection or genetic conditions that affect the immune system) may also get Cronobacter in their blood.

Sources

How Cronobacter is Spread

Sometimes powdered formula gets germs in it while it is being made at the factory. Other times, Cronobacter can get into powdered infant formula after it was opened at home or somewhere else. Since Cronobacter germs live in the environment, there might be other ways babies can catch it. We do not know if Cronobacter infection can be spread from one person to another, but other types of bacteria spread this way, especially in hospitals if people do not wash their hands well.

Risks from Factories and Homes

Powdered baby formula is not germ-free. Factory workers report that it is not possible to remove all germs from powdered baby formula. At the factory,Cronobacter could get into formula powder if dirty ingredients are used to make the formula or if the formula powder touches a Cronobacter-covered surface in the factory.

At home, Cronobacter could get into the formula if formula lids or scoops are placed on Cronobacter-covered surfaces and later touch the formula or if the formula is mixed with water or in a bottle that has Cronobacter in it.

People at Risk

Any person can get sick from Cronobacter. Babies, older people, and people with weakened immune systems (for example, people being treated with immune-suppressing drugs for cancer, organ transplants, or other illnesses, or those with HIV infection or genetic conditions that affect the immune system) seem to get it more often. Meningitis from Cronobacter almost always happens in babies less than 2 months old. Almost all babies with Cronobacter have been fed powdered infant formula. Almost none have been fed only breast milk or liquid formula.

Testing & Treatment

Cronobacter can be found by testing blood or other samples in the lab.

Babies whose blood might have Cronobacter need to go to a doctor or hospital right away so they can get germ-fighting medicine called antibiotics. Babies who have meningitis from Cronobacter usually need special tests to look at the brain.

Adults are treated with antibiotics, too.

Prevention & Control

Getting sick with Cronobacter does not happen often, but infections in babies can be fatal.

Powdered infant formula is not sterile.

Manufacturers report that, using current methods, it is not possible to eliminate all germs from powdered infant formula in the factory.

When a source of a baby’s Cronobacter infection has been found, nearly all have been associated with consumption of reconstituted powdered infant formula. In several outbreak investigations, Cronobacter has been found in powdered infant formula that had been contaminated in the factory. In other cases, Cronobacter might have contaminated the powdered infant formula after it was opened at home or elsewhere.

Very young infants, infants born prematurely, and infants with weakened immune systems are at the highest risk.

Breastfeeding is the best option for feeding your baby. If you use infant formula, try to choose formula sold in liquid form because it is made to be sterile. Practice careful hygiene (e.g. handwashing, cleaning and sterilizing feeding bottles, clean preparation areas, etc.,) when preparing formula and giving it to your baby to help prevent Cronobacter infection. Specific steps you can take to decrease the risk of Cronobacter infection are outlined in more detail below.

To best protect your infant, here are some things you can do:

Breastfeeding:

Breastfeeding helps prevent many kinds of infections among infants. Almost no cases of Cronobacter infection have been reported among infants who were being exclusively breastfed (meaning, the baby was fed only breast milk and no formula or other foods).

If you use a breast pump, practicing careful hygiene can reduce the risk of germs getting into the milk.

  • Read all of the instructions that came with your pump, and make sure you understand the manufacturer’s instructions for handling and cleaning your pump’s flanges, valves, and collection bottles. Learn which parts must be washed and the best method for removing, cleaning, and drying parts that need to be cleaned.
  • Clean your baby’s feeding bottles in a dishwasher or by hand.
    • In a dishwasher, use hot water and a heated drying cycle.
    • By hand, scrub in hot, soapy water in a tub or basin reserved for washing bottles, then rinse well and air dry on a clean rack or dish towel.
    • Consider using a bottle sterilizer or boiling the bottles after washing and rinsing them by hand.
  • Wash your hands with soap and water before pumping, and be sure  anyone preparing bottles or feeding your baby washes their hands with soap and water first.
If you baby gets formula, choose infant formula sold in liquid form, especially when your baby is a newborn or very young: Liquid formulations of infant formula are made to be sterile and should not transmit Cronobacter infection when handled carefully. To prevent contamination of liquid formula:
  • Wash hands with soap and water before preparing bottles or feeding your baby.
  • Clean your baby’s feeding bottles in a dishwasher or by hand. In a dishwasher, use hot water and a heated drying cycle. By hand, scrub in hot, soapy water in a  tub or basin reserved for washing bottles, then rinse well and air dry on a clean rack or dish towel. Consider using a bottle sterilizer or boiling the bottles after washing and rinsing them by hand.
  • If your baby does not finish drinking a bottle within 2 hours, throw away the unfinished formula.
If your baby gets powdered formula, follow these steps: If your baby gets powdered infant formula, there are things you can do to protect your baby from infections – not just from Cronobacter infections. Good hygiene, mixing the formula with water hot enough to kill germs, and safely storing formula can prevent growth of Cronobacter bacteria and other germs. These are keys to keeping your baby safe and healthy.
  • Clean up before preparation
    • Wash your hands with soap and water
    • Clean bottles in a dishwasher with hot water and a heated drying cycle, or scrub bottles in hot, soapy water and then sterilize them
    • Clean work surfaces, such as countertops and sinks
  • Prepare safely
    • Keep powdered formula lids and scoops clean (be careful about what they touch)
    • Close containers of infant formula or bottled water as soon as possible
    • Use hot water (158° F/70° C and above) to make formula
    • Carefully shake, rather than stir, formula in the bottle
    • Cool formula to ensure it is not too hot before feeding your baby by running the prepared, capped bottle under cool water or placing it into an ice bath, taking care to keep the cooling water from
    • getting into the bottle or on the nipple
    • Before feeding the baby, test the temperature by shaking a few drops on your wrist
  • Use quickly or store safely
    • Use formula within 2 hours of preparation. If the baby does not finish the entire bottle of formula, discard the unused formula.
    • If you do not plan to use the prepared formula right away, refrigerate it immediately and use it within 24 hours. Refrigeration slows bacterial growth and increases safety.
    • When in doubt, throw it out. If you can't remember how long you have kept formula in the refrigerator, it is safer to throw it out than to feed it to your baby.
Practice proper hygiene:
  • Always wash your hands carefully with soap and water during key times.
    • Before preparing and feeding bottles or foods to your infant.
    • Before touching your infant's mouth.
    • Before touching pacifiers or other things that go into your infant's mouth.
    • After using the toilet or changing diapers.
  • If soap and water aren't available, use an alcohol-based hand sanitizer. These  alcohol-based products can quickly reduce the number of germs on hands in some situations, but they are not a substitute for washing with soap and water.
  • It is also important to keep all objects that enter infants' mouths (such as pacifiers and teethers) clean.
Content source: Centers for Disease Control and Prevention

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Enuresis

Enuresis (Bed-Wetting)

What is enuresis?

Enuresis (say "en-yur-ee-sis") is the medical term for bed-wetting during sleep. Bed-wetting is fairly common and is often just a developmental stage. Bed-wetting is more common among boys than girls. What causes bed-wetting? Some of the causes of bed-wetting include the following:
  • Genetic factors (it tends to run in families)
  • Difficulties waking up from sleep
  • Stress
  • Slower than normal development of the central nervous system (which reduces the child's ability to stop the bladder from emptying at night)
  • Hormonal factors (not enough antidiuretic hormone is produced, which is the hormone that slows urine production at night)
  • Urinary tract infections
  • Abnormalities in the urethral valves in boys or in the ureter in girls or boys
  • Abnormalities in the spinal cord
  • A small bladder
  • Bed-wetting is not a mental or behavior problem. It doesn't happen because the child is too lazy to get out of bed to go to the bathroom.
  • When do most children achieve bladder control?

Children achieve bladder control at different ages. By the age of 6 years, most children no longer urinate in their sleep. Bed-wetting up to the age of 6 is not unusual, even though it may be frustrating to parents. Treating a child for bed-wetting before the age of 6 is not usually necessary.

How can my family doctor help?

First, your doctor will ask questions about your child's daytime and nighttime bathroom habits. Then your doctor will do a physical exam and probably a urine test (called a urinalysis) to check for infection or diabetes. Although most children who wet the bed are healthy, your doctor will also check for problems in the urinary tract and the bladder.

Your doctor may also ask about how things are going at home and at school for your child. Although you may be worried about your child's bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your doctor will also ask about your family life, because treatment may depend on changes at home.

What are the treatments for bed-wetting?

Most children outgrow bed-wetting without treatment. However, you and your doctor may decide your child needs treatment. There are 2 kinds of treatment: behavior therapy and medicine.

Behavior therapy helps teach your child not to wet the bed. Some behavioral treatments include the following:
  • Limit fluids before bedtime.
  • Have your child go to the bathroom at the beginning of the bedtime routine and then again right before going to sleep.
  • An alarm system that rings when the bed gets wet and teaches the child to respond to bladder sensations at night.
  • A reward system for dry nights.
  • Asking your child to change the bed sheets when he or she wets.
  • Bladder training: having your child practice holding his or her urine for longer and longer times during the day, in effort to stretch the bladder so it can hold more urine.

What kinds of medicines are used to treat bed-wetting?

