Month: February 2023

Overview

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.

Children with ADHD may also struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful.

While treatment won’t cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcome.

Symptoms

The primary features of ADHD include inattention and hyperactive-impulsive behavior. ADHD symptoms start before age 12, and in some children, they’re noticeable as early as 3 years of age. ADHD symptoms can be mild, moderate or severe, and they may continue into adulthood.

ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive.

There are three subtypes of ADHD:

• Predominantly inattentive. The majority of symptoms fall under inattention.
• Predominantly hyperactive/impulsive. The majority of symptoms are hyperactive and impulsive.
• Combined. This is a mix of inattentive symptoms and hyperactive/impulsive symptoms.

Inattention

A child who shows a pattern of inattention may often:

• Fail to pay close attention to details or make careless mistakes in schoolwork
• Have trouble staying focused in tasks or play
• Appear not to listen, even when spoken to directly
• Have difficulty following through on instructions and fail to finish schoolwork or chores
• Have trouble organizing tasks and activities
• Avoid or dislike tasks that require focused mental effort, such as homework
• Lose items needed for tasks or activities, for example, toys, school assignments, pencils
• Be easily distracted
• Forget to do some daily activities, such as forgetting to do chores

Hyperactivity and impulsivity

A child who shows a pattern of hyperactive and impulsive symptoms may often:

• Fidget with or tap his or her hands or feet, or squirm in the seat
• Have difficulty staying seated in the classroom or in other situations
• Be on the go, in constant motion
• Run around or climb in situations when it’s not appropriate
• Have trouble playing or doing an activity quietly
• Talk too much
• Blurt out answers, interrupting the questioner
• Have difficulty waiting for his or her turn
• Interrupt or intrude on others’ conversations, games or activities

Typical developmental behavior vs. ADHD

Most healthy children are inattentive, hyperactive or impulsive at one time or another. It’s typical for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest.

The same is true of hyperactivity. Young children are naturally energetic — they often are still full of energy long after they’ve worn their parents out. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having ADHD just because they’re different from their friends or siblings.

Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.

When to see a doctor

If you’re concerned that your child shows signs of ADHD, see your pediatrician or family doctor. Your doctor may refer you to a specialist, such as a developmental-behavioral pediatrician, psychologist, psychiatrist or pediatric neurologist, but it’s important to have a medical evaluation first to check for other possible causes of your child’s difficulties.

Causes

While the exact cause of ADHD is not clear, research efforts continue. Factors that may be involved in the development of ADHD include genetics, the environment or problems with the central nervous system at key moments in development.

Risk factors

Risk factors for ADHD may include:

• Blood relatives, such as a parent or sibling, with ADHD or another mental health disorder
• Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings
• Maternal drug use, alcohol use or smoking during pregnancy
• Premature birth

Although sugar is a popular suspect in causing hyperactivity, there’s no reliable proof of this. Many issues in childhood can lead to difficulty sustaining attention, but that’s not the same as ADHD.

Complications

ADHD can make life difficult for children. Children with ADHD:

• Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults
• Tend to have more accidents and injuries of all kinds than do children who don’t have ADHD
• Tend to have poor self-esteem
• Are more likely to have trouble interacting with and being accepted by peers and adults
• Are at increased risk of alcohol and drug abuse and other delinquent behavior

Coexisting conditions

ADHD doesn’t cause other psychological or developmental problems. However, children with ADHD are more likely than others to also have conditions such as:

• Oppositional defiant disorder (ODD), generally defined as a pattern of negative, defiant and hostile behavior toward authority figures
• Conduct disorder, marked by antisocial behavior such as stealing, fighting, destroying property, and harming people or animals
• Disruptive mood dysregulation disorder, characterized by irritability and problems tolerating frustration
• Learning disabilities, including problems with reading, writing, understanding and communicating
• Substance use disorders, including drugs, alcohol and smoking
• Anxiety disorders, which may cause overwhelming worry and nervousness, and include obsessive compulsive disorder (OCD)
• Mood disorders, including depression and bipolar disorder, which includes depression as well as manic behavior
• Autism spectrum disorder, a condition related to brain development that impacts how a person perceives and socializes with others
• Tic disorder or Tourette syndrome, disorders that involve repetitive movements or unwanted sounds (tics) that can’t be easily controlled

Prevention

To help reduce your child’s risk of ADHD:

• During pregnancy, avoid anything that could harm fetal development. For example, don’t drink alcohol, use recreational drugs or smoke cigarettes.
• Protect your child from exposure to pollutants and toxins, including cigarette smoke and lead paint.
• Limit screen time. Although still unproved, it may be prudent for children to avoid excessive exposure to TV and video games in the first five years of life.

