Questions about Fever:

What is a normal temperature?
A normal temperature is about 98.6°F when taken orally (by mouth). Temperatures taken rectally (by rectum) usually run 1° higher than those taken orally. So a normal temperature is about 99.6°F when taken rectally. Many doctors define a fever as an oral temperature above 99.4°F or a rectal temperature above 100.4°F

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How should I take my child's temperature?

• Mercury thermometers should not be used. Mercury is an environmental toxin, and you don't want to risk exposing your family to it. If you have a mercury thermometer at home, you should remove it and use a digital thermometer.
• Don't bundle your baby or child up too tightly before taking the temperature.
• Never leave your child alone while taking his or her temperature.
• Be sure you use the right thermometer. Read the package instructions to see if you have an oral or rectal thermometer.
• If you're taking your child's temperature rectally, coat the tip of the thermometer with petroleum jelly (brand name: Vaseline) and insert it half an inch into the rectum. Hold the thermometer still and do not let go. When the thermometer beeps, remove it and check the digital reading.
• If you're taking your child's temperature orally, place the end of the thermometer under the tongue and leave it there until the thermometer beeps. Remove the thermometer and check the digital reading.
• After you're done using the thermometer, wash it in cool, soapy water.

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When should I try to lower my child's fever?
Fevers are a sign that the body is fighting an infection. The main reason to treat your child is to make him or her feel better. When your child is achy and fussy, you may want to give him or her some medicine.

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How much medicine is needed to lower a fever?
Acetaminophen (brand names: Children's or Infants' Tylenol) relieves pain and lowers fever. How much acetaminophen your child may need depends on his or her weight and age, as shown in the chart below. When the age and weight don't match, use the weight as the main guide. The doses in the chart may be a little higher than what's on the medicine package. Ask your doctor if you have any questions.

Talk to your doctor before giving ibuprofen (brand names: Children's Advil, Children's Motrin) to your child. Your doctor will tell you the correct dose for your child

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Age Weight Acetaminophen dose
(every 4 hours) 0-3 mos 6-11 lbs. Ask your family doctor
4-11 mos 12-17 lbs. 80 mg
1-2 yrs 18-23 lbs. 120 mg
2-3 yrs 24-35 lbs. 160 mg
4-5 yrs 36-47 lbs. 240 mg
Tips on giving medicine

• Don't give more than 5 doses in 1 day.
• Don't give a baby younger than 4 months old medicine unless your family doctor tells you to.
• Read labels carefully. Make sure you are giving your child the right amount of medicine.
• If using drops, fill the dropper to the line.
• For liquid elixir, use a liquid measuring device to make sure you give the right dose. Get one at your drug store or ask your pharmacist.

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Why not use aspirin to lower my child's fever?
In rare cases aspirin can cause Reye's syndrome in children who have the flu or the chickenpox. Reye's syndrome is a serious illness that can lead to death. Because it may be hard to tell if your child has one of these infections, it's best not to use aspirin.

Are there other ways to help my child feel better?

• Give your child plenty to drink to prevent dehydration (not enough fluid in the body) and help the body cool itself.
• Keep your child still and quiet.
• Keep the room temperature at about 70°F to 74°F.
• Dress your child in light cotton pajamas so that body heat can escape.
• If your child is chilled, put on an extra blanket but remove it when the chills stop.

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Will a bath help lower my child's fever?
Used together, acetaminophen and a lukewarm bath may help lower a fever. Give the acetaminophen before the bath. If the bath is given alone, your child may start shivering as his or her body tries to raise its temperature again. This may make your child feel worse. Don't use alcohol or cold water for baths.

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When should I call the doctor?
If your child has any of the warning signs listed in the box below, call your family doctor.

Under 1 month old. Call your doctor right away if your baby's temperature goes over 100.5°F rectally, even if he or she doesn't seem sick. Babies this young can get very sick very quickly.

One to 3 months old. Call your doctor if your baby has a temperature of 100.5°F (even if your baby doesn't seem sick) or a temperature of 99.5°F that has lasted more than 24 hours.

Three months and older. If your child has a fever of 101.4°F, watch how he or she acts. Call your doctor if the fever rises or lasts for more than 3 days. In children 3 months to 2 years of age, if the temperature is 102°F, call your doctor even if your child seems to feel fine.

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Call your doctor if your child has any of these warning signs

• Changes in behavior
• Constant vomiting or diarrhea
• Dry mouth
• Earache or pulling at ears
• Fever comes and goes over several days
• High-pitched crying
• Irritable
• Not hungry
• Pale
• Seizures
• Severe headache
• Skin rash
• Sore or swollen joints
• Sore throat
• Stiff neck
• Stomach pain
• Swelling of the soft spot on the head
• Unresponsive or limp
• Wheezing or problems breathing
• Whimpering

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Tips for Talking to Your Doctor
Taking an active role in your health care can help you get the best care possible from your doctor. One way to do this is to improve your relationship with your doctor. The following are some tips to help you and your doctor improve your health care together.

