Next to the common cold, an ear infection is the most common childhood illness. In fact, most children have at least one ear infection by the time they are 3 years old. Many ear infections clear up without causing any lasting problems.

The following is information from the American Academy of Pediatrics about the symptoms, treatments, and possible complications of acute otitis media, a common infection of the middle ear.

How do ear infections develop?

The ear has 3 parts—the outer ear, middle ear, and inner ear. A narrow channel (eustachian tube) connects the middle ear to the back of the nose. When a child has a cold, nose or throat infection, or allergy, the mucus and fluid can enter the eustachian tube causing a buildup of fluid in the middle ear. If bacteria or a virus infects this fluid, it can cause swelling and pain in the ear. This type of ear infection is called acute otitis media (middle ear inflammation).

Often after the symptoms of acute otitis media clear up, fluid remains in the ear, creating another kind of ear problem called otitis media with effusion (middle ear fluid). This condition is harder to detect than acute otitis media because except for the fluid and usually some mild hearing loss, there is often no pain or other symptoms present. This fluid may last several months and, in most cases, disappears on its own. The child’s hearing then returns to normal.

Is my child at risk for developing an ear infection?

Risk factors for developing childhood ear infections include

• Age. Infants and young children are more likely to get ear infections than older children. The size and shape of an infant’s eustachian tube makes it easier for an infection to develop. Ear infections occur most often in children between 6 months and 3 years of age. Also, the younger a child is at the time of the first ear infection, the greater the chance he will have repeated infections.

• Family history. Ear infections can run in families. Children are more likely to have repeated middle ear infections if a parent or sibling also had repeated ear infections.

• Colds. Colds often lead to ear infections. Children in group child care settings have a higher chance of passing their colds to each other because they are exposed to more viruses from the other children.

• Tobacco smoke. Children who breathe in someone else’s tobacco smoke have a higher risk of developing health problems, including ear infections.

How can I reduce the risk of an ear infection?

Some things you can do to help reduce your child’s risk of getting an ear infection are

• Breastfeed instead of bottle-feed. Breastfeeding may decrease the risk of frequent colds and ear infections.

• Keep your child away from tobacco smoke, especially in your home or car.

• Throw away pacifiers or limit to daytime use, if your child is older than 1 year.

• Keep vaccinations up to date. Vaccines against bacteria (such as pneumococcal vaccine) and viruses (such as influenza vaccine) reduce the number of ear infections in children with frequent infections.

What are the symptoms of an ear infection?

Your child may have many symptoms during an ear infection. Talk with your pediatrician about the best way to treat your child’s symptoms.

• Pain. The most common symptom of an ear infection is pain. Older children can tell you that their ears hurt. Younger children may only seem irritable and cry. You may notice this more during feedings because sucking and swallowing may cause painful pressure changes in the middle ear.

• Loss of appetite. Your child may have less of an appetite because of the ear pain.

• Trouble sleeping. Your child may have trouble sleeping because of the ear pain.

• Fever. Your child may have a temperature ranging from 100°F (normal) to 104°F.

• Ear drainage. You might notice yellow or white fluid, possibly blood-tinged, draining from your child’s ear. The fluid may have a foul odor and will look different from normal earwax (which is orange-yellow or reddish-brown). Pain and pressure often decrease after this drainage begins, but this doesn’t always mean that the infection is going away. If this happens it’s not an emergency, but your child will need to see your pediatrician.

• Trouble hearing. During and after an ear infection, your child may have trouble hearing for several weeks. This occurs because the fluid behind the eardrum gets in the way of sound transmission. This is usually temporary and clears up after the fluid from the middle ear drains away.

Important: Your doctor cannot diagnose an ear infection over the phone; your child’s eardrum must be examined by your doctor to confirm fluid buildup and signs of inflammation.

What causes ear pain?

There are other reasons why your child’s ears may hurt besides an ear infection. The following can cause ear pain:

• An infection of the skin of the ear canal, often called “swimmer’s ear”

• Reduced pressure in the middle ear from colds or allergies

• A sore throat

• Teething or sore gums

• Inflammation of the eardrum alone during a cold (without fluid buildup)

How are ear infections treated?

Because pain is often the first and most uncomfortable symptom of an ear infection, it’s important to help comfort your child by giving her pain medicine. Acetaminophen and ibuprofen are over-the-counter (OTC) pain medicines that may help decrease much of the pain. Be sure to use the right dosage for your child’s age and size. Don’t give aspirin to your child. It has been associated with Reye syndrome, a disease that affects the liver and brain. There are also ear drops that may relieve ear pain for a short time. Ask your pediatrician whether these drops should be used. There is no need to use OTC cold medicines (decongestants and antihistamines), because they don’t help clear up ear infections.

Not all ear infections require antibiotics. Some children who don’t have a high fever and aren’t severely ill may be observed without antibiotics. In most cases, pain and fever will improve in the first 1 to 2 days.

If your child is younger than 2 years, has drainage from the ear, has a fever higher than 102.5°F, seems to be in a lot of pain, is unable to sleep, isn’t eating, or is acting ill, it’s important to call your pediatrician. If your child is older than 2 years and your child’s symptoms are mild, you may wait a couple of days to see if she improves.

Your child’s ear pain and fever should improve or go away within 3 days of their onset. If your child’s condition doesn’t improve within 3 days, or worsens at any time, call your pediatrician. Your pediatrician may wish to see your child and may prescribe an antibiotic to take by mouth, if one wasn’t given initially. If an antibiotic was already started, your child may need a different antibiotic. Be sure to follow your pediatrician’s instructions closely.

If an antibiotic was prescribed, make sure your child finishes the entire prescription. If you stop the medicine too soon, some of the bacteria that caused the ear infection may still be present and cause an infection to start all over again.

As the infection starts to clear up, your child might feel a “popping” in the ears. This is a normal sign of healing. Children with ear infections don’t need to stay home if they are feeling well, as long as a child care provider or someone at school can give them their medicine properly, if needed. If your child needs to travel in an airplane, or wants to swim, contact your pediatrician for specific instructions.

What are signs of hearing problems?

Because your child can have trouble hearing without other symptoms of an ear infection, watch for the following changes in behavior (especially during or after a cold):

• Talking more loudly or softly than usual

• Saying “huh?” or “what?” more than usual

• Not responding to sounds

• Having trouble understanding speech in noisy rooms

• Listening with the TV or radio turned up louder than usual

If you think your child may have difficulty hearing, call your pediatrician. Being able to hear and listen to others talk helps a child learn speech and language. This is especially important during the first few years of life.

Are there complications from ear infections?

Although it’s very rare, complications from ear infections can develop, including the following:

• An infection of the inner ear that causes dizziness and imbalance (labyrinthitis)

• An infection of the skull behind the ear (mastoiditis)

• Scarring or thickening of the eardrum

• Loss of feeling or movement in the face (facial paralysis)

• Permanent hearing loss

It’s normal for children to have several ear infections when they are young—even as many as 2 separate infections within a few months. Most ear infections that develop in children are minor. Recurring ear infections may be a nuisance, but they usually clear up without any lasting problems. With proper care and treatment, ear infections can usually be managed successfully. But, if your child has one ear infection after another for several months, you may want to talk about other treatment options with your pediatrician.

Allergy describes a condition involving the immune system that causes sneezing and itching, chronic rashes, wheezing, or even life-threatening allergic reactions. Whether minor or serious, there are things you can do to prevent or control most allergic problems. The more you know about allergies—the symptoms, causes, and treatments—the more prepared you will be to help your child. Read on to find out more.

What is an allergy?

Allergies happen when the part of the body that fights off illnesses (the immune system) overreacts to a usually harmless substance (called an allergen) that is eaten, breathed in, injected, or touched. An allergy is not a disease but a description of a way that the immune system reacts. This allergic reaction can affect different parts of the body, resulting in diseases or conditions such as

• Anaphylaxis—a severe and possibly life-threatening allergic reaction.

• Asthma—when the airways swell and spasm and cause air passages in the lungs to narrow. This may be triggered by an allergic reaction, although nonallergic triggers can also be the cause (such as an infection or exercise).

• Contact dermatitis—an itchy rash caused by skin coming in contact with things like poison ivy or oak and certain chemicals in items like creams, cosmetics, and jewelry.

• Eczema—also called atopic dermatitis; a chronic, itchy rash.

• Food allergy—an allergic reaction to food that can range from stomachache, to skin rash, to a serious medical emergency like anaphylaxis.

• Hay fever—an allergic reaction in the nasal passages causing a runny, itchy, and stuffy nose and sneezing. It can occur at certain times of the year or all year long. Symptoms like itchy, red, and watery eyes often occur along with the nose symptoms.

• Hives—itchy welts that may be caused by foods, a virus, medicines, or other triggers.

• Insect sting allergy—potentially severe reactions from the stings of yellow jackets, wasps, fire ants, or other stinging insects.

• Medication allergy—symptoms such as rashes or more severe problems from various prescription or nonprescription medicines or vaccines.

What causes allergies?

Children get allergies from coming into contact with allergens. Allergens can be inhaled, eaten, or injected (from stings or medicine) or they can come into contact with the skin. Some of the more common allergens are

• Pollens from trees, grasses, and weeds

• Molds, both indoor and outdoor

• Dust mites that live in bedding, carpeting, and other items that hold moisture

• Animal dander from furred animals such as cats, dogs, horses, and rabbits

• Some foods and medicines

• Venom from insect stings

Allergies tend to run in families. If a parent has an allergy, there is a higher chance that his or her child also will have allergies. This risk increases if both parents are allergic.

How can I tell if symptoms are from allergies or a cold?

Allergies affecting the nose can result in the following symptoms:

• An itchy, runny nose with thin, clear nasal discharge and/or a stuffy nose

• Itchy, watery eyes

• Repeated sneezing and itching of the nose, eyes, or skin that last for weeks or months

• No fever

• Often seasonal (for example, spring, summer, fall before frost)

Although nasal allergies can sometimes cause sleepiness, usually children with nasal symptoms caused by allergies do not “act sick.”

Cold symptoms include

• Stuffy nose

• Nasal discharge that is clear or colored and thick that lasts 3 to 10 days, with or without fever, usually at times of the year such as the “cold and flu” season

• Occasional sneezing

• Feeling sick, tired, or listless and having a poor appetite

What is anaphylaxis?

Anaphylaxis is a serious allergic reaction. It comes on quickly and can be fatal. Your child will need to be treated right away followed by a call to 911 or your local emergency number.

When do allergic symptoms in children first show up?

Some allergic conditions show up early in life. For example, eczema often occurs in the first few years of life while hay fever usually appears during preschool or early grade school. For some children, allergies lessen around the time of puberty. Others will continue to have problems into adult years.

Do drug treatments help?

There are many medicines to treat allergic conditions. Medicines include antihistamine pills or syrup, eyedrops, nose sprays, asthma treatments, and creams or ointments. Some are available over the counter. These medicines can help relieve symptoms such as itching, sneezing, congestion, runny nose, wheeze, cough, and rashes and asthma. Allergy medicines may have minor side effects such as sleepiness or irritability. Before using any allergy medicines, carefully read the warnings on the label. If any of these medicines does not relieve your child’s symptoms or if the side effects are too strong, call your pediatrician. Your child may need a different medicine or dose. Although medicines can be helpful, it is also important to identify allergy triggers and remove them when possible.

When does my child need to see an allergist?

In some cases, your pediatrician may recommend that you see a board-certified allergist, a doctor who specializes in allergies. The allergist will most likely

• Look for triggers for your child’s allergy.

• Suggest ways to avoid the cause of your child’s symptoms.

• Give you a treatment plan to follow.

What are allergy shots?

Allergy shots, also called immunotherapy, may be recommended. These shots contain small amounts of the substances to which your child is allergic. This allows your child’s body to become less sensitive to these substances. Allergy shots can help decrease symptoms of hay fever and asthma and prevent anaphylaxis from insect sting allergies. However, they are not available for food allergies.

How can I help my child?

Identifying and avoiding the things your child is allergic to is best. If your child has an allergic condition, try the following:

• Keep windows closed during the pollen season, especially on dry, windy days when pollen counts are highest.

• Keep the house clean and dry to reduce mold and dust mites.

• Avoid having pets and indoor plants.

• Avoid those things that you know cause allergic reactions in your child.

• Prevent anyone from smoking anywhere near your child, especially in your home and car.

• See your pediatrician for safe and effective medicine that can be used to help alleviate or prevent allergy symptoms.

Common allergic conditions

Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.

Anaphylaxis is a serious allergic reaction. It comes on quickly and can be fatal. It often affects many body systems. This type of reaction is a medical emergency and immediate medical attention is important. Children with asthma and allergies to certain foods, stinging insects, or medicines are at highest risk, though anaphylaxis may occur in anyone. Your pediatrician may refer you to an allergist. An allergist has specialized training in diagnosing the cause of anaphylaxis and providing additional treatment. Parents should know the symptoms of anaphylaxis and what to do in case it happens to their child.

