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Diseases and Medical Conditions

Flu Season

By | Diseases and Medical Conditions

Last year’s flu season was a long, memorable one for many people. This year, Cottonwood Pediatrics hopes to see fewer children for the flu because parents took preventive steps. Here are a few questions we hear from parents:

Does my child need a flu shot?
The American Academy of Pediatrics (AAP) recommends everyone ages 6 months and older to get the influenza vaccine annually. If you have babies younger than 6 months, everyone else in the household should be immunized. The flu caused thousands of deaths in the United States last year and some of them were previously healthy children.

Can my kids get a flu shot yet?
Everyone 6 months and older should schedule to get a flu shot starting on the last week of September/beginning of October. We require that kids are up to date on their yearly well-checks. Parents and other adults can get the immunization at their doctor’s office or at pharmacies.

Can’t we just get Tamiflu instead?
Antiviral medication is not a substitute for the flu shot. We received many calls asking for Tamiflu last year but parents should know that the medicine should be given within 48 hours of the first symptoms. The reactions from the medicine could be just as bad as the flu symptoms, so please do not skip the vaccine.

Will my child be 100% protected from the flu this once vaccinated?
The virus can mutate but your child’s immune system will have 3x more work if your child is not vaccinated.

Schedule everyone’s flu shot and teach appropriate hand hygiene and cough etiquette.

To learn more about the flu season please visit:
Prepare Your Family for Flu Season – healthychildren.org
AAP policy emphasizes importance of vaccination after high-severity flu season – aappublications.org

Bronchiolitis and Your Young Child

By | Diseases and Medical Conditions

Bronchiolitis and Your Young Child

Guidelines for Parents

Adapted from Caring for Your Baby and Young Child: Birth to Age 5

Respiratory illnesses caused by viruses are some of the most common health problems in infancy. The common cold is the one we see most often. Bronchiolitis is another. Because of its symptoms, bronchiolitis can be scary for parents as well as children. This brochure explains what bronchiolitis is, as well as its causes, symptoms, and treatments.

What is bronchiolitis?

Bronchiolitis is an infection of the small breathing tubes (bronchioles) of the lungs. It occurs most often in infants.

Bronchiolitis is sometimes confused with bronchitis, which is an infection of the larger, more central airways.

Bronchiolitis is almost always caused by a virus. The infection causes the small airways in the lungs to swell. This blocks the flow of air through the lungs and makes it hard for your baby to breathe. From October through March, bronchiolitis is often caused by respiratory syncytial virus (RSV) infection. During the other months, the illness is usually caused by other viruses.

Most adults and many children with RSV infections get only a cold. In infants the infection is more likely to lead to bronchiolitis. This is because their airways are smaller and are more easily blocked. Infants who develop bronchiolitis may develop asthma later in life. It is possible that RSV infection is the first trigger for the asthma. RSV is spread by contact with an infected person’s mucus or saliva. It often spreads through families, child-care centers, and hospital wards. Careful hand washing can help prevent the spread of this infection.

Signs and symptoms

A baby who develops bronchiolitis often starts off with signs of a cold, such as a runny nose, a mild cough, and a fever. After a day or two his cough may get worse. He will begin to breathe faster. The following signs may mean that he is having trouble breathing:

  • He may widen his nostrils and squeeze the muscles under his rib cage to try to get more air in and out of his lungs.
  • When he breathes he may grunt and tighten his stomach muscles.
  • He will make a high-pitched whistling sound, called a wheeze, each time he breathes out.
  • He may not take fluids well because he is working so hard to breathe that he has trouble sucking and swallowing.
  • If it gets very hard for him to breathe, you may notice a bluish tint around his lips and fingertips. This tells you that his airways are so blocked that there is not enough oxygen getting into the blood.

If your baby shows any of these signs of trouble breathing, or if his fever lasts more than 24 hours (or is present at all in an infant under 3 months of age), call your pediatrician.

Also call your pediatrician if your baby develops any of the following signs or symptoms of dehydration:

  • Taking less than her normal amount of fluids
  • Dry mouth
  • Crying without tears
  • Urinating less often than normal

If you think your child has bronchiolitis and your child has any of the following conditions, call your pediatrician.

  • Cystic fibrosis
  • Congenital heart disease
  • Bronchopulmonary dysplasia (seen in some infants who have been on a respirator as newborns)
  • Immune deficiency disease (like AIDS)
  • Organ transplant
  • A cancer for which she is receiving chemotherapy

Home Treatment

There are no medications you can use to treat RSV infections at home.

Antibiotics, which treat bacteria, are not helpful for bronchiolitis because it is almost always caused by a virus. However, you can ease your child’s cold symptoms. Try the following suggestions:
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To relieve stuffy nose and fever:

  • Thin the mucus using mild salt-solution (saline) nose drops recommended by your pediatrician. Never use nonprescription nose drops that contain any medication. Only use salt-solution nose drops.
  • Clear your baby’s nose with a suction bulb. Squeeze the bulb part of the device first. Gently put the rubber tip into one nostril, and slowly release the bulb. This slight amount of suction will draw the clogged mucus out of the nose. This works best when your baby is under 6 months old.
  • Place a cool-mist humidifier (vaporizer) in your baby’s room. Set it close to her. Be sure to clean and dry the humidifier each day to keep bacteria or mold from growing. Do not use hot water vaporizers since they can cause serious scalds or burns.
  • bullet
  • If your baby has a fever, give her acetaminophen. (Be sure to follow the recommended dosage for your child’s age.) Do not give aspirin to your child. Aspirin has been associated with Reye syndrome, a disease that affects the liver and the brain. Never give her any other kind of cold medicine without first checking with your pediatrician.

To prevent dehydration:

  • Make sure your baby drinks lots of fluid so he does not become dehydrated. He may prefer clear liquids rather than milk or formula. He may feed more slowly and may not tolerate solid foods very well because he is having trouble breathing.

Professional Treatment

If your baby is having mild to moderate trouble breathing, your pediatrician may try using a drug that opens up the breathing tubes, which seems to help some infants.

Some children with bronchiolitis need to be hospitalized, either for breathing problems or dehydration. Your pediatrician will treat your baby’s breathing problems with oxygen and medication. The dehydration will be treated with a special liquid diet or with fluids given intravenously (directly into the blood stream)..

Very rarely an infant will not respond to any of these treatments. She might have to be put on a breathing machine (respirator). This usually is only a temporary measure to help her until her body is able to overcome the infection.

Prevention

The best way to protect your baby from bronchiolitis is to keep him away from the viruses that cause it. When possible, avoid close contact with children or adults who have colds. If your baby is in a child-care center where other children might have RSV, make sure that those who care for him wash their hands well and often.

When your baby has a cold, he needs a bit more attention to detect early signs of bronchiolitis or another serious infection. Be sure to call your pediatrician if you think your baby might have such a problem.

Pandemic Influenza Planning: A Guide for Individuals and Families

By | Diseases and Medical Conditions

Pandemic Influenza Planning:
A Guide for Individuals and Families
Get Informed. Be Prepared.

U.S. Department of Health and Human Services
May 2006

“While the Federal Government will use all resources at its disposal to prepare for and respond to an influenza pandemic, it cannot do the job alone. This effort requires the full participation of and coordination by all levels of government and all segments of society… perhaps most important, addressing the challenge will require active participation by individual citizens in each community across our Nation.”

George W. Bush, President
United States of America

“Pandemics are global in nature, but their impact is local. When the next pandemic strikes, as it surely will, it is likely to touch the lives of every individual, family, and community. Our task is to make sure that when this happens, we will be a Nation prepared.”

Michael O. Leavitt, Secretary
U.S. Department of Health and Human Services

Pandemic Influenza – Get Informed. Be Prepared.

This guide is designed to help you understand the threat of a pandemic influenza outbreak in our country and your community. It describes commonsense actions you can take now in preparing for a pandemic. We cannot predict how severe the next pandemic will be or when it will occur, but being prepared may help lower the impact of an influenza pandemic on you and your family. Additional information including a planning checklist for individuals and families can be found at www.pandemicflu.gov.

What You Need to Know

An influenza (flu) pandemic is a worldwide outbreak of flu disease that occurs when a new type of influenza virus appears that people have not been exposed to before (or have not been exposed to in a long time). The pandemic virus can cause serious illness because people do not have immunity to the new virus. Pandemics are different from seasonal outbreaks of influenza that we see every year. Seasonal influenza is caused by influenza virus types to which people have already been exposed. Its impact on society is less severe than a pandemic, and influenza vaccines (flu shots and nasal-spray vaccine) are available to help prevent widespread illness from seasonal flu.

