Important Principles for Weaning

  1. Begin at ~ 6 mo of age.
  2. Avoid foods with high allergenic potential (cow's milk, eggs, fish, nuts, soybeans).
  3. At the proper age, encourage a cup rather than a bottle.
  4. Introduce 1 food at a time.
  5. Energy density should exceed that of breast milk.
  6. Iron-containing foods (meat, iron-supplemented cereals) are required.
  7. Zinc intake should be encouraged with foods such as meat, dairy products, wheat, and rice.
  8. Phytate intake should be low to enhance mineral absorption.
  9. Breast milk should continue to 12 mo; formula or cow's milk is then substituted.Give no more than 24 oz/day of cow's milk.
  10. Fluids other than breast milk, formula, and water should be discouraged. Give no more than 4–6 oz/day of fruit juices. No soda.

Patient Guide to Bacterial Vaginosis

What is bacterial vaginosis?
Bacterial vaginosis (BV) is the name of a condition in women where the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria. It is sometimes accompanied by discharge, odor, pain, itching, or burning. 


How common is bacterial vaginosis?
Bacterial vaginosis (BV) is the most common vaginal infection in women of childbearing age. In the United States, BV is common in pregnant women. 


How do people get bacterial vaginosis?
The cause of BV is not fully understood. BV is associated with an imbalance in the bacteria that are normally found in a woman's vagina. The vagina normally contains mostly "good" bacteria, and fewer "harmful" bacteria. BV develops when there is an increase in harmful bacteria.
Not much is known about how women get BV. There are many unanswered questions about the role that harmful bacteria play in causing BV. Any woman can get BV. However, some activities or behaviors can upset the normal balance of bacteria in the vagina and put women at increased risk including:
It is not clear what role sexual activity plays in the development of BV. Women do not get BV from toilet seats, bedding, swimming pools, or from touching objects around them. Women who have never had sexual intercourse may also be affected. 


What are the signs and symptoms of bacterial vaginosis?
Women with BV may have an abnormal vaginal discharge with an unpleasant odor. Some women report a strong fish-like odor, especially after intercourse. Discharge, if present, is usually white or gray; it can be thin. Women with BV may also have burning during urination or itching around the outside of the vagina, or both. However, most women with BV report no signs or symptoms at all.
BV can increase a woman's susceptibility to other STDS such as HIV, Herpes, Chlamydia, and Gonorrhea. 


What are the complications of bacterial vaginosis?
In most cases, BV causes no complications. But there are some serious risks from BV including:
  • Having BV can increase a woman's susceptibility to HIV infection if she is exposed to the HIV virus.
  • Having BV increases the chances that an HIV-infected woman can pass HIV to her sex partner.
  • Having BV has been associated with an increase in the development of an infection following surgical procedures such as a hysterectomy or an abortion.
  • Having BV while pregnant may put a woman at increased risk for some complications of pregnancy, such as preterm delivery.
  • BV can increase a woman's susceptibility to other STDs, such as herpes simplex virus (HSV), chlamydia, and gonorrhea.

 
How does bacterial vaginosis affect a pregnant woman and her baby?
Pregnant women with BV more often have babies who are born premature or with low birth weight (low birth weight is less than 5.5 pounds).
The bacteria that cause BV can sometimes infect the uterus (womb) and fallopian tubes (tubes that carry eggs from the ovaries to the uterus). This type of infection is called pelvic inflammatory disease (PID). PID can cause infertility or damage the fallopian tubes enough to increase the future risk of ectopic pregnancy and infertility. Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube which can rupture. 


How is bacterial vaginosis diagnosed?
A health care provider must examine the vagina for signs of BV and perform laboratory tests on a sample of vaginal fluid to look for bacteria associated with BV. 


What is the treatment for bacterial vaginosis?
Although BV will sometimes clear up without treatment, all women with symptoms of BV should be treated to avoid complications. Male partners generally do not need to be treated. However, BV may spread between female sex partners.
Treatment is especially important for pregnant women. All pregnant women who have ever had a premature delivery or low birth weight baby should be considered for a BV examination, regardless of symptoms, and should be treated if they have BV. All pregnant women who have symptoms of BV should be checked and treated.
Some physicians recommend that all women undergoing a hysterectomy or abortion be treated for BV prior to the procedure, regardless of symptoms, to reduce their risk of developing an infection.
BV is treatable with antibiotics prescribed by a health care provider. Two different antibiotics are recommended as treatment for BV: metronidazole or clindamycin. Either can be used with non-pregnant or pregnant women, but the recommended dosages differ. Women with BV who are HIV-positive should receive the same treatment as those who are HIV-negative. 


How can bacterial vaginosis be prevented?
BV is not completely understood by scientists, and the best ways to prevent it are unknown. However, it is known that BV is associated with having a new sex partner or having multiple sex partners.
The following basic prevention steps can help reduce the risk of upsetting the natural balance of bacteria in the vagina and developing BV:
  • Be abstinent.
  • Limit the number of sex partners.
  • Do not douche.
  • Use all of the medicine prescribed for treatment of BV, even if the signs and symptoms go away.


Source: CDC

Patient Guide to Chlamydia

What is Chlamydia?
Chlamydia is a common sexually transmitted disease (STD) caused by the bacterium, Chlamydia trachomatis, which can damage a woman's reproductive organs. Even though symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a woman ever recognizes a problem. Chlamydia also can cause discharge from the penis of an infected man. 


How common is chlamydia?
Chlamydia is the most frequently reported bacterial sexually transmitted disease in the United States. In 2009, 1,244,180 chlamydial infections were reported to CDC from 50 states and the District of Columbia. Under-reporting is substantial because most people with chlamydia are not aware of their infections and do not seek testing. Also, testing is not often done if patients are treated for their symptoms. An estimated 2.8 million infections occur annually in the U.S. Women are frequently re-infected if their sex partners are not treated. 

 
How do people get chlamydia?
Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.
Any sexually active person can be infected with chlamydia. The greater the number of sex partners, the greater the risk of infection. Because the cervix (opening to the uterus) of teenage girls and young women is not fully matured and is probably more susceptible to infection, they are at particularly high risk for infection if sexually active. Since chlamydia can be transmitted by oral or anal sex, men who have sex with men are also at risk for chlamydial infection. 


