Cause
Tuberculosis (TB) is primarily caused by the bacterium Mycobacterium tuberculosis, but other related mycobacteria may cause similar symptoms.
Symptoms
Initially there are no signs of disease, except a positive tuberculin skin test, which indicates the child has been infected. The infection usually resolves on its own as the child develops immunity over a 6- to 10-week period. But in some cases tuberculosis can progress and spread throughout the lungs and to other organs. Symptoms include fever, night sweats,weight loss, fatigue, loss of appetite, and cough, sometimes with blood-tinged mucus. In other cases, more often in older children and adults, the infection remains dormant, sometimes for years, and then is reactivated when the immune system is weakened.
How It Spreads
TB is spread by inhaling airborne fluid droplets from an infected person who sneezes or coughs. Young children with TB rarely infect older children or adults.
Incubation Period
The time between initial infection and apparent disease is variable; early signs often occur within two to six months of infection with the germ, but they may not show up for years.
How Long Symptoms Last
Tuberculosis is a chronic disease that can persist for years if not treated.
When to Call Your Child’s Doctor
Call your child’s doctor if your child has a persistent fever or cough or if your child has come in contact with someone who is known to have or who is suspected to have TB.
How the Diagnosis Is Made
A skin test (PPD), involving a small injection of test material under the skin, will tell if the child has been exposed to tuberculosis. If positive, the doctor may order a chest X-ray and examination of stomach fluid to look for the bacteria in swallowed mucus coughed up from the lungs.
Treatment
Generally, children with a positive skin test but no symptoms will be given one drug. Those with active infection are given several, usually over a period of months. These may include isoniazid, rifampin, pyrazinamide, streptomycin, ethambutol, and others.
Home Treatment
A child with TB needs adequate rest and nutrition. You need to make sure your child takes his medications as prescribed to ensure that the bacteria are killed.
Prevention
Prevention depends on avoiding contact with those (usually adults) who have active disease, testing those who are at high risk for the disease, and promptly and adequately treating those with active infections to control spread to others. A vaccine called BCG can prevent TB in some situations, but it is not routinely given in this country due to the low likelihood of contracting the disease. It is recommended for children who are at high risk of long-term, close exposure to untreated or ineffectively treated adults.
Contagious Periods
Someone infected with tuberculosis is very contagious to others because tuberculosis is spread through the air, by coughing or sneezing. TB bacteria can remain airborne for a period of time, long enough for an uninfected person to breathe them in. Anyone with active TB should not be around anyone with immune system problems such as someone with HIV or someone who is receiving chemotherapy.
Complications
TB can spread to other organs, such as the kidney, liver, spleen, and brain, causing severe illness and requiring hospitalization. Untreated, TB can be fatal.
Tetanus (Lockjaw)
Cause
Tetanus is caused by a toxin released into the nerves and muscles by the bacterium Clostridium tetani, which is found in soil, dust, and the feces of some animals. The disease occurs very rarely in the United States, in part due to the availability and routine use of the tetanus vaccine.
Symptoms
It usually begins with muscle spasms in the jaw, along with headache, restlessness, and irritability, followed by difficulty chewing and swallowing and stiffness or pain in the muscles of the neck, shoulders, or back. The muscles of the face can lock into a characteristic smile with arched eyebrows. There may be a fever and chills. Spasms spread to muscles in the stomach, back, hip, and thigh muscles.
How It Spreads
Most cases in the United States develop from a puncture wound or cut from a dirty object such as a nail, splinter, or fragment of glass. Neonatal tetanus occurs after a baby is delivered in unsanitary conditions, especially if the umbilical cord cut is contaminated with the bacteria and the mother has not been immunized against tetanus.
Incubation Period
The incubation period is typically 2 to 14 days, but it can be as long as months after the injury. Symptoms of neonatal tetanus typically begin 3 to 12 days after birth.
How Long Symptoms Last
Recovery usually takes at least four to six weeks.
When to Call Your Child’s Doctor
Call your child’s doctor if your child gets a wound, especially if it is a puncture wound or an animal bite, and she has not been immunized against tetanus or you are unsure when she got her last tetanus booster; if your child develops any of the symptoms of tetanus; or if you are pregnant and unsure about your tetanus immunization status.
How the Diagnosis Is Made
The diagnosis is usually made based on the history of symptoms and the doctor’s physical examination of the child.
Treatment
Tetanus is treated in the hospital, usually in an intensive care unit. The child receives antibiotics to kill the bacteria and an antitoxin to neutralize the toxin. Medications are given to control muscle spasms and to stop abnormal nerve activity that can cause disturbances in heartbeat, blood pressure, and body temperature.
Prevention
Tetanus can be prevented by receiving the recommended routine immunizations with tetanus vaccine—usually as part of the DTaP (diphtheria-tetanuspertussis) vaccine—at 2, 4, 6, and 15 to 18 months and again at 4 to 6 years. Boosters should be given thereafter at 10-year intervals. Although cleaning a dirt- or soilcontaminated wound is not a substitute for immunization, be sure to clean all wounds.
Contagious Periods
The disease is not a contagious one.
Complications
Death occurs in 5 to 35 percent of cases. With intensive care treatment, fewer than 10 percent of infants with neonatal tetanus will die; without it, more than 75 percent die. In some cases, children, especially infants, will suffer brain injury, resulting in cerebral palsy, mental retardation, or behavioral difficulties.
Tetanus is caused by a toxin released into the nerves and muscles by the bacterium Clostridium tetani, which is found in soil, dust, and the feces of some animals. The disease occurs very rarely in the United States, in part due to the availability and routine use of the tetanus vaccine.
Symptoms
It usually begins with muscle spasms in the jaw, along with headache, restlessness, and irritability, followed by difficulty chewing and swallowing and stiffness or pain in the muscles of the neck, shoulders, or back. The muscles of the face can lock into a characteristic smile with arched eyebrows. There may be a fever and chills. Spasms spread to muscles in the stomach, back, hip, and thigh muscles.
How It Spreads
Most cases in the United States develop from a puncture wound or cut from a dirty object such as a nail, splinter, or fragment of glass. Neonatal tetanus occurs after a baby is delivered in unsanitary conditions, especially if the umbilical cord cut is contaminated with the bacteria and the mother has not been immunized against tetanus.
Incubation Period
The incubation period is typically 2 to 14 days, but it can be as long as months after the injury. Symptoms of neonatal tetanus typically begin 3 to 12 days after birth.
How Long Symptoms Last
Recovery usually takes at least four to six weeks.
When to Call Your Child’s Doctor
Call your child’s doctor if your child gets a wound, especially if it is a puncture wound or an animal bite, and she has not been immunized against tetanus or you are unsure when she got her last tetanus booster; if your child develops any of the symptoms of tetanus; or if you are pregnant and unsure about your tetanus immunization status.
How the Diagnosis Is Made
The diagnosis is usually made based on the history of symptoms and the doctor’s physical examination of the child.
Treatment
Tetanus is treated in the hospital, usually in an intensive care unit. The child receives antibiotics to kill the bacteria and an antitoxin to neutralize the toxin. Medications are given to control muscle spasms and to stop abnormal nerve activity that can cause disturbances in heartbeat, blood pressure, and body temperature.
Prevention
Tetanus can be prevented by receiving the recommended routine immunizations with tetanus vaccine—usually as part of the DTaP (diphtheria-tetanuspertussis) vaccine—at 2, 4, 6, and 15 to 18 months and again at 4 to 6 years. Boosters should be given thereafter at 10-year intervals. Although cleaning a dirt- or soilcontaminated wound is not a substitute for immunization, be sure to clean all wounds.
Contagious Periods
The disease is not a contagious one.
Complications
Death occurs in 5 to 35 percent of cases. With intensive care treatment, fewer than 10 percent of infants with neonatal tetanus will die; without it, more than 75 percent die. In some cases, children, especially infants, will suffer brain injury, resulting in cerebral palsy, mental retardation, or behavioral difficulties.
Sinusitis
Cause
Viruses that cause colds also can cause inflammation of the sinuses, the air spaces found in the facial bones around the nose. Acute bacterial infections of the sinuses around the nose are caused by the same germs that cause middle ear infections: Streptococcus pneumoniae, Moraxella catarrhalis, and Hemophilus influenzae. In chronic sinusitis, Staphylococcus aureus or multiple types of bacteria may be involved.
Symptoms
Cough and nasal discharge are the most common symptoms of acute sinusitis. The cough occurs during daytime and often is worse when lying down for naps or at bedtime. Nasal discharge may be clear or cloudy. The child may have a sore throat as a result of postnasal drip, and the child may sniff, snort, or snore to clear the drainage. Viral upper respiratory infections usually clear up within 10 to 14 days. If symptoms persist without improvement for more than 10 to 14 days, bacterial sinusitis should be suspected. A more severe but less common form of sinusitis can occur in which the child develops a fever higher than 101 degrees Fahrenheit, a cloudy nasal discharge, headache, and eye swelling. In chronic sinusitis, cough, nasal discharge, and bad breath last for more than 30 days.
How It Spreads
Bacteria and viruses are passed via throat and nose droplets.
Incubation Period
The incubation period varies.
How Long Symptoms Last
Viral infections resolve on their own within 10 to 14 days. With bacterial infections, once the child begins antibiotics, symptoms will usually subside within several days, but it may take several weeks for symptoms to completely disappear.
When to Call Your Child’s Doctor
Call your child’s doctor if your child has a “cold” that lasts more than 10 to 14 days, if there are any symptoms of “allergies” that don’t clear up with the usual allergy treatments, if she complains about a headache or pressure behind her cheeks or forehead, or if she has facial swelling.
How the Diagnosis Is Made
The doctor will ask about symptoms, how long your child has had them, and where the pain and pressure is to try to distinguish whether the symptoms are caused by nasal allergies or viral or bacterial infection of the sinuses. X-rays or other imaging studies are sometimes used to diagnose sinusitis.
Treatment
For viral infections, there is no specific treatment. For bacterial infections, antibiotics are given for 14 to 21 days. Decongestants may improve symptoms but do not clear the infection faster. Antihistamines are not helpful and may interfere with sinus drainage because they may cause thickening of secretions.
Home Treatment
Acetaminophen, ibuprofen, and/or warm compresses may help reduce facial pain. Do not use aspirin because of the rare but potentially fatal Reye syndrome. If the child is old enough, saline nose drops can be used to help promote drainage of secretions and reduce swelling. A cool-mist vaporizer can help keep secretions moist so that the sinuses can drain more easily.
Prevention
Encourage your child to cover her nose and mouth when she coughs or sneezes and not to share food or utensils. In the winter months, use a humidifier to keep home humidity at 45 to 50 percent; this will help make sinuses less of a target for infections. Avoid exposing your child to cigarette smoke—this can irritate mucous membranes and set the stage for sinusitis.
Complications
In rare cases, the infection can spread out of the sinuses into other parts of the head, invading the bones (osteomyelitis) of the skull or spreading toward the eyes, causing an abscess (collection of pus) in or near the eye (orbital cellulitis). The infection can also invade the membranes surrounding the brain causing meningitis, which can be life-threatening.
Viruses that cause colds also can cause inflammation of the sinuses, the air spaces found in the facial bones around the nose. Acute bacterial infections of the sinuses around the nose are caused by the same germs that cause middle ear infections: Streptococcus pneumoniae, Moraxella catarrhalis, and Hemophilus influenzae. In chronic sinusitis, Staphylococcus aureus or multiple types of bacteria may be involved.
Symptoms
Cough and nasal discharge are the most common symptoms of acute sinusitis. The cough occurs during daytime and often is worse when lying down for naps or at bedtime. Nasal discharge may be clear or cloudy. The child may have a sore throat as a result of postnasal drip, and the child may sniff, snort, or snore to clear the drainage. Viral upper respiratory infections usually clear up within 10 to 14 days. If symptoms persist without improvement for more than 10 to 14 days, bacterial sinusitis should be suspected. A more severe but less common form of sinusitis can occur in which the child develops a fever higher than 101 degrees Fahrenheit, a cloudy nasal discharge, headache, and eye swelling. In chronic sinusitis, cough, nasal discharge, and bad breath last for more than 30 days.
How It Spreads
Bacteria and viruses are passed via throat and nose droplets.
Incubation Period
The incubation period varies.
How Long Symptoms Last
Viral infections resolve on their own within 10 to 14 days. With bacterial infections, once the child begins antibiotics, symptoms will usually subside within several days, but it may take several weeks for symptoms to completely disappear.
When to Call Your Child’s Doctor
Call your child’s doctor if your child has a “cold” that lasts more than 10 to 14 days, if there are any symptoms of “allergies” that don’t clear up with the usual allergy treatments, if she complains about a headache or pressure behind her cheeks or forehead, or if she has facial swelling.
How the Diagnosis Is Made
The doctor will ask about symptoms, how long your child has had them, and where the pain and pressure is to try to distinguish whether the symptoms are caused by nasal allergies or viral or bacterial infection of the sinuses. X-rays or other imaging studies are sometimes used to diagnose sinusitis.
Treatment
For viral infections, there is no specific treatment. For bacterial infections, antibiotics are given for 14 to 21 days. Decongestants may improve symptoms but do not clear the infection faster. Antihistamines are not helpful and may interfere with sinus drainage because they may cause thickening of secretions.
Home Treatment
Acetaminophen, ibuprofen, and/or warm compresses may help reduce facial pain. Do not use aspirin because of the rare but potentially fatal Reye syndrome. If the child is old enough, saline nose drops can be used to help promote drainage of secretions and reduce swelling. A cool-mist vaporizer can help keep secretions moist so that the sinuses can drain more easily.
Prevention
Encourage your child to cover her nose and mouth when she coughs or sneezes and not to share food or utensils. In the winter months, use a humidifier to keep home humidity at 45 to 50 percent; this will help make sinuses less of a target for infections. Avoid exposing your child to cigarette smoke—this can irritate mucous membranes and set the stage for sinusitis.
Complications
In rare cases, the infection can spread out of the sinuses into other parts of the head, invading the bones (osteomyelitis) of the skull or spreading toward the eyes, causing an abscess (collection of pus) in or near the eye (orbital cellulitis). The infection can also invade the membranes surrounding the brain causing meningitis, which can be life-threatening.
Rabies
Cause
The rabies virus causes an infection of the nervous system. It is usually transmitted by an animal bite. Human cases are extremely rare in the United States; most years, there are no reported cases.
