Cellulitis

Cellulitis is an infection of the skin and underlying tissues that can affect any area of the body. It often begins in an area of broken skin, like a cut or scratch, when bacteria invade and spread, causing inflammation, pain, swelling, warmth, and redness.

Causes

Conditions that create breaks in the skin and allow bacteria to enter, such as eczema and severe acne, will put a child at risk for cellulitis. Chickenpox, scratched insect bites, animal bites, and puncture wounds are other causes.

Cellulitis also can form in areas of intact skin, especially in people who have diabetes or who are taking medicines that suppress the immune system.

Cellulitis requires particularly close monitoring when it infects the eyelid and tissues surrounding the eye. It can be the result of minor trauma to the area around the eye (such as an insect bite or a scratch), or it may be an extension of another infection, such as sinusitis. This kind of cellulitis is treated with antibiotics and close follow-up. If untreated, it can progress to a more serious infection that affects vision.

Symptoms

Cellulitis typically begins as a small, inflamed area of pain, swelling, warmth, and redness on a child's skin. As this red area begins to spread, the child may begin to feel sick and develop a fever, sometimes with chills and sweats. Swollen lymph nodes (commonly called swollen glands) are sometimes found near the area of infected skin. Cellulitis is not contagious.

Prevention

You can prevent cellulitis by protecting your child's skin from cuts, bruises, and scrapes. This may not be easy, especially if you have an active child who loves to explore or play sports. Protective equipment worn to prevent other injuries during active play can also protect skin: elbow and knee pads while skating, a bike helmet during bike riding, shin guards during soccer, long pants and long-sleeved shirts while hiking in the woods, sandals (not bare feet) on the beach, and seatbelts while riding in a motor vehicle.

If your child does get a scrape, wash the wound well with soap and water. Apply an antibiotic ointment and cover the wound with an adhesive bandage or gauze. Check in with your doctor if your child has a large cut, deep puncture wound, or bite (animal or human).

Diagnosis

The incubation period for cellulitis varies, depending on the type of bacteria causing it. Your doctor can diagnose cellulitis by asking a few questions and examining the area of affected skin. Sometimes, especially in younger kids, a blood culture may be done to check for bacteria growth. A positive blood culture means that bacteria from the skin infection have spread into the bloodstream, a condition known as bacteremia. This can potentially lead to septicemia, an infection affecting many systems of the body.

Treatment

A child with severe cellulitis may be treated in the hospital using intravenous (IV) antibiotics. Kids with milder cellulitis can be treated at home with antibiotics. The doctor may also suggest that the affected part of the body be immobilized and elevated to reduce swelling and pain. Pain relievers such as acetaminophen or ibuprofen can help reduce discomfort.

After 1 or 2 days on antibiotics at home, a child may return to see the doctor, who'll check that the area of cellulitis has improved and that the antibiotics are working to heal the infection.

When to Call the Doctor

Call the doctor whenever any area of your child's skin becomes red, warm, and painful — with or without fever and chills. This is especially important if the affected skin is on the face or if your child has a chronic illness (like diabetes) or a condition that suppresses the immune system.

Because cellulitis can happen very quickly after an animal bite, call the doctor whenever your child is bitten by an animal, especially if the puncture wound is deep. Human bites also can cause skin infections and should be seen by a doctor. If red streaks develop from the infected area or symptoms worsen despite antibiotic treatment, your child should be reexamined.

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Cat Scratch Disease

Cat scratch disease is a bacterial infection that typically causes swelling of the lymph nodes. It usually results from the scratch, lick, or bite of a cat — more than 90% of people with the illness have had some kind of contact with cats, often with kittens.

Bartonella henselae is the bacterium that causes cat scratch disease, and it's found in all parts of the world. Cat scratch disease occurs more often in the fall and winter. In the United States, about 22,000 cases are diagnosed annually, most of them in people under the age of 21. This may be because children are more likely to play with cats and be bitten or scratched.

Fleas spread the bacteria between cats, although currently there is no evidence that fleas can transmit the disease to humans. Once a cat is infected, the bacteria live in the animal's saliva. Bartonella henselae does not make a cat sick, and kittens or cats may carry the bacteria for months. Experts believe that almost half of all cats have a Bartonella henselae infection at some time in their lives, and cats less than 1 year old are more likely to be infected.

Signs and Symptoms

Most people with cat scratch disease remember being around a cat, but often cannot recall receiving a scratch or a bite. A blister or a small bump develops several days after the scratch or bite and may be mistaken for a bug bite. This blister or bump is called an inoculation lesion (a wound at the site where the bacteria enter the body), and it is most commonly found on the arms and hands, head, or scalp. These lesions are generally not painful.

Usually within a couple of weeks of a scratch or bite, one or more lymph nodes close to the area of the inoculation lesion will swell and become tender. (Lymph nodes are round or oval-shaped organs of the immune system that are often called glands.) For example, if the inoculation lesion is on the arm, the lymph nodes in the elbow or armpit will swell.

These swollen lymph nodes appear most often in the underarm or neck areas, although if the inoculation lesion is on the leg, then the nodes in the groin will be affected. They range in size from about ½ inch to 2 inches in diameter and may be surrounded by a larger area of swelling under the skin. The skin over these swollen lymph nodes may become warm and red, and occasionally the lymph nodes drain pus.

In most children and adolescents, swollen lymph nodes are the main symptom of the disease, and the illness often is mild. About one third of people with cat scratch disease have other general symptoms. These include fever (usually less than 101° Fahrenheit or 38.3° Celsius), fatigue, loss of appetite, headache, rash, sore throat, and an overall ill feeling.

Atypical cases of cat scratch disease do occur, but they are much less common. In such cases, a person may have infections of the liver, spleen, bones, joints, or lungs, or a lingering high fever without any other symptoms. Some people get an eye infection known as Parinaud oculoglandular syndrome, with symptoms including: a small sore on the conjunctiva (the membrane lining the eye or inner eyelid), redness of the eye, and swollen lymph nodes in front of the ear. Others may develop inflammation of the brain or seizures, although this is rare. All of these complications of cat scratch disease usually resolve without any lasting illness.

Contagiousness

Cat scratch disease is not contagious from person to person. The bacteria are spread by the scratch or bite of an infected animal, most often a kitten. They can also be transmitted if the animal's saliva comes in contact with broken skin or an eye. Sometimes multiple cases of the illness occur in the same family, but these likely result from contact with the same infected animal.

Having one episode of cat scratch disease usually makes people immune for the rest of their lives.

Prevention

If you're concerned about cat scratch disease, you do not need to get rid of the family pet. The illness is relatively rare and usually mild, and a few steps can go a long way toward limiting your child's chances of contracting the disease.

Teaching kids to avoid stray or unfamiliar cats can reduce their exposure to sources of the bacteria. To lower the risk of getting the disease from a family pet or familiar cat, kids should avoid rough play with any pets so they can avoid being scratched or bitten. Have your family members wash their hands after handling or playing with a cat.

If your child is scratched by a pet, wash the injured area thoroughly with soap and water. Keeping the house and your pet free of fleas will reduce the risk that your cat could become infected with the bacteria in the first place.

If you suspect that someone in your family has caught cat scratch disease from your family pet, you don't need to worry that the animal will have to be put to sleep. Talk with your veterinarian about the problem.

Incubation

It typically takes 3 to 10 days for a blister or small bump to appear at the site of a scratch or bite. Lymph node swelling usually begins about 1 to 4 weeks later.

Duration

The inoculation lesion where the bacteria entered the body usually takes days to heal. The swollen lymph nodes typically disappear within 2 to 4 months, although they occasionally last much longer.

