Croup

Definition

Croup, which is marked by a harsh, repetitive cough similar to the noise of a seal barking, can be scary for both children and their parents. After all, attacks of croup may jar your children awake at night and leave them gasping for breath.

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

Croup usually isn't serious. In fact, for most cases, croup can be treated at home. Sometimes, your child will need prescription medication.

Symptoms

The classic sign of croup is a loud, harsh, barking cough — which often comes in bursts at night. Your child's breathing may be labored or noisy. Fever and a hoarse voice are common, too.

When to see a doctor
Most cases of croup can be treated at home with a few simple self-care measures. However, you should seek immediate medical attention if your child:

• Makes noisy, high-pitched breathing sounds when inhaling (stridor)
• Begins drooling or has difficulty swallowing
• Seems agitated or extremely irritable
• Struggles to breathe
• Develops blue or grayish skin around the nose, mouth or fingernails
• Has a fever of 103.5 F (39.7 C) or higher

Causes

Croup is often caused by the parainfluenza virus. Less often, respiratory syncytial virus or various other respiratory viruses cause croup.

Your child may contract a virus by breathing infected respiratory droplets coughed or sneezed into the air. Virus particles in these droplets may also survive on toys and other surfaces. If your child touches a contaminated surface and then touches his or her eyes, nose or mouth, an infection may follow.

Rarely, croup may be caused by a bacterial infection.

Risk factors

Croup is most common in children age 5 and younger — particularly those who were born prematurely. Because of their smaller airways, signs and symptoms are typically most severe in children age 3 and younger.

Treatments and drugs

In most cases, self-care measures at home — such as breathing moist air and drinking fluids — can speed your child's recovery. More aggressive treatment is rarely needed.

If your child's symptoms persist or worsen, his or her doctor may prescribe corticosteroids, epinephrine or another medication to open the airways. Antibiotics are effective only if your child has a bacterial infection.

For severe croup, your child may need to spend time in a hospital receiving humidified oxygen. Rarely, a temporary breathing tube may need to be placed in a child's windpipe.

Croup can be scary — especially if it lands your child in the doctor's office, hospital or emergency room. Hold your child, sing lullabies or read quiet stories. Offer a favorite blanket or toy. Speak in a soothing voice. Your presence can help keep your child calm.

http://www.mayoclinic.com/

Fever treatment: Quick guide to treating a fever

A fever is a common sign of illness, but that's not necessarily a bad thing. In fact, fevers seem to play a key role in fighting infections. So should you treat a fever or let the fever run its course? Here's help making the call.

Age	Temperature	What to do
Infants
Birth to 3 months	100.4 F (38 C) or higher taken rectally	Call the doctor, even if your child doesn't have any other signs or symptoms.
3 months to 24 months	Up to 102 F (38.9 C) taken orally	Encourage your child to rest and drink plenty of fluids. Medication isn't needed. Call the doctor if your child seems unusually irritable, lethargic or uncomfortable.
3 months to 24 months	102 F (38.9 C) or higher taken orally	Give your child acetaminophen (Tylenol, others). If your child is age 6 months or older, ibuprofen (Advil, Motrin, others) is OK, too. Read the label carefully for proper dosage. Don't give aspirin to anyone age 18 or younger. Call the doctor if the fever doesn't respond to the medication or lasts longer than one day.
Children
2 years to 18 years	Up to 102 F (38.9 C) taken orally	Encourage your child to rest and drink plenty of fluids. Medication isn't needed. Call the doctor if your child seems unusually irritable or lethargic or complains of significant discomfort.
2 years to 18 years	102 F (38.9 C) or higher taken orally	Give your child acetaminophen or ibuprofen. Read the label carefully for proper dosage. Don't give aspirin to anyone age 18 or younger. Call the doctor if the fever doesn't respond to the medication or lasts longer than three days.
Adults
18 years and older	Up to 102 F (38.9 C) taken orally	Rest and drink plenty of fluids. Medication isn't needed. Call the doctor if the fever is accompanied by a severe headache, stiff neck or other unusual signs or symptoms.
18 years and older	102 F (38.9 C) or higher taken orally	If you're uncomfortable, take acetaminophen, ibuprofen or aspirin. Read the label carefully for proper dosage. Call the doctor if the fever doesn't respond to the medication, is consistently 103 F (39.4 C) or higher, or lasts longer than three days.

http://www.mayoclinic.com/

Childhood obesity

Definition

Do you know when to be concerned about your child's weight? Of course, all children gain weight as they grow older. But extra pounds — more than what's needed to support their growth and development — can lead to childhood obesity.

Childhood obesity is a serious medical condition that affects children and adolescents. It occurs when a child is well above the normal weight for his or her age and height. Childhood obesity is particularly troubling because the extra pounds often start kids on the path to health problems that were once confined to adults, such as diabetes, high blood pressure and high cholesterol.

One of the best strategies to combat excess weight in your child is to improve the diet and exercise levels of your entire family. This helps protect the health of your child now and in the future.

Causes

Although there are some genetic and hormonal causes of childhood obesity, most excess weight is caused by kids eating too much and exercising too little. Children, unlike adults, need extra nutrients and calories to fuel their growth and development. So if they consume the calories needed for daily activities, growth and metabolism, they add pounds in proportion to their growth. But children who eat more calories than needed gain weight beyond what's required to support their growing bodies.

Far less common than lifestyle issues are genetic diseases and hormonal disorders that can predispose a child to obesity. These diseases, such as Prader-Willi syndrome and Cushing's syndrome, affect a very small proportion of children. In the general population, eating and exercise habits play a much larger role.

Risk factors

Many factors — usually working in combination — increase your child's risk of becoming overweight:

• Diet. Regular consumption of high-calorie foods, such as fast foods, baked goods and vending machine snacks, contribute to weight gain. High-fat foods are dense in calories. Loading up on soft drinks, candy and desserts also can cause weight gain. Foods and beverages like these are high in sugar and calories.
• Inactivity. Sedentary kids are more likely to gain weight because they don't burn calories through physical activity. Inactive leisure activities, such as watching television or playing video games, contribute to the problem.
• Genetics. If your child comes from a family of overweight people, he or she may be genetically predisposed to put on excess weight, especially in an environment where high-calorie food is always available and physical activity isn't encouraged.
• Psychological factors. Some children overeat to cope with problems or to deal with emotions, such as stress or boredom. Their parents may have similar tendencies.
• Family factors. Most children don't shop for the family's groceries. Indeed, parents are responsible for putting healthy foods in the kitchen at home and leaving unhealthy foods in the store. You can't blame your kids for being attracted to sweet, salty and fatty foods; after all they taste good. But you can control much of their access to these foods, especially at home.
• Socioeconomic factors. Children from low-income backgrounds are at greater risk of becoming obese. Poverty and obesity often go hand in hand because low-income parents may lack the time and resources to make healthy eating and exercise a family priority.

Treatments and drugs

Treatment for childhood obesity is based on your child's age and if he or she has other medical conditions. Treatment usually includes changes in your child's diet and level of physical activity. In certain circumstances, treatment may include medications or weight-loss surgery.

For children under age 7 who have no other health concerns, the goal of treatment may be weight maintenance rather than weight loss. This strategy allows the child to add inches but not pounds, causing BMI-for-age to drop over time into a healthier range. However, for an obese child, maintaining weight while waiting to grow taller may be as difficult as losing weight for older people.

Weight loss is typically recommended for children over age 7 or for younger children who have related health concerns. Weight loss should be slow and steady — anywhere from 1 pound (0.45 kilograms) a week to 1 pound a month, depending on your child's situation.

The methods for maintaining weight or losing weight are the same: Your child needs to eat a healthy diet and increase his or her physical activity. Success depends largely on your commitment to helping your child make these changes. Think of eating habits and exercise habits as two sides of the same coin: When you consider one, you also need to consider the other.

