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Undescended Testicles
What is an undescended testicle?
Testicles are part of the male body. They make male hormones and sperm. Usually both testicles are inside the scrotum. While male babies are still growing inside the uterus, their testicles are inside their abdomen. The testicles usually move down into the scrotum just before or just after birth. An undescended testicle is one that did not move down into the scrotum.

Undescended testicles are common in male babies. Up to 30 percent of boys born early and 3 to 5 percent of boys born on time have at least one undescended testicle. If your newborn baby has an undescended testicle, it will usually move down on its own in the first few months of life. If this doesn’t happen after 3 or 4 months, it may need to be treated by a doctor.

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How will I know if my baby has an undescended testicle?
Your doctor can tell whether your baby has an undescended testicle by checking the baby’s scrotum. If your doctor can’t feel the testicle inside the scrotum, it’s called a “nonpalpable” testicle. A nonpalpable testicle might be inside the abdomen, too small to feel or not there at all. It’s important to find out which one is the reason. Your doctor may perform an X-ray or ultrasound to locate an undescended testicle.
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Why does an undescended testicle have to be treated?
There are several reasons to treat an undescended testicle. First, undescended testicles may not make sperm. Testicles are in the scrotum because the temperature there is cooler than it is inside the body. A cooler temperature helps the testicles make sperm. A man’s ability to make sperm can be lost in early childhood if the testicle doesn’t drop down into the scrotum. A baby boy with an undescended testicle can start to lose the ability to make sperm by 12 months of age. Getting the testicle down into the scrotum early in life can help him have a better chance of having children when he grows up.

Second, an undescended testicle is more likely to develop a tumor. Testicular cancer affects one of every 2,000 men with undescended testicles. This rate of testicular cancer is higher than the rate in men whose testicles have dropped naturally. When the testicle is inside the scrotum, a man can easily feel his testicles to check for a tumor, or he can be checked by his doctor. This way, any tumor can be found early, when the cancer is easier to cure.

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How is an undescended testicle treated?
Treatment for an undescended testicle depends on where it is. Babies who have a testicle that can be felt in the groin (the area where your thigh meets your body) often get an operation called orchiopexy (say: “or-key-oh-peck-see”). Babies who have this operation usually go home the same day. The operation is done through a small cut in the groin. Most babies get better very quickly.

Another treatment is a hormone called hCG. Your doctor might give your child hCG in a shot. HCG helps the testicles make male hormones. A higher level of male hormones might move the testicle down into the scrotum.

If you are an adult with an undescended testicle, moving the testicle to the scrotum probably won’t improve your ability to make sperm. So, in adult men an undescended testicle is usually just removed. If you are an older man with an undescended testicle, your doctor can help you decide what to do.

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Diaper Rash
What does diaper rash look like?
Diaper rash usually causes mild redness and scaling where the diaper touches your baby’s skin. In bad cases, the rash can cause pimples, blisters and other sores on your baby’s buttocks, thighs or genital area. If the rash gets infected, it may become bright red and the skin may get swollen. Small red patches or spots may spread beyond the main part of the rash, even outside the diaper area.
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What causes diaper rash?
Most diaper rashes are caused by skin irritation. Irritation can be caused by diapers that rub against the skin or fit too tightly. Irritation can also occur if your baby is left in a wet or dirty diaper for a long period of time. Your baby’s skin can also be irritated by the soap used to wash cloth diapers, or by some brands of disposable diapers or baby wipes.

Plastic pants that fit over diapers raise the temperature and moisture in the diaper area. Heat and moisture make it easier for diaper rash to start and for germs to grow.

Diaper rash can also develop while the baby is on antibiotics (or if the mother is on antibiotics while breastfeeding).
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How can I prevent and treat diaper rashes?
The key to preventing and treating diaper rash is to keep your baby’s diaper area clean, cool and dry.

Change your baby’s diaper often, and let him or her go without a diaper when possible to let the air dry his or her skin.

Try placing your baby on an open cloth diaper during nap time. Check the diaper shortly after your baby falls asleep and replace it if it’s wet. Babies often urinate right after falling asleep.

See the box below for tips on preventing and treating diaper rash. If these things don’t work, talk to your doctor.

Don’t use creams that contain boric acid, camphor, phenol, methyl salicylate or compound of benzoin tincture. These things can be harmful.
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Tips on preventing and treating diaper rash
•Check your baby’s diaper often and change it as soon as it’s wet or soiled.
•Carefully clean your baby’s bottom between diaper changes. Use plain warm (not hot) water with or without a very mild soap.
•Allow your baby’s skin to dry completely before putting on another diaper.
•Avoid baby wipes and soaps that are scented. The alcohol or fragrance can make skin irritation worse.
•Use products that contain zinc oxide ointment (such as Desitin Ointment) or petroleum (such as Vaseline) to protect your baby’s skin from moisture.
•Avoid using plastic pants or diapers with plastic edges.
•After bathing, pat your baby’s bottom dry with a towel rather than scrubbing it. Scrubbing can irritate your baby’s sensitive skin.
•If diaper rash persists, change the type of wipes, diapers or soap you’re using.
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What if my baby has an infection?
If your baby also has an infection with the rash, your doctor might give you a prescription for a special antifungal cream to use on your baby’s rash.
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What about powder?
Doctors don’t recommend using talcum powder or cornstarch. Talcum powder can get in your baby’s lungs. Cornstarch may make a diaper rash caused by a yeast infection worse.
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Should I use cloth or disposable diapers?
The choice is up to you. Some research suggests that because disposable diapers are more absorbent they keep babies drier.

