Category: Treatments

Every person encounters infectious organisms throughout the day in the air, in soil and water, in foods, and on surfaces everywhere. Fortunately, your child’s immune system is capable of resisting most of these organisms, keeping her healthy. When these organisms become a problem and cause an infection, your pediatrician has a number of medicines that can help your child get better.

Antibacterials are the prescription drugs with which parents are probably most familiar. Nearly every parent has had the experience of giving their child a course of antibacterials for an ear infection or strep throat. Most can name some of the most common antibacterials—penicillin, amoxicillin, tetracycline—that have helped their youngster fight off bacterial infections. Although your child has probably been given antibacterials more often than other types of infection-fighting prescription medicines, drugs are also available to fight certain childhood diseases caused by

• Viruses  
• Fungi (yeasts and molds)  
• Parasites

Remember, as important as antibacterials are, they are useful only against infections caused by bacteria. For illnesses caused by other kinds of germs, antibacterials simply will not help your child get better. They can actually add risks because of the possible side effects that all medicines have. At the same time, inappropriately used medicines can contribute to the growing problem of antibiotic resistance.

Antiviral Medicines

Every child gets a viral illness from time to time. Many viral infections affect the respiratory tract, which includes the nose, throat, and breathing passages where they can cause the common cold, the flu, a sore throat, and sinusitis. Viruses also can cause more serious illnesses such as acquired immunodeficiency syndrome (AIDS), hepatitis, and rabies. Because immunizations are available to protect your child against some viral infections (eg, chickenpox, polio), make sure she is fully protected by all the vaccines recommended by the American Academy of Pediatrics.

Antiviral drugs are relatively recent developments, but an increasing number of these virus-fighting drugs are now available. They are made to prevent infection or shorten the duration of infections by preventing the virus from spreading, although they may not kill viruses that already exist. These medicines aren’t appropriate for all viral infections—if your child has the common cold, for instance, simply let it run its course. Your pediatrician will be able to tell you when prescription antiviral drugs may be needed.

Unlike broad-spectrum antibiotics, which are often useful against a wide range of bacterial organisms, antiviral medicines tend to be more specific and attack particular viruses. Here are a few examples of antiviral drugs sometimes prescribed for children.  

• Acyclovir is a medicine that can be used to treat chickenpox, as well as the symptoms associated with herpes infections that may affect the skin, eyes, mouth, genitals, or brain. Acyclovir can ease the discomfort and speed up the healing of herpes sores, but it will not completely kill the virus. The herpes simplex virus will stay dormant in the body and can cause symptoms again in the future.  
• Amantadine is among several antiviral medications that can be used to treat and prevent the flu. These medicines are most useful when started soon after your child’s flu symptoms begin. In general, the medicine should be started within the first 2 days of the illness. Amantadine is only effective in treating one type of flu virus, influenza A.  
• Ribavirin and interferon are antiviral drugs sometimes prescribed for adults who develop chronic hepatitis. Their use in children has been limited.

Other medicines, called antiretroviral drugs, are used to combat infections caused by a particular type of virus called a retrovirus. The most widely known retrovirus, human immunodeficiency virus (HIV), is responsible for AIDS.

Keep in mind that even though viral illnesses should not be treated with antibacterials, bacterial infections sometimes occur as a secondary complication of a viral disease. In those cases, antibacterials can be used to treat the bacterial infection.

Antifungal Medicines

Fungal infections are caused by microscopic plants whose spores become airborne and are breathed in by children. They can also enter the body through a cut in the skin. When these spores are inhaled, they may settle in the lungs and begin to multiply and form clusters. Eventually they make their way into the bloodstream and travel throughout the body. Like many infectious organisms, they can cause serious illnesses in children whose immune systems are already weakened by another disease such as cancer or AIDS.

You’re probably most familiar with fungi such as mushrooms, yeast, mold, and mildew. Some fungi can live in the body and never cause any sickness. But others cause diseases, including common infections such as ringworm of the skin, hair, and nails; athlete’s foot; jock itch; and thrush or yeast infections (candidiasis).

Many drugs can fight these fungal infections. They’re often available in a topical form that can be applied directly on the skin. Some are over-the-counter medicines, while others must be prescribed by your doctor.

For serious fungal infections, pediatricians may select a medication called amphotericin B or newer antifungal drugs called azoles. Two of the most widely used azoles are fluconazole and itraconazole. Some prescription antifungal drugs are not licensed for use in children, largely because little research has been done with youngsters. These medicines should be used with care and your pediatrician’s guidance because they may have serious side effects.

Although over-the-counter antifungal products are considered safe when used according to the instructions on the label, it’s always a good idea to talk with your pediatrician before treating your child with these medicines.

Antiparasitic Medicines

Parasites can cause childhood infections. In some parts of the world, they are a common cause of illness and death. In the Western world, adults and children often contract parasitic diseases while traveling to tropical regions of the world where these illnesses are most prevalent, such as rural Central and South America, Asia, and Africa.

