The basics of RSV

RSV is most common during October to April, which coincides with flu season. This can make it tough to tell which illness your child has, and your pediatric provider can order a nasal swab to test for both. Commonly, kids will have:

• Runny nose
• Decreased appetite
• Cough
• Wheezing
• Fever
• Fast breathing
• Tiredness or fatigue

The biggest worry with RSV is that it can make it hard for people to breathe. This video shows what to look for when it comes to RSV and breathing. Call your pediatric provider or seek emergent care if you notice any of these symptoms – even one. Babies under age one, children born prematurely, and any child with a high-risk condition are at greatest risk for complications. Older people are also at higher risk of hospitalization and complications from RSV. Encourage the grandparents and other older adults in your life to get vaccinated to protect the whole family.

What now?

If your child has been diagnosed with RSV, or it’s strongly suspected, try not to panic. Most children recover well and only need rest, hydration and maybe medication for fever. Keep a close eye out for severe symptoms and breathing difficulties, and alert your pediatric provider if your child is high-risk or having trouble eating or drinking. 

For young children and babies, it can be hard to eat and drink while sick with RSV. Signs of dehydration can be found here, but try to offer lots of fluids or water-rich foods, like fruit or popsicles, often throughout the day. Babies under age one don’t need additional water, just breastmilk and/or formula. Breastfed babies may want to breastfeed all day or find it tough to stay latched – both are common experiences. On the other end, it can be helpful to track wet diapers again in the Ovia Parenting app – even if it’s been a while! 

Because RSV spreads so easily, your child should not go back to daycare or preschool until their symptoms have resolved. Your family may also want to consider limiting contact with other high-risk family members, like grandparents.

Preventing RSV

Preventing RSV is similar to preventing other respiratory illnesses like the flu or Covid-19. Hand washing, masking and avoiding large indoor groups during RSV season can all help. Preventative treatment is approved for babies entering their first RSV season or high-risk children entering their second RSV season. 

In addition, there are currently two ways to protect your baby from the risk of getting RSV that you may want to consider. 

Nirsevimab (Beyfortus) for infants

• The RSV antibody is available for babies and some young children to protect against severe RSV.
• Recommended for infants under eight months of age born during RSV season or about to enter RSV season, especially those who are at an increased risk, such as infants:
  • Children born prematurely
  • Those with a severely compromised immune system
  • Children with cystic fibrosis
  • American Indian and Alaska Native children
• If the birthing parent gives birth 14 or more days after being vaccinated against RSV, except in rare circumstances, most infants younger than 8 months of age do not need to receive the Nirsevimab vaccine.

RSV Vaccine (Pfizer ABRYSVO) for those who are pregnant and people over 60

• An RSV maternal vaccine for the pregnant parent to pass on protection to their babies. 
• Individuals in their third trimester, from September through January, should receive the vaccine, specifically during weeks 32-36 of pregnancy. 
• Taking the vaccine will pass on valuable antibodies to your newborn baby. 
• RSV Vaccine is also approved for people over 60. If you have close family members who may live with you or care for your children, discussing vaccination may be a good idea to help protect both the baby and family members.

It’s important to explore these options with your OB provider and family to determine what’s best for your baby. It’s a big step forward in protecting those most vulnerable to severe RSV infection and hospitalization.

Reviewed by the Ovia Health Clinical Team

Sources:

• Signs & Symptoms of RSV in Babies. American Academy of Pediatrics, AAP. Oct 26, 2022 https://www.youtube.com/watch?v=_2qh31Wndls
• Signs of Dehydration in Infants & Children, HealthyChildren.org. Healthy Children. Last Updated 9/24/2019 https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/dehydration.aspx
• RSV in Infants and Young Children, CDC, Center for Disease Control, Last sourced: July 17, 2024 https://www.cdc.gov/rsv/high-risk/infants-young-children.html
• RSV Immunizations to Protect Infants. CDC, Center for Disease Control, Last Reviewed: July 17, 2024 https://www.cdc.gov/rsv/vaccines/?CDC_AAref_Val=https://www.cdc.gov/rsv/about/prevention.html

What is eczema?

Eczema also called atopic dermatitis, is a skin condition with inflammation, itching, pain, and sometimes rashes. It is not contagious (it can’t be spread from one person to another). In infants and children, eczema typically causes dry, itchy skin patches. Your child’s healthcare provider or a specialized skin doctor (dermatologist) will diagnose your child’s eczema and help you find the best way to treat it.

How is eczema treated?

There is no cure for eczema, but a treatment plan can limit how much it impacts your child. Eczema treatments usually target four problems: dryness, itching, irritated skin (inflammation), and infection. Childhood eczema is best controlled by a regular bathing and moisturizing routine, treating flares (times when eczema worsens), and avoiding triggers (those things that cause flares). The goal of treating eczema is to reduce your child’s discomfort, help them sleep better if itching keeps them awake at night, and reduce scratching, so they don’t cause skin infections or scarring.

For several reasons, eczema can be tricky to treat, especially in infants and children. 

1. Eczema symptoms can vary from child to child.
2. It can cause severe itching, especially at night, disrupting infants’, children’s, and (let’s face it) your entire family’s sleep.
3. It can be stressful as a parent to try to stop your child from scratching the uncontrollable itch of eczema rashes. 
4. It can be frustrating and time-consuming to treat. Sometimes it can still get worse, despite treatment efforts.

Which medications treat childhood eczema?

Healthcare providers treat eczema with medications called corticosteroids, applied to your child’s skin (topically). Topical steroid medications are the most effective treatment for eczema. They work because they reduce inflammation. Corticosteroids should be applied twice a day during an eczema flare. Only apply the steroids to your child’s irritated or itchy areas, avoiding other skin areas. Corticosteroids have different strengths and forms (lotions, ointments, creams, gels, and oils). When used as prescribed, topical steroids are very safe and effective — but you should speak to your provider about the right fit for your child. 

Non-steroid eczema medicines (tacrolimus ointment, pimecrolimus cream, crisaborole ointment) also help heal eczema rashes for children over 2. They have different ingredients than corticosteroids. They work well for mild eczema and delicate areas of skin, like the eyelids, armpits, and groin (between the legs).

Biologic therapies target your child’s immune system to decrease the allergic response. Dupilumab is the first biologic therapy approved by the U.S. Food & Drug Administration (FDA) to treat eczema in children ages six months and up. Dermatologists use Dupilumab to treat moderate to severe eczema that corticosteroids failed to improve.

Continuous scratching may leave your child’s skin raw, sensitive, and swollen. If their scratching has caused open areas that have become infected, your pediatric provider may prescribe antibiotics. Signs of a skin infection include oozing, crusting, pus bumps, blisters, or a worsening rash that does not improve with your usual treatments. These are important to get treatment for right away. If your child is prone to frequent infections, there are special baths that may be recommended by your healthcare provider as part of a prevention strategy. 

Antihistamine medicines like diphenhydramine (Benadryl) and hydroxyzine (Atarax, Vistaril) can help your child feel drowsy so they fall asleep instead of scratching their skin. Follow directions based on their age and weight, and talk with their pediatric provider or pharmacist if you have questions about how to give your child the correct dose of these medications. These medications should only be given exactly as directed and with the approval of your healthcare provider if your child is under age 6. 

Bathing and moisturizing: Two key pieces of your child’s eczema puzzle

Infants and children with eczema have a skin barrier that isn’t working effectively — meaning that their skin does not work as well to keep moisture inside and dries out more easily. Skin dryness is a trigger for eczema symptoms. Bathing and moisturizing help strengthen your child’s skin, making it more eczema resistant. A healthy skin barrier also keeps out bacteria, viruses, and irritants. Applying moisturizer (also called an emollient) after a bath is crucial because it provides an artificial barrier preventing water loss. Giving your child a bath and not putting moisturizer on afterward might do more harm than good, leaving their skin drier than it was before the bath. Here’s a suggested bathing and moisturizing treatment plan for eczema:

• Give your infant or child a lukewarm bath every day. Let them soak for at least 5-10 minutes (with supervision, of course). Longer than 20 minutes risks further skin drying.
• While in the bath, only wash their dirty or smelly areas with a gentle cleanser. Do not use any soap or cleanser on the skin areas with eczema.
• When they are out of the bath, gently dry them off, leaving their skin still damp and patting with the towel rather than rubbing.
• Smear a thick layer of moisturizing lotion or ointment twice daily all over your child’s skin. When the skin is very itchy, using an eczema-friendly ointment provides more relief than a cream or lotion.
• If your child uses topical corticosteroids to treat their eczema, apply them to the eczema-affected areas after your child’s bath but before the moisturizer to increase their absorption. 
• Put PJs on immediately to help seal in moisture. Use non-synthetic fabrics like cotton or bamboo. 

Remember, all soaps, shampoos, conditioners, and moisturizers should be fragrance-free, specially formulated for sensitive skin, and without dyes or other irritating chemicals. Do not use bubble baths or bath oils.

Although it seems counter-intuitive, do not use anti-itch creams or lotions. The American Academy of Dermatology says that these products do not relieve the eczema itch and can sometimes contain ingredients that cause flares.

What makes my child’s eczema worse?

