TRAINING COURSE

What is allergic rhinitis?

Rhinitis is a reaction that occurs in the nose when airborne irritants (allergens) trigger the release of histamine. Histamine causes inflammation and fluid production in the fragile linings of nasal passages, sinuses, and eyelids.

There is usually a family history of allergic rhinitis.

What are the types of allergic rhinitis?

The two categories of allergic rhinitis include:

• Seasonal - occurs particularly during pollen seasons. Seasonal allergic rhinitis does not usually develop until after 6 years of age.
• Perennial - occurs throughout the year. This type of allergic rhinitis is commonly seen in younger children.

What are the causes of allergic rhinitis?

The most common causes of allergic rhinitis include the following:

• pollen
• dust mites
• mold
• animal dander

What are the symptoms of allergic rhinitis?

The following are the most common symptoms of allergic rhinitis. However, each child may experience symptoms differently. Symptoms may include:

• sneezing
• congestion
• runny nose
• itchy nose, throat, eyes, and ears
• nosebleeds
• clear drainage from the nose

Children with perennial allergic rhinitis may also have the following:

• recurrent ear infections
• snoring
• mouth breathing
• fatigue
• poor performance in school
• "allergic salute" - when a child rubs his/her hand upward across the bridge of the nose while sniffing. This may cause a line or crease to form across the bridge of the nose.

The symptoms of allergic rhinitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is allergic rhinitis diagnosed?

Typically, the diagnosis is made by your child's physician based on a thorough medical history and physical examination. In addition to the above symptoms, your child's physician may find, upon physical examination, dark circles under the eyes, creases under the eyes, and swollen tissue inside the nose.

Treatment for allergic rhinitis:

Specific treatment for allergic rhinitis will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the reaction
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the reaction
• your opinion or preference

Treatment options may include:

• Avoidance of the allergens: Avoidance of the allergens that are causing the problem is the best treatment.
• Over-the-counter antihistamines: Antihistamines help to decrease the release of histamine, possibly decreasing the symptoms of itching, sneezing, or runny nose. Some examples of antihistamines are diphenhydramine (Benadryl®) or hydroxyzine (Atarax®). These medications may cause drowsiness. Consult your child's physician to determine the proper dosage for your child.
• Nonsedating prescription antihistamines: Nonsedating antihistamines work like antihistamines but without the side effect of drowsiness. Nonsedating antihistamines may include cetirizine (Zyrtec®), loratadine (Claritin®), or fexofenadine (Allegra®). Consult your child's physician to determine the proper dosage for your child.
• Anti-inflammatory nasal sprays: Anti-inflammatory nasal sprays help to decrease the swelling in the nose. Consult your child's physician to determine the proper dosage for your child.
• Corticosteroid nasal sprays: Corticosteroid nasal sprays also help to decrease the swelling in the nose. Corticosteroid nasal sprays work best when used before the symptoms start, but can also be used during a flare-up. Consult your child's physician to determine the proper dosage for your child.
• Decongestants: Decongestants help by making the blood vessels in the nose smaller, thus, decreasing congestion. Decongestants can be purchased either over-the-counter or by prescription. Consult your child's physician to determine the proper dosage for your child.
• Anti-leukotrienes: These are a relatively new type of medication being used to control the symptoms of asthma. These medications help to decrease the narrowing of the lungs and decrease the chance of fluid in the lungs. These are usually given by mouth.

If your child does not respond to avoidance or to the above medications, your child's allergist then may recommend allergy shots or immunotherapy based on the findings. Immunotherapy usually involves a three to five-year course of repeated injections of specific allergens to decrease the reaction to these allergens when your child comes into contact with them. Consult your child's physician for more information.

How is allergic rhinitis prevented?

Preventive measures for avoiding allergic rhinitis include the following:

• environmental controls, such as air conditioning, during pollen season
• avoiding areas where there is heavy dust, mites, molds
• avoiding pets

The link between allergic rhinitis and asthma:

Controlling asthma may mean controlling allergic rhinitis in some patients, according to allergy and asthma experts. Allergic rhinitis is a common problem that may be associated with asthma.

Guidelines from the World Health Organization (WHO) recognize the link between allergic rhinitis and asthma. Although the link is not fully understood, one theory asserts that rhinitis makes it difficult to breathe through the nose, which hampers the normal function of the nose. Breathing through the mouth does not warm the air, or filter or humidify it before it enters the lungs, which can make asthma worse.

What is a food allergy?

A food allergy is an abnormal response of the body to a certain food. It is important to know that this is different than a food intolerance, which does not affect the immune system, although some of the same symptoms may be present.

What causes food allergy?

Before having a food allergy reaction, a sensitive child must have been exposed to the food at least once before, or could also be sensitized through breast milk. It is the second time your child eats the food that the allergic symptoms happen. At that time, when IgE antibodies react with the food, histamines are released, which can cause your child to experience hives, asthma, itching in the mouth, trouble breathing, stomach pains, vomiting, and/or diarrhea.

What is the difference between food allergy and food intolerance?

Food allergy causes an immune system response, causing symptoms in your child that range from uncomfortable to life-threatening. Food intolerance does not affect the immune system, although some symptoms may be the same as in food allergy.

What foods most often cause food allergy?

Approximately 90 percent of all food allergies are caused by the following six foods:

• milk
• eggs
• wheat
• soy
• tree nuts
• peanuts

Eggs, milk, and peanuts are the most common causes of food allergies in children, with wheat, soy, and tree nuts also included. Peanuts, tree nuts, fish, and shellfish commonly cause the most severe reactions. About 6 percent to 8 percent of children under the age of six years have food allergies. Although most children "outgrow" their allergies, allergies to peanuts, tree nuts, fish, and shellfish may be life-long.

What are the symptoms of food allergy?

Allergic symptoms may begin within minutes to an hour after ingesting the food. The following are the most common symptoms of food allergy. However, each child may experience symptoms differently. Symptoms may include:

• vomiting
• diarrhea
• cramps
• hives
• swelling
• eczema
• itching or swelling of the lips, tongue, or mouth
• itching or tightness in the throat
• difficulty breathing
• wheezing
• lowered blood pressure

According to the National Institute of Allergy and Infectious Disease, it does not take much of the food to cause a severe reaction in highly allergic people. As little as 1/44,000 of a peanut kernel can cause an allergic reaction in severely allergic individuals. The symptoms of food allergy may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

Treatment for food allergy:

There is no medication to prevent food allergy. The goal of treatment is to avoid the foods that cause the symptoms. After seeing your child's physician and finding which foods your child is allergic to, it is very important to avoid these and other similar foods in that food group. If breastfeeding your child, it is important to avoid foods in your diet that your child is allergic to. Small amounts of the food allergen may be transmitted to your child through your breast milk and cause a reaction.

It is also important to give vitamins and minerals to your child if he/she is unable to eat certain foods. Discuss this with your child's physician.

For children who have had a severe food reaction, your child's physician may prescribe an emergency kit that contains epinephrine, which helps stop the symptoms of severe reactions. Consult your child's physician for further information.

Some children, under the direction of his/her physician, may be given certain foods again after 3 to 6 months to see if he/she has outgrown the allergy. Many allergies may be short-term in children and the food may be tolerated after the age of 3 or 4.

Milk and soy allergy:

Allergies to milk and soy are usually seen in infants and young children. Often, these symptoms are unlike the symptoms of other allergies, but, rather, may include the following:

• colic (fussy baby)
• blood in your child's stool
• poor growth

Often, your child's physician will change your baby's formula to a soy formula or breast milk if it is thought he/she is allergic to milk. If your child has problems with soy formula, your child's physician might change him/her to an easily digested hypoallergenic formula.

The symptoms of a milk or soy allergy may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

Prevention of food allergies:

The development of food allergies cannot be prevented, but can often be delayed in infants by following these recommendations:

• If possible, breastfeed your infant for the first 6 months.
• Do not give solid foods until your child is 6 months of age or older.
• Avoid cow's milk, wheat, eggs, peanuts, and fish during your child's first year of life.

Dining out with food allergies:

If your child has one or more food allergies, dining out can be a challenge. However, it is possible to have a healthy and satisfying dining-out experience - it just takes some preparation and persistence on your part.

The American Dietetic Association offers these tips for dealing with food allergies when your family is eating away from home:

• Know what ingredients are in the foods at the restaurant where you plan to eat. When possible, obtain a menu from the restaurant ahead of time and review the menu items.
• Let your server know from the beginning about your child's food allergy. He or she should know how each dish is prepared and what ingredients are used. Ask about preparation and ingredients before you order. If your server does not know this information or seems unsure of it, ask to speak to the manager or the chef.
• Avoid buffet-style or family-style service, as there may be cross-contamination of foods from using the same utensils for different dishes.
• Avoid fried foods, as the same oil may be used to fry several different foods.

Another strategy for dining out with food allergies is to give your server or the manager a food allergy card. A food allergy card contains information about the specific items your child is allergic to, along with additional information, such as a reminder to make sure all utensils and equipment used to prepare your meal are thoroughly cleaned before use. You can easily print these cards yourself using a computer and printer. If your child is eating out with friends and you are not going to be present, give your child a food allergy card (or make sure the adult in charge has one) to give to the server.

Alternately, there are several types of allergy cards available on the internet that can be customized with your child's personal information. One example is the "Food Allergy Buddy" Dining Card, promoted by the National Restaurant Association.

The Food Allergy Initiative, in conjunction with the National Restaurant Association and the Food Allergy and Anaphylaxis Network, has developed the Food Allergy Training Program for Restaurants and Food Services. This training program was developed to help restaurants and other food service outlets ensure their customers, including those with food allergies, will receive a safe meal prepared to customer specifications.

What is asthma?

Asthma is a chronic, inflammatory disease in which the airways become sensitive to allergens (any substance that triggers an allergic reaction). Several things happen to the airways when a child is exposed to certain triggers:

• The lining of the airways becomes swollen and inflamed.
• The muscles that surround the airways tighten.
• The production of mucus is increased, leading to mucus plugs.

All of these factors will cause the airways to narrow, thus, making it difficult for air to go in and out of your child's lungs, causing the symptoms of asthma.

Facts about asthma:

According to the latest information available from the American Lung Association, the Centers for Disease Control and Prevention (CDC), and the National Institute of Allergy and Infectious Diseases (NIAID):

• Approximately 22.2 million people in the US have been diagnosed with asthma, with at least 6.5 million of them children under the age of 18.
• Asthma is the leading, serious, chronic illness among children in the US.
• Asthma accounts for 14 million absences from school each year.
• Asthma is the third-ranking cause of childhood hospitalizations under the age of 15.

What causes asthma?

The exact cause of asthma is not completely known. It is believed to be partially inherited, but it also involves many other environmental, infectious, and chemical factors.

After a child is exposed to a certain trigger, the body releases histamine and other agents that can cause inflammation in your child's airways. The body also releases other factors that can cause the muscles of the airways to tighten, or become smaller. There is also an increase in mucus production that may clog the airways.

