Nursing

Here are a few guidelines you might wish to follow: 

• Fever is an important symptom.  When it occurs along with a sore throat, an earache, nausea, listlessness, or a rash, your child may be carrying something very contagious.  Most pediatricians advise parents to keep children home during the course of a fever and for an additional 24 hours after the fever has passed.  Children must be fever-free for 24 hours without the use of fever-reducing medications. 
• A bad cough or cold symptoms can indicate a severe cold, bronchitis, flu, or even pneumonia.  Some children suffer one cold after another all winter long and a run-of-the-mill cold should not be a reason to miss school.  But, if your child is not acting “right”, has difficulty breathing, or is becoming dehydrated, it could be serious.  Check with your doctor right away. 
• A runny nose is the way many children respond to pollen, dust, chalk, or simply a change of season.  If it isn’t a common cold, then it’s an allergy and allergies aren’t contagious.  Don’t keep the child home. 
• Diarrhea and vomiting make children very uncomfortable, and being near a bathroom becomes a top priority.  If your child has repeated episodes of diarrhea and vomiting, accompanied by fever, a rash, or general weakness, consult your doctor and keep your child out of school until the illness passes. 
• Conjunctivitis or “pink eye” is highly contagious and uncomfortable.  Symptoms include eye or eyes burning, itching, and producing a whitish discharge.  Minor cases (caused by a virus) and severe cases (caused by bacteria) require treatment with prescription eye drops.  Keep your child home until 24 hours after medication is started.
• Strep throat and scarlet fever are two highly contagious conditions caused by streptococcal (bacterial) infection.  Symptoms include a sore throat and a high fever.  With scarlet fever a rash will also appear 12 to 48 hours later.  A child with strep throat or scarlet fever should be kept home and treated with antibiotics, as prescribed by a physician.  After 24 hours on an antibiotic, a child is usually no longer contagious and may return to school. 
• Ringworm is a mild fungal infection of the skin and is easily treated.  Typically, ringworm appears as a flat, growing, ring-shaped rash.  The edges of the circle are usually reddish and may be raised, scaly, and itchy; the center of the circle is often clear.  Another type of ringworm fungus causes skin color to become lighter in flat patches, especially on the trunk and face.  On the scalp, ringworm infection typically begins as a small bump and spreads outward, leaving scaly patches of temporary hair loss. 
• Ringworm is spread when infected skin comes in direct contact with healthy skin or infected skin flakes fall and are touched by other people.  A person with ringworm is infectious as long as the fungus is present in the infected area. 
• Treatment: An antifungal ointment is typically applied to the skin for several weeks.  Occasionally, oral antifungal medicine is prescribed, particularly if the diagnosis is ringworm of the scalp. 
• School attendance guidelines: Students with ringworm will be dismissed from school, but may return as soon as treatment has begun. Affected areas of the body should be loosely covered with gauze, bandage, or clothing to prevent shedding of infected scales.

Special Medical Issues

If your child has any medical issues that we should be aware of, such as asthma, allergies (food, drugs, bees/wasps, environmental), seizures, diabetes, heart disease, etc., please, stop by the nurse's office.

If your child has asthma, please, bring an extra inhaler to the nurse's office to be available in the event of an asthma episode occurring during school hours.  Also, have your physician complete an Asthma Action Plan for inclusion in your child's health folder.

Medications Taken at School

To ensure the well-being of every child at NES, please, remember that all medications, including over-the-counter preparations, brought to school must be delivered by the parent to the nurse's office to be dispensed by the nurse.  The medication must be in the original container and include a note with the name of the medication, the time it is to be administered, and the reason it is being given.

**For safety concerns, please, do not have students bring medications to school. 

Over-the-Counter Medications Available at School

A few over-the-counter medications are available at school to be dispensed by the nurse.    

• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Benedryl
• Sudafed
• Robitussin
• Antacid
• Cepacol throat lozenges
• Chloroceptic throat spray  

Written permission must be documented each year before a medication will be administered.  Consent forms are sent home in September (fall information packet) and should be signed and returned to the nurse's office. These forms are, also, available in the health office.

What is a vaccine and how does it work?  Vaccines are preparations designed to provide protection against certain diseases or infections, like tetanus, measles, polio, hepatitis, and the seasonal flu.  They are created by using small amounts of killed or weakened microorganisms (bacteria or virus) that cause a specific disease.  The resulting vaccine stimulates the immune system to react as if a real infection was present in the body.  Once the immune system is stimulated, it recognizes and "remembers" the organism and then fights the infection if the organism enters the body at a later time.  Due to the widespread use of these vaccines, the world has seen a dramatic decline of many infectious diseases, but they still circulate either in the U.S. or in other parts of the world.

Why are vaccines important? Babies are born with immunity that protects them from certain diseases due to antibodies that are passed from the mother during pregnancy.  This immunity is only temporary, however, so vaccines are started once the babies' immune system is developed enough to respond to the vaccines.

Some people feel that they do not have to vaccinate their children because most other people in the community are immunized.  They are relying on what's known as "herd immunity".  This is only effective if all members of the population are vaccinated and the individual remains within the herd.  Once the individual goes beyond the herd, they are susceptible to any disease they have not had, including those that could have been prevented through vaccines.  This is often seen when people travel to areas where vaccines are not given routinely.

The CDC has designed a schedule for the vaccines it recommends, giving the times the vaccines should be started.  Some vaccines require more than one dose to be effective and the schedule includes the intervals between shots in a specific series.  To be effective, all doses of a vaccine series should be given.  If your child is behind on immunizations, there is a "catch-up" schedule your doctor can use.  However, immunizations do not have to be restarted if the schedule between doses is interrupted.

How safe are vaccines?  Vaccines are among the safest and most reliable drugs available.  Some parents may hesitate to have their children vaccinated because they worry there will be serious reactions to the vaccine or that the child may get the illness the vaccine is designed to prevent.  But, because the components of vaccines are weakened or killed, and in some cases, only parts of the microorganism are used, they're very unlikely to cause any serious illness.

What are the reactions to vaccination?  After receiving some vaccines, there may be mild reactions, such as soreness where the shot was given or fever, but serious reactions are rare.  However, the risks of reaction related to the use of vaccinations are small compared with the risks associated with the disease the immunizations are designed to prevent.

 Understanding the Risks of Choosing Not to Vaccinate

If You Choose Not to Vaccinate Your Child, Understand the Risks and Responsibilities - Information from the CDC

If you choose to delay some vaccines or reject some vaccines entirely, there can be risks.  Please follow these steps to protect your child, your family, and others.

With the decision to delay or reject vaccines comes an important responsibility that could save your child’s life or the life of someone else.

Anytime that your child is ill and you:

• Call 911;
• Ride in an ambulance;
• Visit a hospital emergency room; or
• Visit your child’s doctor or any clinic

You must tell the medical staff that your child has not received all the vaccines recommended for his or her age.  Keep a vaccination record easily accessible so that you can report exactly which vaccines your child has received, even when you are under stress.

Telling health care professional your child’s vaccination status is essential for two reasons:

• When your child is being evaluated, the doctor will need to consider the possibility that your child has a vaccine-preventable disease. Many of these diseases are now uncommon, but they still occur.
• The people who help your child can take precautions, such as isolating your child, so that the disease does not spread to others. One group at high risk for contracting disease is infants who are too young to be fully vaccinated.  For example, the measles vaccine is not usually recommended for babies younger than 12 months.  Very young babies who get measles are likely to be seriously ill, often requiring hospitalization.  Other people at high risk for contracting disease are those with weaker immune systems, such as some people with cancer and transplant recipients.

Before an outbreak of a vaccine-preventable disease occurs in your community:

• Talk to your child’s doctor or nurse to be sure your child’s medical record is up to date regarding vaccination status. Ask for a copy of the updated record.
• Inform your child’s school, childcare facility, and other caregivers about your child’s vaccination status.
• Be aware that your child can catch diseases from people who don’t have symptoms. For example, Hib meningitis can be spread from people who have the bacteria in their body, but are not ill.  You can’t tell who is contagious.

When there is vaccine-preventable disease in your community:

• It may not be too late to get protection by getting vaccinated. Ask your child’s doctor.
• If there are cases (or, in some circumstances, a single case) of a vaccine-preventable disease in your community, you may be asked to take your child out of school, childcare, or organized activities (for example, playgroups or sports).
• Your school, childcare facility, or other institution will tell you when it is safe for an unvaccinated child to return. Be prepared to keep your child home for several days up to several weeks.
• Learn about the disease and how it is spread. It may not be possible to avoid exposure.  For example, measles is so contagious, that hours after an infected person has left the room, an unvaccinated person can get measles just by entering that room.
• Each disease is different and the time between when your child might have been exposed to a disease and when he or she may get sick will vary. Talk with your child’s doctor or the health department to get their guidelines for determining when your child is no longer at risk of coming down with the disease.

Be Aware:

• Any vaccine-preventable disease can strike at any time in the U.S. because all of these diseases still circulate either in the U.S. or elsewhere in the world.
• Sometimes vaccine-preventable diseases cause outbreaks, that is, clusters of cases in a given area.
• Some of the vaccine-preventable diseases that still circulate in the U.S. include whooping cough, chickenpox, Hib (a cause of meningitis), and influenza. These diseases, as well as the other vaccine-preventable disease, can range from mild to severe and life-threatening.  In most cases, there is no way to know beforehand if a child will get a mild or serious case.
• For some diseases, one case is enough to cause concern a community. An example is measles, which is one of the most contagious diseases known.  This disease spreads quickly among people who are not immune.

If you know your child is exposed to a vaccine-preventable disease for which he or she has not been vaccinated:

• Learn the early signs and symptoms of the disease.
• Seek immediate medical help if your child or any family members develop early signs or symptoms of the disease.
  • IMPORTANT: Notify the doctor’s office, urgent care facility, ambulance personnel, or emergency room staff that your child has not been fully vaccinated before medical staff have contact with your child or your family members. They need to know that your child may have a vaccine-preventable disease so that they can treat your child correctly as quickly as possible.  Medical staff also can take simple precautions to prevent diseases from spreading to others if they know ahead of time that their patient may have a contagious disease.
• Follow recommendations to isolate your child from others, including family members, and especially infants and people with weakened immune systems. Most vaccine-preventable diseases can be very dangerous to infants who are too young to be fully vaccinated or children who are not vaccinated due to certain medical conditions.
• Be aware that for some vaccine-preventable diseases, there are medicines to treat infected people and medicines to keep people they come in contact with from getting the disease.
• Ask your health care professional about other ways to protect your family members and anyone else who may come into contact with your child.
• Your family may be contacted by the state or local health department who track infectious disease outbreaks in the community.

If you travel with your child:

• Review the CDC travelers’ information website (http://www.cdc.gov/travel) before traveling to learn about possible disease risks and vaccines that will protect your family. Diseases that vaccines prevent remain common throughout the world, including Europe.
• Don’t spread disease to others. If an unimmunized person develops a vaccine-preventable disease while traveling, to prevent transmission to others, he or she should not travel by a plane, train, or bus until a doctor determines the person is no longer contagious.

Massachusetts allows for medical and religious exemptions of vaccinations. 

• Medical exemptions require a letter from the student's doctor, documenting a contraindication. 
• Religious exemptions require a letter from the parent/guardian stating in writing that a vaccine conflints with his/her sincerely held religious beliefs.

Peanut allergy is common in children and appears to be increasing in frequency.  It often starts in early childhood and although a few children outgrow it, for most peanut allergy is life-long.  Also, even when the child appears to have outgrown the allergy, it can recur. 

Peanut allergy occurs when the body’s immune system mistakenly perceives peanut proteins as something harmful and develops allergic antibodies to these proteins. When the next exposure occurs, certain chemicals are released into the bloodstream producing the signs and symptoms of an allergic response.  This response can range from mild (hives, itching, stomach cramps) to life-threatening (shock, throat swelling, constricting of the airways).  A mild first reaction, however, does not guarantee that a more severe or life-threatening reaction won’t occur.

Symptoms of an allergic reaction:

• Hives, redness or swelling
• Itching or tingling in or around the mouth and throat
• Diarrhea, stomach cramps, nausea or vomiting
• Chest tightness
• Shortness of breath or wheezing
• Runny or stuffy nose
• Anaphylaxis

Anaphylaxis is a severe, life-threatening response to any substance that causes an allergic reaction; examples include exposure to peanuts, tree nuts, bee/wasp stings, seafood, etc.  Anaphylaxis can occur within seconds or minutes of exposure to the offending allergen and always requires treatment with epinephrine (EpiPen, Twinjet) plus a trip to the emergency room for observation and possible additional treatment.

Symptoms of anaphylaxis:

• Constriction of airways, including swollen throat and difficulty breathing
• Shock with a severe drop in blood pressure
• Rapid pulse
• Dizziness, lightheadedness or loss of consciousness

 People can be exposed to peanuts in several ways..

• Direct contact – eating peanuts or peanut-containing foods. Occasionally, exposure can occur from skin contact
• Cross-contamination – the unintended introduction of peanuts during processing or handling of a food. This can happen as simply as making a peanut butter and jelly sandwich using the same knife for both food items.  The jelly is then contaminated with peanuts making it unsafe to for the allergic person to eat.          
• Inhalation – inhaling dust or aerosols containing peanuts – peanut flour or peanut oil cooking spray.

There are certain risk factors that make a person more susceptible to having an allergic reaction to peanuts.  These include having family members with allergies, especially to foods, and a previous allergic reaction to peanuts. 

 Treatment for peanut allergy:

1. Avoid peanuts and peanut products – read product labels carefully
2. EpiPen/Twinjet and emergency room visit for anaphylaxis
3. Antihistamines (Benadryl) for mild symptoms (itching or hives).  Antihistamines will not relieve anaphylaxis

 Common foods in which peanuts, peanut oils or trace amounts of peanuts may be present:

1. • Peanuts, ground nuts
   • Peanut butter
   • Baked goods – pastry, biscuits, cookies, crackers, health breads
   • Asian foods – Thai, Chinese and Indonesian
   • Vegetarian foods
   • Cold pressed peanut oil (arachis oil)
   • Muesli, granola and other cereals
   • Ice creams and frozen desserts
   • Mixed nuts, marzipan
   • Soups
   • Natural flavoring
   • Egg rolls
   • Health foods – nutrition and energy bars and other sweets
   • Sauces

 What to do if your child has a peanut allergy:

1. Notify the people who regularly interact with the child – teachers, coaches, parents of the child’s friends, scout leaders, etc.
2. Always keep an epinephrine auto-injector (EpiPen, Twinjet) available for use in an emergency
3. Teach adults who spend time with the child the signs and symptoms of an allergic reaction
4. Have the child wear a medical alert bracelet or necklace
5. Write an action plan describing how to care for the child when he/she has an allergic reaction.
6. Discourage the child from sharing foods. 

Allergies to peanuts, peanut butter and tree nuts are serious problems and the number of people with these types of allergies is increasing dramatically across the country.  As a community, we need to be conscious of the food that comes to school.  The issue of cross-contamination is complex and far-reaching so areas that are used by the entire school population need to be safe-guarded.  For some people, an extremely minute amount of peanut/nut exposure is enough to cause a problem and, occasionally, just peanut dust in the air will bring on a reaction.

