Pediatric Advise | Forest Lane Pediatrics Dallas Plano

Pediatric Advice

Acting Sick

How your child is acting is more important than how high the fever is running. The terms lethargic and listless or acting sick can mean different things to different people. In order to tell how sick the child is acting when they have a fever, give an appropriate dose of acetaminophen or ibuprofen (see chart) and see how the child is acting about 1 to 2 hours after the dose. Many parents who call us find out they have not given enough acetaminophen or ibuprofen. The fever may not necessarily return to normal, but is often lower. Keep in mind that some children can be seriouly ill without having any fever.

A baby or child is probably not seriously ill if:

a baby will coo, make eye contact, smile or reach for an object
a toddler will pay attention to activities, smile, walk around to get things
an older child will engage in quiet activities like coloring or reading

A child is seriously ill if despite reducing the fever:

a baby is not making eye contact, refuses to feed, cries or cannot be comforted
a toddler refuses to play, cries inconsolably, moans, appears very weak, turns away and stares repeatedly or is very hard to awaken if sleeping * an older child refuses to talk and won't interact or is unable to get out of bed
keeps dropping off to sleep without periods of activity and difficult to arouse; remember sick children do tend to sleep more
©1997CallYour Ped.com, Encinitas California

Baby Bottle Tooth Decay

Baby Bottle Tooth Decay (BBTD) is caused by prolonged contact with almost any liquid other than water. This can happen from putting her to bed with a bottle of formula, milk, juice, soft drinks, sugar water, sugared drinks, etc. Allowing her to suck on a bottle or breastfeed for longer than a mealtime, either when awake or asleep, can also cause BBTD.

When liquid from a baby bottle builds up in the mouth, the natural or added sugars found in the liquid are changed to acid by germs in the mouth. This acid then starts to dissolve the teeth (mainly the upper front teeth), causing them to decay. Baby Bottle Tooth Decay can lead to severe damage to your child's baby teeth and can also cause dental problems that affect her permanent teeth.

But there are steps you can take to prevent Baby Bottle Tooth Decay. Keep these pointers in mind as you care for your child's teeth:

Never put your child to bed with a bottle. By 7 or 8 months of age, most children no longer need feedings during the night. Children who drink bottles while lying down also may be more prone to getting ear infections.
Only give your baby a bottle during meals. Do not use the bottle as a pacifier; do not allow your child to walk around with it or to drink it for extended periods. These practices not only may lead to BBTD, but children can suffer tooth injuries if they fall while sucking on a bottle.
Teach your child to drink from a cup as soon as possible, usually by 1 year of age. Drinking from a cup does not cause the liquid to collect around the teeth, and a cup cannot be taken to bed. If you are concerned that a cup may be messier than a bottle, especially when you are away from home, use one that has a snap-on lid with a straw or a special valve to prevent spilling.
Keep your baby's mouth clean. This is an important part of preventing tooth decay. After feedings, gently brush your baby's gums and any baby teeth with a soft infant toothbrush.
Use water and a soft child-sized toothbrush for daily cleaning once your child has 7 to 8 teeth.

By the time your toddler is 2 years of age, you should be brushing his teeth once or twice a day, preferably after breakfast and before bedtime. Once you are sure your child will spit, and not swallow, toothpaste, you should begin using a fluoride toothpaste. Use a pea-sized amount of toothpaste to limit the amount he can accidently swallow.

Bicycle Safety

Do not push your child to ride a 2-wheeled bike until he or she is ready, at about age 5 or 6. Consider the child's coordination and desire to learn to ride. Stick with coaster brakes until your child is older and more experienced.
Take your child with you when you shop for the bike, so that he or she can try it out. The value of a properly fitting bike far outweighs the value of surprising your child with a new bike.
Buy a bike that is the right size, not one your child has to "grow into." Oversized bikes are especially dangerous.
Your child needs to wear a helmet on every bike ride, no matter how short or how close to home. Many accidents happen in driveways, on sidewalks, and on bike paths, not just on streets.
A helmet protects your child from serious injury, and should always be worn. And remember, wearing a helmet at all times helps children develop the helmet habit.

American Academy of Pediatrics, May, 2004

Breastfeeding

One of the most common concerns of breastfeeding mothers is: how can I be sure my baby is getting enough milk? Well, there are several ways to tell. One is by the number of wet diapers he has in a day. Make sure he has at least six wet diapers per day with pale yellow urine, beginning around the third or fourth day of life.

Your infant should also have several small bowel movements daily (there may be one after every feeding in the first few weeks). During the first week of life, your infant should have at least two stools per day. From about 1 to 4 weeks old these should increase to at least five per day. As your baby gets older, bowel movements may occur less often, and may even skip a number of days. Bowel movements of breastfed babies usually smell somewhat sweeter than the stools of formula fed babies.

Your baby's feeding patterns are also an important sign that he is feeding enough. A newborn may nurse every 1½ to three hours around the clock. If your baby sleeps for stretches of longer than four hours in the first two weeks, wake him for a feeding. It is most important that your baby is latched-on properly during feedings. Listen for gulping sounds to know that your baby is actually swallowing the milk and not just sucking. Also look for slow, steady jaw movement.

Your baby should be steadily gaining weight after the first week of life. During the first week, some infants lose several ounces of weight, but they should be back up to their birth weight by the end of the second week. Your pediatrician's office will weigh your baby at each visit. Keep in mind that your baby may breastfeed more often during growth spurts.

Signs that baby is getting enough milk are as follows:

* At least six wet diapers per day and two to five loose yellow stools per day, depending on baby's age. (Your baby's stools should be loose and have a yellowish color to them. Be sure your child's stools are not white or clay-colored.)

* Steady weight gain, after the first week of age.

* Pale yellow urine, not deep yellow or orange.

* Sleeping well, yet baby looks alert and healthy when awake.

Most breastfeeding babies do not need any water, vitamins or iron in addition to breast milk for at least the first 6 months. Human milk provides all the fluids and nutrients a baby needs to be healthy. By about 6 months of age, however, you should start to introduce your infant to baby foods that contain iron.

If your baby cannot or will not nurse, or if you are having problems with breastfeeding, it is important that you call your pediatrician as soon as possible. Refusal to breastfeed may be a sign of illness that needs prompt attention.

Another frequent concern for mothers is engorgement. Engorgement is uncomfortable for the mother and can make nursing more difficult for a baby. Feeding on demand not only ensures that your baby's hunger is satisfied, but it also helps prevent engorgement. Engorgement occurs when your breasts become too full with milk. A little engorgement is normal, but excessive engorgement can be uncomfortable or painful. If your breasts do become engorged, try the following:

Express some milk before you breastfeed, either manually or with a breast pump.
Soak a cloth in warm water and put it on your breasts. Or take a warm shower before feeding your baby. For severe engorgement, warmth may not help. In this case, you may want to use cold compresses as you express milk. Ice packs used between feedings can relieve your discomfort and reduce swelling.
Feed your baby in more than one position. Try sitting up, then lying down.
Gently massage your breasts from under the arm and down toward the nipple. This will help reduce soreness and ease milk flow.
Do not take any medications without approval from your doctor. Acetaminophen (eg, Tylenol) may relieve pain and is safe to take occasionally during breastfeeding.

It is important to keep breastfeeding. Engorgement is a temporary condition and will be most quickly relieved by effective milk removal.

Once the engorgement passes, your breasts will become soft again. This is normal and is exactly what should happen.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. © Copyright 1999 American Academy of Pediatrics

Breastmilk Storage

Wash your hands before expressing or handling your milk.

Be sure to use only clean containers to store expressed milk. *Try to use screw-cap bottles, hard plastic cups with tight caps, or special heavy nursing bags that can be used to feed your baby. Do not use ordinary plastic storage bags or formula bottle bags, since these can easily split and leak. Do not store breastmilk in ice-cube trays.

Use sealed and chilled milk within twenty-four hours if possible. Discard all milk that has been refrigerated for more than seventy-two hours.

Freeze milk if you do not plan to use it within twenty-four hours. Frozen milk is good for at least one month in a freezer attached to a refrigerator or for three to six months if kept in a zero-degree deep freezer. Store it at the back of the freezer, where the temperature is coldest. Be sure to label the milk with the date and time that you expressed it. Use the oldest milk first. Keep in mind that the fats in human milk begin to break down with storage, so using frozen breastmilk within three months is desirable.

Freeze about two to four ounces of milk per container, to avoid wasting milk after you thaw it. You can always thaw an extra bag if needed. Do not add fresh milk to already frozen milk in a storage container. You may thaw milk in the refrigerator or by placing it in a bowl of warm water.

Bug Safety

Don't use scented soaps, perfumes or hair sprays on your child.
Avoid areas where insects nest or congregate, such as stagnant pools of water, uncovered foods and gardens where flowers are in bloom.
Avoid dressing your child in clothing with bright colors or flowery prints.
To remove a visible stinger from skin, gently scrape it off horizontally with a credit card or your fingernail.
Insect repellents containing DEET are the most effective.
The concentration of DEET in products may range from less than 10 percent to over 30 percent. The benefits of DEET reach a peak at a concentration of 30 percent, the maximum concentration currently recommended for infants and children. DEET should not be used on children under 2 months of age. # The concentration of DEET varies significantly from product to product, so read the label of any product you purchase. American Academy of Pediatrics, May, 2004

Children and Colds

My child seems to get a lot of colds. Is this normal?

My child has a virus, how can I help him/her feel better?

What are some common over-the-counter medicines available for children?

Circumcision

Circumcision is a surgical procedure in which the skin covering the end of the penis is removed. Circumcision is usually performed by a doctor in the first few days of life. An infant must be stable and healthy to safely be circumcised.

Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised. Parents may want their sons circumcised for religious, social and cultural reasons. Since circumcision is not essential to a child’s health, parents should choose what is best for their child by looking at the benefits and risks.

Many parents choose to have their sons circumcised because "all the other men in the family were circumcised" or because they do not want their sons to feel "different." Others feel that circumcision is unnecessary and choose not to have it done. Some groups, such as followers of the Jewish and Islamic faiths, practice circumcision for religious and cultural reasons. Since circumcision may be more risky if done later in life, parents may want to decide before or soon after their son is born if they want their son circumcised.

