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HealthHints Newsletter, Texas AgriLife Extension Service, The Texas A&M University System

Keeping Children Healthy

Volume 2, Number 6 - July/August, 1998

Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, and Janet M. Pollard, MPH, Extension Associate-Health

Inside HealthHints....

Healthy Children Learn Better and Have Higher School Attendance

Though the sun and heat are still indicating that it's summer, already we must start thinking about sending our kids back to school.

Children heading back to school means an increase in illness incidents for children. Healthy children do better in school because, among other things, they are present more often. The more absences, the less likely a child will do well in school. Thus, beyond getting appropriate school clothes and school supplies, there are many health issues at the forefront of parents' minds:

These are a few of the issues this issue of HealthHints will help you address with your community, clientele, and at home.

Immediate Action

To assist clientele and yourself, order these resources as soon as possible.

Healthy Children are Immunized Children

The purpose of immunizations is to protect people from infectious diseases which cause serious illnesses, complications such as brain damage, paralysis, deafness, blindness, or even death. Except for tetanus, these diseases are easily spread from one person to another (e.g. through the air, coughing, sneezing, touching an infected person or object with the virus on it, etc.).

Children's immunizations are hepatitis B, Heamophilus influenza type b (Hib), polio, diphtheria, tetanus, pertussis (DPT), measles, mumps, rubella (MMR), and chickenpox (Varicella Zoster).

Immunizations should be started at birth, and most are complete by age two if the recommended immunization schedule is followed (see your Family Health and Medical Record Booklet [B-1377] [http://fcs.tamu.edu/health/child_health/family_medical_record/family_medical_record.htm]). It is especially important to get your children's shots on time because children tend to be more susceptible to catching these diseases, and the results can be very dangerous without the ability to fight off these infections. To complete the immunization schedule, however, there are a few shots that are still needed before school starts. These shots include the following:

Your child may also need a "catch-up" vaccine of the following shots at 11-12 years, if he has not already been vaccinated:

Important Immunization Update

Effective August 1,1998: Children born on or after September 2, 1992 must have 3 doses hepatitis B vaccine.

For children who are beginning (or completing) the series of hepatitis B vaccines are 6 months or later, the following rules apply:

- Texas Department of Health

Responding to Misconceptions About Vaccination

In promoting immunizations among our children, you may encounter parents or other adults who have reservations about getting their children vaccinated. There can be many reasons for these reservations including:

Here are some facts to deal with some of the concerns may keep kids from being immunized:

Misconception 1: Vaccines cause many harmful side effects, illnesses, and even death -- not to mention possible long-term effects we don't even know about.

Response: Vaccines are actually very safe. Most vaccine adverse events are minor and temporary, such as a sore arm or a mild fever. These can usually be controlled with acetaminophen (e.g., Tylenol, NOT aspirin - See Reye Syndrome box) before or after vaccination.

More serious adverse events are so rare that risk cannot be accurately assessed; and so few deaths can plausibly be attributed to vaccine that it is hard to assess the risk statistically. The benefits of vaccine, however, far outweigh the risks.

Reye Syndrome

Reye syndrome is an illness associated with giving aspirin to children with flu, chickenpox, or other viral illness.

In most cases of Reye syndrome, children seem to be recovering from a viral illness (e.g., flu, chicken pox, etc.) when the following symptoms occur: nausea, severe vomiting, fever, lethargy, stupor or coma (sometimes followed by convulsions), wild delirium and unusual restlessness (in about 1/2 of cases) (Zamula, 1994).

Parents should never give aspirin to children or teens under age 20.

Misconception 2: Giving a child multiple vaccinations for different diseases at the same time increases the risk of harmful side effects and can overload the immune system.

Response: Studies by the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) have shown that the recommended vaccines are as effective in combinations as they are individually, and that such combinations carry no greater risk for adverse effects.

Scientific data shows that these combinations or simultaneous vaccines have no adverse effect on the normal childhood immune system.

Misconception 3: Diseases had already begun to disappear before vaccines were introduced, because of better hygiene and sanitation. Immunizations, therefore, are no longer important.

Response: Though it is true that better sanitation, hygiene, nutrition, etc. have all contributed to reduced disease transmission, when we look at the actual incidence of disease over time, we see the real story.

After the measles vaccination licensure in 1963, for example, we saw a major drop in measles incidence corresponding with this licensure and wide-spread use of the vaccine. We see similar patterns with other vaccine-preventable diseases as well.

Additionally, when Great Britain, Japan, and Sweden cut back the use of the pertussis vaccine because of a fear of the vaccine, we saw an epidemic of cases of pertussis in these countries.

