Urinary Tract Infections

Urinary tract infections (UTIs) are common in kids. By 5 years old, about 8% of girls and about 1-2% of boys have had at least one.

In older kids, UTIs may cause obvious symptoms such as burning or pain with urination (peeing). In infants and young children, UTIs may be harder to detect because symptoms are less specific. In fact, fever is sometimes the only sign.

About UTIs

Most UTIs are caused when bacteria infect the urinary tract. The urinary tract is made up of the kidneys, ureters, bladder, and urethra, and each plays a role in removing liquid waste from the body. The kidneys filter the blood and produce urine; the ureters carry the urine from the kidneys to the bladder; and the bladder stores the urine until it is eliminated from the body through the urethra.

An infection can occur anywhere along this tract, but the lower part — the urethra and bladder — is most commonly involved. This is called cystitis. If the infection travels up the ureters to the kidneys, it's called pyelonephritis and it's generally more serious.

Although bacteria aren't normally found in the urine, they can easily enter the urinary tract from the skin around the anus (the intestinal bacteria E. coli is the most frequent cause of UTIs). Many other bacteria, and some viruses, can also cause infection. Rarely, bacteria can reach the bladder or kidneys through the blood. Bacterial UTIs are not contagious.

UTIs occur much more frequently in girls, particularly those around the age of toilet teaching, because a girl's urethra is shorter and closer to the anus. Uncircumcised boys younger than 1 year also have a slightly higher risk of developing a UTI.

Other risk factors for developing a UTI include:

• an abnormality in the structure or function of the urinary tract (for example, a malformed kidney or a blockage somewhere along the tract of normal urine flow)
• an abnormal backward flow (reflux) of urine from the bladder up the ureters and toward the kidneys. This condition, known as vesicoureteral reflux (VUR), is present at birth, and about 30% to 50% of children with a UTI are found to have it.
• poor toilet and hygiene habits
• the use of bubble baths or soaps that irritate the urethra
• family history of UTIs

Signs and Symptoms

Signs and symptoms of UTIs vary depending on the child's age and on which part of the urinary tract is infected. In younger children and infants, the symptoms may be very general. The child may seem irritable, begin to feed poorly, or vomit. Sometimes the only symptom is a fever that seems to appear for no reason and doesn't go away.

In older kids and adults, symptoms can reveal which part of the urinary tract is infected. In a bladder infection, the child may have:

• pain, burning, stinging sensation when urinating
• an increased urge to urinate or frequent urination (though a very small amount of urine may actually be produced)
• fever (though this is not always present)
• frequent night waking to go to the bathroom
• wetting problems, even though the child is toilet taught
• low back pain or abdominal pain in the area of the bladder (generally below the navel)
• foul-smelling urine that may look cloudy or contain blood

Many of these symptoms are also seen in a kidney infection, but the child often appears more ill and there is more likely to be fever with shaking chills, pain in the side or back, severe fatigue, or vomiting.

Prevention

In infants and toddlers, frequent diaper changes can help prevent the spread of bacteria that cause UTIs. When kids begin to self-care, it's important to teach them good hygiene. After every bowel movement, girls should remember to wipe from front to rear — not rear to front — to prevent germs from spreading from the rectum to the urethra. Kids should also be taught not to "hold it in" when they have to go because urine that remains in the bladder gives bacteria a good place to grow.

School-age girls should avoid bubble baths and strong soaps that might cause irritation, and they should also wear cotton underwear instead of nylon because it's less likely to encourage bacterial growth. Other ways to decrease the risk of UTIs include drinking enough fluids and avoiding caffeine, which can irritate the bladder.

Any kids diagnosed with VUR should follow their do

UTIs are highly treatable, but it's important to catch them early. Undiagnosed or untreated UTIs can lead to kidney damage, especially in kids younger than 6.

Duration

Most UTIs are cured within a week with proper medical treatment. Recurrences are common in certain kids with urinary abnormalities, those who have problems emptying their bladders (such as children with spina bifida), or those with very poor toilet and hygiene habits.

Diagnosis

After performing a physical exam and asking about symptoms, your doctor may take a urine sample to check for and identify bacteria causing the infection. How a sample is taken depends on how old your child is. Older kids might simply need to urinate into a sterile cup.

For younger children in diapers, a plastic bag with adhesive tape may be placed over their genitals to catch the urine. However, urine that comes in contact with the skin may become contaminated with the same bacteria causing the infection, so a catheter is usually preferred. This is when a thin tube is inserted into the urethra up to the bladder to get a "clean" urine sample.

The sample may be used for a urinalysis (a test that microscopically checks the urine for germs or pus) or a urine culture (which attempts to grow and identify bacteria in a laboratory). Knowing what bacteria are causing the infection can help your doctor choose the best medication to treat it.

Most children with a UTI recover just fine, but some of them — especially those who are very young when they have their first infection or those who have recurrent infections — may need further testing to rule out abnormalities of the urinary tract.

If an abnormality is suspected, the doctor may order special tests, such as an ultrasound of the kidneys and bladder or X-rays that are taken during urination (called a voiding cystourethrogram, or VCUG). These tests, as well as other imaging studies, can check for problems in the structure or function of the urinary tract. Your child may also be referred to a urologist (a doctor who specializes in diseases of the urinary tract).

Treatment

UTIs are treated with antibiotics. The type of antibiotic used and how long it must be taken will depend on the type of bacteria that is causing the infection and how severe it is. After several days of antibiotics, your doctor may repeat the urine tests to confirm that the infection is gone. It's important to make sure the infection is cleared because an incompletely treated UTI can recur or spread.

If a child is having severe pain with urination, the doctor may also prescribe a medication that numbs the lining of the urinary tract. This medication temporarily causes the urine to turn orange, but don't be alarmed — the color is of no significance.

Give prescribed antibiotics on schedule for as many days as your doctor directs. Keep track of your child's trips to the bathroom, and ask your child about symptoms like pain or burning on urination. These symptoms should improve within 2 to 3 days after antibiotics are started.

Take your child's temperature once each morning and each evening, and call the doctor if it rises above 101° Fahrenheit (38.3° Celsius), or above 100.4° Fahrenheit (38° Celsius) rectally in infants. Encourage your child to drink plenty of fluids, but avoid beverages containing caffeine, such as soda and iced tea.

Kids with a simple bladder infection are usually treated at home with oral antibiotics. However, those with a more severe infection may need to be treated in a hospital to receive antibiotics by injection or intravenously (delivered through a vein right into the bloodstream).

Kids tend to be hospitalized for UTI if:

• the child has high fever or looks very ill, or there is a probable kidney infection
• the child is younger than 6 months old
• bacteria from the infected urinary tract may have spread to the blood
• the child is dehydrated (has low levels of body fluids) or is vomiting and cannot take any fluids or medication by mouth

Kids diagnosed with vesicoureteral reflux (or VUR), in which urine goes back up into the ureters instead of flowing out of the urethra, will be watched closely by the doctor. Treatment may include medications or, less commonly, surgery. Most kids outgrow mild forms of VUR, but some can develop kidney damage or kidney failure later in life.

When to Call the Doctor

Call your doctor immediately if your child has an unexplained fever with shaking chills, especially if accompanied by back pain or any type of discomfort during urination.

Also call the doctor if your child has any of the following:

• unusually frequent urination or frequent urination during the night
• bad-smelling, bloody, or discolored urine
• low back pain or abdominal pain (especially below the navel)
• a fever of 100.4° Fahrenheit (38° Celsius) rectally in infants, or over 101° Fahrenheit (38.3°) in children

Call the doctor if your infant has a fever, feeds poorly, vomits repeatedly, or seems unusually irritable.

Pinkeye (Conjunctivitis)

About Pinkeye

Conjunctivitis, commonly known as pinkeye, is an inflammation of the conjunctiva, the clear membrane that covers the white part of the eye and the inner surface of the eyelids.

While pinkeye can be alarming because it may make the eyes extremely red and can spread rapidly, it's a fairly common condition and usually causes no long-term eye or vision damage. But if your child shows symptoms of pinkeye, it's important to see a doctor. Some kinds of pinkeye go away on their own, but other types require treatment.

Causes

Pinkeye can be caused by many of the bacteria and viruses responsible for colds and other infections, — including ear infections, sinus infections, and sore throats — and by the same types of bacteria that cause the sexually transmitted diseases (STDs) chlamydia and gonorrhea.

Pinkeye also can be caused by allergies. These cases tend to happen more frequently among kids who also have other allergic conditions, such as hay fever. Triggers of allergic conjunctivitis include grass, ragweed pollen, animal dander, and dust mites.

