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Childhood diseases

Related Terms

Anaphylactic shock, anaphylaxis, anti-diarrheals, B. pertussis, Bordetella pertussis contagious, chicken pox, chickenpox, conjunctivitis, cough, croup, dehydration, diarrhea, diphtheria, ear infection, ectoparasites, electrolyte imbalance, encephalitis, fever, food allergy, herpes, immune system, immunity, infections, lice, middle ear infection, otitis media, pediculosis, pertussis, pink eye, pinkeye, tetanus, upper respiratory infection, vaccination, vaccine, Varicella, whopping cough.

Background

Children are vulnerable to certain illnesses and infections for several reasons. First, children do not have fully developed immune systems until they are about 7-8 years old. Because the immune system helps the body fight against diseases and infections, children have an increased risk of developing conditions, such as whooping cough, diarrhea, ear infections, chickenpox, croup, and food allergies, compared to adults.

Another reason children may develop illnesses is because they are frequently exposed to germs. Young children are not as aware or diligent about proper hygiene as adults. Children may wipe their noses with their hands and then play with toys shared with other children. When children are at daycare or school, they are exposed to an exceptionally wide range of germs, and it is easy to spread infections among friends or classmates.

Research suggests that babies who are breastfed are less likely to develop infections (especially lung infections, ear infections, and diarrhea) during their first year of life compared to babies who are fed formulas. This is because the mother's breast milk contains important antibodies, enzymes, fats, and proteins that help boost the baby's immune system. Although baby formulas contain all of the important vitamins and nutrients a growing baby needs, manufacturers have not been able to replicate all of the components in breast milk. Formulas lack the antibodies found in breast milk, and they are more difficult for newborns to digest.

Many other factors, such as inherited disorders (such as immune system deficiencies) and the home environment, may contribute to childhood illnesses. For instance, children who are exposed to cigarette smoke in the home have an increased risk of developing infections.

Because diseases and infections are often more severe in children than adults, it is important that children be taken to their doctors when symptoms develop.

Treatment for childhood illnesses varies depending on the specific child. Because children are smaller than adults and their bodies are still developing, they do not usually receive the same treatments. They may require different doses or different types of medicines. It is important that parents and caregivers carefully read the labels of medications to make sure they are safe before giving them to their children. For instance, aspirin is safe in adults, but it should not be given to children because it may cause serious side effects, including Reye's syndrome, a life-threatening condition that causes brain inflammation and vomiting.

When a child is sick, parents are encouraged to have the child stay at home instead rather than attend school or daycare. This helps prevent the sick child from spreading his/her illness to other children. Although individual facilities each have their own rules, most require children to stay at home if they have a fever that is higher than 100 degrees Fahrenheit, are vomiting, or have diarrhea. Some facilities also require children with bacterial infections, such as pinkeye or strep throat, to stay at home for the first 24 hours of antibiotic therapy. Once medicine has been started, the infections are less likely to be contagious.

Many steps can be taken to decrease the risk of childhood illnesses. For instance, children should regularly wash their hands with soap and warm water. This is especially important after using the bathroom, before eating food, and after touching objects that may contain disease-causing germs. Avoiding close contact with people who have contagious illnesses may also help reduce the risk of contacting infections. Parents or caregivers are also encouraged to talk with their children's pediatricians about recommended immunizations, such as the flu shot.

Integrative therapies

Note: Most integrative therapies have not been well-studied in children. Safety in children has not been proven for most of the therapies listed below. Therefore, parents and caregivers should talk to their children's pediatricians before trying integrative therapies.

Strong scientific evidence:

Saccharomyces boulardii: There is good evidence that concurrent use of Saccharomyces boulardii with antibiotic therapy reduces the incidence of developing antibiotic-associated diarrhea (AAD) (Clostridium difficile and other). In general, positive results occur only when Saccharomyces boulardii is continued for several days to several weeks after the course of antibiotics is stopped. Duplication of these results should be attempted to confirm these findings.

Avoid if allergic or hypersensitive to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Use cautiously in immunocompromised or critically ill patients. Use cautiously with indwelling central venous catheters, colitis, cancer, or constipation. Use cautiously in the elderly, in individuals undergoing chemotherapy, and in infants. Use cautiously if taking antidiarrheal agents. Avoid with a yeast infection. Avoid if pregnant or breastfeeding.

Zinc: Multiple studies in developing countries found that zinc supplementation may reduce the severity and duration of diarrhea in children, especially those that are malnourished and with low zinc levels.

Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.

Good scientific evidence:

Iodine: Povidone-iodine solutions appear to have broad-spectrum activity against bacteria and have been used in the management of childhood bacterial conjunctivitis. Povidone-iodine solutions may also be used for ophthalmia neonatorum, a type of bacterial conjunctivitis with eye discharge that occurs during the first month of life, and may be as effective as other anti-bacterial solutions such as neomycin-polymyxin B-gramicidin. Medical supervision is recommended and povidone-iodine solutions are not an effective treatment for viral conjunctivitis.

Reactions can be severe and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.

Probiotics: Lactobacillus GG may reduce the risk of nosocomial (originating in a healthcare setting) diarrhea in children and infants, particularly cases caused by rotavirus gastroenteritis. Probiotics may reduce the duration of diarrhea and related hospital stays in children. Fermented formula and formula supplemented with probiotics may reduce both the number and duration of episodes of diarrhea. There is tentative support for probiotics for diarrhea prevention in adults and children. Supplementation may benefit HIV-positive men, and yogurt containing Lactobacillus casei may help reduce incidence in healthy young adults. Children may benefit from Bifidobacterium lactis (strain Bb 12) added to their formula. Probiotics may reduce duration of symptoms in adults and children with infectious diarrhea by 17 to 30 hours. Effective forms include Lactobacillus strain GG, Lactobacillus reuteri, combination Lactobacillus rhamnosus and Lactobacillus reuteri, and combination Lactobacillus acidophilus and Lactobacillus bifidus. More studies are needed to evaluate types, dosages, duration of treatment, and relationships to specific pathogens.

Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.

Psyllium: Psyllium, also known as ispaghula, comes from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber and is the main ingredient in many commonly used laxatives, such as Metamucil? and Serutan?. Psyllium has been studied for the treatment of diarrhea, particularly in patients undergoing tube feeding. It has also been studied in addition to treatment with orlistat (a lipase inhibitor that is designed to help people lose weight) in hopes of decreasing gastrointestinal effects (diarrhea and oily discharge) of this weight loss agent. An effective stool bulking effect has generally been found in scientific studies.

Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantain (Plantago lanceolata). Prescription drugs should be taken one hour before or two hours after psyllium. Use cautiously if pregnant or breastfeeding because psyllium may lower blood sugar levels.

Saccaromyces boulardii: Saccharomyces boulardii is a non-pathogenic yeast strain that has been used to treat and prevent diarrhea that is caused by many different factors. Several trials suggest the efficacy of Saccharomyces boulardii in the treatment of diarrhea in children. Further studies are still required. Use of Saccharomyces boulardii may be advantageous in both the reduction of stool frequency per day and the duration of diarrhea in this age group.

Avoid if allergic/hypersensitive to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Use cautiously in immunocompromised or critically ill patients. Use cautiously with indwelling central venous catheters, colitis, cancer, or constipation. Use cautiously in the elderly, in individuals undergoing chemotherapy, and in infants. Use cautiously if taking antidiarrheal agents. Avoid with a yeast infection. Avoid if pregnant or breastfeeding.

Soy: Numerous studies report that infants and young children (ages two to 36 months) with diarrhea who are fed soy formula experience fewer bowel movements per day and fewer days of diarrhea. This research suggests soy to have benefits over other types of formula, including cow milk-based solutions. The addition of soy fiber to soy formula may increase the effectiveness. Better quality research is needed before a firm conclusion can be made on the use of soy for acute diarrhea in infants and young children.

Parents are advised to speak with a qualified healthcare provider if infants experience prolonged diarrhea, become dehydrated, develop signs of infection such as fever, or experience blood in the stool. A healthcare provider should be consulted for current breastfeeding recommendations, and to suggest long-term formulas with adequate nutritional value. A doctor may recommend a specially designed soy formula, but regular soy milk should not be given to infants.

Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, such as increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with their doctors and/or pharmacists before taking soy supplements.

Unclear or conflicting scientific evidence:

Acupuncture: Acupuncture plus point-injection has been found beneficial for the treatment of hives, although more research is needed to confirm these findings.

Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, or with agents that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, and neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary diseases (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.

American pawpaw: American pawpaw (Asimina triloba) is a fruiting tree native to North America. However, the tree is also cultivated in Asia, Australia, and Europe. Pawpaw extract in combination with thymol (thyme oil) and tea tree oil in a shampoo formulation may effectively treat lice. Better-quality studies using pawpaw alone are needed before a firm recommendation can be made.

Well-designed studies on the long-term effects of pawpaw extracts have not been conducted. The constituents in pawpaw extract are cytotoxic (poisonous to cells). Therefore, oral use of pawpaw extract is not recommended without the supervision of a physician. Avoid if allergic to Asimina triloba or any other members of the Annonaceae plant family (including other species of Asimina and those in the genera Annona, Deeringothamnus, Disepalum, Goniothalanus, Rollinia, Uvaria, or Xylopia). Use cautiously with gastrointestinal problems or with a history of dermatological reactions.

Applied kinesiology: Applied kinesiology (AK) is commonly used for food allergy diagnosis. However, evidence is mixed as to whether AK can aid in this type of assessment.

Applied kinesiology techniques in themselves are considered harmless. However, medical conditions should not be treated with AK alone, and AK should not delay appropriate medical treatment.

Arnica: Arnica has not been well studied for its effects on diarrhea, but early study suggests that homeopathic arnica may decrease the duration of acute diarrhea in children. Further study is needed to make a strong recommendation.

Avoid if allergic or hypersensitive to arnica or any member of the Asteraceae or Compositae families (sunflowers, marigolds or any related plants like daisies, ragweed or asters). Use cautiously with blood thinners, protein-bound drugs, cholesterol or heart medications, or diabetes drugs. Use cautiously with a history of stroke. Avoid contact with open wounds or near the eyes and mouth. Avoid if pregnant or breastfeeding.