Talk to your doctor
Be sure to tell your doctor about any current and past health care issues or concerns. It's important to share any information you can, even if you're embarrassed. Give your doctor the following information during the exam:

• Any symptoms you are having.
• Your health history. You can create a “health journal” for yourself on paper or in a notebook, and bring it to your appointments. See the handout, "Creating a Health Journal" for more information.
• Personal information, including whether you are stressed or if your life is changing.
• Any medicines you are currently taking. Bring them with you or create a list of all your medicines. Include information about when and how often you take the medicine. You should also write down the strength of the medicine (for example, do you take 150 mg or 200 mg?).
• Any side effects you have from your medicine(s), especially if it makes you feel sick or if you think you may be allergic to it.
• Any vitamins or supplements you take.
• Any x-rays, tests results or medical records you have can be brought with you to the appointment.

Ask questions
Don't be afraid to speak up. It's important for you to let your doctor know if you don’t understand something. If you don’t ask questions, your doctor will think you understand everything he or she has told you. The following are some tips on asking your doctor questions during the exam:

• Ask every time you don't understand something.
• If you have questions before the appointment, just write them down and ask them during the exam. Be sure to write down the most important questions first to make sure they get answered.
• Tell your doctor when you need more time to talk about something. If the doctor isn’t available to help, you should be able to talk to a physician assistant or a nurse. If no one else is available, see if you can schedule another appointment to continue your talk.

Take information home with you.
Taking written or recorded information home with you can help you remember information and instructions any time you need to. Your doctor is a good source of accurate information you can trust. The following are types of information you can take home with you:

• Notes that you have taken during the appointment. It's ok for you to write down the information your doctor gives you. Sometimes it helps to bring a friend or family member with you. They can help write down the answers to your questions.
• Written instructions from your doctor.
• A tape recording. Ask your doctor if it's ok to bring a tape recorder to the appointment.
• Brochures or other educational materials. If there aren't any available, ask where you can find some.

Follow up with your doctor
Make sure to follow any instructions your doctor gave you during the appointment, like taking medicine, scheduling a test or scheduling an appointment with a specialist. If you’re confused or if you've forgotten some information, it's ok to contact your doctor. The following are some common reasons you may need to call your doctor:

• If you have any questions after the appointment. Ask to leave a message with the doctor or speak with a nurse.
• If you start to feel worse or have problems with your medicine.
• If you had tests and haven’t gotten the results

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QUESTIONS ABOUT ACUTE OTITIS MEDIA:

What are the new guidelines?
The new guidelines define acute otitis media (AOM), or middle ear infections, and outline appropriate diagnosis and treatment standards – including pain management – based on a child’s age and other factors.

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Why were these new guidelines developed?
Acute otitis media (AOM) is the most common bacterial illness in children and the one most commonly treated with antibiotics. There has been a significant increase in, and concern about antibacterial resistance of the organisms that cause AOM. These factors suggested the need for a detailed evaluation of AOM and its management.
While the number of office visits for otitis media with effusion – middle ear fluid – (OME) have decreased over the past decade from 25 million in 1990 to just 16 million in 2000, the number of antibiotic prescriptions to treat AOM has remained constant. At the same time, concerns about the rising rate of antibiotic – or antibacterial – use and resistance have emerged.

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What do the new guidelines recommend?
1.   Accurately diagnose AOM and differentiate it from OME, which requires different management.
2.   Relieve pain, especially in the first 24 hours, with ibuprofen or acetaminophen.
3.   Minimize antibiotic side effects by giving parents of select children the option of fighting the infection on their own for 48-72 hours, then starting antibiotics if they do not improve.
4.   Prescribe initial antibiotics for children who are likely to benefit the most from treatment.
5.   Encourage families to prevent AOM by reducing risk factors. For babies and infants these include breastfeeding for at least six months, avoiding “bottle propping,” and eliminating exposure to passive tobacco smoke.
6.   If antibiotic treatment is agreed upon, the clinician should prescribe amoxicillin for most children.

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Do the guidelines apply to all children?
No. The guidelines apply only to an otherwise healthy child without underlying conditions that may alter the natural course of AOM. These conditions include, but are not limited to, anatomic abnormalities such as cleft palate, genetic conditions such as Down syndrome, immune system disorders, and cochlear implants. Also excluded are children with a clinical recurrence of AOM within 30 days or AOM with underlying chronic OME.

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What is acute otitis media?
A diagnosis of acute otitis media requires:
·     Recent, usually abrupt, onset of illness.
·     The presence of middle ear fluid, or effusion.
·     Signs or symptoms of middle ear inflammation.
Over 5 million AOM cases occur annually in US children, resulting in more than 10 million annual antibiotic prescriptions and about 30 million annual visits to doctor’s offices. Fifty percent of antibiotics for preschoolers in the US are prescribed for ear infections. Using an observation option could reduce antibiotic prescriptions annually by up to 3 million and would significantly reduce the prevalence of resistant bacteria.

