Kids' Page

Introduction
Immunizations
Injections
Common Illnesses
School-age physicals

People who care (parents, doctors, teachers, and others) want to know how to help kids be more fit. Being fit is a way of saying a person eats well, gets a lot of physical activity (exercise), and has a healthy weight. If you're fit, your body works well, feels good, and can do all the things you want to do, like run around with your friends.

Immunizations are one of the best ways to protect children from a multitude of serious diseases. Children in the United States routinely get vaccines that protect them from more than a dozen diseases. Some vaccines are given in combination with others. Most vaccines require multiple doses given at various intervals.

The majority of vaccines protect against serious, potentially fatal diseases that are most likely to occur when children are very young. And the immune systems of infants are still developing and may need help fighting serious infection. If we wait until the child is older, we may return to an era of high infant mortality - and many children may never reach school age.

Each state has its own immunization requirements that must be met before your child can enter school. You may need proof - such as an immunization record obtained from your doctor's office - at the time of school registration. Your local school system can inform you about relevant state laws. Most states have religious-exception clauses if your faith prohibits immunization.

For most vaccine-preventable diseases, immunity from the vaccine is as strong as immunity following the natural disease. Furthermore, vaccines can be administered without risk of the serious effects of disease, which might include permanent disability and even death.

Few circumstances require that immunizations be postponed or avoided. If your child has a serious illness, it may be important to wait until he or she has recovered before receiving certain vaccines. The common cold or an ear infection isn't a reason to avoid or defer immunization. If a child developed a life-threatening reaction to a particular vaccine, further doses of that vaccine would not be given.

Your child may be able to perceive any fears that you have, so try to stay calm and relaxed. Hold your child and talk with him or her during the shot.

To minimize discomfort, you can give your child acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) before or after a shot. Follow the label instructions for the correct dose. You can also use an ice pack on the injection site to reduce redness and swelling.

Vaccine side effects may be different for each particular immunization, but they fall into two general categories: Common but not serious and rare but serious.

Common side effects include:

• Low-grade fever
• Soreness at the injection site

In rare circumstances, a child may experience:

• Serious allergic reactions (anaphylaxis)
• Neurological side effects

However, for healthy children, the benefits of vaccine protection far outweigh these rare risks of vaccination.

Most babies and toddlers receive up to 20 shots by their second birthday, and kids with health conditions such as allergies, asthma or diabetes have far more experiences with needles and doctors. It's no surprise that needle sticks and shots are the things kids often fear most when they need to see the doctor.

Many kids are so scared of shots that they become highly distressed the moment they see a needle. Once your child is all worked up, he or she is unlikely to calm down before the injection. You can anticipate your child's distress and take steps to reduce it before you even reach the doctor's office.

Perhaps the most important thing you can do is to stay calm and collected. Although babies can't talk, they do sense fear and anxiety, especially in their parents. Your anxiety fuels your baby's insecurity and fear. If you feel yourself becoming anxious, take deep breaths and relax your muscles.

Other strategies include:

• Bring a familiar and soothing object. Your baby's favorite stuffed animal or blanket will serve as a comforting distraction.
• Hold and talk to your child during a shot. Comfort your baby with hugs and caresses. Your voice also helps your baby feel secure, so softly sing a familiar song or whisper reassuring words.
• Offer a pacifier or bottle.

Once children can talk, you can explain how shots protect them. Because shots hurt, children often assume they are harmful or even a form of punishment. Make sure your child understands that needles are the only way to get certain medicine inside the body to prevent illness. Never let your child talk his or her way out of getting a shot.

Be honest and tell your child that the shot will probably hurt. Compare the pain to that of a mosquito bite, and emphasize that it will probably last only a few seconds.

Children who know that they're going to get a shot generally do much better than children who aren't told in advance. Wait until the day of the appointment to mention the shot. If you bring it up days before the event, your child may worry obsessively about it. It's even OK to share the information right before you go into the doctor's office.

If you promise your child there will be no shots and then learn during the visit that one is needed, you've created a conflict. Instead say, "The doctor will tell us, but I am not aware of any needed shots."

Reading aloud, talking or watching a video are all good waiting-room distractions. Just before the injection, you might ask your child to:

• Take a deep breath and blow during the injection. Some parents even provide a party noisemaker.
• Count out loud during the shot - you might say "by the time you count to five, the shot will likely be done."
• Squeeze your hand as hard as the shot hurts.

Some shots, particularly immunizations, cause minor, temporary side effects, such as a mild fever or sore arm. To minimize these effects, you can give your child acetaminophen (Tylenol, others) before or after a shot. Follow the label instructions for the correct dose.

You can also use an ice pack on the injection site to reduce redness and swelling. If you're concerned that your child might be having a serious reaction related to an immunization, contact your doctor as soon as possible or seek emergency care.