Things that make your child’s eczema worse (called a flare or flare-up) are triggers. Some of the items listed below may trigger your child’s eczema:

• Dry skin
• Dry air
• Indoor heat (indoor temperatures hotter than 75 degrees F)
• Tight-fitting clothing or clothes with irritating seams or tags
• Scented laundry detergents and fabric softeners
• Soaps, shampoos, or lotions that are scented or contain irritating dyes and chemicals
• Dust mites (found in old pillows, carpets, and bedding)
• Pet dander
• Pollen
• Saliva (infants’ drool can irritate cheeks, chin, and neck)
• Sweat
• Fragrances from indoor candles, air fresheners, and incense
• Insect bites and stings
• Tobacco smoke
• Wool and synthetic fabrics

Avoiding triggers will help prevent eczema flares. Some parents and healthcare providers consider allergy testing to identify triggers better.

Can changing my child’s diet help treat my child’s eczema?

Maybe, but it’s complicated. Having eczema (AD) is closely linked with food allergies (as well as asthma and hayfever). Restrictive or fad diets are never a good plan for babies and children, who have specific nutrient needs and can also be picky. If you’ve noticed flares around certain foods, discussing this with your child’s providers is a great idea. No two cases of eczema are the same or have the same triggers. It can be so tempting to hunt a cause, but often flares are a result of many different external and internal factors.

Healthcare providers advise against changing your child’s diet or avoiding any foods without first talking to them. The American Academy of Dermatology recommends allergy testing for foods only when a child has an immediate allergic skin reaction after eating a specific food. In addition, there is no conclusive scientific research to demonstrate any dietary supplements, including probiotics, help treat eczema. Instead, keep your child (and their skin) healthy by feeding them a complete, balanced diet

Home remedies can help break the itch-scratch cycle.

Increasing how often you apply emollients or the strength of the corticosteroid medication are usually the ways your child’s pediatrician or dermatologist will treat flare-ups. Unfortunately, the medication can take a couple of days to work. In the meantime, here are some tips from the American Academy of Dermatology to help your child itch and scratch less:

• Apply a cool compress (a cold face cloth, cold pack wrapped in a towel) to itchy areas
• Take a colloidal oatmeal bath (usually sold at pharmacies or health food stores, pick unscented, and add to running lukewarm water, then let your child soak for 10-15 minutes)
• Keep your child’s nails cut short, or have infants and toddlers sleep in pajamas with hand covers so they cannot scratch while asleep.
• Try a wet-wrap treatment if your provider recommends it. 

Can eczema be cured?

Unfortunately not. Some children outgrow eczema. For most, eczema improves with age. Others will continue to have flare-ups mixed with symptoms-free times for the rest of their lives.

The best way to manage your child’s eczema is to learn more about their symptoms and triggers to keep flare-ups under control. Treating symptoms right when they first start can help your child feel better and prevent sleep disruptions, irritable behavior, and skin infections. Working with your child’s healthcare provider to create a stepped eczema treatment plan with effective treatment options will help your entire family feel better.

Dealing with eczema can be so overwhelming for families and if you’re struggling to manage the physical and/or emotional aspects of it — please reach out to a provider to get some support.

Sources

“Baby eczema: Causes, symptoms, treatment, and more.” National Eczema Association. National Eczema Association. https://nationaleczema.org/eczema/children/

“Can food fix eczema?” American Academy of Dermatology. American Academy of Dermatology. 2022. https://www.aad.org/public/diseases/eczema/childhood/treating/food-fix

“Childhood Eczema.” American Academy of Dermatology Association. American Academy of Dermatology Association. https://www.aad.org/public/diseases/eczema/childhood

Stein, S. and S. Maguiness. “How to treat and control eczema rashes in children.” Healthychildren.org. American Academy of Pediatrics. April 19, 2021. https://www.healthychildren.org/English/health-issues/conditions/skin/Pages/How-to-Treat-and-Control-Eczema-Rashes-in-Children.aspx

“Treating your child’s eczema can help the whole family.” Mayo Clinic. Mayo Clinic. March 21, 2019. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/treating-your-childs-eczema

How high does the temperature have to be for it to be considered a fever?

If your child has a temperature of 100.4F (38C) or higher, they have a fever. Fever happens when the body’s internal “thermostat” raises body temperature above normal. 

It might seem obvious, but if you suspect your child has a fever, take their temperature with a thermometer. Feeling their forehead or other parts of the body is not accurate, especially if they’re having chills. While other symptoms and how they are acting are important clues, your child’s healthcare provider will want to know an accurate temperature when considering what medical advice to give you.

A child’s normal temperature can vary depending on age and activity level. Body temperature is highest in the late afternoon and early evening, for example, and lowest at night and early morning. Infants tend to have higher temperatures than older children. In older children, an oral temperature is the most accurate. Any oral temperature over 100 is considered a fever. According to the American Academy of Pediatrics, parents of babies should use rectal thermometers for the most accurate reading. Generally, in infants and babies, a rectal reading of above 100.4 degrees Fahrenheit (38 degrees Celsius) is considered a fever. It’s also okay to use a digital ear or forehead thermometer on older babies and children. Keep in mind they can have more user errors, so you may want a basic backup at home as well. Use 100.4 as a cut-off for fever with an ear or forehead thermometer.  

When should you call your child’s healthcare provider about a fever?

The American Academy of Pediatrics (AAP) advises caregivers to call a healthcare provider any time their child has a fever and:

• Looks very ill, is unusually drowsy, very fussy, or is not eating or drinking
• Has been in a very hot place, such as an overheated car
• Other symptoms include a stiff neck, severe headache, sore throat, severe ear pain, unexplained rash, or repeated vomiting or diarrhea
• Has immune system problems, such as sickle cell disease or cancer, or is taking steroids
• Has had a seizure
• Is younger than three months (12 weeks) and has a temperature of 100.4°F (38.0°C) or higher even without any other symptoms
• Is having trouble breathing or breathing more forcefully or quickly than normal.
• The fever rises above 104°F (40°C) repeatedly for a child of any age.
• Still “acts sick” even after their fever is brought down with medication (see below)
• Your child seems to be getting worse.
• The fever persists for more than 24 hours in a child younger than two years.
• The fever lasts for two to three days (even a low-grade fever) in a child older than three years.

You should also check in with your child’s provider if you gave your child acetaminophen or ibuprofen (see fever medicines section below) to lower their fever, but their temperature did not return to normal (98.6F or below).

It is not always necessary for a child with a fever to see their provider.

How to help your child with a fever feel better.

Sometimes children with fevers don’t drink as much as they should and can become dehydrated. Running a fever and sweating cause dehydration. If you notice that your infant has fewer wet diapers than normal or your older child is going to the bathroom less frequently or has darker yellow-colored urine, give your pediatrician a call. Keeping your child well-hydrated is an important part of feeling better.

And there are plenty of comfort measures you can offer your child with a fever.

• If your child won’t drink, try having them slurp frozen juice pops.
• Try a lukewarm sponge bath if they are hot and sweaty. The water should still feel warm, not cold — 85-90 degrees if you have a bath thermometer.
• Dress them in lightweight, breathable clothing (cotton, for example).
• Cover them with light sheets or cotton blankets. Layers will help them stay comfortable depending on if they are hot or have chills.
• Encourage them to rest and take it easy.
• Try a cool compress (like a wet face cloth chilled in the refrigerator) on the back of their neck or forehead.
• Keep room temperatures at their norm and run a fan if it’s hot or stuffy inside 
• Drinks or popsicles with electrolytes can be helpful for older feverish children (if your child is under 1 do not give electrolytes or large amounts of water without consulting your provider, breastmilk or formula is usually all you need)

It is a good sign if your child plays and interacts with you after any of these fever-busters- that means they are feeling more like themselves.

When should I give my child medicine to treat their fever?

Sometimes, your child may still not feel better even after all of the tried-and-true fever comfort measures listed above. You can try giving them some over-the-counter medication to lower their fever. Acetaminophen (Children’s Tylenol) and ibuprofen (Children’s Motrin) reduce fevers. Both are available in infant and child formulations. Check the label or call your pediatrician for the correct dosage for your child. There are two critical cautions for over-the-counter fever relievers:

1. Ibuprofen is not safe for infants under six months of age.
2. Do not give aspirin to children 18 or younger.

If your child is acting fine and drinking, let the fever run its course. This will help your child’s body do its job and fight off the illness. If your child vomits the medication, going back to the basics above — especially sponging in a bath — can be helpful.

Can fevers cause children to have seizures?

Yes, but fortunately, not often. Febrile seizures are most common in 12-18 month-olds but can happen in any child under 5. They tend to happen with higher fevers, but can even happen during a less severe fever. Only two to four out of 100 children with a fever will have febrile seizures.

A seizure is an uncontrollable convulsion or jerking of the arms and legs. Sometimes children’s eyes will roll back, briefly lose consciousness, or their limbs will become stiff. Febrile seizures tend to run in families. Fevers from common childhood infections like the flu, strep throat, and ear infections can cause febrile seizures. Children are not diagnosed with a seizure disorder such as epilepsy if they have a febrile seizure.

