Recurrent Urinary Tract Infections

Urinary tract infections (UTIs) are common in kids. By age 5, about 8% of girls and 1%-2% of boys have had at least one UTI. They occur when the kidneys, ureters, bladder, or urethra

become infected.

Symptoms of a UTI can include:

• pain when urinating
• changes in frequency, appearance, or smell of urine
• fever
• chills
• loss of appetite
• nausea
• vomiting
• lower abdominal pain
• lower back pain or discomfort

UTIs can also cause bedwetting in kids who were previously dry at night. Infants and young children may only show nonspecific signs such as fever, vomiting, or decreased appetite or activity.

Some kids experience UTIs again and again — these are called recurrent UTIs. If left untreated, recurrent UTIs can cause kidney damage, especially in kids younger than 6. So it's important to know how to recognize the signs of these infections and get help for your child.

Types of UTIs

Common types of UTIs include:

• cystitis, the most common type of UTI, is a bladder infection that can occur when bacteria move up the urethra (the tube-like structure that allows urine to exit the body from the bladder) and into the bladder
• urethritis, when bacteria infect the urethra
• pyelonephritis, a kidney infection that can occur when infected urine flows backward from the bladder to the kidneys, or when an infection in the bloodstream reaches the kidneys

Related Conditions Associated With Recurrent UTIs

Recurrent UTIs are sometimes seen in conjunction with other conditions, such as:

• vesico-ureteral reflux (VUR), which is found in 30%-50% of kids diagnosed with a UTI and is a congenital (present at birth) condition in which urine flows backward from the bladder to the ureters (the thin, tube-like structures that carry urine from the kidney to the bladder) and sometimes reaches the kidneys. If the urine in the bladder is infected with bacteria, VUR can lead to pyelonephritis.
• hydronephrosis, which is an enlargement of one or both kidneys due to backup or blockage of urine flow and is usually caused by severe VUR or a blocked ureter. Kids with hydronephrosis are sometimes at risk of recurrent UTIs and may need to take daily low doses of antibiotics to prevent them.

But not all cases of recurrent UTIs can be traced back to these body structure-related abnormalities. For example, dysfunctional voiding — when a child doesn't urinate frequently enough or doesn't relax his or her muscles properly while urinating — is a common cause of UTIs.

Unrelated conditions that compromise the body's natural defenses, such as diseases of the immune system, can also lead to recurrent UTIs. In addition, using a nonsterile urinary catheter can introduce bacteria into the urinary tract and cause an infection.

Detecting Abnormalities

Although UTIs can be treated with antibiotics, it's important for your child's doctor to rule out any underlying abnormalities in the urinary system when these infections occur repeatedly.

Some abnormalities can be detected even before birth. Hydronephrosis, when it occurs as a congenital condition, can be detected in a fetus by ultrasound as early as 16 weeks of gestation. When hydronephrosis poses significant danger to the developing kidneys, surgery may be performed while the baby is in the womb; however, in most cases, doctors wait until after birth before treating the condition because almost half of all cases that are diagnosed prenatally disappear by birth.

Once a baby suspected to have hydronephrosis or another urinary system abnormality is born, the baby's blood pressure will be monitored carefully because some kidney abnormalities can cause high blood pressure. An ultrasound may be used again to get a closer look at the bladder and kidneys.

Diagnosis and Treatment

If your doctor suspects that your child may have an abnormality of the urinary tract, he or she may order tests to make an accurate diagnosis including:

Ultrasound

Using high-frequency sound waves to "echo," or bounce, off the body and create a picture of it, an ultrasound can detect some abnormalities in the kidneys, ureters, and bladder. It can also measure the size and shape of the kidneys. When an ultrasound suggests VUR, a voiding cystourethrogram (VCUG) or a renal scan (see below for descriptions of both) may be performed for further evaluation.

Renal scan (nuclear scan)

Radioactive material is injected into a vein and followed through the urinary tract. The material can show the shape of the kidneys, how well they function, if there is damaged kidney tissue, and the course of the urine. A small amount of radiation is received in the study and leaves the body in the urine.