Some children have exercise-induced asthma, which is caused by varying degrees of exercise. Symptoms can occur during, or shortly after, exercise. Each child has different triggers that cause the asthma to worsen. You should discuss this with your child's physician.

The changes that occur in asthma are believed to happen in two phases:

• An immediate response to the trigger leads to swelling and narrowing of the airways. This makes it initially difficult for your child to breathe.
• A later response, which can happen four to eight hours after the initial exposure to the allergen, leads to further inflammation of the airways and obstruction of airflow.

What are the symptoms of asthma?

The following are the most common symptoms of asthma. However, each child may experience symptoms differently. Symptoms may include:

• coughing (either constant or intermittently)
• wheezing (this is a whistling sound that may be heard while your child is breathing)
• trouble breathing or shortness of breath while your child is playing or exercising
• chest tightness (your child may say his/her chest hurts or does not feel good)
• fatigue
• nighttime cough
• noisy breathing

The symptoms of asthma may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

Who is at risk for developing asthma?

Although anyone may have asthma, it most commonly occurs in:

• children and adolescents ages 5 to 17 years.
• a child with a family history of asthma.
• children who have allergies.
• children who have exposure to secondhand tobacco smoke.

What happens during an asthma attack or asthma exacerbation?

Children with asthma have acute episodes when the air passages in their lungs become narrower, and breathing becomes more difficult. These problems are caused by an over-sensitivity of the lungs and airways.

• The lungs and airways overreact to certain triggers causing:
  • the lining of the airways to become inflamed and swollen.
  • tightening of the muscles that surround the airways.
  • an increased production of mucus.
• Breathing becomes harder and may hurt.
• There may be coughing.
• There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because of the rush of air which moves through the narrowed airways.

How is asthma diagnosed?

To diagnose asthma and distinguish it from other lung disorders, physicians rely on a combination of medical history, physical examination, and laboratory tests, which may include:

• spirometry - a spirometer is a device used by your child's physician that assesses lung function. Spirometry, the evaluation of lung function with a spirometer, is one of the simplest and most common pulmonary function tests and may be necessary for any/all of the following reasons:
  • to determine how well the lungs receive, hold, and utilize air
  • to monitor a lung disease
  • to monitor the effectiveness of treatment
  • to determine the severity of a lung disease
  • to determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)
• peak flow monitoring (PFM) - a device used to measure the amount of air a person can blow out of the lungs. During an asthma or other respiratory flare-up, the large airways in the lungs slowly begin to narrow. This will slow the speed of air leaving the lungs and can be measured by a PFM. This measurement is very important in evaluating how well or how poorly the disease is being controlled.
• chest x-rays - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• blood tests (to analyze the amount of carbon dioxide and oxygen in the blood)
• allergy tests

What is croup?

Croup is a disease caused by a virus that leads to swelling in the airways and problems breathing. The child may also have stridor, a high-pitched sound usually heard when the child breathes in (inspiration).

What causes croup?

Croup is caused by a variety of different viruses. The most common virus is the parainfluenza virus. Other viruses may include:

• respiratory syncytial virus (RSV)
• influenza virus
• measles
• adenovirus
• enteroviruses

A child becomes infected through direct contact with a person or the secretions of another person who is infected with the disease. The infection begins in the upper respiratory tract and then slowly spreads down the tract. Swelling affects the area around the voice box (larynx) and into the trachea.

Younger children are more affected by croup because their airways are smaller. Therefore, a small amount of swelling can cause a large amount of obstruction in their airways.

Facts about croup:

• Croup is most commonly seen in children 3 months old to 5 years old.
• The peak time for croup to occur is 2 years old.
• Boys seem to be more affected by croup than girls.
• Croup is seen more often in the winter.

What are the symptoms of croup?

The following are the most common symptoms of croup. However, each child may experience symptoms differently. As the disease progresses down the respiratory tract, the symptoms also change and may include:

• a runny nose, congestion, and slight cough
• a cough develops into a "seal's bark"
• laryngitis
• fever
• stridor - Stridor is a high-pitched sound that is usually noted as the child breathes in (inspiration), although it can also be heard as the child breathes out (expiration).

Very often, the symptoms are worse at night and wake the child from sleep. Symptoms also seem to improve in the morning but progress as the day goes on. The extent of the disease varies for each child. Most children improve in three to seven days. The symptoms of croup may resemble other conditions and medical problems. Always consult your child's physician for a diagnosis.

How is croup diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for croup may include:

• neck and chest x-rays - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• blood tests
• pulse oximetry - an oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a Band-Aid®) is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.

Treatment for croup:

Specific treatment for croup will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the disease
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

In severe cases of croup, or if your child is not breathing well, hospitalization may be considered. This is sometimes hard to tell because the disease fluctuates, and your child may seem better at one moment, and then get worse the next. Your child's physician may also order the following medications to help with the symptoms of croup:

• breathing treatments (to help open up the airways)
• injections of medications (to help decrease the swelling in the airways)
• steroids given by mouth (to also help with the swelling of the airways)

Supportive treatment at home may also include:

• using a cool mist humidifier
• taking the child outside into cool, dry, night air
• increased fluid intake
• treating a fever with acetaminophen or ibuprofen, as instructed by your child's physician
• keeping your child as quiet and calm as possible (to help decrease the breathing effort)

Where should a baby's temperature be taken?

Most physicians recommend taking a baby's temperature rectally, by placing a thermometer in the baby's anus. This method is accurate and gives a quick reading of the baby's internal temperature. Axillary (underarm) temperature measurements must be held in place for 10 minutes. The tympanic (ear) type thermometers may not be accurate for newborns and require careful positioning to get an accurate reading. Skin strips that are pressed on the skin to measure temperature are not recommended for babies. Touching a baby's skin can let you know if he/she is warm or cool but you cannot measure body temperature simply by touch.

Preparing the thermometer:

There are different instructions depending on which type of thermometer you are using to take your baby's temperature. Be sure to follow the instructions for each carefully.

• Glass thermometers:
  • Check the thermometer carefully for cracks or splinters. If broken, do not use.
  • Disinfect the thermometer with rubbing alcohol or an antiseptic solution.
  • Rinse well in cool, not hot water.
  • Hold the thermometer on the opposite end of the bulb between your thumb and fingers.
  • Hold the thermometer just below your eye level to read it.
  • Roll the thermometer until you can see the line inside the glass.
  • Make sure the temperature reads below 96° F.
  • If the reading is higher, use quick, whip-like movements of your wrist to shake the line down.
  • Shake over a bed or carpet. This helps prevent the thermometer from breaking if you accidentally drop it while shaking it.
  • Lubricate the thermometer bulb with a water-soluble lubricant or petroleum jelly.
• Electronic Digital thermometers:
  • Place a disposable sheath over the thermometer.
  • Zero or reset the thermometer.
  • Lubricate the insertion end with a water-soluble lubricant.

About glass thermometers containing mercury:

According to the Environmental Protection Agency (EPA), mercury is a toxic substance that poses a threat to the health of humans, as well as to the environment. Because of the risk of breaking, glass thermometers containing mercury should be removed from use and disposed of properly in accordance with local, state, and federal laws. Contact your local health department, waste disposal authority, or fire department for information on how to properly dispose of mercury thermometers.

Taking the baby's rectal temperature:

Oral and rectal glass thermometers have different shapes and one should not be substituted for the other. Do not use oral thermometers rectally as these can cause injury. Rectal thermometers have a security bulb designed specifically for safely taking rectal temperatures.

• Place the baby across your lap or changing table, on his/her abdomen, facing down. Place your hand nearest the baby's head on his or her lower back and separate the baby's buttocks with your thumb and forefinger.
• Using your other hand, gently insert the lubricated bulb end of the thermometer one-half to one inch, or just past the anal sphincter muscle.
• The thermometer should be pointed towards the child's navel.
• Hold the thermometer with one hand on the baby's buttocks so the thermometer will move with the baby. Use the other hand to comfort the baby and prevent moving.
• Never leave a baby unattended with a rectal thermometer inserted. Movement or a change in position can cause the thermometer to break.
• Hold the thermometer for at least 2 minutes or until an electronic thermometer beeps or signals.
• Remove the thermometer.
• Wipe the bulb.
• Read immediately and record.
• Disinfect the thermometer with rubbing alcohol or an antiseptic solution.

High Temperature:

If a baby's temperature is 100.4° F or higher, make sure he/she is not dressed too warmly or over bundled with blankets. Crying may also raise a baby's temperature. Retake the baby's temperature in about 30 minutes. If the temperature is still high, call your baby's physician immediately.

What is chickenpox?

Chickenpox is a highly contagious disease, usually associated with childhood. By adulthood, more than 90 percent of Americans have had chickenpox.

The disease is caused by the varicella-zoster virus (VZV). Transmission occurs from person to person by direct contact or through the air.

Until 1995, chickenpox infection was a common occurrence, and almost everyone had been infected by the time he or she reached adulthood. However, the introduction of the chickenpox vaccine in 1995 has caused a decline in the incidence of chickenpox in all ages, particularly in ages one through four years.

What are the symptoms of chickenpox?

Symptoms are usually mild among children but may be life-threatening to adults and people with impaired immune systems. The following are the most common symptoms of chickenpox. However, each child may experience symptoms differently. Symptoms may include:

• fatigue and irritability one to two days before the rash begins
• itchy rash on the trunk, face, under the armpits, on the upper arms and legs, and inside the mouth
• feeling ill
• decreased appetite

The symptoms of chickenpox may resemble other skin problems. Always consult your child's physician for a diagnosis.

How is chickenpox spread?

Once exposed, the incubation period is typically 14 to 16 days, but it may take as few as 10 and as many as 21 for the chickenpox to develop. Chickenpox is contagious for one to two days before the appearance of the rash and until the blisters have dried and become scabs. The blisters usually dry and become scabs within four to five days of the onset of the rash. Children should stay home and away from other children until all of the blisters have scabbed over.

Family members who have never had chickenpox have a 90 percent chance of becoming infected when another family member in the household is infected.

How is chickenpox diagnosed?

The rash of chickenpox is unique and therefore the diagnosis can usually be made on the appearance of the rash and a history of exposure.

Treatment for chickenpox:

Specific treatment for chickenpox will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment for chickenpox may include:

• acetaminophen or ibuprofen for fever (DO NOT GIVE ASPIRIN)
• antibiotics for treating bacterial infections
• calamine lotion (to relieve itching)
• antiviral drugs (for severe cases)
• bed rest
• increased fluid intake (to prevent dehydration)
• cool baths with baking soda or Aveeno (to relieve itching)

Children should not scratch the blisters, as this could lead to secondary bacterial infections. Keep your child's fingernails short to decrease the likelihood of scratching.

Aspirin and the Risk of Reye Syndrome in Children

Do not give aspirin to a child without first contacting the child's physician. Aspirin, when given as treatment for children, has been associated with Reye syndrome, a potentially serious or deadly disorder in children. Therefore, pediatricians and other healthcare providers recommend that aspirin (or any medication that contains aspirin) not be used to treat any viral illnesses in children.

