Sex education: Start discussions early

It's never too early to start talking to your children about sexual matters. Openness, even with young children, will show that sex is an acceptable topic of conversation. Teach your child that you are available to discuss sexual issues, and establish a comfort level — for both of you — with the topic.

Don't feel like you have to include everything in one big discussion. Instead, talk about questions and behaviors as they occur.

Toddlers explore themselves

Between the ages of 18 months to 3 years, children begin to learn about their own bodies. Teach your child the proper names for sex organs. Otherwise, he or she might get the idea that something is wrong with these parts of the body.

It's normal for a child to explore his or her body and to do what feels good. Self-stimulation is one way a child's natural sexual curiosity is manifested. Boys typically pull at their penis, and girls rub their external genitalia.

The concept of privacy

This may be a good time to teach your child about privacy. Masturbation is a normal, but private, activity. If your child suddenly starts masturbating in the middle of a play group, try to distract him or her. If that fails, take your child aside for a reminder about the importance of privacy.

Sometimes, frequent masturbation can indicate a problem in the child's life. Perhaps he or she is under a lot of stress, or isn't receiving enough attention at home. It can even be a sign of sexual abuse. Teach your child that the parts of the body covered by a bathing suit are private, and that no one should be allowed to touch them without permission.

Curiosity about others

By the age of 3 or 4, children are ready to know that boys and girls have different genitals. To satisfy their normal curiosity about each other's sex organs, children may play "doctor" or matter-of-factly take turns examining each other. This exploration is far removed from adult sexual activity, and it's harmless when only young children are involved. As a family matter, however, you may want to set limits on such exploration, discouraging it if you see it going on.

At this age, many children ask the dreaded question: "Where do babies come from?" Try to give a simple and direct response, such as: "Babies grow in a special place inside the mother." As your child matures, you can add more details.

Segregation of the sexes

Between the ages of 5 and 7, children become more aware of their gender. Boys may tend to associate only with boys, and girls only with girls. In fact, they may even say they hate children of the opposite sex.

At this age, questions about sex will become more complex, as your child tries to understand the connection between sexuality and making babies. He or she may turn to friends for some of these answers.

Because children can pick up faulty information about sex and reproduction, it may be best to ask what your child knows about a particular topic before you start explaining it.

Preteen angst

Children between the ages of 8 and 12 worry a lot about whether they are "normal." Penis size and breast size figure heavily in these worries. Children of the same age mature at wildly different rates. Reassure your child that he or she is well within the normal range of development.

What kids should know before they reach puberty

The American Academy of Pediatrics recommends that before they reach puberty, children should have a basic understanding of:

* The names and functions of male and female sex organs
* What happens during puberty and what the physical changes of puberty mean — movement into young womanhood or young manhood
* The nature and purpose of the menstrual cycle
* What sexual intercourse is and how females become pregnant
* How to prevent pregnancy
* Same-sex relationships
* Masturbation
* Activities that spread sexually transmitted diseases (STDs), in particular AIDS
* Your expectations and values

Be honest, open and matter-of-fact

Talking about sexual matters with your child can make you both feel uncomfortable and embarrassed. Let your child guide the talk with his or her questions. Don't giggle or laugh, even if the question is cute. Try not to appear overly embarrassed or serious.

If you have been open with your child's questions since the beginning, it is more likely that your child will come to you with his or her questions in the future. The best place for your child to learn about relationships, love, commitment and respect is from you.
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Headaches and kids: More common — and complicated — than you think

Kids are always getting stomachaches and rashes. But headaches? Strictly for grown-ups, right?

Wrong. The majority of school-age children get headaches, and many have headaches on a recurrent basis. Even before entering school, roughly one-third of children experience a headache at some point.

You know the pain is real, but what can you do? Find out what's triggering your child's head pain and identify measures you can take to help.

What causes children's headaches?

A number of factors, singly or in combination, can make your child headache-prone. These factors include:

* Genetic predisposition. Headaches, particularly migraines, tend to run in families. If you have a family history of bad headaches, your child will have a higher risk of getting them too.
* Head trauma. Accidental bumps and bruises can cause headaches. Although most head injuries are minor, seek medical attention right away if your child falls hard on his or her head. Also contact a doctor if your child has a steadily worsening headache after a bang on the head.
* Illness and infection. Headache is a frequent symptom of many common childhood illnesses. Ear infections, sinus infections, colds and flu are often accompanied by headache.
* Environmental factors. Conditions in the environment, including weather changes, odors, loud noises and bright light all can cause headaches.
* Emotional factors. Peer pressure, school problems and parental expectations can lead to high levels of stress and anxiety. Children with depression may complain of headaches, particularly if they have trouble recognizing feelings of sadness and loneliness.
* Certain foods and beverages. The food additive monosodium glutamate (MSG), found in such foods as bacon, bologna and hot dogs, has been known to trigger headaches. Also, caffeine, which is in soda, chocolate, coffee and tea, can cause headaches.
* Sleep deprivation. Overtiredness may cause headaches in children.
* Inadequate hydration. Lack of fluids can also cause headaches.

What kind of headache does your child have?

Headaches are typically hard to describe, especially for children. Some headaches are related to stress, while others are the result of an illness or injury. All headaches, though, are classified into two main categories — primary and secondary.

Primary headaches

Primary headaches develop by themselves rather than as a result of illness or injury. Headaches in this category include:

* Tension-type headache. Often stress related, this type accounts for many children's headaches. If your child has this type of headache, he or she may complain of a tightening or pressure in the head, neck and skull muscles.
* Migraine. Approximately 10 percent of school-age children experience migraines. Before children reach puberty, migraines affect about the same number of boys as girls, but in the teen years, girls tend to have migraines more often than boys do. While a migraine lasts, it may be disabling, causing not just pain but nausea, vomiting and extreme sensitivity to light and sound. Unlike tension-type headaches, migraines often occur during nonstressful or recreational times.
* Cluster headache. This is the least common type of headache in children. It's usually disabling and involves a sharp, stabbing pain on one side of the head.

