Common Childhood Infections

My daughter has had one ear infection after another. When she gets an infection, she seems to have trouble hearing, but with medicine it always gets better. Still, I’m worried that these infections could lead to permanent hearing loss somewhere down the line. Could this happen?
– Yasmine

Ear infections are common in childhood. As with your daughter, some kids do have temporary hearing loss due to the build up of fluid in the middle ear, but it usually goes away with treatment.

It’s very rare, however, for kids to develop permanent hearing loss, even when they’ve had several ear infections. A child with frequent or chronic ear infections is at risk for permanent hearing loss only when damage has been done to the eardrum, the bones of the ear, or the hearing nerve.

Since your daughter’s hearing appears to return to normal after treatment for an ear infection, she’s probably not at risk for permanent hearing loss. But if you’re concerned, talk to your doctor about scheduling a hearing exam.

If your daughter’s ear infections continue to be a problem, the doctor might refer her to an otolaryngologist (ear, nose, and throat doctor), who may suggest ear tube placement to help reduce the number of ear infections she gets, and limit the hearing problems they may cause.

About Chickenpox

Chickenpox used to be a common childhood illness in the United States, especially in kids under age 12. It’s much rarer now, thanks to the varicella vaccine that’s given when kids are between 12 and 15 months old, followed by a booster shot at 4 to 6 years of age.

Caused by the varicella-zoster virus (VZV), chickenpox is very contagious. Kids who do get it might have an itchy rash of spots all over the body and flu-like symptoms. An infected child should stay home and rest until the rash is gone.

Kids can be protected by getting the vaccine, which greatly reduces their chances of getting chickenpox. And vaccinated kids who do get chickenpox tend to have milder cases and quicker recoveries compared with those who get it and weren’t immunized.

Symptoms

Chickenpox often starts with a fever, headache, sore throat, or stomachache. These symptoms may last for a few days, with the fever in the 101°-102°F (38.3°-38.8°C) range.

Chickenpox causes a red, itchy skin rash that usually appears first on the abdomen or back and face, and then spreads to almost everywhere else on the body, including the scalp, mouth, arms, legs, and genitals.

The rash begins as multiple small red bumps that look like pimples or insect bites, usually less than a quarter of an inch wide. They appear in crops over 2 to 4 days and develop into thin-walled blisters filled with fluid. The blister walls break, leaving open sores, which finally crust over to become dry, brown scabs. The rash is very itchy, and cool baths or calamine lotion may help to manage the itching.

A hallmark of chickenpox is that all stages (red bumps, blisters, and scabs) can appear on the body at the same time. The rash may be more extensive or severe in kids who have skin disorders like eczema or weak immune systems. Young kids tend to have a mild illness with fewer blisters than older children or adults.

In rare cases, serious bacterial infections involving the skin, lungs, bones, joints, and the brain can happen.

Risk of Shingles

Anyone who has had chickenpox is at risk for developing a skin condition called shingles (herpes zoster) later in life. After someone has had chickenpox, the virus stays dormant (sleeping) in the nervous system for the rest of his or her life, even though the chickenpox goes away. The virus can reactivate (“wake up”) later as shingles. Symptoms include tingling, itching, or pain in one area of the body, followed by a rash with red bumps and blisters.

Luckily, kids and teens almost always have mild cases; severe shingles cases usually affect older people.

Kids who are vaccinated against chickenpox are much less likely to develop shingles when they get older. If it does happen, the case of shingles is usually milder and less likely to cause complications than in someone who wasn’t immunized.

Contagiousness

The chickenpox virus spreads both through the air (by coughing and sneezing) and by direct contact with mucus, saliva (spit), or fluid from the blisters. Chickenpox is contagious from about 2 days before the rash appears until all the blisters are crusted over.

A child with chickenpox should be kept out of school until all blisters have dried, usually about 1 week. If you’re unsure about whether your child is ready to return to school, ask your doctor.

Chickenpox is very contagious — most kids with a sibling who’s been infected also will get it (if they haven’t already had the disease or the vaccine), showing symptoms about 2 weeks after the first child does. To help keep it from spreading, make sure your kids wash their hands often, particularly before eating and after using the bathroom.

People who haven’t had chickenpox or the vaccine also can catch it from someone with shingles, but they cannot catch shingles itself. That’s because shingles can only develop from a reactivation of VZV in someone who has previously had chickenpox.

High-Risk Groups

Certain groups of people are more at risk for complications from chickenpox, including pregnant women and anyone with immune system problems. These groups should avoid anyone who has chickenpox.

If a pregnant woman who hasn’t had chickenpox in the past develops it (especially in the first 20 weeks of pregnancy), the fetus is at risk for birth defects and the mother is at risk for more health complications than if she’d been infected when she wasn’t pregnant. If she develops chickenpox just before or after the child is born, the newborn is at risk for serious health complications. There is no risk to a developing baby if the mother develops shingles during pregnancy.

If a pregnant woman has had chickenpox before the pregnancy, the baby will be protected from infection for the first few months of life, since the mother’s immunity gets passed on to the baby through the placenta and breast milk.

Those at risk for severe disease or serious complications — such as newborns whose mothers had chickenpox at the time of delivery, patients with leukemia or immune deficiencies, and kids receiving drugs that suppress the immune system — may be given a medicine after exposure to chickenpox to reduce its severity.

Prevention

The chickenpox vaccine is 99% effective at preventing the VZV infection in kids. Doctors recommend that kids receive the chickenpox vaccine twice:

1. a first injection when they’re 12 to 15 months old
2. a booster shot when they’re 4 to 6 years old

People 13 years of age and older who have never had chickenpox or haven’t gotten the vaccine should receive two doses of the vaccine at least 28 days apart to be protected. While few people who’ve been vaccinated actually develop chickenpox, those who do tend to develop very mild cases of the condition and recover quickly.

Healthy kids who have had chickenpox do not need the vaccine — they usually have lifelong protection against the illness.

Treatment

Since a virus causes chickenpox, doctors won’t prescribe antibiotics to treat it. However, antibiotics may be required if the sores become infected by bacteria. This is pretty common among kids because they often scratch and pick at the blisters.