Influenza pandemics are different from many of the other major public health and health care threats facing our country and the world. A pandemic will last much longer than most flu outbreaks and may include “waves” of influenza activity that last 6-8 weeks separated by months. The number of health care workers and first responders able to work may be reduced. Public health officials will not know how severe a pandemic will be until it begins.

An Historical Perspective

In the last century there were three influenza pandemics. All of them were called pandemics because of their worldwide spread and because they were caused by a new influenza virus. The 1918 pandemic was especially severe.

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1918-1919 Most severe, caused at least 675,000 U.S. deaths and up to 50 million deaths worldwide.

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1957-1958 Moderately severe, caused at least 70,000 U.S. deaths and 1-2 million deaths worldwide.

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1968-1969 Least severe, caused at least 34,000 U.S. deaths and 700,000 deaths worldwide.

Some Differences Between Seasonal Flu and Pandemic Flu

 

Seasonal Flu

Pandemic Flu

  Caused by influenza viruses that are similar to those already circulating among people. Caused by a new influenza virus that people have not been exposed to before. Likely to be more severe, affect more people, and cause more deaths than seasonal influenza because people will not have immunity to the new virus.
  Symptoms include fever, headache, tiredness, dry cough, sore throat, runny nose, and muscle pain. Deaths can be caused by complications such as pneumonia. Symptoms similar to the common flu but may be more severe and complications more serious.
  Healthy adults usually not at risk for serious complications (the very young, the elderly, and those with certain underlying health conditions at increased risk for serious complications). Healthy adults may be at increased risk for serious complications.
  Every year in the United State, on average:

bullet 5% to 20% of the population gets the flu;
bullet More than 200,000 people are hospitalized from flu complications; and
bullet About 36,000 people die from flu.

The effects of a severe pandemic could be much more damaging than those of a regular flu season. It could lead to high levels of illness, death, social disruption, and economic loss. Everyday life could be disrupted because so many people in so many places become seriously ill at the same time. Impacts could range from school and business closings to the interruption of basic services such a public transportation and food delivery.

Importance and Benefits of Being Prepared

The effects of a pandemic can be lessened if you prepare ahead of time. Preparing for a disaster will help bring peace of mind and confidence to deal with a pandemic.

When a pandemic starts, everyone around the world could be at risk. The United States has been working closely with other countries and the World Health Organization (WHO) to strengthen systems to detect outbreaks of influenza that might cause a pandemic.

A pandemic would touch every aspect of society, so every part of society must begin to prepare. All have roles in the event of a pandemic. Federal, state, tribal, and local governments are developing, improving, and testing their plans for an influenza pandemic. Businesses, schools, universities, and other faith-based and community organizations are also preparing plans.

As you begin your individual or family planning, you may want to review your state’s planning efforts and those of your local public health and emergency preparedness officials. State plans and other planning information can be found at www.pandemicflu.gov/plan/checklists.html.

The Department of Health and Human Services (HHS) and other federal agencies are providing funding, advice, and other support to your state. The federal government will provide up-to-date information and guidance to the public if an influenza pandemic unfolds.

For reliable, accurate, and timely information, visit the federal government’s official Web site atwww.pandemicflu.gov.

Pandemic Influenza – Challenges and Preparation

As you and your family plan for an influenza pandemic, think about the challenges you might face, particularly if a pandemic is severe.

You can start to prepare now to be able to respond to these challenges. The following are some challenges you or your family may face and recommendations to help you cope. In addition, checklists and other tools have been prepared to guide your planning efforts. A series of planning checklists can be found at www.pandemicflu.gov/plan/checklists.html.

Essential Services You Depend on May Be Disrupted

bullet Plan for the possibility that usual services may be disrupted. These could include services provided by hospitals and other healthcare facilities, banks, restaurants, government offices, telephone and cellular phone companies, and post offices.
bullet Stores may close or have limited supplies. The planning checklists can help you determine what items you should stockpile to help you manage without these services
bullet Transportation services may be disrupted and you may not be able to rely on public transportation. Plan to take fewer trips and store essential supplies.
bullet Public gatherings, such as volunteer meetings and worship services, may be canceled. Prepare contact lists including conference calls, telephone chains, and email distribution lists, to access or distribute necessary information.
bullet Consider that the ability to travel, even by car if there are fuel shortages, may be limited.
bullet You should also talk to your family about where family members and loved ones will go in an emergency and how they will receive care, in case you cannot communicate with them.
bullet In a pandemic, there may be widespread illness that could result in the shut down of local ATMs and banks. Keep a small amount of cash or traveler’s checks in small denominations for easy use.

Food and Water Supplies May Be Interrupted and Limited

Food and water supplies may be interrupted so temporary shortages could occur. You may also be unable to get to a store. To prepare for this possibility you should store at least one to two weeks supply of non-perishable food and fresh water for emergencies.

Food

bullet Store two weeks of nonperishable food.
bullet Select foods that do not require refrigeration, preparation (including the use of water), or cooking.
bullet Insure that formulas for infants and any child’s or older person’s special nutritional needs are a part of your planning.

Water

bullet Store two weeks of water, 1 gallon of water per person per day. (2 quarts for drinking, 2 quarts for food preparation/sanitation), in clean plastic containers. Avoid using containers that will decompose or break, such as milk cartons or glass bottles.

Being Able to Work May Be Difficult or Impossible

bullet Ask your employer how business will continue during a pandemic.
bullet Discuss staggered shifts or working at home with your employer. Discuss telecommuting possibilities and needs, accessing remote networks, and using portable computers.
bullet Discuss possible flexibility in leave policies. Discuss with your employer how much leave you can take to care for yourself or a family member
bullet Plan for possible loss of income if you are unable to work or the company you work for temporarily closes.

For the Business Checklist visit: http://www.pandemicflu.gov/plan/businesschecklist.html

Schools and Daycare Centers May Be Closed for an Extended Period of Time

bullet Schools, and potentially public and private preschool, childcare, trade schools, and colleges and universities may be closed to limit the spread of flu in the community and to help prevent children from becoming sick. Other school-related activities and services could also be disrupted or cancelled including: clubs, sports/sporting events, music activities, and school meals. School closings would likely happen very early in a pandemic and could occur on short notice.
bullet Talk to your teachers, administrators, and parent-teacher organizations about your school’s pandemic plan, and offer your help.
bullet Plan now for children staying at home for extended periods of time, as school closings may occur along with restrictions on public gatherings, such as at malls, movie theaters.
bullet Plan home learning activities and exercises that your children can do at home. Have learning materials, such as books, school supplies, and educational computer activities and movies on hand.
bullet Talk to teachers, administrators, and parent-teacher organizations about possible activities, lesson plans, and exercises that children can do at home if schools are closed. This could include continuing courses by TV or the internet.
bullet Plan entertainment and recreational activities that your children can do at home. Have materials, such as reading books, coloring books, and games, on hand for your children to use.

For the “Childcare, School, and University Checklist,” visit: http://www.pandemicflu.gov/plan/tab5.html

Medical Care for People with Chronic Illness Could be Disrupted

bullet In a severe pandemic, hospitals and doctors’ offices may be overwhelmed.
bullet If you have a chronic disease, such as heart disease, high blood pressure, diabetes, asthma, or depression, you should continue taking medication as prescribed by your doctor.
bullet Make sure you have necessary medical supplies such as glucose and blood-pressure monitoring equipment.
bullet Talk to your healthcare provider to ensure adequate access to your medications.
bullet If you receive ongoing medical care such as dialysis, chemotherapy, or other therapies, talk with your health care provider about plans to continue care during a pandemic.

A “Family Emergency Health Information Sheet” is provided in this guide and at:http://www.pandemicflu.gov/planguide/familyhealthinfo.html

Pandemic Influenza – Prevention and Treatment

Stay Healthy

These steps may help prevent the spread of respiratory illnesses such as the flu:

bullet Cover your nose and mouth with a tissue when you cough or sneeze-throw the tissue away immediately after you use it.
bullet Wash your hands often with soap and water, especially after you cough or sneeze. If you are not near water, use an alcohol-based (60-95%) hand cleaner.
bullet Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
bullet If you get the flu, stay home from work, school, and social gatherings. In this way you will help prevent others from catching your illness.
bullet Try not to touch your eyes, nose, or mouth. Germs often spread this way.

