Infant and Child Health
Children are vulnerable to certain illnesses and infections for several reasons. First, children do not have fully developed immune systems until they are about 7-8 years old. Because the immune system helps the body fight against diseases and infections, children have an increased risk of developing conditions, such as whooping cough, diarrhea, ear infections, chickenpox, croup, and food allergies, compared to adults.
Another reason children may develop illnesses is because they are frequently exposed to germs. Young children are not as aware or diligent about proper hygiene as adults. Children may wipe their noses with their hands and then play with toys shared with other children. When children are at daycare or school, they are exposed to an exceptionally wide range of germs, and it is easy to spread infections among friends or classmates.
Research suggests that babies who are breastfed are less likely to develop infections (especially lung infections, ear infections, and diarrhea) during their first year of life compared to babies who are fed formulas. This is because the mother’s breast milk contains important antibodies, enzymes, fats, and proteins that help boost the baby’s immune system. Although baby formulas contain all of the important vitamins and nutrients a growing baby needs, manufacturers have not been able to replicate all of the components in breast milk. Formulas lack the antibodies found in breast milk, and they are more difficult for newborns to digest.
Many other factors, such as inherited disorders (such as immune system deficiencies) and the home environment, may contribute to childhood illnesses. For instance, children who are exposed to cigarette smoke in the home have an increased risk of developing infections.
Because diseases and infections are often more severe in children than adults, it is important that children be taken to their doctors when symptoms develop.
Treatment for childhood illnesses varies depending on the specific child. Because children are smaller than adults and their bodies are still developing, they do not usually receive the same treatments. They may require different doses or different types of medicines. It is important that parents and caregivers carefully read the labels of medications to make sure they are safe before giving them to their children. For instance, aspirin is safe in adults, but it should not be given to children because it may cause serious side effects, including Reye’s syndrome, a life-threatening condition that causes brain inflammation and vomiting.
When a child is sick, parents are encouraged to have the child stay at home instead rather than attend school or daycare. This helps prevent the sick child from spreading his/her illness to other children. Although individual facilities each have their own rules, most require children to stay at home if they have a fever that is higher than 100 degrees Fahrenheit, are vomiting, or have diarrhea. Some facilities also require children with bacterial infections, such as pinkeye or strep throat, to stay at home for the first 24 hours of antibiotic therapy. Once medicine has been started, the infections are less likely to be contagious.
Many steps can be taken to decrease the risk of childhood illnesses. For instance, children should regularly wash their hands with soap and warm water. This is especially important after using the bathroom, before eating food, and after touching objects that may contain disease-causing germs. Avoiding close contact with people who have contagious illnesses may also help reduce the risk of contacting infections. Parents or caregivers are also encouraged to talk with their children’s pediatricians about recommended immunizations, such as the flu shotWhooping Cough
Whooping cough, also called pertussis, is a highly contagious bacterial infection of the respiratory system that causes uncontrollable coughing.
Anyone can get whooping cough, but it is more common among infants (younger than six months of age) and children (ages 11-18) who have weak immune systems. This is because the immune system helps the body fight against diseases and infections.
Before the whooping cough vaccine was developed, it was one of the most common childhood diseases and a major cause of childhood deaths in the United States, killing 5,000-10,000 children each year. There are fewer cases today because there are both pertussis-only vaccines and combination vaccines for tetanus, diphtheria, and pertussis.
Infants and toddlers have the greatest risk of experiencing complications from whooping cough, and they are most likely to need hospital treatment. Complications may include ear infections, seizures, pneumonia, emphysema, bleeding in the brain, swelling in the brain, dehydration, slowed or stopped breathing, and/or hernias.
If a person is diagnosed with whooping cough, treatment with antibiotics may help if given soon after symptoms develop.
Causes: Whooping cough is caused by the bacterium Bordetella pertussis (or B. pertussis). The infection is passed from person to person by droplets of respiratory secretions that are coughed or sneezed into the air by someone who is already infected.