What are the symptoms of anaphylaxis?

Anaphylaxis includes a wide range of symptoms that often happen quickly. The most severe symptoms restrict breathing and blood circulation. Combinations of symptoms may occur. The most common symptoms may affect the following:

• SKIN: itching, hives, redness, swelling

• NOSE: sneezing, stuffy nose, runny nose

• MOUTH: itching, swelling of lips or tongue

• THROAT: itching, tightness, difficulty swallowing, hoarseness

• CHEST: shortness of breath, cough, wheeze, chest pain, tightness

• HEART: weak pulse, passing out, shock

• GUT: vomiting, diarrhea, cramps

• NEUROLOGIC: dizziness, fainting, feeling that you are about to die

What causes anaphylaxis?

Anaphylaxis occurs when the immune system overreacts to normally harmless substances called allergens. The following are the most common allergens that can trigger anaphylaxis:

• Food such as

  • Peanuts

  • Nuts from trees (such as walnuts, pistachios, pecans, cashews)

  • Shellfish (such as shrimp, lobster)

  • Fish (such as tuna, salmon, cod)

  • Milk

  • Eggs

• In rare cases, anaphylaxis may be related to a certain food followed by exercise.

• Insect stings such as from

  • Bees

  • Wasps

  • Hornets

  • Yellow jackets

  • Fire ants

• Medicines. Antibiotics and antiseizure medicines are some of the more common medicines that cause anaphylaxis. However, any medicine, even aspirin and other non­steroidal anti-inflammatory drugs, have the potential to cause severe reactions.

What should I do if my child has an anaphylactic reaction?

For anyone experiencing anaphylaxis, epinephrine should be given right away followed by a call to 911 for further treatment and transfer to a hospital. The main medicine to treat anaphylaxis is epinephrine. This is a medicine given by an injection. The best place to inject it is in the muscles of the outer part of the thigh. If the symptoms do not improve very quickly, the injection should be given again in 5 to 30 minutes.

Children who are old enough can be taught how to give themselves epinephrine if needed. The medicine comes in auto-injector syringes (EpiPen or Twinject) to make this easier. Epinephrine should be prescribed for anyone who has ever had an anaphylactic attack and for children at high risk for anaphylaxis. They are available in 2 different doses based on the weight of the child. You should always have at least 2 doses with you at all times. School-aged children also need one at school with instructions from their doctor about how and when to use it.

During a reaction, an oral antihistamine may also be given, but not as a substitute for epinephrine. Also helpful in case of an emergency is medical identification jewelry that includes information about your child's allergy. This should be worn at all times. Your doctor should also give you a written action plan outlining the steps to take in the event of an emergency. It is important to share this action plan with anyone who cares for your child.

How can I prevent another anaphylactic attack?

After an anaphylactic attack, your child needs to be seen by a doctor. Even if the cause seems obvious, it may be more complicated than you think. An evaluation by an allergist is often needed to identify the cause(s). A customized care plan for prevention and treatment can be created once the causes are known.

In most cases, the only way to prevent it from happening again is to avoid the cause. However, your child's care plan can help provide safe alternatives without unnecessary restriction of safe foods, medicines, or activities. An emergency action plan describing the allergies, symptoms, and treatments can help prepare you if your child has another attack.

Can anaphylaxis be outgrown or cured?

Although children's allergies are often outgrown, anaphylaxis frequently lasts for many years or even for life. Periodic reevaluation may be needed to see if your child is still allergic and to review how to avoid triggers and treat reactions. In the case of anaphylaxis caused by stinging insects, immunotherapy (also called allergy injections or shots) can help prevent anaphylaxis from future stings, but is currently not available for other types of anaphylactic allergies.

To find out more

• American Academy of Pediatrics— Section on Allergy and Immunology: www.aap.org/sections/allergy

• American Academy of Allergy Asthma & Immunology: www.aaaai.org/patients/gallery

• American College of Allergy, Asthma & Immunology: www.acaai.org/public

• Food Allergy & Anaphylaxis Network (FAAN): www.foodallergy.org

Please note: Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this publication. Phone numbers and Web site addresses are as current as possible, but may change at any time.

Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.

Acute ankle and foot injuries are common in athletes and other active young people. Sprains account for the greatest number of acute injuries.

The following is information from the American Academy of Pediatrics summarizing the treatment phases of rehabilitation for ankle sprain.

Phases of rehabilitation for ankle sprain

Exercises

Return-to-play criteria

Because injuries and recovery rates are different for every athlete, it is difficult to estimate an exact date or time when return to sports will be safe. However, by plotting the phases of rehabilitation (see graph), doctors can discuss with athletes the necessary steps for recovery and will be able to measure an athlete's progress against this standard.

Asthma (AZZ-muh) is a disease of the breathing tubes that carry air to the lungs. The linings of the tubes swell, and they fill up with mucus (MYOO-kus). This is called inflammation (in-fluh-MAY-shun). It makes the tubes get narrow. This makes it hard to breathe.

Asthma can cause sickness, hospital stays, and even death. But children with asthma can live normal lives.

Signs of Asthma

Symptoms of asthma can be different for each person. They can come quickly or start slowly and they can change. Symptoms may include:

• Coughing.

• Trouble breathing.

• Wheezing *.

• Shortness of breath.

• Tightness in the chest.

• Trouble exercising.

What to Do for Asthma

• There is no cure for asthma. But you can help control it. Your child will likely need one or more medicines. Using them right is very important.

• Make a plan for what to do for your child's asthma, wherever he or she is.

• Keep your child away from things that can make asthma worse (triggers).

Using Medicines

There are 2 kinds of asthma medicines:

• Quick-relief (rescue) medicines

• Controller medicines

Always use a spacer for medicines that are breathed in through the mouth. A spacer is a tube that you put between the medicine and the mouth. It helps get the medicine into the lungs (see picture above).

Make an Asthma Action Plan

Your child's doctor can help you write an asthma action plan*. This lists:

• What medicines your child should take and how often.

• What to do if the symptoms get worse.

• When to get medical help right away.

You can check your action plan when you are not sure what to do for your child's symptoms.

Give a copy of the action plan to your child's school so they know what to do too.

Using a Peak Flow Meter

This is a tool that measures how fast a person can blow air out of the lungs. The peak flow meter has 3 zones—green, yellow, and red—like a traffic light. The different colors help show if your child's asthma is doing well or getting worse. Ask your child's doctor for help setting the green, yellow, and red zones for your child:

• Green—Asthma is under good control.

• Yellow—Your child may be having some asthma symptoms and may need to change medicines. Talk with the doctor and check your child's asthma action plan.

• Red—This is an emergency. Check your child's asthma action plan or call the doctor right away.

When Your Child Is Away From Home

Children's asthma symptoms need to be controlled wherever they are.

Talk with teachers, the school nurse, office staff, and coaches. They need to know your child has asthma, what medicines your child takes, and what to do in an emergency. They need copies of your child's asthma action plan.

They also have forms for you to fill out and return:

• A medicine permission form from your child's doctor so your child can take medicines at school if needed

• A release form signed by a parent so the school nurse can talk with your child's doctor if needed

This publication was written by the American Academy of Pediatrics to inform parents about asthma. It includes information about asthma symptoms, triggers, treatments, medicines, and how to communicate with your child's school.

What is asthma?

Asthma is a chronic disease of the airways in the lungs. The airways are very sensitive and may be inflamed even though symptoms are not always present. The degree and severity of airway irritation varies over time. One of the most important goals of asthma treatment is to control the irritation in the airways and the symptoms that result.

In an asthma "attack," the airways become narrowed or blocked. The inner lining of the airways becomes inflamed (swollen and irritated) and the outer muscles tighten around the airways, making breathing difficult. The good news is that this can be treated and controlled.

Who gets asthma?

Asthma is the most common serious chronic disease of childhood. It is one of the main reasons children miss school and the most frequent cause for hospitalization in children. In the United States, nearly 1 out of every 10 children has asthma.

Many things can influence the onset of asthma and include family history (children who have family members with allergies or asthma), infections, exposure to allergens, exposure to tobacco smoke, and exposure to air pollutants. Children with other types of allergic diseases (eczema, food allergy, hay fever) also are more likely to develop asthma.

The number of children with asthma has been increasing worldwide, and the amount of illness caused by asthma may also be increasing in some parts of the country. The reasons for these increases are not exactly known.

What are symptoms of asthma?

Symptoms of asthma can appear quickly or develop slowly. Some children have symptoms of asthma often enough that they have to take medicine every day. Other children may need medicine just once in a while. Every child is different.

A cough may be the first and sometimes only asthma symptom. Other symptoms may include

• Wheezing (a high-pitched whistling sound)

• Difficulty breathing or shortness of breath

• Tightness in the chest

• Decreased ability to exercise or self-limiting exercise

How is asthma diagnosed?

There is no simple test to diagnose asthma. It's often difficult to diagnose, especially in young children. Your child's doctor will need to ask you specific questions about your child's health and then a careful physical exam is done. The information that you provide will help your child's doctor determine if your child has asthma.

• Does your child have symptoms such as wheezing, coughing, or shortness of breath?

• How often do the symptoms occur and how bad do they get? For example, is your child missing school or unable to participate in sports or other activities because of breathing problems? Or is coughing or wheezing keeping your child up at night?

• What triggers the symptoms or makes them worse? (For example, with colds, exercise, smoke, allergens, or stress/emotions?)

• Is there a history of chronic runny nose or eczema?

• Which medicines have been tried? Did they help?

• Is there any family history of allergies or asthma?

If your child is old enough (usually older than 5 or 6 years), your child's doctor may test your child's lung function. One way to do this is with a machine called a spirometer (which is different from a peak flow meter). Spirometry measures the amount of air and how fast it can be blown out of the lungs. Your child's doctor may also want to retest your child's lung function after giving her some asthma medicine.

Some children don't feel better after using medicines. If medicines don't work, tests may be done to check for other conditions that can make asthma worse or have the same symptoms as asthma. These conditions include allergic rhinitis (hay fever), sinusitis (sinus infection), gastroesophageal reflux disease (GERD—heartburn), and vocal cord dysfunction (spasms of the vocal cords or voice box).

Keep in mind that asthma can be a difficult disease to diagnose, and the results of lung function testing may be normal even if your child has asthma. For some children, the tendency to wheeze with colds (or respiratory infections) goes away as their lungs grow.

How is asthma treated?

The goal of asthma treatment is to eliminate or reduce symptoms so children can fully participate in normal physical activities. This can be done by avoiding asthma triggers and providing asthma medicine. It's also important to prevent emergency department visits and hospital stays because of asthma attacks. If your child experiences asthma symptoms more than twice per week, let your child's doctor know.

What are asthma triggers?

Certain things cause asthma attacks or make asthma worse. These are called triggers. It is important to find out what those triggers are for your child and learn ways to help your child avoid them. Allergens and irritants are triggers that can be found in your home, school, child care, and relatives' homes.

Some common asthma triggers are

• Allergens: These are things to which your child might be allergic. Many children with asthma have allergies, and allergies can be a major cause of asthma symptoms.

  • – House dust mites (tiny "bugs" you cannot see that are commonly found in bedding, carpet, and upholstered furniture)

  • – Animals with fur or hair

  • – Cockroaches

  • – Mice

  • – Pollens (trees, grass, weeds)

• Infections of the lungs and sinuses

  • – Viral infections

  • – Bacterial infections, such as pneumonia or sinus infections

• Irritants in the environment (air that you breathe)

  • – Cigarette and other smoke

  • – Air pollution (chemicals, smog, auto exhaust, etc)

  • – Cold or dry air

  • – Sudden changes in weather

  • – Odors, fragrances, chemicals in sprays, and cleaning products

  • – Unventilated space heaters (gas or kerosene) and fireplaces

  • – Odors and gases released from new carpets, furniture, or materials in new buildings

• Exercise (About 80% of people with asthma develop wheezing, coughing, and a tight feeling in the chest when they exercise or may develop prolonged cough or wheeze on completion of exercise.)

• Emotional stress (laughing or crying hard)

How can triggers be avoided?

While you can't make your home completely allergen- or irritant-free, there are things you can do to reduce your child's exposure to triggers. This will help decrease symptoms as well as the need for asthma medicines. The following tips may help:

• Don't smoke. Don't let anyone smoke in your home or car or around your child (like at child care or at school).