Some parasites are so tiny that they can’t be seen except under the microscope, while others are large enough to be viewed very easily with the naked eye. Most live in food, water, and soil. When they’re transmitted to your child, often when she consumes contaminated food or water, her immune system can successfully fight off many of them. Other parasites, however, can cause potentially serious infections.

The parasitic infection best known to parents is pinworms, but others include malaria, tapeworms, hookworms, and trichinosis. Some antibacterials also work against parasites. Metronidazole can block the reproduction cycle of some parasites as well as some bacteria. There are some antiparasitic drugs that are only available directly from the Centers for Disease Control and Prevention (CDC), and your doctor must specifically request them from the CDC.

Resistance is increasingly becoming a problem with some antiparasitic medicines. For example, some drugs used to treat malaria are not as effective as they were in the past because of resistance. As a result, new antimalaria drugs are now in development and being studied in clinical trials.

There are common myths that certain parasitic diseases are caused by poor hygiene and can only be prevented or treated by improving personal cleanliness. These are only myths. Medicines are available to treat parasitic infections. Your child’s cleanliness is not going to cure the infection. However, as with many other infectious diseases, including some parasitic illnesses, hand washing is important and a good way to avoid germs that can make your child sick.

Antibiotics: What’s in a Name?

The term antibiotics literally means “against life”; in this case, against microbes. There are many types of antibiotics—antibacterials, antivirals, antifungals, and antiparasitics. Some drugs are effective against many organisms; these are called broad-spectrum antibiotics. Others are effective against just a few organisms and are called narrowspectrum antibiotics. The most commonly used antibiotics are antibacterials. Your child may have received ampicillin for an ear infection or penicillin for a strep throat.

When a child is sick, parents worry. Even if he has only a mild cold that makes him cranky and restless or an achy ear that only hurts a little, these times can be very stressful. Of course, you want him to get the best possible treatment. For many parents, this means taking him to the pediatrician and leaving the office with a prescription for antibiotics.But that isn’t necessarily what will happen during the doctor’s visit. After examining your youngster, your pediatrician may tell you that based on your child’s symptoms and perhaps some test results, antibiotics just are not necessary.

Many parents are surprised by this decision. After all, antibiotics are powerful medicines that have eased human pain and suffering for decades. They have even saved lives. But most doctors aren’t as quick to reach for their prescription pads as they once were. In recent years, they’re realizing there is a downside to choosing antibiotics—if these medicines are used when they’re not needed or they’re taken incorrectly, they can actually place your child at a greater health risk. That’s right—antibiotics have to be prescribed and used with care, or their potential benefits will decrease for everyone.

A Look Back

Serious diseases that once killed thousands of youngsters each year have been almost eliminated in many parts of the world because of the widespread use of childhood vaccinations.

In much the same way, the discovery of antimicrobial drugs (antibiotics) was one of the most significant medical achievements of the 20th century. There are several types of antimicrobials—antibacterials, antivirals, antifungals, and antiparasitic drugs. (Although antibacterials are often referred to by the general term antibiotics, we will use the more precise term.) Of course, antimicrobials aren’t magic bullets that can heal every disease. When used at the right time, they can cure many serious and life-threatening illnesses.

Antibacterials are specifically designed to treat bacterial infections. Billions of microscopic bacteria normally live on the skin, in the gut, and in our mouths and throats. Most are harmless to humans, but some are pathogenic (disease producing) and can cause infections in the ears, throat, skin, and other parts of the body. In the pre-antibiotic era of the early 1900s, people had no medicines against these common germs and as a result, human suffering was enormous. Even though the body’s disease-fighting immune system can often successfully fight off bacterial infections, sometimes the germs (microbes) are too strong and your child can get sick. For example,

• Before antibiotics, 90% of children with bacterial meningitis died. Among those children who lived, most had severe and lasting disabilities, from deafness to mental retardation.
• Strep throat was at times a fatal disease, and ear infections sometimes spread from the ear to the brain, causing severe problems.
• Other serious infections, from tuberculosis to pneumonia to whooping cough, were caused by aggressive bacteria that reproduced with extraordinary speed and led to serious illness and sometimes death.

The Emergence of Penicillin

With the discovery of penicillin and the dawning of the antibiotic era, the body’s own defenses gained a powerful ally. In the 1920s, British scientist Alexander Fleming was working in his laboratory at St. Mary’s Hospital in London when almost by accident, he discovered a naturally growing substance that could attack certain bacteria. In one of his experiments in 1928, Fleming observed colonies of the common Staphylococcus aureus bacteria that had been worn down or killed by mold growing on the same plate or petri dish. He determined that the mold made a substance that could dissolve the bacteria. He called this substance penicillin, named after the Penicillium mold that made it. Fleming and others conducted a series of experiments over the next 2 decades using penicillin removed from mold cultures that showed its ability to destroy infectious bacteria.

