Ask the Expert

Giving 'tweens and teens the human papillomavirus vaccine called Gardisil® before they are sexually active and exposed to HPV can cut the risk of cervical cancer by 70 percent, according to the American Academy of Pediatrics. With all of the media attention surrounding the vaccine, it is natural for parents to have many questions. Some of the most common questions include:

Which age group is recommended for the vaccine?
Girls and women age 13 to 25 who are not sexually active are encouraged to receive Gardisil®, which is given in a series of three injections over a six-month period.

Why is the vaccine recommended for 'tweens and teens?
The vaccine is most effective in girls who are not sexually active and have not acquired one of the 40 types of the HPV virus that are high-risk and associated with cervical cancer, as well as pharyngeal, or throat cancer. Gardisil® specifically targets these two types of cancers and two types of genital warts.

Why can’t boys receive the vaccine?
The vaccine has only been FDA approved for girls at this time.  Currently, studies are being done to look at the effectiveness of the vaccine in males as well.  If approved for use in males, it will have the benefit of preventing some types of throat cancer and decreasing the spread of genital warts to females.

Are there any side affects from receiving the vaccine?
There may be minor side affects from the vaccine such as local irritation, pain or fainting. Patients are monitored after the vaccine is injected to watch for fainting.

Gardisil® has been tested for five years. Because it has a lasting immunity, a booster shot is not recommended for children receiving the vaccine.

FAST FACT: The HPV vaccine is the first vaccine that specifically targets cancer.

Sarah J. Lerand, MD, MPH, is a physician in the Adolescent Health and Medicine Program at Children’s Hospital of Wisconsin. The program sees 'tweens and teens for issues related to nutrition, general physical development, concerns related to puberty, assessment for eating disorders, stress and anxiety, depression and developmental and transitional periods complicated by chronic illness, developmental or learning disorders.

Children's Hospital is Growing UP! Take a virtual tour at thisismychildrens.org. 

Before the school buses return to their routes, it is time to start thinking about your child’s back-to-school physical. The American Academy of Pediatrics recommends a yearly physical for all school-aged children. Many summer camps, schools and sports require that a physical card be updated every two years. Here are some things you can expect at the exam:

• Medical history. An important part of every check up is the medical history. Nutrition, diet and exercise should be discussed. The doctor should be made aware of activities your child is involved in to consider risks, physical maturity and readiness. This also is a good time to review ongoing medical problems, like asthma or allergies, refill medications and complete medication sheets for school. The doctor will likely need to spend some time alone with teens in order to review confidential information related to drinking, smoking, drugs, sexual activity and depression. Write down questions for the doctor beforehand. Common questions during the medical history include:
• Were there missed school days last year?
• Any serious or recurring sports injuries?  
• Any visits to the emergency room, urgent care or another medical specialist?
• Has your child started any new medications, vitamins or supplements?
• Has your child been successful in school and maintained friendships?
• Medical exam. The medical exam begins with height, weight, blood pressure and comparison to past measurements. A child’s growth is one of the best indicators of overall health. A head-to-toe exam should be performed. After the exam, the physician will determine if any laboratory, X-ray or other tests are necessary. Vaccination history should be checked and shots should be updated. Vision and hearing may be screened. Forms for school, camp or sports can then be completed.
  

A healthy childhood means balancing home life, school, social activities, sports and extracurricular activities. An annual visit to the pediatrician can help ensure your child is fit to participate and can head off illness or injury with guidance and treatment of ongoing medical issues.

FAST FACT: Children’s Medical Group physicians provide primary and behavioral care for children in 18 clinics throughout southeastern Wisconsin. In addition, Children’s Medical Group oversees school-based health centers located in central city Milwaukee Public Schools.

Mary Lehrmann, MD, FAAP, is a pediatrician at Children’s Medical Group-Westbrook Pediatrics.



 

Food-borne illness can occur in any home. Symptoms of food-borne illness resemble the flu and include nausea, vomiting and diarrhea. Because of their small body sizes, young children are even more at risk.

These tips about safe storage, handling and preparation of food will help you prevent the spread of bacteria in your kitchen:

• Always wash your hands and cutting boards or other food preparation surfaces with hot, soapy water before preparing any food and after handling raw meat, poultry, seafood and eggs.
• Always use a food thermometer when you cook. A food thermometer will help you make sure your food has reached a high enough temperature to kill harmful bacteria.
• Cook all meat and poultry at an oven temperature of at least 325 degrees.
• Do not thaw raw fish in the refrigerator for more than 24 hours. Raw poultry or ground beef will keep one to two days and raw red meat three to five days.
• Thaw frozen foods under lukewarm running water, in the refrigerator or in the microwave. Meats thawed in the microwave must be cooked immediately. Do not thaw foods on the countertop.
• Never put cooked food on a plate that was used for raw meat.
• Always refrigerate leftovers within two hours of eating.
• You can put the kitchen sponge, washcloth or scouring pad in the microwave for one minute or run it through the dishwasher to help prevent bacteria growth.