• Reduce exposure to dust mites if your child is allergic to dust mites. Cover your child's mattress and pillows with special dust mite–proof covers. Wash your child's bedding in hot water every week. Remove stuffed toys from the bedroom. Vacuum and dust often. Use a dehumidifier to reduce indoor humidity to 30% to 50% (if possible). Remove carpeting in the bedroom; bedrooms in basements should not be carpeted.

• Reduce exposure to pet allergens. If your child is allergic to furry pets, remove the pets from the home. If this isn't possible, keep the pets out of your child's bedroom and keep the bedroom door closed. You may also consider a high-efficiency particulate air (HEPA) filter in the bedroom or on the furnace. Although these interventions may reduce pet allergen levels some, they are much less effective than finding the pet a new home.

• Control cockroaches. If you have a roach problem, always use the least toxic method to control them. For example, you should repair holes in walls or other entry points, set roach traps, and avoid leaving out exposed food, water, or garbage. Avoid bug sprays and bombs, as these could trigger an asthma attack. If these measures fail, you may need to consult a licensed pest control professional.

• Control mice. If you have seen mice or signs of mice in your home, several steps can be taken to control them. Setting traps, sealing holes and cracks or other entry points, and storing dry goods in plastic, sealable containers can help. If these measures fail, you may need to consult a licensed pest control professional.

• Prevent mold. Mold in homes is often caused by excessive moisture indoors. This can result from water damage caused by flooding, leaky roofs, leaking pipes, or excessive humidity. Repair any sources of water leakage. Control indoor humidity by using exhaust fans in the bathrooms and kitchen and adding a dehumidifier in areas with high humidity. The Environmental Protection Agency (EPA) currently recommends cleaning existing mold with detergent and water (though there may be debris that can continue to contribute to allergic reactions). Some materials, such as wallboards with mold, have to be replaced.

• Reduce pollen exposure if your child is allergic to pollen. Use an air conditioner in your child's bedroom, with the fresh air vent closed, and leave doors and windows closed during high pollen times. Seasons with high pollen counts vary by region. Check with your allergist, local newspaper, or the Internet for local pollen counts.

• Reduce indoor irritants. Use unscented cleaning products and avoid mothballs, room deodorizers, and scented candles.

• Check air quality reports. When the air quality is very poor, keep your child indoors. Check weather forecasts or the Internet for air quality reports.

What types of medicines are used?

Asthma is different in every child, and symptoms can change over time. Your child's doctor will decide which asthma medicine is best for your child based on how severe and how often your child has symptoms. Medicines may also vary depending on your child's age.

Children with asthma whose symptoms occur once in a while are given medicines only as needed and usually for short periods. Children with asthma whose symptoms occur more often need to take a different kind of medicine every day to control their symptoms. (See "Groups of asthma medicines.")

Sometimes it's necessary to take several medicines at the same time to control and prevent symptoms. Your child's doctor may give your child several medicines at first, to get the asthma symptoms under control, and then decrease the medicines as needed.

It usually helps to have an asthma action plan or asthma home management plan written down so you can refer to it from time to time. Such a plan should contain information on daily medicines your child takes as well as instructions on what to do when symptoms occur. A copy of the plan should also be provided to your child's school or child care provider.

An example of an asthma action plan is available on the National Heart, Lung, and Blood Institute (NHLBI) Web site at http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf.

What devices are used to help deliver asthma medicines?

Medicines for asthma can be given to your child using a variety of devices including the following:

• Nebulizer. This device uses an air compressor and cup to change liquid medicine into a mist that can be inhaled. To be sure that the medicine gets into the lungs, controller medicines and quick-relief medicines must be given with a mouthpiece or mask.

An example of a nebulizer machine with mask delivery.

• Metered-dose inhaler (MDI). This is the most commonly used device for asthma medicines. Spacers, with an attached mask or mouthpiece, should be used to help make it easier to use MDIs. Spacers should always be used with inhaled steroids.

  As of January 1, 2009, MDIs no longer contain propellants that damage the ozone layer. The current inhalers use a propellant gas that is safe for the environment and gives a gentler, softer spray.

A meter-dosed inhaler (MDI).

• Dry powder inhaler (DPI). This device is available for some medicines. You don't need to coordinate pressing with breathing with a DPI, but its use still requires some training. It may have less taste and does not require the use of a spacer. DPIs may be placed directly into the mouth for inhalation of the medication. These devices vary in shape and size.

Because there are several different inhalers on the market, your child's doctor will suggest the one that is best for your child. There are important differences in the way they are used and amounts of medicines they deliver to the airways. You and your child will be taught how to use the inhaler, but your child's technique should be checked regularly to make sure your child is getting the right dose of medicine.

Exercise and asthma

Physical activity is important for your child's physical and mental health. Children with asthma should be able and encouraged to participate completely in physical education, sports, and other activities in school.

Exercise can often trigger symptoms in children with asthma. It can almost always be prevented with the use of quick-relief medicines taken 10 to 15 minutes before exercise. If it occurs often, however, it may mean your child's asthma isn't under control. Proper asthma control can make a great difference in your child's ability to exercise normally. It is important for parents to speak with their child's physical education teachers and coaches about their child's asthma management. If your child's asthma is interfering with your child's ability to participate in physical activity, tell your child's doctor.

Peak flow meter

A peak flow meter is a handheld device that measures how fast a person can blow air out of the lungs. This device may be recommended by your child's doctor to help monitor your child's asthma; however, this handheld device does not give a detailed assessment of asthma like a spirometer does (described earlier).

Asthma and schools

Children spend many hours at school, which is why it is so important that asthma symptoms are well managed while they are there. It's also important that you are aware of your child's symptoms and any problems with how your child's asthma is managed in school. The following are other things to keep in mind:

• Good communication is important to asthma care and management in school.

  • – Consider meeting with your child's teachers, the school nurse, and coaches at the beginning of the school year. The school needs to know about your child's asthma, how severe it is, what medicines your child takes, and what to do in an emergency.

  • – Ask your child's doctor to complete an asthma action plan for the school, as well as a medicine permission form that includes whether your child should be allowed to carry and use his or her own inhaler and instructions about use of a spacer with the inhaler.

  • – Sign a release at school and your child's doctor's office to allow the exchange of medical information between you, the school, and your child's doctor.

  • – Ask the school official or nurses about its policies on how your child will get access to his medicines and how they deal with emergencies, field trips, and after-school activities.

  • – Ask for updates if necessary. The school should also inform you about any changes or problems with your child's symptoms while your child is at school.

• Check for triggers at school. The environment at school is as important as the environment at home. Use the "How Asthma-Friendly Is Your School?" checklist to check your child's school and classroom. This checklist is available on the National Heart, Lung, and Blood Institute Web site at http://www.nhlbi.nih.gov/health/public/lung/asthma/friendhi.htm.

• Help your child cope with asthma at school. Talk with your child about how well his asthma is being managed in school. Also talk with your child's teachers, school nurse, coaches, and other school personnel about how well your child is coping with asthma in school.

  The following are some problems students with asthma may face at school:

  • Missing school because of asthma symptoms or doctor visits.

  • Avoiding school or school activities. Work with your child's doctor and school personnel to encourage your child to participate in school activities.

  • Not taking medicine before exercise. Your child may avoid going to the school office or nurse's office to use his inhaler before exercise. Schools that allow children to carry their inhalers with them can help avoid this problem. This is a good idea only if your child always remembers to take his medicine and knows how to take it properly.

Remember

Asthma is a complex yet treatable condition. By using medicines, avoiding triggers and environments that can cause asthma attacks, and carefully managing symptoms, children with asthma can lead normal and healthy lives.

The following are some things to keep in mind:

• If you are concerned your child may have asthma, talk with your child's doctor. Your child's doctor may test your child's airway function. It is important to remember that asthma is a difficult disease to diagnose, and the results of lung function testing may be normal even if your child has asthma.

• Decreasing your child's exposure to triggers will help decrease symptoms and the need for asthma medicines.

• There is no one magic medicine that controls all asthma. Sometimes several medicines need to be taken at the same time to control and prevent symptoms. Your child's doctor will choose the best medicines for your child and talk with you about when and how to use them.

• It's important that asthma symptoms are well managed while your child is at school.

If you have any questions about your child's health, symptoms of asthma, or how your child's asthma is being managed, talk with your child's doctor.

Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this publication. Web site addresses are as current as possible, but may change at any time.

Things that cause asthma (AZZ-muh) attacks or make asthma worse are called triggers. Asthma triggers can be found in your home, your child's school, child care, and other people's homes.

Common Asthma Triggers

Allergens (AL-er-jinz) are things your child may be allergic to.

• House dust mites—tiny bugs you can't see. They live in carpets, drapes, cloth furniture, pillows, mattresses, and dust.

• Animal dander—tiny flakes of skin from furry animals like cats and dogs. You can't see animal dander.

• Cockroaches

• Mold

• Pollen (PAH-lin)—the dust from plants.

Sinus (SYE-nis) and lung infections. The sinuses are spaces inside your head, behind your nose. They can get infected. Pneumonia (nuh-MOH-nyuh) is a kind of lung infection.

Things your child breathes in.

• Tobacco and other smoke

• Air pollution

• Cold or dry air

• Perfumes, chemicals, and cleaning products

• Fumes from gas or kerosene heaters and fireplaces

Exercise. Some people with asthma wheeze*, cough, and get a tight feeling in the chest when they exercise. But they can still be active. There are medicines to use before exercise.

Avoiding Triggers

You can’t get rid of all the asthma triggers in your home. But there's still a lot you can do. Here are some tips:

Don't smoke. And don't let anyone else smoke in your home or car.

Protect your child from dust and dust mites.

• Cover your child's mattress and pillows with allergy-proof covers.

• Wash your child's bedding in hot water every 1 to 2 weeks.

• Make sure your child's stuffed toys can be cleaned in a washing machine every 1 to 2 weeks. Check the label.

• Vacuum and dust often.

• Take carpet out of the bedroom.

• Use a HEPA air filter in the bedroom. This special kind of filter cleans the air. You can buy one at some drugstores.

Keep pets away.

• Try to find new homes for furry pets.

• Keep pets out of your child's bedroom.

• Wash pets often.

Control cockroaches.

• Repair holes in walls, cupboards, and floors.

• Set roach traps.

• Don't leave out food, water, or trash.

• Don't use bug sprays or bombs.

• Call an exterminator (ex-TUR-muh-nay-tur).

Prevent mold. Floods, leaks, or dampness in the air can cause mold.

• Fix any leaks.

• Use exhaust fans in the bathrooms and kitchen.

• Use a dehumidifier (dee-hyoo-MID-uh-fye-ur) in damp parts of the house. A dehumidifier is a machine that takes dampness out of the air.

• Clean mold with water and detergent.

• Replace moldy wallboards.

Keep pollen away. If your child has hay fever:

• Find out when pollen is high in your area. Check with your child's doctor, your local newspaper, or the Internet.

• Put an air conditioner in your child's bedroom. Close the fresh air vent when pollen is high.

• Keep doors and windows closed.

Keep strong smells out of the house.

• Use unscented cleaning products.

• Avoid mothballs, air fresheners, perfumes, and scented candles.

Keep your child indoors when the air quality is very poor. Air quality is how clean or dirty the air is. It can change from day to day.

• Check weather reports or the Internet for air quality news.

What Is Asthma?

Asthma is a disease of the breathing tubes that carry air to the lungs. The linings of the tubes swell and they fill up with mucus (MYOO-kus). This is called inflammation (in-fluh-MAY-shun). It makes the tubes get narrow. This makes it hard to breathe

Asthma can cause sickness, hospital stays, and even death. But children with asthma can live normal lives.

Signs of Asthma

Symptoms of asthma can be different for each person. They can come quickly or start slowly and they can change. Symptoms may include:

• Coughing.

• Trouble breathing.

• Wheezing *.

• Shortness of breath.

• Tightness in the chest.

• Trouble exercising.

What to Do for Asthma

• There is no cure for asthma. But you can help control it. Your child will likely need one or more medicines. Using them right is very important.

• Make a plan for what to do for your child's asthma, wherever he or she is.

• Talk with teachers, the school nurse, office staff, and coaches. They need to know your child has asthma, what medicines your child takes, and what to do in an emergency. They need copies of your child's asthma action plan*.

Most children learn to use the toilet between 2 and 4 years of age. Even after children are toilet-trained, they may wet the bed until they are older. It's even common for 6-year-olds to wet the bed once in a while. Some children still wet the bed at age 12.

What to Do About Bedwetting

Bedwetting usually goes away as your child gets older. Talk with the doctor if you or your child are worried about bedwetting. These tips can help in the meantime.

If You Need More Help…

Try the tips on the first page of this handout for 1 to 3 months. Then, talk with your child's doctor if bedwetting is still a problem. The doctor may suggest one of the following:

Reasons for Bedwetting

We don't always know what causes bedwetting. Here are some possible reasons:

• There is a family history of bedwetting. (Most children who wet the bed have at least one parent who did it as a child.)

