HealthyChildren Summer07

Healthy
Children
American Academy of Pediatrics
Summer 2007
Sponsored by
Waiting Room Copy
Probiot ics
What s New in
Inf ant Formula
Type 2
Diabet es
Is Your Child
at Risk?
Child Care
Make the
Right Choice
for Your Family
Keeping the
I nt er net
Saf e
for Your
Family
Asaparent, you know how important it isto teach children the value of keeping
their promises. That isevery bit asimportant when it comesto adults including your
pediatrician in keeping our promise to ensure the optimal health and well being for
all children.
Im pleased to announce that your pediatrician, asamember of the American
Academy of Pediatrics(AAP), hasrenewed the commitment to AmericasPromise:
Alliance for Youth, asit launchesits10th anniversary year.
AmericasPromise wascreated asaresult of the 1997 PresidentsSummit for
AmericasFuture, where PresidentsClinton, Bush, Carter, and Ford, with Nancy
Reagan representing President Reagan, challenged Americato make children a
national priority. The presidentsafrmed our special obligation asAmericansto keep
ve essential promisesto young people: caring adults, safe places, a healthy start,
effective education, and opportunities to help others.
Retired Gen. Colin L. Powell became the Alliancesfounding chairman. Today,
hiswife AlmaPowell servesaschair of the Alliance, which hasgrown to become
the nationslargest private-public partnership committed to ensuring that every child
receivesthe fundamental resourcescontained in the Five Promises.
Joining the AAP in thisdynamic, results-oriented alliance are organizationsthat
represent all strandsfrom the rich fabric of American life: corporations, nonprots,
higher education and faith-based groups, associationsand federal agencies, and
community groups.
Last November, the Alliance released the resultsof astudy conducted to determine
the measurable changesthat occur when children receive the Five Promises. It found
that when youth are provided with at least four out of ve fundamental resources, their
life chancesfor successdramatically increase, and damaging gapsseparating low-income
and minority youth from other youth are signicantly reduced.
Improvementswere seen in early school readiness; high school completion rates;
college or post-secondary enrollment; math and English prociency; juvenile crime;
drug and alcohol abuse; child crime-victim rates; childhood suicide; teen pregnancy;
and young peoplescivic engagement. Unfortunately, the dataalso showed that more
than two-thirdsof our youth are not receiving enough of these resourcesto benet
from their full effects.
Aspediatricians, we want all parentsto know that we are your partnersin helping to
make sure that children have everything they need for asafe, healthy, and productive life.
We also hope that you nd thisissue of Healthy Children informative and useful.
Jay E. Berkelhamer, M.D., FAAP
President
Keeping Promises to Children
2 Healthy Children Summer 2007
The American Academy of Pediatrics is updating its award-winning
publication, Caring for Your Baby and Young Child, Birth to Age 5 and
would like to hear from you. Please take a few minutes to complete our survey
and share your thoughts by going to www.aap.org/ healthychildren.
All responses received by September 7, 2007, will be entered into a drawing
for a publication gift pack.
Healthy Children Summer 2007 3
IFC Welcome
Dr. Jay Berkelhamer, AAP president, welcomesyou to AAPs
authoritative resource for parents.
3 Table of Cont ent s
4 This Just In
The latest parenting news, research, and health tipsfrom our
experts
6 Ask t he Pediat rician
Answersto common questions
8 Making Child Care Choices Count
f or Your Family
Understand what isout there and what your child needsto make
the right choicesfor day care.
10 Immunizat ions:
Your Childs Best Def ense
Which vaccinesshould your child receive, and when? Hereswhat
you need to know.
12 Caut ion! Children at Play!
Playtime isan important part of your childshealthy growth and
development. Give it some thought, but let them have fun, too.
14 Type 2 Diabet es:
A Manageable Epidemic
Once a disease that affected adultsalmost exclusively, type
2 diabetesisa growing epidemic that isbeginning to impact
children, aswell.
16 Probiot ics: A New
Inf ant Formula Feat ure
A type of infant formula that may offer more health benets
than regular formula isnow available in the United States.
18 Log on t o Saf et y
The Internet can be a risky place for an unsupervised child to
roam. Follow these simple online tipsto protect your family.
20 Yes, We Can!
Promoting good nutrition and healthy physical activitiesfor
children concernsusall. A program from the National Institutes
of Health ishelping many communitiesdo just that.
24 Underst anding Mot herhood
and Mood
Isit the baby blues or postpartum depression? Whatsthe
difference? Find out.
26 Ear Inf ect ion Today, Gone Tomorrow
For many children, ear infectionsare part of growing up. But
there are stepsparentscan take to reduce the risks.
28 Drivers Edge
Taking some wise precautionscan help keep your teen safe
behind the wheel.
Summer 2007
Copyright 2007 by the American Academy of Pediatrics. No part of this publication may be reproduced
or transmitted in any form or by any means without written permission from the American Academy of Pe-
diatrics. Articles in this publication are written by professional journalists who strive to present reliable, up-
to-date health information. However, personal decisions regarding health, nance, exercise and other matters
should be made only after consultation with the readers physician or professional adviser. All editorial rights
reserved. Opinions expressed herein are not necessarily those of the American Academy of Pediatrics. Models
are used for illustrative purposes only.
The information contained 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
individual facts and circumstances.
Managing Editors. . . . . . . . . . . . . . . . . . . . . . . . . . . Selby Bateman, Sam Gaines
Creative Director . . . . . . . . . . . . . . . . . . . . . . . . . . . Jan McLean
Production Director . . . . . . . . . . . . . . . . . . . . . . . . . Traci Marsh
President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . William G. Moore
Controller. . . . . . . . . . . . . . . . . . . . . . . . . . .Pat Blake
Administrative Assistant . . . . . . . . . . . . . . . . . . .Pat Schrader
attn: Healthy Children Magazine
141 Northwest Point Blvd.
Elk Grove Village, IL 60007
healthychildren@aap.org
AAP Editorial Advisory Board
Tanya Remer Altmann, MD, FAAP
Westlake Village, CA
Laura A. Jana, MD, FAAP
Omaha, NE
Jennifer Shu, MD, FAAP
Atlanta, GA
Robert W. Steele, MD, FAAP
Springeld, MO
Paul R. Stricker, MD, FAAP
San Diego, CA
Executive Director
Errol R. Alden, MD, FAAP
Associate Executive Director
Roger F. Suchyta, MD, FAAP
Director, Department of Marketing and Publications
Maureen DeRosa, MPA
Director, Division of Product Development
Mark Grimes
Manager, Consumer Publishing
Carolyn Kolbaba
Manager, Patient Education
Regina Moi Martinez
Coordinator, Product Development
Holly Kaminski
Manager, Consumer Product Marketing and Sales
Kathleen Juhl
Healthy Children is published by Vitality Communications
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The American Academy of Pediatricswould like to thank

