Your Baby's First Vaccines

YOUR BABY’S FIRST VACCINES W H A T Y O U N E E D T O K N O W

Babies get six vaccines between birth and 6 months of age.

These vaccines protect your baby from 8 serious diseases (see the next page).

Your baby will get vaccines today that prevent these diseases: Hepatitis B Polio Pneumococcal Disease Diphtheria, Tetanus & Pertussis Rotavirus Hib

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These vaccines may be given separately, or some might be given together in the same shot (for example, Hepatitis B and Hib can be given together, and so can DTaP, Polio and Hepatitis B). These “combination vaccines” are as safe and effective as the individual vaccines, and mean fewer shots for your baby.

These vaccines may all be given at the same visit. Getting several vaccines at the same time will not harm your baby.

This Vaccine Information Statement (VIS) tells you about the benefits and risks of these vaccines. It also contains information about reporting an adverse reaction, the National Vaccine Injury Compensation Program, and how to get more information about childhood diseases and vaccines.

Please read this VIS before your child gets his or her immunizations, and take it home with you afterward. Ask your doctor, nurse, or other healthcare provider if you have questions. Individual Vaccine Information Statements are also available for these vaccines. Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis Vaccine Information Statement department of health and human services (Interim) Centers for Disease Control and Prevention 42 U.S.C. § 300aa-26 9/18/2008 Vaccine Benefits: Why get vaccinated? Your children’s first vaccines protect them from 8 serious diseases, caused by viruses and bacteria. These diseases have injured and killed many children (and adults) over the years. Polio paralyzed about 37,000 people and killed about 1,700 each year in the 1950s before there was a vaccine. In the 1980s, Hib disease was the leading cause of bacterial meningitis in children under 5 years of age. About 15,000 people a year died from diphtheria before there was a vaccine. Most children have had at least one rotavirus infection by their 5th birthday. None of these diseases has completely disappeared. Without vaccination, they will come back. This has happened in other parts of the world.

8 Diseases Virus Prevented by Childhood Vaccines HEPATITIS B You can get it from contact with blood or body fluids of an infected person. Babies can get it at birth if the mother is DIPHTHERIA Bacteria infected, or through a cut or wound. Adults can get it from You can get it from contact with an infected person. unprotected sex, sharing needles, or other exposures to blood. Signs and symptoms include a thick covering in the back of Signs and symptoms include tiredness, diarrhea and the throat that can make it hard to breathe. vomiting, jaundice (yellow skin or eyes), and pain in muscles, joints and stomach. It can lead to breathing problems, heart failure, and death. It can lead to liver damage, liver cancer, and death.

(Lockjaw) Bacteria TETANUS Virus You can get it from a cut or wound. It does not spread from P0LIO person to person. You can get it from close contact with an infected person. It enters the body through the mouth. Signs and symptoms include painful tightening of the muscles, usually all over the body. Signs and symptoms can include a cold-like illness, or there may be no signs or symptoms at all. It can lead to stiffness of the jaw, so the victim can’t open his mouth or swallow. It leads to death in about 1 case out of 5. It can lead to paralysis (can't move arm or leg), or death (by paralyzing breathing muscles).

(Whooping Cough) Bacteria PERTUSSIS Bacteria You can get it from contact with an infected person. PNEUMOCOCCAL You can get it from contact with an infected person. Signs and symptoms include violent coughing spells that can make it hard for an infant to eat, drink, or breathe. These spells Signs and symptoms include fever, chills, cough, and chest can last for weeks. pain.

It can lead to pneumonia, seizures (jerking and staring spells), It can lead to meningitis (infection of the brain and spinal cord brain damage, and death. coverings), blood infections, ear infections, pneumonia, deafness, brain damage, and death. HIB (Haemophilus influenzae type b) Bacteria You can get it from contact with an infected person. ROTAVIRUS Virus Signs and symptoms . There may be no signs or symptoms in You can get it from contact with other children who are infected. mild cases. Signs and symptoms include severe diarrhea, vomiting and It can lead to meningitis (infection of the brain and spinal cord fever. coverings); pneumonia; infections of the blood, joints, bones, and covering of the heart; brain damage; deafness; and death. It can lead to dehydration, hospitalization (up to about 70,000 a year), and death.

How Vaccines Work Immunity from Disease: When a child gets sick with one of these diseases, her immune system produces immunity, which keeps her from getting the same disease again. But getting sick is unpleasant, and can be dangerous. Immunity from Vaccines: Vaccines are made with the same bacteria or viruses that cause a disease, but they have been weakened or killed to make them safe. A child’s immune system responds to a vaccine the same way it would if the child had the disease. This means he will develop immunity without having to get sick first. Routine Childhood Vaccines Six vaccines are recommended for children between birth and 6 months of age. They can prevent the 8 diseases described on the previous page. Children will also get at least one “booster” dose of most of these vaccines when they are older. • DTaP (Diphtheria, Tetanus & Pertussis) Vaccine: 5 doses – 2 months, 4 months, 6 months, 15-18 months, 4-6 years. Some children should not get pertussis vaccine. These children can get a vaccine called DT, which does not contain pertussis. • Hepatitis B Vaccine: 3 doses – Birth, 1-2 months, 6-18 months. • Polio Vaccine: 4 doses – 2 months, 4 months, 6-18 months, 4-6 years. • Hib (Haemophilus influenzae type b) Vaccine: 3 or 4 doses – 2 months, 4 months, 6 months, 12-15 months. Several Hib vaccines are available. With one type, the 6-month dose is not needed. • Pneumococcal Vaccine: 4 doses – 2 months, 4 months, 6 months, 12-15 months. Older children with certain diseases may also need this vaccine. • Rotavirus Vaccine: 2 or 3 doses – 2 months, 4 months, 6 months. Rotavirus is an oral (swallowed) vaccine, not a shot. Two rotavirus vaccines are available. With one type, the 6 month dose is not needed.