• Your child is a deep sleeper and doesn't wake up when he or she has to pee.

• Your child's bladder* is still too small to hold urine all night.

• Your child has trouble passing stool (poop). This can put pressure on the bladder.

• Your child has a minor illness, is very tired, or is going through changes or stress at home.

Signs of a Health Problem

Talk with your child's doctor if:

• Your child has been completely toilet-trained for more than 6 months AND

• Your child starts wetting the bed again.

These 2 things together may mean that your child has a health problem.

Did you know that there are about 5 million children in the United States who wet the bed? If your child wets the bed, he or she is not alone.

Though most children are toilet trained between 2 and 4 years of age, some children may not be able to stay dry at night until they are older. Children develop at their own rate. For example, 20% of 5-year-olds, 10% of 7-year-olds, and 5% of 10-year-olds may still wet the bed.

Bedwetting is not a serious medical condition, but it can be a challenging problem for children and parents. Read on to find out more from the American Academy of Pediatrics about bedwetting and what can be done about it.

Causes of bedwetting

Although not all of the causes of bedwetting are fully understood, the following are some that are possible:

• Your child is a deep sleeper and does not awaken to the signal of a full bladder.

• Your child has not yet learned how to hold and empty urine well. (Communication between the brain and bladder may take time to develop.)

• Your child’s body makes too much urine at night.

• Your child is constipated. Full bowels can put pressure on the bladder and lead to problems with holding and emptying urine well.

• Your child has a minor illness, is overly tired, or is responding to changes or stresses going on at home.

• There is a family history of bedwetting. Most children who wet the bed have at least one parent who had the same problem as a child.

• Your child’s bladder is small or not developed enough to hold urine for a full night.

• Your child has an underlying medical problem.

What you can do

Most children wet their beds during toilet training. Even after they stay dry at night for a number of days or even weeks, they may start wetting at night again. If this happens to your child, simply go back to training pants at night and try again another time. The problem usually disappears as children get older. If children reach school age and still have problems wetting the bed, it most likely means they have never developed nighttime bladder control.

If you are concerned about your child’s bedwetting or your child expresses concern, talk with your child’s doctor. You may be asked the following questions about your child’s bedwetting:

• Is there a family history of bedwetting?

• How often and when does your child urinate during the day?

• Have there been any changes in your child’s home life such as a new baby, divorce, or new house?

• Does your child drink carbonated beverages, caffeine, citrus juices, or a lot of water before bed?

• Is there anything unusual about how your child urinates or the way the urine looks?

Signs of a medical problem

If your child has been completely toilet trained for 6 months or longer and suddenly begins wetting the bed, talk with your child’s doctor. It may be a sign of a medical problem. However, most medical problems that cause bedwetting to recur suddenly have other signs, including

• Changes in how much and how often your child urinates during the day

• Pain, burning, or straining while urinating

• A very small or narrow stream of urine or dribbling that is constant or happens just after urination

• Cloudy or pink urine or bloodstains on underpants

• Daytime and nighttime wetting

• Sudden change in personality or mood

• Poor bowel control

• Urinating after stress (coughing, running, or lifting)

• Certain gait disturbances (problems with walking that may mean an underlying neurologic problem)

• Continuous dampness

If your child has any of these signs, your child’s doctor may want to take a closer look at the kidneys or bladder. If necessary, your child’s doctor will refer you to a pediatric urologist, a doctor who is specially trained to treat children’s urinary problems.

Managing bedwetting

Keep the following tips in mind when dealing with bedwetting:

• Do not blame your child. Remember that it is not your child’s fault. (See “Causes of bedwetting.”)

• Be honest with your child about what is going on. Let your child know it’s not his or her fault and that most children outgrow bedwetting.

• Be sensitive to your child’s feelings. If you don’t make a big issue out of bedwetting, chances are your child won’t either. Also remind your child that other children wet the bed.

• Protect the bed. A plastic cover under the sheets protects the mattress from getting wet and smelling like urine.

• Let your child help. Encourage your child to help change the wet sheets and covers. This teaches responsibility. It can also keep your child from feeling embarrassed if the rest of the family knows. However, if your child sees this as punishment, it is not recommended.

• Set a no-teasing rule in your family. Do not let family members, especially siblings, tease your child. Let them know that it’s not your child’s fault.

• Take steps before bedtime. Have your child use the toilet and avoid drinking large amounts of fluid just before bedtime.

• Try to wake your child up to use the toilet 1 to 2 hours after going to sleep to help your child stay dry through the night.

• Be positive. Reward your child for dry nights. Offer support, not punishment, for wet nights.

• Be aware of your child’s daily urine and bowel habits.

Bedwetting alarms

If your child is still not able to stay dry during the night after using these steps for 1 to 3 months, a bedwetting alarm may be recommended. When a bedwetting alarm senses urine, it sets off an alarm so the child can wake up to use the toilet. When used correctly, it will detect wetness right away and sound the alarm. Be sure your child resets the alarm before going back to sleep.

Bedwetting alarms are successful 50% to 75% of the time. They tend to be most helpful for children who are deep sleepers and have some bladder control on their own. Ask your child’s doctor which type of alarm would be best for your child.

Medicines

Medicines are available to treat bedwetting for children 6 years and older. Though medicines rarely cure bedwetting, they may be helpful, especially when children begin attending sleepovers or overnight camps. Your child’s doctor can tell you more about these medicines and if they are right for your child. Remember to ask about possible side effects.

Beware of “cures”

There are many treatment programs and devices that claim they can “cure” bedwetting. Be careful; many of these products make false claims and promises and may be very expensive. Your child’s doctor is the best source for advice about bedwetting. Talk with your child’s doctor before starting any treatment program.

Stay positive

Do not be discouraged if one treatment does not work. Some children will respond well to a combination of treatments involving medicines and bedwetting alarms. This often involves care by a pediatric specialist. (If your child is one of a small number of children who do not respond to any treatment, talk with your child’s doctor about ways to manage bedwetting.)

Also, in most cases, bedwetting decreases as the child’s body matures. By the teen years, almost all children outgrow bedwetting. Only about 2% to 3% of children continue to have problems with bedwetting as adults.

Until your child outgrows bedwetting, your child will need a lot of emotional support from your family. Support from your child’s doctor, pediatric urologist, or mental health professional also can help.

Bronchiolitis is a common respiratory illness among infants. One of its symptoms is trouble breathing, which can be scary for parents and young children. Read on for more information from the American Academy of Pediatrics about bronchiolitis, causes, signs and symptoms, how to treat it, and how to prevent it.

What is bronchiolitis?

Bronchiolitis is an infection that causes the small breathing tubes of the lungs (bronchioles) to swell. This blocks airflow through the lungs, making it hard to breathe. It occurs most often in infants because their airways are smaller and more easily blocked than in older children. Bronchiolitis is not the same as bronchitis, which is an infection of the larger, more central airways that typically causes problems in adults.

What causes bronchiolitis?

Bronchiolitis is caused by one of several respiratory viruses such as influenza, respiratory syncytial virus (RSV), parainfluenza, and human metapneumovirus. Other viruses can also cause bronchiolitis.

Infants with RSV infection are more likely to get bronchiolitis with wheezing and difficulty breathing. Most adults and many older children with RSV infection only get a cold. RSV is spread by contact with an infected person's mucus or saliva (respiratory droplets produced during coughing or wheezing). It often spreads through families and child care centers. (See “How can you prevent your baby from getting bronchiolitis?”).

What are the signs and symptoms of bronchiolitis?

Bronchiolitis often starts with signs of a cold, such as a runny nose, mild cough, and fever. After 1 or 2 days, the cough may get worse and an infant will begin to breathe faster. Your child may become dehydrated if he cannot comfortably drink fluids.

If your child shows any signs of troubled breathing or dehydration, call your child's doctor.

Croup is a common illness that affects the airways, making it hard for a child to breathe. It's most common in toddlers but can affect children between 6 months and 12 years of age. Another symptom is a loud barking cough that is worse at night. Trouble breathing and the barking cough can be scary for parent and child. Most children with viral croup also have low fever.

Symptoms to watch for

Most cases of croup can be treated successfully at home. However, children with severe cases of croup may need to be treated in the hospital. Call 911 or an ambulance right away if your child

• Makes a whistling sound (called stridor) that gets louder with each breath.

• Cannot speak because of a lack of breath.

• Seems to struggle to get a breath.

• Has a bluish color of the lips, mouth, or fingernails.

• Drools or has trouble swallowing.

Care of your child at the hospital

At the hospital, your child's doctor will decide the best way to treat your child. Treatments may include the following:

• Epinephrine. This medicine can help reduce swelling in the upper airways so that your child can breathe better. Epinephrine is given through a nebulizer. A nebulizer is a machine that turns liquid medicine into a fine mist. The mist is breathed in through a mouthpiece or face mask. Often, when this medicine is used, doctors prefer to continue to watch a child for several hours after it is given. This sometimes requires a stay in the hospital.

• Corticosteroids. These medicines can be useful in reducing inflammation in the body. They work in 2 ways. Systemic corticosteroids must go through the body to treat the inflammation in the upper airway. Inhaled or intranasal corticosteroids go directly to where the inflammation is. (Corticosteroids are not the same as anabolic steroids that are used illegally by some athletes to build muscle.)

• Oxygen. Sometimes when breathing is very difficult for a child, the body may not get enough oxygen and the work of breathing increases. Oxygen given through a mask or a small tube near the nose will make it easier to breathe.

When can my child go home?

As soon as your child's breathing improves, usually within a few hours, he will be allowed to go home. Sometimes a child with croup will stay in the hospital overnight for observation.

Care of your child at home

If your child has a mild case of croup, breathing in moist air may help.

• Bring your child into a bathroom where a hot shower is running. Let your child breathe in the moist air to help open her airway. However, do not leave a young child alone with the shower running.

• Use a cool-mist humidifier in your child's room.

• Take your child outdoors for a few minutes. Inhaling moist, cool night air may help open the air passages so that she can breathe more freely. Remember to dress your child for the cold weather.

If breathing in moist air doesn't help and you notice any of the "Symptoms to watch for" listed previously, your child needs to be taken to the hospital right away. Call 911 or an ambulance for help.

Keep your child healthy

The following are ways to keep your child healthy:

• Stop germs from spreading. Most cases of croup are caused by cold and flu viruses. Frequent hand washing with soap is the best way to prevent germs from spreading. You can also use a waterless hand cleaner.

• Avoid germs. Try to keep your child away from other children with croup or other upper respiratory infections (such as colds and flu).

• Avoid smokers. Do not let anyone smoke around your child, as it can make croup worse.

Most babies get diaper rash, but it is usually not serious. Read on to find out more about what causes diaper rash and how to treat it.

What is diaper rash?

Diaper rash is any rash that develops inside the diaper area. In mild cases, the skin might be red. In more severe cases, there may be painful open sores. It is usually seen around the groin and inside the folds of the upper thighs and buttocks. Mild cases clear up within 3 to 4 days with treatment.

What causes diaper rash?

Over the years diaper rash has been blamed on many causes, such as teething, diet, and ammonia in the urine. However, we now believe it is caused by any of the following:

• Too much moisture

• Chafing or rubbing

• When urine, stools, or both touch the skin for long periods of time

• Yeast infection

• Bacterial infection

• Allergic reaction to diaper material

When skin stays wet for too long, it starts to break down. When wet skin is rubbed, it also damages more easily. Moisture from a soiled diaper can harm your baby's skin and make it more prone to chafing. When this happens, a diaper rash may develop.

More than half of babies between 4 and 15 months of age develop diaper rash at least once in a 2-month period. Diaper rash occurs more often when

• Babies get older—mostly between 8 to 10 months of age.

• Babies are not kept clean and dry.

• Babies have frequent stools, especially when the stools stay in their diapers overnight.

• Babies have diarrhea.

• Babies begin to eat solid foods.

• Babies are taking antibiotics, or in nursing babies whose mothers are taking antibiotics.

When to call the pediatrician

Sometimes a diaper rash needs medical attention. Talk with your pediatrician if

• The rash does not look like it's going away or gets worse 2 to 3 days after treatment. (See “What can I do if my baby gets diaper rash?”)

• The rash includes blisters or pus-filled sores.

• Your baby is taking an antibiotic and has a bright red rash with red spots at its edges. This might be a yeast infection.

• Your baby has a fever along with a rash.

• The rash is very painful. Your baby might have a skin condition called cellulitis.

What can I do if my baby gets diaper rash?

If your baby gets a diaper rash (and to prevent future diaper rashes) it's important to keep the area as clean and dry as possible. Change wet or soiled diapers right away. This helps cut down how much moisture is on the skin.