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What are the harmful effects of antibiotics?
Each course of antibiotic given to a child can make future infections more difficult to treat. The result is an increase in the use of a larger range of – and generally more expensive – antibiotics. In addition, the benefit of antibiotics for AOM is small on average, and must be balanced against potential harm of therapy. About 15 percent of children who take antibiotics suffer from diarrhea or vomiting and up to 5 percent have allergic reactions, which can be serious or life threatening. The average preschooler carries around 1 to 2 pounds of bacteria – about 5 percent of his or her body weight. These bacteria have 3.5 billion years of experience in resisting and surviving environmental challenges. Resistant bacteria in a child can be passed to siblings, other family members, neighbors, and peers in group-care or school settings.

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When should antibiotics be prescribed?
·     For children age 6 months and younger – for certain or suspected AOM.
·     Children age 6 months to 2 years – for certain AOM or suspected AOM with severe symptoms; observation is an option for suspected or uncertain AOM if non-severe.
·     Children age 2 to 12 years – antibiotic treatment for certain AOM with severe symptoms; observation is an option for suspected or non-severe AOM.
The guideline provides an option to observe select children and only start antibiotic treatment if symptoms have not improved in 48-72 hours. Approximately 80 percent of children with AOM get better without antibiotics. And children whose ear infections are not treated immediately with antibiotics are not likely to develop a serious illness.

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What if a child with a middle ear infection is in great pain and discomfort?
The mainstay of pain management for AOM is medications such as acetominophen and ibuprofen, not antibiotics. Most children with AOM have significant ear pain, which may manifest in young children as ear rubbing, sleep disruption, or temper tantrums. Analgesics are most important in the first 24 hours after diagnosis, especially before the child’s bedtime. Fortunately, by 24 hours about 60 percent of children feel better, rising to 80-90 percent within a few days. Antibiotics do not relieve pain in the first 24 hours, and have only a small effect after that.

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Is my child at risk for developing other infections if she is not treated with antibiotics?
Published trials of observation, placebo, or non-antibiotic AOM therapy have shown no increased rate of complications, provided that children are followed carefully and receive antibiotics if symptoms persist or worsen. These studies vary in the age of children studied and the severity of illness, factors taken into consideration in determining which children are suitable for the observation option.

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HIGH BLOOD PRESSURE IN KIDS:

Can children get high blood pressure?
We usually think of high blood pressure, or hypertension, as a problem that affects adults. But, in fact, this condition can be present at any age, even in infancy. About five of every hundred children have higher than normal blood pressure, although fewer than one in a hundred has medically significant hypertension.

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How blood pressure is measured?
The term blood pressure actually refers to two separate measurements:
·     systolic blood pressure is the highest pressure reached in the arteries as the heart pumps blood out for circulation through the body
·     diastolic blood pressure is the much lower pressure that occurs in the arteries when the heart relaxes to take blood in between beats
If either or both of these measurements are above the range found in healthy individuals of similar age and sex, it’s called hypertension.

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Who gets high blood pressure?
·     Hypertension is more common among individuals of color than whites. It also seems to be more prevalent in some parts of the world; for example, it’s very rare among Alaskan Inuit, but affects as many as forty of every hundred adults in northern Japan.
·     In many cases hypertension seems to develop with age. As a result, your child may show no signs of high blood pressure as an infant, but may develop the condition as she grows.
·     Youngsters who are overweight are also more prone to have hypertension (and other chronic diseases). Thus good eating habits (without overeating and without emphasizing high-fat foods) and plenty of physical activity are important throughout the early years of childhood (and for the rest of her life).

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Causes?
In most instances of high blood pressure, no known cause can be identified. However, when hypertension becomes severe in children, it’s usually a symptom of another serious problem, such as kidney disease or abnormalities of the heart or of the nervous or endocrine (gland) system.

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Detection is key
Fortunately, high blood pressure alone rarely causes serious problems in children, and can be controlled through dietary changes, medication, or a combination of the two. However, if hypertension is allowed to continue or become worse over many years, the prolonged extra pressure can lead to heart failure. In addition, the stress on blood vessels in the brain can cause them to burst, producing a stroke. Also, long-term hypertension causes changes in blood vessel walls that may result in damage to the kidneys, eyes, and other organs. For these reasons it’s important for children found to have hypertension to have their blood pressure checked regularly by their pediatrician, and for you to follow the doctor’s advice carefully.

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Signs and symptoms
In most routine physical examinations, your child's blood pressure will be measured. This is how hypertension is usually discovered. Most often this condition causes no noticeable discomfort, but any of the following may indicate high blood pressure:
·     Headache
·     Dizziness
·     Shortness of breath
·     Visual disturbances
·     Fatigue

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Diagnosis
If your child is found to have high blood pressure, your pediatrician will order tests to see if there is an underlying medical problem causing it. These tests include studies of the urine and blood. Sometimes special X rays are used to examine the blood supply to the kidneys. If, as in most cases, no causative medical problem can be found, the diagnosis of essential hypertension will be made. (In medical terms, the word essential refers only to the fact that no cause could be found.)

