Health Insurance

Health insurance is insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a government-sponsored social insurance program, or from private insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. In each case, the covered groups or individuals pay premiums or taxes to help protect themselves from high or unexpected healthcare expenses. Similar benefits paying for medical expenses may also be provided through social welfare programs funded by the government.

By estimating the overall risk of healthcare expenses, a routine finance structure (such as a monthly premium or annual tax) can be developed, ensuring that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.

How it works

A health insurance policy is a contract between an insurance company and an individual or his sponsor (e.g. an employer). The contract can be renewable annually or monthly. The type and amount of health care costs that will be covered by the health insurance company are specified in advance, in the member contract or "Evidence of Coverage" booklet. The individual insurered person's obligations may take several forms:

• Premium: The amount the policy-holder or his sponsor (e.g. an employer) pays to the health plan each month to purchase health coverage.
• Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care.
• Copayment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 copayment for a doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service is obtained.
• Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a copayment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.
• Exclusions: Not all services are covered. The insured person is generally expected to pay the full cost of non-covered services out of their own pocket.
• Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
• Out-of-pocket maximums: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and the health company pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
• Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.
• In-Network Provider: (U.S. term) A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or copayments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.
• Prior Authorization: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assume it matches what was authorized. Many smaller, routine services do not require authorization.
• Explanation of Benefits: A document sent by an insurer to a patient explaining what was covered for a medical service, and how they arrived at the payment amount and patient responsibility amount.

Prescription drug plans are a form of insurance offered through some employer benefit plans in the U.S., where the patient pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan.

Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than the provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider.

Health plan vs. health insurance

Historically, HMOs tended to use the term "health plan", while commercial insurance companies used the term "health insurance". A health plan can also refer to a subscription-based medical care arrangement offered through HMOs, preferred provider organizations, or point of service plans. These plans are similar to pre-paid dental, pre-paid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a fixed number of services (for instance, $300 in preventive care, a certain number of days of hospice care or care in a skilled nursing facility, a fixed number of home health visits, a fixed number of spinal manipulation charges, etc.) The services offered are usually at the discretion of a utilization review nurse who is often contracted through the managed care entity providing the subscription health plan. This determination may be made either prior to or after hospital admission (concurrent utilization review).

Comprehensive vs. scheduled

Comprehensive health insurance pays a percentage of the cost of hospital and physician charges after a deductible (usually applies to hospital charges) or a co-pay (usually applies to physician charges, but may apply to some hospital services) is met by the insured. These plans are generally expensive because of the high potential benefit payout — $1,000,000 to 5,000,000 is common — and because of the vast array of covered benefits.

Scheduled health insurance plans are not meant to replace a traditional comprehensive health insurance plans and are more of a basic policy providing access to day-to-day health care such as going to the doctor or getting a prescription drug. In recent years, these plans have taken the name mini-med plans or association plans. These plans may provide benefits for hospitalization and surgical, but these benefits will be limited. Scheduled plans are not meant to be effective for catastrophic events. These plans cost much less than comprehensive health insurance. They generally pay limited benefits amounts directly to the service provider, and payments are based upon the plan's "schedule of benefits". Annual benefits maximums for a typical scheduled health insurance plan may range from $1,000 to $25,000.

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MMR (measles, mumps, rubella) Vaccine

The MMR vaccine protects against measles, mumps, and rubella (German measles). MMR vaccinations are given by injection in two doses. The first is administered at age 12 to 15 months; the second generally is given at age 4 to 6 years.

Why the Vaccine Is Recommended

Measles, mumps, and rubella are infections that can lead to significant illness. More than 95% of children receiving MMR will be protected from the three diseases throughout their lives.

Possible Risks

Serious problems are rare. Potential mild to moderate adverse effects include rash, fever, swollen cheeks, febrile seizures, and mild joint pain.

When to Delay or Avoid Immunization

• if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
• if your child has an allergy to eggs, gelatin, or to the antibiotic neomycin that has required medical treatment
• if your child has recently received gamma globulin or a blood transfusion
• if your child has immune system problems related to cancer
• if your child is taking prednisone, steroids, or other immunosuppressive drugs
• if your child is undergoing chemotherapy or radiation therapy

Caring for Your Child After Immunization

If a rash develops without other symptoms, no treatment is necessary and it should resolve within several days. Pain and fever may be treated with acetaminophen or ibuprofen. Check with your doctor about the appropriate dose.

When to Call the Doctor

• if you aren't sure if the vaccine should be postponed or avoided
• if there are problems after the immunization

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Influenza Vaccine

Influenza, commonly known as "the flu," is a highly contagious viral infection of the respiratory tract.

Immunization Schedule

These groups, who are at increased risk of flu-related complications, should receive the flu shot every year:

• all children between 6 months and 18 years old, especially those 6 to 59 months old
• any child or adult with chronic medical conditions, such as asthma, cystic fibrosis, diabetes, sickle cell anemia, and HIV/AIDS
• children and teens on long-term aspirin therapy
• anyone age 50 and older
• women who will be pregnant during the flu season
• anyone who lives or works with infants (especially those under 6 months old)
• residents of long-term care facilities, such as nursing homes
• health care personnel who have direct contact with patients
• out-of-home caregivers and household contacts of anyone in any of these high-risk groups

In the past, there have been times when there were vaccine shortages and delays. So talk with your doctor about availability.

For kids younger than 9 who are getting a flu shot for the first time, it's given in two separate shots a month apart. It can take about 2 weeks after the shot is given for the body to build up protection to the flu.

Another non-shot option called the nasal mist vaccine came on the market in 2003 and is now approved for use in healthy 2- to 49-year-olds. But this nasal mist isn't for everyone, and can't be used by high-risk children and adults or pregnant women.

Why the Vaccine Is Recommended

The flu vaccine reduces the average person's chances of catching the flu by up to 80% during the season. 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.

The shot usually becomes available between September and mid-November. Although you can get a flu shot well into flu season, it's best to try to get it earlier rather than later, if your doctor thinks it's necessary. However, even as late as January there are still 2 to 3 months left in the flu season, so it's still a good idea to get protection.