• Gently clean the diaper area with water and a soft washcloth. Disposable diaper wipes may also be used. Avoid wipes that contain alcohol and fragrance. Use soap and water only if the stool does not come off easily. If the rash is severe, use a squirt bottle of water so you can clean and rinse without rubbing.

• Pat dry; do not rub. Allow the area to air-dry fully.

• Apply a thick layer of protective ointment or cream (such as one that contains zinc oxide or petroleum jelly). These ointments are usually thick and pasty and do not have to be completely removed at the next diaper change. Remember, heavy scrubbing or rubbing will only damage the skin more.

• Do not put the diaper on too tight, especially overnight. Keep the diaper loose so that the wet and soiled parts do not rub against the skin as much.

• Use creams with steroids only if your pediatrician recommends them. They are rarely needed and may be harmful.

• Check with your pediatrician if the rash

  • — Has blisters or pus-filled sores.

  • — Does not go away within 2 to 3 days.

  • — Gets worse.

Which type of diaper should I use?

Diapers are made of either cloth or disposable materials. Cloth diapers can be washed after they get soiled and used again. Disposable diapers are thrown away after each use.

If you choose not to wash cloth diapers yourself, you can have a diaper service clean them. If you do your own washing, you will need to presoak heavily soiled diapers. Keep and wash soiled diapers separate from other clothes. Use hot water and double-rinse each wash. Do not use fabric softeners or antistatic products on the diapers because they may cause rashes in sensitive skin.

Research suggests that diaper rash is less common with the use of disposable diapers. However, what is more important than the type of diaper is how often it is changed. Whether you use cloth diapers, disposables, or both, always change diapers as needed to keep your baby clean, dry, and healthy.

For more information, visit the official AAP Web site for parents, http://HealthyChildren.org.

Supported by a grant from

This publication has been developed by the American Academy of Pediatrics. the author and contributors are expert authorities in the field of pediatrics. No commercial involvement of any kind has been solicited or accepted in the development of the content of this publication.

Diarrhea (loose poop) and vomiting, or “throwing up,” are why many parents call the doctor. Your child's doctor may call this gastroenteritis (GAS- troh-en-tur-EYE-tis). These symptoms are often caused by a virus*.

Your child may first have a fever and some vomiting. Diarrhea often starts later. The symptoms usually go away in a day or two. But they can last a week before getting better.

One danger with diarrhea and vomiting is that your child's body can get dried out or dehydrated (dee-hye-DRAY-dud). This happens when the body loses too much water.

Call the Doctor If…

…your child has diarrhea, vomiting, and is younger than 6 months or your child has:

• A fever over 102°F or 39°C.

• Blood in the stool (poop) or vomit.

• Green vomit.

• Vomiting for more than 12 hours or diarrhea for more than 2 days.

• Belly pain.

Also Call the Doctor If…

. ..your child has any of these signs of being too dry:

• Pees very little (wets fewer than 6 diapers per day)

• Has no tears when crying

• Can't or won't drink anything or feels very thirsty

• Has a dry, sticky mouth, or dry lips

• Looks like he or she has lost weight

• Has sunken eyes or sunken soft spot on head (for babies)

• Acts very tired or strange

Most of the time you can treat this by getting your child to drink something and eat simple foods.

(See the list below.)

But your child may need a special fluid that you can buy in a store. It's called an electrolyte drink*. If your child can't drink this, then he or she may need to go to the hospital.

Call your child's doctor if vomiting or diarrhea won't go away. The doctor may want to check your child.

What to Do for Vomiting

• Give small sips of clear fluids every 10 to 15 minutes.

• If your child keeps vomiting but is NOT dry, wait 1 to 2 hours before trying again. Stop if your child starts to throw up again, and call the doctor.

• If your child is keeping down fluids and wants to eat, try giving small amounts of simple foods. See the chart on simple foods on the first page of this handout.

Remember, if you are worried or don't know what to do, call your child's doctor.

What to Do for Diarrhea

Most diarrhea lasts 3 to 6 days or even longer. Don't worry as long as your child acts well and is eating and drinking and peeing like usual.

Answers to Common Questions

Ear infections (in-FEK-shuns) in children are common. Most kids get at least one ear infection by the time they are 3 years old. Most ear infections clear up without any lasting problems. Your child's doctor may also call an ear infection otitis (oh-TYE-tis) media.

Ear infections usually hurt. Older kids can tell you that their ears hurt. Little children may only cry and act fussy. You may notice this more when your child eats. That's because sucking and swallowing can make the pain worse. Children with an ear infection may not want to eat. They may have trouble sleeping. Ear infections also can cause fever.

What to Do for Ear Pain

Give your child acetaminophen* or ibuprofen* for pain. They work well for pain with or without fever.

• Be sure to get your child the right kind for your child's age. Follow what the label says. Ask your child's doctor how much to give if your child is younger than 2 years.

• The pain may last up to 3 days. So it's fine to give medicine at the right dose during the day and at night for 3 days. Follow the label to see how often you can give it.

• There are also ear drops that can help with pain. Ask the doctor before you try them.

Call the Doctor If…

…your child has ear pain and any of these signs:

• Your child is younger than 2 years.

• Yellowish-white or bloody fluid is coming out of your child's ear.

• Your child is in a lot of pain.

• Your child is acting sick or can't sleep.

• Your child has trouble hearing. This could be from an ear infection. But it might be something else. It's important to get help if your child has a hearing problem.

• Your child has one ear infection after another for many months. It may be time to try a new treatment.

If your child is older than 2 years, you can wait 1 or 2 days to call the doctor if…

• Your child does not have a high fever (over 103°F or 39.4°C) AND

• Your child does not act sick.

What About Antibiotics?

The doctor may prescribe medicine for your child. This medicine will probably be an antibiotic (ant-uh-by-AH-tik). Antibiotics kill the germs that cause some infections.

Some ear infections will get better on their own. It's best for your child not to take an antibiotic unless it is needed. So the doctor may ask you to wait 1 or 2 days to see if your child gets better without medicine.

So when is an antibiotic needed? The doctor may prescribe an antibiotic if your child:

• Is very sick.

• Is younger than 2 years.

• Does not feel better 2 days after the ear pain began.

Make sure your child takes all the antibiotics. This may mean finishing the bottle. Or it may mean taking the medicine for a certain number or days. Follow what the doctor says. It you stop the medicine too soon, some germs may still be left. That can make the infection start all over again.

If your child is taking antibiotics and isn't starting to get better after 2 days, call the doctor.

What Not to Do

• Don't give your child aspirin. It's dangerous for children younger than 18 years.

• Don't give your child over-the-counter cold medicines. They don’t help clear up ear infections.

• Don't let your child swim or travel by plane right after an ear infection. Check with the doctor first.

What to Expect

With any ear infection:

• After 1 to 2 days, pain and fever should start getting better.

• After 3 days, pain and fever should go away.

• Call the doctor if your child doesn't start feeling better in 2 days.

Your child might feel a “popping” in the ears as the infection starts to clear up. This is a sign of healing.

Children with ear infections don't need to stay home if they feel OK. Just make sure your child keeps taking any medicine he or she needs.

How to Prevent Ear Infections

Here are some ways to lower your child's risk of an ear infection:

• Breastfeed instead of bottle-feed. Breastfeeding may help prevent colds and ear infections.

• If you bottle-feed, hold your child's head higher than the stomach during feedings. This helps keep the ear tubes from being blocked.

• Keep your child away from tobacco smoke, especially in your home and car.

• Some vaccines may help your child get fewer ear infections. These include vaccines to prevent flu and pneumonia (nuh-MOH-nyuh).

Other Causes of Ear Pain

Here are some other things that can make your child's ears hurt:

• An infection of the outer ear canal, often called “swimmer's ear” (Ask your child's doctor about home treatment for swimmer's ear.)

• Blocked or plugged middle ear tubes from colds or allergies

• A sore throat

• Teething or sore gums

Most people enjoy eating.

But for people with an eating disorder, it brings about very different feelings. They become obsessed with thoughts of eating and have an intense fear of gaining weight. These thoughts disrupt their daily activities.

The 2 most well-known eating disorders are anorexia nervosa and bulimia nervosa.  Anorexia is self-starvation. Bulimia is a disorder in which a person eats large amounts of food (binges) and then tries to undo the effects of the binge in some way, usually by ridding the body of the food that was eaten. Some people have symptoms of both anorexia and bulimia. (A quick note about people with binge-eating disorder: they eat large amounts of food in a short time and feel intense guilt afterward, but unlike people with bulimia, they don't purge themselves.)

What causes eating disorders?

There is no single cause of eating disorders. But many factors can lead to an eating disorder. Genetics are now felt to play an important role. Although each person's situation is different, people with eating disorders may share many of the same traits, such as

• Feeling insecure

• An excessive desire to be in control

• A distorted body image (feeling fat even when they're not)

• A family history of depression or an eating disorder

• Severe family problems

• A history of sexual or physical abuse

• Pressure from activities that place a high value on body size such as running, gymnastics, wrestling, or ballet

What is anorexia?

People with anorexia have a distorted image of their bodies and such an intense fear of becoming fat that they hardly eat and become dangerously thin. Many people with anorexia also vomit and overexercise, and they may abuse diet pills to keep from gaining weight. If the condition gets worse, they can die from suicide, heart problems, or starving to death.

People with anorexia focus all of their energy on staying thin. Much of their time is spent thinking about food. For example, people with anorexia may

• Eat only a small number of “safe” foods, usually those low in calories and fat.

• Cut up food into tiny pieces.

• Spend more time playing with food than eating it.

• Cook food for others but not eat it.

• Exercise compulsively.

• Wear baggy clothes to hide their bodies, or complain that normal clothes are too tight.

• Spend more time alone and isolated from friends and family.

• Become more withdrawn and secretive.

• Seem depressed or anxious.

• Have a decrease in activities, motivation, or energy level.

• Do things to keep their minds off their hunger, such as chewing food 30 times before swallowing.

What does anorexia do to the body?

Over time, anorexia can lead to kidney and liver damage, bone damage, and heart problems. When the body is starved of food, many physical changes occur like

• The constant feeling of being cold because the body has lost the fat and muscle it needs to keep warm. (People with anorexia may exercise even more to try to get warm).

• Dizziness, fainting, or near-fainting.

• Bones sticking out and skin shrinking around the bones. The stomach may look like it's sticking out (often causing anorexics to think they're still fat).

• Hair loss.

• Brittle hair and fingernails.

• Dry and rough skin.

• Menstrual periods stopping (or not starting at all if a girl developed anorexia before her first period). This condition is called amenorrhea.

• Stomach pain, constipation, and bloating.

• Stunted growth that could be permanent.

• Anemia (low red blood cells) causing tiredness, weakness, and dizziness.

• Loss of sexual function in boys.

Who is at risk of developing anorexia?

Most people with anorexia are girls in their teens or even younger. But boys can be anorexic, too. Teens who develop anorexia usually are good students, even overachievers. They get along well with others, tend to be perfectionists, and don't like to admit they need help with anything. They may appear to be in control. However, they actually are insecure, self-critical, and have low self-esteem. They are very concerned about being liked and focused on pleasing others.

Most people who develop anorexia start by dieting. Dieting becomes more severe and strict over time. They may think that losing weight will make them feel better about themselves. Dieting also might be a response to a major life change like puberty or going away to college. Because people with anorexia have low self-esteem, they have a hard time coping with these changes and feel like they're losing control. Over time, dieting is no longer about losing weight, but a way to feel in control.

When should a person get help?

It's important to know the early signs of anorexia before it's too late. The earlier an eating disorder is recognized, the better chance there is of recovery. If someone is having physical symptoms caused by weight loss or answers “yes” to any of the following, that person should get help right away.

• “I can't stop dieting, even though I've been told that I've lost too much weight.”

• “Even though I've lost a lot of weight, when I look in the mirror, I still think I'm fat.”

• “I can't stop exercising.”

What is bulimia?

Bulimia is another eating disorder that is harmful to a person's physical and mental health. Bulimia and anorexia share some of the same symptoms.

• As with anorexia, food and staying thin become an obsession, but instead of avoiding food, people with bulimia eat large amounts of food in a short time (binge).

• Guilt and fear then cause them to get rid of the food (purge) by vomiting or other means such as overexercising.

People with bulimia have a difficult time controlling their eating behavior. They may be afraid to eat in public or with other people because they are afraid they won't be able to control their urges to binge and purge. Their fear may cause them to avoid being around people. They also may

• Become very secretive about eating food.

• Spend a lot of time thinking about and planning the next binge, set aside certain times to binge and purge, or avoid social activities to binge and purge.

• Steal food or hide it in strange places, like under the bed or in closets.

• Binge on foods with distinct colors to know when the food is later thrown up.