The classrooms in which these children are enrolled will be peanut/nut-free.  Parents, students, and teachers are requested to avoid bringing all peanut/nut products to school for snacks, activities, parties, etc.  There will be a peanut/nut-free table in the cafeteria for the child/children and his/her friends and no peanut products will be allowed at this table.  As some children will bring items like peanut butter sandwiches to lunch, all children should be asked to wash their hands or use handi-wipes after they eat on the way to the playground.  

In addition, hand lotions with nut oils (almond oil, for example) should be avoided, as well as nut-flavored beverages like hazelnut or almond-flavored coffees.

Asthma is a chronic lung disease characterized by episodes of breathing problems which include coughing, wheezing, tightness in the chest, and shortness of breath.  It is the most common chronic childhood illness and the leading cause of school absences.

In normal breathing, the airways are open allowing air to move freely in and out of the lungs.  When a person has an asthma episode, muscles around the airways tighten, the airway swells, and an excess of mucus is produced.  This causes narrowing of the air passages leading to breathing problems resulting in difficulty getting air into and out of the lungs.

 The cause of asthma is unknown. Every person with asthma has specific triggers and/or allergens which can bring on an asthma episode.  Triggers are varied and may include viruses, cold air, exercise, tobacco smoke, molds, cats, dogs, and other furred animals, and feathered pets.  Strong smells, household sprays, and even laughing or crying too hard may bring on an asthma episode.

Asthma can be controlled, but does require regular, long term medical care.  Medications used to treat asthma include fast acting bronchodilators, such as Albuterol, which relax the muscles and open the airways. These medications are used for quick relief of an asthma episode.  Other medications used to treat moderate to severe asthma are anti-inflammatory drugs.  These medications reduce inflammation in the lungs and are taken daily.

The goal of asthma management is enjoy an active life, to participate in normal activities, and to sleep through the night uninterrupted.

 Common signs of uncontrolled asthma:

  * Lingering cough after a cold

  * Persistent cough during the day

  * Coughing during the night or early in the morning

  * Coughing, wheezing, chest tightness, or shortness of breath after vigorous physical activity or activity in cold or windy weather

  * Low level of stamina during physical activity or reluctance to participate

  * Coughing, wheezing, chest tightness, or shortness of breath even though the child is taking medicine for asthma

  * Increased use of asthma medicine to relieve coughing, wheezing, chest tightness, or shortness of breath

Asthma Action Plans

Helps school nurse take better care of your child

Asthma Action Plan should be in writing and updated yearly by the physician submitted to the nurse's office by the start of the school year

Asthma and Allergy Foundation of America - New England Chapter http://www.asthmaandallergies.or

EXERCISE INDUCED BRONCHOSPASM (EIA)

Similar to asthma, exercise induced bronchospasm (asthma), EIA, is a condition that produces many of the same symptoms, including wheezing, coughing, shortness of breath, and chest tightness.  It typically strikes during or after vigorous exercise.  However, sometimes the symptoms can occur both during the activity and 10 to 15 minutes after the exercise has stopped.

 EIA is caused when the smooth muscles around the bronchial tubes constrict.  This causes spasms of the bronchial tubes (airways) and causes the lungs to produce extra mucous.

 People with EIA may experience fatigue during exercise resulting in poor athletic performance.  The severity of symptoms varies with the individual, the intensity and the kind of exercise, along with the level of pollen or other airborne pollutants.

 About 15% of the population is affected by exercise-induced asthma with running being the activity most likely to trigger an episode.  EIA can hit people at any age, but seems most common in children.  Having EIA doesn’t mean that you shouldn’t exercise.  With proper treatment, which usually includes taking a medication about 20 minutes before activity, an active life-style, including exercise, can and should be maintained. 

Exposure to any one of over 200 viruses may result in a person getting an upper respiratory infection, otherwise known as the “common cold”. Colds occur year-round, but are more frequent during the winter season. Every year, in the United States, over one billion colds affect children and adults. The frequency of getting respiratory infections is greater in children and on average a child will have three to eight colds per year.  As a result, colds are the most common reason for missing school. 

Cold viruses are easily passed from person to person by coughing, sneezing, and blowing the nose. In addition, the virus can be transmitted by touching an object contaminated by a cold virus and then touching the nose, eyes, and mouth. Covering the mouth and nose when sneezing and frequent hand-washing are very helpful in preventing the spread of cold viruses.

The main symptoms of the common cold are usually associated with the nose and include nasal congestion, sneezing, and a runny nose.  Young children may run a fever (100-102ᵒF).  Older children and adults generally are fever-free.  If they do run a fever, it will be mild.

Symptoms of a cold generally begin 2-3 days after exposure to a cold virus, but may take as long as a week.  A scratchy throat and an itchy or irritated nose are typically the first signs.  This is followed by sneezing and a watery discharge from the nose a few hours later.  After 1 to 3 days, secretions become thicker and yellow or green in color.  This is a normal course for a cold and not an indication that antibiotics are needed. (Antibiotics are not effective in treating viral infections.)

Other symptoms associated with a cold, depending on the virus: 

• Sore throat
• Cough
• Headache
• Decreased appetite
• Muscle aches
• Post-nasal drip

The majority of symptoms of a cold usually last about 7 days, but a few symptoms, such as a cough, may last for another week.  If symptoms last longer than 2 weeks, a sinus infection or allergies may be the cause and a visit to the doctor is advised.

Children often complain of ear pain following a cold.  Because the eardrum is congested during the course of the viral infection, it is possible to have a build- up of fluid behind the eardrum and not have a bacterial infection.  If ear pain is severe, a visit to the doctor is recommended.

What is chickenpox?  Chickenpox, also called varicella, is a viral disease that can spread easily and quickly from person to person.

• The disease is most common among children under 15 years old.  
• Serious complications are rare, but are more common in newborns, pregnant women, people with weakened immune systems, and adults.

What are the symptoms?

• People with chickenpox get an itchy rash that looks like tiny blisters.
• The rash usually starts on the face, stomach, chest or back, and spreads to other parts of the body.
• A mild fever, tiredness, and slight body discomfort usually come with the rash.

Symptoms usually begin about 10-21 days after exposure to the virus.

How is chickenpox spread?

• Chickenpox is spread from person to person by coughing, sneezing, or touching the rash.
• People with chickenpox can spread the disease from 1-2 days before symptoms start until all the lesions are crusted over, which usually takes 5 days.

Under state regulations, people with chickenpox must stay out of school and work and refrain from public activities until all their blisters have dried and crusted.

Who gets chickenpox?

• Anyone who has never had chickenpox and has never been vaccinated against chickenpox can get the disease.
• Sometimes, even people who have been vaccinated will still get chickenpox (called "breakthrough" chickenpox.  Breakthrough disease is usually milder, but it is still contagious.

How can you prevent chickenpox?

• A vaccine is available to prevent chickenpox and is required for school attendance.
• Additionally, when people receive chickenpox vaccine within 3 (and possibly up to 5) days of being in contact with someone with chickenpox, it decreases their chances of getting chickenpox.

Those who have already received one dose of chickenpox vaccine should talk with their healthcare provider about receiving a second dose of chickenpox vaccine.  All children enrolled in school are required to have 2 doses of varicella (chickenpox) vaccine.

What should pregnant women and those with weakened immune systems do?

• Newborns, pregnant women, and some people with weakened immune systems cannot receive chickenpox vaccine. 
• If you have been in contact with someone with chickenpox and you do not have a history of chickenpox, you should see a doctor immediately.

You may not be able to receive the vaccine, but you may get a shot of antibodies to chickenpox called VZIG (varicella-zoster immune globulin), or intravenous immunoglobulin (IVIG), if VZIG is not available, to lower the chances of severe complications.  VZIG or IVIG should be given with 96 hours of exposure.

What should I do if my child gets chickenpox?

•  Please say home, call your doctor and your supervisor at work.
• Also, keep all chickenpox lesions and other wounds clean and watch for possible signs of infection, including increasing redness, swelling, drainage and pain at the wound site.
• A person with an infected wound, especially if fever develops, should seek medical care.
• Good hand-washing and covering your mouth when coughing can help prevent the spread of infections. 
• Thoroughly wash your hands and children's hands after wiping noses and before eating or preparing food.
• Do not share food, cups, spoons, or drinking straws.

What should students do?

• If your child does not have serologic proof of immunity, a history of chickenpox as verified by a healthcare provider, or documentation of at least one dose of chickenpox vaccine, you child must receive a dose of vaccine as soon as possible.
• If your child has already received one dose of chickenpox vaccine, you should talk with your provider about your child receiving a second dose of vaccine.

All students entering kindergarten, and those in grades 1 through 5 are required to have 2 doses of varicella.

If you develop symptoms of chickenpox, please stay home, follow the guidelines above, and call your doctor and the school nurse.

For more information, please call your local board of health or MDPH at 617-983-6800. 

Vaccine-modified varicella syndrome (VMVS or "breakthrough chickenpox")      

Breakthrough chickenpox is a form of chickenpox that occurs in vaccinated individuals.  It is less severe, due to the development of "partial immunity", which, although not sufficient to prevent disease, does cause the symptoms to be less severe.  This illness usually presents as a generalized rash consisting of fewer than 50 lesions. The rash is generally seen as red spots on the skin which may be flat or raised.  A few fluid-filled vesicles may be present.  There is often no fever and symptoms may be slight, however, people with breakthrough chickenpox are still considered infectious.    

Chickenpox is transmitted person-to-person when a person coughs or sneezes or by direct contact with nasopharyngeal secretions or lesions of an infected person.    

It usually takes 14-16 days from the time of exposure until a person develops the symptoms of chickenpox (may take from 10-12 days). The infectious period for chickenpox begins 1-2 days before the rash appears.  If vesicles are present, individuals are considered infectious until all of the vesicles have formed scabs, usually within 5 days of rash onset.            

Vaccinated persons with chickenpox may develop lesions that do not crust (red spots only). These persons are no longer contagious once the lesions have faded or no new lesions appear with a 24-hour period.

Caution: Aspirin (or products containing salicylate) should never be used in any viral illness, but particularly if influenza or chickenpox is suspected, because of the association of Reye's syndrome (vomiting, liver function abnormalities, and/or coma) with aspirin use in these illnesses. 

By Mayo Clinic Staff

A concussion is a traumatic brain injury that alters the way your brain functions. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination.

Although concussions usually are caused by a blow to the head, they can also occur when the head and upper body are violently shaken. These injuries can cause a loss of consciousness, but most concussions do not. Because of this, some people have concussions and don't realize it.

Concussions are common, particularly if you play a contact sport, such as football. But every concussion injures your brain to some extent. This injury needs time and rest to heal properly. Most concussive traumatic brain injuries are mild, and people usually recover fully.

The signs and symptoms of a concussion can be subtle and may not be immediately apparent. Symptoms can last for days, weeks or even longer.

Common symptoms after a concussive traumatic brain injury are headache, loss of memory (amnesia) and confusion. The amnesia, which may or may not follow a loss of consciousness, usually involves the loss of memory of the event that caused the concussion.

Signs and symptoms of a concussion may include:

• Headache or a feeling of pressure in the head
• Temporary loss of consciousness
• Confusion or feeling as if in a fog
• Amnesia surrounding the traumatic event
• Dizziness or "seeing stars"
• Ringing in the ears
• Nausea
• Vomiting
• Slurred speech
• Delayed response to questions
• Appearing dazed
• Fatigue

Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury, such as:

• Concentration and memory complaints
• Irritability and other personality changes
• Sensitivity to light and noise
• Sleep disturbances
• Psychological adjustment problems and depression
• Disorders of taste and smell

Symptoms in children

Head trauma is very common in young children. But concussions can be difficult to recognize in infants and toddlers because they may not be able to describe how they feel. Nonverbal clues of a concussion may include:

• Appearing dazed
• Listlessness and tiring easily
• Irritability and crankiness
• Loss of balance and unsteady walking
• Crying excessively
• Change in eating or sleeping patterns
• Lack of interest in favorite toys

When to see a doctor

See a doctor within 1 to 2 days if:

• You or your child experiences a head injury, even if emergency care isn't required

The American Academy of Pediatrics recommends that you call your child's doctor for advice if your child receives anything more than a light bump on the head.

If your child doesn't have signs of a serious head injury, and if your child remains alert, moves normally and responds to you, the injury is probably mild and usually doesn't need further testing. In this case, if your child wants to nap, it's OK to let him or her sleep. If worrisome signs develop later, seek emergency care.

Seek emergency care for an adult or child who experiences a head injury and symptoms such as:

• Repeated vomiting
• A loss of consciousness lasting longer than 30 seconds
• A headache that gets worse over time
• Changes in his or her behavior, such as irritability
• Changes in physical coordination, such as stumbling or clumsiness
• Confusion or disorientation, such as difficulty recognizing people or places
• Slurred speech or other changes in speech

Other symptoms include:

• Seizures
• Vision or eye disturbances, such as pupils that are bigger than normal (dilated pupils) or pupils of unequal sizes
• Lasting or recurrent dizziness
• Obvious difficulty with mental function or physical coordination
• Symptoms that worsen over time
• Large head bumps or bruises on areas other than the forehead in children, especially in infants under 12 months of age

Athletes

No one should return to play or vigorous activity while signs or symptoms of a concussion are present.

Experts recommend that an athlete with a suspected concussion not return to play until he or she has been medically evaluated by a health care professional trained in evaluating and managing concussions. Children and adolescents should be evaluated by a health care professional trained in evaluating and managing pediatric concussions.

Experts also recommend that adult, child and adolescent athletes with a concussion not return to play on the same day as the injury.

Your brain has the consistency of gelatin. It's cushioned from everyday jolts and bumps by cerebrospinal fluid inside your skull. A violent blow to your head and neck or upper body can cause your brain to slide back and forth forcefully against the inner walls of your skull.

Sudden acceleration or deceleration of the head, resulting from certain events such as a car crash or being violently shaken, also can cause brain injury.

These injuries affect brain function, usually for a brief period, resulting in signs and symptoms of concussion.

A brain injury of this sort may lead to bleeding in or around your brain, causing symptoms such as prolonged drowsiness and confusion that may develop right away or later.

Such bleeding in your brain can be fatal. That's why anyone who experiences a brain injury needs monitoring in the hours afterward and emergency care if symptoms worsen.

Factors that may increase your risk of a concussion include:

• Participating in a high-risk sport, such as football, hockey, soccer, rugby, boxing or other contact sport; the risk is further increased if there's a lack of proper safety equipment and supervision
• Being involved in a motor vehicle collision
• Being involved in a pedestrian or bicycle accident
• Being a soldier involved in combat
• Being a victim of physical abuse
• Falling, especially in young children and older adults
• Having had a previous concussion

Potential complications of concussion include:

• Epilepsy. People who have had a concussion double their risk of developing epilepsy within the first five years after the injury.
• Cumulative effects of multiple brain injuries. Evidence exists indicating that people who have had multiple concussive brain injuries over the course of their lives may acquire lasting, and even progressive, impairment that limits their ability to function.
• Post-concussion syndrome. Some people begin having post-concussion symptoms — such as headaches, dizziness and thinking difficulties — a few days after a concussion. Symptoms may continue for weeks to a few months after a concussion.
• Post-traumatic headaches. Some people experience headaches within a week to a few months after a brain injury.
• Post-traumatic vertigo. Some people experience a sense of spinning or dizziness for days, week or months after a brain injury.