If you use cloth diapers and wash them at home, boil them for 15 minutes on the stove after washing them to kill germs and remove soap that could irritate your baby’s skin.

But remember that the most important thing about diapers is to change them often.
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Call your doctor if:
•The diaper rash occurs in the first 6 weeks of life
•Pimples and small ulcers form
•Your baby has a fever
•Your baby loses weight or isn’t eating as well as usual
•Large bumps or nodules appear
•The rash spreads to other areas, such as the arms, face or scalp
•The rash doesn’t get better after trying the tips on treating diaper rash for 1 week

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Mononucleosis
What is mononucleosis and what are the symptoms?
Mononucleosis (often called “mono”) is an infection caused by the Epstein-Barr virus. Symptoms of mono include:
•Fever
•Sore throat
•Fatigue
•Weakness
•Swollen glands in your neck and armpits
•Loss of appetite
•Night sweats
Symptoms in young children are generally mild, while symptoms in adolescents and young adults tend to be more severe.
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How do people get mono?
Mono is not spread as easily as some other viruses, such as the common cold. The mono virus is found in saliva and mucus. It is usually passed from one person to another through kissing, which is why it is often called the kissing disease. However, mono can also be passed through exposure to a cough, sneeze or through sharing food utensils (such as drinking glasses, spoons and forks) with someone who has mono. Signs of mono usually develop 4 to 6 weeks after you’re exposed to the virus. Generally, people only get mono once. It’s most common among people 15 to 35 years old.
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How is mono diagnosed?
Your doctor will probably first ask you some questions about your symptoms and then may do blood tests to confirm the diagnosis. One common test used to diagnose mono is called the Monospot test. Sometimes other blood tests are needed if the results of the Monospot test aren’t clear.
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Does mono have any complications?
Sometimes. The main complication with mono is the enlargement of the spleen. The spleen is like a large gland. It’s located in the upper part of your abdomen on the left side. It helps filter your blood. In severe cases of mono, the spleen can rupture (tear open).

Although a ruptured spleen is rare in people who have mono, it’s wise to be aware of the signs and call your doctor right away if you notice any of them. Signs of a ruptured spleen include sharp pain in the left upper part of your abdomen (under the left chest), feeling lightheaded, feeling confused, blurred vision and fainting.

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Can mono be cured?
No, there isn’t a cure for mono. But the virus will go away on its own. Symptoms usually last about 4 weeks.

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How is mono treated?
The main goal of treatment is to relieve your symptoms. The following list includes tips on treatment:

•Rest. Sleep helps your body fight infection.
•Drink plenty of fluids. They help prevent dehydration.
•If you have a sore throat, gargle with salt water, or suck on throat lozenges, hard candy or flavored frozen desserts (such as Popsicles).
•You may want to take acetaminophen (one brand name: Tylenol) or ibuprofen (some brand names: Advil, Motrin, Nuprin) to relieve pain and fever. Do not give aspirin to children. Aspirin should be avoided because it has been associated with a disease called Reye’s syndrome in children. Reye’s syndrome is a serious illness that can lead to death.
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Do I need an antibiotic?
Antibiotics are not effective against mono. Mono is caused by a virus, and antibiotics don’t work against viruses. If you have a bacterial infection in addition to having mono (such as strep throat), your doctor may give you an antibiotic to treat that infection.

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What about sports and exercise?
Avoid sports, physical activities or exercise of any kind until your doctor tells you it’s safe. Moving around too much puts you at risk of rupturing your spleen, especially if it is enlarged. You need to avoid physical activities and contact sports for about 3 to 4 weeks after you’ve had mono.

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Everyone knows the teen years can be difficult — for both teens and parents. All those physical changes during puberty can make adolescents feel awkward and unsure of themselves.

This is particularly true for girls when it comes to menstruation. For a girl, getting her first period is a physical milestone and a sign of becoming a woman. But it can also be confusing and scary, particularly if she encounters certain problems like irregular periods or premenstrual syndrome (PMS).

Common Menstrual Problems
Most issues teens confront when they start menstruating are completely normal. In fact, many girls and women have had to deal with one or more of them at one time or another:

Premenstrual Syndrome (PMS)
PMS includes both physical and emotional symptoms that many females get right before their periods, such as:

•acne
•bloating
•fatigue
•backaches
•sore breasts
•headaches
•constipation
•diarrhea
•food cravings
•depression or feeling blue
•irritability
•difficulty concentrating
•difficulty handling stress
Different girls may have some or all of these symptoms in varying combinations. PMS is usually at its worst during the 7 days before the period starts and disappears soon after it begins. But girls usually don’t develop symptoms associated with PMS until several years after menstruation starts — if ever.

Although the exact cause of PMS is unknown, it seems to occur because of changing hormone levels, and their effect on chemicals in the brain. During the second half of the menstrual cycle, the amount of progesterone in the body increases. Then, about 7 days before the period starts, levels of both progesterone and estrogen drop.

