Strattera

WHAT EVERY PARENT NEEDS TO KNOW NOW Could a vaccine harm my baby? Does my adolescent have ADHD? These are just a few questions you may have asked yourself, your friends, your mother or your child's doctor. What's frustrating is that the answers often vary, depending on whom you ask. With this in mind, we offer this guide full of essential advice. Use it in good health!

asthma When you think of asthma, you might picture a panting child reaching for his inhaler during an attack. But the symptoms of and best treatment for asthma, a respiratory condition that has been on the rise in recent years, are not always so obvious. Approximately 80 percent of asthmatics also have allergies, says Juan C. Celedon, M.D., a doctor of public health and assistant professor of medicine at Harvard Medical School's Brigham and Women's Hospital in Boston. A recent study led by Celedon found that African-American and Puerto Rican children with asthma are more likely than Whites to be allergic to outdoor allergens such as tree and grass pollens. These common substances can trigger asthma symptoms like frequent coughing, shortness of breath and wheezing.

Pollution and inferior housing conditions--peeling paint, leaky pipes, water damage--can increase our exposure to allergens. Combine these with everyday indoor triggers such as dust and molds, and you've got a toxic mix that can make an asthmatic child susceptible to serious attacks.

To minimize that possibility, have your child tested for allergies, then take steps to lessen your child's contact with allergens. Follow pollen counts and close windows during high-pollen days. Remove carpets and stuffed animals from your little one's room; use allergyproof covers on mattresses and pillows; wash bedding frequently in hot water using mild detergents; keep rooms clean and dust-free; wash furry pets weekly or give them away. And for your kids' sake, don't smoke or clean with harsh chemicals in their presence.

breast-feeding

It's often said that "breast is best," and for very good reasons. Breast milk provides natural protection against common childhood illnesses such as ear infections and diarrhea, and it's easier for your baby to digest than cow's milk or formula. Breast-fed babies even are less likely to become overweight adults, according to a recent report by the American Academy of Pediatrics. For mothers, nursing burns calories, boosts bone strength and even protects against breast cancer and other diseases. To learn more, pick up such pamphlets as The Womanly Art of Breastfeeding from the La Leche league (lalecheleague.org), an international breast-feeding support network whose volunteers offer instruction and advice.

colds

Sniffles. Sneezes. Sore throats. These are typical signs that your child has come down with the common cold. Passed on by casual contact--hugs, kisses, touching infected toys or objects--colds may be annoying but usually last only a week to ten days. There's no quick cure: Lots of fluids (water, decaffeinated tea) and rest will lessen symptoms. If your doctor gives the okay to use over-the-counter medications to relieve symptoms like a runny nose, congestion and cough, use them only as directed.

"For the child with frequent colds, families should practice good hygiene, which includes washing hands frequently and not sharing drinking or feeding utensils," says LeRoy M. Graham, M.D., a pediatric pulmonary specialist in Atlanta. Because cold viruses stay alive up to eight hours on surfaces, Graham also recommends disinfecting toys, changing tables, and eating and playing surfaces. If a cold lasts longer than a week, your child may have a secondary infection---bronchiolitis or pneumonia--that requires a doctor visit, Graham says.

diabetes

It's no secret that Black adults suffer disproportionately from diabetes. What's shocking is that this chronic condition is on the rise among kids. Each year, 13,000 children are diagnosed with type 1 diabetes (previously known as juvenile diabetes). Today an increasing number of children are being diagnosed with type 2, adult-onset diabetes, a phenomenon linked to the growing overweight and obesity problem in youngsters.

If your child has to urinate frequently (or wets the bed), or is constantly thirsty, tired, weak or irritable, she may be suffering from diabetes. If you're unsure, see your pediatrician and have her tested.

If your little one has been diagnosed with diabetes, you already know that living with the disease can be challenging. For a child, perhaps the hardest thing is consistency. According to the American Diabetes Association, the condition is typically managed through a three-pronged strategy: insulin therapy, nutrition and exercise. Depending on the type of diabetes your child has, she may need insulin injections or oral medication. Either way, she'll need to check her insulin levels frequently throughout the day with a blood glucose meter and keep a record. If glucose levels are too low or too high, she'll have to meet with her doctor, who may adjust her medication or the types of foods she eats.

