Dr. Greene’s Answer:

Most adults — but not all — have already had Hand Foot and Mouth and are not at risk. There are a few different strains of viruses that cause Hand Foot and Mouth though, so having had the illness once isn’t a guarantee.

Kids may be contagious just by being in the same room while they have a fever and up to 24 hours after. The saliva can contain the virus for up to 2-3 weeks. The stool can contain the virus for 3-8 weeks or so.

I don’t recommend keeping kids out of school beyond 24 hours after fever – because there are enough kids in class with it anyway without the fever, and don’t even know they have it. Keeping kids out doesn’t appreciably change the spread.

But I do keep away from “vulnerable” adults not around a lot of kids, if possible. Not in same room if they have a fever, plus 24 hours after the fever is gone. Not sharing same food or utensils while any sores are still present in mouth or on body. No changing diapers or toileting assistance for two months. and good hand-washing all the way around, after toilet and before eating or drinking or hands in the mouth.

If others in the family do get sick, first symptoms usually occur 3-5 days after getting the virus – and become contagious about the same time (unlike chickenpox where your are contagious 24-48 hours before symptoms).

My 10-year-old daughter wants a cell phone. She wants it bad. So bad that the other night I came home to the note pictured below.

(Natasha’s treatise, page 1)

Her three older siblings got cell phones in middle school, when they began to routinely go places without us. But Natasha (who just finished 4th grade) wants one now. So she put together a treatise (you can’t tell from the picture, but it was on really big paper) about why she needs one.

The truth is, she doesn’t need one. She is never really far from us on walks or bike rides. While it might be nice to time pickup from swim practice, we’re actually reasonably good at figuring out how long it takes Tash to shower and get dressed (longer than is reasonable + 10 minutes). If we’re wrong, or there’s some sort of emergency, there are phones at the YMCA she can use.

(Natasha’s treatise, page 2)

This is what I told her the next morning, as she sat on the stool with her arms crossed, scowling at me. And then she burst into tears. “Do you know how hard it is,” she sniffled, “not to have one when all your friends do?”

Of course. The real reason. Cell phones are cool. Tash is all about cool.

According to a 2009 Kaiser Family Foundation report, 31 percent of 8-10-year-olds have cell phones. The numbers have certainly gone up since then. So while I doubt that all of Tash’s friends have a cell phone, I wouldn’t be surprised if a bunch of them do.

So why do I care? We’ve got old phones around the house. We have a family plan, so we’d just have to pay the monthly charge, which isn’t so much.

Here’s why I care. First of all, that same Kaiser report said that the average 7th to 12th grader spends and hour and a half a day texting.

They text during school, even when there are rules against it. They talk and text as they walk (how many times have you had someone on a cell phone walk obliviously in front of your car?). They play games on them, watch TV, or surf the Web. It is a huge distraction. I don’t want Tash distracted like that.

It’s not just the distraction factor.There’s the problem of sexting, in which kids send lewd or suggestive pictures of themselves to each other (which is a felony, as it’s distributing porn). Bullying happens via text.

And now the World Health Organization says that cell phone use is a “possible carcinogen”: the low-level radiation cell phones emit could possibly increase the risk of certain brain tumors. This kind of radiation, if it does damage, does it over years. The earlier you start using a cell phone, the more years of exposure.

We can set rules around her cell phone use, sure (interestingly, very few of the kids in the Kaiser report said that their parents set rules). But these rules are hard to enforce, and it’s hard for me to imagine Tash being careful to hold the phone away from her head.

For some young kids, cell phones truly do improve their health and safety. Kids with chronic and dangerous health problems, like diabetes or bad asthma, can use them to get help quickly. Kids who will be alone for more than brief periods are safer if they can be in touch with a grownup easily. And for various reasons, some families need the ability to be in close contact. In these situations, the benefits outweigh the risks. In Natasha’s situation, they don’t.

I don’t know the right age for giving a child a cell phone. Maybe middle school is too early (more than two-thirds of 11 to 14-year-olds have them). Ultimately, families need to decide what makes sense for them. But as they do, I hope they think about the risks and downsides of cell phones.

We did some serious thinking about those risks and downsides. Sorry, sweetie. You’re not getting one yet.

Parents often use their kids as an excuse as to why they can’t grow their own food.

To that I’ll ask, “Why not include the kids and make it a family experience?”

I mean it is what families have done for thousands of years. It’s not until recent that this trend has changed. The school year is based on the agricultural calendar. Kids were off for the summer to help tend the fields.

It’s not until the past 100 or so years that families and society have placed the responsibility of providing food for their family to others. We don’t have a sense of where it came from or what’s happened to it. We just know that it’s there.

Food is something that should be communal from the planting, growing, harvesting, preparing, sharing and eating. These all help to bring a real appreciation for everything that’s involved in getting it to our dinner tables. In modern times, we have skipped straight to the eating part and most people even do that on the run as if it’s another item on the to-do list.

There are a bunch of fun projects that you can do as a family to keep everyone involved, costs low all while spending some quality family time together.

Now let’s get into where to begin.

Deciding what to grow. Have a family meeting to make this decision. Let everyone voice their opinions and come to a conclusion as a family.

Potting soil. Go to your local nursery or health food store and buy some organic potting soil to get started.

Starting seeds. This can be a whole fun project unto itself. There are a bunch of ways (and expensive supplies to buy) that you can be used to start your seeds, but they are not required. You just need toilet paper rolls, potting soil and your seeds. Here’s a video of how to use toilet paper rolls as a seed starter pot.

Once your seeds are planted, you’ll want to keep them in a nice sunny area and keep them moist. After a week or so, you’ll start to see sprouts develop and peek their way through the soil. This should keep you and the kids entertained.

Containers. If you don’t have a front or backyard to plant in, which is common, but do have a porch, patio, fire escape or balcony, you can still grow your own food. You’ll just have to use containers.

I’ve found that self-watering containers work great and use them in my gardens.

Kids can be get involved in the process by having them decorate the containers.