Sometimes a substance in the environment can irritate the eyes and cause pinkeye; for example, chemicals (such as chlorine and soaps) and air pollutants (such as smoke and fumes).

Pinkeye in Newborns

Newborns are particularly susceptible to pinkeye and can be more prone to serious health complications if it goes untreated.

If a baby is born to a mother who has an STD, during delivery the bacteria or virus can pass from the birth canal into the baby's eyes, causing pinkeye. To prevent this, doctors give antibiotic ointment or eye drops to all babies immediately after birth. Occasionally, this preventive treatment causes a mild chemical conjunctivitis, which typically clears up on its own. Doctors also can screen pregnant women for STDs and treat them during pregnancy to prevent transmission of the infection to the baby.

Many babies are born with a narrow or blocked tear duct, a condition which usually clears up on its own. Sometimes, though, it can lead to conjunctivitis.

Symptoms

The different types of pinkeye can have different symptoms. And symptoms can vary from child to child.

One of the most common symptoms is discomfort in the eye. A child may say that it feels like there's sand in the eye. Many kids have redness of the eye and inner eyelid, which is why conjunctivitis is often called pinkeye. It can also cause discharge from the eyes, which may cause the eyelids to stick together when the child awakens in the morning. Some kids have swollen eyelids or sensitivity to bright light.

In cases of allergic conjunctivitis, itchiness and tearing are common symptoms.

Contagiousness

Cases of pinkeye that are caused by bacteria and viruses are contagious; cases caused by allergies or environmental irritants are not.

A child can get pinkeye by touching an infected person or something an infected person has touched, such as a used tissue. In the summertime, pinkeye can spread when kids swim in contaminated water or share contaminated towels. It also can be spread through coughing and sneezing.

Doctors usually recommend keeping kids diagnosed with contagious conjunctivitis out of school, day care, or summer camp for a short time.

Someone who has pinkeye in one eye can also inadvertently spread it to the other eye by touching the infected eye, then touching the other eye.

Preventing Pinkeye

To prevent pinkeye caused by infections, teach kids to wash their hands often with warm water and soap. They also should not share eye drops, tissues, eye makeup, washcloths, towels, or pillowcases with other people.

Be sure to wash your own hands thoroughly after touching an infected child's eyes, and throw away items like gauze or cotton balls after they've been used. Wash towels and other linens that the child has used in hot water separately from the rest of the family's laundry to avoid contamination.

If you know your child is prone to allergic conjunctivitis, keep windows and doors closed on days when the pollen is heavy, and dust and vacuum frequently to limit allergy triggers in the home. Irritant conjunctivitis can only be prevented by avoiding the irritating causes.

Many cases of pinkeye in newborns can be prevented by screening and treating pregnant women for STDs. A pregnant woman may have bacteria in her birth canal even if she shows no symptoms, which is why prenatal screening is important.

Treatment

Pinkeye caused by a virus usually goes away on its own without any treatment. If a doctor suspects that the pinkeye has been caused by a bacterial infection, antibiotic eye drops or ointment will be prescribed.

Sometimes it can be a challenge to get kids to tolerate eye drops several times a day. If you're having trouble, put the drops on the inner corner of your child's closed eye — when the child opens the eye, the medicine will flow into it. If you continue to have trouble with drops, ask the doctor about antibiotic ointment. It can be applied in a thin layer where the eyelids meet, and will melt and enter the eye.

If your child has allergic conjunctivitis, your doctor may prescribe anti-allergy medication, which comes in the form of pills, liquid, or eye drops.

Cool or warm compresses and acetaminophen or ibuprofen may make a child with pinkeye feel more comfortable. You can clean the edges of the infected eye carefully with warm water and gauze or cotton balls. This can also remove the crusts of dried discharge that may cause the eyelids to stick together first thing in the morning.

When to Call the Doctor

If you think your child has pinkeye, it's important to contact your doctor to learn what's causing it and how to treat it. Other serious eye conditions can mimic conjunctivitis, so a child who complains of severe pain, changes in eyesight, or sensitivity to light should be examined. If the pinkeye does not improve after 2 to 3 days of treatment, or after a week when left untreated, call your doctor.

If your child has pinkeye and starts to develop increased swelling, redness, and tenderness in the eyelids and around the eye, along with a fever, call your doctor. Those symptoms may mean the infection has started to spread beyond the conjunctiva and will require additional treatment.

Neonatal Infections

The vast majority of newborns enter the world healthy. But sometimes, infants develop conditions that require medical tests and treatment.

Newborns are particularly susceptible to certain diseases, much more so than older children and adults. Their new immune systems aren't adequately developed to fight the bacteria, viruses, and parasites that cause these infections.

As a result, when newborns get sick, they may need to spend time in the hospital — or even the neonatal intensive care unit (NICU) — to recover. Although it can be frightening to see your baby hospitalized, a hospital stay is often the best way back to good health for a sick newborn.

Signs to Look for

Many infections cause similar symptoms. Call your child's doctor or seek emergency medical care if your new baby shows any of these possible signs of infection:

• poor feeding
• breathing difficulty
• listlessness
• decreased or elevated temperature
• unusual skin rash or change in skin color
• persistent crying
• unusual irritability

A marked change in a baby's behavior, such as suddenly sleeping all the time or not sleeping much at all, can also be an indication that something isn't right.

These signs are of even greater concern if the baby is less than 2 months old. To make ensure good health, have your baby checked by a doctor right away if you suspect a problem.

Group B Streptococcal Disease (GBS)

What is it?

Group B streptococcus is a common type of bacterium that can cause a variety of infections in newborns. Some of the most common are sepsis, pneumonia, and meningitis. Babies usually get the bacteria from their mothers during birth — many pregnant women carry these bacteria in the rectum or vagina, where they can easily pass to the newborn if the mother hasn’t been treated with antibiotics.

Babies with GBS often show symptoms of infection within the first week of life, although some develop symptoms weeks or months later. Depending on the infection (pneumonia or sepsis, for example), the symptoms might include trouble breathing or feeding, a high temperature, listlessness, or unusual crankiness.

How is it diagnosed and treated?

To diagnose GBS, doctors run blood tests and take cultures of blood, urine, and, if necessary, cerebrospinal fluid to look for bacteria. Doctors use needles to obtain a blood sample and a spinal needle to do a lumbar puncture for the cerebrospinal fluid. The urine is usually obtained by a catheter inserted into the urethra. Infections caused by GBS are treated with antibiotics, as well as careful care and monitoring in the hospital.

Listeriosis

What is it?

Infection with Listeria monocytogenes bacteria can lead to diseases such as pneumonia, sepsis, and meningitis in newborns. Most people encounter the bacteria by eating contaminated food because the bacteria are found in soil and water and can end up on fruits and vegetables, as well as in foods that come from animals, such as meat and dairy products. Food that isn't properly cleaned, pasteurized, or cooked may give someone listeriosis.

Babies can acquire bacteria from their mothers if the mother contracts listeriosis while pregnant. In severe cases, listeriosis may lead to premature delivery or even stillbirth. Babies born with listeriosis may show signs of infection similar to those of GBS.

How is it diagnosed and treated?

A blood or spinal fluid culture can reveal the presence of the bacteria, and infected babies will be treated with antibiotics in the hospital.

E. Coli

What is it?

Escherichia coli (E. coli) is another bacterial culprit behind some common neonatal infections, and can lead to urinary tract infections, sepsis, meningitis, and pneumonia. Everyone carries E. coli in their bodies, and babies can become infected during childbirth, when they pass through the birth canal, or by coming into contact with the bacteria in the hospital or at home. Most newborns who become ill from E. coli infection have particularly fragile immune systems that make them particularly vulnerable to getting sick.

As with other bacterial infections, the symptoms will depend on the kind of infection that develops from E. coli, but fever, unusual fussiness, listlessness, or lack of interest in feeding are common.

How is it diagnosed and treated?

Doctors diagnose E. coli infection by culturing blood, urine, or cerebrospinal fluid and treat the infection with antibiotics.

Meningitis

What is it?

Meningitis is an inflammation of the membranes surrounding the brain and spinal cord. It can be caused by viruses, fungi, and bacteria, including Listeria, GBS, and E. coli. Newborns can pick up one of these pathogens during birth or from their surroundings, particularly if they have weakened immune systems that would make them more susceptible.