Thus, it seems clear that without vaccination, not only would diseases not be disappearing, but if we stopped vaccinating, they would come back.

Misconception 4: Vaccine-preventable diseases have been virtually eliminated in the United States, so there is no need for my child to be vaccinated.

Response: It is true that vaccination has enabled us to reduce most vaccine-preventable diseases to a very low level in the United States. Some of these diseases, however, are still very prevalent, even epidemic in other parts of the world.

Travelers can unknowingly bring these diseases into the United States, and if we were not protected by vaccinations, these diseases could rapidly spread throughout the population. Additionally, the relatively few cases we have in the U.S. could rapidly become epidemic without the protection we get from vaccines.

Misconception 5: The majority of people who get disease have been vaccinated.

Response: Most routine childhood vaccines are effective for 85 to 95% of recipients. Not all vaccinated persons develop immunity; however, most people do.

Misconception 6: There are 'hot lots' of vaccine that have been associated with more adverse events and deaths than others. Parents should find the numbers of these lots and not allow their children to receive vaccines from them.

Response: There are two points to make here. First, just because an adverse effect is reported from a vaccine, does not mean that the vaccine caused the event. Although vaccines are known to cause minor, temporary side effects such as soreness or fever, there is little evidence linking vaccination with permanent problems or death.

Second, lots of vaccine are distributed in different quantities and for different periods of time. Therefore, it is likely that a larger lot with a longer distribution time will be associated with more adverse events simply by chance.

If, however, an unusual number of adverse events were reported on a specific lot of a vaccine, the FDA has the legal authority to recall that lot. To date, no vaccine lot in the modern era has been found to be unsafe on the basis of VAERS reports (the system used for reporting events temporarily associated with receipt of vaccine) (Centers for Disease Control and Prevention, 1996).

Setting Up an Immunization Clinic

To set up the immunization clinic, take the following steps:

  1. Contact the appropriate medical personnel to provide immunizations. Depending on your county structure you could call:
    • Your local health department.
    • Your Regional Immunization Program Manager (see below). This manager can also help you in acquiring free vaccines and immunization consent forms.
    • Your local hospital(s).
    • Your local clinic(s).
    • Your local physician(s).

      Once you have the appropriate medical staff in place, you can do the rest with the help of some volunteers.
  2. Solicit volunteers to help with the immunization area. You might want to solicit volunteer assistance from the following:
    • 4-H
    • Rotary
    • Kiwanis
    • Lions Club
    • Salvation Army
    • Red Cross
    • Junior League
    • Vista Volunteers
    • YMCA
    • Ministers/Churches
    • School District Representatives, Teachers, and Students.

      These volunteers can then take on the following responsibilities to complete the clinic.
  3. Set up publicity/community outreach efforts. Have volunteers put out posters, fliers, and public service announcements about the health fair and immunization opportunity out. Be sure to include information about free or sliding scaled costs for immunizations.
  4. Coordinate logistics. You may want to ask someone to be the Site Coordinator, or you may want to do this yourself.
    • Preview the site to make sure it will be appropriate.
    • Determine how everything at the site will flow.
    • Have someone there to help with set-up and take-down.
    • Assign runners to make sure supplies are available at all times and appropriate communication can occur when needed.
  5. Provide entertainment (such as the Texas Department of Health Puppet show, contact 1-800-252-9152) and/or incentives. If immunizations are provided as part of a health fair, you will probably not need to set up additional entertainment for the immunization area. Just be sure to include some activities that will attract parents and their children. You may also want to ask local merchants for incentives to give out for those who receive shots (e.g., free hamburger, ice cream, french fries, t-shirt, pencil, or shoe laces).

To set up immunization clinics, contact your Public Health Regional Immunization Program Managers:

Note: All Region 11 offices have a mobile clinic which can be brought to your site and provide free immunizations. If you are in Laredo, Corpus Christi, Brownsville, Harlingen, or the surrounding areas, one of these mobile units can serve your community.

Guess What I Brought Home from School?

Colds, flu, head lice, pinkeye, ringworm, pinworms, and impetigo are common diseases that cause absence from school.

Pediculosis (Head Lice)

Although head lice has long been thought of as a sign of poor hygiene, there is no justification for this stigma; anyone with hair can get head lice! As a matter of fact, head lice occurs more often on clean heads than on dirty or dandruffed ones. The primary sign of head lice is frequent head scratching, especially behind the ears. Scratching is often so intense that noticeable scratch marks can be seen on the scalp and behind the ears.

