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The Essential Guide to Your Child's Health

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When we decided to put together a comprehensive children's health handbook, we knew right away that we wanted to team up with the experts at the American Academy of Pediatrics (AAP) -- the most trusted and respected group of pediatricians in the country. The result: A guide that you can print out and refer to over and over again. From food allergies to fever facts to first aid, here's the latest news you need to keep your kids safe, healthy, and happy.

SIDS Safety

Sudden infant death syndrome (SIDS) is the number-one cause of death in infants 1 to 2 months old. Doctors aren't exactly sure what causes SIDS, but these key steps can minimize your child's risk.

  1. Put her to sleep on her back. Why is stomach sleeping so dangerous? Researchers think that when a child sleeps facedown, she runs the risk of rebreathing her own exhaled air, which contains potentially toxic carbon dioxide. In addition, experts believe that in a SIDS baby, the area of the brain that's responsible for arousal and respiration is underdeveloped -- meaning she's unable to wake herself up and gulp fresh air.
  2. Keep his crib safe. It should have a firm mattress and be free of blankets, pillows, and stuffed animals. Because overheating makes arousal more difficult, the AAP also recommends that you don't overdress your baby for bed or keep his bedroom too warm.
  3. Don't cosleep. Your baby may be suffocated by blankets or entrapped in bed slats; if you're a deep sleeper or have consumed alcohol or taken any medication, you could also roll onto her by accident.
  4. Reduce your baby's exposure to tobacco smoke -- in utero and after birth. Experts believe that a smoke byproduct may be responsible for that underdevelopment of the brain area that keeps babies from waking up. Mothers who smoke cigarettes during pregnancy double their baby's risk of SIDS.
  5. Get the word out. Make sure grandparents, babysitters, and day-care providers follow all these recommendations.

    -Source: John Kattwinkel, M.D., a University of Virginia neonatologist and chair of the AAP's Task Force on SIDS.

Fever Facts

When your child's temperature spikes, will you know how to control his fever? Answer these questions to find out.

1. True or false: Every fever needs to be treated.

*False. Fever is the body's response to infection. If you try to quell every fever, you may be inhibiting a natural, helpful, disease-fighting mechanism. As long as your child is eating, drinking, and playing, there's no reason to medicate her. If, on the other hand, she's lethargic or has a history of febrile seizures, then you need to give her a pain reliever.

2. Call the doctor when your child's fever goes above:

a. 100?F.

b. 103?F.

c. It depends on your child's age and symptoms.

*C. Seek immediate medical help for any baby under 3 months of age with a rectal temperature above 100.2?F. Call the doctor if your baby is between 3 and 6 months and has a temperature of 101? or greater. In children 6 months and older, a temperature of 103? or higher is cause for alarm. High fevers in young children can signal serious infections.

3. The most accurate way to take a baby's temperature is:

a. Orally.

b. Rectally.

c. Under the arm.

d. With an ear thermometer.

*B. A rectal reading is closest to the body's core temperature.

4. The best drug to bring down a fever is:

a. Aspirin.

b. Acetaminophen.

c. Ibuprofen.

d. Either acetaminophen or ibuprofen.

e. Alternating doses of acetaminophen and ibuprofen.

*D. Both acetaminophen and ibuprofen are highly effective fever reducers, although you shouldn't give ibuprofen to children under 6 months of age. Alternating the drugs isn't recommended. And never give aspirin to children, because of its association with Reye's syndrome, a potentially fatal disease.
Source: Robert Walker, M.D., a member of the AAP's Committee on Practice and Ambulatory Medicine.

6 Ways to Fat-Proof Your Child

Fifteen percent of kids in this country are overweight -- more than double the number 20 years ago. We asked the experts for the skinny on helping your child fight flab.