Symptoms of infection in newborns aren't very specific and may include persistent crying, irritability, sleeping more than usual, lethargy, refusing to take the breast or bottle, low or unstable body temperature, jaundice, pallor, breathing problems, rashes, vomiting, or diarrhea. As the disease progresses, babies' fontanels, or soft spots, may begin to bulge.

How is it diagnosed and treated?

Meningitis, particularly bacterial meningitis, is a serious infection in newborns. If it is suspected, a doctor will do a lumbar puncture (also known as a spinal tap), inserting a needle into the spine to withdraw a sample of cerebrospinal fluid.

Treatment of meningitis depends on what caused it. Infants with bacterial and fungal meningitis receive antibiotics, while viral meningitis may be treated with antiviral medication. All infants with meningitis usually spend time in the hospital for monitoring and intense supportive care.

Sepsis

What is it?

Sepsis is a serious infection that involves the spread of germs throughout the body's blood and tissues. It can be caused by viruses, fungi, parasites, or bacteria. Some of these infectious agents are acquired during birth, while others are picked up from the environment. As with meningitis, the symptoms of sepsis are not specific and vary from child to child. A lower heart rate, breathing problems, jaundice, trouble feeding, low or unstable body temperature, lethargy, or extreme fussiness can all be signs of an infection.

How is it diagnosed and treated?

To diagnose or rule out sepsis, doctors draw blood and sometimes examine cerebrospinal fluid and other body fluids to look for bacteria or other pathogens. They typically look for sepsis and meningitis in the same work-up. Once a positive diagnosis is made, the child will receive a course of antibiotics during a stay in the hospital.

Conjunctivitis

What is it?

Some newborns develop an inflammation of the eye's covering membranes (or conjunctiva), known as conjunctivitis or pinkeye, which appears as redness and swelling in the eye, usually accompanied by a discharge. Both bacterial and viral infections can cause conjunctivitis in newborns.

How is it diagnosed and treated?

A thorough physical examination and lab tests on a sample of discharge from the eye will help the doctor determine the cause of the infection. Antibiotics, eye drops, or ointment may used to treat conjunctivitis in a newborn. The infection can be very contagious, so the doctor may also suggest that other children in the family limit contact with the baby. If a more serious type of conjunctivitis is suspected, hospitalization may be necessary.

Candidiasis

What is it?

An overgrowth of the common yeast candida, found on everyone's body, leads to the fungal infection candidiasis. In newborns, it usually shows up as diaper rash, but babies can also develop oral thrush in the mouth and throat. It causes cracks in the corners of the mouth and white patches on the tongue, palate, lips, and insides of the cheeks. Newborns who get thrush have often picked up the fungus from the mother's vagina during delivery or during breastfeeding.

How is it diagnosed and treated?

Sometimes the doctor will take a swab of one of the patches in the mouth and examine it for signs of the fungus. In most cases, this isn't necessary and treatment is started based on the appearance of the mouth lesions alone. Thrush can be treated with liquid antifungal medicine.

Congenital Infections

What are they?

Many infections that affect newborns are transmitted from mother to infant, either during pregnancy or delivery. Because the baby is born with them, they're known as congenital infections. They are most often caused by viruses and parasites.

Congenital infections include: HIV (which causes AIDS); rubella (German measles); chickenpox; syphilis; herpes; toxoplasmosis; and cytomegalovirus (CMV), the most common congenital infection and the leading cause of congenital hearing loss. Several of these infections, such as GBS infection and listeriosis, can be acquired either from the mother or later from the newborn's environment.

It's more likely that babies will be born with an infection if their mothers become infected for the first time with a particular germ while pregnant. However, transmission to the baby doesn't always occur, so many babies born to mothers with these infections don't have the infection themselves. Other newborns may not initially show signs of disease, but may later exhibit its effects.

The risk these infections pose to an infant often depends on when the mother is exposed to the germ. With many infections, such as rubella and toxoplasmosis, the risk is greatest in the first trimester. If the mother becomes infected then, it can cause serious problems such as heart disease, brain damage, deafness, visual impairment, or even miscarriage. Infection later in the pregnancy may lead to less severe effects on the fetus but can still cause problems with the infant's growth or development.

Some early signs of a possible congenital infection include: a large or small head, small body size, seizures, problems with the eyes, skin rashes, jaundice, enlarged abdominal organs, and a heart murmur.

How are they diagnosed and treated?

If a congenital infection is suspected, a doctor will run blood tests and cultures of blood and other fluids from the infant, and sometimes the mother, to try to make a diagnosis. Treatment often includes the antiviral or antibiotic medications that are used to treat the diseases in older patients, as well as intense supportive care while the baby's in the hospital. Congenital infections also call for close medical follow-up to watch for any effects of the disease that may develop as the infant grows.

Complications of Neonatal Infections

Neonatal infections that aren't treated promptly or that spread can have serious consequences. Because babies' bodies and organs are undergoing rapid development, any interruption in that process can lead to complications, including growth, developmental, neurological, cardiac, respiratory, and sensory problems. In some severe cases, neonatal infections can even be fatal.

With their fragile new immune systems, babies aren't well equipped to deal with infection. Premature or otherwise immunocompromised babies are at an even greater risk of developing a critical disease from a bacterium or virus that might cause a simple illness in an older child. An early diagnosis, swift treatment, and close monitoring and care give a baby the best chance of overcoming the infection.

Can Neonatal Infections Be Prevented?

If a pregnant woman is diagnosed with one of these infections, or if she is considered at risk of infection, preventive measures can lower the probability that she will pass it to her baby. Because many infections can be treated with medicine given to the mother while she's pregnant, maternal testing is extremely useful.

In many cases, a quick blood or fluid test can determine if a pregnant woman should receive treatment. For a woman with listeriosis, a course of antibiotics usually prevents transmission of the bacterium to the fetus. Women who are HIV positive are advised to take antiretroviral medication during pregnancy to lower the risk that their babies will contract HIV infection.

Other neonatal infections are best prevented through steps that keep expectant mothers from developing the infection in the first place.

Women can help protect themselves and their unborn babies by:

• making sure they've been immunized against rubella and chickenpox infection before trying to become pregnant

• thoroughly washing and cooking food, regularly washing hands (particularly before and after preparing food, after using the toilet, and after coming into contact with bodily fluids and waste), and avoiding all contact with cat and other animal feces to lower the risk of contracting bacteria and parasites that lead to infections such as listeriosis and toxoplasmosis

• practicing safe sex to avoid sexually transmitted diseases (STDs) that can lead to congenital infections

Some preventive measures are routine parts of pregnancy and delivery. Many doctors recommend that an expectant mother have a simple swab test late in pregnancy to check whether she's carrying GBS. If she is, she will receive intravenous (IV) antibiotics during delivery to lower the risk of transmitting the bacteria to her baby. Doctors also routinely put antibiotic drops or ointment in newborns' eyes to prevent conjunctivitis caused by gonorrhea bacteria.

Mononucleosis

What Is "Mono"?

Mononucleosis — or "mono" — is an infection that produces flu-like symptoms, and usually goes away on its own in a few weeks with the help of plenty of fluids and rest.

Mono is usually caused by the Epstein-Barr virus (EBV), a very common virus that most kids are exposed to at some point while growing up. Infants and young kids infected with EBV usually have very mild symptoms or none at all. But teens and young adults who become infected often develop mono.

Mono is spread through kissing, coughing, sneezing, or any contact with the saliva of someone who has been infected with the virus. (That's how mono got nicknamed "the kissing disease.") It can also be spread through other types of direct contact, like sharing a straw or an eating utensil. Researchers believe that mono may be spread sexually as well.

Symptoms

Symptoms of mono can often be mistaken for the flu or strep throat. Call your doctor if your child has a fever, a sore throat, swollen lymph nodes (in the neck, underarms, or groin), or unexplained constant fatigue or weakness.

Other symptoms of mono can include:

• headaches
• sore muscles
• larger-than-normal liver and spleen
• skin rash
• abdominal pain

Kids with mono may have different combinations of these symptoms, and some teens may have symptoms so mild that they are hardly noticeable. Your doctor will likely perform a blood test to make a firm diagnosis.

Mono symptoms usually go away on their own within 2 to 4 weeks. But in some teens, the fatigue and weakness can last for months.

Mono and Sports

Doctors usually recommend that kids who get mono avoid sports for at least a month after symptoms are gone because the spleen is usually enlarged temporarily from the illness. An enlarged spleen can rupture easily — causing internal bleeding, fever, and abdominal pain — and require emergency surgery. Vigorous activities, contact sports, weightlifting, cheerleading, or even wrestling with siblings or friends should be avoided until your doctor gives the OK.