• Second impact syndrome. Experiencing a second concussion before signs and symptoms of a first concussion have resolved may result in rapid and usually fatal brain swelling.

  After a concussion, the levels of brain chemicals are altered. It usually takes about a week for these levels to stabilize again. However, recovery time is variable, and it's important for athletes never to return to sports while they're still experiencing signs and symptoms of concussion.

It's important for anyone who has a head injury to be evaluated by a doctor, even if emergency care isn't required.

If your child has received a head injury that concerns you, call your child's doctor immediately. Depending on the signs and symptoms, your doctor may recommend seeking immediate medical care.

Here's some information to help you get ready for and make the most of your medical appointment.

What you can do

• Be aware of any pre-appointment restrictions or instructions. The most important thing for you to do while waiting for your appointment is to rest your brain physically and mentally. Avoid sports or vigorous physical activities and minimize difficult, stressful or prolonged mental tasks.

  At the time you make the appointment, ask what steps you or your child should take to encourage recovery or prevent re-injury. Experts recommend that athletes not return to play until they have been medically evaluated.

• List any symptoms you or your child have been experiencing and the length of time you or your child have been experiencing them.
• Write down key medical information, including other medical problems for which you or your child are being treated and any history of previous head injuries. Also write down the names of any medications, vitamins, supplements or other natural remedies you or your child are taking.
• Take a family member or friend along. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

For a concussion, some basic questions to ask your doctor include:

• Is it a concussion?
• What kinds of tests are needed?
• What treatment approach do you recommend?
• How soon will symptoms begin to improve?
• What is the risk of future concussions?
• What is the risk of long-term complications?
• When will it be safe to return to competitive sports?
• When will it be safe to resume vigorous exercise?
• Is it safe to return to school or work?
• Is it safe to drive a car or operate power equipment?
• I have other medical problems. How can they be managed together?
• Should a specialist be consulted? What will that cost, and will my insurance cover seeing a specialist? You may need to call your insurance provider for some of these answers.
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

Being ready to answer your doctor's questions may reserve time to go over any points you want to talk about in-depth.

You or your child should be prepared to answer the following questions about the injury and related signs and symptoms:

• Do you play contact sports?
• How did you get this injury?
• What symptoms did you experience immediately after the injury?
• Do you remember what happened right before and after the injury?
• Did you lose consciousness after the injury?
• Did you have seizures?
• Have you experienced nausea or vomiting since the injury?
• Have you had a headache? How soon after the injury did it start?
• Have you noticed any difficulty with physical coordination since the injury?
• Have you had any problems with memory or concentration since the injury?
• Have you noticed any sensitivity or problems with your vision and hearing?
• Have you had any mood changes, including irritability, anxiety or depression?
• Have you felt lethargic or easily fatigued since the injury?
• Are you having trouble sleeping or waking from sleep?
• Have you noticed changes in your sense of smell or taste?
• Do you have any dizziness or vertigo?
• What other signs or symptoms are you concerned about?
• Have you had any previous head injuries?

What you can do in the meantime

Rest as much as possible before your appointment. This includes avoiding sports or other physical activities that increase your heart rate, such as prolonged walking, or require vigorous muscle contractions, such as weightlifting.

Also, minimize activities that increase your symptoms, such as those that require a significant amount of focused attention. Examples include working on the computer, schoolwork, watching TV, texting or playing video games.

If you have a headache, acetaminophen (Tylenol, others) may ease the pain. Avoid taking other pain relievers such as aspirin or ibuprofen (Advil, Motrin IB, others) if you suspect you've had a concussion. It's possible that these may increase the risk of bleeding.

A blow to your head, neck or upper body can cause a concussion, which may include symptoms such as a headache, dizziness, nausea or loss of consciousness. If you suspect you or your child has had a concussion, contact your doctor.

Your doctor will evaluate your signs and symptoms, review your medical history, and conduct a neurological examination. Signs and symptoms of a concussion may not appear until hours or days after the injury.

Tests your doctor may perform or recommend include:

Neurological examination

After your doctor asks detailed questions about your injury, he or she may perform a neurological examination. This evaluation includes checking your:

• Vision
• Hearing
• Strength and sensation
• Balance
• Coordination
• Reflexes

Cognitive testing

Your doctor may conduct several tests to evaluate your thinking (cognitive) skills during a neurological examination. Testing may evaluate several factors, including your:

• Memory
• Concentration
• Ability to recall information

Imaging tests

Brain imaging may be recommended for some people with symptoms such as severe headaches, seizures, repeated vomiting or symptoms that are becoming worse. Brain imaging may determine whether the injury is severe and has caused bleeding or swelling in your skull.

A cranial computerized tomography (CT) scan is the standard test to assess the brain right after injury. A CT scan uses a series of X-rays to obtain cross-sectional images of your skull and brain.

Magnetic resonance imaging may be used to view bleeding in your brain or to diagnose complications that may occur after a concussion.

An MRI uses powerful magnets and radio waves to produce detailed images of your brain. 

Observation

You may need to be hospitalized overnight for observation after a concussion.

If your doctor agrees that you may be observed at home, someone should stay with you and check on you for at least 24 hours to ensure your symptoms aren't worsening. Your caregiver may need to awaken you regularly to make sure you can awaken normally.

Rest is the most appropriate way to allow your brain to recover from a concussion. Your doctor will recommend that you physically and mentally rest to recover from a concussion.

This means avoiding general physical exertion, including sports or any vigorous activities, until you have no symptoms.

This rest also includes limiting activities that require thinking and mental concentration, such as playing video games, watching TV, schoolwork, reading, texting or using a computer.

Your doctor may recommend that you have shortened school day or workdays, take breaks during the day, or have reduced school workloads or work assignments as you recover from a concussion.

As your symptoms improve, you may gradually add more activities that involve thinking, such as doing more schoolwork or work assignments, or increasing your time spent at school or work.

For headaches, try taking a pain reliever such as acetaminophen (Tylenol, others). Avoid other pain relievers such as ibuprofen (Advil, Motrin IB, others) and aspirin, as there's a possibility these medications may increase the risk of bleeding.

If you or your child sustained a concussion while playing competitive sports, ask your doctor or your child's doctor when it is safe to return to play. Resuming sports too soon increases the risk of a second concussion and of lasting, potentially fatal brain injury.

Evidence is emerging that some people who have had multiple concussions over the course of their lives are at greater risk of developing lasting, and even progressive, impairment that limits their ability to function.

No one should return to play or vigorous activity while signs or symptoms of a concussion are present.

Experts recommend that adults, children and adolescents not return to play on the same day as the injury.

Some tips that may help you to prevent or minimize your risk of head injury include:

• Wearing protective gear during sports and other recreational activities. Always use the appropriate protective gear for any sport you or your child undertakes. Make sure the equipment fits properly, is well-maintained and worn correctly. Follow the rules of the game and practice good sportsmanship.

  When bicycling, motorcycling, snowboarding or engaging in any recreational activity that may result in head injury, wear protective headgear.

• Buckling your seat belt. Wearing a seat belt may prevent serious injury, including an injury to your head, during a traffic accident.
• Making your home safe. Keep your home well-lit and your floors free of anything that might cause you to trip and fall. Falls around the home are a leading cause of head injury.
• Protecting your children. To help lessen the risk of head injuries to your children, block off stairways and install window guards.
• Exercising regularly. If you're older, exercise regularly to strengthen your leg muscles and improve your balance.
• Educating others about concussions. Educating coaches, athletes, parents and others about the features of a concussion, how to evaluate a concussion, and how to determine when it's appropriate to return to play or school can help spread awareness and knowledge about concussions. Coaches and parents can also help encourage good sportsmanship.

Getting Better: Tips for Children

Parents and caregivers of children who have had a concussion can help them recover by taking an active role in their recovery:

• Having the child get plenty of rest.
• Keep a regular sleep schedule, including no late nights and no sleepovers.
• Making sure the child avoids high-risk/ high-speed activities such as riding a bicycle, playing sports, or climbing playground equipment, roller coasters or rides that could result in another bump, blow, or jolt to the head or body.
  • Children should not return to these types of activities until their health care professional says they are well enough.
• Giving the child only those drugs that are approved by the pediatrician or family physician.
• Talking with their health care professional about when the child should return to school and other activities and how the parent or caregiver can help the child deal with the challenges that the child may face.
  • For example, your child may need to spend fewer hours at school, rest often, or require more time to take tests.
• Sharing information about concussion with parents, siblings, teachers, counselors, babysitters, coaches, and others who interact with the child helps them understand what has happened and how to meet the child’s needs.

http://hitstothehead.org/

Otitis media is an infection or inflammation generally caused by viruses or bacteria entering the middle ear.  It often occurs after a child has a cold, sore throat, or other respiratory problem.  It is primarily a disease of infants and young children with 75% of children experiencing at least one episode by their third birthday. Many children will have three or more infections before they turn three.

The ear is composed of three parts - the outer ear, the middle ear, and the inner ear.  The outer ear includes the part you can see and the ear canal.  It ends at the eardrum.  The middle ear is an air-filled chamber containing 3 small bones that transmit sound to the inner ear.  The inner ear consists of the cochlea, a snail shaped organ that contains the hearing organ, and an organ that controls balance 

There is a passageway that connects the middle ear to the upper part of the throat called the Eustachian tube. It is generally closed, but opens occasionally to replenish the air in the middle ear.  It also equalizes pressure in response to changes in air pressure in the environment.  When you have a cold the Eustachian tube may swell or become clogged with mucus and be unable to open and ventilate the middle ear.  This may allow fluid to accumulate behind the eardrum.

Bacteria entering the middle ear by way of the Eustachian tube may cause an infection and lead to more accumulation of fluid causing pressure on the eardrum and pain.  If the pressure is not relieved, the eardrum may eventually rupture allowing the fluid to drain.

Hearing loss from otitis media is usually temporary, but if left untreated, may lead to permanent hearing impairment.  Other serious complications can occasionally occur. 

Signs of otitis media in small children:

• Unusual irritability
• Difficulty sleeping
• Tugging or pulling at one or both ears
• Fever
• Fluid draining from the ear
• Loss of balance
• Unresponsiveness to quiet sounds or other signs of hearing difficulty such as sitting too close to the television or being inattentive   

A physician can diagnose otitis media by looking at the eardrum and the ear canal.  He/she may use an instrument to blow a puff of air onto the eardrum to test eardrum movement.  Fluid behind the eardrum does not allow the eardrum to move as easily as it would normally.

 Antibiotics are often prescribed to treat otitis media and a pain reliever may be needed to relieve discomfort. If antibiotics are prescribed, the full course of medication should be taken and a follow-up visit should be done to make sure the infections is cleared. 

What is hand, foot, and mouth disease?

Hand, foot, and mouth disease (HFMD) is a common illness of infants and children. It is characterized by fever, sores in the mouth, and a rash with blisters. HFMD begins with a mild fever, poor appetite, malaise ("feeling sick"), and frequently a sore throat. One or 2 days after the fever begins, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks. The skin rash develops over 1 to 2 days with flat or raised red spots, some with blisters. The rash does not itch, and it is usually located on the palms of the hands and soles of the feet. It may also appear on the buttocks. A person with HFMD may have only the rash or the mouth ulcers.

Is HFMD the same as foot-and-mouth disease?

No. HFMD is often confused with foot-and-mouth disease of cattle, sheep, and swine. Although the names are similar, the two diseases are not related at all and are caused by different viruses. For information on foot-and-mouth disease, please visit the web site of the US Department of Agriculture .

What causes HFMD?

Viruses from the group called enteroviruses cause HFMD. The most common cause is coxsackievirus A16; sometimes, HFMD is caused by enterovirus 71 or other enteroviruses. The enterovirus group includes polioviruses, coxsackieviruses, echoviruses and other enteroviruses.

Is HFMD serious?  

Usually not. HFMD caused by coxsackievirus A16 infection is a mild disease and nearly all patients recover without medical treatment in 7 to 10 days. Complications are uncommon. Rarely, the patient with coxsackievirus A16 infection may also develop "aseptic" or viral meningitis, in which the person has fever, headache, stiff neck, or back pain, and may need to be hospitalized for a few days. Another cause of HFMD, EV71 may also cause viral meningitis and, rarely, more serious diseases, such as encephalitis, or a poliomyelitis-like paralysis. EV71 encephalitis may be fatal. Cases of fatal encephalitis occurred during outbreaks of HFMD in Malaysia in 1997 and in Taiwan in 1998.

Is HFMD contagious?

Yes, HFMD is moderately contagious. Infection is spread from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. A person is most contagious during the first week of the illness. HFMD is not transmitted to or from pets or other animals.

How soon will someone become ill after getting infected? 

The usual period from infection to onset of symptoms ("incubation period") is 3 to 7 days. Fever is often the first symptom of HFMD.

Who is at risk for HFMD?  

HFMD occurs mainly in children under 10 years old, but may also occur in adults too. Everyone is at risk of infection, but not everyone who is infected becomes ill. Infants, children, and adolescents are more likely to be susceptible to infection and illness from these viruses, because they are less likely than adults to have antibodies and be immune from previous exposures to them. Infection results in immunity to the specific virus, but a second episode may occur following infection with a different member of the enterovirus group.

What are the risks to pregnant women exposed to children with HFMD?

Because enteroviruses, including those causing HFMD, are very common, pregnant women are frequently exposed to them, especially during summer and fall months. As for any other adults, the risk of infection is higher for pregnant women who do not have antibodies from earlier exposures to these viruses, and who are exposed to young children - the primary spreaders of enteroviruses.

Most enterovirus infections during pregnancy cause mild or no illness in the mother. Although the available information is limited, currently there is no clear evidence that maternal enteroviral infection causes adverse outcomes of pregnancy such as abortion, stillbirth, or congenital defects. However, mothers infected shortly before delivery may pass the virus to the newborn. Babies born to mothers who have symptoms of enteroviral illness around the time of delivery are more likely to be infected. Most newborns infected with an enterovirus have mild illness, but in rare cases, they may develop an overwhelming infection of many organs, including liver and heart, and die from the infection. The risk of this severe illness in newborns is higher during the first two weeks of life.

Strict adherence to generally recommended good hygienic practices by the pregnant woman may help to decrease the risk of infection during pregnancy and around the time of delivery.

When and where does HFMD occur?  

Individual cases and outbreaks of HFMD occur worldwide, more frequently in summer and early autumn. In the recent past, major outbreaks of HFMD attributable to enterovirus 71 have been reported in some South East Asian countries (Malaysia, 1997; Taiwan, 1998).

How is HFMD diagnosed?

HFMD is one of many infections that result in mouth sores. Another common cause is oral herpesvirus infection, which produces an inflammation of the mouth and gums (sometimes called stomatitis). Usually, the physician can distinguish between HFMD and other causes of mouth sores based on the age of the patient, the pattern of symptoms reported by the patient or parent, and the appearance of the rash and sores on examination. A throat swab or stool specimen may be sent to a laboratory to determine which enterovirus caused the illness. Since the testing often takes 2 to 4 weeks to obtain a final answer, the physician usually does not order these tests.

How is HFMD treated?  

No specific treatment is available for this or other enterovirus infections. Symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers.  