If you think your child is having a febrile seizure, take the following steps to keep them safe:

• Note the start time of the seizure. If the seizure lasts longer than five minutes, call an ambulance. Take your child immediately to the nearest medical facility to be evaluated.
• Call an ambulance if the seizure is less than five minutes, but your child does not seem to be recovering quickly.  
• Gradually place your child on a protected surface, such as the floor or ground, to prevent accidental injury. Do not restrain or hold them down during a convulsion.
• Position your child on their side or stomach to prevent choking. When possible, gently remove any objects from their mouth. Don’t put anything in their mouth during a seizure.
• Seek immediate medical attention if this is your child’s first febrile seizure. Call your child’s healthcare provider once the seizure has ended to check for the cause of the fever. Also, seek emergency medical attention if your child has a febrile seizure with a stiff neck, is very weak, or is frequently vomiting – they can be signs of meningitis, a life-threatening brain infection.

Although they may seem to last forever, febrile seizures typically only last a minute or two. The vast majority of febrile seizures do not cause any long-term damage.  

Trust your parental instincts.

While reading about the possibility of febrile seizures may cause some anxiety, remember that most fevers are nothing to worry about and pass in a day or two. In addition, it is normal for children to get several viruses or infections a year, and running a fever is their body’s way of killing the virus or bacteria. Most importantly, though, remember that you know your child better than anyone else does. Always trust your parenting instincts. If you feel something isn’t right with your child, call their healthcare provider to discuss their fever and any other symptoms they might have.

Sources

“Febrile Seizures Fact Sheet.” National Institutes of Health. National Institute of Neurological Disorders and Stroke. June 16, 2021. https://www.ninds.nih.gov/febrile-seizures-fact-sheet

“Fever and your baby.” Healthychildren.org. American Academy of Pediatrics. July 19, 2021. https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Fever-and-Your-Baby.aspx

“Fevers in babies and children: When to Worry.” Cleveland Clinic. Cleveland Clinic. September 27, 2022. https://health.clevelandclinic.org/kids-fevers-when-to-worry-when-to-relax/

“Fever in children: How can you reduce a child’s fever?” InformedHealth.org. Institute for Quality and Efficiency in Health Care. June 6, 2019. https://www.ncbi.nlm.nih.gov/books/NBK279453/

McCarthy C. “When to worry about your child’s fever.” Harvard Health Publishing.  Harvard Health Publishing. June 1, 2020. https://www.health.harvard.edu/blog/worry-childs-fever-2017072512157

“When to call the pediatrician: Fever”. Healthychildren.org. American Academy of Pediatrics. Updated November 21, 2015. https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/When-to-Call-the-Pediatrician.aspx.

Learn more about this respiratory infection, the pertussis vaccine, and how to keep your family safe and healthy. As adults, you have an important role to play in keeping young children healthy.

What is whooping cough?

Whooping cough is an infection of the lungs and respiratory tract that can cause coughing fits. Whooping cough is also known as pertussis. A bacteria called Bordetella pertussis causes this highly contagious (easily spread) infection. Whooping cough spreads easily when an infected person coughs, spraying droplets filled with bacteria into the air. Other people are then infected when they inhale these droplets.

What are the symptoms?

Whooping cough starts with mild symptoms and is often mistaken for a cold. It usually takes five to ten days for symptoms to appear after first being infected, but it can take as long as three weeks. It is extremely contagious, and for a long period of time. Without treatment, it can spread to others for weeks after the cough first appears.

After the early days of cold-like symptoms (runny nose, congestion, fever, red and watery eyes, and cough), pertussis symptoms worsen to include:

• Uncontrollable coughing fits
• Thick mucus in the lungs, which triggers a hacking cough
• Gagging or vomiting as a result of coughing
• A blue tint around the mouth from lack of oxygen after a coughing fit
• A reddening of the face from the work of coughing
• Low-grade fever (less than 100.4° Fahrenheit)
• Dehydration (not having enough fluid in your body)
• Coughing ending with a high-pitched “whoop” sound during the next inhalation of air.

Not everyone with pertussis will make this “whooping” or barking sound when they cough. Babies may not cough at all. Instead, they can struggle to breathe and may even temporarily stop breathing (apnea).

On the other hand, sometimes the only symptom of whooping cough in adults and adolescents is a hacking cough that goes on for six weeks or longer (pertussis has been known as the 100-day cough). While it can help make a diagnosis, healthcare providers don’t require this type of coughing to diagnose whooping cough.

How is whooping cough diagnosed?

While some healthcare providers diagnose whooping cough based on symptoms alone, others use medical tests to diagnose the infection. These possible tests are:

• A swab of the back of the throat (like the test for Strep throat)
• A blood test (checking for signs of infection in your blood, used to tell the severity of the infection, but not to diagnose whooping cough)
• An X-ray of the chest to check for a lung infection. An X-ray can show if the whooping cough bacteria has caused a lung infection (pneumonia).

Because the signs and symptoms of whooping cough can be tricky to identify in young infants and children, call your healthcare provider if prolonged coughing spells cause you or your child to:

• Vomit
• Turn red or blue
• Struggle to breathe or have noticeable pauses in breathing 
• Inhale with a whooping sound

How serious is whooping cough?

While it is rare for someone to die from whooping cough, deaths can occur in infants. Infants under 12 months who are unvaccinated or not yet fully vaccinated are at the greatest risk for severe complications and death, according to the U.S. Centers for Disease Control and Prevention (CDC). Unfortunately, babies do not start building their own protection against whooping cough until they get their first pertussis vaccine when they are two months old. That’s why it’s crucial for pregnant people — and others in close contact with infants — to be vaccinated against whooping cough. The CDC recommends the vaccine (and boosters) for people of all ages.

Is there a vaccine?

Yes. There are two vaccines in the U.S. to prevent the spread of whooping cough: DTaP and Tdap. These vaccines protect against three infections: pertussis, tetanus, and diphtheria.

The CDC recommends that babies and young children get five shots of DTaP between 2 months and 6 years. Older children and teens should get one shot of Tdap when they are 11 to 12 years old. Although it seems like a lot of doses, repeated small doses of the pertussis vaccine help to build immunity over time and keep your baby protected. The vaccine isn’t perfect, but it greatly reduces the risk of catching it and makes the illness milder for those who do get it.

Pregnant people should get Tdap during the early part of the 3rd trimester of each pregnancy. There are three good reasons to get the Tdap vaccine during pregnancy. 

1. Pregnancy causes immune system changes that make it more likely a pregnant person will get sick or have complications from an illness. So, if they are vaccinated with Tdap, they can protect their own health. 
2. We now know that babies are protected for about two months from vaccination during pregnancy. That’s right! Your choice to get vaccinated against whooping cough is a “vaccination” for your newborn. Research suggests it’s about 78% effective for the first two months of life. Perfect timing, as your baby can get their first dose of Dtap at their 2-month visit. 
3. If expectant parents and adult caregivers and family are vaccinated (and boosted) before the birth, then the infant will be at a much lower risk of catching whooping cough in the two months before they are old enough to get their first DTaP vaccine.

How is whooping cough treated?

Healthcare providers usually hospitalize infants with whooping cough for close monitoring and treatment because the infection is more severe for infants. Intravenous fluids (via a small tube in their veins) may be needed if your baby can’t keep down liquids or food. Your child will also be isolated from others so they don’t get other babies sick. They will be monitored for severe complications like apnea, pneumonia, and seizures. 

Antibiotics (medications to kill the bacteria causing pertussis) are the preferred treatment for whooping cough. Exposed family members may be given antibiotics to prevent them from getting infected. These medications can make it less likely your baby will infect others, but unfortunately, they don’t stop the cough. Early treatment can be beneficial if you know you or your child have been exposed. Healthcare providers do not recommend treatment with over-the-counter cough-suppressing medications.

Older children and adults can usually safely recover at home while taking prescribed antibiotics. Make sure your child has plenty to drink (water, juice, and soup) to avoid dehydration (not having enough fluids). Signs of dehydration to watch for are dizziness, dry, cracked lips, no tears when crying, and not peeing as often as usual. Resting in a cool, dark bedroom or room without any lung-irritating smoke from a fireplace or cigarettes will help your child recover faster and have fewer coughing spells. A cool-mist vaporizer can help ease breathing, loosening secretions in your child’s lungs. It’s not uncommon for children with a severe cough to lose control of their bladder. It’s important to reassure them that accidents of this kind are normal and will not happen when they are well. Watch for episodes of passing out or severe pain in the chest (it’s possible to break a rib from the force of coughing). 

If someone you live with is diagnosed with whooping cough, you can minimize its spread to other family members by the same COVID-19 protections you are already familiar with, such as:

• Limiting contact with the infected person (having them isolate in their bedroom, for example).
• Wash your hands often.
• Wearing a mask when around them.

Talk to your healthcare providers about whether other family members or close contacts need antibiotic treatment. Vaccinating against pertussis is the best way to protect you and your family, especially if you are pregnant or have young children at home with you. With widespread vaccination, pertussis outbreaks are rare and cause very few complications or deaths. Talk with other adults and caregivers around your family to make sure they are up to date on their vaccines and boosters.