Voiding cystourethrogram (VCUG or cystogram)

A catheter (a hollow, soft tube) is used to inject an opaque dye into the bladder. This X-ray test can diagnose VUR and identify problems with the bladder or urethra.

Cystoscopy

A cystoscope uses lenses and a light source within a tube inserted through the urethra to directly view the inside of the bladder. It's used when other tests or symptoms indicate a possible bladder abnormality.

Intravenous pyelogram

Opaque dye is injected into a vein and then X-rays are taken to follow the course of the dye through the urinary system. Although this test is still used sometimes, the renal ultrasound and renal scan have replaced intravenous pyelogram in most cases.

Because VUR can lead to kidney infection (pyelonephritis) and subsequent kidney damage, children with the condition must be monitored closely. Usually, surgery isn't necessary because many kids will outgrow the condition. Even in those who don't, surgery may be unnecessary because antibiotics are often successful in warding off UTIs.

The most common type of surgery to correct VUR is ureteral reimplantation, in which one or both ureters are reattached to the bladder to decrease backflow of urine from the bladder to the ureters and kidneys. Although the success of ureteral reimplantation is greater than 90%, only those who have recurrent UTIs while on antibiotic prophylaxis (preventive therapy) will be considered for surgery.

Blockages can interfere with normal urine flow, which serves to wash bacteria out of the urinary tract. Because severe blockages in the ureter or the urethra may ultimately lead to repeated kidney infections and kidney damage, they may require surgical intervention. Kidney stones are another source of blockage that may obstruct the path of urine.

When anatomical defects have been ruled out, antibiotics may be prescribed for months or even years to prevent recurrent infections.

The Future for Managing Recurrent UTIs

Doctors have started to use a less-invasive way to correct VUR than implantation. The procedure involves the injection of such materials as Teflon, Delflux, or collagen through a cystoscope. This procedure was considered experimental a few years ago, but is rapidly gaining wider acceptance.

Recent studies have found that women and children who get recurrent UTIs may lack certain immunoglobins (a group of proteins that fight infections). Some researchers are optimistic that a vaccine may be developed that could help boost production of antibodies that fight UTIs. A promising vaccine that would protect against E. coli (the most common bacterium that causes UTIs) is being tested.

Home Treatment

Additional things to consider to help prevent recurrent UTIs in kids:

Diet Modifications

Encourage kids to drink 8 to 10 glasses of water and other fluids per day. Cranberry juice is often suggested because it may prevent E. coli from attaching to the walls of the bladder. Always ask your doctor, though, if your child should drink cranberry juice because it can interfere with some medicines.

Multivitamins

Vitamin C acidifies the urine, making the environment less friendly to bacteria. Vitamins designed for kids are generally safe, but always ask your doctor before increasing the dose beyond the currently recommended daily allowance.

No Bubble Baths

Kids should avoid bubble baths and perfumed soaps because they can irritate the urethra.

Frequent Diaper Changes

Kids in diapers should be changed frequently to prevent stool from having prolonged contact with the genital area, which can increase the chance that bacteria will move up the urethra and into the bladder.

Proper Wiping Technique

In females, wiping from front to back after using the toilet will reduce exposure of the urethra to UTI-causing bacteria in the stool.

Cotton Underwear

Breathable cotton underwear is less likely to encourage bacterial growth near the urethra than nylon or other fabrics.

Frequent Bathroom Visits

Some kids may object to using the school bathroom or may become so engrossed in a project that they delay urination. Kids with UTIs should urinate at least every 3 to 4 hours to help flush bacteria from the urinary tract.

Follow-Up Visits

Your doctor may advise performing another urine culture after treatment of a UTI is completed to be sure that the infection has cleared.

When to Call the Doctor

As soon as you suspect a UTI in your child, it's important to contact your doctor.

If your child suffers from recurrent UTIs, consult a pediatric nephrologist or urologist who can perform a thorough evaluation and, if necessary, order tests for urinary system abnormalities. In the meantime, follow your doctor's instructions for treating a UTI.

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Rabies

Rabies infections in people are rare in the United States. However, worldwide about 50,000 people die from rabies each year, mostly in developing countries where programs for vaccinating dogs against rabies don't exist. But the good news is that problems can be prevented if the exposed person receives treatment before symptoms of the infection develop.