What are the symptoms of chlamydia?
Chlamydia is known as a "silent" disease because the majority of infected people have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure.
In women, the bacteria initially infect the cervix and the urethra (urine canal). Women who have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. If the infection spreads from the cervix to the fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods. Chlamydial infection of the cervix can spread to the rectum.
Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis. Pain and swelling in the testicles are uncommon.
Men or women who have receptive anal intercourse may acquire chlamydial infection in the rectum, which can cause rectal pain, discharge, or bleeding. Chlamydia can also be found in the throats of women and men having oral sex with an infected partner. 


What complications can result from untreated chlamydia?
If untreated, chlamydial infections can progress to serious reproductive and other health problems with both short-term and long-term consequences. Like the disease itself, the damage that chlamydia causes is often "silent."
In women, untreated infection can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). This happens in about 10 to 15 percent of women with untreated chlamydia. Chlamydia can also cause fallopian tube infection without any symptoms. PID and “silent” infection in the upper genital tract can cause permanent damage to the fallopian tubes, uterus, and surrounding tissues. The damage can lead to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy (pregnancy outside the uterus). Chlamydia may also increase the chances of becoming infected with HIV, if exposed.
To help prevent the serious consequences of chlamydia, screening at least annually for chlamydia is recommended for all sexually active women age 25 years and younger. An annual screening test also is recommended for older women with risk factors for chlamydia (a new sex partner or multiple sex partners). All pregnant women should have a screening test for chlamydia.
Complications among men are rare. Infection sometimes spreads to the epididymis (the tube that carries sperm from the testis), causing pain, fever, and, rarely, sterility.
Rarely, genital chlamydial infection can cause arthritis that can be accompanied by skin lesions and inflammation of the eye and urethra (Reiter's syndrome). 

 
How does chlamydia affect a pregnant woman and her baby?
In pregnant women, there is some evidence that untreated chlamydial infections can lead to premature delivery. Babies who are born to infected mothers can get chlamydial infections in their eyes and respiratory tracts. Chlamydia is a leading cause of early infant pneumonia and conjunctivitis (pink eye) in newborns. 


How is chlamydia diagnosed?
There are laboratory tests to diagnose chlamydia. Some can be performed on urine, other tests require that a specimen be collected from a site such as the penis or cervix. 


What is the treatment for chlamydia?
Chlamydia can be easily treated and cured with antibiotics. A single dose of azithromycin or a week of doxycycline (twice daily) are the most commonly used treatments. HIV-positive persons with chlamydia should receive the same treatment as those who are HIV negative.
All sex partners should be evaluated, tested, and treated. Persons with chlamydia should abstain from sexual intercourse for 7 days after single dose antibiotics or until completion of a 7-day course of antibiotics, to prevent spreading the infection to partners.
Women whose sex partners have not been appropriately treated are at high risk for re-infection. Having multiple infections increases a woman's risk of serious reproductive health complications, including infertility. Women and men with chlamydia should be retested about three months after treatment of an initial infection, regardless of whether they believe that their sex partners were treated. 


How can chlamydia be prevented?
The surest way to avoid transmission of STDs is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
CDC recommends yearly chlamydia testing of all sexually active women age 25 or younger, older women with risk factors for chlamydial infections (those who have a new sex partner or multiple sex partners), and all pregnant women. An appropriate sexual risk assessment by a health care provider should always be conducted and may indicate more frequent screening for some women.
Any genital symptoms such as an unusual sore, discharge with odor, burning during urination, or bleeding between menstrual cycles could mean an STD infection. If a woman or man has any of these symptoms, they should stop having sex and consult a health care provider immediately. Treating STDs early in women can prevent PID. Women and men who are told they have an STD and are treated for it should notify all of their recent sex partners (sex partners within the preceding 60 days) so they can see a health care provider and be evaluated for STDs. Sexual activity should not resume until all sex partners have been examined and, if necessary, treated.


Source: CDC

Patient Guide to Gonorrhea

What is gonorrhea?
Gonorrhea is a sexually transmitted disease (STD). Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus. 


How common is gonorrhea?
Gonorrhea is a very common infectious disease. CDC estimates that more than 700,000 persons in the U.S. get new gonorrheal infections each year. Less than half of these infections are reported to CDC. In 2009, 301,174 cases of gonorrhea were reported to CDC. 


How do people get gonorrhea?
Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to baby during delivery.
People who have had gonorrhea and received treatment may get infected again if they have sexual contact with a person infected with gonorrhea.
Who is at risk for gonorrhea?
Any sexually active person can be infected with gonorrhea. In the United States, the highest reported rates of infection are among sexually active teenagers, young adults, and African Americans. 


What are the signs and symptoms of gonorrhea?
Some men with gonorrhea may have no symptoms at all. However, some men have signs or symptoms that appear one to fourteen days after infection. Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis. Sometimes men with gonorrhea get painful or swollen testicles.
In women, the symptoms of gonorrhea are often mild, but most women who are infected have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and signs in women include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.
Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements. Rectal infection also may cause no symptoms. Infections in the throat may cause a sore throat, but usually causes no symptoms. 
 

What are the complications of gonorrhea?
Untreated gonorrhea can cause serious and permanent health problems in both women and men.
In women, gonorrhea is a common cause of pelvic inflammatory disease (PID). About 750,000 women each year in the United States develop PID. The symptoms may be quite mild or can be very severe and can include abdominal pain and fever. PID can lead to internal abscesses (pus-filled “pockets” that are hard to cure) and long-lasting, chronic pelvic pain. PID can damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy. Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube.
In men, gonorrhea can cause epididymitis, a painful condition of the ducts attached to the testicles that may lead to infertility if left untreated.
Gonorrhea can spread to the blood or joints. This condition can be life threatening. In addition, people with gonorrhea can more easily contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea can transmit HIV more easily to someone else than if they did not have gonorrhea. 


How does gonorrhea affect a pregnant woman and her baby?
If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby. Treatment of gonorrhea as soon as it is detected in pregnant women will reduce the risk of these complications. Pregnant women should consult a health care provider for appropriate examination, testing, and treatment, as necessary. 


How is gonorrhea diagnosed?
Several laboratory tests are available to diagnose gonorrhea. A doctor or nurse can obtain a sample for testing from the parts of the body likely to be infected (cervix, urethra, rectum, or throat) and send the sample to a laboratory for analysis. Gonorrhea that is present in the cervix or urethra can be diagnosed in a laboratory by testing a urine sample. A quick laboratory test for gonorrhea in men with symptoms that can be done in some clinics or doctor’s offices is a Gram stain. A Gram stain of a sample from a urethra allows the doctor to see the gonorrhea bacterium under a microscope.

