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With all the sore throats, runny noses, intestinal disorders, and allergies that plague our kids, childhood must sometimes seem like a constant blur of illnesses--especially to the parent doing the nursing. But even though these ailments are debilitating and take an enormous toll on the young patient, most of the problems clear up pretty quickly, are not life-threatening, and carry few long-term effects. (See the appropriate chapters for information on these disorders.)

Even so, parents still need to be particularly vigilant about safeguarding their children's health. The recent rise in the incidence of serious diseases--including whooping cough, rubella, measles, mumps, and hepatitis B--makes a compelling case for keeping vaccinations up-to-date. One of the latest vaccines, now recommended for all newborns, is for hepatitis B, a viral infection that causes an inflamed liver, and may lead to chronic infection and even cancer of the liver.

Routine medical checkups, proper diet, and plenty of rest are also essential to give children the protection they need. When a child falls ill or shows any unexplained or persistent symptoms, prompt medical advice and attention are crucial. This strategy helps keep minor illnesses from getting out of control and ensures early treatment for more serious disorders.

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Treating the Diseases of Childhood

Despite great strides in preventive medicine, many familiar diseases of childhood continue to haunt us. Here's a closer look at the most common, and the ways they are treated today.

Chickenpox

Chickenpox remains one of the most prevalent childhood diseases, occurring most frequently in those between two and eight years of age. This highly contagious disease begins with a slight fever, loss of appetite, and malaise. Next, the distinctive itchy, blister-like rash appears, usually on the trunk or scalp at first, later spreading over the body. Scratching the blisters may result in scarring, impetigo, boils, and other infections. Children mustn't scratch.

Children must be isolated until the blisters are crusted, usually five to seven days from the time of onset. The contagious period starts one or two days before the rash appears, so keep an eye on your child if he or she has been around someone who later broke out in a rash. The time between exposure and onset of the illness is usually 14 to 16 days. Cases have been known to occur as early as 11 or as late as 20 days after exposure.

Treatment of chickenpox consists of acetaminophen (Tylenol) and daily baths with lukewarm water. The doctor may prescribe an antihistamine such as Benadryl to help reduce itching. Trimming the child's fingernails minimizes the possibility of scarring. Medical care generally isn't necessary unless the child's temperature exceeds 102 degrees, or if the fever lasts for more than four days. In severe cases, acyclovir (Zovirax) may be prescribed. If the rash becomes very warm, red, or tender, the child may have a bacterial infection that requires antibiotics, and a physician should be called. Prompt medical treatment is also necessary if a child shows confusion, nervousness, vomiting, convulsions, lack of responsiveness, poor balance, or increasing sleepiness.

A vaccine for chickenpox (Varivax) is now available. Check with your pediatrician about getting this new type of shot.

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Measles

There is a vaccine for measles, yet the number of cases in the United States rose from fewer than 1,500 in 1983 to 27,672 cases in 1990. Measles may well be the most serious communicable disease of childhood, and it is also becoming more prevalent in adolescents and young adults who did not respond to vaccination. Authorities now recommend a second measles, mumps, rubella vaccination after age five.

The incubation period for measles lasts from seven to 14 days. The disease is most communicable during the three to five days before the rash appears. Pre-rash symptoms last four to five days and include malaise, loss of appetite, inflamed eyelids, fever, sensitivity to light, hoarseness, runny nose, and a severe cough. Toward the end of this period, tiny, bluish-gray specks encircled by red appear in the mouth. A day or two after their appearance, the temperature shoots up, the oral spots slough off, and an itchy rash appears behind the ears and on the neck and cheeks.

The final stage of measles is marked by a high fever, puffy, red eyes, extensive rash, and a severe cough. Symptoms usually disappear--and communicability ends--five days after the rash begins.

Treatment of measles consists of bed rest and isolation. Vaporizers and a warm room help relieve respiratory symptoms; taking acetaminophen reduces the fever.