Even if you or your child got the vaccine last year, that won't protect you 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.

Possible Risks

Given as one injection in the upper arm, the flu shot contains killed flu viruses that will not cause someone to get the flu, but will cause the body to fight off infection by the live flu virus. Getting a shot of the killed virus offers protection against that particular type of live flu virus if someone comes into contact with it.

Some of the most common side effects from the flu shot are soreness, redness, or swelling at the site of the injection. A low-grade fever and aches are also possible. Because the nasal spray flu vaccine is made from live viruses, it may cause mild flu-like symptoms, including runny nose, headache, vomiting, muscle aches, and fever. Very rarely, the flu vaccine can cause serious side effects such as a severe allergic reaction.

When to Delay or Avoid Immunization

People who should not get the flu shot include:

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

Caring for Your Child After Immunization

Pain and fever may be treated with acetaminophen or ibuprofen. Check with your doctor about the appropriate dose. Some doctors recommend a dose just before the immunization. A warm, damp cloth or a heating pad also may help minimize soreness. Moving or using the limb that has received the injection often reduces the soreness as well.

When to Call the Doctor

• if you aren't sure if the vaccine should be postponed or avoided
• if there are problems after the immunization

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IPV

Polio is a viral infection that can result in permanent paralysis.

Immunization Schedule

The inactivated poliovirus vaccine (IPV) is usually given at ages 2 months, 4 months, 6 to 18 months, and 4 to 6 years.

Until recently, the oral poliovirus vaccine (OPV) was given in the United States. Updated recommendations by the Advisory Committee on Immunization Practices now call for IPV injections. This change eliminates the previous small risk of developing polio after receiving the live oral polio vaccine.

Why the Vaccine Is Recommended

Protection against polio occurs in more than 95% of children immunized.

Possible Risks

Side effects include fever and redness or soreness at the site of injection.

When to Delay or Avoid Immunization

• IPV should not be given to kids with severe allergy to neomycin, streptomycin, or polymyxin B.

Caring for Your Child After Immunization

IPV may cause mild fever, and soreness and redness at the site of the injection for several days. Depending on the age of your child, pain and fever may be treated with acetaminophen or ibuprofen. Check with your doctor to see if you can give either medication, and to find out the appropriate dose.

When to Call the Doctor

• if you aren't sure whether the vaccine should be postponed or avoided
• if moderate or severe adverse reactions occur after the immunization

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Hib Vaccine

Haemophilus influenzae type b bacteria were the leading cause of meningitis in children until the Hib vaccine became available.

Immunization Schedule

The Hib vaccine is given by injection at ages 2 months, 4 months, and 6 months (however, some of the Hib vaccines do not require a dose at 6 months). A booster dose is given at 12 to 15 months.

Why the Vaccine Is Recommended

Long-term protection from Haemophilus influenzae type b occurs in more than 90% of infants receiving three doses of the vaccine. Those immunized have protection against Hib meningitis, pneumonia, pericarditis (an infection of the membrane covering the heart), and infections of the blood, bones, and joints caused by the bacteria.

Possible Risks

Minor problems, such as redness, swelling, or tenderness where the shot was given, may occur.

When to Delay or Avoid Immunization

• if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
• if severe allergic reaction occurs after an injection of the Hib vaccine, further Hib immunizations may not be given to your child

Caring for Your Child After Immunization

The vaccine may cause mild soreness and redness in the area where the shot was given. Depending on the age of your child, pain and fever may be treated with acetaminophen or ibuprofen. Check with your doctor to see if you can give either medication, and to find out the appropriate dose.

When to Call the Doctor

• if you aren't sure whether the vaccine should be postponed or avoided
• if moderate or serious adverse reactions appear after the Hib injection

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Mumps part 2

Contagiousness

The mumps virus is contagious and spreads in tiny drops of fluid from the mouth and nose of someone who is infected. It can be passed to others through sneezing, coughing, or even laughing. The virus can also spread to other people through direct contact, such as picking up tissues or using drinking glasses that have been used by the infected person.

People who have mumps are most contagious from 2 days before symptoms begin to 6 days after they end. The virus can also spread from people who are infected but have no symptoms.

Prevention

Mumps can be prevented by vaccination. The vaccine can be given alone or as part of the measles-mumps-rubella (MMR) immunization, which is usually given to children at 12 to 15 months of age. A second dose of MMR is generally given at 4 to 6 years of age. As is the case with all immunization schedules, there are important exceptions and special circumstances.

If they haven't already received them, students who are attending colleges and other post-high school institutions should be sure they have had two doses of the MMR vaccine.

During a measles outbreak, your doctor may recommend additional shots of the vaccine, if your child is 1 to 4 years old. Your doctor will have the most current information.

Incubation

The incubation period for mumps can be 12 to 25 days, but the average is 16 to 18 days.

Duration

Children usually recover from mumps in about 10 to 12 days. It takes about 1 week for the swelling to disappear in each parotid gland, but both glands don't usually swell at the same time.

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Mumps part 1

Mumps is a disease caused by a virus that usually spreads through saliva and can infect many parts of the body, especially the parotid salivary glands. These glands, which produce saliva for the mouth, are found toward the back of each cheek, in the area between the ear and jaw. In cases of mumps, these glands typically swell and become painful.

The disease has been recognized for several centuries, and medical historians argue over whether the name "mumps" comes from an old word for "lump" or an old word for "mumble."

Mumps was common until the mumps vaccine was licensed in 1967. Before the vaccine, more than 200,000 cases occurred each year in the United States. Since then the number of cases has dropped to fewer than 1,000 a year, and epidemics have become fairly rare. As in the pre-vaccine era, most cases of mumps are still in kids ages 5 to 14, but the proportion of young adults who become infected has been rising slowly over the last two decades. Mumps infections are uncommon in kids younger than 1 year old.

After a case of mumps it is very unusual to have a second bout because one attack of mumps almost always gives lifelong protection against another. However, other infections can also cause swelling in the salivary glands, which might lead a parent to mistakenly think a child has had mumps more than once.