Vaccination

Vaccines are used to protect people from contracting a virus once a particular threat is identified. After an individual has been infected by a virus, a vaccine generally cannot help to combat it. Because viruses change over time, a specific pandemic influenza vaccine cannot be produced until a pandemic influenza virus emerges and is identified. Once a pandemic influenza virus has been identified, it will likely take 4-6 months to develop, test, and begin producing a vaccine.

While there is currently no human pandemic influenza in the world, the federal government is facilitating production of vaccines for several existing avian influenza viruses. These vaccines may provide some protection should one of these viruses change and cause an influenza pandemic. The supply of pandemic vaccine will be limited, particularly in the early stages of a pandemic. Efforts are being made to increase vaccine-manufacturing capacity in the United States so that supplies of vaccines would be more readily available. In addition, research is underway to develop new ways to produce vaccines more quickly.

Antivirals

A number of antiviral drugs are approved by the U.S. Food and Drug Administration to treat and prevent seasonal influenza. Some of these antiviral medications may be effective in treating pandemic influenza. These drugs may help prevent infection in people at risk and shorten the duration of symptoms in those infected with pandemic influenza. However, it is unlikely that antiviral medications alone would effectively contain the spread of pandemic influenza. The federal government is stockpiling antiviral medications that would most likely be used in the early stages of an influenza pandemic and working to develop new antiviral medications. These drugs are available by prescription only.

Stay Informed

bullet Knowing the facts is the best preparation. Identify sources you can count on for reliable information. If a pandemic occurs, having accurate and reliable information will be critical.
bullet Reliable, accurate, and timely information is available at www.pandemicflu.gov.
bullet Another source for information on pandemic influenza is the Centers for Disease Control and Prevention (CDC) Hotline at: 1-800-CDC-INFO (1-800-232-4636). This line is available in English and Spanish, 24 hours a day, 7 days a week.
bullet Look for information on your local and state government Web sites. Links are available to each state department of public health at www.pandemicflu.gov.
bullet Listen to local and national radio, watch news reports on television, and read your newspaper and other sources of printed and web-based information.
bullet Talk to your local health care providers and public health officials.

Questions and Answers

Will bird flu cause the next influenza pandemic?

Avian influenza (bird flu) is a disease of wild and farm birds caused by avian influenza viruses. Bird flu viruses do not usually infect humans, but since 1997 there have been a number of confirmed cases of human infection from bird flu viruses. Most of these resulted from direct or close contact with infected birds (for example: domesticated chickens, ducks, and turkeys). It is important not to handle, play with, or pick up dead birds. Information on who to contact in your state is at:http://www.pandemicflu.gov/state/statecontacts.html

The spread of bird flu viruses from an infected person to another person has been reported very rarely and has not been reported to continue beyond one person. A worldwide pandemic could occur if a bird flu virus were to change so that it could easily be passed from person to person. Experts around the world are watching for changes in bird flu viruses that could lead to an influenza pandemic.

Is it safe to eat poultry?

Yes, it is safe to eat properly cooked poultry. Cooking destroys germs, including bird flu viruses. The United States maintains trade restrictions on the importation of poultry and poultry products from countries where the highly pathogenic H5N1 avian influenza strain has been detected in commercial or traditionally raised poultry, not in wild or migratory birds.

Guidelines for the safe preparation of poultry include the following:

bullet Wash hands before and after handling food.
bullet Keep raw poultry and its juices away from other foods.
bullet Keep hands, utensils, and surfaces, such as cutting boards, clean.
bullet Use a food thermometer to ensure food has reached the safe internal temperature – in all parts of the bird. Cook poultry to at least 165°F to kill food-borne germs that might be present, including the avian influenza virus.

For more information, see poultry preparation fact sheets at:http://www.fsis.usda.gov/Fact_Sheets/Poultry_Preparation_Fact_Sheets/index.asp

What types of birds can carry bird flu viruses?

Avian influenza viruses can infect chickens, turkeys, pheasants, quail, ducks, geese, and guinea fowl, as well as a wide variety of other birds, including migratory waterfowl.
Each year, there is a flu season for birds just as there is for humans and, as with people, some forms of the flu are worse than others, depending on how strong the virus. A weak virus may cause only mild illness in infected poultry and birds but a strong virus could cause severe and extremely contagious illness, and even death, among infected poultry and birds.

Will the seasonal flu shot protect me against pandemic influenza?

bullet No, it won’t protect you against pandemic influenza. But flu shots can help you to avoid seasonal flu.
bullet Get a flu shot to help protect you from seasonal flu.
bullet Get a pneumonia shot to prevent secondary infection if you are over the age of 65 or have a chronic illness such as diabetes or asthma. For specific guidelines, talk to your health care provider or call the Centers for Disease Control and Prevention (CDC) Hotline at 1-800-232-4636.
bullet Make sure that your family’s immunizations are up-to-date.

What is the U.S. government doing to prepare for pandemic influenza?

bullet The U.S. government has been preparing for pandemic influenza for several years. In November 2005, the President announced the National Strategy for Pandemic Influenza.
bullet Ongoing preparations include the following:
bullet Monitoring migratory and wild birds for avian flu.
bullet Working with the World Health Organization (WHO) and other nations to help detect human cases of bird flu and respond to an influenza pandemic, if one begins.
bullet Supporting the manufacturing and testing of influenza vaccines, including finding more reliable and quicker ways to make large quantities of vaccines through cell-based technologies.
bullet Developing a national stockpile of antiviral drugs to help treat and control the spread of disease.
bullet Supporting the efforts of federal, state, tribal, and local health agencies to prepare for and respond to pandemic influenza, including hosting planning summits with state and local leaders in each state.
bullet Working with federal agencies to prepare and to encourage communities, businesses, and organizations to plan for pandemic influenza. These efforts have included joint exercises in pandemic preparation.

For More Information
Visit: www.pandemicflu.gov

The Centers for Disease Control and Prevention (CDC) hotline, 1-800-CDC-INFO (1-800-232-4636), is available in English and Spanish, 24 hours a day, 7 days a week. TTY: 1-888-232-6348. Questions can be emailed to inquiry@cdc.gov.

Links to state departments of public health can be found atwww.pandemicflu.gov/state/statecontacts.html.

  http://www.who.int/csr/disease/avian_influenza/en/

The World Health Organization –

WHO is coordinating the global response to human cases of H5N1 avian influenza and monitoring the corresponding threat of an influenza pandemic. Information on this page tracks the evolving situation and provides access to both technical guidelines and information useful for the general public.

Preventing Common Springtime Allergies

By | Diseases and Medical Conditions

Preventing Common Springtime Allergies

Dehumidification to Reduce Dust Mites and Mold

The arrival of spring for much of North America means April showers and May’s warmer temperatures. Unfortunately, moisture and warmth are two conditions that contribute to increases in both dust mites and mold. As you plan for ways to reduce your allergen exposure in spring and summer, keeping your home’s relative humidity low should be one of your top priorities.

One important step is to add dehumidification to your allergen avoidance protocol if you haven’t already done so.

Countless studies have shown the link between humidity and the prevalence of dust mite populations. The reason is simple: 70-75% of the weight of a house dust mite is water. They maintain this needed water level through the absorption of water vapor in the air. So high relative humidity is crucial to their survival. Some of the leading experts in the field of dust mites and their allergen wrote the following in a recent article:

“Maintaining RH [relative humidity] below 50% is one of the most common recommendations for reducing dust mites and their allergen levels in homes because ambient RH is the key factor that influences dust mite prevalence. Mites must obtain sufficient water from the air to survive. Laboratory studies have shown that adult mites die of dehydration in 5 to 11 days, depending on temperature (25°C-34°C), when continuously exposed to RHs of 40% or 50%.” [ Larry G. Arlian, PhD, Thomas A. E. Platts-Mills, MD, PhD. “The Biology of Dust Mites and the Remediation of Mite Allergens in Allergic Disease.” Journal of Allergy and Clinical Immunology. March 2001]

Moisture in your home’s air not only makes the environment more hospitable to dust mites, but to mold growth as well. Molds thrive in humidity at or above 50-55%. A musty smell in your basement or bathroom is likely a mold or mildew problem as a result of excess moisture from leaks or spills or from consistently high relative humidity in your home. Extra care should be taken to monitor your home’s relative humidity especially if your region is prone to heat and moisture.

What Is Relative Humidity And How Can It Be Controlled?

