Cytomegalovirus (CMV)

Infection with cytomegalovirus (CMV), a member of the herpes virus family, is very common. Between 50% and 85% of people in the United States have had a CMV infection by the time they are 40 years old, according to the Centers for Disease Control and Prevention (CDC).

Children typically become infected with the virus in early childhood, especially those in child-care and preschool settings. CMV infections are rarely serious in otherwise healthy kids and adults; they usually cause only mild symptoms, if any. When symptoms do appear, they are similar to those seen in mononucleosis ("mono") and only last a few weeks.

CMV is mainly a problem for certain high-risk groups, including:

• unborn babies whose mothers become infected with CMV during the pregnancy
• children or adults whose immune systems have been weakened by disease or drug treatment, such as organ transplant recipients or people infected with HIV

Once a person has had a CMV infection, the virus usually lies dormant (or inactive) in the body, but it can be reactivated. The virus is more likely to be reactivated — and cause serious illness — in people who have weakened immune systems due to illness.

Symptoms of CMV Infections

The symptoms of a CMV infection vary depending upon the age and health of the person who is infected, and how the infection occurred.

Infants who are infected before birth usually show no symptoms of a CMV infection after they are born, although some of these infants can develop hearing, vision, neurologic, and developmental problems over time. In a few cases, there are symptoms at birth, which can include premature delivery, being small for gestational age, jaundice, enlarged liver and spleen, microcephaly (small head), seizures, rash, and feeding difficulties. These infants are also at high risk for developing hearing, vision, neurologic, and developmental problems.

Newborns can also contract CMV infection during or soon after birth by passing through the birth canal of an infected mother, consuming breast milk from a mother with the virus, or receiving a transfusion of blood donated by a person infected with CMV. Most of these infants show no symptoms of CMV infection, however, a few may develop pneumonia or other symptoms. Premature and ill full-term infants who are infected soon after birth are also at risk for neurologic and developmental problems over time.

Although CMV infections that occur in kids after the newborn period usually don't cause significant illness, some infants and young children may develop pneumonia, hepatitis (inflammation of the liver), or a rash.

Older children and teens who become infected with the virus may have mononucleosis-like symptoms, including fatigue, muscle aches, headache, fever and enlarged liver and spleen. These symptoms are generally mild, and usually last only 2-3 weeks.

In people who have received organ transplants, or in people whose immune systems are weakened, CMV can cause serious infections. In people who have AIDS or HIV, CMV infection may involve the lungs, nervous system, gastrointestinal tract, and the eye, sometimes causing blindness.

Duration

If symptoms of CMV do appear, how long they last varies depending on how the infection occurs and the age and general health of the patient. For example, serious CMV infections before birth may cause developmental problems that affect a child for a lifetime. On the other hand, infection in teens may last only 2 to 3 weeks and cause no lasting problems.

How Does CMV Spread?

In the United States, about 1% of infants are infected with CMV before birth — usually only if the mother has developed a first-time CMV infection during pregnancy. As discussed above, an infected mother can pass the virus to her child before, during, or after birth.

Any person with a new or past CMV infection can transmit the virus to others, even if he or she isn't showing any symptoms. But transmission usually requires fairly close contact; the virus can be spread through saliva, breast milk, vaginal fluids, semen, urine, and stool. The virus can also be present in blood products and donated organs, causing infection after a blood transfusion or organ transplantation.

Among kids, the virus is commonly spread in child-care centers or preschool settings, where it passes easily through indirect contact, especially though contaminated toys. Children who are infected may then spread the infection to their families.

Diagnosis and Treatment

In serious cases of CMV infection, doctors can make the diagnosis by detecting the virus in a cultured sample taken from a sick person's throat, urine, blood, or other body tissues or fluid. Blood is also drawn at different time intervals to measure levels of certain antibodies. These antibodies are part of the immune system's response to a CMV infection, and they can signal that an active CMV infection exists. Special viral DNA-detecting tests are also sometimes used to diagnosis CMV infection.

Currently, there is no specific treatment available or recommended for otherwise healthy people with CMV infection.

In patients where CMV infection can be life-threatening (newborn infants, organ-transplant patients, and people being treated for cancer or who have immune disorders such as AIDS), serious CMV infections may be treated with intravenous (IV) antiviral medication, usually in a hospital. Oral antiviral medication may also be used at home once the infection is under control and the patient is stable. Because these antiviral medicines may have serious side effects, doctors use them with great caution, especially in children.

In bone-marrow transplant patients, CMV-immune globulin (CMV-IVIG) and the antiviral drug ganciclovir given intravenously can be used to fight CMV infections.

Preventing CMV Infections

Currently, there is no vaccine to prevent CMV infection. For those who have close contact with children, especially pregnant women or women who might become pregnant, hand washing is effective at reducing the risk of infection from exposure to CMV. Not sharing eating utensils with young kids and avoiding kissing or intimate contact with CMV-positive individuals is also important.

A mother who has CMV infection shouldn't stop breastfeeding, as the benefits of breastfeeding are believed to outweigh the risks of passing CMV to the infant, and the infant is unlikely to develop any symptoms if infected.

For organ-transplant patients who are at risk of getting CMV from a transplanted organ, preventive therapies are available. Blood banks have certain screening and processing procedures that help to prevent CMV from being passed in blood products.

When to Call the Doctor

Call your doctor if your child has any of these or other "mono-like" symptoms:

• fever that lasts for several days
• unusual or extreme tiredness
• muscle aches
• headache

If you are pregnant, ask your doctor about your risk for CMV infection and about how you can help protect your developing baby from CMV infection before birth.

If your child has had an organ transplant or has HIV, AIDS, cancer, or any disease that affects the immune system, he or she is at special risk of CMV infection. Keep in close contact with your doctor about signs and symptoms to watch for.

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HIV / AIDS

AIDS stands for acquired immunodeficiency syndrome, a disease that makes it difficult for the body to fight off infectious diseases. The human immunodeficiency virus known as HIV causes AIDS by infecting and damaging part of the body's defenses against infection — lymphocytes, which are a type of white blood cell in the body's immune (infection-fighting) system that is supposed to fight off invading germs.

HIV can be transmitted through direct contact with the blood or body fluid of someone who is infected with the virus. That contact usually comes from sharing needles or by having unprotected sex with an infected person. An infant could get HIV from a mother who is infected.