Vaccine Risks Vaccines can cause side effects, like any other medicine. Mostly these are mild “local” reactions such as tenderness, redness or swelling where the shot is given, or a mild fever. They happen in up to 1 child out of 4 with most childhood vaccines. They appear soon after the shot is given and go away within a day or two. More severe reactions can also occur, but this happens much less often. Some of these reactions are so uncommon that experts can’t tell whether they are caused by vaccines or not. Among the most serious reactions to vaccines are severe allergic reactions to a substance in a vaccine. These reactions happen very rarely – less than once in a million shots. They usually happen very soon after the shot is given. Doctor’s office or clinic staff are trained to deal with them. The risk of any vaccine causing serious harm, or death, is extremely small. Getting a disease is much more likely to harm a child than getting a vaccine.

Other Reactions The following conditions have been associated with routine childhood vaccines. By “associated” we mean that they appear more often in children who have been recently vaccinated than in those who have not. An association doesn’t prove that a vaccine caused a reaction, but does mean it is probable. DTaP Vaccine Mild Problems: Fussiness (up to 1 child in 3); tiredness or poor appetite (up to 1 child in 10); vomiting (up to 1 child in 50); swelling of the entire arm or leg for 1-7 days (up to 1 child in 30) – usually after the 4th or 5th dose. Moderate Problems: Seizure (jerking or staring)(1 child in 14,000); non-stop crying for 3 hours or more (up to 1 child in 1,000); fever over 105°F (1 child in 16,000). Serious Problems: Long-term seizures, coma, lowered consciousness, and permanent brain damage have been reported very rarely after DTaP vaccine. They are so rare we can’t be sure they are caused by the vaccine. Polio Vaccine / Hepatitis B Vaccine / Hib Vaccine These vaccines have not been associated with mild problems other than local reactions, or with moderate or serious problems. Pneumococcal Vaccine Mild Problems: During studies of the vaccine, some children became fussy or drowsy or lost their appetite. Rotavirus Vaccine Mild Problems: Children who get rotavirus vaccine are slightly more likely than other children to be irritable or to have mild, temporary diarrhea or vomiting. This happens within the first week after getting a dose of vaccine. Rotavirus vaccine does not appear to cause any serious side effects. Precautions If your child is sick on the date vaccinations are scheduled, your provider may want to put them off until she recovers. A child with a mild cold or a low fever can usually be vaccinated that day. But for a more serious illness, it may be better to wait. Some children should not get certain vaccines. Talk with your provider if your child had a serious reaction after a previous dose of a vaccine, or has any life-threatening allergies. (These reactions and allergies are rare.)

If your child had any of these reactions to a previous dose of DTaP: - A brain or nervous system disease within 7 days - Non-stop crying for 3 or more hours - A seizure or collapse - A fever over 105°F Talk to your provider before getting DTaP Vaccine.

If your child has: - A life-threatening allergy to the antibiotics neomycin, streptomycin, or polymyxin B Talk to your provider before getting Polio Vaccine.

If your child has: - A life-threatening allergy to yeast Talk to your provider before getting Hepatitis B Vaccine.

If your child has: - A weakened immune system - Ongoing digestive problems - Recently gotten a blood transfusion or other blood product - Ever had intussusception (an uncommon type of intestinal obstruction) Talk to your provider before getting Rotavirus Vaccine.

What if my child has a moderate or severe reaction? What should I look for? What should I do? Look for any unusual condition, such as a serious allergic Call a doctor, or get the child to a doctor right away. reaction, high fever, weakness, or unusual behavior. Tell your doctor what happened, the date and time it Serious allergic reactions are extremely rare with any happened, and when the shot was given. vaccine. If one were to happen, it would most likely Ask come within a few minutes to a few hours after the shot. your healthcare provider to report the reaction by filing a Vaccine Adverse Event Reporting System Signs of a serious allergic reaction can include: (VAERS) form. Or you can file this report yourself through the VAERS website at www.vaers.hhs.gov, or by - difficulty breathing - weakness - hives calling 1-800-822-7967. - hoarseness or wheezing - dizziness - paleness - swelling of the throat - fast heart beat VAERS does not provide medical advice.