Relative humidity is the measure of the amount of water in the air compared with the amount of water the air can hold at a specific temperature. For example, a 77° F room with 60% relative humidity means that at that point in time, the air is 60% water! An instrument called a hygrometer [or humidity gauge] is used to measure relative humidity in the home and is an important tool for monitoring your home’s humidity levels all year long.

In any given home on a summer day, humidity levels from room to room can range from 50-100%! Air conditioning and electric dehumidifiers are the most effective ways to control indoor humidity levels. Air conditioning works because cool air cannot hold as much moisture as warm air. Most dehumidifiers use a fan or a blower to pull air in, where it then passes through a cooling coil and is chilled to its dew point. This process results in condensation on the coils, which then flows into a bucket. Some dehumidifiers allow for the collected water to be pumped through a hose and into a sink, bathtub or out a window. After passing through the coils, the moisture-reduced air is then heated back to room temperature and released into the room.

Questions to Ask When Looking For A Dehumidifier

  • There are several key questions you should ask when looking at the various models and options for home dehumidification:
  • What is the unit’s water extraction capability?
  • Does it have an automatic shut-off when the tank is full?
  • Can the water be pumped to a sink or outside using a hose or tube?
  • What is the lowest temperature at which the unit can operate without freezing up?
  • Does it have a multi-speed fan?
  • What is the energy consumption?
  • How loud is it?

Study Finds Parents Overlook Most Important Asthma Steps

By | Diseases and Medical Conditions

Study Finds Parents Overlook Most Important Asthma Steps

WASHINGTON (Reuters) – Parents of children with asthma try hard to protect their youngsters but often overlook the most important measures, including banning smoking in the house and shutting windows to keep pollen out, U.S. researchers report.

A quarter of parents surveyed said a smoker lived in the same house as the child with asthma but admitted they had not done anything about it.

Many parents reported they had bought a mattress cover, protecting their child from dust mite allergens, but did not shut windows to keep pollen out of the house — even when they knew their child’s asthma was triggered by pollen.

“Eighty percent of parents in this study knew at least one specific factor that triggered their child’s asthma symptoms, and 82 percent of those had devoted some effort to help their children avoid these triggers,” said Dr. Michael Cabana, the University of Michigan pediatrician who led the study.

Only half of the 1,788 asthma-proofing steps taken by parents of 896 asthmatic children in the study were likely to work, the researchers reported in the August issue of the Journal of Allergy and Clinical Immunology.

Many tried useless products, they found.

“Parents hear ‘Sprinkle this on your carpet’ or ‘Clean out your air ducts’ or ‘Buy this air ionizer’ and parents who are desperate to help their kids can get misled into spending money on things of questionable value,” said Dr. Toby Lewis, who also worked on the report.

“The bottom line is, talk to your doctor before you spend a lot of money, and do the cheap, easy things first,” she added.

Doctors need to do more to educate parents about the best ways to prevent asthma attacks, the researchers said.

“The first level of education for parents is to learn that much of asthma occurs as a reaction to triggers in the environment, and that everyone’s triggers are different. One of the first steps in getting asthma under control is figuring out a child’s triggers,” said Lewis.

Some of the potentially harmful things parents were doing included using a humidifier in the room of a child whose triggers include house dust mites. House dust mites thrive in humid environments.

Allergies and Pollens

By | Diseases and Medical Conditions

Allergies and Pollens

The pollens most people are allergic to are produced by plain-looking plants that do not have showy flowers because these type of plants rely on bees and birds to carry their pollen. The pollens that cause allergy problems are carried through the air. It could be said that the more you see of a plant or its pollen, the less sensitive you probably are to it. Just outside of Atlanta, Georgia, in spring, virtually everything will be coated with a layer of yellow pine tree pollen. Many people think that this it the cause of their misery since they see it everywhere. But very few people are actually allergic to pine pollen – it just happens to be the most visible. The fact that we can see it everywhere tells us that it is a heavy particle that settles quickly out of the air making it rather tough to breathe in. Hundreds of other pollen allergens that we can’t see are also in the air.

The main allergy culprits in the early spring are other tree pollens like hickory, elm and oak. Late spring and early summer is when weeds such as ragweed, sagebrush, redroot, pigweed and Russian thistle (tumbleweed) produce their pollen. A single ragweed plant can generate a million grains of pollen a day, but unlike pine tree pollen, you may never see a single one. Unfortunately, your body will know they are there. Ragweed is one of the major culprits for sneezing and runny noses in North America. In the late summer and early fall, grasses including Kentucky bluegrass, timothy grass, Bermuda grass and redtop grass are the main pollen offenders. Most people who are allergic to pollen are usually sensitive to several different types.

Pollen Counts

You’ve probably heard your local news station give you information about pollen counts in your area. A pollen count represents the concentration of all the pollen (or a particular type if noted) in the air in a certain area at a specific time. The measurement is expressed in grains of pollen per square meter of air collected over 24 hrs. The National Allergy Bureau and Pollen.com offer pollen counts, which may be available for your area.

Peak times for pollen vary by region of the country. The further north you are, the later your area’s pollinating period and allergy season will begin.

Anemia and Your Young Child

By | Diseases and Medical Conditions

Anemia and Your Young Child
Guidelines for Parents
Adapted from Caring for Your Baby and Young Child: Birth to Age 5.

Anemia is a condition that is sometimes found in young children. It can make your child feel cranky, tired, and weak. Though these symptoms may worry you, most cases of anemia are easily treated. This brochure explains the different types of anemia and its causes, symptoms, and treatments.

What is anemia?

Anemia is a condition that occurs when there are not enough red blood cells or hemoglobin to carry oxygen to the other cells in the body. The body’s cells need oxygen to survive. Your child may become anemic for any of the following reasons:

  • Her body does not produce enough red blood cells.
  • Her body destroys or loses (through bleeding) too many red blood cells.
  • There is not enough hemoglobin in her red blood cells. Hemoglobin is a special pigment that makes it possible for the red blood cells to carry oxygen to all the cells of the body, and to carry waste material (carbon dioxide) away.

Types of anemia

Iron-deficiency anemia is the most common type of anemia in young children. It is caused by a lack of iron in the diet. The body needs iron to produce hemoglobin. If there is too little iron, there will not be enough hemoglobin in the red blood cells. Infants who are given cow’s milk too early (before 1 year of age) often develop anemia because there is very little iron in cow’s milk. Also, it is hard for young infants to digest cow’s milk. Cow’s milk can irritate a young infant’s bowel and cause slight bleeding. This bleeding lowers the number of red blood cells, and can result in anemia. A lack of other nutrients in the diet can also cause anemia. Too little folic acid can lead to anemia, though this is very rare. It is most often seen in children fed on goat’s milk, which contains very little folic acid. Rarely, too little vitamin B12, vitamin E, or copper can also cause anemia.

Blood loss can also cause anemia. Blood loss can be caused by illness or injury. In rare cases, the blood does not clot properly. This can cause a newborn infant to bleed heavily from his circumcision or a minor injury. Because newborns often lack vitamin K, which helps the blood clot, infants generally get a vitamin K injection right after birth.

Hemolytic anemia occurs when the red blood cells are easily destroyed.

Sickle-cell anemia, a very severe hemolytic anemia, is most common in children of African heritage. Sickle-cell anemia is caused by an abnormal hemoglobin. Children with sickle-cell anemia may suffer many “crises” or periods of great pain, and need to be hospitalized.

Thalassemia, another hemolytic anemia, is most common in children of Mediterranean or East Asian origin. If you have a history of sickle-cell anemia or thalassemia in your family, make sure you tell your pediatrician so that your child is tested for it.

Signs and symptoms of anemia

Anemia causes the following signs and symptoms:

  • Pale, gray, or “ashy” skin (also, the lining of the eyelids and the nail beds may look less pink than normal)
  • Irritability
  • Mild weakness
  • Tiring easily

Children with severe anemia may have the following additional signs and symptoms:

  • Shortness of breath
  • Rapid heart rate
  • Swollen hands and feet

Also, a newborn with hemolytic anemia may become jaundiced (turn yellow), although many newborns are mildly jaundiced and do not become anemic.

Children who lack iron in their diets may also eat strange things such as ice, dirt, clay, and cornstarch. This behavior is called “pica.” It is not harmful unless your child eats something toxic, such as lead paint chips. Usually the pica stops after the anemia is treated and as the child grows older.

If your child shows any of these symptoms or signs, see your pediatrician.

A simple blood count can diagnose anemia in most cases.