Your doctor may give your child medicine if your child is 7 years of age or older and if behavior therapy has not worked. But medicines aren't a cure for bed-wetting. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. These medicines may have side effects, such as dry mouth and flushing of the cheeks.

How can I help my child cope with wetting the bed?

Bed-wetting can lead to behavior problems because of the guilt and embarrassment a child feels. It's true that your child should take responsibility for bed-wetting (this could mean having your child help with the laundry). But your child shouldn't be made to feel guilty about something he or she cannot control. It's important for your child to know that bed-wetting isn't his or her "fault." Punishing your child for wetting the bed will not solve the problem.

It may help your child to know that no one knows the exact cause of bed-wetting. Explain that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child).

Remind your child that it's okay to use the bathroom during the night. Place nightlights leading to the bathroom so your child can easily find his or her way. You may also cover your child's mattress with a plastic cover to make cleanup easier. If accidents occur, praise your child for trying and for helping clean up.



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Febrile Seizures

What are Febrile Seizures?

Febrile seizures are convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes. Less commonly, a child becomes rigid or has twitches in only a portion of the body. Most febrile seizures last a minute or two; some can be as brief as a few seconds, while others last for more than 15 minutes. Febrile seizures usually occur in children between the ages of 6 months and 5 years and are particularly common in toddlers. A few factors appear to boost a child's risk of having recurrent febrile seizures, including young age (less than 15 months) during the first seizures, frequent fevers, and having immediate family members with a history of febrile seizures.

Is there any treatment?

A child who has a febrile seizure usually doesn't need to be hospitalized. If the seizure is prolonged or is accompanied by a serious infection, or if the source of the infection cannot be determined, a doctor may recommend that the child be hospitalized for observation. Prolonged daily use of oral anticonvulsants, such as phenobarbital or valproate, to prevent febrile seizures is usually not recommended because of their potential for side effects and questionable effectiveness for preventing such seizures.

What is the prognosis?

The vast majority of febrile seizures are harmless. There is no evidence that febrile seizures cause brain damage. Certain children who have febrile seizures face an increased risk of developing epilepsy. These children include those who have febrile seizures that are lengthy or that recur within 24 hours and who have cerebral palsy, delayed development, or other neurological abnormalities.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) conducts research related to febrile seizures in its laboratories at the National Institutes of Health (NIH) and also supports additional febrile seizure research through grants to major medical institutions across the country. NINDS-supported scientists are exploring what environmental and genetic risk factors make children susceptible to febrile seizures. Investigators continue to monitor the long-term impact that febrile seizures might have on intelligence, behavior, school achievement, and the development of epilepsy. Select this link to view a list of studies currently seeking patients.

Organizations

Epilepsy Foundation 8301 Professional Place Landover, MD 20785-7223 postmaster@efa.org http://www.epilepsyfoundation.org Tel: 301-459-3700 800-EFA-1000 (332-1000) Fax: 301-577-2684

Related NINDS Publications and Information

  • Febrile Seizures Fact Sheet Febrile seizures fact sheet compiled by the National Institute of Neurological Disorders and Stroke (NINDS)
  • Seizures and Epilepsy: Hope Through Research Information booklet on seizures, seizure disorders, and epilepsy compiled by the National Institute of Neurological Disorders and Stroke (NINDS).

Publicaciones en Español

  • La Parálisis Cerebral: Esperanza en la Investigación
  • Convulsiones Febriles


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Fever

While you often can tell if your child is warmer than usual by feeling his forehead, only a thermometer can tell if he has a fever and how high the temperature is. There are several types of thermometers and methods for taking your child's temperature. Mercury thermometers should not be used. The American Academy of Pediatrics (AAP) encourages parents to remove mercury thermometers from their homes to prevent accidental exposure to this toxin.

Rectal

If your child is younger than 3 years of age, taking his temperature with a rectal digital thermometer provides the best reading. Clean the end of the thermometer with rubbing alcohol or soap and water. Rinse it with cool water. Do not rinse with hot water. Put a small amount of lubricant, such as petroleum jelly, on the end. Place your child belly down across your lap or on a firm surface. Hold him by placing your palm against his lower back, just above his bottom. With the other hand, turn on the thermometer switch and insert the thermometer 0.5" to 1" into the anal opening. Hold the thermometer in place loosely with two fingers, keeping your hand cupped around your child's bottom. Do not insert the thermometer too far. Hold in place for about one minute, until you hear the "beep." Remove the thermometer to check the digital reading.

Oral

Once your child is 4 or 5 years of age, you may prefer taking his temperature by mouth with an oral digital thermometer. Clean the thermometer with lukewarm soapy water or rubbing alcohol. Rinse with cool water. Turn on the switch and place the sensor under his tongue toward the back of his mouth. Hold in place for about one minute, until you hear the "beep." Check the digital reading. For a correct reading, wait at least 15 minutes after your child has had a hot or cold drink before putting the thermometer in his mouth.

Ear

Tympanic thermometers, which measure temperature inside the ear, are another option for older babies and children. Gently put the end of the thermometer in the ear canal. Press the start button. You will get a digital reading of your child's temperature within seconds. While it provides quick results, this thermometer needs to be placed correctly in your child's ear to be accurate. Too much earwax may cause the reading to be incorrect.

Underarm (Axillary)

Although not as accurate, if your child is older than 3 months of age, you can take his underarm temperature to see if he has a fever. Place the sensor end of either an oral or rectal digital thermometer in your child's armpit. Hold his arm tightly against his chest for about one minute, until you hear the "beep." Check the digital reading. Other methods for taking your child's temperature are available. They are not recommended at this time. Ask your pediatrician for advice.


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Fifth Disease

What's Fifth Disease?

Especially common in kids between the ages of 5 and 15, fifth disease typically produces a distinctive red rash on the face that makes the child appear to have a "slapped cheek." The rash then spreads to the trunk, arms, and legs. Fifth disease is actually just a viral illness that most kids recover from quickly and without complications. Fifth disease (also called erythema infectiosum) is caused by parvovirus B19. A human virus, parvovirus B19 is not the same parvovirus that veterinarians may be concerned about in pets, especially dogs, and it cannot be passed from humans to animals or vice versa. Studies show that although 40% to 60% of adults worldwide have laboratory evidence of a past parvovirus B19 infection, most of these adults can't remember having had symptoms of fifth disease. This leads medical experts to believe that most people with a B19 infection have either very mild symptoms or no symptoms at all. Fifth disease occurs everywhere in the world. Outbreaks of parvovirus tend to happen in the late winter and early spring, but there may also be sporadic cases of the disease any time throughout the year.

Signs and Symptoms

fifthdisease_illustrationFifth disease begins with a low-grade fever, headache, and mild cold-like symptoms (a stuffy or runny nose). These symptoms pass, and the illness seems to be gone until a rash appears a few days later. The bright red rash typically begins on the face. Several days later, the rash spreads and red blotches (usually lighter in color) extend down to the trunk, arms, and legs. The rash usually spares the palms of the hands and soles of the feet. As the centers of the blotches begin to clear, the rash takes on a lacy net-like appearance. Kids younger than 10 years old are most likely to get the rash. Older kids and adults sometimes complain that the rash itches, but most children with a rash caused by fifth disease do not look sick and no longer have fever. It may take 1 to 3 weeks for the rash to completely clear, and during that time it may seem to worsen until it finally fades away entirely. Certain stimuli (including sunlight, heat, exercise, and stress) may reactivate the rash until it completely fades. Other symptoms that sometimes occur with fifth disease include swollen glands, red eyes, sore throat, diarrhea, and rarely, rashes that look like blisters or bruises. In some cases, especially in adults and older teens, an attack of fifth disease may be followed by joint swelling or pain, often in the hands, wrists, knees, or ankles.

Contagiousness

A person with parvovirus infection is most contagious before the rash appears ? either during the incubation period (the time between infection and the onset of symptoms) or during the time when he or she has only mild respiratory symptoms. Because the rash of fifth disease is due to an immune reaction (a defense response launched by the body against foreign substances like viruses) that occurs after the infection has passed, a child is usually not contagious once the rash appears. Parvovirus B19 spreads easily from person to person in fluids from the nose, mouth, and throat of someone with the infection, especially through large droplets from coughs and sneezes. In households where a child has fifth disease, another family member who hasn't previously had parvovirus B19 has about a 50% chance of also getting the infection. Children with fifth disease may attend childcare or school, since they are no longer contagious. Once infected with parvovirus B19, a person develops immunity to it and won't usually become infected again. Parvovirus B19 infection during pregnancy may cause problems for the fetus. Some fetuses may develop severe anemia if the mother is infected while pregnant ? especially if the infection occurs during the first half of the pregnancy. In some cases, this anemia is so severe that the fetus doesn't survive. Fortunately, about half of all pregnant women are immune from having had a previous infection with parvovirus. Serious problems occur in less than 5% of women who become infected during pregnancy.

Prevention

There is no vaccine for fifth disease, and no real way to prevent spreading the virus. Isolating someone with a fifth disease rash won't prevent spread of the infection because the person usually isn't contagious by that time. Practicing good hygiene, especially frequent hand washing, is always a good idea since it can help prevent the spread of many infections.