• Exercise to “purge” their bodies of food consumed.

People with bulimia often suffer from other problems as well, such as

• Depression and thoughts of suicide

• Substance abuse

What are bingeing and purging?

Bingeing

• During a binge, people with bulimia eat large amounts of food, often in less than a few hours.

• Eating during a binge is almost mindless. They eat without paying attention to what the food tastes like or if they are hungry or full.

• Binges usually end when there is no more food to eat, their stomachs hurt from eating, or something such as a phone call breaks their concentration on bingeing.

Purging

• After bingeing, people with bulimia feel guilty and are afraid of gaining weight. To ease their guilt and fear, they purge the food from their bodies by vomiting or other means.

• They also may turn to extreme exercise or strict dieting.

• This period of “control” lasts until the next binge, and then the cycle starts again. Bulimia becomes an attempt to control 2 very strong impulses—the desire to eat and the desire to be thin.

What does bulimia do to the body?

Like anorexia, bulimia damages the body. For example,

• Teeth start to decay from contact with stomach acids during vomiting.

• Weight goes up and down.

• Menstrual periods become irregular or stop.

• The face and throat look puffy and swollen.

• Periods of dizziness and blackouts occur.

• Dehydration caused by loss of body fluids occurs (treatment in a hospital may be needed).

• Constant upset stomach, constipation, and sore throat may be present.

• Damage to vital organs such as the liver and kidneys, heart problems, and death can occur.

Who gets bulimia?

Most people with bulimia are girls in their teens and young adult women. But boys can be bulimic, too. People with bulimia often have a hard time controlling impulses, stress, and anxieties. As with anorexia, people with bulimia aren't happy with their bodies and think they are fat. This leads to dieting. Then in response to anxiety and other emotions or hunger, they give in to their impulses and cravings for food by bingeing. People with bulimia may be underweight, overweight, or of average weight.

How are eating disorders treated?

The earlier an eating disorder is recognized, the higher the chances are of treatment working. Treatment depends on many things, including the person's willingness to make changes, family support, and the stage of the eating disorder.

Successful treatment of eating disorders involves a team approach. The team includes many health care professionals working together, each treating a certain aspect of the disorder. Treatment should begin with a visit to a pediatrician to see how the eating disorder has affected the body. If the effects are severe, the person may need medical treatment or even need to be hospitalized.

In treating anorexia, increasing the person's weight is crucial. If this person refuses to eat, hospitalization may be needed so that adequate nutrition can be ensured. People with bulimia also may need to be hospitalized to treat medical complications, replace needed nutrients in the body, or stop the cycle of bingeing and purging.

Counseling is an important part of treatment. Counseling helps people with eating disorders understand how they use food as a way to deal with problems and feelings. It helps them improve their self-images and develop the confidence to take control of their lives. Family therapy usually is needed to help family members understand the problem, how to be encouraging and supportive, and how to help manage the symptoms. Nutrition counseling with a registered dietitian also is recommended to assist patients and families in returning to healthy eating habits.

Living with an eating disorder is very hard on teens and their families! The wear and tear on the body is tremendous. Without help, a person with an eating disorder can have serious health problems, become very sick, and even die. However, with treatment, a person can get well and go on to lead a healthy life.

Where can I find more information?

• National Eating Disorders Association

• http://www.nationaleatingdisorders.org

• 800/931-2237

• National Association of Anorexia Nervosa and Associated Disorders

• http://www.anad.org

• 847/831-3438

Please note: Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this brochure. Phone numbers and Web site addresses are as current as possible, but may change at any time.

The persons whose photographs are depicted in this publication are professional models. They have no relation to the issues discussed. Any characters they are portraying are fictional.

In some children, fevers can trigger seizures. Febrile seizures occur in 2% to 5% of all children between the ages of 6 months and 5 years. Seizures, sometimes called “fits” or “spells,” are frightening, but they usually are harmless. Read on for information from the American Academy of Pediatrics that will help you understand febrile seizures and what happens if your child has one.

What is a febrile seizure?

A febrile seizure usually happens during the first few hours of a fever. The child may look strange for a few moments, then stiffen, twitch, and roll his eyes. He will be unresponsive for a short time, his breathing will be disturbed, and his skin may appear a little darker than usual. After the seizure, the child quickly returns to normal. Seizures usually last less than 1 minute but, although uncommon, can last for up to 15 minutes.

Febrile seizures rarely happen more than once within a 24-hour period. Other kinds of seizures (ones that are not caused by fever) last longer, can affect only one part of the body, and may occur repeatedly.

What do I do if my child has a febrile seizure?

If your child has a febrile seizure, act immediately to prevent injury.

• Place her on the floor or bed away from any hard or sharp objects.

• Turn her head to the side so that any saliva or vomit can drain from her mouth.

• Do not put anything into her mouth; she will not swallow her tongue.

• Call your child's doctor.

• If the seizure does not stop after 5 minutes, call 911 or your local emergency number.

Will my child have more seizures?

Febrile seizures tend to run in families. The risk of having seizures with other episodes of fever depends on the age of your child. Children younger than 1 year of age at the time of their first seizure have about a 50% chance of having another febrile seizure. Children older than 1 year of age at the time of their first seizure have only a 30% chance of having a second febrile seizure.

Will my child get epilepsy?

Epilepsy is a term used for multiple and recurrent seizures. Epileptic seizures are not caused by fever. Children with a history of febrile seizures are at only a slightly higher risk of developing epilepsy by age 7 than children who have not had febrile seizures.

Are febrile seizures dangerous?

While febrile seizures may be very scary, they are harmless to the child. Febrile seizures do not cause brain damage, nervous system problems, paralysis, intellectual disability (formerly called mental retardation), or death.

How are febrile seizures treated?

If your child has a febrile seizure, call your child's doctor right away. He or she will want to examine your child in order to determine the cause of your child's fever. It is more important to determine and treat the cause of the fever rather than the seizure. A spinal tap may be done to be sure your child does not have a serious infection like meningitis, especially if your child is younger than 1 year of age.

In general, doctors do not recommend treatment of a simple febrile seizure with preventive medicines. However, this should be discussed with your child's doctor. In cases of prolonged or repeated seizures, the recommendation may be different.

Medicines like acetaminophen and ibuprofen can help lower a fever, but they do not prevent febrile seizures. Your child's doctor will talk with you about the best ways to take care of your child's fever.

If your child has had a febrile seizure, do not fear the worst. These types of seizures are not dangerous to your child and do not cause long-term health problems. If you have concerns about this issue or anything related to your child's health, talk with your child's doctor.

A fever is usually a sign that the body is fighting an illness or infection. Fevers are generally harmless. In fact, they can be considered a good sign that your child's immune system is working and the body is trying to heal itself. While it is important to look for the cause of a fever, the main purpose for treating it is to help your child feel better if he is uncomfortable or has pain.

Read on to find out more from the American Academy of Pediatrics (AAP) about how to tell if your child has a fever and how to manage a fever.

What is a fever?

Normal body temperature varies with age, general health, activity level, and time of day. Infants tend to have higher temperatures than older children. Everyone's temperature is highest between late afternoon and early evening, and lowest between midnight and early morning. Even how much clothing a person wears can affect body temperature.

A fever is a body temperature that is higher than normal. While the average normal body temperature is 98.6°F (37°C), a normal temperature range is between 97.5°F (36.4°C) and 99.5°F (37.5°C). Most pediatricians consider a temperature 100.4°F (38°C) or higher a sign of a fever (see "Taking Your Child's Temperature").

Signs and symptoms of a fever

If your child has a fever, she may feel warm, appear flushed, or sweat more than usual. She may also be more thirsty than usual.

Some children feel fine when they have a fever. However, most will have symptoms of the illness that is causing the fever. Your child may have an earache, a sore throat, a rash, or a stomachache. These signs can provide important clues as to the cause of the fever.

When to call the doctor

The most important things you can do when your child has a fever are to improve your child's comfort by making sure they drink enough fluids to stay hydrated and monitor for signs and symptoms of a serious illness. It is a good sign if your child plays and interacts with you after receiving medicine for discomfort.

Call your child's doctor right away if your child has a fever and

• Looks very ill, is unusually drowsy, or is very fussy

• Has been in a very hot place, such as an overheated car

• Has other symptoms, such as a stiff neck, severe headache, severe sore throat, severe ear pain, an unexplained rash, or repeated vomiting or diarrhea

• •Has immune system problems, such as sickle cell disease or cancer, or is taking steroids or other medicines that could affect his immune system

• Has had a seizure

• Is younger than 3 months (12 weeks) and has a temperature of 100.4°F (38.0°C) or higher

• •Fever rises above 104°F (40°C) repeatedly for a child of any age

Also call your child's doctor if

• Your child still "acts sick" once his fever is brought down.

• Your child seems to be getting worse.

• The fever persists for more than 24 hours in a child younger than 2 years.

• The fever persists for more than 3 days (72 hours) in a child 2 years of age or older.

Treating your child's fever

If your child is older than 6 months and has a fever, she probably does not need to be treated for the fever unless she is uncomfortable. Watch her behavior. If she is drinking, eating, sleeping normally, and is able to play, you should wait to see if the fever improves by itself and do not need to treat the fever.

What you can do

• Keep her room comfortably cool.

• Make sure that she is dressed in light clothing.

• Encourage her to drink fluids such as water, diluted juices, or a store-bought electrolyte solution.

• Be sure that she does not overexert herself.

• See “How to improve your child’s comfort with medicine”

Taking your child’s temperature

While you often can tell if your child is warmer than usual by feeling his forehead, only a thermometer can tell how high the temperature is. Even if your child feels warmer than usual, you do not necessarily need to check this temperature unless he has other signs of illness described above.

Always use a digital thermometer to check your child’s temperature (see “Types of digital thermometers” chart for more information, including guidelines on what type of thermometer to use by age). Mercury thermometers should not be used. The AAP encourages parents to remove mercury thermometers from their homes to prevent accidental exposure and poisoning.

Note: Temperature readings may be affected by how the temperature is measured and other factors (see “What is a fever?”). Your child’s temperature and other signs of illness will help your doctor recommend treatment that is best for your child.

Types of digital thermometers

The following are 3 types of digital thermometers. While other methods for taking your child’s temperature are available, such as pacifier thermometers or fever strips, they are not recommended at this time. Ask your child’s doctor for advice.

How to use a digital multiuse thermometer

How to improve your child’s comfort with medicine

Acetaminophen and ibuprofen are safe and effective medicines if used as directed for improving your child’s comfort, and they may also decrease the fever. They do not need a prescription and are available at grocery stores and drugstores. However, keep the following in mind:

• Ibuprofen should only be used for children older than 6 months. It should not be given to children who are vomiting constantly or are dehydrated.

• Do not use aspirin to treat your child’s fever or discomfort. 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 cannot take anything by mouth, a rectal suppository may be needed. Acetaminophen comes in suppository form and can help reduce discomfort in a vomiting child.

Before giving your child any medicine, read the label to make sure that you are giving the right dose for his age and weight. Also, if your child is taking other medicines check the ingredients. If they include acetaminophen or ibuprofen, let your child’s doctor know. To be safe, talk with your child’s doctor before giving your child any medicine to treat discomfort or a fever if he is younger than 2 years. (Note: In 2011 manufacturers began replacing infant acetaminophen drops 80 mg/0.8 mL with infant or children acetaminophen liquid 160 mg/5 mL. Visit HealthyChildren.org at www.healthychildren.org/feverpain for more information. If giving acetaminophen, be sure to tell your child’s doctor if you are using infant drops 80 mg/0.8 mL or infant or children’s liquid 160 mg/5 mL.)

Should sponging be used to reduce a fever?

It is not recommended that you use sponging to reduce your child’s fever. There is no information that shows that sponging or tepid baths improve your child’s discomfort associated with a fever or illness. Cool or cold water can cause shivering and increase the temperature. Never add rubbing alcohol to the water. Rubbing alcohol can be absorbed into the skin or inhaled, causing serious problems such as a coma.

What if my child has a febrile seizure?

In some children younger than 6 years, fever can trigger seizures. While this can be frightening, these seizures are usually harmless. During a seizure your child may look strange for a few minutes; shake; then stiffen, twitch, and roll his eyes. The color of his skin may also change and appear blue. If this happens,

• Place him on the floor or bed, away from any hard or sharp objects.

• Turn his head to the side so that any saliva or vomit can drain from his mouth.

• Do not put anything into his mouth, not even a finger.

• Call your child’s doctor.

Your child’s doctor will want to check your child, especially if it is his first seizure. It is important to look for the cause of the febrile seizure.

If your child has had a febrile seizure in the past, treating your child with acetaminophen or ibuprofen when he has another fever will not prevent another febrile seizure from occuring. Discuss this at your child’s next well-visit.