for their sponsorship of thisissue of Healthy Children.
Healthy
Children
An Early Spring
A recent study by the University of Pittsburgh reports
that women who become pregnant duringthe springseason
are more likely to deliver prematurely. Pretermbirth is
a complex condition, and risk factors can change with the
seasons, says Dr. Lisa Bodnar, assistant professor of epi-
demiology at the University of Pittsburgh Graduate School
of Public Health and a co-author of the study. Givingbirth
prematurely (before the 37th week of gestation) happens to
about 12 percent of pregnancies in the United States, which
adds up to more than 500,000 a year. Thats an increase of
more than 30 percent since 1981.
Solving the Mystery of SIDS
Researchers have come one step closer to solvingthe
heartbreakingmystery of Sudden Infant Death Syndrome
(SIDS), the unexplained and unexpected death of a baby.
SIDS is the nations leadingcause of death for babies
between 1 month and 1 year old. It claims the lives of nearly
3,000 infants in the United States each year, accordingto the
National Institutes of Health (NIH).
Infants who die of SIDS have abnormalities in the
brainstem, a part of the brain that helps control heart
rate, breathing, blood pressure, temperature, and arousal,
reported researchers funded by the NIH.
These ndings provide evidence that SIDS is not a
mystery but a disorder that we can investigate with scientic
methods, and some day, may be able to identify and treat,
says Dr. Hannah Kinney, the senior author.
The study appeared in a recent edition of the Journal of the
American Medical Association. It was conducted by researchers
led by Dr. Kinney at Childrens Hospital Boston and Harvard
Medical School, as well as at other institutions.
The latest parenting news, research,
and health tips from our experts
ThisJust In...
Just for Kicks
A study published in the February issue of The
American Journal of Sports Medicine tracked nearly 1.6
million soccer injuries fromemergency roomreports
around the country. It is the rst nationwide analysis of
soccer injuries amongchildren ages 2 to 18.
The number of injuries among girls grew during
the 13-year period studied. The most common were
sprained ankles, knee injuries, scrapes and bruises,
and fractures.
On the other hand, boys were more likely to
have face, head, and neck injuries, as well as cuts and
punctures. Children 2 to 4 years old had a higher
proportion of head, neck, and face injuries than the
older children in the survey.
With more children playingsoccer, the true injury
rate may actually be going down. The study concluded
that children need adult guidance to prevent severe
injury. It also called for tracking injury risks by setting
up a national database to track soccer participation
and injuries.
Researchers fromChildrens Research and Ohio
State Universitys Department of Pediatrics, both in
Columbus, Ohio, conducted the study. The mean
(average) age of children was 13.2 years, and boys made
up 58.6 percent of the study.
Model Misbehavior
Youngwomen are puttingtheir physical and mental health at
risk by followingthe extreme eatinghabits of modern magazine
models who appear in publications featuringdietingand weight
loss, accordingto new research.
Researchers found that the more frequently teenage girls
read magazines about dietingand weight loss, the more likely
they were to engage in unhealthy eatinghabits. The ndings
came froma ve-year study by the School of Public Health at
the University of Minnesota and were published in the journal
Pediatrics.
The study charted the eating, activity, weight, and related
issues in 2,516 middle and high-school students. Girls who often
read magazines about dietingwere twice as likely to engage in
unhealthy weight-control behavior, such as fasting, skipping
meals, and smoking, than those who did not read them.
The group at highest risk was made up of girls who read the
most articles about dietingand weight loss. They were three
times more likely to engage in extreme behaviors, such as self-
induced vomitingor usinglaxatives, than those who never read
the same type of articles.
Researchers recommend that adults should reduce their
daughters exposure to dietingand weight loss messages in the
media, and nd ways to reduce the emphasis on those messages
when they see them.
By contrast, teenage boys did not exhibit the same
psychological associations or effects, accordingto the study.
Breast is Still Best
The number of Americans who wrongly believe that infant
formula is as good as breast milk has increased from14.3
percent in 1999 to 25.7 percent in 2003, accordingto a new
study.
The ndings underscore the need to educate the general
public that breastfeedingis the best method of feedingand
nurturinginfants, concludes the Centers for Disease
Control and Preventions (CDC) Dr. Rowe Li and
colleagues in the January issue of the Journal of the
American Dietetic Association.
The nationwide HealthStyles survey is conducted annually
by the USC AnnenbergNorman Lear Centers Hollywood,
Health & Society project and funded by the CDC, the
National Institutes of Health, and partneringagencies.
Sparky to the Rescue
Natural disasters disrupt the lives of thousands
of families each year its just a fact of life. But
if you are concerned that your children would not
know what to do in a crisis, check out the new
online game Look and Learn, compliments of
the National Fire Protection Association
(www.riskwatch.org/kids.html#).
The game teaches children about the importance
of beingprepared for an emergency by showing
themitems that should be included in an emergency
supplies kit. Led by Sparky, the NFPAs ofcial spokes-
dog, players visit six different scenes as they help the
pooch nd hidden items for his emergency supplies
kit. Players try to locate emergency staples such as
ashlights, batteries, extra clothing, a whistle, canned
food, and other necessities.
After ndingall of the supplies in each section of
the game, children will be able to download and print
out a checklist that they can use to make their own
emergency supplies kit.
Look and Learn is part of the NFPAs Risk
Watch, a comprehensive injury prevention and
disaster preparation programthat gives children and
their families the skills and knowledge to create safer
homes and communities.
The game is most appropriate for children in
kindergarten through second grade. In addition, the
Web site (www.sparky.org) offers lots of other fun
and educational activities, includingSparkys Arcade
and a Sparky e-greeting. There is no advertisingon
the kids section of the site.
1. Parents Gone Wild
Q: Over the past few years,my daughters friends have invited
her to very elaborate and expensive birthday parties.I feel these
are inappropriate and instill materialistic values,but my daughter
thinks I ampunishingher if I dont allow her to join the party
circuit. How can we celebrate my daughters birthday without
goingto such extremes?
A: Manyparentsshare your frustration, but with a little creativity, a
childsbirthdaypartycan be great fun without great expense. A few
ideasthat parentshave shared include gift-free parties, partiesthat
dont have a theme, cookingor craft parties, and activitiessuch as
hostinga treasure hunt or doingcommunityservice work. For more
ideas, there are organizationssuch asBirthdaysWithout Pressure
( www.birthdayswithoutpressure.org) that offer helpful, creative
alternativesto such overindulgent occasions.
2. Cancer Wise
Q: My daughter just turned 13,and our doctor recently
suggested she be vaccinated against the human papillomavirus
(HPV).Is she too young?
A: Your 13-year-old daughter isnot too youngto get the HPV
vaccine. In fact, the Centersfor Disease Control and Prevention
( CDC) recommendsthat girls11 yearsand older receive the vaccine,
which isgiven in a seriesof three injections.
Accordingto the CDC, there are more than 100 different typesof
HPV. More than 30 of these virusesare sexuallytransmitted. At least
50 percent of sexuallyactive people will get HPV at some time in
their lives. While most HPV infectionsdont cause anysymptomsand
go awayon their own, in some casesHPV can cause cervical cancer
in women. Cervical cancer claimsthe livesof some 4,000 American
women each year. That iswhyit isso important for preteenage girls
to get vaccinated before becomingsexuallyactive and beingexposed
to HPV.
3. Time Out
Q: What is the best way to discipline my 3-year-old son?Is
spankingmore effective than other methods?
A: While it isimportant to establish effective methodsof disciplining
your three-year-old, spankingisnot the wayto do it. Accordingto Dr.
Paul Frick, a psychologist at the Universityof New O rleans, it would
be much more benecial to put your little guyin time out rather
than breakingout the hickoryswitch. And he certainlyisnot alone in
hisbelief that there isan association between spankingand behavioral
and emotional problemsin children. Thisisespeciallytrue in children
who experienced high levelsof physical punishment and who didnt
live in a warm and supportive environment.
In an article published in the November-December issue of the
Q&A
Ask the
Pediatrician
Solving the Riddles of Parenthood
To submit questions to Healthy Children,
send an e-mail to healthychildren@aap.org
or write to American Academy of Pediatrics
attn: Healthy Children Magazine
141 Northwest Point Blvd.
Elk Grove Village, IL 60007
Journal of Applied Developmental Psychology,
Frick suggestsparentsuse other typesof
discipline, such astime out, extra chores, and
lossof privileges.
Frick reached thisconclusion after recently
completinga studyof 98 children who
all showed negative effectsfrom physical
punishment and didnt learn what their
parentswere tryingto teach.
It isbetter to use other typesof discipline
and focuson the consistency, Frick told
Reutershealth.com. The keyisto have a lot
of different formsof punishment depending
on the age of the child. O f course, giving
positive reinforcement for good behavior can
be just aseffective in helpinga child learn
what you expect of hisbehavior.
4. Made in the Shade
Q: My family is planningavacation to the
coast this summer.Do I need to protect
my children fromthe sun?What are the
best ways?
A: In addition to makingyour kids and
you miserable from sunburn on your
vacation, too much sun can cause skin
cancer later in life. ( Coveringup also helps
prevent mosquito bites, which reducesyour
risk of gettingWest Nile virus.) Children are
particularlyat risk from the dangersof the
sunsultraviolet raysbecause a childsskin
isthinner than an adults. In fact, a childs
skin can burn within onlya few minutesof
exposure to the sun. To keep your children
from too much exposure to the sun, make
sure theywear hatsor sit under a shade, put
on sunglasses, and applygenerousamounts
of strongsunscreen ( at least a sun protection
level of 15) . Itsimportant to cover up infants
under 6 monthsof age asmuch aspossible,
but a good idea to applysunscreen on their
exposed areas. Itsalso best to stayin the
shade when the sun isat itsstrongest 10
a.m. to 4 p.m. Finally, encourage your kidsto
drink water or other liquidsfrequentlyto
keep them from becomingdehydrated.
5. Fast Doesnt Mean
Fattening
Q: I have three children in elementary
school who are always goingin different
directions.To keep up with them,
unfortunately,I often dont have time to
prepare nutritious meals and rely on dinner
fromalocal fast-food place.How can I
make their drive-through meals healthier?
A: The American Heart Association offers
the followingtipsto keep fast food from
becominga biggie nutritional disaster:
Resist combination or value size meals.
Skip mayonnaise and other fattening
condimentsor dressings.
Avoid double burgersand sandwiches
with bacon.
Drink water, diet sodas, or low-fat milk
instead of regular cola or milkshakes.
O rder healthyside dishes, such asfruit.
6. Hard as Nails
Q: How do I trimmy babys ngernails
without cuttingher ngers?
A: Manyparentshave a difcult time trimming
their babysnailsbecause theyare so small and
soft, and babiesdont sit still for a manicure.
But itsimportant to trim your babysnails
regularly perhapsonce or twice a week
to keep your babyfrom scratchingherself.
Here are some helpful hints:
Use small nail clippers; parents can buy
clippers specically for babies at the
local drugstore.
Trim your babysnailsafter her bath because
theyare softer after beingin the water.
If your babyisa wiggle worm ( and most
are while someone istryingto cut their
nails) , have someone playwith her to
distract her while you are trimming.
You can also trytrimmingthem while your
babyisasleep.
If your babysnailshave rough edges, use a
small emeryboard or le to smooth them.
When trimming, hold her nger, press
the skin under the nail down, and trim
straight across.
Do not bite your babysnails; thiscan
cause nailsto break off unevenly, and the
germsfrom your mouth will get on her
hands, which can cause infection.
7. Cycling Safety
Q: My son received his rst bicycle this
spring.Its been alongtime since I have
ridden abike;will you refresh my memory
about bike safety?
A: Accordingto Safe KidsUSA, more than
130 children die from bicycle-related injuries
each year, and more than 280,000 are
treated in emergencyrooms. Here are a few
precautionsthat will help keep your son safe
while riding:
First and foremost, a bike helmet isessential
safetygear. Safe Kidsreportsthat helmets
could prevent an estimated 75 percent of
fatal head injuriesto child cyclists. When
buyinga helmet:
Make sure it meetsthe standardsof
the U.S. Consumer Product Safety
Commission.
Let your son pick out hishelmet, because
if he likesit, he will be much more likely
to wear it.
Check to make sure the helmet ts
securelyand your son knowshow to
wear it correctly. Safe Kidsrecommends
the Eyes, Ears, and Mouth test:The rim
of the helmet should be one to two
nger-widthsabove the eyebrows, the
strapsshould form a V just below the
ear lobe, the buckle should be at against
the skin, and the strap should feel snug
when the ridersmouth isopen.
Replace a helmet that hasbeen in a
crash. It maynot protect your child
properlyif he crashesagain.
Additional tipsfrom Safe Kidsincludes:
Familiarize yourself with the lawsin your
state. Manystatesnow require that children
younger than 16 wear a helmet while
cycling, but people of all agesshould use
bike helmets, even if not required bylaw.
Set a good example bywearinga helmet
when you cycle.
Teach your son to obeytrafcsignsand the
rulesof the road. Cyclistsshould ride with
the trafc, not facingit.
Make sure the bike itself isthe right size for
the child. There should be 2 to 4 inchesof
clearance between the bike frame and the
childsgroin when the childsfeet are at on
the ground. Also, make sure the bike isin
good repair reectorsare secure, brakes
work properly, gearsshift smoothly, and tires
are secured and properlyinated.
When in doubt, get help. The salesstaff
at anybicycle shop or outdoor recreation
store should be able to provide expert
advice on ttingand adjustingbikesand
helmets.