Treatment for anemia

Since there are so many different types of anemia, it is very important to identify the cause before beginning any treatment. Do not try to treat your child with vitamins, iron, or other nutrients or over-the-counter medications unless your pediatrician recommends it. This is important because such treatment may mask the real cause of the problem. This could delay a proper diagnosis.

If the anemia is due to a lack of iron, your child will be given an iron containing medication. This comes in a drop form for infants, and liquid or tablet forms for older children. Your pediatrician will determine how long your child should take the iron medication by checking her blood regularly.

Do not stop giving the medication until your pediatrician tells you it is no longer needed.

Iron medications are extremely poisonous if too much is taken.

Iron is one of the most common causes of poisoning in children under 5 years of age. Keep this and all medication out of the reach of small children.

Following are a few tips concerning iron medication:

  • Do not give iron with milk. Milk blocks the absorption of iron.
  • Vitamin C increases iron absorption. You might want to follow the dose of iron with a glass of orange juice.
  • Liquid iron can turn the teeth a grayish-black color. Have your child swallow it quickly and then rinse her mouth with water. You also may want to brush your child’s teeth after every dose of iron. Tooth-staining by iron looks bad, but it is not permanent.
  • Iron can cause the stools to become a dark black color. Do not be worried by this change.

Preventing anemia

Iron-deficiency anemia and other nutritional anemias can be prevented easily.

Make sure your child is eating a well-balanced diet by following these suggestions:
bullet

  • Do not give your baby cow’s milk until he is over 12 months old.
  • If your child is breast-fed, give him foods with added iron, such as cereal, when you begin feeding him solid foods. Before then, he will get enough iron from the breast milk. However, feeding him solid foods with too little iron will decrease the amount of iron he gets from the milk.
  • If you formula-feed your baby, give him formula with added iron.
  • Make sure your older child eats a well-balanced diet with foods that contain iron. Many grains and cereals have added iron (check labels to be sure).

Other good sources of iron include egg yolks, red meat, potatoes, tomatoes, molasses, and raisins. Also, to increase the iron in your family’s diet, use the fruit pulp in juices, and cook potatoes with the skins on.

With proper treatment, your child’s anemia should improve quickly. Be sure to contact your pediatrician if you think your child might be anemic.

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

Seven Steps to Stop Smoking

By | Diseases and Medical Conditions
    Seven Steps to Stop Smoking

    • Recognize your habit and your addiction. There are two basic reasons for smoking: nicotine addiction and pleasure. Paying more attention to when you smoke and what makes you light up can help you develop strategies for quitting.
    • Build your motivation to quit. List the pros and cons of smoking and quitting and write down your top five reasons for quitting.
    • Develop a quitting plan. Would you rather go it alone or with a group? Would quitting cold turkey be preferable to gradually reducing your nicotine intake? Do you want to use medications to boost your efforts?
    • Set a quit date.
    • Quit. Get rid of all of the cigarettes, ashtrays, matches and lighters in the house. Keep your top five quitting reasons with you and refer to them when you crave a cigarette.
    • Maintain your program for the first two weeks. The cravings will subside and you will begin to feel better in a few days, though irritability, nervousness, sleep problems, difficulty concentrating and coughing may last for a few weeks.
    • Survive the first six months. The physical addiction subsides after a week or two, but psychological cues can still give you the urge to light up.

Alcohol: Your Child and Drugs

By | Diseases and Medical Conditions

Alcohol: Your Child and Drugs

Children are challenged at younger ages than ever before to try drugs. Use of tobacco, marijuana, and cocaine are serious problems. However, one of the most abused drugs in our society is alcohol. Alcohol is a drug because it acts as a depressant on the nervous system and is very addictive. Though it’s illegal for people under age 21 to drink, we all know that most teenagers are no strangers to alcohol. Many of them are introduced to alcohol during childhood.

Why parents should worry

  • About 1 out of 5 fifth graders have been drunk.
  • Four out of 10 sixth graders say there is pressure from other students to drink.
  • Nearly 80% of high school seniors report having used alcohol.

Alcohol is often the first drug that young people try. Some parents may breathe a sigh of relief when they find out their teen is “only” drinking alcohol. Since alcohol is legal and found in most American homes, parents may think it isn’t dangerous. Not true. Alcohol can be very harmful.

Childhood drinking begins early, often between 11 and 13 years of age, and sometimes even younger. Alcohol is often called a “gateway drug.” When young people like the feeling they get from alcohol, they may be interested in trying other drugs later. This can lead to multiple drug use, which is very dangerous.

The use of alcohol, by itself or with other drugs, can harm your child’s normal growth and development.

Even if a teenager only drinks occasionally, intoxicated behavior can be lethal. Just one drink can impair decision-making and slow down reaction time in any situation. Alcohol is linked with a variety of risky behaviors, such as:

  • Crime and serious violence
  • Early sexual activity, multiple partners, sexually transmitted diseases including AIDS, and unintended teenage pregnancy
  • Fetal Alcohol Syndrome—Drinking during pregnancy can cause a baby to be born with major birth defects. No one knows exactly how much alcohol is too much during pregnancy, but the more a mother drinks, the greater the risk to her baby.
  • Drunk driving—It is the leading cause of death for young adults, aged 15 to 24 years. In one study, an estimated 6% to 14% of drivers under 21 years of age who were stopped at roadside checkpoints had been drinking. This age group makes up only one fifth of the licensed drivers in the United States, yet they are involved in almost half of all fatal car crashes.

Why young people drink

Young people drink alcohol for a variety of reasons.

  • Curiosity—They have heard that getting drunk is fun and they want to find out for themselves.
  • They see drinking as a “rite of passage”—something to be experienced on the way to adulthood.
  • To get drunk—This explains why they often drink until they are out of control. Binge drinking (consuming five or more drinks in a row for males, four for females) is alarmingly common. Sixteen percent of 8th graders, 25% of 10th graders, and 30% of seniors have reported binge drinking.
  • To fit in with friends who are already using alcohol.
  • To feel relaxed and to boost self-confidence.
  • To escape problems, such as depression, family conflict, trouble in school or with boyfriend or girlfriend.

Stages of alcohol use

The same pattern of use and abuse exists for alcohol as with other drugs such as marijuana or cocaine. Experts have noted the following stages of alcohol use:

Stage 1:
Experimenting with alcohol—There may be strong peer pressure to use alcohol “just for fun” and to be part of the group. Most use happens on weekends. There often is no change in behavior between uses.

Stage 2:
Actively seeking alcohol—Alcohol is used to produce good feelings during times of stress. Usage occurs during the week. Schoolwork may suffer. Changes in behavior may include:

  • An increase in time spent alone
  • A decline in communication with family members, frequent arguing, and a high level of secretiveness
  • Changes in dress and grooming
  • Changes in choice of friends
  • Repeated or unexplained injuries or fights
  • Poor sleeping habits and a lack of energy
  • Irregular eating habits
  • Bloodshot eyes
  • Mood changes, including irritability and depression
  • Running away from home
  • Attempting suicide

Keep in mind that some of these symptoms occur from time to time in normal, non-alcohol-using teens, and none alone is proof of alcohol or drug use. However, a combination of any of the above symptoms may signal a problem.

Stage 3:
Preoccupation with alcohol—There is an almost total loss of control over the use of alcohol. Attempts to limit alcohol use at this stage can cause withdrawal symptoms of depression, moodiness, and irritability. Alcoholic beverages may disappear from the home. There is a danger of turning to other drugs or stronger forms of liquor. Family possessions may also disappear as the alcohol user seeks money to support his habit. There may be trouble with the law for these same reasons.

The good news

Most adolescents never move beyond the first stage of alcohol use. Whether they do or not depends for the most part on their personality, their family, and their community. For those who do move to the advanced stages, the entire process can take months or years. Many young people and adults receive help too late. This is why early detection is so important.

How to prevent alcohol use and abuse

As with any disease, prevention is the best treatment. Parents must learn the facts about teen alcohol use and abuse to help their children remain alcohol free.

Parents should set a good example at home by limiting their own use of alcohol and other drugs. Parents who don’t drink should be aware that this alone will not guarantee their children and teenagers won’t use alcohol.

Parents who are alcoholics or problem drinkers place their children at increased risk of alcohol dependence. Studies suggest that alcoholism may run in the family. One out of 5 young adults with an alcoholic parent is likely to become an alcoholic too.