Specific prevention for HFMD or other non-polio enterovirus infections is not available, but the risk of infection can be lowered by good hygienic practices. Preventive measures include frequent handwashing, especially after diaper changes, cleaning of contaminated surfaces and soiled items first with soap and water, and then disinfecting them by diluted solution of chlorine-containing bleach (made by mixing approximately ¼ cup of bleach with 1 gallon of water.  Avoidance of close contact (kissing, hugging, sharing utensils, etc.) with children with HFMD may also help to reduce of the risk of infection to caregivers.

HMFD in the childcare setting

HFMD outbreaks in child care facilities occur most often in the summer and fall months, and usually coincide with an increased number of cases in the community.

CDC has no specific recommendations regarding the exclusion of children with HFMD from child care programs, schools, or other group settings.  Children are often excluded from group settings during the first few days of the illness, which may reduce the spread of infection, but will not completely interrupt it.  Exclusion of ill persons may not prevent additional cases since the virus may be excreted for weeks after the symptoms have disappeared.  Also, some persons excreting the virus, including most adults, may have no symptoms.  Some benefit may be gained, however, by excluding children who have blisters in their mouths and drool or who have weeping lesions on their hands.

If an outbreak occurs in the child care setting:

Make sure that all children and adults use good handwashing technique, especially after diaper changes.

Thoroughly wash and disinfect contaminated items and surfaces using diluted solution of chlorine-containing bleach.

The main symptoms of influenza (flu) include fever and cough and/or sore throat.  Some people also have a runny nose, body aches, headache, chills and feel tired.  Some people also have diarrhea and vomiting.  The most important thing that you can do to keep flu from spreading in the community is to keep your sick child at home when they are sick.

SHOULD I KEEP MY CHILD HOME?

___ Yes ___ No - Has your child had a fever of 100.4 degrees or more in the past 24 hours?

___ Yes ___ No - Does your child have a cough OR sore throat?

If you answered YES to both questions above, keep your child home.

Your child has an influenza-like illness.

WHEN CAN MY CHILD RETURN TO SCHOOL?

___ Yes ___ No - Has your child had a fever of 100.4 degrees or more in the past 24 yours?

___ Yes ___ No - Has your child had acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) in the past 24 hours?

If you answered NO to both questions above, your child can return to school.

If you answered YES to one of the questions above, your child CANNOT return to school.  Keep your child home for at least another day to observe for additional symptoms.  Then use the checklist questions again to decide whether you should continue to keep your child home.

Where can I find more information about influenza?

• Call the Massachusetts Department of Public Health information line 211
• Go to the Massachusetts Department of Public Health influenza website:
• www.mass.gov/flu
• A "Fever Fact Sheet" with information on how to take a temperature is also available.

The Flu: A guide for Parents  

What is the flu?

Influenza (the flu) is an infection of the nose, throat and lungs caused by influenza viruses that are constantly changing.  Flu causes illness, hospital stays and deaths in the United States each year.  Flu can be very dangerous for children.  Each year about 20,000 children younger than 5 years old are hospitalized from flu complications, like pneumonia.

How serious is the flu?

Flu illness can vary from mild to severe.  Flu can be especially dangerous for young children and children of any age who have certain long term health conditions, including asthma (even mild or controlled), neurological conditions, chronic lung disease, heart disease, blood disorders, endocrine disorders (such as diabetes), and weakened immune systems due to disease or medication.  Children with these conditions and those receiving long-term aspirin therapy, can have more severe illness from the flu. 

How does the flu spread?

Most experts believe that flu viruses spread mainly by droplets made when people with the flu cough, sneeze, or talk.  These droplets can land in the mouths or noses of people who are nearby.  Less often, a person might get the flu by touching something that has flu virus on it and then touching their own mouth, eyes or nose. 

What are the symptoms of flu?

Symptoms of the flu can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue and sometimes vomiting and diarrhea.  Some people with flu will not have a fever.

How long can a sick person spread the flu?

People with the flu may infect others from 1 day before getting sick to 5-7 days after.  Children and people with weakened immune systems can shed virus for longer and might still be contagious past 7 days, especially if they still have symptoms.

Can my child go to school, daycare or camp if he or she is sick?

No.  Your child should stay home to rest and to avoid giving the flu to other children or to caregivers.

When can by child go back to school after having the flu?

Keep your child home until at least 24 hours after their fever is gone, without using fever-reducing medications, like acetaminophen (Tylenol) or ibuprofen (Motrin or Advil).  A fever is defined as 100.4o F (38o C) or higher.

Protect your child

How can I protect my child against flu?

The first and most important thing to do is to get flu vaccine for your child, yourself, and everyone else in your household every year.  Get the vaccine as soon as it is available.

Vaccination is recommended for everyone 6 months and older.

It's especially important that young children and children with certain health conditions (see above) get vaccinated.

It's very important for parents, grandparents, teachers and caregivers to get vaccinated.

Everyone caring for infants under 6 months (who are too young to be vaccinated) should be vaccinated, if possible.  Vaccinating pregnant women can offer some protection to the baby during pregnancy and after birth.

About flu vaccine  

What kinds of flu vaccine are there?

There are two kinds of flu vaccine:

Inactivated (killed) flu vaccine, the "flu shot", is given by injection with a needle.

Live, attenuated (weakened) flu vaccine is sprayed into the nostrils.

The kind of vaccine your child will get depends on their age and health.  Your child may be eligible to receive either kind of flu vaccine.

Every time your child receives vaccine, your healthcare provider will ask questions which will help determine whether the child should receive vaccine that day and what kind of vaccine your child should get.

Are there any risks from flu vaccine?

Vaccine reactions, if they occur, are usually mild and can include soreness, redness and swelling where the shot is given or runny nose after getting the nasal spray.  Some people have experienced fever, body aches, headache and fatigue.  These reactions usually begin soon after the vaccine is given and last 1-2 days.

A vaccine, like any medicine, could possibly cause more serious problems, such as severe allergic reactions.  The risk of a vaccine causing serious harm is extremely small.  Life threatening allergic reactions from vaccines are very rare.  If they do occur, it is usually within a few minutes to a few hours after the vaccination.

More detailed information about flu vaccine is available at www.immunize.org/vis.  At this site you will find Vaccine Information Statements about inactivated and live influenza vaccines (the shot and the nasal spray) designed to educate and inform in many languages.

Is influenza vaccine effective?

Yes.  While no vaccine is 100% effective, influenza vaccine is the best protection against getting the flu.

Influenza vaccine tends to be most effective in people who are younger and healthy.  It takes about two weeks after vaccination to protect against flu, so vaccination does not protect immediately.  Also, flu viruses are always changing, so the vaccine needs to be updated every year, before flu season starts.  When the vaccine isn't a good match with the flu viruses that are circulating, it offers less protection.

People who get flu vaccine are much less likely to get the flu than those who don't get vaccine and, if vaccinated people get sick with the flu, their illness is not as severe.

Other steps to take  

What else can I do to protect my child?

• Cover coughs and sneezes with a tissue.  Throw the tissue in the trash after use.
• Stay away from people who are sick.
• Wash hands often with soap and water.
• Use an alcohol-based hand rub if soap and water are not available.
• Contact your healthcare provider if your child gets sick, especially if the child is very young (under 5) or has long-term health conditions.
• Seek emergency care if your child has trouble breathing, fast breathing, turns bluish or gray, has severe or persistent vomiting, has trouble waking up, or doesn't interact normally.

Lyme disease, transmitted by the blacklegged (deer) tick, is the most common vector-borne disease in the US and the number of cases continues to rise every year.  Although Lyme disease has been reported in all fifty states, it is most prevalent in the Northeast, North Central and the West Coast areas.

Life cycle of the blacklegged tick:

Deer ticks have a two year life cycle and must feed three times – during the larval, nymphal, and adult stage.  In the spring, the adult female tick lays thousands of eggs on the ground.  During the summer months the eggs hatch into larvae and require a meal.  The larvae attach to a small animal or bird, which if infected with the Lyme disease bacterium, transfers the bacteria to the tick along with the blood the tick is feeding on.  Once infected, the tick remains infected for the rest of its life.  After feeding, the larvae become inactive until the following spring while they molt into nymphs.  The nymphs, active during both the spring and summer months, usually feed on small animals, but they will attach to pets and humans and this is the time when most humans become infected.  The nymphs molt again into reddish-brown adults and need one more meal to reproduce.  They prefer to feed on deer, but will also feed on humans and pets. Once fed, the male deer tick dies after mating with the female and the female dies after she lays her eggs; the life-cycle is now complete.  Interestingly, the deer do not become infected, but provide a means for transporting the ticks to surrounding areas of the environment. 

 Lyme disease symptoms:

 Once the bacterium has been transferred to a human, it can affect several parts of the body and produce different symptoms at different times.  Not everyone will experience the same symptoms.

• Most common symptom is a circular rash (Erythema migrans) - it begins at the site of the tick bite, gradually expands over several days, and usually occurs between 3 and 30 days after the bite.  The center of the rash may clear as it becomes larger leaving red margins, thus producing a “bull’s eye” appearance.  It is not usually painful, but may be warm to the touch.
• fatigue
• chills
• fever
• headache
• muscle and joint aches
• swollen lymph nodes

 If untreated or improperly treated, Lyme disease may spread to other parts of the body, producing different symptoms.  These may include:

• Arthritis - pain and swelling of the joints, especially the knees
• Central nervous system symptoms - numbness, pain, nerve paralysis (often of the facial muscles and, maybe, only on one side), and meningitis (fever, stiff neck, and severe headache)
• Heart rhythm irregularities – these are rare
• Problems with memory or cognition, fatigue, headache, and sleep disturbances sometimes persisting after treatment.

 Early treatment of Lyme disease symptoms is very important so it is vital to check with your health care provider if you suspect you have Lyme disease.  Most cases can be treated successfully with a few weeks of antibiotics especially if begun early in the course of the disease.

What is "fifth disease”?

Fifth disease is a mild rash illness that occurs most commonly in children. The ill child typically has a "slapped-cheek" rash on the face and a lacy red rash on the trunk and limbs. Occasionally, the rash may itch. An ill child may have a low-grade fever, malaise, or a "cold" a few days before the rash breaks out. The child is usually not very ill, and the rash resolves in 7 to 10 days.

What causes fifth disease?

Fifth disease is caused by infection with human parvovirus B19. This virus infects only humans. Pet dogs or cats may be immunized against "parvovirus," but these are animal parvoviruses that do not infect humans. Therefore, a child cannot "catch" parvovirus from a pet dog or cat, and a pet cat or dog cannot catch human parvovirus B19 from an ill child.

Can adults get fifth disease?

Yes, they can. An adult who is not immune can be infected with parvovirus B19 and either have no symptoms or develop the typical rash of fifth disease, joint pain or swelling, or both. Usually, joints on both sides of the body are affected. The joints most frequently affected are the hands, wrists, and knees. The joint pain and swelling usually resolve in a week or two, but they may last several months. About 50% of adults, however, have been previously infected with parvovirus B19, have developed immunity to the virus, and cannot get fifth disease.

Is fifth disease contagious?

Yes. A person infected with parvovirus B19 is contagious during the early part of the illness, before the rash appears. By the time a child has the characteristic "slapped cheek" rash of fifth disease, for example, he or she is probably no longer contagious and may return to school or child care center. This contagious period is different than that for many other rash illnesses, such as measles, for which the child is contagious while he or she has the rash.

How does someone get infected with parvovirus B19?

Parvovirus B19 has been found in the respiratory secretions (e.g., saliva, sputum, or nasal mucus) of infected persons before the onset of rash, when they appear to "just have a cold." The virus is probably spread from person to person by direct contact with those secretions, such as sharing drinking cups or utensils. In a household, as many as 50% of susceptible persons exposed to a family member who has fifth disease may become infected. During school outbreaks, 10% to 60% of students may get fifth disease.

How soon after infection with parvovirus B19 does a person become ill?  

A susceptible person usually becomes ill 4 to 14 days after being infected with the virus, but may become ill for as long as 20 days after infection.

Does everyone who is infected with parvovirus B19 become ill?

No. During outbreaks of fifth disease, about 20% of adults and children who are infected with parvovirus B19 do not develop any symptoms. Furthermore, other persons infected with the virus will have a non-specific illness that is not characteristic of fifth disease. Persons infected with the virus, however, do develop lasting immunity that protects them against infection in the future.

How is fifth disease diagnosed?

A physician can often diagnose fifth disease by seeing the typical rash during a physical examination. In cases in which it is important to confirm the diagnosis, a blood test may be done to look for antibodies to parvovirus. Antibodies are proteins produced by the immune system in response to parvovirus B19 and other germs. If immunoglobulin M (IgM) antibody to parvovirus B19 is detected, the test result suggests that the person has had a recent infection.

Is fifth disease serious?

Fifth disease is usually a mild illness that resolves on its own among children and adults who are otherwise healthy. Joint pain and swelling in adults usually resolve without long-term disability.

Parvovirus B19 infection may cause a serious illness in persons with sickle-cell disease or similar types of chronic anemia. In such persons, parvovirus B19 can cause an acute, severe anemia. The ill person may be pale, weak, and tired, and should see his or her physician for treatment. (The typical rash of fifth disease is rarely seen in these persons.) Once the infection is controlled, the anemia resolves. Furthermore, persons who have problems with their immune systems may also develop a chronic anemia with parvovirus B19 infection that requires medical treatment. People who have leukemia or cancer, who are born with immune deficiencies, who have received an organ transplant, or who have human immunodeficiency virus (HIV) infection are at risk for serious illness due to parvovirus B19 infection.

Occasionally, serious complications may develop from parvovirus B19 infection during pregnancy. For details, please see the CDC information sheet entitled, "Parvovirus B19 Infection and Pregnancy."

How are parvovirus B19 infections treated?

Treatment of symptoms such as fever, pain, or itching is usually all that is needed for fifth disease. Adults with joint pain and swelling may need to rest, restrict their activities, and take medicines such as aspirin or ibuprofen to relieve symptoms. The few people who have severe anemia caused by parvovirus B19 infection may need to be hospitalized and receive blood transfusions. Persons with immune problems may need special medical care, including treatment with immune globulin (antibodies), to help their bodies get rid of the infection.

Can parvovirus B19 infection be prevented?

There is no vaccine or medicine that prevents parvovirus B19 infection. Frequent handwashing is recommended as a practical and probably effective method to decrease the chance of becoming infected. Excluding persons with fifth disease from work, child care centers, or schools is not likely to prevent the spread of the virus, since people are contagious before they develop the rash.

Powassan is a potentially severe viral infection transmitted to people from the bite of an infected tick. It is a "cousin" of West Nile virus and is rare with only about 75 cases being reported in the United States over the past 10 years.   Most of the reported cases have occurred in the Northeast, including the Cape, and in the Great Lakes region.  A recent survey of ticks collected in several communities on Cape Cod have tested positive for this virus.

The incubation period or the time from tick bite to emergence of symptoms for this virus range from one week to one month.   The signs and symptoms of infection can include fever, headache, vomiting, weakness, confusion, seizures, and memory loss.  In addition, long-term neurologic problems may occur.  

Powassan is a viral disease, unlike Lyme which is caused by a bacteria, and because it is viral there is no specific treatment.  For many people there are no symptoms of infection.  But, people with severe Powassan illness often need to be hospitalized to receive respiratory support, intravenous fluids, or medications to reduce swelling in the brain.

