Health Room Articles

Attention-deficit/hyperactivity disorder (ADHD) is a condition of the brain that makes it hard for children to control their behavior. It is one of the most common chronic conditions of childhood. All children have behavior problems at times, but those with ADHD have frequent, severe behavioral symptoms including inattention, hyperactivity and/or impulsivity problems that interfere with their ability to live normal lives.

The diagnosis is a process that involves several steps. It requires gathering information about your child’s behavior from you, your child’s school and/or other caregivers. Your pediatrician will assess whether your child has ADHD, as well as, check for other conditions that have the same types of symptoms as ADHD.  

Your pediatrician will help guide the process of diagnosing, coordinating treatments and follow-up care.

For more info:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/
http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml

Allergy is a hypersensitivity disorder of the immune system where reactions to normally harmless substances in the environment results in an inflammatory response which can range from uncomfortable to dangerous. These reactions are acquired, predictable, and rapid, however, the appearance of allergen sensitization/symptoms is completely individual and not at all predictable as to timing or source. Mild-form reactions are like the seasonal/pollen nuisance symptoms of sneezing, itchy skin or eyes, sinus congestion/post-nasal drip, headache, sore throat; moderate to severe reactions include asthma inflammation symptoms of chronic cough, wheezing, shortness-of-breath; severe reactions include life-threatening anaphylaxis response to food, medication, or other triggers, like bee stings. The Health Room Nurse is available to assess allergy & asthma conditions and is equipped to provide prescribed treatments. Please complete the Green Emergency Card, all relevant Allergy & Asthma Checklists, Action Plans and Medication Authorization forms for medication and/or treatment to be available at school when needed.

For more info:  
http://www.aafa.org/index_noflash.cfm
http://www.nhlbi.nih.gov/health/prof/lung/asthma/emer_med.htm

What is body temperature?

Body temperature is a measure of the body's ability to generate and get rid of heat. The body is very good at keeping its temperature within a narrow, safe range in spite of large variations in temperatures outside the body. When you are too hot, the blood vessels in your skin expand (dilate) to carry the excess heat to your skin's surface. You may begin to sweat, and as the sweat evaporates, it helps cool your body. When you are too cold, your blood vessels narrow (contract) so that blood flow to your skin is reduced to conserve body heat. You may start shivering, which is an involuntary, rapid contraction of the muscles. This extra muscle activity helps generate more heat. Under normal conditions, this keeps your body temperature within a narrow, safe range. 

Where is body temperature measured?

Body temperature can be measured in many locations. Most common places are the mouth, ear, armpit, and rectum.  Temperature can also be measured on your forehead. 

What are Fahrenheit and Celsius?

Thermometers are calibrated in either degrees Fahrenheit (°F) or degrees Celsius (°C), depending on regional custom and standards. Temperatures in the US are often measured in Fahrenheit, but the standard in medicine, science, and most other countries is Celsius. 

What is normal body temperature?

Most people think of a "normal" body temperature as an oral temperature of 98.6°F (37°C). This is an average of normal body temperatures. Your temperature may actually be 1°F (0.6°C) or more above or below 98.6°F (37°C). Also, normal body temperature changes by as much as 1°F (0.6°C) throughout the day, depending your activity and the time of day. Body temperature is very sensitive to hormone levels and may be higher or lower during ovulation or menstruation. A rectal or ear canal (tympanic) temperature reading is slightly higher than an oral temperature reading. A temperature taken in the armpit is slightly lower than oral temperature. The most accurate way to measure body temperature is to take a rectal temperature. 

What can cause a fever?

A fever may occur as a reaction to:

• Infection is the most common cause of a fever. Infections may affect the whole body or only a specific body part (localized).
• Medicines, such as antibiotics, narcotics, barbiturates, antihistamines, and many others. These are called drug fevers. Some medicines, such as antibiotics, raise the body temperature directly. Other medicines interfere with the body's ability to readjust its temperature when other factors cause the temperature to rise.
• Severe trauma or injury, such as a heart attack, stroke, burns, heat exhaustion or heatstroke.
• Other medical conditions, such as arthritis, hyperthyroidism, and some cancers, such as leukemia, Hodgkin's lymphoma, and liver and lung cancer.

Can a low body temperature be dangerous?

An abnormally low body temperature (hypothermia) can be serious, even life-threatening. Hypothermia may occur from cold exposure, shock, alcohol or drug use, certain metabolic disorders such as diabetes or hypothyroidism, or an overwhelming infection such as sepsis. Newborns, older adults, or people who are frail and who have an infection are at risk of hypothermia.

