Keeping your child healthy

Children's Health: Your Child's Cough




Children's Health: Your Child's Cough


Coughs are one of the most common symptoms of childhood illness. Although a cough can sound awful, it's not usually a sign of a serious condition. In fact, coughing is a healthy and important reflex that helps protect the airways in the throat and chest.

But sometimes, your child's cough will warrant a trip to the doctor. Understanding what different types of cough could mean will help you know how to take care of them and when to go to the doctor.

"Barky" Cough
Barky coughs are usually caused by a swelling in the upper part of the airway. Most of the time, a barky cough comes from croup, a swelling of the larynx (voice box) and trachea (windpipe).

Croup usually is the result of a virus, but can also come from allergies or a change in temperature at night. Younger children have smaller airways that, if swollen, can make it hard to breathe. Kids younger than 3 years old are at the most risk for croup because their airways are so narrow.

A cough from croup can start suddenly and in the middle of the night. Often a kid with croup will also have stridor, which is a noisy, harsh breathing (often described as a coarse, musical sound) that occurs when a child inhales.

Whooping Cough
Whooping cough is another name for pertussis, an infection of the airways caused by the bacteria Bordetella pertussis. Kids with pertussis will have spells of back-to-back coughs without breathing in between. At the end of the coughing, they'll take a deep breath in that makes a "whooping" sound. Other symptoms of pertussis are a runny nose, sneezing, mild cough, and a low-grade fever.

Although pertussis can happen at any age, it's most severe in infants under 1 year old who did not get the pertussis vaccine. Pertussis is very contagious, so your child should get the pertussis shot at 2 months, 4 months, 6 months, 15 months, and 4-6 years of age. This shot is given as part of the DTaP vaccine (diphtheria, tetanus, acellular pertussis).

The Tdap vaccine (which is similar to DTaP but with lower concentrations of diphtheria and tetanus toxoid for adults) is given to children at 11-12 years and once again in adulthood as a part of one of the tetanus boosters. Adults are recommended to receive this pertussis vaccine since immunity to pertussis lessens over time. By protecting yourself against pertussis, you are also protecting your kids from getting it.

Since pertussis is very contagious, it can spread from person to person through tiny drops of fluid in the air coming from the nose or mouth when people sneeze, cough, or laugh. Others can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses.

Cough With Wheezing
If your child makes a wheezing (whistling) sound when breathing out, this could mean that the lower airways in the lungs are swollen. This can happen with asthma or with a viral infection (bronchiolitis). Also, wheezing can happen if the lower airway is blocked by a foreign object.

Nighttime Cough
Lots of coughs get worse at night. When your child has a cold, the mucus from the nose and sinuses can drain down the throat and trigger a cough during sleep. This is only a problem if the cough won't let your child sleep.

Asthma also can trigger nighttime coughs because the airways tend to be more sensitive and irritable at night.

Daytime Cough
Cold air or activity can make coughs worse during the daytime. Try to make sure that nothing in your house — like air freshener, pets, or smoke (especially tobacco smoke) — is making your child cough.

Cough With a Fever
A child who has a cough, mild fever, and runny nose probably has a common cold. But coughs with a fever of 102° F (39° C) or higher can sometimes be due to pneumonia, especially if a child is weak and breathing fast. In this case, call your doctor immediately.

Cough With Vomiting
Kids often cough so much that it triggers their gag reflex, making them vomit. Also, a child who has a cough with a cold or an asthma flare-up might throw up if lots of mucus drains into the stomach and causes nausea. Usually, this is not cause for alarm unless the vomiting doesn't stop.

Persistent Cough
Coughs caused by colds due to viruses can last weeks, especially if your child has one cold right after another. Asthma, allergies, or a chronic infection in the sinuses or airways also might cause persistent coughs. If the cough lasts for 3 weeks, call your doctor.

When to Call the Doctor
Most childhood coughs are nothing to be worried about. However, call your doctor if your child:

has trouble breathing or is working hard to breathe
is breathing more quickly than usual
has a blue or dusky color to the lips, face, or tongue
has a high fever (especially if your child is coughing but does NOT have a runny or stuffy nose)
has any fever and is less than 3 months old
is an infant (3 months old or younger) who has been coughing for more than a few hours
makes a "whooping" sound when breathing in after coughing
is coughing up blood
has stridor (a noisy or musical sound) when breathing in
has wheezing when breathing out (unless you already have a home asthma care plan from your doctor)
is weak, cranky, or irritable
is dehydrated
What Your Doctor Will Do
One of the best ways to diagnose a cough is by listening. Knowing what the cough sounds like will help your doctor decide how to treat your child. The treatment for different types of coughs can vary, based on the cause.

Because most coughs are caused by viruses, doctors usually do not give antibiotics for a cough. A cough caused by a virus just needs to run its course. A viral infection can last for as long as 2 weeks.

Unless a cough won't let your child sleep, cough medicines are not needed. They might help a child stop coughing, but do not treat the cause of the cough. If you do choose to use an over-the-counter (OTC) cough medicine, call the doctor to be sure of the correct dose and to make sure it's safe for your child.

Do not use OTC combination medicines like "Tylenol Cold" — they have more than one medicine in them, and kids can have more side effects and are more likely to get an overdose of the medicine.

Cough medicines are not recommended for children under age 6

Home Treatment
Here are some ways to help your child feel better:

If your child has asthma, make sure you have an asthma care plan from your doctor. The plan should help you choose the right asthma medicines to give.
For a "barky" or "croupy" cough, turn on the hot water in the shower in your bathroom and close the door so the room will steam up. Then, sit in the bathroom with your child for about 20 minutes. The steam should help your child breathe more easily. Try reading a book together to pass the time.
A cool-mist humidifier in your child's bedroom might help with sleep.
Sometimes a brief exposure to the cool air of the outdoors can relieve the cough. Make sure to dress your child appropriately for the outdoor weather and try this for 10-15 minutes.
Cool beverages like juice can be soothing and it is important to keep your child hydrated. But do not give soda or orange juice, as these can hurt a throat that is sore from coughing.
You should not give your child (especially a baby or toddler) OTC cough medicine without first checking with your doctor.
Cough drops are OK for older kids, but kids younger than 3 years old can choke on them. It's better to avoid cough drops unless your doctor says that they're safe for your child.
Reviewed by: Yamini Durani, MD
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Children's Health: Why Is Hand Washing So Important?




Children's Health: Why Is Hand Washing So Important?


A delicious mud pie, a good-luck rock, or a friendly frog are the types of goodies kids love to bring home. But these adorable gifts can also bring millions of germs with them.

Kids don't always listen when you tell them to wash their hands before eating, after using the bathroom, or when they come inside from playing. But it's a message worth repeating — hand washing is by far the best way to prevent germs from spreading and to keep your kids from getting sick.

First Line of Defense Against Germs
Germs can be transmitted many ways, including:

touching dirty hands
changing dirty diapers
through contaminated water and food
through droplets released during a cough or a sneeze
via contaminated surfaces
through contact with a sick person's body fluids
When kids come into contact with germs, they can unknowingly become infected simply by touching their eyes, nose, or mouth. And once they're infected, it's usually just a matter of time before the whole family comes down with the same illness.

Good hand washing is the first line of defense against the spread of many illnesses, from the common cold to more serious illnesses such as meningitis, bronchiolitis, influenza, hepatitis A, and most types of infectious diarrhea.

Washing Hands Correctly
Here's how to scrub those germs away. Demonstrate this routine to your kids — or better yet, wash your hands together often so they learn how important this good habit is:

Wash your hands in warm water. Make sure the water isn't too hot for little hands.
Use soap and lather up for about 20 seconds (antibacterial soap isn't necessary — any soap will do). Make sure you get in between the fingers and under the nails where uninvited germs like to hang out. And don't forget the wrists!
Rinse and dry well with a clean towel.
To minimize the germs passed around your family, make frequent hand washing a rule for everyone, especially:

before eating and cooking
after using the bathroom
after cleaning around the house
after touching animals, including family pets
before and after visiting or taking care of any sick friends or relatives
after blowing one's nose, coughing, or sneezing
after being outside (playing, gardening, walking the dog, etc.)
Don't underestimate the power of hand washing! The few seconds you spend at the sink could save you trips to the doctor's office.

Reviewed by: Mary L. Gavin, MD
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Children's Health: What Are Germs?




Children's Health: What Are Germs?


The term "germs" refers to the microscopic bacteria, viruses, fungi, and protozoa that can cause disease.

Hand washing is the single most important thing your family can do to prevent germs from leading to infections and sickness.

Types of Germs
Bacteria are tiny, single-celled organisms that get nutrients from their environments. In some cases, that environment is your child or some other living being.