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Managing your child's high blood pressure?
·     The first step toward reducing your child’s blood pressure is to limit the salt in her diet. Giving up the use of table salt and restricting salty foods can reverse mild hypertension and will help lower more serious blood pressure elevations. You’ll also have to be cautious when shopping for packaged foods; most canned and processed foods contain a great deal of salt, so check labels carefully to make sure the items have little or no salt added.
·     The pediatrician also may suggest that your child get more exercise. Physical activity seems to help regulate blood pressure and thus can reduce mild hypertension. Weight reduction in the obese individual also may serve to lower blood pressure; in addition, the avoidance of excessive weight provides other health benefits.

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Medication?
Once the pediatrician knows your child has high blood pressure, he’ll want to check it frequently to make sure the hypertension is not becoming more severe. Depending on how high the blood pressure is, the pediatrician may refer the child to a child hypertension specialist, usually a kidney expert. If it does become worse, it may be treated with medication as well as diet and exercise.
Many types of medications are available, which work through different parts of the body. At first the pediatrician may prescribe a diuretic, a medicine that increases urine output of salt (sodium), before trying stronger drugs. Alternatively, or if this doesn’t return your child’s blood pressure to normal, an antihypertensive drug will be prescribed. Initially the doctor will prescribe a single drug, adding others only if the blood pressure is difficult to control.

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Follow your pediatrician's instructions
When your child’s blood pressure is brought under control with diet or medication, you may be tempted to let her increase her salt intake or stop taking her medicine because the problem seems to be gone. However, doing this will only bring back the hypertension, so be sure to follow your pediatrician’s instructions exactly.

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Early detection is key
It’s very important to detect hypertension early. It is now recommended that all children have their blood pressure checked beginning at age three, sooner for those at high risk (infants that were preterm, had a low birth weight, and who had a difficult or prolonged hospital stay, as well as in children who have congenital heart disease, who are receiving medications that might increase blood pressure, or who have any other condition that might lead to high blood pressure).

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Prevention
Because overweight children are more likely to develop hypertension (as well as other health problems), watch your child’s caloric intake and make sure she gets plenty of exercise.
It’s also wise to keep excess salt out of your child’s diet, even if she doesn’t have high blood pressure. There’s no clear evidence that salt causes this problem, but your child doesn’t need extra salt, and once she develops a taste for it, she’ll have more difficulty decreasing salt intake if she develops blood pressure problems later in life.

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What is ADHD?
Attention-deficit hyperactivity disorder (ADHD) is the name of a group of behaviors found in many children and adults. People who have ADHD have trouble paying attention in school, at home or at work. They may be much more active and/or impulsive than what is usual for their age. These behaviors contribute to significant problems in relationships, learning and behavior. For this reason, children who have ADHD are sometimes seen as being "difficult" or as having behavior problems.

ADHD is common, affecting 4% to 12% of school-age children. It's more common in boys than in girls. You may be more familiar with the term attention deficit disorder (ADD). This disorder was renamed in 1994 by the American Psychiatric Association (APA).

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What are the symptoms of ADHD?
The child with ADHD who is inattentive will have 6 or more of the following symptoms:

• Has difficulty following instructions
• Has difficulty keeping attention on work or play activities at school and at home
• Loses things needed for activities at school and at home
• Appears not to listen
• Doesn't pay close attention to details
• Seems disorganized
• Has trouble with tasks that require planning ahead
• Forgets things
• Is easily distracted

The child with ADHD who is hyperactive/impulsive will have at least 6 of the following symptoms:

• Fidgety
• Runs or climbs inappropriately
• Can't play quietly
• Blurts out answers
• Interrupts people
• Can't stay in seat
• Talks too much
• Is always on the go
• Has trouble waiting his or her turn

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What should I do if I think my child has ADHD?
Talk with your child's doctor. A diagnosis of ADHD can be made only by getting information about your child's behavior from several people who know your child. Your doctor will ask you questions and may want to get information from your child's teachers or anyone else who is familiar with your child's behavior. Your doctor may have forms or checklists that you and your child's teacher can fill out. This will help you and your doctor compare your child's behavior with other children's behavior.
Your doctor will do vision and hearing tests if these tests haven't been done recently.

Your doctor may recommend trying medicine to see if it helps control your child's hyperactive behavior. A trial of medicine alone cannot be the basis for diagnosing ADHD. However, it can be an important part of evaluating your child if ADHD is suspected.

It might be hard for your doctor to tell if your child has ADHD. Many children who have ADHD aren't hyperactive in the doctor's office. For this reason, your doctor may want your child to see someone who specializes in helping children who have behavior problems, such as a psychologist.