Professional Treatment

Doctors usually diagnose cat scratch disease based on a child's history of exposure to a cat or kitten and a physical examination. During the exam, a doctor will look for signs of a cat scratch or bite and swollen lymph nodes. In some cases, doctors use laboratory tests to help make the diagnosis, including:

• skin tests, blood tests, and cultures to rule out other causes of swollen lymph nodes
• a blood test that is positive for cat scratch disease
• a microscopic examination of a removed lymph node that shows signs of cat scratch disease

Most cases of cat scratch disease resolve without any treatment at all. Rarely, a swollen lymph node becomes so large and painful that the doctor may recommend removing fluid from the node with a needle and syringe. Antibiotics can be used to treat the disease. If your doctor has prescribed antibiotics, give the medication to your child on schedule for as many days as the doctor has advised.

Home Treatment

A child who has cat scratch disease does not need to be isolated from other family members. Bed rest is not necessary, but it may help if your child tires easily. If your child feels like playing, encourage quiet play while being careful to avoid injuring swollen lymph nodes. To ease the soreness of these nodes, try warm, moist compresses or give your child nonprescription medicines like acetaminophen or ibuprofen.

When to Call the Doctor

Call your doctor whenever your child has swollen or painful lymph nodes in any area of the body, or if your child is ever bitten by an animal. You should call if your child has been bitten or scratched by a cat and the wound does not seem to be healing, an area of redness around the wound keeps expanding for several days, or your child develops a fever that lasts for a few days after receiving the scratch or bite.

If your child has already been diagnosed with cat scratch disease, call the doctor if your child has a high fever, has lots of pain in a lymph node, seems very sick, or develops any new symptoms.

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Lyme Disease

Lyme disease is an infection caused by the bacterium Borrelia burgdorferi. This bacterium is usually found in animals such as mice and deer. Ixodes ticks can pick up the bacteria when they bite an infected animal, then transmit it to a person, which can lead to Lyme disease.

Ticks live in grass and shrubs and attach themselves to a suitable host as it passes by. Ticks are small and can be hard to see. Immature ticks, or nymphs, are about the size of a poppy seed.

The majority of reported Lyme disease cases occur in the Northeast, upper Midwest, and Pacific coastal areas of the United States because these regions are where ticks tend to live. Though Lyme disease cases have been reported from all over, in 2005 the majority of cases were reported in:

• Connecticut
• Delaware
• Maine
• Maryland
• Massachusetts
• Minnesota
• New Hampshire
• New York
• New Jersey
• Pennsylvania
• Wisconsin

Some cases of Lyme disease have also been reported in Asia, Europe, and parts of Canada.

Signs and Symptoms

Lyme disease can affect the skin, joints, nervous system, and other organ systems. Symptoms, and their severity, can vary from person to person.

The symptoms of Lyme disease are often described as occurring in three stages, though not everyone experiences all stages:

1. The first sign of infection usually is a circular rash, called erythema migrans, that appears within 1–2 weeks of infection but may develop up to 30 days after the tick bite. This rash often has a characteristic "bull's-eye" appearance, with a central red spot surrounded by clear skin that is ringed by an expanding red rash. It may also appear as an expanding ring of solid redness. It may be warm to the touch and is usually not painful or itchy. The bull's-eye rash may be more difficult to see on people with darker skin tones, where it may take on a bruise-like appearance. The rash usually resolves in about a month. Although this rash is considered typical of Lyme disease, many patients never develop it.
2. Along with the rash, a person may experience flu-like symptoms such as swollen lymph nodes, fatigue, headache, and muscle aches. Left untreated, symptoms of the initial illness may go away on their own. But in some people, the infection can spread to other parts of the body. Symptoms of this stage of Lyme disease usually appear within several weeks after the tick bite, even in someone who has not developed the initial rash. The person may feel very tired and unwell, or may have more areas of rash that aren't at the site of the bite.
   
   Lyme disease can affect the heart, leading to an irregular heart rhythm or chest pain. It can spread to the nervous system, causing facial paralysis (Bell's palsy) or tingling and numbness in the arms and legs. It can start to cause headaches and neck stiffness, which may be a sign of meningitis. Swelling and pain in the large joints can also occur.
3. The last stage of Lyme disease may occur if early disease was not detected or appropriately treated. Symptoms of late Lyme disease can appear any time from weeks to years after an infectious tick bite and include arthritis, particularly in the knees, and, mainly in adults, cognitive deterioration.

Contagiousness

Lyme disease is not transmitted from person to person. The risk of developing Lyme disease depends on an individual's exposure to ticks. Kids and adults who spend a lot of time outdoors — particularly in or near wooded areas — are more likely to contract Lyme disease.

In rare cases, Lyme disease contracted during pregnancy may infect the fetus. If you are pregnant and are concerned about this, talk with your doctor.

Domestic animals, such as dogs and cats, may become infected with Lyme disease bacteria and may carry infected ticks into areas where humans live. If you have a dog or a cat, talk with your veterinarian about what kinds of tick-control products and other protective measures you can take for your pet.

Diagnosis

The most telling symptom of Lyme disease is the circular bull's-eye rash. Usually, because the rash is very distinct, a person with the rash can be immediately diagnosed with Lyme disease and blood tests are not necessary. Because the rash can rapidly disappear, consider taking a picture of any suspicious rash on your child if you are unable to see the doctor immediately.

In some cases, the bull's-eye rash never forms. In the absence of the rash, doctors must rely on other symptoms combined with an assessment of someone's likelihood of exposure to an infected tick. Blood tests can help diagnose Lyme disease by detecting the presence of antibodies to Borrelia burgdorferi in the patient's blood. However, blood tests can give inaccurate results if done within a month after initial infection, since it takes time for the antibodies to develop. Lyme disease can be difficult to diagnose because it may resemble many other medical conditions. Your doctor can help to decide whether your child needs a blood test for Lyme disease.

Treating Lyme Disease

Treatment of early localized Lyme disease typically involves a course of antibiotics administered for 3 to 4 weeks.

If diagnosed quickly and treated with antibiotics, Lyme disease in children is almost always treatable. The skin rash usually goes away within several days after starting treatment, but other signs and symptoms may persist for several weeks.

Prevention

Ticks frequently live in shady, moist ground cover and also cling to tall grass, brush, shrubs, and low tree branches. Lawns and gardens may harbor ticks, especially at the edges of woods and forests and around old stone walls (areas where deer and mice, the primary hosts of the deer tick, thrive).

To prevent Lyme disease, avoid contact with soil, leaves, and vegetation as much as possible, especially during May, June, and July, when ticks have not yet matured and are harder to detect.

When you do venture into the great outdoors, follow these tips:

• Wear enclosed shoes and boots, long-sleeved shirts, and long pants. Tuck pants into boots or shoes to prevent ticks from crawling up legs.
• Wear light-colored clothing to help you see ticks easily.
• Keep long hair pulled back or placed in a cap for added protection.
• When outside, don't sit on the ground.
• While outdoors, check yourself and your child frequently for ticks.
• Wash all clothes after leaving tick-infested areas, and bathe and shampoo your child thoroughly to eliminate any unseen ticks.

Insect repellents containing DEET (look for N,N-diethyl-meta-toluamide) can help to repel ticks. Choose one with a 10% to 30% concentration of DEET. Generally, DEET should not be applied more than once a day, and is not recommended for babies younger than 2 months. DEET can be used on exposed skin, as well as clothing, socks, and shoes, but should not be used on the face, under clothing, or on the hands of young children.

Ticks can bite anywhere, but they prefer certain areas of the body, such as:

• behind the ears
• the back of the neck
• armpits
• the groin
• behind the knees

If you find a tick on your child, call your doctor, who may want you to save the tick after removal (you can put it in a jar of alcohol to kill it). Use tweezers to grasp the tick firmly at its head or mouth, next to your child's skin. Pull firmly and steadily on the tick until it lets go, then swab the bite site with alcohol.