For More Information The National Vaccine Injury Compensation Program Ask your healthcare provider. They can show you the vaccine package insert or suggest other sources of A federal program exists to help pay for the care of any- information. one who has a serious reaction to a vaccine. Call your local or state health department. For information about the National Vaccine Injury Contact the Centers for Disease Control and Prevention Compensation Program, call 1-800-338-2382 or visit (CDC) at 1-800-232-4636 (1-800-CDC-INFO). their website at www.hrsa.gov/vaccinecompensation. Visit CDC websites at www.cdc.gov/vaccines and www.cdc.gov/ncidod/diseases/hepatitis. Baby-sitting Reminders IMPORTANT PHONE NUMBERS PARENTS POLICE NEIGHBOR(S) POISON HELPLINE 1-800-222-1222 DOCTOR HOME PHONE FIRE/RESCUE HOME ADDRESS

PARENTS SHOULD ● Meet the sitter and check references and training in advance. ● Be certain the sitter has had first aid training and knows CPR. ● Be sure the sitter is at least 13 years old and mature enough to handle common emergencies. ● Have the sitter spend time with you before baby-sitting to meet the children and learn their routines. ● Show the sitter around the house. Point out fire escape routes and potential problem areas. Instruct the sitter to leave the house right away in case of fire and to call the fire department from a neighbor’s house. ● Discuss feeding, bathing, and sleeping arrangements for your children. ● Tell your sitter of any allergies or specific needs your children have. ● Have emergency supplies available including a flashlight, first aid chart, and first aid supplies. ● Tell the sitter where you will be and when you will return.

Baby-sitting Reminders ● Be sure any guns are stored unloaded in a locked cabinet, and lock and store the ammunition in a separate place.

SITTERS SHOULD ● Be prepared for an emergency. ● Always phone for help if there are any problems or questions. ● Never open the door to strangers. ● Never leave the children alone in the house — even for a minute. ● Never give the children any medicine or food unless instructed to do so by the parents. ● Remember that your job is to care for the children. Tender loving care usually quiets an unhappy child.

From Your Doctor

The information in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on the individual facts and circumstances.

In the first months of life, babies learn about movement of their body and develop the physical skills required for rolling over, sitting and crawling. They learn to respond and adapt to challenges. For this reason, a baby needs the opportunity to play on its tummy during waking hours (while being supervised) and to spend limited time in an infant seat/carrier, swing or other restrictive devices which inhibit free movement.

Visual stimulation is another benefit of the tummy position. Unlike a baby on its back (who sees only the ceiling and objects on either side) a baby placed on the tummy will lift its head and view the world at eye-level.

In 1992 the American Academy of Pediatrics (AAP) published recommendations to put healthy babies to sleep on their backs, resulting in a dramatic reduction of SIDS (Sudden Infant Death Syndrome). The AAP’s “Back to Sleep – Tummy to Play” campaign reminds parents to provide babies with adequate supervised tummy time, to promote growth and development.

Not all babies enjoy tummy time. Some may cry or refuse to lift up their head. We have provided guidelines to help you with this challenge and to make tummy time an enjoyable bonding experience and a productive part of your baby’s life, while mastering important skills.

Plagiocephaly (abnormal head shape in infants) – its causes, prevention and treatment – has been the focus of Cranial Technologies since the company was founded in 1986.

We publish research articles in collaboration with cranio- facial and neurological surgeons, present papers at national and international medical conferences and we have been the leading advocate in educating professionals and parents about plagiocephaly.

Cranial Technologies’ DOC Band® was the first FDA-approved cranial banding device and remains the only one with clinical studies proving its safety and effectiveness. As the incidence of plagiocephaly increased and demand for its treatment grew, we opened clinics providing DOC Band treatment in the US, Canada and Europe.

While the Back-to-Sleep campaign has reduced the risk of SIDS, it has overshadowed the importance of tummy time and its benefit to a baby’s development of motor control and planning, sensory integration, environmental awareness, and postural strength.

Cranial Technologies’ Clinicians (pediatric physical and occu- pational therapists) worked together to prepare the information for this brochure. Their combined professional knowledge of a child’s motor development and skill acquisition was incorpo- rated to help parents in providing effective tummy time activities. BIRTH TO 6 MONTHS Safety for Your Child Did you know that hundreds of children younger than 1 year die every year in the United States because of injuries — most of which could be prevented? Often, injuries happen because parents are not aware of what their children can do. Children learn fast, and before you know it, your child will be wiggling off a bed or reaching for your cup of hot coffee. Car Injuries Car crashes are a great threat to your child’s life and health. Most injuries and deaths from car crashes can be prevented by the use of car safety seats. Your child, besides being much safer in a car safety seat, will behave better, so you can pay attention to your driving. Make your newborn’s first ride home from the hospital a safe one — in a car safety seat. Your infant should ride in the back seat in a rear-facing car seat. Make certain that your baby’s car safety seat is installed correctly. Read and follow the instructions that come with the car safety seat and the sections in the owners’ manual of your car on using car safety seats correctly. Use the car safety seat EVERY time your child is in the car. NEVER put an infant in the front seat of a car with a passenger air bag. Falls Babies wiggle and move and push against things with their feet soon after they are born. Even these very first movements can result in a fall. As your baby grows and is able to roll over, he or she may fall off of things unless protected. Do not leave your baby alone on changing tables, beds, sofas, or chairs. Put your baby in a safe place such as a crib or playpen when you cannot hold him. Your baby may be able to crawl as early as 6 months. Use gates on stairways and close doors to keep your baby out of rooms where he or she might get hurt. Install operable window guards on all windows above the first floor. Do not use a baby walker. Your baby may tip the walker over, fall out of it, or fall down stairs and seriously injure his head. Baby walkers let children get to places where they can pull heavy objects or hot food on themselves. If your child has a serious fall or does not act normally after a fall, call your doctor.