F
or more and more parents,
making the child care decision
isnot asimple choice. Along
with weighing your childs
needs, there are three main types
of child care to think about. There isno
simple formulafor choosing the right child
care provider for your child. However,
learning asmuch asyou can about your
optionscan help you decide what isbest
for your family.
What Type for Your Child?
There are three basic typesof child care:
In-home care: A caregiver comes
into your home and supervisesyour
child there.
Family child care: Child caregivers
provide their service out of their
own homes.
Center-based care: Child care
organizationsfeature structured activities
and programs, aswell asatrained staff.
Choosing the right option for your

family comesdown to thinking about the
prosand consof each type.
In-Home Care
For some families, the most convenient
option ishaving the caregiver come to
your own home. In some cases, caregivers
may even live in the family home. The
advantagesto thisapproach include the
potential for your child to receive more
individual attention, limited exposure to
seasonal ailmentssuch ascoldsand the
u, and your childscomfort level with a
familiar place.
There are challengesto having an in-
home caregiver, however. For starters,
skilled in-home providersare not easy to
nd. If you do nd one, realize that both
the caregiver and child need clear rules
about what your expectationsare. These
rulesshould include how to discipline the
child in your absence; how much TV
time (if any) isOK; what activitiesyou
want your child to take part in (reading,
playtime, etc.); and when itsOK to take
your child on an outing.
An in-home caregiver should be willing
to provide acomplete daily schedule and
report of your childsactivities, and to
make use of positive, effective methodsof
discipline. Even so, itsnot easy to know
for sure what your childscaregiver is
Child care isnt
a one-size-ts-all
decision. Heres what
you need to think
about before you
go shopping for a
child care provider.
BySam Gaines
Making
Child
Care
Choices
Count for
Your Family
doing when youre not there. Thatswhy
frequent, unannounced visitsfrom friends
or family membersare agood idea.
Keep in mind that youll need to have a
backup plan in place for those timeswhen
your childscaregiver issick, needspersonal
time, or ison vacation.
Family Child Care
Some child care providerswork out
of their own homes, often supervising
other children alongside their own. These
family child care providersare usually not
asconvenient for parentsasin-home care.
But they can sometimesprovide amore
focused, home-like environment than
center-based care and are usually easier to
nd than in-home caregivers.
If you are thinking about afamily child
care situation, there are some questionsyou
will want to ask:
What are the caregiverspoliciesand
qualications? Ishe or she licensed or
registered with the state, or accredited by
arecognized child care organization?
What kind of program doesthe
caregiver provide, and what condition is
the caregivershome in?
Are there other children, teens, or adults
in the home besidesthe caregiver?
If so, who are they, what are their
backgrounds, and how will they be
involved in the care of your child?
The American Academy of Pediatrics
recommendsthat afamily child care
businesshave no more than six children
per adult caregiver (including the
caregiversown children), with no more
than two of those children younger than
2 yearsold. However, be aware that
state regulationsoften allow for more
children per caregiver. Also, make sure
that you have abackup plan. If your
caregiver issick or unavailable, or in case
of emergencies, youll need afallback
option since usually only one adult is
providing the care. Ask the provider if
he or she belongsto alocal network that
can provide support if needed.
Center-Based Care
Child care centersare widely available.
Some are independently owned, while
othersare sponsored by churches,
employers, schools, or government

agenciesor programs, such asHead Start.
Whether itscalled achild care center,
preschool, nursery school, learning center,
or something similar, it servesthe same
basic function: providing care for children
at acentral location.
Regardlessof who sponsorsit or what
it iscalled, achild care center should be
licensed and inspected on aregular basis
for health, safety, cleanliness, stafng, and
program content. Many stateslicense
child care centers, but these regulationsset
only the minimum standardsfor operating
and some typesof child care operation
may be exempt under the law. Either
way, be sure that what the center offers
meetsnot only the statesstandardsbut
also your expectationsfor appropriate care
for your child.
Aswith family-based care, written
policiesand safety guidelinesshould be
available for your review.
What You Need to Consider
A good place to start your search for
aquality child care option isto contact a
reliable information resource, such asChild
Care Aware (1-800-424-2246, www.
childcareaware.org). Thisorganization can
provide helpful information and contactsto
steer you toward locally available child care
in your community.
Get alist of child care providersin your
community, then call them and ask for
information about who they are and what
they offer. Asyou review those materials,
write down the questionsyou want to ask
them when you call them back.
Here are afew thingsyou want to think
about in choosing achild care provider:
Location: Isthe provider near your
home or workplace? Can aparent get
there quickly in case of emergency?
Hours: When isthe operation open
to parents? What istheir policy
regarding parentswho are late
picking up their children?
Licensing and accreditation: Is
the facility licensed with the state, or
accredited by arecognized professional
child care association?
Inspections and consultations: Does
the program have aqualied health
professional such asadoctor or anurse
who servesasconsultant? Keep in mind

that the national standard isfor center-
based child care facilitiesto be visited by
ahealth professional at least monthly,
with all othersto receive quarterly visits.
Policies: Doesthe provider welcome
parent visitsduring normal operating
hours, including after enrollment? Can
you inspect the areasyour child will use?
What isthe sick child policy? Are the
centerspoliciesavailable in writing, and
are they consistent with your own?
Staff: What isthe caregivers
educational and professional
background? Hashe or she received any
outside training from qualied expertsin
the past year? IsCPR/First Aid training
required of the staff? How many trained
adultsare available for the children
there? Are there enough staff members
per number of children, and isthe
stafng sufcient to cover absences?
Availability: Doesthe center keep
reasonable hours, given your schedule?
Do you have accessto the caregiver
during the day or by phone on a
regular basis?
Once youve narrowed your list down,
visit the providersyoure considering
and notice how they operate. Note any
concernsyou have about:
How children are treated
How clean the facilitiesare
Whether the food seemsto be
nutritiousand well prepared
How safe the roomsare
How much space is available
for activities
Whether the children and caregiver(s)
there seem happy
Any other such measuresof quality
child care
With some very worthwhile
homework, you can rest assured that
youve made the right child care decision
for your child and your family.

T
he list of childrensvaccinesand the diseasesthey
prevent containssome strange-sounding names. The
good newsisthat these vaccinesare protecting your
child against infectiousdiseasesmore than ever before.
From birth through age 18, your child should be given aseries
of vaccinationson aset schedule. These vaccineshave been tested
and found to be safe and effective, which iswhy theyve been
licensed by the U.S. Food and Drug Administration (FDA). Their
use hasbeen endorsed by the Centersfor Disease Control and
Prevention (CDC) aswell asthe American Academy of Pediatrics
(AAP) and the American Academy of Family Physicians(AAFP).
There isnothing more important for children than getting these
vaccineson the recommended schedule, notesAAP President Jay
E. Berkelhamer, M.D. Immunizationsare our best defense in
protecting our patientsagainst infectiousdiseases, he says.
The 2007 recommended immunization schedules, one for
children ages0 to 6 yearsand another for those 7 to 18 years,
were released earlier thisyear. The biggest changesfrom last
year are these:
The new rotavirusvaccine isrecommended in athree-dose
schedule at ages2, 4, and 6 months. Rotavirusisthe most
common cause of severe diarrheaamong children. It is
responsible for the putting around 55,000 U.S. children in the
hospital each year.
The inuenza(u) vaccine isnow recommended for all
children ages6 to 59 months, aswell assiblingsand parentsof
all infantsand children 0 to 59 monthsof age.
Varicella(chickenpox) vaccine recommendationshave been
updated. The rst dose should be given at age 12 to 15
months, and anewly recommended second dose should be
given at age 4 to 6 years.
The new human papillomavirusvaccine (HPV) isrecom-

mended asaroutine vaccine for girlsto prevent cervical cancer
among women. The rst dose should ideally be given at 11
to 12 yearsof age. Three dosesare required. The second and
third dosesshould be given 2 and 6 months, respectively, after
the rst dose. Catch-up vaccinesshould be given to adolescent
girlsolder than 12 yearsif they have not yet received it.
Are Vaccines Safe?
Asresearch by the CDC shows, the United Stateshasthe
safest, most effective vaccine supply in history. Federal law
requiresyearsof testing before avaccine can be licensed. Once
in use, vaccinesare checked for safety and effectiveness.
In most cases, vaccineswork well and cause no side effectsor
only mild reactions, such asfever or sorenessat the site of the
shot. Very rarely, people experience more seriousside effects,
such asallergic reactions, according to the CDC. If your child
hashealth problemsor known allergies, be sure to tell your
pediatrician about them before your child isvaccinated.
Studiesfrom the CDC and the FDA also show that your
child facesmuch greater risksif he isnt vaccinated. For example,
measlesisavery seriousdisease. One out of 17 children
with measlesgetspneumonia. For every 1,000 children who
get measles, one or two will die from it and one will get
encephalitis, aseriousinammation of the brain. Thanksto
vaccines, there are few casesof measlesin the United States
today, and most of those affect those who travel abroad. The
disease isextremely contagious, however, so the vaccine isjust
asneeded asever before. Each year, dozensof casesare imported
from outside the country.
Immunizations
Your ChildsBest Defense
Parentssometimesfeel confused
about which vaccinestheir children
should get and when they should
receive them. Your pediatrician
can help you understand them all
and make sure that your childs
vaccinationsare up to date.
Vaccines for Children
For children up to 6 yearsof age, the 2007 Immunization
Schedule includesthe following vaccinations. Talk with your
pediatrician to make sure that your child hasthese vaccinations
when appropriate or to have catch-up immunizationsif particular
vaccineshave been missed:
Hepatitis B vaccine (HepB). (Minimum age: birth)
Rotavirus vaccine. (Minimum age: 6 weeks; maximum age:
32 weeks)
Diphtheria and tetanustoxoidsand acellular pertussis
vaccine (DTaP). (Minimum age: 6 weeks)
Haemophilus inuenzaetype b conjugate vaccine (Hib).
(Minimum age: 6 weeks)
Pneumococcal vaccine. (Minimum age: 6 weeksfor
pneumococcal conjugate vaccine [PCV]; 2 yearsfor
pneumococcal polysaccharide vaccine [PPV])
Inuenza vaccine. (Minimum age: 6 monthsfor trivalent
inactivated inuenzavaccine [TIV]; 5 yearsfor live, attenuated
inuenzavaccine [LAIV])
Measles, mumps, and rubella vaccine (MMR). (Minimum
age: 12 months)
Varicella[chickenpox] vaccine. (Minimum age: 12 months)
Hepatitis A vaccine (HepA). (Minimum age: 12 months)
Vaccines for Adolescents
Immunizationscan prevent several infectionsthat pose
seriousthreatsto adolescents. In addition to HPV vaccine for
all adolescent and pre-adolescent girls, two new vaccinesagainst
meningococcusand whooping cough (pertussis) have recently
become available and are recommended for all adolescents. Three
other vaccines(hepatitisB, varicella, and measles-mumps-rubella)
are recommended for adolescentswho did not receive them
aschildren. Immunization can protect not only the health of
adolescentsbut also their friends, families, and communities.
Pertussis (WhoopingCough)
Highly contagiouswith prolonged debilitating cough.
Whooping cough may be life threatening to infants.
NEW VACCINE: Tetanus-diphtheria-acellular pertussis
vaccine (Tdap) addspertussisprotection while maintaining
tetanusand diphtheriaprotection.
Adolescentsfrom 11 to 18 yearsof age should receive asingle

shot of Tdap. Adolescentswho have received atetanus-
diphtheriabooster (Td) should receive Tdap at least two years
after they received Td.
Meningococcal Infections
Extremely seriousdisease that can rapidly progressto shock,
meningitis, and death.
NEW VACCINE: Meningococcal conjugate vaccine (MCV4)
providesprotection against these infections.
Adolescentsshould receive asingle shot of thisvaccine during
their 11- to 12-year-old check-up, or when they enter high
school or college.