Secondary headaches

Secondary headaches result from some underlying condition such as:

* Fever
* Head trauma
* Cold
* Sinus infection
* Strep throat
* Ear infection
* Meningitis
* Temporomandibular joint disorders (TMJ) and other jaw-related problems
* Medication side effects

Is your child's headache chronic?

Because children's headaches have many possible causes, each child needs a personal evaluation. As a rule of thumb, though, your child should see a doctor if he or she starts having headaches on a weekly basis or has any episode of head pain bad enough to keep him or her out of school or other activities. Children who are too young to tell you what's wrong may cry and hold their heads to indicate severe pain.

Two common types of chronic headache are:

* Transformed migraines. This happens when an occasional migraine occurrence turns into a daily occurrence.
* Rebound headaches. This can result from overusing certain over-the-counter and prescription medications for chronic tension-type headaches.

How do doctors diagnose chronic headaches?

Doctors diagnose most chronic headaches after taking a detailed medical history and performing a neurological exam.

Occasionally, this work-up suggests that an abnormality in the brain or skull may be responsible for a child's headaches. In these instances, imaging tests, usually performed in hospital radiology departments, can pinpoint the problem. The most common imaging techniques are:

* Computerized tomography (CT). A CT scan is a diagnostic imaging procedure that uses a series of computer-directed X-rays to provide a comprehensive view of the brain.
* Magnetic resonance imaging (MRI). An MRI doesn't use X-rays. Instead, it combines magnetism, radio waves and computer technology to produce detailed images of the brain.

Preventing children's headaches

A few simple measures will prevent all but the occasional headache in a child:

* Insist on adequate rest. Young children and adolescents need plenty of sleep — eight to 10 hours minimum. On the flip side, too much sleep can cause headaches, so don't let your child sleep the day away.
* Provide a healthy diet. Make sure your child eats breakfast, lunch and dinner and has healthy snacks to choose from throughout the day. Also, make sure your child drinks enough water, particularly in hot weather and after strenuous activity.
* Take steps at the first sign of a headache. If you think your child is developing a headache, encourage him or her to take a nap — if possible, in a dark, quiet room.
* Keep a headache diary. Note times and places that headaches occur. Also describe any thoughts, behaviors or events that occur with headaches. Use information from the diary to help your child avoid possible headache triggers. Wait for the child to volunteer that he or she has a headache rather than soliciting the symptom.
* Avoid stressors. Be alert for things that may be causing stress in your child's life, such as difficulty doing schoolwork or strained relationships with peers. If your child's headaches are linked to anxiety or depression, consider talking to a counselor.

Baseline prevention consists of a predictable daily routine, adequate rest, and healthy meals and snacks. Over time, the items you note in the headache diary should help you understand your child's symptoms and take specific preventive measures.

Treating children's headaches

Treatment depends on the type of headache. It may include:

* Behavior therapy. Stress- and anxiety-related headaches are often the culmination of several physical and emotional factors. If your child shows signs of stress — behavioral changes, eating and sleep disturbances, lack of interest in favorite activities — he or she may benefit from professional and peer counseling.
* Over-the-counter medications. Pain relievers such as acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others) relieve the immediate symptoms of mild headaches. Both ibuprofen and acetaminophen reduce fever too. Don't give aspirin to children under age 16 unless instructed to do so. Aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition in children.
* Prescription medications. Ergotamine and the triptan medications, such as sumatriptan, zolmitriptan and rizatriptan, relieve migraines already in progress. Other prescription drugs, including tricyclic antidepressants, beta blockers, calcium channel blockers and anticonvulsants, are taken regularly to prevent frequent and disabling migraines.

Remember, the medication strategy differs from child to child. Ask your doctor or pharmacist if you have questions. Keep these points in mind:

* Read labels carefully. Use only the dosages recommended for children, not adults. Some products come in infant, child and adult strengths but may look the same.
* Don't give doses more frequently than recommended.
* Ask about possible side effects of any medication.

Bottom line: If your child has chronic headaches, you can do more than simply surrender to the condition. Get help to find out how you can make a difference.
source from www.cnn.com

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Teen weight loss: Safe steps to a healthy weight

Teenage obesity is a dangerous — and growing — problem. But what can you do about it? Plenty. Turn your concern about your teenager's weight into action.

There's no magic bullet for teen weight loss. The key to success is adopting healthy habits that can last a lifetime.

Start with a heart-to-heart

If your teen is overweight, he or she is probably concerned about the excess weight, too. Aside from lifelong health risks such as high blood pressure and diabetes, the social and emotional fallout of being overweight can be devastating for a teenager. Offer support and gentle understanding — and a willingness to help your teen take control of the problem.

You might say, "I can't change your weight. That's up to you. But I can help you make the right decisions."

Dispute unrealistic images

Weight and body image can be delicate issues — especially for teenage girls. When it comes to teen weight loss, remind your teen that there's no single ideal and no perfect body. The right weight for one person might not be the right weight for another.

Rather than talking about "fat" and "thin," encourage your teen to focus on practicing the behaviors that promote a healthy weight. Your family doctor can help set realistic goals for body mass index and weight based on your teen's age, height and general health.

Resist quick fixes

Help your teen understand that losing weight — and keeping it off — is a lifetime commitment. Fad diets may rob your growing teen of iron, calcium and other essential nutrients. Weight-loss pills and other quick fixes don't address the root of the problem. And the effects are often short-lived. Without a permanent change in habits, any lost weight is likely to return — and then some.

Promote activity

Like adults, teens need about 60 minutes of physical activity a day. But that doesn't mean 60 solid minutes at a stretch. Shorter, repeated bursts of activity during the day can help burn calories, too.