Complications

Most kids who get mono recover completely with no problem, but in rare cases, complications can occur. These can include problems with the liver or spleen, anemia, meningitis, trouble breathing, or inflammation of the heart.

Prevention and Treatment

There is no vaccine for the Epstein-Barr virus, but you can try to protect your kids from mono by making sure that they avoid close contact with other kids who have it. But sometimes people have the virus without any symptoms and can still pass it to others. So teach your kids to wash their hands often, and not to share drinks or eating utensils with others, even when they seem healthy.

The best treatment for mono is plenty of rest, especially early in the course of the illness when symptoms are the most severe. Acetaminophen or ibuprofen can help to relieve the fever and aching muscles. Remember, never give aspirin to a child who has a viral illness because this has been associated with the development of Reye syndrome, which may lead to liver failure and can be fatal.

In most cases, the symptoms of mono go away in a matter of weeks with plenty of rest and fluids. If the symptoms seem to linger, or if you have any other questions, talk with your doctor.

Middle Ear Infections

A Close Look at the Ear

Next to the common cold, ear infections are the most commonly diagnosed childhood illness in the United States. More than 3 out of 4 kids have had at least one ear infection by the time they reach 3 years of age. To understand how ear infections develop, let's review how the ear works.

Think about how you can feel speakers vibrate as you listen to your favorite CD in the car or how you feel your throat vibrate when you speak. Sound, which is made up of invisible waves of energy, causes these vibrations. Every time you hear a sound, the various structures of the ear have to work together to make sure the information gets to the brain.

The ear is responsible for hearing and balance and is made up of three parts — the outer ear, middle ear, and inner ear. Hearing begins when sound waves that travel through the air reach the outer ear, or pinna, which is the part of the ear that's visible. The sound waves then travel from the pinna through the ear canal to the middle ear, which includes the eardrum (a thin layer of tissue) and three tiny bones called ossicles. When the eardrum vibrates, the ossicles amplify these vibrations and carry them to the inner ear.

The inner ear translates the vibrations into electric signals and sends them to the auditory nerve, which connects to the brain. When these nerve impulses reach the brain, they're interpreted as sound.

The Eustachian Tube

To function properly, the middle ear must be at the same pressure as the outside world. This is taken care of by the eustachian tube, a small passage that connects the middle ear to the back of the throat behind the nose.

By letting air reach the middle ear, the eustachian tube equalizes the air pressure in the middle ear to the outside air pressure. (When your ears "pop" while yawning or swallowing, the eustachian tubes are adjusting the air pressure in your middle ears.) The eustachian tube also allows for drainage of mucus from the middle ear into the throat.

Sometimes, the eustachian tube may malfunction. For example, when someone has a cold or an allergy affecting the nasal passages, the eustachian tube may become blocked by congestion in its lining or by mucus within the tube. This blockage will allow fluid to build up within the normally air-filled middle ear. Bacteria or viruses that have entered the middle ear through the eustachian tube can also get trapped in this way. These germs can breed in the trapped fluid, eventually leading to an ear infection.

About Middle Ear Infections

Inflammation in the middle ear area is known as otitis media. When referring to an ear infection, doctors most likely mean "acute otitis media" rather than the common ear infection called swimmer's ear, or otitis externa.

Acute otitis media is the presence of fluid, typically pus, in the middle ear with symptoms of pain, redness of the eardrum, and possible fever.

Other forms of otitis media are either more chronic (fluid is in the middle ear for 6 or more weeks) or the fluid in the middle ear is temporary and not necessarily infected (called otitis media with effusion).

Doctors try to distinguish between the different forms of otitis because this affects treatment options. Not all forms of otitis need to be treated with antibiotics.

Causes

Kids develop ear infections more frequently in the first 2 to 4 years of life for several reasons:

• Their eustachian tubes are shorter and more horizontal than those of adults, which allows bacteria and viruses to find their way into the middle ear more easily. Their tubes are also narrower and less stiff, which makes them more prone to blockage.

• The adenoids, which are gland-like structures located in the back of the upper throat near the eustachian tubes, are large in children and can interfere with the opening of the eustachian tubes.

A number of other factors can contribute to kids getting ear infections, such as exposure to cigarette smoke, bottle-feeding, and day-care attendance.

Ear infections also occur more commonly in boys than girls, in kids whose families have a history of ear infections, and during the winter season when upper respiratory tract infections or colds are frequent.

Signs and Symptoms

The signs and symptoms of acute otitis media may range from very mild to severe:

• The fluid in the middle ear may push on the eardrum, causing ear pain. An older child may complain of an earache, but a younger child may tug at the ear or simply act irritable and cry more than usual.

• Lying down, chewing, and sucking can also cause painful pressure changes in the middle ear, so a child may eat less than normal or have trouble sleeping.

• If the pressure from the fluid buildup is high enough, it can cause the eardrum to rupture, resulting in drainage of fluid from the ear. This releases the pressure behind the eardrum, usually bringing relief from the pain.

Signs of Hearing Difficulties

Fluid buildup in the middle ear also blocks sound, which can lead to temporary hearing difficulties. A child may:

• not respond to soft sounds
• turn up the television or radio
• talk louder
• appear to be inattentive at school

Other symptoms of acute otitis media can include:

• fever
• nausea
• vomiting
• dizziness

However, otitis media with effusion often has no symptoms. In some kids, the fluid that's in the middle ear may create a sensation of ear fullness or "popping." As with acute otitis media, the fluid behind the eardrum can block sound, so mild temporary hearing loss can happen, but might not be obvious.

Ear infections are also frequently associated with upper respiratory tract infections and, therefore, with their common signs and symptoms, such as a runny or stuffy nose or a cough.

Contagiousness

Ear infections are not contagious, though the cold that may lead to one can be.

Duration

Middle ear infections often go away on their own within 2 or 3 days, even without any specific treatment. If your doctor decides to prescribe antibiotics, a 10-day course is usually recommended.

For kids 6 years of age and older with a mild to moderate infection, a shortened course of antibiotics (5 to 7 days) may be appropriate.

But even after antibiotic treatment for an episode of acute otitis media, fluid may remain in the middle ear for up to several months.

Diagnosis and Treatment

A child who might have an ear infection should visit a doctor, who should be able to make a diagnosis by taking a medical history and doing a physical exam.

To examine the ear, doctors use an otoscope, a small instrument similar to a flashlight, through which they can see the eardrum.

There's no single best approach for treating all middle ear infections. In deciding how to manage your child's ear infection, a doctor will consider many factors, including:

• the type and severity of the ear infection
• how often your child has ear infections
• how long this infection has lasted
• your child's age
• risk factors your child may have
• whether the infection affects your child's hearing

The fact that most ear infections can clear on their own has led a number of physician associations to recommend a "wait-and-see" approach, which involves giving the child pain relief without antibiotics for a few days.

Another important reason to consider this type of approach are the limitations of antibiotics, which:

• won't help an infection caused by a virus
• won't eliminate middle ear fluid
• may cause side effects
• typically do not relieve pain in the first 24 hours and have only a minimal effect after that

Also, frequent use of antibiotics can lead to the development of antibiotic-resistant bacteria, which can be much more difficult to treat.

When Antibiotics Are Required

However, kids who get a lot of ear infections may be prescribed daily antibiotics by their doctor to help prevent future infections. And younger children or those with more severe illness may require antibiotics right from the start.

The "wait-and-see" approach also might not apply to children with other concerns, such as cleft palate, genetic conditions such as Down syndrome, underlying illnesses such as immune system disorders, or a history of recurrent acute otitis media.

Kids with persistent otitis media with effusion (lasting longer than 3 months) should be reexamined periodically (every 3 to 6 months) by their doctors. Often, though, even these kids won't require treatment.

Whether or not the choice is made to treat with antibiotics, you can help to reduce the discomfort of an ear infection by using acetaminophen or ibuprofen for pain and fever as needed. Your doctor may also recommend using pain-relieving eardrops as long as the eardrum hasn't ruptured.

But certain children, such as those with persistent hearing loss or speech delay, may require ear tube surgery. In some cases, an ear, nose, and throat doctor will suggest surgically inserting tubes (called tympanostomy tubes) in the tympanic membrane. This allows fluid to drain from the middle ear and helps equalize the pressure in the ear because the eustachian tube is unable to.