Education about alcohol should begin early. Parents can help their children resist alcohol use in these ways:

  • Give your child a sense of confidence. This is the best defense against peer pressure. Build your child’s self-esteem with praise and avoid frequent criticism.
  • Listen to what your child says. Pay attention, and be helpful during periods of loneliness or doubt.
  • Know who your child’s friends are and make a point to get to know them.
  • Provide parental supervision. Don’t allow your teen to attend parties where alcohol is being served. Insist that a parent be present at parties to supervise. Contact other parents to arrange alcohol-free social events.
  • Offer a “free call home.” Drinking and driving may lead to death. Make sure your child knows not to ride with a driver who has been drinking. Let him know that he can call home without fear of consequences that night. Discuss the incident the next day.
  • Help your child learn to handle strong emotions and feelings. Model ways to control stress, pain, or tension.
  • Talk about things that are important issues for your child, including alcohol, drugs, and the need for peer-group acceptance.
  • Encourage enjoyable and worthwhile outside things to do; avoid turning leisure time into chores.
  • Join your child in learning all you can about preventing alcohol abuse. Programs offered in schools, churches, and youth groups can help you both learn more about alcohol abuse.

Your pediatrician understands that good communication between parents and children is one of the best ways to prevent alcohol use. If talking with your teenager about alcohol is difficult, your pediatrician may be able to help open the lines of communication. If you suspect your child is using alcohol or any other drug, ask your pediatrician for advice and help.

Parents who drink

Parents who choose to use alcohol must be careful how it is used in the home. Having a drink should never be shown as a way to cope with problems.

Don’t drink in unsafe conditions—driving the car, mowing the lawn, using the stove, etc. Don’t encourage your child to drink or to join you in having a drink. Never make jokes about getting drunk; make sure that your children understand that it is neither funny nor acceptable. Show your children that there are many ways to have fun without alcohol. Happy occasions and special events don’t have to include drinking.

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

Understanding ADHD

By | Diseases and Medical Conditions

Understanding ADHD
Information for Parents About Attention-Deficit/Hyperactivity Disorder

  Almost all children have times when their behavior veers out of control. They may speed about in constant motion, make noise nonstop, refuse to wait their turn, and crash into everything around them. At other times they may drift as if in a daydream, failing to pay attention or finish what they start. However, for some children, these kinds of behaviors are more than an occasional problem. Children with attention-deficit/hyperactivity disorder (ADHD), have behavior problems that are so frequent and severe that they interfere with their ability to live normal lives.

These children often have trouble getting along with siblings and other children at school, at home, and in other settings. Those who have trouble paying attention usually have trouble learning. An impulsive nature may put them in actual physical danger. Because children with ADHD have difficulty controlling this behavior, they may be labeled “bad kids” or “space cadets.”

Left untreated, more severe forms of ADHD can lead to serious, lifelong problems such as poor grades in school, run-ins with the law, failed relationships, and the inability to keep a job.

Effective treatment is available. If your child has ADHD, your pediatrician can offer a long-term treatment plan to help your child lead a happy and healthy life. As a parent, you have a very important role in this treatment.

  What is ADHD?

ADHD is a condition of the brain that makes it difficult for children to control their behavior. It is one of the most common chronic conditions of childhood.

It affects 4% to 12% of school-aged children. About 3 times more boys than girls are diagnosed with ADHD.

The condition affects behavior in specific ways.

  What are the symptoms of ADHD?

ADHD includes 3 behavior symptoms: inattention, hyperactivity, and impulsivity. Table 1 explains these symptoms.

    TABLE 1. Symptoms of ADHD
    Symptom How a child with this symptom may behave
   

Inattention

Has a hard time paying attention, daydreams

Does not seem to listen

Is easily distracted from work or play

Does not seem to care about details, makes careless mistakes

Does not follow through on instructions or finish tasks

Is disorganized

Loses a lot of important things

Forgets things

Does not want to do things that require ongoing mental effort

    Hyperactivity Is in constant motion, as if “driven by a motor”

Cannot stay seated

Squirms and fidgets

Talks too much

Runs, jumps, and climbs when this is not permitted

Cannot play quietly

    Impulsivity Acts and speaks without thinking

May run into the street without looking for traffic first

s trouble taking turns

Cannot wait for things

Calls out answers before the question is complete

Interrupts others

  Are there different types of ADHD?

Children with ADHD may have one or more of the symptoms listed in Table 1.

The symptoms usually are classified as the following types of ADHD:

   
bullet Inattentive only (formerly known as attention-deficit disorder [ADD]}—Children with this form of ADHD are not overly active. Because they do not disrupt the classroom or other activities, their symptoms may not be noticed. Among girls with ADHD, this form is most common.
bullet Hyperactive/Impulsive—Children with this type of ADHD show both hyperactive and impulsive behavior, but can pay attention.
bullet Combined Inattentive/Hyperactive/Impulsive—Children with this type of ADHD show all 3 symptoms. This is the most common type of ADHD.
  How can I tell if my child has ADHD?

Remember, it is normal for all children to show some of these symptoms from time to time. Your child may be reacting to stress at school or home.

She may be bored or going through a difficult stage of life. It does not mean she has ADHD.

Sometimes a teacher is the first to notice inattention, hyperactivity, and/or impulsivity and bring these symptoms to the parents’ attention.

Perhaps questions from your pediatrician raised the issue. At routine visits, pediatricians often ask questions such as the following:

   
bullet How is your child doing in school?
bullet Are there any problems with learning that you or your child’s teachers have seen?
bullet Is your child happy in school?
bullet Is your child having problems completing class work or homework?
bullet Are you concerned with any behavior problems in school, at home, or when your child is playing with friends?
  Your answers to these questions may lead to further evaluation for ADHD.

If your child is 6 years of age or older and has shown symptoms of ADHD on a regular basis for more than 6 months, discuss this with your pediatrician.

  Keep safety in mind

If your child shows any symptoms of ADHD, it is very important that you pay close attention to safety. A child with ADHD may not always be aware of dangers and can get hurt easily. Be especially careful around the following:

bullet Traffic
bullet Firearms
bullet Swimming pools
bullet Tools such as lawn mowers

 

  DiagnosisYour pediatrician will determine whether your child has ADHD using standard guidelines developed by the American Academy of Pediatrics. These diagnosis guidelines are for children 6 to 12 years of age.

It is difficult to diagnose ADHD in children 5 years of age and younger.

This is because many preschool children have some ADHD symptoms in various situations. In addition, children change very rapidly during the preschool years. It is also difficult to diagnose ADHD once a child becomes a teenager.

There is no single test for ADHD. The process requires several steps and involves gathering a lot of information from multiple sources. You, your child, your child’s school, and other caregivers should be involved in assessing your child’s behavior.

Children with ADHD, show signs of inattention, hyperactivity, and/or impulsivity in specific ways. (See the behaviors listed in Table 1.) Your pediatrician will look at how your child’s behavior compares to that of other children his own age, based on the information reported about your child.

  To confirm a diagnosis of ADHD, these behaviors must
   
bullet Occur in more than 1 setting, such as home, school and social situations.
bullet Be more severe than in other children the same age.
bullet Start before the child reaches 7 years of age. (However, these may not be recognized as ADHD symptoms until a child is older.)
bullet Continue for more than 6 months.
bullet Make it difficult to function at school, at home, and/or in social situations.
  In addition to looking at your child’s behavior, your pediatrician will do a physical examination. A full medical history will be needed to put your child’s behavior in context and screen for other conditions that may affect your child’s behavior. Your pediatrician also will talk to your child about how he acts and feels.

Your pediatrician may refer your child to a pediatric subspecialist if there are concerns in one of the following areas:

   
bullet Mental retardation
bullet Developmental disorders such as speech problems, motor problems, or a learning disability
bullet Chronic illness being treated with a medication that may interfere with learning
bullet Trouble seeing and/or hearing
bullet History of abuse
bullet Major anxiety or major depression
bullet Severe aggression
bullet Possible seizure disorder
  How can parents help with the diagnosis?

As a parent, you will provide crucial information about your child’s behavior and how it affects her life at home, in school, and in other social settings.

Your pediatrician will want to know what symptoms your child is showing, how long the symptoms have occurred, and how the behavior affects your child and your family. You may need to fill in checklists or rating scales about your child’s behavior.

In addition, sharing your family history can offer important clues about your child’s condition.

  How will my child’s school be involved?