Before long, other researchers in Europe and the United States started recreating Fleming’s experiments. They were able to make enough penicillin to begin testing it in animals and then humans. Starting in 1941, they found that even low levels of penicillin cured very serious infections and saved many lives. For his discoveries, Alexander Fleming won the Nobel Prize in Physiology and Medicine.

Drug companies were very interested in this discovery and started making penicillin for commercial purposes. It was used widely for treating soldiers during World War II, curing battlefield wound infections and pneumonia. By the mid- to late 1940s, it became widely accessible for the general public. Newspaper headlines hailed it as a miracle drug (even though no medicine has ever really fit that description).

With the success of penicillin, the race to produce other antibiotics began. Today, pediatricians and other doctors can choose from dozens of antibiotics now on the market, and they’re being prescribed in very high numbers. At least 150 million antibiotic prescriptions are written in the United States each year, many of them for children.

Problems With Antibiotics

The success of antibiotics has been impressive. At the same time, however, excitement about them has been tempered by a phenomenon called antibiotic resistance. This is a problem that surfaced not long after the introduction of penicillin and now threatens the usefulness of these important medicines.

Almost from the beginning, doctors noted that in some cases, penicillin was not useful against certain strains of Staphylococcus aureus (bacteria that causes skin infections). Since then, this problem of resistance has grown worse, involving other bacteria and antibiotics. This is a public health concern. Increasingly, some serious infections have become more difficult to treat, forcing doctors to prescribe a second or even third antibiotic when the first treatment does not work.

In light of this growing antibiotic resistance, many doctors have become much more careful in the way they prescribe these medicines. They see the importance of giving antibiotics only when they’re absolutely necessary. In fact, one recent survey of office-based physicians, published in JAMA: The Journal of the American Medical Association in 2002, showed that doctors lowered the number of antibiotic prescriptions they prescribed for children with common respiratory infections by about 40% during the 1990s.

Antibiotics should be used wisely and only as directed by your pediatrician. Following these guidelines, their life-saving properties will be preserved for your child and generations to come.

​Clinical trials are research studies designed to learn more about ways to prevent, detect, or treat diseases. Clinical trials can also help people with chronic (long-term) illnesses find better ways to live each day with their illness.

The goal of a clinical trial for children is to find out whether a treatment is safe, helpful, and well tolerated by children. Researchers may study new drugs, vaccines, devices, or procedures, or new ways to use current treatments.

Before you and your child decide whether a clinical trial may be a good option for your child, it’s important to know more about the study, including the risks and benefits.

Why are clinical trials for children needed?

It’s important to study new treatments in children because children are not little adults. Children have different treatment needs than adults, and sometimes they have different diseases than adults. Also, dosages of medicine, sizes of devices, or types of therapy may change over time, according to each child’s needs and stage of growth.

A successful clinical trial can create a new standard of care for children with certain conditions. Without this standard of care, treatment for children may need to be based on what works for adults. For example, most medicines given to children as part of standard treatments have been tested only in adults. When medicine that has been tested only in adults is given to children, this is called off-label use of the medicine.

In recent years, laws have been passed that require pediatric clinical trials for certain conditions. As a result, the number and range of clinical trials for children have expanded.

How are clinical trials done?

Each clinical trial follows a detailed plan called a protocol. A protocol is carefully designed to minimize the risks of the study, to increase the chance of getting useful results, and to answer specific research questions. It includes a description of who can and cannot participate, the likely length of the study, information about what is being tested, and how information will be collected.

NOTE: Before clinical trials of new medicines begin, these medicines are first tested and studied in a laboratory and in animals.

What are the benefits and risks of a clinical trial?

Clinical trials are done because we do not know the best treatments of many diseases or because researchers believe that a new treatment may work better than current treatments. However, as with any new or existing treatment, there may be certain benefits and risks. Also, sometimes the risks and benefits are unknown.

Possible Benefits

• My child may have access to new drugs or treatments that are not yet available and may be more effective.
• My child will help provide information that will benefit children in the future.
• My child may receive extra care from caregivers.
• My child may receive closer monitoring or extra testing that may not be a part of regular care.
• My child (we) may have access to more information about the condition or illness.
• Financial rewards or other incentives may be offered.

Possible Risks

• My child may find the treatment unpleasant or there may be harmful side effects that can range from minimal to serious or life-threatening.
• Treatment may be ineffective.
• Treatment may involve a lot of time, including visits to the study site, more blood tests, more treatments, or hospital stays.
• My child may need to follow complex medicine dosing or procedures.

What do I need to know before I sign up my child for a clinical trial?