Hepatitis B
Causeshepatitiswith fever, fatigue, and jaundice.
Can cause chronic infection resulting in chronic liver disease
and liver cancer.
Adolescentswho did not receive the hepatitisB vaccine during
childhood should receive the three-shot course of thisvaccine.
Varicella (Chickenpox)
Highly contagiousand can be aseriousand sometimeslife-
threatening disease.
Adolescentswho have not had chickenpox or the vaccine
should receive thisvaccine at their 11- to 12-year-old check-up.
Parentswho arent sure can ask their pediatrician about ablood
test for their child to see if she isalready immune to the disease.
If she had only asingle dose asachild, she should receive a
second dose.
Measles, Mumps, and Rubella
Historically among the most seriousvaccine-preventable
diseases.
Adolescentswho did not receive the two-shot course of
measles-mumps-rubellavaccine (MMR) during childhood
should receive thisvaccine at their 11- to 12-year-old check-up.
Human Papillomavirus
Human papillomavirus(HPV) isavirusthat causescervical
cancer and genital warts.
HPV vaccine preventscervical cancer among women.
Routine vaccination with HPV isrecommended for girlsages
11 to 12 years, with catch-up vaccination for female adolescents
who have not received it.
Recommended in a three-dose schedule with the second
and third doses given 2 and 6 months, respectively, after
the rst dose.
Additional Vaccines
Some adolescentswith certain health conditionsmay need
additional vaccines, such ashepatitisA, inuenza, and
pneumococcal vaccines.
Resources to Help Parents

Understand Vaccines
Trusted medical organizations such as the AAP, AAFP,
and American Medical Association (AMA) provide accurate,
up-to-date information on vaccines to parents.Other
organizations include:
CDC:Information on immunization,vaccines,and the
diseases they prevent.www.cdc.gov/nip,or call the CDC-
INFO Contact Center at 1-800-CDC-INFO (232-4636)
C
hildrensplay isseriousbusiness. Asparentsand
caregivers, we might assume that play isalready a
basic part of our childrenslives. Most parentsare
used to seeing the curioushandsand questioning
mindsof their children asthey explore and learn
about the world around them. It seemsthat children are busy all day
long, whether we give them something to do or not.
It isup to adultsto dene what healthy play should be, and to
schedule that time so that itssafe, age-appropriate, and abig part of
the livesof our children. Once you decide what the limitsof healthy
play are for your child, you may still have questions. Should you
time how long your children play by the clock? Should structured
activitiesbe part of playtime?
Timing Playtime?
The Nemours Foundation (www.kidshealth.org) suggests
that toddlers should not remain idle for more than one hour
at a time. The foundations guidelines provide for 30 minutes
of adult-led physical activity and 60 minutes of unstructured
play each day. Other parenting sources offer similar guidelines,
although most agree the time frame should vary to suit each
childs interests and abilities.
Were not giving a prescription, says Dr. Kenneth
Ginsburg of the Childrens Hospital of Philadelphia.
Each child deserves enrichment activities, time to deeply
connect with family, and free, unscheduled time to master
his or her environment.
Pediatriciansagree that playtime isa very important part of a childs
development. But hectic family schedulesand other issuesare
making nding time for playtime more challenging than ever.
ByDeanna A. Stephens
Dr. Ginsburg also recommends adding independent time
into childrens lives to give them the opportunity to be
creative, to reect, and to relax. When children have a
downtime, theyre going to ll that time with whatever ts
their needs, he adds.
Learning Through Play
Kids learn as they play. As they practice making decisions,
play with imagination, and take active leadership, they also
grow in condence and resilience.
In his report to the American Academy of Pediatrics about
the importance of play, Dr. Ginsburg stresses the role of
play in promoting healthy child development and building
strong parent-child bonds. Play is so important to optimal
child development that it has been recognized by the United
Nations High Commission for Human Rights as a right of
every child, Dr. Ginsburg points out.
The healthy balance between reality and playtime is still
more theory than reality, though medical professionals take
the subject very seriously. Youll nd kid zones at doctors
ofces and hospitals across the nation. Some medical centers
have several areas set aside for childrens play.
Playtime as Healing
At St. Jude ChildrensResearch Hospital in Memphis, playtime
isconsidered crucial to achildsmedical treatment and emotional
healing. The hospital staffscertied child life specialistswho give
children just what the doctor ordered and then some.
Child life specialist Amy Wortham saysthat play ishelpful for
avariety of reasons. More than anything, itsaway for youngsters
to enjoy some normal time in aplace where children are out
of their comfort zone. Playing isthe way that kidslearn about
their world. It helpsthem processand experience it on their own
terms, saysWortham.
Both individual and group playtimesare adaily goal at St. Jude.
Playtime can include artsand crafts, playing with toys, going to
parties, and just about any other way you can imagine achild
having safe, healthy fun.
It dependson how achild isfeeling; theresnot astructured
guideline. But play and toysare often acomfort, saysAmy Seitz,
another child life specialist at St. Jude.
Like Dr. Ginsburg, the St. Jude staff encouragesparentsto make
room for play and routinely remindsthem that playtime isan
important part of childrenslives.
Sometimesparentsnd it hard to tame their daily stressand
busy schedulesso that it doesnt affect their children. But if you
want to help your child build social skills, intelligence, physical
coordination, and lifelong coping mechanisms, it seemsthe most
clearly dened rule isto let them have fun.
Play is essential to development because it contributes
to the cognitive, physical, social, and emotional well-being
of children and youth, says Dr. Ginsburg.
Children who dont get enough time to act out or
take charge of the world around them may show signs of
distress. The same is true for children who are constantly
pushed beyond their comfort limits. Symptoms of anxiety
may include:
Avoiding other people
Lack of appetite
Nervousness
Disrupted sleep
Headaches
Stomach aches
Depression
Even in safe, nurturing environments, playtime is
threatened by a nationwide reduction in school recess
time and families increasingly hectic lifestyles. Its true

that school work and schedules teach important life skills.
But most experts agree that childrens health and
everyday progress stand to suffer when scheduled
activities leave no room for free playtime.
Most pediatricians also warn against entertainment
that fails to stimulate interaction or thought especially
television shows and computer games. These tools
and programs are heavily marketed, and many parents
have unfortunately grown to believe that they are a
requirement of good parenting and a necessity for
appropriate development, says Dr. Ginsburg.
Putting play back on the schedule doesnt have to
be difcult, though. Old-fashioned toys like rattles for
babies, blocks for toddlers, and jump ropes for school-
aged children still work wonders. Even better, simply
remember to carve out plenty of family time for
talking, working on a hobby, playing make-believe, and
reading together.
The Best Way to Play
Type 2
Diabetes:
A Manageable Epidemic
T
ype 2 diabeteswasonce considered adisease that only adultshad to worry about. Indeed,
the condition wasonce called adult onset diabetes. But thatsall changing. Type 2
diabetesismirroring the obesity epidemic, notesDr. Francine Kaufman, head of
endocrinology and metabolism at ChildrensHospital LosAngelesand past president of the
American DiabetesAssociation.
Researchersare just starting to look into the quickly growing trend of children diagnosed with type 2
diabetes. The American DiabetesAssociation estimatesthat 2 million children 1 out of every 6 have
pre-diabetes, which isacollection of risk factorsthat often leadsto type 2 diabetes.
While the media has focused
more on the national epidemic
of childhood and adolescent obesity,
a related trend needs just as much
attention starting now.
ByKeith Ferrell
Diabetesmellitustype 2 (the full name of the disease) isa
disorder in which the body cant use insulin to control and process
glucose (sugars) in the blood the way it should. To correct this
condition, the body may produce more insulin at rst. But in
many cases, the body makeslessand lessinsulin over the years,
resulting in diabetes.
Because the disease developsgradually, itscrucial that parents
be alert to the risk factorsand typical symptomsof type 2 diabetes.
Knowing the Risks
There isstill no certain link between certain genesand
the risk of developing type 2 diabetes. But atype 2 diagnosis
for one family member often meansagreater risk for other
members, aswell.
Type 2 diabetesand obesity share some common risk factors.
These unhealthy lifestyle habitsinclude lack of exercise and poor
nutrition, such asfoodshigh in calories, saturated fat, and sodium.
A more dramatic and obvious symptom is a skin condition
called acanthosis nigricans (AN),
which appears as darkened
skin around the neck or in the
armpit. Almost three-quarters of
all children who develop type 2
diabetes get AN.
Not every child with these risk factorswill develop type 2
diabetes. But parentsshould be alert to the most common warning
signs. (See the sidebar above, Type 2 Diabetes: Warning Signs,
for more information.) If you notice any of these symptomsin
your child, you should see your childsdoctor.
Choosing Healthy Living
The best way to manage type 2 diabetesisto make healthy
lifestyle changes. These work best if they involve the entire
family, and they benet all involved not just those with type 2
diabetes. These stepsinclude:
Eat healthy. Work with adietitian or nutritionist to create a
meal plan that includesmore healthy foodswhile limiting or
cutting out lesshealthy choices. A healthy diet will usually cut
out or limit soft drinksand most juicesin favor of drinking
more water, and will restrict carbohydrates, sodium, and fat.