Most people, regardless of age, don't like to get shots. Adults typically submit to injections because they realize the benefit of the medication is worth the tiny prick of pain. With your help, your children will learn how to do this, too.

Common cold is an infection of your upper respiratory tract. It's relatively harmless - but it usually doesn't feel that way. If it's not a runny nose, sore throat and cough, it's watery eyes, sneezing and congestion. Or maybe all of the above. In fact, because any one of more than 200 viruses can cause a common cold, symptoms tend to vary greatly.

Unfortunately, if you're like most adults, you're likely to have a common cold two to four times a year. Children, especially preschoolers, may have a common cold as many as eight to 10 times annually.

The good news is that you or your child should be feeling better in about a week or so. If symptoms of a common cold aren't improving in that time, see your doctor to make sure you don't have a bacterial infection in your lungs, sinuses or ears.

Croup has an unmistakable sound - a harsh, repetitive cough similar to the noise of a seal barking. Attacks of croup often jar children awake and leave them frightened and gasping for breath. Croup can be scary for parents, too, but it's usually not serious. At its worst, croup can be treated in the doctor's office most of the time.

The harsh, barking cough is the result of swelling around the vocal cords (larynx) and windpipe (trachea). When the cough reflex forces air through this narrowed passage, the vocal cords vibrate with a barking noise. Because children have small airways to begin with, those younger than age 5 are most susceptible to croup.

Fluids, moist air and other self-care measures can speed recovery from croup. If you stay calm, you can quiet your child's cough so that everyone can get back to sleep.

Ear infections are among the most common illnesses of early childhood. Three out of four children have had at least one ear infection by age 3, according to the National Institute on Deafness and Other Communication Disorders.

The medical term for middle ear infections is otitis media. Otitis refers to inflammation of the ear, and media means middle.

Although ear infections worry parents and make children uncomfortable, take heart. Most ear infections clear up on their own within a few days, and most children stop having ear infections once they reach school age.

Childhood asthma has become more widespread in recent decades. As the most common chronic illness in children, childhood asthma causes more missed school and places more limits on activity than any other disease.

Childhood asthma and adult asthma have the same underlying cause - continuous inflammation of the airways leading to the lungs. This inflammation makes the airways overly sensitive and prone to tightening and constricting when irritated. Fortunately, childhood asthma is treatable. With the right medications and action plan, a child with asthma can enjoy normal activities with few disruptions.

Diabetes

Type 1 diabetes in children presents special challenges for parents and children alike.

Type 1 diabetes - once known as juvenile diabetes - is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to convert sugar (glucose) into energy. Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence.

Various factors may contribute to type 1 diabetes in children, including genetics and exposure to certain viruses. Although type 1 diabetes requires consistent care, advances in blood sugar monitoring and insulin delivery have simplified the daily routine of managing type 1 diabetes in children. With proper treatment, children who have type 1 diabetes can expect to live long, healthy lives.

Type 2 diabetes is a similar condition in which a child's body becomes resistant to the effects of insulin or when a child's body produces some, but not enough, insulin to maintain a normal blood sugar level. Type 2 diabetes was once a condition confined to adults. But type 2 diabetes in children is on the rise, fueled largely by the current obesity epidemic. This increasingly common condition presents special challenges for parents and children alike.

Type 2 diabetes is a chronic condition that affects the way the body metabolizes sugar (glucose). Type 2 diabetes in children develops when a child's body becomes resistant to the effects of insulin - a hormone that regulates the absorption of sugar into cells - or when a child's pancreas produces some, but not enough, insulin to maintain a normal blood sugar level. Prediabetes, a precursor to type 2 diabetes, also is a concern. Left untreated, prediabetes can progress to type 2 diabetes.

Influenza - Millions of people, including 500,000 Americans, died in the 1918 influenza pandemic. Today, according to the Centers for Disease Control and Prevention, as many as 36,000 Americans die each year of complications of influenza and more than 200,000 are hospitalized.

Influenza is a viral infection that attacks the respiratory system, including your nose, throat, bronchial tubes and lungs. Although it's commonly called the flu, influenza is not the same as the stomach virus that causes diarrhea and vomiting.

Anyone can get the flu, but young children, older adults, people with weakened immune systems and those with chronic illnesses are especially vulnerable. If you're at high risk of flu, your first line of defense is an annual flu shot. Although the shot doesn't offer 100 percent protection, it can reduce your chance of infection and help prevent serious complications if you do get sick.

Tonsils are recognized for their role in filtering harmful bacteria and viruses that could cause more serious infections. When tonsillitis strikes, the first line of treatment is typically self-care or antibiotics. Surgery is seldom necessary, unless tonsillitis recurs often or it interferes with breathing or swallowing.