Signs and Symptoms

Cases of mumps may start with a fever of up to 103° Fahrenheit (39.4° Celsius), as well as a headache and loss of appetite. The well-known hallmark of mumps is swelling and pain in the parotid glands, making the child look like a hamster with food in its cheeks. The glands usually become increasingly swollen and painful over a period of 1 to 3 days. The pain gets worse when the child swallows, talks, chews, or drinks acidic juices (like orange juice).

Both the left and right parotid glands may be affected, with one side swelling a few days before the other, or only one side may swell. In rare cases, mumps will attack other groups of salivary glands instead of the parotids. If this happens, swelling may be noticed under the tongue, under the jaw, or all the way down to the front of the chest.

Mumps can lead to inflammation and swelling of the brain and other organs, although this is not common. Encephalitis (inflammation of the brain) and meningitis (inflammation of the lining of the brain and spinal cord) are both rare complications of mumps. Symptoms appear in the first week after the parotid glands begin to swell and may include: high fever, stiff neck, headache, nausea and vomiting, drowsiness, convulsions, and other signs of brain involvement.

Mumps in adolescent and adult males may also result in the development of orchitis, an inflammation of the testicles. Usually one testicle becomes swollen and painful about 7 to 10 days after the parotids swell. This is accompanied by a high fever, shaking chills, headache, nausea, vomiting, and abdominal pain that can sometimes be mistaken for appendicitis if the right testicle is affected. After 3 to 7 days, testicular pain and swelling subside, usually at about the same time that the fever passes. In some cases, both testicles are involved. Even with involvement of both testicles, sterility is only a rare complication of orchitis.

Additionally, mumps may affect the pancreas or, in females, the ovaries, causing pain and tenderness in parts of the abdomen.

In some cases, signs and symptoms are so mild that no one suspects a mumps infection. Doctors believe that about 1 in 3 people may have a mumps infection without symptoms.

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Conditions Associated With Apnea

Apnea can be seen in connection with:

Apparent Life-Threatening Events (ALTEs)

An ALTE itself is not a sleep disorder — it's a serious event with a combination of apnea and change in color, change in muscle tone, choking, or gagging. Call 911 immediately if your child shows the signs of an ALTE.

ALTEs, especially in young infants, are often associated with medical conditions that require treatment Examples of these medical conditions include gastroesophogeal reflux (GERD), infections, or neurological disorders. ALTEs are scary to observe, but can be uncomplicated and may not happen again. However, any child who has an ALTE should be seen and evaluated immediately.

Apnea of Prematurity (AOP)

AOP can occur in infants who are born prematurely (before 34 weeks of pregnancy). Because the brain or respiratory system may be immature or underdeveloped, the baby may not be able to regulate his or her own breathing normally. AOP can be obstructive, central, or mixed.

Treatment for AOP can involve the following:

• keeping the infant's head and neck straight (premature babies should always be placed on their backs to sleep to help keep the airways clear)
• medications to stimulate the respiratory system
• continuous positive airway pressure (CPAP) — to keep the airway open with the help of forced air through a nose mask
• oxygen

Premature infants with AOP are followed closely in the hospital. If AOP doesn't resolve before discharge from the hospital, an infant may be sent home on an apnea monitor and parents and other caregivers will be taught CPR. The family will work closely with the child's doctor to have a treatment plan in place.

Apnea of Infancy (AOI)

Apnea of infancy occurs in children who are younger than 1 year old and who were born after a full-term pregnancy. Following a complete medical evaluation, if a cause of apnea isn't found, it's often called apnea of infancy. AOI usually goes away on its own, but if it doesn't cause any significant problems (such as low blood oxygen), it may be considered part of the child's normal breathing pattern.

Infants with AOI can be observed at home with the help of a special monitor prescribed by a sleep specialist. This monitor records chest movements and heart rate and can relay the readings to a hospital apnea program or save them for future examination by a doctor. Parents and caregivers will be taught CPR before the child is sent home.

If You Think Your Child Has Apnea

If you suspect that your child has apnea, call your doctor. If you suspect that your child is experiencing an ALTE, call 911 immediately.

Although prolonged pauses in breathing can be serious, after a doctor does a complete evaluation and makes a diagnosis, most cases of apnea can be treated or managed with surgery, medications, monitoring devices, or sleep centers. And many cases of apnea go away on their own.

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Apnea

Everyone has brief pauses in their breathing pattern called apnea. Usually these brief stops are completely normal.

Sometimes, though, apnea can cause a prolonged pause in breathing, making the breathing pattern irregular. Someone with apnea might actually stop breathing for short amounts of time, decreasing oxygen levels in the body and disrupting sleep.

Types of Apnea

The word apnea comes from the Greek word meaning "without wind." Although it's perfectly normal for everyone to experience occasional pauses in breathing, apnea can be a problem when breathing stops for 20 seconds or longer.

There are three types of apnea:

1. obstructive
2. central
3. mixed

Obstructive Apnea

A common type of apnea in children, obstructive apnea is caused by an obstruction of the airway (such as enlarged tonsils and adenoids). This is most likely to happen during sleep because that's when the soft tissue at back of the throat is most relaxed. As many as 1% to 3% of otherwise healthy preschool-age kids have obstructive apnea.

Symptoms include:

• snoring (the most common) followed by pauses or gasping
• labored breathing while sleeping
• very restless sleep and sleeping in unusual positions
• changes in color

Because obstructive sleep apnea may disturb sleep patterns, these children may also show continued sleepiness after awakening in the morning and tiredness and attention problems throughout the day. Sometimes apnea can affect school performance. One recent study suggests that some kids diagnosed with ADHD actually have attention problems in school because of disrupted sleep patterns caused by obstructive sleep apnea.

Treatment for obstructive apnea involves keeping the throat open to aid air flow, such as with adenotonsillectomy (surgical removal of the tonsils and adenoids) or continuous positive airway pressure (CPAP), which is delivered by having the child wear a nose mask while sleeping.

Central Apnea

Central apnea occurs when the part of the brain that controls breathing doesn't start or properly maintain the breathing process. In very premature infants, it's seen fairly commonly because the respiratory center in the brain is immature. Other than being seen in premature infants, central apnea is the least common form of apnea and often has a neurological cause.