FAST FACT: Consult your child's doctor if your child has symptoms that include high fever, blood in the stools, prolonged vomiting or signs of dehydration, including a decrease in urination, a dry mouth and throat, and dizziness when standing up.

Heather Fortin, RD, CD, CSCS, CLC, is a registered dietitian with the NEW (Nutrition, Exercise and Weight Management) Kids Program™ at Children’s Hospital of Wisconsin.
 

Proper hearing is essential to a child’s ability to develop speech and language skills, as well as his or her cognitive, social and emotional development. The first few years of a child’s life are particularly important. During this time, children learn to make sense of sounds via their ears, working in conjunction with their brains. The importance of these early years is what prompted many states to initiate hearing tests for all newborns. Early detection and appropriate intervention are key factors in eliminating or minimizing the negative impact of hearing loss.

Despite the importance of early intervention, on rare occasions parents still are told their child is too young for a hearing test. Very young children can be tested. Here are some of the more common tests:
 
Visual reinforcement audiology
This is a behavioral testing technique typically used with children between 6 months and 3 years old. In a special booth, the child is seated on a parent's lap with speakers situated on either side. An audiologist transmits speech and different pitches of sounds through the speakers. When the child hears the voice or sounds and looks in the direction of the sound, an animated, lighted toy appears. Using this type of visual reinforcement, the child eventually learns to look toward the source of the sound when he or she hears it, allowing the audiologist to evaluate the child’s hearing.

Conditioned play audiometry
This test typically is used for children between 3 and 5 years old. While wearing headphones, the child is encouraged to play a listening game. Different sound pitches are introduced through the headphones, and the child is taught to perform a task, such as putting a block in a bucket every time a sound is heard. If the child is willing and able, his or her ability to hear and understand speech also can be assessed by using a picture-pointing task or repeating words. By having the child wear headphones, the audiologist is able to determine the level of hearing in each ear.

Conventional audiometric testing
Most people are familiar with this test. It typically can be used with children age 5 and older. With headphones on, the child is asked to raise his or her hand every time different sounds or pitches are heard. In addition, the child’s ability to detect and understand speech is evaluated by having him or her repeat words.

Newborns, very young infants and some children with special needs, such as visual difficulties, cognitive or physical impairments, and/or behavioral issues, may not be able or willing to perform some of these tests. In these situations, audiologists rely on electrophysiological tests that do not require any responses from the child. These tests include auditory brain stem response evaluations and auditory steady state response testing. During these noninvasive and painless tests the child typically is sedated. Headphones generate a series of clicking sounds, and electrodes attached to the child’s head record neural responses. Using these tests, audiologists are able to obtain very good, objective estimates of a child’s hearing status.

If you have concerns about your child’s hearing, discuss them with your pediatrician. Masters Family Speech and Hearing Center at Children’s Hospital of Wisconsin offers comprehensive hearing tests by audiologists who specialize in working with kids.

FAST FACT: If you have concerns with your child’s hearing, don’t dismiss them just because he or she passed a newborn hearing screening. It is not uncommon for children to develop temporary hearing problems, such as fluid behind their eardrums, which require medical attention. On rare occasions, a progressive, possibly permanent hearing loss may develop that was not present at birth.

Catherine Holland, MS, CCC-A, is a pediatric audiologist with Masters Family Speech and Hearing Center at Children’s Hospital of Wisconsin.

 

Fourth of July activities can provide a fun-filled time for families. But, fireworks needlessly injure children every year.

Children ages 10 to 14 suffer from fireworks-related injuries more than any other age group. Sparklers, often considered the safest of fireworks, are most frequently linked to injuries among children age 5 and under.

To prevent accidents, keep these firework safety tips in mind during the Fourth of July:

• The best way for families to enjoy the holiday's festivities is to leave the fireworks to the professionals. Attend public firework displays where your whole family can watch the show from a distance.
• If your family has purchased fireworks, make sure your children do not use them, including sparklers.
• Discuss the dangers of fireworks with your children. Tell them never to purchase fireworks or accept them from friends, and to stay away from those who are using fireworks.
• Always have water handy–a hose or bucket of water–when using fireworks or sparklers.
• Never make your own fireworks.
• Don’t allow your child to pick up pieces of fireworks after an event. Some still may be ignited and can explode unexpectedly.

FAST FACT: Children, age 5 and younger, account for one third of all firework injuries. Keep your children away from fireworks, especially sparklers, because they can reach temperatures up to 1,800 degrees Fahrenheit.

Elizabeth Cleek, RN, MS, APNP, is an advanced practice nurse with the Trauma Program at Children’s Hospital of Wisconsin.