Myths abound about ways to kill ticks (such as using petroleum jelly or a lit match), but don't try them — these methods don't work.

You can help keep ticks away from your house by keeping lawns mowed and trimmed; clearing brush, leaf litter, and tall grass; and stacking woodpiles off the ground. In addition, you can have a licensed professional spray your yard with insecticide in May and September to prevent ticks from multiplying.

There is no vaccine for Lyme disease currently on the market in the United States.

When to Call the Doctor

If your child has a bull's-eye rash or other symptoms that can occur in Lyme disease — such as swollen lymph glands near a tick bite, general achiness, headache, or fever — call your doctor right away.

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Campylobacter Infections

Campylobacter bacteria, usually transmitted in contaminated food or water, can infect the gastrointestinal tract and cause diarrhea, fever, and cramps. Practicing good hand-washing and food safety habits will help prevent Campylobacter infections (or campylobacteriosis), which usually clear up on their own but sometimes are treated with antibiotics.

Campylobacter infects over 2 million people each year, and it's a leading cause of diarrhea and food-borne illness. Babies under 1 year old, teens, and young adults are most commonly affected.

Causes

Campylobacter is found in the intestines of many wild and domestic animals. The bacteria are passed in their feces, which can lead to infection in humans via contaminated food, meats (especially chicken), water taken from contaminated sources (streams or rivers near where animals graze), and milk products that haven't been pasteurized.

Bacteria can be transmitted from person to person when someone comes into contact with fecal matter from an infected person, especially a child in diapers. Household pets can carry and transmit the bacteria to their owners.

Once inside the human digestive system, Campylobacter infects and attacks the lining of both the small and large intestines. The bacteria can also affect other parts of the body. In some cases — particularly in very young patients and those with chronic illnesses or a weak immune system — the bacteria can get into the bloodstream, causing bacteremia. In rare cases, campylobacteriosis can lead to Guillain-Barré syndrome, a rare autoimmune disorder.

Symptoms

Symptoms generally appear 1 to 7 days after ingestion of the bacteria. The main symptoms of campylobacteriosis are fever, abdominal cramps, and mild to severe diarrhea. Diarrhea can lead to dehydration, which should be closely monitored. Signs of dehydration include: thirst, irritability, restlessness, lethargy, sunken eyes, dry mouth and tongue, dry skin, fewer trips to the bathroom to urinate, and (in infants) a dry diaper for several hours.

In cases of campylobacteriosis, the diarrhea is initially watery, but it may later contain blood and mucus. Sometimes, the abdominal pain appears to be a more significant symptom than the diarrhea. When this happens, the infection may be mistaken for appendicitis or a problem with the pancreas.

Prevention

You can prevent campylobacteriosis by using drinking water that's been tested and approved for purity, especially in developing countries, and by drinking milk that's been pasteurized. While hiking and camping, avoid drinking water from streams and from sources that pass through land where animals graze.

Kill any bacteria in meats by cooking these foods thoroughly and eating while still warm. Whenever you prepare foods, wash your hands well before and after touching raw meats, especially poultry. Clean cutting boards, countertops, and utensils with soap and hot water after contact with raw meat.

As you care for a family member who has diarrhea, remember to wash your hands before touching other people in your household and before handling foods. Clean and disinfect toilets after they're used by the person with diarrhea. Also, if a pet dog or cat has diarrhea, wash your hands frequently and check with your veterinarian about treatment.

Diagnosis

Your doctor may send a stool sample to the lab to be tested for Campylobacter bacteria. Other lab tests may also be needed, especially if your child has blood in the stool.

Treatment

Most kids with campylobacteriosis will recover without medication. Occasionally, the doctor may prescribe an antibiotic, especially if the child is very young or the symptoms are severe or persistent. If your child receives an antibiotic, give it on schedule for as long as the doctor has ordered. Also, do not give nonprescription medicines for diarrhea without first checking with your doctor.

After being checked by a doctor, most kids with Campylobacter infections are treated at home, especially if they show no signs of being seriously dehydrated. They should drink plenty of fluids as long as the diarrhea lasts and be monitored for signs of dehydration.

Kids with mild diarrhea and no dehydration should continue to eat normally and increase their fluid intake — but fruit juices and soft drinks can worsen diarrhea and should be avoided. If your child is dehydrated, your doctor may recommend using an oral rehydration solution. Babies with campylobacteriosis who are breastfed should continue to be breastfed throughout the illness.

Diarrhea usually stops within 2 to 5 days. Full recovery usually takes about 1 week. In about 20% of cases, diarrhea can last longer or recur.

When to Call the Doctor

If your child has bloody or black, tar-like bowel movements or seems dehydrated, call your doctor immediately.

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Otitis Externa

Otitis externa — commonly known as swimmer's ear — is an infection of the ear canal, the tubular opening that carries sounds from the outside of the body to the eardrum. It can be caused by many different types of bacteria or fungi.

The infection commonly occurs in kids who spend a lot of time in the water. Too much moisture in the ear can irritate and break down the skin in the canal, allowing bacteria or fungi to penetrate. In temperate climates, otitis externa occurs more often in summertime, when swimming is common.

But you don't have to swim to get swimmer's ear. Anything that causes a break in the skin of the ear canal can lead to an infection. Dry skin or eczema, scratching the ear canal, vigorous ear cleaning with cotton-tipped applicators, or inserting foreign objects like bobby pins or paper clips into the ear can all increase the risk of developing otitis externa.

And if someone has a middle ear infection, pus collected in the middle ear can drain into the ear canal through a hole in the eardrum and cause otitis externa.

Signs and Symptoms

The primary symptom of otitis externa is ear pain, which can be severe and gets worse when the earlobe or other exterior part of the ear is pulled or pressed on. It may also be painful for a person with otitis externa to chew. Sometimes the ear canal itches before the pain begins.

Swelling of the ear canal may make your child complain of a full or uncomfortable feeling in the ear. The outer ear may become reddened or swollen, and lymph nodes around the ear may become enlarged and tender. There may be some discharge from the ear canal as well; it may be clear at first but then turn cloudy, yellowish, and pus-like. Hearing may temporarily be affected if pus and debris or swelling of the canal blocks the passage of sound into the ear. Fever is not common in typical cases of otitis externa.

Otitis externa is not contagious.

Prevention

Using over-the-counter drops of a dilute solution of acetic acid or alcohol in the ears after getting them wet can help prevent otitis externa, especially if a child is prone to the infection. These drops are available at pharmacies and should only be used in kids who do not have ear tubes or a hole in the eardrum.

After time in the water, kids should gently dry their ears with a towel and help water run out of their ears by turning their heads to the side. Speak with your doctor before using earplugs.

To avoid trauma to the ear, kids should not clean their ears themselves and should never put objects into their ears, including cotton-tipped applicators.

Professional Treatment

Treatment of otitis externa depends on the severity of the infection and how much pain the child feels. For milder cases, your doctor may prescribe eardrops that contain antibiotics to fight the infection and a steroid to reduce swelling of the ear canal. Eardrops are usually given several times a day for 7 to 10 days.

If swelling of the ear canal makes it difficult to give the drops, the doctor may insert a cotton wick into the canal to help carry the medicine inside the ear. In some cases, the doctor may need to remove pus and debris from the ear with gentle cleaning or suction. This will allow the eardrops to work more effectively. For more severe infections, oral antibiotics also may be given, and the doctor may order a culture of some of the discharge from the ear to help identify which bacteria or fungi are causing the infection.

Over-the-counter pain relievers can be used to manage pain. Once treatment has begun, your child will start to feel better in a day or two. Otitis externa is usually cured within 7 to 10 days of starting treatment.