Some bacteria are good for our bodies — they help keep the digestive system in working order and keep harmful bacteria from moving in. Some bacteria are used to produce medicines and vaccines.

But bacteria can cause trouble, too, as with cavities, urinary tract infections, or strep throat. Antibiotics are used to treat bacterial infections.

Viruses can't survive, grow, and reproduce unless a person or an animal puts up rental space. Viruses can only live for a very short time outside other living cells. For example, viruses in infected bodily fluids left on surfaces like a countertop or toilet seat can live there for a short time, but quickly die unless a live host comes along.

Once they've moved into someone's body, though, viruses spread easily and can make a person sick. Viruses are responsible for some minor sicknesses like colds, common illnesses like the flu, and extremely serious diseases like smallpox or HIV/AIDS.

Antibiotics are not effective against viruses. Antiviral agents have been developed against a small select group of viruses.

Fungi are multi-celled, plant-like organisms. They get nutrition from plants, food, and animals in damp, warm environments.

Many, such as athlete's foot and yeast infections, are not dangerous in a healthy person. People who have weakened immune systems (from diseases like HIV or cancer), though, may develop more serious fungal infections.

Protozoa are, like bacteria, one-celled organisms; many of which are able to move on their own. Protozoa love moisture, so intestinal infections and other diseases they cause are often spread through contaminated water. Some are also encapsulated in cysts, which help them live outside the human body and in harsh environments for long periods of time.

What Germs Do
Once organisms like bacteria, viruses, fungi, and protozoa invade a body, they get ready to stay for a while. These germs draw all their energy from the host. They may damage or destroy healthy cells. As they use up your nutrients and energy, they may produce proteins known as toxins.

Some toxins cause the annoying symptoms of common colds or flu-like infections, such as sniffles, sneezing, coughing, and diarrhea.

But other toxins can cause high fever, increased heart rate, low blood pressure, a generalized inflammatory response in the body, and even life-threatening illness.

If a child isn't feeling well, the doctor may take blood tests, throat cultures, or urine samples to determine which germs (if any) are responsible.

Protection From Germs
Because most germs are spread through the air in sneezes or coughs or through bodily fluids like sweat, saliva, semen, vaginal fluid, or blood, your best bet is to limit contact with those substances, as far as possible.

Hand washing. Washing your hands and teaching kids the importance of hand washing is absolutely the best way to stop germs from causing sickness. It's especially important after coughing or nose blowing, after using the bathroom, after touching any pets or animals, after gardening, and before and after visiting a sick relative or friend.

There's a right way to wash hands, too. Use warm water and plenty of soap, then rub your hands together vigorously for at least 15 seconds (away from the water). You may want to sing a short song — try "Happy Birthday" — during the process to make sure you spend enough time washing. Rinse your hands and finish by drying them thoroughly on a clean towel.

When working in the kitchen, wash your hands before you eat or prepare food, and make sure that kids do the same. Use proper food-handling techniques — use separate cutting boards, utensils, and towels for preparing uncooked meat and poultry; and warm, soapy water to clean utensils and countertops.

Cleaning. Periodically wipe down frequently handled objects around the house, such as toys, doorknobs, light switches, sink fixtures, and flushing handles on the toilets.

Soap and water are perfectly adequate for cleaning. If you want something stronger, you may want to try an antibacterial soap. It may not kill all the germs that can lead to sickness but it can reduce the amount of bacteria on an object.

You can also use bleach or a diluted solution that contains bleach, but you may want to use soap and water afterward so that the strong smell doesn't irritate anyone's nose.

It's generally safe to use any cleaning agent that's sold in stores but try to avoid using multiple cleaning agents or chemical sprays on a single object because the mix of chemicals can irritate skin and eyes.

Vaccines
Another way to fight infections from germs is to make sure your family has the right immunizations, especially if you'll be traveling to countries outside the United States. Be sure to check with your doctor before travel and make sure you have taken the necessary precautions because different infections are prominent in different countries and often have seasonal variation.

Other yearly immunizations such as the flu vaccine are a good idea, especially if someone in your family has a weakened immune system or other chronic medical problems.

Teens who are sexually active should understand that condoms can prevent infection because viruses, bacteria, fungi, and protozoa can be spread via oral, anal, or vaginal contact.

Also, all teens should be vaccinated against hepatitis B. This disease is often transmitted through sexual activity but people also can get it from contaminated needles, such as those used for tattooing or drugs.

Human papillomavirus (HPV) is one of the most common sexually transmitted diseases (STDs) and causes genital warts. The HPV vaccine is approved for use in both males and females.

Be sure to talk to your doctor if you have any questions. With a little prevention, you can keep harmful germs out of your family's way!

Reviewed by: Yamini Durani, MD
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Children's Health: Urine Tests




Children's Health: Urine Tests


Doctors order urine tests for kids to make sure that the kidneys and certain other organs are functioning properly, or when they suspect that a child might have an infection in the kidneys, bladder, or other parts of the urinary tract.

The kidneys make urine as they filter wastes from the bloodstream while leaving substances in the blood that the body needs, like protein and glucose. So when urine contains glucose, too much protein, or has other irregularities, it's usually a sign of a health problem.

Urinalysis
A urinalysis is usually ordered when a doctor suspects that a child has a urinary tract infection or a health problem that can cause an abnormality in the urine. This test can measure:

the number and variety of red and white blood cells
the presence of bacteria or other organisms
the presence of substances, such as glucose, that usually shouldn't be found in the urine
the pH, which shows how acidic or basic the urine is
the concentration of the urine
Sometimes, when the urine contains white blood cells or protein, or the test results seem abnormal for another reason, it's because of how or when the urine was collected. For example, a dehydrated child may have concentrated urine (darker urine) or a small amount of protein in the urine.

But that may not necessarily mean that there's a health problem. Once the child is rehydrated, these "abnormal" results may disappear. Depending on the amount of protein or other cells in the urine, the doctor may repeat the urine test at another time, just to make sure that everything is back to normal.

How a Urinalysis Is Done
In most cases, urine is collected in a clean container, then a small plastic strip that has patches of chemicals on it (the dipstick) is placed in the urine. The patches change color to indicate things like the presence of white blood cells or glucose.

Next, the doctor or laboratory technologist also usually examines the same urine sample under a microscope to check for other substances that indicate different conditions.

If either the urine dipstick test or the microscopic test shows white blood cells, red blood cells, or bacteria — which may mean that there's an infection in the kidneys or the bladder — the doctor may decide to send the urine to a lab for a urine culture to identify bacteria that may be causing the infection.

Getting a urine sample. It can be difficult to get urine samples from kids to analyze for a possible infection. That's because the skin around the urinary opening normally is home to some of the same bacteria that cause infections in the urinary tract. If these bacteria contaminate the urine, the doctors may not be able to use the sample to tell if there is a true infection or not.

To avoid this, the skin surrounding the urinary opening has to be cleaned and rinsed immediately before the urine is collected. In this "clean-catch" method, the patient (or parent) cleans the skin around the urinary opening. The child then urinates, stops momentarily (if the child is old enough to cooperate), then urinates again into the collection container. Catching the urine in "midstream" is the goal.

In some cases, like when the child is not yet toilet trained, the doctor or nurse will insert a catheter (a narrow, soft tube) through the urinary tract opening into the bladder to get the urine sample.

If you have any questions about urine tests, talk with your doctor.

Reviewed by: Yamini Durani, MD
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Children's Health: Too Late for a Flu Shot?




Children's Health: Too Late for a Flu Shot?


Although the flu season lasts from October until May, with most cases occurring between late December and early March, the flu vaccine is usually offered between September and mid-November. Getting the shot before the flu season is in full force gives the body a chance to build up immunity to, or protection from, the virus.

Even though it's ideal to get vaccinated early, the flu shot can still be helpful later. Even as late as January, there are still 2 or 3 months left in the flu season, so it's still a good idea to get protected.

Who Should Get the Flu Shot?
Federal health officials now recommend flu vaccinations for everyone 6 months of age and older (instead of just certain groups, as was recommended before). It's still especially important that certain groups of people get vaccinated. These groups, which should get priority during times of shortage, are:

people at higher risk for developing serious complications from the flu
people who live with or care for the people at high risk
High-risk groups include:

all kids 6 months through 4 years old
anyone 50 years and older
anyone with a weakened immune system
women who will be pregnant during the flu season
anyone who lives or works with children under 5 or adults aged 50 or older
residents of long-term care facilities, such as nursing homes
any adult or child with chronic medical conditions, such as asthma
health care personnel who have direct contact with patients
out-of-home caregivers and household contacts of anyone in any of the high-risk groups
Ideally, kids and adults should be immunized in October so they're adequately protected before flu season hits. Kids under 9 who get a flu shot for the first time will receive it in two separate shots a month apart. It can take 1 to 2 weeks for the flu shot to become effective, so it's best to get vaccinated as soon as possible if your doctor thinks it's necessary.

