Insulin resistance occurs when the body doesn't respond as well to insulin. Insulin, a hormone, is made by the pancreas and allows the body to process glucose, the main type of sugar in the blood. When a person has insulin resistance, glucose is less able to enter the cells and supply energy to the body. Insulin resistance is a problem because it has been linked to the development of type 2 diabetes, as well as a number of other health problems including high blood pressure and heart disease.

In adults, having a lot of fat in the abdomen and a large waist size has been linked to insulin resistance. To help understand the risk of insulin resistance in kids, researchers from the University of Buenos Aires in Argentina studied 84 6- to 13-year-olds. The kids were weighed and had their heights and waist sizes measured. In addition, each child underwent blood tests, blood pressure measurements, and tests to measure the body's ability to process glucose.

Forty of the children in the study were overweight (in the 95th percentile or above in weight for height); 28 of the children in the study were at risk for overweight (between the 85th and 94th percentile in weight for height); and 16 of the children in the study were not overweight or at risk for overweight.

Kids who had larger waistlines tended to have:

* higher blood pressure measurements

* abnormal cholesterol levels

* higher levels of triglycerides, another type of blood fat linked to heart disease

* a higher risk of insulin resistance

Even after the researchers took into account a kid's height and weight, children with larger waistlines still had a higher risk of insulin resistance.

What This Means to You: Insulin resistance has been linked to the development of type 2 diabetes and heart disease. According to the results of this study, waist measurements could help to identify kids at greater risk for developing insulin resistance.

Children who have insulin resistance are often overweight and may not get much physical activity, but the good news is that eating healthy foods and portion sizes, engaging in regular physical activity, and getting to a healthy weight may help some kids reverse their insulin resistance. If you have questions about your child's weight or insulin resistance, talk to your child's doctor. He or she may recommend that you talk to a registered dietitian if your child needs help managing his or her weight.

Teaching Your Child How to Use 911

One of the challenges you have as a parent is to help your child acquire the skills to work through whatever obstacles life presents. Teaching your child how to use 911 in an emergency could be one of the simplest - and most important - lessons you'll ever share.

Talking About 911 With Your Child

Not that many years ago, there was a separate telephone number for each type of emergency agency. For a fire, you called the fire department number. For a crime, you called the police. For a medical situation, you phoned the ambulance or doctor.

In 1968, the U.S. government worked with the phone company to establish 911 as a central number for all types of emergencies. An emergency dispatch operator quickly takes information from the caller and puts the caller in direct contact with whatever emergency personnel are needed, thus making response time quicker.

According to the National Emergency Number Association, 911 covers nearly all of the population of the United States. Check your phone book to ensure that 911 is the emergency number you should use in your area.

Everyone needs to know about calling 911 in an emergency. But children in particular need specifics about what an emergency is. Asking your child, "What would you do if we had a fire in our house?" or "What would you do if you saw someone trying to break in?" gives you a chance to discuss what constitutes an emergency and what should be done if one occurs. Role playing is an especially good way to address various emergency scenarios and give your child the confidence he or she will need to handle them.

For younger children, it might also help to talk about who the emergency workers are in your community - police officers, firefighters, paramedics, doctors, nurses, and so on - and what kinds of things they do to help people who are in trouble. This will paint a clear picture for your little one of not only what types of emergencies can occur, but also who can help.

When to Call 911

Learning what is an emergency goes hand in hand with learning what isn't. A fire, an intruder in the home, an unconscious family member - these are all things that would require a call to 911. A skinned knee, a stolen bicycle, or a lost pet wouldn't. Still, teach your child that if ever in doubt and there's no adult around to ask to always make the call. It's much better to be safe than sorry.

Make sure your child understands that calling 911 as a joke is a crime in many places. In some cities, officials estimate that as much as 75% of the calls made to 911 are nonemergency calls. These are not all pranks. Some people accidentally push the emergency button on their cell phones. Others don't realize that 911 is for true emergencies only. That means it's not for such things as a flat tire or even about a theft that occurred the week before.

Stress to your child that whenever an unnecessary call is made to 911, it can delay a response to someone who actually needs it. Most areas now have what is called enhanced 911, which enables a call to be traced to the location from which it was made. So if someone dials 911 as a prank, emergency personnel could be dispatched directly to that location. Not only could this mean life or death for someone having a real emergency on the other side of town, it also means that it's very likely the prank caller will be caught and punished.