Lice are blood-sucking parasites that depend on their hosts for food and warmth. Transmission of head lice occurs through direct contact with the hair or scalp of an infested individual; although infected inanimate objects, such as combs, hats, linens, pillows, upholstered furniture etc. may also be a source of transmission. Lice feed approximately 5 to 7 times per day. Lice can be difficult to detect because they are small and run quickly from light. Lice, especially the nymph (immature form of the parasite, not yet an adult), are white or grey, while adults are often reddish-brown, especially after a blood meal.

Since nymphs and adults are difficult to see, most diagnoses of head lice infestation are made by identification of nits (cases containing the eggs of the louse). Nits are usually found close to the scalp and are about the size of a typewriter comma. A magnifying glass may be needed to distinguish the smooth, shiny pearly white or silver nits from dandruff, dried hair spray flecks, lint, etc. Additionally, unlike other hair debris, nits cannot be easily brushed from the hair. Nits are tightly cemented or glued to the hair shaft and can only be removed with effort.

Adult lice live 23 to 30 days. In this time the pregnant female can lay 110 to 400 eggs!

Lice are typically sighted on the crown of the head, behind the ears, and at the nape of the neck. Sometimes, on an individual with long hair, bites may be visible along the neck. In severe cases, the hair may appear matted and the scalp may develop impetigo, however, about half of children show no clinical symptoms. Systemic symptoms of illness, such as fever, are not characteristics of head lice infestations.

Currently, there are three compounds available for treatment of head lice in the United States. Two of these, pyrethrins, a natural insecticide, combined with piperonyl butoxide, and permethrin, a synthetic pyrethroid, are available over the counter. The third, lindane, is only available via prescription and is only recommended for secondary treatment due to it's higher toxicity level.

Pyrethrines and permethrins have excellent safety profiles. These compounds are easily absorbed by the parasite, but are poorly absorbed through the skin of mammals. Only about 2% of these insecticides are absorbed into the bloodstream; and toxicity is low even if ingested, most likely due to rapid metabolism into water-soluble compounds, which are excreted from the body.

Pyrethrin with piperonyl butoxide, and permethrin are highly effective in eradicating lice and nits within 2 weeks in 80 to 100% of cases.

To eradicate head lice and nits, it is essential to follow product directions exactly. Incorrect use of first-line treatments is one of the most significant causes of persistent infestations. Be sure to:

  1. Read directions carefully.
  2. Leave the compound on the hair for the specified amount of time.
  3. Do not use pyrethrin-based products on wet hair.
  4. Spend adequate time combing out nits with a nit comb.
  5. Comb only small sections of hair at a time.
  6. Keep nits away from eyes by coating eye lashes and eyebrows with petroleum jelly, when removal is needed in these areas.
  7. Repeat treatment after 7 to 10 days. (After 7 to 10 days, any nits that were missed will have hatched, but resulting insects will not have matured to produce more eggs, which would cause a continued infestation cycle.)
  8. Linens, hats, combs, pillows, and other items that have come into contact with the infested individuals head should be washed in hot water (130 to 150 degree Fahrenheit water, at least 5 to 10 minutes) and dried in a hot dryer (at least 20 minutes). Items that cannot be washed should be sealed in a plastic bag for 1 to 2 weeks.
  9. Carpeting and upholstery in the home and car should be thoroughly vacuumed. Using a hot iron on upholstery is also advised (check the temperature of the iron to make sure it is safe before ironing upholstery).
  10. Other members of the household should be check and treated simultaneously if necessary.

Note: Do not ever use kerosene, gasoline, or other home treatments or less conventional remedies. Severe consequences have resulted from such procedures.

Occasionally, even after following all directions and guidelines, an individual may persist with head lice infestations. This may be due to a resistance to pediculicides that may be emerging. If you suspect resistance:

  1. Review the proper use of pediculicide compounds.
  2. Try switching to a different pediculicide compound.
  3. If persistent infestation continues, see your health care provider (Carson, 1997).

Children with head lice can miss weeks of school, and will not be permitted to attend until free of infestation. Thus, it is essential that parents and other care providers know how to manage the problem.

Impetigo

Impetigo is a contagious bacterial infection. It usually starts with an insect bite (e.g., mosquito), small cut, scratch, or burn that becomes infected. The bacteria enter where the skin is broken. Impetigo is characterized by blisters that become pus-filled and then erupt to form yellow crusts.

Impetigo often appears on the face between the nose and upper lip after a cold. Scratching the sores, however, may spread the infection to other parts of the body. Impetigo is passed on to others through direct contact with the moist discharge of the blisters or lesions.

To prevent impetigo, be sure to:

If infection does occur, some prompt home treatment may be effective. Small area of infection may respond to the following:

If home treatment is not effective, or possible, or if the case is a more severe one, you will want to see your health care provider.