Those Who Should Not Get a Flu Shot
Those who should not get a flu shot include:

infants under 6 months old
anyone who's severely allergic to eggs and egg products. People with a mild egg allergy can receive the vaccine, but it should be given in a doctor's office so that they can be monitored for side effects for 30 minutes after the shot is given.
anyone who's ever had a severe reaction to a flu vaccination
anyone with Guillain-Barré syndrome (GBS), a rare medical condition that affects the immune system and nerves
anyone with a fever
A non-shot option, the nasal mist vaccine, is now available, but because it contains weakened live flu viruses it is not for people with weakened immune systems or certain health conditions. The nasal mist vaccine is only for healthy, non-pregnant people between the ages of 2 and 49 years. Check with your doctor to see if your child can — or should — get this type of flu vaccine.

Are There Side Effects?
Most people do not experience any side effects from the flu shot. Some have soreness or swelling at the site of the shot or mild side effects, such as headache or low-grade fever.

Some people who get the nasal spray vaccine also may develop mild flu-like symptoms, including runny nose, headache, vomiting, muscle aches, and fever.

Where Can My Family Get Flu Shots?
Flu shots are available at:

many health care settings, including doctors' offices and public, employee, and university health clinics
some pharmacies
some supermarkets
some community groups
If you have an HMO insurance plan, be sure to check with your primary care doctor before having your kids vaccinated outside the office, since most HMOs will pay for shots only if they're given through their plan.

Flu shots are covered by Medicare for senior citizens and are generally covered by insurance for people in other high-risk groups. Otherwise, flu shots may cost anywhere from $10 to $50. If you opt for the nasal mist flu vaccine, check to see if your insurance plan covers it.

Reviewed by: Elana Pearl Ben-Joseph, MD
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Children's Health: Talking to the Pharmacist




Children's Health: Talking to the Pharmacist


If your child is sick, you'll probably have many questions to ask your doctor. But have you made a list of questions and concerns to share with your pharmacist?

If you're like most parents, the answer is probably "very few" or "none." But today's pharmacists are trained to provide valuable information about the prescriptions they fill and to answer questions that affect the patients they serve.

To encourage questions from their customers, many pharmacies provide counseling rooms where pharmacists can talk to patients and families privately.

Reasons to Talk to the Pharmacist
Pharmacists cannot diagnose medical conditions but can answer many questions about medicines, recommend nonprescription drugs, and discuss side effects of specific medications. And some also can provide blood sugar and blood pressure monitoring and offer advice on home monitoring tests.

Most pharmacists who graduated in the 1980s received 5-year bachelor's degrees. Recently, it has become popular for pharmacists to receive a doctor of pharmacy degree. This 6- to 8-year-program requires pharmacists in training to go on hospital rounds with doctors and be there when decisions are made to begin drug use. These skills are particularly useful for pharmacists who operate within hospital settings.

Pharmacists are required to stay up-to-date on the changing world of medicine and to take continuing education classes on drug therapy. (Requirements can vary from state to state.)

Starting the Conversation
Many pharmacies have private counseling areas where you talk without interruption. Some pharmacists also accept questions over the telephone. And if you ask, almost all pharmacies will provide you with detailed literature about a particular medication.

It's never too late to ask your pharmacist a question. Even if you don't think of one until after you get home, you can still call the pharmacist for advice. That's part of his or her job.

Questions to Ask
A typical question parents have is about allergic reactions. First and foremost, make sure that your pharmacist knows exactly what allergies your child has and what medications your child is already taking. This will help the pharmacist protect against possible drug interactions that could be harmful.

Once you have received the medication, always look at it carefully before you leave the pharmacy. Read the instructions to be sure you understand how to give it to your child. Even if the medication is a refill, check to make sure the drug is the same size, color, and shape that you are used to receiving. If anything doesn't look right, ask.

Consider the following additional questions for your pharmacist:

Does this medication require special storage conditions (for example, at room temperature or in a refrigerator)?
How many times a day should it be given? Should it be given with food? Without food?
Should my child avoid certain foods (such as dairy products) when taking this medication?
Are there special side effects that I should look for? What should I do if I notice any of these side effects?
Should my child take special precautions, such as avoiding exposure to sunlight, when taking this medication?
What should I do if my child skips a dose?
Is it OK to cut pills in half or crush them to mix into foods?
Will this medicine conflict with my child's other medications, including over-the-counter medicines and alternative treatment such as herbal remedies?
Common Problems With Childhood Medications
Some parents may forget to have their children finish a prescription. If the medication (for example, a pain medication) is to be taken "as needed for symptoms," you don't need to finish the entire prescription within a set number of days. But with prescriptions like antibiotics, the medication must be finished for it to be effective.

Throw away any old prescriptions. If your child doesn't finish a medication, don't save it for a future illness because most drugs lose their potency after a year. Do not use after the expiration date and talk with your doctor before giving old prescriptions to your child.

Another common problem is the sharing of medications between siblings. Pharmacists and doctors recommend that no one take a drug prescribed for anyone else or offer prescription drugs to another person, no matter how similar the symptoms or complaints.

Tips From the Pharmacist
Pharmacists offer the following advice:

Do not keep medicine in the medicine cabinet! Ironically, the medicine cabinet in a steamy, moist bathroom is not the best place to keep any medication — prescription or otherwise. The room's moisture can make medications less potent. It's best to keep medicines in a hall closet or on a high shelf in the kitchen.
Remember to keep prescription and nonprescription medications out of the reach of children.
Never repackage medications; keep them in their original childproof containers so that you'll have the expiration date and instructions on hand.
Toss medications when they have expired (usually 1 year for pills or sooner for liquids — check the prescription label for the expiration date) or the doctor has told you that your child should stop taking them.
Though most liquid medications are now flavored, some might not be very palatable to a young child. Some medicines can be mixed with chocolate or maple syrup to encourage kids to take the entire dosage. Check with your pharmacist to see what would work best with which drug. However, pharmacists discourage putting liquid medication into a bottle for babies; if they don't finish the bottle, they won't get all the medication.
When giving liquid medicine, it's best to use a medication syringe (instead of a household spoon) to ensure that your child will get the exact amount prescribed. You can buy a medication syringe at your pharmacy.
What if your child takes the wrong dosage? Call the pharmacist or doctor right away, and follow his or her instructions.
If medications need to be refrigerated, make sure you keep them cool while traveling. Freezer packs in coolers work fine. If you can, take the entire medicine bottle; that way, you won't have any reason to forget the prescription dosage and if something happens to the medication, you can get a refill. And never mix two different drugs in the same pillbox.
How to Choose a Pharmacist
It's important to establish a relationship with one pharmacy so that your pharmacist has a complete history of your family's prescribed medications. A pharmacist is an important resource when it comes to making sure your child is getting the right medicine.

If you move, you might want to consider staying within the same chain of pharmacy stores to ensure that your patient profiles and records are available in a common computer database. Or you could request that your most recent pharmacist give you a copy of your family's patient profiles and pharmaceutical history to take with you to share with your new pharmacist.

Reviewed by: Steven Dowshen, MD
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Children's Health: Strep Test: Throat Culture




Children's Health: Strep Test: Throat Culture


What It Is
A throat culture or strep test is performed by using a throat swab to detect the presence of group A streptococcus bacteria, the most common cause of strep throat. These bacteria also can cause other infections, including pneumonia, tonsillitis, and meningitis.

A sample swabbed from the back of the throat is put on a special plate (culture) that enables bacteria to grow in the lab. The specific type of infection is determined using chemical tests. If bacteria don't grow, the culture is negative and the person doesn't have a strep throat infection.

Strep throat is a bacterial infection that affects the back of the throat and the tonsils, which become irritated and swell, causing a sore throat that's especially bothersome when swallowing. White or yellow spots or a coating on the throat and tonsils also might be present, and the lymph nodes along the sides of the neck may swell.



Strep throat is most common among school-age children. The infection may cause headaches, stomachaches, nausea, vomiting, and listlessness. Strep throat infections don't usually include cold symptoms (such as sneezing, coughing, or a runny or stuffy nose).

While symptoms of strep throat usually go away within a few days without direct treatment, doctors will prescribe antibiotics to help prevent related complications such as rheumatic fever, and it reduces the length of time a person is contagious.

Why It's Done
The throat culture test can help determine the cause of a sore throat. Often, a sore throat is caused by a virus, but a throat culture will determine if it's definitely caused by strep bacteria so doctors can provide proper treatment.

Preparation
Encourage your child to stay still during the procedure. Be sure to tell the doctor if your child has taken any antibiotics recently, and try to have your child avoid antiseptic mouthwash before the test as this could affect test results.