Symptoms
The first stage usually lasts 2 to 10 days. Symptoms include fever, headache, muscle aches, loss of appetite, nausea, vomiting, sore throat, cough, and fatigue. There may be a tingling or twitching sensation around the area of the bite. The second stage, lasting 2 to 21 days, begins with a fever as high as 105 degrees Fahrenheit and any of the following: irritability; excessive movement or agitation; confusion; hallucinations; aggressiveness; muscle spasm; seizures; weakness or paralysis; extreme sensitivity to light, sounds, or touch; increased saliva or tears; and an inability to speak as vocal cords become paralyzed. In the last phases, there may be double vision, abnormal movements of the muscles that control breathing, and difficulty swallowing. Swallowing problems and increased saliva lead to foaming at the mouth.
How It Spreads
The rabies virus is carried in the saliva of infected animals and is usually transmitted to humans through an animal bite. In rare cases, it can be spread when an infected animal’s saliva touches mucous membranes, like the mouth or eyelids, or comes in contact with a cut or broken skin. In the United States the most common carriers are bats, raccoons, skunks, and foxes; cases have been reported with wolves, coyotes, bobcats, and ferrets as carriers. Animals not expected to carry rabies include small rodents, rabbits, and hares. In Central and South America, dogs are the main carriers.
Incubation Period
The incubation period is usually 20 to 180 days, with the peak at 30 to 60 days.
How Long Symptoms Last
Recovery is rare in humans who have developed symptoms.
When to Call Your Child’s Doctor
Call your child’s doctor immediately if your child has any signs or symptoms of rabies, especially if he has been bitten recently by an animal. Call the doctor as well if your child has been bitten by an animal or has been exposed to a cat, dog, bat, or other animal that might have rabies. Also, call if you are planning a trip abroad where you might come in contact with infected animals.
How the Diagnosis Is Made
The doctor will ask about recent animal exposure and look for symptoms.
Treatment
There is no specific effective treatment once symptoms have developed. The person receives supportive care in an intensive care setting. Only a few individuals who have developed the disease have survived.
Prevention
If your child is bitten by an animal, wash the area of the bite thoroughly with soap and water for 10 minutes and call your child’s doctor, who will clean the wound thoroughly and check to make sure tetanus shots are up to date. You may also call the local animal control authorities to help find the animal that caused the bite. If the doctor decides to treat your child to prevent rabies, the treatment will involve shots of human diploid cell vaccine and human rabies immune globulin into a muscle, which should begin the day the child was bitten to be most effective. Part of human rabies immune globulin is usually injected near the bite area. Warn your child not to touch or feed stray animals, even dogs or cats. Report any stray animals to local health or animal control authorities, especially if they are acting strangely.
The rabies virus causes an infection of the nervous system. It is usually transmitted by an animal bite. Human cases are extremely rare in the United States; most years, there are no reported cases.
Symptoms
The first stage usually lasts 2 to 10 days. Symptoms include fever, headache, muscle aches, loss of appetite, nausea, vomiting, sore throat, cough, and fatigue. There may be a tingling or twitching sensation around the area of the bite. The second stage, lasting 2 to 21 days, begins with a fever as high as 105 degrees Fahrenheit and any of the following: irritability; excessive movement or agitation; confusion; hallucinations; aggressiveness; muscle spasm; seizures; weakness or paralysis; extreme sensitivity to light, sounds, or touch; increased saliva or tears; and an inability to speak as vocal cords become paralyzed. In the last phases, there may be double vision, abnormal movements of the muscles that control breathing, and difficulty swallowing. Swallowing problems and increased saliva lead to foaming at the mouth.
How It Spreads
The rabies virus is carried in the saliva of infected animals and is usually transmitted to humans through an animal bite. In rare cases, it can be spread when an infected animal’s saliva touches mucous membranes, like the mouth or eyelids, or comes in contact with a cut or broken skin. In the United States the most common carriers are bats, raccoons, skunks, and foxes; cases have been reported with wolves, coyotes, bobcats, and ferrets as carriers. Animals not expected to carry rabies include small rodents, rabbits, and hares. In Central and South America, dogs are the main carriers.
Incubation Period
The incubation period is usually 20 to 180 days, with the peak at 30 to 60 days.
How Long Symptoms Last
Recovery is rare in humans who have developed symptoms.
When to Call Your Child’s Doctor
Call your child’s doctor immediately if your child has any signs or symptoms of rabies, especially if he has been bitten recently by an animal. Call the doctor as well if your child has been bitten by an animal or has been exposed to a cat, dog, bat, or other animal that might have rabies. Also, call if you are planning a trip abroad where you might come in contact with infected animals.
How the Diagnosis Is Made
The doctor will ask about recent animal exposure and look for symptoms.
Treatment
There is no specific effective treatment once symptoms have developed. The person receives supportive care in an intensive care setting. Only a few individuals who have developed the disease have survived.
Prevention
If your child is bitten by an animal, wash the area of the bite thoroughly with soap and water for 10 minutes and call your child’s doctor, who will clean the wound thoroughly and check to make sure tetanus shots are up to date. You may also call the local animal control authorities to help find the animal that caused the bite. If the doctor decides to treat your child to prevent rabies, the treatment will involve shots of human diploid cell vaccine and human rabies immune globulin into a muscle, which should begin the day the child was bitten to be most effective. Part of human rabies immune globulin is usually injected near the bite area. Warn your child not to touch or feed stray animals, even dogs or cats. Report any stray animals to local health or animal control authorities, especially if they are acting strangely.
Pneumonia
Cause
Pneumonia is a general term referring to an infection of the lungs caused by viruses, bacteria, fungi, and parasites. In otherwise healthy children, viral pneumonia is most common. Viruses causing pneumonia include respiratory syncytial virus (RSV), parainfluenza, influenza, and adenoviruses. Among bacteria, Streptococcus pneumoniae, Streptococcus pyogenes (group A Streptococcus), and Staphylococcus aureus are the most common causes. Since the introduction of the Hib vaccine, Hemophilus influenzae type B is less often a cause.
The sexually transmitted bacterium Chlamydia trachomatis can be passed on from the mother to the baby during delivery, leading to pneumonia. The microbe Mycoplasma pneumoniae also accounts for many cases the ribs and the nostrils flare; vomiting; chest pain; abdominal pain; decreased activity; loss of appetite or poor feeding; and bluish lips, tongue, and fingernails.
How It Spreads
The viruses and bacteria are usually spread by nose and throat droplets passed along by coughing, sneezing, or coming in contact with the germ on utensils or used tissues. Although the person with the germ may not have pneumonia, the germ can cause pneumonia when passed on to the child.
Incubation Period
The incubation period depends on the organism. Incubation for RSV is four to six days; influenza is one to four days; mycoplasma is one to three weeks.
How Long Symptoms Last
With antibiotics, symptoms of most bacterial pneumonia will subside within the first 24 to 48 hours, although it may take several weeks before the lungs return to normal. Symptoms of viral pneumonia may last several days longer. With antibiotics, symptoms of mycoplasma pneumonia will improve over four to five days.
When to Call Your Child’s Doctor
Call your child’s doctor if your child has any signs or symptoms of pneumonia, especially if he is breathing faster than usual, has a cough that is getting worse, has a fever of 101 to 102 degrees Fahrenheit or higher, or has signs of respiratory distress. Take your child to the emergency room if he is making a grunting sound when breathing; is struggling or gasping to breathe; has a bluish color of the lips, tongue, and fingernails; is lethargic or unresponsive; or pauses in breathing for longer than 15 seconds. Call your child’s doctor if your child is being treated forpneumonia and symptoms have not improved within 48 to 72 hours.
How the Diagnosis Is Made
Your child’s doctor will ask about symptoms and listen to your child’s chest with a stethoscope to hear where and how breathing is impaired; he or she may order a chest X-ray. The doctor may also take a blood test and a sample of mucus produced by coughing to see what organism is causing the infection.
Treatment
In severe cases the child may be hospitalized. Bacterial or mycoplasma pneumoniais treated with antibiotics; the type used depends on the germ. Antibiotics are ineffective against viral pneumonia, and most patients recover with supportive care such as fluids, rest, and, if necessary, extra oxygen. If diagnosed within 48 hours of the infection, viral pneumonia may be treated in some cases with antiviral medication to reduce symptoms.
Home Treatment
Use a cool-mist humidifier to increase air moisture. Encourage your child to drink fluids, especially with a fever. Ask your child’s doctor before using cough suppressant medications because they can interfere with clearing mucus from the lungs, and this may be harmful in some cases of pneumonia.
Prevention
Children younger than two years, those with weakened immune systems, and other high-risk children should be vaccinated against Streptococcus pneumoniae. The influenza vaccine is also recommended for high-risk children, including those with chronic lung or heart conditions that can make them more likely to develop pneumonia if they are infected with the virus.
Pertussis (whooping cough), which can also lead to pneumonia, is the “P” part of the routine DTaP vaccine. The Hemophilus influenzae type B vaccine, given to infants beginning at two months, is 70 to 100 percent effective in protecting against infection with this germ. If someone in your house has pneumonia or a respiratory infection that could lead to pneumonia, keep your child away and practice good hygiene, keeping eating utensils separate and washing hands frequently.
Contagious Periods
The contagious period depends on the organism.
Complications
The mortality rate for children with bacterial pneumonia is less than 1 percent with antibiotic treatment. Almost all children with viral pneumonia recover without treatment, although RSV infections can be life-threatening, especially in infants younger than six weeks or those with heart or lung problems or a weakened immune system.
Pneumonia is a general term referring to an infection of the lungs caused by viruses, bacteria, fungi, and parasites. In otherwise healthy children, viral pneumonia is most common. Viruses causing pneumonia include respiratory syncytial virus (RSV), parainfluenza, influenza, and adenoviruses. Among bacteria, Streptococcus pneumoniae, Streptococcus pyogenes (group A Streptococcus), and Staphylococcus aureus are the most common causes. Since the introduction of the Hib vaccine, Hemophilus influenzae type B is less often a cause.
The sexually transmitted bacterium Chlamydia trachomatis can be passed on from the mother to the baby during delivery, leading to pneumonia. The microbe Mycoplasma pneumoniae also accounts for many cases the ribs and the nostrils flare; vomiting; chest pain; abdominal pain; decreased activity; loss of appetite or poor feeding; and bluish lips, tongue, and fingernails.
How It Spreads
The viruses and bacteria are usually spread by nose and throat droplets passed along by coughing, sneezing, or coming in contact with the germ on utensils or used tissues. Although the person with the germ may not have pneumonia, the germ can cause pneumonia when passed on to the child.
Incubation Period
The incubation period depends on the organism. Incubation for RSV is four to six days; influenza is one to four days; mycoplasma is one to three weeks.
How Long Symptoms Last
With antibiotics, symptoms of most bacterial pneumonia will subside within the first 24 to 48 hours, although it may take several weeks before the lungs return to normal. Symptoms of viral pneumonia may last several days longer. With antibiotics, symptoms of mycoplasma pneumonia will improve over four to five days.
When to Call Your Child’s Doctor
Call your child’s doctor if your child has any signs or symptoms of pneumonia, especially if he is breathing faster than usual, has a cough that is getting worse, has a fever of 101 to 102 degrees Fahrenheit or higher, or has signs of respiratory distress. Take your child to the emergency room if he is making a grunting sound when breathing; is struggling or gasping to breathe; has a bluish color of the lips, tongue, and fingernails; is lethargic or unresponsive; or pauses in breathing for longer than 15 seconds. Call your child’s doctor if your child is being treated forpneumonia and symptoms have not improved within 48 to 72 hours.
How the Diagnosis Is Made
Your child’s doctor will ask about symptoms and listen to your child’s chest with a stethoscope to hear where and how breathing is impaired; he or she may order a chest X-ray. The doctor may also take a blood test and a sample of mucus produced by coughing to see what organism is causing the infection.
Treatment
In severe cases the child may be hospitalized. Bacterial or mycoplasma pneumoniais treated with antibiotics; the type used depends on the germ. Antibiotics are ineffective against viral pneumonia, and most patients recover with supportive care such as fluids, rest, and, if necessary, extra oxygen. If diagnosed within 48 hours of the infection, viral pneumonia may be treated in some cases with antiviral medication to reduce symptoms.
Home Treatment
Use a cool-mist humidifier to increase air moisture. Encourage your child to drink fluids, especially with a fever. Ask your child’s doctor before using cough suppressant medications because they can interfere with clearing mucus from the lungs, and this may be harmful in some cases of pneumonia.
Prevention
Children younger than two years, those with weakened immune systems, and other high-risk children should be vaccinated against Streptococcus pneumoniae. The influenza vaccine is also recommended for high-risk children, including those with chronic lung or heart conditions that can make them more likely to develop pneumonia if they are infected with the virus.
Pertussis (whooping cough), which can also lead to pneumonia, is the “P” part of the routine DTaP vaccine. The Hemophilus influenzae type B vaccine, given to infants beginning at two months, is 70 to 100 percent effective in protecting against infection with this germ. If someone in your house has pneumonia or a respiratory infection that could lead to pneumonia, keep your child away and practice good hygiene, keeping eating utensils separate and washing hands frequently.
Contagious Periods
The contagious period depends on the organism.
Complications
The mortality rate for children with bacterial pneumonia is less than 1 percent with antibiotic treatment. Almost all children with viral pneumonia recover without treatment, although RSV infections can be life-threatening, especially in infants younger than six weeks or those with heart or lung problems or a weakened immune system.
Meningitis
Cause
An inflammation of the meninges, the membrane covering the brain and spinal cord, meningitis can be caused by bacteria, viruses, fungi, or parasites that enter into the cerebrospinal fluid from the blood. Streptococcus pneumoniae, Neisseria meningitidis, and Hemophilus influenzae type B are the most common bacteria causing the infection in children. Enteroviruses are the most frequent viral cause. Bacterial infections are generally more serious than viral defects of the meninges and are potentially life-threatening.
Symptoms
Symptoms may include fever, severe headache, stiff neck, nausea, vomiting, irritability, sensitivity to light, seizure, rash, bulging fontanel (soft spot on top of the head) in infant, rash or bruise marks, confusion, or coma (unconsciousness).
How It Spreads
The bacteria and viruses are usually spread by contact with infected feces or nose and throat drops. Typically, the infection begins in the respiratory system, but it can begin in other parts of the body, including the heart valves, bones, ears, nose, or teeth.