Healthy eating
Parents are the ones who buy the food, cook the food and decide where the food is eaten. Even small changes can make a big difference in your child's health.

• When buying groceries, choose fruits and vegetables over convenience foods high in sugar and fat. Always have healthy snacks available. And never use food as a reward or punishment.
• Limit sweetened beverages, including those containing fruit juice. These drinks provide little nutritional value in exchange for their high calories. They also can make your child feel too full to eat healthier foods.
• Sit down together for family meals. Make it an event — a time to share news and tell stories. Discourage eating in front of a screen, such as a television, computer or video game. This leads to fast eating and lowered awareness of how much you're eating.
• Limit the number of times you eat out, especially at fast-food restaurants. Many of the menu options are high in fat and calories.

Physical activity
A critical component of weight loss, especially for children, is physical activity. It not only burns calories but also builds strong bones and muscles and helps children sleep well at night and stay alert during the day. Such habits established in childhood help adolescents maintain healthy weight despite the hormonal changes, rapid growth and social influences that often lead to overeating. And active children are more likely to become fit adults.

To increase your child's activity level:

• Limit recreational screen time to fewer than two hours a day. A surefire way to increase your child's activity levels is to limit the number of hours he or she is allowed to watch television each day. Other sedentary activities — playing video and computer games or talking on the phone — also should be limited.
• Emphasize activity, not exercise. Your child's activity doesn't have to be a structured exercise program — the object is just to get him or her moving. Free-play activities, such as playing hide-and-seek, tag or jump-rope, can be great for burning calories and improving fitness.
• Find activities your child likes to do. For instance, if your child is artistically inclined, go on a nature hike to collect leaves and rocks that your child can use to make a collage. If your child likes to climb, head for the nearest neighborhood jungle gym or climbing wall. If your child likes to read, then walk or bike to the neighborhood library for a book.
• If you want an active child, be active yourself. Find fun activities that the whole family can do together. Never make exercise seem a punishment or a chore.
• Vary the activities. Let each child take a turn choosing the activity of the day or week. Batting practice, bowling and swimming all count. What matters is that you're doing something active.

Medications
Two prescription weight-loss drugs are available for adolescents: sibutramine (Meridia) and orlistat (Xenical). Sibutramine, which is approved for adolescents older than 16, alters the brain's chemistry to make the body feel fuller more quickly. Orlistat, which is approved for adolescents older than 12, prevents the absorption of fat in the intestines.

The Food and Drug Administration has approved a reduced-strength over-the-counter (nonprescription) version of orlistat (Alli). Though readily available in pharmacies and drugstores, Alli is not approved for children or teenagers under age 18.

Prescription medication isn't often advisable for adolescents. The risks of taking the medications long term are still unknown, and their effect on weight loss and weight maintenance for adolescents is still questioned. And, once again, weight-loss drugs don't replace the need to adopt a healthy diet and exercise regimen.

Weight-loss surgery
Weight-loss surgery can be a safe and effective option for some severely obese adolescents who have been unable to lose weight using conventional weight-loss methods. However, as with any type of surgery, there are potential risks and long-term complications. Also, the long-term effects of weight-loss surgery on a child's future growth and development are largely unknown.

Weight-loss surgery in adolescents is still uncommon. But your doctor may recommend this surgery if your child's weight poses a greater health threat than do the potential risks of surgery. It is important that a child being considered for weight-loss surgery meet with a team of pediatric specialists, including a pediatric endocrinologist.

Even so, surgery isn't the easy answer for weight loss. It doesn't guarantee that your child loses all of his or her excess weight or that your child keeps it off long term. It also doesn't replace the need for following a healthy diet and regular physical activity program.

http://www.mayoclinic.com/

Baby's head shape: What's normal?

A baby's head is easily molded, and not necessarily symmetrical. Here's how to prevent flat spots — and detect more serious problems.

Many newborns have slightly lopsided heads. Sometimes a baby's head is molded unevenly while passing through the birth canal. In other cases, head shape changes after birth as a result of spending too much time in one position. Although your baby's head shape will probably even out on its own, you can help prevent flat spots — and detect more serious problems.

How position affects head shape

You'll notice two soft areas at the top of your baby's head where the skull bones haven't yet grown together. These spots, called fontanels, are designed to allow a baby's relatively large head to move through the narrow birth canal. They also accommodate your baby's rapidly growing brain during infancy. But because your baby's skull is malleable, too much time in one position can result in an uneven head shape well past the time when birth-related lopsidedness evens out. This is known as positional molding.

Positional molding is often most noticeable when you're looking at your baby's head from the top down. From that angle, the back of your baby's head may look flatter on one side than on the other. The cheekbone on the flat side may protrude, and the ear on the flat side may look pushed forward.

What you can do about it

Positional molding is most common in babies who spend most of their time on their backs in cribs, car seats or infant seats. Although this is the safest position for sleep, there's plenty you can to do to keep your baby's head from becoming flat or lopsided.

• Change direction. Place your baby on his or her back to sleep, but alternate the direction your baby's head faces. Or place your baby's head near the foot of the crib one day, the head of the crib the next. Use varying positions in the car seat and other infant seats, too. You might also consider using a neck-positioning device — such as a specially designed wedge or U-shaped pad — while your baby sleeps. Never rest your baby's head on a pillow or other type of soft bedding.
• Hold your baby. Holding your baby when he or she is awake will help relieve pressure on your baby's head from swings, carriers and infant seats.
• Try tummy time. With close supervision, place your baby on his or her tummy to play. Make sure the surface is firm. If you must leave the room, bring your baby with you.
• Get creative. Position your baby so that he or she will have to turn away from the flattened side of the head to look at you or to track movement or sound in the room. Move the crib occasionally to give your baby a new vantage point.

Helmets and head shape

Varying a baby's head position is typically enough to prevent or treat flat spots. If the lopsidedness doesn't improve within a few months, your baby's doctor might prescribe a special headband or molded helmet to help shape your baby's head. These devices work by applying gentle but constant pressure in an effort to redirect skull growth.

Headbands and helmets are most effective when treatment begins by ages 3 to 6 months, when the skull is still malleable and the brain is growing rapidly. The headband or helmet is worn continuously during the treatment period — often up to 12 weeks — with time off only to clean the device and the skin underneath. Adjustments to the headband or helmet may be needed every one to two weeks. Correction may be possible for older babies, too, but the headband or helmet may need to be worn more than 12 weeks.

More serious causes

Rarely, two or more of the bony plates in a baby's head fuse prematurely. This rigidity pushes other parts of the head out of shape as the brain expands. This condition, known as craniosynostosis, is typically treated during infancy. To give the brain enough space to grow and develop, the fused bones must be surgically separated.

Keep it in perspective

If you spend too much time worrying about your baby's head shape, you may miss some of the fun of being a new parent. In a few short months, better head and neck control will help your baby keep pressure more evenly distributed on the skull. Until then, change your baby's position often — and check with your baby's doctor if you're concerned about your baby's head shape.

Choosing a thermometer

Types of thermometers

Years ago, a glass mercury thermometer was a staple in most medicine cabinets. Today, mercury thermometers are scarce because of the health and environmental concerns surrounding mercury. So what's the best option for your family? A digital thermometer? An ear thermometer? Or maybe another type of thermometer? Here's a quick guide to the latest temperature-taking gadgets.

Digital thermometer

Digital thermometers, which are powered by small batteries, use electronic heat sensors to record body temperature. Most digital thermometers can record temperatures from the mouth (oral), armpit (axillary) or rectum (rectal) — often in 30 seconds or less. The result appears in a window on the upper side of the thermometer. Digital thermometers are inexpensive and appropriate for infants, children and adults.