Incubation

The incubation period (the time between infection and the onset of symptoms) for fifth disease ranges from 4 to 28 days, with the average being 16 to 17 days.

Duration

The rash of fifth disease usually lasts 1 to 3 weeks. In a few cases in older kids and adults, joint swelling and pain because of fifth disease have lasted from a few months up to a few years.

Diagnosis

Doctors can usually diagnose fifth disease by the distinctive rash on the face and body. If a child or adult has no telltale rash but has been sick for a while, a doctor may perform blood tests to see if the illness could be caused by parvovirus B19.

Treatment

Fifth disease is caused by a virus, and it cannot be treated with antibiotics used to treat bacterial infections. Although antiviral medicines do exist, there are currently none available that will treat fifth disease. In most cases, this is such a mild illness that no medicine is necessary. Usually, kids with fifth disease feel fairly well and need little home treatment other than rest. After the fever and mild cold symptoms have passed, there may be little to treat except any discomfort from the rash itself. If your child has itching from the rash of fifth disease, ask the doctor for advice about relieving discomfort. The doctor may also recommend acetaminophen for fever or joint pain.

Complications

The majority of kids with fifth disease recover with no complications. By the time the rash appears and while it's present, they usually feel well and are back to their normal activities. However, some children with weakened immune systems (such as those with AIDS or leukemia) or with certain blood disorders (like sickle cell anemia or hemolytic anemia) may become significantly ill when infected with parvovirus B19. Parvovirus B19 can temporarily slow down or stop the body's production of the oxygen-carrying red blood cells (RBCs), causing anemia. When a child is healthy, this slowdown of red blood cell production usually goes unnoticed because it doesn't affect overall health. But some kids who are already anemic can become sick if their RBC production is further affected by the virus. The RBC levels may drop dangerously low, affecting the supply of oxygen to the body's tissues.

When to Call the Doctor

Call the doctor if your child develops a rash, especially if the rash is widespread over the body or accompanied by other symptoms. If you're pregnant and develop a rash or if you've been exposed to someone with fifth disease (or to anyone with an unusual rash), call your obstetrician. Reviewed by: Joel Klein, MD Date reviewed: November 2007


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Gastroenteritis

DIARRHEA AND VOMITING

The home treatment of diarrhea consists of resting the stomach and intestines. Stop giving your child all solid foods and milk/formula. Feed the child according to the following diet:

DIET INSTRUCTIONS FOR INFANTS (6-12 months)

Clear liquids only for 24 hours: pedialyte or any weak tea, Kool-aid, Gatorade, flat soda, Jello water (1 pkg jello to 4 cups water). No fruit juices or milk. No rice water. It would be best to give the fluids mixed half and half with Pedialyte. After 24 hours on clear liquids, feed the infant on one-half strength formula for the next 24 hours. After 24 hours on one-half strength formula, begin feeding the infant full strength formula. If the infant tolerates the formula and the stools are becoming normal after the third day you may resume solid foods. If your child is vomiting, give small amounts of fluids frequently; for example, 1-2 ounces every 1-2 hours. If he only has diarrhea, give larger amounts less frequently.

DIET INSTRUCTIONS FOR CHILDREN

Clear liquids only for 24 hours: Pedialyte/flat soda/weak tea/popsicles/ Jello/Jello water/Gatorade/Kool-aid - Thirst Quencher It would be best to give the fluids mixed with half and half with Pedialyte. No milk, fruit juices or rice water After 24 hours on clear liquids, you may slowly begin feeding the child bland solid foods: - toast/bananas/applesauce/saltine crackers potatoes/eggs/cereal without milk/rice/apples - pasta without sauce/clear broth soups/boiled or broiled chicken without the skin After 24 hours on the bland diet, you may feed the child a regular diet.

When to Call the Doctor

Call your doctor if you have questions or concerns or if any of the following is true: The child has not urinated for 8 hours. There are no tears when the child cries. There is blood in the vomit. The child has had stomach pain for more than 4 hours. The child has a fever exceeding 102°F. It is hard to wake the child. - You suspect the child might have eaten something poisonous, such as spoiled food or a household chemical. - Frequent vomiting has continued for more than 24 hours. The child does not improve within 48 hours or seems to be getting worse.


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Gastroesophageal Reflux

What happens when my baby spits up?

Babies spit up when they've eaten too much or when they're burped. It can also happen when your baby is drooling. Spitting up is not vomiting. Babies usually don't notice when they spit up, while vomiting is forceful and painful. Spitting up is a common occurrence for most babies. The medical term for "spitting up" is gastroesophageal reflux, or reflux. It happens when milk or solid food in the stomach comes back up into your baby's esophagus. The esophagus is a tube that joins the mouth and the stomach. When the baby's milk or food is in the esophagus, 3 things can happen:
  • The milk or food can be spit out of the mouth.
  • The milk or food can be sucked into the lungs.
  • The milk or food can go into the stomach for a while, but then it can go back up into the esophagus. It stays in the esophagus for a while before going back into the stomach.

What can be done for reflux?

Feed your baby by placing him or her in an upright position. If you bottle-feed you baby, burp him or her every 3 to 5 minutes. Avoid laying your baby down following a feeding. Some babies spit up less if their formula is thickened with rice cereal. Ask your doctor if you can add 2 to 3 teaspoons of rice cereal to each ounce of formula. You might have to enlarge the nipple hole a little so the thicker formula will come out easily. Some babies also spit up less if they are given less milk at each feeding, but are fed more often.

Will reflux cause problems for my baby?

Spitting up is messy, but it is a normal occurrence during your baby's early months. It rarely involves choking, coughing or pain. When problems do happen, they are related to the 3 things that can happen to milk or food when it goes back up into the esophagus. Some of these problems are listed here: Spitting up milk or food: growth problems, gagging. Breathing milk or food into the lungs: lung infections, asthma, coughing. Milk or food coming up into the esophagus for a while, then going back down into the stomach: crying from pain, not wanting to eat, vomiting blood.

Should I take my baby to the doctor?

If your baby experiences any of the problems listed above, you should see your doctor. First, your doctor will make sure your baby is healthy and growing well. Your doctor will also check whether your baby has breathing problems. If your doctor thinks your baby is fine, nothing else has to be done. Your doctor will want to see your baby regularly. If your baby's reflux is causing excessive problems, your doctor may prescribe medicine to help stop it. This medicine is the same one used for heartburn in adults. If your baby continues to not gain weight or develops other problems, your doctor might do some tests.


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Hand, Foot & Mouth Disease

Hand, foot, and mouth disease is common in infants and young children. It usually causes fever, painful sores in the mouth, and a rash on the hands and feet. Most infected people recover in a week or two. Wash your hands often and practice good hygiene to reduce your risk of infection.

Hand, foot, and mouth disease, or HFMD, is a contagious illness that is caused by different viruses. It is common in infants and children younger than 5 years old, because they do not yet have immunity (protection) to the viruses that cause HFMD. However, older children and adults can also get HFMD. In the United States it is more common for people to get HFMD during spring, summer, and fall.

What Are the Symptoms of HFMD?

Symptoms of hand, foot, and mouth disease often include the following:
  • Fever.
  • Reduced appetite.
  • Sore throat.
  • A feeling of being unwell.
  • Painful sores in the mouth that usually begin as flat red spots.
  • A rash of flat red spots that may blister on the palms of the hands, soles of the feet, and sometimes the knees, elbows, buttocks, and/or genital area.
These symptoms usually appear in stages, not all at once. Also, not everyone will get all of these symptoms. Some people may show no symptoms at all, but they can still pass the virus to others.

Is HFMD Serious?

HFMD is usually not serious. The illness is typically mild, and nearly all people recover in 7 to 10 days without medical treatment. Complications are uncommon. Rarely, an infected person can develop viral meningitis (characterized by fever, headache, stiff neck, lack of energy, sleepiness, or trouble waking up from sleep) and may need to be hospitalized for a few days. Other even more rare complications can include polio-like paralysis, or encephalitis (brain inflammation) which can be fatal.

Is HFMD Contagious?

Yes. The viruses that cause HFMD can be found in an infected person’s:
  • Nose and throat secretions (such as saliva, sputum, or nasal mucus).
  • Blister fluid.
  • Feces (poop).
HFMD spreads from an infected person to others through:
  • Close contact, such as kissing, hugging, or sharing cups and eating utensils.
  • Coughing and sneezing.
  • Contact with feces, for example when changing a diaper.
  • Contact with blister fluid.
  • Touching objects or surfaces that have the virus on them.
People with HFMD are most contagious during the first week of their illness. However, they may sometimes remain contagious for weeks after symptoms go away. Some people, especially adults, may not develop any symptoms, but they can still spread the viruses to others. This is why you should always try to maintain good hygiene, like washing hands often with soap and water, so you can minimize your chance of getting and spreading infections.

Who Is at Risk for HFMD?

HFMD mostly affects infants and children younger than 5 years old. However, older children and adults can get it, too. When someone gets HFMD, they develop immunity (protection) to the specific virus that caused their infection. However, because HFMD is caused by several different viruses, people can get the disease again.