Prevention

Some factors associated with the development of ear infections can't be changed (such as family history of frequent ear infections), but certain lifestyle choices can minimize the risk for kids:

• breastfeed infants for at least 6 months to help to prevent the development of early episodes of ear infections. If a child is bottle-fed, hold the infant at an angle rather than allowing the child to lie down with the bottle.
• prevent exposure to secondhand smoke, which can increase the frequency and severity of ear infections
• reduce exposure, if possible, to large groups of other kids, such as in child-care centers. Because multiple upper respiratory infections may also lead to frequent ear infections, limiting exposure may result in less frequent colds early on and, therefore, fewer ear infections.
• both parents and kids should practice good hand washing. This is one of the most important ways to decrease person-to-person transmission of the germs that can cause colds and, therefore, ear infections.
• keep children's immunizations up-to-date, because certain vaccines can help prevent ear infections

Also be aware that research has shown that cold and allergy medications, such as antihistamines and decongestants, aren't helpful in preventing ear infections.

When to Call the Doctor

Although quite rare, ear infections that don't go away or severe repeated middle ear infections can lead to complications, including spread of the infection to nearby bones. So kids with an earache or a sense of fullness in the ear, especially when combined with fever, should be evaluated by their doctors if they aren't improving.

Other conditions can also result in earaches, such as teething, a foreign object in the ear, or hard earwax. Consult your doctor to help determine the cause of the discomfort and how to treat it.

Fever and Taking Your Child's Temperature

The bane of many parents, the head louse is a tiny, wingless parasitic insect that lives among human hairs and feeds on extremely small amounts of blood drawn from the scalp. Although they may sound gross, lice (the plural of louse) are a very common problem, especially for kids ages 3 years to 12 years (girls more often than boys).

Lice aren't dangerous and they don't spread disease, but they are contagious and can just be downright annoying. Their bites may cause a child's scalp to become itchy and inflamed, and persistent scratching may lead to skin irritation and even infection.

Signs of Head Lice

Though very small, lice can be seen by the naked eye. What you or your doctor might see by thoroughly examining your child's head:

Lice eggs (called nits). These look like tiny yellow, tan, or brown dots before they hatch. After hatching, the remaining shell looks white or clear. Lice lay nits on hair shafts close to the skin's surface, where the temperature is perfect for keeping warm until they hatch. Nits look sort of like dandruff, only they can't be removed by brushing or shaking them off. Unless the infestation is heavy, it's more common to see nits in a child's hair than it is to see live lice crawling on the scalp. Lice eggs hatch within 1 to 2 weeks after they're laid.

Adult lice and nymphs (baby lice). The adult louse is no bigger than a sesame seed and is grayish-white or tan. Nymphs are smaller and become adult lice about 1 to 2 weeks after they hatch. Most lice feed on blood several times a day, but they can survive up to 2 days off the scalp.

Scratching. With lice bites come itching and scratching. However, the itching may not always start right away — that depends on how sensitive your child's skin is to the lice. It can sometimes take weeks for kids with lice to start scratching. They may complain, though, of things moving around on or tickling their heads.

Small, red bumps or sores from scratching. For some kids, the irritation is mild; for others, a more bothersome rash may develop. Excessive scratching can lead to a bacterial infection (the skin would become red and tender and may have crusting and oozing along with swollen lymph glands). If your doctor thinks this is the case, he or she may treat the infection with an oral antibiotic.

You may be able to see the lice or nits by parting your child's hair into small sections and checking for lice and nits on the scalp, behind the ears, and around the nape of the neck (it's rare for them to be found on eyelashes or eyebrows). A magnifying glass and bright light may help. But it can be tough to find a nymph or adult louse — often, there aren't many of them and they're able to move fast.

Call your doctor if your child is constantly scratching his or her head or complains of an itchy scalp that won't go away. The doctor should be able to tell you if your child is infested with lice and needs to be treated.

Also be sure to check with your child's school nurse or childcare center director to see if other kids have recently been treated for lice. If you discover that your child does, indeed, have lice or nits, contact the staff at the school and childcare center to let them know.

Are Lice Contagious?

Lice are highly contagious and can spread quickly from person to person, especially in group settings (schools, childcare centers, slumber parties, sports activities, and camps).

Though they can't fly or jump, these tiny parasites have specially adapted claws that allow them to crawl and cling firmly to hair. They spread mainly through head-to-head contact, but sharing clothing, bed linens, combs, brushes, and hats can also help pass them along. Kids are most prone to catching lice because they tend to have close physical contact with each other and often share personal items.

And you may wonder if Fido or Fluffy may be catching the pests and passing them on to your family. But rest assured that pets can't catch head lice and pass them on to people or the other way around.

Treatment

Your doctor can recommend a medicated shampoo, cream rinse, or lotion to kill the lice. These may be over-the-counter (OTC) or prescription medications, depending on what treatments have already been tried. Medicated lice treatments usually kill the lice and nits, but it may take a few days for the itching to stop.

It's important to follow the directions exactly because these products are insecticides. Applying too much medication or too frequently can increase the risk of causing harm. Following the directions on the product label is also important to ensure that the treatment works properly.

Treatment may be unsuccessful if the medication is not used correctly or if the lice are resistant to the medication. After treatment, your doctor may suggest combing out the nits with a fine-tooth comb and also may recommend repeating treatment in 7 to 10 days to kill any newly hatched nits.

If your child is 2 years old or under, you should not use medicated lice treatments. You'll need to remove the nits and lice by hand.

To remove lice and nits by hand, use a fine-tooth comb on your child's wet, conditioned hair every 3 to 4 days for 2 weeks after the last live louse was seen. Wetting the hair beforehand is recommended because it temporarily immobilizes the lice and the conditioner makes it easier to get a comb through the hair. Wet combing is also an alternative to pesticide treatments in older children. Though petroleum jelly, mayonnaise, or olive oil are sometimes used in an attempt to suffocate head lice, these treatments have not been proven to be effective.

Keep in mind that head lice don't survive long once they fall off a person. So it's unnecessary to spend a great deal of time and money trying to rid the house of lice.

Here are some simple ways to get rid of the lice and their eggs, and help prevent a lice reinfestation:

• Wash all bed linens and clothing that's been recently worn by anyone in your home who's infested in very hot water (130° Fahrenheit, 54.4° Celsius), then put them in the hot cycle of the dryer for at least 20 minutes.

• Dry clean any clothing that isn't machine washable.

• Have bed linens, clothing, and stuffed animals and plush toys that can't be washed dry-cleaned. Or, put them in airtight bags for 2 weeks.

• Vacuum carpets and any upholstered furniture (in your home or car).

• Soak hair-care items like combs, barrettes, hair ties or bands, headbands, and brushes in rubbing alcohol or medicated shampoo for 1 hour. You can also wash them in hot water or just throw them away.

Because lice are easily passed from person to person in the same house, bedmates and infested family members will also need treatment to prevent the lice from coming back.

In your efforts to get rid of the bugs, there are some things you shouldn't do. Some don'ts of head lice treatment include:

• Don't use a hair dryer on your child's hair after applying any of the currently available scalp treatments because some contain flammable ingredients.
• Don't use a cream rinse or shampoo/conditioner combination before applying lice medication.
• Don't wash your child's hair for 1 to 2 days after using a medicated treatment.
• Don't use sprays or hire a pest control company to try to get rid of the lice, as they can be harmful.
• Don't use the same medication more than three times on one person. If it doesn't seem to be working, your doctor may recommend another medication.
• Don't use more than one head lice medication at a time.

Preventing Lice

Having head lice is not a sign of uncleanliness or poor hygiene. The pesky little bugs can be a problem for kids of all ages and socioeconomic levels, no matter how often they do — or don't — clean their hair or bathe.

However, you can help to prevent kids from getting lice — or from becoming reinfested with lice — by taking the following precautions:

• Tell kids to try to avoid head-to-head contact at school (in gym, on the playground, or during sports) and while playing at home with other children.

• Tell kids not to share combs, brushes, hats, scarves, bandanas, ribbons, barrettes, hair ties or bands, towels, helmets, or other personal care items with anyone else, whether they may have lice or not.

• Tell kids not to lie on bedding, pillows, and carpets that have recently been used by someone with lice.

• Every 3 or 4 days, examine members of your household who have had close contact with a person who has lice. Then, treat those who are found to have lice or nits close to the scalp.

Will They Ever Be Gone?

As many parents know firsthand, lice infestation can be a persistent nuisance, especially in group settings. If you feel like you're following every recommendation and your child still has lice, it may be because:

• there are still some nits left behind
• your child is still being exposed to someone with lice
• the treatment you're using isn't effective

There's no doubt that they can be hard bugs to get rid of. If your child still has lice for 2 weeks after you started treatment or if your child's scalp looks infected, call your doctor.