Can a high body temperature be dangerous?

Heatstroke occurs when the body fails to regulate its own temperature and body temperature continues to rise. Symptoms include mental changes (eg. confusion, delirium, unconsciousness) and red, dry, hot skin, even under the armpits.

Classic heatstroke can develop without exertion when exposed to a hot environment and the body is unable to cool itself effectively. The body's ability to sweat and transfer the heat to the environment is reduced; the person may stop sweating altogether, and it may develop over several days. Babies, older adults, and people with chronic health problems are at greatest risk

Exertional heatstroke may develop when working or exercising in a hot environment; the person may sweat profusely, but the body still produces more heat than it can lose, causing the body's temperature to rise to high levels. Both types of heatstroke cause severe dehydration and can cause body organs to stop functioning.

Heatstroke is a life-threatening medical emergency requiring emergency medical treatment--call 911 for a suspected or known incident of heat stroke.

Measuring Body Temperature

Take your temperature several times when you are feeling well to find out what is normal for you. Check in both morning and evening, since body temperature can vary by as much as 1°F (0.6°C) throughout the day. Wait at least 20--30 minutes after smoking, eating, or drinking hot or cold liquids before taking your temperature, and wait at least an hour after vigorous exercise or a hot bath. 

Several different types of thermometers are available: 

• Electronic thermometers are plastic, shaped like a pencil, with a display window at one end and temperature probe at the other end. They work by measuring how well electricity travels through a wire. Electronic thermometers are used in the mouth, rectum, or armpit. They are easy to use and easy to read. When buying, check the package for information about its accuracy.

Taking your temperature orally is only mildly uncomfortable, since you must keep your mouth closed and breathe through your nose while the thermometer is in place. There is very little risk of complications from taking a temperature, however do not insert rectal thermometer more than ½  to 1 in. (1.25 to 2.5 cm) as further insertion can be painful and damage rectal tissues.

• Ear thermometers are plastic and come in different shapes. They use infrared energy to measure body temperature and the results show within seconds. The small cone-shaped end of the thermometer is placed in the ear canal, and the temperature shows on a digital display. Some models also show corresponding oral and rectal readings. Taking your temperature with an ear thermometer causes little to no discomfort. It is not inserted very far into the ear, and provides a reading within seconds. For this reason, ear thermometers are widely used in doctor offices and hospitals, but may still be less accurate than rectal thermometers.

• Temporal artery thermometers are electronic devices using infrared energy to measure body temperature. The device has a small "cup" that is moved across the skin over an artery in the forehead (superficial temporal artery). When used correctly, temporal artery thermometers are accurate for measuring body temperature and the slight pressure while gliding across the skin is not painful.

• Disposable thermometers are thin flat pieces of plastic with temperature markings and colored dots on one end; the color of the dots shows the temperature. They can be used in the mouth or rectum. These thermometers are safe, do not contain glass, latex, or mercury, but are not as accurate as electronic or ear types. One type (a patch) can be used on a baby's skin to measure temperature continuously for 48 hours. You can reuse the thermometer throughout an illness and then throw it away.

• Forehead thermometers use skin temperature to determine body temperature. They are thin pieces of plastic with numbers on them. The strip is pressed against the forehead, and the temperature makes some numbers change colors or light up. They should not cause discomfort and feel like having a Band-aid on your forehead, but are not very accurate.

• Pacifier thermometers are shaped like a baby's pacifier, which is placed in the child’s mouth, and shows the temperature on a digital display. They may take longer to get a reading and are not as accurate as other types.

NOTE: Glass thermometers containing mercury are no longer recommended. If you still have one, contact your local Health Dept. for safe disposal instructions. If you break a glass thermometer, call your local poison control center immediately.

Temperature: Measuring Accuracy & Comparing Thermometer Devices   

You can take a temperature using the mouth (oral), anus (rectal), armpit (axillary), or ear (tympanic). But temperature readings vary depending on which one you use, and you need an accurate body temperature to determine if a fever is present. Medical research hasn't determined an exact correlation between oral, rectal, ear, armpit, and forehead temperature measurements. However, the correlation of temperature results are generally as follows: 

• The average normal oral temperature is 98.6°F (37°C).
• An anal (rectal) or ear (tympanic)  temperature is 0.5°F (0.3°C) to 1°F (0.6°C) higher than an oral temperature.
• An armpit (axillary) temperature is usually 0.5°F (0.3°C) to 1°F (0.6°C) lower than an oral temperature.
• A forehead (temporal) scanner temperature is usually 0.5°F (0.3°C) to 1°F (0.6°C) lower than an oral temperature.