Children with diabetes can usually eat what they want--in moderation. Too much of any food can wreck the delicate balance of blood sugar and insulin in the body. Though many people still believe the myth that diabetics can't consume any sugar, the occasional brownie or ice-cream cone can be included in a well-planned diet. The best type of diet includes moderate portions of carbohydrates, vegetables and fruit, and protein at each meal. Physical activity such as walking, roller-skating, swimming and biking is also part of treatment (see advice on physical activity). It helps balance blood sugar and prevent too much weight gain.

ear infections

Middle-ear infections are so common that most children have had at least one by age 7. Because these infections are frequently triggered by colds and can be very painful, parents are often eager to have them treated with antibiotics. But pediatricians are increasingly hesitant to suggest their use, says Christina McAlpin, M.D., an otolaryngologist in Los Angeles. If your youngster shows signs of an ear infection--fever, irritability, ear tugging, excessive crying--see a doctor. A mild ear infection can be treated with over-the-counter medication like ibuprofen and might clear up on its own after a few days. But a prolonged infection should be treated with antibiotics to avoid complications like bone inflammation and even meningitis.

fevers

An above-normal body temperature is usually a telltale sign of a cold, flu or other bacterial or viral infection. If your child has even a low- or medium-grade fever (above 98.6[degrees]F but less than 102[degrees]F with an oral or ear thermometer), it's important to call or visit your pediatrician. Aggressively treating fevers in this range may actually interfere with the body's immune response. In general, dispensing the appropriate dose of acetaminophen (as directed on the package) and dressing your child in light layers should lower his temperature until the infection passes.

growth hormone

Worried that your child is too little for his age? If his small stature can be attributed to a deficiency in natural growth hormone, you might want to consider hormone shots. The Food and Drug Administration has sanctioned this controversial practice by approving the drug Humatrope for use in shorter-than-average kids. While the shots may increase height, thereby preventing the teasing and isolation a short child might experience, treatment is expensive ($20,000 a year) and may not be covered by insurance. There is also a risk that you may have to give your child several injections a week for years before you'll see results. Experts say the long-term risks are unknown.

hyperactivity Many parents find it difficult to distinguish attention deficit/hyperactivity disorder, or ADHD, from normal childhood antics. Signs of the disorder typically include an inability to pay attention and follow through on tasks; impulsive and impatient behavior; and hyperactivity or constant restlessness. With true ADHD, symptoms interfere with home and school life for more than six months.

Contrary to popular myth, ADHD may not be overdiagnosed, but actually underrecognized among African-American children. "Not enough people are educated about ADHD, so these behaviors are attributed to 'normal boy behavior,' 'daydreaming girls' or, especially as it pertains to African-Americans, 'just plain hardheadedness,'" says Marilyn M. Benoit, M.D., FAACAP, a child psychiatrist and assistant professor of psychiatry at Howard University College of Medicine in Washington, D.C. But, Benoit notes, scientific studies demonstrate that ADHD in Black children and teens is undertreated. If the disease is left untreated, children with ADHD could face social problems, poor grades and low self-esteem.

For historical reasons, many Black parents are distrustful of the "drugging" of their children, Benoit notes. "African-Americans in general do not have a mind-set that embraces medical intervention where it concerns our mental health," she says. But medication may be one of the few ways to avoid the problems that can result in untreated ADHD. Medications include Ritalin, Concerta and a recently approved medication called Strattera that does not have the potential side effects (loss of appetite, sleep problems, nervousness) that the other medications do. A treatment plan that combines medication, behavior therapy, social-skills training (good manners, for example) and "parent training" may be the best option, Benoit says. The bottom line: Whether you choose to medicate or not, it's important to persist in finding therapies that work.