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What causes ADHD?
Children who have ADHD do not make enough chemicals in key areas in the brain that are responsible for organizing thought. Without enough of these chemicals, the organizing centers of the brain don't work well. This causes the symptoms in children who have ADHD. Research shows that ADHD is more common in children who have close relatives with the disorder. Recent research also links smoking and other substance abuse during pregnancy to ADHD.

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Things that don't cause ADHD:

• Bad parenting (though a disorganized home life and school environment can make symptoms worse)
• Too much sugar
• Too little sugar
• Aspartame (brand name: Nutrasweet)
• Food additives or colorings
• Food allergies or other allergies
• Lack of vitamins
• Fluorescent lights
• Too much TV
• Video games

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What can I do to help my child?
A team effort, with parents, teachers and doctors working together, is the best way to help your child. Children who have ADHD tend to need more structure and clearer expectations. Some children benefit from counseling or from structured therapy. Families may benefit from talking with a specialist in managing ADHD-related behavior and learning problems. Medicine also helps many children. Talk with your doctor about what treatments he or she recommends.

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What medicines are used to treat ADHD?
Some of the medicines for ADHD are methylphenidate (some brand names: Ritalin, Concerta), dextroamphetamine (brand name: Dexedrine), pemoline (brand name: Cylert), atomoxetine (Strattera), and a combination drug called Adderall. These medicines improve attention and concentration, and decrease impulsive and overactive behaviors. Other medicines can also be used to treat ADHD.

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What can I do at home to help my child?
Children who have ADHD may be difficult to parent. They may have trouble understanding directions. Children who are in a constant state of activity can be challenging for adults. You may need to change your home life a bit to help your child. Here are some things you can do to help:

• Make a schedule. Set specific times for waking up, eating, playing, doing homework, doing chores, watching TV or playing video games, and going to bed. Post the schedule where your child will always see it. Explain any changes to the routine in advance.
• Make simple house rules. It's important to explain what will happen when the rules are obeyed and when they are broken. Write down the rules and the results of not following them.
• Make sure your directions are understood. Get your child's attention and look directly into his or her eyes. Then tell your child in a clear, calm voice specifically what you want. Keep directions simple and short. Ask your child to repeat the directions back to you.
• Reward good behavior. Congratulate your child when he or she completes each step of a task.
• Make sure your child is supervised all the time. Because they are impulsive, children who have ADHD may need more adult supervision than other children their age.
• Watch your child around his or her friends. It's sometimes hard for children who have ADHD to learn social skills. Reward good play behaviors.
• Set a homework routine. Pick a regular place for doing homework, away from distractions such as other people, TV and video games. Break homework time into small parts and have breaks.
• Focus on effort, not grades. Reward your child when he or she tries to finish school work, not just for good grades. You can give extra rewards for earning better grades.
• Talk with your child's teachers. Find out how your child is doing at school--in class, at playtime, at lunchtime. Ask for daily or weekly progress notes from the teacher.

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Will my child outgrow ADHD?
We used to think children would "grow out" of ADHD. We now know that is not true for most children. Symptoms of ADHD often get better as children grow older and learn to adjust. Hyperactivity usually stops in the late teenage years. But about half of children who have ADHD continue to be easily distracted, have mood swings, hot tempers and are unable to complete tasks. Children who have loving, supportive parents who work together with school staff, mental health workers and their doctor have the best chance of becoming well-adjusted adults

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FLU:

If you get the flu vaccine, or shot, it will protect you from getting a bad case of the flu. You either won't get the flu at all or, if you do get it, you will have only mild symptoms and you should get better pretty quickly. Like other shots, a flu shot is given using a needle. There's also a nasal mist flu vaccine, which is a spray that's squirted up your nose.
Whichever one you get, you need to get a new vaccine every year. Why? Because the flu virus changes every year and the vaccine is specially created to fight the viruses that are going to be a problem that year.

How Does the Flu Spread?
This virus gets around in little drops that spray out of an infected person's mouth and nose when he or she sneezes, coughs, or even laughs. You can catch the flu from someone who it if you breathe in some of those tiny flu-infected drops. You can also catch the flu if those drops get on your hands and you touch your mouth or nose. No wonder people are always saying to cover your mouth when you sneeze!

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What If You Get the Flu?
But even if you steer clear of sneezers and you wash your hands regularly, you still might get the flu. At the doctor's office, the doctor will ask you how you've been feeling and examine you. He or she might use a long cotton swab to get a sample of the gunk in your nose or throat. Testing this sample in a lab can determine, for sure, that you have the flu. But usually this isn't necessary. Based on your symptoms, your doctor can usually tell if you have the flu, especially during times when a lot of flu is going around your town.
Once your doctor says you have the flu, you can start taking these steps to feel better:

• Rest in bed or on the couch.
• Drink lots of liquids, like water, chicken broth, and other fluids.
• Take the medicine your mom or dad gives you to ease your fever, aches, and pains.
• Tell your mom or dad if you have trouble breathing, your muscles really hurt, or if you feel confused. These are signs you may need to see the doctor again.