 
What is the treatment for gonorrhea?
Antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States, and successful treatment of gonorrhea is becoming more difficult. CDC now recommends dual therapy (i.e. using two drugs) for the treatment of gonorrhea. Persons with gonorrhea should be tested for other STDs.
It is important to take all of the medication prescribed to cure gonorrhea. Although medication will stop the infection, it will not repair any permanent damage done by the disease. People who have had gonorrhea and have been treated can get the disease again if they have sexual contact with persons infected with gonorrhea. If a person’s symptoms continue even after receiving treatment, he or she should return to a doctor to be reevaluated. 


How can gonorrhea be prevented?
The surest way to avoid transmission of STDs is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea.
Any genital symptoms such as discharge or burning during urination or unusual sore or rash should be a signal to stop having sex and to see a doctor immediately. If a person has been diagnosed and treated for gonorrhea, he or she should notify all recent sex partners so they can see a health care provider and be treated. This will reduce the risk that the sex partners will develop serious complications from gonorrhea and will also reduce the person’s risk of becoming re-infected. The person and all of his or her sex partners must avoid sex until they have completed their treatment for gonorrhea and until they and their sex partners no longer have symptoms. 


Source: CDC

Patient Guide to Bladder cancer

What is bladder cancer? 
Bladder cancer happens when normal cells in the bladder change into abnormal cells, and grow out of control. Bladder cancer is more common in men and in older people.


What are the symptoms of bladder cancer? 
Symptoms of bladder cancer can come and go. They can include:
Blood in the urine, which makes your urine look pink or red.
Pain on the sides of your back or above your pubic area.
Pain when urinating, urinating often, or leaking urine
These symptoms can also be caused by conditions that are not bladder cancer. But if you see blood in your urine, you should be checked by a doctor.


Is there a test for bladder cancer? 
Yes. Doctors can use different types of tests to look for bladder cancer. These include:
  • Urine tests : Urine tests can show what kind of cells are in the urine.
  • X-rays, CT scans, or other imaging tests : These tests create images of your urinary tract. They can show tumors or abnormal growths.
  • Cystoscopy : Cystoscopy is a procedure that allows the doctor to look inside the bladder. To do a cystoscopy, the doctor inserts a small tube into the urethral opening, the opening through which urine leaves the body. Then he or she threads the tube up into the bladder. The tube has a tiny camera that projects images of the bladder onto a screen. If the doctor sees anything unusual, he or she might take a sample of tissue (biopsy) to look at under the microscope.


What is bladder cancer staging? 
Cancer staging is a way in which doctors find out how far a cancer has spread. The right treatment for you will depend a lot on the stage of your cancer. Your treatment will also depend on your age and your other medical problems.


How is bladder cancer treated? 
People with bladder cancer often have one or more of the following treatments:
  • Surgery: Bladder cancer is usually treated with surgery that can include:
    • Taking out the cancer and leaving the bladder in place. In many cases, this is done through cystoscopy.
    • Taking out the cancer and a part of the bladder. After this surgery, people can often urinate normally and have normal sexual function.
    • Taking out the cancer, the bladder, and nearby internal organs. This surgery can damage the nerves that control sexual function.
  • Chemotherapy : Chemotherapy is the term doctors use to describe a group of medicines that kill cancer cells. These medicines can go either into a vein or directly into your bladder. Some people get these medicines before surgery to shrink the cancer and make it easier to remove. People might also receive these medicines after surgery to keep the cancer from growing, spreading, or coming back.
  • Other therapy : Another type of medicine for bladder cancer goes directly into the bladder. This medicine is different than chemotherapy. It teaches your body’s infection-fighting system to attack cancer cells.
  • Radiation therapy : Radiation kills cancer cells. 
 

Patient Guide to Crohn’s disease

What is Crohn’s disease? 
Crohn’s disease is a disorder that can cause diarrhea, belly pain, and other symptoms that affect the digestive tract. The digestive tract is the part of the body and takes in and breaks down food. It includes the mouth, the stomach, and the intestines.
When it is working normally, the body’s immune system kills germs and "bad" cells that could turn into cancer. Sometimes, instead of killing only bad cells, something goes wrong and the immune system starts to attack healthy cells. That is called an "autoimmune response." It is what happens in Crohn’s disease. If you have Crohn’s disease, your body is attacking the lining of the digestive tract. This causes inflammation, which can lead to sores (ulcers) and bleeding.
The symptoms of Crohn’s disease can get better or worse at different times. But the condition cannot be cured. Luckily, there are medicines and other treatments that can improve its symptoms.


What are the symptoms of Crohn’s disease?
The most common symptoms are diarrhea, belly pain, feeling tired, weight loss, and fever. Some people with Crohn’s disease also get mouth sores, skin rashes, joint pain, and eye redness.


Is there a test for Crohn’s disease? 
Yes. There are a few tests that can help diagnose Crohn’s disease. Doctors use x-rays or scans to look at the upper intestine and a test called “colonoscopy” to look at the lower intestine. During a colonoscopy, the doctor puts a thin tube into your rectum and threads it up into your colon. The tube has a camera attached to it, so the doctor can look inside your colon.


Is there anything I can do on my own to feel better? 
Yes. Your symptoms might improve if you:
  • Cut down on foods that make your symptoms worse. Some people have problems with foods that have a lot of fiber, such as fruits and vegetables.
  • Quit smoking, if you smoke. Smoking makes symptoms worse and increases the chances that you will need surgery.
  • Avoid medicines such as ibuprofen and naproxen.


How is Crohn's disease treated? 
There are many different medicines that help reduce the symptoms of Crohn’s disease. Almost all of these medicines work by reducing inflammation and the body’s immune response. Some medicines treat symptoms when they are at their worst. Other medicines help keep symptoms from starting up or coming back. Doctors sometimes also prescribe antibiotics to people with Crohn’s disease. 
 

Patient Guide to Bell's Palsy

What is Bell's palsy?
Bell's palsy is a condition in which the nerve that controls the muscles of the face becomes injured or even stops working altogether. This causes the facial muscles to become weak or paralyzed. Common signs of Bell's palsy are weakness of muscles on one side of the face, drooping eyelid or mouth on one side, or drooling from one side of the mouth.
Bell's palsy affects about 40,000 people each year in the United States, affecting all races and both genders equally. Diabetes and pregnancy increase the risk of developing Bell's palsy.
Most people with Bell's palsy recover completely. A minority of people continue to have some symptoms for life. If you have any signs of Bell's palsy, you should see a doctor or nurse because treatment is available.