Digital thermometer drawings by Anthony Alex LeTourneau

The flu (influenza) is an illness caused by a virus. It affects the whole body. This is not the same as what we often call the “stomach flu.”

Flu season is mostly in the winter. Each year the flu is a little different because there are different types of flu viruses and they change over time. So, people can get the flu many times in their life.

Signs of the Flu

The flu can last a week or more. Your child usually will feel the worst during the first 2 or 3 days. Flu symptoms include:

• A sudden fever (usually over 101°F or 38.3°C).

• Chills and shakes with the fever.

• Headache, body aches, and extreme tiredness.

• Sore throat and/or dry, hacking cough.

• Stuffy, runny nose.

• Throwing up (vomiting) and loose, runny stools (diarrhea).

Is It the Flu or a Cold?

Both the flu and colds are caused by viruses. They can have some of the same symptoms. But there are differences:

What to Do for the Flu

How to Prevent the Flu

The flu spreads very easily, especially to children and adults who spend time with children. It usually spreads during the first several days of the illness.

There are 3 ways to prevent the flu:

A food allergy happens when the body reacts against harmless proteins found in foods. The reaction usually happens shortly after a food is eaten. Food allergy reactions can vary from mild to severe.

Because many symptoms and illnesses could be wrongly blamed on "food allergies," it is important for parents to know the usual symptoms. The following is information from the American Academy of Pediatrics about food allergies and how to recognize and treat the symptoms. There is also important information about how to keep your child safe and healthy at home and in school if he has a food allergy.

Who gets food allergies?

A food allergy can happen at any age but occurs most often in infants and children younger than 6 years. It is estimated that 1 out of 20 to 25 children has a food allergy. Food allergies occur more often in children who have other allergies or who have family members with allergies.

What are the symptoms of a food allergy?

When the body's immune system overreacts to certain foods, the following symptoms may occur:

• Skin problems

  • Hives (red spots that look like mosquito bites)

  • Itchy skin rashes (eczema, also called atopic dermatitis)

  • Swelling

• Breathing problems

  • Sneezing

  • Wheezing

  • Throat tightness

• Stomach symptoms

  • Nausea

  • Vomiting

  • Diarrhea

• Circulation symptoms

  • Pale skin

  • Light-headedness

  • Loss of consciousness

If several areas of the body are affected, the reaction may be severe or even life-threatening. This type of allergic reaction is called anaphylaxis and requires immediate medical attention.

What is not a food allergy?

Food can cause many illnesses that are sometimes confused with food allergies. The following are not food allergies:

• Food poisoning—Can cause diarrhea or vomiting, but is usually caused by bacteria in spoiled food or undercooked food.

• Drug effects—Certain ingredients, such as caffeine in soda or candy, can make your child shaky or restless.

• Skin irritation—Can often be caused by acids found in such foods as orange juice or tomato products.

• Diarrhea—Can occur in small children from too much sugar, such as from fruit juices.

Some food-related illnesses are called intolerance, or a food sensitivity, rather than an allergy because the immune system is not causing the problem. Lactose intolerance is an example of a food intolerance that is often confused with a food allergy. Lactose intolerance is when a person has trouble digesting milk sugar, called lactose, leading to stomachaches, bloating, and loose stools.

Sometimes reactions to the chemicals added to foods, such as dyes or preservatives, are mistaken for a food allergy. However, while some people may be sensitive to certain food additives, it is rare to be allergic to them.

Which foods cause food allergies?

Any food could cause a food allergy, but most food allergies are caused by the following:

• Cow milk

• Eggs

• Peanuts

• Soy

• Wheat

• Nuts from trees (such as walnuts, pistachios, pecans, cashews)

• Fish (such as tuna, salmon, cod)

• Shellfish (such as shrimp, lobster)

Peanuts, nuts, and seafood are the most common causes of severe reactions. Allergies also occur to other foods such as meats, fruits, vegetables, grains, and seeds such as sesame.

Food allergies can be confusing. When a child is allergic to one type of food, such as peanuts (which is a type of bean), you may worry that she will also be allergic to other beans like soybeans or green beans. However, this is not always true. Most children allergic to peanuts tolerate other beans. In contrast, children allergic to cow milk are often allergic to goat milk, and children allergic to one type of shellfish, like shrimp, are likely to be allergic to other shellfish, such as crab and lobster.

How is a food allergy diagnosed?

If you think your child may have a food allergy, talk with your pediatrician. He or she will take a careful look at your child's symptoms and their relationship to foods. Sometimes the relationship is obvious. For example, if your child gets hives and lip swelling right after eating a walnut, it is likely a food allergy. Sometimes chronic health problems, like skin rashes or stomach problems, are caused by a food allergy, but it may be more difficult to know for sure. Many times causes other than food allergy must be considered.

If a food allergy is suspected, it is important to figure out which food(s) is the cause. This can be difficult if the allergic reaction occurred following a meal with many different foods. If your child has a chronic problem, such as skin rash or stomachaches, many foods in the diet must be looked at as possible causes.

There are blood tests to see if your child has a food allergy. Another type of test is a skin prick or scratch test. In this test, a small amount of the food is put into the skin by making a tiny, painless scratch on the skin. If your child is possibly allergic to the tested food, a small hive appears within minutes where the tiny scratch was made. If the tests are negative, they usually mean there is no food allergy. However, blood tests and skin tests are not perfect. It is possible to have a positive test and yet have no problems eating the food, and sometimes a negative test is found despite a true allergy.

Your pediatrician may refer you to an allergist. An allergist has specialized training in diagnosing and treating food allergies. The allergist can perform additional tests to see if a food allergy is the cause of your child's symptoms. If these tests do not clearly show a food allergy, the allergist may want to watch your child eat to see if the body reacts. This type of medical test is called a food challenge.

Severe allergic reactions

Anaphylaxis is a serious allergic reaction. It comes on quickly and can be fatal. It includes a wide range of symptoms that often happen quickly. Combinations of symptoms may occur. (See “What are the symptoms of a food allergy?”) The most severe symptoms restrict breathing and blood circulation.

This type of reaction is a medical emergency and immediate medical attention is important. Anaphylaxis is treated with a medicine called epinephrine. This is a medicine given by an injection. (See “Emergency treatments.”)

If your child experiences a severe allergic reaction to any food, inject epinephrine, if prescribed, and go to an emergency department or call 911 (or your local emergency number).

After an anaphylactic attack, your child needs to be seen by a doctor. It is important to find out exactly why the reaction happened so another one can be avoided. In most cases, the only way to prevent it from happening again is to avoid the cause. However, an evaluation by your pediatrician or an allergy specialist is important so that an action plan for prevention and treatment can be made.

(More information is available in the American Academy of Pediatrics brochure Anaphylaxis.)

How are food allergies treated?

The main way a food allergy is treated is to simply avoid the foods that cause the problems. However, it is also important to be ready to treat symptoms right away if your child accidentally eats the food. Children should be taught how to protect themselves by knowing which foods are off-limits. Teach your children to report any symptoms to an adult and, if appropriate for age, how to use emergency medicines.

Food allergy at school and camp

Whenever your child is away from you, whether it is at school, a child care center, or camp, there must be a plan to avoid problem foods, recognize and treat a reaction, and get medical care. Meet with staff early to set up an action plan. Here are some things to remember.

• Medical information. Give the school, child care center, or camp written medical information and instructions as directed by your doctor. Make sure that all staff who interact with your child understand his food allergy, can recognize symptoms of a reaction, and know what to do in an emergency.

• Medications. Provide the school, child care center, or camp with your child's medicines. Make sure his name is clearly marked on the medicine and that it is stored in an unlocked area (or carried by your child, if allowed). Designate school, child care, or camp staff who are properly trained to give your child his medicines.

• Contact information. Provide emergency contact information.

• Policies. Ensure that "no food sharing" policies are in place for your child. Have a plan for the school bus, such as no eating food on the bus. Do not forget to make arrangements for safe eating on school trips. Do not do crafts using foods.

• Have alternatives. Provide safe snacks for special occasions.

Will my child outgrow food allergies?

The good news is that food allergies are often outgrown during early childhood. It is estimated that 80% to 90% of egg, milk, wheat, and soy allergies go away by age 5 years. Some allergies are more persistent. For example, 1 in 5 young children will outgrow a peanut allergy and fewer will outgrow allergies to nuts or seafood. Your pediatrician or allergist can perform tests to track your child's food allergies and watch to see if they are going away.

Remember

Food allergies can be severe. Once your child has been diagnosed with a food allergy, it is best to avoid the problem foods. It is also important to have an action plan in the event of a reaction, and instruct anyone who cares for your child on how to help her. If you have any questions about your child's food allergies, talk with your pediatrician and allergist.

Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics (AAP).

Hip dysplasia (developmental dysplasia of the hip) is a condition in which a child's upper thighbone is dislocated from the hip socket. It can be present at birth or develop during a child's first year of life.

Hip dysplasia is not always detectable at birth or even during early infancy. In spite of careful screening of children for hip dysplasia during regular well-child exams, a number of children with hip dysplasia are not diagnosed until after they are 1 year old.

Hip dysplasia is rare. However, if your baby is diagnosed with the condition, quick treatment is important.

What causes hip dysplasia?

No one is sure why hip dysplasia occurs (or why the left hip dislocates more often than the right hip). One reason may have to do with the hormones a baby is exposed to before birth. While these hormones serve to relax muscles in the pregnant mother's body, in some cases they also may cause a baby's joints to become too relaxed and prone to dislocation. This condition often corrects itself in several days, and the hip develops normally. In some cases, these dislocations cause changes in the hip anatomy that need treatment.

Who is at risk?

Factors that may increase the risk of hip dysplasia include

• Sex—more frequent in girls

• Family history—more likely when other family members have had hip dysplasia

• Birth position—more common in infants born in the breech position

• Birth order—firstborn children most at risk for hip dysplasia

Detecting hip dysplasia

Your pediatrician will check your newborn for hip dysplasia right after birth and at every well-child exam until your child is walking normally.

During the exam, your child's pediatrician will carefully flex and rotate your child's legs to see if the thighbones are properly positioned in the hip sockets. This does not require a great deal of force and will not hurt your baby.

Your child's pediatrician also will look for other signs that may suggest a problem, including

• Limited range of motion in either leg

• One leg is shorter than the other

• Thigh or buttock creases appear uneven or lopsided

If your child's pediatrician suspects a problem with your child's hip, you may be referred to an orthopedic specialist who has experience treating hip dysplasia.

Treating hip dysplasia

Early treatment is important. The sooner treatment begins, the simpler it will be. In the past parents were told to double or triple diaper their babies to keep the legs in a position where dislocation was unlikely. This practice is not recommended. The diapering will not prevent hip dysplasia and will only delay effective treatment. Failure to treat this condition can result in permanent disability.

If your child is diagnosed with hip dysplasia before she is 6 months old, she will most likely be treated with a soft brace (such as the Pavlik harness) that holds the legs flexed and apart to allow the thighbones to be secure in the hip sockets.

The orthopedic consultant will tell you how long and when your baby will need to wear the brace. Your child also will be examined frequently during this time to make sure that the hips remain normal and stable.

In resistant cases or in older children, hip dysplasia may need to be treated with a combination of braces, casts, traction, or surgery. Your child will be admitted to the hospital if surgery is necessary. After surgery, your child will be placed in a hip spica cast for about 3 months. A hip spica cast is a hard cast that immobilizes the hips and keeps them in the correct position. When the cast is removed, your child will need to wear a removable hip brace for several more months.

Remember

If you have any concerns about your child's walking, talk with his pediatrician. If the cause is hip dysplasia, prompt treatment is important.

HIV (human immunodeficiency virus) is a virus that can lead to AIDS (acquired immunodeficiency syndrome). While there is no cure for HIV, early diagnosis and treatment are very effective at keeping people healthy. In addition, there are things you can do to prevent getting HIV. Read on to learn more about HIV and AIDS and how to keep you and your children healthy.

What are HIV and AIDS?

HIV is a virus that causes damage to the body's immune system. The immune system is the body's way of fighting infections. When the immune system does not work well, the body cannot fight off many serious illnesses.

The damage caused by HIV can occur over months, as sometimes happens when infants have HIV. In adults with HIV, the damage can occur more slowly. People with HIV are said to have AIDS when their immune systems are severely damaged or when HIV-related infections or cancers occur.

Because it can take years for symptoms to develop, many people do not know they have HIV. During this time, they can unknowingly spread the virus to others. Most people with HIV appear healthy. You cannot tell just by looking at people whether they have HIV. A blood test is the only way to be sure.

How is HIV spread?

HIV can be spread in the following ways:

• By sexual intercourse (vaginal, anal, or oral) with a person who has HIV. Both males and females can spread HIV.