Some girls’ bodies seem to be more sensitive to these hormone changes than others. Talk to your daughter’s doctor if her symptoms are severe or interfere with her normal activities.

Other Conditions
Cramps
Many girls experience abdominal cramps during the first few days of their periods. They’re caused by prostaglandin, a chemical in the body that makes the smooth muscle in the uterus contract. These involuntary contractions can be either dull or sharp and intense.

The good news is that cramps usually only last a few days. But call your daughter’s doctor if she has severe cramps that keep her home from school or from doing stuff with her friends.

Irregular Periods
It can take 2 to 3 years from a girl’s first period for her body to develop a regular cycle. During that time, the body is essentially adjusting to the influx of hormones unleashed by puberty. And what’s “regular” varies from person to person. The typical cycle of an adult female is 28 days, although some are as short as 21 days and others are as long as 45.

Changing hormone levels might make a girl’s period last a short time during one month (just a few days) and a long time the next (up to a week). She may skip months, get two periods almost right after each other, or alternate between heavy and light bleeding from one month to another.

But any girl who’s sexually active and skips a period should see a doctor to make sure she’s not pregnant. And if your daughter’s period still hasn’t settled into a relatively predictable pattern after 3 years, or if she has four or five regular periods and then skips her period or becomes irregular, make an appointment with her doctor to check for possible problems. Also let your daughter’s doctor know if her cycle is less than 21 days or more than 45 days, or if she doesn’t get a period for 3 months at any time after first beginning to menstruate.

Delayed Menarche
Girls go through puberty at different rates. Some reach menarche (the medical term for the first period or the beginning of menstruation) as early as 9 or 10 years old and others don’t have their first periods until they’re well into their teen years. So, if your daughter is a “late bloomer,” it doesn’t necessarily mean there’s something wrong with her.

When girls get their periods actually depends a lot on genetics. Girls often start menstruating at approximately the same age their mothers or grandmothers did. Also, certain ethnic groups, on average, go through puberty earlier than others. For instance, African-American girls, on average, start puberty and get their periods before Caucasian girls do.

Let your daughter’s doctor know if she hasn’t gotten her period by age 15, or by 3 years after starting puberty.

Problems That May Be Cause for Concern
Although most period problems are harmless, a few conditions can be more serious and require medical attention:

Amenorrhea (the Absence of Periods)
Girls who haven’t started their periods by the time they’re 16 years old or 3 years after they’ve shown the first signs of puberty have primary amenorrhea, which is usually caused by a genetic abnormality, a hormone imbalance, or a structural problem. Hormones are also often responsible for secondary amenorrhea, which is when a girl who had normal periods suddenly stops menstruating for more than 6 months or three of her usual cycles.

Since pregnancy is the most common cause of secondary amenorrhea, it should always be ruled out when a girl skips periods. In addition to hormone imbalances, other things that can cause both primary and secondary amenorrhea include:

•stress
•significant weight loss or gain
•anorexia (amenorrhea can be a sign that a girl is losing too much weight and may have anorexia)
•stopping birth control pills
•thyroid conditions
•ovarian cysts
•other conditions that can affect hormone levels
Something that can also cause primary and secondary amenorrhea is excessive exercising (often distance running, ballet, figure skating or gymnastics) combined with a poor diet, which usually results in inappropriate weight loss or failure to gain weight during growth. But this doesn’t include the usual gym class or school sports team, even those that practice often. To exercise so much that she delays her period, a girl would have to train vigorously for several hours a day, most days of the week, and not get enough calories, vitamins, and minerals.

Menorrhagia (Extremely Heavy, Prolonged Periods)
It’s normal for a girl’s period to be heavier on some days than others. But signs of menorrhagia (excessively heavy or long periods) can include soaking through at least one sanitary napkin (pad) an hour for several hours in a row or periods that last longer than 7 days. Girls with menorrhagia sometimes stay home from school or social functions because they’re worried they won’t be able to control the bleeding in public.

The most frequent cause of menorrhagia is an imbalance between the levels of estrogen and progesterone in the body, which allows the endometrium (the lining of the uterus) to keep building up. When the endometrium is finally shed during menstruation, the resulting bleeding is particularly heavy.

Because many adolescents have slight hormone imbalances during puberty, menorrhagia isn’t uncommon in teens. But in some cases, heavy menstrual bleeding can be caused by problems such as:

•fibroids (benign growths) or polyps in the uterus
•thyroid conditions
•clotting disorders
•inflammation or infection in the vagina or cervix
If your daughter has heavy periods, or periods that last longer than 7 days, talk to her doctor.

Dysmenorrhea (Painful Periods)
There are two types of dysmenorrhea, which is severely painful menstruation that can interfere with a girl’s ability to attend school, study, or sleep:

1.Primary dysmenorrhea is very common in teens and is not caused by a disease or other condition. Instead, the culprit is prostaglandin, the same chemical behind cramps. Large amounts of prostaglandin can lead to nausea, vomiting, headaches, backaches, diarrhea, and severe cramps. Fortunately, these symptoms usually last for only a day or two.

2.Secondary dysmenorrhea is pain caused by some physical condition like polyps or fibroids in the uterus, endometriosis, pelvic inflammatory disease (PID), or adenomyosis (uterine tissue growing into the muscular wall of the uterus).
Having cramps for a day or two each month is common, but if your daughter has symptoms severe enough to keep her from her normal activities, discuss it with her doctor.