Can HFMD Be Treated?

There is no specific treatment for HFMD. Fever and pain can be managed with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen. It is important for people with HFMD to drink enough fluids to prevent dehydration (loss of body fluids).

Can HFMD Be Prevented?

There is no vaccine to protect against HFMD. However, you can reduce the risk of getting infected with the viruses that cause HFMD by following a few simple steps:
  • Wash your hands often with soap and water for 20 seconds, especially after changing diapers, and help young children do the same.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid close contact such as kissing, hugging, and sharing cups and eating utensils with people who have HFMD.
  • Disinfect frequently touched surfaces and objects, such as toys and doorknobs, especially if someone is sick.

Is HFMD the Same as Foot-and-Mouth Disease?

No. HFMD is often confused with foot-and-mouth disease (also called hoof-and-mouth disease), which affects cattle, sheep, and swine. Humans do not get the animal disease, and animals do not get the human disease.

Content source: National Center for Immunizations and Respiratory Diseases, Division of Viral Diseases

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Head Injuries

Head Injuries: What to Watch for Afterward

What are the main causes of head injuries?

A serious head injury is most likely to happen to someone who is in a car wreck and isn't wearing a seat belt. Other major causes of head injuries include bicycle or motorcycle wrecks, falls from windows (especially among children who live in the city) and falls around the house (especially among toddlers and the elderly).

Are head injuries serious?

They can be. Bleeding, tearing of tissues and brain swelling can occur when the brain moves inside the skull at the time of an impact. But most people recover from head injuries and have no lasting effects. See the box below for a list of types of head injuries.

Types of head injuries

A concussion is a jarring injury to the brain. A person who has a concussion passes out for a short while. The person may feel dazed and may lose vision or balance for a while after the injury. A brain contusion is a bruise of the brain. This means there is some bleeding in the brain, causing swelling. A skull fracture is when the skull cracks. Sometimes the edges of broken skull bones cut into the brain and cause bleeding or other injury. A hematoma is bleeding in the brain that collects and clots, forming a bump. A hematoma may not be apparent for a day or even as long as several weeks. So it's important to tell your doctor if someone with a head injury feels or acts oddly. Watch out for headaches, listlessness, balance problems or throwing up.

How can the doctor tell how bad the damage is?

Your doctor will ask about how the injury occurred, about past medical problems, and about vomiting, seizures (fits) or problems breathing after the injury. The injured person may need to stay in the hospital to be watched. Sometimes, special pictures of the brain may be needed to find out more about the damage.

What happens after the injury?

It's normal to have a headache and nausea, and feel dizzy right after a head injury. Other symptoms include ringing in the ears, neck pain, and feeling anxious, upset, irritable, depressed or tired. The person who has had a head injury may also have problems concentrating, remembering things, putting thoughts together or doing more than one thing at a time. These symptoms usually go away in a few weeks, but may go on for over a year if the injury was severe.

Will the head injury cause permanent brain damage?

This depends on how bad the injury was and how much damage it did. Most head injuries don't cause permanent damage.

What about memory loss?

It's common for someone who's had a head injury to forget the events right before, during and right after the accident. Memory of these events may never come back. Following recovery, the ability to learn and remember new things almost always returns.

Is it true that the person must be kept awake after the injury?

No. If your doctor thinks the person needs to be watched this closely, your doctor will probably put the person in the hospital. Sometimes, doctors will send someone who has had a head injury home if the person with them is reliable enough to watch the injured person closely. In this case, your doctor may ask you to wake the person frequently and ask questions such as "what's your name?" and "where are you?" to make sure everything is okay.

Get help if you notice

  • Any symptom that is getting worse, such as headaches, nausea or sleepiness
  • Nausea that doesn't go away
  • Changes in behavior, such as irritability or confusion
  • Dilated pupils (pupils that are bigger than normal) or pupils of different sizes
  • Trouble walking or speaking
  • Drainage of bloody or clear fluids from ears or nose
  • Vomiting
  • Seizures
  • Weakness or numbness in the arms or legs

Post Head Trauma Instructions

The patient has been examined, and no evidence of skull fracture or concussion can be found; however, after a blow to the head signs of bleeding inside the head may sometimes show up only after several hours or even days later. Please follow these instructions and contact the doctor if anything abnormal occurs. Awaken the patient every ___ to see that he is arousable and can be awakened. Using a flashlight, check both eyes to see if both pupils are equal in size and react normally to light by getting smaller when the light is shined at them. Do not give aspirin or any stronger pain medication. Tylenol may be given for mild headache. Call the doctor or take the patient to the nearest emergency room if any of the following occurs:
  • Unequal pupil size.
  • Seizures or convulsions.
  • Excessive drowsiness or inability to wake up.
  • Unusual or bizarre behavior or change in personality.
  • Severe headache nor relieved by Tylenol.
  • Continuous vomiting or vomiting associated with severe headaches.
  • Difficulty in talking, walking, or inability to move part of the body. h. Inability to control bowel or bladder function. i. Clear or blood-tinged fluid coming from nose or ear.
copyright 1996-2005 American Academy of Family Physicians


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Head Lice

Head Lice - What They Are and How to Eliminate Them

What are head lice?

Head lice are small wingless insects (bugs) that can get on your hair and scalp. Lice are parasites (say: pah-ruh-sytes) that feed on very small amounts of your blood. Lice bites may cause constant scratching, and lead to skin irritation or even infection.

Who is at risk of getting head lice?

Anyone can get head lice, but they are more common among school-aged children. Head lice spread more easily among children 3 to 12 years of age because they share their belongings more often than adults and play close together. It's not true that people get head lice because they're dirty. Head lice are very contagious. No matter how many times you or your child takes a shower or washes his or her hair, it's still possible to get head lice from head-to-head contact with someone who is already infested with lice. You can also get head lice if you share hats, towels, pillows, combs or brushes with someone who has head lice.

Can head lice be prevented?

It may be difficult to prevent head lice from spreading among children, but the following are some steps you can take to help keep lice away:
  • Ask your child not to share combs, brushes or hair decorations.
  • Ask your child not to try on hats that belong to other children.
  • If your child will be sleeping away from home, be sure to pack his or her own pillow and towels.

What are the signs of head lice?

Because lice move very fast, they are not always easy to see. Here's what you can watch for:
  • Frequent scratching
  • Small red bumps or sores on the scalp, neck and shoulders
  • Lice eggs, also called nits, which look like tiny, oval shaped, white or clear dots. Nits usually stick at an angle on hair shafts.
  • If you think someone in your family has head lice, it's probably best to check everyone in the family. If you're not sure, your family doctor can help diagnose head lice.

How can I treat head lice?

Head lice can be treated with over-the-counter or prescription products. Shampoos and lotions that kill head lice contain pesticides and other chemicals, so it is important to talk to your doctor before using these products, especially if you are pregnant or nursing, or if you have allergies or asthma. It is also not safe to use products with pesticides on or near your eyes. If you find head lice or nits in eyelashes or brows, talk to your doctor. The products that kill head lice don't usually kill all nits. To reduce the risk of another lice infestation, pick the remaining lice and nits by hand or by using a special comb (one brand name: LiceMeister comb) to remove them. Comb through all of the hair one section at a time every 3 days or more often, for at least 2 weeks or until you stop seeing head lice and nits. You should also use hot water to wash any bed linens, towels and clothing recently worn by the person who had head lice. Vaccuum anything that can't be washed such as the couch, carpets, your child's car seat and any stuffed animals. Because head lice don't live very long away from the scalp, you don't need to use lice spray on these items.


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Hives

Help with Hives

After eating some big, red strawberries, you decide to walk to your friend's house. Just as you're turning the corner, you notice reddish bumps and patches on your arms and chest. What are these itchy welts or blotches on your skin? Should you turn around and head home?

What Are Hives?

Hives are pink or red bumps or slightly raised patches of skin. Sometimes, they have a pale center. Hives usually itch, but they also can burn or sting. Hives can occur anywhere on the body and vary in size and shape. They can be small like a mosquito bite or big like a dinner plate. Hives also might look like rings or groups of rings joined together. Hives can appear in clusters and might change locations in a matter of hours. A bunch of hives might be on a person's face, then those might go away. Later some more may appear on a person's arms. Hives are common - between 10% and 25% of people get them at least once in their lives. They are usually harmless, though they may occasionally be a sign of a serious allergic reaction. (So, yes, you should go home and tell your mom or dad.) The medical term for hives is urticaria (say: ur-tuh-kar-ee-uh). When a person is exposed to something that can trigger hives, certain cells in the body release histamine (say: his-tuh-meen) and other substances. This causes fluid to leak from the small blood vessels under the skin. When this fluid collects under the skin, it forms the blotches, which we call hives.

Why Do I Get Hives?

People can get hives for lots of different reasons. Often, the cause is not known. One common reason for getting hives is an allergic reaction. Some common allergic triggers are certain foods (like milk, shellfish, berries, and nuts), medications (such as antibiotics), and insect stings or bites. Other causes of hives are not related to allergies and these can include:
  • exposure to the cold (like diving into a cold pool)
  • exercise
  • sun exposure
  • nervousness or stress
  • infections caused by viruses
  • No matter what the cause, a case of hives can last for a few minutes, a few hours, or even days.