incontinence A lack of bladder control due to developmental delays, genetics or, less commonly, emotional problems causes many kids to wet the bed at night. Though children typically outgrow the problem, it can be embarrassing to a youngster when it occurs. Bed-wetting is beyond your child's control, so it won't help to punish him or tell him not to do it. What will help is patience. To cope, invest in water-resistant sheeting to place between the bedding and the mattress. Remind your son or daughter to urinate regularly during the day. If the problem doesn't go away by age 10, talk to your child's doctor about such options as medication or a pad with a moisture-activated alarm.

jaundice

Many newborn babies, and particularly premature ones, develop a deep yellow tint to the skin, called jaundice, within the first few days of life. The cause is the buildup in the blood of a molecule known as bilirubin, which occurs when the liver isn't functioning properly. Jaundice almost always goes away on its own within a week or so after birth, but your child's pediatrician should monitor it over time. If the condition does not subside, brief in-hospital phototherapy treatment under ultraviolet lights will return bilirubin levels--and the child's skin color--to normal.

kisses & ways to say "I LOVE YOU"

An apple a day may help keep your young one physically healthy, but a loving, nurturing relationship with you is equally important to her well-being. These days, parents and children have long hours and busy schedules; it's easy to forget to offer hugs, kisses and warm words. Daily positive reinforcement will fortify her--and keep her strong in our race-conscious society--for a lifetime. "Let kids know they are truly loved," says child psychiatrist Benoit.

lead poisoning Lead, a toxin that affects the nervous system, can contribute to learning disabilities, speech and language problems, poor muscle coordination, stunted growth and hearing damage in young children. To protect your kids, have your home or apartment's water and paint tested by your local health department. They can help determine, for example, if it's best to remove old paint or simply cover it up. And there are filters that can be used to extract lead from your drinking water. Discuss your concerns with your pediatrician.

mental health A child can suffer from many of the same mental illnesses that adults do: depression, anxiety, bipolar disorder. (The treatments aren't always the same for kids as they are for adults.) The challenge is recognizing when behavior is normal and when it is not. If you suspect your child is struggling with feelings of anxiety, irrational fears, intense shyness, sadness, depression or anger, and if the behavior interferes with normal life or lasts up to six months, get help from a mental health counselor. Ask your family physician for a referral.

obesity

Today nearly one in five children ages 6 to 19 has a weight problem. Why are our little ones getting so big? Research points to everything from their eating more convenience foods and supersize fast-food portions than other children, to the lack of school fitness programs and safe places for kids to play, to their spending too much time in front of the TV or computer. Ironically, though our children are eating too much, they may be undernourished. Many kids today fill up on sodas and fruit drinks loaded with sugar. Because they're forgoing healthier fluids like milk, their diets are deficient in calcium and other key nutrients, says a recent U.S. Department of Agriculture study.

If your youngster is already tipping the scales, seek advice from your family physician. Many parents avoid talking about nutrition and exercise for fear of further stigmatizing an overweight or obese child. But denial won't protect your child from health risks--or other people's comments. In the book Rescuing the Emotional Lives of Overweight Children (Rodale), author Sylvia Rimm, Ph.D., argues that your persistent support and optimism is key to helping your child overcome the low self-esteem that can be caused by a weight problem.

That's why it's a good idea for the entire family to make lifestyle changes. In KidShape (Rutledge Hill Press) childhood-obesity expert Naomi Klein, M.D., describes a comprehensive plan she calls the family table. It involves a preliminary family meeting followed by weekly "workshops" to learn about nutrition, portion sizes, food labels, getting fit, stretching, eating out and avoiding temptation. The idea is if the entire family undergoes change, it is more likely to be lasting.

physical activity

When children first learn to crawl and walk, it seems that their energy and desire to be on the move are boundless. But all too often, they soon settle into more sedentary lifestyles. Today many of our kids don't have challenging physical-fitness classes in school. To keep them active, you must be active, too. The President's Council on Physical Fitness and Sports suggests physical games for toddlers and preschoolers, organized sports for older children and regular family walks or hikes. For more ideas, check out the Fit'n Active Kids section of the Council's Web site (fitness.gov/funfit/funfit.html).

nutrition

Soda. Sweets. Supersize fries. Poor nutritional options seem to be the standard for young kids these days. But a diet loaded with sugar and fat could set your child up for a weight problem that will be hard to reverse. The good news is you have more influence over your child's eating habits than you may realize. So model positive behavior by cleaning up your own nutritional act.