Note: For infants younger than age 3 months, rectal temperatures are the most accurate. For older children and adults, oral readings are usually accurate — as long as the mouth is closed while the thermometer is in place. Armpit readings tend to be less accurate than rectal and oral readings.

Digital pacifier thermometer

If your child uses a pacifier, you may want to try a digital pacifier thermometer. Your child simply sucks on the pacifier until the peak temperature is recorded. The temperature appears in a window on the front of the thermometer. There are a few caveats, however. Pacifier thermometers aren't recommended for infants younger than age 3 months. And for the most accurate reading, your child must hold the pacifier still in his or her mouth for about three minutes — which is difficult for many young children.

Digital ear thermometer

Digital ear thermometers, also called tympanic thermometers, use an infrared ray to measure the temperature inside the ear canal. When positioned properly, ear thermometers are quick and accurate — often measuring body temperature in just a few seconds. The result appears in a window on the upper side of the thermometer. Digital ear thermometers are powered by small batteries. They're appropriate for infants older than age 3 months, children and adults. Digital ear thermometers aren't recommended for newborns because their ear canals are usually too small. Digital ear thermometers are usually more expensive than other types of digital thermometers.

Temperature strip

Temperature strips contain liquid crystals that react to heat. Simply apply the strip to your forehead or your child's forehead. The strip will register body temperature by changing color. Temperature strips are appropriate for infants, children and adults. The strips aren't precise, however. If you need an exact temperature reading, use a digital thermometer instead.

http://www.mayoclinic.com/

Breast-feeding positions

Breast-feeding: Cross-cradle hold

Breast-feeding can be awkward at first. Experiment with various positions until you feel comfortable.

The cross-cradle hold is ideal for early breast-feeding. Sit up straight in a comfortable chair with armrests. Hold your baby crosswise in the crook of the arm opposite the breast you're feeding from — left arm for right breast, right arm for left. Support the baby's trunk and head with your forearm and palm. Place your other hand beneath your breast in a U-shaped hold to guide the baby's mouth to your breast. Don't bend over or lean forward. Instead, cradle your baby close to your breast.

Breast-feeding: Cradle hold

The cradle hold is similar to the cross-cradle hold, but you support the baby with the arm on the same side as the nursing breast, rather than the opposite arm. As with the cross-cradle hold, sit up straight — preferably in a chair with armrests. Cradle your baby and rest his or her head in the crook of your elbow while he or she faces your breast. For extra support, place a pillow on your lap

Breast-feeding: Football hold

Another option is the football hold. This position may be a good choice if you're recovering from a C-section, you have large breasts or you're nursing two babies at once.

Hold your baby at your side, with your elbow bent. With your open hand, support your baby's head and face him or her toward your breast. Your baby's back will rest on your forearm. It may help to support your breast in a C-shaped hold with your other hand. For comfort, put a pillow on your lap and use a chair with broad, low arms.

Breast-feeding: Side-lying hold

A lying position may help your baby latch onto your breast correctly in the early days of breast-feeding, especially after a C-section. It's also a good choice when you're tired.

Lie on your side and face your baby toward your breast, supporting him or her with the hand of the arm you're resting on. With your other arm and hand, grasp your breast and then touch your nipple to your baby's lips. Once your baby latches on, use the bottom arm to support your own head and your top hand and arm to help support the baby.

http://www.mayoclinic.com/

Children and sports: Choices for all ages

Children's sports promote fitness and prevent obesity, but not all children thrive in formal leagues. Help your child find the right sport and venue — school, recreation center or backyard.

Want to give your child a head start on lifelong fitness? Consider children's sports and other kid-friendly physical activities.

With your encouragement and support, chances are a few sports will spark your child's interest. Fan the flame by taking your child to local sporting events and sharing your own sports interests with your child. Then, when the time is right, provide opportunities for your child to try out equipment and experiment with various sports.

What are age-appropriate activities?

Your child is likely to show natural preferences for certain sports or activities. Start there, being careful to keep your child's maturity and skill level in mind.

Ages 2 to 5
Toddlers and preschoolers are beginning to master many basic movements, but they're too young for most types of organized sports. At this age, unstructured free play is usually best. Try:

• Running
• Climbing
• Kicking
• Tumbling
• Dancing
• Playing catch with a lightweight ball
• Pedaling a tricycle or a bike with training wheels
• Supervised water play

Ages 6 to 7
As children get older, their coordination and attention spans improve. They're also better able to follow directions and understand the concept of teamwork. Consider organized activities such as:

• T-ball, softball or baseball
• Soccer
• Gymnastics
• Swimming
• Tennis
• Golf
• Track and field
• Martial arts

Ages 8 and older
By age 8, nearly any sport — including contact sports — may be acceptable. Carefully supervised strength training is OK at this age, too.

Of course, organized athletics aren't the only option for fitness. If your child doesn't seem interested in sports, find other physical activities. Take family bike rides, check out local hiking trails or visit indoor climbing walls. Encourage active time with friends, such as jumping rope, shooting baskets or playing tag. You can even encourage fitness through video games that prompt dancing, virtual sports or other types of movement.

MORE ON THIS TOPIC

• Strength training: OK for kids when done correctly

Practical matters

If several sports are available in your community, allow your child to sample a range of activities before settling on one or two — perhaps both team sports and individual sports. When you're comparing sports, consider the:

• Amount and cost of equipment
• Amount of physical contact
• Emphasis on individual skill vs. team performance
• Opportunity for each child to participate

Also consider your child's schedule. Children who are already signed up for music lessons or other activities may feel overwhelmed if athletics are added to the mix.

Above all, make sure your child really wants to play. Organized athletics have many benefits, but a healthy lifestyle doesn't have to include sports. What's most important is helping your child realize that physical activity is fun.

Assessing youth sports

As your child tries various sports, stay involved. Consider:

• Team assignments. Are the children grouped according to physical maturity and skill level?
• Coaching quality. Look for an emphasis on safety and participation. Does the coach require that players follow the rules and use proper safety equipment? Does everyone have a chance to play? Do they take time to warm up and cool down before and after each practice or event? Are children taught proper movement and body positioning?
• Coaching style. Also consider a coach's attitude toward the game. If a coach consistently yells at the children or lets only the most skilled players into the game, your child may become discouraged. Beware of a win-at-all-costs attitude.

Overall, be positive and encouraging. Emphasize effort and improvement over winning or personal performance. Attend events and practices as your schedule allows, and act as a good model of sportsmanship yourself. Whether your child swims, runs track or plays catch in the backyard, keep your eye on the long-term goal — a lifetime of physical activity.

http://www.mayoclinic.com/

Breast-feeding: What every mom needs to know

Breast-feeding is a learned art — but it's worth the effort. Consider these tips to get off to a good start.

You know the benefits of breast-feeding. Breast milk contains the right balance of nutrients for your baby. It's easier to digest than is commercial formula, and the antibodies in breast milk will boost your baby's immune system. Breast-feeding may even help you lose weight after the baby is born.

But breast-feeding isn't always easy. You may need more practice — and patience — than you might have imagined. Here's help getting off to a good start.

Ask for help — right away

Reading about breast-feeding is one thing. Doing it on your own is something else. The first few times you breast-feed your baby — starting as soon after delivery as possible — ask for help. The maternity nurses or the hospital's lactation consultant can help you position the baby and make sure he or she is latching on correctly. Your doctor, your baby's doctor or your childbirth educator may be able to help, too. Learning correct technique from the very beginning can help you avoid trouble later on.

Feed your baby often

For the first few weeks, most newborns breast-feed every two to three hours around-the-clock. It's intense. But frequent breast-feeding sessions help stimulate your breasts to produce milk. And the sooner you begin each feeding, the less likely you'll need to soothe a frantic baby. Watch for early signs of hunger, such as stirring and stretching, sucking motions and lip movements. Fussing and crying are later cues.