Overview

Hypothermia is a medical emergency that occurs when your body loses heat faster than it can produce heat, causing a dangerously low body temperature. Normal body temperature is around 98.6 F (37 C). Hypothermia (hi-poe-THUR-me-uh) occurs as your body temperature falls below 95 F (35 C).

When your body temperature drops, your heart, nervous system and other organs can’t work normally. Left untreated, hypothermia can lead to complete failure of your heart and respiratory system and eventually to death.

Hypothermia is often caused by exposure to cold weather or immersion in cold water. Primary treatments for hypothermia are methods to warm the body back to a normal temperature.

Symptoms

Shivering is likely the first thing you’ll notice as the temperature starts to drop because it’s your body’s automatic defense against cold temperature — an attempt to warm itself.

Signs and symptoms of hypothermia include:

• Shivering
• Slurred speech or mumbling
• Slow, shallow breathing
• Weak pulse
• Clumsiness or lack of coordination
• Drowsiness or very low energy
• Confusion or memory loss
• Loss of consciousness
• Bright red, cold skin (in infants)

Someone with hypothermia usually isn’t aware of his or her condition because the symptoms often begin gradually. Also, the confused thinking associated with hypothermia prevents self-awareness. The confused thinking can also lead to risk-taking behavior.

Causes

Hypothermia occurs when your body loses heat faster than it produces it. The most common causes of hypothermia are exposure to cold-weather conditions or cold water. But prolonged exposure to any environment colder than your body can lead to hypothermia if you aren’t dressed appropriately or can’t control the conditions.

Specific conditions leading to hypothermia include:

• Wearing clothes that aren’t warm enough for weather conditions
• Staying out in the cold too long
• Being unable to get out of wet clothes or move to a warm, dry location
• Falling into the water, as in a boating accident
• Living in a house that’s too cold, either from poor heating or too much air conditioning

How your body loses heat

The mechanisms of heat loss from your body include the following:

• Radiated heat. Most heat loss is due to heat radiated from unprotected surfaces of your body.
• Direct contact. If you’re in direct contact with something very cold, such as cold water or the cold ground, heat is conducted away from your body. Because water is very good at transferring heat from your body, body heat is lost much faster in cold water than in cold air. Similarly, heat loss from your body is much faster if your clothes are wet, as when you’re caught out in the rain.
• Wind. Wind removes body heat by carrying away the thin layer of warm air at the surface of your skin. A wind chill factor is important in causing heat loss.

Risk factors

Risk factors for hypothermia include:

• Exhaustion. Your tolerance for cold diminishes when you are fatigued.
• Older age. The body’s ability to regulate temperature and to sense cold may lessen with age. And some older adults may not be able to communicate when they are cold or to move to a warm location if they do feel cold.
• Very young age. Children lose heat faster than adults do. Children may also ignore the cold because they’re having too much fun to think about it. And they may not have the judgment to dress properly in cold weather or to get out of the cold when they should.
• Mental problems. People with a mental illness, dementia or other conditions that interfere with judgment may not dress appropriately for the weather or understand the risk of cold weather. People with dementia may wander from home or get lost easily, making them more likely to be stranded outside in cold or wet weather.
• Alcohol and drug use. Alcohol may make your body feel warm inside, but it causes your blood vessels to expand, resulting in more rapid heat loss from the surface of your skin. The body’s natural shivering response is diminished in people who’ve been drinking alcohol.In addition, the use of alcohol or recreational drugs can affect your judgment about the need to get inside or wear warm clothes in cold-weather conditions. If a person is intoxicated and passes out in cold weather, he or she is likely to develop hypothermia.
• Certain medical conditions. Some health disorders affect your body’s ability to regulate body temperature. Examples include an underactive thyroid (hypothyroidism), poor nutrition or anorexia nervosa, diabetes, stroke, severe arthritis, Parkinson’s disease, trauma, and spinal cord injuries.
• Medications. Some drugs can change the body’s ability to regulate its temperature. Examples include certain antidepressants, antipsychotics, narcotic pain medications and sedatives.

Complications

People who develop hypothermia because of exposure to cold weather or cold water are also vulnerable to other cold-related injuries, including:

• Freezing of body tissues (frostbite)
• Decay and death of tissue resulting from an interruption in blood flow (gangrene)

Prevention

Staying warm in cold weather

Before you or your children step out into cold air, remember the advice that follows with the simple acronym COLD — cover, overexertion, layers, dry:

• Cover. Wear a hat or other protective covering to prevent body heat from escaping from your head, face and neck. Cover your hands with mittens instead of gloves.
• Overexertion. Avoid activities that would cause you to sweat a lot. The combination of wet clothing and cold weather can cause you to lose body heat more quickly.
• Layers. Wear loosefitting, layered, lightweight clothing. Outer clothing made of tightly woven, water-repellent material is best for wind protection. Wool, silk or polypropylene inner layers hold body heat better than cotton does.
• Dry. Stay as dry as possible. Get out of wet clothing as soon as possible. Be especially careful to keep your hands and feet dry, as it’s easy for snow to get into mittens and boots.