What are the causes of Bell's palsy?
Bell’s palsy is caused by an inflammation of the facial nerve. This inflammation may be caused by a virus. There is some evidence that the virus is often herpes simplex virus (HSV), the same virus that causes cold sores and genital herpes. Other viruses may also cause the condition, including herpes zoster virus, cytomegalovirus, and Epstein Barr virus. 
The inflammation causes swelling of a nerve that controls movement of one side of the face. The nerve, as well as tiny blood vessels near the nerve, must travel through a tight area surrounded by bone. As the nerve swells, it becomes compressed (pinched) and its protective covering breaks down, interfering with the nerve's ability to communicate with the muscles. This causes weakness or paralysis of the muscles in one side of the face. Weakness of these muscles can make it difficult to smile or close the eye.


What are the symptoms of Bell's palsy?
Bell's palsy causes one side of the face to be partly or completely paralyzed. This may cause:
  • Eyebrow sagging.
  • Drooping of the eye and corner of the mouth.
  • One eye will not close completely.
In some cases, you may lose the normal ability to close one eye, which can lead to drying of the surface of the eye (the cornea). Loud noises may cause discomfort in the ear on the affected side — a condition called dysacusis. In addition, some people lose the sense of taste on the front of the tongue.
The changes caused by Bell's palsy will affect the appearance of your face, including how you smile. These changes are often obvious to others, and can cause people with Bell's palsy to feel distressed and to avoid social activities.
The symptoms of Bell's palsy usually appear over a period of a day or two. Most patients begin to improve within three weeks after the first symptoms begin. Improvement may continue for three to six months.


How is Bell's palsy diagnosed?  
Bell's palsy is usually diagnosed based on your symptoms and a physical examination. Blood and other tests are not usually needed, but doctors do sometimes test for Lyme disease, an infection that can cause weakness of the face.


How is Bell's palsy treated?
There is no cure for Bell's palsy, but treatment can help you to get better faster, especially if you can start treatment within the first few days. However, you may not have to be treated for Bell's palsy if your symptoms are mild. Talk to your doctor or nurse to ask if you should be treated.
  • Eye care — You will need eye treatments if you cannot close your eye. If the cornea, which is the clear protective covering of the eye, becomes overly dry, there is a risk of permanent eye damage. You can use artificial tears (eye drops) as often as every hour during the day to keep the eye moist. A moisturizing ointment is usually better at night. You can use the ointment during the day, although it will make your vision blurry. If your eye does not close completely, you should protect it during the day with glasses or goggles. Use a patch over your eye at night, but be sure not to use tape on your eyelid since the patch could slip and scratch the cornea.
  • Medications — Most people who are diagnosed with Bell's palsy quickly (within 2 to 3 days of the first symptoms) are treated with steroids (eg, prednisone) for one week. Steroids, also called glucocorticoids, can reduce swelling and improve your chances of recovering completely [1]. These medicines work best when started early (within three days of the first symptoms). Antiviral medicines (eg, valacyclovir, Valtrex®) are sometimes used in conjunction with glucocorticoids, but controlled trials have not found an added benefit from the use of these agents.
  • Monitoring — You will need a follow up visit with your doctor or nurse after you start treatment. At this visit, you will have an examination and you can discuss any questions or problems. 

Patient Guide to Glaucoma

What is glaucoma? 
Glaucoma is a disease that damages the main nerve in the eye, called the optic nerve. It causes vision loss and can even lead to blindness. There are different types of glaucoma. The most common type in the United States is open-angle glaucoma. This article is about open-angle glaucoma.


What are the symptoms of glaucoma? 
At first, glaucoma does not usually cause symptoms. When it does cause vision loss, it starts by affecting the edges of what you see. In other words, the center of what you look at often looks clear. But things that are off to the side do not. Some people call this “tunnel vision.” As the disease gets worse, all vision can be affected.


Is there a test for glaucoma? 
Yes. To check for glaucoma, doctors can use a few different tests. They can:
  • Look into the back of your eye with a magnifying tool and see if there are signs of nerve damage.
  • Check how well you see things in the center of your vision, and how well you see things that are off to the side.
  • Check the pressure inside your eye by pushing or blowing on your eye with a special tool. (People with glaucoma often have too much pressure inside the eye.)
Everyone age 40 and older should be tested for glaucoma at least once. Testing helps doctors find and treat the disease early, before it causes symptoms. That’s important, because treatment for glaucoma can prevent or slow down vision loss. But it cannot undo damage that has already been done.


How is glaucoma treated? 
Effective treatments for glaucoma all work by lowering the pressure inside the eye. There are 3 ways to lower eye pressure: eye drops, surgery, or laser therapy.
  • Eye drop medicines : There are 2 main types of glaucoma eye drops: prostaglandins and beta blockers.
  • Laser therapy : Laser therapy improves the way fluid drains from the eye.  
  • Surgery : Surgery involves making a small opening or inserting a tiny tube in the eye so that fluid can drain better. 
 

Patient Guide to Appendicitis

What is appendicitis? 
Appendicitis is the name for when the appendix gets infected and inflamed. The appendix is a long, thin pouch that is shaped like a finger. It hangs down from the large intestine, or colon. If that happens, the pouch can swell and in some cases burst. That’s dangerous, because a burst appendix can cause widespread infection.

 
What are the symptoms of appendicitis? 
The usual symptoms include:
  • Severe pain in the lower part of the belly, on the right side. (For many people, the pain starts near the belly button and then moves to the lower right side.)
  • Loss of appetite Nausea and vomiting.
  • Fever.
Some people have a different set of symptoms that include:
  • Stomach upset.
  • Having a lot of gas.
  • Irregular bowel movements.
  • Diarrhea.
  • Feeling ill.


Is there a test for appendicitis? 
Your doctor can run tests that can help him or her find the cause of your symptoms. But if you do have appendicitis, he or she will probably be able to diagnose it just by doing an exam. Your doctor or nurse can learn a lot about your condition by pressing on your belly and talking with you about your symptoms.


