A harmless small flat pink skin blemish (also called “salmon patch”) found in up to 50 percent of newborn babies. These blemishes found around the eyes usually disappear within the first year; those around the nape of the neck may persist indefinitely.

Stimulants are often used in the treatment of ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD). RITALIN (methylphenidate) is most commonly prescribed. Other stimulant medications that are frequently prescribed include Dexedrine (dextroamphetamine), Adderall (amphetamine and dextroamphetamine), and Cylert (pemoline).

For more than 50 years, these drugs have been used to treat the behavior of children with hyperactive symptoms; as many as 80 percent of students with ADHD respond to these drugs. Exactly what makes these medications effective against ADHD is unknown, although experts suspect they affect the rate and balance of specific neurotransmitters in certain areas of the brain. This results in a greater ability to pay attention and stay focused, and a decrease in hyperactivity. Since these children also tend to become less impulsive, aggressive, and destructive, the drugs also help improve social acceptance. These medications are often used in combination with behavioral and educational interventions.

Children who respond to stimulant medications generally show improvement in their academic work and in their interactions with others right away. (However, there is a lag before Cylert achieves its maximum effect in children.) Several studies have found that after students with ADHD started taking stimulants, their test scores and accuracy and speed in completing homework improved. The long-term gains are less clear.

Because most stimulant medications are metabolized quickly, often several doses a day are necessary. Stimulant medications are taken for as long a period of time as is helpful or necessary. Some children find that in adolescence the medication is no longer necessary; others find the medication less necessary as their situation changes, for example a change in environment or academic demands. Many find that they face the frustrations of ADHD through adolescence and adulthood and some of these individuals may benefit from using stimulant medication on a long-term basis.

Successful treatment with stimulants lies in finding the right drug at the right dosage. It is important to remember that the child with ADHD will still remain impulsive and energetic even while taking stimulants, but their ability to pay attention should improve.

Treatment with stimulants for ADHD is a longterm therapy; the government estimates that 80 percent of those who need medication for ADHD in childhood will still need drugs as teenagers, and 50 percent will be helped by stimulants as adults.

Side Effects
The most common side effects include weight loss and appetite loss, together with problems in falling asleep, although these problems may fade away as a student becomes used to the drug. Some studies have found that a child’s growth begins to lag, although this usually rebounds after the first year in those who are on low or moderate doses. Children taking Dexedrine or high doses of Ritalin may experience prolonged growth lag as long as they remain on the medication, but once the drug is stopped growth begins again. For this reason, some experts recommend “drug holidays” during vacation to allow a child’s growth to catch up.

Less common side effects include stomach problems, headaches, lethargy, irritability, nausea, euphoria, depression, nightmares, dry mouth, constipation, anxiety, hallucinations, nervous tics, and tremors. In children at risk for TIC disorders such as TOURETTE’S SYNDROME the medication may trigger the condition. Because individual reactions and needs change, it is very important that the use and result of the medication be monitored.

Addiction
While some stimulants can be addictive if abused, low doses seem to be safe for children, who do not become addicted nor become likely to be addicts when they are older. On the other hand, some studies suggest that untreated students with ADHD are at higher risk for developing substance abuse in adolescence.

Infections caused by staphylococci bacteria and characterized by the formation of abscesses in the skin or other organs. Staphylococci, which grow in grapelike clusters, are a common cause of skin infections, but they also can cause serious internal disorders.

Staphylococcal bacteria are normally found on the skin of most people, but if the bacteria get trapped within the skin by blocked sweat or sebaceous glands, they can cause a wide variety of skin infections including pustules, boils, styes, or carbuncles. The bacteria also can cause a severe blistering rash in newborn babies called SCALDED SKIN SYNDROME.

The bacteria is found in the throats and nose in most people; when mucus is not cleared from the lungs (such as after a viral infection), organisms can multiply in the lungs and cause PNEUMONIA.

Staphylococcal infections are among the most common infections in surgical patients, and the number of hospital-acquired staph infections that are resistant to antibiotics has been steadily rising.

An overstretched and partly torn ligament, which holds bones together. It is more serious than a strain, which is simply an overstretching of any part of the musculature. Sprains and strains usually cause swelling, pain, and bruises around the injured area. After medical evaluation, most sprains can be treated at home.

If a sprain involves a child’s neck or back, he should not be moved unless the child is in imminent danger. Movement can cause serious nerve damage. If the child must be moved, the neck and back must be completely immobilized first and the head, neck, and back aligned.

Sprain vs. Break
It is sometimes difficult to tell the difference between a sprain and a broken bone. If there is any doubt, the child should be taken to the nearest hospital emergency department, where an X ray can identify a broken bone. A strain typically involves simple swelling, bruising, and pain. A possible broken bone should be suspected if a child heard or felt a bone snap, if the child cannot move the injured part, or if the injured part moves in an unnatural way or is very painful.