With your kids, focus on good nutrition early: Make sure infants are getting vegetables like pureed carrots and broccoli as well as sweeter snacks like applesauce. Offer healthy choices from all the different food groups--grains, veggies, fruit, fish or chicken or meat, dairy, and healthy fats such as avocados and low-fat peanut butter--to toddlers as their tastes develop. Don't allow them to sip nonstop on sugary fruit juices. Serve picky eaters foods in varying colors and fun shapes. Make healthy snacks available at home and in lunch boxes: a fruit basket with bite-size fruit, dried fruit and nut mixes, chopped-up veggies with dip, fruit spreads for crackers, wholegrain cereals, homemade popcorn.

The U.S. Department of Agriculture has issued Tips for Using the Food Guide Pyramid for Young Children Booklet ($5, usda.gov/cnpp/KidsPyra/). Growing Up Healthy: A Complete Guide to Childhood Nutrition and Well-Being, Birth Through Adolescence (Atria) by Joan Lunden and Myron Winick, M.D., is also useful.

quiet time

Today's youngsters and teens are often busier than their parents. Between school, play dates, after-school activities and music or dance lessons, children seldom get a chance to simply unwind. While a jam-packed schedule may seem impressive to a future college recruiter, it might also lead to an overtired and stressed-out child. Instead, why not encourage quiet activities like reading, doodling or drawing, playing cards or board games, or walking in the park or woods. Outings to the zoo, biking, and enjoying music and dancing together are other options. "The best thing parents can do for their kids' mental health is to spend unhurried, joyful time with them," says child psychiatrist Benoit.

ringworm A common skin problem among all children, ringworm is "epidemic" among our kids, says Susan Taylor, M.D., a dermatologist, mother of two and author of Brown Skin (Amistad Press). Ringworm, a fungal infection that commonly occurs on the scalp, has nothing to do with worms and may not even have a ring shape. "Symptoms include a flaky and itchy scalp that does not improve with dandruff shampoo," Taylor explains. "More extensive cases will have hair loss or a large oozing area called a kerion." Because it may be mistaken for dandruff or other conditions, it's often misdiagnosed in Black children but is simple to cure. Grifulvin V, an oral prescription medication a child takes once or twice daily with food for up to eight weeks, is one popular treatment.

sids The rate of sudden infant death syndrome, or SIDS, has dropped substantially, but some 2,000 babies still die each year from this mysterious condition. Our infants are more likely than white babies to be victims. Experts suspect the increased incidence among Black (and Native American) babies has to do with possible genetic factors as well as cultural practices, such as putting babies to sleep on their tummies despite a doctor's advice not to. SIDS is most common among babies under 6 months of age, so until your child is older, play it safe and always lay her down on her back. More prevention tips: Put your baby to sleep only on firm mattresses with fitted sheets, dress her in a full-body sleep sack instead of using blankets, remove stuffed animals and other objects from her crib, maintain a moderate room temperature, and don't smoke or let others smoke around your infant.

tooth decay

Like most healthy habits, good dental hygiene begins early. Though it may be tempting to put an infant or toddler to bed with a bottle in his mouth, this practice could cause your child to lose his baby teeth early, setting the stage for later dental problems.

Use gauze to keep those early teeth clean. As your child matures, you'll need to help him maintain good dental hygiene habits.

The American Academy of Pediatrics guide, Caring for Your School-Age Child, recommends these strategies for preventing tooth decay: fluoride treatments (either in tap water, as a vitamin supplement, or in treatments administered by a dental professional) and sealants (long-lasting plastic coatings placed on back teeth by a dentist to thwart cavities). Also minimize sweets both during and between meals.