It is important to remember:

• Rectal temperatures are generally thought to be the most accurate for checking a young child's temperature.
• The manufacturer of the temperature device you use, such as an ear or forehead thermometer, provides information on how to use it. Be sure to read and follow the instructions to obtain an accurate temperature. The information may also include how the results of the device correlate with the results from other methods of taking a temperature.
• Plastic strip thermometers have some uses, but are not recommended for general home use. Unlike oral, rectal, and ear thermometers, plastic strip thermometers measure skin temperature, not body temperature.
• If you talk with your doctor about a temperature, be sure to say what method was used to take the temperature.

The Temperature comparison table below gives the range of temperatures & correlations between different methods used. 

To use the table:

• Find the method that you use to take a temperature.
• Find the correct temperature range of the reading you measured.
• Compare with temperature ranges of the other methods correlating to the method you used.

For example, if your 2-year-old child's oral temperature is 101°F (38.3°C), the rectal or ear temperature may be about 102°F (38.9°C). If their axillary temperature is 100°F (37.8°C), their oral temperature is about 101°F (38.3°C). Remember, a child has a fever when their temperature, measured rectally, is 100.4°F (38°C) or higher.

Weblinks:

http://www.webmd.com/first-aid/body-temperature?page=3

http://www.webmd.com/first-aid/body-temperature

http://www.webmd.com/children/tc/fever-temperatures-accuracy-and-comparison-topic-overview

Coughs & Colds are usually due to a viral infection lasting a few days to a week, and usually eased by rest, fluids and cough/cold/allergy medicines. Your sick child should stay home and recover/rest until medically cleared (no more risk of passing illness on to others and symptoms are no longer disruptive/chronic). Congestion & cough are often accompanied by a fever if viral, and normal to low-grade temperature if due to allergies or asthma. Coughing is triggered by mucous and inflammation; it is a protective function attempting to clear the airways. A chronic, wheezing or barking cough can signal more serious illness; if persistent, ineffective and debilitating you should consult your Pediatrician.

Seasonal preventive measures include getting a flu shot or flu mist, and are especially recommended for children with chronic health issues e.g. asthma.

***Call 911 immediately if child starts acting very sick, symptoms worsen or breathing becomes difficult***

For more info:
http://www.webmd.com/cold-and-flu/tc/coughs-topic-overview http://www.cdc.gov/flu/about/qa/coldflu.htm
http://www.cdc.gov/getsmart/antibiotic-use/URI/colds.html
http://www.cdc.gov/flu/

A preventable, highly contagious bacterial illness all but eliminated until recent years thought in part attributable to some parents “opting out” of vaccinations for their children. The childhood DPT vaccine series protects against Diphtheria, Pertussis and Tetanus; it is usually given at 2, 4, 6 and 15 months of age, and boostered again at 4-6 years of age. Initially symptomatically similar to a common cold, a dry, irritating cough persists and evolves into distressed and prolonged coughing “spells.” At the end of a coughing spell, the child makes the signature “whooping” sound while gasping between coughs, trying to breathe in, and often the individual appears red or purple in the face from the effort and strain. Adults can get pertussis once their previous vaccine protection wears off; incidence of infection is up since many people opted out or haven't kept up with booster shots. Since 2005 the revised Tdap vaccine (protecting against Tetanus and Pertussis) is being offered to extend protection instead of the Td booster (protecting against Tetanus only) previously given to adolescents & adults after a cut/injury or every 5-10 years depending upon type of employment.

For more info:  
http://www.cdc..gov/pertussis/

http://www.medicinenet.com/pertussis/article.htm

Fifth disease (Parvovirus B19) is a common contagious but mild viral illness, affecting children more often than adults, characterized by a “slapped cheek” red face rash and lacey rash over the lower body. The symptoms are usually mild (cold-like symptoms preceding the rash, low-grade fever, malaise, itch of the rash) and recovery usually occurs without problems; the rash usually resolves in about 7-10 days.