Team sports through school or community programs are great ways to get active. If your teen isn't an athlete or is hesitant to participate in certain sports, that's OK. Encourage him or her to walk, bike or in-line skate to school, or to walk a few laps through the halls before class. Suggest trading one hour of after-school channel surfing for shooting baskets in the driveway, jumping rope or walking the dog. Even household chores such as vacuuming and washing the car have aerobic benefits.

Eat breakfast

If your teen fights the alarm clock the way it is, getting up even earlier to eat breakfast may be a tough sell. But it's important. A nutritious breakfast will jump-start your teen's metabolism and give him or her energy to face the day ahead. Even better, it may keep your teen from eating too much during the rest of the day.

If your teen resists high-fiber cereal or whole-wheat toast, suggest last night's leftovers. Even a piece of string cheese or a small handful of nuts and a piece of fruit can do the job.

Snack wisely

It can be tough to make healthy choices when school halls are lined with vending machines, but it's possible. Encourage your teen to replace even one bag of chips a day with a healthier grab-and-go option from home:

* Frozen grapes
* Oranges, strawberries or other fresh fruit
* Sliced red, orange or yellow peppers
* Cherry tomatoes
* Baby carrots
* Low-fat yogurt or pudding
* Pretzels
* Graham crackers
* String cheese

Watch portion sizes

When it comes to portions, size matters. Encourage your teen to scale back and stop eating when he or she is full. It might take just one slice of pizza or half the pasta on the plate to feel full — and there's no shame in sharing a meal, ordering a smaller portion or taking home leftovers.

Count liquid calories

The average 12-ounce can of soda has 150 calories and 10 teaspoons of sugar. The calories and sugar in fruit juice, specialty coffees and other drinks can add up quickly as well. Drinking water instead of soda and other sugary drinks may spare your teen hundreds of calories and a day's worth of sugar — or even more. For variety, suggest flavored water, seltzer water or unsalted club soda.

Allow occasional treats

Late-night pizza with friends or nachos at the mall don't need to derail your teen's healthy-eating plan. Suggest a breadstick and marinara sauce instead of garlic bread dripping in butter and cheese, or a shared snack rather than a full-size order. Let your teen know that he or she is in control — and an occasional indulgence is OK. A trend toward healthier habits is what really matters.

Make it a family affair

Rather than singling out your teen, adopt healthier habits as a family. After all, eating healthier foods and getting more exercise is good for everybody.

* Encourage the entire family to eat more fruits, veggies and whole grains. Be sure to set a good example yourself.
* Leave junk food at the grocery store. Healthy foods sometimes cost more, but it's an important investment.
* Try new recipes or healthier alternatives to family favorites.
* Banish food from the couch to curb mindless munching.
* Plan active family outings, such as evening walks or weekend visits to a local recreation center.

Be positive

Being overweight doesn't inevitably lead to a lifetime of low self-esteem. But your acceptance is critical. Listen to your teen's concerns. Comment on his or her efforts, skills and accomplishments. Make it clear that your love is unconditional — not dependent on weight loss. Help your teen learn healthy ways to express his or her feelings, such as writing in a journal.

If your teen is struggling with low self-esteem or isn't able to cope with his or her weight in a healthy manner, consider a support group, formal weight-control program or professional counseling. Additional support may give your teen the tools to counter social pressure, cultivate more positive self-esteem and take control of his or her weight. The benefits will last a lifetime.
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Asthma sidelining your child? Playing sports safely

Physical activity is a common trigger of asthma symptoms in people with asthma. If you have a child with asthma, you are understandably concerned about preventing flare-ups when you can — but does this mean that you should keep your child from participating in sports? No. In fact, regular exercise can benefit asthmatic lungs by conditioning them to work more efficiently. You can take steps to protect your child during physical activity — even if you can't be there for every practice.

Control the asthma first

Before your child participates in sports, be sure that his or her asthma is under control. Controlled asthma means that your child isn't having regular symptoms and flare-ups are rare.

Each child's asthma control will be different based on symptoms and triggers, but typically a treatment plan involves a combination of long-acting medications to control the asthma over time, and short-acting inhalers for quick relief of symptoms. Many children will benefit from using a short-acting bronchodilator such as albuterol about 15 minutes before exercise.

If your child is on medication but continues to have symptoms or regular flare-ups, check with your child's doctor for possible changes to medications or dosages.

Choose activities wisely

Certain physical activities are more likely to cause asthma attacks, particularly those that are aerobic, high intensity and high endurance, such as:

* Basketball
* Cross-country skiing
* Cycling
* Ice hockey
* Long-distance running
* Rugby
* Soccer

Although some activities are more likely to cause symptoms, your child may be able to participate in any sport he or she chooses with the right medications and asthma control.

If your child is especially sensitive to exercise as a trigger, you may want to consider activities that are less likely to trigger asthma, such as:

* Baseball
* Golf
* Sprinting
* Swimming
* Weightlifting

While sprinting and swimming are aerobic activities, they are less likely to cause symptoms. Sprinting is high intensity, but doesn't require endurance. Swimming can be high intensity and high endurance, but the warm, humid environment usually protects those with asthma from having attacks. Golf usually requires less intense exercise; however, the outdoor exposure may trigger asthma for kids who also have allergies.

It's also important to consider your child's competitiveness. Younger children tend to slow down their activity level when they feel discomfort. Older children are more likely to push themselves to perform even when having asthma symptoms. This is usually because they want recognition or find satisfaction in competing on the same level as their peers. A combination of high-endurance sports and a high level of competitiveness can be dangerous for children with asthma. If you notice growing competitiveness in your child, be sure to continue to involve him or her in maintaining the asthma treatment plan. Better control of asthma may result in better athletic performance. Involving your child in the decision-making process makes it more likely that he or she will follow the plan.