Keeping children safe from the cold

To help prevent hypothermia when children are outside in the winter:

• Dress infants and young children in one more layer than an adult would wear in the same conditions.
• Bring children indoors if they start shivering — that’s the first sign that hypothermia is starting.
• Have children come inside frequently to warm themselves when they’re playing outside.
• Don’t let babies sleep in a cold room.

Winter car safety

Whenever you’re traveling during bad weather, be sure someone knows where you’re headed and at what time you’re expected to arrive. That way, if you get into trouble on your way, emergency responders will know where to look for your car.

It’s also a good idea to keep emergency supplies in your car in case you get stranded. Supplies may include several blankets, matches, candles, a clean can where you can melt snow into drinking water, a first-aid kit, dry or canned food, a can opener, tow rope, booster cables, compass, and a bag of sand or kitty litter to spread for traction if you’re stuck in the snow. If possible, travel with a cellphone.

If you’re stranded, put everything you need in the car with you, huddle together and stay covered. Run the car for 10 minutes each hour to warm it up. Make sure a window is slightly open and the exhaust pipe isn’t covered with snow while the engine is running.

Alcohol

To avoid alcohol-related risks of hypothermia, don’t drink alcohol:

• If you’re going to be outside in cold weather
• If you’re boating
• Before going to bed on cold nights

Cold-water safety

Water doesn’t have to be extremely cold to cause hypothermia. Any water that’s colder than normal body temperature causes heat loss. The following tips may increase your survival time in cold water if you accidentally fall in:

• Wear a life jacket. If you plan to ride in a watercraft, wear a life jacket. A life jacket can help you stay alive longer in cold water by enabling you to float without using energy and by providing some insulation. Keep a whistle attached to your life jacket to signal for help.
• Get out of the water if possible. Get out of the water as much as possible, such as climbing onto a capsized boat or grabbing onto a floating object.
• Don’t attempt to swim unless you’re close to safety. Unless a boat, another person or a life jacket is close by, stay put. Swimming will use up energy and may shorten survival time.
• Position your body to minimize heat loss. Use a body position known as the heat escape lessening posture (HELP) to reduce heat loss while you wait for assistance. Hold your knees to your chest to protect the trunk of your body. If you’re wearing a life jacket that turns your face down in this position, bring your legs tightly together, your arms to your sides and your head back.
• Huddle with others. If you’ve fallen into cold water with other people, keep warm by facing each other in a tight circle.
• Don’t remove your clothing. While you’re in the water, don’t remove clothing because it helps to insulate you from the water. Buckle, button and zip up your clothes. Cover your head if possible. Remove clothing only after you’re safely out of the water and can take measures to get dry and warm.

Help for people most at risk

For people most at risk of hypothermia — infants, older adults, people who have mental or physical problems, and people who are homeless — community outreach programs and social support services can be of great help. If you are at risk or know someone at risk, contact your local public health office for available services, such as the following:

• Assistance for paying heating bills
• Check-in services to see if you and your home are warm enough during cold weather
• Homeless shelters
• Community warming centers, safe and warm daytime locations where you can go during cold weather

High blood pressure is a common condition that affects the body’s arteries. It’s also called hypertension. If you have high blood pressure, the force of the blood pushing against the artery walls is consistently too high. The heart has to work harder to pump blood.

Blood pressure is measured in millimeters of mercury (mm Hg). In general, hypertension is a blood pressure reading of 130/80 mm Hg or higher.

The American College of Cardiology and the American Heart Association divide blood pressure into four general categories. Ideal blood pressure is categorized as normal.)

• Normal blood pressure. Blood pressure is 120/80 mm Hg or lower.
• Elevated blood pressure. The top number ranges from 120 to 129 mm Hg and the bottom number is below, not above, 80 mm Hg.
• Stage 1 hypertension. The top number ranges from 130 to 139 mm Hg or the bottom number is between 80 and 89 mm Hg.
• Stage 2 hypertension. The top number is 140 mm Hg or higher or the bottom number is 90 mm Hg or higher.

Blood pressure higher than 180/120 mm Hg is considered a hypertensive emergency or crisis. Seek emergency medical help for anyone with these blood pressure numbers.

Untreated, high blood pressure increases the risk of heart attack, stroke and other serious health problems. It’s important to have your blood pressure checked at least every two years starting at age 18. Some people need more-frequent checks.