Symptoms: Symptoms of whooping cough typically last 6-10 weeks, but they may last longer. Symptoms usually occur in three stages. During stage one, patients usually experience cold-like symptoms, such as sneezing, runny nose, mild coughing, watery eyes, and sometimes, a mild fever. This stage usually lasts several days to two weeks. An infected person is most contagious during this stage.
During stage two, cold-like symptoms fade, but the cough worsens, changing from a dry, hacking cough to bursts of uncontrollable, often violent coughing. During a coughing episode, it may be difficult to breath. When the patient is able to breathe, a high-pitched, “whooping noise” may occur when he/she inhales through the swollen and narrowed airways. Vomiting and severe exhaustion often follow a coughing spell. But between coughing episodes (about 15 coughs an episode), the infected person often appears normal. This is the most serious stage of whooping cough, usually lasting from 2-4 weeks or longer.
During stage three, the patient may improve and gain strength, but the cough may become worse. Coughing episodes may occur from time to time for weeks to months and may flare up if a cold or other upper respiratory illness develops. This final stage may last a few weeks longer in people who have never received the whooping cough vaccine. Children often have a much more severe form of the illness than adults who are younger than 60 years of age.
In infants, complications may include pneumonia, ear infections, slowed or stopped breathing, seizures, and/or brain damage. In children and teenagers, uncontrollable coughing may lead to complications, such as a bruised or broken rib or a hernia.
Pinkeye
Pinkeye (conjunctivitis) describes the inflammation or bacterial or viral infection of the membrane that lines the eyelid (called the conjunctiva) and part of the eyeball. Bacterial conjunctivitis is most common among children, and it is highly contagious.
Even though conjunctivitis that is caused by an infection is highly contagious, it does not cause serious health problems if it is diagnosed and treated early. However, if left untreated, it can lead to serious eye damage, including permanent vision loss.
Causes: Conjunctivitis can be caused by an infection, allergic reaction to allergens (such as dust mites or pollen), or exposure to chemicals or irritants. Bacterial conjunctivitis is most common among children, and it is highly contagious. If the bacteria are present on the skin, it may spread to the eyes, where it causes conjunctivitis. The bacteria can also be spread from sharing eye makeup or contact lenses or after touching or rubbing the eyes with dirty hands.
Symptoms: In general, common symptoms include red, irritated, and watery, itchy eyes, blurred vision, and discharge from the eyes that forms a crust at the edges of the lids and on the eyelashes during sleep. Other less common symptoms may include pain and sensitivity to light.
Allergic conjunctivitis affects both eyes. The eyes become extremely itchy and the eyelids swell. This form causes swelling as a result of excess water in the tissues of the conjunctiva and sometimes the whole eyelid. The eyes may also secrete a mucus discharge. Symptoms will continue as long as the person is exposed to the allergens, unless anti-allergy medicine is taken.
Bacterial conjunctivitis usually affects one eye at first and often spreads to the other. Common symptoms include a feeling of grittiness in the eyes, irritation, reddening of the eyes, and a thick yellow-green discharge that may cause the lids to stick together, especially after sleeping. Symptoms generally last a few days. Depending on the type of bacteria that is causing symptoms, eye damage and/or vision loss may occur if treatment is not started.
Viral conjunctivitis usually starts with one eye and often spreads to the other. Viral conjunctivitis is usually caused by the same viruses that cause upper respiratory (lung) infection, a common cold, or sore throat. Common symptoms include watery eye discharge and itchy eyes. Symptoms generally last a few days.
Conjunctivitis caused by chemicals or irritants is usually painful and it may cause reddening of the eyes and sometimes mucus secretion. Depending on the type of chemical or irritant, eye damage may also occur.
Conjunctivitis caused by chemicals or irritants is usually painful and it may cause reddening of the eyes and sometimes mucus secretion. Depending on the type of chemical or irritant, eye damage may also occur.
Lice
Lice (also called pediculosis) are tiny, parasitic insects that feed on blood from their hosts, which may be human. When a human becomes infected with lice, it is not considered a major health concern. However, it typically causes the skin to become red and itchy.