If you and your child are interested in a clinical trial or have been asked to join one, it’s important that you know all the facts. As part of the clinical trial process, informed consent ensures that parents are fully informed and can ask questions about the clinical trial. Informed consent grants permission but is not a contract. Parents and children can leave a clinical trial at any time. However, for some children, doctors may recommend that certain steps are taken before treatment is completely ended, depending on what is safest for the child.

In addition to informed consent from parents, assent from children in many clinical trials is also required. Assent is the term used to describe when a child agrees to be in a clinical trial. Before children are asked whether they want to assent to join a clinical trial, they must first be old enough to understand basic facts about the clinical trial and be able to ask questions about the trial.

Your care team would be involved in helping you and your child make those important decisions.

What questions should I ask about a clinical trial?

Before you and your child join a clinical trial, it’s important that each of you understands the process from start to finish. The following questions about clinical trials can help:

About the Trial

• What is the purpose of the trial?
• Is there an age range that qualifies my child for the trial?
• Who is sponsoring or funding the trial? (Sponsors may be organizations or individuals—including medical doctors, foundations, medical institutions, voluntary groups, and biopharmaceutical companies—as well as federal agencies.)
• Why do the researchers believe that the treatment being studied may be better than the one being used now? Why may it not be better?
• What kinds of tests and treatments are involved?
• How will the doctor know whether the treatment is working?
• How and when will we be told about the trial’s results?
• Will we be told about changes in the study that might make us want to quit the study?
• When do we need to decide about joining this trial?
• Who can answer questions before, during, and after the trial?
• Who will be in charge of care?

Benefits and Risks

• What are possible benefits?
• What are possible side effects or risks?
• How do possible risks and benefits of this trial compare with those of standard treatment?
• If my child receives a placebo, could that be harmful to his or her care?

Privacy and Rights

• Will I have access to my child’s test results throughout the trial?
• How will my child’s health information be kept private? Who will have access to my child’s information?
• What happens if I want to take my child out of the trial?

Costs

• Will I have to pay for any of the treatments or tests?
• What costs will my health insurance cover?
• Who pays the medical bills if my child is injured in the trial?
• Who can help answer questions from my insurance company?
• Are any personal costs such as meals or gas paid for by the organization or individual running the clinical trial?

Time

• How long is the trial?
• How often and for how long will my child have to go to the hospital or clinic?
• Will my child have to stay in the hospital during the clinical trial? If so, how often and for how long?
• How much time will be spent traveling to and from the hospital or clinic?
• Will my child have checkups after the trial?

Other Choices

• What are other treatment choices, including standard treatments?
• How does treatment my child would receive in this trial compare with other treatment choices?
• What will happen to my child’s illness or disease without treatment?

When children have a chronic, serious illness or disability, their parents may turn to “natural” therapies. Other terms that describe these therapies include alternative, complementary, and folk remedy.

In some cases, natural therapies may may be used in addition to the care their child receives from their pediatrician or other mainstream practitioner. Families may turn to natural therapies even when they’re happy with this traditional care, because they are willing to try everything and anything to help their child. In some cases, however, may turn to them when they become frustrated with all that mainstream medicine can offer their child.

Better together: how your pediatrician can help

If you’ve made the decision to seek natural therapies for your child’s care, involve your pediatrician in the process. In most cases, such therapies work best when used in combination with traditional medical care. Your doctor may be able to help you better understand these therapies, whether they have scientific merit, whether claims about them are accurate or exaggerated and whether they pose any risks to your child’s well-being.

Natural doesn’t always mean safe

Keep in mind that a “natural” treatment does not always mean a “safe” one. Your pediatrician can help you determine whether there is a risk of interactions with your child’s other medications.

The American Academy of Pediatrics has encouraged pediatricians to:

• Evaluate the scientific merits of natural therapies
• Determine whether they might cause any direct or indirect harm
• Advise parents on the full range of treatment options

If you decide to use a natural therapy, your pediatrician also may be able to assist in evaluating your child’s response to that treatment.

​

​​Fast Facts:

• One in 10 young people in the US experiences recurrent headaches.
• One in 3 young people ages 10 to 17 who regularly experience headaches are turning to some type of “natural” or integrative medical therapy, which consists of the use of conventional, complementary and alternative medicine (CAM) for prevention and treatment.

What are your responsibilities as a parent when considering a natural therapy for your child?

If you are exploring natural therapies to treat your child’s headaches, it is important for you to educate yourself fully on the pros and cons of each approach and discuss the options thoroughly with your child’s pediatrician before you take any action.

Mind and Body Approaches:

Massage

• Massage therapy may be helpful for a child with chronic daily headaches and includes a variety of techniques in which practitioners manipulate the soft tissues of the body. Massage therapy can be used in conjunction with a healthy diet, regular exercise, stress management, and avoidance of headache triggers. There are relatively few side effects when massage is performed by a trained practitioner, but its use should be discussed with the child’s pediatrician to be sure they know every therapy your child is receiving.