Incubation Period
This varies with the organism. For enteroviruses, the incubation period is 3 to 6 days; other viruses may range from 4 to 21 days. Once the infection has entered the spinal fluid, symptoms usually occur rapidly.
How Long Symptoms Last
The duration of symptoms varies according to cause. Once treatment begins, fever associated with bacterial infection usually resolves in 5 to 7 days, but fever longer than 10 days occurs in 10 percent of children. Viral infections usually are milder and symptoms last several days.
When to Call Your Child’s Doctor
Call your child’s doctor immediately if your child has any of these symptoms: persistent vomiting, severe headache, stiff neck, lethargy or confusion, rash, or fever. In infants, also look for a bulging soft spot, irritability, poor feeding, and lethargy. If your child has had contact with someone with meningitis, consult your child’s doctor.
How the Diagnosis Is Made
A lumbar puncture, or spinal tap, is performed to examine the spinal fluid. Blood and urine tests may also be done.
Treatment
Often antibiotics and intravenous fluids are given before the organism is identified, and the child is placed in isolation in the hospital. If the cause is a virus, the antibiotics will be stopped and the child may be given a pain reliever such as acetaminophen and, in some cases, intravenous fluids. If the cause is bacterial, antibiotics will be continued for up to several weeks; corticosteroids to relieve inflammation may also be given.
Prevention
The Hemophilus influenzae type B vaccine, given to infants beginning at two months, is 70 to 100 percent effective in protecting against this cause of meningitis. Children younger than two years and children with weakened immune systems should be vaccinated against Streptococcus pneumoniae. For children exposed to meningitis caused by certain bacteria, the doctor may prescribe the antibiotic rifampin to prevent infection.
Complications
Most children completely recover from viral meningitis. Severe cases can result in seizures and intellectual, motor, hearing, visual, and psychiatric problems. In bacterial infections, the mortality rate in infants (after the newborn period) and children is 1 to 8 percent. Significant neurological and developmental problems occur in 10 to 20 percent of patients surviving the infection, including hearing loss, mental retardation, seizures, delay in speaking, visual impairment, and behavioral problems.
An inflammation of the meninges, the membrane covering the brain and spinal cord, meningitis can be caused by bacteria, viruses, fungi, or parasites that enter into the cerebrospinal fluid from the blood. Streptococcus pneumoniae, Neisseria meningitidis, and Hemophilus influenzae type B are the most common bacteria causing the infection in children. Enteroviruses are the most frequent viral cause. Bacterial infections are generally more serious than viral defects of the meninges and are potentially life-threatening.
Symptoms
Symptoms may include fever, severe headache, stiff neck, nausea, vomiting, irritability, sensitivity to light, seizure, rash, bulging fontanel (soft spot on top of the head) in infant, rash or bruise marks, confusion, or coma (unconsciousness).
How It Spreads
The bacteria and viruses are usually spread by contact with infected feces or nose and throat drops. Typically, the infection begins in the respiratory system, but it can begin in other parts of the body, including the heart valves, bones, ears, nose, or teeth.
Incubation Period
This varies with the organism. For enteroviruses, the incubation period is 3 to 6 days; other viruses may range from 4 to 21 days. Once the infection has entered the spinal fluid, symptoms usually occur rapidly.
How Long Symptoms Last
The duration of symptoms varies according to cause. Once treatment begins, fever associated with bacterial infection usually resolves in 5 to 7 days, but fever longer than 10 days occurs in 10 percent of children. Viral infections usually are milder and symptoms last several days.
When to Call Your Child’s Doctor
Call your child’s doctor immediately if your child has any of these symptoms: persistent vomiting, severe headache, stiff neck, lethargy or confusion, rash, or fever. In infants, also look for a bulging soft spot, irritability, poor feeding, and lethargy. If your child has had contact with someone with meningitis, consult your child’s doctor.
How the Diagnosis Is Made
A lumbar puncture, or spinal tap, is performed to examine the spinal fluid. Blood and urine tests may also be done.
Treatment
Often antibiotics and intravenous fluids are given before the organism is identified, and the child is placed in isolation in the hospital. If the cause is a virus, the antibiotics will be stopped and the child may be given a pain reliever such as acetaminophen and, in some cases, intravenous fluids. If the cause is bacterial, antibiotics will be continued for up to several weeks; corticosteroids to relieve inflammation may also be given.
Prevention
The Hemophilus influenzae type B vaccine, given to infants beginning at two months, is 70 to 100 percent effective in protecting against this cause of meningitis. Children younger than two years and children with weakened immune systems should be vaccinated against Streptococcus pneumoniae. For children exposed to meningitis caused by certain bacteria, the doctor may prescribe the antibiotic rifampin to prevent infection.
Complications
Most children completely recover from viral meningitis. Severe cases can result in seizures and intellectual, motor, hearing, visual, and psychiatric problems. In bacterial infections, the mortality rate in infants (after the newborn period) and children is 1 to 8 percent. Significant neurological and developmental problems occur in 10 to 20 percent of patients surviving the infection, including hearing loss, mental retardation, seizures, delay in speaking, visual impairment, and behavioral problems.
Influenza (Flu)
Cause
There are three types of influenza virus: Type A is usually responsible for large epidemics and is constantly changing with new strains appearing. Type B causes smaller, more localized outbreaks. Type C is less common and usually causes mild illness. Flu epidemics usually occur between November and March.
Symptoms
Flu symptoms may be similar to those of the common cold, but they tend to develop quickly and are more severe. They can include fever (often sudden and high), chills, headache, muscle aches, dizziness, loss of appetite, cough, sore throat, runny nose, nausea, and weakness.
How It Spreads
Flu spreads by virusinfected droplets coughed or sneezed into the air.
Incubation Period
Symptoms usually appear one to four days after exposure to the virus.
How Long Symptoms Last
Fever and most other symptoms subside within 5 days, but cough and weakness may persist. All symptoms are usually gone within 7 to 14 days.
When to Call Your Child’s Doctor
Children with mild cases usually don’t need to see their doctor. Do call your child’s doctor if your child has a fever of 103 degrees Fahrenheit or higher, if your child—especially your infant younger than three months—has a cough that does not get better over a three- to four-day period, or if your child is having difficulty breathing. A persistent cough, fever, increased breathing rate, or respiratory difficulty may indicate that your child has developed pneumonia as a complication of the flu.
How the Diagnosis Is Made
The doctor will examine your child and listen to the lungs to determine whether any complications have developed, such as pneumonia. If pneumonia is suspected, a chest X-ray may be ordered.
Treatment
Because the flu is caused by a virus, it is not treated with antibiotics unless there is a secondary bacterial infection. Some children with chronic medical conditions may require hospitalization. For a very ill child or one with other conditions that may predispose him to complications, a doctor may prescribe an antiviral medication to relieve symptoms; the medicine must be given within 48 hours of the onset of symptoms.
Home Treatment
Children should rest in bed or play quietly. Give a nonaspirin medication such as acetaminophen (Tylenol) to relieve fever and aches. Do not give aspirin because it is associated with Reye syndrome, a rare but potentially fatal disease, especially if given to a child with influenza or chicken pox.
Prevention
Try to keep your child away from crowds during an epidemic. Make sure that your child washes his hands thoroughly and doesn’t pick up used tissues. The flu vaccine is not routinely recommended for children, except those with chronic heart or lung diseases (including asthma), sickle-cell anemia, diabetes, HIV, or other chronic conditions.
Contagious Periods
The contagious period lasts from the day before to seven days after symptoms appear.
Complications
Pneumonia (infection and inflammation of the lung), caused by the virus and/or a secondary bacterial infection, and otitis media (middle ear infection) are the most common complications. Myocarditis (an infection of the heart) and Reye syndrome are rare complications.
There are three types of influenza virus: Type A is usually responsible for large epidemics and is constantly changing with new strains appearing. Type B causes smaller, more localized outbreaks. Type C is less common and usually causes mild illness. Flu epidemics usually occur between November and March.
Symptoms
Flu symptoms may be similar to those of the common cold, but they tend to develop quickly and are more severe. They can include fever (often sudden and high), chills, headache, muscle aches, dizziness, loss of appetite, cough, sore throat, runny nose, nausea, and weakness.
How It Spreads
Flu spreads by virusinfected droplets coughed or sneezed into the air.
Incubation Period
Symptoms usually appear one to four days after exposure to the virus.
How Long Symptoms Last
Fever and most other symptoms subside within 5 days, but cough and weakness may persist. All symptoms are usually gone within 7 to 14 days.
When to Call Your Child’s Doctor
Children with mild cases usually don’t need to see their doctor. Do call your child’s doctor if your child has a fever of 103 degrees Fahrenheit or higher, if your child—especially your infant younger than three months—has a cough that does not get better over a three- to four-day period, or if your child is having difficulty breathing. A persistent cough, fever, increased breathing rate, or respiratory difficulty may indicate that your child has developed pneumonia as a complication of the flu.
How the Diagnosis Is Made
The doctor will examine your child and listen to the lungs to determine whether any complications have developed, such as pneumonia. If pneumonia is suspected, a chest X-ray may be ordered.
Treatment
Because the flu is caused by a virus, it is not treated with antibiotics unless there is a secondary bacterial infection. Some children with chronic medical conditions may require hospitalization. For a very ill child or one with other conditions that may predispose him to complications, a doctor may prescribe an antiviral medication to relieve symptoms; the medicine must be given within 48 hours of the onset of symptoms.
Home Treatment
Children should rest in bed or play quietly. Give a nonaspirin medication such as acetaminophen (Tylenol) to relieve fever and aches. Do not give aspirin because it is associated with Reye syndrome, a rare but potentially fatal disease, especially if given to a child with influenza or chicken pox.
Prevention
Try to keep your child away from crowds during an epidemic. Make sure that your child washes his hands thoroughly and doesn’t pick up used tissues. The flu vaccine is not routinely recommended for children, except those with chronic heart or lung diseases (including asthma), sickle-cell anemia, diabetes, HIV, or other chronic conditions.
Contagious Periods
The contagious period lasts from the day before to seven days after symptoms appear.
Complications
Pneumonia (infection and inflammation of the lung), caused by the virus and/or a secondary bacterial infection, and otitis media (middle ear infection) are the most common complications. Myocarditis (an infection of the heart) and Reye syndrome are rare complications.
Hepatitis, Viral
Cause
This inflammation of the liver is usually caused by infection with one of three hepatitis viruses: hepatitis A virus (HAV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Viral hepatitis can also occur with cytomegalovirus (CMV), Epstein-Barr virus (the virus that causes infectious mononucleosis), and other viral infections.
Symptoms
In the early stages of the illness, flulike symptoms are common in hepatitis A and hepatitis B and less frequent (less than 25 percent of cases) in hepatitis C. Symptoms may be very mild or may not occur in many children. These may include fever, malaise, muscle aches, loss of appetite, nausea, vomiting, and diarrhea. Jaundice (yellowing of the skin and whites of the eyes) may or may not occur in children with these infections. Tenderness over the swollen, inflamed liver (right upper abdomen) or swollen spleen (left upper abdomen) may be present. The urine may become dark (“tea-colored”), and the stools may become white or “clay-colored.”
How It Spreads
Hepatitis A infection occurs when a person touches or eats anything that has been contaminated with HAV-infected stool, such as water, milk, and foods (especially shellfish from sewage-contaminated waters). It spreads easily in overcrowded or unsanitary conditions and among young children who may not be suspected of having the illness because of mild or absent symptoms. Hepatitis B spreads through infected body fluids including blood, saliva, semen, vaginal fluids, breast milk, and urine.
Infected infants usually have acquired the virus during the birth process from their HBV-carrier mothers. Hepatitis C usually spreads to children through transfused blood products, particularly with repeated blood product exposure as with chronic hemodialysis in a child with kidney failure. The virus may be passed from mother to infant, especially if the mother is also infected with HIV.
Incubation Period
The incubation period for hepatitis A is 2 to 6 weeks; for hepatitis B, it’s one to five months; for hepatitis C, it’s 2 to 26 weeks.
How Long Symptoms Last
Almost all previously healthy children with hepatitis A infection will recover fully within a few weeks or months. If symptoms develop with hepatitis B infection, they usually subside within six to eight weeks, but chronic infection with the virus can occur and can lead to liver damage and liver cancer.
Chronic infection with the virus is particularly common (70 to 90 percent) in infants who acquire the infection from their mothers at birth and are not treated. Children with hepatitis C usually have no symptoms but are at risk for future liver damage due to chronic infection with the virus.
When to Call Your Child’s Doctor
Your child’s doctor should be called for any child who develops jaundice or the other symptoms of hepatitis described earlier or whobecomes very drowsy or confused. Also contact the doctor if your child has had contact with others with viral hepatitis or if your child will be traveling to an area where hepatitis infection is common.
How the Diagnosis Is Made
The doctor suspects the diagnosis based on the child’s symptoms; inflammation of the liver and infection with a specific hepatitis virus can be detected by blood tests.
Treatment
Children with hepatitis who develop symptoms typically need no specific treatment other than specific supportive care—plenty of rest and adequate fluid intake to prevent dehydration. In a child with a poor appetite due to hepatitis, offering smaller, more frequent meals and fluidsthat are high in calories (like milk shakes) may help ensure that the child receives adequate nutrition while recovering. Some children whose symptoms are more severe may require hospitalization to receive IV fluids and other treatment.
Prevention
The risk of exposure to hepatitis A can be reduced by following good hygiene—including hand washing—and avoiding crowded, unsanitary living conditions or drinking or swimming in contaminated water. Shellfish from sewage contaminated waters should not be eaten. If someone in the household develops hepatitis, antiseptic cleansers should be used to clean any toilet, sink, potty chair, or bedpan used by that person.
A hepatitis A vaccine is available, and it is recommended for children traveling to areas of the world where the risk of exposure to the virus is high. The staffs of child-care facilities, family members of infected persons, and sexual partners of someone with the infection are also candidates to receive the vaccine. Giving immune globulin within one to two weeks after exposure to the virus can prevent illness from developing in 80 to 90 percent of individuals.
Hepatitis B infection from transfusions is very rare in the United States today because blood products are screened for the presence of the virus. Hepatitis B vaccine is now recommended for routine immunization of all infants and for adolescents who didn’t receive the vaccine in infancy. Hepatitis B infection in infants and young children is usually the result of transmission of the disease at birth by an infected mother who carries the virus.
Pregnant women should be screened for the virus, and if a woman is found to be a carrier, her infant should be given a dose of hepatitis B immune globulin (HBIG) at birth, followed by the recommended doses of the vaccine. In the United States, blood and plasma donors are screened for HCV infection. At present, there is no vaccine for the prevention of hepatitis C.