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Mumps

Mumps, an acute viral disease, is most common in children between the ages of five and nine years. The disease is transmitted in the saliva of an infected person and has an incubation period of 14 to 24 days.

Mumps begins with a headache, muscle pain, low-grade fever, loss of appetite, and malaise. The next wave of symptoms includes an earache, along with swelling and tenderness in the parotid, and, possibly, other salivary glands. Possible complications include swelling and inflammation of the testicles in males past puberty, abdominal pain, nausea, fever, vomiting, and chills. Meningitis develops in about 10 percent of the cases, but does not usually lead to long-term problems.

Treatment for mumps includes acetaminophen to ease the pain and fever and adequate fluid intake. If swallowing is difficult, it may be necessary to replace the fluids intravenously.

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Whooping Cough

In the past few years, approximately 4,200 cases of whooping cough (Pertussis) have been reported annually in the United States. Whooping cough may produce shock, seizures, pneumonia, and other serious side effects, especially in children younger than 12 months of age.

Whooping cough is highly contagious, and is marked by sudden fits of coughing followed by a high-pitched whooping sound when the child inhales.

The incubation period for whooping cough is seven to 10 days. The first symptoms include thick mucus, a hacking cough, loss of appetite, sneezing, conjunctivitis, listlessness, and, sometimes, a low-grade fever. The next stage is marked by an increasingly spasmodic cough and possible choking on mucus. The characteristic cough may be triggered by respiratory infections that occur months after this illness subsides. Infants often must be hospitalized for supportive care. Antibiotics such as erythromycin are sometimes administered.

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Mononucleosis

Mononucleosis is a viral disease frequently contracted by teenagers. Preschoolers also get mononucleosis, although symptoms may be so mild that the disease is often overlooked. Mononucleosis is caused by the Epstein-Barr virus, which appears intermittently in the mouth of anyone ever infected by it. The disease is usually contracted from someone who is not ill at the time of contact. Symptoms of mononucleosis include fever, sore throat, headache, extreme fatigue, swollen lymph nodes, and possibly a rash. The symptoms tend to subside after six to 10 days, but sometimes may continue for weeks.

Treatment consists of bed rest and acetaminophen. In rare cases, steroids such as prednisone are given if swelling of the tonsils obstructs the airway and makes it hard for the person to breathe.

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Other Childhood Diseases

Rubella (German measles) appears most frequently in children between the ages of five and nine years, adolescents, and young adults. The rash is the first sign of disease in children. In adults, the rash, if it develops at all, follows a low-grade fever, loss of appetite, malaise, headache, and swollen glands. In either case, the rash spreads, then disappears rapidly, and usually is completely gone after four to five days. In both children and adults, symptoms may be minimal, or may not appear at all. Treatment includes isolation until the rash disappears plus acetaminophen for pain and fever. Thanks to widespread use of rubella vaccine, the disease is now very rarely seen.

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Reye's syndrome is a very rare, but acute and extremely serious childhood disease that usually appears one to three days following a viral illness such as an upper respiratory infection or chickenpox. The child typically recovers from the initial infection only to relapse a few days later with intractable vomiting, mild to severe confusion, agitation, and irritability. The syndrome often progresses to coma and is fatal in 20 percent of the cases. Needless to say, you should contact a doctor immediately if any of these symptoms appear. And, since aspirin increases the risk of Reye's syndrome, give your child acetaminophen instead.

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Pinworms are the most common type of worms found in children. Rectal itching at night is the first--and sometimes the only--symptom. The itching can disturb the child's sleep and result in irritability, skin irritation, and scratching. Treatment usually consists of anti-worm medication such as mebendazole (Vermox).

Other childhood diseases include ringworm, lice, and appendicitis. Children also commonly suffer from allergy, dermatitis, middle-ear infections, anemia, asthma, croup, diarrhea, warts, nosebleeds, and impetigo.

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