Immunity from chickenpox:

Most individuals who have had chickenpox will be immune to the disease for the rest of their lives. However, the virus remains dormant in nerve tissue and may reactivate, resulting in herpes zoster (shingles) later in life. Sometimes, a second case of chickenpox does occur. Blood tests can confirm immunity to chickenpox in people who are unsure if they have had the disease.

What complications are commonly associated with chickenpox?

Complications can occur from chickenpox. Those most susceptible to severe cases of chickenpox are adults and people with impaired immune systems. Complications may include:

• secondary bacterial infections
• pneumonia
• encephalitis (inflammation of the brain)
• cerebellar ataxia (defective muscular coordination)
• transverse myelitis (inflammation along the spinal cord)
• Reye syndrome (a serious condition which may affect all major systems or organs)
• death

What is fifth disease?

Fifth disease is a viral illness that results in a viral exanthem. Exanthem is another name for a rash or skin eruption. It is spread from one child to another through direct contact with discharge from the nose and throat. It can also be spread through contact with infected blood. It is moderately contagious and usually does not include a high fever, as seen with some other viral skin conditions.

What causes fifth disease?

Fifth disease is caused by the human parvovirus. It is most prevalent in the winter and spring and is usually seen in children 5 to 14 years of age. Outbreaks of the disease frequently occur in school settings.

What are the symptoms of fifth disease?

It may take between four to 14 days for the child to develop symptoms of fifth disease after being exposed to the disease. Children are most contagious before the rash occurs. Therefore, children may be contagious before they even know they have the disease. Also, about 20 percent of people with the virus do not have

symptoms but can still spread the disease. The following are the most common symptoms of fifth disease. However, each child may experience symptoms differently. Symptoms may include:

• There may be an early phase with the following symptoms, although this is not very common. If present, symptoms may include the following:
  • fever
  • headache
  • red eyes
  • sore throat
• The rash is usually the primary symptom of fifth disease. The rash:
  • starts on the cheeks and is bright red. The rash makes the child look as though he/she has been "slapped" on the cheeks.
  • then spreads to the trunk, arms, and legs, and lasts two to four days.
  • may then continue to reappear if the child is exposed to sunlight, very hot or cold temperature, or trauma to the skin. This may continue for several days.

The most serious complication of the disease affects pregnant women. The virus that causes fifth disease can cause fetal death. The symptoms of fifth disease may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is fifth disease diagnosed?

Fifth disease is usually diagnosed based on a complete medical history and physical examination of your child. The rash of fifth disease is unique, and usually allows for a diagnosis simply on physical examination. In addition, your child's physician may order blood tests to aid in the diagnosis.

Treatment for fifth disease:

Specific treatment for fifth disease will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the disease
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

The goal of treatment for fifth disease is to help decrease the severity of the symptoms. Since it is a viral infection, there is no cure for fifth disease.

Treatment may include:

• increased fluid intake
• acetaminophen for fever (DO NOT GIVE ASPIRIN)

What is roseola?

Roseola is a viral illness that results in a viral exanthem. Exanthem is another name for a rash or skin eruption. Roseola is a contagious disease that usually consists of a high fever and a rash that develops as the fever decreases.

What causes roseola?

Roseola is caused by many viruses. The most common cause is the human herpesvirus 6 (HHV-6). It occurs mostly in children under the age of 3. Roseola is contagious, although the way it is spread is not known. It occurs throughout the year.

What are the symptoms of roseola?

It may take between five to 15 days for a child to develop symptoms of roseola after being exposed to the disease. A child is probably most contagious during the period of high fever before the rash occurs. The following are the most common symptoms of roseola. However, each child may experience symptoms differently. Symptoms may include:

• high fever that starts abruptly
• fever (may last three to four days)
• irritability
• swelling of the eyes
• rash (As the fever decreases, a pink rash, with either flat or raised lesions, starts to appear on the trunk and then spreads to the face, arms, and legs).

The most serious complication that can occur with roseola is febrile seizures. This means that as the child's temperature becomes high, there is a chance of the child having a seizure that is directly related to the fever.

The symptoms of roseola may resemble other skin conditions or medical problems. Always consult your child's physician for a diagnosis.

How is roseola diagnosed?

Roseola is usually diagnosed based on a complete medical history and physical examination of your child. The rash of roseola that follows a high fever is unique and usually allows for a diagnosis simply on physical examination. In addition, your child's physician may order blood tests to aid in the diagnosis.

Treatment for roseola:

Specific treatment for roseola will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the disease
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

The goal of treatment for roseola is to help decrease the severity of the symptoms. Since it is a viral infection, there is no cure for roseola. Treatment may include:

• increased fluid intake
• acetaminophen for fever (DO NOT GIVE ASPIRIN)

Aspirin and the Risk of Reye Syndrome in Children

Do not give aspirin to a child without first contacting the child's physician. Aspirin, when given as treatment for children, has been associated with Reye syndrome, a potentially serious or deadly disorder in children. Therefore, pediatricians and other healthcare providers recommend that aspirin (or any medication that contains aspirin) not be used to treat any viral illnesses in children.

What is infectious mononucleosis?

Infectious mononucleosis, also known as mononucleosis, "mono," or glandular fever, is characterized by swollen lymph glands and chronic fatigue.

What causes infectious mononucleosis?

Infectious mononucleosis is either caused by the Epstein-Barr virus (EBV) or the cytomegalovirus, both of which are members of the herpes simplex virus family. Consider the following statistics:

• Most adults in the US have been exposed to the Epstein-Barr virus, which is a very common virus. When children are infected with the virus, they usually do not experience any noticeable symptoms. However, uninfected adolescents and young adults who come in contact with the virus may develop infectious mononucleosis in nearly 50 percent of exposures.
• The cytomegalovirus is a group of viruses in the herpes simplex virus family that often cause cells to enlarge. Most healthy persons who become infected with the CMV virus after birth have few if any, symptoms and have no long-term effects on their health.
• The Epstein-Barr virus (EBV) may cause infectious mononucleosis in adolescents and young adults. However, even after the symptoms of infectious mononucleosis have disappeared, the EBV will remain dormant in the throat and blood cells during that person's lifetime. The virus can reactivate periodically, however, usually without symptoms.

What are the symptoms of infectious mononucleosis?

Mononucleosis usually lasts for one to two months. The following are the most common symptoms of mononucleosis. However, each individual may experience symptoms differently. Symptoms may include:

• fever
• swollen lymph glands in the neck, armpits, and groin
• constant fatigue
• sore throat due to tonsillitis, which often makes swallowing difficult
• enlarged spleen
• liver involvement, such as mild liver damage that can cause temporary jaundice, a yellow discoloration of the skin and eye whites due to abnormally high levels of bilirubin (bile pigmentation) in the bloodstream

Once a person has had mononucleosis, the virus remains dormant in the throat and blood cells for the rest of that person's life. Once a person has been exposed to the Epstein-Barr virus, the person is usually not at risk for developing mononucleosis again.

The symptoms of mononucleosis may resemble other medical conditions. Always consult your child's physician for a diagnosis

How is infectious mononucleosis diagnosed?

In addition to a complete medical history and physical examination of your child, a diagnosis of mononucleosis is usually based on reported symptoms. However, diagnosis can be confirmed with specific blood tests and other laboratory tests, including:

• white blood cell count
• heterophile antibody test or mono spot test, which, if positive, indicates infectious mononucleosis

How is infectious mononucleosis spread?

Mononucleosis is often spread through contact with infected saliva from the mouth. Symptoms can take between four to six weeks to appear and usually do not last beyond four months, according to the Centers for Disease Control and Prevention (CDC). Transmission is impossible to prevent, according to the CDC, because even symptom-free people can carry the virus in their saliva.

Treatment for infectious mononucleosis:

Treatment for mononucleosis may include:

• rest for about one month (to give the body's immune system time to destroy the virus)
• corticosteroids (to reduce swelling of the throat and tonsils)

What are antibiotics?

Antibiotics are powerful drugs used to treat certain illnesses. However, antibiotics do not cure everything, and unnecessary antibiotics can even be harmful.

There are two main types of germs that cause most infections. These are viruses and bacteria.

• Viruses cause:
  • all colds and flu.
  • most coughs.
  • most sore throats.
• Antibiotics cannot kill viruses.
• Bacteria cause:
  • most ear infections.
  • some sinus infections.
  • strep throat.
  • urinary tract infections.
• Antibiotics do kill specific bacteria.

Some viruses cause symptoms that resemble bacterial infections, and some bacteria can cause symptoms that resemble viral infections. Your child's physician can determine what type of illness your child has and recommend the proper type of treatment.

What are resistant bacteria?

Each time you take an antibiotic, bacteria are killed. Sometimes, bacteria may be resistant or become resistant. Resistant bacteria do not respond to the antibiotics and continue to cause infection. A common misconception is that a person's body becomes resistant to specific drugs. However, it is the bacteria, not people, that become resistant to the drugs.

Each time you take or give your child an antibiotic unnecessarily or improperly, you increase the chance of developing drug-resistant bacteria. Therefore, it is critically important to take antibiotics only when necessary. Because of these resistant bacteria, some diseases that used to be easy to treat are now becoming nearly impossible to treat.

Bacteria can develop resistance to certain medications.

• Drug resistance happens when bacteria develop ways to survive the use of medications meant to kill or weaken them.
• If a germ becomes resistant to many drugs, treating the infections can become difficult or even impossible.
• Someone with an infection that is resistant to a certain medication can pass that resistant infection to another person. In this way, a hard-to-treat illness can be spread from person to person. In some cases, the illness can lead to serious disability or even death.

When are antibiotics needed?

This complicated question, which should be answered by your child's physician, depends on the specific diagnosis. For example, there are several types of ear infections - most need antibiotics, but some do not. Most cases of sore throat are caused by viruses. One kind, strep throat, diagnosed by a laboratory test, requires antibiotics.

Viral infections can sometimes lead to bacterial infections. However, treating viral infections with antibiotics to prevent bacterial infections is not recommended.

• Remember that antibiotics do not work against colds and flu and that unnecessary antibiotics can be harmful.
• Consult your child's pediatrician about antibiotics and find out about the differences between viruses and bacteria, and when antibiotics should and should not be used.
• If your child does receive an antibiotic, be sure to give it exactly as prescribed to decrease the development of resistant bacteria.
• Antibiotic resistance is particularly dangerous for children, but it can occur in adults, as well.

Remember that taking antibiotics appropriately and making sure your child receives the proper immunizations will help prevent having to take more dangerous and more costly medications. Consult your child's physician for more information.

What is acne?

Acne is a disorder of the hair follicles and sebaceous glands. With acne, the sebaceous glands are clogged, which leads to pimples and cysts.

Acne is very common - nearly 17 million people in the US are affected by this condition. Acne most often begins in puberty. During puberty, the male sex hormones (androgens) increase in both boys and girls, causing the sebaceous glands to become more active - resulting in increased production of sebum.

How does acne develop?