Endometriosis
In this condition, tissue normally found only in the uterus starts to grow outside the uterus — in the ovaries, fallopian tubes, or other parts of the pelvic cavity. It can cause abnormal bleeding, dysmenorrhea, and general pelvic pain.

Treating Menstrual Problems
To determine whether a problem requires treatment, the doctor will ask several questions and do a thorough physical exam. The doctor may do a pelvic exam, a Pap smear, blood tests (to check hormone levels), or urine tests. If there might be a structural problem or some sort of growth, an ultrasound or CAT scan may be performed. Together, these tests can help the doctor determine how a condition should be handled.

Growths such as polyps or fibroids can often be removed and endometriosis can often be treated with medications or surgery. If a hormone imbalance is to blame, the doctor will likely suggest hormone therapy with birth control pills or other hormone-containing medications.

And for menstrual pain with no underlying medical cause, anti-inflammatory medicines are the most effective treatment. Conditions like clotting disorders or thyroid problems may require treatment with medications as well.

When to Call the Doctor
Although most period problems aren’t cause for alarm, certain symptoms do call for a trip to the doctor. This is particularly true if a girl’s normal cycle changes. So take your daughter to her doctor if she:

•hasn’t started her period by the time she’s 15 or her period hasn’t become regular after 3 years of menstruating. The most likely cause is a hormone imbalance (which may need treatment), but this also might point to another medical problem.

•stops getting her period or it becomes irregular after it has been regular. Also let your daughter’s doctor know if her cycle is less than 21 days or more than 45 days, or if she doesn’t get a period for 3 months at any time after first beginning to menstruate.

•has heavy or long periods, especially if she gets her period frequently. In some cases, significant blood loss can cause iron-deficiency anemia. Also, heavy bleeding could be a sign of a growth in the uterus, a thyroid condition, an infection, or a blood clotting problem.

•has very painful periods. Having cramps for a couple of days is normal, but if your daughter isn’t able to participate in her normal activities, let the doctor know. She might have a medical problem, such as endometriosis, causing the pain.

Helping Your Daughter
When your daughter’s experiencing a particularly bad bout of PMS or cramps, you can help make her more comfortable. Suggest that she:

•eat a balanced diet with lots of fresh fruit and vegetables
•reduce her intake of salt (which can cause water retention) and caffeine (which can make her jumpy and anxious)
•include foods with calcium, which may reduce the severity of her PMS symptoms
•try over-the-counter pain relievers like acetaminophen or ibuprofen for cramps, headaches, or back pain
•take a brisk walk or bike ride to relieve stress and aches
•soak in a warm bath or put a hot water bottle on her abdomen, which may help her relax
If you notice that your daughter’s usual periods are causing her great discomfort and interfering with her life, talk to her doctor to make sure nothing else is causing the problem and to see if anything can help. Sometimes, hormone treatment, usually in the form of birth control pills, can help ease many symptoms associated with uncomfortable periods.

But the most important way you can help your daughter feel more at ease about her period is to talk to her and explain that most annoying or uncomfortable conditions that accompany menstruation are normal and may improve over time. And be understanding when she’s cranky and unhappy. After all, no one’s at her best all the time — including you.

Reviewed by: Larissa Hirsch, MD

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Depression in Children and Teens
What is depression?
Sometimes when people feel sad, they say they are “depressed.” But depression is more than just feeling sad. It’s a medical illness. It’s not your child’s fault if he or she is depressed.
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What causes depression?
Depression may be caused by an imbalance of chemicals in the brain. The body contains chemicals that help control moods. When there aren’t enough of these chemicals or when the brain doesn’t respond to them properly, you may become depressed. Depression can be genetic (meaning it can run in families).

Depression can also be triggered by stressful events, like the death of a parent or loved one, the breakup or divorce of a relationship, abuse or a physical illness.

Depression is not caused by personal weakness, laziness or lack of willpower.

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What are some of the signs of depression in children and teens?
Infants and preschool children who are depressed may have a poor appetite and may lose weight. You may notice that they don’t seem to enjoy playing.

School-aged children who are depressed may seem less confident. They might feel like they can’t do anything right. Older children and teens who are depressed may seem to stop caring about themselves or family members, may not want to go to school and, in general, may lose interest in life activities. Older children may also show signs of eating more and sleeping more, or eating less and sleeping less.

In some children, the only signs of depression may be having a headache or stomachache, not wanting to go to school or losing their temper. If you notice these signs everyday for several weeks, they might mean your child is depressed.

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Why do young people get depressed?
The following are some of the reasons children and teens might get depressed:
•The family moves to a new place to live.
•The child has to change to a new school.
•A pet, friend or family member dies.
•Someone in the family is very sick.
•The child experiences the hormonal changes of puberty.
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What should I do if I think my child is depressed?
Ask your child about his or her thoughts and feelings. It may also be a good idea to talk to your doctor about your child’s behavior and your concerns about depression. In most cases, taking your child to your family doctor is a good idea. A medical problem may be causing the depression. Your doctor may want to give your child a general medical check-up.
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What can be done to help depressed children and teens?
Depression can be treated with counseling, medicines called antidepressants, or both. Most depressed children and teens should talk to a counselor, therapist, psychologist or psychiatrist about what is making them feel the way they are feeling. Family counseling can help everyone in the family. Your family doctor can refer you and your child to someone for counseling. Most depressed children and teens do best when they get both counseling and medicine.
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How do antidepressants work?
Most antidepressants are believed to work by slowing the removal of certain chemicals from the brain. These chemicals are called neurotransmitters. Neurotransmitters are needed for normal brain function. Antidepressants help people with depression by making these natural chemicals more available to the brain. Antidepressants usually take weeks to months to have a full effect.