Regular sodashould not even be in the house, because many
children will choose it over diet sodaif no one iswatching.
Make physical activity a daily part of life. The more energy
your child burns, the better hisbody usesinsulin. There are
added benetsof physical activity for the entire family, too,
including healthy weight management, better physical tness,
enhanced self-esteem, and improved overall health. An hour or
so of lively physical activity every day isagood goal.
Reduce screen time. Watching TV, surng the Internet,
and playing video gamesdont count asexercise. The time
your child spendsin front of amonitor should be kept to a
limit. Some researchersrecommend no more than 1 hour of
screen time aday. The risk of obesity increaseswhen your child
watchesmore than 2 hoursof TV per day.
All of these lifestyle changesare good stepsto take, even if
your child hasno symptomsof type 2 diabetes. By making
healthy eating and physical activity routine in your home, while
limiting screen time, you can help prevent the onset of the type
2 diabetes, aswell asmanage itsprogressin those whove been
diagnosed with it.
Managing the Condition
While there iscurrently no cure for type 2 diabetes, the disease
can be managed well. Your child can most likely lead anormal
life by following her doctorsordersand by working with school
staff and health care providers.
A crucial part of managing type 2 diabetesismaking sure that
your child understandsitscausesand effects. It isimportant that
she perceiveswhat he hasasthe result of many factors, and not as
something she hasdone wrong. One helpful fact to use when
explaining the disease to children ishow common diabetesis
in the U.S. More than 20 million Americanshave diabetes, and
most of them have type 2. If she knowsshesnot alone, your
child may be better prepared to do what it takesto monitor and
manage the disease.
School ofcialscan be very important alliesin helping your
child manage her condition. Notify your childsschool ofcials
assoon asyour child isdiagnosed. Be sure to provide them with
monitoring and medicine schedulesif your doctor recommends
that your child check hisblood sugar. You can also set up a504
plan to ask school personnel to monitor food intake to make
sure your child iseating ahealthy lunch and that he isactive in
PE and during recess. A 504 plan isalegal document you can le
with your childsschool that describeswhat the childsmedical
limitationsare and what accommodationsthe school will make to
help the child manage in aregular educational setting.
Along with ahealthy diet and exercise, your doctor may
prescribe medicine to help your child manage hisblood glucose
levels. Aswith blood-glucose testing, you should show your child
exactly how to use the medicine and help him understand the
importance of following the instructions.
Type 2 Diabetes:
Warning Signs
Warningsignsto be alert for
include:
Excessive thirst
Frequent urination (includingbedwetting)
Blurred vision
Tiredness or fatigue
Frequent infections
Slow-to-heal cuts and sores
Acanthosis nigricans (AN), a darkeningof the
skin around the neck or under the arms

Probiotics
A New Infant Formula Feature
A
sit alwayshasbeen, breastfeeding isthe gold
standard in feeding your baby. Why? Because
breast milk containsnutrientsand other factors
that promote growth and immunity. Breastfed
babiestypically have healthier immune systems
compared to formula-fed infants. Thatswhy breastfed babies
tend to get fewer infectionsand recover more quickly when
they do get them.
Babiesare born with asterile (bacteria-free) digestive system,
which soon after birth becomescolonized with the bacteriafrom
the mother and the environment. Breast milk containslarge
quantitiesof complex starchesthat favor the presence of health-
promoting bacteriain the infantsdigestive system, unlike infant
formula. Thatsone reason why the digestive bacteriain breastfed
babiesare different from those of formula-fed infants.
How Probiotics Work
The most predominant bacteriathat colonize abreastfed infants
digestive system are Bidobacteria. When they are present in
the digestive system, these typesof microbesare also considered
probiotic bacteria. Probiotic bacteriafavor the development of
ahealthy digestive tract and good overall general health. The
complex starchesin breast milk that promote the growth of the
Bidobacteriaand other benecial bacteriaspeciesare categorized
asprebiotics.
Breast milk doesmore than enhance your babysimmune
system and general digestive health. For most healthy babies, its
easy to digest and may have other health benetsthat extend
beyond infancy, according to some recent research. Itsalso easier
on the pocketbook because itsfree.
When Breast Milk Isnt an Option
For some mothers, though, breastfeeding isnt alwaysan
option. Some mothersdont breastfeed, or choose to combine
breastfeeding with supplemental formulafeeding. Indeed, infant
formulahasoffered enough benetsto make it agood enough
option to breastfeeding, even if it could never completely replace
what nature providesin amothersbreast milk. While formula-fed
babiesdont get all the complex nutrientsor immune benetsthat
are in breast milk, they do receive the nutrition necessary for an
infant to grow and thrive.
In addition to good basic nutrition, infant formulaproducts
sold in the United Statesoffer other optionsfor babieswith
special dietary needs. Some babieshave atrue cowsmilk
allergy or signicant medical conditionsthat impair normal
digestion. For these babies, there are soy-based formulasand
formulaswith hydrolyzed (predigested) proteins. The content
of infant formulasisregulated and issometimesmodied by
the manufacturer with the intent to improve the overall health
benet to the consuming infant. Until recently, however, none
of the infant formulassold in the United Statescontained either
probiotic bacteriaor prebiotic nutrients.
A New Formula Option
A new infant formulaisnow available in the United Statesthat
containsprobiotics. Thisnew formulaaddsBidobacteriumlactis, a
key type of probiotic microorganism present in ahealthy breastfed
babysdigestive system. While thisnewly available formula
doesnt provide the full benetsof mothersmilk, it isdesigned
to increase aformula-fed babysdigestive bacteriato alevel closer
to that of breastfed babies. Thistype of infant formulahasbeen
commercially available abroad for more than 15 years.
The resultsof scientic research using probiotic bacteria
to treat or prevent some childhood disordershave been
encouraging. Probioticshave shown abenet in reducing
antibiotic-associated diarrheaand acute gastroenteritis(diarrhea
due to stomach viruses), lowering the risk of food allergy, and
improving infantile colic.
It iswidely believed that the newly available probiotic-
containing infant formulawill balance ababysdigestive bacteriato
favor the growth of Bidobacteriumlactis. But the overall long-term
benetsto formula-fed babiesremain uncertain. For example,
researchersdont know if the health benetsof probiotic formula
will continue after the formulaisstopped. Further research into
the overall health benetsof breast milk and infant formulamay
provide the answersin the near future.
BySam Gaines
ByColleen Marble
W
ith aclick of amouse, your kidscan jump onto
the World Wide Web. The Web isan amazing
resource children can use to research term papers,
connect with friends, play gamesonline, and keep
up with pop culture.
But despite the benets, using the Web isnot without danger,
especially for children and teenagerswho have yet to learn how to avoid
Internet danger zones. Inappropriate material, identity theft, predators,
and cyberbullies are just afew of the threatslurking out there.
Asparents, we want to do all we can to protect our children from
harm. We supervise their playdates, we ask questionsabout who their
friendsare, we teach them to avoid strangers yet many of usarent as
careful aswe need to be when we allow our children log on to the Web.
So whatsaparent to do? Start by following afew basic Internet
safety tips.
Limit screen time.
The lesstime your child spendsonline, the lesschance he hasof
nding inappropriate material, predators, and other dangers. The
American Academy of Pediatricsrecommendsno more than two hoursa
day of total screen time (which includescomputer and television, aswell
asvideo games).
Watch the computer.
Itseasier to monitor your childsonline activitieswhen the
computer isin acommon areaof your home, like the den or the
kitchen. Avoid allowing children, even teenagers, to have acomputer
permanently located in their bedroom, where they may be online
without your knowledge.
Track their activities.
Invest in asoftware package that allowsyou to monitor past online
surng, and check often to make sure your child isnot visiting sitesthat
are off-limits.
Talk often.
DiscussInternet safety and responsible online behavior with your
children. Let them know that they can and should to come to you if
they ever feel threatened or uncomfortable with messages, content, or
other online experiences.
Become Net-savvy.
Itsdifcult to set and enforce rulesif you dont understand what a
blog isor how MySpace, Club Penguin, or Facebook works. Take time
to visit the sitesyour child visits.
Log on to Safety
Protect your family with these simple online tips.
Free Internet Protection
for Your Family
You can make the Web a safer place to surf for your entire family
bytakingadvantage of a free software package like WindowsLive
O neCare FamilySafety(https://fss.live.com) from Microsoft.
FamilySafetyoffers:
Safer browsing for your kids, with guidelines you
personalize. FamilySafetygivesyou the toolsto help guide
each member of the familybased on your valuesand their age.
Developed in partnership with the AAP, FamilySafetysthree
age-based default lteringsettingsare:
Up to age 10: Supervise your childscomputer use, and use
Internet safetytoolsto limit accessto content, Web sites, and
activitiesthat are inappropriate.
Ages 11 to 14:Children thisage can be given a bit more
freedom; however, theystill need supervision.
Ages 15 to 18:Children thisage should have fewer limitations
on content, Web sites, or activities; however, theystill need
parentsto dene appropriate safetyguidelines.
Safer searching and learning. FamilySafetyworkswith
MSN
Encarta
, WindowsLive
Search and other search