Treatment
First aid for sprains and strains includes rest, ice, compression, and elevation (known as RICE). As the injured part of the body is rested, ice packs or cold compresses should be applied for up to 10 or 15 minutes at a time every few hours for the first two days to prevent swelling. Wearing an elastic compression bandage (such as an ACE bandage) for at least two days also will help reduce swelling. Keeping the injured part above the level of the heart as much as possible is another good way to reduce swelling. Heat should not be applied in any form for at least 24 hours, because heat will increase swelling and pain.

A doctor may recommend an over-the-counter pain reliever such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil).

Football, basketball, baseball, soccer, hockey, gymnastics, and volleyball are the top six sports that cause the most injuries in children. Although these activities help develop muscles and coordination, they can also result in injury, especially in children, whose bones, muscles, tendons, and ligaments are still growing.

An estimated 3.5 million children’s fractures, dislocations, and soft-tissue injuries related to these recreation activities were treated at U.S. hospital emergency rooms, doctor’s offices, and clinics each year.

Basketball leads the list of most dangerous sport, with 574,000 injuries reported in 2001, followed closely by football, with 448,200 injuries. Children playing baseball received 252,665 injuries; those playing soccer included 227,100 injuries. Hockey, which many consider to be a violent sport, was fifth on the list, with 80,700 injuries, followed by gymnastics at 75,000, and volleyball at 50,100.

Other non-team sports can also lead to a considerable number of injuries. For example, biking causes a very high number of fractures, dislocations, strains/sprains, and abrasions; among children ages five to 14, there were 415,000 injuries a year to arms, legs, and trunk. Roller sports caused more than 297,000 injuries, and trampolines caused 135,000 injuries. Scooter-related injuries increase each year (including sprains and strains, cuts and bruises, fractures, and dislocations); more than 84,400 injuries were severe enough to go to the emergency room in 2001 for treatment.

Prevent Injuries
Coaches and parents can prevent injuries by promoting an atmosphere of healthy competition emphasizing self-reliance, confidence, cooperation, and a positive self-image, rather than just winning. Young athletes need proper training before participating in a sport; they should not expect the sport itself to get them into shape. Injuries can be prevented if children participate in a regular conditioning program designed by a coach. It is also important that parents make sure their child’s coaches are qualified to supervise a particular sport, provide well-maintained safety equipment, and help with proper conditioning.

Alarmingly, experts estimate that at least 500,000 young athletes use black-market anabolic steroids to improve their athletic performance. Although these types of steroids can increase muscle mass, they also cause serious and potentially life-threatening complications.

Children playing sports should follow these guidelines to reduce injuries:

• Follow the rules of the sport.
• Wear appropriate protective gear (for example, shin guards for soccer, a hard-shell helmet when facing a baseball pitcher, a helmet for bike riding).
• Check equipment first and know how to use athletic equipment (breakaway bases have dramatically reduced leg injuries in children).
• Always warm up before playing.
• Avoid playing when very tired or in pain.

The common name for a lumbar puncture, a procedure in which cerebrospinal fluid is removed by using a hollow needle inserted into the lower back, usually between the third and fourth lumbar vertebrae. The fluid is checked for appearance, white blood cells, sugar, and protein in a lab and is also sent for culture, which can help determine what sort of germ is causing symptoms.

While some children fear the thought of a spinal tap, in fact the procedure is not terribly painful. It is a safe procedure when done in a large hospital emergency room or in an experienced pediatrician’s office. A spinal tap must be done whenever there is a suspicion of MENINGITIS.

A nonprofit organization dedicated to publicizing developments in medicine, education, and legislation; supporting research, promoting treatment; and encouraging the training of competent professionals. The Spina Bifida Association of America (SBAA) publishes brochures, reports, and educational videotape programs for parents and health professionals, plus a 35-mm slide presentation on the abilities and potential of people with spina bifida.

The most common permanently disabling birth defect that affects about one out of every 1,000 newborns in the United States. Spina bifida, the most common NEURAL TUBE DEFECT, is one of the most devastating of all birth defects.

Cause
Spina bifida occurs when the spine does not close properly during the first month of pregnancy. In severe cases, the spinal cord protrudes through the child’s back and may be covered by skin or a thin membrane. Surgery to close a newborn’s back is generally performed within 24 hours after birth to minimize the risk of infection and to preserve existing function in the spinal cord.

Many things can affect a pregnancy, including family genes and things women may come in contact with during pregnancy. However, recent studies have shown that folic acid is one factor that may reduce the risk of having a baby with a neural tube defect such as spina bifida.

Symptoms
Because of paralysis resulting from the damage to the spinal cord, children born with spina bifida may need surgery and other extensive medical care. The condition also can cause bowel and bladder complications.

In addition, many children born with spina bifida also have an accumulation of fluid in the brain (HYDROCEPHALUS), which can be controlled by a surgical procedure called “shunting” to relieve the fluid by redirecting it into the abdominal area. Most children born with spina bifida live well into adulthood as a result of today’s sophisticated medical techniques.

Some children with spina bifida also experience learning problems. They may have difficulty with paying attention, expressing or understanding language, organizing, sequencing, and grasping reading and math.

Other conditions associated with spina bifida include LATEX ALLERGY, tendonitis, OBESITY, skin breakdown, stomach problems, DEPRESSION, and social and sexual issues.