An antiviral medicine might be prescribed for people with chickenpox who are at risk for complications. The decision to use this will depend on a child’s age and health, the extent of the infection, and the timing of the treatment. Your doctor can tell you if the medicine is right for your child.

Dealing With Discomfort

To help relieve the itchiness, fever, and discomfort of chickenpox:

• Use cool wet compresses or give baths in cool or lukewarm water every 3 to 4 hours for the first few days. Oatmeal bath products, available at supermarkets and drugstores, can help to relieve itching. (Baths do not spread the rash.)
• Pat (don’t rub) the body dry.
• Put calamine lotion on itchy areas (but don’t use it on the face, especially near the eyes).
• Serve foods that are cold, soft, and bland because chickenpox in the mouth can make drinking or eating difficult. Avoid feeding your child anything highly acidic or especially salty, like orange juice or pretzels.
• Ask your doctor or pharmacist about pain-relieving creams to apply to sores in the genital area.
• Give your child acetaminophen regularly to help relieve pain if your child has mouth blisters.
• Ask the doctor about using over-the-counter medicine for itching.

Never use aspirin to reduce pain or fever in kids with chickenpox because aspirin has been associated with a rare but serious disease, Reye syndrome, which can lead to liver failure and even death.

As much as possible, discourage kids from scratching. This can be difficult for them, so consider putting mittens or socks on your child’s hands to prevent scratching during sleep. Also, trim fingernails and keep them clean to help lessen the effects of scratching, including broken blisters and infection.

Most chickenpox infections don’t need special medical treatment. But sometimes, there are problems. Call the doctor if your child:

• has fever that lasts for more than 4 days or rises above 102°F (38.8°C)
• has a severe cough or trouble breathing
• has an area of rash that leaks pus (thick, yellowish fluid) or becomes red, warm, swollen, or sore
• has a severe headache
• is unusually drowsy or has trouble waking up
• has trouble looking at bright lights
• has difficulty walking
• seems confused
• seems very ill or is vomiting
• has a stiff neck

Call your doctor if you think your child has chickenpox and you have a question or are concerned about a possible complication. The doctor can guide you in watching for complications and in choosing medicine to ease itching.

If you take your child to the doctor, let the office know in advance that your child might have chickenpox. It’s important to try to avoid exposing other kids in the office — for some of them, a chickenpox infection could cause severe complications.

About Cold Sores

Cold sores are small and painful blisters that can appear around the mouth, face, or nose. Sometimes referred to as fever blisters, they’re caused by herpes simplex virus type 1 (HSV-1). Kids can get cold sores by kissing or sharing eating utensils with an infected person.

Colds sores in the mouth are very common, and many kids get infected with HSV-1 during the preschool years. The sores usually go away on their own within about a week.

Symptoms

Most kids who get cold sores get infected by eating or drinking from the same utensils as someone who is infected with the herpes virus or by getting kissed by an infected adult.

The cold sores first form blisters on the lips and inside the mouth. The blisters then become sores. In some cases, the gums become red and swollen. In other cases, the virus also leads to a fever, muscle aches, eating difficulties, a generally ill feeling, irritability, and swollen neck glands. These symptoms can last up to 2 weeks.

After a child is initially infected, the virus can lie dormant without causing any symptoms. But it can reactivate later, typically after some sort of stress like other infections, fever, sunlight, cold weather, menstrual periods, or even before a big test at school. When the virus is reactivated, it can cause tingling and numbness around the mouth before blisters appear.

Treatment

Usually, HSV-1 causes cold sores in the mouth or face, and herpes simplex virus type 2 (HSV-2) causes lesions in the genital area, resulting in genital herpes. But sometimes, HSV-1 can cause genital lesions as well, especially if someone has received oral sex from an infected partner.

Cold sores from HSV-1 usually go away in about a week. Although no medications can make the infection go away, some treatments are available that can shorten the length of the outbreak and make the cold sores less painful.

Cool foods and drinks can help relieve discomfort, and acetaminophen may also ease the pain. Aspirin should not be given to kids with viral infections since it has been associated with Reye syndrome.

Call the doctor if your child:

• has another health condition that has weakened the immune system, which could allow the HSV infection to spread and cause problems in other parts of the body
• has sores that don’t heal by themselves within 7 to 10 days
• has any sores near the eyes
• gets cold sores frequently

Since the virus that causes cold sores is so contagious, it’s important to prevent it from spreading to other family members. Precautions to take with kids who have cold sores include:

• keeping their drinking glasses and eating utensils, as well as washcloths and towels, separate from those used by other family members and washing these items thoroughly after use
• teaching them not to kiss others until the sores heal
• having them wash their hands frequently and as soon as possible after touching the cold sores
• trying to keep them from touching their eyes — if HSV infects the eyes, it can be very serious

If you’re caring for a child with a cold sore, you also should be sure to wash your hands frequently so that you don’t contract the virus or spread it to others.

The common cold catches all of us from time to time, bringing sniffles and sneezes and perhaps a sore throat and annoying cough.

Kids can get eight colds per year or more, making them the most common infectious disease in the United States and the top reason kids visit the doctor and miss school.

Causes

The common cold is a contagious viral infection of the upper respiratory tract. Most are caused by rhinoviruses carried in invisible droplets in the air we breathe or on things we touch. These viruses can get into the protective lining of the nose and throat, setting off an immune system reaction that can cause a sore throat, headache, and trouble breathing through the nose.

Dry air — indoors or outside — can lower resistance to infection by the viruses that cause colds. So can being a smoker or being around someone who smokes. Smokers are more likely to catch a cold than people who don’t smoke, and their symptoms probably will be worse and last longer, and can even lead to bronchitis or pneumonia.

But despite some old wives’ tales, not wearing a jacket or sweater when it’s chilly, sitting or sleeping in a draft, and going outside while your hair’s wet do not cause colds.

Signs and Symptoms

The first symptoms of a cold are often a tickle in the throat, a runny or stuffy nose, and sneezing. Kids with colds also might feel very tired and have a sore throat, cough, headache, mild fever, muscle aches, and loss of appetite. Mucus from the nose may become thick yellow or green.