Get comfortable

Don't bend over or lean forward to bring your breast to your baby. Instead, cradle your baby close to your breast. Sit in a chair that offers good arm and back support. Support yourself with pillows if needed. Or lie on your side with your baby on his or her side, facing you.

When you're settled, tickle your baby's lower lip with your nipple. Make sure your baby's mouth is open wide and he or she takes in part of the darker area around the nipple (areola). Your nipple should be far back in the baby's mouth, and the baby's tongue should be cupped under your breast. Listen for a rhythmic sucking and swallowing pattern.

If you need to remove the baby from your breast, first release the suction by inserting your finger into the corner of your baby's mouth.

Let your baby set the pace

Let your baby nurse from the first breast thoroughly, until the breast feels soft — often about 15 minutes. Then try burping the baby. After that, offer the second breast. If your baby's still hungry, he or she will latch on. If not, simply start the next breast-feeding session with the second breast. If your baby consistently nurses on only one breast at a feeding during the first few weeks, pump the other breast to relieve pressure and protect your milk supply.

If your baby pauses during breast-feeding sessions to gaze at you or look around the room, enjoy the moment. Consider it an opportunity to slow down and bond with your baby.

Hold off on a pacifier — at first

Some babies are happiest when they're sucking on something. Enter pacifiers — but there's a caveat. Giving your baby a pacifier too soon may interfere with breast-feeding. The American Academy of Pediatrics recommends waiting to introduce a pacifier until a baby is 1 month old and breast-feeding is well established.

Gauge your success

When your baby is latched on successfully, you'll feel a gentle pulling sensation on your breast — rather than a pinching or biting sensation on your nipple. Your breasts may feel firm or full before the feeding, and softer or emptier afterward. Look for your baby to gain weight steadily, produce six to eight wet diapers a day and be content between feedings. Your baby's stools will become yellow, seedy and loose.

Take care of your nipples

After each feeding, it's OK to let the milk dry naturally on your nipple. If you're in a hurry, gently pat your nipple dry. To keep your nipples dry between feedings, change bra pads often.

When you bathe, keep soap, shampoo and other cleansers away from your nipples. If your nipples are dry or cracked, try an ointment containing lanolin. Rubbing olive oil or expressed milk on your nipples may help, too.

Think privacy

Many breast-feeding moms wear loose tops that can be partially unbuttoned — from the bottom up — for feedings. You can also use a receiving blanket to cover yourself and your baby while you're breast-feeding. If you'd like more privacy, ask someone to hold a baby blanket or stand in front of you while you get the baby settled.

Make healthy lifestyle choices

Your lifestyle choices are just as important when you're breast-feeding as they were when you were pregnant.

• Eat plenty of fruits, vegetables and whole grains.
• Drink lots of fluids.
• Rest as much as possible.
• Only take medication with your doctor's OK.
• Don't smoke.

Also beware of caffeine and alcohol. Too much caffeine can make your baby irritable and interfere with your baby's sleep. If you choose to have an occasional alcoholic drink, avoid breast-feeding for two hours afterward.

Give it time

If breast-feeding is tougher than you expected, try not to get discouraged. It's OK to have a slow start. As you and your baby get to know each other, breast-feeding will begin to feel more natural.

If you're struggling, ask a lactation consultant or your baby's doctor for help — especially if every feeding is painful or your baby isn't gaining weight. Although your nipples may be tender for the first few weeks, breast-feeding isn't supposed to hurt. If you haven't worked with a lactation consultant, ask your baby's doctor for a referral or check with the obstetrics department at a local hospital. Early support is often the key to breast-feeding success.

http://www.mayoclinic.com/

Virginity pledges can be effective: study

Last Updated: 2008-09-11 12:33:29 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Teens who take a pledge to remain a virgin until marriage may in fact be more likely than their peers to delay sex, according to a U.S. study.

Investigators at the RAND research institute found that even among U.S. teenagers with similar backgrounds and values, those who'd taken a virginity pledge were less likely to start having sex over the three-year study period.

"Our data suggest that it is a good idea for teens who are inclined to delay sex to make a pledge, because they're more likely to delay sex if they do so," lead researcher Dr. Steven C. Martino said in a statement. "A public statement or commitment to do -- or not do -- something makes it more likely that you will follow through on your stated intention."

On the other hand, virginity pledges alone are not enough to prevent teen pregnancies and sexually transmitted diseases, noted Martin of RAND in Pittsburgh, Pennsylvania.

"You also need a comprehensive program of sexual education for young people who are not inclined to delay sex and for virginity pledgers who eventually break their pledge," Martino said.

The findings, published in the Journal of Adolescent Health, are based on telephone surveys of 1,461 U.S. teenagers who were interviewed at the beginning of the study and again one and three years later.

The adolescences were selected to reflect a nationwide sample; 68 percent were white, 47 percent were female, 14 percent were African American, 12 percent were Hispanic and 6 percent were "other." One third had a parent with a college degree and nearly two thirds had parent with some education after high school.

During the first interview, they were questioned about their sexual history and about characteristics that would make them more or less likely to take a virginity pledge -- factors such as how many of their friends were sexually active, how involved they were at school and church, and their parents' attitudes toward premarital sex.

Martino's team found that even among teens who had values that made them more likely to take a virginity pledge, those who actually took one were more likely to delay having sex.

Of the former group, 42 percent started having sex during the study period. In contrast, one third of "pledgers" did.

Among those pledgers who did have sex, the rate of condom use was similar to that of other sexually active teens -- suggesting that taking such a pledge does not diminish teenagers' knowledge about safer sex.

"Making a virginity pledge appears to be an effective means of delaying sexual intercourse initiation among those inclined to pledge without influencing other sexual behavior," Martino and his colleagues conclude.

An estimated 23 percent of teenage girls and 16 percent of teenage boys in the U.S. have taken a virginity pledge, according to the researchers. Hundreds of churches, schools and colleges across the country now advocate them.

SOURCE: Journal of Adolescent Health, October 2008.

Weight doesn't hamper women's sexual activity

Last Updated: 2008-09-11 15:52:00 -0400 (Reuters Health)

By Joene Hendry

NEW YORK (Reuters Health) - A high body mass index (BMI), indicating overweight or obesity, may not play a significant role in women's sexual activity, researchers report.

"Obese and overweight women are just as sexually active as normal-weight women and need to be counseled similarly about their risks of unintended pregnancy and infection," Dr. Bliss E. Kaneshiro told Reuters Health.

Kaneshiro, of the University of Hawaii in Honolulu, and colleagues base these findings on surveys from 6,690 women, 15 to 44 years old, who participated in the 2002 National Survey of Family Growth.

The group is representative of the women living in the U.S. at the time. Just over half were 30 to 45 years old and about 16 percent were 15 to 19 years of age, the researchers report in the journal Obstetrics and Gynecology.

Overall, 54 percent of the women were of normal weight (BMI of less than 25). Another 25 percent were overweight (BMI between 25 and 30), and 21 percent were considered obese (body mass index than 30). Body mass index -- the ratio of weight to height - is often used to classify subjects as under- or overweight.

Women in different weight groups were similar in age, cohabitation status, race, ethnicity, education, and total household income. A higher proportion of normal-weight women reported never having borne a child and a higher proportion of overweight and obese women reported having three or more children.

The investigators found no significant differences among the weight groups in sexual orientation, frequency of sexual intercourse, the number of current partners, age at first intercourse, the number of lifetime male partners, or the number of male partners in the previous year.

However, Kaneshiro's group unexpectedly found that obese and overweight women, compared with normal-weight women, were more likely to report a history of intercourse with a male, even though they did not report an early initiation of intercourse.

The investigators suggest continuing research into the association between BMI and women's sexual behavior as this association can affect the risk of unintended pregnancy and sexually transmitted diseases.