Caring for. As a family, you can divide up the chores of caring for your garden. These will include watering, checking for bugs and taking care of the plant. You can keep a diary and pictures of your weekly progress to chart growth to show how garden is doing.

Harvesting and preparing. Once the plants are mature, you’ll have to harvest it to get it ready for your meal. Then, you’ll have to decide how you want to prepare it. Come to this decision as a family.

Sharing. This is where it all comes together and becomes totally worth it. You know very well that if you made a salad for dinner and the parsley was the only ingredient that you grew, you are going to brag about it. There is nothing wrong with that.

Your sense of accomplishment and pride will shine through and it will show in the food. You’ll tell everyone that you grew this parsley from seed. I’m certain that you kids will be bragging as well.

There isn’t the expectation to have a huge garden. All it takes is growing that one plant to make a difference. It will bring your family closer together and make you appreciate your food that much more.

What are you going to start growing?

Most American students cheat.

In nationwide surveys on college campuses, about seven in ten students admitted to some cheating.  Three in five high school students admitted that they had cheated on an exam, and more than four in five admitted copying another student’s homework in the past 12 months.

There is a cheating crisis in our schools, and the problem is not confined to low-achieving or unmotivated students. Cheating is common among most types of students—boys, girls, athletes, smart kids, student leaders, even those with “strong religious beliefs.” Why are so many students cheating?

Our culture has become preoccupied with achievement. Pressure for grades—to win parents’ approval and gain admission to colleges—leads many students to cheat. While many students are pushed to succeed by parents and a grade-based system that starts naming winners at an early age, students also feel pulled by a desire to get on a path to top colleges and high-paying jobs.

But there are serious ramifications to ‘winning at any cost,’ including lack of character in students, and also the lack of self-esteem.

Never kid a kid. They will never misread our true expectations of them. They know we have created an educational system that values their aptitude more than their attitude, their ability more than their effort, and their talent more than their character. They are surrounded by signs that tell them that what they can do is more important than who they are.

Unfortunately, an environment that values only achievement can make it extremely easy for test scores and awards to lure good kids into a false sense of fulfillment. This is not the genuine self-esteem that is earned from the learning process—which includes mistakes and some hardship—and it can leave kids feeling empty.

In a character culture, achievement is valued, but principles are valued more. That is, what you stand for is more important than merely how you stack up against others.

In addition to this pressure for external achievements, there is another debilitating grip on today’s kids, which is the result of a prevalent mindset in our homes, schools, and culture, that asserts that kids need to feel good about themselves all of the time.

Applied to education, this mindset seems to say, ‘If we make kids feel good about themselves, they will do great things.’ But, in fact, it’s the other way around. When kids do well, and do it honestly, they will feel good about themselves.

Character is inspired, not imparted. We cannot pour it into our kids or our families. Self-esteem—real, authentic self-esteem—is essential, and once earned, it can never be taken away. Our children should graduate from schools with a healthy amount of it.

Introduction to tonsillitis:

If you look into your child’s throat, you might see what look like small, dimpled, pink golf balls on either side of the throat. These are the tonsils.
The tonsils are the visible part of the immune system’s ring of protection that surrounds the back of the throat. This immune tissue stands guard to protect your child’s lungs and intestines from foreign invaders. The adenoids, the other famous part of this ring, are hidden out of site above.
Tonsils are normally large during childhood, but they can cause trouble when they become infected or grow too large.

What is tonsillitis?

Tonsillitis is the name given to swollen, red, and tender tonsils. This is usually caused by an infection of the tonsils. The most common causes of tonsillitis are viral infections. Many of the viruses are the same as those that cause the common cold.
Coxsackievirus can cause painful tonsillitis with a high fever and decreased appetite, sometimes with a rash as well. Mononucleosis can also cause severe tonsillitis.
Bacterial infections are important causes of tonsillitis, even though they are less common. Streptococcus is the most common type of bacteria involved.
Tonsillitis overlaps with strep throat and other sore throats. When a child has a sore throat, either the tonsils may be red and swollen, or other parts of the throat may be red and swollen – or both.

Who gets tonsillitis?

Tonsillitis is not common before the first birthday. It tends to peak in the years surrounding kindergarten, but can occur throughout childhood and even in adult life.

What are the symptoms of tonsillitis?

Generally, children with tonsillitis have a sore throat and pain with swallowing. Babies and toddlers may simply refuse to eat or drink because of the throat pain. There may also be some difficulty with swallowing or breathing. You might notice snoring or mouth breathing, accompanied by a dry mouth and mouth odor. Sleep disturbances sometimes result in bed-wetting (enuresis). Decreased appetite, fatigue, and swollen glands in the neck are also common.
The specific symptoms of tonsillitis will depend largely on the underlying cause. Tonsillitis caused by an upper respiratory virus, for instance, may start gradually and be accompanied by nasal congestion. On the other hand, tonsillitis caused by strep might start suddenly with a high fever.

Is tonsillitis contagious?

Most forms of tonsillitis are contagious and are spread by droplet transmission.

How long does tonsillitis last?

The length of tonsillitis depends largely on the underlying cause. Most viral tonsillitis tends to last a matter of days; strep tonsillitis for up to a couple of weeks, and tonsillitis caused by mononucleosis commonly lasts for weeks or months.
Sometimes bacterial tonsillitis will last for months, even with appropriate antibacterial therapy.

How is tonsillitis diagnosed?

Tonsillitis can be diagnosed with a history and physical exam. A throat culture and/or rapid strep test are important to identify the cause, especially if antibiotics are being considered. A mono test, and other specific blood tests, may be indicated if the cause is not clear.

How is tonsillitis treated?

Taking out the tonsils for tonsillitis used to be common. Today, most cases of viral tonsillitis are managed by watching and waiting (while treating the pain and fever). Tonsillitis will be treated with antibiotics if bacteria appear to be the cause. The longer that tonsillitis lasts, the more likely that it will require stronger treatment. In some circumstances, steroids are used to reduce tonsil swelling.
The American Academy of Pediatrics recommends removing the tonsils under some conditions:

• Tonsil or adenoid swelling that makes normal breathing difficult (this may or may not include sleep apnea).
• Tonsils that are so swollen that your child has problems swallowing.
• An enlarged adenoid that makes breathing uncomfortable, severely alters speech, and possibly affects normal growth of the face. In this case, surgery to remove only the adenoid may be recommended.
• Your child has repeated ear or sinus infections despite treatment. In this case, surgery to remove only the adenoid may be recommended.
• Your child has an excessive number of severe sore throats each year.
• Your child’s lymph nodes beneath the lower jaw are swollen or tender for at least six months, even with antibiotic treatment.