For an accurate diagnosis, your pediatrician will need to get information about your child directly from your child’s classroom teacher or another school professional. Children 6 to 12 years of age spend many of their waking hours at school. Teachers provide valuable insights. Your child’s teacher may write a report or discuss the following with your pediatrician:

   
bullet Your child’s behavior in the classroom
bullet Your child’s learning patterns
bullet How long the symptoms have been a problem
bullet How the symptoms are affecting your child’s progress at school
bullet Ways the classroom program is being adapted to help your child
bullet Whether other conditions may be affecting the symptoms

In addition, your pediatrician may want to see report cards and samples of your child’s schoolwork

  How will others who care for my child be involved?

Other caregivers may also provide important information about your child’s behavior. Former teachers, religious leaders, or coaches may have valuable input. If your child is homeschooled, it is especially important to assess his behavior in settings outside of home.

Your child probably does not behave the same way at home as he does in other settings. Direct information about the way your child acts in more than one setting is required. It is important to consider other possible causes of your child’s symptoms in these settings.

In some cases, other mental health care professionals may also be involved in gathering information for the diagnosis.

  Coexisting conditions

As part of the diagnosis, your pediatrician will look for other conditions that show the same types of symptoms as ADHD. Your child may simply have a different condition or ADHD and another condition. Many children who have been diagnosed with ADHD have at least 1 coexisting condition.

Common coexisting conditions include the following:

   
bullet Oppositional defiant disorder or conduct disorderUp to 35% of children with ADHD also have oppositional defiant disorder or conduct disorder. Children with oppositional defiant disorder tend to lose their temper easily and annoy people on purpose and are defiant and hostile toward authority figures. Children with conduct disorder break rules, destroy property, and violate the rights of other people. Children with coexisting conduct disorder are at much higher risk for getting into trouble with the law than children who have only ADHD. Studies show that this type of coexisting condition is more common among children with the primarily hyperactive/impulsive and combination types of ADHD.

Your pediatrician may recommend counseling for your child if she has this condition.

bullet Mood disorders/depressionAbout 18% of children with ADHD also have mood disorders such as depression. There is frequently a family history of these types of disorders. Coexisting mood disorders may put children at higher risk for suicide, especially during the teenage years.

These disorders are more common among children with inattentive and combined types of ADHD. Children with mood disorders or depression often require a different type of medication from those normally used to treat ADHD.

bullet Anxiety disorders—These affect about 25% of children with ADHD.

Children with anxiety disorders have extreme feelings of fear, worry, or panic that make it difficult to function. These disorders can produce physical symptoms such as racing pulse, sweating, diarrhea and nausea.

Counseling and/or medication may be needed to treat these coexisting conditions.

bullet Learning disabilities—Learning disabilities are conditions that make it difficult for a child to master specific skills such as reading or math. ADHD is not a learning disability. However, ADHD can make it hard for a child to do well in school. Diagnosing learning disabilities requires evaluations such as IQ and academic achievement tests.

 

  Are there other tests for ADHD?You may have heard theories about other tests for ADHD. There are no other proven tests for ADHD at this time.

Many theories have been presented. But studies have shown that the following tests have little value in diagnosing an individual child:

bullet Screening for high lead levels in the blood
bullet Screening for thyroid problems
bullet Computerized continuous performance tests
bullet Brain imaging studies such as CAT scans, MRIs, etc
bullet Electroencephalogram (EEG) or brain-wave test

While these tests are not helpful in diagnosing ADHD, your pediatrician may see other signs or symptoms in your child that warrant blood tests, brain imaging studies, or an EEG.

 

  What causes ADHD?ADHD is one of the most studied conditions of childhood. But, the cause of ADHD is still not clear at this time.

Research to date has shown the following:

   
bullet ADHD is a biological disorder. Children with ADHD have problems with chemicals that send messages in the brain.
bullet A lower level of activity in the parts of the brain that control attention and activity level may be associated with ADHD.
bullet ADHD appears to run in families. Sometimes a parent is diagnosed with ADHD at the same time as the child.
bullet In very rare cases, toxins in the environment may lead to ADHD.
bullet Very severe head injuries may cause ADHD in some cases.
  There is no evidence that ADHD is caused by the following:
   
bullet Eating too much sugar
bullet Food additives
bullet Allergies
bullet Immunizations
  Treatment

Once the diagnosis is confirmed, the outlook for most children who receive treatment for ADHD is very encouraging. There is no specific cure for ADHD, but there are many treatment options available.

Each child’s treatment must be tailored to meet individual needs. In most cases, treatment for ADHD should include the following:

   
bullet A long-term management plan with

bullet Target outcomes for behavior
bullet Follow-up activities
bullet Monitoring

 

bullet Education about ADHD
bullet Teamwork among doctors, parents, teachers, caregivers, other health care professionals, and the child
bullet Medication
bullet Behavior therapy
bullet Parent training
bullet Individual and family counseling
  Treatment for ADHD uses the same principles that are used to treat other chronic conditions like asthma or diabetes. Long-term planning is needed because these conditions continue or recur for a long time. Families must manage them on an ongoing basis. In the case of ADHD, schools and other caregivers must also be involved in managing the condition.

Educating the people involved about ADHD is a key part of treating your child. As a parent, you will need to learn about ADHD. Read about the condition and talk to people who understand it. This will help you manage the ways ADHD affects your child and your family on a day-to-day basis. It will also help your child learn to help himself.

  Setting target outcomes

At the beginning of treatment, your pediatrician should set 3 to 6 “target outcomes” (goals) for your child’s behavior. These goals will guide the treatment plan. Your child’s target outcomes should focus on helping her function as well as possible at home, at school, and in your community.

The following are examples of target outcomes:

   
bullet Improved relationships with parents, siblings, teachers, and friends
bullet Better schoolwork
bullet More independence in self-care or homework
bullet Improved self-esteem
bullet Fewer disruptive behaviors
bullet Safer behavior in the community (e.g., when crossing streets)
  The target outcomes should be
   
bullet Realistic
bullet Something your child will be able to do
bullet Behaviors that you can observe and measure (e.g., with rating scales)
  Your child’s treatment plan will be set up to help your child achieve these goals.
  Medication
For most children, stimulant medications are a safe and effective way to relieve ADHD symptoms. As glasses help people focus their eyes to see, these medications help children with ADHD focus their thoughts better and ignore distractions. This makes them more able to pay attention and control their behavior.

Stimulants may be used alone or combined with behavior therapy. Studies show that about 80% of children with ADHD who are treated with stimulants improve a great deal.

Different types of stimulants are available, in both short-acting (immediate release), intermediate-acting, and long-acting forms. (See Table 2.) Short-acting forms usually are taken every 4 hours when the medication is needed. Long-acting medications usually are taken once in the morning.

Table 2. Common stimulants
   

Generic Class

Brand Names

   

Methylphenidate, short-acting

Ritalin®

Methylin®

   

Methylphenidate, intermediate-acting

Ritalin SR®

Metadate ER®

Methylin ER®

    Methylphenidate, long-acting Concerta®

Metadate CD®

Ritalin LA®*

    Amphetamine, short-acting Dexadrine®

Dextrostat®

    Amphetamine, intermediate-acting Adderall®

Dexedrine spansule

    Amphetamine, long-acting Adderal-XR®*
    *Not Food and Drug Administration (FDA) approved at the time of original publication
  Children who use long-acting forms of stimulants can avoid taking medication at school or after school. It is important not to chew or crush long-acting capsules or tablets.
  Which medication is best for my child?

It may take some time to find the best medication, dosage, and schedule for your child.
Your child may need to try different types of stimulants. Some children respond to one type of stimulant but not another.

The amount of medication (dosage) that your child needs also may need to be adjusted. The dosage is not based solely on her weight. Your pediatrician will vary the dosage over a period of time to get the best results and control possible side effects.

The medication schedule also may be adjusted depending on the target outcome. For example, if the goal is to get relief from symptoms at school, your child may take the medication only on school days.

It is important for your child to have regular medical checkups to monitor how well the medication is working and check for possible side effects.

  What side effects can stimulants cause?

Side effects occur sometimes. These tend to happen early in treatment and are usually mild and short-lived. The most common side effects include the following:

   
bullet Decreased appetite/weight loss
bullet Sleep problems
bullet Headaches
bullet Jitteriness
bullet Social withdrawal
bullet Stomachaches
  Some less common side effects include the following:
   
bullet Dry mouth
bullet Dizziness
bullet Rebound effect (increased activity or a bad mood as the medication wears off)
bullet Transient tics
  Very rare side effects include the following:
   
bullet Stuttering
bullet Increase in blood pressure or heart rate
bullet Growth delay
  More than half of children who have tic disorders such as Tourette syndrome also have ADHD. Tourette syndrome is an inherited condition associated with frequent tics and unusual vocal sounds. The effect of stimulants on tics is not predictable, although most studies indicate that stimulants are safe for children with ADHD and tic disorders.