As noted above, research studies suggest that there may be some medical benefits to circumcision. These include the following:

A lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised infant boy has about a 1 in 100 chance of developing a UTI in the first year of life.
A lower risk of getting cancer of the penis. However, this type of cancer is very rare in both circumcised and uncircumcised males.
A slightly lower risk of getting sexually transmitted diseases (STDs), including HIV, the AIDS virus.
Prevention of foreskin infections. * Prevention of phimosis, a condition in uncircumcised males that makes foreskin retraction impossible.
Easier genital hygiene.

Just as there are reasons parents may choose circumcision, they are reasons why parents may choose NOT to have their son circumcised:

Possible risks. As with any surgery, circumcision has some risks. Complications from circumcision are rare and usually minor. They may include bleeding, infection, cutting the foreskin too short or too long, and improper healing.
The belief that the foreskin is necessary to protect the tip of the penis. When removed, the tip of the penis may become irritated and cause the opening of the penis to become too small. Rarely, this can cause urination problems that may need to be surgically corrected.
Some people believe that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life. This has not been proven by any medical or psychological study.

Almost all uncircumcised boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis, and sexually transmitted diseases.

Croup

Croup is an inflammation of the voice box (larynx) and windpipe (trachea). When a child has croup, the airway just below the vocal cords becomes swollen and narrow. This makes breathing noisy and difficult.

Some children get croup often, such as whenever they have a respiratory illness. Children are most likely to get croup between 6 months and 3 years of age. After age 3, it is not as common because the windpipe is larger, so swelling is less likely to get in the way of breathing. Croup can occur at any time of the year, but it is more common between October and March.

There are two different types of croup:

Spasmodic croup is usually caused by a mild upper respiratory infection or allergy. It is often frightening because it comes on suddenly in the middle of the night. Your child may go to bed with a mild cold and wake up in a few hours, gasping for breath. He will also be hoarse and have a cough that sounds like a seal barking. Most children with spasmodic croup do not have a fever. This type of croup can reoccur.

Viral croup results from a viral infection in the voice box and windpipe. This kind of croup often starts with a cold that slowly develops into a barking cough. As your child's airway swells and she secretes more fluid, it becomes harder for her to breathe. Her breathing will also get noisier, and it may make a coarse musical sound each time she breathes in. This condition is called stridor. Most children with viral croup have a low fever, but some have temperatures up to 104°F.

As your child's effort to breathe increases, he may stop eating and drinking. He also may become too tired to cough, although you will hear the stridor more with each breath. The danger with croup accompanied by stridor is that the airway will keep swelling. If this happens, it may reach a point where your child cannot breathe at all.

Stridor is common with mild croup, especially when a child is crying or moving actively. But if a child has stridor while resting, it can be a sign of severe croup.

Treating Croup

If your child wakes up in the middle of the night with croup, take her into the bathroom. Close the door and turn the shower on the hottest setting to let the bathroom steam up. Sit in the steamy bathroom with your child. Within 15 to 20 minutes, the warm, moist air should help her breathing. (She will still have the barking cough, though.)

For the rest of that night and 2 to 3 nights after, try to use a cold-water vaporizer or humidifier in your child's room. Sometimes another attack of croup will occur the same night or the next. If it does, repeat the steam treatment in the bathroom. Steam almost always works. If it does not, take your child outdoors for a few minutes. Inhaling moist, cool night air may loosen up the air passages so that he can breathe more freely. If that does not help, consult your pediatrician about other options. If your child's breathing becomes a serious struggle, call for emergency medical services. (In most areas, dial 911.)

Never try to open your child's airway with your finger. Breathing is being blocked by swollen tissue out of your reach, so you cannot clear it away. Besides, putting your finger in your child's throat will only upset her. This can make her breathing even more difficult. For the same reasons, do not force your child to throw up. If she does happen to vomit, hold her head down and then quickly sit her back up once she is finished.

Your pediatrician will ask if your child's breathing is better after the steam treatment. If it is not, your pediatrician may prescribe a steroid medication to reduce swelling in the throat or shorten the illness. Although it has not been firmly proven that this works, treatment with a steroid for 5 days or less should do no harm.

Antibiotics, which treat bacteria, are not helpful for croup because the problem is almost always caused by a virus or allergy. Cough syrups are of little use too, because they do not affect the larynx or trachea, where the infection is located. These also may get in the way of your child coughing up the mucus from the infection.

If you suspect your child has croup, call your pediatrician—even if it is the middle of the night. Also, listen closely to your child's breathing. Call for emergency medical services immediately if he:

makes a whistling sound that gets louder with each breath
cannot speak for lack of breath
seems to be struggling to get a breath
seems very pale or has a bluish mouth or fingernails
has stridor when resting
drools or has extreme difficulty swallowing saliva

In the most serious cases, your child will not be getting enough oxygen into her blood. If this happens, she may need to go into the hospital. There she may be put in a plastic tent, called a croup tent, to receive oxygen. She may also be fed through a vein and take medication by inhaling it. Sometimes a tube is inserted through the nose or mouth into the windpipe to bypass the swelling in the larynx and trachea. Your child may be hoarse for a while after the tube is removed, but this usually does not last. Luckily, these severe cases of croup do not occur very often.

Diaper Rash

Almost every child will get a diaper rash sometime in their life no matter how clean we try to keep them. They may occur with cloth or disposable diapers.
Diarrhea is a common factor to trigger a diaper rash. It is typically caused by moisture, and skin irritation from bacteria in the stool or chemicals in the urine. This creates an irritant diaper rash that appears like a burn more predominately in the rectal area.
Yeast (candidal) diaper rashes are also common. This comes from a moist, heated environment and typically looks red, sometimes raw or raised with small bumps. The bumps that look like pimples around the edge of the rash are called "satellite lesions." Yeast rashes usually occur more towards the front of the genitals - on the labia in girls, on the testes and groin area of boys and can even spread down the thighs.

Call the doctor immediately if:

Large blisters more than one inch
Acting sick

Call during office hours if:

Rash is worsening despite home treatment after 3 days
Blisters, sores or crusting develops

Home Treatment

Irritant diaper rash. Change diapers frequently and immediately after bowel movements. Wash with warm water and mild soap or you may use Vaseline to clean the skin. Allow the diaper area to air dry whenever possible. Carefully use a blow dryer on a low setting to help dry the area. Avoid airtight plastic pants. A barrier ointment like Desitin, Dyprotex or A & D ointment are helpful to protect the skin. Powders are not generally recommended because of the risk of a baby aspirating the powder into their lungs when it is being used.

Yeast (candidal) rash. Yeast infections are very common in babies. Yeast is present everywhere in our environment. It loves moist areas such as the diaper area. It can also be found in other areas like the creases under the arms and the neck of a chubby baby. It may also be present in the mouth and is called thrush when it occurs orally. If your baby has a yeast diaper rash, be sure to check the mouth also and call the doctor during office hours to receive a prescription for thrush. Thrush appears as white patches inside the cheeks, lips and on the tongue. Yeast diaper rashes needs an antifungal cream to cure it. These creams are available by prescription or over-the-counter. The over-the-counter cream contains clotrimazole and one brand of this is called Lotrimin.

Discipline Basics

The first goal of discipline is to protect your child from danger. Another important goal is to teach your child an understanding of right from wrong. Reasonable limit setting keeps us from raising a “spoiled” child. To teach respect for the rights of others, first teach your child to respect your rights. Begin external controls by 6 months of age. Children don’t start to develop internal controls (self control) until 3 or 4 years of age. They continue to need external controls, in gradually decreasing amounts, through adolescence.

Guidelines For Setting Rules

1. Begin discipline after 6 months of age. Young infants don’t need any discipline. By the time they crawl, all children need rules for their safety.

2. Express each misbehavior as a clear and concrete rule. Examples of clear rules are “Don’t push your brother” and “Don’t interrupt me on the telephone.

3. Also state the acceptable or appropriate behavior. Your child needs to know what is expected of him. Examples are “Play with your brother.” “Look at books when I’m on the telephone.” or “Walk, don’t run.”

4. Ignore unimportant or irrelevant misbehavior. Avoid constant criticism. Behavior such as swinging the legs, poor table manners, or normal negativism is unimportant during the early years.

5. Use rules that are fair and attainable. A child should not be punished for behavior that is part of normal emotional development, such as thumb sucking, fears of being separated from the parents, and toilet training accidents.

6. Concentrate on two or three rules initially. Give highest priority to issues of safety, such as not running into the street, and to the prevention of harm to others. Of next importance is behavior that damages property. Then come all the annoying behavior traits that wear you down (such as tantrums or whining).

7. Avoid trying to change “no win” behavior through punishment. Examples are wetting pants, pulling their own hair, thumb sucking, body rocking, masturbation, not eating enough, not going to sleep, and refusal to complete schoolwork. The first step in resolving such a power struggle is to withdraw from the conflict and stop punishing your child for the misbehavior. Then give your child positive feedback when he behaves as you’d like.

8. Apply the rules consistently. After the parents agree on the rules, it may be helpful to write them down and post them.

Discipline Techniques (Including Consequences)

1. Techniques to use for different ages are summarized here. The techniques mentioned here are further described after this list. From birth to 6 months, no discipline necessary. From 6 months to 3 years: structuring the home environment, distracting, ignoring, verbal and nonverbal disapproval, physically moving or escorting, and temporary time-out. From 3 year to 5 years: the preceding techniques (especially temporary time-out) plus natural consequences, restricting places where the child an misbehave, and logical consequences. From 5 years to adolescence: the preceding techniques plus delay of a privilege, “ I” messages, and negotiation via family conferences. Adolescence: logical consequences, “I” messages, and family conferences about house rules, time-out and manual guidance (see below) can be discontinued.

2. Structure the home environment. You can change your child’s surroundings so that an object or situation that could cause a problem is eliminated. Examples are installing gates, locks, and fences to protect the child.

3. Distracting your child from misbehavior. Distracting a young child from temptation by attracting his attention to something else is especially helpful when the child is in someone else’s house or a store (e.g., distract with toys, food, or games).

4. Ignore the misbehavior. Ignoring, helps to stop unacceptable behavior that is harmless–such as tantrums, sulking, whining, quarreling, or interrupting.

5. Use verbal and nonverbal disapproval. Mild disapproval is often all that is required to stop a young child’s misbehavior. Get close to your child, get eye contact, look stern , and give a brief “no” or “stop”.

6. Physically move or escort (“manual guidance”). Manual guidance means that you move a child from one place to another (e.g., to bed, bath, car, or time-out chair) against his will and help him as much as needed (e.g., carrying).