How to Use 911

Although most 911 calls are now traced, it's still important for your child to have your street address and phone number memorized. Your child will need to give that information to the operator as a confirmation so time isn't lost sending emergency workers to the wrong address.

Make sure your child knows that even though he or she shouldn't give personal information to strangers, it's OK to trust the 911 operator. Walk him or her through some of the questions the operator will ask, including:

Where are you calling from? (Where do you live?)

What type of emergency is this?

Who needs help?

Is the person awake and breathing?

Explain to your child that it's OK to be frightened in an emergency, but that it's important to stay calm, speak slowly and clearly, and give as much detail to the 911 operator as possible. If your child is old enough to understand, also explain that the emergency dispatcher may give first-aid instructions before emergency workers arrive at the scene.

Make it clear that your child should not hang up until the person on the other end says it's OK, otherwise important instructions or information could be missed.

More Safety Tips

Here are some additional safety tips to keep in mind:

Always refer to the emergency number as "nine-one-one" not "nine-eleven." In an emergency, your child may not know how to dial the number correctly because of trying to find the "eleven" button on the phone.

Make sure your house number is clearly visible from the street so that police, fire, or ambulance workers can easily locate your address.

If you live in an apartment building, make sure your child knows the apartment number and floor you live on.

Keep a list of emergency phone numbers handy near each phone for your children or babysitter. This should include police, fire, and medical numbers (this is particularly important if you live in one of the few areas where 911 is not in effect), as well as a number where you can be reached, such as your cell phone, pager, or work number. In the confusion of an emergency, calling from a printed list is simpler than looking in the phone book or figuring out which is the correct speed-dial number. The list should also include known allergies, especially to any medication, medical conditions, and insurance information.

If you have special circumstances in your house, such as an elderly grandparent or a person with a heart condition, epilepsy, or diabetes living in your home, prepare your child by discussing specific emergencies that could occur and how to spot them.

Keep a first-aid kit handy and make sure your child and babysitters know where to find it. When your child is old enough, teach him or her basic first aid.

Whooping cough (pertussis)

Reviewed by Dr John Pilinger, GP

What is whooping cough?

Whooping cough (pertussis) is still a very serious disease when it occurs in children under the age of one year old. But thanks to an effective vaccine and prevention against infection, it is now quite rare.

Whooping cough is a very serious disease when it occurs in children aged under one year.

Before the vaccination against whooping cough was introduced, three out of four children caught the disease and some died every year. Today only a few get whooping cough.

What causes whooping cough?

Whooping cough is caused by a bacteria (Bordetella pertussis) and is one of the most contagious bacterial infections. If one child in a group of siblings gets it, the other children are extremely likely to become infected if they have not already had the disease or been vaccinated.

This also includes babies. Although infants who are breastfed are usually protected against most common childhood infections, they receive no protection against whooping cough. This is why early vaccination is recommended.

Children with a cold or cough should be kept away from non-vaccinated children as well as women in labour and newborn babies.

How is whooping cough contracted?

The infection is transferred through airborne droplets when an infected person coughs. Anyone who has not been vaccinated is highly likely to contract the disease just by spending time in the same room as an infected person.

Anyone who has been vaccinated or has suffered from whooping cough will have a degree of immunity to the disease. They may contract a mild case some years later but this will not develop into a full-blown attack.

The incubation period - the time between contracting the infection and the appearance of the main symptoms - can vary from 5 to 15 days or even longer.

Whooping cough is infectious from the first sneezes and throughout the course of the disease, which can last for up to eight weeks. This is a much longer period than with other children's diseases.

What are the symptoms of whooping cough?

The disease begins with a cold and a mild cough. After this, the typical coughing bouts set in. The coughing continues until no air is left in the lungs. After this comes a deep intake of breath that produces a heaving, 'whooping' sound when the air passes the larynx (windpipe) that gives rise to the name of the disease.

The patient will eventually cough up some phlegm and these attacks may well be followed by vomiting. The child's temperature is likely to remain normal.

A bout of whooping cough can be very distressing for both the child and the parents who feel unable to help.

Coughing attacks may occur up to 40 times a day and the disease can last for up to eight weeks.

How does the doctor make the diagnosis? The diagnosis is usually made from the symptoms and the history of contact with a person suffering from whooping cough. In case of doubt, the doctor can take swabs from the nose and throat for analysis and have the results in about five days.