Healthy lifestyle habits —such as not smoking, exercising and eating well — can help prevent and treat high blood pressure. Some people need medicine to treat high blood pressure.

Symptoms

Most people with high blood pressure have no symptoms, even if blood pressure readings reach dangerously high levels. You can have high blood pressure for years without any symptoms.

A few people with high blood pressure may have:

• Headaches
• Shortness of breath
• Nosebleeds

However, these symptoms aren’t specific. They usually don’t occur until high blood pressure has reached a severe or life-threatening stage.

When to see a doctor

Blood pressure screening is an important part of general health care. How often you should get your blood pressure checked depends on your age and overall health.

Ask your provider for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re 18 to 39 with a high risk of high blood pressure, ask for a blood pressure check every year.

Your care provider will likely recommend more-frequent readings if have high blood pressure or other risk factors for heart disease.

Children age 3 and older may have blood pressure measured as a part of their yearly checkups.

If you don’t regularly see a care provider, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. Free blood pressure machines are also available in some stores and pharmacies. The accuracy of these machines depends on several things, such as a correct cuff size and proper use of the machines. Ask your health care provider for advice on using public blood pressure machines.

Tests

If you are diagnosed with high blood pressure, your provider may recommend tests to check for a cause.

• Ambulatory monitoring. A longer blood pressure monitoring test may be done to check blood pressure at regular times over six or 24 hours. This is called ambulatory blood pressure monitoring. However, the devices used for the test aren’t available in all medical centers. Check with your insurer to see if ambulatory blood pressure monitoring is a covered service.
• Lab tests. Blood and urine tests are done to check for conditions that can cause or worsen high blood pressure. For example, tests are done to check your cholesterol and blood sugar levels. You may also have lab tests to check your kidney, liver and thyroid function.
• Electrocardiogram (ECG or EKG). This quick and painless test measures the heart’s electrical activity. It can tell how fast or how slow the heart is beating. During an ECG, sensors called electrodes are attached to the chest and sometimes to the arms or legs. Wires connect the sensors to a machine, which prints or displays results.
• Echocardiogram. This noninvasive exam uses sound waves to create detailed images of the beating heart. It shows how blood moves through the heart and heart valves.

Taking your blood pressure at home

Your health care provider may ask you to regularly check your blood pressure at home. Home monitoring is a good way to keep track of your blood pressure. It helps your care providers know if your medicine is working or if your condition is getting worse.

Home blood pressure monitors are available at local stores and pharmacies.

For the most reliable blood pressure measurement, the American Heart Association recommends using a monitor with a cuff that goes around your upper arm, when available.

Devices that measure your blood pressure at your wrist or finger aren’t recommended by the American Heart Association because they can provide less reliable results.

Treatment

Changing your lifestyle can help control and manage high blood pressure. Your health care provider may recommend that you make lifestyle changes including:

• Eating a heart-healthy diet with less salt
• Getting regular physical activity
• Maintaining a healthy weight or losing weight
• Limiting alcohol
• Not smoking
• Getting 7 to 9 hours of sleep daily

Sometimes lifestyle changes aren’t enough to treat high blood pressure. If they don’t help, your provider may recommend medicine to lower your blood pressure.

Medications

The type of medicine used to treat hypertension depends on your overall health and how high your blood pressure is. Two or more blood pressure drugs often work better than one. It can take some time to find the medicine or combination of medicines that works best for you.

When taking blood pressure medicine, it’s important to know your goal blood pressure level. You should aim for a blood pressure treatment goal of less than 130/80 mm Hg if:

• You’re a healthy adult age 65 or older
• You’re a healthy adult younger than age 65 with a 10% or higher risk of developing cardiovascular disease in the next 10 years
• You have chronic kidney disease, diabetes or coronary artery disease

The ideal blood pressure goal can vary with age and health conditions, particularly if you’re older than age 65.

Medicines used to treat high blood pressure include:

• Water pills (diuretics). These drugs help remove sodium and water from the body. They are often the first medicines used to treat high blood pressure.There are different classes of diuretics, including thiazide, loop and potassium sparing. Which one your provider recommends depends on your blood pressure measurements and other health conditions, such as kidney disease or heart failure. Diuretics commonly used to treat blood pressure include chlorthalidone, hydrochlorothiazide (Microzide) and others.A common side effect of diuretics is increased urination. Urinating a lot can reduce potassium levels. A good balance of potassium is necessary to help the heart beat correctly. If you have low potassium (hypokalemia), your provider may recommend a potassium-sparing diuretic that contains triamterene.
• Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels. They block the formation of a natural chemical that narrows blood vessels. Examples include lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and others.
• Angiotensin II receptor blockers (ARBs). These drugs also relax blood vessels. They block the action, not the formation, of a natural chemical that narrows blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others.
• Calcium channel blockers. These drugs help relax the muscles of the blood vessels. Some slow your heart rate. They include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others. Calcium channel blockers may work better for older people and Black people than do ACE inhibitors alone.Don’t eat or drink grapefruit products when taking calcium channel blockers. Grapefruit increases blood levels of certain calcium channel blockers, which can be dangerous. Talk to your provider or pharmacist if you’re concerned about interactions.