Duration

Cold symptoms usually appear 2 or 3 days after exposure to a source of infection. Most colds clear up within 1 week, but some last a bit longer.

Contagiousness

Colds are very contagious, especially in the first 2 to 4 days after symptoms begin. They can even spread for a couple of weeks after someone starts feeling sick.

Colds spread through person-to-person contact or by breathing in virus particles, which can travel up to 12 feet through the air when someone with a cold coughs or sneezes. Touching the mouth or nose after touching skin or another contaminated surface can also spread a cold.

Prevention

Because so many viruses cause colds, there isn’t a vaccine to protect against them. To help avoid catching one, kids should:

• steer clear of anyone who has a cold
• avoid secondhand smoke
• wash their hands well and often, especially after blowing their noses
• sneeze or cough into a tissue or their elbow, not into their hands
• not share towels, drinking glasses, or eating utensils with someone who has a cold
• not pick up other people’s used tissues

Experts aren’t sure whether taking extra zinc or vitamin C can limit how long cold symptoms last or how severe they become, but large doses taken every day can cause negative side effects. Studies on herbal remedies, like echinacea, are either negative or aren’t conclusive. Few properly-designed scientific studies of these treatments have been done in kids.

Talk to your doctor before you give your child any herbal remedy or more than the recommended daily allowance (RDA) of any vitamin or supplement.

Treatment

“Time cures all.” That may not always be true, but in the case of the common cold, it’s pretty close. Medicine can’t cure the common cold, but it can be used to relieve symptoms like muscle aches, headache, and fever. You can give your child acetaminophen or ibuprofen based on the package recommendations for age or weight.

Never give aspirin to children younger than 12, or to kids and teens under age 19 who have a viral illness. Such use has been linked to Reye syndrome, a rare but serious condition that can be fatal.

You might be tempted to give your child over-the-counter (OTC) decongestants and antihistamines to try to ease the cold symptoms. But there’s little or no evidence to support that they actually work. In fact, decongestants can cause hallucinations, irritability, and irregular heartbeats, particularly in infants, and shouldn’t be used in kids younger than 4 years old without first consulting a doctor. Many experts now believe that there’s usually no reason to use these medicines in any child younger than 6.

Some ways you can help ease cold discomfort include:

• put saline (saltwater) drops in the nostrils to relieve nasal congestion
• run a cool-mist humidifier to increase air moisture
• dab petroleum jelly on the skin under the nose to soothe rawness
• give hard candy or cough drops to relieve sore throat (for kids older than 3)
• run a warm bath or use a heating pad to soothe aches and pains
• run a hot shower to create a steam-filled bathroom where your child can sit to help clear stuffiness

What about chicken soup? There’s no real proof that eating it can cure a cold, but sick people have been swearing by it for more than 800 years. Chicken soup contains a mucus-thinning amino acid called cysteine, and some research shows that chicken soup helps control congestion-causing white cells, called neutrophils.

The best plan, though, is not to worry about whether to “feed a cold” or “starve a fever.” Just make sure your child eats when hungry and drinks plenty of fluids like water or juice to help replace the fluids lost during a fever or from mucus production.

When to Call the Doctor

Your doctor won’t be able to identify the specific virus causing cold symptoms, but can examine your child’s throat and ears and take a throat culture to make sure the symptoms aren’t from another condition that may need treatment. If symptoms get worse instead of better after 3 days or so, the problem could be strep throat, sinusitis, pneumonia, or bronchitis, especially if your son or daughter smokes.

If symptoms last for more than a week, appear at the same time every year, or happen when your child is around pollen, dust, or animals, an allergy could be to blame. Kids who have trouble breathing or wheeze when they catch a cold could have asthma.

Always call the doctor if you think your child might have more than a cold, your child gets worse instead of better, or if your child has any of these symptoms:

• coughing up a lot of mucus
• shortness of breath
• unusual lethargy/tiredness
• inability to keep food or liquids down or poor fluid intake
• increasing headache or facial or throat pain
• severely painful sore throat that interferes with swallowing
• fever of 103°F (39.3°C) or higher, or a fever of 101°F (38.0°C) or higher that lasts for more than a day
• chest or stomach pain
• swollen glands (lymph nodes) in the neck
• earache

Like most viral infections, colds just have to run their course. Getting plenty of rest, avoiding vigorous activity, and drinking lots of fluids — juice and water — all may help your child feel better while on the mend.

Keeping up regular activities like going to school probably won’t make a cold any worse. But it will increase the likelihood that the cold will spread to classmates or friends. So you might want to put some daily routines aside until your child is feeling better.

Most kids battle diarrhea — frequent, runny bowel movements (poop) — from time to time. The good news is that it usually doesn’t last long and is more annoying than dangerous. Still, it’s important to know how to relieve and even prevent diarrhea.

What Causes Diarrhea?

Diarrhea is usually brought on by gastrointestinal (GI) infections caused by germs (viruses, bacteria, or parasites).

Viruses

Viral gastroenteritis (often called the “stomach flu”) is a common cause of diarrhea and, often, nausea and vomiting. It can spread through a household, school, or childcare center quickly. The symptoms usually last just a few days, but kids (especially babies) who can’t get enough fluids can become dehydrated.

Rotavirus infection, a frequent cause of diarrhea in kids, can bring on explosive, watery diarrhea. Outbreaks are more common in the winter and early spring months, especially in childcare centers. A very effective rotavirus vaccine is now recommended for infants.

Enteroviruses, particularly coxsackievirus, also can cause diarrhea in kids, especially during the summer months.

Bacteria and Parasites

Many different types of bacteria and parasites can cause GI and diarrhea, including E. coli, Salmonella, Campylobacter, and Shigella bacteria; and Giardia and Cryptosporidium parasites.

Sometimes, diarrhea can be due to a non-infectious disease or condition, especially if it lasts several weeks or longer. In those cases, it could be a sign of a food allergy, lactose intolerance, or diseases of the gastrointestinal tract, such as celiac disease and inflammatory bowel disease.

What Are the Symptoms?