What Will the Doctor Do?

Doctors usually can diagnose hives just by looking at you and hearing your story about what happened. The doctor can try to help figure out what might be causing your hives, although often the cause will remain a mystery. If you're getting hives a lot, or your reaction was serious, your doctor might send you to another doctor who specializes in allergies. Sometimes, doctors will suggest you take a type of medication called an antihistamine to relieve the itchiness. In many cases, hives clear up on their own without any medication or doctor visits. Less often, hives can be a sign of a more serious allergic reaction that can affect breathing and other body functions. In these cases, the person needs immediate medical care. Some people who know they have serious allergies carry a special medicine to use in an emergency. This medicine, called epinephrine, is given by a shot. Ordinarily, a nurse gives you a shot, but because some allergic reactions can happen really fast, many adults and kids carry this emergency shot with them and know how to use it, just in case they ever need it in a hurry.

Can I Prevent Hives?

Yes and no. The answer is "yes" if you know what causes your hives - the strawberries at the start of this article, for example. If you know they cause you trouble, you can just avoid them. If you get hives when you're nervous, relaxation breathing exercises may help. But if you don't know why you get hives, it's tough to prevent them. Some kids get hives when they have a virus, such as a bad cold or a stomach flu. Other than washing your hands regularly, there's not much you can do to avoid getting sick occasionally. The good news is that hives usually aren't serious and you might even grow out of them. Who wouldn't want to give hives the heave-ho? Reviewed by: Elana Pearl Ben-Joseph, MD Date reviewed: October 2007


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How to treat a Fever?

When Your Infant or Child Has a Fever

What is a normal temperature?

A normal temperature is about 98.6°F when taken orally (by mouth). Temperatures taken rectally (by rectum) usually run 1° higher than those taken orally. So a normal temperature is about 99.6°F when taken rectally. Many doctors define a fever as an oral temperature above 99.4°F or a rectal temperature above 100.4°F.

How should I take my child's temperature?

The most accurate way to take your child's temperature is orally or rectally with a digital thermometer. In a child younger than about 4 years, take the temperature rectally. In an older child, take it orally. Mercury thermometers should not be used. Mercury is an environmental toxin, and you don't want to risk exposing your family to it. If you have a mercury thermometer at home, you should remove it and use a digital thermometer. Don't bundle your baby or child up too tightly before taking his or her temperature. Never leave your child alone while taking his or her temperature. Be sure you use the right thermometer. Read the package instructions to see if you have an oral or rectal thermometer. If you're taking your child's temperature rectally, coat the tip of the thermometer with petroleum jelly (brand name: Vaseline) and insert it half an inch into the rectum. Hold the thermometer still and do not let go. When the thermometer beeps, remove it and check the digital reading. If you're taking your child's temperature orally, place the end of the thermometer under the tongue and leave it there until the thermometer beeps. Remove the thermometer and check the digital reading. After you're done using the thermometer, wash it in cool, soapy water.

When should I try to lower my child's fever?

Fevers are a sign that the body is fighting an infection, so you may want to avoid giving medicine if your child is running a low-grade (up to 100.2°F) fever. The main reason to treat your child is to make him or her feel better. When your child is achy and fussy or his of her temperature is above 100.2°F, you may want to give him or her some medicine.

What kind of medicine and how much is needed to lower a fever?

Acetaminophen (one brand name: Children's or Infants' Tylenol) relieves pain and lowers fever. How much acetaminophen your child may need depends on his or her weight and age. Check the package label or ask your doctor about the correct dosage for your child. Talk to your doctor before giving ibuprofen (brand names: Children's Advil, Children's Motrin) to your child. Your doctor will tell you the correct dose for your child.

Tips on giving medicine

  • Don't give more than 5 doses in 1 day.
  • Don't give a baby younger than 3 months old medicine unless your family doctor tells you to.
  • Read labels carefully. Make sure you are giving your child the right amount of medicine.
  • If using drops, fill the dropper to the line.
  • For liquid elixir, use a liquid measuring device to make sure you give the right dose. Get one at your drug store or ask your pharmacist.

Why not use aspirin to lower my child's fever?

In rare cases aspirin can cause Reye's syndrome in children. Reye's syndrome is a serious illness that can lead to death. Doctors recommend that parents avoid giving aspirin to children under 18 years of age.

Are there other ways to help my child feel better?

  • Give your child plenty of fluids to drink to prevent dehydration (not enough fluid in the body) and help the body cool itself.
  • Make sure your child gets plenty of rest.
  • Keep the room temperature at about 70°F to 74°F.
  • Dress your child in light cotton pajamas so that body heat can escape.
  • If your child is chilled, put on an extra blanket but remove it when the chills stop.

Will a bath help lower my child's fever?

Used together, acetaminophen and a lukewarm bath may help lower a fever. Give the acetaminophen before the bath. If the bath is given alone, your child may start shivering as his or her body tries to raise its temperature again. This may make your child feel worse. Don't use alcohol or cold water for baths.

When should I call the doctor?

If your child has any of the warning signs listed in the box below, call your family doctor.
  • Under 3 months old. Call your doctor right away if your baby's temperature goes over 100.4°F rectally, even if he or she doesn't seem sick. Babies this young can get very sick very quickly.
  • Three to 6 months old. Call your doctor if your baby has a temperature of 101°F or higher (even if your baby doesn't seem sick) or a temperature of 99.5°F that has lasted more than 24 hours.
  • Six months and older. If your child has a fever of 101.4°F, watch how he or she acts. Call your doctor if the fever rises or lasts for more than 3 days. In children 3 months to 2 years of age, if the temperature is 103°F, call your doctor even if your child seems to feel fine.
Call your doctor if your baby or child has any of these warning signs:
  • Constant vomiting or diarrhea
  • Dry mouth
  • Earache or pulling at ears
  • Fever comes and goes over several days
  • High-pitched crying
  • Irritable
  • Not hungry
  • Pale
  • Seizures
  • Severe headache
  • Skin rash
  • Sore or swollen joints
  • Sore throat
  • Stiff neck
  • Stomach pain
  • Swelling of the soft spot on the head
  • Unresponsive or limp
  • Wheezing or problems breathing
  • Whimpering


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Influenza

Influenza is an infection mainly affecting the respiratory tract, including the throat and airways. It is caused by a family of related viruses and can become quite severe. Most children with influenza recover completely. However, full recovery may take several weeks, and complications may occur. Getting a yearly "flu shot" helps prevent influenza.

What is Influenza?

Influenza is an infectious illness caused by a certain family of viruses. Worldwide outbreaks of influenza occur each year, with young children being at high risk for infection. Influenza is highly contagious and can spread rapidly through communities, especially in places like schools and hospitals. Influenza can develop suddenly, and become quite severe. Although most children with influenza recover completely, there is a risk of further infection such as ear infections and pneumonia.

What does it look like?

The symptoms and severity of influenza depend on several factors, including the characteristics of the influenza virus that is being spread in your community. Illness may develop quite suddenly: within 2 or 3 days after your child is exposed to the influenza virus. Some common symptoms of influenza are:
  • Fever and chills, usually lasting 2 to 4 days
  • Dry cough, which may continue for a long time
  • Sore throat
  • Headache and muscle aches
  • Runny nose and eyes
  • Malaise; feeling sick
  • Diarrhea
  • Other members of your family may be sick at the same time. Infants and young children may develop more severe symptoms, including high fevers.

What causes influenza?

Influenza is caused by a family of related viruses "going around" each year. Once your child has been exposed to a specific influenza virus, he or she will usually become immune to it. Because babies and young children have not been exposed to as many influenza viruses, they may be more likely to catch influenza.

What are some possible complications of influenza?

  • Ear infections (otitis media) occur in up to one fourth of children with influenza.
  • Pneumonia (infection of the lungs)
  • Other complications such as myositis (inflammation of the muscles) or myocarditis (inflammation of the heart muscle) are possible, but uncommon

What puts your child at risk of influenza?

  • Infants and young children are more likely to be infected with influenza virus and may have more severe symptoms
  • Influenza is most common during the winter months
  • Influenza is more likely to cause more problems in children with pre-existing health problems (such as heart disease, asthma, or cystic fibrosis).

Can influenza be prevented?

  • Getting a yearly influenza vaccination ("flu shot") can help prevent influenza. Currently influenza vaccination is recommended for all children between 6 months and 5 years old. It is also recommended for children with certain high risk diseases, such diseases of the heart and lungs (including asthma), cancer, or HIV or other conditions causing reduced immune function.
  • Influenza vaccination is also recommended for adults who are in close contact with "high-risk" children, and for women who will be in second or third trimester of pregnancy during "flu season." Ask your doctor whether your child, you, or other family members should get vaccinated.
  • Certain antiviral drugs may be used to treat or prevent influenza in children and adults who have been exposed to influenza outbreaks at home, school or work.

How is influenza diagnosed and treated?

  • Diagnosis is based on symptoms and whether a lot of cases are occurring in the community at the time. If necessary, tests on mucous from the nose and throat can be done.
  • Make sure your child gets plenty of rest and drinks extra fluids.