You can reduce your risk of becoming infected by avoiding bushy and wooded areas where ticks are common, using tick repellents (permethrin) on clothes or products containing DEET on skin, wearing long sleeves and pants, and doing thorough tick checks after spending time outdoors.  Pets should also be checked for ticks frequently and spraying perimeters of yards may prove helpful.

It's very important that you contact your healthcare provider if you think you or a family member may have Powassan disease. 

Measles is a highly contagious viral respiratory disease that begins with a high fever, as much as 104 degrees F.  Other symptoms include cough, runny nose, red eyes, and a rash.  The rash consists of tiny, red spots that start at the head and spread to the rest of the body.  Measles can be a dangerous disease for anyone, but especially for babies, young children, and those whose immune system is compromised.  Complications from measles include ear infections, pneumonia, and encephalitis.  Children younger than 5 years and adults over 20 years are more likely to suffer complications.

Measles is spread through the air when an infected person coughs or sneezes.  The virus can linger in the air or on a surface for up to 2 hours, so a person can become infected without direct contact with someone who has the measles.  A person infected with measles is contagious four days before the rash occurs until four days after the onset of the rash.

Measles can be prevented with the MMR vaccine.  This vaccine protects against not only measles, but also, mumps and rubella.  The vaccine is very effective in preventing the spread of measles and very few cases have been reported in the U.S.  In countries where people are not vaccinated, measles is still common and the disease spreads rapidly.  Because is extremely contagious, 90% of unvaccinated people in contact with an infected person will become ill with this virus.

 Measles Vaccination:

The CDC recommends that all children get two doses of MMR vaccine.  The first dose is administered between 12 months and 15 months of age.  The second dose is given between the 4th and 6th birthday.  The second dose can be given earlier, as long as it is at least 28 days after the first dose.

Traveling internationally, including some countries in Europe, Asia, the Pacific, and Africa, poses a risk for people who are unvaccinated.  In fact, most cases of measles in the U.S. result from travelers who are not vaccinated.  The CDC has developed guidelines for people who travel out of the country and these recommendations can be found on their website.  All people 6 months of age and older should be protected against measles.  

Exclusion from school during disease outbreaks:

Massachusetts Department of Public Health has developed guidelines for exclusion from school in the event a serious communicable disease occurs in the school setting.  These guidelines include measles.  The law reads:

In situations when one or more cases of a vaccine-preventable or any other communicable disease are present in a school, all susceptibles, including those with medical or religious exemptions, are subject to exclusion as described in the Reportable Diseases and Isolation and Quarantine Requirements (105 CMR 300.000)

Mandated requirements in the case of measles: 

For Case and Symptomatic Contacts - Exclude student/staff through 4 days after onset of rash.  (Count the day of rash onset as day zero.)

For asymptomatic contacts – If one case of measles: exclude susceptibles from work or classes from the 5th through the 21st day after their exposure.  If multiple cases or continuous (two or more days) exposure: exclude susceptibles through the 21st day after rash onset in the last case. 

These restrictions remain even if the contact received immune globulin (IG).

These mandates are in place to protect the health and well-being of all school and community members.  As a public school we are required to follow these regulations and all children without two MMR vaccinations will be excluded from school if a case of measles is reported.

Information from the Mass Department of Public Health

What is meningococcal disease?

Meningococcal disease is caused by infection with bacteria called Neisseria meningitides.  These bacteria can infect the tissue (the “meninges”) that surrounds the brain and spinal cord and cause meningitis, or they may infect the blood or other organs of the body.  In the US, about 1,000-3,000 people get meningococcal disease each year and 10-15% die despite receiving antibiotic treatment. Of those who survive, about 11-19% may lose limbs, become deaf, have problems with their nervous system, become mentally retarded, or have seizures or strokes.

How is meningococcal disease spread?

These bacteria are passed from person-to-person through saliva (spit).  You must be in close contact with an infected person’s saliva in order for the bacteria to spread.  Close contact includes activities such as kissing, sharing water bottles, sharing eating/drinking utensils or sharing cigarettes with someone who is infected; or being within 3-6 feet of someone who is infected and is coughing and sneezing.

Who is at most risk for getting meningococcal disease?

High-risk groups include anyone with a damaged spleen or whose spleen has been removed, those with persistent complement deficiency (an inherited immune disorder), HIV infection, those traveling to countries where meningococcal disease is very common, microbiologists and people who may have been exposed to meningococcal disease during an outbreak.  People who live in certain settings such as college freshmen living in dormitories and military recruits are also at greater risk of disease.

Are children in daycare at increased risk for meningococcal disease?

Children under 5 years of age have a higher rate of meningococcal disease then older children, but daycare is not considered to increase risk for meningococcal disease.

Is there a vaccine against meningococcal disease?

There are currently 2 types of vaccines available in the US that protect against 4 of the most common of the 13 serogroups (subgroups) of N. meningitides that cause serious disease. Meningococcal polysaccharide vaccine is approved for use in those 2 years of age and older.  There are 2 licensed meningococcal conjugate vaccines.  MenactraR is approved for use in those 9 months – 55 years of age.  MenveoR is approved for use in those 2 to 55 years of age.  Meningococcal vaccines are thought to provide protection for approximately 5 years.

Should my child receive meningococcal vaccine?

Meningococcal vaccine is now recommended routinely for children 11-12 years of age with a booster dose at 16-18 years of age.  College freshmen and other newly enrolled college students living in dormitories are recommended to have received a dose of meningococcal vaccine within 5 years of enrollment.  Other high-risk groups include anyone with a damaged spleen or whose spleen has been remove, those with persistent complement component deficiency, HIV infection, those traveling to countries where meningococcal disease is very common, microbiologists and people who may have been exposed to meningococcal disease during an outbreak.  Children and adults with terminal complement component deficiency (an inherited immune disorder) should also receive the vaccine.  Parents of children in these groups should discuss vaccination with their child’s healthcare provider.

At the current time, routine vaccination with meningococcal vaccine is not recommended for healthy pre-school children who are not in one of the high-risk groups.  Your child’s healthcare provider can provide additional information about vaccination in this age group.

How can I protect my child from getting meningococcal disease?

The best protection against meningococcal disease and many other infectious diseases is thorough and frequent handwashing and respiratory hygiene and cough etiquette.  Individuals should:

1. Wash their hands often, especially after using the toilet and before eating or preparing food (hands should be washed with soap and water, or an alcohol-based hand gel or rub may be used if hands are not visibly dirty);
2. Cover their nose and mouth with a tissue when coughing or sneezing and discard the tissue in a trash can; or is they don’t have a tissue, cough or sneeze into their upper sleeve.
3. Not share food, drinks or eating utensils with other people, especially if they are ill.

You can obtain more information about meningococcal disease or vaccination from your healthcare provider, your local Board of Health (listed in the phone book under government), or the Massachusetts Department of Public Health Division of Epidemiology and Immunization at (617) 983-6800 or toll-free at (888) 658-2850 or on the MDPH website.

Provided by the Massachusetts Department of Public Health in accordance with M.G.L. c.111, s.219.

By Mayo Clinic Staff

Reye's (Ryes) syndrome is a rare but serious condition that causes swelling in the liver and brain. Reye's syndrome most often affects children and teenagers recovering from a viral infection, most commonly the flu or chickenpox.

Signs and symptoms such as confusion, seizures and loss of consciousness require emergency treatment. Early diagnosis and treatment of Reye's syndrome can save a child's life.

Aspirin has been linked with Reye's syndrome, so use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

In Reye's syndrome, a child's blood sugar level typically drops while the levels of ammonia and acidity in his or her blood rise. At the same time, the liver may swell and develop fatty deposits. Swelling may also occur in the brain, which can cause seizures, convulsions or loss of consciousness.

The signs and symptoms of Reye's syndrome typically appear about three to five days after the onset of a viral infection, such as the flu (influenza) or chickenpox, or an upper respiratory infection, such as a cold.

Initial signs and symptoms

For children younger than age 2, the first signs of Reye's syndrome may include:

• Diarrhea
• Rapid breathing

For older children and teenagers, early signs and symptoms may include:

• Persistent or continuous vomiting
• Unusual sleepiness or lethargy

Additional signs and symptoms

As the condition progresses, signs and symptoms may become more serious, including:

• Irritable, aggressive or irrational behavior
• Confusion, disorientation or hallucinations
• Weakness or paralysis in the arms and legs
• Seizures
• Excessive lethargy
• Decreased level of consciousness

These signs and symptoms require emergency treatment.

When to see a doctor

Early diagnosis and treatment of Reye's syndrome can save a child's life. If you suspect that your child has Reye's syndrome, it's important to act quickly.

Seek emergency medical help if your child:

• Has seizures or convulsions
• Loses consciousness

Contact your child's doctor if your child experiences the following after a bout with the flu or chickenpox:

• Vomits repeatedly
• Becomes unusually sleepy or lethargic
• Has sudden behavior changes

The exact cause of Reye's syndrome is unknown, although several factors may play a role in its development. Reye's syndrome seems to be triggered by using aspirin to treat a viral illness or infection — particularly flu (influenza) and chickenpox — in children and teenagers who have an underlying fatty acid oxidation disorder.

Fatty acid oxidation disorders are a group of inherited metabolic disorders in which the body is unable to break down fatty acids because an enzyme is missing or not working properly. A screening test is needed to determine if your child has a fatty acid oxidation disorder.

In some cases, Reye's syndrome may be an underlying metabolic condition that's unmasked by a viral illness. Exposure to certain toxins — such as insecticides, herbicides and paint thinner — also may contribute to Reye's syndrome.

The following factors — usually when they occur together — may increase your child's risk of developing Reye's syndrome:

• Using aspirin to treat a viral infection, such as flu, chickenpox or an upper respiratory infection
• Having an underlying fatty acid oxidation disorder

Most children and teenagers who have Reye's syndrome survive, although varying degrees of permanent brain damage are possible. Without proper diagnosis and treatment, Reye's syndrome can be fatal within a few days.

Reye's syndrome is often diagnosed in an emergency situation because of serious signs and symptoms, such as seizures or loss of consciousness. In some cases, early signs and symptoms prompt a doctor's appointment.

You'll likely be referred to a doctor who specializes in conditions of the brain and nervous system (neurologist).

Because appointments can be brief and there's often a lot of ground to cover, it can help to be well-prepared. Here are some tips to help you get ready for your appointment.

What you can do

• Be aware of any pre-appointment restrictions.At the time you make the appointment, ask if there's anything you need to do in advance.
• Write down any symptoms your child is experiencing,including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications,including vitamins, dietary supplements and over-the-counter drugs, that your child has taken, especially any containing aspirin. Even better, take the original bottles and a written list of the dosages and directions.
• Take along a family member or friend.It can be difficult to recall all the information provided to you during an appointment. The person who accompanies you may remember something that you forgot or missed.
• Write down questions to ask your doctor.Don't be afraid to ask questions or to speak up when you don't understand something your doctor says.

List your questions from most important to least important in case your time with your doctor runs out. For Reye's syndrome some basic questions to ask your doctor include:

• What are other possible causes for my child's symptoms?
• What tests are needed to confirm the diagnosis?
• What are the treatment options and the pros and cons for each?
• What results can I expect?
• What kind of follow-up should I expect?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

The neurologist is likely to ask about your child's symptoms and history of viral illnesses. The doctor will also conduct a medical exam and schedule tests to gather information about your child's condition and to rule out other diseases, such as meningitis or encephalitis.

There's no specific test for Reye's syndrome. Instead, screening for Reye's syndrome usually begins with blood and urine tests as well as testing for fatty acid oxidation disorders and other metabolic disorders.

Sometimes more-invasive diagnostic tests are needed to evaluate other possible causes of liver problems and investigate any neurological abnormalities. For example:

• Spinal tap (lumbar puncture).A spinal tap can help the doctor identify or rule out other diseases with similar signs and symptoms, such as infection of the lining that surrounds the brain and spinal cord (meningitis) or inflammation or infection of the brain (encephalitis).

During a spinal tap, a needle is inserted through the lower back into a space below the end of the spinal cord. A small sample of cerebrospinal fluid is removed and sent to a lab for analysis.

• Liver biopsy.A liver biopsy can help the doctor identify or rule out other conditions that may be affecting the liver.

During a liver biopsy, a needle is inserted through the skin on the upper right side of the abdomen and into the liver. A small sample of liver tissue is removed and sent to a lab for analysis.

• Computerized tomography (CT) scan or magnetic resonance imaging (MRI).A head CT or MRI scan can help the doctor identify or rule out other causes of behavior changes or decreased alertness.

A CT scan uses a sophisticated imaging machine linked to a computer to produce detailed, 2-D images of the brain. An MRI scan uses a strong magnetic field and radio waves rather than X-rays to generate images of the brain.

• Skin biopsy.Testing for fatty acid oxidation disorders or metabolic disorders may require a skin biopsy.

During a skin biopsy, a doctor takes a small skin sample (biopsy) for analysis in a lab. A biopsy can usually be done in a doctor's office using a local anesthetic.

Reye's syndrome is usually treated in the hospital. Severe cases may be treated in the intensive care unit. The hospital staff will closely monitor your child's blood pressure and other vital signs. Specific treatment may include:

• Intravenous fluids.Glucose and an electrolyte solution may be given through an intravenous (IV) line.
• These medications may be used to decrease intracranial pressure and increase fluid loss through urination.
• Medications to prevent bleeding.Bleeding due to liver abnormalities may require treatment with vitamin K, plasma and platelets.

If your child has trouble breathing, he or she may need assistance from a breathing machine (ventilator).

Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This includes plain aspirin and medications that contain aspirin.

Some hospitals and medical facilities conduct newborn screenings for fatty acid oxidation disorders to determine which children are at greater risk of developing Reye's syndrome. Children with known fatty acid oxidation disorders should not take aspirin or aspirin-containing products.

Always check the label before you give your child medication, including over-the-counter products and alternative or herbal remedies. Aspirin can show up in some unexpected places, such as Alka-Seltzer.

Sometimes aspirin goes by other names, too, such as:

• Acetylsalicylic acid
• Acetylsalicylate
• Salicylic acid
• Salicylate

If your child has the flu, chickenpox or another viral illness, use other medications — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Children's Motrin, Motrin IB, others) or naproxen (Aleve) — to reduce high fever or relieve pain.

There's one caveat to the aspirin rule, however. Children and teenagers who have certain chronic diseases, such as Kawasaki disease, may need long-term treatment with drugs that contain aspirin.

If your child needs aspirin therapy, make sure his or her vaccines are current — including two doses of the varicella (chickenpox) vaccine and a yearly flu vaccine. Avoiding these two viral illnesses can help prevent Reye's syndrome.

Warts are common skin lesions caused by viruses of the HPV family.  They usually appear as small, round or oval, painless growths on the surface of the skin.  The wart is formed when the virus infects the top layer of the skin causing rapid tissue growth.  Warts may be lighter or darker in color than the surrounding skin and often have a rough surface.   They can be found anywhere on the body, but are most frequently seen on the fingers, hands, and feet.

There are several kinds of warts:

Common warts: 

• painless
• round, raised, with dark spots in the center
• gray-brown in color
• surface resembles a head of cauliflower
• generally seen on the hands, but can appear anywhere. 