7. Use temporary time-out or social isolation. Time-out is the most effective discipline technique available to parents. Time-out is used to interrupt unacceptable behavior by removing the child from the scene to a boring place, such as a playpen, corner of a room, chair, or bedroom. Time-outs should last about 1 minute per year of age and not more than 5 minutes.

8. Restrict places where a child can misbehave. This technique is especially helpful for behavior problems that can’t be eliminated. Allowing nose picking and masturbation in your child’s room prevents an unnecessary power struggle.

9. Use natural consequences. Your child can learn good behavior from the natural laws of the physical world; for example, not dressing properly for the weather means your child will be cold or wet, or breaking a toy means it isn’t fun to play with anymore.

10. Use logical consequences. These should be logically related to the misbehavior, making your child accountable for his problems and decisions. Many logical consequences are simply the temporary removal of a possession or privilege if your child has misused the object or right.

11. Delay a privilege. Examples of work before play are “After you clean your room, you can go out and play” or “When you finish your homework, you can watch television.

12. Use “I” messages. When your child misbehaves, tell your child how you feel. Say, “I am upset when you do such and such.” Your child is more likely to listen to this than a message that starts with “you.” “You messages usually trigger a defensive reaction.

13. Negotiate and hold family conferences. As children become older they need more communication and discussion with their parents about problems. A parent can begin such a conversation by saying, “We need to change these things. What are some ways we could handle this? What do you think would be fair?”

14. Temporarily discontinue any physical punishment. Most out-of-control children are already too aggressive. Physical punishment teaches them that it is acceptable to be aggressive (e.g., hit or hurt someone else) to solve problems.

15. Discontinue any yelling. Yelling and screaming teach your child to yell back; you are thereby legitimizing shouting matches. Your child will respond better in the long run to a pleasant tone of voice and words of diplomacy.

16. Don’t forget to reward acceptable (desired) behaviors. Don’t take good behavior for granted. Watch for behavior you like, and then praise your child. At these times, move close to your child, look at him, smile, and be affectionate. A parent’s attention is the favorite reward of most children.

Guidelines For Giving Consequences (Punishments)

1. Be un-ambivalent. Mean what you say and follow through.

2. Correct with love. Talk to your child the way you want people to talk to you. Avoid yelling or using a disrespectful tone of voice. Correct your child in a kind way. Sometimes begin your correction with “I’m sorry I can’t let you...

3. Apply the consequence immediately. Delayed punishments are less effective because young children forget why they are being punished. Punishment should occur very soon after the misbehavior and be administered by the adult who witnessed the misdeed.

4. Make a one-sentence comment about the rule when you punish your child. Also restate the preferred behavior, but avoid making a long speech.

5. Ignore your child’s arguments while you are correcting him. This is the child’s way of delaying punishment. Have a discussion with your child at a later, more pleasant time.

6. Make the punishment brief. Take toys out of circulation for no more than 1 or 2 days. Time-outs should last no longer than 1 minute per year of the child’s age and 5 minutes maximum.

7. Follow the consequence with love and trust. Welcome your child back into the family circle and do not comment on the previous misbehavior or require an apology for it.

8. Direct the punishment against the misbehavior, not the person. Avoid degrading comments such as “You never do anything right.”

Call Our Office

During regular hours if:

Your child’s misbehavior is dangerous.

The instances of misbehavior seem too numerous to count.

Your child is also having behavior problems at school

Your child doesn’t seem to have many good points.

Your child seems depressed.

The parents can’t agree on discipline.

You can’t give up physical punishment.

(Note: Call immediately if you are afraid you might hurt your child.)

The misbehavior does not improve after 1 month of using this approach.

Instructions for Pediatric Patients. 2nd Edition. 1999 by WB Saunder Company

Written by Barton D. Schmitt M.D. pediatrician and author of Your Child's Health

Dry Skin

1. Bathe with Dove unscented soap.

2. If above soap is not helping, then try one of the following soapless cleansers:

a. Cetaphil soapless cleanser.

b. Aquanil soapless cleanser.

3. Apply one of the following lotions after bath to moisten skin and as necessary:

a. Curel

b. Eucerin

c. Lubriderm

d. Moisturel

e. Aquaphor

f. Theraplex Emollient

4. Apply prescription medication as ordered.

Fever

While most fevers don't require a call to your pediatrician, there are certain circumstances when a fever could indicate something more serious.

Call your pediatrician immediately if your child has a fever and:

Looks very ill, is unusually drowsy or is very fussy
Has been in an extremely hot place, such as an overheated car
Has additional symptoms, such as a stiff neck, severe headache, severe sore throat, severe ear pain, an unexplained rash, or repeated vomiting or diarrhea
Has a condition that suppresses immune responses, such as sickle-cell disease or cancer or is taking steroids
Has had a seizure
Is younger than 2 months of age and has a rectal temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher

A child older than 6 months of age who has a temperature below 101 degrees Fahrenheit (38.3 degrees Celsius) probably does not need to be treated for fever, unless the child is uncomfortable. Observe her behavior. If she is eating and sleeping well and is able to play, you may wait to see if the fever improves by itself.

In the meantime:

Keep her room comfortably cool * Make sure that she is dressed in light clothing
Encourage her to drink fluids such as water, diluted fruit juices, or a commercially prepared oral electrolyte solution
Be sure that she does not overexert herself

There are also medications you can give your child to reduce his temperature if he is uncomfortable. Both acetaminophen and ibuprofen are safe and effective in proper doses. Be sure to follow the correct dosage and medication schedule for your child. Remember, any medication can be dangerous if you give your child too much.

Ibuprofen should only be used for children older than 6 months of age. It should not be given to children who are vomiting constantly or are dehydrated. Do not use aspirin to treat your child's fever. Aspirin has been linked with side effects such as an upset stomach, intestinal bleeding and, most seriously, Reye syndrome.

If your child is vomiting and unable to take medication by mouth, your pediatrician may recommend a rectal suppository for your child. Acetaminophen suppositories can be effective in reducing fever in a vomiting child.

Read the label on all medications to make sure that your child receives the right dose for his age and weight. To be safe, talk to your pediatrician before giving your child any medication to treat fever if he is younger than 2 years of age.

An alternative to over-the-counter medications is to sponge your child with lukewarm water. Sponging may reduce your child's temperature as water evaporates from her skin.

Your pediatrician can advise you on this method. Your pediatrician may recommend that you try sponging your child with lukewarm water in cases such as the following:

Your child's temperature is above 104 degrees Fahrenheit (40 degrees Celsius)
She is vomiting and unable to take medication
She has had a febrile seizure in the past Do not use cold water to sponge your child, as this could cause shivering. That could increase her temperature. Never add alcohol to the water. Alcohol can be absorbed into the skin or inhaled, causing serious problems such as a coma.

Usually 5 to 10 minutes in the tub is enough time for a child's temperature to start dropping. If your child becomes upset during the sponging, simply let her play in the water. If she is still bothered by the bath, it is better to remove her even if she has not been in long enough to reduce her temperature. Also remove her from the bath if she continues to shiver because shivering may increase body temperature.

Do not try to reduce your child's temperature to normal too quickly. This could cause the temperature to rebound higher.

Be sure to call your pediatrician if your child still "acts sick" once the fever is brought down, or if you feel that your child is very sick. Also call if the fever persists for

More than 24 hours in a child younger than 2 years of age
More than three days in a child 2 years of age or older

Fever — How to Take a Temperature
Fever — Understanding a Fever
Home Treatment of a Fever © 2002 American Academy of Pediatrics

Firework Safety

Fireworks can result in severe burns, scars and disfigurement that can last a lifetime.
Fireworks that are often thought to be safe, i.e. sparklers, can reach temperatures above 1000 degrees F, and can burn users and bystanders.
The AAP recommends prohibiting public sale of all fireworks, including those by mail or Internet, and encourages parents to attend professional fireworks displays instead of using fireworks at home. American Academy of Pediatrics, May, 2004

Handling a Poison Emergency

Sometimes despite your best efforts, a child will get into a harmful substance. In cases like these, it's important to stay calm and gather the information necessary to help your child. Here are some suggestions for handling different types of poisoning emergencies.

Swallowed Poison

If you find your child with an open or empty container of a nonfood item, your child may have been poisoned. Stay calm and act quickly.

First, get the item away from your child. If there is still some in your child's mouth, make him spit it out or remove it with your fingers. Keep this material along with anything else that might help determine what your child swallowed.

Take the poison container with you to help the doctor determine what was swallowed. Do not make your child vomit because it may cause more damage.

If a child is unconscious, not breathing, having convulsions or having seizures, call 911 or your local emergency number right away.

If your child does not have these symptoms, call the poison center at 1-800-222-1222. You may be asked for the following information:

Your name and phone number.
Your child's name, age and weight.
Any medical conditions your child has.
Any medicine your child is taking.
The name of the item your child swallowed. Read it off the container and spell it.
The time your child swallowed the poison (or when you found your child), and the amount you think was swallowed.

If the poison is very dangerous, or if your child is very young, you may be told to take him right to the nearest hospital. If not, you will be told what to do at home.

Poison on the Skin

If your child spills a dangerous chemical on her body, remove her clothes and rinse the skin with room temperature water for at least 15 minutes, even if your child resists. Then call the poison center at 1-800-222-1222. Do not use ointments or grease.

Poison in the Eye

Flush your child's eye by holding the eyelid open and pouring a steady stream of room temperature water into the inner corner. It is easier if another adult holds your child while you rinse the eye. If another adult is not around, wrap your child tightly in a towel and clamp him under one arm. Then you will have one hand free to hold the eyelid open and the other to pour in the water. Continue flushing the eye for 15 minutes. Then call the poison center at 1-800-222-1222. Do not use an eyecup, eyedrops or ointment unless the poison center tells you to.

Poisonous Fumes

In the home, poisonous fumes can come from:

A car running in a closed garage
Leaky gas vents
Wood, coal or kerosene stoves that are not working right
Space heaters, ovens, stoves or hot water heaters that use gas

If your child is exposed to fumes or gases, have her breathe fresh air right away. If she is breathing, call the poison center at 1-800-222-1222 about what to do next. If she has stopped breathing, start cardiopulmonary resuscitation (CPR) and do not stop until she breathes on her own or someone else can take over. If you can, have someone call 911 right away. If you are alone, wait until your child is breathing, or after one minute of CPR, then call 911.