Call a health professional if:

Your doctor may prescribe a topical antibiotic ointment. If the infection is around the mouth, where ointments could be licked off, an oral antibiotic may be prescribed. Keep the skin around the lesions clean, and expose to air to encourage drying.

Your child can usually return to school 24 hours after treatment has begun (Kemper, 1997; Hey Mom!, 1998).

Conjunctivitis (Pinkeye)

Conjunctivitis, or pinkeye, is an inflammation of the membrane lining the eyelids and eyeballs. It can be caused by viruses, bacteria, allergies, pollution, or other irritants. When conjunctivitis is caused by viruses or bacteria, it is called pinkeye, and can be very contagious.

Symptoms include red, watery, itchy eyes, swollen eyelids, and lots of tears. The eyes also emit secretions that crust and may cause the eyelids to stick together, especially during sleep. The eyes may also be sensitive to light.

Colds and poor hand-washing can result in infection with pink eye. Additionally, adolescents often transmit the infection by sharing eye makeup.

To prevent pinkeye:

Most cases of conjunctivitis will clear up within 5 to 7 days. Viral pinkeye, however, can last several weeks; and conjunctivitis due to allergies or pollutants will last as long as you exposes to the irritating substance. To bring relief and speed recovery, try the following:

Most likely, you doctor will prescribe antibiotic eyedrops or ointment. If antibiotic drops are prescribed to your children, try the following for simple insertion:

If ointment is prescribed, it can be difficult to get in the eye. If you can get it on the eyelashes, it will melt and get into the eye.

Usually after a day or two of treatment the infection will subside. Children will be allowed to return to school after the infection is gone (Kemper, 1997; Hey Mom!, 1998).

Ringworm

Ringworm is a contagious fungal infection. The infection usually appears on areas of exposed skin, such as the face, upper extremities, and trunk. It is not caused by a worm, but is characterized by round reddish spots or patches, which may be scaly or itchy and grow to about one inch across. Ringworm is often found on the scalp as well. In this case, however, the infection can cause destruction of the hair shaft, resulting in bald patches.

Ringworm is most often caused by skin to skin contact, or the sharing of linens, combs, brushes, etc. In rare cases, ringworm may also be transmitted by animals. To prevent ringworm:

Ringworm can usually be effectively treated with the prolonged use of an antifungal cream, which can be purchased over the counter or through a doctor's prescription. Your doctor or pharmacist can advise you about what is best. If the scalp is affected, however, oral medication will be prescribed. In both cases, you will not see immediate results; treatment over several weeks is not uncommon, so stick with the treatment until the infection is gone.

Students can usually return to school 24 hours after treatment begins (Kemper, 1997; Hey Mom).

Pinworms

Pinworms are tiny (2 to 5 mm), yellow-white, thread-like worms that infect the digestive tract of young children. Pinworms are most common among 4 to 6 year olds, but can infect anyone.

Pinworms live in the upper end of the large intestine, but migrate out of the anus at night to lay their eggs, causing other problems such as pruritis, vulvitis, and restless sleep. As the worms migrate out at night, they usually cause the child to scratch the anal area. When the child later sucks its thumb or licks its fingers, the eggs are ingested and the cycle begins again.

Because the eggs are very sticky and can survive on clothing, linens, etc. for days, whole families can ultimately become infected.

Infection with pinworms is most often characterized by rectal itching. In severe cases, however, there may also be abdominal pain and loss of appetite.

If you suspect pinworms, you can find out for sure by going into your child's darkened bedroom a few hours after bedtime and shining a flashlight on the child's anus. The light will make the worms move back into the anus. If you don't see worms after checking for 2 to 3 nights, the child is probably not infected. If you are still concerned, however, consult your health care provider.

If you do find pinworms, try the following home treatments:

If you continue to see worms after three days of treatment, consult your doctor. You may need a prescription medication. Your doctor may also ask you to obtain pinworm specimens on a cellophane tape for your doctor's visit.

Keep in mind, to prevent pinworm infection or reinfection:

Keeping Them Clean: Handwashing Can Reduce Their Sick Days and Ours

In a recent survey, 9 in 10 adults (94%) said they washed their hands after using public restrooms; but, upon observation only 6 in 10 (68%) actually did so.

In New York, only 60% of those observed washed their hands after using a public restroom. In Chicago, however, 78% washed their hands, followed by adults in New Orleans (71%), San Francisco (69%), and Atlanta (64%). (Texans were not observed in the survey.)

Across all cities observed, women washed their hands more often than men (74% vs. 61%).