Symptoms usually start with crampy abdominal pain followed by diarrhea that usually lasts no more than a few days. Infections with many of the viruses, bacteria, and parasites that cause diarrhea also can bring on other symptoms, such as:

• fever
• loss of appetite
• nausea
• vomiting
• weight loss
• dehydration

In cases of viral gastroenteritis, kids often develop fever and vomiting first, followed by diarrhea.

When to Call the Doctor

Call your doctor if your child has diarrhea and is younger than 6 months old or has:

• a severe or long-lasting episode of diarrhea
• fever of 102°F or higher
• repeated vomiting, or refusal to drink fluids
• severe abdominal pain
• diarrhea that has blood or mucus

Call the doctor immediately if your child seems to be dehydrated. Signs include:

• dry or sticky mouth
• few or no tears when crying
• eyes that look sunken
• in a baby, the soft spot (fontanelle) on top of the head looks sunken
• peeing less or fewer wet diapers
• dry, cool skin
• irritability
• drowsiness or dizziness

How Can I Care for My Child?

Mild diarrhea usually isn’t cause for concern if your child is acting normally and drinking and eating enough. It usually passes in a few days, and kids recover with home care, rest, and plenty of fluids.

Kids who aren’t dehydrated or vomiting can continue eating and drinking as usual. In fact, continuing a regular diet may even shorten the diarrhea episode. You may want to serve smaller portions of food until the diarrhea ends.

Do not give your child an over-the-counter anti-diarrhea medicine unless your doctor gives the OK.

The goal when treating diarrhea is to replace the lost fluids and electrolytes (salts and minerals). For kids who aren’t dehydrated, doctors recommend:

• Continuing with a regular diet and giving more liquids to replace those lost while the diarrhea continues.
• Offering additional breastmilk or formula to infants.

For kids who show signs of mild dehydration, doctors often recommend rehydration with an oral rehydration solution (ORS). These are available in most grocery stores and drugstores without a prescription and replace body fluids quickly. Your doctor will tell you what kind to give, how much, and for how long.

Kids should never be rehydrated with water alone because it doesn’t contain the right mix of sodium, potassium, and other important minerals and nutrients.

In some cases, kids with severe diarrhea may need to get IV fluids at the hospital for a few hours to help combat dehydration.

Can Diarrhea Be Prevented?

It’s almost impossible to prevent kids from ever getting diarrhea. But here are some ways to make it less likely:

• Make sure kids wash their hands well and often, especially after using the toilet and before eating. Hand washing is the most effective way to prevent diarrheal infections that pass from person to person. Dirty hands carry germs into the body when kids bite their nails, suck their thumbs, eat with their fingers, or put any part of their hands into their mouths.
• Keep bathroom surfaces clean.
• Wash fruits and vegetables well before eating.
• Wash kitchen counters and cooking utensils thoroughly after they’ve been in contact with raw meat, especially poultry.
• Refrigerate meats as soon as possible after bringing them home from the store. Cook cook them until they’re no longer pink. Refrigerate all leftovers as soon as possible.
• Never drink from streams, springs, or lakes unless local health authorities have certified that the water is safe for drinking.
• Avoid washing pet cages or bowls in the same sink that you use to prepare food. And keep pet feeding areas separate from family eating areas.

You’ve probably experienced waking in the middle of the night to find your child flushed, hot, and sweaty. Your little one’s forehead feels warm. You immediately suspect a fever, but are unsure of what to do next. Should you get out the thermometer? Call the doctor?

In healthy kids, fevers usually don’t indicate anything serious. Fever itself causes no harm and can actually be a good thing — it’s often the body’s way of fighting infections. And not all fevers need to be treated. High fever, however, can make a child uncomfortable and make problems (such as dehydration) worse.

Here’s more about fevers, how to measure and treat them, and when to call your doctor.

Fever Facts

Fever happens when the body’s internal “thermostat” raises the body temperature above its normal level. This thermostat is found in a part of the brain called the hypothalamus. The hypothalamus knows what temperature your body should be (usually around 98.6°F/37°C) and will send messages to your body to keep it that way.

Most people’s body temperatures even change a little bit during the course of the day: It’s usually a little lower in the morning and a little higher in the evening and can vary as kids run around, play, and exercise.

Sometimes, though, the hypothalamus will “reset” the body to a higher temperature in response to an infection, illness, or some other cause. Why? Researchers believe turning up the heat is the body’s way of fighting the germs that cause infections and making the body a less comfortable place for them.

Causes of Fever

It’s important to remember that fever by itself is not an illness — it’s usually a symptom of another problem.

Fevers have a few potential causes:

Infection: Most fevers are caused by infection or other illness. A fever helps the body fight infections by stimulating natural defense mechanisms.

Overdressing: Infants, especially newborns, may get fevers if they’re overbundled or in a hot environment because they don’t regulate their body temperature as well as older kids. However, because fevers in newborns can indicate a serious infection, even infants who are overdressed must be checked by a doctor if they have a fever.

Immunizations: Babies and kids sometimes get a low-grade fever after getting vaccinated.

Although teething may cause a slight rise in body temperature, it’s probably not the cause if a child’s temperature is higher than 100°F (37.8°C).

When Fever Is a Sign of Something Serious

In the past, doctors advised treating a fever on the basis of temperature alone. But now they recommend considering both the temperature and a child’s overall condition.

Kids whose temperatures are lower than 102°F (38.9°C) often don’t need medicine unless they’re uncomfortable. There’s one important exception to this rule: If you have an infant 3 months or younger with a rectal temperature of 100.4°F (38°C) or higher, call your doctor or go to the emergency department immediately. Even a slight fever can be a sign of a potentially serious infection in very young infants.

If your child is between 3 months and 3 years old and has a fever of 102.2°F (39°C) or higher, call your doctor to see if he or she needs to see your child. For older kids, take behavior and activity level into account. Watching how your child behaves will give you a pretty good idea of whether a minor illness is the cause or if your child should be seen by a doctor.