The Procedure
A health professional will ask your child to tilt his or her head back and open his or her mouth as wide as possible. If the back of the throat cannot be seen clearly, the tongue will be pressed down with a flat stick (tongue depressor) to provide a better view. A clean cotton swab will be rubbed over the back of the throat, over the tonsils, and over any red or sore areas to collect a sample.

You may wish to hold your child on your lap during the procedure to prevent movement that could make it difficult for the health professional to obtain an adequate sample.



What to Expect
Your child may have some gagging when the cotton swab touches the back of the throat. If your child's throat is sore, the swabbing may cause brief discomfort.

Getting the Results
Throat culture test results are generally ready in 2 days.

Risks
Throat swabbing can be uncomfortable, but no risks are associated with a throat culture test.

Helping Your Child
Explaining the test in terms your child can understand might help ease any fear. During the test, encourage your child to relax and stay still so the health professional can adequately swab the throat and tonsils.

If You Have Questions
If you have questions about the throat culture strep test, speak with your doctor.

Reviewed by: Yamini Durani, MD
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Children's Health: Stool Tests




Children's Health:  Stool Tests


About Stool Tests
Stool (or feces) is usually thought of as nothing but waste — something to quickly flush away. But bowel movements can provide doctors with valuable information as to what's wrong when a child has a problem in the stomach, intestines, or another part of the gastrointestinal system.

A doctor may order a stool collection to test for a variety of possible conditions, including:

allergy or inflammation in the body, such as part of the evaluation of milk protein allergy in infants
infection, as caused by some types of bacteria, viruses, or parasites that invade the gastrointestinal system
digestive problems, such as the malabsorption of certain sugars, fats, or nutrients
bleeding inside of the gastrointestinal tract
The most common reason to test stool is to determine whether a type of bacteria or parasite may be infecting the intestines. Many microscopic organisms living in the intestines are necessary for normal digestion. If the intestines become infected with harmful bacteria or parasites, though, it can cause problems like certain types of bloody diarrhea, and testing stool can help find the cause.

Stool samples are also sometimes analyzed for what they contain; for instance, examining the fat content. Normally, fat is completely absorbed from the intestine, and the stool contains virtually no fat. In certain types of digestive disorders, however, fat is incompletely absorbed and remains in the stool.

Collecting a Stool Specimen
Unlike most other lab tests, stool is sometimes collected by the child's family at home, not by a health care professional. Here are some tips for collecting a stool specimen:

Collecting stool can be messy, so be sure to wear latex gloves and wash your hands and your child's hands well afterward.
Many kids with diarrhea, especially young children, can't always let a parent know in advance when a bowel movement is coming. Sometimes a hat-shaped plastic lid is used to collect the stool specimen. This catching device can be quickly placed over the toilet bowl or your child's rear end to collect the specimen. Using a catching device can prevent contamination of the stool by water and dirt. If urine contaminates the stool sample, it will be necessary to take another sample. Also, if you're unable to catch the stool sample before it touches the inside of the toilet, the sample will need to be repeated. Fishing a bowel movement out of the toilet does not provide a clean specimen for the laboratory to analyze.
Another way to collect a stool sample is to loosely place plastic wrap across the rim of the toilet, under the seat. Then place the stool sample in a clean, sealable container before taking to the laboratory. Plastic wrap can also be used to line the diaper of an infant or toddler who is not yet using the toilet.
The stool should be collected into clean, dry plastic jars with screw-cap lids. You can get these from your doctor or through hospital laboratories or pharmacies, although any clean, sealable container could do the job. For best results, the stool should then be brought to the laboratory immediately.

If the stool specimen is going to be examined for an infection, and it's impossible to get the sample to the laboratory right away, the stool should be refrigerated, then taken to the laboratory to be cultured as soon as possible after collection. When the sample arrives at the lab, it is either examined and cultured immediately or placed in a special liquid medium that attempts to preserve potential bacteria or parasites.

The doctor or the hospital laboratory will usually provide written instructions on how to successfully collect a stool sample; if written instructions are not provided, take notes on how to collect the sample and what to do once you've collected it.

If you have any questions about how to collect the specimen, be sure to ask. The doctor or the lab will also let you know if a fresh stool sample is needed for a particular test, and if it will need to be brought to the laboratory right away.

Most of the time, disease-causing bacteria or parasites can be identified from a single stool specimen. Sometimes, however, up to three samples from different bowel movements must be taken. The doctor will let you know if this is the case.

Testing the Stool Sample
In general, the results of stool tests are usually reported back within 3 to 4 days, although it often takes longer for parasite testing to be completed.

Examining the Stool for Blood
Your doctor will sometimes check the stool for blood, which can be caused by certain kinds of infectious diarrhea, bleeding within the gastrointestinal tract, and other conditions. However, most of the time, blood streaking in the stool of an infant or toddler is from a slight rectal tear, called a fissure, which is caused by straining against a hard stool (this is fairly common in infants and kids with ongoing constipation).

Testing for blood in the stool is often performed with a quick test in the office that can provide the results immediately. First, stool is smeared on a card, then a few drops of a developing solution are placed on the card. An instant color change shows that blood is present in the stool. Sometimes, stool is sent to a laboratory to test for blood, and the result will be reported within hours.

Culturing the Stool
Stool can be cultured for disease-causing bacteria. A stool sample is placed in an incubator for at least 48 to 72 hours and any disease-causing bacteria are identified and isolated. Remember that not all bacteria in the stool cause problems; in fact, about half of stool is bacteria, most of which live there normally and are necessary for digestion. In a stool culture, lab technicians are most concerned with identifying bacteria that cause disease.

For a stool culture, the lab will need a fresh or refrigerated sample of stool. The best samples are of loose, fresh stool; well-formed stool is rarely positive for disease-causing bacteria. Sometimes, more than one stool will be collected for a culture.

Swabs from a child's rectum also can be tested for viruses. Although this is not done routinely, it can sometimes give clues about certain illnesses, especially in newborns or very ill children. Viral cultures can take a week or longer to grow, depending on the virus.

Testing the Stool for Ova and Parasites
Stool may be tested for the presence of parasites and ova (the egg stage of a parasite) if a child has prolonged diarrhea or other intestinal symptoms. Sometimes, the doctor will collect two or more samples of stool to successfully identify parasites. If parasites — or their eggs — are seen when a smear of stool is examined under the microscope, the child will be treated for a parasitic infestation. The doctor may give you special collection containers that contain chemical preservatives for parasites.

Reviewed by: Steven Dowshen, MD
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Children's Health: Soiling (Encopresis)




Children's Health: Soiling (Encopresis)


If your child who has bowel movements (BMs) in places other than the toilet, you know how frustrating it can be. Many parents assume that kids who soil their pants are simply misbehaving or that they're too lazy to use the bathroom when they have the urge to go.

The truth is that many kids beyond the age of toilet teaching (generally older than 4 years) who frequently soil their underwear have a condition known as encopresis. They have a problem with their bowels that dulls the normal urge to go to the bathroom — and they can't control the accidents that typically follow.

Although encopresis is estimated to affect 1% to 2% of kids under the age of 10, problems with encopresis and constipation account for more than 25% of all visits to pediatric gastroenterologists (doctors who specialize in disorders of the stomach and intestines).

Most encopresis cases (90%) are due to functional constipation — that is, constipation that has no medical cause. The stool (or BM) is hard, dry, and difficult to pass when a person is constipated. Many kids "hold" their BMs to avoid the pain they feel when they go to the bathroom, which sets the stage for having a poop accident.

Well-intentioned advice from family members and friends isn't always helpful because many people mistakenly believe that encopresis is a behavioral issue — a simple lack of self-control. Frustrated parents, grandparents, and caregivers may advocate various punishments and consequences for the soiling — which only leaves the child feeling even more alone, angry, depressed, or humiliated. Up to 20% of kids with encopresis experience feelings of low self-esteem that require the intervention of a psychologist or counselor.

Punishing or humiliating a child with encopresis will only make matters worse. Instead, talk to your doctor, who can help you and your child through this challenging but treatable problem.

Encopresis and Its Causes
Three to six times more common in boys, encopresis isn't a disease, but rather a symptom that may have different causes. To understand encopresis, it's important to understand constipation.

There's a wide range of normal when it comes to having a BM. The frequency of BMs varies with a person's age and individual nature. "Normal" pooping might range from one or two BMs per day to only three or four per week. Some kids don't poop on a regular basis, but a child who passes a soft BM without difficulty every 3 days is not constipated. However, a child who passes a hard BM (small or large) every other day is. Other kids may go every day, but they only release little, hard balls and there's always poop left behind in the rectum.