  1. Breastfeed. Studies have shown that kids who are breastfed are leaner than kids who are bottle-fed, says Reginald Washington, M.D., a Denver pediatric cardiologist and cochair of the AAP's Task Force on Obesity.
  2. Watch for dramatic, early weight gains. In one recent study, researchers found that rapid weight gain in the first four months of life was associated with an increased risk of being overweight at age 7. "A lot of people like to think of it as baby fat," Dr. Washington says. "But we're learning now that baby fat generally doesn't disappear."
  3. Get to an ideal weight yourself. Young children of an obese mother are three times more likely than those with a lean mom to become obese adults; the odds jump to ten times when both parents are obese. While you can't control genetics, you can set a good example. Cook nutritious meals, limit junk food, and encourage physical activity -- for the entire household.
  4. Restrict your toddler's fat intake. When she's 2, switch her from whole milk and high-fat dairy products to lower-fat varieties. "We know now that if you have a heart attack at 40, your cholesterol may have been building up since age 5," Dr. Washington says.
  5. Limit screen time. It's a no-brainer: When your child is hunkered down in front of a TV or glued to a computer or video game, he isn't being physically active. Research shows that kids who watch four or more hours of TV a day have more body fat and a greater body-mass index than those who watch less than two hours a day. The AAP recommends limiting screen time to two hours a day or less.
  6. Cut back on fruit juice. It's the drink of choice for many children -- but juice is high in calories and low in nutrients. The AAP suggests that you restrict a young child's juice consumption to six or fewer ounces a day.

Be Smart About Snacks

Because they can't eat large quantities at one sitting, toddlers and young kids need to consume up to one third of their calories from high-energy snacks like fruit, milk, yogurt, and cheese. What if your kid clamors for chocolate-chip cookies, not cheddar? "If your child is not overweight, has a healthy diet, and eats a variety of foods, then an occasional cookie is fine," says Fima Lifshitz, M.D., a member of the AAP's Committee on Nutrition. For smart serving suggestions, see our guide below.

Good for Every Day
Whole-wheat crackers, unsweetened cereal, cut-up vegetables, fresh fruit, dried fruit, string cheese, peanut butter, yogurt, breadsticks.

Fine 3 or 4 Times a Week
Animal crackers, pretzels, popcorn, snack crackers, granola bars, ice pops, pudding, frozen pizza, frozen yogurt, bagels, vanilla wafers.

Only as a Special Treat
Candy, chocolate, cheese puffs, potato chips, taco chips, cookies, toaster pastries, cupcakes, snack cakes, doughnuts, french fries, soda.

Health Habits to Make and Break

Good Habits

  • Buckling up your children. According to the National Highway Traffic Safety Administration, 30 kids die and more than 5,000 are injured every week in automobile crashes. Use an appropriate car seat for your child (rear-facing for infants; forward-facing for toddlers; booster seats starting at 40 pounds and up until your child is 8 years old or 4'9"). And always put kids 12 and under in the backseat.
  • Teaching your kids how to swim. Drowning is the second leading cause of injury-related death among kids ages 1 to 14. It's crucial to sign up your child for a water-safety class when he turns 4. At the very least, kids should be able to swim to the side in case they fall into a pool or a stream.
  • Having your kids wash their hands frequently. "It's the number-one way to control disease," says Norman Harbaugh, M.D., of the AAP's Committee on Practice and Ambulatory Medicine. Make sure they suds up when they come in from playing, after using the bathroom, before they sit down for a meal, and before they go to bed.

Bad Habits

  • Putting them to bed too late. School-age children should get between nine and 12 hours of sleep a night. Anything less and they'll be tired and irritable and have difficulty concentrating.
  • Scrimping on sunscreen. Now is the time to start protecting your child against skin cancer. The AAP recommends you slather your kids with SPF 15 or higher sunscreen every day. Reapply every two hours, and after swimming or sweating.
  • Letting kids ride without helmets. Your child will reduce her risk of head injury by 85 percent if she wears a helmet when she in-line skates or rides her bike, scooter, or skateboard.

Get a Move On!

Your kids should get some sort of exercise every day. Here are three easy ways to keep them active.

  1. Make it a family thing. Exercise is always more fun when you do it with a buddy. Start a tradition of after-dinner walks, visit the Y on family swim night, or take the gang to the bowling alley instead of the movies on Saturday afternoons.
  2. Let them sample sports. The more you allow your child to try a variety of activities -- soccer, baseball, hockey, tennis -- the more likely she is to hit on one she likes and is good at.
  3. Think beyond teams. Unless they're star athletes and playing most of the game, a lot of kids in organized sports get only a few minutes of heart-pumping activity at a time -- not enough to really increase overall fitness. Whether they wear a uniform or not, encourage your kids to be active -- shoot hoops with them, or have them walk the dog with you each morning.

Doctor-Approved Home Remedies

Cuts and Scrapes
Treatment: Gently clean the wound with water to remove debris, and pat dry. To stop bleeding, apply continuous pressure for five minutes. Use an antibacterial ointment on the wound, and cover with a bandage.
Call Your Doctor If: The wound is a more than a quarter inch deep or an inch long, is gaping open, or is on the face.