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Are antidepressants safe for children and teens?
In some cases, the use of antidepressants has been linked to an increase in suicidal thoughts and suicidal behavior in children and teens. The Food and Drug Administration (FDA) now requires antidepressants to carry a warning about the risk of suicide in children, teens, and young adults up to age 24. However, this doesn’t mean that people in this age group should not take antidepressants. But it does mean that they should be carefully monitored by their doctors and loved ones while they are on an antidepressant.

Many doctors will want to see a child or teen sometime in the first few weeks after starting an antidepressant to assess any risk for suicide. If you are worried that your child may be suicidal, call your doctor right away or take your child to the nearest emergency room.

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Enuresis (Bed-Wetting)
What is enuresis?
Enuresis (say “en-yur-ee-sis”) is the medical term for bed-wetting during sleep. Bed-wetting is fairly common and is often just a developmental stage. Bed-wetting is more common among boys than girls.
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What causes bed-wetting?

Some of the causes of bed-wetting include the following:
•Genetic factors (it tends to run in families)
•Difficulties waking up from sleep
•Stress
•Slower than normal development of the central nervous system (which reduces the child’s ability to stop the bladder from emptying at night)
•Hormonal factors (not enough antidiuretic hormone is produced, which is the hormone that slows urine production at night)
•Urinary tract infections
•Abnormalities in the urethral valves in boys or in the ureter in girls or boys
•Abnormalities in the spinal cord
•A small bladder
Bed-wetting is not a mental or behavior problem. It doesn’t happen because the child is too lazy to get out of bed to go to the bathroom.
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When do most children achieve bladder control?
Children achieve bladder control at different ages. By the age of 6 years, most children no longer urinate in their sleep. Bed-wetting up to the age of 6 is not unusual, even though it may be frustrating to parents. Treating a child for bed-wetting before the age of 6 is not usually necessary.
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How can my family doctor help?
First, your doctor will ask questions about your child’s daytime and nighttime bathroom habits. Then your doctor will do a physical exam and probably a urine test (called a urinalysis) to check for infection or diabetes. Although most children who wet the bed are healthy, your doctor will also check for problems in the urinary tract and the bladder.

Your doctor may also ask about how things are going at home and at school for your child. Although you may be worried about your child’s bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your doctor will also ask about your family life, because treatment may depend on changes at home.

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What are the treatments for bed-wetting?
Most children outgrow bed-wetting without treatment. However, you and your doctor may decide your child needs treatment. There are 2 kinds of treatment: behavior therapy and medicine. Behavior therapy helps teach your child not to wet the bed. Some behavioral treatments include the following:

•Limit fluids before bedtime.
•Have your child go to the bathroom at the beginning of the bedtime routine and then again right before going to sleep.
•An alarm system that rings when the bed gets wet and teaches the child to respond to bladder sensations at night.
•A reward system for dry nights.
•Asking your child to change the bed sheets when he or she wets.
•Bladder training: having your child practice holding his or her urine for longer and longer times during the day, in effort to stretch the bladder so it can hold more urine.
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What kinds of medicines are used to treat bed-wetting?
Your doctor may give your child medicine if your child is 7 years of age or older and if behavior therapy has not worked. But medicines aren’t a cure for bed-wetting. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. These medicines may have side effects, such as dry mouth and flushing of the cheeks.

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How can I help my child cope with wetting the bed?
Bed-wetting can lead to behavior problems because of the guilt and embarrassment a child feels. It’s true that your child should take responsibility for bed-wetting (this could mean having your child help with the laundry). But your child shouldn’t be made to feel guilty about something he or she cannot control. It’s important for your child to know that bed-wetting isn’t his or her “fault.” Punishing your child for wetting the bed will not solve the problem.

It may help your child to know that no one knows the exact cause of bed-wetting. Explain that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child).

Remind your child that it’s okay to use the bathroom during the night. Place nightlights leading to the bathroom so your child can easily find his or her way. You may also cover your child’s mattress with a plastic cover to make cleanup easier. If accidents occur, praise your child for trying and for helping clean up.

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Poisoning
What is poison?
A poison is any substance that is harmful to your body. There are many different types of poison. Many poisonous substances are products you have around the house. Even medicines that aren’t taken as directed can be harmful.

Ways you can be exposed to poison include breathing it in, swallowing it or absorbing it through your skin.