Complications
Although children with HAV infection almost always recover fully without specific treatment, children with chronic HBV and HCV infections are at increased risk for the development of liver damage (cirrhosis), liver failure, and liver cancer as they get older. It is important that these individuals be followed medically for signs of these complications. New drugs, such as interferon alpha, may be helpful in some cases, and patients who develop liver failure may receive liver transplants.
This inflammation of the liver is usually caused by infection with one of three hepatitis viruses: hepatitis A virus (HAV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Viral hepatitis can also occur with cytomegalovirus (CMV), Epstein-Barr virus (the virus that causes infectious mononucleosis), and other viral infections.
Symptoms
In the early stages of the illness, flulike symptoms are common in hepatitis A and hepatitis B and less frequent (less than 25 percent of cases) in hepatitis C. Symptoms may be very mild or may not occur in many children. These may include fever, malaise, muscle aches, loss of appetite, nausea, vomiting, and diarrhea. Jaundice (yellowing of the skin and whites of the eyes) may or may not occur in children with these infections. Tenderness over the swollen, inflamed liver (right upper abdomen) or swollen spleen (left upper abdomen) may be present. The urine may become dark (“tea-colored”), and the stools may become white or “clay-colored.”
How It Spreads
Hepatitis A infection occurs when a person touches or eats anything that has been contaminated with HAV-infected stool, such as water, milk, and foods (especially shellfish from sewage-contaminated waters). It spreads easily in overcrowded or unsanitary conditions and among young children who may not be suspected of having the illness because of mild or absent symptoms. Hepatitis B spreads through infected body fluids including blood, saliva, semen, vaginal fluids, breast milk, and urine.
Infected infants usually have acquired the virus during the birth process from their HBV-carrier mothers. Hepatitis C usually spreads to children through transfused blood products, particularly with repeated blood product exposure as with chronic hemodialysis in a child with kidney failure. The virus may be passed from mother to infant, especially if the mother is also infected with HIV.
Incubation Period
The incubation period for hepatitis A is 2 to 6 weeks; for hepatitis B, it’s one to five months; for hepatitis C, it’s 2 to 26 weeks.
How Long Symptoms Last
Almost all previously healthy children with hepatitis A infection will recover fully within a few weeks or months. If symptoms develop with hepatitis B infection, they usually subside within six to eight weeks, but chronic infection with the virus can occur and can lead to liver damage and liver cancer.
Chronic infection with the virus is particularly common (70 to 90 percent) in infants who acquire the infection from their mothers at birth and are not treated. Children with hepatitis C usually have no symptoms but are at risk for future liver damage due to chronic infection with the virus.
When to Call Your Child’s Doctor
Your child’s doctor should be called for any child who develops jaundice or the other symptoms of hepatitis described earlier or whobecomes very drowsy or confused. Also contact the doctor if your child has had contact with others with viral hepatitis or if your child will be traveling to an area where hepatitis infection is common.
How the Diagnosis Is Made
The doctor suspects the diagnosis based on the child’s symptoms; inflammation of the liver and infection with a specific hepatitis virus can be detected by blood tests.
Treatment
Children with hepatitis who develop symptoms typically need no specific treatment other than specific supportive care—plenty of rest and adequate fluid intake to prevent dehydration. In a child with a poor appetite due to hepatitis, offering smaller, more frequent meals and fluidsthat are high in calories (like milk shakes) may help ensure that the child receives adequate nutrition while recovering. Some children whose symptoms are more severe may require hospitalization to receive IV fluids and other treatment.
Prevention
The risk of exposure to hepatitis A can be reduced by following good hygiene—including hand washing—and avoiding crowded, unsanitary living conditions or drinking or swimming in contaminated water. Shellfish from sewage contaminated waters should not be eaten. If someone in the household develops hepatitis, antiseptic cleansers should be used to clean any toilet, sink, potty chair, or bedpan used by that person.
A hepatitis A vaccine is available, and it is recommended for children traveling to areas of the world where the risk of exposure to the virus is high. The staffs of child-care facilities, family members of infected persons, and sexual partners of someone with the infection are also candidates to receive the vaccine. Giving immune globulin within one to two weeks after exposure to the virus can prevent illness from developing in 80 to 90 percent of individuals.
Hepatitis B infection from transfusions is very rare in the United States today because blood products are screened for the presence of the virus. Hepatitis B vaccine is now recommended for routine immunization of all infants and for adolescents who didn’t receive the vaccine in infancy. Hepatitis B infection in infants and young children is usually the result of transmission of the disease at birth by an infected mother who carries the virus.
Pregnant women should be screened for the virus, and if a woman is found to be a carrier, her infant should be given a dose of hepatitis B immune globulin (HBIG) at birth, followed by the recommended doses of the vaccine. In the United States, blood and plasma donors are screened for HCV infection. At present, there is no vaccine for the prevention of hepatitis C.
Complications
Although children with HAV infection almost always recover fully without specific treatment, children with chronic HBV and HCV infections are at increased risk for the development of liver damage (cirrhosis), liver failure, and liver cancer as they get older. It is important that these individuals be followed medically for signs of these complications. New drugs, such as interferon alpha, may be helpful in some cases, and patients who develop liver failure may receive liver transplants.
Hand, Foot, and Mouth Disease
Cause
Certain strains of the Group A coxsackieviruses cause this disease.
Symptoms
Symptoms include fever (usually mild) and malaise, followed by a characteristic rash: red bumps and/or blisters on the hands and feet, along with blisters and ulcers on the tongue and the inner linings of the cheeks. Most outbreaks occur during summer and fall.
How It Spreads
It spreads person-to-person through stool and respiratory fluids.
Incubation Period
The incubation period is four to six days.
How Long Symptoms Last
Symptoms last four to seven days. Mouth pain is usually gone by about four days; mouth blisters are usually gone within one week.
When to Call Your Child’s Doctor
Call your child’s doctor if your child develops a rash on the hands and feet and blisters or ulcers in the mouth. Call the doctor if your child will not eat or drink, shows signs of dehydration, or has fever for more than three days.
How the Diagnosis Is Made
The doctor observes the characteristic rash and mouth lesions.
Home Treatment
Nonprescription drugs such as acetaminophen (Tylenol) can be given to reduce fever or mouth and throat soreness. Do not give aspirin. Fluids such as water, ice chips, fruit ices, or cool gelatin can help relieve a sore mouth or throat. Avoid giving your child acidic, hot, or spicy foods that may irritate a sore mouth.
Prevention
Encourage your child to wash his hands after going to the bathroom and blowing his nose and before and after eating. If changing the diaper of your child with the virus, make sure to wash your hands afterward. Also, wash your child’s towels and sheets.
Complications
A child can become dehydrated from inadequate fluid intake due to mouth pain. Inflammation of the brain (encephalitis) and membranes covering the brain and spinal cord (meningitis) can occur.
Certain strains of the Group A coxsackieviruses cause this disease.
Symptoms
Symptoms include fever (usually mild) and malaise, followed by a characteristic rash: red bumps and/or blisters on the hands and feet, along with blisters and ulcers on the tongue and the inner linings of the cheeks. Most outbreaks occur during summer and fall.
How It Spreads
It spreads person-to-person through stool and respiratory fluids.
Incubation Period
The incubation period is four to six days.
How Long Symptoms Last
Symptoms last four to seven days. Mouth pain is usually gone by about four days; mouth blisters are usually gone within one week.
When to Call Your Child’s Doctor
Call your child’s doctor if your child develops a rash on the hands and feet and blisters or ulcers in the mouth. Call the doctor if your child will not eat or drink, shows signs of dehydration, or has fever for more than three days.
How the Diagnosis Is Made
The doctor observes the characteristic rash and mouth lesions.
Home Treatment
Nonprescription drugs such as acetaminophen (Tylenol) can be given to reduce fever or mouth and throat soreness. Do not give aspirin. Fluids such as water, ice chips, fruit ices, or cool gelatin can help relieve a sore mouth or throat. Avoid giving your child acidic, hot, or spicy foods that may irritate a sore mouth.
Prevention
Encourage your child to wash his hands after going to the bathroom and blowing his nose and before and after eating. If changing the diaper of your child with the virus, make sure to wash your hands afterward. Also, wash your child’s towels and sheets.
Complications
A child can become dehydrated from inadequate fluid intake due to mouth pain. Inflammation of the brain (encephalitis) and membranes covering the brain and spinal cord (meningitis) can occur.
Epiglottitis
Cause
Epiglottitis is an inflammation of the child’s epiglottis, the flap of tissue that covers the windpipe, and is usually caused by the bacterium Hemophilus influenzae type B. Epiglottitis occurs most often in children age three to seven years, and it is more common in the fall and spring.
Symptoms
Symptoms may develop very rapidly. The child may have symptoms of an upper respiratory infection. As the epiglottis becomes inflamed and begins to swell, the throat becomes sore and painful and the child’s temperature may rise to 102 to 104 degrees Fahrenheit. The child may begin to drool because swallowing is painful. The voice may sound muffled.
Within hours, the child may develop breathing difficulty. With each breath, the child may make a high-pitched squeaking sound (stridor). The nostrils may flare out as the child breathes. The child may appear anxious and want to sit up, holding the head and neck forward to help him breathe. The lips and fingertips may start to turn blue as less oxygen gets into the bloodstream. If not treated quickly, a child with this infection may die due to blockage of the windpipe by the swollen epiglottis.
How It Spreads
The bacteria, found in nasal secretions, are spread when a person who may carry the bacteria without even being sick coughs or sneezes.
How Long Symptoms Last
Symptoms usually improve quickly with treatment, but the child usually needs to stay in the hospital for several days to a week.
When to Call Your Child’s Doctor
Bring your child to the emergency room immediately if she shows the symptoms described. Epiglottitis can be deadly if not treated quickly.
How the Diagnosis Is Made
Doctors suspect the diagnosis based on a child’s symptoms. Your child is then usually taken to an operating room where a doctor will insert a lighted thin tube into the throat to see if the epiglottis is inflamed and swollen. It may appear cherry red. The swollen epiglottis can also be seen on an X-ray of the neck.
Treatment
A specialist may insert a breathing tube into the windpipe to hold the airway open. Your child may then be placed on a ventilator (breathing machine) in the hospital to help her breathe. Intravenous antibiotics are given to kill the bacteria causing the infection. When the infection and swelling of the epiglottis subside with treatment, the breathing tube can be removed.
Prevention
The incidence of epiglottitis has decreased dramatically since the vaccine against Hemophilus influenzae type B was introduced. Infants should be immunized against this bacterium, which also causes meningitis and pneumonia. If your child develops epiglottitis, your child’s doctor may recommend that anyone in the household not fully vaccinated (except pregnant women) receive a course of the antibiotic rifampin. The doctor may recommend the same for anyone not fully vaccinated at your child’s school or child-care center.
Epiglottitis is an inflammation of the child’s epiglottis, the flap of tissue that covers the windpipe, and is usually caused by the bacterium Hemophilus influenzae type B. Epiglottitis occurs most often in children age three to seven years, and it is more common in the fall and spring.
Symptoms
Symptoms may develop very rapidly. The child may have symptoms of an upper respiratory infection. As the epiglottis becomes inflamed and begins to swell, the throat becomes sore and painful and the child’s temperature may rise to 102 to 104 degrees Fahrenheit. The child may begin to drool because swallowing is painful. The voice may sound muffled.
Within hours, the child may develop breathing difficulty. With each breath, the child may make a high-pitched squeaking sound (stridor). The nostrils may flare out as the child breathes. The child may appear anxious and want to sit up, holding the head and neck forward to help him breathe. The lips and fingertips may start to turn blue as less oxygen gets into the bloodstream. If not treated quickly, a child with this infection may die due to blockage of the windpipe by the swollen epiglottis.
How It Spreads
The bacteria, found in nasal secretions, are spread when a person who may carry the bacteria without even being sick coughs or sneezes.
How Long Symptoms Last
Symptoms usually improve quickly with treatment, but the child usually needs to stay in the hospital for several days to a week.
When to Call Your Child’s Doctor
Bring your child to the emergency room immediately if she shows the symptoms described. Epiglottitis can be deadly if not treated quickly.
How the Diagnosis Is Made
Doctors suspect the diagnosis based on a child’s symptoms. Your child is then usually taken to an operating room where a doctor will insert a lighted thin tube into the throat to see if the epiglottis is inflamed and swollen. It may appear cherry red. The swollen epiglottis can also be seen on an X-ray of the neck.
Treatment
A specialist may insert a breathing tube into the windpipe to hold the airway open. Your child may then be placed on a ventilator (breathing machine) in the hospital to help her breathe. Intravenous antibiotics are given to kill the bacteria causing the infection. When the infection and swelling of the epiglottis subside with treatment, the breathing tube can be removed.
Prevention
The incidence of epiglottitis has decreased dramatically since the vaccine against Hemophilus influenzae type B was introduced. Infants should be immunized against this bacterium, which also causes meningitis and pneumonia. If your child develops epiglottitis, your child’s doctor may recommend that anyone in the household not fully vaccinated (except pregnant women) receive a course of the antibiotic rifampin. The doctor may recommend the same for anyone not fully vaccinated at your child’s school or child-care center.
Encephalitis
Cause
Encephalitis is an inflammation of the brain. Acute infectious encephalitis is most often caused by a virus. Enteroviruses cause about 80 percent of all cases. Arboviruses, transmitted by insects such as ticks and mosquitoes, can also causeencephalitis. West Nile encephalitis virus is an example. Measles, mumps, chicken pox, and mononucleosis can sometimes cause encephalitis, usually a mild case. Rabies can also cause encephalitis. Although rare, herpes simplex virus, the virus that causes cold sores, can cause a serious, life-threatening form of encephalitis. Tuberculosis, syphilis, and Lyme disease can also cause brain inflammation.
Symptoms
In mild cases, the child may have a fever, headache, poor appetite, lethargy, sensitivity of the eyes to light, and a general “sick” feeling. Severe cases may involve high fever, severe headache, nausea and vomiting, stiff neck, seizures (convulsions), blurred vision, confusion, personality changes, problems in speech or hearing, hallucinations, difficulty moving limbs, involuntary movements, difficulty walking, loss of sensation in some part of the body, memory loss, drowsiness, and coma. In infants, look for vomiting, a full or bulging soft spot (fontanel), and persistent crying and irritability.