So, what causes the hard poop in the first place? Any number of things, including diet, illness, decreased fluid intake, fear of the toilet during toilet teaching, or limited access to a toilet or a toilet that's not private (like at school). Some kids may develop chronic constipation after stressful life events such as a divorce or the death of a close relative. Whatever the cause, once a child begins to hold his or her BMs, the poop begins to accumulate in the rectum and may back up into the colon and a vicious cycle begins.

The colon's job is to remove water from the poop before it's passed. The longer the poop is stuck there, the more water is removed — and the harder it is to push the large, dry poop out. The large poop also stretches out the colon, weakening the muscles there and affecting the nerves that tell a child when it's time to go to the bathroom. Because the flabby colon can't push the hard poop out, and it's painful to pass, the child continues to avoid having a BM, often by dancing, crossing the legs, making faces, or walking on tiptoes.

Eventually, the rectum and lower part of the colon becomes so full that it's difficult for the sphincter (the muscular valve that controls the passage of feces out of the anus) to hold the poop in. Partial BMs may pass through, causing the child to soil his or her pants. Softer poop may also leak out around the large mass of feces and stain the child's underwear when the sphincter relaxes. The child can't prevent the soiling — nor does he or she have any idea it's happening — because the nerves aren't sending the signals that regulate defecation (or pooping).

At first, parents may think their child has a simple case of diarrhea. But after repeated episodes, it becomes clear that there's another problem — especially because the soiling occurs when the child isn't sick.

Parents are often frustrated by the fact that their child seems unfazed by these accidents, which occur mostly during waking hours. Denial may be one reason for the child's nonchalance — kids just can't face the shame and guilt associated with the condition (some even try to hide their soiled underpants from their parents). Another reason may be more scientific: Because the brain eventually gets used to the smell of feces, the child may no longer notice the odor.

When to Call the Doctor
Although rectal surgery or birth defects such as Hirschsprung disease and spina bifida can cause constipation or encopresis without constipation, these are uncommon.

Call the doctor if your child shows any of the following symptoms:

poop or liquid stool in the underwear when your child isn't ill
hard poop or pain when having a BM
toilet-stopping BM
abdominal pain
loss of appetite
Treating Encopresis
As the colon is stretched by the buildup of stool, the nerves' ability to signal to the brain that it's time for a BM is diminished. If untreated, not only will the soiling get worse, but kids with encopresis may lose their appetites or complain of stomach pain.

A large, hard poop may also cause a tear in the skin around the anus that will leave blood on the stools, the toilet paper, or in the toilet. Constipation is also associated with wetting and urinary tract infections (UTI). If you think your child has encopresis, call your doctor.

Most cases of encopresis can be managed by your doctor, but if initial efforts fail, you may be referred to a gastroenterologist.

Treatment is done in three phases:

The first phase involves emptying the rectum and colon of hard, retained poop. Different doctors might have different ways of helping kids with encopresis. Depending on the child's age and other factors, the doctor may recommend medicines, including a stool softener (such as mineral oil), laxatives, and/or enemas. (Laxatives and enemas should be given only under the supervision of a doctor; never give these treatments at home without first checking with your doctor.) As unpleasant as this first step sounds, it's necessary to clean out the bowels to successfully treat the constipation and end your child's soiling.
After the large intestine has been emptied, the doctor will help the child begin having regular BMs with the aid of stool-softening agents, most of which aren't habit-forming. At this point, it's important to continue using the stool softener to give the bowels a chance to shrink back to normal size (the muscles of the intestines have been stretched out, so they need time to be toned without the poop piling up again). Parents will also be asked to schedule potty times twice daily after meals (when the bowels are naturally stimulated), in which the child sits on the toilet for about 5 to 10 minutes. This will help the child learn to pay attention to his or her own urges. It's especially helpful for parents to keep a record of their child's daily BMs.
As regular BMs become established, your doctor will reduce the child's use of stool softeners.
Keep in mind that relapses are normal, so don't get discouraged if your child occasionally becomes constipated again or soils his or her pants during treatment, especially when trying to wean the child off of the medications.

A good way to keep track of your child's progress is by keeping a daily poop calendar. Make sure to note the frequency, consistency (i.e., hard, soft, dry), and size (i.e., large, small) of the BMs.

Patience is the key to treating encopresis. It may take anywhere from several months to a year for the stretched-out colon to return to its normal size and for the nerves in the colon to become effective again.Diet and Exercise
In the meantime, diet and exercise are extremely important in keeping stools soft and BMs regular. Also, make sure your child gets plenty of fiber-rich foods such as fresh fruits, dried fruits like prunes and raisins, dried beans, vegetables, and high-fiber bread and cereal.

Because kids often cringe at the thought of fiber, try these creative ways to incorporate it into your child's diet:

Bake cookies or muffins using whole-wheat flour instead of regular flour. Add raisins, chopped or pureed apples, or prunes to the mix.
Add bran to baking items such as cookies and muffins, or to meatloaf or burgers, or sprinkled on cereal. (The trick is not to add too much bran or the food will taste like sawdust.)
Serve apples topped with peanut butter.
Create tasty treats with peanut butter and whole-wheat crackers.
Top ice cream, frozen yogurt, or regular yogurt with high-fiber cereal for some added crunch.
Serve bran waffles topped with fruit.
Make pancakes with whole-grain pancake mix and top with peaches, apricots, or grapes.
Top high-fiber cereal with fruit.
Sneak some raisins or pureed prunes or zucchini into whole-wheat pancakes.
Add shredded carrots or pureed zucchini to spaghetti sauce or macaroni and cheese.
Add lentils to soup.
Make bean burritos with whole-grain soft-taco shells.
And don't forget to have your child drink plenty of fluids each day, especially water. Diluted 100% fruit juice (like pear, peach, or prune) is an option if your child is not drinking enough water. Also limiting your child's daily dairy intake (including milk, cheese, and yogurt) may help.

Successful treatment of encopresis depends on the support the child receives. Some parents find that positive reinforcement helps to encourage the child throughout treatment. Provide a small incentive, such as a star or sticker on the poop calendar, for having a BM or even just for trying, sitting on the toilet, or taking medications.

Whatever you do, don't blame or yell — it will only make your child feel bad and it won't help manage the condition. Show lots of love and support and, assure your child that he or she isn't the only one in the world with this problem. With time and understanding, your child can overcome encopresis.

Reviewed by: Mary L. Gavin, MD
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Children's Health: Munchausen by Proxy Syndrome




Children's Health: Munchausen by Proxy Syndrome


Munchausen by proxy syndrome (MBPS) is a relatively rare form of child abuse that involves the exaggeration or fabrication of illnesses or symptoms by a primary caretaker.

Also known as "medical child abuse," MBPS was named after Baron von Munchausen, an 18th-century German dignitary known for making up stories about his travels and experiences in order to get attention. "By proxy" indicates that a parent or other adult is fabricating or exaggerating symptoms in a child, not in himself or herself.

Munchausen by proxy syndrome is a mental illness and requires treatment.

About MBPS
In MBPS, an individual — usually a parent or caregiver— causes or fabricates symptoms in a child. The adult deliberately misleads others (particularly medical professionals), and may go as far as to actually cause symptoms in the child through poisoning, medication, or even suffocation. In most cases (85%), the mother is responsible for causing the illness or symptoms.

Typically, the cause is a need for attention and sympathy from doctors, nurses, and other professionals. Some experts believe that it isn't just the attention that's gained from the "illness" of the child that drives this behavior, but also the satisfaction in deceiving individuals who they consider to be more important and powerful than themselves.

Because the parent or caregiver appears to be so caring and attentive, often no one suspects any wrongdoing. Diagnosis is made extremely difficult due to the the ability of the parent or caregiver to manipulate doctors and induce symptoms in their child.

Often, the perpetrator is familiar with the medical profession and knowledgeable about how to induce illness or impairment in the child. Medical personnel often overlook the possibility of MBPS because it goes against the belief that parents and caregivers would never deliberately hurt their child.

Most victims of MBPS are preschoolers (although there have been cases in kids up to 16 years old), and there are equal numbers of boys and girls.

Diagnosing MBPS
Diagnosis is very difficult, but could involve some of the following:

a child who has multiple medical problems that don't respond to treatment or that follow a persistent and puzzling course
physical or laboratory findings that are highly unusual, don't correspond with the child's medical history, or are physically or clinically impossible
short-term symptoms that tend to stop or improve when the victim is not with the perpetrator (for example, when hospitalized)
a parent or caregiver who isn't reassured by "good news" when test results find no medical problems, but continues to believe that the child is ill and may "doctor shop" to find a professional who believes them
a parent or caregiver who appears to be medically knowledgeable or fascinated with medical details or seems to enjoy the hospital environment and attention the sick child receives
a parent or caregiver who's overly supportive and encouraging of the doctor, or one who is angry and demands further intervention, more procedures, second opinions, or transfers to more sophisticated facilities
If you have any concerns about a child you know, it is important to speak to someone at your local child protective services agency — even if you prefer to call in anonymously.