Important Information

About Syrup of Ipecac Syrup of ipecac is a drug that was used in the past to make children vomit after they had swallowed a poison. Although this may seem to make sense, this is not a good poison treatment. You should not make a child vomit in any way, including giving him syrup of ipecac, making him gag or giving him saltwater. If you have syrup of ipecac in your home, flush it down the toilet and throw away the container.

How to Poison-Proof Your Home
Protect Your Child From Poison

Q. How can I improve the taste of my child's medicine?

A. Unfortunately, many medications for children have an unpleasant taste or texture. We will always try to prescribe a medicine that tastes o.k., but many times the best medication for a particular condition may still taste terrible. There are many things you can try to help your child tolerate their medication better.

Ask your pharmacist to add a flavored syrup to the medication. Many local pharmacies can add FlavoRx to your prescription. They have more than 30 flavors available; check their website at www.flavorx.com for locations and flavors.
Give your child some chocolate syrup before and after the medication.
If the medicine has a gritty texture, give the child graham crackers after taking the medicine to remove any bitter particles from the tongue.
Mix the medication with some jelly.
Offer a popsicle after giving the medicine to remove the taste and “numb” the tastebuds.
Use positive reinforcement as a reward for taking medicines well. (The chocolate syrup and the popsicles may work for this reason, too!)

Always follow the advice of your pharmacist about proper preparation and storage of medications; when in doubt, follow the instructions of your pharmacist. There are no official guidelines from drug manufacturers, but the suggestions above should not change the effectiveness of the medication. Please call us for any questions or problems. You should always store medications in a safe place and be careful not to tell the child that a medication is candy. Children may accidentally get into medications, potentially leading to a harmful overdose.

How to Suction the Nose

1. Irrigate the nose with saline (5-6 drops each nostril).

2. Use a long tip nasal bulb syringe.

3. Insert the tip of the bulb in one of the nostrils (think about where the opening of the tip is pointing). Opening needs to point behind the nose, not above the nose at the forehead

4. Close the opposite nostril that you are not using off when suctioning.

5. Need to suction 3 to 4 times per day when there is nasal congestion.

How to Take a Temperature

While you often can tell if your child is warmer than usual by feeling his forehead, only a thermometer can tell if he has a fever and how high the temperature is. There are several types of thermometers and methods for taking your child's temperature.

Mercury thermometers should not be used. The American Academy of Pediatrics (AAP) encourages parents to remove mercury thermometers from their homes to prevent accidental exposure to this toxin.

Rectal

If your child is younger than 3 years of age, taking his temperature with a rectal digital thermometer provides the best reading.

1. Clean the end of the thermometer with rubbing alcohol or soap and water. Rinse it with cool water. Do not rinse with hot water.

2. Put a small amount of lubricant, such as petroleum jelly, on the end.

3. Place your child belly down across your lap or on a firm surface. Hold him by placing your palm against his lower back, just above his bottom.

4. With the other hand, turn on the thermometer switch and insert the thermometer 0.5" to 1" into the anal opening. Hold the thermometer in place loosely with two fingers, keeping your hand cupped around your child's bottom. Do not insert the thermometer too far.

5. Hold in place for about one minute, until you hear the "beep." Remove the thermometer to check the digital reading.

Oral

Once your child is 4 or 5 years of age, you may prefer taking his temperature by mouth with an oral digital thermometer.

1. Clean the thermometer with lukewarm soapy water or rubbing alcohol. Rinse with cool water.

2. Turn on the switch and place the sensor under his tongue toward the back of his mouth.

3. Hold in place for about one minute, until you hear the "beep." Check the digital reading.

4. For a correct reading, wait at least 15 minutes after your child has had a hot or cold drink before putting the thermometer in his mouth.

Ear

Tympanic thermometers, which measure temperature inside the ear, are another option for older babies and children.

1. Gently put the end of the thermometer in the ear canal. Press the start button. You will get a digital reading of your child's temperature within seconds.

While it provides quick results, this thermometer needs to be placed correctly in your child's ear to be accurate. Too much earwax may cause the reading to be incorrect.

Underarm (Axillary)

Although not as accurate, if your child is older than 3 months of age, you can take his underarm temperature to see if he has a fever.

1. Place the sensor end of either an oral or rectal digital thermometer in your child's armpit.

2. Hold his arm tightly against his chest for about one minute, until you hear the "beep."

3. Check the digital reading.

Other methods for taking your child's temperature are available. They are not recommended at this time. Ask your pediatrician for advice.

Injuries

Lice

Please see our documents about Lice (pdf) and Lice Treatments (pdf).

Nasolacrimal Obstruction / Blocked Tear Duct

Many infants are born with incomplete development of the tear duct drainage system (nasolacrimal duct). As a consequence of this blockage, tearing and repeated infections (conjunctivitis) tend to occur. Since tears, which are being constantly produced, cannot drain into the nose, there is a “spillover.” Infections, associated with discharge or crusting, commonly develop as bacteria grow within the blocked system. In the vast majority of children these “blocked tear ducts” open within the first few months following birth. Management consists of daily finger pressure to the area of the lacrimal sac and antibiotic medication to combat infection as necessary. If signs of obstruction (wetness, tearing, infection) persist as the child approaches age 5-7 months, then a simple surgical procedure (probing and irrigation) may be required. Earlier intervention is recommended in few with sever infection. The procedure is typically accomplished in the office and is extremely effective.

Diagnostic Findings

--Continuously watery eye

--Tears running down the face even without crying

--During crying, nostril on blocked side remains dry

--Onset not red and eyelid not swollen (unless the soggy tissues become infected)

Cause

Your child probably has a blocked tear duct on that side. This means that the channel that normally carries tears from the eye to the nose is blocked. Although the obstruction is present at birth, the delay in onset of symptoms can be explained by the occasional delay in tear production until the age of 3 or 4 weeks in some babies. Both sides are blocked 30% of the time.

Expected Course

This is a common condition, affecting 6% of newborns. Over 90% of blocked tear ducts open up spontaneously by the time the child is 12 months of age. If the obstruction persists beyond 12 months of age, an ophthalmologist (eye specialist) can open it with a probe. Home Care for Preventing Infection Because of poor drainage, eyes with blocked tear ducts become easily infected. The infected eye produces a yellow discharge. To keep the eye free of infection, massage the lacrimal sac (where tears collect) twice daily. Always wash your hands carefully before doing this. The lacrimal sac is located in the inner lower corner of the eye. This sac should be massaged to empty it of old fluids and to check for infection. Start at the inner corner of the eye and press upward using a cotton swab. (Caution: Massaging downward is not helpful and may lead to infection.) If the eye becomes infected, it is very important to begin antibiotic eye drops.

Call Our Office

Immediately if:

--the eyelids are red or swollen.

--A red lump appears at the inner lower corner of the eyelid.

During office hours if:

--The eyelids are stuck together with pus after naps.

--Much yellow discharge is present.

--Your child reaches 12 months of age and the eye is still watering.

--You have other concerns or questions.

Instructions for Pediatric Patients, 2nd Edition, 1999 by WB Saunders Company

Written by Barton D. Schmitt, M.D. pediatrician and author of Your Child’s Health

Newborn Rashes and Birthmarks

After the first bath, your newborn will normally have a ruddy complexion from the extra high count of red blood cells. He can quickly change to a pale or mottled-blue color if he becomes cold, so keep him warm. During the second week of life, the skin normally becomes dry and flaky. This guideline covers seven rashes and birthmarks. Save time by going directly to the one that pertains to your baby.

Acne of Newborn

More than 30% of newborns develop acne of the face, mainly small red bumps. This neonatal acne begins at 3 to 4 weeks of age and lasts until 4 to 6 months of age. The cause appears to be the transfer of maternal androgens (hormones) just before birth. Since it is temporary, no treatment is necessary. Baby oil or ointments will just make it worse.

Drooling Rash

Most babies have a rash on the chin or cheeks that comes and goes. This is often due to contact with food and acid that has been spat up from the stomach. Rinse the baby’s face with water after all feedings or spitting up.

Other temporary rashes on the face are heat rashes in areas held against the mother’s skin during nursing (especially in the summertime). Change your baby’s position more frequently and put a cool washcloth on the area. No baby has perfect skin. The babies in advertisements wear makeup.

Erythema Toxicum

More than 50% of babies get a rash called erythema toxicum on the second or third day of life. The rash is composed of ½ to 1 inch red blotches with a small white lump in the center. They look like insect bites. They can be numerous, keep occurring, and be anywhere on the body surface. Their cause is unknown; they are harmless and resolve themselves by 2 weeks of age (rarely 4 weeks).

Forceps or Birth Canal Trauma

If delivery was difficult, a forceps may have been used to help the baby through the birth canal. The pressure of the forceps on the skin can leave bruises or scrapes or can even damage fat tissue anywhere on the head or face. Skin overlying bony prominences (such as the sides of the skull bone) can become damaged even without a forceps delivery by pressure from the birth canal. Fetal monitors can also cause scrapes and scabs on the scalp. The bruises and scrapes will be noted on day 1 or 2 and disappear by 1 to 2 weeks. The fat tissue injury won’t be apparent until day 5 to 10. A thickened lump of skin with an overlying scab is the usual finding. This may take 3 or 4 weeks to resolve. For any breaks in the skin, apply an antibiotic ointment (over the counter) four times a day until healed. If it becomes tender to the touch or soft in the center or shows other signs of infection, call our office.

Milia

Milia are tiny white bumps that occur on the faces of 40% of newborn babies. The nose and cheeks are most often involved, but milia are also seen on the forehead and chin. Although they look like pimples, they are smaller and not infected. They are blocked-off skin pores and will open up and disappear by 1 to 2 months of age. No ointments or creams should be applied to them.

Any true blisters (little bumps containing clear fluid) or pimples (especially of the scalp) that occur during the first month of life must be examined and diagnosed quickly. If they are caused by the herpes virus, treatment is urgent. If you suspect blisters or pimples, call our office immediately.

Mongolian Spots

A Mongolian spot is a bluish-gray flat birthmark found in more than 90% of Native American, Asian, Hispanic, and Black babies. Mongolian spots occur most commonly over the back and buttocks, although they can be present on any part of the body. They vary greatly in size and shape. Most fade away by 2 or 3 years of age, although a trace may persist into adult life.