Mixed Apnea

Mixed apnea is a combination of central and obstructive apnea and is seen particularly in infants or young children who have abnormal control of breathing. Mixed apnea may occur when a child is awake or asleep.

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DTaP Vaccine

DTaP

The DTaP vaccine protects against:

• diphtheria — a serious infection of the throat that can block the airway and cause severe breathing difficulty
• tetanus (lockjaw) — a nerve disease, which can occur at any age, caused by toxin-producing bacteria contaminating a wound
• pertussis (whooping cough) — a respiratory illness with cold symptoms that progress to severe coughing (the "whooping" sound occurs when the child breathes in deeply after a severe coughing bout); serious complications of pertussis can occur in children under 1 year of age, and those under 6 months old are especially susceptible. Teens and adults with a persistent cough may not realize they have pertussis, and may pass it to vulnerable infants.

Immunization Schedule

DTaP immunizations are given as a series of five injections and are usually administered at ages 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years. After the initial series of immunizations, a vaccine called Tdap (the booster shot) should be given at ages 11 to 12, or to older teens and adults who haven't yet received a booster with pertussis coverage. Then, Td (tetanus and diphtheria) boosters are recommended every 10 years.

Why the Vaccine Is Recommended

Use of the DTaP vaccine has virtually eliminated diphtheria and tetanus in childhood and has markedly reduced the number of pertussis cases.

Possible Risks

The vaccine frequently causes mild side effects: fever, mild crankiness, tiredness, loss of appetite, and tenderness, redness, or swelling in the area where the shot was given. Rarely, seizures can occur following DTaP. Most of these side effects result from the pertussis component of the vaccine. Severe complications caused by DTaP immunization are rare. Most kids have little or no problem.

When to Delay or Avoid Immunization

• if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
• if your child has an uncontrolled seizure disorder or certain neurologic diseases or seems not to be developing normally — the pertussis component of the vaccine may not be given, and your child may receive a DT (diphtheria and tetanus) vaccine instead

If your child experienced any of the following after an earlier DTaP, consult with your doctor before your child receives another injection of the vaccine:

• seizures within 3 to 7 days after injection
• worsening of seizures
• an allergic reaction after receiving the vaccine, such as mouth, throat, or facial swelling
• difficulty breathing
• temperature of 105° Fahrenheit (40.5° Celsius) or higher during the first 2 days after injection
• shock or collapse during the first 2 days after injection
• persistent, uncontrolled crying that lasts for more than 3 hours during the first 2 days after injection

Caring for Your Child After Immunization

Your child may experience fever, soreness, and some swelling and redness in the area where the shot was given. Depending on the age of your child, pain and fever may be treated with acetaminophen or ibuprofen. Check with your doctor to see if you can give either medication, and to find out the appropriate dose.

A warm, damp cloth or a heating pad also may help reduce soreness. Moving or using the limb that has received the injection often reduces the soreness.

When to Call the Doctor

• if you aren't sure whether the vaccine should be postponed or avoided. Children who have had certain problems with the DTaP vaccine usually can safely receive the DT vaccine.
• if complications or severe symptoms develop after immunization, including seizures, fever above 105° Fahrenheit (40.5° Celsius), difficulty breathing or other signs of allergy, shock or collapse, or uncontrolled crying for more than 3 hours

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Pneumococcal Vaccine

Pneumococcal Vaccine (PCV)

The pneumococcal conjugate vaccine (PCV) protects against pneumococcal infections. The bacterium is a leading cause of serious infections, including pneumonia, blood infections, and bacterial meningitis.

Children under 2 years old, adults over 65 years old, and people with certain medical conditions are most susceptible to serious pneumococcal infections. The pneumococcus bacterium is spread through person-to-person contact. The vaccine not only prevents the infection in children who receive it, it also helps stop its spread.

Immunization Schedule

PCV immunizations are given as a series of four injections starting at 2 months of age and following at 4 months, 6 months, and 12 to 15 months. Kids who miss the first dose or may have missed subsequent doses due to vaccine shortage should still receive the vaccine, and your doctor can give you a modified schedule for immunization.

Why the Vaccine Is Recommended

The most serious infections affect children younger than 2 years old, and the vaccine will protect them when they're at greatest risk.

PCV also is recommended for kids between 2 and 5 years of age who are at high risk for serious pneumococcal infections because they have medical problems such as:

• sickle cell anemia
• a damaged spleen or no spleen
• HIV/AIDS
• cochlear implants
• a disease that affects the immune system, such as diabetes or cancer
• receiving medications that affect the immune system, such as steroids or chemotherapy

In addition, these high-risk children may also receive the pneumococcal polysaccharide vaccine (PPV) in addition to the PCV when they're older than 24 months.

The PCV vaccine should be considered for all other unvaccinated 2- to -5-year-olds, especially those who are under 3 years of age; are of Alaska Native, American Indian, or African American descent; or who attend group childcare centers.

Possible Risks

Children who receive the PCV vaccine may have redness, tenderness, or swelling where the shot was given. A child may also have a fever after receiving the shot.

When to Delay or Avoid Immunization

• if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
• if your child has had a severe allergic reaction to a previous dose of the vaccine

Caring for Your Child After Immunization

The vaccine may cause mild fever, and soreness and redness in the area where the shot was given. Depending on the age of your child, pain and fever may be treated with acetaminophen or ibuprofen. Check with your doctor to see if you can give either medication, and to find out the appropriate dose.

When to Call the Doctor

• if your child missed a dose in the series
• if a severe allergic reaction or high fever occurs after immunization

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Hepatitis B Vaccine

Hepatitis B

Hepatitis B virus (HBV) affects the liver. Those who are infected can become lifelong carriers of the virus and may develop long-term problems such as cirrhosis (liver disease) or cancer of the liver.

Immunization Schedule

Hepatitis B vaccine usually is given as a series of three injections. The first shot is often given to infants shortly after birth. If the mother of a newborn carries the hepatitis B virus in her blood, the infant needs to receive the first shot within 12 hours after birth, along with another shot (HBIG) to immediately provide protection against the virus. If a newborn's mother shows no evidence of HBV in her blood, the infant may receive the hepatitis B vaccine any time prior to leaving the hospital. It may also be delayed until the 1- or 2- month visit to your doctor.