The sebaceous glands produce oil (sebum) which normally travels via hair follicles to the skin surface. However, skin cells can plug the follicles, blocking the oil coming from the sebaceous glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P. acnes) begin to grow inside the follicles, causing inflammation. Acne progresses in the following manner:

• Incomplete blockage of the hair follicle results in blackheads (a semisolid, black plug).
• Complete blockage of the hair follicle results in whiteheads (a semisolid, white plug).
• Infection and irritation cause whiteheads to form.

Eventually, the plugged follicle bursts, spilling oil, skin cells, and bacteria onto the skin surface. In turn, the skin becomes irritated and pimples or lesions begin to develop. The basic acne lesion is called a comedo.

Acne can be superficial (pimples without abscesses) or deep (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).

What causes acne?

Rising hormone levels during puberty may cause acne. In addition, acne is often inherited. Other causes of acne may include the following:

• hormone level changes during the menstrual cycle in women
• certain drugs (such as corticosteroids, lithium, and barbiturates)
• oil and grease from the scalp, mineral or cooking oil, and certain cosmetics may worsen acne
• bacteria inside pimples

Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard.

What are the symptoms of acne?

Acne can occur anywhere on the body. However, acne most often appears in areas where there is a high concentration of sebaceous glands, including the following:

• face
• chest
• upper back
• shoulders
• neck

The following are the most common symptoms of acne. However, each child may experience symptoms differently. Symptoms may include:

• blackheads
• whiteheads
• pus-filled lesions that may be painful
• nodules (solid, raised bumps)

The symptoms of acne may resemble other skin conditions. Always consult your child's physician for a diagnosis.

Treatment of acne:

Specific treatment will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• severity of the acne
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

The goal of acne treatment is to minimize scarring and improve appearance. Acne treatment will include topical or systemic drug therapy. Depending upon the severity of acne, topical medications (medications applied to the skin) or systemic medications (medications taken orally) may be prescribed by your child's physician. In some cases, a combination of both topical and systemic medications may be recommended.

Systemic medications to treat acne:

Systemic antibiotics are often prescribed to treat moderate to severe acne and may include the following:

• doxycycline
• erythromycin
• tetracycline

Treatment for severe, cystic, or inflammatory acne:

Isotretinoin (Accutane®), an oral drug, may be prescribed for individuals with severe, cystic, or inflammatory acne that cannot be effectively treated by other methods to prevent extensive scarring. Isotretinoin reduces the size of the sebaceous glands that produce the skin oil, increases skin cell shedding, and affects the hair follicles, thereby reducing the development of acne lesions. Isotretinoin can clear acne in 85 percent of patients. However, the drug has major unwanted side effects, including psychiatric side effects. It is very important to discuss this prescription medication with your child's physician.

Isotretinoin must not be taken by women who are pregnant or who can become pregnant because there is a very high likelihood of birth defects occurring in babies whose mothers took the medication during pregnancy. Isotretinoin can also cause miscarriage or premature birth. Because of these effects and to minimize fetal exposure, isotretinoin is approved for marketing only under a special restricted distribution program approved by the US Food and Drug Administration (FDA). This program is called iPLEDGE.

The goal of the iPLEDGE program is to prevent pregnancies in females taking isotretinoin and to prevent pregnant females from taking isotretinoin. Requirements of the iPLEDGE program include:

• Isotretinoin must only be prescribed by prescribers who are registered and activated with the iPLEDGE program.
• Isotretinoin must only be dispensed by a pharmacy registered and activated with iPLEDGE.
• Isotretinoin must only be dispensed to patients who are registered with and meet all the requirements of iPLEDGE
• Female patients who can get pregnant are required to use birth control for one month before treatment, during treatment, and for one month after stopping treatment.
• Pregnancy tests are required before, during, and after treatment.

What is a blister?

A blister is a bump on the skin containing fluid. Blisters are usually circular. The fluid that forms underneath the skin can be bloody or clear.

What causes a blister?

Blisters are caused by injury, allergic reactions, or infections, which may include the following:

• burns/scalds
• sunburns
• friction (from a shoe, for example)
• contact dermatitis
• impetigo (a contagious infection of the skin)
• viral infections (including chickenpox and herpes zoster)

The symptoms of a blister may resemble other skin conditions or medical problems. Always consult your child's physician for a diagnosis.

First-aid for blisters:

Blisters often heal spontaneously. Treatment will vary according to the cause. Some general guidelines for treatment may include:

• Wash the area with soap and water.
• A cold or ice pack may help reduce swelling and discomfort.
• Keep the area clean and dry - do not burst or puncture the blister.
• If the blister bursts, place an adhesive bandage or dressing on the area to keep it clean.
• Observe the area for signs of infection such as increased warmth, swelling, redness, drainage, pus formation, or pain. If you notice any signs of infection, call your child's physician. Antibiotics may be needed.

Heat and cold injuries:

Children are much more vulnerable to changes in the temperature of the environment because they produce and lose heat faster than adults. Because they are so often busy playing and having fun, children tend to pay less attention when they are becoming too hot or too cold until problems occur. It is important for you to protect your child from the sun and from heat and cold exposures that may cause them illness or injury. Knowing what to do in case a burn or thermal injury occurs can help prevent a medical emergency.

Caring for a heat-induced or thermal burn:

• Remove the child from the heat source.
• Cool the affected area with cold water or cold compresses until pain is reduced or alleviated.
• If a blister has formed, do not break it.
• Protect the burn with a dry, sterile, gauze bandage or with a clean bed sheet or cloth.
• If your child's clothing is stuck to the burned area, do not attempt to remove it. Instead, cut around the clothing leaving the burn intact.
• Do not apply any ointments, oils, or sprays to the burned area.
• If the burn is serious, seek medical attention or dial 911 for emergency medical attention.

Caring for an electrical burn:

• Call or send someone to call 911 for emergency medical assistance. Significant electrical injuries will need medical care.
• Unplug the appliance or device that has caused the injury or turn off the electrical current.
• If the child is in contact with the electrical current do not touch them until you turn off the source or the circuit breaker.
• Determine that the child is still breathing. If the child is not breathing, begin cardiopulmonary resuscitation (CPR).
• Cover the burned area with a sterile gauze bandage or clean bed sheet.
• Maintain your child's normal body temperature, and take the child to an emergency center.
• Be aware that a child may experience "shock" after an electrical burn. If your child is showing signs of shock, send someone to call 911 immediately.
• Do not give your child anything to eat or drink.
• Place the child on his/her back, unless a neck or back injury is suspected.
• If the child has vomited or has a serious injury to the face or mouth area, you may lay the child on his/her side.
• Keep your child warm with blankets or extra clothing, but do not use a heat source to warm them.
• Elevate your child's feet and legs, using a prop or pillow.

What are the symptoms of shock?

The following are the most common symptoms of shock. However, each child may experience symptoms differently. Symptoms of shock may include:

• cold sweat
• weakness
• irregular breathing
• chills
• pale or blue-colored lips
• pale or blue-colored fingernails
• a fast, but weak pulse
• nausea

The symptoms may resemble other conditions or medical problems. Consult your child's physician immediately for diagnosis and treatment.

What is contact dermatitis?

Contact dermatitis is a physiological reaction that occurs after skin comes in contact with certain substances. Irritants to the skin cause the vast majority of these reactions. The remaining reactions are caused by allergens, which trigger an allergic response.

Adults are most commonly affected by allergic contact dermatitis, but it can affect persons of all ages.

What causes irritant contact dermatitis?

The most common causes of irritants to children include the following:

• soaps
• saliva
• different foods
• detergents
• baby lotions
• perfumes

Plants, as well as metals, cosmetics, and medications may also cause contact dermatitis:

• Poison Ivy: Poison ivy, the plant family that also includes poison oak and sumac, is a common cause of a contact dermatitis reaction.
• Metals: Nearly 3,000 chemical agents are capable of causing allergic contact dermatitis. Nickel, chrome, and mercury are the most common metals that cause contact dermatitis:
  • Nickel is found in costume jewelry, belt buckles, and wristwatches, as well as zippers, snaps, and hooks on clothing. Contact with objects that are chrome-plated, which contain nickel, may also cause skin reactions in children who are sensitive to nickel.
  • Mercury, which is found in contact lens solutions, may cause problems for some children.
• Latex: Some children have an allergy or sensitivity to latex (rubber). Reactions can be seen when products made from latex come in contact with the child's skin. Latex is found in products made with natural rubber latex, such as rubber toys, balloons, bells, rubber gloves, and pacifiers or nipples.
• Cosmetics: Many types of cosmetics can cause allergic contact dermatitis. Permanent hair dye that contains paraphenylenediamine is the most common cause. Other products that may cause problems include dyes used in clothing, perfumes, eye shadow, nail polish, lipstick, and some sunscreens.
• Medications: Neomycin, which is found in antibiotic creams, is a common cause of medication contact dermatitis. Local anesthetics, such as novocaine or paraben, are other possible causes.

What are the symptoms of contact dermatitis?

The following are some of the other symptoms associated with contact dermatitis. However, each child may experience symptoms differently. Symptoms may include:

• mild redness and swelling of the skin
• blistering of the skin
• itching
• scaling and temporary thickening of skin

The most severe reaction is at the contact site. The symptoms of contact dermatitis may resemble other skin conditions. Always consult your child's physician for a diagnosis.

Treatment for contact dermatitis:

The best treatment is to identify and avoid the substances that may have caused the allergic contact dermatitis. The following is recommended by the American Academy of Allergy, Asthma, and Immunology, for mild to moderate reactions:

• Thoroughly wash skin with soap and water as soon after the exposure as possible.
• Wash clothing and all objects that touched plant resins (poison ivy/oak) to prevent re-exposure.
• Use wet, cold compresses to soothe and relieve inflammation if blisters are broken.
• For severe reactions, always contact your child's physician.

What is seborrheic dermatitis (cradle cap)?

Also called cradle cap, seborrheic dermatitis in the infant is characterized by fine white scales. However, seborrheic dermatitis can also occur in the diaper area, face, neck, and trunk. Seborrheic dermatitis in this age group usually clears within the first year.

What causes cradle cap?

The exact cause of this skin condition is not known.

What does cradle cap look like?

The following are the most common signs and symptoms of cradle cap. However, each child may experience symptoms differently. Symptoms include dry or greasy scales on the scalp.

How is cradle cap diagnosed?

Cradle cap is usually diagnosed based on physical examination of your child. The rash involved with cradle cap is unique, and can usually be diagnosed simply on physical examination.

Treatment for cradle cap:

Specific treatment for cradle cap will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Although the condition responds to treatment, it may recur. Treatment is usually effective in helping symptoms and may include:

• rubbing the scalp with baby oil or petroleum jelly (to soften crusts before washing)
• special shampoo, as prescribed by your child's physician
• Corticosteroid cream or lotion

What is diaper dermatitis?

Diaper dermatitis, commonly known as a diaper rash, is a term used to describe different skin rashes in the diapered area. The rash is usually red, scaling, and, rarely, ulcerated. It is most commonly seen in infants between the ages of 9 to 12 months but may begin within the first 2 months of life.

What causes diaper dermatitis?