Keep preventive tips in mind

In addition to controlling symptoms with medication, be sure your child follows these practical tips to avoid flare-ups:

* Always warm up and cool down. Help your child make it a habit to spend 15 minutes warming up before more intense physical activity, and to do another 15 minutes of cool-down after exercise. While it's a good recommendation for all athletes, warm-ups and cool-downs are especially important for those with asthma.
* Pay attention to environmental conditions. Cold temperatures, poor air quality and high concentrations of pollen in the air make conditions right for an asthma attack. If possible, encourage your child to stay indoors during these times. When the weather is cold, your child may be able to control symptoms by wearing a scarf or mask to warm the air before it enters his or her lungs.
* Exercise only when healthy. Asthma attacks are more likely during or immediately after a cold or other respiratory infection. Wait a few days after cold symptoms subside before resuming physical activity.
* Use a peak flow meter to monitor airflow. A peak flow meter is a hand-held tool that monitors how well your child's lungs are working from day to day. With the help of your child's doctor, you first determine your child's average peak flow reading. A drop in the reading may indicate an increase in airway inflammation, even when your child feels fine. An abnormal peak flow reading prompts you and your child to take extra precautions that day to prevent an attack.

Communicate your child's asthma action plan

Every child with asthma should have an asthma action plan, which is a step-by-step guide for preventing, recognizing and treating an asthma attack. This important tool helps ensure that you, your child and other caregivers all follow the same plan if action needs to be taken.

Typical asthma action plans include a list of medications and dosages, symptoms and average peak flow readings, signs of an attack, when to seek emergency care, and contact numbers. Because teachers, coaches and other caregivers may have different levels of education on asthma, it's important that they know exactly what to do if your child needs help.

Make copies of your child's asthma action plan and give them to your child's school nurse, teachers and coaches, and be sure to regularly communicate the importance of knowing the plan and having it accessible in case of an attack.

With the help of your child's doctor, revise the plan regularly based on changing needs in different seasons, sports or ages as your child grows and treatments or symptoms change.

Asthma and sports can be a winning combination

Children with asthma can participate in sports; in fact, your child's condition may improve with regular physical activity. First, have an asthma action plan in place, and communicate regularly with your child's teachers and coaches. These and other practical steps allow your child to enjoy sports in an environment that keeps him or her safe.
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Asthma and school: Take a team approach

Asthma is the leading cause of school absences in the U.S., accounting for more than 14 million missed school days each year, according to the Asthma and Allergy Foundation of America. An asthma attack at school can be frightening for your child. Close communication with your child's school is essential in preventing and treating an asthma attack.
You can help keep your child from missing important school lessons and interactions with classmates by working with teachers and school personnel to be part of an asthma management team. Together, the members of the team can be sure your child's asthma will be kept under control.

Develop an asthma action plan

Work with your child's doctor to write an asthma action plan with step-by-step instructions to prevent and treat an asthma attack. Ask the doctor to help you personalize the plan for your child. Your child's asthma action plan is a crucial part of controlling and monitoring asthma symptoms while your child is in school. It can help you work closely with school personnel in two key ways:

Prevent an attack

* Help manage your child's medications.
* Identify asthma triggers and reduce your child's exposure.
* Take action based on symptoms and peak flow readings.

Manage an attack

* Recognize an asthma attack.
* Give quick-relief medications.
* Seek emergency care.
* Access contact information.

Build an asthma action team

Share your asthma action plan with all the adults who regularly interact with your child at school. Your asthma action team might include:

* School nurses
* Teachers, including music, art and physical education teachers
* Administrators, such as the school principal
* After-school caregivers
* Playground staff
* Bus drivers
* Cafeteria staff

Each of your team members needs to know about your child's asthma and how best to help keep your child's symptoms under control. Meet with the members of this team early in the school year to:

* Describe any medications your child takes, including how and when to use a peak flow meter
* Discuss how medications are given and any possible side effects
* Explain how your child can manage an asthma attack
* Encourage teachers to treat your child the same as other students, without drawing attention to his or her condition
* Discuss activities that may bring on symptoms, such as sports, gym class or field trips, and the limitations your child may have

Discuss medications at school

Talk with your asthma action team about how and when your child should take medicine at school. If your child feels self-conscious, try to arrange for him or her to take medication in a private area, without disruption or attention.

If your child is comfortable and his or her doctor approves, request that he or she be able to carry and use a metered dose inhaler without having to ask permission each time. The goal is to help your child feel comfortable about having asthma and taking medication.

Monitor the school environment

Look around your child's school for triggers that might set off an asthma attack. If asthma triggers can't be reduced or eliminated, you might be able to switch your child's homeroom to one that can be more accommodating. Pay attention to:

* Air quality and ventilation. Cigarette smoke and certain chemicals in the air can trigger asthma. Is your school free of tobacco smoke? Can the school reduce or eliminate allergens and irritants such as dust, pollen and freshly cut grass? Are chemistry and art classrooms well ventilated, so chemical vapors don't spread to the rest of the building?
* Classroom pets. Animal fur and dander are common allergens that can trigger an asthma attack. If pets are kept in classrooms, they may worsen asthma. But even having animals elsewhere in the school can trigger your child's asthma. Air circulation systems can spread animal dander to other parts of the building.
* Cleanliness. Dust can trigger allergies in some children. Are classrooms cleaned, dusted and vacuumed regularly? Is dust-free chalk used? Are storage areas kept free of dust? Are cleaning products used appropriately? Strong odors and chemicals in cleaning supplies can trigger asthma. Ask the school to use unscented and nonaerosol cleaners whenever possible.
* Moisture. Moisture can lead to mold, which can trigger asthma symptoms in some children. Are windows and interior surfaces free of condensation? Are classroom sinks and bathrooms free of leaks? Is standing water present in locker room showers? Is air conditioning used to keep the relative humidity in the school at 50 percent or below?