If the first dose is given shortly after birth, the second shot is given at 1 to 2 months and the third at 6 to 18 months. For infants who don't receive the first shot until 1 to 2 months, the second shot is given at 3 to 4 months and the third at 6 to 18 months. In either case, the second and third shots are usually given in conjunction with other routine childhood immunizations.

Why the Vaccine Is Recommended

The hepatitis B vaccine usually creates long-term immunity. Infants who receive the HBV series should be protected from hepatitis B infection not only throughout their childhood but also into the adult years. Eliminating the risk of infection also decreases risk for cirrhosis of the liver, chronic liver disease, and liver cancer. Young adults and adolescents should also receive the vaccine if they did not as infants.

Possible Risks

Serious problems associated with receiving the HBV vaccine are rare. Problems that do occur tend to be minor, such as fever or redness or tenderness at the injection site.

When to Delay or Avoid Immunization

• if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
• if a severe allergic reaction (called anaphylaxis) occurred after a previous injection of the HBV vaccine

Caring for Your Child After Immunization

The vaccine may cause mild fever, and soreness and redness in the area where the shot was given. Depending on the age of your child, pain and fever may be treated with acetaminophen or ibuprofen. Very young infants should not be given either medication, but for older infants or children, you can check with the doctor about the appropriate dose.

When to Call the Doctor

• if you're not sure of the recommended schedule for the hepatitis B vaccine
• if you have concerns about your own HBV carrier state
• if moderate or serious adverse effects appear after your child has received an HBV injection

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Staph Infections part 3

MRSA

You may have heard about methicillin-resistant Staphylococcus aureus (MRSA), a type of staph bacteria with a resistance to the antibiotics usually used to treat staph infections. Although MRSA infections can be harder to treat, in most cases they heal with proper care.

Most MRSA infections involve the skin, but sometimes MRSA can cause more serious problems, such as bone infections or pneumonia. MRSA pneumonia is rare, but is more of a risk for kids already sick with the flu.

Scalded Skin Syndrome

Scalded skin syndrome (SSS) most often affects newborns and kids under age 5. The illness usually starts with a localized staph skin infection, but the staph bacteria manufacture a toxin that affects skin all over the body. The child has a fever, rash, and sometimes blisters. As blisters burst and the rash passes, the top layer of skin is dislodged and the skin surface becomes red and raw, like a burn.

SSS is a serious illness that needs to be treated and monitored in a hospital. It affects the body in the same way as serious burns. After treatment, most kids make a full recovery.

Treating Staph Infections

Most localized staph skin infections can be treated by washing the skin with an antibacterial cleanser, warm soaks, applying an antibiotic ointment prescribed by a doctor, and covering the skin with a clean dressing. To keep the infection from spreading, use a towel only once when you soak or clean an area of infected skin, then wash it.

Your doctor may prescribe an oral antibiotic for your child's staph skin infection. If so, give the antibiotic on schedule for as many days as the doctor directs. More serious staph infections may require hospitalization.

Call the doctor whenever your child has an area of red, irritated, or painful skin, especially if you see whitish pus-filled areas or your child has a fever or feels sick. Also, call the doctor if skin infections seem to be passing from one family member to another or if two or more family members have skin infections simultaneously.

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Staph Infections part 2

Complications of Staph Infections

Staph bacteria can cause toxic shock syndrome, cellulitis, and these infections:

Folliculitis and Boils

Folliculitis is an infection of hair follicles, tiny pockets under the skin where hair shafts (strands) grow. In folliculitis, tiny white-headed pimples appear at the base of hair shafts, sometimes with a small red area around each pimple. This infection often occurs in areas where there's been friction or irritation, such as with shaving.

Folliculitis often clears up on its own with good skin hygiene. Sometimes, it can progress to become a boil. With a boil, the staph infection spreads deeper and wider, often affecting the skin's subcutaneous tissue (deeper tissue under the skin) and the oil-producing glands, which are called sebaceous glands. In the first stage, which parents and kids often miss, the area of skin either begins to itch or becomes mildly painful. Next, the skin turns red and begins to swell over the infected area. Finally, the skin above the infection becomes very tender and a whitish "head" may appear. The head may break, and the boil may begin to drain pus, blood, or an amber-colored liquid. Boils can occur anywhere on the skin, especially under the arms or on the groin or buttocks in kids.

To help relieve pain from a boil, try warm-water soaks, a heating pad, or a hot-water bottle applied to the skin for about 20 minutes, three or four times a day. Make sure that the washcloths used for the soaks are washed after each use. Boils are occasionally treated with oral antibiotics and in some cases need to be surgically drained.

Impetigo

Impetigo can affect skin anywhere on the body but commonly occurs around the nose and mouth. It usually affects preschoolers and school-age kids, especially in the summer months.

Impetigo caused by staph bacteria is characterized by large blisters containing fluid that is first clear, then cloudy. The blisters may burst, ooze fluid, and develop a honey-colored crust. Impetigo may itch and can be spread by scratching. Doctors usually prescribe a topical ointment to treat it and may, depending on the severity, add oral antibiotics.

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Staph Infections part 1

What Are Staph Infections?

Staph infections are caused by the bacteria Staphylococcus aureus, which many healthy people carry on their skin and in their noses without getting sick. But when skin is punctured or broken, staph bacteria can enter the wound and cause infections, which can lead to other health problems.

You can help prevent staph infections in your family by encouraging regular hand washing and daily bathing, and by keeping areas that have been cut clean or covered.

How Staph Infections Spread

Staph bacteria can spread through the air, on contaminated surfaces, and from person to person. Kids can carry staph bacteria from one area of their body to another — or pass it to other people — via dirty hands or fingernails. So good hand washing is vital to preventing staph infections.

It's also important to encourage kids to keep their skin clean with a daily bath or shower. If your child has a skin condition such as eczema that makes frequent bathing difficult, ask your doctor for advice.