Possible contributors to diaper dermatitis include the following:

• Irritation - from urine and feces trapped in the diaper.
• Candida diaper dermatitis - dermatitis caused by a yeast infection in the diaper area, often preceded by diaper dermatitis.
• Seborrheic diaper dermatitis - a common, chronic skin condition that can affect the diaper area as well as other locations on the body.

Other less common causes of dermatitis in the diaper area include the following:

• Impetigo - dermatitis caused by a bacterial infection.
• Perianal streptococcal disease - dermatitis caused by a streptococcus.
• Allergic dermatitis - a type of dermatitis that is rare in the first 2 years of life, but may be caused by soaps and detergents, or the diaper.

What are the symptoms of diaper dermatitis?

The symptoms of diaper dermatitis vary depending on the cause of the dermatitis and may be different for each child that is affected. The following are common characteristics of the rash that may occur with each type of infection:

• Candida diaper dermatitis - this rash usually begins in the creases or folds of the thighs and the diaper area and then spreads. The rash is usually a deep, red, shiny rash with red, satellite lesions. This type of rash may be associated with thrush, a yeast infection in the baby's mouth.
• Seborrheic diaper dermatitis - this rash also affects the skin folds in the groin area and is usually pink. Infants may also have this rash on their face, scalp, or neck at the same time.
• Contact diaper dermatitis - this rash is mostly seen on the buttocks and may extend to the thighs, stomach, and waist area, but does not generally involve folds in the area. The rash is usually red and shiny.

The symptoms of diaper dermatitis may resemble other skin conditions. always consult your child's physician for a diagnosis.

How is diaper dermatitis diagnosed?

Diaper dermatitis is usually diagnosed based on the location and appearance of the rash during a physical examination of your child. In addition, your child's physician may do skin scraping to aid in the diagnosis.

Treatment for diaper dermatitis:

Treatment for diaper dermatitis will vary based on the cause of the dermatitis. Specific treatment for diaper dermatitis will also be determined by your physician based on:

• your child's age, overall health, and medical history
• extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment may include:

• removal of the diaper for a few days
• medicated diaper cream (as prescribed by your child's physician)
• anti-inflammatory creams
• moisture-resistant diaper creams

Proper skin care is also very important in preventing diaper dermatitis. This includes:

• keeping the diaper area clean and dry.
• changing diapers frequently.
• allowing the diaper area to air dry at times.
• limiting the use of soap and other harsh cleaners in the diaper area.

What is impetigo?

Impetigo is a superficial infection of the skin, caused by bacteria. The lesions are often grouped and have a red base. The lesions open and become crusty and have a "honey color," which is typical of impetigo. Impetigo is very contagious and can be spread throughout a household, with children re-infecting themselves or other family members.

What causes impetigo?

Common bacteria, some of which are found normally on the skin, cause impetigo. When the bacteria enter an open area in the skin, the infection can occur. The most common bacteria that cause impetigo include the following:

• group A ß - hemolytic streptococcus
• Staphylococcus aureus

Impetigo is more common in children than adults, but adults may also have the infection. Impetigo is made worse by poor hygiene and warm temperatures.

What are the symptoms of impetigo?

Impetigo usually occurs on the face, neck, arms, and limbs, but the lesions may appear on any part of the body. Impetigo starts as a small vesicle or fluid-filled lesion. The lesion then ruptures and the fluid drains leaving areas that are covered with honey-colored crusts. The lesions may all look different, with different sizes and shapes. Your child may also have swollen lymph nodes (small lumps that are located mostly in the neck, arm, under the arm, and in the groin area). The lymph nodes become enlarged when your child's body is fighting an infection.

The symptoms of impetigo may resemble other skin conditions. Always consult your child's physician for a diagnosis.

How is impetigo diagnosed?

Impetigo is usually diagnosed based on a medical history and physical examination of your child. The lesions of impetigo are unique and usually allow for a diagnosis based simply on physical examination. In addition, your child's physician may order a culture of your child's lesion to confirm the diagnosis and the type of bacteria that is present.

Treatment for impetigo:

Specific treatment for impetigo will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment may include:

• For a child with many lesions, oral antibiotics may be prescribed.
• If your child only has a few lesions, your child's physician may prescribe a topical antibiotic applied directly to the lesions.
• Your child should wash daily with an antibacterial soap to help decrease the chance of spreading the infection.
• Proper hand washing technique by everyone in the household is very important to help decrease the chance of spreading the infection.
• Keep your child's fingernails short to help decrease the chance of scratching and spreading the infection.
• Avoid sharing of garments, towels, etc. to prevent the spreading of the infection.

What are lice?

Lice are tiny insects that can infest the skin anywhere on the body. Lice infection is characterized by intense itching. Lice are highly contagious, spreading from person to person by close body contact, shared clothes, and other items (such as hats, hairbrushes, and combs). There are three types of human lice:

• head lice
• body lice
• pubic lice

Facts about lice:

Head lice:

• Head lice are seen mostly in childcare settings and among school-aged children.
• The child usually has itching in the head area.
• Lice, or the eggs (called nits), can usually be seen on the hair, behind the ears, and on the neck.

Body lice:

• Body lice are usually seen in people with poor hygiene.
• Body lice are rare in children.
• Body lice cause severe itching, which is often worse at night.
• With body lice, in some cases, lice and eggs can be found in the seams of clothes.

Pubic lice:

• Pubic lice are very contagious and can be transmitted through sexual contact or by contaminated items such as towels and clothes.
• Pubic lice can affect the pubic hair but also can cause infections of the hair on the chest, abdomen, thighs, and eyebrows.
• Itching of the affected area is a common symptom of pubic lice.

How are lice diagnosed?

The eggs laid by lice are usually visible to the naked eye, making it easy for your child's physician to diagnose. Pubic lice leave small brown spots on the parts of clothing that come into contact with the genitals or anus.

Treatment for lice:

Specific treatment for lice will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the infestation
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the infestation
• your opinion or preference

Lice are treatable.

Treatment for head lice and pubic lice:

• Application of a medicated cream rinse or shampoo is usually an effective treatment for head and/or pubic lice. Specific instructions need to be followed. Discuss this with your child's physician. Examples of medicated cream rinses or shampoos include the following:
  • malathion (Ovide®) - this is a new treatment that is safe and effective for lice and nits
  • lindane (Kwell®) - do not use if there are open sores on the head because of toxicity
  • pyrethrins (RID®) - this treatment does not kill nits (lice eggs)
  • permethrin cream rinse (NIX®) - this treatment does not always work due to lice resistance
• Nits need to be removed from the hair with a fine-tooth comb.
• Combs and brushes should be soaked in hot water with the shampoo for at least 15 minutes.
• Children can return to school or daycare the day following their first treatment for head lice.

Treatment for body lice:

• Medications are usually not needed to treat body lice.
• Treatment for body lice usually consists of improving hygiene and washing clothes.
• Bed sheets and blankets should be washed in hot water and dried in a hot dryer.

What is poison ivy/poison oak?

Three native American plants collectively may be called poison ivy:

• poison ivy
• poison oak
• poison sumac

These plants can cause an allergic reaction in nearly 85 percent of the population. To be allergic to poison ivy, your child must first be "sensitized" to the oils. This means that next time there is contact with the plant, a rash may occur.

What causes an allergic reaction?

The resin in the plants contains an oily substance called urushiol. Urushiol is easily transferred from plants to other objects, including toys, garments, and animals. This chemical can remain active for a year or longer. It is important to know that the oils can also be transferred from clothing, and pets, and can be present in the smoke from a burning plant.

What are the symptoms of an allergic reaction to poison ivy/poison oak?

The reaction is usually contact dermatitis, which may occur several hours, days, or even weeks after exposure. The dermatitis is characterized by a rash followed by bumps and blisters that itch. Sometimes, swelling occurs in the area of contact. Eventually, the blisters break, ooze, and then crust over.

Treatment for poison ivy/poison oak:

Making sure your child avoids poisonous plants is the best treatment. It is important to teach your children what the plants look like and not to touch them.

If contact with the plants has already occurred, you should remove the oils from the skin as soon as possible. Cleansing with an ordinary soap within six hours after the initial exposure has proven to be effective. Repeat the cleaning with the soap three times. There are also alcohol-based wipes that help remove the oils. Wash all clothes and shoes also, because the oils can remain on these.

If the blisters and rash are on the face, near the genitals, or all over the body, your child's physician should be notified. After a medical history and physical examination, your child's physician may prescribe a steroid cream, oral steroids, or steroid injections to help with the swelling and itching.

Is poison ivy/poison oak contagious?

Poison ivy/ poison oak cannot be spread from person to person by touching the blisters, or from the fluid inside the blisters. It can be spread, however, if the oils remain on the skin, clothes, or shoes. This is why washing your child's hands, clothes, and shoes as soon as possible is very important.

Preventing poison ivy/poison oak:

• Teach all family members to recognize the plants.
• Make sure your child wears long pants and long sleeves when poison ivy or poison oak are in the vicinity.
• Wash all clothes and shoes immediately after your child has been outside.
• Make sure your child does not touch a pet that might have been in contact with a poisonous plant.
• Wash your child's hands thoroughly.

What is sunburn?

Sunburn is a visible reaction of the skin's exposure to ultraviolet (UV) radiation, the invisible rays that are part of sunlight. Ultraviolet rays can also cause invisible damage to the skin. Excessive and/or multiple sunburns cause premature aging of the skin and lead to skin cancer. Skin cancer is the most common type of cancer in the US and exposure to the sun is the leading cause of skin cancer.

Children often spend a good part of their day playing outdoors in the sun, especially during the summer. Children who have fair skin, moles, or freckles, or who have a family history of skin cancer, are more likely to develop skin cancer in later years.

Exposure to the sun during daily activities and play causes the most sun damage. Overexposure to sunlight before age 18 is most damaging to the skin.

UV rays are strongest during summer months when the sun is directly overhead (normally between 10:00 a.m. and 3:00 p.m.).

What are the symptoms of sunburn?

The following are the most common symptoms of sunburn. However, each child may experience symptoms differently. Symptoms may include:

• redness
• swelling of the skin
• pain
• blisters
• fever
• chills
• weakness
• dry, itching, and peeling skin days after the burn

The symptoms of sunburn may resemble other skin conditions. Always consult your child's physician for a diagnosis.

First-aid for sunburn:

• Have your child take a cool bath or use cool compresses on the sunburned area.
• Give your child acetaminophen or ibuprofen for discomfort. Be sure to follow the directions on the container.
• Apply a topical moisturizer, aloe gel, hydrocortisone cream, or a topical pain reliever to sunburned skin. Avoid commercial products that contain Benadryl or benzocaine, because of the possibility of skin irritation or allergy.
• If blisters are present, do not break them open, as infection can occur.
• Keep your child out of the sun until the burn is healed.

When should I call my child's physician?

Specific treatment for sunburn will be determined by your child's physician and may depend on the severity of the sunburn. In general, call your child's physician if:

• the sunburn is severe or forms blisters.
• your child has symptoms of heat stress such as fever, chills, nausea, vomiting, or feeling faint.