Reviewed by the Ovia Health Clinical Team

Sources

“DTaP. Diphtheria, Tetanus, Pertussis. Vaccine Information Sheet (VIS)”. CDC. CDC. August 6, 2021.https://www.cdc.gov/vaccines/hcp/vis/vis-statements/dtap.html

“Get the whooping cough vaccine during each pregnancy”.  CDC. CDC. June 10, 2021. https://www.cdc.gov/pertussis/pregnant/mom/get-vaccinated.html

Skoff T, Blain A, Watt J, Scherzinger K, et al. “Impact of the US Maternal Tetanus, Diphtheria, and Acellular Pertussis Vaccination Program on Preventing Pertussis in Infants <2 Months of Age: A Case-Control Evaluation”. Clinical Infectious Diseases. 65(12):1977-1983. December 15, 2017.

“Whooping Cough (Pertussis)”. CDC. CDC. August 8, 2021. https://www.cdc.gov/pertussis/index.html

“Whooping Cough”. Mayo Clinic. Mayo Clinic. February 11, 2022. https://www.mayoclinic.org/diseases-conditions/whooping-cough/symptoms-causes/syc-20378973

“Whooping cough vaccination”. CDC. CDC. August 4, 2021. https://www.cdc.gov/pertussis/vaccines.html

“Whooping cough: What parents need to know.” healthychildren.org. American Academy of Pediatrics. December 10, 2021. https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Whooping-Cough.aspx

What is measles?

Measles is a highly-contagious infection caused by a virus. Once in the air, measles can infect anyone who comes into contact with it for up to two hours. Direct contact with fluids from the nose or mouth of an infected person can also transmit the virus. Vaccination with the Measles, Mumps, and Rubella (MMR) vaccine is the highest level of protection against measles.

How does the measles (MMR) vaccine protect children?

The MMR vaccine prevents children from getting infected with the measles virus in the first place. Before widespread measles vaccination in the U.S., measles used to infect between three to four million Americans yearly. Worldwide, major epidemics occurred approximately every 2–3 years. Worldwide, measles vaccination resulted in a seventy-three percent drop in measles deaths between 2000 and 2018. The CDC declared measles eliminated (absence of continuous disease transmission for greater than 12 months) from the U.S. in 2000.

What about recent measles outbreaks in the U.S.?

Since 2016 there have been several smaller measles outbreaks (there were 24 measles cases in five different locations in the U.S. in 2022, for example). The CDC believes outbreaks like these occurred because:

1. There was an increase in the number of travelers who get measles abroad and bring it into the U.S. 
2. There is further spread of measles in U.S. communities with pockets of unvaccinated people.

To prevent measles outbreaks within a community (also known as herd immunity), the vaccination rate for the population needs to be above 95 percent. In other words, if a community has 100 people, at least 95 people must be fully vaccinated to prevent an outbreak.

If you and your child are fully vaccinated with the MMR vaccine, you have a very low risk of getting sick with measles. The vaccine works very well, it’s about 97% effective! Infants too young for the vaccine (less than one year) and adults with certain medical conditions who can’t get vaccinated are at the greatest risk of getting seriously ill from a measles infection.

When should my child get the MMR vaccine?

According to the CDC, children should get the MMR vaccine when they are:

• 12 to 15 months old for the first dose
• 4 to 6 years old for the second dose

Children as young as 6 months may be eligible for vaccination in certain circumstances, particularly for any local outbreaks (with or without known exposure) or planned international travel. Talk to your pediatric provider if you’re wondering if this would be best for your child.

What are the risks or complications of measles infections in children?

In the short-term, young children with measles may develop other symptoms, including an ear infection, croup (a type of cough), diarrhea, pneumonia (a lung infection), and seizures (often associated with high fevers). Rarely, measles can cause hearing loss, permanent brain damage, or death if the infection worsens. 

There are some rare long-term effects of measles to know about. Children who have recovered from measles may have an increased risk of severe infections for months or years through a process called immune amnesia. Imagine your body forgot every illness it ever had, and you had to start from scratch fighting off every bug. In addition, there is a fatal syndrome called SSPE which develops after it appears someone has recovered from measles. 

All of these can be avoided through routine vaccination with the MMR vaccine. The MMR vaccine is a safe and well-tolerated vaccine. It carries none of the risks of measles infection and is recommended by the AAP, CDC, and WHO. Intentionally exposing your child to measles to avoid vaccination and gain immunity through illness is not recommended. Your child may not acquire measles or immunity, or they may get severe measles and suffer any of the complications listed above. There is no way to predict which child will become seriously ill. 

What are the symptoms of measles in children?

Measles signs and symptoms appear around 7 to 14 days after exposure to the virus. Measles symptoms can include:

• A blotchy red skin rash, commonly starting on the face, made up of large, flat blotches that can run into one another
• Dry cough
• Runny nose
• Fever
• Red and irritated eyes
• White spots in the mouth (Koplik spots)
• Sore throat

Children with measles usually develop cold-like symptoms before developing a rash. The cold-like symptoms tend to worsen during the first 1 to 3 days of the illness.

After the first few days of symptoms, a rash usually appears first on the face, then spreads down the arms, chest, and back, then over the thighs, lower legs, and feet over the next several days. At the same time, children’s fevers can rise sharply, often to higher than 104F.

A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days. The measles rash may last about seven days.

When should you call your child’s healthcare provider if you are worried about measles?

If your child develops symptoms associated with measles, isolate and contact your healthcare provider immediately. They will examine your child or send you for lab testing to diagnose the illness. In addition, if your child was exposed to measles, contact their provider as soon as possible whether they have symptoms or not. They may be eligible for preventative treatment to decrease their risk of serious illness if they are not yet vaccinated.

Your child’s healthcare provider can help plan how to keep your child from infecting other children and adults who might be at risk. If your child has confirmed measles, your local health department requires that your healthcare provider notify them to help prevent the spread of measles in your community.

How is measles treated?

Currently, there are no specific antiviral treatments (medications to treat viruses) to help treat measles once a person becomes infected. However, high-risk infants or children can get support after exposure, so it’s important not to wait for symptoms if you know your family was exposed. Your pediatric provider can also give you information on when and where to seek urgent care if certain symptoms develop, such as febrile seizures or difficulty breathing.

If your child has contracted measles, keep them home from school or child care. Be sure they stay away from others who are not vaccinated. To help your child recover, give them plenty of liquids to drink, use a humidifier where they sleep, and keep medications for fever and pain on hand. In general, Tylenol and Ibuprofen are preferred, but ask your pediatric provider for additional guidance. Children with low levels of vitamin A are more likely to have a more severe case of measles. Therefore, your provider may direct you to use a Vitamin A supplement. 

What if I have questions about measles, the MMR vaccine, or childhood rashes?

Your pediatric provider can help you understand how you can protect your family from many childhood illnesses, such as measles. They can also help you sort out your family’s vaccination records to make sure everyone is up to date. Being up to date on vaccination against measles is so important to protect them, your family, and others. Speak with your pediatric provider about recommended vaccine schedules, vaccine safety, and ways to keep your family healthy.

Reviewed by the Ovia Health Clinical Team

Sources

D’Souza RM, D’Souza R. “Vitamin A for treating measles in children”. Cochrane Database Syst Rev. 2002;(1). October 19, 2005. 

“Measles”. healthychildren.org. American Academy of Pediatrics. November 21, 2015. https://www.healthychildren.org/english/health-issues/vaccine-preventable-diseases/Pages/Measles.aspx

“Measles”. Mayo Clinic. Mayo Clinic. May 11, 2022. https://www.mayoclinic.org/diseases-conditions/measles/symptoms-causes/syc-20374857

“Measles history”. CDC. CDC. November 5, 2020. https://www.cdc.gov/measles/about/history.html

“Measles”. World Health Organization. World Health Organization. December 5, 2019. https://www.who.int/en/news-room/fact-sheets/detail/measles

“Measles, Mumps, and Rubella (MMR) Vaccine Information Sheet (VIS)”. CDC. CDC. August 6, 2021. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html

What are the different types of diabetes in children?

The two types of diabetes children can have are type 1 diabetes (formerly known as Juvenile Diabetes) and type 2 diabetes (formerly known as Adult-Onset Diabetes). Children are more likely to be diagnosed with type 1, but there is a growing awareness that children can have type 2. Both diagnoses have been increasing over the last two decades, but we’ll focus here on type 1. 

What causes type 1 diabetes?

In type 1 diabetes, an organ called the pancreas does not make insulin. Insulin is a hormone that helps glucose (the type of sugar your body uses) get into your cells to give them energy. Insulin works like a key that opens the door to your body’s cells to let the glucose inside them. Without insulin, too much glucose stays in the blood. Usually, after eating, the amount of glucose in the blood goes up (your blood sugar level rises). In response, the pancreas sends insulin into the bloodstream.

People with type 1 diabetes can not make insulin because their immune system attacks and destroys their own pancreatic cells responsible for making insulin. Type 1 diabetes is called an autoimmune disease because your immune system (designed to attack foreign bacteria or viruses) attacks itself – in this case, the pancreas. Doctors and scientists don’t yet know for sure why this happens in some children and not others, although there are genes that make the risk higher. Type 1 diabetes can’t be prevented and isn’t caused by what kids eat or how active they are.

What are the signs and symptoms of type 1 diabetes in children and teens?

As the pancreas stops making insulin, symptoms of type 1 will begin to appear. Left untreated, they are life-threatening. Here are some signs and symptoms:

• Needing to pee frequently
• Wetting the bed after having been dry at night
• Increased thirst and drinking more than usual
• Feeling tired
• Unintentional weight loss
• Irritability or behavior changes
• Fruity-smelling breath

How is type 1 diabetes diagnosed?