Though there are treatments for HIV and AIDS, there are no vaccines or cures for them. But there are things you can do to prevent you and your child from getting the disease.

What Does HIV Do to the Body?

The virus attacks specific lymphocytes called T helper cells (also known as T-cells), takes them over, and multiplies. This destroys more T-cells, which damages the body's ability to fight off invading germs and disease.

When the number of T-cells falls to a very low level, people with HIV become more susceptible to other infections and they may get certain types of cancer that a healthy body would normally be able to fight off. This weakened immunity (or immune deficiency) is known as AIDS and can result in severe life-threatening infections, some forms of cancer, and the deterioration of the nervous system. Although AIDS is always the result of an HIV infection, not everyone with HIV has AIDS. In fact, adults who become infected with HIV may appear healthy for years before they get sick with AIDS.

How Common Are HIV and AIDS?

The first case of AIDS was reported in 1981, but the disease may have existed unrecognized for many years before that. HIV infection leading to AIDS has been a major cause of illness and death among children, teens, and young adults worldwide. AIDS has been the sixth leading cause of death in the United States among 15- to 24-year-olds since 1991.

In recent years, AIDS infection rates have been increasing rapidly among teens and young adults. Half of all new HIV infections in the United States occur in people who are under 25 years old; thousands of teens acquire new HIV infections each year. Most new HIV cases in younger people are transmitted through unprotected sex; one third of these cases are from injection drug usage via the sharing of dirty, blood-contaminated needles.

Among children, most cases of AIDS — and almost all new HIV infections — resulted from transmission of the HIV virus from the mother to her child during pregnancy, birth, or through breastfeeding.

Fortunately, medicines currently given to HIV-positive pregnant women have reduced mother-to-child HIV transmission tremendously in the United States. These drugs (discussed in detail in the Drug Treatments section of this article) are also used to slow or reduce some of the effects of the disease in people who are already infected. Unfortunately, these medicines have not been readily available worldwide, particularly in the poorer nations hardest hit by the epidemic. Providing access to these life-saving treatments has become an issue of global importance.

How Is HIV Transmitted?

HIV is transmitted through direct contact with the blood or body fluid of someone who is infected with the virus.

The three main ways HIV is passed to a very young child are:

1. while the baby develops in the mother's uterus (intrauterine)
2. at the time of birth
3. during breastfeeding

Among teens, the virus is most commonly spread through high-risk behaviors, including:

• unprotected sexual intercourse (oral, vaginal, or anal sex)
• sharing needles used to inject drugs or other substances (including contaminated needles used for injecting steroids and tattooing and body art)

In very rare cases, HIV has also been transmitted by direct contact with an open wound of an infected person (the virus may be introduced through a small cut or tear on the body of the healthy person) and through blood transfusions. Since 1985, the U.S. blood supply has been carefully screened for HIV.

Signs and Symptoms of HIV

Although there may be no immediate physical signs of HIV infection at birth, signs of the infection might appear within 2 to 3 months after a child is born. Kids who are born with HIV can develop opportunistic infections, which are illnesses that can develop in weakened immune systems, such as Pneumocystis carinii pneumonia (PCP). A child with HIV may also get more severe bouts of other common childhood infections, such as Epstein-Barr virus (EBV) infection, which generally causes mild illness in most kids. In developing countries, tuberculosis has been a particularly common problem and often the cause of death of children and adults.

A baby born with HIV infection most likely will appear healthy. But sometimes, within 2 to 3 months after birth, an infected baby may begin to appear sick, with poor weight gain, repeated fungal mouth infections (thrush), enlarged lymph nodes, enlarged liver or spleen, neurological problems, and multiple bacterial infections, including pneumonia.

Teens and young adults who contract HIV usually show no symptoms at the time of infection. In fact, it may take up to 10 years or more for symptoms to show. During this time, they can pass on the virus without even knowing they have it themselves. Once the symptoms of AIDS appear, they can include rapid weight loss, intense fatigue, swollen lymph nodes, persistent diarrhea, night sweats, or pneumonia. They, too, will be susceptible to life-threatening opportunistic infections.

Diagnosing HIV Infections and AIDS

Every pregnant woman should be tested for HIV to have a better chance of preventing transmission to her unborn child.

If a woman knows she is HIV-infected and already has children, it is recommended that all of her children be tested for HIV. Even if she has older children and they seem healthy, they could still have an HIV infection if she was HIV-positive at the time they were born. A blood test is needed to know for sure.

However, when a new baby is born to an HIV-infected mother, there is no immediate way to know whether the baby is infected with the virus. This is because if the mother is infected, an ELISA test (which checks for HIV antibodies in the blood) will almost always be positive, too. Babies will have their HIV-infected mother's antibodies (which are passed to the baby through the placenta) even if they are not truly infected with HIV. These babies may remain HIV-antibody positive for up to 18 months after birth, even if they are not actually infected.

Infants who are not actually infected with the virus (but are born to HIV-positive mothers) will not make their own antibodies; the HIV antibodies that came from their mothers will gradually disappear from their blood before they reach 2 years of age. Any blood tests performed after this point will likely be HIV-negative. Infants who are infected with HIV from their mothers will begin to make their own HIV antibodies and will generally remain HIV-positive after 18 months of age.

The most accurate diagnosis of HIV infection in early infancy comes from tests that show the presence of the virus itself (not HIV antibodies) in the body. These tests include an HIV viral culture and PCR (polymerase chain reaction), a blood test that looks for the DNA of the virus.

Older children, teens, and adults are tested for HIV infection by an ELISA test to detect the presence of HIV antibodies in the blood. Antibodies are specific proteins that the body produces to fight infections; HIV-specific antibodies are produced in response to infection with HIV. Someone with antibodies against HIV is said to be HIV-positive. If the ELISA test is positive, it is always confirmed by another test called a Western blot. If both of these tests are positive, the patient is almost certainly infected with HIV.

Can Young Children Spread HIV?

Across the United States, there have been only a handful of reported cases where HIV infection was contagious from a child to another person. All of those cases involved direct blood contact within a household. The typical baby secretions (urine, drool, spit up, vomit, feces, etc.) do not seem to transmit the virus, so routine care of babies with HIV is considered safe.

Despite widespread concerns, there are no reported transmissions of HIV within a school or child-care setting. Because the danger in transmitting HIV involves direct contact with blood, personnel at schools and child-care programs should routinely use gloves when any child has a cut, scrape, or is bleeding.