Complications While whooping cough is very unpleasant, there may also be other complications, such as bronchitis, pneumonia and ear infections. These complications may cause a high temperature, and change the course of the disease. If one or more of these problems occur, they will usually be treated with antibiotics.

How is whooping cough treated? Most cases of whooping cough require no specific treatment. Infants and small children with other conditions such as asthma require constant monitoring which, at least for a while, is best done in a hospital. The effect of antibiotics is uncertain but they are sometimes used in the early period of the disease.

Vaccination is recommended.

How does one prevent the infection?Just as important as the vaccination, is the necessity to prevent the infection spreading especially to small children. This is especially important for children in nursery school.

If there are infected children in childcare, other infants under the age of one year should not be admitted unless they have had whooping cough or have been vaccinated against it twice, with a period of four weeks between vaccinations.

If the children are more than one year old they may be admitted even if they have not had the disease themselves or been vaccinated. But the parents must be informed of the danger of infection.

If whooping cough occurs at home, no special measures are necessary.

Which medicine can be used?There is no medical treatment against whooping cough as such. However, the infectious period may be reduced by giving certain antibiotics (eg erythromycin).

Who should be vaccinated?The vaccination takes place at the age of two, three and four months as part of the 'triple' Diphtheria-Tetanus-Pertussis (DTP) immunisation. After the first two vaccinations protection is almost 100 per cent. (DTP is now routinely combined with vaccination against Haemophilus influenzae in the UK.)

It is advisable that all children should be vaccinated against whooping cough, as it is important to prevent this dangerous disease.

Based on a text by Dr Hanne Korsholm

Last updated 01.02.2002

FDA Warns Against Codeine for Mothers of Nursing Infants

Emma Hitt, PhD

August 17, 2007 — Medications containing codeine given to breast-feeding mothers who rapidly metabolize codeine into morphine may cause adverse effects in their infants, according to an alert sent today from MedWatch, the US Food and Drug Administration (FDA) adverse event and reporting program.

Codeine is generally considered safe for use in nursing mothers; however, last year, a healthy 13-day-old breast-fed infant died from very high levels of morphine received through breast milk. The mother was taking codeine at a dose lower than that usually prescribed for episiotomy pain, but genetic testing revealed that the infant's mother was an ultrarapid metabolizer of codeine.

According to the FDA, depending on ethnicity, approximately anywhere from 1 to 28 per 100 individuals rapidly metabolize codeine. Genetic testing is the only way to determine whether someone is a rapid metabolizer; an FDA-cleared test for determining a patient's CYP2D6 genotype is available, but there is limited information about using this test to characterize codeine metabolism. In addition, the test result is insufficient in predicting whether too much morphine will be passed along in a mother breast-feeding an infant.

The FDA recommends that patients be made aware of the signs of morphine overdose. Patients should be told to contact their clinician if a baby shows signs of increased sleepiness (ie, sleeping for more than 4 hours at a time), limpness, or difficulty nursing or breathing.

Healthcare professionals and nursing mothers should report adverse effects that occur while using codeine to the FDA's MedWatch adverse event reporting program by phone at 1-800-332-1088.

Circumcision

Whether you're expecting a baby boy or have just welcomed your new little guy into the world, you have an important decision to make before you take your son home: whether to circumcise him.

For some families, the choice is simple because it's based on cultural or religious beliefs. But for others, the right option isn't as clear-cut. Before you make a circumcision decision, it's important to talk to your child's doctor and consider some of the issues.

What Is Circumcision?

Boys are born with a hood of skin, called the foreskin, covering the head (also called the glans) of the penis. In circumcision, the foreskin is surgically removed, exposing the end of the penis.

Approximately 65% of all newborn boys - about 1.2 million babies - are circumcised in the United States each year. The procedure is much more widespread in the United States, Canada, and the Middle East than in Asia, South America, Central America, and most of Europe, where it's uncommon.

Parents who choose circumcision often do so based on religious beliefs, concerns about hygiene, or cultural or social reasons, such as the wish to have their son look like other men in the family.