Stork Bites (Pink Birthmarks)

Flat pink birthmarks (also called capillary hemangiomas) occur over the bridge of the nose, the eyelids, or the back of the neck in more than 50% of newborns. The birthmarks on the bridge of the nose and eyelids clear completely by 1 to 2 years of age. Most birthmarks on the nape of the neck also clear, but 25% can persist into adult life. Those on the forehead that run from the bridge of the nose up to the hairline usually persist into adult life. Laser treatment during infancy should be considered.

Instructions for Pediatric Patients, 2nd Edition, 1999 by WB Saunders Company

Written by Barton D. Schmitt, MD, pediatrician and author of Your Child’s Health

Nightmares and Night Terrors

Every child, like every adult, has frightening dreams that cause him or her to wake up scared. While no one really knows what causes nightmares, most experts feel that scary dreams develop as youngsters resolve internal conflicts and inner fears that surface during normal child development. In addition, real-life events, such as scary movies or violent television shows, can precipitate nightmares.

Parents usually become aware of their youngster’s nightmare once the episode is over and the child runs out of his or her bedroom crying and sobbing. On the other hand, older children begin to understand what a nightmare is and usually put themselves back to sleep without wakening the parents. Nightmares generally occur during the second half of the night when dreaming is most intense.

When a nightmare wakes up a child, the frightened youngster needs physical contact, comfort and reassurance. Following the episode, most children can tell their parents exactly what the bad dream was about, giving parents the opportunity to reassure their youngster that it is only a bad dream. Plan on staying with your child a few minutes until he or she is calm, becomes drowsy, and is ready to go back to sleep. In the morning, talk to your child about things that might be bothering him or her since nightmares are more common in children who are under some unusual stress. To the youngster a severe nightmare is real, so expect several nights of awakening or worrying about going to sleep at night following an episode.

If a child is having frequent nightmares, parents should review their youngster’s activities both during the day and at night. There is a lot going on in today’s world that is difficult for young children to handle. Make sure he or she is not watching too many scary or violent television programs. The distinction between fantasy and realty is often blurred in children. Images produced by violent movies and graphic television programs will stay with kids.

Another common sleep disorder that occurs in children is night terrors, known medically as “pavor nocturnus.” In contrast to nightmares, night terrors develop earlier in the night and usually begin one to four hours after falling asleep. Parents find their child sitting up in bed, screaming and trashing about but not entirely awake. The heart is racing and the eyes are wide open, sometimes even talking to their parents yet not responding to questions. During the episode, the youngster is usually not even aware of the parents’ presence, and may even push the parent away, sobbing and flailing more if touched or disturbed. The child is inconsolable for sometimes up to 30 minutes until finally relaxing and falling back to sleep on his or her own. In the morning, the youngster usually has no memory of the incident.

Night terrors are more common in children between the ages of 3 and 8 and the condition is often inherited. The episodes are not harmful and disappear as the child grows older.Night terrors seem to get worse when the child is over tired or is on an irregular schedule.

Parents should resist trying to comfort or hold their child during a night terror. Since the child is still partly asleep, comforting the youngster could wake him or her, making the child even more disoriented. Instead, watch to make sure he or she is safe from injury until returning to normal sleep. It is important to warn baby sitters and grandparents about night terrors and how to handle the situation, since the episode can be upsetting and scary to a caregiver.

Of course, there will be those situations when your child is neither having a nightmare nor night terror. The child may be seeking attention or special privileges may evoke the behavior. There are certain precautionary steps parents can take. First, give the child some time to go back to sleep (ten minutes is a good period). Then, go into the child’s room, reassure him or her that everything is okay, and put him or her back to bed. Make the visit boring and do not reward the child for waking up by bringing him or her into your room or offering food.

For many parents, a child’s bedtime is the most feared time of the day. Their infant wakes up three times a night for a feeding or their toddler either resists going to bed or keeps getting up after being put to sleep. It is important for parents to teach their children where to sleep, such as their own bed, and when to sleep, namely that special time for sleeping called nighttime. Sleep disorders can easily be prevented when parents allow their child to fall asleep on their own and go back to sleep on their own during periods of normal night wakings. Feeding the infant at night, allowing the child to stay awake until exhausted, or lying down with the child in their bed are approaches that usually prolong sleep problems and establish patterns of behavior that are difficult to eliminate later.

When children develop good sleeping habits they will get more than a good night’s sleep. They will also be taught one of life’s most important lessons. Namely, one gains independence by depending on himself or herself and can get through times of stress without always having to count on others.

Pool Safety

Never leave children alone in or near the pool, even for a moment.
Install a fence at least four-foot high around all four sides of the pool.
Make sure pool gates self-close and self-latch at a height children can't reach.
Keep rescue equipment (a shepherd's hook - a long pole with a hook on the end - and life preserver) and a portable telephone near the pool.
Avoid inflatable swimming aids such as "floaties." They are not a substitute for approved life vests and can give children a false sense of security.
Children are not developmentally ready for swim lessons until after their fourth birthday. Swim programs for children under 4 should not be seen as a way to decrease the risk of drowning. #
Whenever infants or toddlers are in or around water, an adult should be within arm's length, providing "touch supervision."

American Academy of Pediatrics, May, 2004

Quitting Thumb Sucking and Pacifiers

As children grow and develop, their need to suck usually goes away, most often by the time they are 6 to 8 years old. Also, with increases in peer pressure, children are more able to control their behavior. However, parents sometimes want this behavior to stop before peer pressure becomes an issue.

If you want to break your older child's sucking habits, the first step is to ignore them! Most often, they will disappear with time. Harsh words, teasing, or punishment may upset your child, and the habit will get worse. Punishment is not an effective way to get rid of habits.

Older children (more than 3 years of age) may use sucking to relieve boredom. Try getting your child's attention with an activity that she finds fun. Rewarding good behavior is the best way to produce a change. Praise and reward your child when she does not suck her thumb or use the pacifier. Star charts, daily rewards, and gentle reminders, especially during the daytime hours, are also very helpful.

If these measures do not work and your child wants to stop, your pediatrician might recommend trying a reminder such as covering the thumb with a plastic strip or "thumb guard" (an adjustable plastic cap that is taped to the thumb). Your child should be directly involved with the treatment chosen. Before using these methods, be sure to explain them to your child. If they make your child afraid or tense, stop them at once.

If your child's teeth are affected by the behavior and you have tried all the methods described above, talk to a pediatric dentist. Some dentists will install a device in the mouth that prevents the fingers or thumb from putting pressure on the palate or teeth. In fact, this device usually makes it so unpleasant to place the thumb or finger into the mouth that your child removes his thumb or finger.

Severe emotional upsets or stress-related problems might cause your child to suck his thumb or use a pacifier for a long time. It is also possible that your child may be one of the very few who cannot seem to stop. However, most children stop daytime sucking habits before they get very far in school. This is because of peer pressure. These same children might still use sucking as a way of going to sleep or calming themselves when they are upset. This is usually done in private and causes no harm either emotionally or physically. Putting too much pressure on your child to stop this type of behavior may cause more harm than good. Even these children eventually stop the habit on their own.

Respiratory Syncytial Virus

Respiratory syncytial virus (RSV) infects almost all children at least once before they are 2 years old. Most of the time this virus only causes minor coldlike symptoms. However, for some babies infection can be more dangerous.

For certain infants who are extremely preterm (infants born before 32 weeks of pregnancy) or who are born with severe heart disease or severe lung disease, RSV infection can be especially serious. Preterm infants often have underdeveloped lungs and may have difficulty fighting an RSV infection once they become infected.

Each year, about 125,000 children are hospitalized in the United States with RSV infection, and approximately 500 of these children will die. In the first 2 years of life, RSV is the leading cause of pneumonia and bronchiolitis (a swelling of the small airways), and may be associated with wheezing.

Infants born prematurely and term infants younger than 6 weeks of age are at increased risk for developing serious RSV infection. Young children with medical conditions, such as chronic lung disease, serious heart conditions, or problems with their immune system, including problems due to cancer or organ transplants, also are at risk.

When and how is RSV spread?

Respiratory syncytial virus infection occurs most often from late fall to early spring. Most illness occurs between November and April, although there may be seasonal variation by region. Respiratory syncytial virus occurs only in humans and is highly contagious. The virus can live for several hours on a surface such as a countertop, table, or playpen, or on unwashed hands. Respiratory syncytial virus is spread by direct or close physical contact, which includes touching or kissing an infected person, or contact with a contaminated surface.

What are the symptoms of RSV?

For most healthy children the symptoms of RSV resemble the common cold and include:

Runny nose * Coughing
Low-grade fever However, signs of more serious infection may include:
Difficult or rapid breathing * Wheezing
Irritability and restlessness
Poor appetite

Separation Anxiety

Around ten months of age, you may notice that you're child becomes much more "clutchy" about leaving you. When you're out of her sight, she'll know you're somewhere but not with her, and this will cause her great distress. She'll have so little sense of time that she won't know when, or even whether, you'll be coming back. Once she gets a little older, her memory of past experiences with you will comfort her when you're gone, and she'll be able to anticipate a reunion.

But for now she's only aware of the present, so every time you leave her sight, even to go to the next room, she'll fuss and cry. When you leave her with someone else she may scream as though her heart will break. At bedtime she'll refuse to leave you to go to sleep, and then she may wake up searching for you in the middle of the night. This developmental stage is known as separation anxiety. It can be a tough stage for both of you but it also marks the dawning realization for your child that each object is unique and permanent, and that there's only one of you.

Separation anxiety usually peaks between ten and eighteen months, and then fades during the last half of the second year. In some ways, this phase of your child's emotional development will be especially tender for both of you, while in others it will be painful. After all, her desire to be with you is a sign of her attachment to her first and greatest love, namely you. The intensity of her feeling as she hurtles into your arms is irresistible, especially when you realize that no one, including your child herself, will ever again think you are quite as perfect as she does at this age. On the other hand, you may feel suffocated by her constant clinging, while experiencing guilt whenever you leave her crying for you. Fortunately, this emotional roller coaster eventually will subside along with her separation anxiety.

If your child has a strong, healthy attachment to you, her separation anxiety probably will occur earlier than in other babies, and she'll pass through it more quickly. Instead of resenting her possessiveness during these months, maintain as much warmth and good humor as you can. Through your actions, you're showing her how to express and return love. This is the emotional base she'll rely on in years to come. The following suggestions may help ease separation anxiety.