enginesto help block inappropriate search resultsand to help
deliver age-appropriate information.
Activity monitoring with Web-based reports. Keep
an eye on your kids online activitiesfrom almost anyWeb-
connected PC, and give them permission to view content, even
when youre not at home.
Unlimited users and computers in the home. O nce
installed, FamilySafetyworkson everycomputer in the house.
Filtering and guideline applications that work from
almost any Web-connected computer. O nce your kids
are registered, the ltersand guidelinesgo almost anywhere
with them, regardlessof where theylogon.
To learn more about how FamilySafetycan help your family, go
to https://fss.live.com. For more information about your familyssafety
and the Internet, see the AAP publication, The Internet and Your Family,
available at http://safetynet.aap.org/internet.pdf.
www.seattlechildrens.org
Dr. Linda Quan of Childrens Hospital is a nationally recognized
expert on drowning and water safety. One of her projects is
a life-vest fashion showotation devices so hip in design
that teenagers like Susanna Kang will want to wear them.
Childrens Hospital not only cares for sick children. We do a lot
to prevent disease and injury. Our advocacy programs are aimed at
every aspect of a childs lifefrom water safety to immunizations to
preventing obesity. These programs are made possible, in part, by a
tradition of community generosity that dates back to 1907.
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T
he national statisticson childhood obesity are not encouraging. Since 1980,
obesity hasmore than doubled among children ages2 to 5, and more than
tripled among youths6 to 11 and adolescents12 to 17. Since obesity isa
major risk factor for diabetes, heart disease, stroke, and many other serious
health problems, the urgent nature of thisissue should be clear.
Fortunately, the National Heart, Lung, and Blood Institute (NHLBI), one of the
National Institutesof Health (NIH), istaking aleading role in addressing thisnationwide
epidemic head-on. In 2005, the NIH launched We Can! (Waysto Enhance Childrens
Activity & Nutrition), anational education program designed to help children ages8 to
13 achieve and maintain ahealthy weight. The program getscommunity organizations,
A nationwide
programishelping
communitiespromote
good nutrition and fun
physical activitiesfor
better health among
children.
Can!
continuedon page23
A vaccine has been created that may help guard your daughter from
4 types of human papillomavirus. Those types may cause 70% of cervical
cancer cases and 90% of genital warts cases. GARDASIL will not treat
these diseases. GARDASIL works by reaching your daughter before the
virus canby protecting her.
GARDASIL is for girls and young women ages 9 to 26. This vaccine is
part of your daughters recommended vaccination schedule, but only a
doctor or healthcare professional can decide if GARDASIL is right for her.
GARDASIL is covered by many healthcare plans. So ask your daughters
doctor or healthcare professional about getting her vaccinated with
GARDASIL. She could become one less life affected by cervical cancer.
SELECT SAFETY INFORMATION
GARDASIL may not fully protect everyone and does not prevent all types
of cervical cancer, so future cervical cancer screenings will be important
for your daughter. Anyone who is allergic to the ingredients of GARDASIL
should not receive the vaccine, and GARDASIL is not for women who
are pregnant. GARDASIL is given as 3 injections over 6 months and
can cause pain, swelling, itching, and redness at the injection site, fever,
nausea, and dizziness.
Please see Patient Information on the next page.
1-800-GARDASIL GARDASIL.com
GARDASIL is a registered trademark of Merck & Co., Inc.
Copyright 2007 Merck & Co., Inc. All rights reserved. 20702015(1)(302)-GRD-CON
Read this information with care before you or your child gets
GARDASIL*. You or your child will need 3 doses of the vaccine. It is
important to read this leaet when you receive each dose. This leaet
does not take the place of talking with your health care professional
about GARDASIL.
What is GARDASIL and what is it used for?
GARDASIL is a vaccine (injection/shot) that helps protect against the
following diseases caused by Human Papillomavirus (HPV) Types in
the vaccine (6, 11, 16, and 18):
Cervical cancer (cancer of the lower end of the uterus or womb).
Abnormal and precancerous cervical lesions.
Abnormal and precancerous vaginal lesions.
Abnormal and precancerous vulvar lesions.
Genital warts.
GARDASIL helps prevent these diseases but it will not treat them.
You or your child cannot get these diseases from GARDASIL.
What other key information about GARDASIL should I know?
Vaccination does not substitute for routine cervical cancer
screening. Females who receive GARDASIL should continue
cervical cancer screening.
As with all vaccines, GARDASIL may not fully protect everyone who
gets the vaccine.
GARDASIL will not protect against diseases due to non-vaccine
HPV types. There are more than 100 HPV types; GARDASIL helps
protect against 4 types (6, 11, 16, and 18). These 4 types have been
selected for GARDASIL because they cause approximately 70% of
cervical cancers and 90% of genital warts.
This vaccine will not protect you against HPV types to which you
may have already been exposed.
GARDASIL also will not protect against other diseases that are not
caused by HPV.
GARDASIL works best when given before you or your child has any
contact with certain types of HPV (i.e., HPV types 6, 11, 16, and 18).
Who can receive GARDASIL?
GARDASIL is for girls and women 9 through 26 years of age.
See Who should not receive GARDASIL? below.
Who should not receive GARDASIL?
Anyone who:
is allergic to any of the ingredients in the vaccine. A list of
ingredients can be found at the end of this leaet.
has an allergic reaction after getting a dose of the vaccine.
What should I tell my health care professional before I am vaccinated
or my child is vaccinated with GARDASIL?
It is very important to tell your health care professional if you or
your child:
has had an allergic reaction to the vaccine.
has a bleeding disorder and cannot receive injections in the arm.
has a weakened immune system, for example, due to a genetic
defect or HIV infection.
is pregnant or is planning to get pregnant. GARDASIL is not
recommended for use in pregnant women.
has any illness with a fever more than 100F (37.8C).
takes or plans to take any medicines, even those you can buy over
the counter.
Your health care professional will decide if you or your child should
receive the vaccine.
How is GARDASIL given?
GARDASIL is given as an injection.
You or your child will receive 3 doses of the vaccine. Ideally the doses
are given as:
First dose: at a date you and your health care professional choose.
Second dose: 2 months after the rst dose.
Third dose: 6 months after the rst dose.
Make sure that you or your child gets all 3 doses. This allows you or
your child to get the full benets of GARDASIL. If you or your child
misses a dose, your health care professional will decide when to give
the missed dose.
What are the possible side effects of GARDASIL?
As with all vaccines, there may be some side effects with GARDASIL.
GARDASIL has been shown to be generally well tolerated in women
and girls as young as 9 years of age.
The most commonly reported side effects included:
pain, swelling, itching, and redness at the injection site.
fever.
nausea.
dizziness.
Difculty breathing (bronchospasm) has been reported very rarely.
If you or your child has any unusual or severe symptoms after
receiving GARDASIL, contact your health care professional
right away.
For a more complete list of side effects, ask your health care
professional.
What are the ingredients in GARDASIL?
The main ingredients are puried inactive proteins that come from
HPV Types 6, 11, 16, and 18.
It also contains amorphous aluminum hydroxyphosphate sulfate,
sodium chloride, L-histidine, polysorbate 80, sodium borate, and
water for injection.
What are cervical cancer, precancerous lesions, and genital warts?
Cancer of the cervix is a serious disease that can be life-threatening.
This disease is caused by certain HPV types that can cause the cells
in the lining of the cervix to change from normal to precancerous
lesions. If these are not treated, they can turn cancerous.
Genital warts are caused by certain types of HPV. They often appear
as skin-colored growths. They are found on the inside or outside of
the genitals. They can hurt, itch, bleed, and cause discomfort. These
lesions are usually not precancerous. Sometimes, it takes multiple
treatments to eliminate these lesions.
What is Human Papillomavirus (HPV)?
HPV is a common virus. In 2005, the Centers for Disease Control and
Prevention (CDC) estimated that 20 million people in the United States
had this virus. There are many different types of HPV; some cause no
harm. Others can cause diseases of the genital area. For most people
the virus goes away on its own. When the virus does not go away it
can develop into cervical cancer, precancerous lesions, or genital
warts, depending on the HPV type. See What other key information
about GARDASIL should I know?
Who is at risk for Human Papillomavirus?
In 2005, the CDC estimated that at least 50% of sexually active people
catch HPV during their lifetime. A male or female of any age who
takes part in any kind of sexual activity that involves genital contact
is at risk.
Many people who have HPV may not show any signs or symptoms.
This means that they can pass on the virus to others and not know it.
Will GARDASIL help me if I already have Human Papillomavirus?
You may benet from GARDASIL if you already have HPV. This is
because most people are not infected with all four types of HPV
contained in the vaccine. In clinical trials, individuals with current or
past infection with one or more vaccine-related HPV types prior to
vaccination were protected from disease caused by the remaining
vaccine HPV types. GARDASIL is not intended to be used for
treatment for the above mentioned diseases. Talk to your health care
professional for more information.
This leaet is a summary of information about GARDASIL. If
you would like more information, please talk to your health care
professional or visit www.gardasil.com.
Issued October 2006
Manufactured and Distributed by:
MERCK & CO., INC.
Whitehouse Station, NJ 08889, USA
20702015(1)(302)-GRD-CON
Patient Information about
GARDASIL
(pronounced gard-Ah-sill)
Generic name: [Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) Recombinant Vaccine]
* Registered trademark of MERCK & CO., Inc.
Whitehouse Station, NJ 08889, USA
COPYRIGHT 2006 MERCK & CO., Inc.
All rights reserved
9682302
schools, and hospitalsinvolved to assist familiesin making improved food
choices, increasing their physical activity, and reducing their screen time.
The American Academy of Pediatrics(AAP) isamong the
organizationsthat are partnering with NHLBI to make We Can! work
for American children. Communitiesacrossthe nation are getting
involved in We Can! To date, more than 125 have signed on.
Healthy Weight
For adults, the body massindex
(BMI) isakey measure for guring
if your weight isin ahealthy range
for your height. (You can nd a
BMI chart for adultsat the National
Heart, Lung, and Blood Institutes
Web site: www.nhlbi.nih.gov.)
Because children are still growing,
determining their BMI isnot as
simple asit isfor adults. Your
pediatrician can show you where
your childsweight fallsin special
BMI chartsdesigned for children,
based on their age and gender. Talk
with your pediatrician about this. If
your child isoverweight or at risk of becoming so, itstime to take steps
to help him strive for ahealthy weight.
Energy In, Energy Out
One of the most important thingsto understand about keeping a
healthy weight isthat you gain weight if you consume more calories
than your body burns. Likewise, you lose weight if your body burns
more caloriesthan you consume. Your body burnscaloriesin avariety
of ways, including by just doing basic functionslike breathing and
digesting food.
People with active lifestylesburn more caloriesthan do those who
dont do asmuch. Thatswhy physical activity issuch an important part
of getting to and keeping ahealthy weight.
Think of the food you eat in termsof GO, SLOW, and WHOA
foods. Enjoy GO foodsalmost any time you like. Limit SLOW foods
to certain occasions, no more than afew timesper week. And enjoy
WHOA foodsonly on special occasions, and then eat only asmall
portion.
GO foodsinclude low-fat, low-calorie foodsthat are also low in
added sugar. They tend to be rich in nutrients, such asvitamins,
minerals, and other healthy substances. Fresh fruitsand vegetables
are great examplesof GO foods. That said, fried vegetablesand fruits
canned in syrup, despite their fundamental ingredients, fall into the
category of WHOA foods. Be sure to stock up on GO foodsso that
you can offer avariety of foodsto keep thingsinteresting.
SLOW foodstend to be higher in fat and added sugar than GO
foodsare. Examplesinclude fruit juices; baked goodsmade with
white, rened our; and poultry cooked with the skin still on.
WHOA foodsare the highest in fat and added sugar. Foodsprepared
with heavy creamsand butter, fried foods, and fatty meatsare
examplesof foodsyou should only eat once in awhile.
Get Moving
Guidelinesfrom the U.S. Department of Health and Human Services
(HHS) and the U.S. Department of Agriculture (USDA) recommend
that children and teensget physical activity for at least 1 hour per day
on most (or better yet, all) daysof the week. That may sound like alot,
especially if youre not getting any physical activity now.
But physical activity meansmore than exercise. It can mean playing
gamesin the backyard, or washing the
car. It can mean working in the yard,
or walking the dog.
Add the healthy habit of physical
activity to your familysschedule.
Along with ahealthy diet, it can help
you keep every family members
weight in ahealthy range and help
everyone feel better every day.
Screen Time
Americansspend too much time
in front of monitors, sitting still and
burning very few calories. One way to
make time for healthier family life isto
limit the amount of time your children
and you spend in front of ascreen.
Try to limit your familysscreen time to no more than 2 hours
per day. Also, you can make the most of screen time by encouraging
physical activity while watching TV, such asstretching, lifting weights,
or doing yoga. Or enjoy an exercise program together.
Making Changes
Itsone thing to know you need to make changes. Itsanother to
actually make them. But overweight and obese children need your
guidance in making healthier choices.
So whatsthe best way to begin eating healthier, getting more physical
activity into your familysroutine, and keeping screen time limited?
Start small, and do it one small step at a time. By making
gradual changes to your familys routine, it becomes easier to
accept the differences.
For More Information
The We Can! program hasaWeb site for parentswhere you can
download guidesand logsfor tracking your familysprogress, get
suggestionsfor more physical activity, learn some recipe tips, and much
more. Visit the site at http://wecan.nhlbi.nih.gov. While youre there,
be sure to download or order the We Can! booklet, FamiliesFindingthe
Balance: A Parent Handbook. (Click on Get We Can! Materials, then
click on Familiescan Get Involved in the menu bar on the left.) It
hasplenty of easy-to-do ideasfor helping your family making healthy
weight agoal you all can reach.
Also stay tuned for the American Academy of Pediatrics new book,
FoodFights: WinningtheNutritional Challengesof ParenthoodArmedwith
Insight, Humor andaBottleof Ketchup, due for release by the fall of 2007.
continuedfrompage20
Newborns
I
f you dont feel like crying in the rst few daysor weeksafter becoming a
parent, then consider yourself lucky. If you are anew mother, however,
oddsare you have encountered the hard-to-explain boutsof sadnessor
feeling down that seem to arrive soon after the delivery of your baby. Its
often called the baby blues, and it affectsbetween 70 percent and 80 percent
of all new mothers.
Crying and avery real sadnessare main symptomsof the baby blues. Other
symptomscan include problemssleeping, fatigue, strong emotional reactions,
and changesin body weight.
Hormones as Triggers
Itshard to say exactly what causesthe baby blues, but there isamedical
explanation for at least some of the symptoms: the hormonal changesanew
By Dr.Laura A.Jana and Dr.Jennifer Shu
Understanding
Motherhood
and Mood
Baby Blues
and Beyond
mothers body is going through. When a woman is
pregnant, her body produces the female hormones estrogen
and progesterone in much greater amounts. But in the rst
24 hours after childbirth, these hormone levels drop rapidly
back down to their non-pregnant levels. Researchers believe
these sudden hormone changes may lead to depression in
a similar way that menstrual hormone changes can trigger
these symptoms.
In some women, another possible cause of these symptoms
following pregnancy isadrop in thyroid hormones, which are
produced by the thyroid gland (located in the neck). These
hormoneshelp regulate the way your body usesenergy. Low
thyroid levelscan cause depressed or irritated moods, problems
with sleep and concentration, and weight gain.
Combine these changesin your body with the dramatic
changesin your life the normal feelingsof being
overwhelmed with new responsibilities, pressuresto be a
great mom, asense of lossregarding the life you had before
and you have arecipe for the baby blues.
Getting Through the Baby Blues
For most women, the baby bluesistemporary its
usually gone within afew daysor aweek after childbirth. The
symptomsarent usually severe, and there are fairly simple and
effective waysto handle them:
Get plenty of sleep. Take napswhen your baby does.
Take the pressure off yourself. You cant do everything by
yourself who can? Do what you can, and leave the rest for
later or for othersto take care of.
Avoid spending too much time alone.
Get help and support from your spouse or partner, family
members, and friends.
Join asupport group for new mothers.
Get plenty of exercise.
Bluer Than Blue
For 1 out of 10 new mothers, the bluesprogressto full-
blown postpartum depression that can get bad enough to
make it hard for you to care for your baby or yourself. It can
last anywhere from weeksto monthsand usually requires
counseling and treatment. New motherswho nd themselves
overwhelmed, frustrated, anxious, persistently teary, or
depressed and unable to explain or shake these feelings, should
not suffer in silence or shame. Instead, they should talk with
their doctorsright away and get the support and in some
cases, the treatment they need.
Symptomsof postpartum depression can range from mild to
severe. They can include the same symptomsof the baby blues,
but can also include:
Feelingsof guilt, worthlessness, or anxiety
Lacking energy or motivation
Sleeping too much or too little
Trouble focusing, remembering, or making decisions
Lossof interest in the activitiesyou usually enjoy
Withdrawal from friendsand family
For motherswith postpartum depression, there are