Causes of MBPS
MBPS is a psychiatric condition. In some cases, the perpetrators were themselves abused, physically and/or and sexually, as children. They may have come from families in which being sick was a way to get love.

The parent's or caregiver's own personal needs overcome his or her ability to see the child as a person with feelings and rights, possibly because the parent or caregiver may have grown up being treated like he or she wasn't a person with rights or feelings.

In rare cases, MBPS is not caused by a parent or family member, but by a medical professional (such as a nurse or doctor), who induces illness in a child who is hospitalized for other reasons.

What Happens to the Child?
In the most severe instances, parents or caregivers with MBPS may go to great lengths to make their children sick. When cameras were placed in some children's hospital rooms, some perpetrators were filmed switching medications, injecting kids with urine to cause an infection, or placing drops of blood in urine specimens.

In most cases, hospitalization is required. And because they may be deemed a "medical mystery," hospital stays tend to be longer than usual. Whatever the cause, the child's symptoms — whether created or fabricated — ease or completely disappear when the perpetrator isn't present.

According to experts, common conditions and symptoms that are created or fabricated by parents or caregivers with MBPS can include: failure to thrive, allergies, asthma, vomiting, diarrhea, seizures, and infections.

The long-term prognosis for these children depends on the degree of damage created by the illness or impairment and the amount of time it takes to recognize and diagnose MBPS. Some extreme cases have been reported in which children developed destructive skeletal changes, limps, mental retardation, brain damage, and blindness from symptoms caused by the parent or caregiver. Often, these children require multiple surgeries, each with the risk for future medical problems.

If the child lives to be old enough to comprehend what's happening, the psychological damage can be significant. The child may come to feel that he or she will only be loved when ill and may, therefore, help the parent try to deceive doctors, using self-abuse to avoid being abandoned. And so, some victims of MBPS are at risk of repeating the cycle of abuse.

Getting Help for the Child
If MBPS is suspected, health care providers are required by law to report their concerns. However, after a parent or caregiver is charged, the child's symptoms may increase as the person who is accused attempts to prove the presence of the illness. If the parent or caregiver repeatedly denies the charges, the child would likely be removed from the home and legal action would be taken on the child's behalf.

In some cases, the parent or caregiver may deny the charges and move to another location, only to continue the behavior. Even if the child is returned to the perpetrator's custody while protective services are involved, the child may continue to be a victim of abuse while the perpetrator avoids treatment and interventions.

Getting Help for the Parent or Caregiver
To get help, the parent or caregiver must admit to the abuse and seek psychological treatment.

But if the perpetrator doesn't admit to the wrongdoing, psychological treatment has little chance of helping the situation. Recognizing MBPS as an illness that has the potential for treatment is one way to give hope to the family in these rare situations.

Reviewed by: Michelle New, PhD
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Children's Health: Mumps




Children's Health: Mumps


About Mumps
Mumps is a disease caused by a virus that usually spreads through saliva and can infect many parts of the body, especially the parotid salivary glands. These glands, which produce saliva for the mouth, are found toward the back of each cheek, in the area between the ear and jaw. In cases of mumps, these glands typically swell and become painful.

The disease has been recognized for several centuries, and medical historians argue over whether the name "mumps" comes from an old word for "lump" or an old word for "mumble."

Mumps was common until the mumps vaccine was licensed in 1967. Before the vaccine, more than 200,000 cases occurred each year in the United States. Since then the number of cases has dropped to fewer than 1,000 a year, and epidemics have become fairly rare. As in the pre-vaccine era, most cases of mumps are still in kids ages 5 to 14, but the proportion of young adults who become infected has been rising slowly over the last two decades. Mumps infections are uncommon in kids younger than 1 year old.

After a case of mumps it is very unusual to have a second bout because one attack of mumps almost always gives lifelong protection against another. However, other infections can also cause swelling in the salivary glands, which might lead a parent to mistakenly think a child has had mumps more than once.

Signs and Symptoms
Cases of mumps may start with a fever of up to 103° Fahrenheit (39.4° Celsius), as well as a headache and loss of appetite. The well-known hallmark of mumps is swelling and pain in the parotid glands, making the child look like a hamster with food in its cheeks. The glands usually become increasingly swollen and painful over a period of 1 to 3 days. The pain gets worse when the child swallows, talks, chews, or drinks acidic juices (like orange juice).

Both the left and right parotid glands may be affected, with one side swelling a few days before the other, or only one side may swell. In rare cases, mumps will attack other groups of salivary glands instead of the parotids. If this happens, swelling may be noticed under the tongue, under the jaw, or all the way down to the front of the chest.

Mumps can lead to inflammation and swelling of the brain and other organs, although this is not common. Encephalitis (inflammation of the brain) and meningitis (inflammation of the lining of the brain and spinal cord) are both rare complications of mumps. Symptoms appear in the first week after the parotid glands begin to swell and may include: high fever, stiff neck, headache, nausea and vomiting, drowsiness, convulsions, and other signs of brain involvement.

Mumps in adolescent and adult males may also result in the development of orchitis, an inflammation of the testicles. Usually one testicle becomes swollen and painful about 7 to 10 days after the parotids swell. This is accompanied by a high fever, shaking chills, headache, nausea, vomiting, and abdominal pain that can sometimes be mistaken for appendicitis if the right testicle is affected. After 3 to 7 days, testicular pain and swelling subside, usually at about the same time that the fever passes. In some cases, both testicles are involved. Even with involvement of both testicles, sterility is only a rare complication of orchitis.

Additionally, mumps may affect the pancreas or, in females, the ovaries, causing pain and tenderness in parts of the abdomen.

In some cases, signs and symptoms are so mild that no one suspects a mumps infection. Doctors believe that about 1 in 3 people may have a mumps infection without symptoms.

Contagiousness
The mumps virus is contagious and spreads in tiny drops of fluid from the mouth and nose of someone who is infected. It can be passed to others through sneezing, coughing, or even laughing. The virus can also spread to other people through direct contact, such as picking up tissues or using drinking glasses that have been used by the infected person.

People who have mumps are most contagious from 2 days before symptoms begin to 6 days after they end. The virus can also spread from people who are infected but have no symptoms.

Prevention
Mumps can be prevented by vaccination. The vaccine is given as part of the measles-mumps-rubella (MMR) immunization, which is usually given to children at 12 to 15 months of age. A second dose of MMR is generally given at 4 to 6 years of age. As is the case with all immunization schedules, there are important exceptions and special circumstances.
If they haven't already received them, students who are attending colleges and other post-high school institutions should be sure they have had two doses of the MMR vaccine.

During a measles outbreak, your doctor may recommend additional shots of the vaccine, if your child is 1 to 4 years old. Your doctor will have the most current information.

Incubation
The incubation period for mumps can be 12 to 25 days, but the average is 16 to 18 days.

Duration
Children usually recover from mumps in about 10 to 12 days. It takes about 1 week for the swelling to disappear in each parotid gland, but both glands don't usually swell at the same time.

Treatment
If you think that your child has mumps, call your doctor, who can confirm the diagnosis and work with you to monitor your child and watch for complications. The doctor can also notify the health authorities who keep track of childhood immunization programs and mumps outbreaks.

Because mumps is caused by a virus, it cannot be treated with antibiotics.

At home, monitor and keep track of your child's temperature. You can use nonaspirin fever medications such as acetaminophen or ibuprofen to bring down a fever. These medicines will also help relieve pain in the swollen parotid glands. Unless instructed by the doctor, aspirin should not be used in children with viral illnesses because its use in such cases has been associated with the development of Reye syndrome, which can lead to liver failure and death.

You can also soothe the swollen parotid glands with either warm or cold packs. Serve a soft, bland diet that does not require a lot of chewing and encourage your child to drink plenty of fluids. Avoid serving tart or acidic fruit juices (like orange juice, grapefruit juice, or lemonade) that make parotid pain worse. Water, decaffeinated soft drinks, and tea are better tolerated.

When mumps involves the testicles, the doctor may prescribe stronger medications for pain and swelling and provide instructions on how to apply warm or cool packs to soothe the area and how to provide extra support for the testicles.

A child with mumps doesn't need to stay in bed, but may play quietly. Ask your doctor about the best time for your child to return to school.

When to Call the Doctor
Call the doctor if you suspect that your child has mumps. If your child has been diagnosed with mumps, keep track of his or her temperature and call the doctor if goes above 101° Fahrenheit (38.3° Celsius).