Your baby is more susceptible to separation anxiety when she's tired, hungry, or sick. If you know you're going out, schedule your departure so it occurs after she's napped and eaten. Try to stay with her as much as possible when she's sick.
Don't make a fuss over your leaving. Instead, have the person staying with her create a distraction (a new toy, a visit to the mirror, a bath). Then say goodbye and slip away quickly.
Remember that her tears will subside within minutes of your departure. Her outbursts are for your benefit to persuade you to stay. With you out of sight, she'll soon turn her attention to the person staying with her.
Help her cope with separation through short practice sessions at home. Separation will be easier on her when she initiates it, so when she crawls to another room (one that's baby-proofed), don't follow her right away; wait for one or two minutes. When you go to another room for a few seconds, tell her where you're going and that you'll return. If she fusses, call to her instead of running back. Gradually, she'll learn that nothing terrible happens when you're gone and, just as important, you always come back when you say you will.
If you take your child to a sitter's home or a child-care center, don't just drop her off and leave. Spend a few extra minutes playing with her in this new environment. When you do leave, reassure her that you'll be back later.

Excerpted from "Caring for Your Baby and Young Child: Birth to Age 5" Bantam 1998

Swimmers Ear

The ear canal is the tube that ends at the eardrum. This is where wax build-up occurs. When the ear canal is exposed to water from baths or swimming, the ear canal which is simply skin, may become infected with bacteria. The canal may appear red and swollen. The main symptom is pain with movement of the ear or touching the ear or pushing on the area in front the ear. This is commonly called an outer ear infection, swimmer's ear or otitis externa.

Tidbits:

Swimmer's ear does not usually require an urgent call to the doctor after-hours. Acetaminophen or ibuprofen can be used for pain in the middle of the night.

Home Treatment:

Antibiotic ear drops. If your child has a swimmer's ear, presciption antibiotic drops with or without steriods in the drops are usually prescribed. If the case of a severe swimmer's ear, the physician may place a "wick" which is like a piece of cotton for a few days, so the drops will stay in the ear canal better and reach deeper into the ear canal. Occasionally, oral antibiotics will be used in severe cases or will be prescribed if there is an accompanying middle ear infection. Drops are usually used for 5 days and the child should not swim or get water in the ear during this time.

Prevention. Some children are prone to swimmer's ear and there are over-the-counter drops that may be used after swimming to help prevent swimmer's ear. This helps to dry the ear canal and creates acidity where bacteria will not grow as easily. Drops may be made at home by combining half vinegar and half rubbing alcohol.

Treating Diarrhea and Dedhydration

Most children should continue to eat a normal diet including formula or milk while they have mild diarrhea. Breastfeeding should continue. If your baby seems bloated or gassy after drinking cow's milk or formula, call your pediatrician to discuss a temporary change in diet. Special fluids are not usually necessary for children with mild illness.

Children with moderate diarrhea can be cared for easily at home with close supervision, special fluids, and your pediatrician's advice. Your pediatrician will recommend the amount and length of time that special fluids should be used. Later, a normal diet can be resumed. Some children are not able to tolerate cow's milk when they have diarrhea and it may be temporarily removed from the diet by your pediatrician. Breastfeeding should continue.

Special fluids have been designed to replace water and salts lost during diarrhea. These are extremely helpful for the home management of mild to moderately severe illness. Do not try to prepare these special fluids yourself. It is too easy to get confused by some of these complex recipes. You could accidentally make a bad fluid for your baby. Use a fluid that is made by one of the reputable manufacturers. The three most widely available products that you will find in nearly every pharmacy are:

Pedialyte (Ross Laboratories)
Infalyte (Mead Johnson Nutritionals)
ReVital (PTS Labs)

Other brands of special fluids are available and equally effective. Many drug stores have their own generic brands of special fluids. Ask the pharmacist for assistance.

If a child is not vomiting, these fluids can be used in very generous amounts until the child starts making normal amounts of urine again.

If your child develops severe diarrhea, he may require IV fluids in the emergency department for several hours to correct dehydration. Usually hospitalization is not necessary. Immediately seek your pediatrician's advice for the appropriate care if symptoms of severe illness occur.

While this illness runs its course, here are some general do's and don'ts that you should keep in mind:

Watch for signs of dehydration which occur when a child loses too much fluid and becomes dried out. Symptoms of dehydration include a decrease in urination, no tears when baby cries, high fever, dry mouth, weight loss, extreme thirst, listlessness, and sunken eyes.
Keep your pediatrician informed if there is any significant change in how your child is behaving.
Report if your child has blood in his stool.
Report if your child develops a high fever (more than 102ºF or 39ºC).
Continue to feed your child if she is not vomiting. You may have to give your child smaller amounts of food than normal or give your child foods that do not further upset his or her stomach.
Use diarrhea replacement fluids that are specifically made for diarrhea if your child is thirsty.

DON'T

Try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.
Prevent the child from eating if she is hungry.
Use boiled milk or other salty broth and soups.
Use "anti-diarrhea" medicines unless prescribed by your pediatrician.

Vomiting and Spitting Up

First of all, there's a difference between real vomiting and just spitting up.

Vomiting is the forceful throwing up of stomach contents through the mouth. Spitting up (most commonly seen in infants under 1 year of age) is the easy flow of stomach contents out of the mouth, frequently with a burp. Vomiting occurs when the abdominal muscles and diaphragm contract vigorously while the stomach is relaxed. This reflex action is triggered by the "vomiting center" in the brain after it has been stimulated by:

Nerves from the stomach and intestine when the gastrointestinal tract is either irritated or swollen by an infection or blockage
Chemicals in the blood (drugs, for example)
Psychological stimuli from disturbing sights or smells
Stimuli from the middle ear (as in vomiting caused by motion sickness)

Causes of Spitting Up

The common causes of spitting up vary according to age. During the first few months, for instance, most infants will spit up small amounts of formula, usually within the first hour after being fed. This "cheesing," as it is often called, is simply the occasional movement of food from the stomach, through the tube (esophagus) leading to it, and out of the mouth. It will occur less often if a child is burped frequently and if active play is limited right after meals. This spitting up tends to decrease as the baby becomes older but may persist in a mild form until 10 to 12 months of age. Spitting up is not serious and doesn't interfere with normal weight gain.

Causes of Vomiting

After the first few months of life, the most common cause of vomiting is a stomach or intestinal infection. Viruses are by far the most frequent infecting agents, but occasionally bacteria and even parasites may be the cause. The infection also may produce fever, diarrhea, and sometimes nausea and abdominal pain. The infection is usually contagious, so if your child has it, chances are some of her playmates also will be affected.

Occasionally, infections outside the gastrointestinal tract will cause vomiting. These include infections of the respiratory system, infections of the urinary tract, otitis media and pneumonia, as well as meningitis, appendicitis and Reye syndrome.

Warning Signs of Vomiting

Some conditions that cause vomiting require immediate medical treatment, so be alert for the following trouble signs, whatever your child's age, and call your pediatrician if they occur.

Blood or bile (a green-colored material) in the vomitus
Severe abdominal pain
Strenuous, repeated vomiting * Swollen abdomen
Lethargy or severe irritability
Convulsions
Signs or symptoms of dehydration, including dry mouth, absent tears, depression of the "soft spot" and decreased urination
Inability to drink adequate amounts of fluid
Vomiting continuing beyond twenty-four hours

Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999

end faq

Vaccination

Q. Are vaccines safe?

A. Because vaccines are given to people who are not sick, they are held to the highest standards of safety. As a result they are among the safest things we put into our bodies.

How does one define the word safe? If safe is defined as 'free from any negative effects," then vaccines aren’t safe. All vaccines have possible side effects. Most side effects are mild, such as pain or tenderness where the shot is given. But some side effects of vaccines can be severe. For example, vaccines, like all medicine, have been found to rarely cause a severe allergic reaction called anaphylaxis. Symptoms of anaphylaxis can occur within l5 minutes of getting any vaccine and include hives, difficulty breathing, and low blood pressure. Although the reaction can be treated, it can also be quite frightening.

If vaccines cause side effects, wouldn’t it be "safer" to just avoid vaccines? Unfortunately, choosing to avoid vaccine, is simply a choice to take a different risk. Unvaccinated children are at risk from many diseases including meningitis caused by Hib, bloodstream infections caused by pneumococcus, pneumonia caused by measles, deafness caused by mumps and liver cancer caused by hepatitis B virus.

When you compare the risk of vaccines and the risk of diseases, vaccines are the safer choice

Q. Is it better to be naturally infected or immunized?

A. The immunity earned by natural infection comes with the high price of occasionally serious and fatal disease. It is true that natural infection almost always causes better immunity than vaccines. Whereas immunity from disease often follows a single natural infection, immunity from vaccines usually occurs only after several doses. However, the price paid for immunity after natural infection can be high, including the risk of pneumonia from chickenpox, mental retardation from Hib, pneumonia from pneumococcus, birth defects from rubella, liver cancer from hepatitis B virus or death from measles.

Q. Thimerosal Questions?

A. What Parents Should Know About Thimerosal

From the American Academy of Pediatrics What is thimerosal?

* Thimerosal is an organic mercury-based preservative used in vaccines.

* Thimerosal has been used as an additive to vaccines since the 1930s because it is very effective in preventing bacterial and fungal contamination, particularly in opened multi-dose containers.

* Thimerosal is also found in other medicines and products including some throat and nose sprays and contact lens solutions

Does thimerosal cause autism?

* There are no studies that show a link between thimerosal in vaccines and autistic spectrum disorder.

* The CDC examined the incidence of autism in relation to the amount of thimerosal a child receives in vaccines. They found no change in autism rates relative to the amount of thimerosal a child received from vaccines in the first 6 months of life. In other words, a child who received more thimerosal was not more likely to be autistic.

Have any studies shown thimerosal in vaccines causes health problems in children?

An early CDC study suggested a possible weak connection between the amount of thimerosal given and certain neurodevelopmental disorders, such as ADHD, speech and language delays, and tics (but not autism). Further review by independent experts led many to feel this study was flawed in parts of its design that favored a connection when none may have existed. Later studies did not show any connection. Researchers will continue to look at this question.