Rabies is a virus that in the U.S. is usually transmitted by a bite from a wild infected animal, such as a bat, raccoon, skunk, or fox. If a bite from a rabid animal goes untreated and an infection develops, it is almost always fatal.

If you suspect that your child has been bitten by a rabid animal, go to the emergency department immediately. Any animal bites — even those that don't involve rabies — can lead to infections and other medical problems. As a precaution, call your doctor any time your child has been bitten.

Transmission

Approximately 7,000 cases of rabies in animals are reported each year to the Centers for Disease Control and Prevention (CDC). Raccoons are the most common carriers of rabies in the United States, but bats are most likely to infect people. Almost three quarters of rabies cases between 1990 and 2001 came from contact with bats.

Skunks and foxes also can be infected with rabies, and a few cases have been reported in wolves, coyotes, bobcats, and ferrets. Small rodents such as hamsters, squirrels, chipmunks, mice, and rabbits are very rarely infected with the virus.

Because of widespread vaccination programs in the United States, transmission from dogs to people is very rare. Outside the United States, exposure to rabid dogs is the most common cause of transmission to humans.

An infected animal has the rabies virus in its saliva and can transmit it to a person through biting. In rarer cases, an animal can spread the virus when its saliva comes in contact with a person's mucous membranes (moist skin surfaces, like the mouth or inner eyelids) or broken skin such as a cut, scratch, bruise, or open wound.

After a bite, the rabies virus can spread into surrounding muscle, then travel up nearby nerves to the brain. Once the virus reaches the brain, the infection is fatal in almost all cases.

Signs and Symptoms

The first symptoms can appear from a few days to more than a year after the bite occurs.

One of the most distinctive signs of a rabies infection is a tingling or twitching sensation around the area of the animal bite. It is often accompanied by a fever, headache, muscle aches, loss of appetite, nausea, and fatigue.

As the infection progresses, someone infected with rabies may develop any of these symptoms:

• irritability
• excessive movements or agitation
• confusion
• hallucinations
• aggressiveness
• bizarre or abnormal thoughts
• muscle spasms
• abnormal postures
• seizures (convulsions)
• weakness or paralysis (when a person cannot move some part of the body)
• extreme sensitivity to bright lights, sounds, or touch
• increased production of saliva or tears
• difficulty speaking

In the advanced stage of the infection, as it spreads to other parts of the nervous system, these symptoms may develop:

• double vision
• problems moving facial muscles
• abnormal movements of the diaphragm and muscles that control breathing
• difficulty swallowing and increased production of saliva, causing the "foaming at the mouth" usually associated with a rabies infection

If Your Child Is Bitten by an Animal

If your child has been bitten by an animal, take the following steps right away:

• Wash the bite area with soap and water for 10 minutes and cover the bite with a clean bandage.
• Immediately call your doctor and go to a nearby emergency department. Anyone with a possible rabies infection must be treated in a hospital.
• Call local animal-control authorities to help find the animal that caused the bite. The animal may need to be detained and observed for signs of rabies.
• If you know the owner of the animal that has bitten your child, get all the information about the animal, including vaccination status and the owner's name and address. Notify your local health department, particularly if the animal hasn't been vaccinated.
• If you suspect that your child has been bitten by an unknown dog, bat, rat, or other animal, contact your doctor immediately or take your child to the emergency department.

Treatment

At the hospital, it is likely that the doctor will first clean the wound thoroughly and make sure that your child's tetanus immunizations are current.

To keep any potential infection from spreading, the doctor may decide to start treating your child right away with shots of human rabies immune globulin to the wound site and vaccine shots in the arm. This decision is usually based on the circumstances of the bite (provoked or unprovoked), the type of animal (species, wild or domestic), the animal's health history (vaccinated or not), and the recommendations of local health authorities.

Prevention

You can reduce the chances that your family is exposed to rabies. Vaccinate your pets — dogs, cats, and ferrets can be infected by rabies. Report any stray animals to your local health authorities or animal-control officer. Remind kids that animals can be "strangers," too. They should never touch or feed stray cats or dogs wandering in the neighborhood or elsewhere.