If you do opt for circumcision, it's best to perform the operation within the first 2 to 3 weeks after birth, as it can become more complicated as a child gets older. But the procedure is usually performed during the first 10 days (often within the first 48 hours), either in the hospital or, for some religious ritual circumcisions, at home. If you decide to have your son circumcised at the hospital, your pediatrician, family doctor, or obstetrician will perform the procedure before you bring your baby home. The doctor should prepare you by telling you about the procedure he or she will use and the possible risks.

In some instances, doctors may decide to delay the procedure or forgo it altogether. Premature babies or those who have special medical concerns may not be circumcised until they're ready to leave the hospital. And babies born with physical abnormalities of the penis that need to be corrected surgically often aren't circumcised at all because the foreskin may eventually be used as part of a reconstructive operation.

The Pros and Cons

On the plus side, studies indicate that circumcised infants are less likely to contract a urinary tract infection (UTI) in the first year of life. About one out of every 1,000 circumcised boys has a UTI in the first year, whereas the rate is one in 100 (at most) for uncircumcised infants.

Circumcised men may also be at lower risk for penile cancer, although the disease is rare in both circumcised and uncircumcised males. Although some studies indicate that the procedure might offer an additional line of defense against sexually transmitted diseases (STDs), particularly HIV, the results of studies in this area are conflicting and difficult to interpret.

It's also easier to keep a circumcised penis clean, although uncircumcised boys can learn how to clean beneath the foreskin once the foreskin becomes retractable (usually some time before age 5). However, some uncircumcised boys can end up with infected foreskins as the result of poor hygiene.

Some people also claim that circumcision either lessens or heightens the sensitivity of the tip of the penis, decreasing or increasing sexual pleasure later in life. But neither of these subjective findings has been proven to be true.

Although circumcision appears to have some medical benefits, it also carries potential risks - as does any surgical procedure. These risks are small, but you should be aware of both the possible advantages and the problems that can be associated with the procedure before you make your decision. Complications of newborn circumcision are uncommon, occurring in between 0.2% to 3% of cases. Of these, the most frequent are minor bleeding and local infection, both of which can be easily treated by your child's doctor.

Perhaps one of the hardest parts of the decision to circumcise is accepting that the procedure can be painful. In the past, it wasn't commonplace to provide pain relief for babies being circumcised, but because studies have indicated that it benefits the infant to receive anesthesia, most doctors will now provide it. Also, the American Academy of Pediatrics (AAP) recommends the use of pain relief measures for circumcision. Even up until recently, though, anesthesia hasn't been universally used, so it's important to ask your doctor ahead of time what, if any, pain relief will be utilized with your son.

Two primary forms of local anesthetic are used to make the operation less painful for your baby:

* a topical cream (a cream put on the penis) that requires at least 20 to 40 minutes to take its full effect

* an injectable anesthetic that requires less time to take effect and may provide a slightly longer period of anesthesia

Besides anesthesia, giving a pacifier dipped in sugar water can help reduce your baby's level of stress (and yours). Used together, these methods can decrease your baby's discomfort by more than 50%.

Caring for a Circumcised Penis

Whether you choose circumcision or not, it's important to keep your son's penis clean. It should be washed with soap and warm water every time you bathe him. And you don't need to use cotton swabs, astringents, or any special bath products.

There are also no special washing precautions with newly circumcised babies, other than to be gentle, as your baby may have some mild discomfort after the circumcision. If your son has a bandage on his incision, you might need to apply a new one whenever you change his diaper for a day or 2 after the procedure (put petroleum jelly on the bandage so it won't stick to his skin). Doctors often also recommend putting a dab of petroleum jelly on the baby's penis or on the front of the diaper to alleviate any potential discomfort caused by friction against the diaper.

How you take care of your baby's penis may also vary depending on the type of circumcision procedure your child's doctor performs. Be sure to talk to him or her about what aftercare will be needed.

It usually takes between 7 to 10 days for a penis to heal. Until it does, the tip may seem raw or yellowish in color. Although this is normal, certain other symptoms are not. Call your child's doctor right away if you notice any of the following:

* persistent

* bleeding redness around the tip of the penis that gets worse after 3 days

* fever signs of infection, such as the presence of pus-filled blisters

* not urinating normally within 6 to 8 hours after the circumcision

However, with quick intervention, almost all circumcision-related problems are easily treated.

Caring for an Uncircumcised Penis

As with a penis that's circumcised, an uncircumcised one should be kept clean. Also, no cotton swabs, astringents, or any special bath products are needed - simple soap and warm water every time you bathe your baby will suffice.