Flat warts:

• tiny (pinpoint), smooth with flat tops
• usually pink, light brown, or light yellow
• generally found on the face and forehead, more common in children

Plantar warts:

• hard, thick patches of skin with dark specks
• found on the soles of the feet
• can become very painful due to the pressure exerted when walking

Genital warts:

• should be treated by a physician

Filiform warts:

• have finger-shaped threads sticking out of them
• flesh colored
• found on or around the mouth, eyes, or nose

Subungual and periungual warts: 

• appear under and around the fingernails or toenails
• can affect nail growth
• difficult to treat

Warts are contagious, but are generally harmless.  The virus usually enters the body through a small cut or scratch when a person comes in contact with an object that has been handled by someone with a wart.  Transmission can also occur from person to person, but this is less common.  Warts can spread to different parts of the body by picking or scratching and these practices should be avoided.

To reduce the risk of exposure good, frequent hand washing should be encouraged and water-proof sandals or flip-flops should be worn in public pool or shower areas and locker rooms.

Over-the-counter medications are available to treat warts, but if left untreated, they often disappear spontaneously; however, it may take from 6 months to 2 years.  Other treatments include burning with a light electrical current, freezing by applying liquid nitrogen, or laser treatments.

 Attention Deficit/Hyperactivity Disorder

Information from the NIH

What is attention deficit/hyperactivity disorder, or ADHD?

      ADHD is a common mental disorder that begins in childhood and can continue through adolescence and adulthood. It makes it hard for a child to focus and pay attention. Some children may be hyperactive or have trouble being patient. For children with ADHD, levels of inattention, hyperactivity, and impulsive behaviors are greater than for other children in their age group. ADHD can make it hard for a child to do well in school or behave at home or in the community. ADHD can be treated. Doctors and specialists can help.

Who can develop ADHD?

      Children of all backgrounds can have ADHD. Teens and adults can have ADHD too. What causes ADHD? No one knows for sure. ADHD probably stems from interactions between genes and environmental or non-genetic factors. ADHD often runs in families. Researchers have found that much of the risk of having ADHD has to do with genes. Many genes are linked to ADHD, and each gene plays a small role in the disorder. ADHD is very complex and a genetic test for diagnosing the disorder is not yet available. Among the non-genetic factors that may increase a child’s risk for developing ADHD are:

• Smoking or drinking during pregnancy
• Birth complications or very low birth weight
• Exposure to lead or other toxic substances
• Extreme neglect, abuse, or social deprivation.
• Some studies suggest that artificial food additives and dyes may worsen hyperactivity and inattention, but these effects are small and do not account for most cases of ADHD.        

What are the symptoms of ADHD?

      ADHD has many symptoms. Some symptoms at first may look like normal behaviors for a child, but ADHD makes them much worse and occur more often. Children with ADHD have at least six symptoms that start in the first 12 years of their lives. Children with ADHD may:

• Get distracted easily and forget things often
• Switch too quickly from one activity to the next
• Have trouble with directions
• Daydream too much
• Have trouble finishing tasks like homework or chores
• Lose toys, books, and school supplies often
• Fidget and squirm a lot
• Talk nonstop and interrupt people
• Run around a lot Touch and play with everything they see
• Be very impatient
• Blurt out inappropriate comments
• Have trouble controlling their emotions. 

How do I know if my child has ADHD?

      Your child’s doctor may make a diagnosis. Or sometimes the doctor may refer you to a mental health specialist who is more experienced with ADHD to make a diagnosis. There is no single test that can tell if your child has ADHD. To make a diagnosis, the doctor or specialist will examine your child and use several rating scales to track ADHD symptoms. The specialist will also collect information from you, your family, and your child’s teachers.

      Sometimes it can be hard to diagnose a child with ADHD because symptoms may look like other problems. For example, a child may seem quiet and well-behaved, but in fact he or she is having a hard time paying attention and is often distracted. Or, a child may act badly in school, but teachers don’t realize that the child has ADHD. If your child is having trouble at school or at home and has been for a long time, ask his or her doctor about ADHD.            

How do children with ADHD get better?

      Children with ADHD can get better with treatment, but there is no cure. There are three basic types of treatment:

• 1. Medication. Several medications can help. The most common types are called stimulants. Medications help children focus, learn, and stay calm. Sometimes medications cause side effects, such as sleep problems or stomachaches. Your child may need to try a few medications to see which one works best. It’s important that you and your doctor watch your child closely while he or she is taking medicine.
• 2. Therapy. There are different kinds of therapy. Behavioral therapy can help teach children to control their behavior so they can do better at school and at home.
• 3. Medication and therapy combined. Many children do well with both medication and therapy. 

How can I help my child?

      Give your child guidance and understanding. A specialist can show you how to help your child make positive changes. Supporting your child helps everyone in your family. Also, talk to your child’s teachers. Some children with ADHD can get special education services. 

How does ADHD affect teens?

      Being a teenager isn’t always easy. Teens with ADHD can have a tough time. While hyperactivity tends to get better as a child becomes a teen, problems with inattention, disorganization, and poor impulse control often continue through the teen years and into adulthood. School may be a struggle, and some teens take too many risks or break rules. But like children with ADHD, teens can improve with treatment.

What can I do for my teen with ADHD?

      Support your teen. Set clear rules for him or her to follow. Try not to punish your teen every time he or she breaks the rules. Let your teen know you can help.

Can adults have ADHD too?

      ADHD can continue into adulthood. Like ADHD in children and teens, ADHD in adults can make life challenging. ADHD can make it hard for adults to feel organized, stick with a job, or get to work on time. Adults with ADHD may have trouble in relationships. The disorder can also make adults feel restless. ADHD in adults can be diagnosed and treated. For some adults, finding out they have ADHD can be a big relief. Being able to connect ADHD to longtime problems helps adults understand that they can get better. If you’re an adult and think you may have ADHD symptoms, call your doctor.

Good hand washing is the best way to prevent the spread of viruses and bacteria, including the bacteria which cause MRSA, Here's how to do it effectively.

• Wash often and wash well.  Use soap and water to make a good lather.     
• Rub your hands together for 20 seconds, washing fronts and backs, between fingers and under nails.
• Rinse with plenty of water.
• Dry with a paper towel and use the towel to turn off the faucet.  
• Use of an alcohol-based (60% alcohol) hand cleaner (like Purell) is also effective.

• Fruits, nuts, and veggies
• Low-fat yogurt
• Yogurt parfait - low-fat yogurt mixed with fruit or granola
• Popcorn - air popped, add spices for flavor
• Whole wheat pretzels with spicy mustard
• Rice cakes with peanut butter and raisins
•  Ants on a log - celery with nut butter topped with raisins or dried cranberries
• Popsicles made from 100% fruit juice
• Fruit smoothies - blend till smooth (1/2 banana, 6 strawberries, handful of blueberries and low-fat milk, yogurt, or juice)
• Baked tortilla chips with salsa
• Trail mix - toasted whole oat cereal with chopped nuts and dried cranberries
• Frozen berries or grapes
• Orange sorbet - frozen orange juice
•  Low-fat granola and cereal bars
• Veggies and humus
• Whole grain crackers

Should I monitor my child's weight and height?

Childhood is a time of growth both physically and mentally. After infancy, growth in children slows down and occurs in spurts. Weight and height measurements plotted on a growth chart are used to determine the growth pattern of a child compared to other children with typical growth patterns.

You may have heard the term "percentile" and wondered what the word actually means. Percentile is the ranking of a child among 100 other children of the same age and sex. If a child is in the 50th percentile for weight or height for age, this means that 50 children will weigh more or be taller than this child and 50 children will weigh less or be shorter than this child.

Assessing Growth:

• Growth is a good indicator of a child's nutritional status. A child's growth is assessed by a health professional to determine if the child is keeping up with his or her growth pattern.
• Children who are between the 25th and 75th percentiles are considered to be growing appropriately. Children who are between the 10th to 25th percentiles may also be growing appropriately but their food intake needs to be evaluated. Children who are less than the 10th percentile may also be growing appropriately but are considered to be at risk for growth failure and need to be closely evaluated.

What are some causes for under nutrition in children?

• Too much Juice: Too much juice in the diet often replaces milk and other important food groups that the child should be eating. Juices often contain more sugar and fewer vitamins than fresh, canned, or frozen fruits.
• Low-fat diets: Some parents become concerned about heart disease and obesity and may decide to offer their children only non-fat or low-fat food products such as skim milk, or they may decide to reduce calories. It is recommended that children under 2 years of age not be put on a low-fat diet or eating plan as they need adequate fat for growth and brain development. Fat is important for storing energy, protecting and insulating the body and absorbing fat-soluble vitamins in the body.
• No breakfast: Children who skip breakfast eat less calories and nutrients than those children who eat breakfast. If there is little time for preparing breakfast, choose foods that are easily prepared or are ready-to-eat such as yogurt, fruit bars, milk and leftovers.
• Diets that restrict food groups or diets that are inadequate: A vegan diet consists of only plant foods and may not provide the recommended amount of calories, vitamins and minerals required for growth. A vegan diet requires careful planning to ensure children receive nutrients from other sources of food.

Weight Gain Strategies:

Childhood is a time when eating behavior changes. Since the child is not growing as fast as when he/she was an infant, his/her appetite has decreased. Since less food is being taken in, parents or caregivers should offer nutrient dense foods and energy dense foods.

What makes a food nutrient dense? A food is nutrient dense if the vitamin and mineral content is more than its energy or calorie content such as lean meats, beans, oranges, carrots, broccoli, whole-wheat bread, and whole-grain breakfast cereals.

Energy dense foods contribute more calories than they do nutrients such as chips, sodas, cookies and ice cream. Remember to balance healthy nutrient dense foods with energy dense foods. Here are some examples of weight gain strategies:

• Provide small frequent meals with nutrient dense foods and energy dense foods and drinks.
• Add fat to foods such as margarine on mashed potatoes and toast, mayonnaise and cheese on sandwiches.
• Offer whole (not reduced) fat products such as whole milk, cottage cheese, cheese, creamed soups, pudding and yogurt.
• Add calories to foods such as canned fruit in heavy syrup and vegetables with cheese sauce.

A combination of physical activity and good nutrition is essential for good health and physical wellness.  The benefits include becoming more physically fit, maintaining a healthy weight, and reducing the incidences of heart disease, high blood pressure, and diabetes.  In addition, physical activity and good nutrition can relieve stress and improve self-esteem. 

 By following the guidelines shown in the Food Pyramid, a wholesome diet can be achieved.  A healthy diet includes a rich variety of foods including whole grains, vegetables, fruits, dairy, and meat, beans, and eggs.  Portion size is also an important consideration.

FOOD GROUPS

Grains – eat 6 oz. every day.  Choose whole grain

Half of all grains consumed should be whole grains.  A whole grain includes the entire kernel and yields more dietary fiber than a refined grain.  An enriched grain has vitamins and minerals added to it, but it is still refined and, therefore, has less fiber.  Check labels when buying bread – look for “whole wheat” or “whole grains”.  Just because bread is brown in color doesn’t mean it is whole grain. Molasses and other additives can create the brown color associated with whole wheat. 

Vegetables – eat 2 ½ cups every day -vary your veggies

Choose a wide variety of vegetables to get the most vitamins and minerals, but dark green and orange veggies offer the most potassium and vitamin A.

Fruits – eat 1 ½ cups every day - seasonal is the best buy, costs less and tastes better

Whole fruits are high in fiber.  100% fruit juice is a good choice, but it is lower in fiber.  Other choices include dried, frozen and canned fruits, but be careful of choosing fruit in heavy syrup. 

Meats and beans – eat 5 oz. every day – lean meats are best

Low fat meats include tenderloin, ham, 90% lean ground beef, round steak/roast, skinless chicken breasts, and turkey cutlets.  Nuts and seeds offer protein along with healthy oils and vitamin E.  Fish, especially salmon and trout are high in beneficial oils.  Dried or canned beans and peas are good sources of protein. Canned beans are more convenient than dried, offer the same nutrition and fiber and they save time.  Add to soups, chili, salads, and stews.

Milk and dairy – 3 cups every day - change to low-fat or skim milk

It’s easier to change gradually from whole milk to 2%, then to 1%, and finally to skim.

Cheese – choose low-fat or part-skim (mozzarella or provolone).  When selecting meats from the deli, choose low-fat – lean turkey, lean roast beef, and ham.

Not a food group, but oils are important for good health – just switch from solid fats to oils.

Oils are liquid at room temperature; examples include corn oil, olive oil, and canola oil.  Fish and nuts provide “good” oils.

Solid fats are solid at room temperature; butter, lard, and vegetable shortening.  Solid fats raise levels of “bad” cholesterol which has been shown to increase the risk for heart disease.

Beverages

Limit sugary drinks.  Instead choose water, low-fat milk, 100% fruit juice or unsweetened tea or coffee.  When adding milk or cream to coffee or tea, use low-fat or fat-free milk

Snacks

Choose whole grain or baked snacks or popcorn (no butter, and little or no salt).  Make smoothies using frozen fruits and fat-free or low fat yogurt.

The importance of meals

Eating healthy foods in a relaxed atmosphere, enjoying family-oriented conversation and limiting distractions (television and phone conversations) create an atmosphere that is beneficial for the entire family.  It is a time for family togetherness and has been shown to have a positive effect on school success, behavioral issues, weight concerns, and improved nutrition.  

Controlling portion size and focusing on better nutrition will make a determined effort toward overall wellness. 

Tooth decay is the most common childhood infection in the U.S., more common than asthma or hay fever.  Over half of all children between the ages of 5 and 9 have at least one cavity or filling.  By age seventeen, that number jumps to 78% with 7% having lost one permanent tooth to decay.

Dental cavities are painful and may lead to infection and abscess.  In addition, they may cause difficulties with eating (not chewing well or comfortably) and speaking.  Distractions from learning and playing are other possible consequences due to the pain and discomfort from tooth decay. 

Dental cavities are preventable through the use of sealants and fluoride.  Here are some suggestions you can use to help prevent cavities. 

• Eat regular nutritious meals
• Avoid frequent between meal snacks
• Brush with a fluoride toothpaste – children under 7 years old should use only a pea-size amount of fluoride toothpaste
• Have regular dental visits (every 6 months)
• Talk to your dentist about sealants 

Loss of a tooth is traumatic.  You can help prevent accidental tooth loss by:

• Wearing a helmet when riding a bicycle
• Using a mouth guard and protective headgear when playing sports.

Regular physical activity is important for maintaining good health.   Along with helping to maintain healthy weight, the benefits include increasing muscle strength, relieving stress, improving self-esteem, reducing high blood pressure, improving circulation, and lowering the risk of cardiovascular disease and type 2 diabetes.

Exercise, playing sports and games, dancing, swimming, walking, jogging, and running are all good examples of ways to be physically active.  For exercise to be beneficial, activities should increase the heart rate without becoming exhausting; activities like walking briskly, jogging, swimming, and biking. Also, it is important to enjoy what you are doing; you’ll be more likely to do it regularly.  Vary activities so exercise will not become boring.  For some people, exercising with a group or a friend will help with set up a regular Set a goal for 30 minutes a day; this may be divided into three 10-minute sessions.

 Try these web-sites for more information on the benefits of physical activity and health.

 http://www.cdc.gov/healthyweight/physic

Water Safety

Protect the Ones You Love from Drowning - Stay safe in, on, and around the water 

When we're enjoying time at the pool or beach, water safety may not always be the first thing on our minds.  Yet, staying safe enables us to enjoy ourselves to the fullest -- especially when it comes to protecting kids.  Drowning is a leading cause of injury death for young children ages 1 to 4.