Home Treatment

Otitis externa should be treated by a doctor. If left untreated, the ear pain will get worse and the infection may spread. To help relieve the pain until your child sees the doctor, you can place a warm washcloth or heating pad against the affected ear. Acetaminophen or ibuprofen may also ease discomfort.

At home, follow the doctor's instructions for administering eardrops and oral antibiotics, if they are prescribed. It's important to keep water out of your child's ear during the entire course of treatment. A shower cap offers protection while showering or bathing, and your doctor may also recommend earplugs.

When to Call the Doctor

Call your doctor immediately if your child has any of the following: pain in the ear with or without fever, decreased hearing in one or both ears, or abnormal discharge from the ear.

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Pneumocystis Pneumonia

Pneumocystis carinii pneumonia (PCP) is an infection caused by Pneumocystis carinii, a microscopic fungus that lives in the lungs of many people. The infection usually causes no symptoms in healthy people, but can cause pneumonia in infants who have AIDS, cancer, or other conditions that affect the immune system.

In kids who are already seriously ill, symptoms of this form of pneumocystis pneumonia begin suddenly with a fever, a cough, and difficulty breathing.

Pneumocystis pneumonia is the most common pediatric illness associated with AIDS, especially in babies younger than 6 months, and its prevention is very important in AIDS care.

Infants who are weak or sick also can develop pneumocystis pneumonia. Usually the infant is 3 to 6 months old and has no fever, but gradually begins to breathe faster than normal. As the lung infection gets worse, breathing becomes more difficult, and the baby's chest muscles may begin to retract (pull in abnormally) with each breath. The child's lips, fingernails, and skin also may turn blue or gray.

Diagnosing PCP

A doctor can sometimes diagnose pneumocystis pneumonia by X-ray or by finding the organism in lung fluids that have been examined in the laboratory. The doctor may need to use a bronchoscope to take a tissue sample from inside the lungs. This sample will be sent to a laboratory where special chemical stains can identify the pneumocystis organism.

Even if your child has no other medical problems, call your doctor immediately if your child has unusually rapid breathing or difficulty breathing, is coughing, or has a blue or gray color to his or her nails, lips, or skin.

Treating PCP

Antibiotics, either alone or in special combinations, are usually used to treat pneumocystis pneumonia. They may be given by mouth or intravenously (into the veins) for at least 2 weeks. If the child has AIDS, antibiotic treatment will probably last about 3 weeks. Depending on the severity of the PCP infection, the doctor may add a steroid medication.

If your child has any condition that severely weakens the immune system, check with your doctor about the need for giving your child antibiotics to prevent pneumocystis infection.

All infants born to HIV-infected mothers should begin treatment to prevent PCP at 1 month of age until it's known for sure whether they have the HIV infection.

Transmission of PCP

Research is ongoing about how pneumocystis is spread. Scientists believe that it's transmitted through the air, but cannot yet point to sources in the environment. Although animals may carry pneumocystis, they do not seem to be able to pass it to humans. Human-to-human spread may be possible, since there have been hospital outbreaks among sick infants and children with weakened immune systems.

Because of the seriousness of this infection, most kids who have symptoms of pneumocystis infection are treated in the hospital. Some of the different antibiotics that may be used to treat pneumocystis can have side effects, which are easier to monitor in a hospital.

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Croup

The term croup does not refer to a single illness, but rather a group of conditions involving inflammation of the upper airway that leads to a cough that sounds like a bark, particularly when a child is crying.

Most croup is caused by viruses, but similar symptoms may occasionally be caused by bacteria or an allergic reaction. The viruses most commonly involved are parainfluenza virus (accounting for most cases), adenovirus, respiratory syncytial virus, influenza, and measles.

Most children with viral croup are between the ages of 3 months and 5 years old. Croup is most likely to occur during the fall, winter, and early spring, and symptoms are most severe in kids younger than 3 years of age.

Most cases of croup due to viruses are mild and can be treated at home, though rarely it can be severe and even life-threatening. Some kids are more prone to developing croup, especially those who were born prematurely or with narrowed upper airways, and babies with a history of breathing problems like asthma.

The term spasmodic croup refers to a condition similar to viral croup, except that there are few accompanying symptoms of an infection. The cough frequently begins at night with a sudden onset and is often recurrent. The child usually has no fever with spasmodic croup. The symptoms are treated the same for either form of croup.

Signs and Symptoms

Croup is characterized by a loud cough that may sound like the barking of a seal and may be accompanied by fast or difficult breathing and sometimes a grunting noise or wheezing while breathing.

At first, a child may have cold symptoms like a stuffy or runny nose for a few days and may also have fever. As the upper airway (the lining of the windpipe and the voice box) becomes progressively inflamed and swollen, the child may become hoarse, with a harsh, barking cough.

If the upper airway becomes swollen to the point where it is partially blocked off, it becomes even more difficult for a child to breathe. This happens with severe croup. With severe croup, there may be a high-pitched or squeaking noise when breathing in (this is called stridor). A child will tend to breathe very fast, and the stomach or the skin between the ribs may seem to pull in during breathing since he or she is working hard to get air in to the lungs. The child may also appear pale or bluish around the mouth from not getting enough oxygen. These are signs that a child needs immediate medical attention.

Symptoms of croup often worsen at night and when the child is upset or crying. In addition to the effects on the upper airway, the infections that cause croup can result in inflammation further down the airway, including the bronchi (breathing tubes) and the lungs.

Contagiousness

Croup tends to occur in outbreaks in the fall, winter, and early spring when the viruses that usually cause it peak. Many kids who come in contact with the viruses that cause croup will not get croup, but will instead have symptoms of a head cold. The viruses that cause croup can be passed when someone coughs or sneezes.

Diagnosis

Doctors can usually diagnose croup by looking for the telltale barking cough and stridor, the squeaking sound on inhaling. They will also check for fever, cold symptoms (like a runny nose), or a recent viral illness, and ask questions to find out if the child has a prior history of croup or upper airway problems.

If croup is severe and slow to respond to treatment, a neck X-ray may also be taken to rule out any other reasons for the breathing difficulty, such as a foreign object lodged in the throat or epiglottitis (an inflammation of the epiglottis, the flap of tissue that covers the windpipe). Typical findings on an X-ray if a child has croup includes the top of the airway narrowing to a point, which doctors call a steeple sign.

Treatment

Most, though not all, cases of viral croup are mild. Breathing in moist air seems to relieve many of the symptoms. Doctors will also sometimes treat with steroids, which helps with the airway swelling.

One way to humidify the air is with a cool-mist humidifier. Having your child breathe in the moist air through the mouth will sometimes break a croup attack. Or try running a hot shower to create a steam-filled bathroom where you can sit with your child for 10 minutes. While sitting in the bathroom (but outside of the shower), try cuddling and reading a bedtime story to help calm your child.

Sometimes, during cooler months, taking your child outside for a few minutes can help break the attack because the cool air can shrink the swollen tissues lining the airway. Parents can also try driving the child in the car with the windows down to bring in cool air.

If your child has croup, consider sleeping overnight in the same room to provide close observation. If your child is breathing quickly, working hard to breathe, has any stridor, seems less alert than usual, or seems to be worsening in any way, seek medical attention immediately.

Medical professionals will need to evaluate your child if the croup appears serious or if there's any suspicion of airway blockage or bacterial infection. Medications such as epinephrine or corticosteroids may be given to reduce swelling in the upper airways. Oxygen may also be given, and sometimes a child with croup will need to remain in the hospital overnight for observation and further treatment. As with most illnesses, rest and plenty of fluids are recommended.

Duration

The symptoms of croup generally peak 2 to 3 days after the symptoms of infection start. Croup resulting from viral infection usually lasts less 3 to 7 days.