Acupuncture

• Acupuncture may also benefit a child with headaches. This ancient Chinese remedy involves a practitioner inserting thin needles through the skin, which releases endorphins, and reduces the perception of pain. Treatment usually occurs one or two times a week for 4 to 6 weeks. There are few side effects and many children tolerate acupuncture well with a practitioner trained in treating children. Due to needle insertion, rarely mild bleeding and bruising can be seen. Infection is very rare.

Biofeedback

• Biofeedback is one of the treatments researched most extensively for migraines. It measures body functions so that the child can learn to control them. For example, a biofeedback device may show tension in a child’s neck muscles in the back of the head that are causing the headaches. By watching how these measurements change, the child becomes more aware of when his or her muscles are tense and learns to relax them. Several biofeedback programs and devices are available in clinics or at medical centers, but also available for home use. Biofeedback is generally safe to use and does not have any harmful side effects.

Guided Imagery

• Guided imagery, self-hypnosis, or relaxation can be helpful for preventing headaches. Children are often great at this technique, as it uses their imagination and mental images to promote relaxation. Some pediatricians are trained in these relaxation skills or may refer you to another trained practitioner who work with your child.

Dietary Supplements for Headache Prevention:

Certain nutritional and herbal dietary supplements have been studied for prevention or decreasing the pain that comes with headaches. All dietary supplements should be discussed with the child’s pediatrician before use.

Vitamin B2 (riboflavin)

• Riboflavin is a B-vitamin that may reduce the number of headaches and pain. Rare side effects may include diarrhea, increased amount of urination, and yellowish discoloration of urine.

Magnesium

• Magnesium supplements may also help reduce the number of headaches if taken for several months. Magnesium deficiency is related to factors that promote headaches. Teens who get migraines may have lower levels of magnesium in their bodies than those who do not. The typical diet of an American teenager may be deficient in magnesium-rich foods such as dark green leafy vegetables, beans, seeds, nuts, and whole grains. Magnesium supplements can cause diarrhea and may interact with some medications. They should be used only under the supervision of your child’s pediatrician.

Coenzyme Q10 (CoQ10)

• Coenzyme Q10 (CoQ10) is an antioxidant present in each cell of our bodies; however, it was found to be deficient in one third of children with migraines. Taken as a dietary supplement, it may help lower the frequency of headaches. It is generally well-tolerated by children without significant side effects. Rare and mild GI symptoms such as nausea, vomiting, diarrhea, decreased appetite, and heartburn have occurred.

Butterbur

• Butterbur is an herb extract that may reduce the number and severity of migraine headaches. The most common side effects include fatigue, belching, nausea, diarrhea, heartburn, itchy eyes or skin, and allergic reaction for those children allergic to ragweed, chrysanthemums, marigolds or daisies. Raw butterbur contains chemicals called pyrrolizidine alkaloids (PAs). PAs can damage the liver and kidneys and result in serious illness. Only butterbur products that are certified as PA-free should be used.

A Final Reminder:

If you’ve made the decision to seek a natural therapy for your child’s headaches, it is of utmost importance to involve your child’s pediatrician in the process. He or she may also be able to assist in evaluating your child’s response to that treatment.

Is it OK to give my child “natural” therapies when she’s sick?

While most children in North America receive conventional medicine when they are sick, many parents want to know about natural therapies too. Alternative, complementary, and integrative medicine and folk remedies are some of the words used to describe these different therapies. Here’s a few things you should know:

Q: Are all “natural” therapies safe?

A: No. Therapies are not safe just because they are natural. Side effects from natural therapies are rare but can occur. Check with your child’s doctor before adding or changing a therapy. Talk about what you’ve heard and read about natural therapies. Bring the products you give your child to your next medical appointment.

Q: Does the US Food and Drug Administration (FDA) regulate natural products?

A: Yes. The FDA regulates natural products such as dietary supplements. But they are regulated as a food and not as medicine. While most people can avoid buying rotten tomatoes or bruised fruit, it’s much harder to avoid poor-quality supplements. The FDA does not guarantee the purity, potency, effectiveness, or safety of natural products sold as dietary supplements.

Q: Do natural therapies really work?

A: More research is needed for all kinds of therapies for children, including natural therapies. Some work for children with certain conditions but not for children with other conditions. This is true for conventional and natural therapies. For example, massage may help reduce stress, but it is not a cure for cancer.

Q: Do you need a special license to practice complementary medicine?

A: Each state has different licensing rules. Check with the licensing board for your state to find out if a health care professional has a license to practice. If your state does not require a license to practice (for example, some states do not license acupuncturists), be sure the professional is certified by a national professional organization. Always ask about a practitioner’s training and experience. Find out if the practitioner has been specifically trained to treat children and how many children he or she treats each week.

Q: Will insurance pay for it?