Stay in touch

Communicate with your asthma action team on a regular basis. Keep them informed of:

* Changes in your child's asthma symptoms or overall condition
* Medication changes
* Revisions to your child's asthma action plan, including your contact information
* Recent asthma flare-ups or attacks
* Specific times when asthma triggers may be a greater risk to your child, such as changes in the seasons or during times of increased anxiety or stress
Be proactive in managing your child's asthma at school. A team approach is key to keeping his or her asthma under control.
Monitor + control = prevention
It's important that your child's asthma be closely monitored to reduce his or her risk of an asthma attack at school. Make sure your child takes his or her asthma medications on a daily basis to control asthma symptoms. Regularly check his or her peak flow rates to help you and your child feel confident that his or her asthma is well controlled. Watch for peak flow rates that are abnormal or unstable — often an early sign that an asthma attack may be developing. Follow these steps to help prevent asthma attacks — at home and at school.
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Ambiguous genitalia

From MayoClinic.com
Special to CNN.com

Introduction

Boy or girl? It's one of the most common questions asked of brand-new parents in addition to the baby's weight and length. But what if the answer isn't so obvious? Such is the case for newborns with ambiguous genitalia, the medical term for a rare condition in which a newborn's external genitals don't appear to be clearly either male or female.

In ambiguous genitalia, the baby's genitalia may not be well-formed, or the baby may have general characteristics of both sexes.

Ambiguous genitalia can be very upsetting to parents and other family members, both because of the uncertainty involved and because of the social stigma attached to not knowing a child's sex right away. While ambiguous genitalia can present a difficult and complicated situation, medical advances can take much of the guesswork out of the process of assigning a sex to your child, and corrective surgery can help. Sometimes, despite the pressure to announce "girl" or "boy," it's best in the case of ambiguous genitalia to wait to make this important decision about your child's future.

Signs and symptoms

A newborn's genitalia are quite small, and the idea of looking "normal" spans a wide range. Your medical team will likely be the first to recognize the signs of ambiguous genitalia soon after your baby is born. These signs vary from the more obviously apparent to the outwardly invisible.

Characteristics in genetic females
For genetic females, the baby's genitals may take on the following characteristics:

* An enlargement of the clitoris, or what appears to be a small penis.
* A concealment of the vagina because the midline groove has closed over.

Characteristics in genetic males
For genetic males, the following characteristics may be present:

* A condition in which the narrow tube that carries urine and semen (urethra) doesn't fully extend to the tip of the penis (hypospadias).
* An abnormally small penis with the urethral opening nearer to the scrotum, indicating that the penis stopped growing early in its development.
* No recognizable male genitalia, in the most severe cases.

Causes

The genetic sex of a child is established at conception based on the 23rd pair of chromosomes it inherits. The mother's egg contains an X chromosome, and the father's sperm contains either an X or Y chromosome. A baby who inherits the X chromosome from the father is a genetic female (a pair of X chromosomes). A baby who inherits the Y chromosome from the father is a genetic male (one X and one Y chromosome).

In early fetal development, males and females are indistinguishable. Male and female sex organs develop from the same tissue in the fetus. For example, the same fetal tissue that forms a penis in a male also forms a clitoris in a female. The presence or absence of male hormones controls the development of the sex organs. Normally, male genitalia develop because of male hormones from the fetal testicles. In the female fetus — without the effects of male hormones — the genitalia develop as female.

A deficiency of male hormone in a genetic male fetus results in ambiguous genitalia. In a female fetus, the presence of male hormone during development results in ambiguous genitalia.

Although the deficiency or presence of male hormones is the main factor controlling genital development, the exact cause of ambiguous genitalia is often unknown. Many of the disorders seem to happen by chance.

Possible causes in genetic females
Causes of ambiguous genitalia in a genetic female may include:

* Congenital adrenal hyperplasia (CAH). Certain forms of this genetic condition cause the adrenal glands to make excess male hormones (androgens). Congenital adrenal hyperplasia is the most common cause of ambiguous genitalia in newborns.
* Ingestion by the mother of substances with male hormone activity, such as progesterone (taken in the early stages of pregnancy to stop bleeding).
* Tumors in the fetus or the mother that produce male hormones.

Possible causes in genetic males
Causes of ambiguous genitalia in a genetic male may include:

* Impaired testicle development due to genetic abnormalities or unknown causes.
* Leydig cell aplasia, a condition that impairs testosterone production.
* Congenital adrenal hyperplasia. Certain forms of this genetic condition can impair production of male hormones.
* Androgen insensitivity syndrome, a condition in which developing genital tissues are unable to respond to normal male hormone levels.
* 5 alpha reductase deficiency, an enzyme defect that impairs normal male hormone production.
* Ingestion by the mother of substances with female hormone activity, such as estrogens, or anti-androgens. This is unusual, but could occur if a woman taking birth control pills gets pregnant despite taking the pills — then, not knowing she's pregnant, continues taking the pills into pregnancy for several weeks. Also some "nutritional supplements" contain plant estrogens.

Risk factors

As is the case with many abnormalities, family history may play a role in the development of ambiguous genitalia. Possible risk factors associated with ambiguous genitalia include a family history of:

* Unexplained deaths in early infancy
* Infertility in close relatives
* Genital abnormalities
* Abnormal development during puberty

Because most causes of ambiguous genitalia are due to genetic abnormalities, the presence of similar abnormalities in family members is important. Having a family member with known congenital adrenal hyperplasia, infertility or abnormal pubertal development may indicate a genetic abnormality in the family. Also, a personal or family history of prior babies being born with genital abnormalities, or dying shortly after birth, may indicate an inherited abnormality that could result in future children being born with ambiguous genitalia.
When to seek medical advice

If both parents are carriers of congenital adrenal hyperplasia, there's the chance that their baby could develop ambiguous genitalia if he or she inherits the abnormal gene from both parents. Parents may not know they have congenital adrenal hyperplasia because as carriers they show no signs or symptoms of this condition.