effective treatments. Most often, treatment will include some
combination of antidepressant medication, talk therapy, and
support group therapy. Some antidepressantsmay pose health
risksfor breastfeeding babiesor pregnant women, so it is
important to discussthiscarefully with your doctor before taking
antidepressant medicines.
If you are diagnosed with postpartum depression, there are
thingsyou can do to help yourself in addition to following your
doctorstreatment plan. The same tipsfor getting through the
baby bluescan be very helpful in getting through postpartum
depression. Whatever stepsyou and your doctor decide are best,
itsimportant that you stick to atreatment plan for depression.
At the Extreme:Postpartum Psychosis
For every 1,000 new mothers, 1 will face an even more
daunting condition: postpartum psychosis. The symptoms
typically begin during the rst 6 weeks after delivery and
can include:
Rapid mood swings
Delusions
Confusion
Hallucinations
Sleep disturbances
Obsessive thoughtsabout the baby
Women who have been diagnosed with bipolar disorder
or acondition called schizoaffective disorder are at higher risk
for getting postpartum psychosis. Women with postpartum
psychosisrequire immediate medical attention, often including
hospitalization. Whenever any of these symptomsare present,
itsvery important that you speak to ahealth care professional as
soon aspossible.
Laura A. Jana, MD, FAAP

Dr. Jana isa pediatrician and associate direc-
tor of the BoysTown Institute for Child
Health Improvement in O maha, Neb. She is
the mother of three, the owner of an educa-
tional child care center, and alongwith
Dr. Shu, isco-author of the AAPsHeading
Home With Your Newborn:FromBirth to Reality.
Dr. Shu isa mother and pediatrician now
based in Atlanta. She isthe former director
of the newborn nurseryat Dartmouth
and iseditor in chief for the American
Academyof Pediatrics parent publication,
Baby& Child Health:The Essential Guide
FromBirth to 11 Years.
A
rmed with antibacterial wipes, childrenspain reliever, and booksabout
the A-to-Z of health care, most parentsare ready to declare war on germs
that threaten their kids. In spite of all that, three out of four children will
get an ear infection before the age of 3.
While ear infectionsare still avery typical part of childhood, the treatmentsfor the
condition are changing. These days, taking your child to the doctor will likely result in
lessmedication and even lesscause for alarm than ever before.
Childhood
Ear Infection Today,
Gone Tomorrow
ByDeanna A. Stephens
When Is It an Infection?
A typical middle ear infection in achild beginswith either a
viral infection (such asacommon cold) or unhealthy bacterial
growth. Sometimesthe middle ear becomesinamed and causes
uid buildup behind the eardrum. In other cases, the eustachian
tubes the narrow passagewaysconnecting the middle ear to
the back of the nose become swollen.
Children are more prone to both of these problemsfor
several reasons. The passagesin their earsare narrower, shorter,
and more horizontal than the adult versions. Because itseasier
for germsto reach the middle ear, itsalso easier for uid to get
trapped there. And just aschildren are still developing, so are
their immune systems. Once the infection takeshold, itsharder
for achildsbody to ght it than it isfor ahealthy adults.
The symptomsof an ear infection may be hard to detect.
A child who constantly tugsor pullsat the ear could simply be
exploring, or simply showing aself-soothing reex even
though that topsthe list of signalslisted in many booksand
Web sites. Other symptomscan include:
More crying than usual, especially when lying down
Trouble sleeping or hearing
Fever or headache
Fluid coming out of the ears
Doctors can use special instruments to see if an infection
is present.
You must take very seriously acold that wakesachild up
at night, saysDr. Robert M. Jacobson, chair of the Mayo
ClinicsDepartment of Pediatric and Adolescent Medicine.
Since acold normally causestiredness, any sleep interruption
could indicate pain and stufness. In fact, any pain when lying
down iscause for concern, asisacold that lastsfor more than
10 days, he says. These are signsthat acold may have spread
to the earsor sinuses.
Treatment:Less May Be More
Perhapsthe most surprising newsisthat common ear
infectionsrarely require medication or any other action, except
when severe or in young infants. The bodysimmune system
can usually resolve them, saysDr. Jacobson. More and more
studiesshow that children treated or untreated are at the same
place 10 daysout. We are constantly amazed at how many ear
infectionsresolve on their own.
Itstrue: Fewer doctorsare relying on antibiotics, which
can help only if the infection isnot caused by avirus. AsDr.
Jacobson pointsout, itsimportant to understand that taking
antibioticsmight or might not speed recovery, and overusing
them can lead to bacteriadeveloping resistance to the drugs,
asthe germsmutate to defend themselvesagainst medicine.
Asaresult, many pediatricianshave adopted await-and-see
approach, rather than prescribing antibioticsat the rst sign
of infection.
Asking the parentsto observe the child for 48 to 72 hours
isbecoming the most common rst step among pediatricians.