In 2004, the Institute of Medicine Immunization Safety Review Committee conducted a study titled, "Immunization Safety Review: Vaccines and Autism." The report concludes that the body of epidemiological evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism. The committee agreed that further research to find the cause of autism should be directed toward other lines of inquiry that are supported by current knowledge and evidence and offer more promise for providing an answer.

Which vaccines contain thimerosal?

Since 2001, all routinely recommended vaccines manufactured for administration to infants in the U.S. are either thimerosal-free or contain only extremely small amounts of thimerosal. Many routinely recommended childhood vaccines never contained thimerosal: measles/mumps/rubella (MMR), polio (IPV), varicella/chicken pox. Some of the Haemophilus influenzae type b (Hib) and diphtheria/tetanus/pertussis (DTaP) vaccines never used thimerosal as a preservative.
Some vaccines that are not routinely recommended for young children under 6 months of age, such as meningococcal vaccine, are only available with thimerosal.

Why was thimerosal removed from vaccines if there is no danger?

Even though there’s no evidence that thimerosal in vaccines is dangerous, the Public Health Service and the American Academy of Pediatrics believe the effort to remove mercury-based preservatives from vaccines was a good decision. Mercury exists in a different form in our environment (such as in some fish) so children will be exposed to it in other ways. We can’t always remove mercury from the environment. But we can control the mercury used in some vaccines. So, by taking thimerosal out of vaccines, we are lessening the amount of mercury a child will be exposed to early in life.

What risks does mercury pose to an infant's health?

Studies of mercury ingested from fish and other sources have shown that in high doses, mercury can cause brain damage. Mercury can also affect the kidneys and immune system. Mercury in vaccines (ethyl mercury) is in a different form than mercury in food products (methyl mercury). It is difficult to predict adverse effects of ethyl mercury exposure based on studies of exposure to other forms of mercury. Experts have differing opinions.

Have any adverse reactions to thimerosal ever been reported? When vaccines containing thimerosal have been administered in the recommended doses, allergic type reactions (hives, shock) have been noted on rare occasions. No other harmful effects have been reported.

Should parents have their children who have received vaccinations with thimerosal be tested for mercury?

No. Infants and children who have received thimerosal-containing vaccines do not need to have blood, urine or hair tested for mercury. The body eliminates a mercury dose completely within 120 days - it doesn’t stay in your child’s body.
Screening children for mercury exposure will likely result in more questions than answers. Mercury in the urine is a measure of inorganic mercury exposure, not the organic form found in thimerosal. Mercury found in blood, hair or fingernails can come from any mercury source… it is more likely to come from dietary and environmental mercury sources than from thimerosal. Children who are suspected to have had environmental exposures (from broken thermometers or excessive fish consumption) may be appropriately tested.

Who should be concerned about exposure to large amounts of mercury?

Pregnant women, nursing mothers, and young infants should be especially careful about mercury exposure. Some fish contain high levels of organic mercury. State health, environmental and conservation officials have information about which fish to avoid in your state. Pediatricians can also give parents advice about avoiding exposure.

Immunizations have already been successful at nearly wiping out many diseases, so why should children continue to get vaccinated when these diseases barely exist anymore?

Although vaccine-preventable diseases are at record low numbers, the organisms that cause these diseases are still present. Unvaccinated children continue to be at risk of serious, even deadly diseases. We are only one airplane ride away from many parts of the world where these diseases are still rampant and where immunization is not available. We cannot afford to let down our guard. Copyright © 2004 by the American Academy of Pediatrics.

Q. What would happen if we stopped vaccinations?

A. What Would Happen If We Stopped Vaccinations?

At a glance: Vaccines are responsible for the control of many infectious diseases that were once common in this country. Vaccines have reduced, and in some cases, eliminated, many diseases that routinely killed or harmed many infants, children, and adults. However, the viruses and bacteria that cause vaccine-preventable disease and death still exist and can be passed on to people who are not protected by vaccines. Vaccine-preventable diseases have a costly impact, resulting in doctor's visits, hospitalizations, and premature deaths. Sick children can also cause parents to lose time from work.

Polio

Polio virus causes acute paralysis that can lead to permanent physical disability and even death. Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States. These annual epidemics of polio often left thousands of victims--mostly children--in braces, crutches, wheelchairs, and iron lungs. The effects were life-long.

Development of polio vaccines and implementation of polio immunization programs have eliminated paralytic polio caused by wild polio viruses in the U.S. and the entire Western hemisphere.

In 1999, as a result of global immunization efforts to eradicate the disease, there were about 2,883 documented cases of polio in the world.In 1994, wild polio virus was imported to Canada from India, but high vaccination levels prevented it from spreading in the population.

Measles

Before measles immunization were available, nearly everyone in the U.S. got measles. An average of 450 measles-associated deaths were reported each year between 1953 and 1963.

In the U.S., up to 20 percent of persons with measles are hospitalized. Seventeen percent of measles cases have had one or more complications, such as ear infections, pneumonia, or diarrhea. Pneumonia is present in about six percent of cases and accounts for most of the measles deaths. Although less common, some persons with measles develop encephalitis (swelling of the lining of the brain), resulting in brain damage.

It is estimated that as many as one of every 1,000 persons with measles will die in the U.S. In the developing world, the rate is much higher, with death occurring in about one of every 100 persons with measles.

Measles is one of the most infectious diseases in the world and is frequently imported into the U.S. In 1997-2000, most cases were associated with international visitors or U.S. residents who were exposed to the measles virus while traveling abroad. More than 90 percent of people who are not immune will get measles if they are exposed to the virus.

According to the World Health Organization (WHO), nearly 900,000 measles-related deaths occurred among persons in developing countries in 1999. In populations that are not immune to measles, measles spreads rapidly. If vaccinations were stopped, each year, 2.7 million measles deaths worldwide could be expected.

In the U.S., widespread use of measles vaccine has led to a greater than 99 percent reduction in measles compared with the pre-vaccine era. If we stopped immunization, measles would increase to pre-vaccine levels.

Haemophilus Influenzae Type b (Hib) Meningitis

Before Hib vaccine became available, Hib was the most common cause of bacterial meningitis in U.S. infants and children. Before the vaccine was developed, there were approximately 20,000 invasive Hib cases annually. Approximately two-thirds of the 20,000 cases were meningitis, and one-third were other life-threatening invasive Hib diseases such as bacteria in the blood, pneumonia, or inflammation of the epiglottis. About one of every 200 U.S. children under 5 years of age got an invasive Hib disease. Hib meningitis killed 600 children each year, and left many survivors with deafness, seizures, or mental retardation.

Since introduction of conjugate Hib vaccine in December 1987, the incidence of Hib has declined by 98 percent. From 1994-1998, fewer than 10 fatal cases of invasive Hib disease were reported each year.

This preventable disease was a common, devastating illness as recently as 1990; now, most pediatricians just finishing training have never seen a case. If we were to stop immunization, we would likely soon return to the pre-vaccine numbers of invasive Hib disease cases and deaths.

Pertussis (Whooping Cough)

Since the early 1980s, reported pertussis cases have been increasing, with peaks every 3-4 years; however, the number of reported cases remains much lower than levels seen in the pre-vaccine era. Compared with pertussis cases in other age groups, infants who are 6 months old or younger with pertussis experience the highest rate of hospitalization, pneumonia, seizures, Encephalopathy (a degenerative disease of the brain) and death. From 1990 to 1996, 57 persons died from pertussis; 49 of these were less than six months old.

Before pertussis immunizations were available, nearly all children developed whooping cough. In the U.S., prior to pertussis immunization, between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths.

Pertussis can be a severe illness, resulting in prolonged coughing spells that can last for many weeks. These spells can make it difficult for a child to eat, drink, and breathe. Because vomiting often occurs after a coughing spell, infants may lose weight and become dehydrated. In infants, it can also cause pneumonia and lead to brain damage, seizures, and mental retardation.

The newer pertussis vaccine (acellular or DTaP) that has been available for use in the United States since 1991 and has been recommended for exclusive use since 1998. These vaccines are effective and associated with fewer mild and moderate adverse reactions when compared with the older (whole-cell DTP) vaccines.

During the 1970s, widespread concerns about the safety of the older pertussis vaccine led to a rapid fall in immunization levels in the United Kingdom. More than 100,000 cases and 36 deaths due to pertussis were reported during an epidemic in the mid 1970s. In Japan, pertussis vaccination coverage fell from 80 percent in 1974 to 20 percent in 1979. An epidemic occurred in 1979, resulted in more than 13,000 cases and 41 deaths.

Pertussis cases occur throughout the world. If we stopped pertussis immunizations in the U.S., we would experience a massive resurgence of pertussis disease. A recent study* found that, in eight countries where immunization coverage was reduced, incidence rates of pertussis surged to 10 to 100 times the rates in countries where vaccination rates were sustained.

*Reference for study: Gangarosa EJ, et al. Impact of anti-vaccine movements on pertussis control: the untold story. Lancet 1998;351:356-61.

Rubella (German Measles)

While rubella is usually mild in children and adults, up to 90 percent of infants born to mothers infected with rubella during the first trimester of pregnancy will develop congenital rubella syndrome (CRS), resulting in heart defects, cataracts, mental retardation, and deafness.

In 1964-1965, before rubella immunization was used routinely in the U.S., there was an epidemic of rubella that resulted in an estimated 20,000 infants born with CRS, with 2,100 neonatal deaths and 11,250 miscarriages. Of the 20,000 infants born with CRS, 11,600 were deaf, 3,580 were blind, and 1,800 were mentally retarded.

Due to the widespread use of rubella vaccine, only six CRS cases were provisionally reported in the U.S. in 2000. Because many developing countries do not include rubella in the childhood immunization schedule, many of these cases occurred in foreign-born adults. Since 1996, greater than 50 percent of the reported rubella cases have been among adults. Since 1999, there have been 40 pregnant women infected with rubella.

If we stopped rubella immunization, immunity to rubella would decline and rubella would once again return, resulting in pregnant women becoming infected with rubella and then giving birth to infants with CRS.

Varicella (Chickenpox)

Chickenpox is always present in the community and is highly contagious. Prior to the licensing of chicken pox vaccine in 1995, almost all persons in the U.S. had suffered from chickenpox by adulthood. Chickenpox was responsible for an estimated 4 million cases each year, including 11,000 hospitalizations and 100 deaths.