How can tonsillitis be prevented?

Tonsillectomy can prevent tonsillitis, but is only recommended in select circumstances.
Because most types of tonsillitis are spread by droplet transmission, droplet precautions can be effective means of prevention. Some tonsillitis, such as the kind caused by mono, is spread by body fluid transmission. Body fluid precautions are needed to prevent this type of tonsillitis

Related A-to-Z Information:

Adenovirus, Allergies (Allergic Rhinitis), Body-Fluid Transmission, CMV (Cytomegalovirus), Common Cold, Coxsackievirus, Diphtheria, Droplet Transmission, Enteroviruses, Enuresis (Bedwetting), Fomites, Hand-Foot-Mouth Disease, Mononucleosis (Mono), Scarlet Fever, Sleep Apnea, Strep Throat, Streptococcus (Strep)

Related concepts:

Speech disfluency

Introduction to stuttering:

When a child stutters, parents are often told to relax, that the stuttering is a phase that will soon be outgrown, and that nothing need be done. This advice is not always helpful.

What is stuttering?

Stuttering is a speech disorder that arises from a combination of genetic susceptibility and environmental triggers. Stuttering usually begins during the time of intense speech and language development when the child is progressing from 2-word phrases to the use of complex sentences. Stumbling over words is normal. In most children, it gets better over time. In some, it becomes problematic, complicated by fear, embarrassment, and frustration. It can become a habit disorder.
Treatment of stuttering is more effective the earlier it is begun. By needlessly delaying evaluation, parents can miss an important window of time when their child’s stuttering is most treatable. On the other hand, many children go through a developmental stage of speech disfluency that is often confused with true stuttering. This normal disfluency does disappear over time without need for treatment.

Who gets stuttering?

About 4 percent of all children will have true stuttering for at least 6 months, most commonly between the ages of 2 and 5. Boys are far more likely than girls to have prolonged stuttering. Stuttering often runs in families. A child who is a boy, has speech delay, a family history of long-term stuttering, and who has stuttered for 18 months is at the highest risk for long-term stuttering.

What are the symptoms of stuttering?

If a two-year-old begins to repeat syllables, short words, or phrases (su-su-such as this, or such as…such as such as this) about once every 10 sentences, and begins to use more filler words (um, with uh pauses or er hesitations), is this normal disfluency or stuttering?
Children with true stuttering tend to repeat syllables four or more times (a-a-a-a-as opposed to once or twice for normal disfluency). They mmmmmay also occasionally prolong sounds. Children with stuttering show signs of reacting to their stuttering — blinking the eyes, looking to the side, raising the pitch of the voice. True stuttering is frequent — at least 3 percent of the child’s speech. While normal disfluency is especially noticeable when the child is tired, anxious, or excited, true stuttering is noticeable most of the time. Children with true stuttering are usually concerned, frustrated, or embarrassed by the difficulty.

Is stuttering contagious?

No – although pressure from other people can make stuttering worse.

How long does stuttering last?

Most will recover by late childhood, but about one percent of adults have severe, chronic stuttering.

How is stuttering diagnosed?

Whenever parents suspect that their child has true stuttering, it is important to bring it to their pediatrician’s attention. Stuttering is easily treatable, unless you miss the window of time when treatment is most effective.

How is stuttering treated?

Speech therapy is very effective, if initiated early. The therapy is important both for treating the child, and for training the parents how to respond to the stuttering in the meantime. Researchers are also looking at “altered auditory feedback” devices, though there is not yet clear evidence that these are effective in reducing stuttering.

How can stuttering be prevented?

Some children will begin to stutter no matter what parents try to do to prevent it. Nevertheless, language development proceeds most smoothly in an environment that is relaxed and supportive. Avoid rushing or correcting children when they are talking. Focusing the child’s attention on the stuttering can make it worse.

Related A-to-Z Information:

Breath Holding, Ear Infection, Head Banging, Thumb-sucking, Tourette’s Syndrome

Related concepts:

Mite infestation

Introduction to scabies:

A child has an itchy rash. Someone has called it eczema, or something like that, and a cortisone cream was prescribed. But the itching never improved. Or perhaps your child has no rash at all, but scratches relentlessly. Either way, perhaps the child has undiagnosed scabies.

What is scabies?

Scabies are tiny mites that are quite common and can infest the skin. Itching is caused by a normal allergic reaction to the mites, their eggs, and their feces. Itching may be quite intense, and often appears before any visible sign of infestation.
The adult female mite is the size of a pinpoint and is barely visible to the unaided eye. She has four sets of legs on a round body covered with brown spines and bristles. When she lands on someone’s skin, she burrows underneath the outer layer within 30 minutes, usually without being noticed. Every day she extends her burrow by up to 1/4 inch horizontally under the surface of the skin. Along the way, she lays little oval eggs, and also leaves many tiny fecal droppings. She will survive for about a month, and then die within the burrow.
The eggs hatch 3-5 days after being laid. The little larvae squirm through the burrow back towards the skin surface. They reach maturity in 2-3 weeks. They mate as soon as they find partners, and the pregnant females each start new burrows.
Usually the person doesn’t suspect any problem for about four weeks, while the mites burrow and reproduce, without causing any symptoms. Eventually, an allergic response develops in the host person. If a healthy person has had scabies before, the allergic response begins within minutes, rather than weeks. On the other end of the time spectrum, if a new host’s immune system is suppressed, the allergic response may take months rather than weeks.
Chiggers and the mites that cause mange in dogs may also cause mite infestations in children.

Who gets scabies?

