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.

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