How It Spreads
Depending on the type, a virus can be spread through airborne nose or throat fluid droplets or through direct contact with an infected person. Encephalitis caused by an arbovirus is not contagious from person to person but must be transmitted by the bite of an infected insect. Rabies is transmitted by a bite or scratch from an infected animal.
Incubation Period
The incubation period depends on the cause. Enteroviruses have an incubation of four to six days.
How Long Symptoms Last
For most types, the acute phase lasts several days to a week; recovery takes two to three weeks. In severe cases, such as those caused by herpes simplex encephalitis, the child must be hospitalized, and recovery may take several weeks or longer.
When to Call Your Child’s Doctor
Call your child’s doctor immediately if your child has any of the symptoms described earlier, especially if your child is recovering from measles, mumps, or chicken pox and develops a high fever.
How the Diagnosis Is Made
Your child’s doctor may order blood tests and perform a spinal tap (lumbar puncture) to examine spinal fluid for evidence of infection. An EEG (electroencephalogram), which measures brain waves, and either an MRI or CT scan, which looks for swelling and other changes in the brain, may also be done.
Treatment
In some mild cases, children can be treated at home, but others need to be treated and observed closely in a hospital. In most cases children with viral encephalitis will be given nonaspirin medicines to reduce fever and headache and will be placed in a darkened room away from noise and lights to enable comfort and rest. Those with herpes simplex encephalitis will be treated with an antiviral drug like acyclovir. Encephalitis caused by bacteria is treated with appropriate antibiotics.
Prevention
Encephalitis caused by common childhood illnesses such as measles, mumps, and chicken pox can be prevented by getting the appropriate vaccinations. In areas with large numbers of mosquitoes during the summer months, keep children indoors from dusk to dawn when mosquitoes feed. Dress your child in light clothing that covers the skin.
If you have stagnant water around, get rid of it because it breeds mosquitoes. To prevent children from being bitten by a tick, make sure they wear longsleeved shirts and long pants when walking through the woods. Tuck pants into socks. Regularly check for ticks on your child’s body after the child has been outside. Make sure your pets are vaccinated for rabies.
Contagious Periods
The contagious period varies according to the specific virus.
Complications
Most children recover fully from viral encephalitis, but the outcome depends on the severity of the illness and the germ involved. Severe cases of encephalitis can cause damage to the nervous system that can result in epilepsy, hearing and visual problems, and impairment of intelligence and movement. Herpes simplex encephalitis is often fatal.
Encephalitis is an inflammation of the brain. Acute infectious encephalitis is most often caused by a virus. Enteroviruses cause about 80 percent of all cases. Arboviruses, transmitted by insects such as ticks and mosquitoes, can also causeencephalitis. West Nile encephalitis virus is an example. Measles, mumps, chicken pox, and mononucleosis can sometimes cause encephalitis, usually a mild case. Rabies can also cause encephalitis. Although rare, herpes simplex virus, the virus that causes cold sores, can cause a serious, life-threatening form of encephalitis. Tuberculosis, syphilis, and Lyme disease can also cause brain inflammation.
Symptoms
In mild cases, the child may have a fever, headache, poor appetite, lethargy, sensitivity of the eyes to light, and a general “sick” feeling. Severe cases may involve high fever, severe headache, nausea and vomiting, stiff neck, seizures (convulsions), blurred vision, confusion, personality changes, problems in speech or hearing, hallucinations, difficulty moving limbs, involuntary movements, difficulty walking, loss of sensation in some part of the body, memory loss, drowsiness, and coma. In infants, look for vomiting, a full or bulging soft spot (fontanel), and persistent crying and irritability.
How It Spreads
Depending on the type, a virus can be spread through airborne nose or throat fluid droplets or through direct contact with an infected person. Encephalitis caused by an arbovirus is not contagious from person to person but must be transmitted by the bite of an infected insect. Rabies is transmitted by a bite or scratch from an infected animal.
Incubation Period
The incubation period depends on the cause. Enteroviruses have an incubation of four to six days.
How Long Symptoms Last
For most types, the acute phase lasts several days to a week; recovery takes two to three weeks. In severe cases, such as those caused by herpes simplex encephalitis, the child must be hospitalized, and recovery may take several weeks or longer.
When to Call Your Child’s Doctor
Call your child’s doctor immediately if your child has any of the symptoms described earlier, especially if your child is recovering from measles, mumps, or chicken pox and develops a high fever.
How the Diagnosis Is Made
Your child’s doctor may order blood tests and perform a spinal tap (lumbar puncture) to examine spinal fluid for evidence of infection. An EEG (electroencephalogram), which measures brain waves, and either an MRI or CT scan, which looks for swelling and other changes in the brain, may also be done.
Treatment
In some mild cases, children can be treated at home, but others need to be treated and observed closely in a hospital. In most cases children with viral encephalitis will be given nonaspirin medicines to reduce fever and headache and will be placed in a darkened room away from noise and lights to enable comfort and rest. Those with herpes simplex encephalitis will be treated with an antiviral drug like acyclovir. Encephalitis caused by bacteria is treated with appropriate antibiotics.
Prevention
Encephalitis caused by common childhood illnesses such as measles, mumps, and chicken pox can be prevented by getting the appropriate vaccinations. In areas with large numbers of mosquitoes during the summer months, keep children indoors from dusk to dawn when mosquitoes feed. Dress your child in light clothing that covers the skin.
If you have stagnant water around, get rid of it because it breeds mosquitoes. To prevent children from being bitten by a tick, make sure they wear longsleeved shirts and long pants when walking through the woods. Tuck pants into socks. Regularly check for ticks on your child’s body after the child has been outside. Make sure your pets are vaccinated for rabies.
Contagious Periods
The contagious period varies according to the specific virus.
Complications
Most children recover fully from viral encephalitis, but the outcome depends on the severity of the illness and the germ involved. Severe cases of encephalitis can cause damage to the nervous system that can result in epilepsy, hearing and visual problems, and impairment of intelligence and movement. Herpes simplex encephalitis is often fatal.
Ear Infection—Ear Canal (Otitis Externa/Swimmer’s Ear)
Cause
An infection of the ear canal—the opening that carries sound from the outside to the eardrum—otitis externa can be caused by several types of bacteria and fungi.
Symptoms
The major symptom is severe ear pain that gets worse when the ear is pulled. Sometimes there is an itching sensation in the ear before the pain begins. The outer ear may also become reddened. There may be a slight fever or a greenish-yellow discharge from the ear opening, and hearing may be decreased. Otitis externa usually occurs in children whose ears are exposed to persistent moisture, especially when swimming. Chlorinated water can dry out the skin of the ear canal and make it easier for germs to attack. It can also occur when a child’s ear canal has been scratched by a sharp object.
How It Spreads
It is not contagious.
Incubation Period
There is no set incubation period for an enfection of the ear canal, but ear pain often develops gradually over hours after the ear canal has been exposed to moisture, such as during swimming.
How Long Symptoms Last
Pain may continue to increase for the first 12 to 24 hours after treatment begins. If treated with medication, it is usually cured within 7 to 10 days, but the child may have to stay out of the water longer than this.
When to Call Your Child’s Doctor
Call your child’s doctor if there is pain in the ear with or without fever, loss of hearing, or discharge from the ear.
How the Diagnosis Is Made
Your child’s doctor will make a diagnosis by examing the ear with an otoscope.
Treatment
For milder infections, your child’s doctor will prescribe eardrops containing antibiotics, which fight infection, and sometimes corticosteroids, which reduce swelling. Eardrops are usually given several times a day for 7 to 10 days. If the opening of the ear canal is narrowed, the doctor may insert a cotton wick into the canal to help carry the drops into the canal. For more severe infections, oral antibiotics may be given.
Home Treatment
Acetaminophen (Tylenol) or ibuprofen may be given to relieve pain. To protect the infected ear, the doctor will usually advise keeping your child’s head out of water for 10 to 14 days, including covering the ear while bathing or showering. Shower caps or cotton earplugs coated with petroleum jelly—removed after bathing or showering—can be used for this purpose.
Prevention
Children (and adults) should avoid putting straight stiff objects like cotton-tipped applicators or bobby pins in their ears. If your child doesn’t have ear tubes or a hole in the eardrum, acid alcohol drops like SwimEar can be used after swimming to help keep the ear canal dry. Soft earplugs that easily mold to the shape of your child’s ear canal can also be used while your child is swimming.
Complications
Untreated, an infection can spread to the surrounding cartilage and bone.
An infection of the ear canal—the opening that carries sound from the outside to the eardrum—otitis externa can be caused by several types of bacteria and fungi.
Symptoms
The major symptom is severe ear pain that gets worse when the ear is pulled. Sometimes there is an itching sensation in the ear before the pain begins. The outer ear may also become reddened. There may be a slight fever or a greenish-yellow discharge from the ear opening, and hearing may be decreased. Otitis externa usually occurs in children whose ears are exposed to persistent moisture, especially when swimming. Chlorinated water can dry out the skin of the ear canal and make it easier for germs to attack. It can also occur when a child’s ear canal has been scratched by a sharp object.
How It Spreads
It is not contagious.
Incubation Period
There is no set incubation period for an enfection of the ear canal, but ear pain often develops gradually over hours after the ear canal has been exposed to moisture, such as during swimming.
How Long Symptoms Last
Pain may continue to increase for the first 12 to 24 hours after treatment begins. If treated with medication, it is usually cured within 7 to 10 days, but the child may have to stay out of the water longer than this.
When to Call Your Child’s Doctor
Call your child’s doctor if there is pain in the ear with or without fever, loss of hearing, or discharge from the ear.
How the Diagnosis Is Made
Your child’s doctor will make a diagnosis by examing the ear with an otoscope.
Treatment
For milder infections, your child’s doctor will prescribe eardrops containing antibiotics, which fight infection, and sometimes corticosteroids, which reduce swelling. Eardrops are usually given several times a day for 7 to 10 days. If the opening of the ear canal is narrowed, the doctor may insert a cotton wick into the canal to help carry the drops into the canal. For more severe infections, oral antibiotics may be given.
Home Treatment
Acetaminophen (Tylenol) or ibuprofen may be given to relieve pain. To protect the infected ear, the doctor will usually advise keeping your child’s head out of water for 10 to 14 days, including covering the ear while bathing or showering. Shower caps or cotton earplugs coated with petroleum jelly—removed after bathing or showering—can be used for this purpose.
Prevention
Children (and adults) should avoid putting straight stiff objects like cotton-tipped applicators or bobby pins in their ears. If your child doesn’t have ear tubes or a hole in the eardrum, acid alcohol drops like SwimEar can be used after swimming to help keep the ear canal dry. Soft earplugs that easily mold to the shape of your child’s ear canal can also be used while your child is swimming.
Complications
Untreated, an infection can spread to the surrounding cartilage and bone.
Diarrhea
Cause
Diarrhea—frequent and watery bowel movements—can be caused by bacteria, viruses, or parasites that infect the stomach or intestines. The specific germs involved depend on the geographic area and the level of sanitation and hygiene.
Some Infections That Cause Diarrhea Amebiasis
Especially common in the tropics, this is an infection of the large intestine caused by the parasite Entamoeba histolytica, which is transmitted by contaminated food or drink or by direct fecal-oral contact.
Campylobacter. The Campylobacter bacterium can cause diarrhea and is spread by drinking contaminated water, eating undercooked poultry or meat, or coming in contact with contaminated animals.
Cryptosporidium. This parasite is a common cause of diarrhea outbreaks in child-care centers, and it can be spread by contact with infected animals—especially cows—or infected people or by drinking contaminated water.
E. coli. Five classes of E. coli bacteria can cause diarrhea in children either by directly attacking the intestine wall or by producing a toxin that irritates the intestines. E. coli infections are usually spread through contaminated food or water. Undercooked beef in hamburgers can also be a source of E. coli infections.
Giardiasis. Caused by the parasite Giardia, this is a common cause of diarrhea among diaperwearing children, especially in child-care settings. It is spread through contaminated water supplies—especially at water parks, aquarium “touch tanks,” and pools (it is resistant to chlorine)—and through human contact.
Rotavirus. This virus is the most common cause of diarrhea in young children in the United States. It is spread through contact with infected feces, and outbreaks often occur in child-care centers and children’s hospitals.
Salmonella. These bacteria are responsible for 50 percent of food poisoning in the United States. Almost any food of animal origin, especially raw or undercooked meat, poultry, and eggs, can cause salmonella.
Shigella. These bacteria are among the major causes of dysentery (bloody diarrhea) in the world and are spread by contact with contaminated feces.
Yersinia. Contaminated water and meat products, especially chitterlings and other pork products, are a common source of infection with this organism.
Symptoms Symptoms usually include crampy abdominal pain followed by diarrhea. Some bacterial infections, including campylobacter, salmonella, E. coli, shigella, and yersinia also may cause blood in the stools. With salmonella, shigella, and yersinia, the stool may also contain mucus. Some bacteria may also cause fever, loss of appetite, nausea, or vomiting. All can potentially lead to dehydration and weight loss.
Incubation Period
Times vary depending on the germ causing the infection. The incubation period for shigella is usually 16 to 72 hours. For a virus, incubation periods range from 4 to 48 hours. Parasitic infections usually have longer incubation periods; for example, giardia has an incubation period of one to three weeks.
How Long Symptoms Last
In cases of mild diarrhea caused by a virus, the diarrhea resolves within a few days. With bacterial diarrhea, symptoms may last days to weeks. Parasitic infections may cause diarrhea lasting weeks or even months.
When to Call Your Child’s Doctor
Call your child’s doctor if your child has a severe or prolonged bout of diarrhea with fever, vomiting, or severe abdominal pain, or if the stools contain blood or mucus. Call immediately if your child shows the following signs of dehydration: dry lips and tongue; pale, dry skin; sunken eyes; listless behavior; and decreased urination.
How the Diagnosis Is Made
A stool sample may be tested in a lab to identify the specific cause of the infection.
Treatment
First ensure your child receives enough fluids and minerals to replace those lost due to diarrhea. Viral and some of the bacterial infections are not treated with antibiotics because children usually recover on their own. Those infections caused by parasites are treated with antiparasitic medicines.
Home Treatment
Plain water should not be used to treat diarrhea in infants and small children. Your child’s doctor may advise using a special drink called an oral rehydration solution (such as Pedialyte) that replaces salts and other nutrients lost with diarrhea and is available at drugstores or grocery stores. The Centers for Disease Control and Prevention recommends that these be kept in the home for treatment of bouts of diarrhea in young children.