Transmission of HIV Among Teens

Among teens, HIV is spread mostly through unprotected sex with an infected person or sharing intravenous drug needles. Education of children and teens is vitally important to help prevent sexual transmission of HIV, as well as other sexually transmitted diseases (STDs), including chlamydia, genital herpes, gonorrhea, hepatitis B, syphilis, and genital warts. Many STDs cause irritation, sores, or ulcers of the skin and mucous membranes that the virus can pass through. Having an STD, such as genital herpes, for example, has been proven to increase a person's risk of getting HIV if he or she has unprotected sex with someone who is HIV-positive.

HIV is not spread through:

• casual contact, such as hugs or handshakes
• drinking glasses
• sneezes
• coughs
• mosquitoes or other insects
• towels
• toilet seats
• doorknobs

Opportunistic Infections

Opportunistic infections (infections that take advantage of a person's weakened immune system) are the most common complication of HIV/AIDS. Sometimes adults with HIV/AIDS can get an infection from germs that do not normally cause illness in a healthy person (like cryptococcus). People with AIDS (especially children) can get a severe version of a more common infection, such as salmonella (a type of diarrhea-causing bacteria) and chickenpox.

In kids with HIV, the following opportunistic infections and conditions can frequently occur:

• viral infections like a form of chronic walking pneumonia called lymphoid interstitial pneumonia (LIP), herpes simplex virus, shingles, and the cytomegalovirus infection
• parasitic infections such as PCP, a pneumonia caused by Pneumocystis carinii, a microscopic parasite that can't be fought off due to a weakened immune system, and toxoplasmosis
• serious bacterial infections such as bacterial meningitis, tuberculosis, and salmonellosis
• fungal infections such as esophagitis (inflammation of the esophagus), and candidiasis or thrush (yeast infection)

Other Complications

Children with HIV are also at higher risk for some forms of cancer because of their weakened immune systems. Lymphomas associated with Epstein-Barr virus (EBV) infection are more common in older kids with HIV.

The most difficult conditions to treat in kids who have HIV or AIDS are the wasting syndrome (the inability to maintain body weight due to long-term poor appetite and other infections related to HIV disease) and HIV encephalopathy (due to HIV infection of the brain that causes swelling and then damage to the brain's tissues over time). HIV encephalopathy results in AIDS dementia, especially in adults. Wasting syndrome can sometimes be helped with nutritional counseling and daily high-calorie supplements, but preventing HIV encephalopathy remains extremely difficult.

Treating AIDS and HIV

Two major advances in the treatment of HIV/AIDS have occurred over the last 20 years. One is the development of drugs that inhibit the virus's growth, preventing or delaying the onset of AIDS and allowing people living with HIV to remain free of symptoms longer. The other is the development of medications that have proven very important in reducing the transmission of the virus from an HIV-infected mother to her child.

Drug Treatments

As medical understanding about how the virus invades the body and multiplies within cells has increased, drugs to inhibit its growth and slow its spread have been developed. Drug treatment for HIV/AIDS is complicated and expensive, but highly effective in slowing the replication (reproduction) of the virus and preventing or reducing some effects of the disease.

Drugs to treat HIV/AIDS use at least three strategies:

1. interfering with HIV's reproduction of its genetic material (these drugs are classified as nucleoside or nucleotide anti-retrovirals)
2. interfering with the enzymes HIV needs to take over certain body cells (these are called protease inhibitors)
3. interfering with HIV's ability to pack its genetic material into viral code — that is, the genetic "script" HIV needs to be able to reproduce itself (these are called non-nucleoside reverse transcriptase inhibitors [NNRTIs])

Because these drugs work in different ways, doctors generally prescribe a "combination cocktail" of these drugs that are taken every day. This regimen is known as HAART treatment (HAART stands for highly active antiretroviral therapy). Doctors may also prescribe drugs to prevent certain opportunistic infections — for example, some antibiotics can help prevent PCP, especially in kids.

Although a number of medicines are available to treat HIV infection and slow the onset of AIDS, unless they are taken and administered properly on a round-the-clock schedule, the virus can quickly become resistant to that particular mix of medications. HIV is very adaptable and finds ways to outsmart medical treatments that are not followed properly. This means that if prescribed medicines are not taken at the correct times every day, they will soon fail to keep HIV from reproducing and taking over the body. When that happens, a new regimen will need to be established with different drugs. And if this new mix of medicines is not taken correctly, the virus will likely become resistant to it as well and eventually the person will run out of treatment options.

Aside from the difficulty of getting young children to take their medication on a timed schedule, the medications present other problems. Some have unpleasant side effects, such as a bad flavor, whereas others are only available in pill form, which may be difficult for kids to swallow. Parents who need to give their child these medications should ask the doctor or pharmacist for suggestions on making them easier to take. Many pharmacies now offer flavoring that can be added to bad-tasting medicines, or your doctor may recommend mixing pills with applesauce or pudding.

Because the number of drugs described above is still limited, doctors are concerned that if children fail to take their medicines as prescribed (even missing just a few doses), the virus could eventually develop resistance to existing HIV drugs — making treatment difficult or impossible. It is then doubly important that kids take their medications as directed. One of the most important home treatment messages for any parent or caregiver that the child should take all medications consistently, at the time the prescription indicates. This can be difficult — but many HIV/AIDS family support groups and experienced medical providers can help families with practical suggestions to help them be successful with the many day-to-day challenges they face.

Many of the new medications that fight HIV infection are expensive. One of the major challenges facing individuals, families, communities, and nations is how to make these medications easily available to all that need them.

Preventing Mother-to-Child Transmission of HIV

When a pregnant HIV-infected woman receives good medical care early and takes antiviral medications regularly during her pregnancy, the chance that she will pass HIV to her unborn baby is dramatically reduced.

It is important that any pregnant woman who knows she is HIV-positive start prenatal care as soon as possible to take full advantage of such treatments. The sooner a mother receives treatment, the greater the likelihood her baby will not get HIV.

An HIV-infected mother can receive medical treatment:

• before the birth of her baby: antiviral treatments given to the mother in the third trimester can help prevent HIV transmission to the baby
• at the time of birth: antiviral medications can be given to both the mother and the newborn child to lower the risk of HIV transmission that can occur during the birth process (which exposes the newborn to the mother's blood and fluids); in addition, the mother will be encouraged to formula-feed rather than breastfeed because HIV can be transmitted to her baby through breast milk
• during breastfeeding: because breastfeeding is discouraged among HIV-infected mothers, this type of transmission is rare in the United States. However, in places in the world where formula is not readily available, both the mother and child can be treated with medication to lower the risk of the HIV infection to the breastfeeding child.