Arrowroot: Arrowroot refers to any plant of the genus Maranta, but the term is most commonly used to describe the easily digestible starch obtained from the rhizomes of Maranta arundinacea. Arrowroot is an edible starch with proposed demulcent (soothing) effects and is a well-known traditional remedy for diarrhea. Early research suggests it may have a beneficial effect in the treatment of diarrhea in irritable bowel syndrome (IBS) patients. Additional study is needed in this area.

Avoid if allergic or hypersensitive to arrowroot (Marantana arundinacea), its constituents, or members of the Marantaceae family. Use cautiously with a history of constipation. Although arrowroot has been used traditionally in infants, pregnant and breastfeeding women should avoid this herb due to a lack of scientific safety evidence.

Art therapy: It is not clear if play with modeling clay is an effective therapeutic intervention in children with constipation and encopresis (fecal incontinence associated with psychiatric disorders). In one study, play with modeling clay was associated with improvement in five of six children, but was limited by lack of a control group.

Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related clean-up materials (like turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.

Belladonna: Belladonna (Atropa belladonna) is an herb that has been used for centuries for a variety of indications. Belladonna is used as a homeopathic drug regulated by the U.S. Food and Drug Administration (FDA). Homeopathic drugs use very dilute amounts of a plant or mineral, such as belladonna. Reports of side effects associated with homeopathic medicines are lacking in the available literature. In clinical study, individuals taking a 30X dilution of belladonna were reported to experience significantly fewer recurrences of otitis media (29.3 vs. 43.5%), shorter treatment duration, and a shorter duration of symptoms than subjects treated with antibiotics.

Avoid if allergic to belladonna or plants of the Solanaceae(nightshade) family (such as bell peppers, potatoes, or eggplants). Avoid with a history of heart disease, high blood pressure, heart attack, abnormal heartbeat, congestive heart failure, stomach ulcer, constipation, stomach acid reflux, hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy (enlarged prostate), urinary retention, glaucoma (narrow angle), psychotic illness, Sj?gren's syndrome, dry mouth, neuromuscular disorders (such as myasthenia gravis), or Down's syndrome. Avoid if pregnant or breastfeeding.

Berberine: Berberine is a bitter-tasting, yellow, plant alkaloid with a long history of medicinal use in Chinese and Ayurvedic medicine. Berberine has been evaluated as a treatment for infectious diarrhea, including choleric diarrhea, although the data is conflicting. Therefore, there is currently insufficient evidence regarding the efficacy of berberine in the management of infectious diarrhea.

Avoid if allergic or hypersensitive to berberine, to plants that contain berberine (Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric), or to members of the Berberidaceae family. Avoid in newborns due to the potential for an increase in free bilirubin, jaundice, and development of kernicterus. Use cautiously with cardiovascular disease, gastrointestinal disorders, hematologic disorders, leukopenia, kidney disease, liver disease, respiratory disorders, cancer, hypertyraminemia, diabetes, or low blood pressure. Use cautiously in children due to a lack of safety information. Use cautiously in individuals with high exposure to sunlight or artificial light. Use cautiously for longer than eight weeks due to theoretical changes in bacterial gut flora. Use cautiously if taking anticoagulants, antihypertensives, sedatives, anti-inflammatories, medications metabolized by CYP P450 3A4 including cyclosporin, or any prescription medications. Avoid if pregnant or breastfeeding.

Bilberry: Bilberry is an herb made from the wrinkled, black berries of a small deciduous shrub. The use of bilberry fruit in traditional European medicine dates back to the 12th Century. A close relative of blueberry, bilberry is commonly used to make jams, pies, cobblers, syrups, and alcoholic/non-alcoholic beverages. Bilberry is used traditionally to treat diarrhea, but reliable research in this area is currently lacking.

Long-term side effects and safety of bilberry remain unknown. Avoid if allergic to bilberry, anthocyanosides (a component of bilberry), or other plants in the Ericaceae family. Do not consume bilberry leaves. Use cautiously with bleeding disorders or diabetes. Use cautiously if taking anticoagulant/anti-platelet medications or drugs that alter blood sugar levels. Stop use before surgeries or dental or diagnostic procedures that have bleeding risks. Use cautiously in doses higher than recommended. Avoid if pregnant or breastfeeding, due to a lack of safety evidence.

Bovine colostrum: Bovine colostrum is the pre-milk fluid produced from cow mammary glands during the first two to four days after birth. Bovine colostrum confers growth, nutrient, and immune factors to the offspring. Bovine colostrum may be effective for improving gastrointestinal health. Preliminary evidence suggests that colostrum inhibits the adhesion or activity of certain bacteria to intestinal cells, which may help in the treatment of diarrhea. Additional study is needed in this area.

Avoid if allergic to dairy products. Use bovine colostrum cautiously because toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE), have been found in human colostrum and breast milk. Thus, it is possible that these agents may be found in bovine colostrum. Avoid with, or if at risk of, cancer. Use cautiously with immune system disorders or atherosclerosis (hardening of the arteries). Use cautiously if taking medications, such as anti-diarrheal agents (e.g. Imodium?), insulin, or CNS agents (such as amphetamines, caffeine). Avoid if pregnant or breastfeeding.

Bupleurum: Chinese studies have suggested that bupleurum may be helpful for reducing fever. However, additional study is needed to draw a firm conclusion about safety and effectiveness. In traditional Chinese medicine, bupleurum is often used in combination with other herbs.

Avoid if allergic or hypersensitive to bupleurum, Apiaceae or Umbelliferae (carrot) families, snakeroot, cow parsnip, or poison hemlock. Use cautiously if operating motor vehicles or hazardous machinery. Use cautiously with low blood pressure, diabetes, or edema. Use cautiously with a history of bleeding, hemostatic disorders, or drug-related hemostatic disorders. Use cautiously if taking blood thinners. Avoid if pregnant or breastfeeding.

Calendula: Calendula, also known as marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula has been studied for reducing pain caused by otitis media. Some human studies suggest that calendula may possess mild anesthetic (pain-relieving) properties equal to those of similar non-herbal eardrop preparations. Further studies are needed before a conclusion can be made.

Use cautiously if allergic to plants in the Aster/Compositae family (such as ragweed, chrysanthemums, marigolds, or daisies). Use cautiously while driving or operating machinery. Avoid if pregnant or breastfeeding.

Carob: Carob (Ceratonia siliqua) is a leguminous evergreen tree of the family Leguminosae (pulse family). Traditionally, carob has been used for the treatment of gastrointestinal conditions, especially diarrhea. Preliminary study used different types of carob products as an adjunct to oral rehydrating solution for diarrhea in children and showed promising results. Additional study is needed in this area.

Avoid if allergic/hypersensitive to carob (Ceratonia siliqua), its constituents, or any plants in the Fabaceae family, including tamarind. Avoid with metabolic disorders, with a chromium, cobalt, copper, iron, or zinc disorder or deficiency, kidney disorders, or acute diarrhea. Avoid in underweight infants. Use cautiously in patients with anemia, known allergy to peanuts and other nuts, complications with powdered, bulk forming laxative drinks, diabetes, or hyperlipidemia (high cholesterol). Use cautiously if taking oral herbs or drugs. Use cautiously in hypouricemic patients. Avoid if pregnant or breastfeeding.

Carrot: A carrot-rice based rehydration solution decreased the duration of acute diarrhea when compared to two conventional rehydration solutions. However, more research is needed.

Avoid if allergic or hypersensitive to carrot, its constituents, or members of the Apiaceae family. Use cautiously with hypoglycemia (low blood sugar) or diabetes, or if taking hypoglycemics. Use cautiously with bowel obstruction, if taking oral drugs, herbs, or supplements, with hormone-sensitive conditions, and in children. Use cautiously with known allergy/hypersensitivity to carrot or birch pollen-related allergens, as cross-sensitivity has been documented. Use cautiously and only in food amounts in pregnant and breastfeeding women.

Chamomile: Chamomile is an herb that has an apple-like smell and taste. It is commonly taken as a tea. Preliminary study reports that chamomile with apple pectin may reduce the length of time that children experience diarrhea. There is a lack of research on this use in adults. Further research is needed before a recommendation can be made for diarrhea in children.

Avoid if allergic to chamomile or any related plants, such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Avoid with heart disease, breathing disorders, hormone-sensitive conditions, or central nervous system disorders. Avoid if taking cardiac depressive agents, central nervous system depressants, respiratory depressive agents, or anticoagulants. Use cautiously if taking benzodiazepine, anti-arrhythmic medications, calcium channel blockers, alcohol, sedative agents, anxiolytic medications, spasmolytic drugs, oral medications, or agents that are broken down by the liver. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.

Chiropractic: Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health. Although ear infections are treated with chiropractic manipulation with some success, well-designed clinical trials have not yet been conducted. Presently, there is insufficient evidence to support the use of chiropractic manipulation for the treatment of otitis media in children.

Avoid with vertebrobasilar vascular insufficiency, aneurysms, arteritis, or unstable spondylolisthesis. Avoid use on post-surgical areas of para-spinal tissue. Use cautiously with acute arthritis, brittle bone disease, conditions that cause decreased bone mineralization, bleeding disorders, migraines, or if at risk for tumors or metastasis of the spine. Use extra caution during cervical adjustments. Avoid if pregnant or breastfeeding due to a lack of scientific data.

Clay: It is not clear if play with modeling clay is an effective therapeutic intervention in children with constipation and encopresis (fecal incontinence associated with psychiatric disorders). In one study, play with modeling clay was associated with improvement in five of six children, but was limited by lack of a control group.

There is a lack of reports of allergy to clay in the available scientific literature. However, in theory, allergy/hypersensitivity to clay, clay products, or constituents of clay may occur. Avoid if pregnant or breastfeeding.

Chlorophyll: Taking chlorophyll by mouth as a liquid was reported to be an effective treatment for chickenpox. More research is needed before a firm conclusion can be made.

Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or agents used to treat diabetes. Avoid if pregnant or breastfeeding.

Clove: Clove is commonly used as a fragrant or flavoring agent. There is a risk of blindness if it comes in contact with the eyes. Clove oil (eugenol) has been used for its analgesic (pain-relieving), local anesthetic, anti-inflammatory, and antibacterial effects. Early studies suggest that clove may lower fever, but reliable human studies are currently unavailable.

Avoid if allergic to clove, eugenol, or some licorice products or tobacco (clove cigarette) products. Use cautiously if allergic to Balsam of Peru. Avoid with a history of seizures, stroke, or liver damage. Use cautiously if taking medications that treat diabetes. Use cautiously with diabetes, low blood sugar levels, bleeding problems, or impotence. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.