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Inhalers

Metered-Dose Inhaler: How to Use It Correctly

What is a metered-dose inhaler?

A metered-dose inhaler is a device that helps deliver a specific amount of medication to your lungs. It is commonly used to treat asthma, chronic obstructive pulmonary disease (COPD) and other respiratory problems. Each inhaler consists of a pressurized canister of medication and a mouthpiece. Pressing down on the inhaler releases a mist of medicine that you breathe into your lungs. So that your airways receive the right amount of medicine, it is important to use your inhaler correctly.

How do I use a meter-dose correctly?

A. Open mouth. Hold inhaler 1 to 2 inches away. B. Use spacer attached to inhaler. C. Hold inhaler in your mouth

Here's what to do:

  • Remove the cap and hold the inhaler upright.
  • Shake the inhaler.
  • Tilt your head back slightly and breathe out.
  • Hold the inhaler as in one of the pictures to the right. A or B are the most effective, but C is okay for people who are unable to use A or B.
  • Spacers are useful for all patients, especially young children and older adults (see picture B).
  • Press down on the inhaler to release the medicine as you start to breathe in slowly.
  • Breathe in slowly for 3 to 5 seconds.
  • Hold your breath for 10 seconds to allow medicine to go deeply into your lungs.
  • Repeat puffs as directed. Wait 1 minute between puffs to allow the second puff to get into the lungs better.
  • NOTE: These instructions are for a metered-dose inhaler only. Inhaled dry powder capsules are used differently. To use a dry powder inhaler, close your mouth tightly around the mouthpiece of the inhaler and breathe in quickly. Talk to your doctor if you have any questions about how to take your medicine.

How do I keep track of how much medicine I've used?

It's important to keep track of how much medicine you've used so you can plan ahead and replace your inhaler before you run out of medicine. One way to do this is to write a refill date on the canister itself. Use the following method to figure out when you'll need to get a refill: Start with a brand new inhaler. Divide the number of puffs in the canister--the canister will usually have this number printed on it--by the number of puffs you take each day. The number you get will be the number of days the canister should last. (For example, if you take 4 puffs each day from a 200-puff canister, you will need to have a new canister every 50 days.) Using a calendar, count forward that many days to see when your medicine will run out. So you won't run out of the medicine that you use every day, choose a day 1 or 2 days before this date to have your prescription refilled. Using a permanent marker, write the refill date on the canister, and on your calendar. If you use your inhaler for rescue medicine, you probably won't be using it regularly enough for this method to work. In that case, ask your doctor if he or she will write a prescription for two inhalers at a time. Then get your prescription filled when the first inhaler is empty. This way, you'll always have enough rescue medicine on hand when you need it most.


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Language Development

RED FLAGS IN LANGUAGE DEVELOPMENT

I. Infancy

Doesn't turn in response to sound;
Lack of interest in the human face (especially mother's), or in social interaction;
Lack of drive to communicate (sing song type cooing) by 4 months;
Loss of ability to coo and babble;
No production of consonant-vowel syllables by 1 year (ma-ma, ba-ba);

II. Toddler Period

Failure to understand or use pointing;
Poor comprehension of works by 12 - 18 months;
No expressive words by 15 - 18 months;
Any loss of ability to communicate verbally;
Minimal symbolic play (feeding a doll, driving a toy truck);

III. 24 - 36 Months

Fewer than 30 words at 24 months;
Fewer than 50 words by 30 months;
No 2 word utterances (Mommy no!) when vocabulary reaches 50 words;
More than half of utterances are unintelligible;
Rote memorization (parroting songs, videos) rather than creative use of language;

IV. Preschool Period

Limited Vocabulary;
Frequent repetition of what others have said, whether immediate or delayed;
More than a quarter of sentences unintelligible;
Consistent use of short, simple, similar phrases;
True stuttering (of individual sounds or parts of words);
Inability to express thoughts or ideas;

V. School Age

Inability of express ideas fluently and logically;
Persistent stuttering;
Errors in sound production after age 7;
Inability to manipulate the sounds of words rhyming;
Poor reading skills;


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Meningitis

Meningitis can be a serious infection, and it can be contagious - which is why outbreaks make the news. However, it's also pretty rare, and it can be treated.

What Is Meningitis?

Meningitis means inflammation of the membranes surrounding the brain and spinal cord called the meninges (pronounced: muh-nin-jeez). It often occurs when an infection elsewhere in the body spreads through the blood and into the cerebrospinal fluid (the fluid that circulates in the spaces in and around the brain and spinal cord). Although most cases of meningitis happen in kids age 5 and younger, and in 16- to 25-year-olds, people can get it at any age. There are several types of meningitis, and their severity and treatment can vary depending on which type a person has. Most cases of meningitis are caused by viruses (viral meningitis) or bacteria (bacterial meningitis), but fungi and other organisms can also cause infectious meningitis. Some cases of meningitis result from head injuries, certain cancers or other diseases, or reactions to medications.

What Are the Signs and Symptoms?

Viral and bacterial meningitis can cause similar symptoms. Although it may be difficult to identify which type a person has, a doctor can find out. Some symptoms of both viral and bacterial meningitis are:
  • fever
  • stiff neck
  • severe headache
  • sensitivity to light
  • vomiting
  • nausea
  • extreme sleepiness
  • confusion
  • seizure
If you or someone you know has these symptoms - especially if you've been around someone with meningitis - be sure to talk to a doctor. Treating the infection early is very important.

Can It Be Prevented?

Washing your hands really well and often is one way to defend against meningitis and other infections. Although bacterial meningitis can seem scary, the chance of getting it is quite low. It's most likely to happen in places where lots of people get together - like schools and college dorms. This is why doctors now recommend that teens who are about to go to high school or head off for college get vaccinated against meningococcal meningitis. Many colleges actually require their students to get meningitis vaccines. Depending on the type of vaccine a person gets, it can last between 3 and 10 years. It's also sometimes recommended for people traveling to countries where meningitis is more common. There are also vaccines for some other types of meningitis. If you have a medical condition that affects your immune system, for example, a doctor may also recommend a vaccination against the S. pneumoniae type of bacteria. But vaccines don't exist for all types of bacterial meningitis.

When to Call the Doctor

If you have meningitis symptoms, call your doctor right away. Early detection and treatment of meningitis is very important to avoid serious health problems. If you've been in close contact with someone who has bacterial meningitis, see your doctor, even if you have no symptoms. The doctor might prescribe antibiotics to help prevent you from getting the infection. A fast diagnosis can also keep the infection from spreading to others.

What Do Doctors Do?

To diagnose meningitis, a doctor may do a spinal tap, in which a small amount of the cerebrospinal fluid is removed and tested in a lab. If the meningitis is bacterial, this can help the doctor decide which type of antibiotic to prescribe. To find out more about the infection, sometimes the doctor will also do a brain scan (called a CT scan). Bacterial meningitis is treated in the hospital with intravenous antibiotics (for example, through an IV - a drip that delivers the correct dose of a medication directly into a person's vein). Antibiotic treatment for bacterial meningitis may last for a couple of weeks, although a person may not need to spend the full time in a hospital. Lyme meningitis is usually also treated with IV antibiotics, although this can be done at home. Doctors may also prescribe corticosteroids to protect a person from hearing damage as a result of bacterial meningitis. If there are problems caused by the infection, the doctor will need to treat those problems, too. Sometimes people can have permanent brain damage from the disease - especially if it is not diagnosed and treated quickly - so if you have symptoms, it's important to get checked out and treated right away. If the meningitis is viral, it usually goes away on its own (antibiotics are not effective in treating this type of meningitis because it's not caused by bacteria). The doctor will recommend as much rest as possible to help the recovery. He or she may also recommend medication to help relieve any headaches or body aches

Disease Risk for Contacts of Individuals With Meningcoccal Disease


High risk: chemoprophylaxis recommended (close contact)

*Household contact: especially young children *Child care or nursery school contact during 7 days before onset of illness *Direct exposure to index patient's secretions through kissing or through sharing toothbrushes or eating utensils, markers of close social contact during 7 days before onset of illness *Frequently slept or ate in same dwelling as index patient during 7 days before onset of illness

Low risk: chemoprophylaxis not recommended

*Casual contact: no history of direct xposure to index patient's oral secretions (eg, school mate) *Indirect contact: only contact is with a high-risk contact, no direct contact with the index patient *Health care professionals without direct exposure to patient's oral secretions


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Milk Allergy

Tips for managing a Milk Allergy

Cow's milk is a common cause of food allergy, affecting approximately 2.5% of children younger than 3 years of age. An overwhelming majority of infants who develop an allergy to cow's milk will do so in their first year of life.

Ingredients to Avoid

Read the label for every food each and every time you purchase the food. Avoid foods that contain milk or any of these ingredients:
  • artificial butter flavor
  • butter
  • butter fat
  • butter oil
  • buttermilk
  • casein (casein hydrolysate)
  • caseinates (in all forms)
  • cheese
  • cottage cheese
  • cream
  • curds
  • custard
  • ghee
  • half and half
  • lactalbumin
  • lactalbumin phosphate
  • lactoferrin
  • lactulose
  • milk (in all forms)
  • nisin (preservative that can be derived from milk)
  • nougat
  • pudding
  • rennet casein
  • sour cream
  • sour cream solids
  • sour milk solids
  • whey (in all forms)
  • yogurt
May indicate the presence of milk protein: caramel candies, chocolate, flavorings (including natural and artificial), high-protein flour, lactic acid starter culture, lactose.