Keep areas of skin that have been injured — such as cuts, scrapes, and rashes caused by allergic reactions or poison ivy — clean and covered, and follow any directions given by your doctor.

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Smallpox

Smallpox is an infection caused by the variola virus. For centuries, epidemics of smallpox affected people all over the globe, and the disease was often serious. But in 1796, an English doctor named Edward Jenner discovered a way to protect people from getting smallpox, which led to the development of the first smallpox vaccine.

The vaccine worked so well that there hasn't been a case of smallpox in the United States since 1949. The United States stopped vaccinating the general population against smallpox in 1972 because the disease was no longer a threat.

The world's last known case of smallpox was reported in Africa in 1977. In 1980, the World Health Organization (WHO) announced that smallpox was wiped out — the first (and only) time in history that an infectious disease was declared eliminated from the planet.

Worries About Smallpox

Although smallpox infection was wiped out many years ago, samples of the variola virus that causes smallpox were saved in laboratories. Some people have expressed concern that terrorists may try to get access to these stored virus samples with the aim of spreading smallpox infection.

Despite talk about the possibility of terrorists spreading smallpox as a biological weapon, the reality is that this probably wouldn't happen for a couple of reasons. First, terrorists would need access to the virus samples, and the few research laboratories that keep them have security measures to guard them. Also, it would be extremely difficult for a group to take the time to produce a large amount of the variola virus without being detected.

The smallpox vaccine also would prevent the spread of disease because it can:

• prevent people from becoming infected if they're vaccinated quickly after exposure to the virus
• make the illness less severe in people who do become infected if they're vaccinated within a few days

After the September 11, 2001, terrorist attacks and the anthrax scare that same year, the U.S. government took the precaution of asking several companies to begin making smallpox vaccine again. Today, there's enough vaccine on hand to protect the American people in the event of a smallpox outbreak.

Public health officials have a rapid response plan ready to vaccinate anyone exposed to the disease, as well as people who come into contact with them. So although a person doesn't need to get vaccinated at the moment, the vaccine is there in case it's needed.

Given that the vaccine can stop the spread of the disease, experts believe it's unlikely that terrorists will go to the trouble of producing and using smallpox as a biological weapon — it would take too long and have little effect.

Smallpox Infections

If someone becomes infected with smallpox, it may take anywhere from 7 to 17 days for symptoms to develop. At first a person may have flu-like symptoms such as high fever, fatigue, headaches, and backaches.

Within 2 to 3 days after symptoms start, a rash develops that typically affects the face, legs, and arms. It starts with red marks that become filled with pus and crust over. Scabs develop and then fall off after about 3 to 4 weeks.

Smallpox is very contagious, particularly during the first week a person has the rash. It is most commonly spread in infected drops of saliva when people cough or sneeze. Someone is contagious until after all the scabs have fallen off.

What Works Against Smallpox?

Antibiotics don't work against viruses — they're only effective against bacteria — so taking them won't help someone with smallpox. Vaccination is the only effective weapon against the spread of smallpox. Immunization successfully wiped out smallpox before and, should it become necessary, can help stop any future outbreaks. Researchers are also working to develop other treatments, too.

It's very unlikely that you or your child will ever be exposed to the virus that causes smallpox. But if you're worried about it, talk to a medical professional, who can help you find the answers to any questions you may have.

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Sinusitis

Sinuses are moist air spaces within the bones of the face around the nose. When sinuses swell or become irritated, the infection is called sinusitis. These infections usually follow colds or bouts with allergies.

Cases of sinusitis are common and can be easily treated.

Causes

The sinuses are four sets of hollow spaces that are located in the cheekbones, the forehead, behind the nasal passages, and deep in the brain. Sinuses are lined with the same mucous membranes that line the nose and mouth.

When someone has a cold or allergies and the nasal passages become swollen and make more mucus, so do the sinus tissues. The drainage system for the sinuses can get blocked, and mucus can become trapped in the sinuses. Bacteria, viruses, and fungi can grow there and lead to sinusitis.

Symptoms

Sinusitis can cause different symptoms for kids of varying ages.

Younger kids often have cold-like symptoms, including a stuffy or runny nose and slight fever. If your child develops a fever 5-7 days after cold symptoms begin, it could signal sinusitis or another infection (like bronchitis, pneumonia, or an ear infection), so call your doctor.

Many parents mistake cold-related headaches in young kids for sinus infections. But the sinuses in the forehead don't start developing until kids are 6 or 7 years old and aren't formed enough to get infected until the early teen years, so headaches in kids who have colds usually aren't sinus infections.

In older kids and teens, the most frequent symptoms of sinusitis are a daytime dry cough that doesn't improve after the first 7 days of cold symptoms, fever, worsening congestion, dental pain, ear pain, or tenderness in the face. Sometimes teens who have sinusitis also develop upset stomachs, nausea, headaches, and pain behind the eyes.

Prevention

Simple changes in your lifestyle or home environment can help lower the risk of sinusitis. For example, during the winter, when the cold air outside and your heating system make the air inside your home abnormally dry, consider using a humidifier to keep home humidity at 45%-50%. This will stop dry air from irritating the sinuses and make them less of a target for infection. It's important to clean your humidifier regularly to prevent mold growth.

Although sinusitis itself is not contagious, it is often preceded by a cold, which can spread easily, particularly among family or friends. The most effective way to prevent germs from spreading is to teach kids the importance of frequent hand washing, particularly when they're sick.

Treatment

Doctors may prescribe oral antibiotics to treat cases of sinusitis that are believed to be caused by bacteria. Some doctors may recommend decongestants and antihistamines to help reduce the symptoms.

Cases of sinusitis that are caused by viruses usually go away on their own without medical treatment. Acetaminophen, ibuprofen, and/or warm compresses may help reduce any pain your child may be experiencing. But over-the-counter cold preparations have not been found to be effective in reducing symptoms in kids and may cause unwanted side effects.

Call the doctor whenever your child has:

• a cold that lasts for more than 10 days without improvement
• a cold that seems to be getting worse after 7 days of symptoms
• symptoms of allergies that don't clear with the usual allergy medication

Also call the doctor if your child shows any other signs of sinusitis, like pain or stiffness in the cheeks, a fever, or a cold that seems worse than usual.