For more info:
http://www.cdc.gov/ncidod/dvrd/revb/respiratory/parvo_b19.htm
http://children.webmd.com/tc/fifth-disease-topic-overview

The word itself often prompts an instant reaction of “revulsion” and the age-old presumption of personal “uncleanliness.” In truth, they are just a nuisance and no known diseases have ever been spread by lice; in fact, they more often attach to clean rather than dirty hair. They spread by direct person-to-person contact, and most commonly affect pre-school & school-age children. Lice are specific to humans (& primates), are not shared with household pets or farm animals, and occur more commonly in Fall and Spring seasons. 

Adult bugs can live on the scalp up to 30 days; they are small at 2-3mm long, about the size of a sesame seed, and crawl very fast. Their tiny white/yellow eggs (nits) are hard to see, often blend in with hair color and may look like dandruff, but don’t flake off easily. Use a bright light source and magnifier to check the scalp, looking especially around the ears and at nape of the neck. 

Because this is so common a worldwide problem, you should routinely check your children throughout the school year and during summer & Holiday vacations, as well as, teach them preventive habits.

If found, use a recommended Pediculocidal product e.g. NIX, RID, or Benzyl Alcohol (all are safe and non-toxic if used as directed); other treatments aren’t reliable or effective e.g. olive oil, mayonnaise, homeopathics.

Treatment is followed by nit combing to remove dead bugs & most eggs (use a metal Nit comb—the plastic ones just aren’t sturdy enough). A second treatment in 7-10 days usually eliminates stragglers & new hatchlings. All household members should be treated, and thorough house-wide cleaning/vacuuming is essential to preventing re-infestation and spread of Lice.

Please notify the School Nurse if Lice is found & treated at home; if found at school, you are required to treat your child before coming back to school. In either case, before returning to class, your child is expected to bring in the product label/prescription and to be re-checked by the School Nurse.

To request a head-check, consultation or a demo, contact the School Nurse at 301-262-0203 ext 12.

For more info:
http://pediatrics.aappublications.org/content/110/3/638.full.pdf
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001843/
http://www.cdc.gov/parasites/lice/head/schools.html

Scoliosis is a sideways (lateral) curvature of the spine usually recognized as exaggerated in pre or early adolescence, a period of rapid growth & development. Common signs are one prominent shoulder blade, uneven hip and shoulder levels, unequal distance between the arms and body, and clothes that "do not hang right". Scoliosis tends to run in families and affects more girls than boys. Screening between ages 10 - 15 can identify the anomaly, afford early treatment and prevent life-long complications.  Your pediatrician will this guide evaluation.

For more info:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002221/
http://www.scoliosis.org/

Ringworm (Tinea) Facts:

It is not caused by a worm or other pest; it is caused by a fungus that grows into a ring-shaped "rash" on the skin. The usually itchy circular rash will appear externally on the scalp, face, arms, legs, and feet; ringworm on the scalp often looks like a weepy hairless circular sore. It is the same fungus that is also responsible for "jock itch" and "athlete's foot."

It is highly contagious infection, spread from person to person or from one body location to others by direct contact (scratching open sores & then touching other areas) and/or by contact with the infected person's items such as their clothing, towels, community shower stalls & changing room floors, gym/sports equipment, hairbrushes, etc. It can also be transmitted between pets and humans.

Students found with open, exposed sores will be excluded from school and may not return until a Physician/Licensed Provider's written clearance note and/or diagnosis/verification of treatment is provided to the School Nurse. Any exposed lesions or sores must be completely covered by bandaids or dressings before returning to class, even after treatment is initiated, until the sores are healed.

For more info refer to:

http://www.cdc.gov/fungal/diseases/ringworm/index.html

http://www.webmd.com/skin-problems-and-treatments/tc/ringworm-of-the-skin-topic-overview

Check all household members and pets routinely for ticks and especially after spending time outside in grassy, bushy or wooded areas. Using bug repellant products can help deter ticks; wearing long socks, sleeves & pants and showering within 2 hours of returning indoors can reduce being bitten. Both the larger common “dog” tick and smaller Lyme Disease-carrying ticks (deer tick, black-legged tick and lone-star tick) are common to our area.

If you find one, remove the whole tick by pulling it straight off the skin with blunt tweezers in a slow, steady motion—to avoid infection release into the skin, don’t pull off with your fingers, don’t squeeze, puncture, jerk, twist or try to “smother” ticks with chemicals or a hot match. Mark the date on your calendar and watch for a rash or fever/flu symptoms within a few days of the bite; if symptoms develop, call your doctor. Early diagnosis & treatment can avoid chronic conditions & complications.

For more info:  
http://www.cdc.gov/features/stopticks/
http://www.cdc.gov/ticks/removing_a_tick.html
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002296/