Children are the most vulnerable, but anyone can get them. Whenever a child develops intense itching, especially at night, the possibility of scabies should be considered.

What are the symptoms of scabies?

Intense itching, especially at night, is the hallmark symptom. It may be present before any other symptom.
Soon, 1-2 mm raised red bumps typically appear (they often look like pimples). Sometimes they are crusted, scaling, or ulcerated. Occasionally, there are blisters or hives. Threadlike burrows are sometimes visible under the skin. After several weeks or several months, a widespread eczema-like rash may camouflage the original problem. The scabies rash is sometimes confused with drug reactions, eczema, seborrhea, chicken pox, and other viral rashes.
Scabies like to burrow in the web spaces of the fingers, the creases of the wrists, the armpits, the ankles, the feet, the genitals, and the nipples. They can occur anywhere on the body, although the face and neck are usually spared.

Is scabies contagious?

Scabies is highly contagious. Spread of the mites usually occurs directly from person to person. The greater the extent and duration of touch, the more likely the mites are to spread.
Catching scabies from objects (fomites) is far less common, but the mites can live in the absence of a person for 48 to 72 hours. Clothing and bedding that may be contaminated should be washed in hot water. When this is not possible, items should be left in a sealed plastic bag for 7 to 10 days.

How long does scabies last?

The scabies infestation usually lasts until treated. People are usually no longer contagious within 24 hours of treatment.
Even after successful treatment, the dead mites, dead eggs, and fecal material will remain in the skin for 2 to 4 weeks (until the skin grows out). Thus, intense itching is expected to continue. Antihistamines (especially at night), topical steroid creams, and the liberal use of moisturizers will often help. Sometimes antibiotics are needed, if scratching results in a bacterial infection. If the rash continues to spread after treatment, or if itching persists for longer than 2-4 weeks, reexamination and/or retreatment may be necessary.

How is scabies diagnosed?

Scabies is usually diagnosed by the history and physical exam. The diagnosis can be confirmed by examining skin scrapings under a microscope. Mites and their eggs are visible under the microscope.

How is scabies treated?

Most cases of scabies are completely eradicated with a single overnight application of an anti-scabies cream available by prescription. It should be massaged into the skin from the scalp all the way to the soles of the feet, and then thoroughly rinsed off 8-14 hours later. Sometimes a second application is prescribed one week later. All family members, babysitters, and close physical contacts should be treated. Usually, a 2-oz tube will treat one adult. In pregnant women and infants under 2 months, a gentler (and smellier) ointment is often used nightly for 3 to 5 days to control the scabies infestation.

How can scabies be prevented?

Scabies infestations result from close physical contact, not from dirtiness or poor hygiene. Treat all contacts aggressively now, rather than waiting for the infestation to spread any further. Avoiding contact with infected individuals is the best way to prevent an infestation

Related A-to-Z Information:

Chickenpox (Varicella), Contact Transmission, Coxsackievirus, Eczema, Exanthems (Childhood rash), Fomites, Hives, Lice, Pinworms, Poison Ivy, Oak, and Sumac, Ringworm (Tinea corporis), Smallpox, Ticks

Related concepts:

Over-nutrition

Introduction to obesity:

You’ve probably already heard that we are raising the most overweight, out-of-shape generation of children in history. On January 21, 2011, the Centers for Disease Control and Prevention (CDC) released another round of figures. What is amazing is that the problem isn’t staying the same, but keeps increasing, year after year. There was no increase between 1960 and 1980, but since 1980, the percent of overweight children has been rising dangerously. According to the CDC, 17% or 12.5 million children and adolescents are obese.
Obesity among children is literally an epidemic. Unless we get kids moving and teach them to enjoy healthy foods, the outlook for their long-term health is bleak. But we can change things. Tobacco use was once thought to be inevitable; now its use has fallen by half. Wouldn’t it be wonderful for all of us, children and adults, if weight problems fell by half over the next several years?

What is obesity?

Obesity, or over-nutrition, is the generalized accumulation of fat both beneath the skin and throughout the body. Some children are big, or stocky, because they have large skeletal frames. They are not obese. There are general guidelines for appropriate weight for a given height, but these are only general guidelines.
Obesity is usually caused by an individual’s eating more food than is necessary for him or her. Less activity than the individual needs can also cause obesity, but this is less common in children. Whatever the cause, certain children inherit a genetic predisposition to obesity. They may eat the same diets as thinner children, but store more of the calories as fat.
The body stores new fat either by increasing the number of fat cells or by increasing the size of existing cells. It is particularly important to control childhood obesity since new fat cells are primarily formed during childhood. Each year of adding these extra fat cells makes adult obesity more difficult to fight.

Who gets obesity?

Overweight children are not gluttonous or lazy. In fact, many studies have shown that obese children do not eat more calories than their peers. And by measuring caloric expenditure using the double-labeled water method, investigators have shown that obese children actually expend more energy than their non-obese counterparts. Obese children need less food and more activity than their peers.
A variety of hormonal disorders, including problems with insulin, hypothalamic hormones, and pituitary hormones, can cause severe obesity.
There are also a number of rare inherited syndromes (such as Laurence-Moon-Biedl, Prader-Willi, and Cushing) that produce obesity. If a child’s height is appropriate or advanced for her age, one of these underlying medical conditions is extremely unlikely. On the other hand, an obese child with slow height growth should certainly be evaluated.

What are the symptoms of obesity?

Is your child overweight? Underweight? A study in the July 2000 issue of Pediatrics shows us that, at least when it comes to teens, both parents and children are surprisingly poor at judging appropriate weight. Forty-seven percent of teens who reported that they were very overweight were not obese at all, according to objective body mass index (BMI) calculations. But among teens who were objectively obese, most parents and most children themselves did not recognize it!
Obesity can lead to many other health problems, including diabetes, high blood pressure, and asthma. In fact, with the increase in childhood obesity, we are also seeing an alarming increase in the rate of adolescent high blood pressure, high cholesterol, and diabetes!

Is obesity contagious?

No – but the behavior that leads to obesity can be contagious or cultural.

How long does obesity last?