A: Insurance companies and flexible medical spending accounts have many different plans that cover different things. There is often less coverage for complementary therapies than for conventional care. Check with your insurance company.

Q: Why is it important to talk with my child’s doctor about these treatments?

A: Talking with your child’s doctor helps you know if a treatment is safe and effective. Talk about all therapies given to your child including vitamins, herbs, or other supplements. This is especially important because there can be dangerous side effects when medicines or therapies are given at the same time. Include information about other health professionals caring for your child so care can be coordinated.

Ask all your child’s health care professionals to talk with each other. Open communication is the best way to promote the safest care possible.

Pediatricians use different tests and tools to help them diagnose and treat injuries and illnesses. The information below will help answer parents’ questions about imaging and medical radiation safety.

What is imaging?

Imaging tests are used to “see” inside the body. Some types of imaging use ionizing radiation. This includes x-rays, computed tomography (CT) scans, and nuclear medicine (radionuclide) studies. Higher-dose radiation can also be used in therapy, for treatment of cancer, or for treatment of an overactive thyroid gland.

Why does my child need an imaging test?

Sometimes imaging tests are the only tests that can help diagnose certain illnesses. Your child’s doctor can then find out the best treatment options, avoid other tests or surgery, and improve your child’s health.

Isn’t radiation harmful?

The amount of radiation used in imaging tests is very low. In fact, no direct harm has been shown from the levels of radiation used in the imaging tests mentioned above.

We are all exposed to small amounts of radiation daily from soil, rocks, air, water, and cosmic radiation. Most people are exposed to more radiation from the environment than from many of these tests.

How safe is imaging?

Special steps are taken to make sure your child is exposed to the smallest amount of radiation possible during imaging. The AAP belongs to the Alliance for Radiation Safety in Pediatric Imaging, which follows the following medical radiation safety guidelines:

• Imaging is to be used only if there is a definite medical benefit.
• Use the lowest amount of radiation possible for the test based on the size of the child.
• Imaging only includes the parts of the body that need to be evaluated.
• Use other diagnostic studies, like ultrasound and magnetic resonance imaging (MRI), when possible.

If I still have concerns regarding radiation exposure to my child, whom should I talk with?

First talk with the doctor who is ordering the exam. Medical professionals must balance the risks and benefits of performing a study. Your doctor and the radiologist can work together on decisions about which study is best to perform.

If your doctor cannot answer your questions, radiologists can provide further information. Also listed at the end of this handout is a list of resources if you would like to find out more information.

Types of Imaging

The following are 3 types of imaging tests.

​	​X-rays	​CT scans	​Nuclear medicine studies
Types of images taken​:	​2-dimensional pictures of the bones, lungs, and other organs.	​3-dimensional pictures of the body.	​Pictures of different organs and tissues that depend on how they work.
​When this test may be needed:	​X-rays are usually used to see bones, organs (like the lungs), and air inside the body. Metal objects also can be seen.	​CT scans are very useful because they show more detailed pictures of organs than an ordinary x-ray. They can be used to find tumors, infections, or evidence of injury in different parts of the body.	​Organs including the kidneys, liver, heart, lungs, and brain can be studied with these exams. Bone scans can show trauma, infection, or a tumor before any problems are seenwith x-rays.
​What to expect during the test: None of these tests are painful; however, it’s important that your child be still during the tests.	​Your child will need to stay still. Lead shields may be used to cover the parts not being imaged.  Parents can stay in the same room and should wear a lead apron. Pregnant moms should not be in the room.	​Your child will need to lie still on a table while it moves through a large scanner that looks like a donut.  Nothing touches the child, but your child may be afraid of the large machine. An intravenous contrast to show blood vessels and/or a drink may occasionally be given if ordered by your doctor. Parents can stay in the same room and should wear a lead apron. Pregnant moms should not be in the room.	​Before the test an intravenous line is usually needed to inject a radioactive drug called a tracer. Your child will need to stay still.  A machine called a gamma camera scans the body detecting the rays of energy from the tracer, and an image is created and shown on a computer.
Amount of radiation exposure: ​	Very small amounts of radiation exposure to the areas being studied.​	​More radiation exposure than x-rays.	​The amount of radiation exposure depends on the type of study.

Antibacterials aren’t the answer for every infection your child gets. In fact, there are 2 major types of germs that cause most infections, viruses and bacteria, and antibacterials are useful only against bacteria.