Other medicines sometimes used to treat high blood pressure

If you’re having trouble reaching your blood pressure goal with combinations of the above medicines, your provider may prescribe:

• Alpha blockers. These medicines reduce nerve signals to blood vessels. They help lower the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others.
• Alpha-beta blockers. Alpha-beta blockers block nerve signals to blood vessels and slow the heartbeat. They reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
• Beta blockers. These medicines reduce the workload on the heart and widen the blood vessels. This helps the heart beat slower and with less force. Beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL, Kapspargo sprinkle) and others.Beta blockers aren’t usually recommended as the only medicine prescribed. They may work best when combined with other blood pressure drugs.
• Aldosterone antagonists. These drugs may be used to treat resistant hypertension. They block the effect of a natural chemical that can lead to salt and fluid buildup in the body. Examples are spironolactone (Aldactone) and eplerenone (Inspra).
• Renin inhibitors. Aliskiren (Tekturna) slows the production of renin, an enzyme produced by the kidneys that starts a chain of chemical steps that increases blood pressure.Due to a risk of serious complications, including stroke, you shouldn’t take aliskiren with ACE inhibitors or ARBs.
• Vasodilators. These medicines stop the muscles in the artery walls from tightening. This prevents the arteries from narrowing. Examples include hydralazine and minoxidil.
• Central-acting agents. These medicines prevent the brain from telling the nervous system to increase the heart rate and narrow the blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv) and methyldopa.

Always take blood pressure medicines as prescribed. Never skip a dose or abruptly stop taking blood pressure medicines. Suddenly stopping certain ones, such as beta blockers, can cause a sharp increase in blood pressure called rebound hypertension.

If you skip doses because of cost, side effects or forgetfulness, talk to your care provider about solutions. Don’t change your treatment without your provider’s guidance.

Treating resistant hypertension

You may have resistant hypertension if:

• You take at least three different blood pressure drugs, including a diuretic. But your blood pressure remains stubbornly high.
• You’re taking four different medicines to control high blood pressure. Your care provider should check for a possible second cause of the high blood pressure.

Having resistant hypertension doesn’t mean your blood pressure will never get lower. If you and your provider can determine the cause, a more effective treatment plan can be created.

Treating resistant hypertension may involve many steps, including:

• Changing blood pressure medicines to find the best combination and dosage.
• Reviewing all your medicines, including those bought without a prescription.
• Checking blood pressure at home to see if medical appointments cause high blood pressure. This is called white coat hypertension.
• Eating healthy, managing weight and making other recommended lifestyle changes.

High blood pressure during pregnancy

If you have high blood pressure and are pregnant, discuss with your care providers how to control blood pressure during your pregnancy.

Potential future treatments

Researchers have been studying the use of heat to destroy specific nerves in the kidney that may play a role in resistant hypertension. The method is called renal denervation. Early studies showed some benefit. But more-robust studies found that it doesn’t significantly lower blood pressure in people with resistant hypertension. More research is underway to determine what role, if any, this therapy may have in treating hypertension.

A cough is your body’s way of responding when something irritates your throat or airways. An irritant stimulates nerves that send a message to your brain. The brain then tells muscles in your chest and abdomen to push air out of your lungs to force out the irritant.

An occasional cough is normal and healthy. A cough that persists for several weeks or one that brings up discolored or bloody mucus may indicate a condition that needs medical attention.

At times, coughing can be very forceful. Prolonged, vigorous coughing can irritate the lungs and cause even more coughing. It is also exhausting and can cause sleeplessness, dizziness or fainting, headaches, urinary incontinence, vomiting, and even broken ribs.

Causes

While an occasional cough is normal, a cough that persists may be a sign of a medical problem.

A cough is considered “acute” if it lasts less than three weeks. It is considered “chronic” if it lasts longer than eight weeks (four weeks in children).