However, you should never forcibly pull back the foreskin to clean beneath it. Instead, gently tense it against the tip of the penis and wash off any smegma (the whitish "beads" of dead skin cells mixed with the body's natural oil). Over time, the foreskin will retract on its own so that it can be pulled away from the glans toward the abdomen. This happens at different times for different children, but most boys can retract their foreskins by the time they're 5 years old.

As your son grows up, teach him to wash beneath the foreskin by gently pulling it back from the glans, rinsing the glans and the inside of the foreskin with soap and warm water, then pulling the foreskin back over the head of the penis.

Making a Circumcision Decision

In addition to the medical issues discussed, religious and cultural beliefs often figure into the equation. Of course, if these are important to you, they deserve to be seriously considered.

Despite the possible benefits and risks, circumcision is neither essential nor detrimental to a boy's health. The AAP and the American Academy of Family Physicians (AAFP) do not endorse the procedure as a way to prevent any of the medical conditions mentioned previously. The AAP also does not find sufficient evidence to medically recommend circumcision or argue against it.

Talk to your child's doctor about the pros and cons of circumcision to help you make the choice that's right for your son.

Updated and reviewed by: Barbara P. Homeier, MD

Date reviewed: January 2005

Originally reviewed by: Steven Dowshen, MD

Study: Circumcision Protects Against AIDS

Fri Mar 26, 3:28 PM ET By ROBERT BARR, Associated Press Writer

LONDON - A new study found that uncircumcised men were nearly seven times more likely to get the AIDS (news - web sites) virus, giving further support to findings that circumcision .

The study by Robert C. Bollinger and colleagues from Johns Hopkins University Medical School and the National AIDS Research Institute in Pune, India, was published Friday as a "research letter" in The Lancet medical journal.

"It is now about the ninth study which followed men who are HIV (news - web sites)-negative over a period of months or years. It is the ninth study in a row which has found that the effect (of circumcision) is significant," said Robert C. Bailey, professor of epidemiology and biostatistics at the University of Illinois at Chicago, who was not connected with Bollinger's study.

"The fact that they found no behavioral differences between the two groups is all the more compelling, and indicates that there is a biological factor," Bailey said in a telephone interview.

Bailey, like the authors of the Lancet study, believe that cells in the foreskin may be particularly susceptible to infection.

The association between circumcision and a reduced risk of HIV was noted as early as 1987, when Dr. William Cameron of the University of Manitoba in Canada reported findings from a study in Kenya.

The research published in The Lancet tracked 2,298 men who were being treated at three clinics in Pune, and who were confirmed to be HIV-negative at the start of the study.

The study also found that circumcised men were as much at risk of gonorrhea, herpes simplex and syphilis as the uncircumcised.

The nine studies have all tried to control for variables in behavior, Bailey said. "A randomized control trial is what is necessary now to really nail this down," he said.

Two-Year-Olds Mimic Parents' who smoke and drink

TUESDAY, Sept. 6 (HealthDay News) -- Parents, your children are watching: A new study finds that even 2-year-olds are more likely to "smoke" and "drink" during pretend play if their parents smoke and drink regularly.

Toddlers were also more like to mimic these dangerous adult activities if they were regularly exposed to PG-13 or R-rated movies, the researchers found.

It's not news that parental habits can influence their offspring's smoking and drinking habits, said lead researcher Madeline Dalton, director of the Hood Center for Children and Family Community Health Research Program at Dartmouth Medical School, Lebanon, N.H.

"What is new in this study is really the age," she said.

"Lots of people have looked at the social influences of tobacco and alcohol use. Parental smoking and alcohol use are potent predictors of kids' use," she said, noting that that's been long known for teens. "What we wanted to do was to start looking at younger children."

Reporting in the September issue of the Archives of Pediatrics and Adolescent Medicine, Dalton's team observed 120 children, aged 3 to 6, playing with two dolls. The child was asked to pretend to be one of the dolls while the researcher pretended to be the other doll.

The child was told to pretend he or she was the host and had invited the other doll over to watch a movie and have something to eat.

When the researcher-friend said there was nothing to eat, the child was invited to shop at a doll grocery store as researchers recorded the purchases.

For experiments involving 2-year-olds, the child was simply given one doll and told to take her shopping.