Healthcare providers use a blood test that measures the amount of sugar (glucose) in the blood. When these results are very high, they’ll run more lab tests. Often those with type 1 diabetes are very sick when they are first diagnosed. They may need to spend time in a hospital having their blood sugar and hydration status stabilized. This allows children to safely recover and receive life-saving insulin. It also helps parents learn how to check their child’s blood sugar, count carbohydrates for meals, and give them insulin before taking them home. Type 1 diabetics will need insulin every day, several times a day for their entire lives.

Once diagnosed, your child’s pediatric provider will most likely refer you to a pediatric endocrinologist, a doctor specially trained to care for children with diabetes. They usually work as part of a diabetes care team that may include diabetes educators, nurses, nurse practitioners, dieticians, nutritionists, eye doctors, and mental health providers.

What are the treatments for type 1 diabetes?

Although there is no cure for diabetes at this time, children with this disease can lead normal lives, but it can be challenging for parents to manage the nutritional needs of growing children, who may also be picky eaters! Blood sugar can be hard to keep in control at first because of your child’s rapid growth, unpredictable appetite, and energy levels. When diabetes is well-controlled it means that blood sugars remain relatively constant, without falling too low (called hypoglycemia) or too high (hyperglycemia). Keeping blood sugar levels close to normal most of the time can dramatically reduce the risk of many short and long-term complications.

The goal of diabetes treatment is to keep your child’s blood sugar within a target range. Your child’s diabetes care team will let you know your child’s blood sugar target range. This range may change as your child grows and changes. To treat their type 1 diabetes, your child will need to:

• Take insulin daily (by injection or an insulin pump)
• Count carbohydrates (sugar, starch, or fiber)
• Wear a continuous glucose monitoring device or check blood sugar with a finger stick multiple times per day
• Get regular physical activity 

Usually, you or your child will test their blood glucose before every meal, at bedtime, and occasionally during the middle of the night. But, you may need to check it more often if your child doesn’t have a continuous glucose monitor.

What are the health risks of type 1 diabetes?

Type 1 diabetes is a chronic condition – meaning that your child will be living with diabetes for their lifetime unless scientists find a cure. Not treating type 1 diabetes can cause both short-term (acute) health risks and longer-term (chronic) health problems. 

In the short term, uncontrolled type 1 diabetes can cause high blood sugar levels (hyperglycemia). Signs and symptoms of hyperglycemia in children are urinating (peeing a lot), feeling thirsty or having a dry mouth, blurred vision, and feeling tired, weak, or nauseous.

Without insulin delivering sugar to your child’s cells, their body may start to break down fats for energy instead. Breaking down fats produces ketones, resulting in a serious condition called ketoacidosis. Ketoacidosis needs to be treated with intravenous (medication through your child’s veins) insulin and fluids right away at the hospital. If your child is not treated right away, they are at risk for diabetic coma. Very high ketone levels in the blood can trigger brain swelling. Children can lose consciousness and go into a diabetic coma which can lead to death.

In the short term, if your child takes too much insulin, is more active than usual, or waits too long between meals, their blood sugar levels may fall too low (called hypoglycemia). Hypoglycemia can also be life-threatening. Common signs of hypoglycemia are pale skin, shakiness, hunger, sweating, difficulty concentrating or confusion, dizziness or lightheadedness, loss of coordination, and slurred speech. If your child’s blood sugar levels are dangerously low (their pump or your doctor will tell you their danger range), they need treatment immediately. Treatment involves getting them to eat high-sugar foods, drinks, or take medication as soon as possible.

High blood glucose levels over time can damage your child’s health and organ systems if not well controlled. Adults with poorly controlled type 1 diabetes have higher rates of heart disease, heart attacks, kidney disease, blindness, chronic nerve pain, skin and foot problems, tooth and gum issues, and osteoporosis (bone thinning). 

How can I support my child with type 1 diabetes?

Learning all you can about diabetes will help you better advocate for your child and teach the other people in your child’s life (teachers, grandparents, friends’ parents, coaches) how to help keep them safe and healthy. 

Adjusting to a new lifestyle of frequent appointments, carb counting, and emergency medication takes a village. You don’t have to take care of your child’s diabetes alone. Build a support team that will help you and your child so that you can minimize stress. Take comfort and direction from your child’s diabetes care plan, developed collaboratively with your diabetes care team. Scheduling regular visits with your child’s diabetes care professionals will help your child stay healthy as they grow and develop into an adult. Look for access through a patient portal or advocate so that you can get time-sensitive support when you need it. Discuss overnights with a partner so that you can alternate nights of interrupted sleep.

Your diabetes care team can refer you to family support groups so you can learn from other parents and caregivers in a similar situation to yours. Your child may also feel better if they can meet and get to know other peers with diabetes. It can be 

reassuring for children to see that they are not the only ones with diabetes.

As your child becomes more independent, you can help them learn to take more responsibility for caring for their diabetes. For example, children above the age of seven may be able to start giving them­selves insulin injections with supervision. They can also check their blood several times per day, using test strips and a blood sugar meter. Continuous monitoring and pumps are even easier to use and can be set up to allow parental oversight while giving children some independence 

Having a child with type 1 diabetes may sometimes seem overwhelming, but you’re not alone. You may be worried about your child’s safety, mourning the diagnosis, or dealing with the complexities of health insurance. It can feel like you need to know everything immediately, but this is totally new and it takes time to get used to. Give yourself a break and lean on those around you for help. 

Sources

“Diabetes in Children.” healthychildren.org. American Academy of Pediatrics. December 27, 2020. https://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Diabetes.aspx

“Diabetes in Teens and Children.” MedlinePlus.MedlinePlus. August 6, 2018. https://medlineplus.gov/diabetesinchildrenandteens.html

“Type 1 diabetes in children.” John’s Hopkins Medicine. John’s Hopkins Medicine. 2022. https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/type-1-diabetes-in-children

“Type 1 diabetes in children.” Mayo Clinic. Mayo Clinic. December 18, 2020. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes-in-children/symptoms-causes/syc-20355306

“What is Type 1 Diabetes?” Nemours Children’s Health. Nemours. September 2021. https://kidshealth.org/en/parents/type1.html

What causes chickenpox?

A virus called varicella zoster (VZV) causes chickenpox. The VZV virus can be spread through saliva, coughing, sneezing, and contact with fluid from the blisters.

What are the symptoms of chickenpox?

Most people don’t know their children have chickenpox until they see the itchy, red spots, usually starting on the back, belly, and face. People will be infected with the virus seven to 21 days before the rash and other symptoms develop. Your child can accidentally spread the chickenpox virus to others about 48 hours before the skin rash appears. Some of the earlier symptoms of varicella or chickenpox infection your child might have are:

• Fever (usually in the 101-102°F range)
• Headache
• Loss of appetite
• Sore throat

The rash appears in waves of bumps, blisters, and scabs throughout the infection. The rash may be very itchy until it scabs over with a crust. It may spread over more of your child’s body or be more severe if your child has a weak immune system or a skin disorder like eczema. Your child is still contagious until all the blisters have scabbed over. The chickenpox rash usually takes seven to 14 days to disappear completely.

What should I do if I think my child has chickenpox?

You should always call your pediatric care provider any time your child has an unexplained rash, especially if they also have cold symptoms or fever. Also, tell your OBGYN or midwife right away if you are pregnant and your child has chickenpox.

Most children with chickenpox will not need any additional treatment or medication to get better. However, your child must stay home from school and daycare to avoid spreading the virus. Children typically are able to return to normal activities within one to two weeks of diagnosis. Once chickenpox heals, most people become immune to the virus. VZV typically stays dormant (asleep) in a healthy person’s body.

Most chickenpox infections don’t need special medical treatment. But sometimes, problems can happen. Call your provider if your child:

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

How can I help my child feel better if they have chickenpox?

If your child has a headache, aches, pains, or fever when they have chickenpox, your pediatric provider may recommend giving them some acetaminophen (Tylenol) or less commonly, Ibuprofen (Advil). Never give aspirin to kids with chickenpox. It can lead to a serious illness called Reye’s syndrome.

Your doctor may prescribe antihistamine medications or topical ointments to help stop the rash from itching. There are also over-the-counter ointments and creams for itch relief. Other chickenpox rash treatment tricks are to:

• Give your child lukewarm oatmeal or baking soda baths 
• Apply unscented lotion, chilled in the refrigerator, or calamine lotion (not on the face near the eyes) to itchy areas
• Dress your child in lightweight, soft clothing to avoid triggering itching
• Trim and clean your child’s fingernails to prevent scabs or skin infections that can lead to skin scarring
• Have them wear mittens or socks on their hands at bedtime so that they don’t scratch their rash while asleep (permanent scarring is possible)

Depending on your child’s age and health, the extent of their infection, and where they are in the course of the virus, your pediatric provider may prescribe antiviral medicine for your child. If members of your household have been exposed and are not vaccinated, urgent vaccination may also be an option to discuss with your provider.

What are the risks of being infected?