Most of the time, you'll feel better in a week or two. Until then, you'll have to stay home from school and take it easy. We hope you're flu-free this year, but if you do get the flu, now you know what to do!
Uh-oh. Could you need another shot? Yes, but like all shots, this one can protect you from a pretty awful illness — the flu. In a healthy person, the flu causes a fever, body aches, and other cold-like symptoms. A person who has the flu will sleep a lot and feel sick, but will get better in 1 or 2 weeks.
The problem with the flu, also called influenza (say: in-floo-en-zuh), is that it makes some people really sick. They are less able to get well on their own so they may need to go to the hospital. That's why it's so important that certain people get a flu shot.

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Who Must Get a Shot?
Little kids — between the ages of 6 months and 5 years — need a flu shot. Older kids also need a flu shot if they have:

• heart or lung disorders, including asthma
• chronic diseases such as diabetes, kidney disease, certain kinds of anemia, or immune system problems, including HIV/AIDS

Kids also need the flu shot if they live with someone who could get very sick if they get the flu. This includes pregnant women and kids and grownups who have any of the health problems listed above. Little babies, especially ones who were born prematurely, and people older than 65 also should be protected from the flu. So, if there's a baby in your family or you live with a grandparent, you may need to take one for the team and get a flu shot! That way, they'll be protected.
But even if you don't fall into any of those categories, your doctor still might give you a flu shot. Why? Well, if you can avoid getting the flu, then you won't have to feel terrible and miss school.
Because the flu vaccine is grown inside eggs, some people should never get the flu shot or any other kind of flu vaccine (say: vak-seen). Kids who are allergic to eggs or have had allergic reactions to previous flu vaccines should not get one.

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One Shot Or Two?
If you're younger than 9 years old and have never had a flu shot before, you will need two shots a month apart. Everyone else needs only one shot each year. As with any shot, if you're scared, talk with your mom or dad about it. It might help to hold a parent's hand while you're getting the shot.
Some kids won't have to worry about a needle at all when they get their flu vaccine. Another type of flu vaccine uses a nasal spray (a mist that's squirted up your nose) instead of a shot. This type of vaccine contains live flu virus, though, and shouldn't be given to kids who have health problems — or even kids who live with people who could get very sick from the flu.

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When Do You Get a Flu Shot?
If you're getting a flu vaccine, it's best to get it in the fall, before "flu season." Flu season starts in November and usually ends in April. December, January, and February are typically the worst months for flu, when the most people have it and you're most likely to get it.
You may have heard about shortages of the flu shot in the past. This year, authorities expect there will be enough to go around. When shortages occur, health experts sometimes recommend a priority system. That means the people most in danger from the flu get their shots first and other people get theirs later.

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What's in a Flu Shot?
Influenza is a virus (say: vy-rus). The flu shot helps your body get ready to defend itself against that virus in case it tries to invade your body. The flu shot contains a small amount of dead, or killed, flu viruses. The flu shot won't give you the flu, but those dead viruses are enough to get your body's immune system ready to fight off the real flu when it comes around this winter.
The nasal spray does contain live flu virus, so some people who get this vaccine may get some mild flu-like symptoms. But it's still worth getting because just like the flu shot, the flu mist vaccine can keep you from getting a really bad case of the flu.

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New Year, New Shot
To be protected against the flu, you have to get a flu shot every year. Unlike some other illnesses, like chickenpox, the flu virus keeps changing. The vaccine needs to change to keep up with the type of flu that is expected to cause problems that year.
Each year, doctors and scientists who study the flu try to predict which virus will make people sick during the next flu season. Then they make the vaccine out of a mixture of the three most likely viruses.

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After the Shot
The flu shot is very safe, and most people have no problems with it. Occasionally, the spot where you got the shot might feel sore. After the flu shot, some people might feel achy or have a mild fever, but that's nothing like the flu, which can make you sick for 1 or 2 weeks.
Whether you get the flu shot or not, you can take an important step toward preventing the flu and other winter illnesses: Wash your hands regularly. When you do, you wash away those nasty germs that want to make you sick!

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Strep throat:

"It could be strep throat."
Have you ever heard a doctor or your mom say that when you're sick and you have a sore throat? Strep throat is a disease caused by tiny egg-shaped bacteria (say: bak-teer-ee-uh) called Group A streptococci (say: strep-toe-kah-kye). These bacteria cause 15% to 20% of all sore throats and are found in your throat and on your skin.