• Bacteria are one-celled organisms that are just a few thousandths of a millimeter in size. They live on our skin, in our digestive system, and in our mouths and throats. In fact, there are one hundred thousand billion bacteria living and thriving on or inside of us. Although most are either harmless or actually serve a positive role in the body (eg, helping to break down the nutrients in our diet), some are dangerous and cause illnesses. They’re responsible for many childhood diseases, including most ear infections, strep throat, some sinus infections, and urinary tract infections.
• Viruses are even smaller than bacteria. The poliovirus, for example, is only 16 millionths of a millimeter in diameter. Despite their size, viruses can cause mild and serious diseases when they enter healthy cells in the body. They’re responsible for the common cold, the flu, and most sore throats and coughs. They also cause smallpox, the measles, the mumps, hepatitis, and acquired immunodeficiency syndrome (AIDS). As powerful as antibacterials are when used in the right situations, they cannot kill viruses and do not work against viral infections. If they’re given to your child when she has a viral infection, they can not only cause side effects, but also add to the serious problem of antibiotic resistance. There are drugs called antivirals that have been developed to fight viruses.

For children, antibiotics are available in a number of forms, including tablets, capsules, liquids, and chewables. Some antibiotics come as ointments and others come as drops (eg, for ear infections).When your pediatrician prescribes an antibiotic, your pediatrician will choose the best one for the specific germ that is making your child sick.

The Activity of Antibacterials

Antibacterials fight infectious bacteria in the body. They attack the disease process by destroying the structure of the bacteria or their ability to divide or reproduce. Scientists often categorize antibacterials in the following way:

• Some antibacterials (eg, penicillin, cephalosporin) kill bacteria outright and are called bactericidal. They may directly attack the bacterial cell wall, which injures the cell. The bacteria can no longer attack the body, preventing these cells from doing any further damage within the body.
• Other antibacterials (eg, tetracycline, erythromycin) block the bacteria’s growth or reproduction. Often called bacteriostatic antibiotics, they prevent nutrients from reaching the bacteria, which stops them from dividing and multiplying. Because millions of bacteria are needed to continue the disease process, these antibiotics can stop the infection and give the body’s own immune system time to attack.

Some antibacterials are called broad spectrum and can fight many types of germs in the body, while others are more specific. If your pediatrician uses blood, urine, or other tests that identify the specific bacteria causing your child’s infection, your pediatrician can prescribe an antibacterial that can target those germs.

Remember, if your child has a cold, antibiotics aren’t the answer. It’s sometimes difficult for parents to determine if their child’s illness is caused by viruses or bacteria. For this reason, never try to diagnose and treat your youngster’s illness yourself. Contact or visit your pediatrician’s office.

Side Effects of Antibiotics

As powerful and useful as antibiotics can be, they may produce side effects in some people. In children, they can cause stomach discomfort, loose stools, or nausea. Some youngsters have an allergic reaction to penicillin and other antibiotics, producing symptoms such as skin rashes or breathing difficulties. If these allergic symptoms become severe, causing labored breathing, difficulty swallowing because of a tight throat, or wheezing, call your pediatrician and go to the emergency department right away.

Are Antibiotics Ever Used to Prevent Illnesses?

While antimicrobial drugs are mostly used to treat infections that your infant or child may develop, they are sometimes prescribed to prevent an illness from ever occurring. For example, children who have frequent urinary tract infections are sometimes given antibacterials to reduce the likelihood that they’ll recur. Medicines can kill the bacteria before they have a chance to cause an infection.

Here are other circumstances in which prophylactic (preventive) antibacterial drugs may be prescribed for children.

• Your pediatrician may prescribe penicillin for your child for prevention of acute rheumatic fever.
• Sometimes, a child who has been bitten by a dog, another animal, or even another person will be given medicines to prevent an infection from developing.
• When youngsters are hospitalized for a surgical procedure, they may be given medicines before their operation to prevent an infection from developing at the site of the surgical incision. Typically, these drugs are given to children no more than 30 minutes before the operation. A single dose is often all that’s needed.

If your pediatrician believes that your child can benefit from taking medicines as a preventive measure, your pediatrician will choose them carefully and prescribe them for the shortest possible period. This strategy will reduce the chances that use of these drugs will contribute to the problem of antimicrobial resistance.

This article provides information about the FDA’s drug approval process. 

What Does it Mean For a Product to be “FDA-Approved?”

The U.S. Food and Drug Administration (FDA) examines, tests, and approves a wide range of items for medical use, including drugs, medical devices, food, cosmetics and many other health-related products. In the simplest terms, “FDA approval” means that the FDA has decided the benefits of the approved item outweigh its potential risks.

Before the FDA, companies could make claims about a product, without proof that it was safe or that it even worked. This made consumers extremely vulnerable. Now, new products must go through the FDA approval process before they are available to the public.

Why is the FDA Approval Process Important? 

FDA approval is important, because it validates the need for research on how drugs work on children, not just adults. It also allows us the properly determine the appropriate dosage for children, determine the best route of administration, and test for any drug interactions. 

How Does a Drug or Device Get FDA Approval?

In order to receive FDA approval for a drug or a medical device, the manufacturer must prove to the FDA that the item is “safe and effective.” Although no drug or medical device is entirely risk-free, the research and testing must show that the benefits of the drug or device for a particular condition outweigh the risks to patients of using the item.