The illness is probably not serious if your child:

• is still interested in playing
• is eating and drinking well
• is alert and smiling at you
• has a normal skin color
• looks well when his or her temperature comes down

And don’t worry too much about a child with a fever who doesn’t want to eat. This is very common with infections that cause fever. For kids who still drink and urinate (pee) normally, not eating as much as usual is OK.

Is it a Fever?

A gentle kiss on the forehead or a hand placed lightly on the skin is often enough to give you a hint that your child has a fever. However, this method of taking a temperature (called tactile temperature) doesn’t give an accurate measurement.

Use a reliable thermometer to confirm a fever, which is when a child’s temperature is at or above one of these levels:

• measured orally (in the mouth): 99.5°F (37.5°C)
• measured rectally (in the bottom): 100.4°F (38°C)
• measured in an axillary position (under the arm): 99°F (37.2°C)

But how high a fever is doesn’t tell you much about how sick your child is. A simple cold or other viral infection can sometimes cause a rather high fever (in the 102°–104°F/38.9°–40°C range), but this doesn’t usually indicate a serious problem. And serious infections, especially those in infants, might cause no fever or even an abnormally low body temperature (below 97°F or 36.1°C).

Because fevers can rise and fall, a child might have chills as the body’s temperature begins to rise. The child may sweat to release extra heat as the temperature starts to drop.

Sometimes kids with a fever breathe faster than usual and may have a faster heart rate. Call the doctor if your child is having trouble breathing, is breathing faster than normal, or continues to breathe fast after the fever comes down.

Types of Thermometers

Whatever thermometer you choose, be sure you know how to use it correctly to get an accurate reading. Keep and follow the manufacturer’s directions for any thermometer.

Digital thermometers usually give the quickest, most accurate readings. Available in a variety of sizes and shapes, they’re sold at most supermarkets and drugstores. Read the manufacturer’s instructions to see what the thermometer is designed for and how it signals that the reading is complete.

Usually, digital thermometers can be used for these temperature-taking methods:

• oral (in the mouth)
• rectal (in the bottom)
• axillary (under the arm)

Turn on the thermometer and make sure the screen is clear of any old readings. Digital thermometers usually have a plastic, flexible probe with a temperature sensor at the tip and an easy-to-read digital display on the other end. If your thermometer uses disposable plastic sleeves or covers, put one on according to the manufacturer’s instructions. Throw away the sleeve afterward and clean the thermometer according to the manufacturer’s instructions before putting it back in its case.

Electronic ear thermometers measure the tympanic temperature (the amount of heat made by the eardrum). Although they’re quick and easy to use in older babies and kids, ear thermometers aren’t as accurate as digital thermometers for infants 6 months or younger and are more expensive. They can also give inaccurate readings if not placed properly in the ear canal or if a child has earwax buildup.

Temporal artery thermometers, which are swiped over the forehead to behind the ear, measure the temperature of temporal arteries, which are blood vessels in the forehead. Using this type of thermometer takes practice and good technique to be as accurate as oral or rectal digital thermometers. Sweating can affect their accuracy, so it’s important to make sure the child’s forehead is dry and to take multiple readings to confirm the temperature.

Pacifier thermometers can be convenient, but their readings are less reliable than rectal temperatures and shouldn’t be used in infants younger than 3 months. Kids also need to keep the pacifier in their mouth for several minutes without moving, which is a nearly impossible task for most babies and toddlers.

Plastic strip thermometers (small plastic strips that you press against the forehead) might tell you whether your child has a fever, but they don’t give an exact measurement, especially in infants and very young children. If you need to know your child’s exact temperature, plastic strip thermometers are not the way to go.

Glass mercury thermometers were once common, but should not be used because of possible exposure to mercury, an environmental toxin. (If you still have a mercury thermometer, do not throw it in the trash because the mercury can leak out. Talk to your doctor or your local health department about how and where to dispose of a mercury thermometer.)

Tips for Taking Temperatures

As any parent knows, taking a squirming child’s temperature can be a challenge. But it’s one of the most important tools doctors have to determine if a child has an illness or infection. The best method will depend on a child’s age and temperament.

For babies younger than 3 months, you’ll get the most reliable reading by using a digital thermometer to take a rectal temperature. Electronic ear thermometers aren’t recommended for infants younger than 6 months because their ear canals are usually too small. Research shows that temporal artery thermometers may give accurate readings for kids in this age group.

For babies between 3 months and 6 months old, a digital rectal thermometer is still the best choice, but you can also use a temporal artery thermometer.

For kids between 6 months and 4 years old, you can use a digital thermometer to take a rectal temperature, a temporal artery thermometer, or an electronic ear thermometer. You could also use a digital thermometer to take an axillary temperature, although this is a less accurate method.

For kids 4 years or older, you can usually use a digital thermometer to take an oral temperature if your child will cooperate. However, kids who are coughing a lot or breathing through their mouths because of stuffy noses might not be able to keep their mouths closed long enough for an accurate oral reading. In these cases, you can use the tympanic method (with an electronic ear thermometer), forehead method (with a temporal artery thermometer), or axillary method (with a digital thermometer).

To take a rectal temperature: Before becoming parents, most people cringe at the thought of taking a rectal temperature. But don’t worry — it’s a simple process:

1. Wash the end of the thermometer with soap and water and rinse with water.
2. Moisten the tip of the thermometer with a lubricant, such as petroleum jelly.
3. Place your child:
   – belly-down across your lap or on a firm, flat surface and keep your palm along the lower back
   – or face-up with legs bent toward the chest with your hand against the back of the thighs
4. With your other hand, insert the lubricated thermometer into the anal opening about ½ inch to 1 inch (about 1.25 to 2.5 centimeters), or until the tip of the thermometer is fully in the rectum. Stop if you feel any resistance.
5. Steady the thermometer between your second and third fingers as you cup your hand against your baby’s bottom. Soothe your child and speak quietly as you hold the thermometer in place.
6. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen, noting the time of day that you took the reading.

To take an oral temperature: This process is easy in an older, cooperative child.

1. Wait 20 to 30 minutes after your child finishes eating or drinking to take an oral temperature, and make sure there’s no gum or candy in your child’s mouth.
2. Place the tip of the thermometer under the tongue and ask your child to close his or her lips around it. Remind your child not to bite down or talk, and to relax and breathe normally through the nose.
3. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen, noting the time of day that you took the reading.