In the past, before antiviral medicines were routinely given, almost 25% of children born to HIV-infected mothers developed the disease and died by 24 months of age. Recent studies have shown that mothers with HIV or AIDS who get good prenatal care and regularly take antiviral drugs during their pregnancy now have less than a 5% chance of passing HIV to their babies. If these babies do get the HIV virus, they tend to be born with a lower viral load (less HIV virus is present in their bodies) and have a better chance of long-term, disease-free survival.

Long-Term Care of Kids With HIV/AIDS

Cases of HIV infection and AIDS in children are complicated and should be managed by experienced health care professionals. Kids will need to have their treatment schedules closely monitored and adjusted regularly. Any infections that could become life threatening must be quickly recognized and treated.

Medicines are adjusted in relation to the child's viral load. The child's health is also monitored by frequent measurement of T-cell levels because these are the cells that the HIV virus destroys. A good T-cell count is a positive sign that medical treatments are working to keep the disease under control.

Children will need to visit their health care providers often for blood work, physical examinations, and discussions about how they and their families are coping socially with any stress from their disease. Some immunizations during routine visits may be slightly different for infants or children with HIV/AIDS. A child whose immune system is severely compromised will not receive live virus vaccines including measles-mumps-rubella and varicella (chickenpox). All other routine immunizations are given as usual, and a yearly influenza vaccine (flu shot) is recommended as well.

If a family seeks health care in a hospital emergency department, parents should be sure to tell the nurse who registers the child that the child has HIV. This will alert medical caregivers to look closely for any signs of diseases from opportunistic infections and provide the best possible treatment.

Outlook for HIV and AIDS

There is no known cure for HIV or AIDS. Children who acquire HIV at birth develop AIDS sooner and tend to have more serious complications than adults with the virus.

Although all children, teens, and adults with HIV will eventually become sick, recent medical advances have significantly improved their chance for survival. Drug treatments can allow people living with HIV to remain free of symptoms for longer and can improve quality of life for people living with AIDS.

Preventing HIV and AIDS

Prevention of HIV remains of worldwide importance. Despite much research, there is no vaccine that will prevent HIV infection. Only the avoidance of risky behaviors can prevent HIV infection. Among U.S. teens and adults, HIV transmission is almost always the result of sexual contact with an infected person or sharing contaminated needles. Infection can be prevented by never sharing needles, and abstaining, or not having oral, vaginal, or anal sex.

Risk can be substantially reduced by always using latex condoms for all types of sexual intercourse, and avoiding contact with the blood, semen, vaginal fluids, and breast milk of an infected person.

Avoidance of alcohol and drugs is also key in preventing the spread of HIV — not because a person can get HIV directly from drinking and doing drugs, but because drinking and drug use often leads to risky behaviors that are associated with an increased risk of infection (such as having unprotected sex and sharing needles).

The most important means of preventing HIV/AIDS in infancy is to test all pregnant women for the virus. If the result is positive, treatment can immediately begin before the baby is born to prevent HIV transmission.

Talking With Kids About HIV and AIDS

Talking about HIV and AIDS means talking about sexual behaviors — and it's not always easy for parents to talk about sexual feelings and behavior with their kids. Similarly, it's not always easy for teens to open up or to believe that issues like HIV and AIDS can affect them.

Doctors and counselors suggest that parents become knowledgeable and comfortable discussing sex and other difficult issues early on, even before the teen years. After all, the issues involved — understanding the body and sexuality, adopting healthy behaviors, respecting others, and dealing with feelings — are topics that have meaning at all ages (though how parents talk with their children will vary according to the child's age and ability to understand). Open communication and good listening skills are vital for parents and kids.

Schools can help. Every state requires schools to provide age-appropriate information about HIV/AIDS that has been designed to educate kids about the disease. Studies show that such education makes a tremendous difference in stopping risk-taking behavior by young people.

Parents who are well informed about how to prevent HIV and who talk with their children regularly about healthy behaviors, feelings, and sexuality play an important part in HIV/AIDS prevention.

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Influenza (Flu)

Influenza, commonly known as "the flu," is a highly contagious viral infection of the respiratory tract. Although the flu affects both sexes and all age groups, kids tend to get it more often than adults. The illness even has its own season — from November to April, with most cases occurring between late December and early March.

Signs and Symptoms

The flu is often confused with the common cold, but flu symptoms are usually more severe than the typical sneezing and stuffiness of a cold.

Symptoms of the flu may include:

• fever
• chills
• headache
• muscle aches
• dizziness
• loss of appetite
• tiredness
• cough
• sore throat
• runny nose
• nausea or vomiting
• weakness
• ear pain
• diarrhea

Infants with the flu may simply seem sick all of a sudden or "just don't look right." The flu discussed here is not the same strain of virus as the avian flu.

Duration

After 5 days, fever and other symptoms have usually disappeared, but a cough and weakness may continue. All symptoms are usually gone within a week or two. However, it's important to treat the flu seriously because it can lead to pneumonia and other life-threatening complications, particularly in infants, senior citizens, and people with long-term health problems.

Contagiousness

Spread by virus-infected droplets that are coughed or sneezed into the air, the flu is contagious. People infected with the flu are contagious from a day before they feel sick until their symptoms have resolved (usually about 1 week for adults, but can be up to 2 weeks for young kids).

The flu usually occurs in small outbreaks, but epidemics tend to occur every several years. Epidemics (when the illness spreads rapidly and affects many people in an area at the same time) peak within 2 or 3 weeks after the first cases occur

About the Flu Vaccine

The flu vaccine usually is offered between September and mid-November, although it may be given at other times of the year. It reduces the average person's chances of catching the flu by up to 80% during flu season. Because the vaccine prevents infection with only a few of the viruses that can cause flu-like symptoms, it isn't a guarantee against getting sick. But even if someone who's gotten the shot gets the flu, symptoms usually will be fewer and milder.

Flu vaccines are available as a shot or nasal mist. Given as an injection, the flu shot contains killed flu viruses that will not cause the flu, but will prepare the body to fight off infection by the live flu virus. Getting a shot of the killed virus means a person is protected against that particular type of live flu virus if he or she comes into contact with it.