No matter how long the problem lasts, be sure to emphasize to your child that although having lice can certainly be very embarrassing, anyone can get them. It's important for kids to understand that they haven't done anything wrong and that having lice doesn't make them dirty. And reassure them that as aggravating as getting rid of the annoying insects can be, there is light at the end of the tunnel.

Be patient and follow the treatments and preventative tips as directed by your doctor for keeping the bugs at bay, and you'll be well on your way to keeping your family lice-free.

Common Cold

Bringing sniffles and sneezes and perhaps a sore throat and annoying cough, the common cold catches all of us from time to time.

With kids getting as many as eight colds per year or more, this contagious viral infection of the upper respiratory tract is the most common infectious disease in the United States and the No. 1 reason kids visit the doctor and stay home from school.

Causes

Most colds are caused by rhinoviruses that are in invisible droplets in the air we breathe or on things we touch. More than 100 different rhinoviruses can infiltrate the protective lining of the nose and throat, triggering an immune system reaction that can cause a throat sore and headache, and make it hard to breathe through the nose.

Air that's dry — indoors or out — can lower resistance to infection by the viruses that cause colds. And so can being a smoker or being around someone who's smoking. People who smoke are more likely to catch a cold than people who don't — and their symptoms will probably be worse, last longer, and are more likely to lead to bronchitis or even pneumonia.

But despite what old wives' tales may have you believe, not wearing a jacket or sweater when it's chilly, sitting or sleeping in a draft, and going outside while your hair's wet do not cause colds.

Signs and Symptoms

The first symptoms of a cold are often a tickle in the throat, a runny or stuffy nose, and sneezing. Kids with colds may also have a sore throat, cough, headache, mild fever, fatigue, muscle aches, and loss of appetite. Nasal discharge may change from watery to thick yellow or green.

Contagiousness

Colds are most contagious during the first 2 to 4 days after symptoms appear, and may be contagious for up to 3 weeks. Your can catch a cold from person-to-person contact or by breathing in virus particles spread through the air by sneezing or coughing. Touching the mouth or nose after touching skin or another surface contaminated with a rhinovirus can also spread a cold.

Prevention

Because so many viruses cause them, there isn't a vaccine that can protect against catching colds. But to help prevent them, kids should:

• try to steer clear of anyone who smokes or who has a cold. Virus particles can travel up to 12 feet through the air when someone with a cold coughs or sneezes, and secondhand smoke can make your child more likely to get sick.
• wash their hands thoroughly and frequently, especially after blowing their noses
• cover their noses and mouths when coughing or sneezing (have them sneeze or cough into a shirtsleeve, though, not their hands — this helps prevent the spread of germs)
• not use the same towels or eating utensils as someone who has a cold. They also shouldn't drink from the same glass, can, or bottle as anyone else — you never know who might be about to come down with a cold and is already spreading the virus.
• not pick up other people's used tissues

Researchers aren't sure whether taking extra zinc or vitamin C can limit how long cold symptoms last or how severe they become, but large doses taken every day can cause negative side effects.

The results of most studies on the value of herbal remedies, such as echinacea, are either negative or inconclusive, and few properly designed scientific studies of these treatments have been done in kids.

Talk to your doctor before you decide to give your child any herbal remedy or more than the recommended daily allowance (RDA) of any vitamin or supplement.

Duration

Cold symptoms usually appear 2 or 3 days after exposure to a source of infection. Most colds clear up within 1 week, but some last for as long as 2 weeks.

Treatment

"Time cures all." That may not always be true, but in the case of the common cold, it's pretty close. Medicine can't cure the common cold, but it can be used to relieve such symptoms as muscle aches, headache, and fever. You can give your child acetaminophen or ibuprofen based on the package recommendations for age or weight.

However, aspirin should never be given to children younger than 12, and all kids and teens under age 19 shouldn't take aspirin during viral illnesses, because such use may increase the risk of developing Reye syndrome, a rare but serious condition that can be fatal.

Although you may be tempted to give your child over-the-counter (OTC) decongestants and antihistamines to try to ease the cold symptoms, there's little or no evidence to support that they actually work. In fact, decongestants can cause hallucinations, irritability, and irregular heartbeats in infants and shouldn't be used in children younger than 2 without first consulting a doctor.

Some ways you can help ease cold discomfort include:

• saltwater drops in the nostrils to relieve nasal congestion (you can buy these — also called saline nose drops — at any pharmacy)
• a cool-mist humidifier to increase air moisture
• petroleum jelly on the skin under the nose to soothe rawness
• hard candy or cough drops to relieve sore throat (for kids older than 3 years)
• a warm bath or heating pad to soothe aches and pains
• steam from a hot shower to help your child breathe more easily

But what about chicken soup? There's no real proof that eating it can cure a cold, but sick people have been swearing by it for more than 800 years. Why? Chicken soup contains a mucus-thinning amino acid called cysteine, and some research shows that chicken soup helps control congestion-causing white cells, called neutrophils.

The best plan, though, is not to worry about whether to "feed a cold" or "starve a fever." Just make sure your child eats when hungry and drinks plenty of fluids like water or juice to help replace the fluids lost during fever or mucus production. Avoid serving caffeinated beverages, though, which can cause frequent urination and, therefore, increase the risk of dehydration.

When to Call the Doctor

Your doctor won't be able to identify the specific virus causing cold symptoms, but can examine your child's throat and ears and take a throat culture to make sure the symptoms aren't from another condition that may need specific treatment. (If your child's symptoms get worse instead of better after 3 days or so, the problem could be strep throat, sinusitis, pneumonia, or bronchitis, especially if your child or teen smokes.)

Taking a throat culture is a simple, painless procedure that involves brushing the inside of the throat with a long cotton swab. Examining the germs that stick to the swab will help the doctor determine whether your child has strep throat and needs treatment with antibiotics.

If symptoms last for more than a week, appear at the same time every year, or occur when your child is exposed to pollen, dust, animals, or another substance, your child could have an allergy. A child who has trouble breathing or wheezes when he or she catches a cold could have asthma.

Also see your doctor if you think your child might have more than a cold or is getting worse instead of better.

Also call the doctor if your child has any of these symptoms:

• coughing up a lot of mucus
• shortness of breath
• unusual lethargy/tiredness
• inability to keep food or liquids down or poor fluid intake
• increasing headache or facial or throat pain
• severely painful sore throat that interferes with swallowing
• fever of 103 degrees Fahrenheit (39.3° Celsius) or higher, or a fever of 101° F (38.0° C) or higher that lasts for more than a day
• chest or stomach pain
• swollen glands (lymph nodes) in the neck
• earache

Like most virus infections, colds just have to run their course. Getting plenty of rest, avoiding vigorous activity, and drinking lots of fluids — juice, water, and noncaffeinated beverages — all may help your child feel better while on the mend.

Keeping up regular activities like going to school probably won't make a cold any worse. But it will increase the likelihood that the cold will spread to classmates or friends. So you might want to put some daily routines aside until your child is feeling better.

Cold Sores

About Cold Sores

Cold sores are small and painful blisters that can appear around the mouth, face, or nose. Sometimes referred to as fever blisters, they're caused by herpes simplex virus type 1 (HSV-1). Kids can get cold sores by kissing or sharing eating utensils with an infected person.

Colds sores in the mouth are very common, and many kids get infected with HSV-1 during the preschool years. The sores usually go away on their own within about a week.

Symptoms

Most kids who get cold sores get infected by eating or drinking from the same utensils as someone who is infected with the herpes virus or by getting kissed by an infected adult.

The cold sores first form blisters on the lips and inside the mouth. The blisters then become sores. In some cases, the gums become red and swollen. In other cases, the virus also leads to a fever, muscle aches, eating difficulties, a generally ill feeling, irritability, and swollen neck glands. These symptoms can last up to 2 weeks.

After a child is initially infected, the virus can lie dormant without causing any symptoms. But it can reactivate later, typically after some sort of stress like a cold, an infection, hormonal change, menstrual periods, or even before a big test at school. If the virus is reactivated it can cause tingling and numbness around the mouth and a blister.

Treatment

Usually, HSV-1 causes cold sores in the mouth or face, and herpes simplex virus type 2 (HSV-2) causes lesions in the genital area, resulting in genital herpes. But sometimes, HSV-1 can cause genital lesions as well, especially if someone has received oral sex from an infected partner.

Cold sores from HSV-1 usually go away on their own within 5 to 7 days. Although no medications can make the infection go away, some treatments are available that can shorten the length of the outbreak and make the cold sores less painful.