SOURCE: Obstetrics and Gynecology, September 2008.

HIV racial disparities greatest for women, gay men

Last Updated: 2008-09-11 16:21:30 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - Blacks and Hispanics continue to be disproportionately affected by increasing rates of HIV infection, the U.S. Centers for Disease Control and Prevention reported today, with minority women and men who have sex with men at particularly high risk.

Last month, the CDC reported that at 56,300 new cases in 2006, the rate of new HIV infections was roughly 40-percent higher than earlier estimates had indicated. At that time, they found that 75 percent of new infections that year were among men.

In the Morbidity and Mortality Weekly Report, the CDC reports more detailed analysis of data from the HIV Incidence Surveillance System. Dr. Kevin Fenton and Dr. Richard Wolitski, at the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, discussed the findings in a telebriefing.

"For the first time we're able to provide new HIV incidence estimates for specific subpopulations, with further breakdowns of new infections among various races, transmission categories, age groups, and gender," Fenton said. "These data will allow us to target HIV prevention efforts and evaluate their impact with much more precision than ever before."

According to Fenton, the data show a "strikingly high incidence of new HIV infections among young (ages 13 to 29) black males who are gay or bisexual; the heavy impact among white men who have sex with men in their 30s and 40s; and that, compared with other women, black women bear the heaviest burden of HIV."

Dr. Wolitski pointed out that "individual differences in rates of risk behavior and substance use do not account for the disparity in infection rates in young black men who have sex with men, which means that factors outside the individual are increasing the risk associated with any risky sexual encounter."

Such factors include higher background prevalence of HIV among African Americans, he said, the risk is increased because the infection rate among African Americans is already higher than in other groups.

Another factor is the "different patterns of age mixing, in which younger black men who have sex with men may be more likely to have slightly older partners compared with other races or ethnicities."

Other factors likely include stigma, lack of access to effective prevention services, and underestimation of personal risk.

Responding to a question from Reuters Health, Fenton said that the HIV prevalence (overall number of individuals already infected) is driving the disproportionate disease incidence (the rate of new infections) among black women, as well as "patterns of sexual mixing in which they are having intercourse with men who are themselves at high risk, such as bisexual men or men who inject drugs or who were exposed while in prison."

Also at issue among black women, he added, are "power imbalances with men in sexual relationships that limit their ability to protect themselves."

Summing up, Fenton said, "Today's analysis serves as a powerful reminder that the U.S. epidemic of HIV is far from over, and we all need to do more."

He concluded: "The U.S. epidemic will end only when all of us -- federal, state, and local governments; politicians, communities, and businesses; social and civic organizations; schools, families, and individuals across the nation -- realize that ending AIDS is possible, and then collectively committing to make that happen."

"Together we can realize the goal of ending this epidemic in our lifetime."

SOURCE: Morbidity and Mortality Weekly Report, September 12, 2008.

Many colon cancer patients skip follow-up care

Last Updated: 2008-09-11 10:57:58 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - The results of new research indicate that many older patients who survive colorectal cancer do not attend the guideline-recommended follow-up office visits or undergo carcinoembryonic antigen (CEA) testing and colonoscopy.

"The current study is the first known national, population-based study in the U.S. to examine actual adherence to published comprehensive guidelines. The study included patients cared for in diverse practice settings and by different specialists," lead author Dr. Gregory S. Cooper told Reuters Health.

"The biggest finding was the low rate of guideline adherence, with approximately 60 percent receiving less than the recommended care and, in contrast, 20 percent received care in excess of guidelines," according to Cooper, a gastroenterologist with University Hospitals Case Medical Center in Cleveland, Ohio. "All patients were insured under Medicare, so lack of insurance cannot be a factor."

Using a linked tumor registry-claims database, the researchers identified 9,426 patients, 66 years of age or older, who were observed for 3 years following diagnosis and treatment of colorectal cancer in 2000 to 2001. The subjects were classified as receiving recommended follow-up if they had at least two office visits per year; at least two CEA tests per year in the first 2 years; and at least one colonoscopy performed within 3 years.

Overall, 60.2 percent of the patients received follow-up below recommended levels and 22.7 percent received excessive follow-up, according to the report in the journal Cancer. Thus, just 17.1 percent of patients received follow-up at the recommended frequency.

Guideline adherence ranged from 92.3 percent for office visits to 46.7 percent for CEA testing, while 73.6 percent of patients underwent recommended colonoscopy.

Although not recommended, abdominal/pelvic CT was performed in 47.7 percent of patients and PET scan was performed in 6.8 percent.

Adherence to follow-up guidelines was more likely in patients who were younger, white and had regional-stage malignancies and poorly differentiated tumors, the report indicates. The findings also indicate there was significant variation in guideline adherence by geographic location. This suggests that local practice patterns play a role in receipt of recommended follow-up, Dr. Cooper noted.

"Routine surveillance has been shown to improve survival after potentially curative treatment of colorectal cancer," Cooper said. "Assuming that the patient would benefit from early detection of recurrence, the use of these procedures should be encouraged. As some of these patients may be receiving their care from primary care physicians alone, primary providers should also be aware of guidelines."

SOURCE: Cancer, October 15, 2008.

Women respond better than men to antidepressant

Last Updated: 2008-09-11 16:04:30 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Women with major depression are more likely than men to achieve remission during treatment with citalopram, an antidepressant that belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRI), according to findings from the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study.

Previous research on this topic has yielded contradictory results, Dr. Elizabeth A. Young and co-authors note in their report, published online by the Journal of Psychiatric Research. The STAR*D study, they say, is "the largest to address sex differences in depression treatment using a representative sample of treatment-seeking patients."

The current analysis included 2,876 outpatients between 18 and 75 years old, 64 percent of whom were female. Citalopram was initiated at 20 milligrams per day and adjusted up to a maximum dose of 60 milligrams per day. The patients were treated for major depression for up to 14 weeks.

At the beginning of the study, the women had more severe depressive symptoms and more additional illnesses than men did. Women were also more likely than men to have a personal history of a suicide attempt and a family history of depression or substance abuse.

According to Young, of the University of Michigan in Ann Arbor, and her associates, the female patients were significantly more likely to achieve remission, at 29.4 percent vs 24.1 percent, respectively. Remission was defined as a score of 7 or less on the 17-item Hamilton Rating Scale for Depression.

Treatment response -- defined as a reduction of at least 50 percent from the beginning of trial on a self-reported 16-item inventory of depression symptoms -- also occurred more frequently among women than the men (48.5 percent vs 44.0 percent).

Side effects, maximum dose, and length of time on the drug, did not differ between the men and women, the authors report. "The elimination of these potential explanations for the sex differences found in this study increases the likelihood that the explanation is a differential biological response to citalopram in women."

The researchers suggest that the better treatment response among women is related to "the role of estrogen on serotonergic systems," as well as cognitive and psychological factors that differ between men and women.

SOURCE: Journal of Psychiatric Research, August 29, 2008.

Detailed Study on Spread of H.I.V. in U.S.

By GARDINER HARRIS

Published: September 11, 2008

An unusually detailed study of people newly infected with H.I.V. in the United States has confirmed that the majority of new cases occur among gay and bisexual men and that blacks are most at risk. But the data show that whites and blacks tend to be infected at different times in their lives with the virus that causes AIDS.

Most new infections of white gay and bisexual men occur when the men are in their 30s and 40s, the study found, while black gay and bisexual men are more likely to be infected in their teens and 20s. The results were reported on Thursday by the Centers for Disease Control and Prevention.

The C.D.C. reported last month that the study found that the virus was spreading faster in the United States than had been thought. In 2006, the study found, 56,300 people were newly infected with H.I.V. — 40 percent more than the agency’s previous estimate of roughly 40,000 new cases a year. The study was performed using new technology that allowed researchers to distinguish between new and older infections.