Because the nasal mist contains weakened live flu viruses, it is not for people with weakened immune systems or certain health conditions. It is only for healthy, non-pregnant people between the ages of 2 and 49 years.

People who got the vaccine last year aren't protected from getting the flu this year because the protection wears off and flu viruses constantly change. That's why the vaccine is updated each year to include the most current strains of the virus.

Kids under 9 who get a flu shot for the first time will receive two separate shots a month apart. It can take about 2 weeks after the shot for the body to build up protection to the flu.

Getting the shot before the flu season is in full force gives the body a chance to build up immunity to, or protection from, the virus. Although you can get a flu shot well into flu season, it's best to try to get it earlier rather than later. However, even as late as January there are still 2 or 3 months left in the flu season, so it's still a good idea to get protection.

Who Is Considered High Risk?

In times when the vaccine is in short supply, certain people need it more than others. The Centers for Disease Control and Prevention (CDC) often will recommend that certain high-risk groups be given priority when flu shot supplies are limited. The CDC does not anticipate a shortage this year, but it's difficult to predict how many doses will be used. Call your doctor or local public health department about vaccine availability in your area.

The American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and the CDC currently recommend that these high-risk groups be given the flu shot:

• all kids 6 months to 18 years old
• anyone 50 years and older
• women who will be pregnant during the flu season
• anyone who lives or works with infants under 6 months old
• residents of long-term care facilities, such as nursing homes
• any adult or child with chronic medical conditions, such as asthma
• health-care personnel who have direct contact with patients
• out-of-home caregivers and household contacts of anyone in any of the high-risk groups

People who should not get the flu shot include:

• infants under 6 months old
• anyone who's severely allergic to eggs and egg products (ingredients for flu shots are grown inside eggs, so tell your doctor if your child is allergic to eggs or egg products before he or she gets a flu shot)
• anyone who's ever had a severe reaction to a flu vaccination
• anyone with Guillain-Barré syndrome (GBS), a rare condition that affects the immune system and nerves
• anyone with a fever

Preventing the Flu From Spreading

There's no guaranteed way — including being vaccinated — to prevent anyone from getting the flu. Avoiding large crowds can help, but it's often impossible to keep kids cooped up.

Here are some practical ways to help prevent the spread of the flu:

• Wash your hands thoroughly and frequently.
• Never pick up used tissues.
• Never share cups and eating utensils
• Stay home from work or school when you're sick with the flu.
• Cover your mouth and nose with a tissue when you cough or sneeze.

Treatment

Cases of the flu rarely require specific medical treatment. But some kids with chronic medical conditions may become sicker with the flu and need to be hospitalized, and flu in an infant can also be dangerous. For a severely ill child or one with other special circumstances, a doctor may prescribe an antiviral medicine that can ease flu symptoms, but only if it's given within 48 hours of the onset of the flu.

These at-home tips can help most otherwise healthy kids cope with the flu. Have them:

• drink lots of fluids to prevent dehydration
• get plenty of sleep and take it easy
• take acetaminophen or ibuprofen to relieve fever and aches (but do not give aspirin unless your doctor instructs you to do so)
• wear layers, since the flu often makes them cold one minute and hot the next (wearing layers — like a T-shirt, sweatshirt, and robe — makes it easy to add or subtract clothes as needed)

When to Call the Doctor

Call the doctor if your child:

• has flu symptoms
• has a high temperature
• seems to get better, but then feels worse than before
• has any trouble breathing, seems confused, or seems to be getting worse

For the most part, though, the flu is usually gone in a week or two with a little rest and tender loving care.

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Infectious Diarrhea

Most kids battle diarrhea from time to time, but the good news is that it's often caused by infections that don't last long and usually are more disruptive than dangerous. Still, it's important to know what to do to relieve and even prevent diarrhea.

Causes of Diarrhea

Diarrhea — frequent runny or watery bowel movements (poop) — is usually brought on by gastrointestinal (GI) infections caused by viruses, bacteria, or parasites.

The specific germs that cause diarrhea can vary among geographic regions depending on their level of sanitation, economic development, and hygiene. For example, developing countries with poor sanitation or where human waste is used as fertilizer often have outbreaks of diarrhea when intestinal bacteria or parasites contaminate crops or drinking water.

In developed countries, including the United States, diarrhea outbreaks are more often linked to contaminated water supplies, person-to-person contact in places such as child-care centers, or "food poisoning" (when people get sick from improperly processed or preserved foods contaminated with bacteria).

In general, infections that cause diarrhea are highly contagious. Most cases can be spread to others for as long as someone has diarrhea, and some infections can be contagious even longer.

Diarrheal infections can be spread through:

• dirty hands
• contaminated food or water
• some pets
• direct contact with fecal matter (i.e., from dirty diapers or the toilet)

Anything that the infectious germs come in contact with can become contaminated. This includes toys, changing tables, surfaces in restrooms, even the hands of someone preparing food. Kids can become infected by touching a contaminated surface, such as a toilet or toy, and then putting their fingers in their mouths.

A common cause of diarrhea is viral gastroenteritis (often called the "stomach flu," it also can cause nausea and vomiting). Many different viruses can cause viral gastroenteritis, which can pass through a household, school, or day-care center quickly because it's highly infectious. Although the symptoms usually last just a few days, affected kids (especially infants) who are unable to get adequate fluid intake can become dehydrated.

Rotavirus infection is a frequent cause of viral gastroenteritis in kids. Rotavirus, which usually causes explosive, watery diarrhea, infects almost all children in the United States by the time they're 4 or 5 years old, although not all will show symptoms. Rotavirus commonly causes outbreaks of diarrhea during the winter and early spring months, especially in child-care centers and children's hospitals.

Another group of viruses that can cause diarrhea in children, especially during the summer months, are enteroviruses, particularly coxsackievirus.