That doesnt mean that an ofce visit isnt agood idea,
however. Doctorscan prescribe numbing dropsand suggest
over-the-counter pain relieversto treat symptoms, which can
help the child feel better asshe recovers. At home, parentscan
place awarm washcloth over the painful ear.
Along with getting away from prescriptions, pediatricians
are also shying away from myringotomy, aprocedure in which
asmall tube issurgically inserted in the ear to drain uid.
According to Dr. Jacobson, tube placement isbest used with
those children who have recurring hearing problemscaused by
multiple infections.
Tubes dont actually stop ear infections, just symptoms
and uid retention, says Dr. Jacobson. We dont want to
do it too often because there is an increased risk of damage to
the eardrum.
According to Dr. Jacobson, diagnosisand treatment should be
athree-step process:
First, the pediatrician determineswhether or not an ear
infection ispresent.
Second, the pediatrician and parent discussrisk factorsand
how to reduce them.
Finally, observation and treatment of symptomsensure the
child isrecovering without pain.
Reducing the Risks for Ear Infection
While parents cant head off every germ thats headed
for their children, they can take steps to reduce their
childrens risks.
Smoking isahuge contributor to childhood illness. Ear
infectionsare no exception to that rule. Smoking isaddictive
and hard to quit, but not every smoker realizesthe harmful
effectsthat secondhand smoke could have on hisor her
child. Quitting isjust asimportant for your childshealth as
your own.
Bad hygiene habitsare another major problem. Children
in daycare are more exposed to widespread bacteria, asare
those who drink from abottle asopposed to asippy cup,
saysDr. Jacobson. Thatsbecause bottleshave more surface
areafor germsto live on. Teach children to wash their hands
frequently to prevent the spread of germsthat spread illness.
Talk with your childsdoctor about the vaccines that
protect against pneumonia and meningitis. Studiesshow
that vaccinated children experience fewer ear infections.
Breastfeed infantsfor the rst year. Breast milk hasmany
substancesthat protect your baby from avariety of diseases
and infections. Because of these protective substances,
breastfed children are lesslikely to have bacterial or viral
infections, such asear infections
Consider getting immunized against inuenza. Aside
from protecting against thisyearly disease, it can help prevent
ear infections.
C
arsand kidshave been apotentially deadly duo
for decades. Automobile crashescontinue to
claim the livesof 5,500 teenagersayear, making
motor vehicle crashesthe leading cause of death
for 16- to 20-year-olds. Despite the fact that
teenage driversaccount for only 6 percent of the driving public,
they are involved in astaggering 14 percent of all fatal car crashes.
Two-thirdsof the teenagerskilled are male.
Those numbershave also remained remarkably
stable, even allowing for population increases,
and are likely to remain so. But that doesnt
mean that there arent stepsthat parents,
schools, and government agenciescan and
should take to help keep teen driverssafe.
Peer Pressures,
Cultural Messages
Perhapschief among the
reasonsfor the high rate
of crashesinvolving
teenagersisthe nature
of teenage psychology
and culture.
Teenagersare passing
through atime of
rapid change, aprocess
accompanied by plenty
of turmoil and lane
changeson avariety of
fronts physiological,
hormonal, emotional,
social, and cultural. It
isatime of passage, and the chief rite of passage for American teens
remainsthe driverslicense.
At just that moment the 16th birthday, asarule the
challenges, dilemmas, temptations, and distractionsof becoming an
adult become most intense. And thatswhen we place our children
behind the wheel of apowerful machine capable of moving at
high speeds. Driving an automobile isaskill requiring total focus
and constant close attention, snap decision-making, and split-
second reactions.
Temptationsand risksare also part of the adolescent
experience. The new driver takesthe wheel at just that
Adolescents
Drivers
Edge
Taking some wise
precautionscan help
keep your teen safe
behind the wheel.
ByKeith Ferrell
time when peer pressure to experiment with alcohol, marijuana,
and other drugsbecomesespecially intense. Making mattersworse,
the automobile providesthe teenager with the meansto get away
and abuse substancesin private.
Additionally, our entertainment media TV, movies, and an
abundance of video games actually celebrate recklessdriving,
setting an example thatsall too tempting for teensto emulate.
Hormones and Distractions
The role of the teen brainsphysiological development cannot
be underestimated. While the ndingsare thusfar inconclusive,
some scientistsargue that the prefrontal cortex the part of the
brain responsible for decision-making doesnt fully develop until
we reach our 20s. If thisistrue, we may be placing our children in
decision-intensive situationsbefore their brainsare fully equipped
for those decisions.
All of those factorsface acompletely inexperienced driver. Not
surprisingly, younger teensare at greater risk of causing crashesthan
older. A Canadian study found that the highest rate of teenage car
crashesoccurswithin the rst month of licensed driving. Sixteen-
year-old driverscause 35 crashesper million milesdriven, arate
almost twice that of 18-year-olds, who cause 20 over the same
distance. For the general driving population, the rate isan average
of four crashesper million milesof driving.
The paradox of putting ateenager behind the wheel of an
automobile isnothing new. It wasnt even new when most of
our parentswere teenage drivers, for that matter. Nor isall of the
turmoil, uncertainty, experimentation, and risk-taking inherent in
being ateenager. Itsalwaysbeen avolatile combination. But there
are avariety of factorsthat are new and widespread among todays
teens, and which further raise the risksof the car/kid combination
turning tragic.
Those factorsinclude arange of electronic technologies. Gone are
the dayswhen the in-dash radio wasthe only electronic device to
be found in acar. Cell phonesand pagers, iPodsand other music
players, GPS devices, and even DVD playersare among the variety
of devicesthat turn our kidsand their carsinto mobile media
centers. These devicesdemand attention and distract from the
demanding task at hand. Electronicsadd to the longstanding
appeal of the motor vehicle asaparty place.
The Parents Role
Whatsaconcerned parent and society to do?
Several things, asit turnsout.
Know your child. Be sure your child knowswhat you
expect of her or him behind the wheel. In part, thismeans
setting agood example with your own responsible driving.
Dont talk on the cell phone, eat, or drink when youre
behind the wheel, and be sure your children understand that
you expect the same of them.
Set strict rules and enforce them. Your teenage driver
should know:
Seat belts are required. Some studiesshow that barely 60
percent of teenswear safety belts.
Where and when she is allowed to drive. Nighttime
driving isextremely dangerousand should be limited.
How many passengers are allowed. The fewer, the better
for both limiting distractionsand the temptation to show off in
front of onesfriends.
Phones and other devices, as well as eating and
drinking, are not allowed while driving.
Alcohol and drugs are absolutely prohibited (and not just
behind the wheel!)
Stay within the speed limit and obey all trafc signals.
Consider creating
a written contract
with your new
driver. The
contract should spell
out your familys
rulesand regulations
governing
automobile use and
operation. It should
also contain appropriate and
rigorously enforced penaltiesfor
even minor violations.
Practice with your teen in a safe location.
Dont place all of the responsibility for driving
instruction on the driver-training program. Most states driver-
training coursesoffer around 30 hoursof classroom learning.
Much of that time istaken up with videos, with barely afth
that much used for behind-the-wheel training. Parentsshould
do alot of hands-on teaching to reinforce what their teensare
learning in class.
Teach responsible driving with all motor vehicles. The
lawsin most statesallowschildren younger than teensto operate
ATVs, mini-bikes, and other off-road vehicles, but it isbest to
wait until your child hasadriverslicense to allow him to operate
any motorized vehicles. When he isready, be sure he operates
them responsibly, including wearing appropriate safety gear.
Placing your child behind the wheel of amotor vehicle isone of
the largest stepsaparent can take. Itsimportant that you take the
step with your child, helping to ensure that when they drive away,
they are equipped to do so safely and return home the same way.
At just that moment the 16th birthday,

as a rule the challenges, dilemmas,
temptations, and distractions of becoming
an adult become most intense.
Heading Home Wit h
Your Newborn
From Birth to Reality
By Laura A. Jana, MD, FAAP,
and Jennifer Shu, MD, FAAP
This award-winning book
covers everything you need
to know during the rst year
of your babys life: feeding,
sleeping, diaper changing,
dressing, traveling, health,
illness, and so much more.
Dont leave the hospital
without it!
Softcover, 306 pages,
X-CB0037 $15.95
Caring f or Your Baby and Young
Child
Birth to Age 5
By the American Academy of Pediatrics
Steven P. Shelov, MD, MS, FAAP,
Editor in Chief,
Robert E. Hannemann, MD, FAAP,
Associate Medical Editor
The instruction manual for children!
Everything on basic child care is covered
in this comprehensive, richly illustrated
top sellernutrition, safety, growth
milestones, behavior, discipline, common
illnesses, and so much more. Available in
English and Spanish!
English: Softcover, 752 pages,
X-CB0032 $18
NEW EDITION! Spanish: Softcover, 720 pages,
X-CB0046 $18
Baby & Child Healt h
The Essential Guide From Birth to 11 Years
Jennifer Shu, MD, FAAP, Editor in Chief
Focuses on preventive health care,
psychological well-being, and positive
parenting to help parents keep their
children healthy and safe during the rst
decade of life.
Hardcover, 352 pages,
X-CB0034 $30
NEW!
The Wonder Years
Tanya Remer Altmann, MD, FAAP,
Editor in Chief
The rst 5 years of a childs life are
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8 Healthy Children Summer 2007

Choosing the right option for your

employers, schools, or government

who servesasconsultant? Keep in mind

Healthy Children Summer 2007 9

The new human papillomavirusvaccine (HPV) isrecom-

Adolescentsfrom 11 to 18 yearsof age should receive asingle

Resources to Help Parents

time and families increasingly hectic lifestyles. Its true

more water, and will restrict carbohydrates, sodium, and fat.

16 Healthy Children Summer 2007

Search and other search

For motherswith postpartum depression, there are

Laura A. Jana, MD, FAAP

isbecoming the most common rst step among pediatricians.

At just that moment the 16th birthday,

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