There are several types of lice, including head lice, body lice, and pubic lice. Head lice develop on the scalp, and they may be visible near the ears, shoulder, and at the nape of the neck. The lice produce small eggs, called nits, which attach to the shaft of hairs. After about one week, the nits hatch and more lice are then present. Body lice spend most of their lives on a person’s clothing, crawling on the person’s skin to feed a couple times a day. The females attach their sticky eggs to the seams and folds of clothing. Pubic lice, commonly called crabs, are found on the skin and hair of the pubic area and eyelashes. Lice are easily spread through close personal contact with an infected person or his/her belongings. However, lice cannot jump or fly from person to person.
Lice are most common among schoolchildren, individuals living in crowded areas, and people living in poverty or unsanitary conditions.
Causes: Humans can get lice after coming into direct contact with lice or their eggs. Lice cannot fly, but individuals may be exposed to them when they touch an infected person or his/her personal belongings, such as bed linens, clothing, stuffed animals, or towels. For instance, head lice are commonly transmitted after sharing pillows, combs/brushes, or hair clips. They can live for up to two days off of the body. Lice can also be spread through sexual contact or after using a toilet seat that was recently used by someone who is infected. Lice can survive about 1-3 days without a human host.
Symptoms: Lice typically cause intense itching and small red bumps to develop on affected areas of the skin. The lice may be visible on the skin, body hair, clothing, or other personal items. They are about three millimeters long. Lice eggs, called nits, may also be visible on hair shafts. Nits look similar to dandruff, but they are not easily brushed away.
Symptoms of head lice typically develop on the scalp, ears, nape of the neck, and shoulders. Symptoms of body lice may develop anywhere on the body that has hair. Symptoms of pubic lice typically develop in the pubic area and on the eye lashes.
Lice usually do not cause serious health problems, even if it goes untreated. However, if children frequently scratch the skin, bacteria may enter the skin and cause an infection.
Food Allergy
A food allergy occurs when an individual’s immune system mistakes a food protein (called an allergen) for a foreign substance. During an allergic reaction, the immune cells overreact to substances that are normally harmless and the body releases chemicals that trigger symptoms that can than affect the eyes, nose, and throat, as well as the skin and the lungs. Even a trace amount of the allergen can cause a reaction in sensitive individuals.
Food allergy is usually common among people who have family histories of allergies. About eight percent of children (compared to only two percent of adults) in the United States are estimated to have food allergies. Food allergies are most common during the first few years of life, and as the immune system continues to develop, allergic sensitivity declines over the first decade of life for most children.
According to the American Academy of Allergy Asthma & Immunology (AAAAAI), six foods cause 90% of food allergies in children. These six foods are milk, peanuts, soy, eggs, wheat, and tree nuts (such as pecans and walnuts). Children usually outgrow allergies to milk, eggs, and soy. However, allergies to peanuts, tree nuts, fish, and shellfish continue throughout adulthood.
Risk factors: Children with skin disorders, such as eczema, which causes itching, scaling, and thickening of the skin, or psoriasis, which causes, dry, red patches of skin, are more likely to develop food allergies. In fact, food allergies are seen in about 35% of children with eczema.
Children who have allergic reactions to inhaled substances, such as dust, mold spores, or pollen, also have an increased risk of developing food allergies.
Even exposing children to trace amounts of peanut protein or peanut oil products may cause peanut allergies in children, according to one study. Because peanut allergies are among the most common and severe food allergies, the American Academy of Pediatrics recommends that children with histories of food allergies do not consume peanuts or peanut-containing products until they are three years old. Strawberries should also be avoided until the baby is about 10-12 months old.
Children whose mothers have food allergies may be more likely to inherit the allergy if born by cesarean section, according to one study. One study of children with allergic mothers who had C-section deliveries found that the babies were seven times more likely to develop food allergies than predisposed children who were born vaginally. Although the reason for this is not clear, it has been suggested that cesarean deliveries might delay the colonization of the newborn intestine.