Obesity tends to get worse over time, unless intentional steps are taken to change basic habits of activity and diet.

How is obesity diagnosed?

The CDC growth charts are an excellent mirror that can help us see accurately how our children are growing. The BMI curve, in particular, can give us an early warning even before a child is truly overweight or underweight. Sometimes we need to take a more objective look at our kids.

How is obesity treated?

Obesity can be very difficult to treat, since it involves permanently changing basic eating and exercise habits. Successes almost always involve changing the whole family’s habits to those that are appropriate for the obese child.
Cutting excess intake is best achieved by first keeping a careful record of food consumed, to identify particular problem areas in the diet. The entire family must learn which foods are healthy. Whole fruit, whole vegetables, and whole grains should make up the bulk of the diet.
Parents need to know that white bread vs. whole wheat is not a trivial question. Whether or not children eat whole grains could have a major impact on their health. A study in the August 2002 issue of The American Journal of Clinical Nutrition analyzed data from the large, ongoing Framingham Offspring Study. The study found that after adjusting for other variables, there remained a strong correlation between the amounts of whole grain consumed over a four year period, and healthier weight, healthier waist-to-hip ratio, and decreased risk for diabetes. This was true no matter how much refined grain was eaten, and no matter how much fiber.
While changing eating habits, the family also will benefit from changing their active play habits. Whatever the daily activity level of the family, it should be modestly increased.
A January 2000 report to the Centers for Disease Control and Prevention (CDC) identified the single most powerful change teens can make to bring their weight under control. “Of all the ways of tackling this problem, TV reduction appears to be the most effective measure in reducing weight gain in this population,” Dr. William Dietz, Director of the Division of Nutrition and Physical Activity, told the CDC Advisory Board. Bike, dance, play ball – have fun being active!
Most families are not able to make these lasting changes on their own, and will benefit from meeting with an independent party at least once a week for 12 weeks. Ideally, this outside individual should be a nutritionist or an expert in weight management, but even a committed friend will do. In many cities, pediatric weight management programs such as Shapedown are available and are very effective. Whatever the source, monitoring should continue at least monthly for the remainder of the first year, and then every 3 to 4 months until the new habits have become very deeply ingrained.
I often ask my patients to think of one healthy change they can make in their lives, starting today. Then, my role is to “cheer” them on, encouraging them every few weeks to add another lifestyle change while monitoring their weight and any associated health problems.

How can obesity be prevented?

Whether your child is a baby or a teen, now is the best time to be sure that active, physical play is a part of her life for at least 30 minutes every day. According to the CDC, childhood obesity in the US has tripled since 1980. Guidelines released by the National Association for Sport and Physical Education draw on evidence of benefit from over 40 scientific studies to urge those caring for children to be mindful each day of encouraging movement and motor skills. The guidelines were updated in 2009 for children under age 5, and in 2004 for children 5-12 years old. School-age children should be engaging in at least 60 minutes of activity each day. Boring calisthenics are not what the doctor orders. Instead, look for anything fun that gets kids walking, running, rolling, balancing, jumping, kicking, throwing, or dancing. If they’re too young for these, engage them in tummy-time or playing with a rattle. One of our important tasks as parents is to teach a lifelong habit of active fun.
A study published in the April 2001 issue of the American Journal of Public Health offers real hope. Children were 400% to 500% more likely to be physically active if they were given an attractive place to play and were supervised by adults. Among middle-school students, basketball hoops and courts, baseball backstops, volleyball nets, tennis courts, and racquetball courts made the biggest impact. Realistic changes in our schools, parks, neighborhoods, and homes can revolutionize the health of our children.
Healthy eating habits can also prevent obesity. Babies who are breastfed have a 30 percent drop in their risk of obesity, according to a study published in the June 8, 2002 issue of The Lancet. This study looked at more than 32,000 children who were 3 to 4 years old. After adjusting for birth weight and socioeconomic status, those who had been breastfed were only 70 percent as likely as their formula-fed peers to have become obese. Breastfeeding is not a guarantee of a good outcome, but it does improve the odds for your child in many areas of life.
Another important early tip: when babies are transitioning to solid foods, avoid putting cereal or solids in the bottle. Also avoid too much juice. For most children up to age 6, fruit juice should be limited to 4 to 6 ounces per day. For those 7 and over, 8 to 12 ounces per day is a good maximum. And juice does not belong in a baby bottle.

Related A-to-Z Information:

Asthma, Depression,Inconspicuous Penis, Sexual Abuse, Tantrums, Type I Diabetes

Related concepts:

Pediculosis, Head lice

Introduction to lice:

My head starts to itch when I even write about lice. Lice are a common problem wherever children gather. If you are concerned about lice, you are not alone. Each year, many day-care centers, schools, neighborhoods, extended families, and small family units face this problem.

What is lice?

Adult lice (also called Pediculus humanus capitis) are six-legged, wingless insects 2-4 mm long. They have translucent grayish-white bodies, and look a bit like a grain of rice with six legs. Their heads have two tiny eyes (too small to be seen without magnification) and two small antennae (usually visible). Six pairs of hooks that surround the mouth allow them to attach themselves to the skin of the scalp for feeding. The mouth contains two retractable, needle-like tubes that pierce the scalp. Salivary juices are injected into the scalp to prevent blood from clotting, and then the lice feed happily, sucking blood through these same tubes. Their translucent bodies turn reddish brown when engorged with blood. Lice completely depend on the blood extracted from humans for existence, and thus will starve to death after 55 hours without blood.
Adult lice can freely move around a head of hair and travel to another person, clothing, plastic combs or brushes, or upholstered furniture. Adult lice usually live for about a month on a human host. During this time, the females generally lay from three to 10 eggs per day (although some female lice have been known to lay up to 5,000 eggs in their lives when in an environment to their liking).
Lice eggs are called nits. These white, translucent, pinpoint-sized eggs are laid near the base of hair shafts, and move outward as the hair grows (nits found near the tips of long hairs suggest a longstanding infestation). Nits are glued tightly to the side of the hair shafts, and cannot be moved along the shafts or knocked off with fingers. The eggs hatch between ten to fourteen days after they are laid. The empty eggs remain attached to the hair shaft. The newborn larvae must feed on human blood within 24 hours, or they will starve to death. The larvae become sexually mature adult lice within about one week. Adult head lice can survive up to two days away from the scalp, which is how they are transmitted by things like combs, brushes, and hats.
During this whole life cycle, larvae and adult lice deposit their feces in the scalp, which eventually causes itching as the person develops an allergic reaction to the lice stool.