To take an axillary temperature: This is a convenient way to take a child’s temperature. Although not as accurate as a rectal or oral temperature in a cooperative child, some parents prefer to take an axillary temperature, especially for kids who can’t hold a thermometer in their mouths.

1. Remove your child’s shirt and undershirt, and place the thermometer under an armpit (it must be touching skin only, not clothing).
2. Fold your child’s arm across the chest to hold the thermometer in place.
3. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen, noting the time of day that you took the reading.

Whatever method you choose, keep these additional tips in mind:

• Never take a child’s temperature right after a bath or if he or she has been bundled tightly for a while — this can affect the temperature reading.
• Never leave a child unattended while taking a temperature.

Helping Kids Feel Better

Again, not all fevers need to be treated. And in most cases, a fever should be treated only if it’s causing a child discomfort.

Here are ways to ease symptoms that often accompany a fever:

• If your child is fussy or uncomfortable, you can give acetaminophen or ibuprofen based on the package recommendations for age or weight. (Unless instructed by a doctor, never give aspirin to a child due to its association with Reye syndrome, a rare but potentially fatal disease.) If you don’t know the recommended dose or your child is younger than 2 years old, call the doctor to find out how much to give.

  Infants younger than 2 months old should not be given any medicine for fever without being checked by a doctor. If your child has any medical problems, check with the doctor to see which medicine is best to use. Remember that fever medication will usually temporarily bring a temperature down, but won’t return it to normal — and it won’t treat the underlying reason for the fever.

• Dress your child in lightweight clothing and cover with a light sheet or blanket. Overdressing and overbundling can prevent body heat from escaping and can cause a temperature to rise.
• Make sure your child’s bedroom is a comfortable temperature — not too hot or too cold.
• While some parents use lukewarm sponge baths to lower fever, this method only helps temporarily, if at all. In fact, sponge baths can make kids uncomfortable. Never use alcohol (it can cause poisoning when absorbed through the skin) or ice packs/cold baths (they can cause chills that may raise body temperature).
• Offer plenty of fluids to avoid dehydration since fevers cause kids to lose fluids more rapidly than usual. Water, soup, ice pops, and flavored gelatin are all good choices. Avoid drinks with caffeine, including colas and tea, because they can make dehydration worse by increasing urination (peeing).
• If your child also is vomiting and/or has diarrhea, ask the doctor if you should give an electrolyte (rehydration) solution made especially for kids. You can find these at drugstores and supermarkets. Don’t offer sports drinks — they’re not made for younger children and the added sugars can make diarrhea worse. Also, limit your child’s intake of fruits and apple juice.
• In general, let your child eat what he or she wants (in reasonable amounts) but don’t force eating if your child doesn’t feel like it.
• Make sure your child gets plenty of rest. Staying in bed all day isn’t necessary, but a sick child should take it easy.
• It’s best to keep a child with a fever home from school or childcare. Most doctors feel that it’s safe to return when the temperature has been normal for 24 hours.

When to Call the Doctor

The exact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and whether there are other symptoms with the fever.

Call your doctor if you have an:

• infant younger than 3 months old with a rectal temperature of 100.4°F (38°C) or higher
• older child with a temperature of higher than 102.2°F (39°C)

Call the doctor if an older child has a fever of less than 102.2°F (39°C) but also:

• refuses fluids or seems too ill to drink adequately
• has lasting diarrhea or repeated vomiting
• has any signs of dehydration (peeing less than usual, not having tears when crying, less alert and less active than usual)
• has a specific complaint (like a sore throat or earache)
• still has a fever after 24 hours (in kids younger than 2 years) or 72 hours (in kids 2 years or older)
• is getting fevers a lot, even if they only last a few hours each night
• has a chronic medical problem such as heart disease, cancer, lupus, or sickle cell disease
• has a rash
• has pain while urinating (peeing)

Seek emergency care if your child shows any of these signs:

• crying that won’t stop
• extreme irritability or fussiness
• sluggishness and trouble waking up
• rash or purple spots that look like bruises on the skin (that were not there before the child got sick)
• blue lips, tongue, or nails
• infant’s soft spot on the head seems to be bulging outward or sunken inwards
• stiff neck
• severe headache
• limpness or refusal to move
• difficulty breathing that doesn’t get better when the nose is cleared
• leaning forward and drooling
• seizure
• abdominal (belly) pain

Also, ask your doctor for his or her specific guidelines on when to call about a fever.

Fever: A Common Part of Childhood

All kids get fevers, and in most cases they’re completely back to normal within a few days. For older babies and kids (but not necessarily for infants younger than 3 months), the way they act is more important than the reading on your thermometer. Everyone gets cranky when they have a fever. This is normal and should be expected.

But if you’re ever in doubt about what to do or what a fever might mean, or if your child is acting ill in a way that concerns you even if there’s no fever, always call your doctor for advice.

Your child is sent home from school with a sore throat, cough, and high fever — could it be the flu that’s been going around? Or just a common cold?

Although the flu (or influenza) usually causes symptoms that make someone feel worse than symptoms associated with a common cold, it’s not always easy to tell the difference between the two.

Symptoms Guide

The answers to these questions can help determine whether a child is fighting the flu or combating a cold:

If most of your answers fell into the first category, chances are that your child has the flu. If your answers were usually in the second category, it’s most likely a cold.

But don’t be too quick to brush off your child’s illness as just another cold. The important thing to remember is that flu symptoms can vary from child to child (and they can change as the illness progresses), so if you suspect the flu, call the doctor. Even doctors often need a test to tell them for sure if a person has the flu or not since the symptoms can be so similar!

Some bacterial diseases, like strep throat or pneumonia, also can look like the flu or a cold. It’s important to get medical attention immediately if your child seems to be getting worse, is having any trouble breathing, has a high fever, has a bad headache, has a sore throat, or seems confused.

While even healthy kids can have complications of the flu, kids with certain medical conditions are at more of a risk. If you think your kid might have the flu, contact your doctor.