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Syphilis

Syphilis, a sexually transmitted disease (STD), can be frightening because if it goes untreated, it can lead to serious health problems and increase a person's risk for getting human immunodeficiency virus (HIV), the virus that causes AIDS.

A syphilis infection can be treated in its early stages with antibiotics, and can be prevented by avoiding sexual contact with someone who is infected. Unfortunately, people don't always know that they are infected, so anyone having sex (oral, anal, or vaginal) should take precautions against STDs and get screened for them regularly.

Symptoms

Syphilis, which is caused by the bacteria Treponema pallidum, often doesn't cause any symptoms in the early stages. If the infection goes untreated, it can progress to affect the entire body.

Syphilis typically has three stages, and there can be different symptoms in each.

Primary Syphilis

The symptoms of the first stage of the infection, which is called primary syphilis, typically appear 2 to 12 weeks after sexual contact with an infected person. A painless red sore called a chancre can appear on the genitals, at the area where the infection occurred. Enlarged lymph nodes (swollen glands) also might be present in the area. Depending on the type of sexual contact, a chancre might also develop on the mouth or in the rectal area. Chancres are the primary way that syphilis is transmitted between people, but often are unrecognized. Even without treatment, chancres will heal after 3 to 6 weeks, but if the infection isn't treated the disease will progress to the second stage.

Secondary Syphilis

The secondary stage usually begins weeks to months after the chancre sore appears. Syphilis bacteria enter the blood and spread through the body, causing many different symptoms, including rash (small red spots), fever, headache, loss of appetite, weight loss, sore throat, muscle aches, joint pain, a generally ill feeling, and enlarged lymph nodes.

The rash of secondary syphilis can develop on the palms and on the soles, in addition to the trunk, arms, and legs. Gray or white wart-like patches of skin called condylomata can appear on the moist areas around the mouth, anus, and vagina. These lesions are full of bacteria and very contagious. In the secondary stage, syphilis may also affect the liver, kidneys, and eyes, or cause meningitis. The symptoms of secondary syphilis will eventually go away. But without treatment, the infection can advance to the third stage. This is true even if an infected person did not have symptoms of primary or secondary syphilis.

Late (Tertiary) Syphilis

After the secondary stage, some people with syphilis progress to the latent stage, where they have no more symptoms but are still infected. Some of them go on to have symptoms of late syphilis, which can appear even years later and can damage the eyes, large blood vessels, heart, bones, and central nervous system (called neurosyphilis). Symptoms of this late stage of syphilis may include memory loss, problems with mental function, walking, balance, bladder control, and vision, in addition to impotence and loss of feeling, particularly in the legs.

Treatment

A doctor can test for syphilis with a physical exam and blood tests and treat it with antibiotics. The doctor can also check for any other STDs, such as gonorrhea, chlamydia, and HIV.

Anyone who is sexually active should see the doctor to be screened for syphilis and other STDs. Someone who has had sexual contact with a person who has syphilis, or has any symptom of the illness, should be seen by a physician for testing and treatment as soon as possible.

Preventing STDs

Because syphilis is an STD, the best way to prevent getting it is to abstain from having sex. Sexual activity with more than one partner or with someone who has more than one sex partner also increases the risk of contracting an STD.

When properly and consistently used, condoms decrease the risk of STDs. Latex condoms provide greater protection than natural-membrane condoms. The female condom, made of polyurethane, is also considered effective against STDs.

Using douche can actually increase a woman's risk of contracting STDs because it can change the natural flora of the vagina and may flush bacteria higher into the genital tract.

Because many STDs often don't have obvious symptoms, often teens don't know when they're infected, so sexually active teens should get screened regularly for STDs so that they don't lead to other more serious health problems.

A teen who is being treated for syphilis also should be tested for other STDs, and should have time alone with the doctor to openly discuss issues like sexual activity. Not all teens will be comfortable talking with parents about these issues. But it's important to encourage them to talk to a trusted adult who can provide the facts.

Getting Help

If your teen is thinking of becoming sexually active or already has started having sex, it's important to talk with him or her about it. Make sure your teen knows how STDs can be spread (during anal, oral, or vaginal sex) and that these infections often don't have symptoms, so a partner might have an STD without knowing it.

It can be difficult to talk about STDs, but just as with any other medical issue, teens need this information to stay safe and healthy. Provide the facts, and let your child know where you stand.

It's also important that all teens have regular full physical exams — which can include screening for STDs. Your teen may want to see a gynecologist or a specialist in adolescent medicine to talk about sexual health issues. Community health organizations and sexual counseling centers in your local area also may be able to offer some guidance.

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Shigella

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

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

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

Signs and Symptoms

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

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

Other symptoms of shigellosis include:

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

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

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

Contagiousness

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

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

Prevention

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

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

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

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

Diagnosis and Treatment

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

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

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

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

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

When to Call the Doctor

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

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

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

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

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Scarlet Fever

Scarlet fever is caused by an infection with group A streptococcus bacteria. The bacteria make a toxin (poison) that can cause the scarlet-colored rash from which this illness gets its name.

Not all streptococci bacteria make this toxin and not all kids are sensitive to it. Two kids in the same family may both have strep infections, but one child (who is sensitive to the toxin) may develop the rash of scarlet fever while the other may not. Usually, if a child has this scarlet rash and other symptoms of strep throat, it can be treated with antibiotics. So if your child has these symptoms, it's important to call your doctor.

Symptoms of Scarlet Fever

The rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps and it may itch. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks. Areas of rash usually turn white when you press on them. By the sixth day of the infection the rash usually fades, but the affected skin may begin to peel.

Aside from the rash, there are usually other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever above 101° Fahrenheit (38.3° Celsius), and swollen glands in the neck. The tonsils and back of the throat may be covered with a whitish coating, or appear red, swollen, and dotted with whitish or yellowish specks of pus. Early in the infection, the tongue may have a whitish or yellowish coating. A child with scarlet fever also may have chills, body aches, nausea, vomiting, and loss of appetite.