Causes: Most allergies are inherited, which means they are passed on to children by their parents. Although people inherit a tendency to be allergic, they may not inherit an allergy to the same allergen. When one parent has allergies, each of his/her children has a 50% chance of developing allergies. That risk increases to 75% if both parents have allergies.
The first, or several times after the body is exposed to nickel, the immune system becomes sensitized. During this process, the body’s white blood cells develop immunoglobulin E (IgE) antibodies, which are proteins that are specialized to quickly detect and bind to the food allergens when they enter the body. These antibodies also trigger the release of chemicals (such as histamine) that cause allergic symptoms, such as red, itchy, and swollen skin.
In some food groups, especially tree nuts and seafood, an allergy to one food may cause the patient to be allergic to all the members of the same group. This is known as cross-reactivity. However, it is also possible to be allergic to both peanuts and walnuts, which are from different food families. This is because the allergens for these products are very similar.
Cross-reactivity is not as common in the meat food group. For instance, many patients who are allergic to eggs can eat chicken, and many patients who are allergic to cow’s milk can eat beef.
Symptoms: Food allergy symptoms vary among patients. Symptoms can develop anywhere from several minutes to several hours after ingestion. Reactions usually lasts several hours. Hives are the most common allergic skin reaction associated with food allergies. Hives are red, itchy, swollen welts on the skin that may appear suddenly and disappear quickly. They often develop in clusters, with new clusters appearing as other areas clear up. The most severe type of reaction is called anaphylaxis because it causes low blood pressure and swollen airways. The most dangerous symptoms of anaphylaxis are low blood pressure, breathing difficulties, shock, and loss of consciousness, all of which can be fatal. Asthma symptoms, including coughing, wheezing, shortness of breath, or difficulty breathing, may be triggered by food allergies, especially in infants and young children. Eczema, which is itchy, scaly, red skin, may also be triggered by food allergies. Others may experience itchy skin or facial flushing. Gastrointestinal symptoms may include vomiting, diarrhea, gas, and abdominal cramping. Some patients may develop a red rash around the mouth, as well as swelling of the mouth, stomach, and throat.
Ear Infections
Middle ear infections (also called otitis media) are another common childhood illness. An ear infection occurs when a cold, allergy, or upper respiratory tract infection leads to swelling and the accumulation of pus and mucus behind the eardrum, blocking the tube that connects the middle ear to the back of the throat behind the nose (called the Eustachian tube). This collection of fluid provides a suitable environment for infections to develop.
The middle ear contains the eardrum and three tiny bones (called ossicles). It is responsible for carrying vibrations to the inner ear so people can hear. Fluid may collect in the middle ear and push against the eardrum, causing pain and sometimes a temporary or, in severe cases, a permanent loss of hearing.
Acute ear infections usually heal after one to two weeks of treatment. Sometimes, ear infections last longer and become chronic (long-term). After an infection, fluid may stay in the middle ear. This may lead to more infections and hearing loss.
Causes: Ear infections can start with a bacterial or viral infection. In such cases, the middle and/or outer structures of the ear become inflamed. Fluid may also build up behind the eardrum. Bacteria cause about 65-75% of all ear infections. The most common types of these bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Viruses that may lead to ear infections include the respiratory syncytial virus (RSV), the most frequent type found, followed by influenza (flu) viruses.
Ear infections may also be associated with swelling in the Eustachian tubes. Normally, these tubes equalize pressure inside and outside the ear and drain mucus from the middle ear into the throat. A child’s Eustachian tubes are narrower and shorter than an adult’s. This makes it easier for mucus or congestion from a cold or allergy to get trapped in the middle ear, causing the Eustachian tubes to not function properly or become blocked and swollen. The trapped fluid provides a perfect breeding ground for infections. Also, just as mucus in the nose becomes thicker and harder to expel, fluid inside the ear may also become thick and difficult to drain.