Prevention
Hand washing is the best way to prevent infections that are spread from person to person. Child-care personnel and parents should wash hands carefully after changing children’s diapers. Bathroom surfaces should be kept clean. Wash fruits and vegetables thoroughly before eating. Wash kitchen counters and utensils that have been in contact with raw meat, especially poultry. Refrigerate meats immediately after bringing them home, and cook them until they are no longer pink.
Refrigerate left-overs as soon as possible. Never drink from streams, lakes, or springs unless health authorities have said the water is safe for drinking. In developing countries it may be safer not to drink from the tap. Be careful when buying food prepared by street vendors, especially if no health agency oversees their safety practices.
Keep pets’ feeding areas separate from family eating areas. Never wash pet cages or bowls in the same sink where meals are prepared. Reptiles and amphibians such as iguanas and turtles may carry Salmonella bacteria and are not good pets for young children, who may fail to wash their hands adequately after handling them.
Complications
Diarrhea accounts for 9 percent of hospitalizations in children younger than five years. It kills 300 to 500 children in the United States each year, most of them infants younger than one year. Worldwide, it accounts for the deaths of four million children each year.
Diarrhea—frequent and watery bowel movements—can be caused by bacteria, viruses, or parasites that infect the stomach or intestines. The specific germs involved depend on the geographic area and the level of sanitation and hygiene.
Some Infections That Cause Diarrhea Amebiasis
Especially common in the tropics, this is an infection of the large intestine caused by the parasite Entamoeba histolytica, which is transmitted by contaminated food or drink or by direct fecal-oral contact.
Campylobacter. The Campylobacter bacterium can cause diarrhea and is spread by drinking contaminated water, eating undercooked poultry or meat, or coming in contact with contaminated animals.
Cryptosporidium. This parasite is a common cause of diarrhea outbreaks in child-care centers, and it can be spread by contact with infected animals—especially cows—or infected people or by drinking contaminated water.
E. coli. Five classes of E. coli bacteria can cause diarrhea in children either by directly attacking the intestine wall or by producing a toxin that irritates the intestines. E. coli infections are usually spread through contaminated food or water. Undercooked beef in hamburgers can also be a source of E. coli infections.
Giardiasis. Caused by the parasite Giardia, this is a common cause of diarrhea among diaperwearing children, especially in child-care settings. It is spread through contaminated water supplies—especially at water parks, aquarium “touch tanks,” and pools (it is resistant to chlorine)—and through human contact.
Rotavirus. This virus is the most common cause of diarrhea in young children in the United States. It is spread through contact with infected feces, and outbreaks often occur in child-care centers and children’s hospitals.
Salmonella. These bacteria are responsible for 50 percent of food poisoning in the United States. Almost any food of animal origin, especially raw or undercooked meat, poultry, and eggs, can cause salmonella.
Shigella. These bacteria are among the major causes of dysentery (bloody diarrhea) in the world and are spread by contact with contaminated feces.
Yersinia. Contaminated water and meat products, especially chitterlings and other pork products, are a common source of infection with this organism.
Symptoms Symptoms usually include crampy abdominal pain followed by diarrhea. Some bacterial infections, including campylobacter, salmonella, E. coli, shigella, and yersinia also may cause blood in the stools. With salmonella, shigella, and yersinia, the stool may also contain mucus. Some bacteria may also cause fever, loss of appetite, nausea, or vomiting. All can potentially lead to dehydration and weight loss.
Incubation Period
Times vary depending on the germ causing the infection. The incubation period for shigella is usually 16 to 72 hours. For a virus, incubation periods range from 4 to 48 hours. Parasitic infections usually have longer incubation periods; for example, giardia has an incubation period of one to three weeks.
How Long Symptoms Last
In cases of mild diarrhea caused by a virus, the diarrhea resolves within a few days. With bacterial diarrhea, symptoms may last days to weeks. Parasitic infections may cause diarrhea lasting weeks or even months.
When to Call Your Child’s Doctor
Call your child’s doctor if your child has a severe or prolonged bout of diarrhea with fever, vomiting, or severe abdominal pain, or if the stools contain blood or mucus. Call immediately if your child shows the following signs of dehydration: dry lips and tongue; pale, dry skin; sunken eyes; listless behavior; and decreased urination.
How the Diagnosis Is Made
A stool sample may be tested in a lab to identify the specific cause of the infection.
Treatment
First ensure your child receives enough fluids and minerals to replace those lost due to diarrhea. Viral and some of the bacterial infections are not treated with antibiotics because children usually recover on their own. Those infections caused by parasites are treated with antiparasitic medicines.
Home Treatment
Plain water should not be used to treat diarrhea in infants and small children. Your child’s doctor may advise using a special drink called an oral rehydration solution (such as Pedialyte) that replaces salts and other nutrients lost with diarrhea and is available at drugstores or grocery stores. The Centers for Disease Control and Prevention recommends that these be kept in the home for treatment of bouts of diarrhea in young children.
Prevention
Hand washing is the best way to prevent infections that are spread from person to person. Child-care personnel and parents should wash hands carefully after changing children’s diapers. Bathroom surfaces should be kept clean. Wash fruits and vegetables thoroughly before eating. Wash kitchen counters and utensils that have been in contact with raw meat, especially poultry. Refrigerate meats immediately after bringing them home, and cook them until they are no longer pink.
Refrigerate left-overs as soon as possible. Never drink from streams, lakes, or springs unless health authorities have said the water is safe for drinking. In developing countries it may be safer not to drink from the tap. Be careful when buying food prepared by street vendors, especially if no health agency oversees their safety practices.
Keep pets’ feeding areas separate from family eating areas. Never wash pet cages or bowls in the same sink where meals are prepared. Reptiles and amphibians such as iguanas and turtles may carry Salmonella bacteria and are not good pets for young children, who may fail to wash their hands adequately after handling them.
Complications
Diarrhea accounts for 9 percent of hospitalizations in children younger than five years. It kills 300 to 500 children in the United States each year, most of them infants younger than one year. Worldwide, it accounts for the deaths of four million children each year.
Conjunctivitis (Pinkeye)
Cause
Conjunctivitis is caused by an inflammation of the conjunctiva, the thin membrane that covers the whites of the eyes and lines the inner surface of the eyelids. About 80 percent of infectious conjunctivitis cases are caused by bacteria, and the rest are caused by viruses. Allergies or exposure of the eyes to chemicals or other irritants can also be causes.
Symptoms
Symptoms include discomfort or the sensation that something is in the eye, followed by redness and inflammation of the conjunctiva. After a day or so, there may be a discharge from the eye. In bacterial conjunctivitis, the discharge is thick and pus-like; in viral conjunctivitis, the discharge usually is watery. The eyelashes may be matted and stuck together when the child wakes in the morning.
How It Spreads
It is spread through contact with discharge or secretions from the infected eye of someone else.
Incubation Period
For bacterial conjunctivitis, the incubation period is a few days; for viral, it is up to a week.
How Long Symptoms Last
Bacterial conjunctivitis lasts 7 to 10 days if untreated. Viral conjunctivitis can last as long as two weeks.
When to Call Your Child’s Doctor
If your child—particularly your newborn—has any of the symptoms of conjunctivitis, call your child’s doctor. Also, call the doctor if your child complains of severe pain, a change in vision, or sensitivity to light, or if your child’s condition does not get better in four to five days.
How the Diagnosis Is Made
The doctor will examine your child’s eye and in some cases may take a swab of the discharge for lab analysis.
Treatment
Often infectious conjunctivitis will resolve by itself, but doctors usually prescribe antibiotic drops or ointment to decrease the possibility of spreading it to others. Drops are usually prescribed for a week, about four doses a day. Ointment, usually prescribed for infants, is given two times daily and can temporarily blur vision. Children with prolonged or repeated bouts of reddened, itchy, and watery eyes may benefit from treatment for allergies or removal of irritants (such as cigarette smoke) from their environment.
Home Treatment
Warm compresses (a clean washcloth soaked in water) can help loosen crusts on eyelids and lashes. Gauze or cotton balls dipped in warm water can be used to carefully clean the infected eye.
Prevention
Your child should wash her hands after touching the infected eye. Others touching the child’s infected eye should also wash hands. Gauze or cotton balls used to clean the eye should be thrown away; child’s towels, washcloths, and pillowcases should be washed in hot water.
Contagious Periods
Children with bacterial conjunctivitis are contagious as soon as symptoms appear; the child will remain contagious as long as there is discharge or with bacterial conjunctivitis, until antibiotics have been given for 24 hours. Viral conjunctivitis is contagious before the onset of symptoms and for as long as the symptoms last. Children should not be in school or a child-care center while they have visible symptoms of conjunctivitis.
Complications
Some bacteria can cause both conjunctivitis and middle ear infection (otitis media) at the same time.
Conjunctivitis is caused by an inflammation of the conjunctiva, the thin membrane that covers the whites of the eyes and lines the inner surface of the eyelids. About 80 percent of infectious conjunctivitis cases are caused by bacteria, and the rest are caused by viruses. Allergies or exposure of the eyes to chemicals or other irritants can also be causes.
Symptoms
Symptoms include discomfort or the sensation that something is in the eye, followed by redness and inflammation of the conjunctiva. After a day or so, there may be a discharge from the eye. In bacterial conjunctivitis, the discharge is thick and pus-like; in viral conjunctivitis, the discharge usually is watery. The eyelashes may be matted and stuck together when the child wakes in the morning.
How It Spreads
It is spread through contact with discharge or secretions from the infected eye of someone else.
Incubation Period
For bacterial conjunctivitis, the incubation period is a few days; for viral, it is up to a week.
How Long Symptoms Last
Bacterial conjunctivitis lasts 7 to 10 days if untreated. Viral conjunctivitis can last as long as two weeks.
When to Call Your Child’s Doctor
If your child—particularly your newborn—has any of the symptoms of conjunctivitis, call your child’s doctor. Also, call the doctor if your child complains of severe pain, a change in vision, or sensitivity to light, or if your child’s condition does not get better in four to five days.
How the Diagnosis Is Made
The doctor will examine your child’s eye and in some cases may take a swab of the discharge for lab analysis.
Treatment
Often infectious conjunctivitis will resolve by itself, but doctors usually prescribe antibiotic drops or ointment to decrease the possibility of spreading it to others. Drops are usually prescribed for a week, about four doses a day. Ointment, usually prescribed for infants, is given two times daily and can temporarily blur vision. Children with prolonged or repeated bouts of reddened, itchy, and watery eyes may benefit from treatment for allergies or removal of irritants (such as cigarette smoke) from their environment.
Home Treatment
Warm compresses (a clean washcloth soaked in water) can help loosen crusts on eyelids and lashes. Gauze or cotton balls dipped in warm water can be used to carefully clean the infected eye.
Prevention
Your child should wash her hands after touching the infected eye. Others touching the child’s infected eye should also wash hands. Gauze or cotton balls used to clean the eye should be thrown away; child’s towels, washcloths, and pillowcases should be washed in hot water.
Contagious Periods
Children with bacterial conjunctivitis are contagious as soon as symptoms appear; the child will remain contagious as long as there is discharge or with bacterial conjunctivitis, until antibiotics have been given for 24 hours. Viral conjunctivitis is contagious before the onset of symptoms and for as long as the symptoms last. Children should not be in school or a child-care center while they have visible symptoms of conjunctivitis.
Complications
Some bacteria can cause both conjunctivitis and middle ear infection (otitis media) at the same time.
Common Cold
Cause
Dozens of viruses can cause infection of the upper respiratory tract, including rhinoviruses, coronaviruses, adenovirus, respiratory syncytial virus (RSV), enteroviruses, and the influenza and parainfluenza viruses. These can affect the nose, throat, sinuses, ears, eustachian tubes (fleshy tubes connecting the throat with the middle ear), trachea, larynx, and bronchial tubes.
Symptoms
Symptoms include a tickle in the throat, runny or stuffy nose, and sneezing. Children may also have a sore throat, cough, headache, mild fever, fatigue, muscle aches, and loss of appetite.
How It Spreads
It is spread by breathing in the virus spread through the air in secretions from sneezing or coughing, or by person-to-person contact. Children get more colds than adults do, especially through exposure in child care or school.
Incubation Period
It takes two to five days for symptoms to appear after exposure to the virus.
How Long Symptoms Last
Symptoms usually last 7 to 14 days.
When to Call Your Child’s Doctor
It is not necessary to call your child’s doctor if typical symptoms (congestion, cough, sneezing, mild fever) are present, but call if there are other signs of concern. These include sore throat; coughing that produces green or gray sputum (mucus) or a cough that is getting worse or is not getting better over a three- to four-day period; fever lasting several days or higher than 101 degrees Fahrenheit; shaking chills; chest pain; shortness of breath, rapid breathing, or other signs that your child is working hard to breathe; or blue lips, skin, or fingernails.
Other signs include difficulty swallowing, unwillingness to drink fluids, unusual fatigue, or enlarged lymph nodes (glands) in the neck. Also, call your child’s doctor if your child has a very runny nose, especially with a green discharge, that lasts more than two weeks or if your child complains of headache or pressure behind the face.
Treatment
Because a cold is caused by a virus, antibiotics are not helpful.
Home Treatment
Infection resolves by itself; there is no cure. For relief of symptoms try saltwater drops in the nostrils to help relieve a stuffy nose, cool-mist vaporizer to increase air moisture, and petroleum jelly (Vaseline) on the skin under the nose to soothe rawness. Your child should get plenty of fluids and rest. For fever or headache, you can give your infant or child acetaminophen (Tylenol).
Do not give a child aspirin; aspirin in children is associated with Reye syndrome, a rare but lifethreatening disease. Over-the-counter decongestants and antihistamines are of questionable effectiveness, do not shorten the duration of symptoms, and can cause side effects potentially worse than symptoms from the cold itself, especially in infants and toddlers.
Prevention
If possible, avoid contact with the person who has a cold for the first two to four days of symptoms. Usually, however, the person is contagious before he or she is aware of the infection. Children with colds should wash their hands thoroughly, especially after blowing their nose, and should be taught to cover their nose and mouth when coughing or sneezing.
Contagious Periods
The contagious period depends on the virus causing the infection, but it is generally for several days after symptoms appear.