Unexpected Sources of Milk

Milk been found in canned tuna, deli meats, hamburgers, hot dogs, potato chips, sausages, chewing gum, sauces, and dressing, among others. Hair care products, lotions, bath soaps and gels, and other personal-care products sometime contain milk. for example, milk has been found as an ingredient in products for cleaning teeth. Read the labels carefully. Many products labeled as non-dairy contain casein (a milk derivative), which is listed in the ingredients. Some meat may contain casein or lactoferrin. check all labels carefully. Also, be aware that deli meat slicers are frequently used for many products, including milk-, soy-, or nut-containing meat or cheese. Read all labels carefully and ask questions about ingredients used when eating away from home.

Alternate Sources of Nutrients

Milk provides a number of vitamins and minerals, including calcium; pantothenic acid; phosphorus; riboflavin; and vitamins A, B12, and D. Some alternate sources of these nutrients include calcium-fortified juice, carrots, eggs, fish, leafy green vegetable, legumes, meat, poultry, whole-grain products, and sunlight or artificial ultraviolet light. For more information about food allergies, contact the food Allergy & Anaphylaxis Network. http://www.foodallergy.org/


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Mononucleosis

What is mononucleosis?

Mononucleosis (often called "mono") is an infection caused by the Epstein-Barr virus. Signs of mono include fever, sore throat, headaches, white patches on the back of your throat, swollen glands in your neck, feeling tired and not feeling hungry.

How is mono passed?

Mono is not spread as easily as some other viruses, such as the common cold. The mono virus is found in saliva and mucus. It is usually passed from one person to another through kissing, although it may rarely be passed in other ways, such as coughing. Signs of mono usually develop 4 to 6 weeks after you're exposed to the virus. Generally, people only get mono once. It's most common among people 15 to 35 years old.

How is mono diagnosed?

Your doctor will probably first ask you some questions about your symptoms and then may do blood tests to confirm the diagnosis. One common test used to diagnose mono is called the Monospot test. Sometimes other blood tests are needed if the results of the Monospot test aren't clear.

Does mono have any complications?

Sometimes. The main serious concern with mono is that the spleen will enlarge and even rupture (tear open). The spleen is like a large gland. It's located in the upper part of your abdomen on the left side. It helps filter your blood. Although a ruptured spleen is rare in people with mono, it's wise to be aware of the signs and call your doctor right away if you notice any of them. Signs of a ruptured spleen include pain in the left upper part of your abdomen (under the left chest), feeling lightheaded, feeling like your heart is beating fast and hard, bleeding more easily than usual and having trouble breathing.

Can mono be cured?

No. But mono will go away on its own. Symptoms usually last about 4 weeks.

How is mono treated?

The main point of treatment is to relieve your symptoms. The following list includes tips on treatment:
  • Rest.
  • Drink plenty of fluids.
  • If you have a sore throat, gargle with salt water, or suck on throat lozenges, hard candy or flavored frozen desserts (such as Popsicles).
  • You may want to take acetaminophen (one brand name: Tylenol) or ibuprofen (some brand names: Advil, Motrin, Nuprin) to relieve pain and fever. Do not give aspirin to children. Aspirin should be avoided because it has been associated with a disease called Reye's syndrome in children. Reye's syndrome is a serious illness that can lead to death.

Do I need an antibiotic?

Antibiotics like penicillin are of no help in mono. Mono is caused by a virus, and antibiotics don't work against viruses. If you have a bacterial infection in addition to having mono, your doctor may give you an antibiotic.

What about sports and exercise?

Avoid sports, activities or exercise of any kind until your doctor tells you it's safe. Moving around too much puts you at risk of rupturing your spleen. You need to avoid physical activities for about 3 to 4 weeks after the infection starts. Reviewed/Updated: 02/06 Created: 9/00 This handout provides a general overview on this topic and may not apply to everyone. To find out if this handout applies to you and to get more information on this subject, talk to your family doctor.


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MRSA Skin Infections

MRSA is a kind of Staphylococcus ("staph") bacteria that is becoming more common, and is resistant to many antibiotics. Because of that, infections from this staph must be treated aggressively, and certain steps are often recommended for the patient and household contacts to avoid spreading this infection.
  • Take antibiotics by mouth as prescribed. Be sure to complete the full course that the doctor prescribed.
  • Use Phisohex soap if prescribed for bathing for 2 weeks. Rinse well. Do not use in children under 6 months of age.
  • Wash hands thoroughly and frequently, for 20 seconds, in warm water and soap or Phisoderm (OTC).
  • Add 1 tsp. Clorox to each gallon of bath water (not to be used on hair). Rinse tub well after each use.
  • Apply Bactroban inside nostrils, to toenails, fingernails, and nicks or skin scratches, and the perianal area daily.
  • Keep nails clean and cut short.
  • Do not share personal items such as towels, wash cloths, or razors.
  • Use fresh towels daily.
  • Wash linens, blankets, stuffed toys, etc. in hot water and/or use a hot dryer.
  • Adults may gargle with antibacterial mouthwash twice a day for two weeks.

Measures for preventing staphylococcal skin infections among sports participants

  • Cover all wounds. If a wound cannot be covered adequately, consider excluding players with potentially infectious skin lesions from practice or competitions until the lesions are healed or can be covered adequately.
  • Encourage good hygiene, including showering and washing with soap after all practices and competitions.
  • Ensure availability of adequate soap and hot water.
  • Discourage sharing of towels and personal items (e.g., clothing or equipment).
  • Establish routine cleaning schedules for shred equipment.
  • Train athletes and coaches in first aid for wounds and recognition of wounds that are potentially infected.
  • Encourage athletes to report skin lesions to coaches and encourage coaches to assess athletes regularly for skin lesions.

ABCESS with Incision & Drainage

An abscess (sometimes called a "boil") is a pocket of pus under the skin that starts when bacteria get trapped under the skin and begin to grow. This can occur with an infected hair root, oil gland, "pimple," cyst, or puncture wound. Treatment of your abscess has required an incision to drain the pus. If the abscess pocket was large, a gauze packing has been inserted. This will be changed on your next visit. Antibiotics are not required in the treatment of a simple abscess, unless the infection is spreading into the skin around the wound (known as "cellulitis"). Healing of the wound will take about one to two weeks depending on the size of the abscess.

Home Care:

The wound should be kept covered with a dry sterile bandage. If the dressing becomes soaked with blood or pus, change it. You may be advised to soak or irrigate the wound. Follow your doctor's instructions and reapply a sterile dressing. If you were prescribed antibiotics, take them as directed until they are all gone. Follow up with your doctor as advised by our staff. If a gauze packing was inserted in your wound, it should be removed in 1-2 days. If no packing was used, and you were not given a specific follow-up appointment, look at your wound every day for the signs listed below.

Return promptly or contact your doctor if any of the following occur:

  • Increasing redness around the wound.
  • Red streaks in the skin leading away from the wound.
  • Increasing local pain or swelling.
  • Fever over 100.0 oral


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Nebulizer

How to Use A Nebulizer

Nebulizers are used to treat asthma, chronic obstructive pulmonary disease (COPD), and other conditions where inhaled medicines are indicated. Nebulizers deliver a stream of medicated air to the lungs over a period of time. Assemble the nebulizer according to its instructions. These are the basic steps:
  • Connect the hose to an air compressor.
  • Fill the medicine cup with your prescription.
  • Attach the hose and facemask/mouthpiece to the medicine cup.
  • Place the facemask over your nose and mouth, or mouthpiece in your mouth. Breathe through your mouth until all the medicine is used. (Often this takes about 10-15 minutes). If using a facemask, you can breath normally. Wash the medicine cup and mouthpiece with water, and air-dry until your next treatment.


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Nosebleed

What causes nosebleeds?

The purpose of the nose is to warm and humidify the air that we breathe in. The nose is lined with many blood vessels that lie close to the surface where they can be injured and bleed. Once a vessel starts to bleed, the bleeding tends to recur since the clot or scab is easily dislodged. Nosebleeds, called epistaxis, can be messy and even scary, but often look worse than they are. Many can be treated at home, but some do require medical care.

Common causes of nosebleeds include:

  • Dry, heated, indoor air, which dries out the nasal membranes and causes them to become cracked or crusted and bleed when rubbed or picked or when blowing the nose (more common in winter months)
  • Dry, hot, low-humidity climates, which can dry out the mucus membranes
  • Colds (upper respiratory infections) and sinusitis, especially episodes that cause repeated sneezing, coughing, and nose blowing
  • Vigorous nose blowing or nose picking
  • The insertion of a foreign object into the nose
  • Injury to the nose and/or face
  • Allergic and non-allergic rhinitis (inflammation of the nasal lining)
  • Use of drugs that thin the blood (aspirin, non-steroidal anti-inflammatory medications, warfarin, and others)
  • High blood pressure
  • Chemical irritants (e.g., cocaine, industrial chemicals, others)
  • Deviated septum (an abnormal shape of the structure that separates the two sides of the nose)
  • Tumors or inherited bleeding disorders (rare)
  • Facial and nasal surgery
  • How are nosebleeds stopped?