Some causes of coughs include:

Common causes — acute

1. Common cold
2. Influenza (flu)
3. Inhaling an irritant (such as smoke, dust, chemicals or a foreign body)
4. Pneumonia
5. Whooping cough

Common causes — chronic

1. Allergies
2. Asthma (most common in children)
3. Bronchitis
4. Gastroesophageal reflux disease (GERD)
5. Postnasal drip

Others

1. Acute sinusitis (nasal and sinus infection)
2. Bronchiectasis (a chronic lung condition in which abnormal widening of bronchial tubes inhibits mucus clearing)
3. Bronchiolitis (especially in young children)
4. Choking: First aid (especially in children)
5. Chronic sinusitis
6. COPD
7. Coronavirus disease 2019 (COVID-19)
8. Croup (especially in young children)
9. Cystic fibrosis
10. Emphysema
11. Heart failure
12. Laryngitis
13. Lung cancer
14. Medications called angiotensin-converting enzyme (ACE) inhibitors
15. Neuromuscular diseases that weaken the coordination of upper airway and swallowing muscles
16. Pulmonary embolism (blood clot in an artery in the lung)
17. Respiratory syncytial virus (RSV) — especially in young children
18. Sarcoidosis (collections of inflammatory cells in the body)
19. Tuberculosis

When to see Doctor

Call your doctor if your cough (or your child’s cough) doesn’t go away after a few weeks or if it also involves any one of these:

• Coughing up thick, greenish-yellow phlegm
• Wheezing
• Experiencing a fever
• Experiencing shortness of breath
• Experiencing fainting
• Experiencing ankle swelling or weight loss

Seek emergency care if you or your child is:

• Choking or vomiting
• Having difficulty breathing or swallowing
• Coughing up bloody or pink-tinged phlegm
• Experiencing chest pain

Self-care measures

Cough medicines usually are used only when cough is an acute condition, causes a lot of discomfort, interferes with sleep and is not associated with any of the potentially worrisome symptoms indicated above. If you use cough medicine, be sure to follow the dosing instructions.

Over-the-counter cough and cold medicines are intended to treat the symptoms of coughs and colds, not the underlying disease. Research suggests that these medicines haven’t been proved to work any better than inactive medicine (placebo). More important, these medications have potentially serious side effects, including fatal overdoses in children younger than 2 years old.

Don’t use over-the-counter medicines, except for fever reducers and pain relievers, to treat coughs and colds in children younger than 6 years old. Also, consider avoiding use of these medicines for children younger than 12 years old.

To ease your cough, try these tips:

• Suck cough drops or hard candies. They may ease a dry cough and soothe an irritated throat. Don’t give them to a child under age 6, however, because of the risk of choking.
• Consider taking honey. A teaspoon of honey may help loosen a cough. Don’t give honey to children younger than 1 year old because honey can contain bacteria harmful to infants.
• Moisturize the air. Use a cool mist humidifier or take a steamy shower.
• Drink fluids. Liquid helps thin the mucus in your throat. Warm liquids, such as broth tea or lemon juice, can soothe your throat.
• Avoid tobacco smoke. Smoking or breathing secondhand smoke can make your cough worse.

Overview

High blood pressure is a common condition that affects the body’s arteries. It’s also called hypertension. If you have high blood pressure, the force of the blood pushing against the artery walls is consistently too high. The heart has to work harder to pump blood.

Blood pressure is measured in millimeters of mercury (mm Hg). In general, hypertension is a blood pressure reading of 130/80 mm Hg or higher.

The American College of Cardiology and the American Heart Association divide blood pressure into four general categories. Ideal blood pressure is categorized as normal.)

• Normal blood pressure. Blood pressure is 120/80 mm Hg or lower.
• Elevated blood pressure. The top number ranges from 120 to 129 mm Hg and the bottom number is below, not above, 80 mm Hg.
• Stage 1 hypertension. The top number ranges from 130 to 139 mm Hg or the bottom number is between 80 and 89 mm Hg.
• Stage 2 hypertension. The top number is 140 mm Hg or higher or the bottom number is 90 mm Hg or higher.

Blood pressure higher than 180/120 mm Hg is considered a hypertensive emergency or crisis. Seek emergency medical help for anyone with these blood pressure numbers.

Untreated, high blood pressure increases the risk of heart attack, stroke and other serious health problems. It’s important to have your blood pressure checked at least every two years starting at age 18. Some people need more-frequent checks.

Healthy lifestyle habits —such as not smoking, exercising and eating well — can help prevent and treat high blood pressure. Some people need medicine to treat high blood pressure.

Symptoms

Most people with high blood pressure have no symptoms, even if blood pressure readings reach dangerously high levels. You can have high blood pressure for years without any symptoms.

A few people with high blood pressure may have:

• Headaches
• Shortness of breath
• Nosebleeds

However, these symptoms aren’t specific. They usually don’t occur until high blood pressure has reached a severe or life-threatening stage.

When to see a doctor

Blood pressure screening is an important part of general health care. How often you should get your blood pressure checked depends on your age and overall health.