Dozens of viruses can cause infection of the upper respiratory tract, including rhinoviruses, coronaviruses, adenovirus, respiratory syncytial virus (RSV), enteroviruses, and the influenza and parainfluenza viruses. These can affect the nose, throat, sinuses, ears, eustachian tubes (fleshy tubes connecting the throat with the middle ear), trachea, larynx, and bronchial tubes.
Symptoms
Symptoms include a tickle in the throat, runny or stuffy nose, and sneezing. Children may also have a sore throat, cough, headache, mild fever, fatigue, muscle aches, and loss of appetite.
How It Spreads
It is spread by breathing in the virus spread through the air in secretions from sneezing or coughing, or by person-to-person contact. Children get more colds than adults do, especially through exposure in child care or school.
Incubation Period
It takes two to five days for symptoms to appear after exposure to the virus.
How Long Symptoms Last
Symptoms usually last 7 to 14 days.
When to Call Your Child’s Doctor
It is not necessary to call your child’s doctor if typical symptoms (congestion, cough, sneezing, mild fever) are present, but call if there are other signs of concern. These include sore throat; coughing that produces green or gray sputum (mucus) or a cough that is getting worse or is not getting better over a three- to four-day period; fever lasting several days or higher than 101 degrees Fahrenheit; shaking chills; chest pain; shortness of breath, rapid breathing, or other signs that your child is working hard to breathe; or blue lips, skin, or fingernails.
Other signs include difficulty swallowing, unwillingness to drink fluids, unusual fatigue, or enlarged lymph nodes (glands) in the neck. Also, call your child’s doctor if your child has a very runny nose, especially with a green discharge, that lasts more than two weeks or if your child complains of headache or pressure behind the face.
Treatment
Because a cold is caused by a virus, antibiotics are not helpful.
Home Treatment
Infection resolves by itself; there is no cure. For relief of symptoms try saltwater drops in the nostrils to help relieve a stuffy nose, cool-mist vaporizer to increase air moisture, and petroleum jelly (Vaseline) on the skin under the nose to soothe rawness. Your child should get plenty of fluids and rest. For fever or headache, you can give your infant or child acetaminophen (Tylenol).
Do not give a child aspirin; aspirin in children is associated with Reye syndrome, a rare but lifethreatening disease. Over-the-counter decongestants and antihistamines are of questionable effectiveness, do not shorten the duration of symptoms, and can cause side effects potentially worse than symptoms from the cold itself, especially in infants and toddlers.
Prevention
If possible, avoid contact with the person who has a cold for the first two to four days of symptoms. Usually, however, the person is contagious before he or she is aware of the infection. Children with colds should wash their hands thoroughly, especially after blowing their nose, and should be taught to cover their nose and mouth when coughing or sneezing.
Contagious Periods
The contagious period depends on the virus causing the infection, but it is generally for several days after symptoms appear.
Chicken Pox (Varicella)
Cause
Chicken pox is an infection with the varicella-zoster virus.
Symptoms
Characteristic blisters usually appear first on the trunk and face and can spread over the whole body. Blisters may also appear inside the mouth, nose, and vagina. Some children have a few blisters; others have hundreds. The blisters are about 0.2 to 0.4 inch wide, with a reddish base (“dew drop on a rose petal”). The rash is usually associated with moderate to severe itching. Some children have fever (usually mild), stomach pain, and a general ill feeling.
How It Spreads
The virus is spread in nasal secretions and in fluid from inside the blisters. It is very contagious; epidemics are especially common in late winter and early spring. Ninety percent of all nonimmune children (those who haven’t had chicken pox or vaccine) will catch it when exposed.
Incubation Period
Typically, the incubation period is 7 to 21 days after exposure, with most cases appearing between 14 and 17 days.
How Long Symptoms Last
Symptoms last for 7 to 10 days.
When to Call Your Child’s Doctor
If you are uncertain about the diagnosis or concerned about a possible complication, call your child’s doctor. Call if there are signs that the skin blisters are infected (area around the blisters is swollen, red, or painful), the blisters are leaking thick pus-like fluid, or itching is so severe that it doesn’t respond to treatment. Call your child’s doctor immediately if your child is difficult to awaken or is confused, has trouble walking, has a headache, has a stiff neck, is vomiting repeatedly, has difficulty breathing, has a severe cough, or has eyes very sensitive to light. Also call immediately if fever rises above 103 degrees Fahrenheit.
How the Diagnosis Is Made
Diagnosis is made through the appearance of the rash and other symptoms.
Treatment
Because it is a viral infection, antibiotics are not useful unless there is a secondary bacterial infection. Children with a weakened immune system may be treated with the antiviral medicine acyclovir. Because it must be started within 24 hours of the first sign of pox and it is usually only mildly beneficial, it is not generally recommended for otherwise healthy children.
Home Treatment
If your child is uncomfortable because of a fever (most children with chicken pox have only mild fever—less than 102 degrees Fahrenheit—and don’t need treatment), use a nonaspirin medicine such as acetaminophen (Tylenol). Do not use aspirin because it can lead to Reye syndrome in infected children, which can harm the brain and liver. It is also best to avoid giving ibuprofen, as some recent studies indicate it may put children at risk for developing bacterial infections on top of the chicken pox sores.
To relieve itching, use wet compresses or bathe your child in cool or lukewarm water every three to four hours. Calamine lotion may help. Trim your child’s fingernails to help prevent tissue injury and secondary bacterial infection of the skin from scratching. For blisters in the mouth, avoid acidic or salty foods. If your child has sores in the genital area, ask your child’s doctor or pharmacist about anesthetic cream.
Prevention
The vaccine against chicken pox is 70 to 90 percent effective. Vaccinated children who contract the virus have a milder case. A single injection of the vac- People with chicken pox are contagious from two days before blisters appear until all blisters are crusted over. Children with chicken pox should be kept out of child care or school for about a week; it’s not necessary to wait until the scabs fall off to let the child out of isolation. People with certain chronic diseases or weakened immune systems and pregnant women should avoid contact with chicken pox. Once a child has had chicken pox, she will never get it again.
Chicken pox is an infection with the varicella-zoster virus.
Symptoms
Characteristic blisters usually appear first on the trunk and face and can spread over the whole body. Blisters may also appear inside the mouth, nose, and vagina. Some children have a few blisters; others have hundreds. The blisters are about 0.2 to 0.4 inch wide, with a reddish base (“dew drop on a rose petal”). The rash is usually associated with moderate to severe itching. Some children have fever (usually mild), stomach pain, and a general ill feeling.
How It Spreads
The virus is spread in nasal secretions and in fluid from inside the blisters. It is very contagious; epidemics are especially common in late winter and early spring. Ninety percent of all nonimmune children (those who haven’t had chicken pox or vaccine) will catch it when exposed.
Incubation Period
Typically, the incubation period is 7 to 21 days after exposure, with most cases appearing between 14 and 17 days.
How Long Symptoms Last
Symptoms last for 7 to 10 days.
When to Call Your Child’s Doctor
If you are uncertain about the diagnosis or concerned about a possible complication, call your child’s doctor. Call if there are signs that the skin blisters are infected (area around the blisters is swollen, red, or painful), the blisters are leaking thick pus-like fluid, or itching is so severe that it doesn’t respond to treatment. Call your child’s doctor immediately if your child is difficult to awaken or is confused, has trouble walking, has a headache, has a stiff neck, is vomiting repeatedly, has difficulty breathing, has a severe cough, or has eyes very sensitive to light. Also call immediately if fever rises above 103 degrees Fahrenheit.
How the Diagnosis Is Made
Diagnosis is made through the appearance of the rash and other symptoms.
Treatment
Because it is a viral infection, antibiotics are not useful unless there is a secondary bacterial infection. Children with a weakened immune system may be treated with the antiviral medicine acyclovir. Because it must be started within 24 hours of the first sign of pox and it is usually only mildly beneficial, it is not generally recommended for otherwise healthy children.
Home Treatment
If your child is uncomfortable because of a fever (most children with chicken pox have only mild fever—less than 102 degrees Fahrenheit—and don’t need treatment), use a nonaspirin medicine such as acetaminophen (Tylenol). Do not use aspirin because it can lead to Reye syndrome in infected children, which can harm the brain and liver. It is also best to avoid giving ibuprofen, as some recent studies indicate it may put children at risk for developing bacterial infections on top of the chicken pox sores.
To relieve itching, use wet compresses or bathe your child in cool or lukewarm water every three to four hours. Calamine lotion may help. Trim your child’s fingernails to help prevent tissue injury and secondary bacterial infection of the skin from scratching. For blisters in the mouth, avoid acidic or salty foods. If your child has sores in the genital area, ask your child’s doctor or pharmacist about anesthetic cream.
Prevention
The vaccine against chicken pox is 70 to 90 percent effective. Vaccinated children who contract the virus have a milder case. A single injection of the vac- People with chicken pox are contagious from two days before blisters appear until all blisters are crusted over. Children with chicken pox should be kept out of child care or school for about a week; it’s not necessary to wait until the scabs fall off to let the child out of isolation. People with certain chronic diseases or weakened immune systems and pregnant women should avoid contact with chicken pox. Once a child has had chicken pox, she will never get it again.
Cellulitis
Cause
A spreading skin infection, cellulitis often begins in an area of broken skin like a scrape, cut, or scratch. It can be caused by many different bacteria; most common are group A Streptococcus and Staphylococcusaureus.
Symptoms
Cellulitis typically appears on the face and lower legs. It begins as a small, tender, red, swollen area. As it spreads, the child may begin to feel ill. The child also may develop fever, sometimes with chills and sweating. Sometimes lymph nodes (glands) near the area become swollen.
How It Spreads
It is not contagious.
Incubation Period
Depending on the type of bacteria, it can take from hours to days to appear.
How Long Symptoms Last
With antibiotic treatment it is usually cured within 7 to 10 days.
When to Call Your Child’s Doctor
Call your child’s doctor whenever an area of your child’s skin becomes red, warm, and painful, with or without fever and chills, especially if on the face. Call immediately if your child has a chronic illness like sicklecell anemia or is receiving treatment that weakens the immune system.
How the Diagnosis Is Made
Your child’s doctor will examine the involved skin area. In some cases, blood tests will be ordered to check to see if the infection has spread to the blood.
Treatment
Oral antibiotics are usually prescribed. In severe cases, your child will be hospitalized for intravenous antibiotic treatment. Usually your child’s doctor will want to see your child a few days after the start of treatment to see if cellulitis has improved.
Home Treatment
Heat or warm soaks can be applied to the affected area.
Prevention
Wash any wound or scrape well with soap and water. Apply an antibiotic ointment and cover with an adhesive bandage or gauze. Check with your child’s doctor if your child gets a large cut, a deep puncture wound, or a bite (animal or human).
Complications
Cellulitis can occur very quickly after an animal or human bite, especially if the wound is deep.
A spreading skin infection, cellulitis often begins in an area of broken skin like a scrape, cut, or scratch. It can be caused by many different bacteria; most common are group A Streptococcus and Staphylococcusaureus.
Symptoms
Cellulitis typically appears on the face and lower legs. It begins as a small, tender, red, swollen area. As it spreads, the child may begin to feel ill. The child also may develop fever, sometimes with chills and sweating. Sometimes lymph nodes (glands) near the area become swollen.
How It Spreads
It is not contagious.
Incubation Period
Depending on the type of bacteria, it can take from hours to days to appear.
How Long Symptoms Last
With antibiotic treatment it is usually cured within 7 to 10 days.
When to Call Your Child’s Doctor
Call your child’s doctor whenever an area of your child’s skin becomes red, warm, and painful, with or without fever and chills, especially if on the face. Call immediately if your child has a chronic illness like sicklecell anemia or is receiving treatment that weakens the immune system.
How the Diagnosis Is Made
Your child’s doctor will examine the involved skin area. In some cases, blood tests will be ordered to check to see if the infection has spread to the blood.
Treatment
Oral antibiotics are usually prescribed. In severe cases, your child will be hospitalized for intravenous antibiotic treatment. Usually your child’s doctor will want to see your child a few days after the start of treatment to see if cellulitis has improved.
Home Treatment
Heat or warm soaks can be applied to the affected area.
Prevention
Wash any wound or scrape well with soap and water. Apply an antibiotic ointment and cover with an adhesive bandage or gauze. Check with your child’s doctor if your child gets a large cut, a deep puncture wound, or a bite (animal or human).
Complications
Cellulitis can occur very quickly after an animal or human bite, especially if the wound is deep.
Cat Scratch Disease
Cause
Cat scratch disease is caused by the bacterium Bartonella henselae, usually transmitted through a cat scratch.
Symptoms
About one-half to three-fourths of children diagnosed have a cat scratch on their bodies. Within 3 to 10 days after the scratch, a blister or small bump develops. Usually within two weeks of the scratch, lymph nodes (glands) near the scratch swell. The nodes may be painful and surrounded by a larger area of swelling under the skin, which may be red. About one-third of children develop fever, fatigue, loss of appetite, and headache. In a few cases, the bump appears as a small sore on the conjunctiva (lining of the eye surface), with swollen nodes in the area around the ears.
How It Spreads
It is transmitted by a scratch from an infected animal, most often a kitten. It is not spread from person to person.
Incubation Period
It takes 3 to 10 days for a blister or bump to appear at the site of the scratch. Lymph node swelling starts about two weeks after the scratch, with a range of 7 to 60 days.
How Long Symptoms Last
Usually nodes are swollen for one to two months, but swelling may last much longer.
When to Call Your Child’s Doctor
Call your child’s doctor if your child has been scratched by a cat or kitten and develops swollen glands and a fever.
How the Diagnosis Is Made
Exposure to a cat or kitten is the first clue. The doctor may order a blood test for cat scratch disease as well as other skin and blood tests to rule out other causes of swollen lymph nodes.
Treatment
The doctor may or may not prescribe antibiotics. Even without antibiotics, the disease will go away in time.
Home Treatment
The child does not have to be isolated from the rest of the family. Avoid injuring areas of the swollen lymph nodes. Moist compresses of salty water may help soothe painful nodes.
Prevention
Teach children to avoid stray or unfamiliar cats. If your child is scratched by a cat or other pet, wash the area thoroughly with soap and water.
Contagious Periods
For unknown reasons, cat scratch disease occurs more often in fall and winter. Kittens are more often infected with the bacteria than mature cats; once infected they carry the bacteria for months.
Complications
A small number of children (less than 5 percent) develop seizures, bizarre behavior, or other neurologic symptoms several weeks after lymph node swelling appears.
Cat scratch disease is caused by the bacterium Bartonella henselae, usually transmitted through a cat scratch.