Complications

The vast majority of kids recover from croup with no complications. Rarely, some will develop complications like pneumonia.

Children who were born prematurely or who have a history of breathing problems or lung disease (such as asthma) are more likely to develop severe symptoms of croup and may require hospitalization. Croup rarely causes any long-term complications.

Prevention

Frequent hand washing and avoiding contact with people who have respiratory infections are the best ways to reduce the chance of spreading the viruses that cause croup.

When to Call the Doctor

Immediately call your doctor or seek medical attention if your child has any of the following symptoms:

• difficulty breathing, including rapid breathing, belly sinking in while breathing
• the skin between the ribs pulling in with each breath
• stridor
• pale or bluish color around the mouth
• drooling or difficulty swallowing
• greater inactivity than usual when ill or less alert than usual
• high fever
• very sick appearance
• seems to be getting worse

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Genital Warts

Genital warts, sometimes called venereal warts, are growths or bumps contracted through sexual contact. They're caused by certain types of the human papillomavirus (HPV), which is one of the most common sexually transmitted diseases (STDs).

Symptoms

In females, genital warts appear in and around the vagina or anus or on the cervix. In males, they appear on the penis, scrotum, groin, or thigh. Genital warts can be raised or flat, small or large. Sometimes they're clustered together in a cauliflower-like shape. Most of the time, they're flesh-colored and painless. Sometimes, the warts are so small and flat that they may not be noticed right away.

It may take several months or years after infection for symptoms to appear — if there are symptoms at all.

In females, the virus can lead to changes in the cervix that may lead to cancer, so it's important that it is diagnosed and treated as soon as possible. Males infected with HPV can also be at risk for cancer of the penis and the anus.

Contagiousness

Genital warts are transmitted through sexual contact (anal, oral, and vaginal) with an infected person, and warts can appear within several weeks or months afterwards.

The virus is passed through skin-to-skin contact, but not everyone who's been exposed to the virus will develop genital warts.

Prevention

A vaccine for females 9 to 26 years old is approved to prevent HPV infection, which causes most cervical cancers and genital warts. The vaccine, called Gardasil, is given as three injections over a 6-month period. It doesn't protect females who've already been infected with HPV, and doesn't protect against all types of HPV, so be sure your daughter gets routine checkups and gynecologic exams. If you have questions about the vaccine, talk with your doctor.

Because genital warts are spread through sexual contact, the best way to prevent them is to abstain from having sex. Sexual contact with more than one partner or with someone who has more than one partner increases the risk of contracting any 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 female's risk of contracting STDs because it can change the natural flora of the vagina and may flush bacteria higher into the genital tract.

A teen who is being treated for genital warts 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.

Treatment

Though there's no cure for an HPV infection, the genital warts can be treated and removed with prescription medication or other medical procedures, such as freezing or laser treatments.

Because the HPV remains dormant in the body, genital warts may reappear at any time after treatment. Those who have had one outbreak of genital warts still carry the virus and can infect others. Someone who has had HPV can also get a new HPV infection from another partner.

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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Cold Sores

Cold sores are small and painful blisters that can appear around the mouth, face, or nose. They are sometimes referred to as fever blisters, and they're caused by herpes simplex virus type 1 (HSV-1). Kids can get cold sores by kissing or sharing eating utensils with an infected person.

Usually, HSV-1 cause cold sores in the mouth or face, and herpes simplex virus type 2 (HSV-2) causes lesions in the genital area, resulting in genital herpes. But sometimes, HSV-1 can cause genital lesions as well, especially if someone has received oral sex from an infected partner.

Colds sores in the mouth are very common, and many kids get infected with HSV-1 during the preschool years. The sores usually go away on their own within about a week.

Symptoms

Most kids who get cold sores get infected by eating or drinking from the same utensils as someone who is infected with the herpes virus or by getting kissed by an infected adult.

The cold sores first form blisters on the lips and inside the mouth. The blisters then become sores. In some cases, the gums become red and swollen. In other cases, the virus also leads to a fever, muscle aches, eating difficulties, a generally ill feeling, irritability, and swollen neck glands. These symptoms can last up to 2 weeks.

After a child is initially infected, the virus can lie dormant without causing any symptoms. But it can reactivate later, typically after some sort of stress like a cold, an infection, hormonal change, menstrual periods, or even before a big test at school. If the virus is reactivated it can cause tingling and numbness around the mouth and a blister.

Treatment

Cold sores from HSV-1 usually go away on their own within 5 to 7 days. Although no medications can make the infection go away, some treatments are available that can shorten the length of the outbreak and make the cold sores less painful.

Cool foods and drinks can help relieve discomfort, and acetaminophen may also ease the pain. Aspirin should not be given to kids with viral infections since it has been associated with Reye syndrome.

Call the doctor if your child:

• has another health condition that has weakened the immune system, which could allow the HSV infection to spread and cause problems in other parts of the body
• has sores that don't heal by themselves within 7 to 10 days
• has any sores near the eyes
• gets cold sores frequently

Since the virus that causes cold sores is so contagious, it's important to prevent it from spreading to other family members. Precautions to take with kids who have cold sores include:

• keeping their drinking glasses and eating utensils separate from those used by other family members and washing these items thoroughly after use
• teaching them not to kiss others until the sores heal
• having them wash their hands frequently and as soon as possible after touching the cold sores
• trying to keep them from touching their eyes — if HSV infects the eyes, it can be very serious

If you're caring for a child with a cold sore, you also should be diligent about washing your hands frequently so that you don't contract the virus or spread it to others.

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Giardiasis

Giardiasis, an illness that affects the digestive tract, is caused by a microscopic parasite called Giardia lamblia. The parasite attaches itself to the lining of the small intestines in humans, where it sabotages the body's absorption of fats and carbohydrates from digested foods.

Giardia is one of the chief causes of diarrhea in the United States, and is transmitted through contaminated water. It can survive the normal amounts of chlorine used to purify community water supplies, and can live for more than 2 months in cold water. As few as 10 of the microscopic parasites in a glass of water can cause a severe case of giardiasis in a human being who drinks it.

Young kids are three times more likely to have giardiasis than adults, which leads some experts to believe that our bodies gradually develop some form of immunity to the parasite as we grow older. But it isn't unusual for an entire family to have giardiasis, with some family members having diarrhea, some just crampy abdominal pains, and others with few or no symptoms.

Signs and Symptoms

It's estimated that between 1% and 20% of the U.S. population has giardiasis, and this figure may be 20% or higher in developing countries, where giardiasis is a major cause of epidemic childhood diarrhea. But more than two thirds of people who are infected may have no signs or symptoms of illness, even though the parasite is living in their intestines.

When the parasite does cause symptoms, the illness usually begins with severe watery diarrhea, without blood or mucus. Giardiasis affects the body's ability to absorb fats from the diet, so the diarrhea contains unabsorbed fats. That means that the diarrhea floats, is shiny, and smells very bad.

Other symptoms include:

• abdominal cramps
• large amounts of intestinal gas
• an enlarged belly from the gas
• loss of appetite
• nausea and vomiting
• sometimes a low-grade fever

These symptoms may last for 5 to 7 days or longer. If they last longer, a child may lose weight or show other signs of poor nutrition.

Sometimes, after acute (or short-term) symptoms of giardiasis pass, the disease begins a chronic (or more prolonged) phase.