Most side effects can be relieved using one of the following strategies:

   
bullet Changing the medication dosage
bullet Adjusting the schedule of medication
bullet Using a different stimulant
  If your child has tried 2 or 3 stimulants and none have helped, or if your child had side effects that could not be controlled, another medication may be an option. Ask your pediatrician for advice.

Stimulants may not be an option for children who are taking certain other medications or who have some medical conditions.

  Behavior therapy

Most experts recommend using both medication and behavior therapy to treat ADHD. This is known as a multimodal treatment approach.

There are many forms of behavior therapy, but all have a common goal—to change the child’s physical and social environments to help the child improve his behavior.

Under this approach, parents, teachers, and other caregivers learn better ways to work with and relate to the child with ADHD. You will learn how to set and enforce rules, help your child understand what he needs to do, use discipline effectively, and encourage good behavior. Your child will learn better ways to control his behavior as a result.

Behavior therapy has 3 basic principles.

Principles for behavior therapy:

   
  1. Set specific goals. Set clear goals for your child such as staying focused on homework for a certain time or sharing toys with friends.
  2. Provide rewards and consequences. Give your child a specified reward (positive reinforcement) when she shows the desired behavior. Give your child a consequence (unwanted result or punishment) when she fails to meet a goal.
  3. Keep using the rewards and consequences. Using the rewards and consequences consistently for a long time will shape your child’s behavior in a positive way.
  Table 3 shows specific behavior therapy techniques that can be effective with children with ADHD
    Table 3. Behavior therapy techniques
    Technique Description Example
    Positive reinforcement Providing rewards or privileges in response to desired behavior. Child completes an assignment and is permitted to play on the computer.
    Time-out Removing access to desired activity because of unwanted behavior. Child hits sibling and, as a result, must sit for 5 minutes in the corner of the room.
    Response cost Withdrawing rewards or privileges because of unwanted behavior. Child loses free-time privileges for not completing homework.
    Token economy Combining reward and consequence. The child earns rewards and privileges when performing desired behaviors. She loses rewards and privileges as a result of unwanted behavior Child earns stars for completing assignments and loses stars for getting out of seat. The child cashes in the sum of her stars at the end of the week for a prize.
  Behavior therapy recognizes the limits that having ADHD puts on a child. It focuses on how the important people and places in the child’s life can adapt to encourage good behavior and discourage unwanted behavior. It is different from play therapy or other therapies that focus mainly on the child and his emotions.

How can I help my child control her behavior?

As the child’s primary caregivers, parents play a major role in behavior therapy.

Parent training is available to help you learn more about ADHD and specific, positive ways to respond to ADHD-type behaviors. This will help your child improve.

 

  Tips for helping your child control his behavior

bullet Keep your child on a daily schedule. Try to keep the time that your child wakes up, eats, bathes, leaves for school, and goes to sleep the same each day.
bullet Cut down on distractions. Loud music, computer games, and television can be overstimulating to your child. Make it a rule to keep the TV or music off during mealtime and while your child is doing homework. Whenever possible, avoid taking your child to places that may be too stimulating, like busy shopping malls.
bullet Organize your house. If your child has specific and logical places to keep his schoolwork, toys, and clothes, he is less likely to lose them. Save a spot near the front door for his school backpack so he can grab it on the way out the door.
bullet Reward positive behavior. Offer kind words, hugs, or small prizes for reaching goals in a timely manner or good behavior. Praise and reward your child’s efforts to pay attention.
bullet Set small, reachable goals. Aim for slow progress rather than instant results. Be sure that your child understands that he can take small steps toward learning to control himself.
bullet Help your child stay “on task.” Use charts and checklists to track progress with homework or chores. Keep instructions brief. Offer frequent, friendly reminders.
bullet Limit choices. Help your child learn to make good decisions by giving your child only 2 or 3 options at a time.
bullet Find activities at which your child can succeed. All children need to experience success to feel good about themselves.
bullet Use calm discipline. Use consequences such as time-out, removing the child from the situation, or distraction. Sometimes it is best to simply ignore the behavior. Physical punishment, such as spanking or slapping, is not helpful. Discuss your child’s behavior with him when both of you are calm. Treatment plans for ADHD usually require long-term efforts on the part of families and schools. Medication schedules may be complex. Behavior therapies require education and patience. Sometimes it can be hard for everyone to stick with it. Your efforts play an important part in building a healthy future for your child.
  Taking care of yourself also will help your child. Being the parent of a child with ADHD can be tiring and trying. It can test the limits of even the best parents. Parent training and support groups made up of other families who are dealing with ADHD can be a great source of help. Learn stress management techniques to help you respond calmly to your child. Seek counseling if you feel overwhelmed or hopeless.

Ask your pediatrician to help you find parent training, counseling, and support groups in your community. Additional resources are listed at the end of this brochure.

How can my child’s school help my child?

Your child’s school is a key partner in providing effective behavior therapy for your child. In fact, these principles work well in the classroom for most students.

Classroom management techniques may include the following:

   
bullet Keeping a set routine and schedule for activities
bullet Using a system of clear rewards and consequences, such as a point system or token economy (see Table 3)
bullet Sending daily or weekly report cards or behavior charts to parents to inform them about the child’s progress
bullet Seating the child near the teacher
bullet Using small groups for activities
bullet Encouraging students to pause a moment before answering questions
bullet Keeping assignments short or breaking them into sections
bullet Close supervision with frequent, positive cues to stay on task
  Your child’s school should work with you and your pediatrician to develop strategies to assist your child in the classroom. When a child has ADHD that is severe enough to interfere with the child’s ability to learn, two federal laws offer help. These laws require public schools to cover the costs of evaluating the educational needs of the affected child and providing the needed services.

The laws are:

   
bullet The Individuals with Disabilities Education Act, Part B (IDEA)
bullet Section 504 of the Rehabilitation Act of 1973
  If your child has ADHD and a coexisting condition, she may need additional special services such as a classroom aide, private tutoring, special classroom settings, or, in rare cases, a special school.

It is important to remember that once diagnosed and treated, children with ADHD are more likely to achieve their goals in school.

Keeping the treatment plan on track

Ongoing monitoring of your child’s behavior and medications is required to find out if the treatment plan is working. Office visits, phone conversations, behavior checklists, written reports from teachers, and behavior report cards are common tools for following the child’s progress.

Ask your pediatrician to help you find ways to keep your child’s treatment plan on track.

What if my child does not reach his target outcomes?

Most school-aged children with ADHD respond well when their treatment plan includes stimulant medications and behavior therapy. If your child is not achieving his goals, your pediatrician will assess the following factors:

   
bullet Were the target outcomes realistic?
bullet Is more information needed about the child’s behavior?
bullet Is the diagnosis correct?
bullet Is another condition hindering treatment?
bullet Is the treatment plan being followed?
bullet Has the treatment failed?

While treatment for ADHD should improve your child’s behavior, it may not completely eliminate the symptoms of inattention, hyperactivity, and impulsivity. Children who are being treated successfully may still have trouble with their friends or schoolwork.

However, if your child clearly is not meeting his specific target outcomes, your pediatrician will reassess the treatment plan.

 

  Teenagers with ADHD

The teenage years can be a special challenge. Academic and social demands increase. In some cases, symptoms may appear to be less severe as the child grows older, but, in most cases, ADHD symptoms persist. According to the National Institute of Mental Health, about 80% of those who required medication for ADHD as children still need it as teenagers.

Parents play an important role in helping teenagers become independent.
Encourage your teenager to help herself with strategies such as the following:

bullet Using a daily planner for assignments and appointments
bullet Making lists
bullet Keeping a routine
bullet Setting aside a quiet time and place to do homework
bullet Organizing storage for school supplies, clothes, CDs, sports equipment, etc
bullet Being safety conscious (e.g., always wearing seat belts, using protective gear for sports)
bullet Talking about problems with someone she trusts
bullet Getting enough sleep

Activities such as sports, drama, and debate teams can be good places to channel excess energy and develop friendships. Find what your teenager does well and support her efforts to “go for it.”

Milestones such as learning to drive and dating offer new freedom and risks. Parents must stay involved and set limits for safety.

It remains important for parents of teenagers to keep in touch with teachers and make sure that their teenager’s schoolwork is going well.

Talk to your pediatrician if your teenager shows signs of severe problems such as depression, drug abuse, or gang-related activities.