Itchy Bug Bites
Treatment: Reduce skin irritation with calamine lotion or an oral or topical antihistamine.
Call Your Doctor If: The red area is bigger than a golf ball and has a black center or the bite grows larger over a period of several days. "In that case, it could be the bite of a brown recluse spider, which is more toxic than other spiders," Dr. Harbaugh says.

Burns
Treatment: Cool superficial burns with cold water -- not ice, which can damage tissue. Pat dry, and apply a sterile bandage. "Don't pop blisters; this can introduce bacteria," says AAP member Norman Harbaugh, M.D., an Atlanta pediatrician. "That blister is acting as the skin's own bandage."
Go to the E.R. If: The burned area has many blisters; skin is white or charred; there's considerable pain and swelling; the burned area is large; the burn was caused by chemicals or electricity; or the burn is on the hands or face.

Bee Stings
Treatment: Scrape out the stinger from the side using something with a flat edge, like a credit card. Wash the area to remove venom, and run the wound under cold water if swelling develops. For itching or irritation, use an oral or topical antihistamine or a hydrocortisone cream.
Go to the E.R. If: Your child has a severe allergic reaction -- for instance, she has trouble breathing or her throat swells up.

What You Need to Know About Food Allergies

Food allergies affect up to 8 percent of kids younger than 3. Before you give your toddler that PB&J sandwich, read on.

My 18-month-old gets a few hives on his face when I give him eggs, but it's not a severe reaction. Should I keep feeding him eggs?
It's not a good move. "Giving a child more of a food that's causing a reaction cannot desensitize him to that food," says Michael Welch, M.D., chair of the AAP's Section on Allergy and Immunology. "In fact, it may put him at greater risk for a more severe response. It's a better idea to stop giving eggs to your child and reintroduce them in six to 12 months to see whether he can handle them better."

When my 3-year-old drinks milk, he gets a stomachache. Does that mean he's allergic?
Not necessarily. Stomach upset is a symptom of both a milk allergy and a milk intolerance. An allergy involves the immune system, so there will usually be other symptoms such as wheezing or a rash; an intolerance is simply a gastrointestinal reaction. For an intolerance, drinking milk with food can help alleviate symptoms.

I grew up eating peanut butter, but I'm afraid to give it to my 2-year-old. Am I just being neurotic?
Not at all. Peanut allergies can be severe, so you're smart to be cautious. If your child has a sibling with a peanut allergy or you have a family history of food allergies, eczema, asthma, or hay fever, wait until your child is 3 to give her peanut butter and other peanut products. If there's no history of allergy, it's fine to introduce peanut butter after she turns 2.

Do kids outgrow food allergies?
It depends. Peanut allergies are usually not outgrown. But milk and egg allergies typically are, Dr. Welch says.

More Than Just a Bad Mood?

According to the National Institute of Mental Health, 21 percent of U.S. kids ages 9 to 17 suffer from some mental or addictive disorder -- and problems often start when children are much younger. We asked the experts to define the common mental-health disorders in kids and to point out the red flags parents can't ignore.

Anxiety
Anxiety disorders, such as generalized anxiety, social phobia, and obsessive-compulsive disorder, are the most common mental illnesses that affect children.
Red Flags: Different disorders have different symptoms. With generalized anxiety disorder, for example, you may notice your child worrying excessively over everyday events. A kid with social anxiety may have difficulty going to birthday parties. While worry is unavoidable, your child has a more serious problem if anxiety is impairing her life -- for example, she's so nervous and uncomfortable at school that she isn't making friends or performing well.

Depression
Six percent of kids suffer from depression, a disorder characterized by moodiness, sadness, and irritability.
Red Flags: Social or behavioral changes that occur every day for two weeks are top warning signals. For example, a once-outgoing kid may become introverted; an easygoing child may act increasingly prickly and argumentative. You may also notice problems in school, exhaustion, lack of concentration, and frequent headaches and stomachaches.

Autism
Autism is a neurologically based brain disorder affecting 1 in 500 American children. It usually impacts a child's ability to communicate and respond appropriately to the outside world.
Red Flags: Early signs are delayed speech development, inappropriate use of language, inability to communicate nonverbally, lack of social interaction, and an obsession with routines.