Symptoms of chronic giardiasis include:

• periods of intestinal gas
• abdominal pain in the area above the navel
• poorly formed, "mushy" bowel movements (poop)

Prevention

Here are some ways to protect your family from giardiasis:

• Drink only from water supplies that have been approved by local health authorities.
• Bring your own water when you go camping or hiking, instead of drinking from sources like mountain streams.
• Wash raw fruits and vegetables well before you eat them.
• Wash your hands well before you cook food for yourself or for your family.
• Encourage your kids to wash their hands after every trip to the bathroom and especially before eating. If someone in your family has giardiasis, wash your hands often as you care for him or her.
• Have your kids wash their hands well after handling anything in "touch tanks" in aquariums, a potential source of giardiasis.
• Have your water checked on a regular basis if it comes from a well.

Also, it's questionable whether infants and toddlers still in diapers should be sharing public pools. But certainly they should not if they're having diarrhea or loose stools (poop).

Contagiousness

People and animals (mainly dogs and beavers) who have giardiasis can pass the parasite in their stool. The stool can then contaminate public water supplies, community swimming pools, and "natural" water sources like mountain streams. Uncooked foods that have been rinsed in contaminated water may also spread the infection.

In child-care centers or any facility caring for a group of people, giardiasis can easily pass from person to person. At home, an infected family dog with diarrhea may pass the parasite to human family members who take care of the sick animal.

Diagnosis

Doctors confirm the diagnosis of giardiasis by taking stool samples and sending them to the lab to be examined for Giardia parasites. Several samples may be needed before the parasites are found.

For that reason the doctor may order a much more sensitive test called the Enzyme-Linked ImmunoSorbent Assay or ELISA test.

Less often, doctors make the diagnosis by looking at the lining of the small intestine with an instrument called an endoscope and taking samples from inside the intestine to be sent to a laboratory. This is done in more extreme cases, when a definite cause for the diarrhea hasn't been found.

Treatment

Giardiasis is treated with prescription medicines that kill the parasites. Treatment typically takes 5 to 7 days, and the medicine is usually given as a liquid that your child can drink. Some of these medicines may have side effects, so your doctor will tell you what to watch for.

If your child has giardiasis and your doctor has prescribed medication, be sure to give all doses on schedule for as long as your doctor directs. This will help your child recover faster and will kill parasites that might infect others in your family. Again, encourage all family members to wash their hands frequently, especially after using the bathroom and before eating.

A child who has diarrhea from giardiasis may lose too much fluid in the stool and become dehydrated. Make sure the child drinks plenty of fluids but no caffeinated beverages, because they make the body lose water faster.

Ask the doctor before you give your child any nonprescription drugs for cramps or diarrhea because these medicines may mask symptoms and interfere with treatment.

Duration

The incubation period for giardiasis is 1 to 3 weeks after exposure to the parasite. In most cases, treatment with 5 to 7 days of antiparasitic medication will help kids recover within a week's time. Medication also shortens the time that they're contagious. If giardiasis isn't treated, symptoms can last up to 6 weeks or longer.

When to Call the Doctor

Call the doctor whenever your child has:

• large amounts of diarrhea, especially if he or she also has a fever and/or abdominal pain
• occasional, small episodes of diarrhea that continue for several days, especially if appetite is poor, and your child is either gradually losing weight or isn't gaining as much as expected

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Chickenpox

Chickenpox is a common illness among kids, particularly those under age 12. An itchy rash of spots that look like blisters can appear all over the body and may be accompanied by flu-like symptoms. Symptoms usually go away without treatment, but because the infection is very contagious, an infected child should stay home and rest until the symptoms are gone.

Chickenpox is caused by the varicella-zoster virus (VZV). Kids can be protected from VZV by getting the chickenpox (varicella) vaccine, usually between the ages of 12 to 15 months. In 2006, the Centers for Disease Control and Prevention (CDC) recommended a booster shot at 4 to 6 years old for further protection. The CDC also recommends that people 13 years of age and older who have never had chickenpox or received chickenpox vaccine get two doses of the vaccine at least 28 days apart.

A person usually has only one episode of chickenpox, but VZV can lie dormant within the body and cause a different type of skin eruption later in life called shingles (or herpes zoster). Getting the chickenpox vaccine significantly lowers your child's chances of getting chickenpox, but he or she may still develop shingles later.

Symptoms of Chickenpox

Chickenpox causes a red, itchy rash on the skin that usually appears first on the abdomen or back and face, and then spreads to almost everywhere else on the body, including the scalp, mouth, nose, ears, and genitals.

The rash begins as multiple small, red bumps that look like pimples or insect bites. They develop into thin-walled blisters filled with clear fluid, which becomes cloudy. The blister wall breaks, leaving open sores, which finally crust over to become dry, brown scabs.

Chickenpox blisters are usually less than a quarter of an inch wide, have a reddish base, and appear in bouts over 2 to 4 days. The rash may be more extensive or severe in kids who have skin disorders such as eczema.

Some kids have a fever, abdominal pain, sore throat, headache, or a vague sick feeling a day or 2 before the rash appears. These symptoms may last for a few days, and fever stays in the range of 100°–102° Fahrenheit (37.7°–38.8° Celsius), though in rare cases may be higher. Younger kids often have milder symptoms and fewer blisters than older children or adults.

Typically, chickenpox is a mild illness, but can affect some infants, teens, adults, and people with weak immune systems more severely. Some people can develop serious bacterial infections involving the skin, lungs, bones, joints, and the brain (encephalitis). Even kids with normal immune systems can occasionally develop complications, most commonly a skin infection near the blisters.

Anyone who has had chickenpox (or the chickenpox vaccine) as a child is at risk for developing shingles later in life, and up to 20% do. After an infection, VZV can remain inactive in nerve cells near the spinal cord and reactivate later as shingles, which can cause tingling, itching, or pain followed by a rash with red bumps and blisters. Shingles is sometimes treated with antiviral drugs, steroids, and pain medications, and in May 2006 the Food and Drug Administration (FDA) approved a vaccine to prevent shingles in people 60 and older.

Contagiousness

Chickenpox is contagious from about 2 days before the rash appears and lasts until all the blisters are crusted over. A child with chickenpox should be kept out of school until all blisters have dried, usually about 1 week. If you're unsure about whether your child is ready to return to school, ask your doctor.

Chickenpox is very contagious — most kids with a sibling who's been infected will get it as well, showing symptoms about 2 weeks after the first child does. To help keep the virus from spreading, make sure your kids wash their hands frequently, particularly before eating and after using the bathroom. And keep a child with chickenpox away from unvaccinated siblings as much as possible.

People who haven't had chickenpox also can catch it from someone with shingles, but they cannot catch shingles itself. That's because shingles can only develop from a reactivation of VZV in someone who has previously had chickenpox.

Chickenpox and Pregnancy

Pregnant women and anyone with immune system problems should not be near a person with chickenpox. If a pregnant woman who hasn't had chickenpox in the past contracts it (especially in the first 20 weeks of pregnancy), the fetus is at risk for birth defects and she is at risk for more health complications than if she'd been infected when she wasn't pregnant. If she develops chickenpox just before or after the child is born, the newborn is at risk for serious health complications. There is no risk to the developing baby if the woman develops shingles during the pregnancy.

If a pregnant woman has had chickenpox before the pregnancy, the baby will be protected from infection for the first few months of life, since the mother's immunity gets passed on to the baby through the placenta and breast milk.

Those at risk for severe disease or serious complications — such as newborns whose mothers had chickenpox at the time of delivery, patients with leukemia or immune deficiencies, and kids receiving drugs that suppress the immune system — may be given varicella zoster immune globulin after exposure to chickenpox to reduce its severity.

Preventing Chickenpox

Doctors recommend that kids receive the chickenpox vaccine when they are 12 to 15 months old and a booster shot at 4 to 6 years old. The vaccine is about 70% to 85% effective at preventing mild infection, and more than 95% effective in preventing moderate to severe forms of the infection. Although the vaccine works pretty well, some kids who are immunized still will get chickenpox. Those who do, though, will have much milder symptoms than those who haven't had the vaccine and become infected.