If your family has a history of risk factors associated with ambiguous genitalia, seek medical advice before conceiving.
Screening and diagnosis

If your baby is born with ambiguous genitalia, you and your doctor will want to determine the underlying abnormality and extent of deformity. The first indication of ambiguous genitalia will be by a physical examination. Your doctor will likely recommend the following tests and procedures:

* Blood and urine tests to measure hormone levels
* Chromosome analysis to determine the genetic sex (XX or XY)
* Ultrasound to check for the presence of internal female sex organs
* A biopsy of your newborn's reproductive organs to determine if the organs will produce appropriate sex hormones for the sex assigned to the child
* A genitogram, a special X-ray to see if a vagina is present and its size

Using the information gathered from these tests, your doctor may suggest an appropriate sex for the baby.

Despite the social stigma attached to not knowing if your baby is a boy or a girl right away, some research shows that delaying gender assignment until the child is older may be of benefit. If the gender assignment is made too early, and the correct decision isn't made, the child may be confronted with difficult psychological and social issues later in life.
Complications

The outlook is good for many babies born with ambiguous genitalia in terms of their ability to conceive and be fertile later in life. However, for others born with ambiguous genitalia, the severity of the condition, complicated hormone levels and trouble adjusting to their assigned sex may make it difficult or impossible to conceive a child later in life.
Treatment

Management of ambiguous genitalia requires a team of doctors that may involve a number of specialties — pediatric endocrinology, neonatology, urology, plastic surgery, medical genetics and psychology. The timing of treatment depends on a child's specific situation. Your medical team can explain to you the options available for your child and likely suggest a course of action.

Treatment options may include:

*

Reconstructive surgery. The goal of surgery is usually cosmetic, to make the boy's or girl's genitalia look natural. In some cases, the surgery can be more involved in hopes of restoring sexual function.

Some surgeries are carried out soon after birth while others may be scheduled later in your child's development. Some research suggests that in severe cases of ambiguous genitalia, surgery is best delayed until your child can play a role in participating in the sex-assignment decision.

For girls, sexual function of the organs is often not compromised despite any ambiguous appearance. Depending on the severity of the condition, surgery options range from uncovering a vagina hidden under the skin to removing excess masculine tissue around the clitoris. Surgeries are carried out carefully to avoid damaging nerve endings and blood flow in hopes of ensuring normal sexual function in the future. Little long-term research is available, but the initial success of surgeries, both in appearance and sexual functioning later in life, is promising.

For boys, the surgery may be more complicated, but often successful. Surgery gives genetic males born with a shorter, incomplete penis the opportunity to have a normal penis. In many cases, no further surgery is required for this reconstructed organ, and it will have a normal look and erectile functionality. Female organs that remain under the skin — such as a uterus or vagina — rarely cause a physical problem, but are often surgically removed because a boy's knowledge of these structures later in life may be emotionally difficult.
* Hormone therapy. Depending on the severity of the condition, hormone therapy alone may be enough to correct the initial hormonal imbalance. For example, in a genetic female with a slightly enlarged clitoris caused by a minor to moderate case of congenital adrenal hyperplasia, proper levels of hormones may shrink the tissue close to a normal size.

Coping skills

Not knowing the sex of your baby immediately is a difficult issue to face. As parents, it's best to discipline your thoughts not to think of your baby as a girl or a boy until a medical evaluation is complete. Meanwhile you might consider giving the child a neutral name suitable for either a boy or a girl. You might also defer announcing the birth until the evaluations are complete in that the first question everyone asks regarding a new baby is whether it's a girl or a boy.

Because of the additional stress this may place on a family, ongoing counseling for the child as well as the family may become an important part of the process. Psychologists, counselors, mental health professionals and support groups may all help you to deal with this difficult and unexpected set of circumstances.
source from www.cnn.com

full story ...

From MayoClinic.com
Special to CNN.com

Introduction

Boy or girl? It's one of the most common questions asked of brand-new parents in addition to the baby's weight and length. But what if the answer isn't so obvious? Such is the case for newborns with ambiguous genitalia, the medical term for a rare condition in which a newborn's external genitals don't appear to be clearly either male or female.

In ambiguous genitalia, the baby's genitalia may not be well-formed, or the baby may have general characteristics of both sexes.

Ambiguous genitalia can be very upsetting to parents and other family members, both because of the uncertainty involved and because of the social stigma attached to not knowing a child's sex right away. While ambiguous genitalia can present a difficult and complicated situation, medical advances can take much of the guesswork out of the process of assigning a sex to your child, and corrective surgery can help. Sometimes, despite the pressure to announce "girl" or "boy," it's best in the case of ambiguous genitalia to wait to make this important decision about your child's future.

Signs and symptoms

A newborn's genitalia are quite small, and the idea of looking "normal" spans a wide range. Your medical team will likely be the first to recognize the signs of ambiguous genitalia soon after your baby is born. These signs vary from the more obviously apparent to the outwardly invisible.

Characteristics in genetic females
For genetic females, the baby's genitals may take on the following characteristics:

* An enlargement of the clitoris, or what appears to be a small penis.
* A concealment of the vagina because the midline groove has closed over.

Characteristics in genetic males
For genetic males, the following characteristics may be present:

* A condition in which the narrow tube that carries urine and semen (urethra) doesn't fully extend to the tip of the penis (hypospadias).
* An abnormally small penis with the urethral opening nearer to the scrotum, indicating that the penis stopped growing early in its development.
* No recognizable male genitalia, in the most severe cases.