Many different types of bacteria and parasites can cause GI and diarrhea. Here are a few that you may have heard about:

• E. coli bacteria: Most E. coli infections are spread through contaminated food or water, such as undercooked hamburgers or unwashed fruit that came into contact with animal manure. E. coli infections, which usually affect kids during their first few years of life, also can be spread via contaminated swimming water and petting zoos.
• Salmonella enteritidis bacteria: In the United States, these bacteria (found in contaminated raw or undercooked chicken and eggs) are a major cause of food poisoning, especially during summer.
• Campylobacter bacteria: Infants and young adults are most commonly affected by these infections, especially during the summer. The bacteria are often found in raw and undercooked chicken.
• Shigella bacteria: Shigella infection (called shigellosis) spreads easily in families, hospitals, and child-care centers. Kids 2 to 4 years old are the most likely to be infected.
• Giardia parasite: Infection with Giardia (called giardiasis) is easily spread through child-care settings and contaminated water supplies, especially water parks and pools (the bacteria are resistant to chlorine treatment), children's "touch tanks" in aquariums and museums, and contaminated streams or lakes.
• Cryptosporidium parasite: Found especially in drinking and recreational water, this parasite often is the culprit behind diarrhea epidemics in child-care centers and other public places. Cryptosporidiosis often causes watery diarrhea that can last for 2 weeks or more.

Diarrheal infections are a normal part of childhood for many kids, but diarrhea can be a symptom of a number of non-infectious diseases and conditions, especially when it lasts several weeks or longer. It can indicate food allergies, lactose intolerance, or diseases of the gastrointestinal tract, such as celiac disease and inflammatory bowel disease.

Signs and Symptoms

Symptoms typically start with crampy abdominal pain followed by diarrhea that usually lasts no more than a few days. Infections with many of the viruses, bacteria, and parasites that cause diarrhea also can bring on other symptoms, such as:

• fever
• loss of appetite
• nausea
• vomiting
• weight loss
• dehydration

In cases of viral gastroenteritis, kids often develop fever and vomiting first, followed by diarrhea.

Preventing Diarrhea

Although it's almost impossible to prevent kids from ever getting infections that cause diarrhea, here are some things to help lessen the likelihood:

• Make sure kids wash their hands well and often, especially after using the toilet and before eating. Hand washing is the most effective way to prevent diarrheal infections that are passed from person to person. Dirty hands carry infectious germs into the body when kids bite their nails, suck their thumbs, eat with their fingers, or put any part of their hands into their mouths.
• Keep bathroom surfaces clean to help prevent the spread of infectious germs.
• Wash fruits and vegetables thoroughly before eating, since food and water also can carry infectious germs.
• Wash kitchen counters and cooking utensils thoroughly after they've been in contact with raw meat, especially poultry.
• Refrigerate meats as soon as possible after bringing them home from the supermarket, and cook them until they're no longer pink. After meals, refrigerate all leftovers as soon as possible.
• Never drink from streams, springs, or lakes unless local health authorities have certified that the water is safe for drinking. In some developing countries, it may be safer to drink only bottled water and other drinks rather than water from a tap. Also, exercise caution when buying prepared foods from street vendors, especially if no local health agency oversees their operations.
• Don't wash pet cages or bowls in the same sink that you use to prepare family meals.
• Keep pets' feeding areas (especially those of reptiles) separate from family eating areas.

When to Call the Doctor

Call your doctor if your child has diarrhea and is younger than 6 months old or has:

• a severe or prolonged episode of diarrhea
• fever of 102°F or higher
• repeated vomiting, or refusal to drink fluids
• severe abdominal pain
• diarrhea that contains blood or mucus

Call the doctor immediately if your child seems to be dehydrated. Signs of dehydration include:

• dry or sticky mouth
• few or no tears when crying
• eyes that look sunken into the head
• soft spot (fontanelle) on top of the head that looks sunken
• lack of urine or wet diapers for 6 to 8 hours in an infant (or only a very small amount of dark yellow urine)
• lack of urine for 12 hours in an older child (or only a very small amount of dark yellow urine)
• dry, cool skin
• lethargy or irritability
• fatigue or dizziness in an older child

Caring for Your Child

Mild diarrhea is usually no cause for concern as long as your child is acting normally and drinking and eating enough. Mild diarrhea usually passes within a few days and kids recover completely with care at home, rest, and plenty of fluids.

A child with mild diarrhea who isn't dehydrated or vomiting can continue eating and drinking the usual foods and fluids, including breast milk or formula for infants and milk for kids over 1 year old. In fact, continuing a regular diet may even reduce the duration of the diarrhea episode, while also offering proper nutrition. Of course, you may want to give a child smaller portions of food until the diarrhea ends.

Antibiotics or antiviral medications are not prescribed for cases of diarrhea caused by bacteria and viruses because most kids recover on their own. But antibiotics are sometimes given to very young children or those with weak immune systems to prevent a bacterial infection (such as salmonellosis) from spreading through the body.

If the illness is caused by a parasite, it can be treated with antiparasitic medicines to cure or shorten the course of the illness. The doctor may order a stool test, in which a stool sample will be examined in the laboratory to see which specific germ is causing the diarrhea (bacteria, virus, or parasite).

Although you may be tempted to give your child an over-the-counter anti-diarrhea medication, don't do so unless your doctor gives the OK.

The primary concern when treating a diarrhea is the replacement of fluids and electrolytes (salts and minerals) lost from the body from diarrhea, vomiting, and fever. Depending on the amount of fluid loss and the severity of vomiting and diarrhea, your doctor will probably instruct you to:

• Continue your child's regular diet and give more liquids to replace those lost while the diarrhea continues if there are no signs of dehydration.
• Offer additional breastmilk or formula to infants.
• Use an oral rehydration solution (ORS) to replace lost fluids in non-dehydrated children.

Many of the "clear liquids" used by parents or recommended by doctors in the past are no longer considered appropriate for kids with diarrhea. Don't offer: plain water, soda, ginger ale, tea, fruit juice, gelatin desserts, chicken broth, or sports drinks. These don't have the right mix of sugar and salts and can even make diarrhea worse. Infants and small children should never be rehydrated with water alone because it doesn't contain adequate amounts of sodium, potassium, and other important minerals and nutrients.

Doctors often recommend that kids who show signs of mild dehydration be given oral rehydration solutions to replace body fluids quickly. These are available in most grocery stores and pharmacies without a prescription. Brand-name solutions often end in "lyte." Your doctor will tell you what kind to give, how much, and for how long. Never try to make your own ORS at home unless your doctor says it's OK and gives you a precise recipe.

In some cases, kids with severe diarrhea may need to receive IV fluids at the hospital for a few hours to help combat dehydration.

The best way to manage your child's diarrhea depends on how severe it is, what germ caused it, and your child's age, weight, and symptoms. So be sure to ask your doctor for recommendations about treatment.