Because mumps can also involve the brain and its membranes, call the doctor immediately if your child has any of the following: stiff neck, convulsions (seizures), extreme drowsiness, severe headache, or changes of consciousness. Watch for abdominal pain that can mean involvement of the pancreas in either sex or involvement of the ovaries in girls. In boys, watch for high fever with pain and swelling of the testicles.

Reviewed by: Joel Klein, MD
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Children's Health: Lumbar Puncture (Spinal Tap)




Children's Health: Lumbar Puncture (Spinal Tap)


What It Is
A lumbar puncture (LP), often called a spinal tap, is a common medical test that involves taking a small sample of cerebrospinal fluid (CSF) for examination. CSF is a clear, colorless liquid that delivers nutrients and "cushions" the brain and spinal cord, or central nervous system.

In a lumbar puncture, a needle is carefully inserted into the lower spine to collect the CSF sample.

Why It's Done
Medical personnel perform lumbar punctures and test the CSF to detect or rule out suspected diseases or conditions through analysis of the white blood cell count, glucose levels, protein, and bacteria.

Special testing can look for certain bacteria and viruses, or find the presence of abnormal cells that can help identify specific diseases in the central nervous system.

Most LPs are done to test for meningitis, but they also can detect bleeding in the brain and certain conditions affecting the nervous system (such as Guillain-Barré syndrome and multiple sclerosis). LPs also can deliver chemotherapeutic medications.

Preparation
After the procedure is explained to you, you'll be asked to sign an informed consent form — this document states that you give permission for the procedure to be performed and that you understand the procedure, why it is being done, and any potential risks.

The doctor performing the lumbar puncture will know your child's medical history, but might ask additional questions such as whether your child is allergic to any medicines.

You might be able to stay in the room with your child during the procedure, or you can step outside to a waiting area.

The Procedure
A lumbar puncture takes about 30 minutes. The doctor carefully inserts a thin needle between the bones of the lower spine (below the spinal cord) to withdraw the fluid sample.

The patient will be positioned with the back curved out so the spaces between the vertebrae are as wide as possible. This allows the doctor to easily find the spaces between the lower lumbar bones (where the needle will be inserted).

Older kids might be asked to either sit on an exam table while leaning over with their head on a pillow or lie on their side. Infants and younger children are usually positioned on their sides with their knees under their chin.



Once the child in the correct position, the back is cleansed with an antiseptic like iodine solution and a sterile area is maintained to minimize infection risk. The doctor performing the procedure also wears sterile gloves while performing the procedure.

A small puncture through the skin on the lower back is made and liquid anesthetic medicine is injected into the tissues beneath the skin to prevent pain. In many cases, before the injected anesthesia medication is given, a numbing cream is applied to the skin to minimize discomfort.

The spinal needle is thin and the length varies according to the size of the patient. It has a hollow core, and inside the hollow core is a "stylet," another type of thin needle that acts kind of like a plug. When the spinal needle is inserted into the lower lumbar area, the stylet is carefully removed, which allows the cerebrospinal fluid to drip out into the collection tubes.

After the CSF sample is collected (this usually takes about 2-5 minutes), the needle is withdrawn and a small bandage is placed on the site. Collected samples are sent to a lab for analysis and testing.

Sometimes doctors also measure the amount of pressure in the CSF using a special device called a manometer. High CSF pressure can happen under certain conditions, like meningitis.

What to Expect
While some notice a brief pinch and some discomfort, most people don't consider a lumbar puncture to be painful. Depending on the doctor's recommendations, your child might have to lie on his or her back for a few hours after the procedure. Your child might feel tired and have a mild backache the day after the procedure.

Getting the Results
Some results from a lumbar puncture are available within 45 to 60 minutes. However, to look for specific bacteria growing in the sample, a bacterial culture is sent to the lab and these results are usually available in 48 hours. If it's determined there might be an infection, the doctor will start antibiotic treatment while waiting for the results of the culture.

Risks
A lumbar puncture is considered a safe procedure with minimal risks. Most of the time, there are no complications. In some instances, a patient may get a headache. It's recommended that patients lie down for a few hours after the test and drink plenty of fluids to help prevent headaches, which usually resolve with rest, pain medications, and fluids.

In rare cases, infection or bleeding can occur. Also, trauma to spinal cord is extremely rare when the procedure is done correctly, because the cord ends much higher in the back than the area where the needle is inserted for the LP.

Sometimes, sedation medication may be helpful for your child in order to perform the procedure. If sedation is necessary, be sure to discuss the risks and benefits with your doctor.

Helping Your Child
You can help prepare your child for a lumbar puncture by explaining that while the test might be uncomfortable, it shouldn't be painful and won't take long. Also explain the importance of lying still during the test, and let your child know that a nurse might hold him or her in place. After the procedure, make sure your child rests and follow any other instructions the doctor gives you.

If You Have Questions
It's important to understand any procedure your child undergoes. If you have questions or concerns about the lumbar puncture procedure, be sure to speak with your doctor.

Reviewed by: Yamini Durani, MD
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Children's Health: Is My Child Too Sick to Go to School?




Children's Health: Is My Child Too Sick to Go to School?


I'm usually a pretty good judge of when my kids are too sick to go to school or daycare, but other times — like when my youngest seems to be dragging but has no fever — I'm just not sure. How can I tell when they're well enough to go to school and when they should just stay at home?
- Allyson

Many parents have a hard time deciding if their kids are well enough to go to school. After all, what well-intentioned parent hasn't sent a child off with tissues in hand, only to get that mid-morning "come get your child" phone call?

But making the right decision isn't as tough as you might think. It basically boils down to one question: Can your child still participate in school activities? After all, having a sore throat, cough, or mild congestion does not necessarily mean a child can't be active and participate in school activities.

So trust your instincts. If your son has the sniffles but hasn't slowed down at home, chances are he's well enough for the classroom. On the other hand, if he's been coughing all night and needs to be woken up in the morning (if he typically wakes up on his own), he may need to take it easy at home.

Of course, never send a child to school who has a fever, is nauseated, vomiting, or has diarrhea. Kids who lose their appetite, are clingy or lethargic, complain of pain, or who just don't seem to be acting "themselves" should also take a sick day.

If you decide that your child is well enough to go to school, check first with your child's teacher. Most daycares, preschools, and grade schools have rules about when to keep kids home. For example, pinkeye or strep throat usually necessitates a day home with appropriate treatment. Most centers won't let kids return to school until after a fever has broken naturally (without fever-reducing medicines) for at least 24 hours.

And remember, go with your gut. You know your kids best, and you know when they're able to motor through the day — and when they're not.

Reviewed by: Mary L. Gavin, MD
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Children's Health: Is It a Cold or the Flu?




Children's Health: Is It a Cold or the Flu?


Your child is sent home from school with a sore throat, cough, and high fever — could it be the flu that's been going around? Or just a common cold?

Although the flu (or influenza) usually causes symptoms that make someone feel worse than symptoms associated with a common cold, it's not always easy to tell the difference between the two.

Symptoms Guide
The answers to these questions can help determine whether a child is fighting the flu or combating a cold:

Flu vs. Colds: A Guide to Symptoms

Questions Flu Cold
Was the onset of illness ... sudden? slow?
Does your child have a ... high fever? no (or mild) fever?
Is your child's exhaustion level ... severe? mild?
Is your child's head ... achy? headache-free?
Is your child's appetite ... decreased? normal?
Are your child's muscles ... achy? fine?
Does your child have ... chills? no chills?
If most of your answers fell into the first category, chances are that your child has the flu. If your answers were usually in the second category, it's most likely a cold.

But don't be too quick to brush off your child's illness as just another cold. The important thing to remember is that flu symptoms can vary from child to child (and they can change as the illness progresses), so if you suspect the flu, call the doctor. Even doctors often need a test to tell them for sure if a person has the flu or not since the symptoms can be so similar!

Some bacterial diseases, like strep throat or pneumonia, also can look like the flu or a cold. It's important to get medical attention immediately if your child seems to be getting worse, is having any trouble breathing, has a high fever, has a bad headache, has a sore throat, or seems confused.

While even healthy kids can have complications of the flu, kids with certain medical conditions are at more of a risk. If you think your child might have the flu, contact your doctor.

Treatment
Some kids with chronic medical conditions may become sicker with the flu and need to be hospitalized, and flu in an infant also can be dangerous. For severely ill kids or those with other special circumstances, doctors may prescribe an antiviral medicine that can ease flu symptoms, but only if it's given within 48 hours of the onset of the flu.

Most of the time, you can care for your child by offering plenty of fluids, rest, and extra comfort.

And if the doctor says it's not the flu? Ask whether your child should get a flu shot.