Treatment

Some kids with chronic medical conditions may become sicker with the flu and need to be hospitalized, and flu in an infant also can be dangerous. For severely ill kids or those with other special circumstances, doctors may prescribe an antiviral medicine that can ease flu symptoms, but only if it’s given within 48 hours of the onset of the flu.

Most of the time, you can care for your child by offering plenty of fluids, rest, and extra comfort.

And if the doctor says it’s not the flu? Ask whether your child should get a flu vaccine.

After the common cold, ear infections are the most frequently diagnosed childhood illness in the United States. Most kids will have had at least one ear infection by the time they’re 3 years old.

A Close Look at the Ear

To understand how ear infections develop, let’s review how the ear works.

Think about how you can feel speakers vibrate as you listen to your favorite CD in the car or how you feel your throat vibrate when you speak. Sound, which is made up of invisible waves of energy, causes these vibrations. Every time you hear a sound, the various structures of the ear have to work together to make sure the information gets to the brain.

The ear is responsible for hearing and balance and is made up of three parts — the outer ear, middle ear, and inner ear. Hearing begins when sound waves that travel through the air reach the outer ear, or pinna, which is the part of the ear that’s visible. The sound waves then travel from the pinna through the ear canal to the middle ear, which includes the eardrum (a thin layer of tissue) and three tiny bones called ossicles. When the eardrum vibrates, the ossicles amplify these vibrations and carry them to the inner ear.

The inner ear translates the vibrations into electric signals and sends them to the auditory nerve, which connects to the brain. When these nerve impulses reach the brain, they’re interpreted as sound.

The Eustachian Tube

To work as it should, the middle ear must be at the same pressure as the outside world. This is taken care of by the eustachian tube, a small passage that connects the middle ear to the back of the throat behind the nose.

By letting air reach the middle ear, the eustachian tube equalizes the air pressure in the middle ear to the outside air pressure. (When your ears “pop” while yawning or swallowing, the eustachian tubes are adjusting the air pressure in your middle ears.) The eustachian tube also allows for drainage of mucus from the middle ear into the throat.

Sometimes, the eustachian tube may malfunction. For example, when someone has a cold or an allergy affecting the nasal passages, the eustachian tube may become blocked by congestion in its lining or by mucus within the tube. This blockage will allow fluid to build up within the normally air-filled middle ear.

Bacteria or viruses that have entered the middle ear through the eustachian tube also can get trapped in this way. These germs can breed in the trapped fluid, eventually leading to an ear infection.

About Middle Ear Infections

Inflammation in the middle ear area is known as otitis media. When referring to an ear infection, doctors usually mean “acute otitis media” rather than the common ear infection called swimmer’s ear, or otitis externa.

Acute otitis media means that fluid (usually pus) is in the middle ear, causing pain, redness of the eardrum, and possible fever.

In some cases, otitis media can be more chronic (with fluid in the middle ear for 6 weeks or longer) or, in otitis media with effusion, fluid in the middle ear can be temporary and not necessarily infected.

Doctors try to distinguish between the different forms of otitis because this affects treatment options. Not all forms of otitis need to be treated with antibiotics.

Causes

Kids are prone to developing ear infections in the first 2 to 4 years of life for several reasons:

• Their eustachian tubes are shorter and more horizontal than those of adults, which lets bacteria and viruses find their way into the middle ear more easily. The tubes are also narrower and less stiff, so more at risk for blockage.
• The adenoids, which are gland-like structures located in the back of the upper throat near the eustachian tubes, are large in children and can interfere with the opening of the eustachian tubes.

A number of other factors can contribute to kids getting ear infections, such as secondhand exposure to cigarette smoke, bottle-feeding, and childcare attendance.

Boys develop ear infections more often than girls, as do kids with a family history of ear infections. They’re also more common during the winter season, when lots of people get upper respiratory tract infections or colds.

Signs and Symptoms

The signs and symptoms of acute otitis media may range from very mild to severe:

• The fluid in the middle ear may push on the eardrum, causing ear pain. Older kids are able to complain of an earache, but a younger child might just tug at the ear or simply act irritable and cry more than usual.
• Lying down, chewing, and sucking also can cause painful pressure changes in the middle ear, so a child may eat less than normal or have trouble sleeping.
• If the pressure from the fluid buildup gets high enough, it can rupture the eardrum, causing fluid to drain from the ear. This releases the pressure behind the eardrum, usually bringing relief from the pain.

Signs of Hearing Problems

Fluid buildup in the middle ear also blocks sound, which can lead to temporary hearing problems. Kids having a problem might:

• not respond to soft sounds
• need to turn up the TV or radio
• talk louder
• appear to be inattentive at school

Other symptoms of acute otitis media can include:

• fever
• nausea
• vomiting
• dizziness

However, otitis media with effusion often has no symptoms. In some kids, the fluid that’s in the middle ear may create a sensation of ear fullness or “popping.” As with acute otitis media, the fluid behind the eardrum can block sound, so mild temporary hearing loss can happen, but might not be obvious.

Because they’re often related to upper respiratory tract infections, ear infections can be accompanied by symptoms like a runny or stuffy nose or a cough.

Contagiousness

Ear infections are not contagious, though the colds that sometimes cause them can be.

Duration

Middle ear infections often go away on their own within 2 or 3 days, even without any specific treatment. If your doctor decides to prescribe antibiotics, a 10-day course is usually recommended.

For kids 6 years of age and older with a mild to moderate infection, a shortened course of antibiotics (5 to 7 days) may be appropriate.

But even after antibiotic treatment for an episode of acute otitis media, fluid may remain in the middle ear for up to several months.

Diagnosis and Treatment

If your child might have an ear infection, see your doctor, who should be able to make a diagnosis by taking a medical history and doing a physical exam.

To examine the ear, doctors use an otoscope, a small instrument similar to a flashlight, through which they can see the eardrum.

There’s no single best approach for treating all middle ear infections. In deciding how to manage your child’s ear infection, your doctor will consider many things, including:

• the type and severity of the ear infection
• how often your child has ear infections
• how long this infection has lasted
• your child’s age
• risk factors your child may have
• whether the infection affects your child’s hearing

The fact that most ear infections can clear on their own has led a number of physician associations to recommend a “wait-and-see” approach, which involves giving the child pain relief without antibiotics for a few days.