Another factor that contributes to ear infections is the swelling of the small clumps of glandular tissue at the back of the nose (called adenoids). These are tissues located in the upper throat near where the Eustachian tubes connect. Adenoids contain lymphocytes, white blood cells that normally fight against infections. Sometimes the adenoids become infected or enlarged, blocking the Eustachian tubes. Infection in the adenoids may also spread to the Eustachian tubes, causing dysfunction that leads to ear infections.
Children do not have fully developed immune systems, so it is easier for them to develop many illnesses, including ear infections.
Symptoms: Ear infections are often difficult to detect in children because many children affected by this disorder do not yet have sufficient speech and language skills to tell someone what is bothering them. Common signs to look for include unusual irritability, difficulty sleeping, tugging or pulling at one or both ears, earache, fever, fluid draining from the ear, loss of balance, and unresponsiveness to quiet sounds or other signs of hearing difficulty. These signs may include sitting too close to the television or being inattentive. Fluid buildup in the middle ear also blocks sound, which can lead to temporary hearing loss.
If the pressure from the fluid buildup is high enough, it may cause the eardrum to rupture, resulting in drainage of fluid from the outer ear, which may include blood and thick, yellow pus. This releases the pressure behind the eardrum, usually relieving pain. Most ruptured eardrums heal without treatment within a few weeks, although some may take months. Treatment may include an eardrum patch or surgery. Seek medical care if there is pain or swelling in the ear or drainage. See a doctor immediately with a headache, fever, or if the pain in the ear becomes severe.
If there is fluid in the middle ear, it may feel similar to a sensation of ear fullness or “popping.” The fluid behind the eardrum may block sound, so mild temporary hearing loss can happen, although it may not be obvious.
Possible complications include short- or long-term hearing loss, ruptured ear drum, and inflammation and/or infection of the rounded protrusion of bone just behind the ear, called the mastoid bone. When the mastoid bone swells or becomes infected, it is commonly called mastoiditis, and it is usually treated with antibiotics.
Fever
A fever is an increase in normal body temperature. Healthy individuals typically have a body temperature of about 98.6 degrees Fahrenheit. The body temperature fluctuates by about one degree throughout the day. However, if a person’s body temperature increases more than it normally does throughout the day, he/she has a fever.
Fevers are usually not dangerous for adults, unless they are 103 degrees Fahrenheit or higher. However, in infants and very young children, even a slight increase in body temperature may indicate a serious infection. If a baby younger than 12 months old has a temperature higher than 100 degrees, a healthcare provider should be consulted immediately. Adults and children who have temperatures higher than 102 degrees that are not responding to medications, such as ibuprofen (Motrin®, Advil®), aspirin, or acetaminophen (Tylenol®), should visit their doctors.
In serious cases, a fever may lead to a febrile seizure. This occurs when an infant or young child develops a seizure or convulsions when he/she has a fever higher than 102 degrees Fahrenheit. Most febrile seizures are caused by viral upper respiratory infections, ear infections, or roseola. A febrile seizure may cause shaking or jerking of the arms or legs, fixed stare, eyes rolling back, heavy breathing, drooling, and bluish skin. Children who experience any of these symptoms should be taken to the emergency department of a nearby hospital immediately.
Causes: A fever is considered a sign of an underlying medical problem. Most fevers are caused by infections, such as the flu, pneumonia, or strep throat. Other common causes include extreme sunburn, exposure to hot environments, and certain medications. In rare cases, there may be no known underlying cause.
Symptoms: The duration and severity of a fever may vary, depending on the cause. Children who have fevers may experience chills, increased sweating, shivering, and warm skin.
Additional symptoms may also be present, depending on the cause. For instance, if a viral infection, such as the flu, is causing a fever, additional symptoms may include a runny nose, sore throat, headache, aching joints and muscles, nausea, and vomiting.
If a child develops a fever when the body becomes overheated (called hyperthermia) as a result of vigorous exercise or exposure to extremely hot or humid weather, symptoms may include confusion, lethargy, or even coma. In some cases, people suffer from hyperthermia may also have an extremely high body temperature without the ability to sweat.