Causes

The genetic sex of a child is established at conception based on the 23rd pair of chromosomes it inherits. The mother's egg contains an X chromosome, and the father's sperm contains either an X or Y chromosome. A baby who inherits the X chromosome from the father is a genetic female (a pair of X chromosomes). A baby who inherits the Y chromosome from the father is a genetic male (one X and one Y chromosome).

In early fetal development, males and females are indistinguishable. Male and female sex organs develop from the same tissue in the fetus. For example, the same fetal tissue that forms a penis in a male also forms a clitoris in a female. The presence or absence of male hormones controls the development of the sex organs. Normally, male genitalia develop because of male hormones from the fetal testicles. In the female fetus — without the effects of male hormones — the genitalia develop as female.

A deficiency of male hormone in a genetic male fetus results in ambiguous genitalia. In a female fetus, the presence of male hormone during development results in ambiguous genitalia.

Although the deficiency or presence of male hormones is the main factor controlling genital development, the exact cause of ambiguous genitalia is often unknown. Many of the disorders seem to happen by chance.

Possible causes in genetic females
Causes of ambiguous genitalia in a genetic female may include:

* Congenital adrenal hyperplasia (CAH). Certain forms of this genetic condition cause the adrenal glands to make excess male hormones (androgens). Congenital adrenal hyperplasia is the most common cause of ambiguous genitalia in newborns.
* Ingestion by the mother of substances with male hormone activity, such as progesterone (taken in the early stages of pregnancy to stop bleeding).
* Tumors in the fetus or the mother that produce male hormones.

Possible causes in genetic males
Causes of ambiguous genitalia in a genetic male may include:

* Impaired testicle development due to genetic abnormalities or unknown causes.
* Leydig cell aplasia, a condition that impairs testosterone production.
* Congenital adrenal hyperplasia. Certain forms of this genetic condition can impair production of male hormones.
* Androgen insensitivity syndrome, a condition in which developing genital tissues are unable to respond to normal male hormone levels.
* 5 alpha reductase deficiency, an enzyme defect that impairs normal male hormone production.
* Ingestion by the mother of substances with female hormone activity, such as estrogens, or anti-androgens. This is unusual, but could occur if a woman taking birth control pills gets pregnant despite taking the pills — then, not knowing she's pregnant, continues taking the pills into pregnancy for several weeks. Also some "nutritional supplements" contain plant estrogens.

Risk factors

As is the case with many abnormalities, family history may play a role in the development of ambiguous genitalia. Possible risk factors associated with ambiguous genitalia include a family history of:

* Unexplained deaths in early infancy
* Infertility in close relatives
* Genital abnormalities
* Abnormal development during puberty

Because most causes of ambiguous genitalia are due to genetic abnormalities, the presence of similar abnormalities in family members is important. Having a family member with known congenital adrenal hyperplasia, infertility or abnormal pubertal development may indicate a genetic abnormality in the family. Also, a personal or family history of prior babies being born with genital abnormalities, or dying shortly after birth, may indicate an inherited abnormality that could result in future children being born with ambiguous genitalia.
When to seek medical advice

If both parents are carriers of congenital adrenal hyperplasia, there's the chance that their baby could develop ambiguous genitalia if he or she inherits the abnormal gene from both parents. Parents may not know they have congenital adrenal hyperplasia because as carriers they show no signs or symptoms of this condition.

If your family has a history of risk factors associated with ambiguous genitalia, seek medical advice before conceiving.
Screening and diagnosis

If your baby is born with ambiguous genitalia, you and your doctor will want to determine the underlying abnormality and extent of deformity. The first indication of ambiguous genitalia will be by a physical examination. Your doctor will likely recommend the following tests and procedures:

* Blood and urine tests to measure hormone levels
* Chromosome analysis to determine the genetic sex (XX or XY)
* Ultrasound to check for the presence of internal female sex organs
* A biopsy of your newborn's reproductive organs to determine if the organs will produce appropriate sex hormones for the sex assigned to the child
* A genitogram, a special X-ray to see if a vagina is present and its size

Using the information gathered from these tests, your doctor may suggest an appropriate sex for the baby.

Despite the social stigma attached to not knowing if your baby is a boy or a girl right away, some research shows that delaying gender assignment until the child is older may be of benefit. If the gender assignment is made too early, and the correct decision isn't made, the child may be confronted with difficult psychological and social issues later in life.
Complications

The outlook is good for many babies born with ambiguous genitalia in terms of their ability to conceive and be fertile later in life. However, for others born with ambiguous genitalia, the severity of the condition, complicated hormone levels and trouble adjusting to their assigned sex may make it difficult or impossible to conceive a child later in life.
Treatment

Management of ambiguous genitalia requires a team of doctors that may involve a number of specialties — pediatric endocrinology, neonatology, urology, plastic surgery, medical genetics and psychology. The timing of treatment depends on a child's specific situation. Your medical team can explain to you the options available for your child and likely suggest a course of action.

Treatment options may include:

*

Reconstructive surgery. The goal of surgery is usually cosmetic, to make the boy's or girl's genitalia look natural. In some cases, the surgery can be more involved in hopes of restoring sexual function.

Some surgeries are carried out soon after birth while others may be scheduled later in your child's development. Some research suggests that in severe cases of ambiguous genitalia, surgery is best delayed until your child can play a role in participating in the sex-assignment decision.

For girls, sexual function of the organs is often not compromised despite any ambiguous appearance. Depending on the severity of the condition, surgery options range from uncovering a vagina hidden under the skin to removing excess masculine tissue around the clitoris. Surgeries are carried out carefully to avoid damaging nerve endings and blood flow in hopes of ensuring normal sexual function in the future. Little long-term research is available, but the initial success of surgeries, both in appearance and sexual functioning later in life, is promising.