In all, 28 percent of the children bought cigarettes while 61 percent bought alcohol on these "shopping trips." The researchers then compared those buying habits with information they had gathered on the parents' smoking, drinking and movie-viewing habits.

They found that children were nearly four times as likely to buy cigarettes if their parents smoked, and three times as likely to choose wine or beer if their parents drank alcohol at least once a month.

Kids who were allowed to view PG-13 or R-rated movies were five times as likely to choose wine or beer while shopping than kids restricted to watching G-rated movies. According to the researchers, images of drinking adults seen in adult-rated films may be influencing these pro-alcohol "buying" decisions in youngsters.

The study is the first to show that preschoolers have what Dalton calls "social cognitive scripts" of adult social life -- behaviors perceived to be appropriate.

Some of the children even recognized specific brand names of cigarettes, the researchers found, because of the brands their parents smoked. Others role-played the lighting of cigarettes or pouring drinks.

The study findings don't surprise Danny McGoldrick, research director of the Campaign for Tobacco-Free Kids.

"It's an interesting study," he said. "I think it really just points to the social environment that kids grow up in. You see these ads that say 'Talk to Your Kids' [about not smoking]. But the best thing parents can do is not smoke themselves. Smoking has a huge impact on kids, not just with secondhand smoke but with role modeling."

If parents can't quit, McGoldrick said, they should, "at least make the home smoke-free."

The research was an eye-opener for Dalton on a professional and personal level. "It's never too early to talk to your kids about alcohol and cigarettes," she said.

"Certainly there are many instances where it is socially appropriate to use alcohol," she said, "but we need to counterbalance that with a clear message about not misusing it."

Dalton said she realized her habit of offering guests wine or beer when they arrive at her home was giving the wrong message to her young children. "Now, when I have guests, I ask, 'Can I get you something? We have water, we have juice, milk, soda, beer or wine.' Just so [her kids know] it's socially appropriate to choose something else."

Sinusitis Can Strike Kids, Too

It could be the common chronic problem of sinusitis, a condition that is usually associated with adults.

"It is as common in children as in adults, and when sinus problems get worse, asthma and bronchial problems get worse," says Dr. Jordan Josephson, a New York City otolaryngologic surgeon who specializes in pediatric care.

Kids can be particularly susceptible to sinus problems because their sinuses aren't fully formed until age 12, and their sinuses are narrower than an adult's.

If you factor in any allergies a child might have -- as well as environmental triggers like secondhand smoke, air pollution and exposure to bacteria -- that child's susceptibility to sinusitis increases, Josephson says.

Telltale signs of possible sinusitis in a child include a frequent runny nose with yellow mucus, pain near the cheeks or eye areas, and difficulty staying awake in school, Josephson says.

Sinusitis in children -- as well as adults -- can also produce emotional troubles like irritability and a general unhappiness. But a child is often unable to convey this sense of discomfort to a doctor, says Dr. Alexander Chester, an internist at Georgetown University Medical Center.

"It can be really tough for kids who feel poorly but whose illness is not validated by doctors or parents," he says. "A doctor looks at a kid with a runny nose and listlessness and basically tells him to shape up."

Sinusitis is characterized by inflammation of the nasal passages. It can be caused by any number of problems, from a cold to allergies to an infection, doctors say. The inflammation narrows the nasal passages so mucus can't drain properly, causing discomfort and sometimes infection.

Left untreated, sinusitis can become chronic, lasting for anywhere from three to eight weeks, to months or even years, according to the National Institute of Allergies and Infectious Diseases.

Statistics on the prevalence of sinusitis in children are hard to come by. But the National Center for Health Statistics reports that the condition affects about 32 million American adults a year, or approximately 16 percent of the adult population.

Parents should be alert to potential sinusitis symptoms in their children and get them to the doctor.

"If a cold lasts for 72 hours or less, it's nothing to worry about," says Josephson. "But if a child has a runny nose all the time and is home sick once a month, if he's falling asleep in school, getting bad grades or taking his hand and rubbing it up his nose because he can't get relief, you shouldn't dismiss these symptoms."

A pediatrician can prescribe a nasal spray and/or antibiotics if there is a bacterial infection, Josephson says.

"If after two to four weeks the child isn't better, he or she needs to see a specialist," he adds.