Diarrhea
Diarrhea is characterized by loose or watery stools. Diarrhea is a symptom of an underlying health problem, such as an infection, that prevents the intestines from properly absorbing nutrients from food.
Diarrhea causes dehydration because the body loses more water and salts. Compared to adults, infants and young children have a greater risk of developing severe dehydration as a result of diarrhea. Symptoms of dehydration include dry skin, thirst, less frequent urination, light-headedness, headache, and dark-colored urine.
It is estimated that children younger than five years old experience about one episode of diarrhea per year in the United States. About 222,000 people are admitted to the hospital each year for complications related to diarrhea, of which about 10% of patients are five years old or younger. About 400 people die each year due to complications, such as severe dehydration, in the United States.
Causes: There are many potential causes of diarrhea. Infants and young children are most likely to develop diarrhea as a result of a rotavirus infection. Other common causes include bacterial or parasitic infections, lactose intolerance, certain medications, artificial sweeteners, and abdominal surgery.
Symptoms: Children usually experience acute diarrhea, which only lasts a few days. Symptoms of diarrhea often include frequent and loose stools, abdominal pain or cramping, bloating, and fever. Other symptoms, such as nausea, vomiting, fever, and sometimes bloody stools, may occur if a patient has an infection. When a patient experiences frequent (several times a day), severe, and bloody diarrhea, the condition is often called dysentery.
Croup
Croup refers to a group of conditions involving inflammation and swelling around the vocal cords and windpipe that leads to a cough that sounds like a bark, particularly when a child is crying. This cough may also cause difficulty breathing.
Because children have smaller airways, they are more likely to develop croup than adults. It is most common in children who are younger than five years old.
In North America, about 5-6 cases occur in every 100 children. About five percent of children experience more than one episode.
Croup is not usually a cause for concern. Although croup usually goes away without medications, about 5-10% of children need to be admitted to the hospital to receive treatment, such as intravenous antibiotics.
Causes: Croup is most often caused by the parainfluenza virus, which causes infections in the lungs and airways. The respiratory syncytial virus, the measles virus, or various other viruses, such as the flu, may also cause croup. In rare cases, a bacterial infection may cause croup. These infections may occur when a child inhales mucus droplets that have been sneezed or coughed into the air by an infected person. Children may also become infected if they touch a surface with germs on it and then touch their mouths, eyes, or noses.
Symptoms: Symptoms include a loud, barking cough that is often worse at night. The child’s breathing may be labored or noisy. Other symptoms include fever and a hoarse voice.
Chickenpox
Chickenpox (Varicella) is a highly contagious viral infection that causes red, itchy bumps on the skin.
Before the chickenpox vaccine (Varivax®) was created, most children contracted chickenpox before age 15, with the majority of cases occurring between the ages of five and nine. The vaccine was developed in 1995 and since then, there has been a significant decrease in the number of chickenpox cases. In the few instances when the vaccine does not prevent the chickenpox (about 15% of the time), the infection is much milder than if the child had not received the vaccine.
Chickenpox is not usually a serious infection in healthy children. However, it may cause problems for newborns, teens, pregnant women, adults, and people who have weak immune systems that make it hard for the body to fight against infections.
Causes: A virus, called the human herpes virus 3 or varicella-zoster (VZV), causes chickenpox. This virus spreads easily from person to person through the air and physical contact.
Symptoms: The first symptoms of chickenpox usually include a fever, a vague feeling of sickness or discomfort (called malaise), or decreased appetite. Within a few days, an itchy rash appears as small red bumps or blisters. The rash appears in batches over the next 2-4 days. It usually starts on the trunk and then spreads to the head, face, arms, and legs. Blisters may also be found in the mouth or the genital areas. Although some children may have only a few blisters, some may have as many as 100-300. The pimples will progress to red blisters that are teardrop shaped. The blisters mature, break open, form a sore, and then crust over. Most of the blisters will heal within 10-14 days, and usually do not cause scarring unless the blisters become infected when germs enter the open skin.