When scarlet fever occurs because of a throat infection, the fever typically stops within 3 to 5 days, and the sore throat passes soon afterward. The scarlet fever rash usually fades on the sixth day after sore throat symptoms began, but skin that was covered by rash may begin to peel. This peeling may last 10 days. With antibiotic treatment, the infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal.

In rare cases, scarlet fever may develop from a streptococcal skin infection like impetigo. In these cases, the child may not get a sore throat.

Preventing Scarlet Fever

The bacterial infection that causes scarlet fever is contagious. A child who has scarlet fever can spread the bacteria to others through nasal and throat fluids by sneezing and coughing. If a child has a skin infection caused by strep bacteria, like impetigo, it can be passed through contact with the skin.

In everyday life, there is no perfect way to avoid the infections that cause scarlet fever. When a child is sick at home, it's always safest to keep that child's drinking glasses and eating utensils separate from those of other family members, and to wash these items thoroughly in hot soapy water. Wash your own hands frequently as you care for a child with a strep infection.

Treating Scarlet Fever

If your child has a rash and the doctor suspects scarlet fever, he or she will usually take a throat culture (a painless swab of throat secretions) to see if the bacteria grow in the laboratory. Once a strep infection is confirmed, the doctor will likely prescribe an antibiotic for your child to be taken for about 10 days.

Caring for a Child With Scarlet Fever

A child with severe strep throat may find that eating is painful, so providing soft foods or a liquid diet may be necessary. Include soothing teas and warm nutritious soups, or cool soft drinks, milkshakes, and ice cream. Make sure that the child drinks plenty of fluids.

Use a cool-mist humidifier to add moisture to the air, since this will help soothe the sore throat. A moist warm towel may help to soothe swollen glands around your child's neck.

If the rash itches, make sure that your child's fingernails are trimmed short so skin isn't damaged through scratching.

When to Call the Doctor

Call the doctor whenever your child suddenly develops a rash, especially if it is accompanied by a fever, sore throat, or swollen glands. This is especially important if your child has any of the symptoms of strep throat, or if someone in your family or in your child's school has recently had a strep infection.

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Salmonella Infection

A salmonella infection is a foodborne illness caused by the salmonella bacteria carried by some animals, which can be transmitted from kitchen surfaces and can be in water, soil, animal feces, raw meats, and eggs. Salmonella infections typically affect the intestines, causing vomiting, fever, and other symptoms that usually resolve without medical treatment.

You can help prevent salmonella infections by not serving any raw meat or eggs, and by not keeping reptiles as pets, particularly if you have very young children.

Hand washing is a powerful way to guard against salmonella infections, so it's essential to teach kids to wash their hands, particularly after trips to the bathroom and before handling food in any way.

Salmonella Basics

Not everyone who ingests salmonella bacteria will become ill. Children, especially infants, are the most likely candidates to get sick from it. About 50,000 cases of salmonella infection are reported in the United States each year and about one third of those are in kids 4 years old or younger.

The type of salmonella most commonly associated with infections in humans is called nontyphoidal salmonella. It is carried by chickens, cows, and reptiles such as turtles, lizards, and iguanas.

Another, rarer form of salmonella, typhoidal salmonella (typhoid fever), is carried only by humans and is usually transmitted through direct contact with the fecal matter of an infected person. This kind of salmonella infection can lead to high fever, abdominal pain, headache, malaise, lethargy, skin rash, constipation, and delirium. It occurs primarily in developing countries without appropriate systems for handling human waste.

Signs and Symptoms

A salmonella infection generally causes nausea, vomiting, abdominal cramps, diarrhea (sometimes bloody), fever, and headache. Because many different kinds of illnesses can cause these symptoms, most doctors will take a stool sample to make an accurate diagnosis.

Symptoms of most salmonella infections usually appear within 3 days of contamination and typically go away without medical treatment.

In cases of typhoid fever caused by salmonella bacteria, early symptoms are the same. But in the second week, the liver and spleen can become enlarged, and a distinctive "rose spotted" skin rash may appear. From there, the infection can cause other health problems, like meningitis and pneumonia.

People at risk for more serious complications from a salmonella infection include those who:

• have compromised immune systems (such as people with HIV)
• take cancer-fighting drugs
• have sickle cell disease or an absent or nonfunctioning spleen
• take chronic stomach acid suppression medication

In these higher-risk groups, most doctors will treat an infection with antibiotics to prevent it from spreading to other parts of the body and causing additional health problems.

Prevention

You have many ways to help prevent salmonella bacteria from making your family sick. Most salmonella bacteria appear in animal products and can be killed by the heat from cooking. So it's important to make sure that you don't serve raw or undercooked eggs, poultry, or meat. Microwaving is not a reliable way to kill the salmonella bacteria.

Because salmonella bacteria can contaminate even intact and disinfected grade A eggs, avoid serving poached eggs or eggs that are served sunny-side up.

Salmonella also can be spread through cross-contamination, so when you're preparing meals, keep uncooked meats away from cooked and ready-to-eat foods. In addition, thoroughly wash your hands, cutting boards, counters, and knives after handling uncooked foods.

Some foods may contain unrecognized raw-food products and should be avoided. Caesar salad dressing, the Italian dessert tiramisu, homemade ice cream, chocolate mousse, eggnog, cookie dough, and frostings can contain raw eggs. Unpasteurized milk and juices also can be contaminated with salmonella.

Fecal matter is often the source of salmonella contamination, so hand washing is extremely important, particularly after using the toilet and before preparing food.

Take care to avoid contact with the feces of family pets — especially reptiles. Wash your hands thoroughly after handling an animal and ensure that no reptiles are permitted to come into contact with an infant. Even healthy reptiles (especially turtles and iguanas) are not appropriate pets for small children and should not be in the same house as an infant.

Treatment

If your child has a salmonella infection and a healthy immune system, your doctor may let the infection pass without treatment. But any time your child develops a fever, headache, or bloody diarrhea, call the doctor to rule out any other problems.

If your child is infected and has a fever, you may want to give acetaminophen to reduce his or her temperature and relieve cramping. As with any infection that causes diarrhea, it's important to give your child plenty of liquids to avoid dehydration.

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