An otolaryngologist will examine the child in the same way an adult is examined, using CAT scans and maybe an endoscopy. This is a procedure where the doctor, using a slim tube with a camera at the end, can look directly at the sinus passages. Pediatric otolaryngologists have a smaller pediatric endoscope for this purpose, Josephson says. These tests allow the doctor to check for polyps, which can block the nasal passages, or anatomical abnormalities that constrict the natural flow of mucus.

While surgery is rarely performed on children, specialists typically recommend a longer course of antibiotic treatment, usually for a three- to eight-week period, Josephson says.

"Parents are resistant to the idea of an antibiotic for a long period of time," he says. "They often don't want to give kids antibiotics for more than 10 days. But living with an infection for a year isn't good, either. There could be polyp formation and long-term effects of doing poorly in school."

Growing Pains

Your 8-year-old son wakes up crying in the night complaining that his legs are throbbing. You rub them, and soothe him as much as you can, but are uncertain about whether to give him any medication or take him to the doctor. Sound familiar? Your child is probably experiencing growing pains, a normal occurrence in about 25% of children. Read below to find out more about this common problem.

Diagnosis

Growing pains generally strike during two periods: in early childhood among 3- to 5-year-olds and later on in 8- to 12-year-olds. They are what doctors call a diagnosis of exclusion. This means that other conditions should be ruled out before a diagnosis of growing pains is made. A thorough history and physical examination by your child's doctor can usually accomplish this. In rare instances, blood and X-ray studies may be required before a final diagnosis of growing pains is made.

Causes

No firm evidence exists to show that growth of bones causes pain. The most likely causes of growing pains, therefore, are the aches and discomforts resulting from jumping, climbing, and running pursued by active children during the day. The pains can occur after a child has had a particularly athletic day.

Signs and Symptoms

Although growing pains often strike in late afternoon or early evening before bed, there are occasions when pain can wake a slumbering child. The intensity of the pain varies from child to child, and most kids don't experience the pains every day. "Growing pains are often intermittent, coming once a week or even more infrequently," says Dr. James White, a family practitioner.

Growing pains always concentrate in the muscles, rather than the joints. Most children report pains in the front of their thighs, in the calves, or behind the knee. While joints affected by more serious diseases are swollen, red, tender, or warm, the joints of children experiencing growing pains appear normal.

One symptom that doctors find most helpful in making a diagnosis of growing pains is how the child responds to touch while in pain. Children who have pain for a serious medical disease do not like to be handled, since movement tends to increase the pain. Children with growing pains respond differently; they feel better when they are held, massaged, and cuddled.

Treatment

Massage, stretching, heat, acetaminophen (Tylenol) or ibuprofen (Advil) may help to relieve the pain. Although the pains point to no serious illness, they can be upsetting to a child (or a parent!). Because a child seems completely cured of her aches in the morning, parents sometimes suspect that the child faked the pains. However, this usually is not the case. Support and reassurance that growing pains will pass as children grow up can help them relax.

When to Call Your Child's Doctor

Your child's doctor should be alerted if any of the following symptoms occur with your child's pain: persistent pain, swelling, or redness in one particular area or joint; fever; limping; unusual rashes; loss of appetite; weakness; tiredness; or uncharacteristic behavior. These signs do not accompany growing pains and may be an indication of a medical problem that needs attention. Pains or symptoms localized to the shoulders, arms, wrists, hands, fingers, neck, or back, or pain associated with a particular injury are not due to growing pains, and should be evaluated by a child's doctor.

Updated and reviewed by: Kim Rutherford, MD

Date reviewed: June 2001

Originally reviewed by: Steven Dowshen, MD, and Robert Cooper, MD

dehydration

Following a drinking schedule ensures that your children drink enough to stay hydrated without overdrinking.6 Kids should be well hydrated. For kids less than 90 lbs., it will help to drink 3-6 oz. of fluid one hour before activity. For kids more than 90 lbs., it will help to drink 6-12 oz. one hour before activity. For kids less than 90 lbs., drink 3-5 oz. every 20 minutes.

For kids more than 90 lbs., drink 6-9 oz. every 20 minutes. Drink to make up for any remaining fluid loss if a body weight deficit exists. In general, kids weighing less than 90 lbs. may need to drink up to 8 oz. per 1/2 lb. of weight loss and kids more than 90 lbs. may need 12 oz. per 1/2 lb. of weight loss in the first hour after activity. Learn to drink for individual needs. One kid-size gulp equals about 1/2 oz. of fluid.