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What types of substances can be harmful?
Substances that could poison you include the following:
•Cleaning products
•Household products, such as nail polish remover and other personal care products
•Paint thinner
•Pesticides used in the house or in the yard
•Chemicals used in the yard, such as herbicides, fertilizers and fungicides
•Metals, such as lead
•Mercury, which can be found in old thermometers and batteries
•Prescription and over-the-counter drugs when combined or taken the wrong way
•Illegal drugs
•Carbon monoxide gas
•Contaminated food
•Plants, such as poison ivy and poison oak
•Venom from certain snakes and insects
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What are the symptoms of poisoning?
The effects of poisoning depend on what substance you are exposed to, and the type and amount of exposure. Your age, your weight and how healthy you are can also affect your symptoms. Poisoning can cause short-term effects, like a skin rash or vomiting. In serious cases, it can cause brain damage, coma or death.

The following are some possible symptoms of poisoning:
•Vomiting
•Diarrhea
•Nausea
•Redness or sores around the mouth
•Drooling or dry mouth
•Dilated pupils (pupils that are bigger than normal) or constricted pupils (pupils that are smaller than normal)
•Rash
•Confusion
•Shaking or seizures
•Trouble breathing
•Unconsciousness (fainting)
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How can I prevent poisoning?
The best way to guard against poisoning is to avoid exposure to harmful substances. The following are some tips:

•Keep all dangerous household substances in locked cabinets, out of the reach of children. Potentially dangerous substances include medicine, household cleaning products and anything containing harmful chemicals (such as nail polish remover and bug repellent). Childproofing your house with child safety locks and guards may be a good idea.
•Wear protective clothing (such as gloves) when using cleaners and chemicals.
•Avoid using pesticides, paint thinner or other chemicals inside the house or garage. Try to find non-chemical solutions. If you do use these chemicals inside, keep the area well-ventilated.
•Don’t mix chemicals. They may become poisonous when mixed. Bleach and ammonia are just one example; when mixed together, they create a poisonous gas that can be deadly.
•Label everything inside your medicine cabinet. Ask yourself, “If an adult needed a particular medicine, could he or she find the right one easily, without guessing?”
•Get rid of old or expired medicines and household products.
•Keep medicines and chemicals in their original containers.
•Follow the label directions when using a product.
•Have your gas heater and any other gas-, oil- or wood-fueled appliances serviced regularly. Be sure these appliances are properly vented.
•Never run your car in your garage, other than when you are driving in and out.
•Install a carbon monoxide detector to keep you safe in case of a carbon monoxide leak in your home.
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What to do in case of poisoning
Make sure the number for the poison control center (1-800-222-1222) is on or near every phone in your home. In the case of poisoning or suspected poisoning, call the local center right away and make sure you know what the immediate proper care should be. Different types of poison require different treatments.
1.Stay calm.
2.Get the person away from the poison. If the poison is on the skin, rinse it off with running water and remove any poisoned clothing. If the poison is in the air, move the person into fresh air.
3.Call 911 if you have a poison emergency and the person has collapsed or is not breathing. OR
4.If the victim is awake and alert, dial the poison control center at 1-800-222-1222 right away. Try to have the following information ready:
a.The person’s age and weight
b.The container that held the poison, if available
c.The time of the poison exposure
d.The address where the affected person is
5.Stay on the phone and follow the instructions from the emergency operator or the poison control center.
NOTE: If the person swallowed a poisonous substance, do not try to induce vomiting, such as with syrup of ipecac. That approach to swallowed poisons is no longer recommended. Research shows that syrup of ipecac doesn’t improve the outcome of treatment for poisoning. And, because it causes vomiting, it can even get in the way of treatments that could be helpful.

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Ear Infections: Otitis Media With Effusion
What is otitis media with effusion?
Otitis media with effusion means that there is fluid (effusion) in the middle ear. The middle ear is the space behind the eardrum. Fluid in the middle ear usually doesn’t bother children. It almost always goes away on its own in a few weeks to a few months. So, this kind of ear problem doesn’t usually need to be treated with antibiotics, unless the fluid doesn’t go away.
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What are the symptoms of otitis media with effusion?
Children who have otitis media with effusion may have the following symptoms:
•A feeling of fullness in the ear
•Muffled hearing
•Fluid that drains from the ears
•Some pain inside the ear (if your child is too young to speak and tell you his or her ear hurts, he or she may tug at the ear often)
•Trouble sleeping
•Irritability
•Fever
•Headache
Sometimes, otitis media with effusion does not cause any symptoms.
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What causes otitis media with effusion?
Fluid may build up in the middle ear for several reasons. When a child has a cold, the middle ear may produce fluid just like the nose does. A tube called the eustachian (say: “you-stay-shun”) connects the middle ear with the back of the nose. Normally, the eustachian tube lets fluid drain out of the middle ear. However, bacteria or viruses can infect the lining of your child’s eustachian tube causing it to swell. The adenoids (glands near the ear) can also become enlarged and block the eustachian tubes. It is also not a good idea to let your baby fall asleep with a bottle or to leave a bottle in the crib. Drinking while lying down may also block the eustachian tubes.

If the eustachian tubes are blocked, fluid in the ear cannot drain normally. If bacteria grow in the middle ear fluid, an effusion can become a middle ear infection (acute otitis). This will usually increase pressure behind the eardrum and cause a lot of pain. The eardrum will become red and bulging. If this happens,your child may need to be treated with antibiotics.

Children who have frequent ear infections can also develop otitis media with effusion after their infection is gone if the fluid stays in the middle ear.