Ask your provider for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re 18 to 39 with a high risk of high blood pressure, ask for a blood pressure check every year.

Your care provider will likely recommend more-frequent readings if have high blood pressure or other risk factors for heart disease.

Children age 3 and older may have blood pressure measured as a part of their yearly checkups.

If you don’t regularly see a care provider, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. Free blood pressure machines are also available in some stores and pharmacies. The accuracy of these machines depends on several things, such as a correct cuff size and proper use of the machines. Ask your health care provider for advice on using public blood pressure machines.

Overview

Polio is an illness caused by a virus that mainly affects nerves in the spinal cord or brain stem. In its most severe form, polio can lead to a person being unable to move certain limbs, also called paralysis. It can also lead to trouble breathing and sometimes death. The disease also is called poliomyelitis.

A vaccination effort throughout the world has led to only a small number of cases to occur around the world in recent years. But poliovirus still spreads within areas with low vaccination rates.

The U.S. Centers for Disease Control and Prevention (CDC) publishes travel notices of countries where there is a higher risk of polio. Countries at a higher risk of polio are generally in Africa, the Middle East, and southern and central Asia.

Vaccinated adults who plan to travel to an area where polio is spreading should get a booster dose of inactivated poliovirus vaccine (IPV). Immunity after a booster lasts a lifetime.

Symptoms

Most people infected with the virus that causes polio, called poliovirus, don’t get symptoms.

Abortive polio

About 5% of people with the poliovirus get a mild version of the disease called abortive poliomyelitis. This leads to flu-like symptoms that last 2 to 3 days. These include:

• Fever
• Headache
• Muscle aches
• Sore throat
• Stomachache
• Loss of appetite
• Nausea
• Vomiting

Nonparalytic polio

A more severe form of the disease, called nonparalytic polio, affects about 1% of those infected. While the illness lasts longer than a few days, it doesn’t cause paralysis. Besides having more-severe flu-like symptoms, nonparalytic polio symptoms may include:

• Neck pain or stiffness
• Aches or stiffness in the arms or legs
• Severe headache

A second phase of symptoms may follow, or a person may seem to be getting better for a few days before a second phase starts. These symptoms include:

• Stiffness of the spine and neck
• Decreased reflexes
• Muscle weakness

Paralytic polio

This most serious form of the disease is rare. The disease begins much like nonparalytic polio. But it progresses to more-severe signs and symptoms, including:

• Intense pain
• Extreme sensitivity to touch
• Tingling or pricking sensations
• Muscles spasms or twitching
• Muscles weakness progressing to a limp paralysis

Any combination of limbs may experience paralysis. But paralysis of one leg is most common, followed by paralysis of one arm.

Depending on the severity of disease, other signs or symptoms may include:

• Paralysis of muscles involved in breathing
• Difficulty swallowing

Post-polio syndrome

Post-polio syndrome is the appearance of new signs or symptoms or the progression of problems. This usually happens decades after having polio. Common signs and symptoms include:

• Progressive muscle or joint weakness and pain
• Fatigue
• Muscle wasting
• Breathing or swallowing problems
• Sleep-related breathing disorders, such as sleep apnea
• Lowered tolerance of cold temperatures

When to see a doctor

Signs and symptoms of polio are similar to other viral diseases that affect the nervous system. It’s important to get a timely and accurate diagnosis.

If you had polio before, see your health care provider if you have new or worse signs or symptoms.

Causes

Polio is caused by the poliovirus. It mainly targets nerve cells in the spinal cord and brain stem that control muscle movement. Nerve cells controlling sensation are generally not affected.

The naturally-occurring poliovirus, called the wild-type poliovirus, has been eliminated in most countries and causes few cases of polio. Another version of the virus, called the vaccine-derived poliovirus (VDPV), is more widespread and now causes most infections worldwide. VDPV exists mainly in a few countries that use an oral vaccine with a weakened poliovirus.

The weakened virus in the oral vaccine doesn’t itself cause polio, and vaccinated people rarely contract VDPV. Instead, VDPV is a new version of the virus that develops within a community or region where not enough people are vaccinated.

Even though the weakened virus in the oral vaccine doesn’t cause illness, it can spread. If most people in a community are vaccinated, the spread of the weakened virus is controlled. If many people aren’t vaccinated, the weakened virus can move through a community for a long time. This gives the virus the chance to change, or mutate, and behave like the wild-type virus that causes illness.

Infections from VDPV have been reported in the United States. In each case, the person was either not vaccinated or had a significantly weakened immune system. One case in New York in 2022 was in a county with a lower-than-average polio vaccination rate. Samples from wastewater showed that VDPV was spreading in some communities.

Since 2000, polio vaccination in the United States has used an injected vaccine with an inactivated poliovirus that doesn’t create the risk for VDPV.