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Middle Ear Infection

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

A Close Look at the Ear

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

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

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

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

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

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

About Middle Ear Infections

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

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

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

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

Causes

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

• Their eustachian tubes are shorter and more horizontal than those of adults, which allows bacteria and viruses to find their way into the middle ear more easily. Their tubes are also narrower and less stiff, which makes them more prone to blockage.
• The adenoids, which are gland-like structures located in the back of the upper throat near the eustachian tubes, are large in children and can interfere with the opening of the eustachian tubes.

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

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

Signs and Symptoms

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

• The fluid in the middle ear may push on the eardrum, causing ear pain. An older child may complain of an earache, but a younger child may tug at the ear or simply act irritable and cry more than usual.
• Lying down, chewing, and sucking can also cause painful pressure changes in the middle ear, so a child may eat less than normal or have trouble sleeping.
• If the pressure from the fluid buildup is high enough, it can cause the eardrum to rupture, resulting in drainage of fluid from the ear. This releases the pressure behind the eardrum, usually bringing relief from the pain.

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

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

Other symptoms of acute otitis media can include:

• fever
• nausea
• vomiting
• dizziness

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

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

Contagiousness

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

Duration

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

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

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

Diagnosis and Treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

Prevention

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

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

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

When to Call the Doctor

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

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

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Conjunctiva (Pink Eye)

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

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

Conjunctivitis can be caused by infections (such as bacteria and viruses), allergies, or substances that irritate the eyes.

Causes of Pinkeye

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

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

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

Pinkeye in Newborns

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

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

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

Symptoms of Pinkeye

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

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

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

Contagiousness

Cases of pinkeye that are caused by bacteria and viruses are contagious. (Conjunctivitis caused by allergies or environmental irritants are not.)

A child can get pinkeye by touching an infected person or something an infected person has touched, such as a used tissue. In the summertime, pinkeye can spread when kids swim in contaminated water or share contaminated towels. It also can be spread through coughing and sneezing. Doctors usually recommend keeping kids diagnosed with contagious conjunctivitis out of school, day care, or summer camp for a short time.

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

Preventing Pinkeye

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

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

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

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

Treating Pinkeye

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

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

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

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

When to Call the Doctor

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

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

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Helicobacter Pylori

The bacteria H. pylori (Helicobacter pylori) usually don't cause problems in childhood. However, if left untreated the bacteria can lead to digestive illnesses, including gastritis (the irritation and inflammation of the lining of the stomach), peptic ulcer disease (characterized by sores that form in the stomach or the upper part of the small intestine, called the duodenum), and even stomach cancer later in life.

These bacteria are found everywhere in the world, but especially in developing countries, where up to 10% of children and 80% of adults can have laboratory evidence of an H. pylori infection — usually without having symptoms.

Signs and Symptoms

Anyone can have an H. pylori infection without knowing it as most H. pylori infections are "silent" and produce no symptoms. When the bacteria do cause symptoms, they're usually either symptoms of gastritis or peptic ulcer disease.

In kids, symptoms of gastritis may include nausea, vomiting, and frequent complaints about pain in the abdomen. However, these symptoms are seen in many childhood illnesses.

H. pylori, which used to be called Campylobacter pylori, can also cause peptic ulcers (commonly known as stomach ulcers). In older kids and adults, the most common symptom of peptic ulcer disease is a gnawing or burning pain in the abdomen, usually in the area below the ribs and above the navel. This pain often gets worse on an empty stomach and improves as soon as the person eats food, drinks milk, or takes antacid medicine.

Kids who have peptic ulcer disease can have ulcers that bleed, causing hematemesis (bloody vomit or vomit that looks like coffee grounds) or melena (stool that's black, bloody, or looks like tar). Younger children with peptic ulcer disease may not have symptoms as clear-cut, so their illness may be harder to diagnose.

Contagiousness

Scientists suspect that H. pylori infection may be contagious because the infection seems to run in families and is more common where people live in crowded or unsanitary conditions. Although research suggests that infection is passed from person to person, exactly how this happens isn't really known.

Diagnosis

Doctors can make the diagnosis of an H. pylori infection by using many different types of tests. Your doctor may:

• look at the stomach lining directly. This is performed under sedation and involves inserting an endoscope — a small, flexible tube with a tiny camera on the end — down the throat and into the stomach and duodenum. The doctor may then take samples of the lining to be checked in the laboratory for microscopic signs of infection and for H. pylori bacteria.
• do blood tests, which can detect the presence of H. pylori antibodies. Blood tests are common, although they typically aren't as accurate for children as they are for adults.
• do breath tests, which can detect carbon broken down by H. pylori after the patient drinks a solution. But breath tests are also used mostly in adults.

Treatment

Doctors treat H. pylori infections using antibiotics. Because a single antibiotic may not kill the bacteria, your child may be given a combination of antibiotics.

If your child has symptoms of bleeding from the stomach or small intestine, these symptoms will be treated in a hospital.

Because H. pylori infection can be cured with antibiotics, the most important home treatment is to give your child any prescribed antibiotic medicine on schedule for as long as the doctor has directed. The doctor may also give antacids or acid-suppressing drugs to neutralize or block production of stomach acids.

One way to help soothe the abdominal pain is by following a regular meal schedule. This means planning meals so that your child's stomach doesn't remain empty for long periods. Eating five or six smaller meals each day may be best, and your child should take some time to rest after each meal.

It's also important to avoid giving your child aspirin, aspirin-containing medicines, ibuprofen, or anti-inflammatory drugs because these may irritate the stomach or cause stomach bleeding.

With prolonged antibiotic therapy, H. pylori gastritis and peptic ulcer disease (especially ulcers in the duodenum, a portion of the small intestine) can often be cured.

Prevention

Right now, there's no vaccine against H. pylori. And because transmission isn't clearly understood, prevention guidelines aren't available. However, it's always important to make sure you and your family:

• Wash your hands thoroughly.
• Eat food that's been properly prepared.
• Drink water from a safe source.

When to Call the Doctor

Call your doctor immediately if your child has any of these symptoms:

• severe abdominal pain
• vomit that's bloody or looks like coffee grounds
• stool that's bloody, black, or looks like tar
• persistent gnawing or burning pain in the area below the ribs that improves after eating, drinking milk, or taking antacids

However, it's important to remember kids can get stomachaches for many reasons — like indigestion, viruses, tension and worry, and appendicitis. Most stomachaches are not caused by H. pylori bacteria.