Chickenpox is usually mild, but may be severe in some infants, adolescents, and adults. Some people who get chickenpox have also suffered from complications such as secondary bacterial infections, loss of fluids (dehydration), pneumonia, and central nervous system involvement. In addition, only persons who have had chickenpox in the past can get shingles, a painful inflammation of the nerves. There are about 300,000 cases of shingles that occur each year when inactivated chickenpox virus is activated in people who have had chickenpox in the past.

Vaccine coverage among children 19-35 months were 67 percent in 2000.

Hepatitis B

More than 2 billion persons worldwide have been infected with the hepatitis B virus at some time in their lives. Of these, 350 million are life-long carriers of the disease and can transmit the virus to others. One million of these people die each year from liver disease and liver cancer.

National studies have shown that about 12.5 million Americans have been infected with hepatitis B virus at some point in their lifetime. One and one quarter million Americans are estimated to have chronic (long-lasting) infection, of whom 20 percent to 30 percent acquired their infection in childhood. Chronic hepatitis B virus infection increases a person's risk for chronic liver disease, cirrhosis, and liver cancer. About 5,000 persons will die each year from hepatitis B-related liver disease resulting in over $700 million medical and work loss costs.

The number of new infections per year has declined from an average of 450,000 in the 1980s to about 80,000 in 1999. The greatest decline has occurred among children and adolescents due to routine hepatitis B vaccination.

Infants and children who become infected with hepatitis B virus are at highest risk of developing lifelong infection, which often leads to death from liver disease (cirrhosis) and liver cancer. Approximately 25 percent of children who become infected with life-long hepatitis B virus would be expected to die of related liver disease as adults.

CDC estimates that one-third of the life-long hepatitis B virus infections in the United States resulted from infections occurring in infants and young children. About 16,000 - 20,000 hepatitis B antigen infected women give birth each year in the United States. It is estimated that 12,000 children born to hepatitis B virus infected mothers were infected each year before implementation of infant immunization programs. In addition, approximately 33,000 children (10 years of age and younger) of mothers who are not infected with hepatitis B virus were infected each year before routine recommendation of childhood hepatitis B vaccination.

Diphtheria

Diphtheria is a serious disease caused by a bacteria. This germ produces a poisonous substance or toxin which frequently causes heart and nerve problems. The death rate is 5 percent to 10 percent, with higher death rates (up to 20 percent) in the very young and the elderly.

In the 1920's, diphtheria was a major cause of illness and death for children in the U.S. In 1921, a total of 206,000 cases and 15,520 deaths were reported. With vaccine development in 1923, new cases of diphtheria began to fall in the U.S., until in 2000 when only one case was reported.

Although diphtheria is rare in the U.S., it appears that the bacteria continues to get passed among people. In 1996, 10 isolates of the bacteria were obtained from persons in an American Indian community in South Dakota, none of whom had classic diphtheria disease. There has been one death reported in 2000 from clinical diphtheria caused by a related bacteria.

There are high rates of susceptibility among adults. Screening tests conducted since 1977 have shown that 41 percent to 84 percent of adults 60 and over lack protective levels of circulating antitoxin against diphtheria.

Although diphtheria is rare in the U.S., it is still a threat. Diphtheria is common in other parts of the world and with the increase in international travel, diphtheria and other infectious diseases are only a plane ride away. If we stopped immunization, the U.S. might experience a situation similar to the Newly Independent States of the former Soviet Union. With the breakdown of the public health services in this area, diphtheria epidemics began in 1990, fueled primarily by persons who were not properly vaccinated. From 1990-1999, more than 150,000 cases and 5,000 deaths were reported.

Tetanus (Lock Jaw)

Tetanus is a severe, often fatal disease. The bacteria that cause tetanus are widely distributed in soil and street dust, are found in the waste of many animals, and are very resistant to heat and germ-killing cleaners. From 1922-1926, there were an estimated 1,314 cases of tetanus per year in the U.S. In the late 1940's, the tetanus vaccine was introduced, and tetanus became a disease that was officially counted and tracked by public health officials. In 2000, only 41 cases of tetanus were reported in the U.S.

People who get tetanus suffer from stiffness and spasms of the muscles. The larynx (throat) can close causing breathing and eating difficulties, muscles spasms can cause fractures (breaks) of the spine and long bones, and some people go into a coma, and die. Approximately 30 percent of reported cases end in death.

Tetanus in the U.S. is primarily a disease of adults, but unvaccinated children and infants of unvaccinated mothers are also at risk for tetanus and neonatal tetanus, respectively. From 1995-1997, 33 percent of reported cases of tetanus occurred among persons 60 years of age or older and 60 percent occurred in patients greater than 40 years of age. The National Health Interview Survey found that in 1995, only 36 percent of adults 65 or older had received a tetanus vaccination during the preceding 10 years.

Worldwide, tetanus in newborn infants continues to be a huge problem. Every year tetanus kills 300,000 newborns and 30,000 birth mothers who were not properly vaccinated. Even though the number of reported cases is low, an increased number of tetanus cases in younger persons has been observed recently in the U.S. among intravenous drug users, particularly heroin users.

Tetanus is infectious, but not contagious, so unlike other vaccine-preventable diseases, immunization by members of the community will not protect others from the disease. Because tetanus bacteria are widespread in the environment, tetanus can only be prevented by immunization. If vaccination against tetanus were stopped, persons of all ages in the U.S. would be susceptible to this serious disease.

Mumps

Before the mumps vaccine was introduced, mumps was a major cause of deafness in children, occurring in approximately 1 in 20,000 reported cases. Mumps is usually a mild viral disease. However, rare conditions such as swelling of the brain, nerves and spinal cord can lead to serious side effects such as paralysis, seizures, and fluid in the brain.

Serious side effects of mumps are more common among adults than children. Swelling of the testes is the most common side effect in males past the age of puberty, occurring in up to 20 percent to 50 percent of men who contract mumps. An increase in miscarriages has been found among women who develop mumps during the first trimester of pregnancy. An estimated 212,000 cases of mumps occurred in the U.S. in 1964. After vaccine licensure in 1967, reports of mumps decreased rapidly. In 1986 and 1987, there was a resurgence of mumps with 12,848 cases reported in 1987. Since 1989, the incidence of mumps has declined, with an estimated 327 cases in 2000. This recent decrease is probably due to the fact that children have received a second dose of mumps vaccine (part of the two-dose schedule for measles, mumps, rubella or MMR) and the eventual development of immunity in those who did not gain protection after the first mumps vaccination.

If we were to stop vaccination against mumps, we could expect the number of cases to climb back to pre-vaccine levels, since mumps is easily spread among unvaccinated persons.

National Immunization Program (NIP)

Q. Why Immunize?

A. Why Immunize?

Disease	What it Does	Why Immunize
Polio	Causes acute paralysis that can lead to permanent physical disability and even death.	Before Polio vaccination was available, 13,000 to 20,000 cases were reported each year in the U.S. None were reported in 2000.
Measles	Rash that can cause complications such as pneumonia, diarrhea or ear infections in 9% of those infected. Some develop encephalitis, which results in brain damage.	Measles is one of the most infectious diseases in the world, and is frequently imported into the U.S. If vaccinations were stopped, 2.7 million measles deaths worldwide could be expected.
Haemophilus Influenzae Type b (Hib) Meningitis	Most common cause of bacterial meningitis in the U.S. before the vaccine. Led to deafness, seizures or mental retardation in those who survived the disease.	Before the vaccination, Hib meningitis killed 600 children a year, and infected 20,000. If we were to stop immunizing, we would likely return to the pre-vaccine numbers of infections and deaths.
Pertussis (Whooping Cough)	Can lead to pneumonia, seizures, brain disease and death in infants. Results in prolonged coughing that lasts for many weeks, causing dehydration and vomiting.	Before immunization, up to 260,000 cases were reported in the U.S. each year, with up to 9,000 deaths. Pertussis still occurs worldwide.
Rubella (German Measles)	Usually mild in children and adults, up to 90% of infants born to infected mothers will develop congenital rubella syndrome (CRS), resulting in heart defects, cataracts, mental retardation and deafness.	Before the 1965 vaccination was used routinely in the U.S., rubella resulted in an estimated 20,000 infants born with CRS, 2,100 neonatal deaths and 11,250 miscarriages in a two-year time span.
Varicella (Chickenpox)	Always present in the community and highly contagious. Can be severe in some, leading to complications such as dehydration, pneumonia, and shingles. Children miss a week or more of school on average when infected with chickenpox.	Chickenpox was responsible for an estimated 4 million cases, 11,000 hospitalizations and 100 deaths each year before the licensing of the chickenpox vaccine in 1995.
Hepatitis B	Infants and children who become infected with Hepatitis B are at the highest risk of developing life-long infection, which often leads to death from liver disease and liver cancer.	Approximately 25% of children who become infected with life-long hepatitis are expected to die of a related disease as adults. In addition to the 12,000 infants infected by their mother during birth, approximately 33,000 children under the age of 10 were infected before the vaccination.
Diphtheria	A serious disease caused by poison produced from the bacteria. It frequently causes heart and nerve problems.	The death rate before vaccinations was up to 20% in the young and elderly. Although Diphtheria is primarily in other countries, international travels make it easy to contract. In 1921, a diphtheria outbreak caused 12,230 deaths in the U.S. Only one case was reported in 1998, due to vaccinations.
Tetanus (Lock Jaw)	A severe, often fatal disease. Leads to stiffness and spasms of the muscles. Can cause the throat to close, and spasms can cause fractures.	Approximately 30% of reported cases of tetanus end in death. Tetanus kills 300,000 newborns and 30,000 birth mothers worldwide, from lack of immunization. Tetanus is not contagious, and can only be prevented by immunization. People of all ages can be infected.
Mumps	Once a major cause of deafness in children, occurring in approximately 1 of every 20,000 cases reported. Can cause swelling of the brain, nerves and spinal cord that can lead to paralysis, seizures and fluid in the brain.	Before the vaccination was developed in 1967, an estimated 212,000 cases occurred in the U.S. annually. In 1986 and 1987, there was a resurgence of mumps with 12,848 cases reported. Since 1989, the incidence has declined, with a total of 323 cases last year.

Source: Centers for Disease Control and Prevention (www.cdc.gov)

end faq

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Vaccination

Q. Are vaccines safe?

Q. Is it better to be naturally infected or immunized?

Q. Thimerosal Questions?

Q. What would happen if we stopped vaccinations?

Q. Why Immunize?

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