How is appendicitis treated? 
The main treatment for appendicitis is surgery to remove the appendix. This surgery can be done in 2 ways:
  • Open surgery : During an open surgery, the doctor makes a cut near the appendix that is big enough to pull the appendix through.
  • Laparoscopic surgery : During laparoscopic surgery, the doctor makes a few cuts that are much smaller than those used in open surgery. Then he or she inserts long, thin tools into the belly. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. The doctor can look at the image on the screen to know where to cut and what to remove. Then he or she uses the long tools to do the surgery.
If your appendix has burst, your surgery will probably be more complicated than it would be if it had not burst. Your doctor will need to wash away the material that spills out when an appendix bursts. As a result, your cuts may be larger or you may spend more time in surgery.
If it has been a few days since your appendix burst, your doctor might decide not to do surgery at all. That’s because the body sometimes forms a wall inside the belly, to block off the area that became infected when the appendix burst. In cases like that, doctors usually give antibiotics and carefully watch people. But they often avoid surgery, because it can be dangerous in people who fit this description. 
 

Patient Guide to Pancreatitis

What is pancreatitis? 
Pancreatitis is a condition that can cause severe belly pain. The pancreas is an organ that makes hormones and juices that help break down food. Pancreatitis is the term doctors and nurses use when this organ gets irritated or swollen. Most people get over pancreatitis without any long-lasting effects. But a few people get very sick.


What causes pancreatitis? 
There are many causes of pancreatitis. But most cases are caused by gallstones or alcohol abuse:
  • Gallstones : Gallstones are hard lumps that form inside an organ called the gallbladder. Both the pancreas and the gallbladder drain into a single tube. If that tube gets clogged by a gallstone, neither of the organs can drain. When that happens, the fluids from both organs get backed up. That can cause pain.
  • Alcohol abuse : People who drink too much alcohol for too long sometimes get alcohol-related pancreatitis. People with this form of pancreatitis usually start to feel pain 1 to 3 days after drinking a lot of alcohol or after they suddenly stop drinking. They usually also have nausea and vomiting (throwing up). People with this form of pancreatitis must learn to give up alcohol to keep from getting pancreatitis again.


Is there a test for pancreatitis? 
There is no easy test for pancreatitis. Doctors sometimes have trouble diagnosing it, because its symptoms can be caused by a lot of things. Even so, there are a few tests that can help your doctor figure out if you have pancreatitis.


How is pancreatitis treated? 
Pancreatitis is usually treated in the hospital. There, your doctor or nurse can give you fluids and pain medicines to help you feel better. If you cannot eat, he or she can give you food through a tube. Some people with pancreatitis get an infection. Your doctor or nurse may give you antibiotics to treat or prevent infection. Another important part of treatment is to get rid of the cause of the pancreatitis. If your pancreatitis is caused by gallstones, your doctor may need to treat them, too. 
 

Patient Guide to Atrial fibrillation

What is atrial fibrillation? 
Atrial fibrillation is the most common heart rhythm problem people have. The condition puts you at risk of stroke and other problems. Another term for atrial fibrillation is "A-fib."
In people with A-fib, the electrical signals that control the heartbeat become abnormal. As a result, the top two chambers of the heart stop pumping effectively, and blood that should move out of these chambers gets left behind. As the blood pools, it can start to form clots. These clots can travel up to the brain through the blood vessels, and cause strokes.
In some people, A-fib never goes away. In others, A-fib can come and go. If you had one or more bouts of A-fib, but have a normal heart rhythm now, ask your doctor what you can do to keep A-fib from coming back.
Some people can reduce their chances of having A-fib again by:
  • Controlling their blood pressure.
  • Not drinking a lot of alcohol in one sitting (limit to 1 to 2 drinks in one day).
  • Cutting down on caffeine.
  • Getting treatment for an overactive thyroid gland.

What are the symptoms of atrial fibrillation? 
Some people with A-fib have no symptoms. When symptoms do occur, they can include:
  • Feeling as though your heart is racing, skipping beats, or beating out of sync.
  • Mild chest "tightness" or pain.
  • Feeling lightheaded, dizzy, or like you might pass out.
  • Having trouble breathing, especially with exercise.

Is there a test for atrial fibrillation? 
If your doctor or nurse suspects you have A-fib, he or she will probably do a test called an electrocardiogram. This test, also known as an "ECG" or "EKG," measures the electrical activity in your heart.

How is atrial fibrillation treated? 
Treatment can include one or more of these:
  • Medicines to control the speed or rhythm of the heartbeat.
  • Medicines to keep clots from forming.
  • A treatment called “cardioversion” that involves applying a mild electrical current to the heart to fix its rhythm.
  • Treatments called "ablation," which use heat ("radiofrequency ablation") or cold ("cryoablation") to destroy the small part of the heart that is sending abnormal electrical signals.
  • A device called a pacemaker that is implanted in your body and sends electrical signals to the heart to control the heartbeat.
  • Surgery to create scar tissue in the heart to block the flow of electrical signals. 
 

Patient Guide to Rheumatoid arthritis

What is rheumatoid arthritis? 
Rheumatoid arthritis is a disease that causes pain, swelling, and stiffness in the joints. It is one of many different types of arthritis. Doctors and nurses do not know what causes it. But they do know that it happens when the body’s infection-fighting system, called the immune system, "attacks" the joints.


How can I tell whether I have rheumatoid arthritis or another type of arthritis? 
You cannot tell. Only a doctor or nurse can tell you that. But there are some clues to look for. For instance, rheumatoid arthritis usually starts by affecting the small joints in the fingers, the balls of the feet, and the wrists. It usually affects both the left and the right side at the same time.
If your doctor or nurse tells you that you have rheumatoid arthritis, start treatment right away. Do not wait until your symptoms get worse. Getting treated early can help prevent a lot of the damage the disease can do to your body.


What happens as rheumatoid arthritis gets worse? 
Even though it may start in the fingers and toes, rheumatoid arthritis can affect any of the joints. Sometimes it damages the joints forever. Plus, rheumatoid arthritis can cause problems in other parts of the body, such as the heart, lungs, or eyes. Doctors and nurses have no way of knowing which people will get which symptoms or how bad the symptoms will get.


What are the treatments for rheumatoid arthritis? 
There are dozens of medicines for rheumatoid arthritis. The right one for you will depend on:
  • How bad your symptoms are.
  • How many of your joints are affected.
  • How your disease has changed over time.
  • What side effects you feel with the medicines you try.
  • What your X-rays look like.
  • The results of certain blood tests.