As a precaution against rabies or any other infections, call your doctor if:

• your child has been exposed to an animal that might have rabies, but is too young to describe the contact with the animal
• your child has been exposed to bats, even if there is no bite
• you plan to travel abroad and may come into contact with rabid animals, particularly if you're traveling to an area where you might not have access to health care

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Poliomyelitis

Polio (also called poliomyelitis) is a contagious, historically devastating disease that was virtually eliminated from the Western hemisphere in the second half of the 20th century. Although polio has plagued humans since ancient times, its most extensive outbreak occurred in the first half of the 1900s before the vaccination, created by Jonas Salk, became widely available in 1955.

At the height of the polio epidemic in 1952, nearly 60,000 cases with more than 3,000 deaths were reported in the United States alone. However, with widespread vaccination, wild-type polio, or polio occurring through natural infection, was eliminated from the United States by 1979 and the Western hemisphere by 1991.

Signs and Symptoms

Polio is a viral illness that, in about 95% of cases, actually produces no symptoms at all (called asymptomatic polio). In the 4% to 8% of cases in which there are symptoms (called symptomatic polio), the illness appears in three forms:

• a mild form called abortive polio (most people with this form of polio may not even suspect they have it because their sickness is limited to mild flu-like symptoms such as mild upper respiratory infection, diarrhea, fever, sore throat, and a general feeling of being ill)
• a more serious form associated with aseptic meningitis called nonparalytic polio (1% to 5% show neurological symptoms such as sensitivity to light and neck stiffness)
• a severe, debilitating form called paralytic polio (this occurs in 0.1% to 2% of cases)

People who have abortive polio or nonparalytic polio usually make a full recovery. However, paralytic polio, as its name implies, causes muscle paralysis - and can even result in death. In paralytic polio, the virus leaves the intestinal tract and enters the bloodstream, attacking the nerves (in abortive or asymptomatic polio, the virus usually doesn't get past the intestinal tract). The virus may affect the nerves governing the muscles in the limbs and the muscles necessary for breathing, causing respiratory difficulty and paralysis of the arms and legs.

Contagiousness

Polio is transmitted primarily through the ingestion of material contaminated with the virus found in stool (poop). Not washing hands after using the bathroom and drinking contaminated water were common culprits in the transmission of the disease.

Prevention

In the United States, it's currently recommended that children have four doses of inactivated polio vaccination (IPV) between the ages of 2 months and 6 years.

By 1964, the oral polio vaccine (OPV), developed by Albert Sabin, had become the recommended vaccine. OPV allowed large populations to be immunized because it was easy to administer, and it provided "contact" immunization, which means that an unimmunized person who came in contact with a recently immunized child might become immune, too. The problem with OPV was that, in very rare cases, paralytic polio could develop either in immunized children or in those who came in contact with them.

Since 1979 (when wild polio was eliminated in the United States), the approximately 10 cases per year of polio seen in this country were traced to OPV.

IPV is a vaccine that stimulates the immune system of the body (through production of antibodies) to fight the virus if it comes in contact with it. IPV cannot cause polio.

In an effort to eradicate all polio, including those cases associated with the vaccine, the Centers for Disease Control and Prevention (CDC) decided to make IPV the only vaccine given in the United States. Currently, the CDC and American Academy of Pediatrics (AAP) recommend three spaced doses of IPV given before the age of 18 months, and an IPV booster given between the ages of 4 to 6, when children are entering school.

If you're planning to travel outside the United States, particularly to Africa and Asia (where polio still exists), be sure that you and your child have received a complete set of polio vaccinations.

Duration

Although the acute illness usually lasts less than 2 weeks, damage to the nerves could last a lifetime. In the past, some patients with polio never regained full use of their limbs, which would appear withered. Those who did fully recover might go on to develop post-polio syndrome (PPS) as many as 30 to 40 years after contracting polio. In PPS, the damage done to the nerves during the disease causes an acceleration of the normal, gradual weakness due to aging.