Who gets lice?

Lice seem to prefer children to adults, long hair to short hair, and they particularly like the hair of females. Interestingly, lice only rarely afflict African Americans living in North America. The lice in Africa and South America have adapted, however, and cases are common in every group on those continents. Cases of lice are most common in children 3 and 10 years old, but can occur at any age.
Lice have been a nuisance to humans since ancient times. Having head lice is not a sign of poverty or poor hygiene. They have thrived almost wherever humans have been in prolonged close contact with each other. One notable exception to this has been in areas where the pesticide DDT is in widespread use. In the United States, for a period of about 30 years, lice outbreaks were uncommon. Since DDT was banned in 1973, the number of cases of lice has risen steadily. Today, there are about 12 million cases per year in the United States alone.

What are the symptoms of lice?

The hallmark symptom of head lice is itching, but a person may have lice for months before the itching begins.

Is lice contagious?

Lice are quite contagious. They spread from person to person when heads touch. Because they can live independent of a person for up to 55 hours, they are also commonly spread via stuffed animals, hats, headphones, combs, brushes, towels, clothing, car seats, sofa cushions, and bedding.

How long does lice last?

Each louse lives for about a month, but an infestation of lice will usually continue until treated.

How is lice diagnosed?

The best way to diagnose head lice is to inspect the head of anyone who might have been exposed to them using a bright light (full sun or the brightest lights in your home during daylight hours work well). A magnifying glass can make the job easier. Part the hair all the way down to the scalp in very small swaths, looking both for moving insects and nits. The entire head must be inspected to make sure there is no problem. Careful attention should be given to the nape of the neck and around the ears, the most common locations for nits. Even one nit in the hair should be treated. The egg might be empty, or contain a dead larva but then again, it might not!
Frequently, people find “pseudo-nits” and panic unnecessarily. Bits of hair spray, dead skin scales, or loose debris may be seen on hair shafts. These move with pressure from the fingers, and nits do not. Also, live nits glow when exposed to a black light (we use black lights in pediatric offices for inspection) and dead nits and empty nits do not.

How is lice treated?

Mechanical nit removal is the cornerstone of lice treatment, although medicines can be a real help.

The Great Lice Adventure

It is important for everyone potentially involved in an outbreak to be treated at the same time. If 99.99% of the lice are killed, but .01% are not, you already have the makings of another outbreak!

Here is a step-by-step guide for using common, over-the-counter medicines to kill the lice, followed by several great natural remedies:

• Set a community-wide time to act — now!
• Get all the kids excited about The Great Lice Adventure! Have teachers do projects on lice as insects. The more the kids know about what’s going on, the better. Use art, storytelling, science, even math. Start with one louse and calculate how many lice would be on an untreated head at the end of, say, a day, a week, a month …
• Print detailed instructions on how to get rid of lice and distribute them to children, parents, teachers, and anyone else who works at the school.

Day One

Not all of the following steps are always necessary for an individual child. For stubborn cases, especially during school-wide outbreaks, following all of the steps can actually save a lot of hassle and repeated exposure to pesticides

• Carefully comb through the hair using a nit comb. I don’t recommend using the combs that come packaged with lice shampoos. Instead, use a new product, called the LiceMeister. Its metal teeth are very close together, catching lice well, but without catching or pulling on hair. Since most children will only sit still for a short time (and since most parents don’t want to spend longer than necessary combing through lousy hair), using this comb results in a more thorough delousing than when using the ordinary plastic nit combs.
• Recent studies show that while white vinegar does loosen nits from the hair shaft.

Using stronger pesticides can set up a pattern of using more and more powerful pesticides as the lice develop ever-increasing resistance. This pattern has a definite negative long-term impact on the environment. It also exposes children to greater and greater levels of toxins.

Most alternative treatments are untested, but early reports are promising. One method with widespread stories of success is the Vaseline (or mayonnaise) treatment. Cover the infested head liberally in Vaseline. Place a shower cap over the entire head for the night (or an eight-hour period). Then shampoo the Vaseline out of the hair. This treatment is reported to “smother” the lice. The downside of this method is that the Vaseline does not shampoo out of the hair easily — in fact, it usually takes a week or so to get it all out. The upside is that it is not toxic, and from all reports, it seems to work. Washing the hair with dishwashing liquid, which has a degreasing agent in it, may help. I’ve smothered my own hair in mayonnaise (loved the smell), and it came out easily with dishwashing liquid.

To date, the jury is still out about whether or not these alternative treatments are effective. One research scientist has published several articles stating that Vaseline, mayonnaise, and other oil-based treatments cause the lice to go into a dormant state where they are inactive, but not dead. These dormant lice can later “revive” if they are not removed from the hair shaft. It’s important, when trying this method, to brush out any remaining lice to prevent reinfestation after the Vaseline (or mayo) is washed off.

The Packard Children’s Health Services Pediatric Hotline at Stanford is hailing another popular treatment. It uses regular shampoo and three ingredients that can be found at most health-food stores:

Shampoo  3 tbsp olive oil. 1 tsp tea tree oil. 1 tsp rosemary or eucalyptus oil.

Add the oils to a small amount of shampoo and mix well. Work into hair and leave on for half an hour with a tight-fitting shower cap. This mixture has a strong smell. The fumes may burn the eyes, so don’t lean forward. Wash hair two or three times to get the oil out. Repeat the procedure if necessary.

I’m hearing positive reports about this nontoxic treatment, though to my knowledge, no medical studies have been conducted to establish the efficacy or possible side effects of this treatment.