Complications from chickenpox most often affect infants, older adults, people with weak immune systems, and pregnant women. According to the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), possible but rare complications from severe infections can include:

• Lung infection (pneumonia)
• Encephalitis (brain infection)
• Bleeding problems or bloodstream infections (sepsis)
• “Flesh-eating” bacterial infection
• Death

If a pregnant person is not immune to chickenpox (either because they have not been infected or they never received the vaccine) and gets infected, their unborn children may be at risk for:

• poor growth
• small head size
• eye problems
• intellectual disabilities

Is the chickenpox vaccine really necessary?

Yes. While most children in the U.S. survive chickenpox, about 1,400 people are hospitalized each year, and around 30 die of the illness. The chickenpox vaccine is highly effective at preventing the virus — if your child gets both recommended doses. They should get their first shot between 12 and 15 months of age and a second booster between 4 and 6 years of age. People 6 years of age and older who have never had chickenpox and aren’t vaccinated can and should get two “catch-up” doses of the vaccine.

Healthcare providers don’t recommend intentionally exposing your child to another child with chickenpox to avoid vaccination. First, there is no guarantee they will get the illness and develop immunity. Second, you won’t know whether your child will have a mild or severe case. No one can predict which child will have a life-threatening reaction to the disease. Vaccine immunity is protective and does not carry these risks. 

If your vaccinated child still gets chickenpox, their illness will be much milder. Vaccination reduces how many school days your child misses and cuts down on your days out of work. Additionally, kids vaccinated against chickenpox are much less likely to develop shingles when they get older. 

Is there a connection between chickenpox and shingles?

Yes. Remember how if you have had chickenpox, the virus that causes it (VZV) stays in your body without causing any symptoms? Shingles, an extremely painful series of blisters, is also triggered by VZV. The virus is sometimes reactivated in adulthood or when someone’s immune system is weakened. 

Fortunately, thanks to the chickenpox (varicella) vaccine, it is less likely that you will encounter chickenpox as a parent to a young child. Talk to your provider about any confusing childhood rashes and to make sense of routine childhood vaccines like varicella.

Sources

“Chickenpox.” Kids Health. Nemours. February 2020. https://kidshealth.org/en/parents/chicken-pox.html

“Chickenpox Vaccine: Frequently Asked Questions.” healthchildren.org. American Academy of Pediatrics. October 23, 2013. https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Chickenpox-Vaccine-Frequently-Asked-Questions.aspx

“Chickenpox.” Mayo Clinic. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chickenpox/symptoms-causes/syc-20351282

“About Chickenpox.” CDC. CDC. April 28, 2021. https://www.cdc.gov/chickenpox/index.html

What is meningitis?

Meningitis is an infection of the meninges, the membranes covering the brain and spine. Bacteria and viruses can infect the meninges. The bacteria and viruses that cause meningitis can live in the mouths and throats of healthy children. It doesn’t usually cause illness, so many people are exposed and never become ill.

Are there different kinds of meningitis?

Yes. Parasites, fungi, amoebas, bacteria, and viruses can all cause meningitis. Thanks to vaccines that protect people against bacterial meningitis, viral meningitis is the most common type of meningitis in the U.S. today. Fungal and parasitic meningitis are very rare, especially in children and adolescents. Viral meningitis is usually mild — most children and adults get better after 7 to 10 days without needing treatment. In rare cases, particularly for newborns and immunocompromised children, viral meningitis can be severe.

How risky is meningitis for children?

If untreated, meningitis, especially bacterial meningitis, can be life-threatening. Therefore, the faster a healthcare provider diagnoses and treats your child, the better off they are. What can be scary for parents is how quickly meningitis makes their children severely ill – some people can be near death in a few hours and about 10% of cases are fatal. People of all ages can get meningitis, but newborns, young children, adolescents, and people with weakened immune systems are at the greatest risk for serious illness.

Are some children at greater risk than others?

Yes. Infants under age one and adolescents generally have the highest rates of disease. There are some additional risk factors for children of any age, such as:

• Babies, especially those under two months of age
• Children with recurrent sinus infections
• Children with severe recent head injuries and skull fractures
• Children who have just had brain surgery
• Children with cochlear implants

What are the complications?

Some types of meningitis caused by bacteria can cause severe and lasting problems such as:

• Hearing loss
• Brain damage
• Seizures
• Paralysis of arms or legs
• Learning disabilities
• Limb loss by amputation

What are the symptoms in infants?

According to the U.S. Centers for Disease Control and Prevention (CDC), the most common childhood symptoms are:

• Fever
• Irritability
• Not feeding well
• Vomiting
• Sleeping too much
• Slow reflexes (not seeming alert)
• Constant crying
• A bulging fontanel (the soft spot on a baby’s head)
• Seizures, especially if they are running a fever
• Rash

Why are adolescents at risk?

Adolescents are at increased risk due to the way they live their lives – the bacteria causing meningitis can be easily spread in group settings, through saliva, kissing, and sharing drinks. In addition, infectious diseases tend to spread where large groups of people gather, and adolescents and young adults like to gather. For example, college campuses frequently have bacterial meningitis outbreaks. Despite their increased risk, many adolescents don’t get the meningococcal meningitis vaccines recommended at ages 11 and 16. 

What are the symptoms in older children and teens?

Early meningitis can seem like the flu, and symptoms may develop over hours or days. They include: 

• Fever
• Nausea and vomiting
• Irritability
• Back and neck pain or stiffness
• Headache
• Lethargy (feeling low-energy and tired)
• Sensitivity to light
• Rash
• Confusion
• Seizures

Is meningitis contagious?

Yes. The bacteria and viruses that cause meningitis can easily spread from person to person through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush, or a cigarette. Remember, though, only a small number of people who get infected with the bacteria or virus will develop meningitis. Babies younger than one year and adults with compromised immune systems (chronic health conditions or undergoing chemotherapy, for example) are more likely to develop severe meningitis.  Nevertheless, talk to your doctor if a family member or someone you live or work with has meningitis. You may need to take medications to prevent getting the infection.

Are there vaccines for children to prevent them from getting meningitis?

Yes. The Haemophilus influenza type-b (Hib vaccine) is to thank for reducing mortality rates in children younger than five. Therefore, the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend vaccinating all children older than two months with the Hib vaccine.

The WHO and CDC also advise vaccinating all children before age two with the Pneumococcal conjugate vaccine (PCV13) to protect against another type of bacterial meningitis. Talk to your pediatric care provider about additional vaccines if your child is at high risk because of medical or chronic health conditions such as heart or lung disease or cancer.

Two additional vaccines (MenB and MenACWY) protect against strains that typically infect adolescents. The CDC recommends these vaccines for all kids 11 to 12 years old, with a booster later at age 16. 

Don’t wait to call your pediatric care provider.

Meningitis is a serious illness that can become dangerous quickly. You can keep your child safe and healthy by ensuring all of their vaccines are up to date. It’s safe to get the meningitis-preventing vaccines at the same time as other vaccines at routine child health check-up appointments.

Beyond vaccination, trust your instincts about your child’s health. Contact your healthcare provider if you are worried that your child is not feeling well or not acting like themselves, especially if they are younger than two months old when the symptoms can be tricky to notice. When it comes to meningitis, sometimes, every minute counts. It is better to be safe and reassured that your child does not have meningitis than to delay treatment.

Sources

“Bacterial Meningitis.” CDC. CDC. July 15, 2021. https://www.cdc.gov/meningitis/bacterial.html

“Meningitis.” Mayo Clinic Press. Mayo Clinic Press. https://www.mayoclinic.org/diseases-conditions/meningitis/symptoms-causes/syc-20350508

“Meningitis in infants and children.” healthychildren.org. American Academy of Pediatrics. July 13, 2021. https://www.healthychildren.org/English/health-issues/conditions/head-neck-nervous-system/Pages/Meningitis.aspx

“Meningitis Won’t Wait. Help Stop the Clock. Sanofi Pasteur. 2021. https://www.helpstoptheclock.org/know-the-facts
“Viral Meningitis.” CDC. CDC. May 25, 2021. https://www.cdc.gov/meningitis/viral.html

What are lice?

Lice are tiny bugs (insects without wings) about the size of a sesame seed (2–3 millimeters long). Their bodies are usually pale and gray, but their color can vary. One of these tiny bugs is called a louse.

Lice are parasites which means they need human blood to survive. They can’t survive without their human host (you or your children) for longer than one to two days.

There are three kinds of lice – one that lives on your hair and scalp, a second type mostly found on the body, and then pubic lice, which infest pubic hair around the genitals and spread through sexual contact. Fortunately, each type tends to like a different part of the body. So while it is possible to spread lice from one part of the body to the other, it is rare. Because younger children typically only have hair on their heads, head lice are the most common kind of lice parents and caregivers will encounter, and they are what we’ll be talking about here.

How are nits different from lice?

Lice eggs are called nits. Lice lay and attach their eggs to hair strands close to the scalp with sticky glue in their saliva. Nits can be hard to see because they are very tiny — the size of a knot in sewing thread. They are oval and usually yellow or white-colored. Nits are easiest to spot around the ears and the nape (back) of the neck along the hairline. Nits can be mistaken for dandruff, but unlike dandruff, you can’t easily brush them out of your hair. After the eggs hatch, the empty egg shells stay on the hair shaft.