Colon therapy/colonic irrigation: Preliminary study shows possible benefits of regular irrigation of the lower part of the colon in the treatment of fecal incontinence. Further study is needed before a conclusion can be made.

Excessive treatments may allow the body to absorb too much water, which causes electrolyte imbalances, nausea, vomiting, heart failure, fluid in the lungs, abnormal heart rhythms or coma. Infections have been reported, possibly due to contaminated equipment or as a result of clearing out normal colon bacteria that destroys infectious bacteria. There is a risk of the bowel wall breaking, which is a serious complication that can lead to septic shock and death. Avoid with diverticulitis, ulcerative colitis, Crohn's disease, severe or internal hemorrhoids, rectal/colon tumors, or recovering from bowel surgery. Avoid frequent treatments with heart or kidney disease. Colonic equipment must be sterile. Colonic irrigation should not be used as the only treatment for serious conditions. Avoid if pregnant or breastfeeding due to lack of scientific data.

DMSO: Dimethyl sulfoxide (DMSO) is a sulfur-containing organic compound that may help treat herpes zoster. This treatment may work even better when used with the drug idoxuridine. Further research is necessary before a conclusion can be made.

Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.

Eyebright: Eyebright has been used in eye solutions for centuries to manage multiple eye conditions. Currently, there is insufficient scientific evidence to recommend for or against the use of eyebright in the treatment of conjunctivitis.

Avoid if allergic to eyebright, any of its constituents or members of the Scrophulariaceae family. Use cautiously as an eye treatment, particularly homemade preparations, due to the risk of infection if it is not sterile. Use cautiously with diabetes and drugs that are broken down by the liver. Avoid if pregnant or breastfeeding.

Goldenseal: Goldenseal is one of the five top-selling herbal products in the United States. Berberine, a constituent from goldenseal, has been used as a treatment for diarrhea caused by bacterial infections (including infectious diarrhea from cholera). Due to the very small amount of berberine in most goldenseal products, it is unclear whether goldenseal contains enough berberine to have the same effects. Therefore, there is currently not enough scientific evidence to make a recommendation in this area.

Avoid if allergic or hypersensitive to goldenseal or any of its constituents, like berberine and hydrastine. Use cautiously with bleeding disorders, diabetes, or low blood sugar. Avoid if pregnant or breastfeeding.

Hibiscus: The Hibiscus genus contains several species, many of which have been used medicinally. Currently, there is limited available evidence evaluating the effects of hibiscus for the treatment of head lice. Study participants have been treated with creams containing hibiscus tea plus henna. Additional studies involving hibiscus alone are warranted in this area.

Avoid if allergic or hypersensitive to hibiscus, its constituents, or members of the Malvaceae family. Use cautiously with high or low blood pressure.

Lactobacillus acidophilus: Lactobacilli are bacteria that normally live in the gastrointestinal tract, mouth, and vagina. A small amount of human research suggests that Lactobacillus acidophilus may not be effective when used to prevent diarrhea in travelers or in people taking antibiotics. Several studies report that the related species Lactobacillus GG may be helpful for diarrhea prevention in children and travelers. Additional study is needed in these areas before a firm conclusion can be drawn.

A small amount of research in children, using different forms of acidophilus, reports no improvement in diarrhea. Future studies should use a viable Lactobacillus acidophilus culture to assess effects on diarrhea. Lactobacillus GG, a different species, is suggested by multiple human studies to be a safe and effective treatment for diarrhea in otherwise healthy infants and children. Lactobacillus acidophilus may aid in the management of chronic or persistent diarrhea and bacterial-overgrowth related diarrhea. Further research is needed to determine what dose may be safe and effective for diarrhea treatment in children.

There is conflicting information from several human studies as to whether using Lactobacillus acidophilus by mouth improves digestion of lactose. More research is needed before a conclusion can be made on the use of Lactobacillus for lactose intolerance.

Lactobacillus acidophilus may be difficult to tolerate if allergic to dairy products containing L. acidophilus. Avoid with a history of an injury or illness of the intestinal wall, immune-disease, or heart valve surgery. Avoid if taking prescription drugs (such as corticosteroids) because of the risk of infection. Use cautiously with heart murmurs. Antibiotics or alcohol may destroy Lactobacillus acidophilus.Therefore, it is recommended that Lactobacillus acidophilus be taken three hours after taking antibiotics or drinking alcohol. Some individuals can use antacids to decrease the amount of acid in the stomach one hour before taking Lactobacillus acidophilus.

Lavender: Oils from lavender flowers are used in aromatherapy, baked goods, candles, cosmetics, detergents, jellies, massage oils, perfumes, powders, shampoo, soaps, and teas. Limited available clinical study used a naturopathic eardrop called NHED (containing Allium sativum, Verbascum thapsus, Calendula flores, Hypericum perfoliatum, lavender, and vitamin E in olive oil) with and without an antibiotic and topical anesthetic. It was found that the ear pain was self-limiting and resolved after a few days with or without antibiotics. This evidence is early, and further research is needed before any conclusion about this treatment can be made.

Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (such as anorexia or bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.

Mullein: Mullein (Verbascum thapsus) has been used in natural medicine for centuries and is among the oldest known medicinal plants. There are some clinical studies using mullein in combination with other herbal products as an eardrop to treat earaches caused by ear infections. It is not clear what the effects of mullein alone are on ear infections because the product studied was a combination of different herbal products. Additional study is needed before a conclusion can be made regarding use of mullein for earache associated with acute otitis media.

Avoid if allergic/hypersensitive to mullein (Verbascum thapsus), its constituents, or any members of the Scrophulariaceae (figwort) family. Use cautiously if taking anticoagulants (blood thinners). There are reports that mullein may contain a toxin called rotenone, which is an insecticide. Avoid if pregnant or breastfeeding.

Probiotics: Probiotics are beneficial bacteria that are sometimes called "friendly germs." They help maintain a healthy intestine and help the body digest foods. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products.

Saccharomyces boulardii and a probiotic formula Escherichia coli Nissle 1917 (EcN) solution have been shown to moderately improve acute diarrhea in children. However, all probiotic preparations may not have the same effectiveness.

Supplementation of infant formulas with probiotics is a potential approach for the management of cow's milk allergy, but there is conflicting evidence as to whether it improves digestion of lactose. More research is needed before a conclusion can be made on the use of probiotics for lactose intolerance.

Although some data support the use of probiotics for the treatment and prevention of antibiotic-associated diarrhea (AAD), other studies have found a lack of benefit. Although probiotics are considered a safe and reasonable approach for AAD, larger and better-designed studies are needed for definitive recommendations. There is limited evidence suggesting that probiotics may reduce recurrence of Clostridium difficile associated diarrhea and may help in the treatment of bacterial overgrowth-related chronic diarrhea. More studies are needed to provide guidelines for these uses.

Probiotic capsules (containing Lactobacillus rhamnosus GG and LC705, Bifidobacterium breve 99, and Propionibacterium freudenreichii JS) were not shown to protect against ear infections in children. More research is needed to confirm these findings.

Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.

Saccaromyces boulardii: With the introduction of broad-spectrum antibiotics into clinical practice, Clostridium difficile infection has become a common cause of infectious diarrhea in hospitalized patients. For the treatment of Clostridium difficile associated recurrent diarrhea, Saccharomyces boulardii has been shown to decrease recurrences by about 50%, especially when combined with high-dose vancomycin.While only small studies have been performed, treatment with Saccharomyces boulardii may improve quality of life in chronic diarrhea in AIDS patients. As fungemia has been associated with Saccharomyces boulardii administration in patients with central lines, care should be exercised in treating these patients.Preliminary evidence supports the use of Saccharomyces boulardii for diarrhea prevention during tube feeding. However, the role of antibiotics in the results is unclear. Although evidence supports the use of Saccharomyces boulardii for other forms of diarrhea, little evidence exists to support standard treatment with Saccharomyces boulardii for traveler's diarrhea. More studies need to be performed.

Sanicle: Sanicle has been studied as a treatment for recurrent otitis media. More evidence is needed before a conclusion can be made.

Avoid if allergic or sensitive to sanicle. Use cautiously with stomach problems. Use cautiously if taking blood pressure-lowering or diuretic drugs. Avoid if pregnant or breastfeeding.

Slippery elm: Traditionally, slippery elm has been used to treat diarrhea. While theoretically the tannins found in the herb may decrease water content of stool, and the mucilage may act as a soothing agent to inflamed mucous membranes, reliable scientific evidence to support the use of slippery elm for this indication is currently lacking. Systematic research is necessary in this area before a clear conclusion can be drawn.

Avoid if allergic or hypersensitive to slippery elm. Avoid if pregnant or breastfeeding.

Soy: Although soy has been shown to help treat acute diarrhea in children, it remains unknown if it can treat diarrhea in adults. Due to limited human study, there is not enough evidence to recommend for or against the use of soy-polysaccharide/fiber in the treatment of diarrhea in this patient population. Further research is needed before a recommendation can be made.

Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, such as an increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with a doctor and pharmacist before taking soy supplementation.

Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th Century China. A small study showed that treatment with tai chi might increase immunity to the virus that causes shingles. This may suggest the use of tai chi in the prevention of chickenpox (varicella zoster), but further well-designed large studies need to be performed.

Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.

Tea tree oil: Early studies have found that tea tree alone or in combination with other agents may be effective against lice. However, large, well-designed trials are still needed before a conclusion can be made.

Avoid allergic or hypersensitive to tea tree oil (Melaleuca alternifolia), any of its constituents, balsam of Peru, benzoin, colophony (rosin) tinctures, eucalyptol, or other members of the Myrtle (Myrtaceae) family. Avoid taking tea tree oil by mouth. Avoid if taking antineoplastic agents. Use tea tree oil applied to the skin cautiously in patients with previous tea tree oil use. Avoid if pregnant or breastfeeding.

Vitamin A: Vitamin A is an essential fat-soluble vitamin. Vitamin A may reduce the severity and duration of diarrheal episodes in malnourished children but not in well-nourished children. Since diarrhea is a major cause of morbidity and mortality in developing countries, vitamin A supplementation may be considered in undernourished children with diarrhea.

Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.

Fair negative scientific evidence:

Ayurveda: Limited available study compared the three Ayurvedic preparations bel (Aegle marmelos), thankuni (Hydrocotyle asiatica), and gandhavadulia (Paederia foetida) with ampicillin in dysentery (shigellosis), and found them to have no effect.

Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.

Probiotics: Fair evidence suggests that probiotics may not be helpful in treating HIV-associated diarrhea. Probiotic therapy appears to be well tolerated for diarrhea in HIV patients on antiretroviral therapy, but may not be helpful for gastrointestinal symptoms.

Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.

Reflexology: Limited available study suggests that treatment given by a reflexologist is less effective (in terms of number of ear disorders, number of antibiotic treatments, number of sickness days, and duration of ear disorders) than treatment given by a general practitioner for ear infections.

Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle, or severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease, or the presence of a pacemaker, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, or kidney stones. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.

Strong negative scientific evidence:

Bael fruit: Indian bael, an indigenous plant of India, has spread over wide areas of Southeast Asia. Indian bael has traditionally been used as a treatment for diarrhea. However, capsules of dried powder of the unripe fruit were not effective in treating diarrhea in patients with dysentery (shigellosis). Additional study investigating different preparations of bael fruit would help confirm this finding.

Avoid if allergic or hypersensitive to Indian bael or any of its constituents. Avoid dosages that exceed those of use in traditional medicine. Indian bael in large quantities theoretically may result in digestive complaints and constipation, given that tannins are constituents. Use cautiously if taking hypoglycemic agents or thyroid hormone, herbs for thyroid disorders, or herbs that may exacerbate or induce hyperthyroidism. Avoid if pregnant or breastfeeding as Indian bael leaves have been traditionally used to induce abortion and to sterilize women (theoretical).

Traditional or theoretical uses lacking sufficient evidence:

Aconite: The aconite plant grows in rocky areas. It is often found in the mountainous woodlands of many parts of Europe, especially France, Austria, Germany, and Denmark. It has been proposed that aconite may help treat middle ear infections and lice. However, until well-designed human studies are performed, it remains unknown if this is a safe and effective treatment. It has also been suggested that aconite may help reduce the symptoms of fevers. Homeopaths often prescribe aconite preparations at the start of a fever. However, studies are currently lacking in this area.

Aconite is highly toxic and is not safe for human consumption. Avoid with heart disease, irregular heartbeat, hemodynamic instability (abnormal blood flow), and gastrointestinal disorders (such as ulcers, reflux esophagitis, ulcerative colitis, spastic colitis, or diverticulosis). Use cautiously with diabetes or suicidal tendencies.

Agrimony: Agrimony was one of the most famous vulnerary herbs used by the Anglo-Saxons. It has been shown to have anti-inflammatory and diuretic properties. It has been suggested, but not scientifically proven, that agrimony may help reduce fever.

Avoid if allergic to agrimony or related species. When used as recommended, agrimony is considered to be safe. Use cautiously with bleeding disorders. Use cautiously if taking drugs that increase the risk of bleeding or blood pressure-lowering agents. Avoid with diarrhea caused by an underlying illness. Avoid if pregnant or breastfeeding due to a lack of safety evidence.

Chamomile: Chamomile is an herb that has an apple-like smell and taste. It is commonly taken as a tea. Although it has been suggested that chamomile may help treat ear infections, scientific studies are currently lacking. It remains unknown if this is a safe and effective treatment for humans.

Garlic (Allium sativum): Garlic has been used traditionally for ear infections. It is crushed and diluted in a carrier oil, such as olive oil, which is then applied topically. A small clinical trial used a naturopathic eardrop mixture containing garlic,mullein,calendula,St. Johns wort, lavender, and vitamin E in olive oil, with and without an antibiotic and topical anesthetic. It was found that ear pain was self-limiting and resolved after a few days with or without antibiotics. Additional research is needed to make a conclusion.

Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae(lily) family (like hyacinth, tulip, onion, leek, chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure, or thyroid disorders. Stop using supplemental garlic two weeks before dental/surgical/diagnostic procedures and avoid using immediately after such procedures to avoid bleeding problems. Avoid in supplemental doses if pregnant or breastfeeding.

Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (anorexia, bulimia), or anemia (low levels of iron). Avoid consuming lavender if pregnant or breastfeeding. Lavender taken by mouth may stimulate menstruation.

Licorice: Licorice is harvested from the root and dried rhizomes of the low-growing shrub Glycyrrhiza glabra. Historically, licorice has been used to reduce fever. Some cultures have made a tea out of the licorice root to reduce a person's body temperature. However, until studies are performed in humans, it remains unknown if licorice can effectively reduce fevers.

Avoid if allergic to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney disease, liver disease, fluid retention, high blood pressure, or hormonal abnormalities. Avoid if taking diuretics. Licorice may cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities in women.

Rhubarb: Rhubarb is an herb that is commonly used in traditional Chinese medicine (TCM). Traditionally, rhubarb has been used to treat fever. Until studies are performed, it remains unknown if rhubarb can help reduce fevers in humans.

Avoid if allergic to rhubarb, its constituents, or related plants from the Polygonaceae family. Avoid using rhubarb for more than two weeks. Avoid with atony (lack of muscle tone), colitis, Crohn's disease, dehydration with electrolyte depletion, diarrhea, hemorrhoids, insufficient liver function, intestinal obstruction, ileus, irritable bowel syndrome, menstruation, pre-eclampsia, renal disorders, ulcerative colitis, and urinary problems. Avoid handling rhubarb leaves, as they may cause contact dermatitis. Avoid rhubarb in children younger than 12 years old due to water depletion. Use cautiously with bleeding disorders, cardiac conditions, constipation, history of kidney stones, or thin or brittle bones. Use cautiously if taking anticoagulants, anti-psychotic drugs, or oral drugs, herbs, or supplements (including calcium, iron, and zinc). Avoid if pregnant or breastfeeding.

St. John's wort (Hypericum perfoliatum): St. John's wort has been used traditionally for various kinds of pain, however, reliable evidence indicating effectiveness is currently lacking. In clinical study, a naturopathic eardrop mixture containing garlic,mullein,calendula, St. Johns wort, lavender, and vitamin E in olive oil, was used with and without an antibiotic and topical anesthetic. It was found that ear pain was self-limiting and resolved after a few days with or without antibiotics. This evidence is preliminary and further research is needed before any conclusion about this treatment can be made. It is currently unclear if St. John's wort is effective for chronic ear infections.

Avoid if allergic or hypersensitive to plants in the Hypericaceae family. Rare allergic skin reactions like itchy rash have been reported. Avoid with HIV/AIDS drugs (protease inhibitors) like indinavir (Crixivan?), or non-nucleoside reverse transcriptase inhibitors, like nevirapine (Viramune?). Avoid with immunosuppressant drugs (like cyclosporine, tacrolimus or myophenic acid). Avoid with organ transplants, suicidal symptoms or before surgery. Use cautiously with history of thyroid disorders. Use cautiously with drugs that are broken down by the liver, with monoamine oxidase inhibitors (MAOI) or selective serotonin reuptake inhibitors (SSRIS), digoxin, or birth control pills. Use cautiously with diabetes or with history of mania, hypomania (as in Bipolar Disorder), or affective illness. Avoid if pregnant or breastfeeding.

Valerian: Valerian is an herb native to Europe and Asia. Today, the herb grows in most parts of the world. It is unclear if valerian can help treat fevers. Studies have not been performed to determine if this is a safe and effective fever treatment.

Use cautiously if allergic to valerian or other members of the Valerianaceaefamily. Use cautiously with livers disorders. Use cautiously two weeks before surgery. Avoid if driving or operating heavy machinery, as it may cause drowsiness. Avoid if pregnant or breastfeeding.

Author information

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

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Ilicali OC, Keles N, Deqer K, et al. Relationship of passive cigarette smoking to otitis media. Arch Otolaryngol Head Neck Surg. 1999 Jul;125(7):758-62.

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Olifer VV, Roslavtseva SA. Current problems and ways of their solution in the prevention of scabies and pediculosis. Article in Russian. Gig Sanit. 2006 Mar-Apr;(2):25-9.

Chickenpox

Overview: Chickenpox (Varicella) is a highly contagious viral infection that causes red, itchy bumps on the skin.

Before the chickenpox vaccine (Varivax?) was created, most children contracted chickenpox before age 15, with the majority of cases occurring between the ages of five and nine. The vaccine was developed in 1995 and since then, there has been a significant decrease in the number of chickenpox cases. In the few instances when the vaccine does not prevent the chickenpox (about 15% of the time), the infection is much milder than if the child had not received the vaccine.

Chickenpox is not usually a serious infection in healthy children. However, it may cause problems for newborns, teens, pregnant women, adults, and people who have weak immune systems that make it hard for the body to fight against infections.

Causes: A virus, called the human herpes virus 3 or varicella-zoster (VZV), causes chickenpox. This virus spreads easily from person to person through the air and physical contact.

Symptoms: The first symptoms of chickenpox usually include a fever, a vague feeling of sickness or discomfort (called malaise), or decreased appetite. Within a few days, an itchy rash appears as small red bumps or blisters. The rash appears in batches over the next 2-4 days. It usually starts on the trunk and then spreads to the head, face, arms, and legs. Blisters may also be found in the mouth or the genital areas. Although some children may have only a few blisters, some may have as many as 100-300. The pimples will progress to red blisters that are teardrop shaped. The blisters mature, break open, form a sore, and then crust over. Most of the blisters will heal within 10-14 days, and usually do not cause scarring unless the blisters become infected when germs enter the open skin.

Diagnosis: In children, chickenpox is usually diagnosed after a physical examination. A viral culture may also be performed to confirm a diagnosis. This is usually done if other conditions, such as herpes simplex, impetigo, insect bites, or scabies cannot be ruled out. However, it takes between 1-14 days to get test results. This same test may also be performed in vaccinated patients to determine if the natural Varicella virus or the vaccine is causing a Varicella-like infection. This test is useful, but it is sometimes difficult to detect the virus in the samples.

Treatment: Treatment for chickenpox includes pain medicines such as acetaminophen (Tylenol?) or ibuprofen (Motrin?, Advil?). Do not give children younger than 18 years of age aspirin because Reye's syndrome, a life-threatening condition that causes brain inflammation and vomiting, may develop. Caregivers should talk to their children's pediatricians about recommended medications.

Frequent, lukewarm baths are particularly helpful in relieving itching, especially when used with preparations of finely ground (colloidal) oatmeal. Commercial preparations of oatmeal, such as Aveeno?, are available in drugstores, or one can be made at home by grinding or blending dry oatmeal into a fine powder. Use about two cups per bath. The oatmeal will not dissolve, and the water will have a scum. One-half to one cup of baking soda in a bath may also be helpful. Do not rub the skin dry with a towel because this may irritate the skin. Instead, carefully blot the skin dry.