Dr. Kevin Fenton of the C.D.C. said the study’s findings served “as a powerful reminder that the U.S. epidemic of H.I.V. disease is far from over.”

The details of the agency’s demographic analysis were released on Thursday in the hope that knowledge of the age, race and other characteristics of the newly infected would better direct prevention efforts.

“The data really confirm what we had suspected and known before,” said Dr. Fenton, who emphasized the disease’s “disproportionate impact on gay and bisexual men and on blacks and Latinos.”

Black people, who make up about 12 percent of the population, accounted for more than 45 percent of the new infections, the study found, and the disparity was particularly acute among women.

Black women are nearly 15 times as likely to be infected with H.I.V. as white women. Hispanic women are four times as likely to be infected as white women. Black men have six times the H.I.V. incidence rate of white men and nearly three times that of Hispanic men.

Among those newly infected with the virus, black men were no more likely to be drug users or to engage in risky sex than were white men, according to the study. More research is needed to explain why young black men are at such greater risk for contracting the disease, but there are several hints from other studies, researchers said.

The fact that proportionally more blacks than whites are already infected would tend to produce higher transmission rates among blacks, said Dr. Richard Wolitski, acting director of the center’s division for H.I.V. and AIDS prevention. Young black men are much more likely to have been incarcerated. Infection rates among former convicts are high, largely because of behaviors outside of prison, studies show.

Dr. Wolitski said young black gay and bisexual men also tended to have partners who were older than their white counterparts and thus were more likely to have already been infected.

Girls and women make up 27 percent of those newly infected with the virus, and 80 percent of them contracted H.I.V. because of high-risk heterosexual contact. Among newly infected males, 81 percent of white men and 63 percent of black men were gay or bisexual.

In one of the most dismal statistics provided by the centers, researchers said that 80 percent of gay and bisexual men in 15 cities had not been reached by intensive H.I.V. prevention efforts that have proven effective. Agency officials said that more must be done, including expanded H.I.V. screening programs and better directing of prevention efforts at those most at risk.

http://www.nytimes.com

Unsafe sex 'biggest threat' for gay men

Unsafe sex 'biggest threat' for gay men

By Xie Chuanjiao (China Daily)
Updated: 2008-09-09 07:46

The incidence of HIV/AIDS among Beijing's drug users is in decline but the city's gay community remains the most at-risk group, a local health official said on Friday.

He Xiong, deputy director of the Beijing center for disease control and prevention (CDC), said that based on figures for the first seven months, 1.5 percent of the city's drug users are HIV positive, compared with 5 percent in 2001.

In comparison, 5 percent of gay men in the capital are HIV positive, while 0.5 percent of unlicensed prostitutes are infected with the virus, He said, without giving figures for 2001.

"More than 43 percent of all newly reported cases are attributed to people having unprotected sex, and gay men are the most at risk," he said.

Related readings: AIDS rampant among Beijing gays Capital strengthens AIDS prevention and control More prevention, better access to medicine against AIDS

Research carried out over the past three years has shown that less than 50 percent of gay men use condoms, so promoting better health awareness among them is a major task, he said.

During the first seven months of the year, 563 new HIV cases were reported in Beijing, 118 of which involved local people and the rest migrant workers, He said.

New cases were reported in each of Beijing's 18 districts and counties, he said.

In the whole of last year 1,190 new cases were reported, up slightly on 2006, he said.

While the development of a comprehensive HIV/AIDS monitoring network - comprising 69 clinics and 128 laboratories - has helped keep the spread of the virus in check, high-risk groups must become more aware of the dangers, the head of a local volunteer group told China Daily Monday.

Xiao Dong, chief of the Chaoyang Chinese AIDS Volunteer Group, said: "Gay people must voluntarily practice safe sex and take regular tests."

The efforts of groups like Xiao's are vital to reducing the health risks faced by Beijing's gay community, He said.

"They work closely with gay people and provide free condoms and confidential consultancy and test services."

Between January and July, more than 1 million people in Beijing had received an HIV test, He said.

Also, prevention and treatment clinics throughout the city now have intervention teams to work with high-risk groups. These people help not only with essential medical treatments, but also everyday matters such as problems at work, he said.

http://www.chinadaily.com.cn

Hypnosis: Another way to manage pain, kick bad habits

During hypnosis, you might receive suggestions designed to decrease your perception of pain and increase your ability to cope with it. Alternatively, you might receive suggestions designed to decrease cravings.

Have you ever been totally absorbed while reading a book, cooking or watching a movie? Did you zone out to the point you didn't notice what else was going on around you? If so, you've experienced a trance-like state that's similar to what happens to you during hypnosis.

Although its medical uses aren't entirely understood, hypnosis appears to help with a variety of health conditions, when provided by a certified hypnotherapist or other qualified clinician. These range from helping to manage pain from chronic conditions to easing the symptoms of asthma to kicking bad habits like smoking.

What is hypnosis?

Hypnosis, also referred to as hypnotherapy or hypnotic suggestion, is a trance-like state of mind. It is usually achieved with the help of a hypnotherapist and is different from your everyday awareness. When you're under hypnosis:

• Your attention is more focused
• You're deeply relaxed and calm
• You're more open to suggestions, and less critical or disbelieving

The purpose of hypnosis is to help you gain more control over your behavior, emotions or physical well-being.

It's not clear how hypnosis works. Hypnotherapists say that hypnosis creates a state of deep relaxation and quiets the mind. When you're hypnotized, you can concentrate intensely on a specific thought, memory, feeling or sensation while blocking out distractions. You're more open than usual to suggestions, and this can be used to change your behavior and thereby improve your health and well-being.

Who is hypnosis for?

Hypnotherapy has the potential to help relieve the symptoms of a wide variety of diseases and conditions. It can be used independently or along with other treatments. For example, it's one of several relaxation methods for treating chronic pain that has been approved by an independent panel convened by the National Institutes of Health.

According to preliminary studies, hypnotherapy may be used to:

• Change negative behaviors, such as smoking, bed-wetting and overeating
• Reduce or eliminate fears, stress and anxiety
• Treat pain during childbirth and reduce labor time
• Control pain during dental and surgical procedures
• Relieve symptoms associated with irritable bowel syndrome (IBS)
• Lower blood pressure
• Control nausea and vomiting caused by chemotherapy
• Reduce the intensity or frequency of headaches, including migraines
• Treat and ease the symptoms of asthma
• Hasten the healing of some skin diseases, including warts, psoriasis and atopic dermatitis

Although hypnosis may have the potential to help with a wide variety of conditions, it's typically used as one part of a broader treatment plan rather than as a stand-alone therapy. Like any other therapy, hypnosis can be helpful to some people but not to others. It seems to work best when you're highly motivated and your therapist is well trained.

Types of hypnosis

There are a variety of hypnotic techniques. The approach you choose depends on what you want to accomplish as well as your personal preferences. Your hypnotherapist may make a recommendation regarding the best technique for your condition.

For example, in one method a hypnotherapist leads you into hypnosis by talking in a gentle, soothing tone and describing images that create a sense of relaxation, security and well-being. While you're under hypnosis, the hypnotherapist suggests ways for you to achieve specific goals, such as reducing pain or stress or helping to eliminate the cravings associated with smoking cessation.

In another technique, once you're under hypnosis, the hypnotherapist helps stimulate your imagination by suggesting specific mental images for you to visualize. This conscious creation of vivid, meaningful pictures in your mind is called mental imagery, and it's a way to help bring about what you want to achieve. For instance, hypnotherapists can help athletes visualize what they want to accomplish before they perform it physically, such as shooting baskets or hitting a golf ball.