Here’s a brief overview of the steps involved in a drug becoming FDA-approved:

• Drug Developed: A company develops a new drug and seeks to have it approved by the FDA for sale in the United States.
• Animal Testing: Before testing the drug on people, the company must test the new drug on animals to find out whether it has the potential to cause serious harm (i.e. toxicity).
• IND Application: The company submits an Investigational New Drug (IND) application to the FDA based on the results from the initial animal testing. These results must include the drug’s composition and manufacturing and the proposed plan for testing the drug on people.
• Clinical Trials: After the FDA reviews and approves the IND application, clinical trials to test the drug on people can begin. There are 4 phases of clinical trials, starting with small-scale trials, followed by large-scale trials. After the clinical trials, the researchers then submit study reports to the FDA.
• NDA Application: Once a drug developer provides evidence that the drug is safe and effective, the company can file a New Drug Application (NDA). The FDA reviews the application and makes a decision to approve or not approve the drug.
• Drug Labeling: The FDA reviews the drug’s labeling/packaging and makes sure appropriate information is communicated to health care professionals and consumers.  
• Facility Inspection: The FDA inspects the facilities where the drug will be manufactured.
• Drug Approval: The FDA approves the NDA or issues a response letter.
• Post-Marketing Monitoring: Once the FDA approves the drug, the company is required to submit periodic safety updates to the FDA.

Do Over-the-Counter Drugs and Medical Devices Need FDA Approval?

Yes. Drugs sold over-the-counter (without a prescription) must be approved by the FDA. For instance, over-the-counter pain medications must be FDA-approved to treat pain.

What is Considered When Rescheduling A Drug?

The Controlled Substances Act (CSA), part of the Comprehensive Drug Abuse Prevention and Control Act of 1970, is the legal cornerstone of the government’s war against drug abuse. The U.S. Drug Enforcement Administration (DEA) has divided these substances into five categories, called “schedules,” based on each drug’s (1) potential for abuse, (2) safety, (3) addictive potential and (4) whether or not it has any legitimate medical applications.. Schedule I is reserved for drugs considered to have the highest potential for abuse and no current accepted medical use. Rescheduling marijuana, for example, would not make it legal but reclassifying the schedule could potentially increase research being done on the drug.

Many psychiatric conditions are commonly treated with medication. Here’s an overview.

Obsessive-Compulsive Diso​rder

• Selective Serotonin Reuptake Inhibitor (SSRIs): fluoxetine (Prozac), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), sertraline (Zoloft)
• Atypical antipsychotic agents: risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), Valproic acid (Depakene, Depakote)

Attention Deficit Hyperactivity Disorder

• Stimulants: methylphenidate (Ritalin, Ritalin LA, Methylin, Focalin, Focalin XR, Concerta, Metadate CD, Daytrana), dextroamphetamine (Dexedrine), lisdexamfetamine (Vyvanse), mixed amphetamine salts (Adderall, Adderall XR)
• Alpha-2 agonists: clonidine (Catapres, Kapvay), guanfacine (Tenex, Intuniv)
  Atomoxetine (Strattera)
• Atypical antipsychotic agents: risperidone (Risperdal), aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon)

Intermittent Explosive Disorder (aggression, irritability, self-injury)

• Atypical antipsychotic agents: risperidone (Risperdal), aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon)
• Alpha-2 agonists: clonidine (Catapres, Kapvay), guanfacine (Tenex, Intuniv)
• Anticonvulsant mood stabilizers: valproic acid (Depakene, Depakote), topiramate (Topamax)
• SSRIs: fluoxetine (Prozac), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), sertraline (Zoloft)
• Beta blockers: propranolol (Inderal), nadolol (Corgard), metoprolol (Lopressor), pindolol (Visken)

Sleep Disturbances

• Melatonin agonists: melatonin, ramelteon (Rozerem)
• Antihistamines: diphenhydramine (Benadryl), hydroxyzine (Atarax, Vistaril)
• Alpha-2 agonists: clonidine (Catapres, Kapvay), guanfacine (Tenex, Intuniv)
• Atypical antidepressants: mirtazapine (Remeron), trazodone (Desyrel)

Anxiety

• SSRIs: fluoxetine (Prozac), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), sertraline (Zoloft), Buspirone (Buspar), Mirtazapine (Remeron), duloxetine (Cymbalta)

Depression

• SSRIs: fluoxetine (Prozac), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), sertraline (Zoloft)
• Atypical antidepressants: bupropion (Wellbutrin), mirtazapine (Remeron)

Bipolar Disorder

• Anticonvulsant mood stabilizers: lamotrigine (Lamictal), valproic acid (Depakene, Depakote), gabapentin (Neurontin)
• Atypical antipsychotic agents: Lithium, risperidone (Risperdal), aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel),
  Lithium​