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Adenovirus

Adenoviruses — a group of viruses that infect the membranes (tissue linings) of the respiratory tract, the eyes, the intestines, and the urinary tract — account for about 10% of acute respiratory infections in children and are a frequent cause of diarrhea.

Adenoviral infections affect infants and young children much more frequently than adults. Child-care centers and schools sometimes experience multiple cases of respiratory infections and diarrhea that are caused by adenovirus.

Although these infections can occur at any time of the year, respiratory tract disease caused by adenovirus is more common in late winter, spring, and early summer. However, conjunctivitis and pharyngoconjunctival fever caused by adenovirus tend to affect older kids mostly in the summer.

The majority of the population will have experienced at least one adenoviral infection by age 10. Although adenoviral infection in kids can occur at any age, most take place in the first years of life. Since there are many different types of adenovirus, repeated adenoviral infections can occur.

Signs and Symptoms

Depending on which part of the body is affected, the signs and symptoms of adenoviral infections vary:

Febrile respiratory disease, which is an infection of the respiratory tract that includes a fever, is the most common result of adenoviral infection in children. The illness often appears flu-like and can include symptoms of pharyngitis (inflammation of the pharynx, or sore throat), rhinitis (inflammation of nasal membranes, or a congested, runny nose), cough, and swollen lymph nodes (glands). Sometimes the respiratory infection leads to acute otitis media, an infection of the middle ear. Adenovirus often affects the lower respiratory tract as well, causing bronchiolitis, croup, or viral pneumonia, which is less common but can cause serious illness in infants. Adenovirus can also produce a dry, harsh cough that can resemble whooping cough (pertussis).

Gastroenteritis is an inflammation of the stomach and the small and large intestines. Symptoms include watery diarrhea, vomiting, headache, fever, and abdominal cramps.

Urinary tract infections can cause frequent urination, burning, pain, and blood in the urine.

Eye Infections:

• Conjunctivitis (or pinkeye) is a mild inflammation of the conjunctiva (membranes that cover the eye and inner surfaces of the eyelids). Symptoms include red eyes, discharge, tearing, and the feeling that there's something in the eye.
• Pharyngoconjunctival fever, often seen in small outbreaks among school-age children, occurs when adenovirus affects both the lining of the eye and the respiratory tract. Symptoms include very red eyes and a severe sore throat, sometimes accompanied by low-grade fever, rhinitis, and swollen lymph nodes.
• Keratoconjunctivitis is a more severe infection that involves both the conjunctiva and cornea (the transparent front part of the eye). This type of adenoviral infection is extremely contagious, and occurs most often in older children and young adults, who complain of red eyes, photophobia (discomfort of the eyes upon exposure to light), tearing, and pain.

Contagiousness

Adenovirus is highly contagious, as indicated by the occurrence of multiple cases in situations of close contact, such as child-care centers, schools, hospitals, and summer camps.

The types of adenovirus that cause respiratory and intestinal infections spread from person to person through respiratory secretions (coughs or sneezes) or fecal contamination. Fecal material can be ingested through contamination of water supplies, poor hand washing between the bathroom and the kitchen, eating food contaminated by houseflies, or poor hygiene after handling diapers.

A child might also pick up the virus by holding hands or sharing a toy with an infected person. Indirect transmission can occur through exposure to the contaminated surfaces of furniture and other objects.

The types of adenovirus causing conjunctivitis may be transmitted by water (in lakes and swimming pools), by sharing contaminated objects (such as towels or toys), or by touch.

Once a child is exposed to adenovirus, symptoms can develop from 2 days to 2 weeks later.

Treatment

Adenoviral illnesses often resemble certain bacterial infections, which can be treated with antibiotics. But antibiotics don't work against viruses. To diagnose the true cause of the symptoms so that proper treatment can be prescribed, your doctor may want to test a sample of respiratory or conjunctival secretions, a stool specimen, or blood or urine sample — depending on what condition is being considered.

The doctor will decide on a course of action based on your child's condition. Adenoviral infections usually don't require hospitalization. However, infants and young children may not be able to drink enough fluids to replace what they lose during vomiting or diarrhea and may therefore need to be hospitalized to correct or prevent dehydration. Also, young — especially premature — infants with pneumonia usually need to be hospitalized.

In most cases, a child's body will get rid of the virus over time. Because antibiotics are of no use in treating a viral infection, you should simply try to make your child more comfortable.

If your child has a respiratory infection or fever, getting plenty of rest and taking in extra fluids is essential. A cool-mist humidifier (vaporizer) may help loosen congestion and make your child more comfortable. Be sure to clean and dry the humidifier thoroughly each day to prevent bacterial or mold contamination. If your child is under 6 months old, you may need to clear his or her nose with a bulb syringe.

Don't give any over-the-counter (OTC) cold remedies or cough medicines without checking with your child's doctor. You can use acetaminophen to treat a fever; however, do not give aspirin because of the risk of Reye syndrome, a life-threatening illness.

If your child has diarrhea or is vomiting, increase fluid intake and check with the doctor about giving an oral rehydration solution to prevent dehydration.

To relieve the symptoms of conjunctivitis, use warm compresses and a topical eye ointment or drops if your doctor recommends them.

Duration

Most adenoviral infections last from a few days to a week. Severe respiratory infections may last longer and cause lingering symptoms, such as a cough. Pneumonia can last anywhere from 2 to 4 weeks.

In cases of pharyngoconjunctival fever, sore throat and fever may disappear within a week, but conjunctivitis can persist for another several days to a week. The more severe keratoconjunctivitis can even last for several weeks. Adenovirus can also cause diarrhea that lasts up to 2 weeks, which is longer than other viral diarrheas.

Prevention

There's no way to completely prevent adenoviral infections in kids. To reduce the risk of transmission, parents and other caregivers should encourage frequent hand washing, keep shared surfaces such as countertops and toys clean, and remove children with infections from group settings until symptoms subside.

When to Call the Doctor

Most of these adenoviral conditions and their symptoms are also associated with other causes. Call your doctor if:

• a fever continues more than a few days
• symptoms seem to get worse after a week
• your child has breathing problems
• your child is under 3 months old
• any swelling and redness around the eye becomes more severe or painful
• your child shows signs of dehydration, such as appearing tired or lacking energy, producing less urine or tears, or having a dry mouth or sunken eyes

Remember that you know your child best. If he or she appears to be severely ill, don't hesitate to call your doctor right away.

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