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How is otitis media with effusion treated?
If your child is older than 6 months of age and only has mild symptoms, the best treatment is to let the fluid go away on its own. You can give your child an over-the-counter pain reliever, such as acetaminophen, (one brand: Children’s Tylenol) if he or she is uncomfortable. A warm, moist cloth placed over the ear may also help.
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FDA Warning
The. U.S. Food and Drug Administration (FDA) advises against the use of ear candles. Ear candles can cause serious injuries and there is no evidence to support their effectiveness. For more information, please visit the FDA Web site. Will my child need antibiotics?
Your child may need antibiotics if fluid is still there after a few months and is causing hearing loss or problems in both ears. For this reason, your child’s ears should be checked a few months after an ear infection. If the fluid is still there, a hearing test may be the next step. Your doctor may also recommend antibiotics if your child is under 6 months of age or gets frequent middle ear infections.
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Why not just try antibiotics right now?
Giving your child unnecessary antibiotics can be harmful. After each course of antibiotics, the germs in the nose and throat are more likely to become resistant. Resistant germs can’t be killed by the usual antibiotics. More expensive and powerful antibiotics have to be used. Some of these antibiotics must be given in the hospital and their side effects can be very unpleasant or even dangerous. Since fluid in the ears doesn’t usually bother children, it’s better to wait and only give antibiotics when they are necessary.

Thehealthtime.com

Colds and the Flu in Children
What is the common cold and the flu?
Both the common cold and the flu are infections of the respiratory tract, which includes the throat, nose, airways and lungs.

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How do I know if my child has a cold or the flu?
Although the common cold and the flu share many similar symptoms, they are two different conditions.

The symptoms of a cold include:
What is H1N1 flu?
The H1N1 influenza (also called swine influenza or swine flu) is a respiratory infection caused by a virus found in pigs. H1N1 flu can infect humans. For more information, visit our H1N1 Influenza handout.•Fever up to 102 degrees
•Runny or stuffy nose (often with green or yellow-colored discharge)
•Sore throat
•Cough
•Sneezing
•Fatigue and muscle aches
•Headache
The symptoms of the flu include:
•Fever over 102 degrees
•Stuffy nose
•Diarrhea
•Nausea and vomiting
•Chills and sweats
•Fatigue and muscle aches
•Cough
•Headache
•Loss of appetite
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What medicines can I give my child?
There is no cure for the cold or the flu, and antibiotics do not work against viruses.

Pain relievers such as acetaminophen (one brand: Children’s Tylenol) can help ease the pain of headaches, muscle aches and sore throats as well as treat fevers. Be sure you are giving your child the correct dose according to his or her age and weight.

Nasal sprays and decongestants are not recommended for young children, as they may cause side effects. Cough and cold medicines are not recommended for children, especially those under 2 years of age. There is also little evidence that cough and cold medicines and nasal decongestants are effective in treating children.

To treat a cold or the flu, make sure that your child rests and drinks plenty of fluids. You can use a humidifier to help moisten the air in your child’s bedroom. This will help with nasal congestion. You can also use a saline nasal spray to thin nasal mucus, and a bulb syringe to suction mucus out of your baby or child’s nose.
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Is there a way to prevent catching a cold or the flu?
The best way to prevent colds is to make sure you and your family frequently wash your hands. This will kill the germs that can lead to the cold and the flu.

Encourage your child to cough and sneeze into the inside of his or her elbow (rather than into his or her hand). Clean common surfaces such as table and counter tops, your child’s toys, door handles and bathroom facilities with anti-bacterial disinfectant. This can help stop the spread of germs.

To prevent the flu, a flu vaccine is available every fall (October or November). The flu shot is safe for all children age 6 months and older, and it is strongly recommended that all children age 6 months to 59 months get a yearly flu shot. A nasal spray that prevents the flu is also available. It is safe for all children 2 years and older that do not have asthma or breathing problems.

Thehealthtime.com

Breastfeeding: Hints to Help You Get Off to a Good Start
What are the benefits of breastfeeding?
Breastfeeding has many benefits for your baby. Breast milk is rich in nutrients. It is has antibodies, which helps protect your baby against infections. It also helps prevent your baby from having allergies.

Breastfeeding also has benefits for you. It’s clean and simple–you don’t have to wash bottles or mix formula. It’s cheaper than using formula. It helps your uterus contract back to normal size after having been stretched during pregnancy. It delays the return of your periods (though you shouldn’t count on it to prevent pregnancy). And it helps make time for you to be close to your baby.

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How do I begin breastfeeding?
Wash your hands before each feeding. With your free hand, put your thumb on top of your breast and your other fingers below.

Touch your baby’s lips with your nipple until your baby opens his or her mouth very wide. Put your nipple all the way in your baby’s mouth and pull your baby’s body close to you. This lets your baby’s jaw squeeze the milk ducts under your areola.

When your baby is “latched on” the right way, both lips should pout out (not be pulled in over his or her gums) and cover nearly all of the areola. Instead of smacking noises, your baby will make low-pitched swallowing noises. Your baby’s jaw may move back and forth. If you feel pain while your baby is nursing, he or she is probably not latched on correctly.

Your baby’s nose may be touching your breast during nursing. Babies’ noses are designed to allow air to get in and out in just such a case. But if you’re concerned that your baby can’t breathe easily, you can gently press down on your breast near your baby’s nose to give him or her more room to breathe.