Preventing sunburn:

Protection from the sun should start at birth and continue throughout your child's life. It is estimated that 60 to 80 percent of total lifetime sun exposure occurs in the first 18 years of life.

What are sunscreens?

Sunscreens protect the skin against sunburns and play an important role in blocking the penetration of ultraviolet (UV) radiation. However, no sunscreen blocks UV radiation 100 percent.

Terms used on sunscreen labels can be confusing. The protection provided by sunscreen is indicated by the sun protection factor (SPF) listed on the product label. A product with an SPF higher than 15 is called a sunblock.

How to use sunscreens:

A sunscreen protects from sunburn and minimizes suntan by absorbing UV rays. Using sunscreens correctly is important in protecting the skin. Consider the following recommendations:

• Choose a sunscreen for children and test it on your child's wrist before using it. If your child develops skin or eye irritation, choose another brand. Apply the sunscreen very carefully around the eyes.
• Choose a broad-spectrum sunscreen that filters out both ultraviolet A (UVA) and ultraviolet B (UVB) rays.
• Apply sunscreens to all exposed areas of skin, including those easily overlooked areas, such as the rims of the ears, the lips, the back of the neck, and the tops of the feet.
• Use sunscreens for all children over 6 months of age, regardless of skin or complexion type, because all skin types need protection from UV rays. Even dark-skinned children can have painful sunburns.
• Apply sunscreens 30 minutes before going out into the sun to give it time to work. Use it liberally and reapply it every two hours after being in the water or after exercising or sweating. Sunscreens are not just for the beach - use them when your child is playing outdoors in the yard or participating in sports.
• Use a waterproof or water-resistant sunscreen.
• Use of sunscreen with an SPF of 20 to 30 offers substantial protection from sunburn and prevents tanning. High SPF sunscreens protect from burning for longer periods than sunscreens with lower SPF. Talk with your older child or teenager about using sunscreen and why it's important. Set a good example for them by using sunscreen yourself.
• Teach your teenager to avoid tanning beds and salons. Most tanning beds and salons use ultraviolet-A bulbs. Research has shown that UVA rays may contribute to premature aging of the skin and skin cancer.
• The American Academy of Pediatrics (AAP) states that sunscreen may be used on infants younger than 6 months old if adequate clothing and shade are not available. Using sunscreen on small areas of skin on an infant is not harmful, according to the AAP. Parents should still try to avoid sun exposure and dress the infant in lightweight clothing that covers most surface areas of the skin. However, parents also may apply a minimal amount of sunscreen to the infant's face and back of the hands. Always consult your infant's physician for more information.

What is conjunctivitis?

Conjunctivitis, also known as "pink eye," is an inflammation of the conjunctiva of the eye. The conjunctiva is the membrane that lines the inside of the eye and also a thin membrane that covers the actual eye.

What causes conjunctivitis?

There are many different causes of conjunctivitis. The following are the most common causes:

• bacteria, including:
  • Staphylococcus aureus
  • Haemophilus influenza
  • Streptococcus pneumoniae
  • Neisseria gonorrhea
  • Chlamydia trachomatis
• viruses, including:
  • adenoviruses
  • herpes virus
• chemicals (seen mostly in the newborn period after the use of medicine in the eye to prevent other problems)
• allergies

What are the different types of conjunctivitis?

Conjunctivitis is usually divided into at least two categories, newborn conjunctivitis and childhood conjunctivitis, with different causes and treatments for each.

Newborn Conjunctivitis: The following are the most common causes and treatment options of newborn conjunctivitis:

• Chemical Conjunctivitis - This is related to an irritation in the eye from the use of eye drops that are given to the newborn to help prevent a bacterial infection. Sometimes, the newborn reacts to the drops and may develop a chemical conjunctivitis. The eyes are usually mildly red and inflamed, starting a few hours after the drops have been placed in the eye, and lasting for only 24 to 36 hours. This type of conjunctivitis usually requires no treatment.
• Gonococcal Conjunctivitis - This is caused by a bacteria called Neisseria gonorrhea. The newborn obtains this type of conjunctivitis by the passage through the birth canal from an infected mother. This type of conjunctivitis may be prevented with the use of eye drops in newborns at birth. The newborn eyes usually are very red, with thick drainage and swelling of the eyelids. This type usually starts about 2 to 4 days after birth. Treatment for gonococcal conjunctivitis usually will include antibiotics through an intravenous (IV) catheter.
• Inclusion Conjunctivitis - This is caused by an infection with chlamydia trachomatis, obtained by passage through the birth canal from an infected mother. The symptoms include moderate thick drainage from the eyes, redness of the eyes, swelling of the conjunctiva, and some swelling of the eyelids. This type of conjunctivitis usually starts 5 to 12 days after birth. Treatment usually includes oral antibiotics.
• Other bacterial Causes - After the first week of life, other bacteria may be the cause of conjunctivitis in the newborn. The eyes may be red and swollen with some drainage. Treatment depends on the type of bacteria that has caused the infection. Treatment usually will include antibiotic drops or ointments to the eye, warm compresses to the eye, and proper hygiene when touching the infected eyes.

Childhood Conjunctivitis: is a swelling of the conjunctiva and may also include an infection. It is a very common problem in children. Also, large outbreaks of conjunctivitis are often seen in daycare settings or schools. The following are the most common causes of childhood conjunctivitis:

• bacteria
• viral
• allergies
• herpes

What are the symptoms of childhood conjunctivitis?

The following are the most common symptoms of childhood conjunctivitis. However, each child may experience symptoms differently. Symptoms may include:

• itchy, irritated eyes
• clear, thin drainage (usually seen with viral or allergic causes)
• sneezing and runny nose (usually seen with allergic causes)
• stringy discharge from the eyes (usually seen with allergic causes)
• thick, green drainage (usually seen with bacterial causes)
• ear infection (usually seen with bacterial causes)
• lesion with a crusty appearance (usually seen with herpes infection)
• eyes that are matted together in the morning
• swelling of the eyelids
• redness of the conjunctiva
• discomfort when the child looks at a light
• burning in the eyes

The symptoms of conjunctivitis may resemble other medical conditions or problems. Always consult your child's physician for a diagnosis.

How is conjunctivitis diagnosed?

Conjunctivitis is usually diagnosed based on a complete medical history and physical examination of your child's eye. Cultures of the eye drainage are usually not required but may be done to help confirm the cause of the infection.

Treatment for conjunctivitis:

Specific treatment for conjunctivitis will be determined by your physician based on:

• your child's age, overall health, and medical history
• extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Specific treatment depends on the underlying cause of the conjunctivitis.

• Bacterial causes: Your child's physician may order antibiotic drops to put in the eyes.
• Viral causes: Viral conjunctivitis usually does not require treatment. Your child's physician may order antibiotic drops for the eyes to help decrease the chance of a secondary infection.
• Allergic causes: Treatment for conjunctivitis caused by allergies usually will involve treating the allergies. Your child's physician may order oral medications or eye drops to help with the allergies.
• Herpes: If your child has an infection of the eye caused by a herpes infection, your child's physician may refer you to an eye care specialist. Your child may be given both oral medications and eye drops. This is a more serious type of infection and may result in scarring of the eye and loss of vision.

Infection can be spread from one eye to the other, or other people, by touching the affected eye or drainage from the eye. Proper hand washing is very important. Drainage from the eye is contagious for 24 to 48 hours after beginning treatment.

What is ecchymosis or bruising of the eye?

Ecchymosis, more commonly known as a "black eye," usually occurs from some type of trauma to the eye, causing the tissue around the eye to become bruised. Your child's physician will examine the eye closely to make sure there is no damage to the actual eye itself.

Treatment for a black eye:

Specific treatment for a black eye will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the injury
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the injury
• your opinion or preference

Most black eyes heal completely and do not cause any damage to the eye. Treatment may include:

• cold compresses to the eye for the first 24 hours
• warm compresses to the eye after the first 24 hours
• continued compresses until the swelling stops
• keep the child's head elevated to help decrease the amount of swelling

It is important to know that the swelling and bruise may appear to spread and go down the cheek or to the other eye. This is normal. Consult your child's physician if the bruising and swelling does not resolve on its own.

What is Otitis Media (OM)?

Otitis media is inflammation located in the middle ear. Otitis media can occur as a result of a cold, sore throat, or respiratory infection.

Facts about Otitis Media:

• More than 80 percent of children have at least one episode of otitis media by the time they are 3 years of age.
• Nearly half of these children have three or more episodes by the time they are 3 years of age.
• Otitis media can also affect adults, although it is primarily a condition that occurs in children.
• Otitis media is the most common diagnosis for children in the US.
• Otitis media occurs more often in the winter and early spring.

Who is at risk for getting ear infections?

While any child may develop an ear infection, the following are some of the factors that may increase your child's risk of developing ear infections:

• being around someone who smokes
• family history of ear infections
• a poor immune system
• spends time in a daycare setting
• absence of breastfeeding
• having a cold
• bottle-fed while laying on his/her back

What causes Otitis Media?

Middle ear infections are usually a result of a malfunction of the Eustachian tube, a canal that links the middle ear with the throat area. The Eustachian tube helps to equalize the pressure between the outer ear and the middle ear. When this tube is not working properly, it prevents normal drainage of fluid from the middle ear, causing a buildup of fluid behind the eardrum. When this fluid cannot drain, it allows for the growth of bacteria and viruses in the ear that can lead to acute otitis media. The following are some of the reasons that the Eustachian tube may not work properly:

• a cold or allergy which can lead to swelling and congestion of the lining of the nose, throat, and Eustachian tube (this swelling prevents the normal flow of fluids)
• a malformation of the Eustachian tube

What are the different types of otitis media?

• Acute Otitis Media (AOM) - the middle ear infection occurs abruptly causing swelling and redness. Fluid and mucus become trapped inside the ear, causing the child to have a fever, ear pain, and hearing loss.
• Otitis Media with Effusion (OME) - fluid (effusion) and mucus continue to accumulate in the middle ear after an initial infection subsides. The child may experience a feeling of fullness in the ear and hearing loss.

What are the symptoms of otitis media?

The following are the most common symptoms of otitis media. However, each child may experience symptoms differently. Symptoms may include:

• unusual irritability
• difficulty sleeping or staying asleep
• tugging or pulling at one or both ears
• fever
• fluid draining from ear(s)
• loss of balance
• hearing difficulties
• ear pain
• nausea and vomiting
• diarrhea
• decreased appetite
• congestion

The symptoms of otitis media may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is otitis media diagnosed?

In addition to a complete medical history and physical examination, your child's physician will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the physician to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.

Tympanometry, is a test that can be performed in most physicians' offices to help determine how the middle ear is functioning. It does not tell if the child is hearing or not, but helps to detect any changes in pressure in the middle ear. This is a difficult test to perform in younger children because the child needs to remain still and not cry, talk, or move.

A hearing test may be performed for children who have frequent ear infections.

Treatment for otitis media:

Specific treatment for otitis media will be determined by your child's physician based on the following:

• your child's age, overall health, and medical history
• extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment may include:

• antibiotic medication by mouth or ear drops
• medication (for pain)

If fluid remains in the ear(s) for longer than three months, your child's physician may suggest that small tubes be placed in the ear(s). This surgical procedure, called myringotomy, involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and prevent fluid from accumulating. The child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to twelve months.