For boys, the surgery may be more complicated, but often successful. Surgery gives genetic males born with a shorter, incomplete penis the opportunity to have a normal penis. In many cases, no further surgery is required for this reconstructed organ, and it will have a normal look and erectile functionality. Female organs that remain under the skin — such as a uterus or vagina — rarely cause a physical problem, but are often surgically removed because a boy's knowledge of these structures later in life may be emotionally difficult.
* Hormone therapy. Depending on the severity of the condition, hormone therapy alone may be enough to correct the initial hormonal imbalance. For example, in a genetic female with a slightly enlarged clitoris caused by a minor to moderate case of congenital adrenal hyperplasia, proper levels of hormones may shrink the tissue close to a normal size.

Coping skills

Not knowing the sex of your baby immediately is a difficult issue to face. As parents, it's best to discipline your thoughts not to think of your baby as a girl or a boy until a medical evaluation is complete. Meanwhile you might consider giving the child a neutral name suitable for either a boy or a girl. You might also defer announcing the birth until the evaluations are complete in that the first question everyone asks regarding a new baby is whether it's a girl or a boy.

Because of the additional stress this may place on a family, ongoing counseling for the child as well as the family may become an important part of the process. Psychologists, counselors, mental health professionals and support groups may all help you to deal with this difficult and unexpected set of circumstances.
source from www.cnn.com

full story ...

School-age physicals: What to know before you go

From MayoClinic.com
Special to CNN.com

Although well-child visits are most frequent during infancy — when development is most rapid — your doctor also should see your older child periodically to make sure his or her development is progressing at the proper pace. Because there really isn't time to do this type of exam during an office visit when your child is sick, you should make an appointment specifically for a general health assessment.

School physicals

Some schools require a physical exam and proof of up-to-date immunizations before children can enter certain grades or participate in sports. Check with your school district to see what's required.

In the past, many such physicals were conducted en masse in a gymnasium, where a doctor might check as many as 60 children in an hour. Mass screenings in crowded conditions offer little privacy and no opportunity to ask confidential questions.

Taking your child to your pediatrician or family physician is a good idea for several reasons:

* Your doctor is already familiar with your child's medical history.
* An office visit provides more time for a more thorough exam.
* A parent is available to answer questions if needed.

Checkups: When to have them and what they involve

The American Academy of Pediatrics has established a basic schedule of well-child visits for grade school students. Many medical practices adapt this schedule for their own patient population, but it typically includes a well-child visit every other year from age 5 through age 11. Your family's health insurance may also affect the number and timing of these visits.

What happens during checkups is also variable, depending on your child's age and your doctor's style of practice. In general, though, a checkup includes a physical exam and development assessment.

The physical exam.
The doctor will check your child's:

* Height and weight
* Blood pressure and heart rate
* Teeth, gums, tongue and throat
* Reflexes
* Eyes, ears, nose and skin
* Heart, lungs and abdomen
* Fine-motor development, such as the ability to pick up small objects or tie shoes
* Gross-motor development, such as the ability to walk, climb stairs or jump
* Spinal alignment for signs of curvature (scoliosis)
* Genitalia, confirming a normal level of maturation and checking for hernia, infection and other possible problems

Preventive screenings
Several potentially serious conditions that affect children can be detected on routine examinations and tests. Regular exams increase the chance that such conditions will be found early.

* Lead poisoning. Blood tests may be needed for young children who have been exposed to lead paint, which can be found in older houses. Some doctors use a questionnaire to determine who should be tested.
* Tuberculosis. Skin tests may be needed for children who have lived in places where tuberculosis is more common — such as shelters, institutions or countries in which tuberculosis is prevalent. Some doctors use a questionnaire to determine who should be tested.
* Cholesterol. Blood tests may be needed for children who are overweight or obese, or who have parents or grandparents who developed heart disease before the age of 55.

Immunization update
Every checkup is an opportunity to make sure your child is up-to-date on immunizations. Ask for a copy of the immunization dates for your child — many schools require that information. Also keep an immunization record at home.

Behavioral development
In addition to a physical exam, your doctor may also ask a series of questions concerning your child's intellectual and behavioral development. These questions will vary by your child's age:

* 5-year-olds. Can your child get dressed without help? Count to 20 and print his or her name? Can he or she ride a bike with training wheels? Is there any speech impediment?
* Ages 6 to 8. Is your child keeping up with schoolwork? What are some of the things he or she is good at? Does he or she talk about what goes on at school? What happens when your child is frustrated or angry?
* Ages 9 to 11. How does your child get along with other family members? How are his or her grades at school? Any changes with behavior at home, at school or when playing with friends? Is your child proud of his or her achievements?

Safety issues
Your doctor may also make sure you're following the right seat belt and car seat recommendations for your child's age and size. Tips for bicycle and skateboard safety — particularly helmet use — also merit review. Safe storage of any firearms in your home is important as well. When your child reaches the upper grades of elementary school, you'll need to talk about how to reduce your child's risk of abusing alcohol, tobacco, street drugs and inhalants.

Children in preschool and the early elementary grades may benefit from a matter-of-fact reminder that their bodies, particularly their genitals, are private. Your doctor or nurse can pitch this message in terms your child will understand — reassuring, not scary or embarrassing.

Also, older children need to be prepared for the changes that occur at puberty. As your child matures, he or she may want to speak to the doctor alone about sexual concerns.

A value-added proposition

Well-child checkups can reveal problems early and reinforce healthy behavior. In addition, they establish a relationship with your child's doctor. With up-to-date information at hand, your doctor can assess your child's condition more readily, perhaps even addressing future routine questions by telephone. Finally, your child's trusting relationship with his or her doctor may help establish a lifelong pattern of healthy habits and appropriate utilization of medical care.

# Vaccines schedule for children
# Measles study stresses importance of routine vaccination
# Childhood immunizations: First line of defense against illnesses
# Cervical cancer vaccine recommended for girls 11 to 12
# Flu shots: Do children need them?

August 01, 2006

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