Cool foods and drinks can help relieve discomfort, and acetaminophen may also ease the pain. Aspirin should not be given to kids with viral infections since it has been associated with Reye syndrome.

Call the doctor if your child:

• has another health condition that has weakened the immune system, which could allow the HSV infection to spread and cause problems in other parts of the body
• has sores that don't heal by themselves within 7 to 10 days
• has any sores near the eyes
• gets cold sores frequently

Since the virus that causes cold sores is so contagious, it's important to prevent it from spreading to other family members. Precautions to take with kids who have cold sores include:

• keeping their drinking glasses and eating utensils separate from those used by other family members and washing these items thoroughly after use
• teaching them not to kiss others until the sores heal
• having them wash their hands frequently and as soon as possible after touching the cold sores
• trying to keep them from touching their eyes — if HSV infects the eyes, it can be very serious

If you're caring for a child with a cold sore, you also should be sure to wash your hands frequently so that you don't contract the virus or spread it to others.

Chickenpox

About Chickenpox

Chickenpox is a common illness among kids, particularly those under age 12. An itchy rash of spots that look like blisters can appear all over the body and be accompanied by flu-like symptoms. Symptoms usually go away without treatment, but because the infection is very contagious, an infected child should stay home and rest until the symptoms are gone.

Chickenpox is caused by the varicella-zoster virus (VZV). Kids can be protected from VZV by getting the chickenpox (varicella) vaccine, usually between the ages of 12 to 15 months. The Centers for Disease Control and Prevention (CDC) also recommends a booster shot at 4 to 6 years old for further protection. The CDC also recommends that people 13 years of age and older who have never had chickenpox or received the chickenpox vaccine get two doses of the vaccine at least 28 days apart.

A person usually has only one episode of chickenpox, but VZV can lie dormant within the body and cause a different type of skin eruption later in life called shingles (or herpes zoster). Getting the chickenpox vaccine significantly lowers kids' chances of getting chickenpox, but they might still develop shingles later in life.

Symptoms

Chickenpox causes a red, itchy skin rash that usually appears first on the abdomen or back and face, and then spreads to almost everywhere else on the body, including the scalp, mouth, nose, ears, and genitals.

The rash begins as multiple small red bumps that look like pimples or insect bites. They develop into thin-walled blisters filled with clear fluid, which becomes cloudy. The blister wall breaks, leaving open sores, which finally crust over to become dry, brown scabs.

Chickenpox blisters are usually less than a quarter of an inch wide, have a reddish base, and appear in crops over 2 to 4 days. The rash may be more extensive or severe in kids who have skin disorders such as eczema.

Some kids have a fever, abdominal pain, sore throat, headache, or a vague sick feeling a day or 2 before the rash appears. These symptoms may last for a few days, and fever stays in the range of 100°-102° F (37.7°-38.8° C), though in rare cases may be higher. Younger kids often have milder symptoms and fewer blisters than older children or adults.

Chickenpox is usually a mild illness, but can affect some infants, teens, adults, and people with weak immune systems more severely. Some people can develop serious bacterial infections involving the skin, lungs, bones, joints, and the brain (encephalitis). Even kids with normal immune systems can occasionally develop complications, most commonly a skin infection near the blisters.

Anyone who has had chickenpox (or the chickenpox vaccine) as a child is at risk for developing shingles later in life, and up to 20% do. After an infection, VZV can remain inactive in nerve cells near the spinal cord and reactivate later as shingles, which can cause tingling, itching, or pain followed by a rash with red bumps and blisters. Shingles is sometimes treated with antiviral drugs, steroids, and pain medications, and there's now a shingles vaccine for people 60 and older.

Contagiousness

Chickenpox is contagious from about 2 days before the rash appears until all the blisters are crusted over. A child with chickenpox should be kept out of school until all blisters have dried, usually about 1 week. If you're unsure about whether your child is ready to return to school, ask your doctor.

Chickenpox is very contagious — most kids with a sibling who's been infected will get it as well (if they haven't already had the disease or the vaccine), showing symptoms about 2 weeks after the first child does. To help keep the virus from spreading, make sure your kids wash their hands frequently, particularly before eating and after using the bathroom. And keep a child with chickenpox away from unvaccinated siblings as much as possible.

People who haven't had chickenpox or the vaccine also can catch it from someone with shingles, but they cannot catch shingles itself. That's because shingles can only develop from a reactivation of VZV in someone who has previously had chickenpox.

Chickenpox and Pregnancy

Pregnant women and anyone with immune system problems should not be near a person with chickenpox. If a pregnant woman who hasn't had chickenpox in the past contracts it (especially in the first 20 weeks of pregnancy), the fetus is at risk for birth defects and she is at risk for more health complications than if she'd been infected when she wasn't pregnant. If she develops chickenpox just before or after the child is born, the newborn is at risk for serious health complications. There is no risk to the developing baby if the woman develops shingles during the pregnancy.

If a pregnant woman has had chickenpox before the pregnancy, the baby will be protected from infection for the first few months of life, since the mother's immunity gets passed on to the baby through the placenta and breast milk.

Those at risk for severe disease or serious complications — such as newborns whose mothers had chickenpox at the time of delivery, patients with leukemia or immune deficiencies, and kids receiving drugs that suppress the immune system — may be given varicella zoster immune globulin after exposure to chickenpox to reduce its severity.

Prevention

Doctors recommend that kids receive the chickenpox vaccine when they're 12 to 15 months old and a booster shot at 4 to 6 years old. The vaccine is about 70% to 85% effective at preventing mild infection, and more than 95% effective in preventing moderate to severe forms of the infection. Therefore, although some kids who are immunized still will get chickenpox, the symptoms are usually much milder than those of kids who haven't had the vaccine and become infected.

Healthy kids who have had chickenpox do not need the vaccine — they usually have lifelong protection against the illness.

Treatment

A virus causes chickenpox, so the doctor won't prescribe antibiotics. However, antibiotics may be required if the sores become infected by bacteria. This is pretty common among kids because they often scratch and pick at the blisters.

The antiviral medicine acyclovir may be prescribed for people with chickenpox who are at risk for complications. The drug, which can make the infection less severe, must be given within the first 24 hours after the rash appears. Acyclovir can have significant side effects, so it is only given when necessary. Your doctor can tell you if the medication is right for your child.

Dealing With Discomfort

To help relieve the itchiness, fever, and discomfort of chickenpox:

• Use cool wet compresses or give baths in cool or lukewarm water every 3 to 4 hours for the first few days. Oatmeal bath products, available at supermarkets and drugstores, can help to relieve itching. (Baths do not spread the rash.)

• Pat (don't rub) the body dry.

• Put calamine lotion on itchy areas (but don't use it on the face, especially near the eyes).

• Serve foods that are cold, soft, and bland because chickenpox in the mouth may make drinking or eating difficult. Avoid feeding your child anything highly acidic or especially salty, like orange juice or pretzels.

• Ask your doctor or pharmacist about pain-relieving creams to apply to sores in the genital area.

• Give your child acetaminophen regularly to help relieve pain if your child has mouth blisters.

• Ask the doctor about using over-the-counter medication for itching.

Never use aspirin to reduce pain or fever in kids with chickenpox because aspirin has been associated with the serious disease Reye syndrome, which can lead to liver failure and even death.

As much as possible, discourage kids from scratching. This can be difficult for them, so consider putting mittens or socks on your child's hands to prevent scratching during sleep. In addition, trim fingernails and keep them clean to help lessen the effects of scratching, including broken blisters and infection.

Most chickenpox infections require no special medical treatment. But sometimes, there are problems. Call the doctor if your child:

• has fever that lasts for more than 4 days or rises above 102° F (38.8° C)
• has a severe cough or trouble breathing
• has an area of rash that leaks pus (thick, discolored fluid) or becomes red, warm, swollen, or sore
• has a severe headache
• is unusually drowsy or has trouble waking up
• has trouble looking at bright lights
• has difficulty walking
• seems confused
• seems very ill or is vomiting
• has a stiff neck

Call your doctor if you think your child has chickenpox and you have a question or are concerned about a possible complication. The doctor can guide you in watching for complications and in choosing medication to relieve itching.

If taking your child to the doctor, let the office know in advance that your child might have chickenpox. It's important to try to avoid exposing other kids in the office — for some of them, a chickenpox infection could cause severe complications.

Can Chronic Ear Infections Cause Long-Term Hearing Loss?

My daughter has had one ear infection after another. When she gets an infection, she seems to have trouble hearing, but with medicine it always gets better. Still, I’m worried that these infections could lead to permanent hearing loss somewhere down the line. Could this happen?