Is there anything I can do on my own to feel better? 
Yes. It is very important that you stay active. You may want to avoid being active because you are in pain. But that can make things worse. It will make your muscles weak and your joints stiffer than they already are. A physical therapist can help you figure out which exercises will do the most good.
Another thing you can do to on your own is to eat a healthy diet. People with rheumatoid arthritis are at risk for heart disease, so avoid fatty foods. Instead, eats lots of fruits and vegetables. 

Patient Guide to Shingles

What is shingles? 
Shingles is a painful rash. It is caused by the same virus that causes chickenpox. After someone has chickenpox, the virus sometimes hides out, "asleep" in the body. Years later, it can "wake up" and cause shingles. The rash caused by shingles is shaped like a band or a belt. Shingles can affect people of all ages, but it is most common in those older than 50. Another name for shingles is "herpes zoster." That is the name of the virus that causes shingles.


Is shingles contagious? 
Yes and no. It is NOT possible to "catch" shingles from someone who has the rash. But is possible to “catch” the virus that causes shingles and then get sick with chickenpox. Shingles and chickenpox are caused by the same virus. The first time a person is infected with that virus, he or she gets chickenpox, not shingles. You probably will not catch the virus (or get chickenpox) if you:
  • Had chickenpox or shingles in the past.
  • Had the chickenpox vaccine.
  • Were born before 1980 (most people born before 1980 have had chickenpox even if they don’t remember it).
If you have never had chickenpox or the chickenpox vaccine, be careful around anyone with shingles. Do not touch their rash. If you do, you could get sick with chickenpox. In rare cases, people can even get chickenpox from just being near someone with shingles. This is most likely in people who cannot fight infections well.


What are the symptoms of shingles? 
At first, shingles causes weird sensations on your skin. You might feel itching, burning, pain or tingling. Some people get a fever, feel sick, or get a headache. Within 1 to 2 days, a rash with blisters appears. Blisters most often appear in a band across the chest and back. They can show up on other parts of the body, too. The blisters cause pain that can be mild or severe.
Within 3 to 4 days, shingles blisters can become open sores or "ulcers". These ulcers can get infected. Within 7 to 10 days, the rash should scab over. By then, most people are no longer contagious.


Can shingles be serious? 
Yes. Shingles can be serious, but that is rare. About 1 out of 10 people with shingles will get something called “postherpetic neuralgia,” or “PHN.” People with PHN keep feeling pain or discomfort even after their rash goes away. This pain can last for months or even years. It can be so bad that it makes it hard to sleep, causes weight loss, and leads to depression.
Shingles can also cause:
  • Skin infections.
  • Eye problems (if the rash is near the eye).
  • Ear problems (if the rash is near the ear).
  • Dangerous infections in people who have other health problems.


Should I be treated? 
Yes. Your doctor or nurse should give you medicines to help you get rid of the virus. These medicines are called antivirals. They can speed your recovery and reduce the chances that you will have shingles-related problems like PHN.


Can the pain be treated? 
Some people can deal with their pain with non-prescription pain medicines, but most people need prescription medicines.


How should I take care of the rash? 
Keep the parts of your skin that have a rash clean and dry. Do not use creams or gels unless your doctor or nurse says you should.


Can shingles be prevented? 
People can reduce the chances of getting shingles by having the shingles vaccine. The vaccine can also make the symptoms of shingles milder if they do occur. Most people age 60 and older should get the shingles vaccine. 
 

Patient Guide to Stroke

What is a stroke?
Stroke is the term doctors use when a part of the brain dies because it goes without blood for too long. It can happen when the blood supply to a part of the brain is cut off, because an artery in the brain gets clogged or starts bleeding. 
 

How do strokes affect people?
The effects of a stroke depend on a lot of things, including which part and how much of the brain is affected and how quickly the stroke is treated.


How can you tell if someone is having a stroke?
There is an easy way to remember the signs of a stroke. Just think of the word “FAST”. Each letter in the word stands for one of the things you should watch for:
  • Face - Does the person’s face look uneven or droop on one side?
  • Arm - Does the person have weakness or numbness in one or both arms? Does one arm drift down if the person tries to hold both arms out?
  • Speech - Is the person having trouble speaking? Does his or her speech sound strange?
  • Time - If you notice any of these stroke signs, call 9-1-1.
You need to act fast. The sooner treatment begins, the better the chances of recovery.


How are strokes treated?
The right treatment depends on what kind of stroke you are having. To figure this out, you need to get to the hospital quickly. People whose strokes are caused by clogged arteries can get medicines that break up blood clots. These medicines can help reopen clogged arteries. Get medicines that prevent new blood clots. These medicines also help prevent future strokes. People whose strokes are caused by bleeding can have treatments that reduce the damage caused by bleeding in or around the brainStop taking medicines that increase bleeding, or take a lower doseHave surgery to repair the artery or stop the bleeding.


Can strokes be prevented?
You can reduce your chances of having a stroke by:
  • Getting treated for high blood pressure.
  • Not smoking.
  • Being active.
  • Controlling your blood sugar if you have diabetes.
  • Losing weight if you are overweight.
  • Eating lots of fruits, vegetables, and low-fat dairy products, but not a lot of fatty or salty foods.
  • Taking your medicines exactly as directed. 
 

Patient Guide to Fibromyalgia

What is fibromyalgia? 
Fibromyalgia is a condition that causes people to feel pain in the muscles all over their body. People with fibromyalgia also have "tender points," places on their body that hurt when they are touched. No one knows what causes fibromyalgia.


Can fibromyalgia be cured? 
Some people seem to get over fibromyalgia. But in most people it cannot be cured. Even so, people can learn to deal with the condition and to lead fairly normal lives. Fibromyalgia does not get worse over time, and it is not life-threatening.


Does fibromyalgia cause symptoms besides muscle pain? 
Yes. People with fibromyalgia often say they feel tired all the time and that sleep does not help them feel rested. They may also have:
  • Flu-like symptoms.
  • Headaches.
  • Depression and anxiety.
  • Stomach pain.
  • Too many or too few bowel movements (diarrhea or constipation).
  • Pain in the bladder or the need to urinate in a hurry or often.
  • Problems with the jaw.