Another important reason to consider this type of approach are the limitations of antibiotics, which:

• won’t help an infection caused by a virus
• won’t get rid of middle ear fluid
• can cause side effects
• typically do not relieve pain in the first 24 hours and have only a minimal effect after that

Also, overuse of antibiotics can lead to the development of antibiotic-resistant bacteria, which can be much more difficult to treat.

When Antibiotics Are Needed

Antibiotics can be the right treatment, though, for kids who get a lot of ear infections. Their doctors might prescribe daily antibiotics to help prevent future infections. And younger children or those with more severe illness may need antibiotics right from the start.

The “wait-and-see” approach also might not apply to children with other concerns, such as cleft palate, genetic conditions such as Down syndrome, underlying illnesses such as immune system disorders, or a history of recurrent acute otitis media.

Kids with persistent otitis media with effusion (lasting longer than 3 months) should be reexamined every 3 to 6 months by their doctors. Often, though, even these kids won’t require treatment.

Whether or not the choice is made to treat with antibiotics, you can help to ease discomfort by giving your child acetaminophen or ibuprofen for pain and fever as needed. Your doctor also may recommend using pain-relieving ear drops as long as the eardrum isn’t ruptured.

Some children, such as those with persistent hearing loss or speech delay, may need ear tube surgery. An ear, nose, and throat doctor will surgically insert tubes (called tympanostomy tubes) in the tympanic membrane. This lets fluid drain from the middle ear and helps equalize the pressure in the ear because the eustachian tube is unable to.

Prevention

Some of the risk factors for ear infections can’t be changed (such as a family history of frequent ear infections), but certain lifestyle choices can help protect kids:

• Breastfeed infants for at least 6 months to help to prevent the development of early episodes of ear infections. If a baby is bottle-fed, hold the baby at an angle instead of lying the child down with the bottle.
• Prevent exposure to secondhand smoke, which can increase the frequency and severity of ear infections.
• While not always possible, minimizing exposure to large groups of kids (such as in childcare centers) can protect your child from some of the upper respiratory infections that can lead to ear infections.
• Parents and kids should wash their hands well and often. This is one of the most important ways to stop the spread of germs that can cause colds and, therefore, ear infections.
• Keep children’s immunizations up to date because certain vaccines can help prevent ear infections.

Also be aware that research has shown that cold and allergy medications, such as antihistamines and decongestants, don’t help prevent ear infections.

When to Call the Doctor

Although quite rare, ear infections that don’t go away or severe repeated middle ear infections can lead to complications, including spread of the infection to nearby bones. So kids with an earache or a sense of fullness in the ear, especially when combined with fever, should be seen by their doctors if they aren’t getting better.

Other things can cause earaches, such as teething, a foreign object in the ear, or hard earwax. Call your doctor to help determine the cause of your child’s discomfort and how to treat it.

About Mononucleosis

Kids and teens with mononucleosis (mono) can have flu-like symptoms (like a fever, muscle aches, tiredness, and a sore throat), which go away on their own after a few weeks of rest and plenty of fluids.

Mono usually is caused by the Epstein-Barr virus (EBV), a very common virus that most kids are exposed to at some point while growing up. Infants and young kids infected with EBV typically have very mild symptoms or none at all. But teens and young adults who become infected often develop mono.

Mono is spread through kissing, coughing, sneezing, or any contact with the saliva of someone who has been infected with the virus. (That’s how mono got nicknamed “the kissing disease.”) It also can spread by sharing a straw or an eating utensil. Researchers believe that mono may be spread sexually as well.

People who have been infected with EBV will carry the virus for the rest of their lives — even if they never have any signs or symptoms of mono. Those who did have mono symptoms probably will not get sick or have symptoms again.

Although EBV is the most common cause of mono, other viruses, such as cytomegalovirus (sy-toe-meh-guh-low-VY-rus), can cause a similar illness. Like EBV, cytomegalovirus stays in the body for life and may not cause any symptoms.

Signs & Symptoms

Symptoms usually show up about 4 to 7 weeks after infection with the virus and can include:

• being very tired
• fever
• sore throat with swollen tonsils that may have white patches
• loss of appetite
• swollen lymph nodes (commonly called glands, located in the neck, underarms, and groin)
• headaches
• sore muscles
• weakness
• larger-than-normal liver or spleen
• skin rash
• abdominal pain

Mono symptoms usually go away within 2 to 4 weeks. In some teens, though, the tiredness and weakness can last for months.

To make a diagnosis, the doctor may do a blood test and physical exam to check for things like swollen tonsils and an enlarged liver or spleen, which often is a sign of the infection.

Mono and Sports

Doctors recommend that kids who get mono avoid sports for at least a month after symptoms are gone because the spleen usually is enlarged temporarily from the illness. An enlarged spleen can rupture easily — causing internal bleeding and abdominal pain — and require emergency surgery.

So vigorous activities, contact sports, weightlifting, cheerleading, or even wrestling with siblings or friends should be avoided until the doctor says it’s OK.

Complications

Most kids who get mono recover completely with no problems. In rare cases, though, complications can happen. These can include problems with the liver or spleen, anemia, meningitis, trouble breathing, or inflammation of the heart.

Prevention and Treatment

There is no vaccine to protect again the Epstein-Barr virus. But you can help protect your kids from mono by making sure that they avoid close contact with anyone who has it.

Many people who have mono won’t have symptoms, but they can still pass it to others. So kids should wash their hands well and often, and not share drinks or eating utensils with others, even people who seem healthy.

The best treatment for mono is plenty of rest, especially early in the course of the illness when symptoms are the most severe. Acetaminophen or ibuprofen can help to relieve a fever and aching muscles. Never give aspirin to a child who has a viral illness because its use has been linked to Reye syndrome, which may lead to liver failure and can even be fatal.

In most cases, mono symptoms go away in a matter of weeks with plenty of rest and fluids. If they seem to linger, or if you have any other questions, talk with your child’s doctor.