Reviewed by: Iman Sharif, MD
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Children's Health: Talk to Your Child's Doctor




Children's Health: Talk to Your Child's Doctor


Your child's doctor can be an incredible resource when you have questions and concerns about your child's health, but finding time for regular checkups and sick visits may be a stretch for your already jam-packed schedule. The doctor may be overbooked and overscheduled, too, so making the most of your time together is important.

What are the best ways to communicate your concerns and questions? And how can you strengthen your relationship with the doctor who plays such an important role in your child's health?

The Doctor-Patient Relationship
Gone are the days of routine house calls and bartering livestock for health care and medicine. The current-day reality of insurance co-pays and crowded waiting rooms means relationships between doctors and patients have changed drastically.

Today, doctors are pressured to see more patients in less time and to spend less time with each patient. Insurance issues, such as the need for referrals, complicate patient care for parents as well as doctors and their offices.

The increasing complexities of the health care system mean that parents have to take charge of their kids' care. In the past, parents may have known far less about their kids' health, growth, and development. In today's world, the health information that's readily available on the Internet, in bookstores, and on TV suggests that parents have the ability to be more informed than ever before. This is good news, because parents who actively participate in their kids' health care help to ensure the best care possible.

In some cases, though, parents who do their own research may find incomplete or inaccurate medical and health information. Parents armed with stacks of printouts from unreliable Internet sources could find themselves at odds with a tense and frustrated doctor who doesn't have time to agree or disagree with each piece of information.

Another common problem that may hinder a good relationship with your doctor is unrealistic expectations or an unwillingness to trust a doctor's diagnosis or treatment of a minor illness. For example, many parents expect a drug or medicine for common colds, when a wait-and-see approach may be better. As a result, some doctors may feel pressured to give in to parental expectations for prescriptions or treatment, even when it's not necessary or in the best interest of the child's health.

Communicating With the Doctor
The key to building a better relationship with your child's doctor is open communication and reasonable expectations.

What can you expect from your doctor? He or she should:

help you monitor your child's health
explain your child's growth and development and what you can expect
diagnose and treat your child's minor or moderately serious illnesses
explain your child's illnesses and treatment
provide referrals and work with specialists in the case of illnesses requiring special expertise
Your pediatrician, family doctor, or nurse practitioner can also help you with other children's health issues, including exercise, nutrition, and weight issues; behavioral and emotional issues; how to cope with family issues, such as death, separation, and divorce; and how to understand and seek treatment for learning disabilities.

Good communication is a two-way street. You can aid communication by letting the doctor know that you trust him or her to care for your child. It's good to ask questions, but let the doctor know that you want decisions, diagnoses, and prescriptions to be based on the best decision for the health of your child, not what's easier for you or makes you feel better.

You should also be as prepared as possible with details during your doctor visits. When asked how your child is doing, be ready to share any concerns or ask any questions. It's best to be specific. Be sure to tell the doctor details about symptoms — for instance, if your child vomited three times last night, had a temperature of 102° Fahrenheit (39° Celsius), or is having diarrhea. This helps the doctor assess your child's condition more readily and accurately than if you just say that "my child is sick."

Consider jotting down your questions and concerns before the appointment so that you'll remember everything you want to bring up. And if you're worried about symptoms your child is having, mention them to the doctor even if he or she doesn't ask. Tell the doctor what you've tried to make the symptoms better and what worked and what didn't. The more information you provide, the better the doctor will be able to assess your child's health.

Tips for Building a Better Relationship
Make the most of your relationship with the doctor (and the doctor's office) by following these tips:

Be informed, but don't overwhelm. The Internet is a tremendous tool that can help you learn more about your child's health and development, but it's unrealistic to expect your child's doctor to evaluate every health resource or breakthrough you find on the Web or see on TV. If you have a particular article that you'd like the doctor to review or comment on, mail, email, fax, or drop off the article well in advance of the office visit, giving the doctor plenty of time to review and do any necessary research. Keep these requests to a minimum, though. If you're looking for information on a particular children's health topic, talk to the office staff or a nurse about whether they provide informational brochures. Ask the doctor to recommend some reliable resources where you can get health information.
Be focused during the visit. Avoid distractions so you can focus your full attention on answering the doctor's questions. Turn off your cell phone and leave other kids with a spouse, babysitter, or relative, if possible. Also try to stick to the reason for the visit — for example, don't use a sick visit to discuss behavior problems that may require an in-depth evaluation. Instead, schedule a separate visit and let the office staff know the nature of your child's problem so that a longer appointment time can be allotted.
Follow the rules. Respect the doctor's time by arriving for appointments on time or a few minutes early. If you're unavoidably late, let the office know, and give at least 24 hours' notice to cancel or reschedule. Many office schedules are packed weeks in advance, so schedule well-child or non-sick visits early. You should also familiarize yourself with the office's payment requirements and your insurance company's co-pays and referral policy to make appointments go more smoothly.
Follow up. Before you leave the doctor's office, make sure you understand what follow-up appointments, lab tests, or blood work your child needs. Take notes about any instructions so you don't forget them, and if you don't understand how to administer medication, ask the nurse or doctor before leaving the office. Communicate with the office, too, if the medication prescribed isn't working or your child develops worsening or additional symptoms.
Save time by making time. In most cases, it's best if you or your partner attend your child's doctor visits. This is especially true for complicated issues like behavior problems. Relying on a substitute like a nanny or grandparent may mean that information or instructions may be misunderstood or miscommunicated by the time they get to you or that in-depth questions the doctor asks can't be answered.
Use good judgment. Using the phone for questions about symptoms can save you and the doctor time and money, but don't abuse the privilege. Save non-urgent questions about your child's health and development for well-child visits. Many knowledgeable nurses or nurse practitioners answer phone questions for pediatric practices; use these medical professionals as a resource for non-urgent questions instead of demanding to speak with the doctor each time you call. Nighttime calls should be reserved for more urgent issues — remember, the doctor is at home when you're calling.

The stress of having a sick or hurt child can strain communication between doctors and parents, and the many issues covered in well-child visits may leave little room for your questions. But don't hesitate to ask your doctor questions, no matter how insignificant you may think they are. Many times, problems with your child can be resolved easily with the help of the doctor.

And don't be afraid to give the doctor feedback about your office visit experience, such as whether you felt rushed during the appointment or needed more information about a prescription or procedure. A good doctor will want to work with you to provide the best care possible for your child.

Reviewed by: Steven Dowshen, MD
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Children's Health: Febrile Seizures




Children's Health: Febrile Seizures


Febrile seizures are full-body convulsions that can happen during a fever (febrile means "feverish"). They affect kids 6 months to 5 years old, and are most common in toddlers 12 to 18 months old. The seizures usually last for a few minutes and are accompanied by a fever above 100.4° F (38° C).

While they can be frightening, febrile seizures usually end without treatment and don't cause any other health problems. Having one doesn't mean that a child will have epilepsy or brain damage.

About Febrile Seizures
During a febrile seizure, a child's whole body may convulse, shake, and twitch, and he or she may moan or become unconscious. This type of seizure is usually over in a few minutes, but in rare cases can last up to 15 minutes.

Febrile seizures stop on their own, while the fever continues until it is treated. Some kids might feel sleepy afterwards; others feel no lingering effects.

No one knows why febrile seizures occur, although evidence suggests that they're linked to certain viruses. Kids with a family history of febrile seizures are more likely to have one, and about 35% of kids who have had one seizure will experience another (usually within the first 1-2 years of the first).

Febrile seizures are not considered epilepsy, but kids who've had a seizure are at a slightly increased risk for developing epilepsy, especially if there is a family history.

Treating Febrile Seizures
If your child has a febrile seizure, stay calm and:

Make sure your child is in a safe place and cannot fall down or hit something hard.
Lay your child on his or her side to prevent choking.
Watch for signs of breathing difficulty, including any color change in your child's face.
If the seizure lasts more than 10 minutes, or your child turns blue, it is probably a more serious type of seizure — call 911 right away.
It's also important to know what you should not do during a febrile seizure:

Do not try to hold or restrain your child.
Do not put anything in your child's mouth.
Do not try to give your child fever-reducing medicine.
Do not try to put your child into cool or lukewarm water to cool off.
Again, unless the seizure lasts for more than 10 minutes or your child has trouble breathing, there's no need to rush to the ER.

When the seizure is over, call your doctor for an evaluation. The doctor will examine your child and ask you to describe the seizure. In most cases, no additional treatment is necessary. The doctor may recommend the standard treatment for fevers, which is acetaminophen or ibuprofen. But if your child is under 1 year old, looks very ill, or has other symptoms such as diarrhea or vomiting, the doctor may recommend some testing.

Febrile seizures can be scary to witness but remember that they're fairly common, are not usually a symptom of serious illness, and in most cases don't lead to other health problems. If you have any questions or concerns, talk with your doctor.

Reviewed by: Nicole Green, MD
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