Calamine? lotion and similar over-the-counter preparations can be applied to soothe the skin and help dry out blisters and soothe the skin.

For severe itching, a type of over the counter medication called antihistamine diphenhydramine (Benadryl?) is useful, and it may also help children sleep. However, Benadryl? should not be given to children younger than six years of age as hyperexcitability may occur.

Some experts recommend an antiviral medication, called acyclovir (Zovirax?), in children who catch chickenpox from other family members because such patients are at risk for more serious cases, which may lead to bacterial infections of the skin, pneumonia, or swelling of the brain (called encephalitis). To be effective, acyclovir must be taken by mouth within 24 hours of the first signs of the rash. Early intravenous (IV) administration of acyclovir is also used to treat chickenpox pneumonia.

Prevention: A live vaccine, called Varivax?, was developed in 1995 to prevent chickenpox, and it is still used today. Data show that the vaccine can prevent chickenpox or reduce the severity of the illness even if it is used within three days, and possibly up to five days, after exposure to the infection. The vaccine against chickenpox is now recommended in the United States for all children between the ages of 18 months and adolescence who have not yet had chickenpox. Children are given one dose of the vaccine. Two doses one to two months apart are given to people over 13 years of age.

Side effects of Varivax? include discomfort at the injection site. About 20% of vaccine recipients have pain, swelling, or redness at the injection site. Only about five percent of reactions are serious; these may include seizures, pneumonia, a life-threatening allergic reaction (called anaphylaxis), swelling of the brain, a rare skin reaction called Stevens-Johnsons syndrome, nerve damage (called neuropathy), herpes zoster, and blood abnormalities. Although these reactions are serious, they are uncommon and temporary. Children who have recently been vaccinated should avoid close contact with anyone who might be susceptible to severe complications from chickenpox until the risk for a rash has passed. Months or even years after the vaccination, some people develop a mild infection, called modified varicella-like syndrome (MVLS). MVLS causes similar symptoms as chickenpox, although it appears to be less contagious and has fewer complications than naturally acquired chickenpox.

Recent evidence suggests that Varivax? effectively prevents the chickenpox 71-100% of the time. Vaccinated children who develop chickenpox generally experience a milder form of normal chickenpox infections. The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC) recommends that children who are 4-6 years old get a booster shot to help maintain immunity against the virus.

Croup

Overview: Croup refers to a group of conditions involving inflammation and swelling around the vocal cords and windpipe that leads to a cough that sounds like a bark, particularly when a child is crying. This cough may also cause difficulty breathing.

Because children have smaller airways, they are more likely to develop croup than adults. It is most common in children who are younger than five years old.

In North America, about 5-6 cases occur in every 100 children. About five percent of children experience more than one episode.

Croup is not usually a cause for concern. Although croup usually goes away without medications, about 5-10% of children need to be admitted to the hospital to receive treatment, such as intravenous antibiotics.

Causes: Croup is most often caused by the parainfluenza virus, which causes infections in the lungs and airways. The respiratory syncytial virus, the measles virus, or various other viruses, such as the flu, may also cause croup. In rare cases, a bacterial infection may cause croup. These infections may occur when a child inhales mucus droplets that have been sneezed or coughed into the air by an infected person. Children may also become infected if they touch a surface with germs on it and then touch their mouths, eyes, or noses.

Symptoms: Symptoms include a loud, barking cough that is often worse at night. The child's breathing may be labored or noisy. Other symptoms include fever and a hoarse voice.

Diagnosis: Doctors usually diagnose croup based on the observable symptoms and a physical exam. A doctor listens to the child's breathing with a stethoscope to see if there is wheezing or signs of a respiratory infection. The doctor also observes the child's throat for swelling. The doctor may swab the throat to determine what type of infection is causing the illness.

Treatment: Croup does not usually require medical treatment. Instead, it can be treated with simple self-care techniques. Professionals recommend that children drink plenty of fluid, including water or low-sugar and low-acid fruit juices, and get plenty of rest. A humidifier may help reduce symptoms and improve breathing. If the child has a fever, acetaminophen (Tylenol?) may help. Avoid aspirin in children because it may cause serious side effects, including Reye's syndrome, a life-threatening condition that causes brain inflammation and vomiting.

In rare cases, if the child's symptoms worsen, a doctor may prescribe medications, such as epinephrine or corticosteroids, to help open the airways. Antibiotics are only effective if the infection is caused by bacteria. In rare cases, a breathing tube may need to be placed in the child's airway.

Prevention: To help prevent croup, children should regularly wash their hands with soap and warm water. This is especially important after using the bathroom, before eating food, and after touching objects that may contain disease-causing germs. Avoiding close contact with people who have contagious illnesses may also help reduce the risk of contacting infections. Parents or caregivers are also encouraged to talk with their children's pediatricians about recommended immunizations.

Diarrhea

Overview: Diarrhea is characterized by loose or watery stools. Diarrhea is a symptom of an underlying health problem, such as an infection, that prevents the intestines from properly absorbing nutrients from food.

Diarrhea causes dehydration because the body loses more water and salts. Compared to adults, infants and young children have a greater risk of developing severe dehydration as a result of diarrhea. Symptoms of dehydration include dry skin, thirst, less frequent urination, light-headedness, headache, and dark-colored urine.

It is estimated that children younger than five years old experience about one episode of diarrhea per year in the United States. About 222,000 people are admitted to the hospital each year for complications related to diarrhea, of which about 10% of patients are five years old or younger. About 400 people die each year due to complications, such as severe dehydration, in the United States.

Causes: There are many potential causes of diarrhea. Infants and young children are most likely to develop diarrhea as a result of a rotavirus infection. Other common causes include bacterial or parasitic infections, lactose intolerance, certain medications, artificial sweeteners, and abdominal surgery.

Symptoms: Children usually experience acute diarrhea, which only lasts a few days. Symptoms of diarrhea often include frequent and loose stools, abdominal pain or cramping, bloating, and fever. Other symptoms, such as nausea, vomiting, fever, and sometimes bloody stools, may occur if a patient has an infection. When a patient experiences frequent (several times a day), severe, and bloody diarrhea, the condition is often called dysentery.

Diagnosis: Infants, young children, and older adults should visit their doctors if diarrhea lasts longer than 24-48 hours, if they have high fevers (100 degrees Fahrenheit or above), or if they have severe signs of dehydration, such as dry skin or dark urine. A physical examination and detailed medical history will be performed. Patients should tell their doctors if they are taking any drugs (prescription or over-the-counter), herbs, or supplements because these substances may be causing diarrhea. A doctor may take a sample of the patient's blood or stool to check for an infection.

Treatment: Diarrhea usually requires little to no medical treatment, but anti-diarrheal medications, such as bismuth subsalicylate (Pepto-bismol?, Bismatrol?, or Kaopectate?) or loperamide hydrochloride (Imodium?), may help reduce symptoms. Parents and caregivers should carefully read the package labeling before giving medications to children. Children should also drink plenty of fluids to prevent dehydration. Patients may also benefit from drinks that contain electrolytes, such as Pediatric Electrolyte?, Pedialyte?, or Enfalyte?, to help restore lost salts.

If a bacterial infection is causing diarrhea, antibiotics are prescribed to treat the infection.

Prevention: Parents or caregivers should properly wash all produce thoroughly before eating to reduce the risk of developing gastrointestinal infections.

If people are traveling to areas of the world that have poor sanitation, they should only drink bottled water. Parents or caregivers are also encouraged to carry anti-diarrheal medications with them, such as bismuth subsalicylate (Pepto-bismol?, Bismatrol?, or Kaopectate?) or loperamide hydrochloride (Imodium?).

Children should only consume dairy products that have been pasteurized. Pasteurization involves heating liquids in order to kill viruses, bacteria, molds, yeast, protozoa, and other harmful organisms. This reduces the risk of developing a gastrointestinal infection that may cause diarrhea.

Children should avoid or limit their intake of the artificial sweeteners sorbitol and mannitol because they are absorbed slowly and incompletely by the intestine and may cause diarrhea. These artificial sweeteners are commonly found in sugar-free products and chewing gum.

Fever

Overview: A fever is an increase in normal body temperature. Healthy individuals typically have a body temperature of about 98.6 degrees Fahrenheit. The body temperature fluctuates by about one degree throughout the day. However, if a person's body temperature increases more than it normally does throughout the day, he/she has a fever.

Fevers are usually not dangerous for adults, unless they are 103 degrees Fahrenheit or higher. However, in infants and very young children, even a slight increase in body temperature may indicate a serious infection. If a baby younger than 12 months old has a temperature higher than 100 degrees, a healthcare provider should be consulted immediately. Adults and children who have temperatures higher than 102 degrees that are not responding to medications, such as ibuprofen (Motrin?, Advil?), aspirin, or acetaminophen (Tylenol?), should visit their doctors.

In serious cases, a fever may lead to a febrile seizure. This occurs when an infant or young child develops a seizure or convulsions when he/she has a fever higher than 102 degrees Fahrenheit. Most febrile seizures are caused by viral upper respiratory infections, ear infections, or roseola. A febrile seizure may cause shaking or jerking of the arms or legs, fixed stare, eyes rolling back, heavy breathing, drooling, and bluish skin. Children who experience any of these symptoms should be taken to the emergency department of a nearby hospital immediately.

Causes: A fever is considered a sign of an underlying medical problem. Most fevers are caused by infections, such as the flu, pneumonia, or strep throat. Other common causes include extreme sunburn, exposure to hot environments, and certain medications. In rare cases, there may be no known underlying cause.

Symptoms: The duration and severity of a fever may vary, depending on the cause. Children who have fevers may experience chills, increased sweating, shivering, and warm skin.

Additional symptoms may also be present, depending on the cause. For instance, if a viral infection, such as the flu, is causing a fever, additional symptoms may include a runny nose, sore throat, headache, aching joints and muscles, nausea, and vomiting.

If a child develops a fever when the body becomes overheated (called hyperthermia) as a result of vigorous exercise or exposure to extremely hot or humid weather, symptoms may include confusion, lethargy, or even coma. In some cases, people suffer from hyperthermia may also have an extremely high body temperature without the ability to sweat.