Healthy children who have had chickenpox do not need the vaccine — they usually have lifelong protection against the illness.

Treating Chickenpox

A virus causes chickenpox, so the doctor won't prescribe antibiotics. However, antibiotics may be required if the sores become infected by bacteria. This is pretty common among kids because they often scratch and pick at the blisters.

The antiviral medicine acyclovir may be prescribed for people with chickenpox who are at risk for complications. The drug, which can make the infection less severe, must be given within the first 24 hours after the rash appears. Acyclovir can have significant side effects, so it is only given when necessary. Your doctor can tell you if the medication is right for your child.

Dealing With the Discomfort of Chickenpox

You can help relieve the itchiness, fever, and discomfort of chickenpox by:

• Using cool wet compresses or giving baths in cool or lukewarm water every 3 to 4 hours for the first few days. Oatmeal baths, available at the supermarket or pharmacy, can help to relieve itching. (Baths do not spread chickenpox.)
• Patting (not rubbing) the body dry.
• Putting calamine lotion on itchy areas (but don't use it on the face, especially near the eyes).
• Giving your child foods that are cold, soft, and bland because chickenpox in the mouth may make drinking or eating difficult. Avoid feeding your child anything highly acidic or especially salty, like orange juice or pretzels.
• Asking your doctor or pharmacist about pain-relieving creams to apply to sores in the genital area.
• Giving your child acetaminophen regularly to help relieve pain if your child has mouth blisters.
• Asking the doctor about using over-the-counter medication for itching.

Never use aspirin to reduce pain or fever in children with chickenpox because aspirin has been associated with the serious disease Reye syndrome, which can lead to liver failure and even death.

As much as possible, discourage kids from scratching. This can be difficult for them, so consider putting mittens or socks on your child's hands to prevent scratching during sleep. In addition, trim fingernails and keep them clean to help lessen the effects of scratching, including broken blisters and infection.

Most chickenpox infections require no special medical treatment. But sometimes, there are problems. Call the doctor if your child:

• has fever that lasts for more than 4 days or rises above 102° Fahrenheit (38.8° Celsius)
• has a severe cough or trouble breathing
• has an area of rash that leaks pus (thick, discolored fluid) or becomes red, warm, swollen, or sore
• has a severe headache
• is unusually drowsy or has trouble waking up
• has trouble looking at bright lights
• has difficulty walking
• seems confused
• seems very ill or is vomiting
• has a stiff neck

Call your doctor if you think your child has chickenpox, if you have a question, or if you're concerned about a possible complication. The doctor can guide you in watching for complications and in choosing medication to relieve itching. When taking your child to the doctor, let the office know in advance that your child might have chickenpox. It's important to ensure that other kids in the office are not exposed — for some of them, a chickenpox infection could cause severe complications.

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Genital Herpes

Genital herpes is a sexually transmitted disease (STD) that's usually caused by the herpes simplex virus type 2 (HSV2), although it can also be caused by herpes simplex virus type 1 (HSV1), which normally causes cold sores around the mouth.

In some cases, genital herpes causes blisters and pain in the genital area, but in others, it doesn't cause any symptoms, so someone who is infected could unknowingly pass it on to others. Sometimes people who have genital herpes only have one outbreak. Others have many outbreaks, which are less painful and shorter than the first episode.

There's no cure for herpes. Once someone has been infected with the herpes virus, it stays in the body. Medications can alleviate the discomfort of outbreaks or limit their frequency. But it's better to prevent herpes infections. Anyone having sex (oral, anal, or vaginal) should take precautions against STDs and get screened for them regularly.

Symptoms

Symptoms of herpes outbreaks typically begin with pain, tenderness, or itching in the genital area and may also include fever and headache. Bumps and blisters may appear on the vagina, penis, scrotum, anus, thigh, or buttocks. Blisters soon open to form painful sores that can last up to 3 weeks.

Other symptoms may include: pain or a burning sensation during urination; muscle aches; and tender, swollen glands in the groin area. After the first herpes infection, the virus can lie dormant without causing any symptoms. But the virus might reactivate later, leading to sores that usually don't last as long as those during the first outbreak. The virus tends to reactivate following some type of stress, like a cold, an infection, hormone changes, menstrual periods, or even before a big test at school.

After the herpes blisters disappear, a person may think the virus has gone away — but it's actually hiding in the body. Both HSV1 and HSV2 can stay hidden away in the body until the next herpes outbreak, when the virus reactivates itself and the sores return.

Contagiousness

Herpes is contagious and can be passed from person to person through any form of unprotected sex. This can occur even when there are no sores or blisters present. So people who are infected can unknowingly spread the infection to another person.

Treatment

To treat genital herpes, a doctor may prescribe an antiviral medicine in the form of an ointment or pills. These medications can't cure HSV2, but they can help make a person feel better and shorten the duration of outbreaks or prevent them.

If someone is being treated for herpes, any sexual partners should also be tested and, if necessary, treated, even if there are no symptoms. This will reduce their risk of developing serious complications of an undiagnosed infection or passing the infection to others. They should avoid sexual contact until they have completed the prescribed treatment.

Prevention

Because herpes is spread through sexual contact, the best way to prevent it is to abstain from having sex. Sexual contact with more than one partner or with someone who has more than one partner increases the risk of contracting any 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 female's risk of contracting STDs because it can change the natural flora of the vagina and may flush bacteria higher into the genital tract.

A teen who is being treated for herpes 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.

Because many STDs might not cause obvious symptoms, teens often don't know when they're infected. It's important for all teens who have had sex to get screened regularly for STDs so that they don't lead to other more serious health problems.

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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Ascariasis

Ascariasis is an intestinal infection caused by a parasitic roundworm. While it is the most common human infection caused by worms in the world, ascariasis is not common in the United States. It occurs in varying prevalence worldwide, with far greater frequency in areas with poor sanitation or crowded living conditions.

Signs and Symptoms

Although no symptoms may occur, the greater the number of worms involved in the infestation, the more severe a child's symptoms are likely to be. Kids are more likely than adults to develop gastrointestinal symptoms because they have smaller intestines and are at greater risk of developing intestinal obstruction.

Symptoms seen with mild infestation include:

• worms in stool
• coughing up worms
• loss of appetite
• fever
• wheezing

More severe infestations can result in more serious signs and symptoms, including:

• vomiting
• shortness of breath
• abdominal distention (swelling of the abdomen)
• severe stomach or abdominal pain
• intestinal blockage
• biliary tract blockage (includes the liver and gallbladder)

Description

Ascariasis occurs when worm eggs of the parasite Ascaris lumbricoides commonly found in soil and human feces are ingested. The eggs can be transmitted from contaminated food, drink, or soil. The roundworms range in size from 5.9 to 9.8 inches for adult males and 9.8 to 13.8 inches for adult females. The worms can grow to be as thick as a pencil and can live for 1 to 2 years.

Ascariasis is frequently found in developing countries where sanitary conditions are poor or in areas where human feces are used as fertilizer. When the eggs are swallowed and passed into the intestine, they hatch into larvae. The larvae then begin to move through the body.

Once they get through the intestinal wall, the larvae travel from the liver to the lungs through the bloodstream. During this stage, pulmonary symptoms such as coughing (even coughing up worms) may occur. In the lungs, the larvae climb up through the bronchial tubes to the throat, where they are swallowed. The larvae then return to the small intestine where they grow, mature, mate, and lay eggs. The worms reach maturity about 2 months after an egg is ingested from the soil.

Adult worms live and remain in the small intestine. A female worm can produce up to 240,000 eggs in a day, which are then discharged into the feces and incubate in the soil for weeks. Children are particularly susceptible to ascariasis because they tend to put things in their mouths, including dirt, and they often have poorer hygiene habits than adults.