Put Water Safety First

• We all want to help our children live to their full potential and keep them safe and secure.  Thankfully, parents can play a key role in protecting the children they love from drowning.  Here are some good first steps:

Swimming Pools 

• Fence it off.  Install a four-sided isolation fence, with self-closing and self-latching gates, around backyard swimming pools.  This can help keep children away from the area when a parent cannot supervise them.  Pool fences should completely separate the house and play area from the pool.

Life Jackets 

• Make life jackets a "must".  Make sure kids wear life jackets in and around natural bodies of water, such as lakes or the ocean, even if they know how to swim.

Learn CPR.  Learn cardiopulmonary resuscitation (CPR) and get re-certified every two years. Immediate CPR can help a child stay alive and reduce the chance of brain damage.

Stay Alert 

• Be on the lookout.  Supervise young children at all times around bathtubs, swimming pools, ponds, lakes, and other bodies of water.

• Adults watching kids near water should avoid distracting activities like playing cards, reading books, or talking on the phone.

Information obtained from the CDC

Sun Safety - Protecting Children and Yourself from the Sun

When outdoors, children, as well as adults, need protection from the sun's harmful ultraviolet (UV) rays. Just a few serious sunburns can increase the chance of developing skin cancer later in life.  Here are a few things you can do to protect yourself and your child from the sun's exposure.

Seek shade.   

• UV rays are strongest and most harmful during midday, so it's best to plan indoor activities then.  If this is not possible, seek shade under a tree, an umbrella, or a pop-up tent.  Use these options to prevent sunburn, not to seek relief after it's happened.

Cover up   

• Clothing that covers your child's skin helps protect against UV rays.  Although a long-sleeved shirt and long pants with a tight weave are best, they aren't always practical.  A T-shirt, long shorts, or a beach cover-up are good choices, too, but it's wise to double up on protection by applying sunscreen or keeping your child in the shade when possible.

Get a hat  

• Hats that shade the face, scalp, ears, and neck are easy to use and give great protection. Baseball caps are popular among kids, but they don't protect their ears and neck.  If your child chooses a cap, be sure to protect exposed areas with sunscreen.

Wear sunglasses  

• They protect your child's eyes from UV rays, which can lead to cataracts later in life.  Look for sunglasses that wrap around and block as close to 100% of both UVA and UVB rays as possible.

Apply sunscreen 

• Use sunscreen with at least SPF 15 and UVA and UVB protection every time your child goes outside.  For the best protection, apply sunscreen generously 30 minutes before going outdoors.  Don't forget to protect ears, noses, lips, and the tops of feet.

Take sunscreen with you to reapply during the day, especially after swimming or exercising.  This applies to waterproof and water-resistant products as well.  Keep in mind that sunscreen is not meant to allow kids to spend more time in the sun than they would otherwise.  Try combining sunscreen with other options to prevent UV damage.

Too Much Sun Hurts

Turning pink?   

• Unprotected skin can be damaged by the sun's UV rays in as little as 15 minutes. Yet, it can take up to 12 hours for skin to show the full effect of sun exposure.  So, if your child's skin looks "a little pink" today, it may be burned tomorrow morning.  To prevent further burning, get your child out of the sun.

Tanning 

• Tanned skin is damaged skin.  Any change in the color of your child's skin after time outside, whether sunburn or suntan, indicates damage from UV rays.

Cool and cloudy? 

• Everyone still needs protection.  UV rays, not the temperature, do the damage. Clouds to not block UV rays, they filter them and, sometimes, only slightly.
• Kids often get sunburned when they are outdoors unprotected for longer than expected.  Remember to plan ahead and keep sun protection handy. 

Information obtained from the CDC

Exercise and Children - Making Kids Healthier

Running, riding a bike, playing a sport are all great ways to get the exercise needed to stay healthy and fit.  It's important for the whole family and should be are part of daily life.  Exercise not only promotes the building of strong bones and muscles, it's also a great way for social interaction with friends by building valuable relationships and providing opportunities for problem solving. In addition to being healthier in general, exercise helps to reduce the risk of obesity and the health problems that come with being overweight, conditions like diabetes, heart disease, and high blood pressure.  In addition, people who are physically fit feel better; have greater self-confidence, and more energy.

Exercise and children - How much exercise does your child need?  It is recommended that children get 60 minutes of moderate exercise every day.  Moderate activity means that your heart beats at a faster rate than normal and you breathe faster.  Although young children may only be active for 10-15 minutes at a time, the goal is still 60 minutes a day.

Some examples of moderate exercise include:

• running
• swimming
• bicycling
• dancing
• jumping rope
• skateboarding or skating
• team sports
• playing on equipment at a playground 

Because children are more likely to exercise when they are having fun, encourage activities that are enjoyable.  The focus should be on having fun rather than performance.  Examples of activities for children as young as two might be running, walking, galloping, and swimming with adult.  By three, they can start riding a bike with training wheels, climb low perches, and kick a ball.  And, by 4, kids can run, jump, skip, swim, ride a scooter, play tag or catch, and play on age-appropriate playground equipment.                                                                                

Because children learn from the adults around the, make exercise a family affair.  By being good role models, children are more likely to exercise when they see their parents engaged in regular physical activities.  

Massachusetts Public Health Fact Sheet

What are lice?

Lice (singular louse) are tiny, wingless insects that survive by feeding on human blood. They cannot jump or fly, and they do not burrow under the skin. Adult head lice or their eggs (nits) are found in the hair and are most often found behind the ears and at the base of the neck. Head lice usually lay their eggs on strands of hair about 4 mm or ¼ of an inch from the scalp. 

Who gets head lice?

Anyone can get head lice, but in the United States, head lice are most common in children 3-12 years of age.  Having lice is referred to as an “infestation.” An infestation with head lice does not mean someone is dirty. Head lice have special “claws” on their legs to help them cling to the hair. Washing with plain soap and water does little to disturb them. 

How are head lice spread?

Head lice are most commonly spread by direct head-to-head contact with hair of other people who have head lice. Head lice are less commonly spread through contact with an infested person’s personal items, such as hair brushes and combs, hats, unwashed clothing, bedding or towels. Head lice are commonly spread within households. Children often spread head lice to each other during close contact while playing. Head lice can crawl from an infested person or object to a non-infested person. People with head lice can continue to spread head lice to other people until they complete a course of treatment that kills all of the head lice and their eggs. Pets cannot spread head lice.

What are the symptoms of head lice?

A person who has head lice may feel itching caused by a reaction to the louse’s saliva and feces, but many children have no symptoms. Head lice are not known to spread infectious diseases from person to person and should not be thought of as a medical problem. However, there is some risk of skin infection from scratching. Head lice are certainly a nuisance, but they are not generally considered a health hazard. 

How are head lice diagnosed?

The best way to determine if someone is infested with head lice is to find a living adult louse. However, adult head lice are rarely seen because they are fast and hide well. Identification of a head lice infestation is usually made by detecting nits attached to the hair close to the scalp. Nits are tiny, grey, oval specks that do not come off of the hair easily like a speck of dandruff would. Behind the ears and near the hairline at the base of the neck are common places to find nits. Nits found within ¼ of an inch from the scalp usually mean the nits are alive and treatment is needed. If the nits are more than ¼ of an inch from the scalp, you should ask your doctor if treatment is necessary.

How do you prevent head lice?

Children should be checked regularly and treated when head lice are found. Parents should learn to recognize head lice and teach their children not to share hats and scarves or personal hair care items, such as brushes, combs and hair ties.

What is the treatment for head lice?

There are a number of effective treatments for head lice. Treatment for head lice usually consists of shampooing the hair with a medicated shampoo or cream rinse containing one of the following ingredients:

permethrin, pyrethrin, malathion, benzyl alcohol, spinosad, or ivermectin. Shampoos containing lindane are no longer recommended.

 Safety is a major concern and these products should be used with care, under the supervision of a health care provider (even though some of them do not need a prescription) and always according to the instructions on the label. This is especially important for women who are pregnant or nursing, and for infants with head lice. Be sure to follow the package or label instructions very carefully.  Permethrin and pyrethrin-based products have a good safety record but resistance has been documented in the United States. For treatment failures, malathion, benzyl alcohol lotion, or spinosad suspension can be used. Hair should be checked daily for the 10 days following treatment for newly hatched head lice. If these are present, an additional treatment may be necessary. Many of these agents require a reapplication of the treatment 7-10 days later to kill immature lice that may have hatched from eggs that were not inactivated during the initial treatment.

Data are lacking to determine whether suffocation of lice by application of products such as petroleum jelly, olive oil, butter, or fat-containing mayonnaise, are effective methods of treatment of head lice. Manual removal of nits after successful treatment is a difficult and time-consuming process. It is sometimes desired, though, for aesthetic reasons, to avoid diagnostic confusion, or to satisfy “no-nits” policies at some schools and daycare centers (see below).  

Additional precautions:

Household and other close contacts should be examined and treated if head lice are found. Remember, head lice do not survive for long periods of time off of the scalp. Even though head lice are not commonly spread by contact with personal belongings, the following steps can be taken as added precautions to avoid re-infestation by lice that have recently fallen off of the head of an infested person.

• Machine wash and dry clothing, bed linens, and other items that an infested person wore or used during the 2 days before treatment using the hot water (130°F) laundry cycle and the high heat drying cycle. Clothing and items that are not washable can be dry-cleaned OR sealed in a plastic bag and stored for 2 weeks.
• Soak combs and brushes in hot (128.3°F/53.5°C) water for 5 minutes.

• Thoroughly vacuum rugs, upholstered furniture, and mattresses.

• DO NOT USE INSECTICIDE SPRAYS.

What is a “no nits” policy?

Many school departments and child care sites require that children be free of nits before returning to school and  parents should be familiar with their own school’s or day care’s head lice policy. However, both the American Academy of Pediatrics and the National Association of School Nurses advocate that "no-nit" policies should be abandoned. Head lice are not a health hazard or a sign of poor hygiene and are not responsible for the spread of any disease. No healthy child should be excluded from or miss school because of head lice.

Where can I find more information?

• Your doctor, nurse, health clinic, or local board of health (listed in the phone book under “local government”)
• The Massachusetts Department of Public Health (MDPH) Division of Epidemiology and Immunization, (617) 983-6800
• The US Centers for Disease Control and Prevention: cdc.gov/parasites/lice/head/index.html

What are lice?

Lice (singular louse) are tiny, wingless insects that survive by feeding on human blood. They cannot jump or fly, and they do not burrow under the skin. Adult head lice or their eggs (nits) are found in the hair and are most often found behind the ears and at the base of the neck. Head lice usually lay their eggs on strands of hair about 4 mm or ¼ of an inch from the scalp. 

Who gets head lice?

Anyone can get head lice, but in the United States, head lice are most common in children 3-12 years of age.  Having lice is referred to as an “infestation.” An infestation with head lice does not mean someone is dirty. Head lice have special “claws” on their legs to help them cling to the hair. Washing with plain soap and water does little to disturb them. 

How are head lice spread?

Head lice are most commonly spread by direct head-to-head contact with hair of other people who have head lice. Head lice are less commonly spread through contact with an infested person’s personal items, such as hair brushes and combs, hats, unwashed clothing, bedding or towels. Head lice are commonly spread within households. Children often spread head lice to each other during close contact while playing. Head lice can crawl from an infested person or object to a non-infested person. People with head lice can continue to spread head lice to other people until they complete a course of treatment that kills all of the head lice and their eggs. Pets cannot spread head lice.

What are the symptoms of head lice?

A person who has head lice may feel itching caused by a reaction to the louse’s saliva and feces, but many children have no symptoms. Head lice are not known to spread infectious diseases from person to person and should not be thought of as a medical problem. However, there is some risk of skin infection from scratching. Head lice are certainly a nuisance, but they are not generally considered a health hazard. 

How are head lice diagnosed?

The best way to determine if someone is infested with head lice is to find a living adult louse. However, adult head lice are rarely seen because they are fast and hide well. Identification of a head lice infestation is usually made by detecting nits attached to the hair close to the scalp. Nits are tiny, grey, oval specks that do not come off of the hair easily like a speck of dandruff would. Behind the ears and near the hairline at the base of the neck are common places to find nits. Nits found within ¼ of an inch from the scalp usually mean the nits are alive and treatment is needed. If the nits are more than ¼ of an inch from the scalp, you should ask your doctor if treatment is necessary.

How do you prevent head lice?

Children should be checked regularly and treated when head lice are found. Parents should learn to recognize head lice and teach their children not to share hats and scarves or personal hair care items, such as brushes, combs and hair ties.

What is the treatment for head lice?

There are a number of effective treatments for head lice. Treatment for head lice usually consists of shampooing the hair with a medicated shampoo or cream rinse containing one of the following ingredients:

permethrin, pyrethrin, malathion, benzyl alcohol, spinosad, or ivermectin. Shampoos containing lindane are no longer recommended.

 Safety is a major concern and these products should be used with care, under the supervision of a health care provider (even though some of them do not need a prescription) and always according to the instructions on the label. This is especially important for women who are pregnant or nursing, and for infants with head lice. Be sure to follow the package or label instructions very carefully.  Permethrin and pyrethrin-based products have a good safety record but resistance has been documented in the United States. For treatment failures, malathion, benzyl alcohol lotion, or spinosad suspension can be used. Hair should be checked daily for the 10 days following treatment for newly hatched head lice. If these are present, an additional treatment may be necessary. Many of these agents require a reapplication of the treatment 7-10 days later to kill immature lice that may have hatched from eggs that were not inactivated during the initial treatment.

Data are lacking to determine whether suffocation of lice by application of products such as petroleum jelly, olive oil, butter, or fat-containing mayonnaise, are effective methods of treatment of head lice. Manual removal of nits after successful treatment is a difficult and time-consuming process. It is sometimes desired, though, for aesthetic reasons, to avoid diagnostic confusion, or to satisfy “no-nits” policies at some schools and daycare centers (see below).  

Additional precautions:

Household and other close contacts should be examined and treated if head lice are found. Remember, head lice do not survive for long periods of time off of the scalp. Even though head lice are not commonly spread by contact with personal belongings, the following steps can be taken as added precautions to avoid re-infestation by lice that have recently fallen off of the head of an infested person.

• Machine wash and dry clothing, bed linens, and other items that an infested person wore or used during the 2 days before treatment using the hot water (130°F) laundry cycle and the high heat drying cycle. Clothing and items that are not washable can be dry-cleaned OR sealed in a plastic bag and stored for 2 weeks.
• Soak combs and brushes in hot (128.3°F/53.5°C) water for 5 minutes.

• Thoroughly vacuum rugs, upholstered furniture, and mattresses.

• DO NOT USE INSECTICIDE SPRAYS.

What is a “no nits” policy?

Many school departments and child care sites require that children be free of nits before returning to school and  parents should be familiar with their own school’s or day care’s head lice policy. However, both the American Academy of Pediatrics and the National Association of School Nurses advocate that "no-nit" policies should be abandoned. Head lice are not a health hazard or a sign of poor hygiene and are not responsible for the spread of any disease. No healthy child should be excluded from or miss school because of head lice.