Treatment

In the height of the polio epidemic, the standard treatment involved placing a patient with paralysis of the breathing muscles in an "iron lung" - a large machine that actually pushed and pulled the chest muscles to make them work. The damaged limbs were often kept immobilized because of the confinement of the iron lung. In countries where polio is still a concern, ventilators and some iron lungs are still used.

Historically, home treatment for paralytic polio and abortive polio with neurological symptoms wasn't sufficient. However, asymptomatic and mild cases of abortive polio with no neurological symptoms were usually treated like the flu, with plenty of fluids and bed rest.

The Future of Polio

The World Health Organization (WHO) is working toward eradicating polio throughout the world. Significant strides have already been made. In 1988, 355,000 cases of polio in 125 countries were reported. By the end of 2004, there were just 1,255 cases.

Six countries (Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan) still have polio circulating, and the virus could be introduced to other countries. If the polio virus is imported into a country where not enough people have been immunized, there's the risk that it could spread from person to person. That's what has happened in some countries in Africa and Asia. So until it has been eliminated worldwide, it's important to continue vaccinating kids against polio.

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Pinkeye

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

While pinkeye can 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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Mumps

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 prevaccine era, most cases of mumps are still in children 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 children 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.

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.

Professional Treatment

If you think that your child has mumps, call your doctor, who can confirm the diagnosis and work with you to monitor your child's progress and watch for any complications. The doctor can also notify the health authorities who keep track of childhood immunization programs and mumps outbreaks.

Because mumps is caused by a virus, it cannot be treated with antibiotics.

At home, monitor and keep track of your child's temperature. You can use nonaspirin fever medications such as acetaminophen or ibuprofen to bring down a fever. These medicines will also help relieve pain in the swollen parotid glands. Unless instructed by your child's doctor, aspirin should not be used in children with viral illnesses because the use of aspirin in such cases has been associated with the development of Reye syndrome, which can lead to liver failure and death.

You can also soothe your child's swollen parotid glands with either warm or cold packs. Serve a soft, bland diet that does not require a lot of chewing and encourage your child to drink plenty of fluids. Avoid serving tart or acidic fruit juices (like orange juice, grapefruit juice, or lemonade) that make parotid pain worse. Water, decaffeinated soft drinks, and tea are better tolerated.

When mumps involves the testicles, the doctor may prescribe stronger medications for pain and swelling and provide instructions on how to apply warm or cool packs to soothe the area and how to provide extra support for the testicles.

A child with mumps doesn't need to stay in bed, but may play quietly. Ask your doctor about the best time for your child to return to school.

When to Call the Doctor

Call the doctor if you suspect that your child has mumps. If your child has been diagnosed with mumps, keep track of your child's temperature and call the doctor if it climbs above 101° Fahrenheit (38.3° Celsius).

Because mumps can also involve the brain and its membranes, call the doctor immediately if your child has any of the following: stiff neck, convulsions (seizures), extreme drowsiness, severe headache, or changes of consciousness. Watch for abdominal pain that can mean involvement of the pancreas in either sex or involvement of the ovaries in girls. In boys, watch for high fever with pain and swelling of the testicles.

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Mononucleosis

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

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

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

Symptoms

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

Other symptoms of mono can include:

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

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

Mono symptoms usually go away on their own within 2 to 4 weeks, but the enlarged lymph nodes and spleen can last longer. And in some kids, especially teens, the fatigue and weakness can last for months.

Doctors usually recommend that kids who get mono avoid sports for at least a month after symptoms are gone because the spleen is usually enlarged temporarily from the illness. An enlarged spleen can rupture easily — causing bleeding, fever, and abdominal pain — and require emergency surgery.

Complications

Most kids who get mono recover completely with no problem, but in rare cases, complications can occur. These can include blood disorders, such as hemolytic anemia, which involves the premature destruction of red blood cells, and Bell's palsy, an inflammation of a facial nerve that can weaken and paralyze the face muscles (but is usually temporary).

Other rare complications of mono include rupture of the spleen and inflammation of the heart muscle (myocarditis).

Prevention and Treatment

There is no vaccine for the Epstein-Barr virus, but you can try to prevent your child from getting mono by making sure that he or she avoids close contact with other kids who have it.

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

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

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