An adult female louse can lay up to 10 eggs a day. It takes 12 to 14 days for newly hatched eggs to reach adulthood and start reproducing. The cycle can repeat every three weeks if head lice are left untreated. As you can imagine, this would quickly lead to a very uncomfortable situation!

How do lice spread?

When your family is mid-lice infestation, it may feel like lice have magical spreading powers. In reality, they cannot fly, jump, or hop. Lice can only crawl through head-to-head or head-to-body contact when children, family members, or caregivers play or interact closely. Aside from close physical contact, lice and their eggs also spread when people share hair brushes, hats, scarves, sports helmets, clothing, or even headphones.

Less commonly, lice can crawl from one piece of clothing or bedding to another, for example, when hung up or stored side-by-side in lockers, closets, or on hooks. Lice can also spread between pillows, blankets, and stuffed toys when left close to one another. Because lice can live for 1 to 2 days off of the human body, it is possible to catch lice by sitting or lying on a bed or cloth-covered furniture recently used by someone with lice. Are you feeling creepy, crawly, or itchy yet?

How common are lice?

Very. Up to 12 million infestations happen annually in the U.S. among children three to 11 years old. Head lice are most common among preschool children attending daycare, elementary school children, and household members of children with lice. Head lice do not discriminate — they can infect any hair strand on anyone’s body. A lice infection has nothing to do with personal hygiene, lice do not prefer dirty or clean hair — they just want a blood meal. Lice infestations are more common in long hair and in Caucasian people. In addition, lice are more common in those with longer hair than in those with shorter hair.

Are lice harmful?

Not generally. Physically, lice are more of an annoyance and inconvenience than a threat to you or your child’s health. Head lice cannot transmit disease. Scratching can lead to small red bumps that can sometimes get infected with bacteria. Discomfort can interrupt sleep. Sometimes treatment with lice medications can cause skin sensitivities, redness, itching of the scalp, or stinging eyes if the medicine runs into the eyes, but treatment is always recommended because lice will not go away on their own, and they will multiply!

A lice infestation can be traumatic, causing increased family stress and emotional distress due to the stigma of lice. As any parent who has dealt with lice will tell you, a lice infestation can require significant time, effort, and resources to get under control. How painful is it to tell your young child that you can’t snuggle or cuddle with them until their lice are gone? Or that they can’t sleep with their beloved stuffie or blanket for two whole weeks while it has a sleepover in an airtight garbage bag?

It is helpful as a parent if you try to check some of your frustration or disgust with lice so that your sensitive child does not feel ashamed or guilty. Instead, it can be helpful to remind your child that lice love everyone, having lice is not anything to be embarrassed about and that having lice does not mean something is wrong with them or their family.

What are the symptoms of head lice?

Are you noticing your child scratching their head more often recently? Time to do a lice check because itching is the most common symptom of a lice infection in children. Don’t wait around — the more time the lice have to lay nits, the itchier you will be!

Remember, though, if your child only has a mild infection, they may not yet be itching. Also, it may take four to six weeks after lice get on the scalp before the scalp becomes sensitive to the lice’s saliva and begins to itch. Besides itching, the other symptoms you or your child might notice are:

• A tickling feeling from the movement of hair moved by crawling lice.
• The presence of lice or nits on your scalp, body, and clothing.
• Lice eggs (nits) on hair shafts. 
• Sores or scabs on the scalp, neck, and shoulders caused by scratching. 

Just to make things complicated, itching caused by head lice can last for weeks, even after the lice are gone. And a previous lice infestation does not prevent it from happening again, sadly some daycares and schools can get stuck in a tough cycle where lice is brought home again and again.

How do you check for lice?

Live lice are hard to find. They avoid light and move quickly. So instead, try looking for nits, especially along the hairline at the back of the neck and behind your child’s ears. Here are some other lice-hunting tips from the American Academy of Pediatrics:

• Seat your child in a brightly lit room or in direct sunlight outside
• Part their hair
• Look for crawling lice and nits on your child’s scalp one section at a time
• Use a fine-tooth comb (such as a louse or nit comb) to help you search the scalp section by section

If you’re unsure if your child has lice, ask their school nurse, healthcare provider, or local health department official to double-check for you.

How do you treat head lice?

There are commercial services that you can hire to comb nits out of your child’s hair. They are trained in exactly what to look for and how to remove the nits, but this is definitely something you can do yourself too. 

There are both over-the-counter and prescription medications for treating lice. Check with your child’s healthcare provider before beginning any head lice treatment because each medication and shampoo has certain risks and benefits — and some may not be suitable for children under 2. The most effective way to treat head lice is with a combination of head lice medicine and the comb-out method (explained in detail below). There are no studies showing that home remedies, such as petroleum jelly, mayonnaise, or margarine work to treat lice. It can be dangerous to use medications approved for animals or liquids like gasoline or kerosene. Do not use multiple lice medicine treatments at the same time.

Shampoos with a chemical called permethrin or pyrethrinare usually the first options for treating lice. They are both toxic to lice, but not nits. It’s important to read the instructions very carefully and follow them exactly. Don’t be surprised that you need to repeat the process after a certain number of days — this is to get lice at all stages of their lifespan and avoid treatment failure.

There are also many effective prescription medications, lotions, and shampoos. Your pediatric provider may recommend one of these as a first option, and it may even be less expensive than an over-the-counter shampoo if you have insurance coverage. It may also be less expensive to use a highly effective prescription medication once instead of possibly needing to re-treat if an over-the-counter shampoo doesn’t kill all of the lice and nits. Again, it’s really important to follow directions carefully and thoroughly no matter what you choose to use.

After each treatment with head lice medicine, try to use the comb-out method every 2 to 3 days for 2 to 3 weeks to help remove the nits and eggs. The comb-out-method, according to the American Academy of Pediatrics, is a four-step process:

• Step 1: Wet your child’s hair
• Step 2: Use a fine-tooth comb (louse or nit comb) and comb through your child’s hair in small sections
• Step 3: Wipe the comb on a wet paper towel after each comb-through; examine the scalp, comb, and paper towel carefully
• Step 4: Repeat steps 2 and 3 until you’ve combed through all of your child’s hair

Some healthcare providers recommend applying a conditioner or a mild soap such as Cetaphil to help the nit comb slide more easily through your child’s wet hair, but others believe that it makes the hair strand too slippery and that you might miss nits. If you are struggling with pain, tears, and long-hair tangles, a little extra “slip” could make the comb-out method less of a battle. Combination shampoo-conditioner lice treatment products are less effective than plain medicated lice shampoos and are therefore not recommended. Always wait to shampoo your child’s hair again until 24-48 hours (1-2 days) after a lice treatment. 

Be sure to follow these important safety guidelines when using over-the-counter and prescription chemical lice treatments:

• Follow the directions on the package exactly as written.
• Don’t put conditioner on before using the lice treatment. Conditioners can act as a barrier that keeps the head lice medicine from sticking to the hair shafts, reducing the effectiveness of the treatment.
• Never let children apply the medicine themselves.
• Always rinse off the medicine over a sink, not during a shower or bath. Try to keep the medicine from getting onto other skin areas.
• Never use a blow dryer after most treatments because they are flammable.
• Use warm (not hot) water to rinse off the medicine.
• Never place a plastic bag or shower cap on a child’s head.
• Do not leave a child alone with medicine in their hair as it can drip into their eyes.
• Store medicine in a safe place (a locked cabinet, out of sight and reach of children).
• Check with your child’s healthcare provider before beginning treatment or a second or third medicine. You may need to repeat the same medication or switch to a new one.

Annoyingly, several lice species are now resistant to commonly-used lice treatment medications. This makes it even more important to contact your provider for guidance and support.

Some nonprescription (available over-the-counter) products claim to repel lice and prevent them from crawling onto your child’s head. The FDA classifies lice-repellent products made from essential oils such as rosemary and tea tree oil as “natural.” The U.S. Food and Drug Administration (FDA) does not test the safety and effectiveness of so-called natural products. More research is needed to prove the safety and effectiveness of claims made by non-prescription lice-repellent shampoos and hair sprays.

If cost is an issue during treatment, there may be some unexpected and welcome resources from your pediatric provider, school nurse, or local public health department. Having lice (even more than once) is not your fault, and it’s okay to ask for support!

A viable option for some families is shaving hair. Lice and nits cannot survive without a friendly environment. While it’s not an option for some people, it is worth mentioning as an effective and inexpensive treatment strategy if members of your family already shave their heads.

How do you keep lice from spreading within my family?

You’ll want to wash your child’s clothes, towels, hats, and bed linens in hot water and dry them on high heat if they were used within two days before head lice were found and treated, according to the American Academy of Pediatrics. You don’t need to throw away clothing, helmets, or other personal items. Seal all things that can’t be washed in a washing machine in a plastic bag for two weeks or take them to be dry-cleaned. Head lice eggs (nits) cannot hatch and usually die within a week if they aren’t in conditions similar to those found close to the human scalp. Giving stuffies and blankets a plastic bag vacation will kill any lice that were already present, or that might hatch from any nits that may be present on the items. Wash all combs and brushes (especially the nit comb) in hot soapy water after use. Store them separately in a ziploc bag and check them for any signs of life before the next use.