Where can I find more information?

• Your doctor, nurse, health clinic, or local board of health (listed in the phone book under “local government”)
• The Massachusetts Department of Public Health (MDPH) Division of Epidemiology and Immunization, (617) 983-6800
• The US Centers for Disease Control and Prevention: cdc.gov/parasites/lice/head/index.html

Kindergarten through Grade 5

• DTAP/DTP - 5 doses
• Polio (IVP/OVP) - 4 doses - the minimal age for the last dose is on or after the 4th birthday.  Some children may receive more than 4 doses if they received combination shots, but they are still required to have a booster shot of IVP on or after they turn 4.
• MMR - 2 doses
• Hepatitis B - 3 doses - the last dose must be given no earlier than 24 weeks of age - some children may receive 4 doses if combination shots were given.
• Varicella - 2 doses 
• Influenza vaccine yearly - This is highly recommended, not currently required. 

Preschool

• DTaP/DTP - 4 doses
• Polio (IVP/OVP) - 3 doses
• MMR - 1 dose
• Hepatitis B - 3 doses
• Varicella - 1 dose
• Hib - 3 or 4 doses
• Influenza vaccine yearly- This is highly recommended, not currently required. 

Additional immunizations recommended by the MDPH for pre-school children:

• 4 or more doses of Pneumococcal Conjugate vaccine (PCV)
• 2 doses of Hepatitis A vaccine
• 3 doses of rotavirus vaccine

Massachusetts Immunization regulations Regulations 

Physical Examination

A physical examination by a licensed physician is required for all children entering:

• Preschool
• Kindergarten
• 4th grade
• students new to the school system

Mass General Law 105 child's 200.000. Physical Examination of School Children

Lead Test

A lead test is required for all children in preschool and kindergarten.

Call the hospital laboratory for an appointment.  Bring the card to school for inclusion in your child's health record.

Lead Poisoning

Exposure to lead may cause serious health problems.  This is especially true for infants and small children because their young bodies more readily absorb and retain lead.  Each year in the U.S. over 300,000 1-to-5 year-olds are found to have unsafe levels of lead in their blood.  This can cause a wide range of symptoms including headaches, stomach pains, anemia, behavioral problems and developmental delay.

Lead poisoning occurs primarily from exposure to lead-based paint.  Although it has been banned in this country since 19778, some children are still exposed to lead-based paint in older homes, primarily from eating paint chips.  In addition, a number of countries continue to use lead-based pain in products they make and import into the U.S.  Examples include toys, jewelry, and sports and hobby items.  Other environmental areas that may be potential sites of lead exposure are contaminated soil, water that flows through old lead pipes or faucets, food stored in bowls glazed or painted with lead and some cosmetics.

Treatments for lead poisoning vary due to how much lead is in the blood.  Small amounts can be easily treated.  Children exposed to extremely high levels of lead will need medication to rid the body of lead.  The principal goal of any therapy is the reduction of lead exposure.  For more information, please, visit the site below. 

Information on Lead Poisoning from the Mayo Clinic

Immunization Waivers

Immunization waivers are accepted for medical or religious reasons only.  No other exemptions are allowed by the Massachusetts Department of Public Health.  As a public school, we are required to follow these regulations. 

To receive an immunization waiver:

• an appropriate letter documenting your child's medical or religious exemption is required.

• A medical exemption is granted for a child who has suffered an adverse reaction from a vaccine and must be accompanied by a letter from a physician.

• A religious exemption is granted to anyone whose religious beliefs preclude participation in the immunization program.  The waiver must be written and signed by the parent stating that immunizations are against your "sincere religious beliefs".

Philosophical exemptions are not accepted.

There is no exemption for the physical examination.

Scabies is a common skin condition caused by a microscopic burrowing mite.  The female mite digs a tunnel in the upper layers of the skin and lays one to three eggs daily.  When the eggs hatch the larva work their way to the surface of the skin and lie in shallow pockets where they mature into adult mites. Once mature, the female mite wanders about the skin seeking a new place in which to deposit her eggs. 

 Scabies it is not dangerous but, it is very annoying and anyone who has contact with the mite can become infested.  The rash is intensely itchy as a result of the body’s allergic reaction to the mites, the eggs and their waste.  The urge to scratch may be especially strong at night. 

 The rash appears as red bumps and short, wavy lines in the skin (where the mites have dug).  It is especially common to find the rash in the folds of the skin.  Examples include:  finger-webs (the area between fingers), the wrists and elbows, the underarms, and at belt or panty lines. 

 The scabies mite is spread by direct skin-to-skin contact or less commonly by skin contact with clothes, bedding, etc. that the mites have crawled onto.  The mites cannot jump or fly, but they can crawl.  Mites can live for three days off the body. 

Treatment:

1. If you think your child may have scabies, call your physician.  Scabies is diagnosed by the typical appearance of the rash and accompanying symptoms.  Your physician will prescribe a mite-killing cream or lotion which is applied once to the skin and then washed off after a specified period of time.  Over-the-counter lotions are not effective.
2. It is also recommended that all clothes, hats, sheets, pillow cases, blankets, towels, etc. that your child has used be washed in hot water and dried on the hottest setting in the dryer.
3. Difficult-to-wash- items (such as stuffed toys and pillows) can be stored in tightly closed plastic bags for four days and then used again.  Remember, the mites can only live off the body for three days.
4. Thoroughly vacuum any carpet or upholstered furniture.

 Please call the nurse’s office if your child contracts scabies so that we can inform his or her teacher.  Your child may return to school once he/she has received treatment.

Ringworm is a mild fungal infection of the skin and is easily treated. Typically, ringworm appears as a flat, growing, ring-shaped rash. The edges of the circle are usually reddish and may be raised, scaly, and itchy; the center of the circle is often clear. Another type of ringworm fungus causes skin color to become lighter in flat patches, especially on the trunk and face. On the scalp, ringworm infection typically begins as a small bump and spreads outward, leaving scaly patches of temporary hair loss.

Treatment: An antifungal ointment is typically applied to the skin for several weeks. Occasionally, oral antifungal medicine is prescribed, particularly if the diagnosis is ringworm of the scalp.

School attendance guidelines: Students with ringworm will be dismissed from school, but may return as soon as treatment has begun. Affected areas of the body should be loosely covered with gauze, bandage, or clothing to prevent shedding of infected scales.

Ringworm is spread when infected skin comes in direct contact with healthy skin or infected skin flakes fall and are touched by other people. A person with ringworm is infectious as long as the fungus is present in the infected area.

Pinworms, small worms that infect the intestine, are the most common intestinal worm in the U.S.  They are most frequently seen in school-age children between 5 and 10 years old.  Pinworms spread easily from person to person by direct contact or from coming in contact with contaminated food or drink.  Pinworms enter the body through the mouth usually by touching something contaminated with pinworm eggs and then touching the mouth.  The eggs are swallowed and passed through the digestive system.  In the small intestine, they hatch and grow into baby worms.  They then move into the large intestine where they mature into adults.   After a few weeks, the female worms move toward the anal area where they come out at night and deposit eggs in the folds of skin around the anus.  The eggs irritate the skin and may cause intense itching, especially at night, which can interrupt sleep.  By scratching the area, the eggs are transferred to the skin under the fingernails and then transferred to others directly or by contaminating common items.  The whole process from ingestion of the eggs till the mature worms deposit eggs takes between 1 to 2 months.   

Symptoms of pinworm infection:

• Itching of the anal or vaginal area
• Difficulty sleeping due to intense itching
• Irritated or infected skin around the anus from scratching
• Observation of adult worms in the toilet after going to the bathroom
• Observation of worms on underwear or pajamas
• Intermittent abdominal pain and nausea
• Some people have no symptoms

Pinworms can be detected in the anal area, especially at night when the worms lay their eggs.  If you suspect your child has pinworms, you can do a tape test as the eggs can be collected with cellophane tape.  In the morning, before bathing or using the toilet, place a piece of clear cellophane tape against the skin around the anus and remove it.  Take the tape to your physician.  By using a microscope, the doctor can detect the pinworm eggs and recommend treatment.

Treatment:

• Pinworm infection is easily treated with an anti-parasite medication.
• The medication will kill the worms, but it won’t kill the eggs.
• A second treatment is often recommended after 2 weeks – this will kill any newly hatched worms.
• The whole family should be treated since pinworms are easily passed to other family members.

To control the eggs:

• Shower in the morning to remove any eggs that are laid overnight. Showering is preferable to bathing as bath water may become contaminated with eggs.
• Avoid scratching the anal area
• Keep fingernails short and clean – makes it more difficult for eggs to collect under the fingernails
• Wash hands with warm soapy water before meals and after using the toilet
• To help kill pinworm eggs, wash all bed linens and pajamas twice a week in hot water.
• Clean toilet seats every day

Prevention:

• Wash hands with warm soapy water often, but especially after using the bathroom, before preparing food, and before eating.
• Wash bed linens and underwear frequently.

Description and Habits

Adults, nymphs, eggs, shed skins, and fecal spots on a mattress.

Dark spots on mattress and box spring are a telltale sign of bed bugs

Bites and Health Concerns

How Infestations Originate

Controlling Infestations

Where They Hide

Preparing for Treatment

Discarding or Encasement

Vacuuming, Steaming, Freezing

Heat Treatments

Insecticides

Preventing Infestations

Business and Leisure Travelers

Checking beds for bed bugs was a common practice long ago, especially while traveling. Travelers today should consider doing the same, preferably before unpacking. This would entail examining the bed sheets and seams of the mattress and perhaps box spring for signs of bed bugs, especially along the head (pillow end) of the bed. Experts also remove and check behind headboards since this is a frequent hiding place for bed bugs in hotels. Headboards are heavy and cumbersome, however, and untrained persons should not attempt removal themselves.

To help guard against bed bugs while traveling, take a moment to inspect beds. A small flashlight is useful for dimly-lit areas.

Social Service and Emergency Workers

Schools and Daycares

Those Who Cannot Afford a Professional

In case of fire - Call 911

• Have a family escape plan and meeting place

If you suspect a fire:

• get everyone out of the house, then get help. 
• Call 911 from a mobile phone or a neighbor's house.
• Do not open a door unless you put your hand on it to see if it is hot.
• If the door is hot, find another way out

If your clothes catch on fire:

STOP, DROP, AND ROLL - DO NOT RUN

• Drop to the ground
• Cover your face
• Roll over slowly to put out the flames
• If possible, roll up in a rug, coat, or blanket

Test smoke alarms twice a year and change batteries once a year.

Fire safety tips for kids: Interactive web-sites

http://www.kfst.net/ - Kids Fire Safety tips

Halloween Safety Tips

Here are a few tips you can follow for a safe and happy Halloween:

• Always keep the lights on, both inside and outside your house, to welcome and protect trick-or-treaters.
• Keep candles and jack-o-lanterns away from landings and doorsteps where costumes can brush up against the flame and catch fire. Also, keep candles and jack-o-lanterns away from curtains, decorations, and other items that can catch fire.
• Make sure that each part of your child’s costume is flame resistant. Look for the label “flame resistant” or “flame retardant”.
• If your child wears a mask, make sure that it fits properly and that the holes are large enough for their mouth and eyes, so that they can breathe and see properly.
• Costumes and trick-or-treat bags should be light-colored and/or decorated with reflective tape that will glow in light which will make your child visible to drivers. Reflective tape can be found in hardware, bicycle, and sporting goods stores.
• Costumes should fit well and not drag on the floor, to avoid trips and falls.
• Children should wear temperature appropriate clothing underneath their costume.
• Swords, knives, and other pointed objects should be made of soft material.
• Always have an adult accompany children while trick-or-treating.
• Remind your children not to go into strangers’ cars or houses.
• Teach your children how to use crosswalks and walk signals. Teach your child to look left, right, and left again before crossing the street.
• Children should carry flashlights, to make sure that they can see and that people can see them.
• Do not let your child eat any treats until you have checked each one of them.
• Give and accept only wrapped or packaged candy. Throw away all unwrapped or suspicious looking candy.

For more information on how to keep your children safe this Halloween, please contact the Massachusetts Department of Public Health’s Injury Prevention and Control Program at (617) 624-5070. 

Winter Safety Tips     

Whether winter brings severe storms, light dustings of snow, or just cold temperatures, the American Academy of Pediatrics (AAP) has some valuable tips on how to keep your children safe and warm.

What to Wear:

The rule of thumb for older babies and young children is to dress them in one more layer of clothing than an adult would wear in the same conditions.

Frostbite:

Frostbite happens when the skin and outer tissues become frozen.  This condition tends to happen on extremities like the fingers, toes, ears, and nose.  They may become pale, gray, and blistered.  At the same time, the child may complain that his/her skin burns or has become numb.

If frostbite occurs, bring the child indoors and place the frostbitten parts of his/her body in warm (not hot) water.  104 degrees Fahrenheit is recommended.  Warm washcloths may be applied to frostbitten nose, ears, and lips.  Do not rub the frozen areas.

After a few minutes, dry and cover him/her with clothing or blankets.  Give him/her something warm to drink.

If the numbness continues for more than a few minutes, call your doctor.

Winter Health

If your child suffers from winter nosebleeds, try using a cold air humidifier in the child's room at night.  Saline nose drops may help keep tissues moist.

Cold weather does not cause colds or flu.  But, the viruses that cause colds and flu tend to be more common in the winter, when children are in school and are in closer contact with each other.  Frequent hand washing and teaching your child to sneeze or cough into the bend of his/her elbow may help reduce the spread of cold and flu germs.

Children should get the influenza vaccine to reduce their risk of catching the flu.

Hypothermia

Hypothermia develops when a child's temperature falls below normal due to exposure to cold.  It often happens when a youngster is playing outdoors in extremely cold weather without wearing proper clothing.

As hypothermia sets in, the child may shiver and become lethargic and clumsy.  His/her speech may become slurred and his/her body temperature will decline.

If you suspect your child is hypothermic, call 911 at once.  Until help arrives, take the child indoors, remove any wet clothing, and wrap him/her in blankets or warm clothes.

ADHD - Information from National Institute of Mental Health/NIH

CDC - Centers for Disease Control and Prevention

NIH - National Institute of Health

MDPH - Massachusetts Department of PUblic Health

Flu Facts - information about seasonal influenza from the CDC 

MedlinePlus - Information from the National Library of Medicine

NIMH - National Institute of Mental Health

AACAP - American Academy of Child and Adolescent Phychiatry

Mayo Clinic - various health topics

Vaccination Statements by Language (all vaccines)

Autism Spectrum Disorders - Information from the National Institute of Health

Autism Spectrum Disorders - information from the CDC

Americans with Disabilities Act

Preventing Bullying and Cyberbullying - a guide for students, educators, and administrators

Hits to the Head - Concussion Awareness

Lyme Disease - information from the CDC

Asthma and Allergy Foundation of America

Asthma and Allergy Foundation of America - New England Chapter

Harvard School of Public Health - information on nutrition

Healthy Weight - information from the CDC on body weight and BMI

Health Finder - a guide to healthy living

Riverside Trauma Center - resources in the aftermath of a traumatic event

Zoonoses - Animal Diseases and Your Health

Healthy Pets and People

Guidelines for Dealing with Bed Bugs in the School Setting

http://arealonlinedegree.com/college-resources/cyberbullying-awareness-avoidance/ - guide to cyberbullying