If a kid has strep throat, the doctor will probably give him or her medicine called antibiotics. These kill the strep bacteria. That's good news because sometimes strep throat can get worse and cause problems with other parts of a kid's body. In rare cases, untreated strep can cause arthritis (say: arth-rye-tus) or heart problems from a disease called rheumatic (say: roo-mah-tik) fever.
Most of the time kids get the medicine they need and recover from strep throat very quickly. After taking the medicine for 24 hours, you will feel a lot better and will no longer be contagious. However, it is really important to take all 10 days of the medicine to make sure you have treated the infection.

How Do I Get It?
If someone in your family or at school has strep throat, there is a chance you may get it. Strep throat is spread when healthy people come into contact with people who have it. When a person with strep throat sneezes or blows his or her nose and you are close by, or if you share the same forks, spoons, or straws, the bacteria can spread to you.
If you get strep throat, you will start to feel sick within 5 days after you have been around the person who gave it to you.

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What Will the Doctor Do?
Your doctor will look into your mouth to see if your throat is red and your tonsils are swollen and covered with white or yellow spots. He or she will also look for small red spots on the roof of your mouth. Most of the time, strep will give you a sore throat, headache, stomach ache, and fever. Typically strep will not give you a runny nose or cough, and occasionally it won't give you any specific symptoms.
To prove that what you have is strep throat, your doctor may do one or two tests. First he or she can do a rapid strep test to check for strep bacteria. He or she will rub a cotton swab over the back of your throat. With this test, the doctor may be able to find out in less than 1 hour if you have strep throat.
If the first test doesn't prove anything, then your doctor may do a longer test called a throat culture. A swab from your throat will then be rubbed on a special dish and the dish will be left to sit for two nights. If you have strep throat, streptococci bacteria will usually grow in the dish within the next 1 to 2 days.

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How Can I Get Better?
If you have strep throat, your doctor will give you an antibiotic (say: an-tye-bye-ah-tik), a medicine that kills bacteria. Usually the antibiotic used for strep throat is a form of penicillin (say: peh-nuh-sih-lun). You will take penicillin as a pill, a liquid, or a shot.
To make sure the bacteria go away completely and don't spread to other parts of your body, you must finish all of the medicine. Your doctor will have you take the pills or liquid for about a week.
Your mom or dad may give you acetaminophen (say: uh-see-tuh-mih-nuh-fun) to get rid of aches, pains, and fever. You'll want to have soothing drinks, like tea and warm chicken soup. It's best to avoid spicy and acidic foods, such as orange juice, because they could irritate your tender throat.
Your doctor will tell you to stay home from school until you have been taking the antibiotic for at least 24 hours. This way, you won't spread the bacteria to others.

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How Can I Prevent Strep Throat?
If someone in your house has strep throat, you might get it. But you can take these steps to prevent it:

• Make sure the person with strep throat covers his or her mouth when sneezing and coughing.
• Don't handle used tissues or other germy items.
• Wash your hands regularly, especially before cooking and eating.
• Wash dishes, drinking glasses, knives, forks, and spoons in hot, soapy water.
• Keep sores and cuts clean because strep can get in there and cause problems, too.

Strep throat is no fun, but after feeling sick for 2 or 3 days, most kids start feeling better. In other words, they feel less streppy and more peppy!

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What types of OTC cough medicines are available?
Over-the-counter (OTC) drugs are medicines you can buy without a doctor’s prescription. OTC cough medicines are grouped into two types: antitussives and expectorants.

Antitussives are cough suppressants. They relieve your cough by blocking the cough reflex. Dextromethorphan (some brand names: Triaminic Cold & Cough, Robitussin Maximum Strength, Vicks 44 Cough Relief) is a commonly used antitussive.

Expectorants thin mucus. This may make coughing work better to clear the mucus from the airway. The only expectorant available in OTC products is guaifenesin (two brand names: Mucinex, Robitussin).

Dextromethorphan and guaifenesin are sometimes combined with each other (one brand name: Robitussin DM). They are also available in combination with other drugs, such as pain relievers, decongestants or antihistamines. These combination products, such as multisymptom cold medicines, are meant to treat many symptoms at once. However, if your main symptom is cough, be careful of the drying effect of antihistamines and decongestants in combination medicines. This effect can make mucus thicker and harder to clear from the airways, which can make a cough worse.

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Should I treat a cough?
Most of the time, a cough doesn’t require treatment. It will go away on its own. Cough medicines may be helpful if your cough is caused by a cold or the flu (influenza). Some types of cough should not be treated with cough medicines because the cough is helping to keep the lungs clear so you can breathe. Examples include cough from smoking, emphysema, asthma or chronic bronchitis.
What are some common side effects of OTC cough medicines?
Side effects from OTC cough medicines aren’t common for healthy adults. Side effects may be a concern for people who have health problems, are elderly or use cough medicines for long periods of time.

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Can OTC cough medicines cause problems with any other medicines I take?
If certain drugs are used at the same time, the way your body processes them can change. When this happens, your risk of side effects increases.