    Follow these steps to stop a nosebleed: Relax
  • Sit down and lean your body and your head slightly forward. This will keep the blood from running down your throat, which can cause nausea, vomiting, and diarrhea. (Do NOT lay flat or put your head between your legs.)
  • Breathe through your mouth.
  • Use a tissue or damp washcloth to catch the blood.
  • Use your thumb and index finger to pinch together the soft part of your nose. Make sure to pinch the soft part of the nose against the hard bony ridge that forms the bridge of the nose. Squeezing at or above the bony part of the nose will not put pressure where it can help stop bleeding.
  • Keep pinching your nose continuously for at least 5 minutes (timed by clock) before checking if the bleeding has stopped. If your nose is still bleeding, continue squeezing the nose for another 10 minutes.
  • You can spray an over-the-counter decongestant spray, such as oxymetazoline (Afrin®, Dristan®, Neo-Synephrine®, Vicks Sinex®, others) into the bleeding side of the nose and then hold apply pressure to the nose as described above.
  • WARNING: These topical decongestant sprays should not be used over the long term.
  • Once the bleeding stops, DO NOT bend over; strain and/or lift anything heavy; and DO NOT blow, rub, or pick your nose for several days.
  • Under what conditions should I seek physician or emergency care?

    Seek medical care through your physician or an emergency room if:

  • You cannot stop the bleeding after more than 15 to 20 minutes of applying direct pressure.
  • You experience repeated episodes of bleeding.
  • The bleeding is rapid or the blood loss is large (exceeds a coffee cupful).
  • The bleeding was caused by an injury, such as a fall or other blow to the nose or face.
  • You feel weak or faint.
  • The blood goes down the back of your throat rather than out front through the nose even though you are sitting down with body and head leaning slightly forward. (This may indicate the rarer, but more serious, "posterior nosebleed," which almost always requires a physician's care. This condition occurs more frequently in older people and individuals with high blood pressure).
  • Call your physician if:

  • You get nosebleeds often.
  • You get a nosebleed that seems to have occurred with the start of a new medication.
  • You get nosebleeds accompanied by unusual bruising all over your body. (This combination may indicate a more serious condition and will need to be investigated by your doctor.)


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    Peak Flow Meter

    How to Use a Peak Flow Meter

    A peak flow meter helps you check how well your asthma is controlled. Use it every day, and keep track of the results to help your doctor learn about your asthma. This may also help you determine if your asthma is getting worse, even before you have symptoms.

  • First, push the indicator to the bottom of the scale.
  • Stand up straight. Take a deep breath, breathing in as much as you can.
  • Place the mouthpiece in your mouth, between your teeth. Close your lips around it. Do not put your tongue inside the hole or block the vents in the back.
  • Blow out as hard and fast as you can. You want to move the marker as far as you can with your breath, so concentrate on exhaling forcefully and quickly.
  • Move the marker back to the bottom, and repeat these steps two more times. If you cough or make a mistake, do not include this as one of your three tries.
  • Record the highest of the three numbers in your peak flow diary.
  • Check which zone corresponds with your highest score. Follow the plan developed by you and your doctor for the appropriate zone.
  • If your best effort is in the red zone, take your relief medication immediately and call your doctor or go to the emergency room.


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    Sprain

    Your ligaments are tough, elastic-like bands that attach to your bones and hold your joints in place. A sprain is an injury to a ligament caused by excessive stretching. The ligament can have tears in it, or it can be completely torn apart. Of all sprains, ankle and knee sprains occur most often. Sprained ligaments swell rapidly and are painful. Generally the greater the pain, the more severe the injury. For most minor sprains, you can probably treat the injury yourself.

    Follow the instructions for P.R.I.C.E.

    Protect the injured limb from further injury by not using the joint. You can do this using anything from splints to crutches. Rest the injured limb. But don't avoid all activity. Even with an ankle sprain, you can usually still exercise other muscles to prevent deconditioning. For example, you can use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on another part of the bike. That way you still get three-limb exercise to keep up your cardiovascular conditioning. Ice the area. Use a cold pack, a slush bath or a compression sleeve filled with cold water to help limit swelling after an injury. Try to apply ice as soon as possible after the injury. If you use ice, be careful not to use it for too long, as this could cause tissue damage. Compress the area with an elastic wrap or bandage. Compressive wraps or sleeves made from elastic or neoprene are best. Elevate the injured limb whenever possible to help prevent or limit swelling. After the first two days, gently begin using the injured area. You should feel a gradual, progressive improvement. Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others) may be helpful to manage pain during the healing process.

    Get emergency medical assistance if:

    • You heard a popping sound when your joint was injured, you can't use the joint, or you feel unstable when you try to bear weight on the joint. This may mean the ligament was completely torn. On the way to the doctor, apply a cold pack.
    • You have a fever higher than 100 F (37.8 C), and the area is red and hot. You may have an infection.
    • You have a severe sprain. Inadequate or delayed treatment may cause long-term joint instability or chronic pain.
    • You aren't improving after the first two or three days.


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    Swimmer’s Ear

    Swimmer's Ear (Otitis Externa)

    Causes of Swimmer's Ear Swimmer's ear is an infection of the outer ear structures. It typically occurs in swimmers, but since the cause of the infection is water trapped in the ear canal, bathing or showering may also cause this common infection. When water is trapped in the ear canal, bacteria that normal inhabit the skin and ear canal multiply, causing infection and irritation of the ear canal. If the infection progresses, it may involve the outer ear.

    Symptoms of Swimmer's Ear

    The most common symptoms of swimmer's ear are mild to moderate pain that is aggravated by tugging on the auricle and an itchy ear. Other symptoms may include any of the following:
    • Sensation that the ear is blocked or full
    • Drainage
    • Fever
    • Decreased hearing
    • Intense pain that may radiate to the neck, face, or side of the head
    • The outer ear may appear to be pushed forward or away from the skull
    • Swollen lymph nodes

    Treatment of Swimmer's Ear

    Treatment for the early stages of swimmer's ear includes careful cleaning of the ear canal and ear drops that inhibit bacterial growth. For more severe infection, antibiotic drops are needed, sometimes with ear wick. Pain medication may also be prescribed.

    Prevention of Swimmer's Ear

    A dry ear is unlikely to become infected, so it is important to keep the ears free of moisture after swimming or bathing. Removable ear plugs, sometimes worn for hearing protection, can be used to keep moisture out of the ear canal. Q-tips should not be used for the purpose, because they may pack material deeper into the ear canal, remove protective ear wax, and irritate the skin of the ear canal creating the perfect environment. The safest way to dry your ears is with a hair dryer. If you do not have a perforated eardrum, rubbing alcohol or a 50:50 mixture of alcohol and vinegar used as eardrops will evaporate excess water and keep your ears dry.


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    Why are immunizations important?

    "I've heard that vaccines are not needed because these diseases were disappearing even before the vaccines were developed."

    This is not true. Many diseases do not occur or spread as much as they used to, thanks to better nutrition, less crowded living conditions, antibiotics, and, most importantly, vaccines. However, this does not mean that the bacteria and viruses that are responsible for these diseases have disappeared. Immunizations are still needed to protect children from these diseases. For example, Haemophilus influenzae type b (Hib) diseases were a major problem a few years ago until the vaccine was developed for infants. Over several years, we went from 20,000 cases of Hib diseases to less than a few hundred. The vaccine is the only explanation for this decrease. Unvaccinated children are still at risk for Hib meningitis and other serious illnesses.

    "Chickenpox is not a fatal disease, so that vaccine is not necessary."

    This is not true. Each year, about 9,000 people are hospitalized for chickenpox. About 100 people die from the disease. The chickenpox vaccine will protect most children from getting chickenpox. Since the vaccine was licensed in 1995, millions of doses have been given to children in the United States. Many studies show the vaccine is safe and effective. Research is being done to see how long protection from the vaccine lasts and whether a person will need a booster shot in the future.

    "I am breastfeeding so my child doesn't need immunizations."

    Immunizations are still needed. While breastfeeding is the best nutrition for your baby, it does not prevent infections the way vaccines do. Your child may have fewer colds, but breastfeeding does not protect against many serious illnesses such as whooping cough, polio, and diphtheria like immunizations do.

    "These diseases have been virtually eliminated from the United States, so my child doesn't need to be vaccinated."

    Without immunizations at the right times, your child can still catch infectious diseases that may cause high fever, coughing, choking, breathing problems, and even brain injury. These illnesses may leave your child deaf or blind or cause paralysis. Immunizations have reduced most of these diseases to very low levels in the United States. However, some of these diseases are still common in other parts of the world. Travelers can bring these diseases into this country. Without immunizations, these infections could quickly spread here. Immunizations also help people who cannot be vaccinated or who do not respond to vaccines. They can only hope that people around them are immunized. Copyright 2000 American Academy of Pediatrics


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