Self-hypnosis is a third technique. A certified hypnotherapist teaches you how to induce a state of hypnosis in yourself. You then use this skill on your own to help yourself.

Although hypnotherapists, like other health care practitioners, each have their own style, expect some common elements:

• A typical session lasts from 30 to 60 minutes.
• The number of sessions can range from one to several.
• You generally bring yourself out of hypnosis at the end of a session.
• You can usually resume your daily activities immediately after a session.

Myths about hypnosis

If you've ever seen hypnotism used as entertainment in a stage act, you've probably witnessed several of the myths about hypnosis in action. Legitimate clinical hypnotherapy practiced by a qualified professional is not the same process as that performed on stage.

Myth: When you're under hypnosis, you surrender your free will.
Reality: Hypnosis is a heightened state of concentration and focused attention. When you're under hypnosis, you don't lose your personality, your free will or your personal strength.

Myth: When you're under hypnosis, the hypnotherapist controls you.
Reality: You do hypnosis voluntarily for yourself. A hypnotherapist only serves as a knowledgeable guide or facilitator.

Myth: Under hypnosis, you lose consciousness and have amnesia.
Reality: A small number of people who go into a very deep hypnotic state experience amnesia. However, most people remember everything that occurred under hypnosis.

Myth: You can be put under hypnosis without your consent.
Reality: Successful hypnosis depends on your willingness to experience it. Even with voluntary participation, not everyone can be led into a hypnotic state.

How to choose a qualified professional

Hypnosis as a practice is not regulated in most states, so it pays to be very careful when selecting a therapist. Certified lay hypnotherapists are individuals who have completed 200 or more hours of training in hypnosis but don't have additional professional health care training. Licensed health care professionals who practice hypnotherapy, such as psychologists, doctors and social workers, are trained in hypnosis in addition to their university training.

Apply the same care in choosing a hypnotherapist as you would a doctor. Ask someone you trust for recommendations. When you find a potential hypnotherapist, ask questions such as:

• Do you have training in a field such as psychology, medicine, social work or dentistry?
• Are you licensed in your specialty in this state?
• Where did you go to school, and where did you do your internship, residency or both?
• If you're a lay hypnotist, how much training have you had and from what school?
• What professional organizations do you belong to?
• How long have you been in practice?
• What are your fees? Does insurance cover your services?

Risks of hypnosis

Hypnosis conducted under the care of a trained therapist is considered a safe complementary and alternative medicine treatment. Adverse reactions, such as headache, dizziness and nausea, can happen but are uncommon.

Use special caution before allowing a hypnotherapist to help you restore lost memories. In this type of hypnosis, some people actually create "memories" from their imagination. These "implanted memories" can be very troubling to you and your loved ones. You should avoid this type of hypnosis.

http://www.mayoclinic.com

Complementary and alternative medicine: What is it?

Ranging from herbs to acupuncture, alternative medicine is becoming increasingly popular. Learn the basics.

When you were a child and sprained an ankle or came down with the flu, you probably visited a family doctor or a pediatrician to treat your problem. As an adult, you most likely visit your primary care physician for what ails you. But now your friends are suggesting alternative medicine treatments that you've never heard of — things like homeopathy, ayurveda, acupuncture and herbs.

What are these alternative medicine treatments? Are they safe? Will they work? Get the basics yourself before starting any alternative medicine therapy, and always tell your doctor which ones you're trying.

What is alternative medicine? What is complementary medicine?

Alternative medicine generally refers to practices not typically used in conventional medicine. What's considered alternative medicine changes constantly as more and more treatments undergo rigorous study and are proved to be effective or not.

• Complementary medicine is thought of as treatments used in addition to the conventional therapies your doctor may prescribe, such as using tai chi or massage in addition to prescription medicine for anxiety.
• Alternative medicine is generally thought of as being used instead of conventional methods. For example, this might mean seeing a homeopath or naturopath instead of your regular doctor.

Integrative medicine: Combining complementary treatments with conventional care

Conventional doctors are learning more about complementary and alternative medicine (CAM) because they recognize that more than half of people try some kind of alternative treatment. Many health care institutions have begun integrating therapies that aren't part of mainstream medicine into their treatment programs. A number of medical schools now include education on nontraditional techniques in their curriculum. As complementary and alternative therapies prove effective, they're being combined more often with conventional care. This is known as integrative medicine. You're practicing integrative medicine when you choose to add a complementary treatment to an existing conventional treatment. For instance, you may decide to take an omega-3 fatty acid supplement to help keep your heart healthy in addition to statins your doctor prescribed to reduce your cholesterol. Remember, talk to your doctor before combining complementary and alternative treatments with conventional treatments to avoid possible problems.

What are the principles of complementary and alternative medicine?

Many alternative medicine practitioners base their work around a few common principles. Some of these are similar to what your conventional doctor might do, while others are quite different. Basic philosophies of complementary and alternative medicine include:

• Prevention is key to good health. Taking steps to better your health before you get sick is the best way to keep yourself healthy.
• Your body has the ability to heal itself. Alternative medicine practitioners see themselves as facilitators. To them, your body does the healing work, and treatment encourages your natural healing processes.
• Learning and healing go hand in hand. Alternative medicine practitioners see themselves as teachers and mentors who offer guidance. To the practitioner, you're the one who does the healing.
• Holistic care. The focus is on treating you as a whole person — recognizing that physical health, mental well-being, relationships and spiritual needs are interconnected and play a part in your overall health.

What are some examples of complementary and alternative medicine?

To make sense of the many therapies available, it might help to look at them in the broad categories that the National Institutes of Health uses for classification. Keep in mind that while these categories may be useful for understanding types of complementary and alternative medicine, the distinctions between therapies aren't clear-cut. Some treatment systems may use techniques from more than one category. For example, traditional Chinese medicine uses several types of complementary and alternative medicine. Some techniques may fit in more than one category. For example, acupressure could fit either in the category of manipulation and touch or in the category of energy therapies. Here are the broad categories of complementary and alternative medicine.

Healing systems
Healing systems are complete sets of theories and practices. A system isn't just a single practice or remedy — such as massage — but many different practices that all center on a philosophy or lifestyle, such as the power of nature or the presence of energy in your body. Many healing systems developed long before the conventional Western medicine that's commonly used in the United States.

Examples of complementary and alternative medicine healing systems include:

• Ayurveda. This form of medicine, which originated in India more than 5,000 years ago, emphasizes a unique cure per individual circumstances. It incorporates treatments including yoga, meditation, massage, diet and herbs.
• Homeopathy. This treatment uses minute doses of a substance that causes symptoms to stimulate the body's self-healing response.
• Naturopathy. This type of treatment focuses on noninvasive treatments to help your body do its own healing. Naturopaths draw on many forms of complementary and alternative medicine, including massage, acupuncture, herbal remedies, exercise and lifestyle counseling.
• Ancient medicines. These complementary and alternative medicine treatments include Chinese, Asian, Pacific Islander, American Indian and Tibetan practices.

Mind-body connections
Mind-body techniques strengthen the communication between your mind and your body. Complementary and alternative medicine practitioners say these two systems must be in harmony for you to stay healthy. Examples of mind-body connection techniques include:

• Meditation
• Yoga
• Biofeedback
• Prayer
• Hypnosis
• Relaxation and art therapies, such as poetry, music and dance

Dietary supplements and herbal remedies
These treatments use ingredients found in nature. Examples of herbs include ginseng, ginkgo and echinacea, while examples of other dietary supplements include selenium, glucosamine sulfate and SAM-e. Herbs and supplements can be taken as teas, oils, syrups, powders, tablets or capsules. Some say that they trust herbal medicine because it's been used for thousands of years. Others say that they like it because it's "natural."