(over) Birth to 6 Months Burns At 3 to 5 months, babies will wave their fists and grab at things. NEVER carry your baby and hot liquids, such as coffee, or foods at the same time. Your baby can get burned. You can’t handle both! To protect your child from tap water scalds, the hottest temperature at the faucet should be no more than 120˚F. In many cases you can adjust your water heater. If your baby gets burned, immediately put the burned area in cold water. Keep the burned area in cold water for a few minutes to cool it off. Then cover the burn loosely with a dry bandage or clean cloth and call your doctor. To protect your baby from house fires, be sure you have a working smoke alarm on every level of your home, especially in furnace and sleeping areas. Test the alarms every month. It is best to use smoke alarms that use long-life batteries, but if you do not, change the batteries at least once a year. Choking and Suffocation Babies explore their environment by putting anything and everything into their mouths. NEVER leave small objects in your baby’s reach, even for a moment. NEVER feed your baby hard pieces of food such as chunks of raw carrots, apples, hot dogs, grapes, peanuts, and popcorn. Cut all the foods you feed your baby into thin pieces to prevent choking. Be prepared if your baby starts to choke. Ask your doctor to recommend the steps you need to know. Learn how to save the life of a choking child. To prevent possible suffocation and reduce the risk of sudden infant dealth syndrome (SIDS), your baby should always sleep on his or her back. NEVER put your baby on a water bed, bean bag, or anything that is soft enough to cover the face and block air to the nose and mouth. Plastic wrappers and bags form a tight seal if placed over the mouth and nose and may suffocate your child. Keep them away from your baby.

From Your Doctor

A diaper rash is any rash on the skin area covered by a diaper. Almost every child gets diaper rashes from time to time. Most of them are due to prolonged contact with ammonia and other irritants. The ammonia and other skin irritants are made by the reaction of bacteria from stools with certain chemicals in the urine. Bouts of diarrhea can cause rashes in most children. How long will it last?

With proper treatment these rashes are usually better in 3 days. If the rash does not improve with treatment, then your child probably has a yeast infection (Candida). If your child has a yeast infection, then the rash becomes bright red and raw, covers a large area, and is surrounded by red dots. You will need a special cream for yeast infections. How can I take care of my child?

Change diapers frequently

The key to successful treatment is keeping the area dry and clean so it can heal itself. Check the diapers about every hour, and if they are wet or soiled, change them immediately. Exposure to stools causes most of the skin damage. Make sure that your baby's bottom is completely dry before closing up the fresh diaper.

Increase air exposure

Leave your baby's bottom exposed to the air as much as possible each day. Practical times are during naps or after stools. Put a towel or diaper under your baby. When the diaper is on, fasten it loosely so that air can circulate between it and the skin. Avoid airtight plastic pants.

Rinse the skin with warm water

Do not wash the skin with soap after every diaper change because it interferes with healing. Use a mild soap (like Dove) only after stools. The soap will remove the film of bacteria left on the skin. Diaper wipes are inadequate for cleaning off poop. They commonly leave a film of bacteria on the skin. After using a soap, rinse well. If the diaper rash is quite raw, use warm water soaks for 15 minutes three times a day.

Nighttime care At night use disposable diapers that lock wetness inside the diaper and away from the skin. Avoid plastic pants at night. Until the rash is better, awaken your baby once during the night to change the diaper.

Creams and ointments

Most babies don't need any diaper cream. However, if your baby's skin is dry and cracked, apply an ointment to protect the skin after you wash off any stool. A barrier ointment is also needed whenever your child has diarrhea.

Cornstarch reduces friction and can be used to prevent future diaper rashes after this one is healed. Studies showed that cornstarch does not encourage yeast infections. Avoid talcum powder because of the risk of pneumonia if your baby inhales it.

Yeast infections

If the rash is bright red or does not start getting better after 3 days of warm water cleansing and air exposure, your child probably has a yeast infection. Apply Lotrimin cream (no prescription necessary) four times a day or after each bottom rinse for stools. How can I prevent diaper rash?

Changing the diaper right after your child has a stool and rinsing the skin with warm water (rather than just using a diaper wipe) are the most effective things you can do to prevent diaper rash.

If you use cloth diapers and wash them yourself, use bleach (such as Clorox, Borax, or Purex) to sterilize them. During the regular cycle, use any detergent. Then refill the washer with warm water, add 1 cup of bleach, and run a second cycle. Unlike bleach, vinegar is not effective in killing germs. When should I call my child's healthcare provider?

Call IMMEDIATELY if:

The rash looks infected (pimples, blisters, boils, sores). Your child starts acting very sick.

Call within 24 hours if:

The rash isn't much better in 3 days. The diaper rash becomes bright red or raw. You have other concerns or questions.

Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books. Passive Smoking What is passive smoking?

Nonsmoking children who live in homes with smokers are exposed to cigarette smoke. This situation is called "passive smoking."

Passive smoking is caused by secondhand smoke and sidestream smoke. Secondhand smoke is the smoke exhaled by the smoker. Sidestream smoke is the smoke that comes off the end of a burning cigarette. Most of the smoke in a room is sidestream smoke. Sidestream smoke contains 2 or 3 times more harmful chemicals than secondhand smoke because it does not pass through the cigarette filter. At its worst, a child in a very smoky room for one hour with several smokers inhales as many bad chemicals as he would by actually smoking 10 or more cigarettes.

In general, children of smoking mothers absorb more smoke into their bodies than children of smoking fathers because they spend more time with their mothers. Children who are breast-fed by a smoking mother are at the greatest risk because chemicals from the smoke are in the breast milk as well as the surrounding air. How does passive smoke harm my child?

Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.

The impact of passive smoke is worse during the first 5 years of life, when children spend most of their time with their parents. The more smokers there are in a household and the more they smoke, the more severe a child's symptoms are.

Passive smoking is especially harmful to children who have asthma. Exposure to smoke causes more severe asthma attacks, more emergency room visits, and more admissions to the hospital. These children are also less likely to outgrow their asthma.

The following conditions are worsened by passive smoking:

pneumonia coughs or bronchitis croup or laryngitis wheezing or bronchiolitis asthma attacks flu (influenza) ear infections middle ear fluid and blockage colds or upper respiratory infections sinus infections sore throats eye irritation crib deaths (SIDS) school absenteeism caused by illness. How can I protect my child from passive smoking?

Give up smoking.

You can stop smoking if you get help. Sign up for a stop-smoking (smoking cessation) class or program in your community. Use nicotine replacement gum or patches (no prescription needed). For severe nicotine withdrawal symptoms, ask your healthcare provider about prescription medicines to help you quit. If you want your child not to smoke, set a good example by not smoking yourself.

It is even more important to give up smoking if you are pregnant. The unborn baby of a smoking mother has twice the risk for prematurity and newborn complications. You must also avoid smoking if you are breast-feeding because harmful chemicals from the smoke get into the breast milk.

For more self-help information, go to the CDC Web site http://www.smokefree.gov or the American Lung Association Web site http://www.lungusa.org.

Never smoke inside your home.

Some parents find it very difficult to give up smoking, but all parents can change their smoking habits. Smoke only when you are away from home. If you have to smoke when you are home, smoke only in your garage or on the porch.

If you have to smoke inside your house, decide which room in your home will be a smoking room. Keep the door to this room closed and open a window sometimes to let fresh air into the room. Wear an overshirt in this room so your underlying clothing does not collect the smoke. Never allow your child inside this room. Don't smoke in any other parts of the house. Visitors must also smoke only in this one room.

Never smoke when you are close to your child.

Don't smoke when you are holding your child. Never smoke in a car when your child is a passenger. Never smoke when you are feeding or bathing your child. Never smoke in your child's bedroom. These precautions will reduce your child's exposure to smoke and protect him from cigarette burns. Even doing just this much will help your child to some degree.

Avoid leaving your child with someone who smokes. What you need to know about: Respiratory Syncytial Virus (RSV)

What is respiratory syncytial virus (RSV)? What does RSV cause? RSV is a lung infection caused by a virus. Although it can affect anyone, RSV is generally considered as the most frequent cause of lower respiratory tract infections in infants and young children. Each year about 125,000 infants are hospitalized with RSV in the United States.

What are the symptoms of an RSV infection? Many persons with RSV infection show no symptoms. In adults and children older than 3 years, RSV symptoms are usually those of a simple upper respiratory tract illness. The illness typically begins with a low-grade fever, runny nose, cough, and, sometimes, wheezing. In children younger than age 3, RSV can cause a lower respiratory tract illness, such as bronchiolitis or pneumonia, and more severe cases can result in respiratory failure. Symptoms may include a worsening croupy cough, unusually rapid breathing, difficulty breathing (the chest may suck in with each breath), and a bluish color of the lips or fingernails caused by low levels of oxygen in the blood.

RSV has also been found to be a frequent cause of middle ear infections (otitis media) in preschool children.

How common is RSV? RSV infections occur all over the world, most often in outbreaks that can last up to 5 months, from late fall through early spring. RSV epidemics spread easily in households, daycare centers, and schools.

Who is likely to get RSV? Most children are infected at least once by age 2 and continue to be reinfected throughout life. RSV is the most common cause of bronchiolitis and pneumonia in infants and children under the age of one. The majority of children hospitalized for an RSV infection are under the age of six months. The elderly and premature babies or those with lung or heart problems or with weak immune systems have an especially high risk. Those who are exposed to tobacco smoke, attend daycare, live in crowded conditions, or have school-aged siblings could also be at higher risk.

How is RSV spread? Typically a parent, or more likely an older sibling, comes down with what seems like a bad cold first. The virus is found in discharges from the nose and throat of an infected person. People can get RSV infection by breathing in droplets after an infected person has coughed; by hand-to-mouth contact after touching an infected person; and, by hand-to-mouth after touching a surface that an infected person has touched or coughed on. The time period from exposure to illness is usually about 4 days. After an infection, a person may be still contagious for a week.