Diagnosis: If a baby younger than 12 months old has a temperature higher than 100 degrees, a healthcare provider should be consulted immediately. Adults and children who have temperatures higher than 102 degrees that are not responding to medications, such as ibuprofen (Motrin?, Advil?), aspirin, or acetaminophen (Tylenol?), should visit their doctors.

A doctor can easily identify a fever after taking a person's body temperature with a thermometer. However, because it is a symptom of an underlying medical condition, the cause must be identified in order to treat the patient. During a physical examination, a healthcare provider will take a careful medical and social history to determine the underlying cause. If a patient is taking a medication that is known to cause fevers as a side effect, the medication is usually the suspected cause of the fever. Medical tests may also be necessary.

Blood tests may be performed to determine if an infection is causing a fever. Individuals with infections will have a high level of white blood cells, which fight against disease and infection. Samples of the patient's mucus, urine, blood, stools, and/or cerebrospinal fluid may also be taken to determine if an infection is present.

Treatment: Children with fevers should be given acetaminophen (Tylenol?) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin? or Advil?), and should drink cool fluids to help reduce a fever and maintain hydration. Although these do not treat the underlying cause of fever, they will minimize symptoms until the underlying cause is effectively treated. Medication is only recommended for the treatment of fevers that are higher than 102 degrees Fahrenheit. Parents or caregivers should carefully read the packaging labels to ensure that they give their children the appropriate dosages. Avoid aspirin in children because it may cause serious side effects, including Reye's syndrome, a life-threatening condition that causes brain inflammation and vomiting.

Additional treatments, such as antibiotics, may be necessary depending on the underlying cause of the fever.

Prevention: People can take precautions to avoid contracting infections that may cause fevers. Individuals should regularly wash their hands with soap and warm water. This is especially important after using the bathroom, before eating food, and after touching objects that may contain disease-causing germs. Avoiding close contact with people who have contagious illnesses may also help reduce the risk of contracting infections. Patients are also encouraged to talk with their doctors about recommended immunizations, such as the flu shot.

Individuals should minimize exposure to ultraviolet light and use sunblock when they are exposed to sunlight for prolonged periods of time. This helps reduce the risk of sunburn, which may cause fevers.

Ear infections

Overview: Middle ear infections (also called otitis media) are another common childhood illness. An ear infection occurs when a cold, allergy, or upper respiratory tract infection leads to swelling and the accumulation of pus and mucus behind the eardrum, blocking the tube that connects the middle ear to the back of the throat behind the nose (called the Eustachian tube). This collection of fluid provides a suitable environment for infections to develop.

The middle ear contains the eardrum and three tiny bones (called ossicles). It is responsible for carrying vibrations to the inner ear so people can hear. Fluid may collect in the middle ear and push against the eardrum, causing pain and sometimes a temporary or, in severe cases, a permanent loss of hearing.

Acute ear infections usually heal after one to two weeks of treatment. Sometimes, ear infections last longer and become chronic (long-term). After an infection, fluid may stay in the middle ear. This may lead to more infections and hearing loss.

Causes: Ear infections can start with a bacterial or viral infection. In such cases, the middle and/or outer structures of the ear become inflamed. Fluid may also build up behind the eardrum. Bacteria cause about 65-75% of all ear infections. The most common types of these bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Viruses that may lead to ear infections include the respiratory syncytial virus (RSV), the most frequent type found, followed by influenza (flu) viruses.

Ear infections may also be associated with swelling in the Eustachian tubes. Normally, these tubes equalize pressure inside and outside the ear and drain mucus from the middle ear into the throat. A child's Eustachian tubes are narrower and shorter than an adult's. This makes it easier for mucus or congestion from a cold or allergy to get trapped in the middle ear, causing the Eustachian tubes to not function properly or become blocked and swollen. The trapped fluid provides a perfect breeding ground for infections. Also, just as mucus in the nose becomes thicker and harder to expel, fluid inside the ear may also become thick and difficult to drain.

Another factor that contributes to ear infections is the swelling of the small clumps of glandular tissue at the back of the nose (called adenoids). These are tissues located in the upper throat near where the Eustachian tubes connect. Adenoids contain lymphocytes, white blood cells that normally fight against infections. Sometimes the adenoids become infected or enlarged, blocking the Eustachian tubes. Infection in the adenoids may also spread to the Eustachian tubes, causing dysfunction that leads to ear infections.

Children do not have fully developed immune systems, so it is easier for them to develop many illnesses, including ear infections.

Symptoms: Ear infections are often difficult to detect in children because many children affected by this disorder do not yet have sufficient speech and language skills to tell someone what is bothering them. Common signs to look for include unusual irritability, difficulty sleeping, tugging or pulling at one or both ears, earache, fever, fluid draining from the ear, loss of balance, and unresponsiveness to quiet sounds or other signs of hearing difficulty. These signs may include sitting too close to the television or being inattentive. Fluid buildup in the middle ear also blocks sound, which can lead to temporary hearing loss.

If the pressure from the fluid buildup is high enough, it may cause the eardrum to rupture, resulting in drainage of fluid from the outer ear, which may include blood and thick, yellow pus. This releases the pressure behind the eardrum, usually relieving pain. Most ruptured eardrums heal without treatment within a few weeks, although some may take months. Treatment may include an eardrum patch or surgery. Seek medical care if there is pain or swelling in the ear or drainage. See a doctor immediately with a headache, fever, or if the pain in the ear becomes severe.

If there is fluid in the middle ear, it may feel similar to a sensation of ear fullness or "popping." The fluid behind the eardrum may block sound, so mild temporary hearing loss can happen, although it may not be obvious.

Possible complications include short- or long-term hearing loss, ruptured ear drum, and inflammation and/or infection of the rounded protrusion of bone just behind the ear, called the mastoid bone. When the mastoid bone swells or becomes infected, it is commonly called mastoiditis, and it is usually treated with antibiotics.

Diagnosis: Ear infections are usually diagnosed based on the results of a medical history, physical exam, and ear exam. If a middle ear infection is suspected, a healthcare provider will use an instrument, called a pneumatic otoscope, to look at the eardrum for signs of redness, bulging, or fluid behind the eardrum.

Reflectometry is used if the ear exam with a pneumatic otoscope does not indicate that fluid is behind the eardrum. The tip of a small handheld instrument is placed in the ear canal. This instrument sends off a sound. How the eardrum reacts to the sound tells the doctor if fluid is present.

After an ear infection has been diagnosed and treated, a tympanocentesis may be performed if fluid is still behind the eardrum (chronic otitis media with effusion) or if an infection continues despite treatment with antibiotics. Tympanocentesis can remove the fluid. The doctor uses a needle to pierce the eardrum and suck out the fluid. A sample is usually tested for bacterial or viral growth. These tests reveal what kind of bacteria or virus is causing the infection and what medication is best for treatment. Patients may receive pain relievers or sedatives before the procedure. The eardrum usually heals 3-5 days after the procedure.

Treatment: Ear infections can be treated several ways. The best treatment option for a patient depends on several factors, including the person's age, medical history, level of pain, and the type of ear infection. Most ear infections go away without treatment in just a few days, and antibiotics will not help an infection caused by a virus. About 80% of children with middle ear infections recover without antibiotics, according to the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).

If a child is uncomfortable, the doctor may recommend an over-the-counter (OTC) pain reliever, such as acetaminophen (Tylenol? or Tempra?) or ibuprofen (Advil? or Motrin?). It is important to read the labels closely on these medications and give the proper dosage to children and infants.

Ear drops are commonly used to relieve pain and inflammation. If fluid is not draining from the ear or ear tubes, prescription eardrops containing numbing agents and anti-inflammatory drugs may be an option. Examples include benzocaine (Americaine Otic? or Otocain?) and antipyrine/benzocaine (Auralgan?, Auroto?, or Otocalm?). Ear drops containing neomycin and polymixin B (both antibiotics) are available to treat bacterial infections. To help clear up the infection completely, the full dose of medication should be used, even if the symptoms have disappeared. These medications are also available as solutions and suspensions to treat a ruptured eardrum.

If the child is younger than six months or has two or more ear infections within 30 days or fluid remains behind the eardrum, the doctor may recommend an antibiotic. The AAP and the AAFP recommend the use of high doses and short courses of amoxicillin (Amoxil?, Trimox?) or amoxicillin combined with clavulanate potassium (Augmentin?) in individuals (including children) with middle ear infections. Erythromycin antibiotics (Eryped? or Erytab?) may also be used. Antibiotics are only effective against bacterial infections. Side effects may include vomiting, diarrhea, and allergic reactions.

If fluid in the individual's ear is affecting his or her hearing or recurrent ear infections do not respond to antibiotics, surgery may be needed. The most common surgery for ear infections is a myringotomy. During this procedure, which requires general anesthesia, a surgeon inserts a small drainage tube through the eardrum. This helps drain the fluid and equalize the pressure between the middle ear and outer ear. Hearing should improve immediately. If the ear infections continue after age four, the surgeon may recommend removing the adenoids. Complications of this surgery are rare. When performed under general anesthesia, myringotomy has the same general risks as other surgical procedures that require anesthesia.

Prevention: Avoid exposing children to cigarette smoke. Ear infections are more common in children who are exposed to cigarette smoke in the home. Even fumes from tobacco smoke on the hair and clothes may affect the child.

Breastfeeding a baby helps improve immunity and resistance to infections. This is because a mother's breast milk contains important proteins that improve a baby's developing immune system. The baby should be breastfed in an upright position to prevent the possibility of acquiring infections.

Parents should talk to their children's pediatricians about recommended vaccinations. Although there is currently no vaccine for infections, many immunizations can prevent illnesses that may progress to ear infections.

Practicing good hygiene may also help reduce the risk of acquiring infections.

Food allergies

Overview: A food allergy occurs when an individual's immune system mistakes a food protein (called an allergen) for a foreign substance. During an allergic reaction, the immune cells overreact to substances that are normally harmless and the body releases chemicals that trigger symptoms that can than affect the eyes, nose, and throat, as well as the skin and the lungs. Even a trace amount of the allergen can cause a reaction in sensitive individuals.

Food allergy is usually common among people who have family histories of allergies. About eight percent of children (compared to only two percent of adults) in the United States are estimated to have food allergies. Food allergies are most common during the first few years of life, and as the immune system continues to develop, allergic sensitivity declines over the first decade of life for most children.