UTIs More common in girls, urinary-tract infections are caused by bacteria that make their way into the urinary tract. In infants and young children, the signs may include a fever with no cold symptoms, as well as painful urination and strong-smelling urine. These infections tend to recur and, left untreated, can cause such serious problems as kidney damage and even an increased risk of hypertension. Once an infection has occurred, your child's physician will probably recommend antibiotics. To avoid UTIs, practice good hygiene by bathing your child and changing her diaper regularly and wiping little girls from front to back. Encourage frequent bathroom trips in older children, and keep kids well hydrated--drinking fluids such as water and cranberry juice helps rid the body of infections.

vaccinations

These days children receive multiple combinations of shots, beginning at birth through the teen years, mainly to prevent serious illnesses like polio, diphtheria and tetanus. However, the sheer number of immunizations today--20 during the first two years--worries some parents who fear the possible side effects and risks. Concerns have also been raised about suspected links between vaccines and such conditions as allergies, diabetes and autism.

Though there are minor risks and children do sometimes suffer from pain, mild fever, irritability and swelling after a shot, studies have not supported these fears. In recent years changes have been made to vaccines, including the removal of a potentially harmful preservative called thimerosal, to make them as safe as possible. To keep your kids healthy, make sure you know the vaccination schedule and stick to it. For more up-to-date facts, read Vaccines: What You Should Know by Paul A. Offit, M.D., and Louis M. Bell, M.D. (Wiley).

warts

You probably know that your child doesn't need to kiss a frog to get a wart (a skin condition caused by a virus commonly passed from child to child). One type of wart will appear as a singular bump on the hands or feet, but there are others. "Molluscum contagiosum, another type of wart, appears as pink bumps on the body," says dermatologist Taylor. Either one can be embarrassing and hard to get rid of. To make sure they're gone for good, see your family physician to have the wart removed in one of three ways: excision (cutting), cauterization (burning safely) or cryosurgery (freezing with liquid nitrogen). These procedures are safe for kids. To prevent warts, get your child in the habit of washing her hands frequently and not sharing combs, clothing and other personal items.

x-rays

Used to evaluate problems ranging from broken bones to lung ailments to the location of a swallowed object, X-rays are helpful diagnostic tools. They work by projecting a small amount of radiation at the affected body area or part, which creates an image on film or a screen. Some parents worry about the effect of radiation on the body, but the amount used for testing is minimal. "A single X-ray results in radiation exposure comparable to an outing in the sun and, as such, is of little concern," says pulmonary specialist Graham.

yeast infections

Adult women aren't the only ones to get yeast infectious. Diaper rash accompanied by small bumps is often caused by yeast growth. When that happens, you'll need to use wipes to clean the area, then pat dry, apply lotion or an over-the-counter ointment such as Lotrimin (use with Desitin to protect the skin). See the pediatrician if it doesn't clear up. To avoid these annoying rashes, change diapers frequently.

zithromax and other antibiotics

Signs of an ear or sinus infection can send parents running to the doctor for an antibiotic prescription. But experts have learned over the years that too much of a good thing can be bad for children. Misuse and overuse of antibiotics creates resistant bugs, says Los Angeles otolaryngologist McAlpin. Antibiotics are also useless for most colds and sore throats, McAlpin adds. So when should they be prescribed? They are necessary for potentially serious and clearly bacterial infections like Group B beta strep throat and bacterial pneumonia, experts advise. Otherwise it may be better to hold off. The best medicine for the most common ailments is time--and good old-fashioned TLC.

Have questions about your child's health? Consult these informative resources:

* American Academy of Pediatrics, aap.org

* The Black Parenting Book by Anne C. Beal, M.D., Linda Villarosa and Allison Abner. (Broadway Books)

* Children's Defense Fund, childrendefense.org/childhealth/

* Good Health for African American Kids by Barbara Dixon (Three Rivers Press)

* Mayo Clinic Family Health Book (HarperResource)

* National Black Child Development Institute, nbcdi.org/

Ziba Kashef is author of Like a Natural Woman: The Black Woman's Guide to Alternative Healing (Kensington).

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