How can you prevent RSV? Exercise typical cold precautions during the peak of RSV season.

• Wash your hands often. Do not touch your eyes, nose, or mouth without washing your hands first. Soap and water and disinfectants easily inactivate the virus. • If possible, avoid exposure to sick persons. Parents with high-risk young infants should avoid crowds. • When RSV infects a daycare center, it is not unusual to see most, if not all of the children come down with an RSV infection. Make sure that all children and employees use good handwashing techniques and that all children and employees cover their faces when coughing or sneezing. Used tissues should be thrown away in a lined trash can immediately after use. • It is important that infants do not share toys, bottles, etc. Surfaces and toys shared by two or more children should be cleaned and disinfected regularly. • Whenever a school-age child comes down with a cold, keep the child away from an infant brother or sister until the symptoms pass.

What do I do if I think anyone in my family has RSV? Consult with your healthcare provider. Any breathing difficulties in an infant should be considered an emergency, so seek immediate help.

How are RSV infections diagnosed? The diagnosis is usually made by the pattern of a child's symptoms (a clinical diagnosis), especially if he or she has a cold and is wheezing. RSV can be confirmed by checking for the virus in nasal washings or by growing the virus from nasal swabs.

How are RSV infections treated? There is currently no vaccine to prevent RSV infection. Because RSV infection is often resolved on its own, treatment of mild symptoms is not necessary for most people. For babies and children who are at high risk of developing severe RSV, preventive medication is available. Parents of an infant who is premature, has a serious heart or lung disease, or has a weak immune system should contact their doctor or healthcare provider. Antibiotics are not useful in the treatment of RSV or any other viral disease.

Should I worry about RSV when I travel out of the country? RSV is common worldwide, but no additional precautions are needed when traveling. The number of infections usually peaks in the late fall, winter, and early spring in the United States and Europe. In tropical climates, epidemics occur during the rainy season. Child Care: Finding and Choosing

Choosing child care is one of the most important decisions your family will make. It is important to look at several different options. What is good for other children may not be the best for your child. You will need to compare price, hours, quality of the program, and location of different child care options. Child care options include:

center-based child care family child care in-home child care before and after school child care.

If possible, both parents should participate in the child care selection process. Your child should be present for at least some of the time while you observe and interview caregivers.

When choosing child care you it helps to:

Make a list of names, addresses, and phone numbers of child care providers in your area. Research child care licensing regulations for your state. Find out about the training and experience providers have in caring for children. Contact several providers and make an appointment to spend an hour or two with each. If possible, visit when children are present. Meet with the directors and staff or caregiver to discuss your expectations. Spend an hour or two observing active and quiet activities at all facilities you are seriously considering. Review the licensing files, if possible. Ask for references and check them. Talk with other parents from the facilities. Trust your instincts and ask questions. After you find good child care, drop in for visits and check in regularly. What is center-based child care?

Child care centers provide an organized group setting away from home. They may also be called preschools, nursery schools, or learning centers. Most centers take children 3 to 5 years of age who are toilet-trained. Some have infant or toddler nurseries for children younger than 3.

Child care centers are licensed by the state. They must meet safety requirements and the center staff must have certain kinds of training. The states also have rules about the number of adults needed to take care of a certain number of children. Check your state's requirements for center- based infant and toddler care.

Preschools and child care centers can be commercially owned or sponsored by a community organization such as a church or recreation center. Your employer may have an on-site child care center or a reimbursement account to help you save money to pay for child care. Advantages:

Usually has planned program of activities and greater choice of play materials. Caregivers are usually trained and experienced in child development. Licensing is required, ensuring minimum health, safety and enrollment standards. Usually less expensive than in-home care. Your child can play with other children. Generally open 12 hours per day year-round with both full-and half-day schedules available (nursery schools usually open half-days and closed the same months as regular school). Closures due to caregiver being ill are unlikely. Staff is supervised.

Disadvantages:

Your child may be less comfortable in a group setting and receive less attention than in an informal home environment. Your child will be around more children and so will probably be sick more often. When your child is sick you will not be able to send him to the child care center. You may need to agree to year-round day care even if you don't need it. You may need to pay a registration fee. The center hours and days may not be exactly what you need. Staff turnover can be high so your child may not have a consistent caregiver. This usually costs more than family child care. What is family child care?

Family child care is done by providers who are licensed to care for children in their home. The caregiver is often a mother with her own small children. Family child care providers are licensed by the state. The states also have rules about the number of adults needed to take care of a certain number of children. Generally, a child care home should not have more than 6 children per adult caregiver, including the caregiver's own children. No caregiver working alone should care for more than 2 children who are under 2 years of age.

Advantages:

Provides home-like environment (very important for infants and toddlers). Greater flexibility regarding ages and hours of operation. May be licensed by the state, ensuring minimum health, safety, and enrollment standards. May cost less than center-based care. Your child is in a smaller group of children which will allow more individual attention and less exposure to illness. May have more flexible hours than center-based care.