Symptoms
About one-half to three-fourths of children diagnosed have a cat scratch on their bodies. Within 3 to 10 days after the scratch, a blister or small bump develops. Usually within two weeks of the scratch, lymph nodes (glands) near the scratch swell. The nodes may be painful and surrounded by a larger area of swelling under the skin, which may be red. About one-third of children develop fever, fatigue, loss of appetite, and headache. In a few cases, the bump appears as a small sore on the conjunctiva (lining of the eye surface), with swollen nodes in the area around the ears.
How It Spreads
It is transmitted by a scratch from an infected animal, most often a kitten. It is not spread from person to person.
Incubation Period
It takes 3 to 10 days for a blister or bump to appear at the site of the scratch. Lymph node swelling starts about two weeks after the scratch, with a range of 7 to 60 days.
How Long Symptoms Last
Usually nodes are swollen for one to two months, but swelling may last much longer.
When to Call Your Child’s Doctor
Call your child’s doctor if your child has been scratched by a cat or kitten and develops swollen glands and a fever.
How the Diagnosis Is Made
Exposure to a cat or kitten is the first clue. The doctor may order a blood test for cat scratch disease as well as other skin and blood tests to rule out other causes of swollen lymph nodes.
Treatment
The doctor may or may not prescribe antibiotics. Even without antibiotics, the disease will go away in time.
Home Treatment
The child does not have to be isolated from the rest of the family. Avoid injuring areas of the swollen lymph nodes. Moist compresses of salty water may help soothe painful nodes.
Prevention
Teach children to avoid stray or unfamiliar cats. If your child is scratched by a cat or other pet, wash the area thoroughly with soap and water.
Contagious Periods
For unknown reasons, cat scratch disease occurs more often in fall and winter. Kittens are more often infected with the bacteria than mature cats; once infected they carry the bacteria for months.
Complications
A small number of children (less than 5 percent) develop seizures, bizarre behavior, or other neurologic symptoms several weeks after lymph node swelling appears.
Bronchiolitis (Respiratory Syncytial Virus)
Cause
An inflammation of the bronchioles, the lung’s smallest air passages, bronchiolitis is usually caused by a viral infection. The most common cause, especially during cold-weather epidemics, is respiratory syncytial virus (RSV). Other causes include mycoplasma, parainfluenza virus, influenza virus, and some adenoviruses.
Symptoms
Initial symptoms include congestion, runny nose, and mild cough for a day or two. These symptoms are followed by gradually increasing difficulty in breathing characterized by wheezing; rapid, shallow breathing (60 to 80 times a minute); rapid heartbeat; the sucking in of the skin over the neck and chest with each breath; and a cough. Fever may occur. Usually no vomiting or diarrhea occurs, although bouts of coughing may lead to vomiting.
How It Spreads
Respiratory syncytial virus and other viruses spread easily through families, child-care centers, and schools, especially in winter. Children contract the viruses by coming in contact with the nose and throat secretions of others.
Incubation Period
The incubation period is several days to a week, depending on the virus causing the infection.
How Long Symptoms Last
Most cases last about a week, but in severe cases, coughing may continue for a few weeks even after the child appears otherwise well.
When to Call Your Child’s Doctor
If your child is having trouble breathing, contact your child’s doctor immediately.
How the Diagnosis Is Made
The doctor will listen to the child’s lungs with a stethoscope and observe breathing. Rapid test for RSV is available to make the diagnosis.
Treatment
Most cases are mild and can be treated at home. Cases in very young infants or those with other medical problems such as prematurity, lung disease, or heart disease may require hospitalization for oxygen, intravenous fluids, other treatment, and monitoring. Antibiotics are not helpful unless there is a secondary infection caused by bacteria.
Home Treatment
Use a cool-mist humidifier during the dry winter months to keep air humid. (Clean every day to keep mold from growing.) Make sure your child gets enough fluids.
Prevention
Try to get your child to wash her hands frequently and avoid contact with sick children. Bronchiolitis occurs more commonly in male infants three to six months of age who have not been breastfed. Infants exposed to cigarette smoke are more likely to develop respiratory infections and have more severe symptoms. Some children become so ill from RSV infection that they need to be hospitalized, especially premature infants and those with lung or heart conditions. Synagis (palivizumab), a medication containing antibodies against RSV, is available to help prevent infection in these children. The drug is given as monthly injections during RSV season.
Contagious Periods
Most infants infected with RSV can continue to spread the virus for 5 to 12 days after the start of symptoms. Bronchiolitis, especially from RSV, is spread very easily because the virus remains alive in nasal secretions and saliva outside the body for hours. Someone sneezing very close to someone else or touching a surface contaminated with secretions could therefore give someone RSV fairly easily. Therefore, good hand washing is extremely important to prevent outbreaks and rapid spread through child-care centers, schools, and hospitals.
Complications
Complications from bronchiolitis include ear infections, and less commonly, secondary bacterial pneumonia. Sometimes, children with preexisting heart or lung conditions or who are born prematurely need hospitalization for oxygen or respiratory therapy. Up to 30 percent of children who develop bronchiolitis go on to develop some form of asthma, especially if there is a family history of asthma.
An inflammation of the bronchioles, the lung’s smallest air passages, bronchiolitis is usually caused by a viral infection. The most common cause, especially during cold-weather epidemics, is respiratory syncytial virus (RSV). Other causes include mycoplasma, parainfluenza virus, influenza virus, and some adenoviruses.
Symptoms
Initial symptoms include congestion, runny nose, and mild cough for a day or two. These symptoms are followed by gradually increasing difficulty in breathing characterized by wheezing; rapid, shallow breathing (60 to 80 times a minute); rapid heartbeat; the sucking in of the skin over the neck and chest with each breath; and a cough. Fever may occur. Usually no vomiting or diarrhea occurs, although bouts of coughing may lead to vomiting.
How It Spreads
Respiratory syncytial virus and other viruses spread easily through families, child-care centers, and schools, especially in winter. Children contract the viruses by coming in contact with the nose and throat secretions of others.
Incubation Period
The incubation period is several days to a week, depending on the virus causing the infection.
How Long Symptoms Last
Most cases last about a week, but in severe cases, coughing may continue for a few weeks even after the child appears otherwise well.
When to Call Your Child’s Doctor
If your child is having trouble breathing, contact your child’s doctor immediately.
How the Diagnosis Is Made
The doctor will listen to the child’s lungs with a stethoscope and observe breathing. Rapid test for RSV is available to make the diagnosis.
Treatment
Most cases are mild and can be treated at home. Cases in very young infants or those with other medical problems such as prematurity, lung disease, or heart disease may require hospitalization for oxygen, intravenous fluids, other treatment, and monitoring. Antibiotics are not helpful unless there is a secondary infection caused by bacteria.
Home Treatment
Use a cool-mist humidifier during the dry winter months to keep air humid. (Clean every day to keep mold from growing.) Make sure your child gets enough fluids.
Prevention
Try to get your child to wash her hands frequently and avoid contact with sick children. Bronchiolitis occurs more commonly in male infants three to six months of age who have not been breastfed. Infants exposed to cigarette smoke are more likely to develop respiratory infections and have more severe symptoms. Some children become so ill from RSV infection that they need to be hospitalized, especially premature infants and those with lung or heart conditions. Synagis (palivizumab), a medication containing antibodies against RSV, is available to help prevent infection in these children. The drug is given as monthly injections during RSV season.
Contagious Periods
Most infants infected with RSV can continue to spread the virus for 5 to 12 days after the start of symptoms. Bronchiolitis, especially from RSV, is spread very easily because the virus remains alive in nasal secretions and saliva outside the body for hours. Someone sneezing very close to someone else or touching a surface contaminated with secretions could therefore give someone RSV fairly easily. Therefore, good hand washing is extremely important to prevent outbreaks and rapid spread through child-care centers, schools, and hospitals.
Complications
Complications from bronchiolitis include ear infections, and less commonly, secondary bacterial pneumonia. Sometimes, children with preexisting heart or lung conditions or who are born prematurely need hospitalization for oxygen or respiratory therapy. Up to 30 percent of children who develop bronchiolitis go on to develop some form of asthma, especially if there is a family history of asthma.
Botulism
Cause
Botulism is caused by the bacterium Clostridium botulinum. Infant botulism, which is seen in infants six months and younger, occurs when spores of the bacteria are consumed, grow in the intestines, and release a toxin that blocks the messages between nerves and muscles throughout the body, leading to paralysis. Food-borne botulism is caused by eating foods—such as contaminated home-canned foods—that contain the botulism toxin.
Symptoms
Symptoms of infant botulism may include constipation, poor suck, increased drooling, lethargy, weak cry, and worsening muscle weakness. Food-borne botulism may include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness.
How It Spreads
The bacteria live in soil and dust or may contaminate food, including honey (uncommon). The infection is not transmitted from person to person. Spores or the toxin must be consumed.
Incubation Period
The incubation period of infant botulism is 3 to 30 days. With foodborne botulism, symptoms usually begin 18 to 36 hours after eating the contaminated food, but the period can range from 2 hours to as long as 8 days.
How Long Symptoms Last
The average hospital stay is one month.
When to Call Your Child’s Doctor
Untreated cases can be fatal. Call your child’s doctor immediately if your infant has trouble breathing, is drooling abnormally, or has trouble swallowing. Also see the doctor if move normally.
How the Diagnosis Is Made
The doctor detects toxin in the stool or blood or finds the bacteria in the stool.
Treatment
Botulism is treated with supportive care, usually in the intensive care unit. If diagnosed early, food-borne botulism may be treated with an antitoxin that blocks the effects of the toxin circulating in the blood. Doctors may also try to remove contaminated food by inducing vomiting or using enemas. Currently, antitoxin is not routinely given for treatment of infant botulism.
Prevention
Most cases of infant botulism cannot be prevented, but children younger than one year should not be given honey. For food-borne botulism, people who do home canning should follow strict hygienic procedures. Because botulism is destroyed at high temperatures, consider boiling home-canned foods for 10 minutes to ensure safety. Oils infused with garlic or herbs should be refrigerated. Potatoes baked in aluminum foil should be served hot or kept refrigerated.
Complications
Death is rare for patients who are hospitalized in the United States. However, some children may develop other complications, such as respiratory problems, pneumonia, or sepsis (blood poisoning). After recovery, children appear to have an increased incidence of strabismus, a misalignment of the eyes (“wandering” or “crossing” eyes).
Botulism is caused by the bacterium Clostridium botulinum. Infant botulism, which is seen in infants six months and younger, occurs when spores of the bacteria are consumed, grow in the intestines, and release a toxin that blocks the messages between nerves and muscles throughout the body, leading to paralysis. Food-borne botulism is caused by eating foods—such as contaminated home-canned foods—that contain the botulism toxin.
Symptoms
Symptoms of infant botulism may include constipation, poor suck, increased drooling, lethargy, weak cry, and worsening muscle weakness. Food-borne botulism may include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness.
How It Spreads
The bacteria live in soil and dust or may contaminate food, including honey (uncommon). The infection is not transmitted from person to person. Spores or the toxin must be consumed.
Incubation Period
The incubation period of infant botulism is 3 to 30 days. With foodborne botulism, symptoms usually begin 18 to 36 hours after eating the contaminated food, but the period can range from 2 hours to as long as 8 days.
How Long Symptoms Last
The average hospital stay is one month.
When to Call Your Child’s Doctor
Untreated cases can be fatal. Call your child’s doctor immediately if your infant has trouble breathing, is drooling abnormally, or has trouble swallowing. Also see the doctor if move normally.
How the Diagnosis Is Made
The doctor detects toxin in the stool or blood or finds the bacteria in the stool.
Treatment
Botulism is treated with supportive care, usually in the intensive care unit. If diagnosed early, food-borne botulism may be treated with an antitoxin that blocks the effects of the toxin circulating in the blood. Doctors may also try to remove contaminated food by inducing vomiting or using enemas. Currently, antitoxin is not routinely given for treatment of infant botulism.
Prevention
Most cases of infant botulism cannot be prevented, but children younger than one year should not be given honey. For food-borne botulism, people who do home canning should follow strict hygienic procedures. Because botulism is destroyed at high temperatures, consider boiling home-canned foods for 10 minutes to ensure safety. Oils infused with garlic or herbs should be refrigerated. Potatoes baked in aluminum foil should be served hot or kept refrigerated.
Complications
Death is rare for patients who are hospitalized in the United States. However, some children may develop other complications, such as respiratory problems, pneumonia, or sepsis (blood poisoning). After recovery, children appear to have an increased incidence of strabismus, a misalignment of the eyes (“wandering” or “crossing” eyes).
About Childhood Disease
Sooner or later every child gets an infection, and most will have several each year asthey grow up. That’s especially true throughout the first few years of life, as your child is exposed to new bacteria and viruses. Soothing a feverish child, encouraging him to drink fluids, and cheerleading as he swallows an unpleasant-tasting Medicine are all an inevitable part of parenting.
Fortunately, the symptoms of most infections last only a few days, whether specific treatment is needed or not. Some though, can be life-threatening or have long-term consequences. Some infections are common and can be expected to occur in almost every child. Some are extremely rare. Immunizations, which are among the most important developments in the history of medicine, have controlled or wiped out diseases that used to claim or wreck millions of lives.
More vaccines are on the way. Still, the majority of childhood infections can’t be prevented by immunizations. Different infections can have very similar signs and symptoms. And many noninfectious medical conditions can masquerade as infections, and vice versa. That’s why it’s important to consult your child’s doctor whenever you think your child might have a significant illness.
And remember that although we’ve written this chapter to be as up to date as possible, new treatments and ways to make diagnoses are constantly being developed, so be sure to get the latest information from your child’s doctor.
Fortunately, the symptoms of most infections last only a few days, whether specific treatment is needed or not. Some though, can be life-threatening or have long-term consequences. Some infections are common and can be expected to occur in almost every child. Some are extremely rare. Immunizations, which are among the most important developments in the history of medicine, have controlled or wiped out diseases that used to claim or wreck millions of lives.
More vaccines are on the way. Still, the majority of childhood infections can’t be prevented by immunizations. Different infections can have very similar signs and symptoms. And many noninfectious medical conditions can masquerade as infections, and vice versa. That’s why it’s important to consult your child’s doctor whenever you think your child might have a significant illness.
And remember that although we’ve written this chapter to be as up to date as possible, new treatments and ways to make diagnoses are constantly being developed, so be sure to get the latest information from your child’s doctor.
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