Ascariasis is common in warmer or tropical climates, particularly in developing nations, where it can affect large segments of the population. Ascariasis is rare in the United States, due to strict sanitation rules and regulations.

Contagiousness

Ascariasis is not spread directly from one person to another. To become infected, an individual has to consume the worm's eggs.

Prevention

The most important measure of protection against ascariasis is the safe and sanitary disposal of human waste, which can transmit eggs. Areas of the world that use human feces as fertilizer must thoroughly cook all foods or clean them with a proper iodine solution (particularly fruits and vegetables).

Children who are adopted from developing nations are frequently screened for worms as a precautionary measure. Kids who live in underdeveloped areas of the world may be prescribed a preventive deworming medication.

These practices are recommended for all children:

• Try as much as possible to keep kids from putting things in their mouths.
• Teach kids to wash hands thoroughly and frequently, especially after using the bathroom and before eating.

Professional Treatment

The doctor will usually prescribe antiparasitic medication to be taken orally to kill the intestinal roundworms. Sometimes the stool will be re-examined about 3 weeks after treatment to check for eggs and worms. Symptoms usually disappear within 1 week of starting treatment.

Very rarely, surgical removal of the worms may be necessary (particularly in cases of intestinal or liver-related obstruction, or abdominal infection). A child who has ascariasis should be evaluated for other intestinal parasites, such as pinworm.

Home Treatment

If your child has ascariasis, the medication prescribed should be administered accordingly. To prevent reinfection:

• Ensure that your child washes his or her hands properly, particularly after using the bathroom and before eating.
• Have your pets checked for worms regularly.
• Keep your child's fingernails short and clean.
• Sterilize any contaminated clothing, pajamas, and bedding.
• Evaluate the source of the infection. Additional sanitation measures in or around your home may be necessary.

When to Call the Doctor

If your child has any of the symptoms of ascariasis, contact your doctor right away. Stool samples will be sent to a laboratory to check for eggs and worms and confirm the diagnosis.

Call the doctor if symptoms do not improve with treatment or if new symptoms occur.

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Bronchiolitis

Bronchiolitis is a common illness of the respiratory tract caused by an infection that affects the tiny airways, called the bronchioles, that lead to the lungs. As these airways become inflamed, they swell and fill with mucus, making breathing difficult.

Bronchiolitis:

• most often affects infants and young children because their small airways can become blocked more easily than those of older kids or adults
• typically occurs during the first 2 years of life, with peak occurrence at about 3 to 6 months of age
• is more common in males, children who have not been breastfed, and those who live in crowded conditions

Day-care attendance and exposure to cigarette smoke also can increase the likelihood that an infant will develop bronchiolitis.

Although it's often a mild illness, some infants are at risk for a more severe disease that requires hospitalization. Conditions that increase the risk of severe bronchiolitis include prematurity, prior chronic heart or lung disease, and a weakened immune system due to illness or medications.

Kids who have had bronchiolitis may be more likely to develop asthma later in life, but it's unclear whether the illness causes or triggers asthma, or whether children who eventually develop asthma were simply more prone to developing bronchiolitis as infants. Studies are being done to clarify the relationship between bronchiolitis and the later development of asthma.

Bronchiolitis is usually caused by a viral infection, most commonly respiratory syncytial virus (RSV). RSV infections are responsible for more than half of all cases of bronchiolitis and are most widespread in the winter and early spring. Other viruses associated with bronchiolitis include rhinovirus, influenza (flu), and human metapneumovirus.

Signs and Symptoms

The first symptoms of bronchiolitis are usually the same as those of a common cold:

• stuffiness
• runny nose
• mild cough
• mild fever

These symptoms last a day or two and are followed by worsening of the cough and the appearance of wheezes (high-pitched whistling noises when exhaling).

Sometimes more severe respiratory difficulties gradually develop, marked by:

• rapid, shallow breathing
• a rapid heartbeat
• drawing in of the neck and chest with each breath, known as retractions
• flaring of the nostrils
• irritability, with difficulty sleeping and signs of fatigue or lethargy

The child may also have a poor appetite and may vomit after coughing. Less commonly, babies, especially those born prematurely, may have episodes where they briefly stop breathing (this is called apnea) before developing other symptoms.

In severe cases, symptoms may worsen quickly. A child with severe bronchiolitis may tire from the work of breathing and have poor air movement in and out of the lungs due to the clogging of the small airways. The skin can turn blue (called cyanosis), which is especially noticeable in the lips and fingernails. The child also can become dehydrated from working harder to breathe, vomiting, and taking in less during feedings.

Contagiousness

The infections that cause bronchiolitis are contagious. The germs can spread in tiny drops of fluid from an infected person's nose and mouth, which may become airborne via sneezes, coughs, or laughs, and also can end up on things the person has touched, such as used tissues or toys.

Infants in child-care centers have a higher risk of contracting an infection that may lead to bronchiolitis because they're in close contact with lots of other young children.

Prevention

The best way to prevent the spread of viruses that can cause bronchiolitis is frequent hand washing. It may help to keep infants away from others who have colds or coughs. Babies who are exposed to cigarette smoke are more likely to develop more severe bronchiolitis compared with those from smoke-free homes. Therefore, it's important to avoid exposing children to cigarette smoke.

Although a vaccine for bronchiolitis has not yet been developed, a medication can be given to lessen the severity of the disease. It contains antibodies to RSV and is injected monthly during peak RSV season. The medication is recommended only for infants at high risk of severe disease, such as those born very prematurely or those with chronic lung disease.

Incubation

The incubation period (the time between infection and the onset of symptoms) ranges from several days to a week, depending on the infection causing the bronchiolitis.

Duration

Cases of bronchiolitis typically last about 12 days, but kids with severe cases can cough for weeks. The illness generally peaks on about the second to third day after the child starts coughing and having difficulty breathing and then gradually resolves.

Professional Treatment

Fortunately, most cases of bronchiolitis are mild and require no specific professional treatment. Antibiotics aren't useful because bronchiolitis is caused by a viral infection, and antibiotics are only effective against bacterial infections. Medication may sometimes be given to help open a child's airways.

Infants who have trouble breathing, are dehydrated, or appear fatigued should always be evaluated by a doctor. Those who are moderately or severely ill may need to be hospitalized, watched closely, and given fluids and humidified oxygen. Rarely, in very severe cases, some babies are placed on respirators to help them breathe until they start to get better.

Home Treatment

The best treatment for most kids is time to recover and plenty of fluids. Making sure a child drinks enough fluids can be a tricky task, however, because infants with bronchiolitis may not feel like drinking. They should be offered fluids in small amounts at more frequent intervals than usual.

Indoor air, especially during winter, can dry out airways and make the mucus stickier. Some parents use a cool-mist vaporizer or humidifier in the child's room to help loosen mucus in the airway and relieve cough and congestion. If you use one, clean it daily with household bleach to prevent mold from building up. Avoid hot-water and steam humidifiers, which can be hazardous and can cause scalding.

To clear nasal congestion, try a bulb syringe and saline (saltwater) nose drops. This can be especially helpful just before feeding and sleeping. Sometimes, keeping the child in a slight upright position may help improve labored breathing. Give acetaminophen to reduce fever and make the child more comfortable.

When to Call the Doctor

Call your doctor if your child:

• is breathing quickly, especially if this is accompanied by retractions or wheezing
• might be dehydrated due to poor appetite or vomiting
• is sleepier than usual
• has a high fever
• has a worsening cough
• appears fatigued or lethargic

Seek immediate help if you feel your child is having difficulty breathing and the cough, retractions, or wheezing are getting worse, or if his or her lips or fingernails appear blue.

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