According to the CDC, routine house cleaning (vacuuming of carpeting, rugs, furniture, car seats, and other fabric-covered items) and laundering of linens and clothing worn or used by the infested person will help to prevent lice from spreading within your household. Lice are unlikely to survive on hard surfaces. Fumigant spray and fogs can be toxic if inhaled or absorbed through the skin. They are not necessary to control head lice, according to the CDC. Do not spray pesticides or pay to fumigate your home because this can expose your family to unnecessary and dangerous chemicals.

Perhaps the hardest part of containing the spread is avoiding close contact. People with lice shouldn’t lay in other people’s beds, hug, or cuddle them. While this may be impossible to totally avoid, any reduction will reduce the likelihood of spread in your family.

Prevention is the best medicine for lice, so check all household members and close contacts for several weeks after the initial louse is found just to make sure – the last thing you want is to pass the lice back and forth to one another over and over.

Can you prevent lice?

Not entirely. So, first, take a deep breath and go easy on yourself. Just because you or your child have lice does not mean you are dirty or did something wrong. Unfortunately, it’s hard to prevent the spread of head lice among children in childcare and school settings.

That said, there are some steps you can take to minimize the chances you will have to do battle with lice during your family’s early childhood years. The Mayo Clinic suggests these lice prevention strategies:

1. Ask your child to avoid head-to-head contact with classmates during play and other activities.
2. Teach your child not to share hats, scarves, coats, combs, brushes, hair accessories, and headphones.
3. Tell your child to avoid hanging their clothing in shared spaces where hats and clothing from more than one student are hung (such as a shared hook, closet, or locker) if possible.

Regular checks for head lice are an excellent way to spot them before they have time to multiply and cause an infestation (when lice are present in large numbers). You can help your preschool-aged child get used to a nit comb (which can sometimes pull hair) and the process of looking for lice just like you helped them adjust to brushing their teeth. If your child has long hair and their school notified you about a classroom lice outbreak, consider having them wear their hair braided or pulled back under a hat to make it harder for lice to crawl onto their hair.

Does my child need to stay out of school or daycare if they have head lice?

No. Each childcare provider or school may have different policies regarding lice and preventing outbreaks. However, because head lice don’t cause serious health problems for children, the American Academy of Pediatrics and the National Association of School Nurses believe schools should not exclude children or make them miss school because they have head lice. As we all witnessed with the COVID-19 pandemic, exclusion from school can adversely affect students emotionally, socially, and academically.

Feeling any calmer about lice now that you know more?

Knowledge is power! Try not to let a sesame-seed-sized bug take away your power or drive you crazy. Having lice is stressful, overwhelming, and can be expensive. But you don’t have to battle lice alone. Ask your child’s provider if you have any questions or if treatments you have tried have not gotten rid of lice.

Reviewed by the Ovia Health Clinical Team

Sources

“Head lice management in schools”. National Association of School Nurses. National Association of School Nurses. June 2020. https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements/ps-head-lice

“Head lice: Treatment. Frequently asked questions”. CDC. CDC. September 17, 2020. https://www.cdc.gov/parasites/lice/head/gen_info/faqs_treat.html

“Lice.” Mayo Clinic. Mayo Clinic. June 30, 2022. https://www.mayoclinic.org/diseases-conditions/lice/symptoms-causes/syc-20374399

“No panic guide to the treatment of head lice”. Johns Hopkins Medicine.Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/no-panic-guide-to-head-lice-treatment

Nolt, D. “Head Lice: What parents need to know”. healthychildren.org. American Academy of Pediatrics. September 26, 2022. https://healthychildren.org/English/health-issues/conditions/from-insects-animals/Pages/Signs-of-Lice.aspx

“Parasites; Head lice; Epidemiology & Risk factors”. CDC. CDC. October 15, 2019. https://www.cdc.gov/parasites/lice/head/epi.html

What is asthma?

Asthma is a lung condition that makes breathing harder for your child. It affects the tubes that carry air in and out of your lungs. Asthma causes these tubes to become inflamed and narrowed. It can cause wheezing, coughing, and chest tightness. Childhood asthma is not a different disease from adult asthma. The most common symptoms of asthma are:

• Coughing
• Wheezing, a high-pitched, whistle-like sound when exhaling
• Trouble breathing or shortness of breath
• A tight, uncomfortable feeling in the chest
• Worsening of symptoms at night
• Seasonal changes in asthma symptoms based on more cold/flu infections or allergy triggers

What causes asthma?

The exact cause of asthma is not yet known. However, certain risk factors make it more likely that a child will develop asthma.

• Genetics. Asthma runs in families.
• Allergies. If you or your child have allergies (which can also run in families), your child may be more likely to get asthma.
• Lung infections. Infections of the respiratory tract as an infant or young child are linked to childhood asthma.
• Environment. Exposure to allergens, certain irritants, or viral infections as an infant or in early childhood when the immune system isn’t fully developed may play a role in asthma.
• Exposure to smoking during pregnancy or infancy

What triggers my child’s asthma attacks?

Every child’s triggers for an asthma attack are different and your healthcare team will help you identify some possible triggers and then you and your child can look for patterns. The most common triggers for asthma attacks are:

• Allergens such as cats, dogs, pollen, mold, and dust mites
• Cigarette smoke (including second and third-hand exposure), scented products, and cleaning chemicals
• Respiratory infections such as colds, RSV, influenza (flu), or COVID-19
• Emotional stress, such as intense anger, crying, or laughing
• Physical activity, although with treatment, your child should still be able to be active
• Certain medicines, such as aspirin, may cause serious breathing problems in people with severe asthma
• Poor air quality (air pollution) or very cold air
• Insect bites, commonly bees
• Stress from life events

What are the treatments for childhood asthma?

There are various treatments to help your child feel better and thrive. Asthma can be disruptive, but there are ways to manage it depending on severity. Some children with mild asthma do not need to take any medications. In addition, making your house asthma-safe (KidsHealth and the AAP have some great tips) and practicing good hand washing can help you avoid colds and infections, which can go a long way towards preventing asthma flare-ups.

Some children need to take daily medication to treat asthma. Asthma medications come in pill form, inhalers that help your child inhale the medicine into their lungs, and liquid medications that go in a nebulizer for younger children to breathe into their lungs. Quick-relief or rescue inhalers treat asthma symptoms during an attack. Your child should have their rescue inhaler with them at all times.

Can childhood asthma be cured?

No. There is currently no cure for children with asthma. Asthma is a life-long disease. Children do not outgrow asthma, but they have fewer symptoms as they grow into teenagers and adults. Younger children (younger than 6) often wheeze when they have colds, even though they don’t have asthma. This can sometimes lead to confusion about whether a child had asthma in the first place and whether or not they outgrew it.

How can an Asthma Action Plan make my child’s life with asthma better?

An asthma action plan is a personalized plan to help you and your child prevent asthma emergencies by preventing and controlling flare-ups. The asthma action plan follows the traffic light model: green means go, red means stop, and yellow means proceed with caution.

You can download and complete an asthma action plan for your child, or your healthcare provider will make one with you. Share your child’s asthma action plan with their school and anyone who cares for your child so that everyone is on the same page.

While it can seem like a lot of work at first, keeping track of your child’s peak flow values, symptoms, and medications action plans help keep your child healthier and make life with childhood asthma easier. Childhood asthma is a leading cause of emergency department visits, hospitalizations, and missed school days, but it doesn’t have to be. By tracking their symptoms and knowing when they might be entering the “yellow” or caution zone in the traffic light model, you can be prepared to add additional medicines to help relieve their symptoms. Following their asthma action plan will limit and even prevent how many severe attacks your child has – keeping them out of the doctor or nurse’s office, letting them stay in the game or class, and avoiding costly and stressful emergency room visits.

Sources

“Asthma Action Plans”.CDC.CDC. May 2, 2022. https://www.cdc.gov/asthma/actionplan.html

“Asthma in Children.” National Heart, Lung, and Blood Institute. NIH. March 24, 2022. https://www.nhlbi.nih.gov/health/asthma/children

“Asthma-Parents” CDC. CDC. April 24, 2009.https://www.cdc.gov/asthma/parents.html

“Childhood Asthma.” Mayo Clinic. Mayo Clinic. March 13, 2021. https://www.mayoclinic.org/diseases-conditions/childhood-asthma/symptoms-causes/syc-20351507.

“Do Children Outgrow Asthma?” United States Environmental Protection Agency. EPA. April 7, 2022. https://www.epa.gov/asthma/do-children-outgrow-asthma

“Treatment of asthma in children younger than 5.” Mayo Clinic. Mayo Clinic. February 23, 2022. https://www.mayoclinic.org/diseases-conditions/childhood-asthma/in-depth/asthma-in-children/art-20044376

“What Causes Asthma?” American Lung Association. American Lung Association. October 23, 2020. https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/asthma-symptoms-causes-risk-factors/what-causes-asthma.

Razdan, Sheila. “What is an Asthma Action Plan?” Healthychildren.org. Healthychildren.org. January 19, 2021. https://www.healthychildren.org/English/health-issues/conditions/allergies-asthma/Pages/What-is-an-Asthma-Action-Plan.aspx

“What is Asthma?” National Heart, Lung, and Blood Institute. NIH. March 24, 2022. https://www.nhlbi.nih.gov/health/asthma

“Your House: How to Make it Asthma Safe.” KidsHealth. KidsHealth. https://kidshealth.org/en/kids/house-asthma.html