Americans are most likely to say they wash their hands after changing a diaper (78%) and before handling or eating food (81%), but less likely when petting an animal (48%), coughing or sneezing (33%), or handling money (22%) (American Society for Microbiology, 1996).

Keeping our kids healthy and in school throughout the school year can often be a challenge. With so much contact with other children, it seems inevitable that our children will wind up sick. For many, this means, not only lost days at school for our children, but lost time at work for us. It can even result in the entire family becoming sick.

This does not have to be the case. As we have seen in discussing some common contagious infections (see "Guess What I Brought Home from School"), simply washing our hands and teaching our kids to do the same can prevent numerous germs, viruses, and bacteria from infecting our families.

But... Running our hands quickly under a few drops of cold water is not going to do the trick! We are often in such a hurry to eat, pack lunches, rush the kids off to the school bus and ourselves back to work that we either forget or "don't have time" to wash our hands thoroughly. Our children watch us and learn these same hurried practices, which are not effective in eliminating germs.

So...what works? First we have to understand that our skin constantly makes oil, which stays on the surface of the skin. Germs that get on your skin get trapped in this oil. Washing your hands with soap and warm or hot water is the best way to sluff the germs off of your hands and keep you healthy.

Remember that washing and drying your hands appropriately makes a big difference:

We also need to teach our children when to wash their hands. We can do this by using "before" and "after" to help them remember.

What About Antibacterial Soaps and Waterless Hand Sanitizers?

Though antibacterial soaps can help to kill some germs, they do not kill all germs no matter how strong the soap is or how long it sits on your hands. Without appropriate handwashing antibacterial soaps cannot be totally effective. It is still essential to spend enough time washing germs away from the skin.

The same is true of waterless hand sanitizers. If you are in a situation where no running water is available, then certainly, it is better than nothing. Again, however, waterless sanitizers cannot kill all harmful germs, and it doesn't get germs off your hands. Soap and warm, running water is still the best choice (Perdue, 1998).

Food Safety at School: "Safe Sacking"

Twelve million cases of food poisoning occur annually. For most people, food poisoning is usually unpleasant, but not terribly serious; however, 9,000 people die annually from foodborne disease. Unfortunately, most bacteria that cause foodborne illness cannot be seen, smelled or tasted. The way to control their growth is to prevent conditions that allow them to multiply.

Children's sack lunches can pose a challenge because you need to pack nutritionally-sound lunches, but also need to make the portable meals safe and fun to eat. Just remember to practice "safe sacking":

Keep in mind, certain foods are not safe at room temperature, such as:

Try these "safe at room temperature" foods instead:

(Written by Mary Anthony, Extension Agent-Expanded Nutrition, Texas AgriLife Extension Service.)

Nifty Lunch Ideas

- Mary Anthony, Extension Agent Expanded Nutrition, Texas AgriLife Extension Service

Activity Ideas and Resources for a Healthy Mind and Body

Math Practice

While shopping for food and packing lunches, you can get your kids to help you...and help them to build their math skills.

  1. Have your child help you with recipes and directions while you are cooking. Most recipes use fractions and what better way to learn math than with food. Directions on food packages can also strengthen math skills and following directions.
  2. Have your child count out the change when making purchases.
  3. Practice estimations by having your child estimate the weight of fruits and vegetables at the grocery store. Then have your child weigh them on the store scales and compare the actual weight to the estimated weight. (Lampasas County Family and Consumer Sciences Committee, 1998).

Handwashing

Contact the following for resources to promote handwashing:

Head Lice

Contact the following for resources and program ideas regarding head lice:

Immunizations

Contact the following for resources and program ideas on immunizations:

Institute Health Activities

Don't forget to attend the following health-related sessions at the Children, Youth, and Families Institute in Austin, August 25-27, 1998. You'll receive lots of creative ideas and free materials.

Walk Across Texas (WAT) Session: You'll receive the WAT training and kit, including short classes called "Health Breaks."

Family Self-Care: Healthwise Session: You'll receive hands-on training, a training manual, and Healthwise Handbook.

Breast Self-Exam Certification Session: You'll receive training in breast self-exam and free breast models to use in your educational programs.

You've Got My Attention: Creative Cancer Prevention Programming Session: Receive all kinds of new and innovative strategies for teaching and programming that can be related to cancer prevention, along with a low cost exhibit board and display.

Additionally, don't forget to pick up your Health Fair Planning Guide. This guide includes hands-on health fair activities and scavenger hunt ideas. Pick your copy up at registration. (These will only be available to County Extension Agents-FCS.)

Websites with Reliable Information

References

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