Talk to your doctor or pharmacist before taking dextromethorphan if you take a monoamine oxidase inhibitor (MAOI). This is a type of prescription drug used to treat depression and other conditions. MAOIs include isocarboxazid (brand name: Marplan), phenelzine (brand name: Nardil), selegiline (brand names: Eldepryl, Carbex) and tranylcypromine (brand name: Parnate). Dextromethorphan interferes with the way MAOIs work. Dextromethorphan may cause problems while you are taking an MAOI or within two weeks of taking one.

Cough medicine is often combined with decongestants, antihistamines and/or pain relievers. If you take one of these combination medicines, it’s important to understand each of the active ingredients and the interactions they may have with other drugs you’re taking.

Be sure not to “double up” on cough medicine. Many OTC cold and allergy products contain cough medicine, as do some prescription drugs. If you take more than one of these products, you can take more cough medicine than you intend.

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Are there other reasons I should talk to my doctor before taking a cough medicine?
Talk to your doctor before taking cough medicine if you have any of the following symptoms:

• Coughing up mucus or phlegm
• Wheezing when you cough or breathe (you’ll hear a squeaky or musical sound in your chest). This may mean you need a prescription medicine to treat inflammation (swelling) and narrowing of your airways
• A chronic (ongoing) cough, such as from smoking, asthma, chronic bronchitis or emphysema

Stop taking cough medicine and call your doctor if your cough lasts for more than 1 week, if it keeps coming back, or if you also have a fever, rash or ongoing headache. These could be signs of a more serious problem.

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What should I look for on the drug label?

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Questions about Diet:

When can I introduce soymilk and other soy foods to my baby?
Your baby, up until approximately 6 months of age, will thrive solely on breast milk or a suitable infant formula. At around 6 months, you should start your baby on mashed foods and pureed foods such as vegetables, fruits, rice cereal and iron rich foods. Soymilk should not replace breast milk or infant formula while the child is less than 12 months of age. Small amounts of soymilk, however, can be used in cooking dishes such as custards and white sauces. From 12 mDionths of age, your baby can enjoy the same meals that the rest of the family is eating and breast milk or infant formula can be replaced with a full fat soymilk that is enriched with calcium.

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How much fluids does my child require?
Water is essential for life and the most natural and effective thirst quencher. Hydration is important to help blood function efficiently and circulate nutrients and eliminate waste in the body. It also helps maintain a healthy body temperature- this is especially important living in Dubai’s climate and with active children. Always encourage your child to drink plenty of water rather than allowing them to over-consume drinks which are high in energy from refined sugars. Children require between 1-1 ½ Liters (33-50 ounces) of fluids each day depending on their age and physical activity.

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What is the main change I need to make to my diet to help lower my blood cholesterol?
To reduce your blood cholesterol levels, you need to replace much lof the saturated (bad) fats in your diet with polyunsaturated and monounsaturated (good) fats. Examples of polyunsaturated fats are oils such as safflower and soybean plus many margarines these days are made of these oils, nuts, seeds and “oily fish” such as sardines and salmon. Monounsaturated fats are found in oils such as olive oils and avocado. Remember, however, that all fats contain the same amount of kilojoules (calories). So if you need to watch your weight, limiting concentrated sources of fat in your diet is important.

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After Hours AND HOUSE CALL
The doctors take emergency calls from their homes after hours. Call the main office number, and our answering service will page a doctor to call you back. Please save routine questions (mild illness, appointments, prescription refills) for the morning. We encourage you to refer to our website first, when practical, before calling the doctor.

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Appointments
To help provide timely service to our patients, we prefer to schedule all visits. If you are later than 15 minutes for your appointment, we will try to work you back into the schedule, or perhaps offer an appointment to you with another provider. Out of courtesy to our other patients, we may be forced to ask you to reschedule your appointment.

Occasionally, despite our best efforts, we may run late. We will keep you informed so that you have the option of rescheduling your appointment or seeing another provider, if available.

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Sick Child Visits
We make every effort to schedule appointments for ill children on the day that you call us. Please call our office ahead of time so that we can minimize the time that you will spend waiting. If you have a medical emergency during office hours, we will do our best to see your child immediately or refer you to the appropriate facility.

Two or more children: If you would like us to see more than one child, please schedule both of them when you make your appointment. Without an appointment, we may not be able to see a sick sibling right away, and you may be asked to wait while the provider sees a scheduled patient who may be waiting.

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Walk-Ins
Patients who "walk in" with a non-emergency condition will be fit into the existing schedule as best as possible, or they will be asked to return later in the day when the schedule allows.

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Emergencies
If an emergency should arise, please call the emergency department at the nearest hospital. Emergencies are considered to be those conditions that are life-threatening: loss of consciousness, severe bleeding, seizure, etc. In the case of minor emergencies (lacerations, cuts, mild fractures, sprains), please call our office first for instructions.

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Well Child Visits
To keep your children healthy, it is important to bring them in for regular checkups. We recommend that you call 2 month(s) in advance so you may choose the date that best fits your needs.

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