Sore throats - The dry scratchiness and painful swallowing that are the hallmarks of a sore throat - known medically as pharyngitis - can be miserable. Yet a sore throat isn't a disease. Most often, it's a symptom of another illness - usually a viral infection such as a cold or the flu (influenza). In many cases, a sore throat is the first indication that you're getting sick.

Sore throats are so common they're one of the main reasons Americans see a doctor. But many of those office visits aren't necessary. Most sore throats are caused by a virus and go away on their own in about a week. Only a small percentage are bacterial infections that may require medical care.

Bacterial infections are sometimes treated with antibiotics, although drugs don't always speed healing or prevent infections from recurring. And antibiotics aren't effective against viruses, which respond best to self-care measures such as resting and drinking plenty of fluids. Until you're feeling better, salt-water gargles, throat lozenges or warm water with honey and lemon can help make having a sore throat easier to swallow.

Although well-child visits are most frequent during infancy - when development is most rapid - your doctor also should see your older child periodically to make sure his or her development is progressing at the proper pace. Because there really isn't time to do this type of exam during an office visit when your child is sick, you should make an appointment specifically for a general health assessment.

Some schools require a physical exam and proof of up-to-date immunizations before children can enter certain grades or participate in sports. Check with your school district to see what's required.

In the past, many such physicals were conducted en masse in a gymnasium, where a doctor might check as many as 60 children in an hour. Mass screenings in crowded conditions offer little privacy and no opportunity to ask confidential questions.

Taking your child to your pediatrician or family physician is a good idea for several reasons:

• Your doctor is already familiar with your child's medical history.
• An office visit provides more time for a more thorough exam.
• A parent is available to answer questions if needed.

The American Academy of Pediatrics has established a basic schedule of well-child visits for grade school students. Many medical practices adapt this schedule for their own patient population, but it typically includes a well-child visit every other year from age 5 through age 11. Your family's health insurance may also affect the number and timing of these visits.

What happens during checkups is also variable, depending on your child's age and your doctor's style of practice. In general, though, a checkup includes a physical exam and development assessment.

The physical exam.
The doctor will check your child's:

• Height and weight
• Blood pressure and heart rate
• Teeth, gums, tongue and throat
• Reflexes
• Eyes, ears, nose and skin
• Heart, lungs and abdomen
• Fine-motor development, such as the ability to pick up small objects or tie shoes
• Gross-motor development, such as the ability to walk, climb stairs or jump
• Spinal alignment for signs of curvature (scoliosis)
• Genitalia, confirming a normal level of maturation and checking for hernia, infection and other possible problems

Preventive screenings
Several potentially serious conditions that affect children can be detected on routine examinations and tests. Regular exams increase the chance that such conditions will be found early.

• Lead poisoning. Blood tests may be needed for young children who have been exposed to lead paint, which can be found in older houses. Some doctors use a questionnaire to determine who should be tested.

• Tuberculosis. Skin tests may be needed for children who have lived in places where tuberculosis is more common - such as shelters, institutions or countries in which tuberculosis is prevalent. Some doctors use a questionnaire to determine who should be tested.

• Cholesterol. Blood tests may be needed for children who are overweight or obese, or who have parents or grandparents who developed heart disease before the age of 55.

Immunization update
Every checkup is an opportunity to make sure your child is up-to-date on immunizations. Ask for a copy of the immunization dates for your child - many schools require that information. Also keep an immunization record at home.

Behavioral development
In addition to a physical exam, your doctor may also ask a series of questions concerning your child's intellectual and behavioral development. These questions will vary by your child's age:

• 5-year-olds. Can your child get dressed without help? Count to 20 and print his or her name? Can he or she ride a bike with training wheels? Is there any speech impediment?

• Ages 6 to 8. Is your child keeping up with schoolwork? What are some of the things he or she is good at? Does he or she talk about what goes on at school? What happens when your child is frustrated or angry?

• Ages 9 to 11. How does your child get along with other family members? How are his or her grades at school? Any changes with behavior at home, at school or when playing with friends? Is your child proud of his or her achievements?

Safety issues
Your doctor may also make sure you're following the right seat belt and car seat recommendations for your child's age and size. Tips for bicycle and skateboard safety - particularly helmet use - also merit review. Safe storage of any firearms in your home is important as well. When your child reaches the upper grades of elementary school, you'll need to talk about how to reduce your child's risk of abusing alcohol, tobacco, street drugs and inhalants.

Children in preschool and the early elementary grades may benefit from a matter-of-fact reminder that their bodies, particularly their genitals, are private. Your doctor or nurse can pitch this message in terms your child will understand - reassuring, not scary or embarrassing.

Also, older children need to be prepared for the changes that occur at puberty. As your child matures, he or she may want to speak to the doctor alone about sexual concerns.