Is there a test for fibromyalgia? 
No, there is no test. To diagnose it, doctors and nurses have to go by symptoms. First they look for other causes of the symptoms, such as arthritis or a hormone problem. They diagnose the condition if they can find no other cause, and if a person has:
  • Muscle pain all over their body.
  • Severe tenderness in at least 11 of the 18 known “tender points” of fibromyalgia.
Sometimes doctors diagnose fibromyalgia without checking for the number of tender points a person has. This might happen if the person has many areas that feel painful, and is bothered a lot by symptoms that are often caused by fibromyalgia. Some of these symptoms include feeling tired when getting up in the morning and during the day, and having trouble thinking clearly.


How is fibromyalgia treated? 
There are medicines and strategies to help with the symptoms of fibromyalgia. But there is no one treatment that works for everyone. You and your healthcare team will need to work together to find the right mix of treatments for you. In general, treatment can include:
  • Medicines to relieve pain, improve sleep, or improve mood Physical therapy to learn exercises and stretches.
  • Relaxation therapy.
  • Working with a counselor.
To get the best treatment, many people need a team that includes:
  • A doctor.
  • A physical therapist.
  • Someone trained in mental health (such as a social worker or counselor).


Be open to medicines 
Your doctor or nurse may suggest that you take a medicine normally used to treat depression or seizures. If so, be open to trying it. Even if you are not depressed and do not have seizures, these medicines may help. That is because they work on the brain areas that deal with pain.


What can I do on my own? 
It is really important that you stay active. Walking, swimming, or biking can all help ease muscle pain. If you have not been active, it might hurt a little more when you start. But being active can help improve your symptoms.
It is also really important that you try not to be too negative about your life. Your outlook has a big effect on how you feel pain. Do your best to be positive. 
 

Patient Guide to Influenza Vaccine

Getting the influenza vaccine is the most effective way to reduce the chance of becoming infected with the flu. People who get the influenza vaccine have a lower chance of illness and death from influenza compared to people who are not vaccinated. 

Vaccine Timing 
Because the influenza virus changes (or "mutates") slightly from year to year, you need a new influenza vaccine before each flu season. People should get the flu vaccine as soon as it is available to get the most benefit.
In the northern hemisphere, the flu season usually occurs between November and April. In the southern hemisphere, the flu season usually occurs between May and October. Flu can occur at any time of year in the tropics.

Vaccine Effectiveness 
People who are vaccinated form antibodies (proteins), which destroy the influenza virus after the person is exposed. It generally takes about two weeks to make these antibodies. The vaccine usually protects 50 to 80 percent of those who are vaccinated from getting the flu.
If you get the flu after being vaccinated, your symptoms are likely to be milder and last for a shorter time compared to people who were not vaccinated.

Injection versus nasal spray 
The flu vaccine is available in two forms in the United States, as an injection and a nasal spray.
  • The injection is approved for adults and children 6 months and older. 
  • The nasal spray is approved only for healthy children age 2 years and older and healthy adults up to 49 years.
Pregnant women and people who have a weakened immune system or who have chronic medical problems should not get the nasal spray since it contains live virus. If you live with a person with a severely weakened immune system, you should not get the nasal spray.

Vaccine side effects 
The most common side effect of the flu shot is soreness at the injection site.
People with a serious allergy to egg products should talk with their doctor or nurse before getting the nasal spray or shot because both are prepared from viruses grown in eggs.
Other possible side effects of these vaccines include body aches, headache, and a low-grade fever (usually less than 100.4ºF or 38ºC). These problems are usually mild and go away within a day or two.
Many people are concerned about the safety of vaccines. But for most people the risk of complications from the vaccine is much smaller than the risk of complications from being infected with the flu. While no vaccine is 100 percent safe for everyone, the flu vaccine appears to be low-risk. For example:
  • The flu vaccine is less likely than the flu itself to increase the risk of a nervous system disorder called Guillain-Barré syndrome. 
  • There is no evidence that the flu vaccine increases the risk of birth defects or miscarriage. 
  • Some formulations of the flu vaccine contain a preservative called thimerosal, which is derived from mercury. However, there is no convincing evidence that the small amount of thimerosal in this vaccine will be harmful to children, pregnant women, or adults. 
  • Several groups, including the Vaccine Adverse Event Report System (VAERS, http://vaers.hhs.gov), monitor the reports of vaccine side effects closely. 

Who should be vaccinated?
  • Adults age 50 or older. 
  • People who live in nursing homes and other long-term care facilities. 
  • Adults and children who have chronic lung or heart conditions. This includes children with asthma.Adults and children with chronic diseases such as diabetes or kidney disease. 
  • Adults and children with HIV infection, or who have received organ or stem cell transplants. 
  • Children and teenagers age 6 months to 18 years who are taking long-term aspirin therapy and might be at risk for Reye syndrome. 
  • Women who will be pregnant during the influenza season. 
  • Adults and children who might transmit influenza to high-risk individuals (including people listed above). This includes healthcare workers, workers in nursing homes, home health workers, and people who live with a high-risk individual.

Patient Guide to Gallstones

What are gallstones? 
Gallstones are small stones that form inside the gallbladder. The gallbladder is a small, pear-shaped organ that is tucked under your liver. It stores bile, a fluid that helps the body break down fat. They can be tiny specks or get as big as the whole gallbladder, which can be up to 6 inches long.
Normally, the gallbladder fills with bile in between meals. Then, when you eat fatty foods, the gallbladder empties the bile into the intestine. Sometimes, though, gallstones clog the gallbladder and keep it from draining. Other times, gallstones just irritate the gallbladder. If the gallstones are pushed out of the gallbladder, they can keep the liver or pancreas from draining.


What are the symptoms of gallstones? 
In most cases, gallstones do not cause any symptoms. When they do cause symptoms, gallstones can cause:
  • Belly pain : often on the right side just under the rib cage or in the middle top portion of the belly.
  • Pain in the back or right shoulder.
  • Nausea and vomiting.


Are gallstones serious? 
Not usually. In rare cases they can lead to serious problems, including:
  • Jaundice, a condition that turns your skin and eyes yellow.
  • Infection.
  • Gallbladder tears, which can lead to death.
  • Inflammation of the pancreas.

 
Is there a test for gallstones? 
Yes, doctors can find out if you have gallstones by doing an imaging test, such as an ultrasound. An ultrasound is a painless test that uses sound waves to make an image of your gallbladder. Even if tests show that you have gallstones, that does not mean they are causing symptoms. Your doctor might need to do other tests to make sure your stones and your symptoms are related.