Your child's surgeon may also recommend the removal of the adenoids (lymph tissue located in the space above the soft roof of the mouth, also called nasopharynx) if they are infected. Removal of the adenoids has been shown to help some children with otitis media.

Treatment will depend upon the type of otitis media. Consult your child's physician regarding treatment options.

What are the effects of otitis media?

In addition to the symptoms of otitis media listed above, untreated otitis media can result in any/all of the following:

• infection in other parts of the head
• permanent hearing loss
• problems with speech and language development

What causes a nosebleed?

Nosebleeds are caused by many factors, but some of the most common causes include the following:

• picking the nose
• blowing the nose too hard
• injury to the nose
• over-dry air
• colds and allergies
• foreign body in the nose

Many times no apparent cause for a nosebleed can be found.

First-aid for nosebleeds:

Specific treatment for a black eye will be determined by your child's physician based on:

• Calm your child and let him/her know you can help.
• Pinch the nostrils together for five to ten minutes without checking to see if the bleeding has stopped.
• Have your child sit up and lean forward to avoid swallowing blood.
• Apply ice or cold water compress to the bridge of the nose.
• If bleeding does not stop, try the above steps one more time.
• Do not pack your child's nose with tissues or gauze.

When should I call my child's physician?

Specific treatment for nosebleeds, that require more than minor treatment at home, will be determined by your child's physician. In general, call your child's physician for nosebleeds if:

• you are unable to stop the nosebleed or if it recurs.
• your child also has a nose injury that may indicate a more serious problem (such as a fractured nose or other trauma to the head).
• there is a large amount, or rapid loss of blood.
• your child feels faint, weak, ill, or has trouble breathing.
• your child has bleeding from other parts of the body (such as in the stool, urine, or gums) or bruises easily.
• there is a foreign body stuck in your child's nose.

Prevention of nosebleeds:

If your child has frequent nosebleeds, some general guidelines to help prevent nosebleeds from occurring include the following:

• Use a cool mist humidifier in your child's room at night if the air in your home is dry. Be sure to follow the manufacturer's advice for cleaning the humidifier so that germs and mold do not grow in it.
• Teach your child not to pick his/her nose or blow it too forcefully.
• Apply petroleum jelly inside the nostrils several times a day, especially at bedtime, to help keep the area moist.
• Use saline (salt water) drops or a saline nose spray, as directed by your child's physician.
• See your child's physician for treatment of allergies that may contribute to frequent nosebleeds.

What is colic?

Colic is a problem that affects some babies during the first three to four months of life. It can be very stressful and frustrating for parents. It is defined by the "rule of three": crying at least 3 hours per day, more than 3 days per week, and for 3 weeks duration or more. Colic usually begins suddenly, with loud and mostly continuous crying.

What causes colic?

Physicians are not certain what causes colic. There are several theories about why colic may or may not occur, including the following:

• Adjusting to each other: One theory about colic relates to the adjustments that a new baby and his/her parents have to make to each other. Until babies learn to talk, one way they communicate with adults is by crying. Parents have to learn to interpret the reasons their baby is crying, and then figure out what to do to make the baby happy. Is the baby hungry? Wet? Cold? Hot? Tired? Bored? A baby will cry for these reasons, as well as for other problems, and parents must try to determine what is causing their baby's stress, often by trial and error. New parents, especially, may have trouble reading their baby's cues and responding appropriately. The baby may continue to cry simply because its needs have not yet been met.
• Temperament and adjusting to the world: Newborns must also make adjustments to the world they are living in. Not all babies have the same temperament. Some adjust to lights, loud noises, and all the other stimulation around them with no trouble, while others are not able to adapt as easily.

Just like adults, some babies are easy-going, and some are impatient. Crying may be one way for a baby to vent feelings as he/she is getting adjusted to the world. Babies have been noted to cry for specific lengths of time every day, as they are getting used to the world, and as their parents are learning to interpret their needs.

• Oversensitivity to gas: Another possible reason for excessive crying in babies might be due to an oversensitivity to gas in the intestine. Physicians do not think that babies with colic produce more gas than others, but simply that the normal amount of gas that is produced as food is digested is uncomfortable for some babies. If a baby with colic seems to pass more gas than other babies do, it is probably due to swallowing more air while crying for prolonged periods.
• Milk allergy: Milk allergies may cause abdominal pain, but usually also cause diarrhea. A baby who cannot tolerate cow's milk and responds to a change in formula may have a milk allergy.

What are the symptoms of colic?

A child who is otherwise well, who cries or is fussy several hours a day, especially from 6 pm to 10 pm, with no apparent reason, may have colic. Also, babies with colic may burp frequently or pass a significant amount of gas, but this is thought to be due to swallowing air while crying and is not a cause of colic. The face may be flushed. The abdomen may be tense with legs drawn toward it. The hands may be clenched and the feet are often cold.

The symptoms of colic may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

Who is at risk for colic?

Infants who are either under or over-fed may be more susceptible to colic. Those who are allergic to formula or something in the mother's diet (if breastfed), are prone to colic symptoms. Infants in the 0 to 3-month age range who are started on cereal or other high-carbohydrate food are also likely to develop colic as a result of excessive fermentation. Lastly, an emotionally unstable environment may contribute to colic symptoms in an infant.

Why is colic a concern?

Colic may become a concern due to the following reasons:

• frustrating and stressful to parents
• parents and infant lose sleep
• infant may be overfed in an attempt to stop the crying

Babies with colic usually grow and gain weight appropriately, despite being fussy or irritable, being gassy, and losing sleep.

How is colic diagnosed or evaluated?

A physician will examine your baby and obtain a medical history. Questions might be asked about how long and how often your child cries if you have noticed anything that seems to trigger the crying, and what comfort measures are effective, if any. Blood tests and x-rays or other imaging tests may be done to determine if there are other problems present.

When should we contact a physician?

Before assuming your child has colic, you should look for other signs of illness. These may include, but are not limited to, the following:

• not sucking or drinking a bottle well
• drinking less milk than usual
• vomiting
• diarrhea
• becoming more irritable when held or touched
• strange sounding cry
• change in breathing rate or effort
• being more sleepy or sluggish than usual

Call your child's physician if you note any of these symptoms, or if your baby is crying excessively. Your child's physician will examine your child to make sure other problems are not present that might be causing colic-like symptoms.

Dealing with colic:

Learning how to interpret your baby's cry can help deal with colic. It does take some time for parents and babies to become accustomed to each other.

Remember, babies will cry for a certain length of time every day under normal circumstances. Other suggestions include the following:

• Make sure your baby is not hungry, but do not force feed if he/she is not interested in the bottle or breast.
• Change your baby's position. Sit him/her up if lying down. Let your baby face forward if you are carrying or holding him/her facing your chest. Babies like to see different views of the world.
• Give your baby interesting things to look at: different shapes, colors, textures, and sizes. Talk to your baby. Sing softly to your baby.
• Rock your baby.
• Walk your baby.
• Place your baby in an infant swing with a slow setting.
• Let your baby lay on his/her belly on your lap or the bed, and rub his/her back. Never leave your baby unattended on a bed, sofa, or other soft surface.
• Go for a ride in the car. The motion of the car often soothes babies.
• Try using something in your child's room that makes a repetitive sound, like a wind-up alarm clock or heartbeat audio tape.
• Hold and cuddle your baby. Babies cannot be spoiled by too much attention. However, they can have problems later in life if they are ignored and their needs are not met as infants.
• Let an adult family member or friend (or a responsible babysitter) care for your baby from time to time so that you can take a break. Taking care of yourself and lowering your stress level may help your baby as well.

What is the long-term outlook for a child with colic?

The symptoms of colic usually resolve by the time a baby is about 4 months of age. Consult your child's physician for more information.

What is constipation?

Constipation is defined as:

• a decrease in the frequency of bowel movements, compared to a child's usual pattern (some physicians define constipation as fewer than three bowel movements per week).
• the passage of hard, often large caliber dry bowel movements.
• bowel movements that are difficult or painful to push out.

What causes constipation?

Sometimes, there is no identifiable reason for constipation in children. However, some of the causes may include:

• diet
  • Some children eat too much of foods that are high in fat and low in fiber (such as fast foods, "junk" foods, and soft drinks).
  • Some children do not drink enough water and liquids.
• lack of exercise
  • Children who stay inside, watching TV and playing video games, do not get enough exercise. Exercise helps move digested food through the intestines.
• emotional issues
  • Pre-school and school-aged children are sometimes embarrassed to use public bathrooms and hold in their bowel movements, causing constipation.
  • Toddlers can be overwhelmed by toilet training, especially when a parent is more anxious for the child to be out of diapers than the child is.
  • Toddlers can also become involved in power struggles with their parents as they learn to assert their independence, and may intentionally, hold bowel movements in.
  • Some children who experience stress at school, with their friends, or in the family, may have constipation.
• busy children
  • Some children ignore signals their intestines give them to have a bowel movement. This can happen when children are too busy playing and forget to go to the bathroom.
  • Constipation can also be a problem when children start a new school year since they are no longer able to go to the bathroom whenever the urge strikes and have to change their bowel routine.
  • Once a child becomes constipated, a vicious cycle can develop. Hard, dry stools can be painful to push out, and the child can avoid using the bathroom to avoid the discomfort. Eventually, the intestine will not be able to sense the presence of stool.

Physical problems that can cause constipation include the following:

• abnormalities of the intestinal tract, rectum, or anus
• problems of the nervous system, such as cerebral palsy
• endocrine problems, such as hypothyroidism
• certain medications (i.e., iron preparations and narcotics such as codeine)

Why is constipation a concern?

Hard stools can irritate or tear the lining of the anus (fissure), making it painful to have a bowel movement. The child may avoid having a bowel movement, which can cause further constipation.

What are the symptoms of constipation?

The following are the most common symptoms of constipation. However, each individual may experience symptoms differently. Symptoms may include:

• not having a bowel movement for several days, or passing hard, dry stools
• abdominal bloating, cramps, or pain
• decreased appetite
• clenching teeth, crossing legs, squeezing buttocks together, turning red in the face as the child tries to hold in a bowel movement to avoid discomfort
• small liquid or soft stool smears that soil the child's underwear

The symptoms of constipation may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is constipation diagnosed?

A physician will examine your child and obtain a complete medical history. Depending on the age of your child, you might be asked questions such as:

• How old was your baby when he/she had their first stool?
• How often does your child have a bowel movement?
• Does your child complain of pain when he/she has a bowel movement?
• Have you been trying to toilet train your toddler recently?
• What does your child's diet consist of?
• Have there been any stressful events in your child's life lately?
• How often does your child soil his/her pants?