• Through contact with an HIV-infected person's blood. This can happen when sharing syringes or needles, accidentally getting stuck by a needle with a person's blood on it, or contact with other body fluids containing blood.

• To a baby by a mother with HIV during pregnancy, labor, delivery, or breastfeeding, or sharing pre-chewed food.

• Through blood or blood products from blood transfusions, organ transplants, or artificial insemination. This is very rare because today donated blood, sperm, tissue, and organs are routinely screened and tested for HIV.

How is HIV not spread?

It is very important to know how HIV is not spread. You cannot get HIV by

• Shaking hands or hugging a person with HIV

• Sitting next to or playing with a person with HIV

• Eating food prepared by a person with HIV

• Sharing a glass, utensil, or plate with a person with HIV

Also, you cannot get HIV from

• The air

• Insect bites (including mosquito bites)

• Giving blood

• Sharing bathrooms

• Swimming pools

What your children should know about HIV and AIDS

Teach your children the facts about HIV and AIDS, including how HIV is not spread (see previous section) and the following:

Young children will not be able to understand all of the information, but they should know

• To never touch anyone else's blood.

• To never touch needles or syringes. If they find one in the garbage or on the ground, they should tell an adult.

Older children and teens should know about

• Abstinence. The best way to protect themselves against HIV and other sexually transmitted infections (STIs) is to not have any type of sex (vaginal, anal, or oral). Let them know that many people wait to have sex.

• Condoms. The best way to lower the risk of getting HIV and other STIs, if they are sexually active, is to use a latex condom and limit the number of sexual partners they have.

Teens should also know about other types of birth control. However, make sure they know that other forms of birth control will not protect them from HIV or other STIs. If teens are sexually active, encourage them and their partners to be tested for HIV and STIs before sexual activity.

• Drug use. Drugs that are injected with needles are the riskiest because the needle or syringe can spread blood from one person to another. Using other drugs like alcohol, marijuana, or "club" drugs can also increase the risk of getting HIV. This is because drugs affect a person's judgment and can lead to risky behaviors, like having sex without a condom or with multiple partners.

Who should be tested for HIV?

Anyone involved in the risky behaviors listed previously should get an HIV test. Keep in mind, a negative test does not mean a person is safe if the risky behaviors took place only a few months before the test. This is because it can take several months for the HIV test to become positive.

The following symptoms may suggest a need for HIV testing:

• Persistent fevers

• Loss of appetite

• Frequent diarrhea

• Poor weight gain or rapid weight loss

• Swelling of the lymph nodes (glands) that does not go away

• Extreme tiredness or lethargy that does not go away with rest

• White spots in the mouth

• Recurring or unusual infections

How is HIV treated?

There is no cure for HIV or AIDS. However, there are medicines that can help delay symptoms, prevent the virus from spreading to an unborn baby, and help prevent additional infections in people with HIV. Because starting treatment for an HIV infection early (before there are symptoms of AIDS) is most effective at preventing symptoms and keeping people healthy, it is important to get tested to know if you have an HIV infection. If you do, you can stay healthy for many years if you start medicines as early as needed and stay on them.

Remember

HIV and AIDS are important issues to think and talk about. Knowing the facts about HIV and AIDS is the best way to keep you and your family healthy. If you need more information, talk with your child's doctor.

Your child will learn many things in life—how to listen, speak, read, write, and do math. Some skills may be harder to learn than others. If your child is trying his best to learn certain skills but is not able to keep up with his peers, it’s important to find out why. Your child may have a learning disability (also known as LD). If your child has an LD, the sooner you know, the sooner you can get your child help. Your child can succeed in school, work, and relationships. Read on for more information from the American Academy of Pediatrics about LDs.

What is an LD?

Learning disability is a term used to describe a range of learning problems. These problems have to do with the way the brain gets, uses, stores, and sends out information. As many as 15% of children have an LD. Children with LDs may have trouble with one or more of the following skills: reading, writing, listening, speaking, reasoning, and math. The most common type of LD is a reading disorder.

A child is not considered to have an LD if the learning problems are due to another cause, such as attention-deficit/hyperactivity disorder (ADHD), intellectual disability (formerly called mental retardation), lack of instruction, or a hearing, vision, or motor problem. It’s important to understand, though, that some children may have an LD and one or more other conditions that can affect learning. Many children also have more than one LD.

What causes LDs?

There can be many possible causes. The causes aren’t always known, but in many cases children with LDs have a parent or relative with the same or similar learning difficulties. Other risk factors include low birth weight and prematurity, or an injury or illness during childhood (for example, head injury, lead poisoning, a childhood illness like meningitis).

How do I know if my child has an LD?

Learning disabilities aren’t always obvious. However, there are some signs that could mean your child needs help. Keep in mind that children develop and learn at different rates. Let your child’s doctor know if your child shows any of the following signs:

What are common LDs?

The following are some common LDs. Keep in mind that not every child with an LD fits neatly within one of these types. Careful evaluation is important.

Other learning problems

Some children with learning problems may not exactly fit the types of LDs previously mentioned. These learning problems may include the following:

Is there a cure?

There is no single cure for LDs, but there are many things that can be done to help children overcome their LD and live successful lives. Be cautious of people and groups who claim to have simple answers or solutions. You may hear about eye exercises, body movements, special diets, vitamins, and nutritional supplements. There’s no good evidence that these work. If in doubt, talk with your child’s doctor. Also, you can contact trusted resources like the ones listed at the end of this publication for more information.

Who can help?

If you’re concerned about your child’s problems with learning or think your child may have an LD, talk with your child’s teacher and doctor. Teachers and other education specialists can perform screening or evaluation tests to determine if there’s a problem. Your child’s doctor may want to test your child’s vision and hearing to rule out other possible problems. You may also want to see a pediatrician who specializes in neurodevelopmental disabilities, developmental and behavioral pediatrics, or child neurology. Other professionals who can help are psychologists and private educational specialists.

Most children who have problems learning can reach their goals by developing different ways of learning. Special educational services to help children with LDs may be available in your area. These may include specialized instruction, non-timed tests, or sometimes changes in the classroom that are geared toward your child’s specific learning style. One way to ensure that your child is being helped is for teachers and parents (and sometimes your child’s doctor) to meet and develop a written plan that clearly describes the services your child needs. This plan is called an Individualized Education Program (IEP). Once an IEP is in place, it should be reviewed regularly to make sure your child’s needs are being met.

Ways you can help your child

• Focus on strengths. All children have special talents as well as weaknesses. Find your child’s strengths and help her learn to use them. Your child might be good at math, music, or sports. She could be skilled at art, working with tools, or caring for animals. Be sure to praise your child often when she does well or succeeds at a task.

• Develop social and emotional skills. Learning disabilities combined with the challenges of growing up can make your child sad, angry, or withdrawn. Help your child by providing love and support while acknowledging that learning is hard because his brain learns in a different way. Try to find clubs, teams, and other activities that focus on friendship and fun. These activities should also build confidence. And remember, competition isn’t just about winning.

• Plan for the future. Many parents of children with LDs worry about their child’s future. Remind your child that an LD isn’t tied to how smart she is. In fact, many people with LDs are very bright and grow up to be very successful in life. You can help your child plan for adulthood by encouraging her to consider her strengths and interests when making education and career choices. There are special career and vocational programs that help build confidence by teaching decision-making and job skills. Many colleges have programs designed for students with LDs.

Remember

Children with LDs can learn and succeed if they get the right help and support. The sooner you know, the sooner you can get your child help. Talk with your child’s doctor if you have any concerns about your child’s learning.

Where can I find more information?

If you have any questions about LDs, contact your child’s doctor or any of the following resources:

American Academy of Pediatrics National Center for Medical Home Implementation

www.medicalhomeinfo.org

Council for Exceptional Children

www.cec.sped.org

LD OnLine (information about LDs)

www.ldonline.org

Learning Disabilities Association of America

www.ldanatl.org

Learning Disabilities Worldwide

www.ldworldwide.org

National Center for Learning Disabilities

www.ncld.org

Office of Special Education and Rehabilitative Services

www.ed.gov/about/offices/list/osers

Wrightslaw (information about special education law)

www.wrightslaw.org

Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

Lyme disease is an important public health problem in some areas of the United States. Since its discovery in Lyme, CT, in 1975, thousands of cases of the disease have been reported across the United States and around the world. By knowing more about the disease and how to prevent it, you can help keep your family safe from the effects of Lyme disease.

What is Lyme disease?

Lyme disease is an infection caused by a bacteria called a spirochete. The disease is spread to humans by the bites of deer ticks infected with this bacteria. Deer ticks are tiny black-brown creatures. They live in forests or grassy, wooded, marshy areas near rivers, lakes, or oceans. Many people who have been infected with Lyme disease were bitten by deer ticks while hiking or camping, during other outdoor activities, or even while spending time in their own backyards, from the late spring to early fall.

Where is Lyme disease most common?

Deer ticks that are infected with Lyme disease live in areas that have very low and high seasonal temperatures and high humidity. In the United States, almost all cases of Lyme disease occur in the following regions:

• Northeast (Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont)

• North central states (Michigan, Minnesota, and Wisconsin)

• West Coast (California)

How will I know if my child has Lyme disease?

The first and most obvious symptom of Lyme disease is a localized rash that begins as a pink or red circle that expands over time and may become several inches or larger. It may appear from 3 to 30 days after the bite occurred. Some people may have a single circle, while others may have many. Most people who develop the rash won't feel anything, but for others the rash may hurt, itch, burn, or feel warm to the touch. The rash most commonly appears on the head, neck, groin, thighs, trunk, and armpits.

A rash may occur without any other symptoms or may include

• Headache

• Chills

• Fever

• Fatigue

• Swollen glands, usually in the neck or groin

• Aches and pains in the muscles or joints

If your child develops the rash with or without any of these symptoms, call your pediatrician.

How serious is Lyme disease?

For most people, Lyme disease can be easily recognized and treated. If left untreated, Lyme disease can get worse. Occasionally, patients can develop infection of the nervous system (meningitis) or facial muscle problems (facial nerve palsy). Late stage symptoms, occurring 1 or more months after the tick bite, are swelling of one or more joints.

How is Lyme disease treated?

Lyme disease is treated with antibiotics (usually penicillin, a cephalosporin, or a tetracycline) prescribed by your pediatrician. The antibiotics are usually taken by mouth, but also can be given intravenously (directly into the bloodstream through a vein) in more severe cases. Both early and late stages of the disease can be treated with antibiotics.

How can I prevent Lyme disease?

If you live or work in a region where Lyme disease is a problem, or if you visit such an area, the following are ways to protect your family from the ticks that carry the disease:

• Avoid places where ticks live. Whenever possible, avoid shaded, moist areas likely to be infested with ticks.

• Cover arms and legs. Have your child wear a long-sleeved shirt and tuck his pants into his socks.

• Wear a hat to help keep ticks away from the scalp. Keep long hair pulled back.

• Wear light-colored clothing to make it easier to spot ticks.

• Wear enclosed shoes or boots. Avoid wearing sandals in an area where ticks may live.

• Use insect repellent. Products with DEET are effective against ticks and can be used on the skin. However, large amounts of DEET can be harmful to your child if it is absorbed through the skin. Look for products that contain no more than 30% DEET. Wash the DEET off with soap and water when your child returns indoors. Products with permethrin can be used on clothing, but cannot be applied to the skin.

• Stay on cleared trails whenever possible. Avoid wandering from a trail or brushing against overhanging branches or shrubs.

• After coming indoors, check for ticks. This will only take a couple minutes. Ticks often hide behind the ears or along the hairline. It usually takes more than 48 hours for a person to become infected with the bacteria, so removing any ticks soon after they have attached themselves is very effective for reducing the chances of becoming infected.

Keep in mind, ticks can be found right in your own backyard, depending on where you live. Keeping your yard clear of leaves, brush, and tall grass may reduce the number of ticks. Ask a licensed professional pest control expert about other steps you can take to reduce ticks in your yard.

Ticks and how to remove them

Ticks do not fly, jump, or drop from trees. They hide in long grass and small trees, bushes, or shrubs waiting for an animal or person to brush by. Then they attach themselves to the animal or person's skin. When a tick is found on a person or pet, try to remove as much of it as possible using the following steps:

• 1. Grasp the tick as close to the skin as possible with fine-tipped tweezers. Be careful not to squeeze the tick's body.

• 2. Slowly pull the tick away from the skin.

• 3. After the tick is out, clean the bitten area with rubbing alcohol or other first aid ointment.

Remember

If you live in or plan to visit an area where Lyme disease has become a problem, it's important to take steps to avoid being bitten by deer ticks. If you have any questions about the disease, talk with your pediatrician.