Meanwhile, several other natural compounds are being studied as possible treatments for head lice. Recently, a group of scientists in Argentina published a study looking at treating head lice with the fruit of the “paraiso” tree (Melia azedarach L.). This is a tree that grows easily all over Argentina, also known as “chinaberry tree,” “Indian lilac,” or “white cedar.” They found that both the extract and the oil of this fruit were able to kill adult head lice and some of the nits (Carpinella et al. Journal of the American Academy of Dermatology, 56(2) 2007).

One of our readers suggested using a hot blow-dryer for 15 minutes, morning and evening, in conjunction with thorough nit combing. The heat helps to kill the nits and adult lice, but the combing is essential to the process. This type of treatment should not be combined with the over-the-counter chemical treatments such as Rid and Nix since those chemicals are deactivated by the heat of the blow-dryer.  . I’ve had great success combining the blow-dryer with an application of Cetaphil, though. You can read about that treatment here.

As a last resort for extra resistant lice, the Red Book 2000 mentions two prescription medications creams — Lindane and Malathion. To me these cures are worse than the disease — both for those being treated and for the environment. In fact, these creams are thought to be so dangerous in our water supply that the state of California banned the use of lindane to treat lice or scabies.

There are also several prescription oral medications currently being looked at as possible treatments. In the May 1999 issue of Infectious Diseases in Children, Septra (trimethoprim-sulfamethoxazole) is mentioned as a possible treatment for lice. The regimen is twice a day for three days with re-treatment after 7 days. There is some controversy as to whether or not it works. According to the article, it works by changing the bacteria in the gut of the louse, preventing the absorbance of vitamins. The lice then produce infertile eggs and die of malabsorption.

The Key to Success

Whatever treatment you choose, removing lice from the environment is critical to breaking the cycle.

Cleaning Method No. 1

• After the head is treated, wear a tight-fitting shower cap or bathing cap to prevent re-infestation during the cleaning process.
• Every surface in your home and car(s) that has touched a head, or has touched an object that has touched a head, must be deloused! All clothes need to be washed in hot water and dried in a hot drier. Even clean clothes that have been hanging in a closet might need to be washed — if a person with lice wears a sweater, then takes it off and puts it back in the closet, any piece of fabric that it touches could become a new home for lice!
• Wash all bed clothing, including bedspreads, pillows, mattress covers — anything fabric. Dry-cleaning and ironing with a hot iron also kills lice and nits.
• Clothing and bed coverings that cannot be safely washed in hot water can be double bagged in black plastic bags, sealed tightly, and put away for three days. At the end of that time, wash the clothing according to normal washing instructions.
• Combs and brushes should be soaked in rubbing alcohol or Lysol for one hour, followed by washing in soapy water.
• Thoroughly vacuum all carpets — even under the beds! Steam cleaning is even better. Using a high-powered vacuum (not a battery-operated hand-held version), thoroughly vacuum all upholstered furniture. Or better yet, have all upholstered furniture professionally cleaned.
• Spray and powder forms of lice medicines can be used on carpets, floors, and upholstery. I personally prefer not to use these pesticides unless it is impossible to do a thorough cleaning. If you do need to use one of these products, be sure that your children are not present when you use it, and that you thoroughly air out the space before allowing your children to return.
• Before you take that lovely shower cap off, be sure to take off all the clothes you’ve been wearing during this process. Put on freshly hot-water laundered clothes, and put your work clothes in the wash.
• If you do not have access to a washer and dryer in your home, work in teams. Someone who has not been treated yet can put all the loads of laundry into the washers at a public laundry facility. Meanwhile, a second person can be treated, and then go to the laundry and take over. You want to avoid unlaundered clothes if you have been treated (unless you are wearing a shower or bathing cap), and you want to avoid handling clean clothes if you haven’t been treated.

Cleaning Method No. 2 — The Real Alternative

• This great suggestion came from my friend Dr. Donnica, formerly of NBC’s Later Today show. Instead of cleaning every inch of the house, just lock your house up tight and go on vacation. Get rid of the lice on your heads, and then get out of town. I like this idea. Lice die after 55 hours without a human host. If you can afford to be gone for at least three days, you will return to a lice-free environment.

Returning to School

• After everyone in the community has completed Day One treatment, it is safe to return to school. Every child, teacher, and staff member should be inspected for lice prior to re-entry. This will make coming back to school the first day after the big cleanup a real zoo. Consider making it into a party! Have a few parents meet early and inspect each other’s heads. Then they can break up into stations in the school parking lot, playground, or some other convenient location that everyone must pass before going into any of the buildings. As each person is inspected, give him or her a sticker — “The Great Lice Adventure!”
• If a child does not pass, have a plan. Parents cannot be allowed to just drop off their kids on that day. If the child doesn’t pass, the parent must have a provision for alternative child-care (this will be a real incentive to comply with the plan). In addition, have prepared instructions to give to any parents who may need to do all that work over again.

Days Two Through 13

• Shampoo daily and follow with careful nit-combing. I like using tea tree oil shampoo for this purpose (this is not full-strength tea tree oil, but the shampoo that contains tea tree oil.) Found in health-food stores, this shampoo is reported to prevent re-infestation with lice, but studies have not been done to determine its efficacy.

Day 14

• Repeat your original treatment choice in order to catch any lice that might have hatched since the first application. Do one last, thorough nit-combing.

Beyond Day 14

• Continue scalp inspections until the lice have left the community — at least for the time being.

Going back to school to face another year of lice must be very discouraging. Remember that you are part of a community. Blaming others doesn’t help anything; it is important for everyone to work together. By staying positive, the whole process can actually help bring a school together! I know my own children have fond memories of The Great Lice Adventure — now that it’s over!