When the body is low in fluids because a person is not drinking enough to replace what is lost through sweat.

Common warning signs of dehydration include:

thirst,

headache,

dizziness,

weakness,

irritability,

fatigue

nausea.

Children who are in the “tween” years can lose up to a quart of sweat during two hours of activity on a hot day.1,2

Children are more susceptible to heat illness than adults when active in hot weather.3 Why?

– Children produce more metabolic heat per pound of body weight during exercise. They also have a reduced sweating capacity, which lessens their ability to lose heat through sweat evaporation.3

– Like adults, children frequently do not have the physiological drive to drink enough water to replenish fluid loss during prolonged exercise.4

Think of fluids as essential safety equipment for sports, like a bike helmet or shin guards—always pack a squeeze bottle for your child’s practice or game.

Leading health professional organizations recommend kids drink at regular intervals, not just when thirsty. By the time thirst kicks in, they’re likely already dehydrated.

Following a drinking schedule ensures that your children drink enough to stay hydrated without overdrinking.6

Kids should be well hydrated. For kids less than 90 lbs., it will help to drink 3-6 oz. of fluid one hour before activity. For kids more than 90 lbs., it will help to drink 6-12 oz. one hour before activity.

For kids less than 90 lbs., drink 3-5 oz. every 20 minutes.

For kids more than 90 lbs., drink 6-9 oz. every 20 minutes.

Drink to make up for any remaining fluid loss if a body weight deficit exists. In general, kids weighing less than 90 lbs. may need to drink up to 8 oz. per 1/2 lb. of weight loss and kids more than 90 lbs. may need 12 oz. per 1/2 lb. of weight loss in the first hour after activity. Learn to drink for individual needs. One kid-size gulp equals about 1/2 oz. of fluid.

A study that offered active kids (ages 9-12) plain water, flavored water and a sports drink showed that they drank 90% more of the sports drink and stayed better hydrated than when drinking plain water.7

1 Iuliano, S. et al. Evaluation of the self-selected fluid intake practices by junior athletes during a simulated duathlon event. Int J Sports Nutr 8:10-23, 1998.

2 Meyer, F. et al. Sweat electrolyte loss during exercise in the heat: effects of gender and maturation. Med Sci Sports Exerc 24:776-781, 1992.

3 Bar-Or, O. Temperature regulation during exercise in children and adolescents. In: Gisolfi C, Lamb DR, eds. Perspectives in Exercise and Sports Medicine, II. Youth, Exercise and Sport. Indianapolis, IN: Benchmark Press; 1989, 335-367.

4 Rivera-Brown A., et al. Drink composition, voluntary drinking and fluid balance in exercising, trained, heat-acclimatized boys. J Appl Phys 86: 78-84, 1999.

5 Adapted from the 2000 National Athletic Trainers’ Association Position Statement: Fluid Replacement for Athletes, J Athletic Training 35(2): 212-224, 2000.

6 Adapted from the American Academy of Pediatrics Position Statement, Pediatrics 106: 158-159, 2000.

7 Wilk B. and Bar-Or, O. Effect of drink flavor and NaCl on voluntary drinking and hydration in boys exercising in the heat. J Appl Physiol, 80: 1112-1117, 1996.

8 Passe, D. et al. Impact of beverage acceptability on fluid intake during exercise. Appetite 35:219-225, 2000.

9 Epstein, Y. Exertional Heatstroke: Lessons we tend to forget. Am J Med Sports 2: 143-152, 2000.

10 Watts, S. Prevention and treatment of dehydration in athletes. Am J Med Sports 3:286-293, 2001.

* Scientifically formulated sports drink: a sports drink containing 5-8% carbohydrates (14g per 8oz.), at least 100mg sodium, at least 28mg potassium, no carbonation and no caffeine. (Maughan & Murray Sports Drink. Basic Science And Practical Aspects. Boca Raton: CRC PRESS, 2001, pp. 197-224.)

While water is readily available to most kids, research shows active kids don’t always drink enough water to stay fully hydrated.7

Juices have too many carbohydrates, so it takes longer for the fluid to be absorbed into the body.

A scientifically formulated sports drink* helps kids stay better hydrated7 because it:

- Replaces electrolytes active children lose through sweat, helping to maintain the right balance of fluids in the body;2

- Contains flavor and sodium to encourage drinking when active.7,8

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