Treatment
Children with spina bifida need to learn how to walk with crutches, braces, or wheelchairs. With new techniques, children also can become independent in managing their bowel and bladder problems. To promote personal growth, parents should encourage children (within the limits of safety and health) to be independent, to participate in activities with their nondisabled peers, and to assume responsibility for their own care.

Early intervention can help to prepare children with spina bifida and learning disabilities for school, with normal day-to-day activities. It often helps to have a psychological evaluation, which tests the child’s intelligence, academic levels, and basic learning abilities (visual perception, receptive and expressive language skills).

Prevention
While taking folic acid cannot guarantee a healthy baby, it can help. Taking folic acid before and during early pregnancy reduces the risk of spina bifida and other neural tube defects. All women should take a daily vitamin including 400 micrograms (mcg)—the same as 0.4 milligrams (mg)—of folic acid every day.

A woman thinking about getting pregnant, who already has a child with spina bifida, who has spina bifida herself, or who has had a history of pregnancy affected by a neural tube defect, needs a higher dose of folic acid. These women should take 4,000 micrograms (mcg) of folic acid by prescription for one to three months before becoming pregnant. Taking this amount of folic acid by prescription may reduce the chance of a neural tube defect like spina bifida in future pregnancies.

However, any woman taking this extra folic acid should not get this amount by taking more multivitamins, because too much of some of the other vitamins could harm either mother or child. A doctor should prescribe the extra folic acid supplement.

Before the next pregnancy, a woman with any of the above risk factors should speak with her health care provider about her personal risk of having a baby with a neural tube defect. She may need to get a prescription for folic acid before trying to become pregnant.

Folic acid is a common water-soluble B vitamin that is essential for the functioning of the human body. During periods of rapid growth (such as pregnancy and fetal development) the body’s requirement for this vitamin increases. Folic acid can be found in multivitamins, fortified breakfast cereals, dark green leafy vegetables such as broccoli and spinach, egg yolks, and some fruits and fruit juices. However, the average American diet does not supply the recommended level of folic acid.

While most of the more than 50,000 species of spider found in the United States actually possess poison glands connected to their fangs, only a very few are capable of piercing human skin. Those that can include the black widow (Latrodectus), brown recluse spider (Loxosceles), jumping spider (Phidippus), and tarantula (a common name given to many large spiders). Two species of spider are responsible for most of the serious spider bites in the United States; widow spiders and the brown recluse.

In general, most spider attacks occur when someone disturbs a spider’s nest while working outdoors or making house repairs. While tarantulas rarely cause problems, their bite is painful because of their size of their fangs. Brown recluse spiders are most often found in dark places like outhouses.

A problem or delay in verbal, gestural, or speaking skills including articulation (pronunciation), voice quality, fluency, or language that interferes with learning, social adjustment, or communication. Some problem with speech affects one out of every 10 American children.

Cause
Hearing problems, low intelligence, or lack of verbal stimulation at home all may interfere with the development of speech. Children with older siblings or one child in a set of twins may not talk because others talk for them.

Diagnosis
Early detection is critically important if the child is to develop normal speech patterns and prevent the problem from interfering with learning in other areas. Problems with hearing or speech and language development can create barriers to social interaction and emotional well-being at a very young age and make it difficult for a child to progress in school.

Parents who suspect a speech problem should take the child to a speech and language specialist as soon as possible for an evaluation, which will include a full speech workup and a hearing test.

Treatment
Many speech problems can be corrected with short-term treatment, especially if the problem is diagnosed before first grade.

If a child needs therapy, some of the speech therapy options could include individual speech therapy. If the speech-language pathologist thinks the child may not need therapy right away, she may give parents some suggestions for techniques to use at home and check back with the family in a few months to check progress.

Warning Signs
All children develop at different rates, but there are some obvious signs that a child may be developing speech problems. Parents should consult their pediatrician or a speech therapist If the child:

• is not babbling or using language by 15 to 18 months of age
• by age three is using mostly vowels or omitting the beginning sounds in words, or if other people cannot understand what the child is saying
• has not mastered all speech sounds by age eight.

At certain ages, certain speech problems are normal. For example, stuttering is common between ages three and four years, but most children grow out of the habit of repeating sounds and hesitating between words. However, if this is happening for longer than two or three months and interferes with communication, the child may be developing a stuttering problem. Parents should ignore stuttering and not correct the child, but children with a severe stuttering problem should receive speech therapy to avoid a long-term problem.

Nodules on the vocal cords can cause hoarseness; a child should be seen by a doctor if he breathes through the nose while speaking and is hoarse.

Babbling that stops after a brief period may be a sign of a hearing disorder. Frequent ear infections can affect hearing and delay speech.

By the time a child is four years old she should be able to tell a story, and by age five should be able to listen to a story and answer questions.

What Parents Can Do
Parents can encourage speech development by talking and reading to the child, singing songs to the baby. Vocabulary and sentence length should be adjusted for the child’s level. Reading together out loud also helps to improve vocabulary, sequencing, and attention span.