Occasionally, your child's physician may want to perform other diagnostic tests to determine if there are any problems. These tests may include:

• digital rectal examination (DRE) - a physician or healthcare provider inserts a gloved finger into the rectum to feel for anything unusual or abnormal.
• abdominal x-ray - a diagnostic test to evaluate the amount of stool in the large intestine.
• barium enema - a procedure performed to examine the large intestine for abnormalities. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is given into the rectum as an enema. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.
• anorectal manometry - a test that measures the strength of the muscles in the anus, nerve reflexes, ability to sense rectal distention, and coordination of muscles during defecation.
• rectal biopsy - a test that takes a sample of the cells in the rectum to be examined under a microscope for any problems.

When should you contact a physician?

Do not hesitate to contact your child's physician if you have any questions or concerns about your child's bowel habits or patterns. The National Institutes of Health recommends that you talk to your child's physician if:

• episodes of constipation last longer than 3 weeks.
• the child is unable to participate in normal activities because of constipation.
• normal pushing is not enough to expel a stool.
• liquid or soft stool leaks out of the anus.
• small, painful tears appear in the skin around the anus.
• hemorrhoids develop.

Treatment for constipation:

Specific treatment for constipation will be determined by your child's physician based on the following:

• your child's age, overall health, and medical history
• extent of the condition
• type of condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment may include:

• Diet changes - Often, making changes in your child's diet will help with constipation. Consider the following suggestions:
  • Increase the amount of fiber in your child's diet by:
    • adding more fruits and vegetables.
    • adding more whole grain cereals and breads (check the nutritional labels on food packages for foods that have more fiber).
  • Offer your child fruit juice instead of soft drinks.
  • Encourage your child to drink more fluids, especially water.
  • Limit fast foods and junk foods that are usually high in fats and offer more well-balanced meals and snacks.
  • Limit drinks with caffeine, such as cola drinks and tea.
  • Limit whole milk to 16 ounces a day for the child over 2 years of age, but do not eliminate milk entirely. Children need the calcium in milk to help their bones grow strong.
  • Plan to serve your child's meals on a regular schedule. Often, eating a meal will stimulate a bowel movement within 30 minutes to an hour. Serve breakfast early so your child does not have to rush off to school and miss the opportunity to have a bowel movement.
• Increase exercise - Increasing the amount of exercise your child gets can also help with constipation. Exercise aids digestion by helping the normal movements the intestines make to push food forward as it is digested. People who do not move around much are often constipated. Encourage your child to go outside and play rather than watch TV or engage in other indoor activities.
• Proper bowel habits - Have your child sit on the toilet at least twice a day for at least 10 minutes, preferably shortly after a meal. Make this time pleasant; do not scold or criticize the child if they are unable to have a bowel movement. Giving stickers or other small rewards, and making posters that chart your child's progress can help motivate and encourage him/her.

If these methods do not help, or if your physician notices other problems, he/she may recommend laxatives, stool softeners, or an enema. These products should ONLY be used with the recommendation of your child's physician. DO NOT use them without consulting with your child's physician first.

What is the long-term outlook for a child with constipation?

The outlook depends on what type of condition caused the constipation. Those children with diseases of the intestine, such as Hirschsprung's disease, may have chronic problems. However, most of the time, constipation is a temporary situation.

What is diarrhea?

Diarrhea is defined either as a watery stool or increased frequency (or both) when compared to a normal amount. It is a common problem that may last a few days and disappear on its own.

Diarrhea may be:

• acute (short-term, lasting less than two weeks), which is usually related to bacterial or viral infections.
• chronic (long-term, lasting longer than two weeks), which is usually related to functional disorders, such as irritable bowel syndrome, or may be due to diseases such as ulcerative colitis, Crohn's disease, celiac sprue, or Giardia.

What causes diarrhea?

Diarrhea in children may be caused by a number of conditions, including the following:

• bacterial infection
• viral infection
• food intolerances or allergies
• parasites
• reaction to medications

What are the symptoms of diarrhea?

The following are the most common symptoms of diarrhea. However, each child may experience symptoms differently. Severe diarrhea may indicate a serious disease, making it important to consult your child's physician if any/all of the following symptoms persist:

• cramping
• abdominal pain
• bloating
• nausea
• urgent need to use the restroom
• fever
• bloody stools

The symptoms of diarrhea may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

Warning signs of severe diarrhea:

You should call your pediatrician if your child is less than 6 months of age or presents any of the following symptoms:

• abdominal pain
• blood in the stool
• frequent vomiting
• loss of appetite for liquids
• high fever
• dry, sticky mouth
• weight loss
• urinates less frequently (wets fewer than 6 diapers per day)
• frequent diarrhea
• extreme thirst
• no tears when crying
• depressed fontanelle (soft spot) on infant's head

How is diarrhea diagnosed?

In addition to a complete physical examination and laboratory tests for blood and urine, the child's physician may request:

• laboratory examination of stool sample
• additional blood tests

Treatment for diarrhea:

Specific treatment for diarrhea will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• the expectations for the course of the condition
• your opinion or preference

Treatment usually involves replacing lost fluids. Antibiotics may be prescribed when bacterial infections are the cause. A child with diarrhea can have regular fluids or special fluids (such as Pedialyte™ or Gatorade™) for diarrhea. Do not use anti-diarrheal medications unless recommended by your child's physician.

The best defense is prevention. Here are some prevention tips:

• Drink more fluids (nonalcoholic), regardless of your activity level. Don't wait until you're thirsty to drink. Warning: If your doctor generally limits the amount of fluid you drink or has you on water pills, ask him how much you should drink while the weather is hot.
• Don't drink liquids that contain caffeine, alcohol, or large amounts of sugar - these cause you to lose more body fluid. Also, avoid very cold drinks, because they can cause stomach cramps.
• Stay indoors and, if at all possible, stay in an air-conditioned place. If your program does not have air conditioning, go to the shopping mall or public library - even a few hours spent in air conditioning can help your body stay cooler when you go back into the heat. Call your local health department to see if there are any heat-relief shelters in your area.
• Electric fans may provide comfort, but when the temperature is in the high 90s, fans will not prevent heat-related illness. Taking a cool shower or bath, or moving to an air-conditioned place is a much better way to cool off. If fans are used in your program, make sure that the children's safety is your priority. Electric cords should not be in reach of children. Fan blades should be completely covered.
• Wear lightweight, light-colored, loose-fitting clothing.
• NEVER leave anyone, adult or child in a closed, parked vehicle.

Although anyone at any time can suffer from heat-related illness, some people are at greater risk than others. Check regularly on:

• Infants and young children
• People aged 65 or older
• People who have a mental illness
• Those who are physically ill, especially with heart disease or high blood pressure

Visit adults at risk at least twice a day and closely watch them for signs of heat exhaustion or heat stroke. Infants and young children, of course, need much more frequent watching.

If you must be out in the heat:

• Limit your outdoor activity to morning and evening hours. It is suggested to change your outside times at your program so that most children go outside between 7am and noon.
• Cut down on exercise. If you must exercise, drink two to four glasses of cool, nonalcoholic fluids each hour. A sports beverage can replace the salt and minerals you lose in sweat. Warning: If you are on a low-salt diet, talk with your doctor before drinking a sports beverage. Remember the warning in the first "tip" (above), too.
• Try to rest often in shady areas.
• Protect yourself from the sun by wearing a wide-brimmed hat (also keeps you cooler) and sunglasses and by putting on sunscreen of SPF-15 or higher (the most effective products say "broad spectrum" or "UVA/UVB protection" on their labels).

Recognizing Heat Exhaustion

Warning signs of heat exhaustion include the following:

• Heavy sweating
• Muscle Cramps
• Headache
• Tiredness
• Nausea or vomiting
• Weakness
• Fainting
• Dizziness
• Paleness

The skin may be cool and moist. The victim's pulse rate will be fast and weak, and breathing will be fast and shallow. If heat exhaustion is untreated, it may progress to heat stroke. Seek medical attention immediately if any of the following occurs:

• Symptoms are severe.
• The victim has heart problems or high blood pressure.

Otherwise, help the victim to cool off, and seek medical attention if symptoms worsen or last longer than 1 hour.

What to Do

Cooling measures that may be effective include the following:

• Cool, nonalcoholic beverages, as directed by your physician
• Rest
• Cool shower, bath, or sponge bath
• An air-conditioned environment
• Lightweight clothing

Recognizing Heat Stroke

Warning signs of heat stroke vary but may include the following:

• An extremely high body temperature (above 103°F, orally)
• Red, hot, and dry skin (no sweating)
• Rapid, strong pulse
• Throbbing headache
• Dizziness
• Nausea
• Confusion
• Unconsciousness

What to Do

If you see any of these signs, you may be dealing with a life-threatening emergency. Have someone call for immediate medical assistance while you begin cooling the victim. Do the following:

• Get the victim to a shady area.
• Cool the victim rapidly using whatever methods you can. For example, immerse the victim in a tub of cool water; place the victim in a cool shower; spray the victim with cool water from a garden hose; sponge the victim with cool water; if the humidity is low, wrap the victim in a cool, wet sheet and fan him or her vigorously.
• Monitor body temperature, and continue cooling efforts until the body temperature drops to 101-102°F.
• If emergency medical personnel are delayed, call the hospital emergency room for further instructions.
• Do not give the victim alcohol to drink.
• Get medical assistance as soon as possible.

Sometimes a victim's muscles will begin to twitch uncontrollably as a result of heat stroke. If this happens, keep the victim from injuring himself, but do not place any object in his mouth and do not give fluids. If there is vomiting, make sure the airway remains open by turning the victim on his or her side.

Recognizing Sunburn

Symptoms of sunburn are well known: skin becomes red, painful, and abnormally warm after sun exposure.

What to Do

Consult a doctor if the sunburn affects an infant younger than 1 year of age or if these symptoms are present:

• Fever
• Fluid-filled blisters
• Severe pain

Also, remember these tips when treating sunburn:

• Avoid repeated sun exposure.
• Apply cold compresses or immerse the sunburned area in cool water.
• Apply moisturizing lotion to affected areas. Do not use salve, butter, or ointment.
• Do not break blisters.

Recognizing Heat Rash

Heat rash looks like a red cluster of pimples or small blisters. It is more likely to occur on the neck and upper chest, in the groin, under the breasts, and in elbow creases.

What to Do

The best treatment for heat rash is to provide a cooler, less humid environment. Keep the affected area dry. Dusting powder may be used to increase comfort, but avoid using ointments or creams -- they keep the skin warm and moist and may make the condition worse.

Treating heat rash is simple and usually does not require medical assistance. Other heat-related problems can be much more severe.

Recognizing Heat Cramps

Heat cramps are muscle pains or spasms -- usually in the abdomen, arms, or legs -- that may occur in association with strenuous activity. If you have heart problems or are on a low-sodium diet, get medical attention for heat cramps.

What to Do

If medical attention is not necessary, take these steps:

• Stop all activity, and sit quietly in a cool place.
• Drink clear juice or a sports beverage.
• Do not return to strenuous activity for a few hours after the cramps subside, because further exertion may lead to heat exhaustion or heat stroke.
• Seek medical attention for heat cramps if they do not subside in 1 hour.

Be aware of allergies such as bee stings and other insects. Be aware of ragweed, pollen, ECT.