How are gallstones treated? 
People with gallstones generally have 3 treatment options. They can have:
  • No treatment : This option is best for people with no symptoms. If they start having symptoms, they can think about treatment then.
  • Surgery to remove the gallbladder and the stones : Gallbladder surgery is routine in the United States. But it involves using anesthesia, so it has some risks. The surgery does not affect digestion very much. But about half the people who have surgery have mild symptoms afterward, including watery bowel movements, gas, or bloating. These symptoms usually get better. People who have their gallbladder removed do not need to worry about gallstones coming back.
  • Treatment to get rid of the stones but keep the gallbladder : People who choose this approach can take medicines to break up gallstones or be treated with a device that breaks up stones (or both). These treatments can work, but they take time — months to years. People with severe symptoms may not want to wait that long to feel better. Plus, the stones can come back after these treatments.


How do I know which treatment to have? 
The right treatment for you will depend on:
  • How large your stones are.
  • Whether you have symptoms, and how bad the symptoms are.
  • How you feel about the treatment options.
Ask your doctor how each treatment might affect you. Then work with him or her to find the treatment that makes the most sense for you.


Can I do anything to keep from getting (more) gallstones? 
Yes. You can:
  • Eat at least 3 meals a day, and make sure each meal has a little bit of fat. That way the gallbladder has to empty every time you eat.
  • Choose foods that have a lot of fiber and calcium, but not a lot of saturated fat. Good choices include fruits, vegetables, and low-fat dairy products.
  • Try to keep yourself at a healthy weight. People who are overweight are more likely to get gallstones. 
 

How to Treat Child's Croup at Home

Most children with croup have mild symptoms and can be successfully treated at home. This includes using mist from a humidifier or sitting with the child in a bathroom (not in the shower) filled with steam generated by running hot water from the shower. A parent should stay with the child during mist treatment; a favorite book or lullaby may help to decrease the child's anxiety and prevent crying, which can worsen stridor.

Hot steam humidifiers should be avoided because of the risk of burns. If the child's stridor does not improve during the mist treatment, the parent should contact their child's healthcare provider.

Other suggestions for home treatment of mild croup include:
  • Allow the child to breathe cool air during the night by opening a window or door. 
  • Fever can be treated with an over-the-counter medication such as acetaminophen or ibuprofen.  
  • Coughing can be treated with warm, clear fluids to loosen mucus on the vocal chords. Warm water, apple juice, or lemonade is safe for children older than four months. Frozen juice popsicles also can be given. 
  • Smoking in the home should be avoided; smoke can worsen a child's cough. 
  • Keep the child's head elevated. An infant can be placed in a car seat. A child may be propped up in bed with an extra pillow. Pillows should not be used with infants younger than 12 months of age. 
  • Parents may sleep in the same room with their child during an episode of croup so that they will be immediately available if the child begins to have difficulty breathing.

When to take your child or infant to the doctor

Your child should be seen as soon as possible if he or she:
  • Does not respond to you, has trouble waking up, or is limp
  • Has trouble breathing
  • Has blue lips, tongue, or nails
  • Starts to lean forward and drool
  • Is an infant, and the soft spot on his or her head seems to be bulging or caving in
  • Has a stiff neck
  • Has a severe headache
  • Has severe belly pain
  • Has a rash or purple spots that look like bruises on the skin (that were not there before he or she got sick)
  • Refuses to drink anything or seems too sick to drink enough
  • Will not stop crying
  • Is very cranky or irritable
Call or visit your child's doctor or nurse if your child:
  • Has diarrhea that lasts more than two to three days or seems to be getting worse
  • Has vomiting that goes on for more than one day
  • Seems to be dehydrated (signs include urinating less than usual, not having tears when crying, being less alert and less active than usual)
  • Has a specific symptom, such as a sore throat or ear pain
  • Has pain when he or she urinates

Patient Guide to Measure A Child's Temperature

The best way to measure a child's temperature depends upon several factors. In all children, a rectal temperature is the most accurate. However, it is possible to accurately measure the temperature in the mouth (for children older than four or five years) or ear (for children older than six months) when the proper technique is used.

Temperatures measured in the armpit are the least accurate, but may be useful as a first test in an infant who is younger than three months. If the armpit temperature is over 99ºF (37.2ºC), the rectal temperature should be measured.

It is not accurate to measure a child's temperature by feeling the child's skin. This is called a tactile temperature, and it is highly dependent upon the temperature of the person who is feeling the child's skin.

Glass versus digital thermometers 
Digital thermometers are inexpensive, widely available, and are the most accurate way to measure temperature. A variety of styles are available.

Glass thermometers that contain mercury are not recommended due to the potential risks of exposure to mercury (which is toxic) if the thermometer is broken. If a digital thermometer is not available, be sure to carefully "shake down" the glass thermometer before use. Instructions for disposing of thermometers that contain mercury are available online (www.epa.gov/mercury/spills/index.htm).

Other types of thermometers are available, including plastic strip, forehead, and pacifier thermometers. However, these are not as accurate as digital thermometers and are not recommended.

Rectal temperature
  • The child or infant should lie down on their stomach across an adult's lap. 
  • Apply a small amount of petroleum jelly (eg, Vaseline) to the end of the thermometer. 
  • Gently insert the thermometer into the child's anus until the silver tip of the thermometer is not visible (1/4 to 1/2 inch inside the anus). 
  • Hold the thermometer in place. 
  • A glass thermometer requires 2 minutes while most digital thermometers need less than one minute.

Oral temperature 
  • Do not measure the temperature in a child's mouth if he or she has consumed a hot or cold food or drink in the last 30 minutes.
  • Clean the thermometer with cool water and soap. 
  • Rinse with water. 
  • Place the tip of the thermometer under the child's tongue towards the back. 
  • Ask the child to hold the thermometer with his or her lips. 
  • Keep the lips sealed around the thermometer. 
  • A glass thermometer requires about 3 minutes while most digital thermometers need less than one minute.

Armpit temperature
  • Place the tip of the thermometer in the child's dry armpit. 
  • Hold the thermometer in place by holding the child's elbow against the chest for 4 to 5 minutes.

Ear temperature 
  • Ear thermometers are not reliable in infants less than 6 months old. 
  • If the child has been outside on a cold day, wait 15 minutes before measuring the ear temperature. 
  • Ear tubes and ear infections do not affect the accuracy of an ear temperature.
  • To measure temperature accurately in the ear, the parent must pull the child's outer ear backwards before inserting the thermometer. 
  • Hold the ear probe in the child's ear for about two seconds.

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