According to the American Academy of Allergy Asthma & Immunology (AAAAAI), six foods cause 90% of food allergies in children. These six foods are milk, peanuts, soy, eggs, wheat, and tree nuts (such as pecans and walnuts). Children usually outgrow allergies to milk, eggs, and soy. However, allergies to peanuts, tree nuts, fish, and shellfish continue throughout adulthood.

Risk factors: Children with skin disorders, such as eczema, which causes itching, scaling, and thickening of the skin, or psoriasis, which causes, dry, red patches of skin, are more likely to develop food allergies. In fact, food allergies are seen in about 35% of children with eczema.

Children who have allergic reactions to inhaled substances, such as dust, mold spores, or pollen, also have an increased risk of developing food allergies.

Even exposing children to trace amounts of peanut protein or peanut oil products may cause peanut allergies in children, according to one study. Because peanut allergies are among the most common and severe food allergies, the American Academy of Pediatrics recommends that children with histories of food allergies do not consume peanuts or peanut-containing products until they are three years old. Strawberries should also be avoided until the baby is about 10-12 months old.

Children whose mothers have food allergies may be more likely to inherit the allergy if born by cesarean section, according to one study. One study of children with allergic mothers who had C-section deliveries found that the babies were seven times more likely to develop food allergies than predisposed children who were born vaginally. Although the reason for this is not clear, it has been suggested that cesarean deliveries might delay the colonization of the newborn intestine.

Causes: Most allergies are inherited, which means they are passed on to children by their parents. Although people inherit a tendency to be allergic, they may not inherit an allergy to the same allergen. When one parent has allergies, each of his/her children has a 50% chance of developing allergies. That risk increases to 75% if both parents have allergies.

The first, or several times after the body is exposed to nickel, the immune system becomes sensitized. During this process, the body's white blood cells develop immunoglobulin E (IgE) antibodies, which are proteins that are specialized to quickly detect and bind to the food allergens when they enter the body. These antibodies also trigger the release of chemicals (such as histamine) that cause allergic symptoms, such as red, itchy, and swollen skin.

In some food groups, especially tree nuts and seafood, an allergy to one food may cause the patient to be allergic to all the members of the same group. This is known as cross-reactivity. However, it is also possible to be allergic to both peanuts and walnuts, which are from different food families. This is because the allergens for these products are very similar.

Cross-reactivity is not as common in the meat food group. For instance, many patients who are allergic to eggs can eat chicken, and many patients who are allergic to cow's milk can eat beef.

Symptoms: Food allergy symptoms vary among patients. Symptoms can develop anywhere from several minutes to several hours after ingestion. Reactions usually lasts several hours. Hives are the most common allergic skin reaction associated with food allergies. Hives are red, itchy, swollen welts on the skin that may appear suddenly and disappear quickly. They often develop in clusters, with new clusters appearing as other areas clear up. The most severe type of reaction is called anaphylaxis because it causes low blood pressure and swollen airways. The most dangerous symptoms of anaphylaxis are low blood pressure, breathing difficulties, shock, and loss of consciousness, all of which can be fatal. Asthma symptoms, including coughing, wheezing, shortness of breath, or difficulty breathing, may be triggered by food allergies, especially in infants and young children. Eczema, which is itchy, scaly, red skin, may also be triggered by food allergies. Others may experience itchy skin or facial flushing. Gastrointestinal symptoms may include vomiting, diarrhea, gas, and abdominal cramping. Some patients may develop a red rash around the mouth, as well as swelling of the mouth, stomach, and throat.

Diagnosis: Food allergies may be diagnosed using a skin test or blood test. During a skin test, the skin is exposed to allergens that may be causing symptoms. A diluted form of the allergen may be scratched onto the skin's surface, injected under the skin, or applied to a patch that is stuck onto the skin. The skin is then observed for an allergic reaction. During an allergen-specific immunoglobulin E (IgE) test, or radioallergosorbent test (RAST?), a sample of the patient's blood is sent to a laboratory and mixed with allergens to determine if he/she has allergies.

Treatment: Very severe reactions, such as anaphylaxis, can be treated with epinephrine. This medicine is injected and acts as a bronchodilator, which means it widens the breathing tubes. It also helps narrow the blood vessels, which increases blood pressure. Patients who experience anaphylaxis may be admitted to the hospital to have their blood pressure monitored and possibly to receive breathing support. Other emergency interventions may also include placing a tube through the nose or mouth into the airway (called endotracheal intubation) or emergency surgery to place a tube directly into the trachea (tracheostomy or cricothyrotomy).

Less severe allergic reactions that affect breathing and blood pressure may be treated with an inhaled epinephrine bronchodilator. Some inhaled bronchodilators are available over-the-counter in the United States.

Antihistamines, such as diphenhydramine (Benadryl?), reverse the actions of histamine, a chemical that triggers allergic symptoms. Diphenhydramine is injected when quick action is needed during a severe allergic reaction. It may be given by mouth to treat a less severe reaction.

Corticosteroids are usually given through an IV (intravenously) at first in order to quickly reverse the effects of the chemicals (like histamine) that trigger allergic symptoms. These drugs reduce swelling and many other symptoms of allergic reactions. Individuals may also need to take a corticosteroid in pill form for several days after the initial treatment. These drugs are often given for less severe reactions. Also, a corticosteroid cream or ointment may be used for skin reactions.

Prevention: Avoiding known food allergens is the best way to prevent an allergic reaction from occurring. Children's baby-sitters, teachers, and other caretakers should be informed of their allergies. To avoid eating a food allergen, parents should always ask about ingredients in the food when dining at a restaurant or someone else's home. Even a trace amount of the allergen can cause a reaction in sensitive individuals. Therefore, all cooking utensils should be thoroughly washed before serving food to children with food allergies.

Parents should also read food labels carefully. Many countries, including the United States, have food labeling laws that require manufacturing companies to list all food allergens in common language, rather than scientific or technical terms.

Some ingredients, such as hydrolyzed proteins, edible oils, lecithin, lactose, starch, flavors, and gelatin, may be derived from food proteins known to cause allergic reactions in sensitive individuals. To help patients avoid known food allergens, the U.S. Congress passed the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA). The law, which went into effect January 1, 2006, requires food manufacturers to clearly state on their packages whether the food is made with any ingredients that contain protein derived from the eight major allergenic foods. These foods include milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soybeans.

If a child has a history of anaphylaxis, parents or guardians should carry an autoinjectable epinephrine device (known as an EpiPen?) with them at all times.

Children with food allergies can also wear an identification bracelet that describes the allergy.

Healthcare professionals should be aware of food allergies because some medications and vaccines contain food allergens that may trigger severe allergic reactions.

Lice

Overview: Lice (also called pediculosis) are tiny, parasitic insects that feed on blood from their hosts, which may be human. When a human becomes infected with lice, it is not considered a major health concern. However, it typically causes the skin to become red and itchy.

There are several types of lice, including head lice, body lice, and pubic lice. Head lice develop on the scalp, and they may be visible near the ears, shoulder, and at the nape of the neck. The lice produce small eggs, called nits, which attach to the shaft of hairs. After about one week, the nits hatch and more lice are then present. Body lice spend most of their lives on a person's clothing, crawling on the person's skin to feed a couple times a day. The females attach their sticky eggs to the seams and folds of clothing. Pubic lice, commonly called crabs, are found on the skin and hair of the pubic area and eyelashes. Lice are easily spread through close personal contact with an infected person or his/her belongings. However, lice cannot jump or fly from person to person.

Lice are most common among schoolchildren, individuals living in crowded areas, and people living in poverty or unsanitary conditions.

Causes: Humans can get lice after coming into direct contact with lice or their eggs. Lice cannot fly, but individuals may be exposed to them when they touch an infected person or his/her personal belongings, such as bed linens, clothing, stuffed animals, or towels. For instance, head lice are commonly transmitted after sharing pillows, combs/brushes, or hair clips. They can live for up to two days off of the body. Lice can also be spread through sexual contact or after using a toilet seat that was recently used by someone who is infected. Lice can survive about 1-3 days without a human host.

Symptoms: Lice typically cause intense itching and small red bumps to develop on affected areas of the skin. The lice may be visible on the skin, body hair, clothing, or other personal items. They are about three millimeters long. Lice eggs, called nits, may also be visible on hair shafts. Nits look similar to dandruff, but they are not easily brushed away.

Symptoms of head lice typically develop on the scalp, ears, nape of the neck, and shoulders. Symptoms of body lice may develop anywhere on the body that has hair. Symptoms of pubic lice typically develop in the pubic area and on the eye lashes.

Lice usually do not cause serious health problems, even if it goes untreated. However, if children frequently scratch the skin, bacteria may enter the skin and cause an infection.

Diagnosis: A diagnosis can be made after a physical examination. Although lice are very small, they are visible to the human eye. If lice are present, a positive diagnosis is made.

Treatment: Lice can be successfully treated in several days with over-the-counter products and/or prescription-strength anti-parasitic medications. In order to prevent re-infection, it is recommended that parents or caregivers wash and vacuum items that may be contaminated. Also, people who live with or have close personal contact with someone who has lice should receive treatment as well.

Children older than two years old who have lice can use over-the-counter lotions and shampoos, such as Nix? or Rid?, to kill lice and their eggs. These products are made with anti-parasitic medications (such as permethrin) that kill the lice. These products should be used as directed on the package labeling. Sometimes, treatment may need to be repeated 7-10 days later in order to get rid of all the lice. If over-the-counter (OTC) products do not successfully treat lice, a doctor may recommend stronger shampoos or lotions, such as malathion (Ovide?) or lindane (Kwell?), which are only available by prescription. Rare side effects may include seizures, dizziness, clumsiness, fast heartbeat, muscle cramps, nervousness, restlessness, irritability, vomiting, or skin irritation.

Parents may also rinse their children's hair with vinegar after using an anti-parasitic shampoo. First, a parent pours vinegar onto a clean cloth. Then, the parent holds a lock of hair and wipes the hair from the root to the end. This process is repeated until all of the hair has been treated. Rinsing the hair with vinegar helps remove nits that stick to the shaft of the hair.

Combing wet hair with a fine-toothed comb, or a nit comb (available at local pharmacies), may help remove lice and their eggs from the hair. This is generally used in combination with shampoos or lotions that are designed to kill lice.