Disadvantages: The caregiver will not always be available (illness, vacation). The caregiver may stop providing services without much notice. The caregiver may not have appropriate training or experience. The caregiver may not be able to offer all options provided by center-based care. The caregiver is not supervised directly and may not be licensed. What is in-home child care?

In-home care means hiring someone to care for your infant or young toddler in your own home. Your child will be in a familiar place and get lots of personal attention. The caregiver may be a friend, neighbor, relative, or professional nanny. You can hire someone for half-day, all-day, or before or after school. If you hire the person through an agency, a background check should have already been done. Some states have resources that allow you to do background checks.

Advantages:

Care in a familiar place. This is very important for infants and toddlers. Your child should receive enough personal attention. May be the most choice for 3 or more children. Your child can be cared for when sick. There is less exposure to illness from other children.

Disadvantages:

Relatively hard to find a caregiver. May be the most costly choice for 1 or 2 children. You are responsible for all fees, taxes, social security, and sometimes benefits of the caregiver. The caregiver may not always be available (illness, vacation), and turnover may be high. Your child may not get the stimulation of other children. The caregiver may not have appropriate training or experience. It may be hard to change caregivers if it is a relative or friend. What is before- and after-school child care?

Before and after child care is generally available for children 6 to 12 years of age. This type of child care is usually connected with a day care center, school, or community agency, but may be provided in a home setting. Programs offer age-appropriate activities in the hours before and after school. Care is also provided holidays, school breaks, and vacations. Arrangements tend to be flexible and based on family needs. Where do I find information about child care in my area?

You can find information about child care options from: State Department of Social Services, Human Services, or Health (list of licensed day care homes) United Way (information and referral services) YMCA/YWCA Religious organizations Child development departments of local colleges School counselor (before and after school care) Your employer Telephone book ("Child Care, Camps, Nanny Services, Schools - Preschool") Junior League PTA Local child care council Pediatrician Newspaper/bulletin board ads Word-of-mouth (friends, relatives, other parents).

For child care standards see:

NACCRA, National Association of Child Care Reports & Referral Agencies Web site: http://www.naccrra.org/

National Resource Center for Health and Safety in Child Care Web site: http://nrckids.org/

National Association of Education for Young Children Web site: http://naeyc.org

National Association for Family Child Care Web site: http://nafcc.org

Written by Donna Warner Manczak, PhD, MPH. Published by RelayHealth. Last modified: 2011-05-10 Last reviewed: 2009-12-01 This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. References Pediatric Advisor 2011.2 Index © 2011 RelayHealth and/or its affiliates. All rights reserved.

LETTING GO IS HARD TO DO Dealing With Separation Anxieties in Young Children

Separation anxiety is the distress that young children often experience when they are separated from a familiar caregiver or loved one. This often intense distress is a normal process of development for children ages 8 months to about 30 months. For children who are going off to daycare or school for the first time, this can be an extremely difficult transition. Although stressful for the child, parent, and new caregiver, this is a signal that the child is going through a healthy attachment process.

What can parents do?

• Practice separating from your child for short periods of time, so that your child can get used to being away from you. Begin to introduce your child to new people, events and experiences gradually.

• To help ease separation anxieties, it is important to sit down and talk with your child in an effort to prepare them for what they can expect in school.

• Parents need to make every effort to reassure their children that this is a good thing. Respect and acknowledge their fears and distress about separating from you.

• Parents need to make every effort to visit the new school, so that the child can become familiar with his or her new school environment. This will also allow the child an opportunity to have a personal contact with the teacher before the first day of school.

• Parents need to make every effort to show a positive attitude toward going to school and learning new things. First impressions and experiences are important to children and help determine how their brains will be wired.

What should parents not do?

• This time should not be a time for parents to pass on their apprehensions or insecurities about their children leaving home. It should be a time that is used to create excitement about getting older and going off to school.

• Do not sneak away while the child is not looking, this will further compound their fears that you have disappeared. Remember that some children do not yet have object permanence and do not realize that you exist even when you are out of sight.

• Do not linger too long. Give you child a kiss, reassure him or her that you will be back, say good-bye, and then leave.

What can teachers do?

• Teachers should make the child feel comfortable by introducing himself or herself to the child in the presence of the parent. Invite the child to come and play, sit, or eat a snack.

• Allow the child to have a stuffed animal, toy, pictures, or something that will remind them of home and be a source of comfort.

• Develop a routine or transition activity that will aid both the child and parent in separating from each other. Redirecting the child to an activity is often very helpful.

• Provide a supportive, nurturing environment that will help the child to feel loved and cared for. This is important for brain development and to ensure healthy self-esteem.

• Assure parents their child will be well taken care of, and that they can call or stop by to see how their child is doing. Ensure that parents are careful not to be seen by their children, to avoid causing further distress.

What should teachers not do?

• Never scold or criticize a child for crying, feeling sad, or anxious. This is a normal process of development.

• Do not ignore the child’s distress, hoping it would just go away. Respect how the child feels.

• Do not tell the child that their parents will be “right back.” Although the child does not have a good concept of time, they will come to distrust what you say when their parents do not come “right back.”