Related A-to-Z Information:

Contact Transmission, Pinworms, Scabies, Ticks

Related concepts:

Bed-wetting, Primary nocturnal enuresis, PNE

Introduction to enuresis:

Most children learn how to stay dry during the day before they’re able to stay dry at night. Millions of kids wet the bed long after they feel that they should be dry.
Sadly, most of these children feel that they still wet the bed because there is something wrong with who they are.  Many of them feel that it’s the result of either bad thoughts or bad actions. They feel that somehow bed-wetting is a punishment.
Similarly, many parents feel that their children’s bed-wetting is a result of a defect in their parenting. This feeling is heightened by well-meaning friends and relatives who bring up questions of emotional instability as the cause of bed-wetting.
In one survey of parents, 22 percent stated that they thought the reason their child wet the bed was laziness. This could not be further from the truth! Primary nocturnal enuresis is a common developmental phenomenon related to physical and physiologic factors. It does not come from emotional stress, poor self-esteem, or emotional immaturity.

What is enuresis?

Children who can control their bladders during the day, but who have never been dry at night for at least a six-month period, have what is known as primary nocturnal enuresis (PNE), the most common form of bedwetting.
Secondary nocturnal enuretics are completely dry at night for a period of at least six months and then begin wetting again.
In secondary enuresis, the key is finding out exactly what has changed. There might be a new psychological stress such as a divorce, a move, or a death in the family. It might be something physical: the onset of a urinary tract infection or diabetes, for example. It might be a situational change, such as altered eating, drinking, or sleeping habits. Clearly, something has changed. The first step in solving the problem is identifying any changes in your child’s life.
In any case, children who wet the bed have two things in common. First, they need to urinate at night. Not all children do. During the first months of life, babies urinate around-the-clock. Most adults, however, don’t need to urinate at night (although a small percentage of the population will need to urinate at night throughout life). Sometime in middle childhood, most kids make the transition from urinating around-the-clock to only urinating during waking hours. There are three reasons why some children may still need to urinate at night:

1. There is an imbalance of the bladder muscles. (For example, the muscle that contracts to squeeze the urine out is stronger, at moments, than the sphincter muscle that holds the urine in.)
2. They have bladders that are a little too small to hold the normal amount of urine.
3. They make more urine than their normal-size bladders can hold, for several reasons:
   • They may drink too much. Drinking in the two hours before bed increases nighttime urine production.
   • They may be consuming a diuretic medication, a substance that directly increases urine output. They may also consume diuretic beverages or foods like caffeinated cola drinks or chocolate.
   • They may make more urine in response to a chronic disease, such as diabetes.
   • They may make more urine than average because of their hormonal regulatory systems. Babies make about the same amount of urine around-the-clock. Most adults make less urine while they sleep. The reason for this is thought to be a nighttime surge of a hormone called Antidiuretic Hormone (ADH). Some bed-wetters may make less ADH or have kidneys that are less responsive to ADH.

If an individual regularly needs to urinate at night, one or more of the three reasons listed above is the cause.
The second thing children who wet the bed have in common is that they don’t wake up when they need to urinate. When infants need to urinate, there is no signal that goes from the bladder to the brain to wake them up. This is wonderful, since they are not yet able to walk to the bathroom and use the toilet. On the other hand, when an adult’s bladder is full at night, there is a signal that goes from the bladder, through the nervous system, up to the brain. This initiates a dream about water, or more specifically, about going to the bathroom. The dream alerts our reticular activating system, which either awakens us or causes us to tighten our sphincter muscles to hold the urine. This signaling mechanism comes into play sometime in childhood.
Children who wet the bed are dramatically more difficult to wake up than their peers, which confirms what parents have known for years!
Children who wet the bed at night both need to urinate at night and do not wake up when their bladders are full. These are the only children who wet the bed.

Who gets enuresis?

Research has shown that primary nocturnal enuresis is often inherited. If both parents were bedwetters, 77 percent of their children will be. If only one parent wet the bed, 44 percent of their offspring will. If neither parent wet the bed, only about 15 percent of their children will wet the bed. With primary nocturnal enuresis, one almost always finds another relative who was a bed-wetter. This corresponds to what is called an autosomal dominant inheritance pattern.
Bed-wetting is more common in boys.

What are the symptoms of enuresis?

In primary nocturnal enuresis, children have never achieved complete nighttime control. They have always wet the bed at least two times a month.
As a result, these children may suffer significant psychological stress and develop feelings of low self-esteem (including feelings of shame, inferiority, and fear of being discovered by others). These are the result, not the cause, of PNE.
Families of bedwetters can experience disturbed sleep, turmoil, and a drain on energy and resources.

Is enuresis contagious?

No

How long does enuresis last?

At age 5, about 15 percent of children have PNE.
Among those who still have PNE after age 6, only about 15 percent of them will achieve dryness over the course of the next year (without treatment).
At age 15, one to two percent of adolescents still have PNE. If left untreated, some will wet the bed for life.

How is enuresis diagnosed?

When bedwetting continues to age 5 or 6 (or at any age if it is troublesome to the child) it is time to discuss it with the child’s doctor or with a doctor skilled in treating bed-wetting. A careful history, physical exam, and urine test can usually determine the type of bed-wetting and the best treatment approaches. Sometimes it is important to measure the child’s bladder size. This is often done at home with a measuring cup.
It is also important to identify any constipation or encopresis (uncontrolled passing of stools). If one of these conditions is present, it should be treated first. The bed-wetting will often disappear when these conditions are treated.

How is enuresis treated?

A variety of effective solutions are available, alone or in combination. Different solutions work better for different children. Behavioral therapies include motivational programs, guided imagery, and hypnosis. Conditioning therapies involve one of several bedwetting alarms. Specific exercises can be done to strengthen the nighttime resting tone of the sphincter muscles.
Your doctor may recommend a medication such as the DDAVP tablet. The DDAVP tablet can help achieve dryness in some children with PNE. However, it also has the potential for serious side effects and should be used with caution and only under close supervision by a physician. The FDA has recently placed a ban on treating PNE with DDAVP in the nasal spray form.
Behavioral treatments are most effective and with the right approach for the right child, most school-age children can be dry within 12 weeks.
Treatment can improve a child’s self-concept, even if total dryness is not achieved.

How can enuresis be prevented?

Not much can be done to prevent bed-wetting, but adequate sleep may help. Some children will stop wetting the bed with as little as 30 extra minutes of sleep per night.

Related A-to-Z Information:

Constipation, Night Terrors, Sleep Apnea, Tonsillitis