In order to prevent re-infections with lice, it is important to wash all items that may be contaminated. This includes items such as bed linens, pillows, clothing, hats, and stuffed animals. Wash the items for at least 10 minutes in hot, soapy water that is at least 130 degrees Fahrenheit. Then dry the items at high heat for at least 20 minutes. This kills any scabies, lice, or eggs that may be present. Combs and brushes should also be washed in hot soapy water or soaked in rubbing alcohol for one hour. Items that cannot be washed should be sealed in airtight bags for at least two weeks. The lice and scabies will die because they have nothing to eat. Individuals may also cover furniture with plastic drop cloths for two weeks to kill the parasites. However, plastic furniture coverings are not recommended if a toddler lives in the home because there is a risk of suffocation. Thoroughly vacuuming carpeting, furniture, mattresses, and tapestry effectively kills scabies and lice. After vacuuming, the vacuum bag should be thrown away immediately.

Prevention: It is often difficult to prevent lice in young children. This is because children are in close contact with many other children during school and daycare. Children can reduce the risk of getting lice by not sharing hats, combs, hair pins/clips, or other hair products with others. Also, caregivers should wear gloves when treating children who have lice.

Pinkeye

Overview: Pinkeye (conjunctivitis) describes the inflammation or bacterial or viral infection of the membrane that lines the eyelid (called the conjunctiva) and part of the eyeball. Bacterial conjunctivitis is most common among children, and it is highly contagious.

Even though conjunctivitis that is caused by an infection is highly contagious, it does not cause serious health problems if it is diagnosed and treated early. However, if left untreated, it can lead to serious eye damage, including permanent vision loss.

Causes: Conjunctivitis can be caused by an infection, allergic reaction to allergens (such as dust mites or pollen), or exposure to chemicals or irritants. Bacterial conjunctivitis is most common among children, and it is highly contagious. If the bacteria are present on the skin, it may spread to the eyes, where it causes conjunctivitis. The bacteria can also be spread from sharing eye makeup or contact lenses or after touching or rubbing the eyes with dirty hands.

Symptoms: In general, common symptoms include red, irritated, and watery, itchy eyes, blurred vision, and discharge from the eyes that forms a crust at the edges of the lids and on the eyelashes during sleep. Other less common symptoms may include pain and sensitivity to light.

Allergic conjunctivitis affects both eyes. The eyes become extremely itchy and the eyelids swell. This form causes swelling as a result of excess water in the tissues of the conjunctiva and sometimes the whole eyelid. The eyes may also secrete a mucus discharge. Symptoms will continue as long as the person is exposed to the allergens, unless anti-allergy medicine is taken.

Bacterial conjunctivitis usually affects one eye at first and often spreads to the other. Common symptoms include a feeling of grittiness in the eyes, irritation, reddening of the eyes, and a thick yellow-green discharge that may cause the lids to stick together, especially after sleeping. Symptoms generally last a few days. Depending on the type of bacteria that is causing symptoms, eye damage and/or vision loss may occur if treatment is not started.

Viral conjunctivitis usually starts with one eye and often spreads to the other. Viral conjunctivitis is usually caused by the same viruses that cause upper respiratory (lung) infection, a common cold, or sore throat. Common symptoms include watery eye discharge and itchy eyes. Symptoms generally last a few days.

Conjunctivitis caused by chemicals or irritants is usually painful and it may cause reddening of the eyes and sometimes mucus secretion. Depending on the type of chemical or irritant, eye damage may also occur.

Diagnosis: Although tests are available to diagnose the specific cause of conjunctivitis, a diagnosis is typically made after a physical examination and medical history. A slit lamp exam, which uses a microscope to observe the eye, can confirm a diagnosis based on swelling observed in the conjunctiva. A sample of the patient's eye discharge may be cultured to determine whether a bacteria or virus is the cause. Allergy tests may be performed to determine whether the patient is allergic to specific substances.

Treatment: Treatment of conjunctivitis depends on the cause of the infection. Patients who have bacterial or viral conjunctivitis in one eye may be prescribed antibiotic eye drops, pills, or creams for both eyes. This helps prevent the infection from spreading. It may take up to 2-3 weeks for symptoms of infectious pinkeye to completely go away.

Patients who have allergic conjunctivitis are typically treated with antihistamines, ocular (eye) decongestants, and mast cell stabilizers. All of these medications help decrease the immune response, thereby reducing allergy symptoms. These medications are available as eye drops, eye creams, and oral pills.

If conjunctivitis is caused by a chemical or irritant, the affected eye, including under the eyelid, should be flushed with saline. Some patients may also need topical steroids. Some chemicals can severely damage the eye, leading to vision loss, scarring, or surgical removal of the eye.

Refrigerating medicated eye drops may help temporarily soothe eye discomfort.

Prevention: Avoid exposure to known allergens. Do not touch or rub the eyes. Wash hands often with soap and water, especially after coming in contact with an individual who has bacterial or viral conjunctivitis. Wash bed linens and pillowcases regularly with hot water and soap to reduce allergens. Do not share eye makeup, contact lenses, or washcloths with other individuals. Wash hands thoroughly with soap and water before handling contact lenses. Properly clean contact lenses before wearing them. Wash hands thoroughly with soap and water before applying eye drops or ointment. Individuals who are diagnosed with contagious conjunctivitis (caused by a virus or bacteria) should minimize contact with others until they begin treatment and symptoms start to improve. This will help reduce the chance of spreading the infection to others.

Whooping cough

Overview: Whooping cough, also called pertussis, is a highly contagious bacterial infection of the respiratory system that causes uncontrollable coughing.

Anyone can get whooping cough, but it is more common among infants (younger than six months of age) and children (ages 11-18) who have weak immune systems. This is because the immune system helps the body fight against diseases and infections.

Before the whooping cough vaccine was developed, it was one of the most common childhood diseases and a major cause of childhood deaths in the United States, killing 5,000-10,000 children each year. There are fewer cases today because there are both pertussis-only vaccines and combination vaccines for tetanus, diphtheria, and pertussis.

Infants and toddlers have the greatest risk of experiencing complications from whooping cough, and they are most likely to need hospital treatment. Complications may include ear infections, seizures, pneumonia, emphysema, bleeding in the brain, swelling in the brain, dehydration, slowed or stopped breathing, and/or hernias.

If a person is diagnosed with whooping cough, treatment with antibiotics may help if given soon after symptoms develop.

Causes: Whooping cough is caused by the bacterium Bordetella pertussis (or B. pertussis). The infection is passed from person to person by droplets of respiratory secretions that are coughed or sneezed into the air by someone who is already infected.

Symptoms: Symptoms of whooping cough typically last 6-10 weeks, but they may last longer. Symptoms usually occur in three stages. During stage one, patients usually experience cold-like symptoms, such as sneezing, runny nose, mild coughing, watery eyes, and sometimes, a mild fever. This stage usually lasts several days to two weeks. An infected person is most contagious during this stage.

During stage two, cold-like symptoms fade, but the cough worsens, changing from a dry, hacking cough to bursts of uncontrollable, often violent coughing. During a coughing episode, it may be difficult to breath. When the patient is able to breathe, a high-pitched, "whooping noise" may occur when he/she inhales through the swollen and narrowed airways. Vomiting and severe exhaustion often follow a coughing spell. But between coughing episodes (about 15 coughs an episode), the infected person often appears normal. This is the most serious stage of whooping cough, usually lasting from 2-4 weeks or longer.

During stage three, the patient may improve and gain strength, but the cough may become worse. Coughing episodes may occur from time to time for weeks to months and may flare up if a cold or other upper respiratory illness develops. This final stage may last a few weeks longer in people who have never received the whooping cough vaccine. Children often have a much more severe form of the illness than adults who are younger than 60 years of age.

In infants, complications may include pneumonia, ear infections, slowed or stopped breathing, seizures, and/or brain damage. In children and teenagers, uncontrollable coughing may lead to complications, such as a bruised or broken rib or a hernia.

Diagnosis: Sometimes, doctors diagnose whooping cough simply by listening for a cough that is high-pitched and makes a "whooping noise." Medical tests, including nose or throat cultures or blood tests, may be needed to confirm the diagnosis. These tests look for the bacterium Bordetella pertussis, which causes the condition.A chest X-ray may be needed to look for signs of bruised or broken ribs.

Treatment: Treatment for whooping cough varies, depending on the age of the patient and the severity of signs and symptoms. With treatment and rest, a case of whooping cough usually resolves in six weeks.

Almost all infants with whooping cough who are younger than two months, as well as many older babies, need hospital care for a few days. With treatment, most babies overcome the infection without lasting effects, but the risk exists until the infection clears. In the hospital, infants and babies usually receive intravenous antibiotics, such as erythromycin, to treat the infection. They may also receive corticosteroid drugs, such as hydrocortisone, to help reduce swelling in the lungs. Sometimes, an infant's airway may be suctioned to remove mucus that might be making it difficult to breathe. The infant's breathing will be carefully monitored in case extra oxygen is needed. If the infant cannot keep down liquids or food, intravenous (IV) fluids or nutrition may be needed. In some cases, prescription sedatives may be prescribed to help the infant rest. The infant will also be isolated from others to prevent the infection from spreading.

When whooping cough is diagnosed early in older children or teenagers, doctors usually prescribe vaccination, bed rest, and an antibiotic, such as azithromycin (Zithromax?) or erythromycin (E-mycin?, Eryped?). Although antibiotics will not cure whooping cough, they can shorten the duration of the illness and help prevent the infection from being passed to others. Some patients may need to take antibiotics for two weeks or longer. If the illness has progressed to the point of severe coughing spells, antibiotics are not as effective but may still be used. Unfortunately, there are few medications that help provide relief from the symptoms of whooping cough. Over-the-counter (OTC) cough medicines, such as dextromathorpan (Robitussin?), generally have little effect on whooping cough.

Prevention: Vaccines for whooping cough are available. Doctors may give children a three-in-one vaccine (called DTaP) that protects against whooping cough and two other serious diseases called diphtheria and tetanus. This vaccine is generally recommended during infancy. It is given in a series of five shots that are usually given when children are two months, four months, six months, 12-18 months, and 4-6 years old. It takes at least three shots of the vaccine to fully protect a child against whooping cough, but a total of five shots are recommended by age six.

Because the vaccine starts to wear off by age 11, doctors recommend a booster shot of the vaccine when children are 11-18 years old. This booster shot is commonly called Tdap.

Adults are also encouraged to receive an initial Tdap or booster shot every 10 years instead of the Td booster shot. This vaccine protects adults from whooping cough and reduces the risk of spreading the infection to infants.

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