-Liana

Ear infections are common in childhood. As with your daughter, some kids do have temporary hearing loss due to the accumulation of fluid in the middle ear, but it usually goes away with treatment.

It's very rare, however, for kids to develop permanent hearing loss, even when they've had several ear infections. A child with frequent or chronic ear infections is at risk for permanent hearing loss only when damage has been done to the eardrum, the bones of the ear, or the hearing nerve. Since your daughter's hearing appears to return to normal after treatment for an ear infection, she's probably not at risk for permanent hearing loss. But if you're concerned, talk to your doctor about scheduling a hearing exam.

If your daughter's ear infections continue to be a problem, the doctor might refer her to an otolaryngologist (ear, nose, and throat doctor), who may suggest ear tube placement to help reduce the incidence of ear infections and limit the potential problems they can cause to her hearing.

Yersiniosis

Yersiniosis is a relatively uncommon infection contracted through the consumption of undercooked meat products, unpasteurized milk, or water contaminated by the bacteria.

Usually, someone with an infection caused by Yersinia bacteria recovers within a few days without medical treatment (in some cases, doctors prescribe antibiotics).

About Yersiniosis

Of the three main types of yersiniosis that affect people, Yersinia enterocolitica (bacteria that thrive in cooler temperatures) are responsible for most infections in the United States. Still, there is only 1 confirmed case per 100,000 people each year.

The bacteria can infect the digestive tracts of humans, cats, dogs, pigs, cattle, and goats. People can contract it by eating or handling contaminated foods such as raw or undercooked meat, or by drinking untreated water or unpasteurized milk that has been contaminated.

An infant can be infected if a parent or caretaker handles contaminated food without cleaning up adequately before handling the infant's toys, bottles, or pacifiers.

Signs and Symptoms

Symptoms of yersiniosis appear 4 to 7 days after exposure and can last up to 3 weeks. They include fever, stomach pain, nausea, vomiting, and bloody diarrhea. Sometimes, older kids also get pain in the lower right side of the abdomen, which can mimic appendicitis.

If your child has these symptoms, call your doctor. For infants, it's particularly important to call the doctor as soon as symptoms appear to prevent the infection from leading to other health problems.

In rare cases, the infection can cause a skin rash or joint pain that appears a month after the initial symptoms. But these symptoms go away without treatment.

Treatment

Diarrhea caused by yersiniosis generally goes away on its own, though in some cases antibiotics are prescribed. In infants, however — particularly those who are 3 months old or younger — it can develop into a more serious condition called bacteremia, an infection of the blood. Infants who contract yersiniosis are usually treated in a hospital.

Depending on the severity of the diarrhea, your doctor may suggest modifying your child's diet for 1 to 2 days and encouraging your child to drink more fluids (which may include drinks with electrolytes to replace body fluids quickly).

If your child is frequent bouts of diarrhea, watch for signs of dehydration, including:

• severe thirst
• dry mouth or tongue
• sunken eyes
• dry skin
• infrequent urination
• in infants, a dry diaper for several hours

Prevention

To reduce the risk of yersiniosis, take these precautions:

• Don't serve eat raw or undercoooked meat.

• Drink and serve only pasteurized milk or milk products.

• Wash hands with soap and water particularly before eating and preparing food; before touching infants or their toys, bottles, or pacifiers; and after contact with animals or handling raw meat.

• Use separate cutting boards for meat and other foods.

• Clean all cutting boards, countertops, and utensils with soap and hot water after preparing raw meat.

• Always cook meat thoroughly before you eat it, especially pork products.

• Dispose of animal feces and sanitize anything they have touched.

• Avoid drinking directly from natural water sources such as ponds and mountain streams, particularly if the water is near farmland where cattle, pigs, or goats are raised.

• As you care for a family member who has diarrhea, remember to wash your hands thoroughly before touching other people and before handling food.

• If your pet dog or cat has diarrhea, wash your hands frequently as you care for it, and check with your veterinarian about treatment and/or contagiousness.

When to Call the Doctor

Call your doctor if your child:

• has diarrhea streaked with blood
• has been vomiting
• shows any signs of dehydration

With some rest, kids with yersiniosis usually make a full recovery quickly.

Shigella Infections

About

Shigella are bacteria that can infect the digestive tract and cause a wide range of symptoms, from diarrhea, cramping, vomiting, and nausea, to more serious complications and illnesses. Infections, called shigellosis, sometimes go away on their own; in others, antibiotics can shorten the course of the illness.

Shigellosis, which is most common during the summer months, usually affects kids 2 to 4 years old, and rarely infects infants younger than 6 months old.

These infections are very contagious and can be prevented with good hand washing practices.

Signs and Symptoms

Shigella bacteria produce toxins that can attack the lining of the large intestine, causing swelling, ulcers on the intestinal wall, and bloody diarrhea.

The severity of the diarrhea sets shigellosis apart from regular diarrhea. In kids with shigellosis, the first bowel movement is often large and watery. Later bowel movements may be smaller, but the diarrhea may have blood and mucus in it.

Other symptoms of shigellosis include:

• abdominal cramps
• high fever
• loss of appetite
• nausea and vomiting
• painful bowel movements

In very severe cases of shigellosis, a person may have convulsions (seizures), a stiff neck, a headache, extreme tiredness, and confusion. Shigellosis can also lead to dehydration and in rare cases, other complications, like arthritis, skin rashes, and kidney failure.

Some children with severe cases of shigellosis may need to be hospitalized.

Contagiousness

Shigellosis is very contagious. Someone may become infected by coming into in contact with something contaminated by stool from an infected person. This includes toys, surfaces in restrooms, and even food prepared by someone who is infected. For instance, kids who touch a contaminated surface such as a toilet or toy and then put their fingers in their mouths can become infected. Shigella can even be carried and spread by flies that have touched contaminated stool.

Because it doesn't take many Shigella bacteria to cause an infection, the illness spreads easily in families and childcare centers. The bacteria also may spread in water supplies in areas with poor sanitation. Shigella can be passed in the person's stool for about 4 weeks even after the obvious symptoms of illness have resolved (although antibiotic treatment can reduce the excretion of Shigella bacteria in the stool).

Prevention

The best way to prevent the spread of Shigella is by frequent and careful hand washing with soap, especially after they use the toilet and before they eat. This is especially important in childcare settings.

If you're caring for a child who has diarrhea, wash your hands before touching other people and before handling food. (Anyone with a diarrhea should not prepare food for others.) Be sure to frequently clean and disinfect any toilet used by someone with shigellosis.

Diapers of a child with shigellosis should be disposed of in a sealed garbage can, and the diaper area should be wiped with disinfectant after use. Young children (especially those still in diapers) with shigellosis or with diarrhea of any cause should be kept away from other kids.

Proper handling, storage, and preparation of food can also help prevent Shigella infections. Cold foods should be kept cold and hot foods should be kept hot to prevent bacterial growth.

Diagnosis and Treatment

To confirm the diagnosis of shigellosis, your doctor may take a stool sample to be tested for Shigella bacteria. Blood tests and other tests can also rule out other possible causes of the symptoms, especially if your child has a large amount of blood in the stool.

Some cases of shigellosis require no treatment, but antibiotics often will be given to shorten the illness and to prevent the spread of bacteria to others.

If the doctor prescribes antibiotics, give them as prescribed. Avoid giving your child nonprescription medicines for vomiting or diarrhea unless the doctor recommends them, as they can prolong the illness. Acetaminophen (such as Tylenol) can be given to reduce fever and make your child more comfortable.

To prevent dehydration, follow your doctor's guidance about what your child should eat and drink. Your doctor may recommend a special drink called an oral rehydration solution, or ORS (such as Pedialyte), to replace body fluids quickly, especially if the diarrhea has lasted 2 or 3 days or more.

Children who become moderately or severely dehydrated or those with other more serious illnesses may need to be hospitalized to be monitored and receive treatment such as intravenous (IV) fluid therapy or antibiotics.

When to Call the Doctor

Call the doctor if your child has signs of a Shigella infection, including diarrhea with blood or mucus, accompanied by abdominal pain, nausea and vomiting, or high fever.

Kids with diarrhea can quickly become dehydrated, which can lead to serious complications. Signs of dehydration include:

• thirst
• irritability
• restlessness
• lethargy
• dry mouth, tongue, and lips
• sunken eyes
• a dry diaper for several hours in infants or fewer trips to the bathroom to urinate in older children

If you see any of these signs, call the doctor right away.