ADHD
Up to four percent of kids suffer from attention deficit hyperactivity disorder -- an umbrella term used to describe different types of attention and behavior problems.
Red Flags: Signs of trouble include a chronic inability to sit still, focus, or control impulses in a variety of settings, not just school. The typical kid with ADHD may struggle academically, take an inordinate amount of time to do homework, lose belongings, or forget to do things he's been asked to do.

Protect Your Child From Environmental Hazards

We asked the experts for pointers on what to watch out for -- and tips on how to prevent problems before they happen.

Tobacco Smoke
What It Does: Children born to mothers who smoke are more likely to be born premature and have low birth weights. Prenatal exposure -- even if it's to secondhand smoke -- also increases the risk of later developmental and behavioral problems. Kids who breathe in tobacco smoke have a higher incidence of SIDS and have more ear infections and respiratory problems, such as asthma.
Where It's Found: Wherever people smoke.
Safety Tips: If you or your spouse smokes, quit today. Make sure babysitters and day-care providers don't light up either, and never allow anyone to smoke in your home or car.

Lead
What It Does: Depending on the exposure level, lead can produce anything from minor neurological damage, such as learning problems, to death. No levels are safe, but acute exposure usually shows up as extreme sleepiness and irritability.
Where It's Found: Mostly in homes built before 1978. Babies and toddlers ingest lead by swallowing peeling paint (sometimes just opening windows causes tiny paint chips and dust to fall off).
Safety Tips: Have your home tested. If you're renovating an old house, move your family out until the work is finished. Wash your child's hands frequently.

Mold
What It Does: Because the spores are very small, they enter the air and then the lungs easily, causing irritation. The most common reaction: respiratory infections and breathing problems.
Where It's Found: In humid climates, damp places (like a basement or bathroom), and rooms with wet carpeting.
Safety Tips: If your basement floods, get the water out immediately. (Clean up with an antimold chemical.) And while you can dry out a wet carpet, it's virtually impossible to dry the pad underneath, so you'll need to replace it.

Mercury
What It Does: Small amounts usually have no effect. But chronic mercury exposure manifests itself with subtle neurological changes, like a loss of IQ and poor hand-eye coordination. In large doses, it can be fatal.
Where It's Found: The primary sources of mercury exposure for kids are swordfish, tilefish, king mackerel, tuna steak, and skate.
Safety Tips: Give your children steak fish just occasionally (though it's fine to serve canned tuna several times a week).
What You Don't Have to Worry About: thimerisol, a mercury used in vaccines. Since 1999, manufacturers have removed thimerisol from vaccines.
-Source: Dana Best, M.D., M.P.H., member of the AAP's Committee on Environmental Health.

Strides in Kids' Health

Incredible advances have been made in the area of kids' health and safety. Here, six that have improved your child's life.

  1. Fewer babies are dying of SIDS. Since 1992, when the AAP first recommended that babies be placed on their backs to sleep, the SIDS rate has dropped 40 percent.
  2. More vaccines are protecting more kids. Since the varicella vaccine was introduced in 1995, the rate of chicken pox -- a disease that affects some 4 million people a year -- is down 87 percent. The Hib vaccine -- launched in 1985 -- has made infection with haemophilus influenzae Type B, a bacterium that can cause meningitis and facial and brain abscesses, virtually nonexistent. And the recently approved pneumococcal vaccine has put a serious dent in the number of cases of pneumonia and meningitis.
  3. Preemies have a better chance of survival. At the University of California/San Francisco Children's Hospital, for example, babies weighing 3.3 pounds had a three-in-four chance of death or serious impairment 30 years ago. Today, they have a 98 percent survival rate and a nine-in-ten chance of growing up without neurological problems.
  4. Certain birth defects can be prevented. Since 1992, women of childbearing age have been encouraged to consume 400 micrograms of folic acid a day, which can decrease the risk of neural-tube defects, including spina bifida, in their babies by up to 70 percent.
  5. Booster seats are saving lives. A decade ago, belt-positioning booster seats for children 4 and older were not even available. Today, booster use continues to rise (up to 20 percent of kids ride in them now), thanks in part to laws that have been passed in 22 states and Washington, D.C. Using a booster instead of just a seat belt alone reduces a child's risk of injury in a crash by 59 percent.
  6. Treating childhood diabetes is easier. Multiple insulin injections every day used to be the only option for kids with diabetes. Today, they can use a pump -- a beeper-size device that feeds low levels of insulin through a tiny needle inserted under the skin.

Copyright © 2004 Donna Christiano. Reprinted with permission of Parents Magazine May 2004 issue.