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How should I hold my baby while breastfeeding?
You can hold your baby in a number of ways. Your baby shouldn’t have to turn his or her head or strain his or her neck to nurse.

In the cradle position, you put your baby’s head in the crook of your arm. Support your baby’s back and bottom with your arm and hand. Your baby will be lying sideways facing you. Your breast should be right in front of your baby’s face.

The football position consists of tucking your baby under your arm like a football with his or her head resting on your hand. Support your baby’s body with your forearm. This may be a good position if you’re recovering from a cesarean section or if your baby is very small.

You can also lie on your side with your baby facing you. You can use pillows to prop up your head and shoulders. This is also a good position if you’re recovering from a cesarean section or an episiotomy.

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What is the let-down reflex?
A few seconds to several minutes after you start breastfeeding, you may feel a tingle in your breast, and milk may start to drip from the breast not being used. These are signs that your milk has “let-down.” This means your milk is ready to flow.

This let-down reflex makes breastfeeding easier for your baby. Let-down may also occur if a feeding is overdue, if you hear your baby cry or even if you think about your baby.

Let-down can be forceful enough to cause your baby to cough. If this is a problem, you can express some of your milk by hand before a feeding to bring on the let-down reflex before you start breastfeeding.

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What can I do if my nipples get sore?
It’s easier to prevent sore nipples than it is to treat them. The main thing that causes sore nipples is when your baby doesn’t latch on properly.

If your baby isn’t latched on the right way, you’ll need to start over. To take your baby off your breast, release the suction by putting your finger in the corner of your baby’s mouth between the gums.

Don’t limit the time you let your baby nurse. Putting a limit on nursing time doesn’t prevent sore nipples, but it may keep the milk ducts from completely emptying. This can lead to swelling and pain. Applying crushed ice compresses before nursing can ease discomfort.

Some women find that rubbing lanolin on their nipples is soothing. If you use lanolin, wash it off before feeding your baby. Change bra pads between feedings to keep your nipples dry.

Call your doctor if you have a red, sore or painful area on your breast, if you have painful engorgement (overfull breasts), if you have a fever or if you feel achy. These may be signs of an infection.

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Preventing/healing sore nipples
•Make sure your baby is sucking the right way. If the sucking hurts, your baby’s mouth may not be positioned correctly.
•Let your nipples air dry between feedings. Let the milk dry on your nipples.
•Offer your baby the less sore of your two nipples first. Your baby’s sucking may be less vigorous after the first few minutes.
•Change nursing positions.
•If possible, position any cracked or tender part of your breast at the corner of your baby’s mouth, so that it gets less pressure during feeding.
•Wash your nipples daily with warm water. Don’t use soap or lotion that may contain alcohol, which can dry the skin.
•Avoid bra pads lined with plastic.
•Express milk until your let-down reflex occurs. This will help make your milk more available so your baby sucks less hard.
•Breastfeed often to prevent engorgement. Engorgement can make it hard for your baby to latch on.
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How often should I feed my baby?
Feed your baby as often as he or she wants to be fed. This may be 8 to 12 times a day or more. How often your baby wants to feed may change over time as he or she goes through growth spurts. Growth spurts occur at about 2 and 6 weeks of age and again at about 3 and 6 months of age.

Let your baby nurse until he or she is satisfied. This may be for about 15 to 20 minutes at each breast. Try to have your baby nurse from both breasts at each feeding. The box below lists the signs to watch for so you’ll know your baby is getting enough milk. If you’re nursing fewer than 8 times a day, be especially aware of these signs.

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Signs that your baby is getting enough milk
•Acts satisfied after each feeding.
•Gains weight constantly after the first 3 to 7 days after birth. Your baby may lose a little weight during the first week after being born.
•Has about 6 to 8 wet diapers a day.
•Has about 2 to 5 or more stools a day at first and then may have 2 or less a day. Stools will be runny at first.
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How can I increase my milk supply?
If you think your baby needs more milk, increase the number of feedings a day. It’s also important to get plenty of rest and eat right. Give your body time to catch up to your baby’s demands.

Don’t start giving your baby formula or cereal. If you give formula or cereal to your baby, he or she may not want as much breast milk. This will decrease your milk supply. Also, your baby doesn’t need any solid foods until he or she is 4 to 6 months old.

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What should I eat?
The best diet for a breastfeeding woman is well-balanced and has plenty of calcium. This means you should eat fruits, vegetables, whole-grain cereals and breads, meats, beans and milk and dairy foods like cheese. You’ll need to get enough calories–about 500 more per day than usual–and you’ll need to drink more fluids.

A balanced diet that includes 5 servings of milk or dairy products each day will give you enough calcium. If you don’t eat meat or dairy products, you can get the calcium you need from broccoli, sesame seeds, tofu and kale. Talk to your doctor about taking extra calcium if you don’t think you’re getting enough from your diet.

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What should I avoid eating?
If you think a food you’re eating bothers your baby, quit eating it. Caffeine and alcohol can get into your milk, so limit how much you drink. Medicine–even those you can buy without a prescription–can also get into your milk. Don’t take anything without talking to your doctor first. Also, if you smoke, nursing is another good reason to try to quit. Smoking can cause you to make less milk and the chemicals in cigarettes and smoke can get into your milk.