Going away to school is a major milestone for children, and is the beginning of new relationships that will form outside the home. Children will learn how to communicate and how to get along with other people outside of their families. Helping children to embrace this new experience will be a combined effort between the parents and the teachers. READY, SET, READ The Importance of Reading to Young Children

“As parents, the most important thing we can do is read to our children early and often. Reading is the path to success in school and life. When children learn to love books, they learn to love learning.” -Laura Bush-

Learning how to read begins in infancy when we talk, read, and listen to our babies. Through this process, infants and children learn what words have meanings and are important. Taking time out to engage in these learning activities with your child will definitely shape the future of your child’s success. It is important to remember that not all children will learn at the same pace, and to follow their lead.

Reading a book more that once to a child will help them remember the story, and allow them to actively participate in the story. Sometimes it is important to ask the child to tell you the story, or what they think the story is about. This will encourage active thinking. Learning to read will take time and lots of patience.

Here are some things to consider when reading with your child:

Babies (6 weeks to 1 year) • Find a comfortable place to read to your child, where he or she will be happy. • Try to point out the pictures in a book, instead of reading all the words in a book. • Help your baby to use his or her hands to touch the pictures named in a book. This will help to encourage joint attention and learning. • Pay attention to how your child is responding, and recognize when the child is tired or becomes over stimulated.

Toddlers (1 to 3 years) • Find a book your child enjoys and encourage the child to actively participate in the story. • Give the child time to process the story and to respond to questions asked. • Relate the story back to experiences in the child’s life or ask the child to recall similar experiences. • Point out letters, colors, and shapes to the child while reading.

Preschoolers (3 and 4 years) • Continue with all activities recommended above. • Find ways to help you child learn sounds and letters, and match correct letters to sounds.

Kindergarteners (5 years) • Continue with all activities recommended above. • Help your child to begin recognizing printed words. • Ask you child to retell stories they enjoy.

First Graders (6 years) • Continue with all activities recommended above. • Give your child an opportunity to read by using words, picture clues and memory. Help the child to use any method that will make reading fun and enjoyable.

Ten Important Things to Know About Child Safety Seats

1. According to Texas law, every child under 4 years and less than 36” tall must be properly secured in a federally approved safety seat. Every child 4 through 16 years must be properly secured by a safety belt, regardless of whether the child is riding in the front or back seat. A child under 18 years cannot ride in the open bed of a pick-up truck or trailer. All front seat passengers, regardless of age, must be buckled up.

2. Best practice is that children from newborn to 80 pounds, and possibly even up to 100 pounds, should ride in a safety seat.

3. Safety belts in vehicles are made for adults. A child does not fit a safety belt until he or she weighs about 80 pounds and is 4’9” tall. The lap belt must stay low across the hips, touching the top of the thighs, not over the stomach. The shoulder belt should not cross the neck or face.

4. Read and follow safety seat manufacturer’s instructions and the vehicle owner’s manual.

5. Infants should stay rear-facing until at least 20 pounds and at least 1 year old. Some infant seats can hold babies up to 35 pounds. It is recommended that infants stay in rear-facing seats as long as possible.

6. Rear-facing infant seats should never be placed in that front seats of vehicles equipped with air bags. Generally, the safest place for children to ride in a motor vehicle is the back seat.

7. Safety seats should be tightly installed so that they do not move more than 1 inch in any direction at the seat belt path. Some vehicles require a locking clip to make the seat tight. Check the vehicle owner’s manual instructions.

8. Harness straps should be “snug as a hug.” You should not be able to pinch any webbing.

9. Harness retainer clips should be at armpit level.

10. A safety seat should be replaced if it has been involved in a motor vehicle crash, is more than 5 years old, or it has been recalled and cannot be repaired.

• For more information, call Tarrant County Cook Children’s Advocacy, SAFE KIDS CookChildren’s 817-885-4244. Medical Center

TEXAS CHILD PASSENGER SAFETY LAW

Each year car crashes injure or kill more children than any disease. Child traffic fatalities could be prevented in 70% of the motor vehicle crashes if parents and care providers properly restrained children each time they get in the car. Our goal is to help educate people of the importance of proper and continuous use of occupant protection for all passengers in their vehicle.

Effective September 1, 2001, the Texas Occupant Protection Law:

• Requires every child under age 4 and less than 36” tall must be properly secured in a federally approved safety seat. Every child age 4 through 16 years must be properly secured by a safety belt. This law applies whether or not the child is riding in the front or back seat of the vehicle.

• A child under age 18 cannot ride in the open bed of a pick-up truck or trailer.

• Requires all front sear occupants of passenger vehicles, regardless of age, to be buckled up.

BEST PRACTICE:

• All children under 12 years should ride in the back seat.

• Children should ride rear-facing until they reach at least 20 pounds AND are at least one year old.

• Rear-facing child safety seats should NEVER be placed in the front seat of a vehicle equipped with air bags.

• Children who weigh 40 to 80 pounds should ride in a federally approved booster seat until they fit adult seat belt restraints.

Please call Tarrant County SAFE KIDS at 817-855-4244 with question.

For additional information, browse www.carseat.org and www.cookchildrens.org

Please be safe, not sorry, Buckle up!

Tarrant County SAFE KIDS AT CookChildren’s Medical Center