Remember, though, that natural doesn't mean that herbs and supplements are always safe — and added ingredients aren't always natural. Dietary supplements and herbal remedies can cause side effects and interact with medications, so be sure to investigate possible dangers or drug interactions with your doctor. As with other complementary and alternative treatments, always talk to your doctor before taking an herb or supplement to make sure it's safe for you.

Manipulation and touch
These methods use human touch to move or manipulate a specific part of your body. They include:

• Chiropractic and spinal manipulation
• Massage
• Other types of manipulation and touch therapies, such as osteopathy, craniosacral therapy and acupressure

Energy therapies
Some complementary and alternative medicine practitioners believe an invisible energy force flows through your body, and when this energy flow is blocked or unbalanced you can become sick. Different traditions call this energy by different names, such as chi, prana and life force. Unblocking or re-balancing your energy force is the goal of these therapies, and each claims to accomplish that goal differently. Proponents of acupuncture, for instance, say that the insertion of needles into points along energy pathways in your body restores your natural energy.

Other energy therapies include:

• Therapeutic touch
• Reiki
• Magnet therapy
• Polarity therapy
• Light therapy

Are conventional doctors opposed to complementary and alternative medicine?

Many doctors aren't opposed to complementary and alternative medicine. But many doctors practicing today did not receive training in CAM therapies, so they may not feel comfortable addressing questions in this area. However, as the evidence for certain therapies increases, doctors in the United States are increasingly referring people to complementary and alternative practitioners. Your doctor may be willing to discuss these options with you.

At the same time, conventional doctors also have good reason to be skeptical when it comes to complementary and alternative medicine. Some complementary and alternative medicine practitioners make exaggerated claims about curing diseases, and some ask you to forgo treatment from your conventional doctor to use their unproven therapies. Some forms of complementary and alternative medicine can even hurt you.

Conventional medicine relies on methods proved to be safe and effective with carefully designed trials and research. But many complementary and alternative treatments lack solid research on which to base sound decisions. The dangers and possible benefits of many complementary and alternative treatments remain unproved.

Why is there a lack of evidence about complementary and alternative treatments?

One reason for the lack of research in complementary and alternative treatments is that large, carefully controlled medical studies are costly. Trials for conventional medications or procedures are often directly or indirectly funded by the government or drug companies, giving conventional treatments more resources to do studies. Most complementary and alternative treatment trials are more difficult to fund, so there are fewer trials. Nonetheless, a number of studies are currently under way on complementary and alternative treatments ranging from herbs to yoga that may help identify what works and what doesn't, and what's safe and what isn't. In fact, the U.S. government has established a National Center for Complementary and Alternative Medicine to help guide the public in making wise choices when it comes to complementary and alternative treatments.

Talk to your doctor about possible benefits and dangers

Work with your conventional medical doctor to help you make informed decisions regarding complementary and alternative treatments. Even if your doctor can't recommend a specific complementary and alternative treatment, he or she can help you understand possible risks and benefits before you try a treatment. Though some of these treatments can be helpful, many have side effects and can cause problems with certain medications or health conditions. Keep in mind that CAM treatments aren't a substitute or replacement for conventional medical care — but used wisely and in conjunction with conventional medical treatment, they may help you alleviate stress, pain and anxiety, manage your symptoms, maintain strength and flexibility, and promote a sense of well-being.

http://www.mayoclinic.com

Family therapy: Healing family conflicts

Families can be torn apart by illness, divorce or other problems that create conflict and stress. Family therapy can help families identify and resolve problems.

Your family can be your greatest source of support, comfort and love. But it can also be your greatest source of pain and grief. A health crisis, mental illness, work problems or teenage rebellion may threaten to tear your family apart.

Family therapy can help your family weather such storms. Family therapy can help patch strained relationships, teach new coping skills and improve how your family works together. Whether it's you, your partner, a child or even a sibling or parent who's in crisis, family therapy can help all of you communicate better and learn to get along.

What is family therapy?

Family therapy is a type of psychotherapy. It helps families or individuals within a family understand and improve the way family members interact with each other and resolve conflicts.

Family therapy is usually provided by therapists known as marriage and family therapists. These therapists provide the same mental health services as other therapists, simply with a specific focus — family relationships.

Family therapy is often short term. You usually attend one session a week, typically for three to five months. In some cases, though, families may need more intensive treatment. The treatment plan will depend on your family's specific situation.

Who can benefit from family therapy?

In general, anyone who wants to improve troubled relationships can benefit from family therapy. Family therapy can help with such issues as:

• Marital problems
• Divorce
• Eating disorders, such as anorexia or bulimia
• Substance abuse
• Depression or bipolar disorder
• Chronic health problems, such as asthma or cancer
• Grief, loss and trauma
• Work stress
• Parenting skills
• Emotional abuse or violence
• Financial problems

Your family may do family therapy along with other types of mental health treatment, especially if one of you has a serious mental illness that also requires intense individual therapy. Family therapy isn't a substitute for other necessary treatments. For instance, family therapy can help family members cope if a relative has schizophrenia. But the person with schizophrenia should continue with his or her individualized treatment plan, such as medication and possibly hospitalization.

In some cases, family therapy may be ordered by the legal system. Adolescents in trouble with the law may be ordered into family therapy rather than serving jail time, for instance. Violent or abusive parents are sometimes spared jail if they enter family therapy. Divorcing couples may also be required to attend family therapy.

How does family therapy work?

Family therapy often brings entire families together in therapy sessions. However, family members may also see a family therapist individually. Family therapy can even include nonfamily members, such as teachers, other health care providers or representatives of social services agencies.

Working with a family therapist, you and your family will examine your family's ability to solve problems and express thoughts and emotions. You may explore family roles, rules and behavior patterns in order to spot issues that contribute to conflict. Family therapy may help you identify your family's strengths, such as caring for one another, and weaknesses, such as an inability to confide in one other.

For example, say that your adult son has depression. Your family may not understand the roots of his depression or how best to offer help. Although you're worried about your son's health, you have such deep-seated family conflicts that conversations ultimately erupt into arguments. You're left with hurt feelings, decisions go unmade, and the rift grows wider.

Family therapy can help you pinpoint your specific concerns and assess how your family is handling them. Guided by your therapist, you'll learn new ways to interact and overcome old problems. You'll set individual and family goals and work on ways to achieve them. In the end, your son may be better equipped to cope with his depression, you'll understand his needs better, and you, your partner and your son may all get along better.

How do you choose a family therapist?

Like other psychotherapists, family therapists are licensed mental health professionals. Although different states have different licensing or credentialing requirements, most states require advanced training, including a master's or doctoral degree, graduate training in marriage and family therapy, and training under the supervision of other experts. Many marriage and family therapists opt to become credentialed by the American Association for Marriage and Family Therapy (AAMFT), which sets specific eligibility criteria.

Most family therapists work in private practice. But they may also work in clinics, mental health centers, hospitals and government agencies.

Ask your primary care doctor for a referral to a marriage or family therapist. Family and friends also may give you recommendations based on their experiences. Your health insurer, employee assistance program, clergy, or state or local agencies also may offer recommendations. You can also look in the phone book.

What questions should you ask when choosing a family therapist?

Before choosing a family therapist, you can ask lots of questions to see if he or she is the right fit for your family. Consider asking questions like these:

• Are you a clinical member of the AAMFT or licensed by the state, or both?
• What is your educational and training background?
• What is your experience with my type of problem?
• How much do you charge?
• Are your services covered by my health insurance?
• Where is your office, and what are your hours?
• How long is each session?
• How often are sessions scheduled?
• How many sessions should I expect to have?
• What is your policy on canceled sessions?
• How can I contact you if I have an emergency?

Starting therapy with a family therapist can be one of the best things you do when your family is torn apart. You can heal emotional wounds, come to understand one another better and restore a sense of harmony you may not have felt for a long time.

http://www.mayoclinic.com