How polio spreads

People carrying the poliovirus — even people who don’t get sick — can pass along the virus in feces, also called stool, or droplets from sneezing or coughing. The virus enters another person through the mouth. The virus can spread easily. For example, the virus can spread if people haven’t washed their hands after coughing, using the toilet or before eating.

The virus also may be in water contaminated with feces carrying the poliovirus.

Risk factors

Polio mainly affects children. But anyone who hasn’t been vaccinated is at risk of getting the disease.

Complications

Severe disease that affects the ability to breathe can cause death. Long-term complications for people who recover may include:

• Permanent paralysis
• Muscle shortening that causes deformed bones or joints
• Chronic pain
• Post-polio syndrome

Prevention

The most effective way to prevent polio is vaccination.

Polio vaccine

The CDC recommends four doses of inactivated poliovirus vaccine (IPV) at the following ages:

• 2 months
• 4 months
• Between 6 and 18 months
• Between ages 4 and 6 when children are just entering school

If your child is missing a dose, talk to your health care provider about a catch-up schedule for vaccination.

Adult vaccination

In the U.S., most adults have immunity to the poliovirus because of childhood vaccination. And U.S. adults have little chance of being exposed to the virus. But adults who are traveling to or living in a region with high rates of spreading poliovirus should receive more vaccinations.

If you had a complete course of vaccination, you should get a one-time IPV booster. You should get three IPV doses if you aren’t vaccinated, didn’t receive a complete vaccination or are unsure of your vaccination status.

The IPV schedule for adults is a second dose 1 to 2 months after the first dose. Then the third dose is 6 to 12 months after the second dose. Talk to your health care provider if you know you have an incomplete vaccination history.

Vaccine safety

IPV is safe for people with weakened immune systems, although it’s not certain how protective the vaccine is in cases of severe immune deficiency. Common side effects are pain and redness at the injection site.

IPV can cause an allergic reaction in some people. Because the vaccine has trace amounts of the antibiotics streptomycin, polymyxin B and neomycin, it may cause a reaction in people allergic to one of these antibiotics. A person who has a severe reaction to a first dose of IPV won’t get more doses.

Signs and symptoms of an allergic reaction usually occur within minutes to a few hours after the shot. Watch for:

• Skin reactions, including hives and itching and flushed or pale skin
• Low blood pressure (hypotension)
• Narrowing of the airways and a swollen tongue or throat, which can cause wheezing and trouble breathing
• A weak and fast pulse
• Nausea, vomiting or diarrhea
• Dizziness or fainting

If you or your child has an allergic reaction after any vaccination, get medical help right away.

Overview

Dengue (DENG-gey) fever is a mosquito-borne illness that occurs in tropical and subtropical areas of the world. Mild dengue fever causes a high fever and flu-like symptoms. The severe form of dengue fever, also called dengue hemorrhagic fever, can cause serious bleeding, a sudden drop in blood pressure (shock) and death.

Millions of cases of dengue infection occur worldwide each year. Dengue fever is most common in Southeast Asia, the western Pacific islands, Latin America and Africa. But the disease has been spreading to new areas, including local outbreaks in Europe and southern parts of the United States.

Researchers are working on dengue fever vaccines. For now, in areas where dengue fever is common, the best ways to prevent infection are to avoid being bitten by mosquitoes and to take steps to reduce the mosquito population.

Symptoms

Many people experience no signs or symptoms of a dengue infection.

When symptoms do occur, they may be mistaken for other illnesses — such as the flu — and usually begin four to 10 days after you are bitten by an infected mosquito.

Dengue fever causes a high fever — 104 F (40 C) — and any of the following signs and symptoms:

• Headache
• Muscle, bone or joint pain
• Nausea
• Vomiting
• Pain behind the eyes
• Swollen glands
• Rash

Most people recover within a week or so. In some cases, symptoms worsen and can become life-threatening. This is called severe dengue, dengue hemorrhagic fever or dengue shock syndrome.

Severe dengue happens when your blood vessels become damaged and leaky. And the number of clot-forming cells (platelets) in your bloodstream drops. This can lead to shock, internal bleeding, organ failure and even death.

Warning signs of severe dengue fever — which is a life-threatening emergency — can develop quickly. The warning signs usually begin the first day or two after your fever goes away, and may include:

• Severe stomach pain
• Persistent vomiting
• Bleeding from your gums or nose
• Blood in your urine, stools or vomit
• Bleeding under the skin, which might look like bruising
• Difficult or rapid breathing
• Fatigue
• Irritability or restlessness

When to see a doctor

Severe dengue fever is a life-threatening medical emergency. Seek immediate medical attention if you’ve recently visited an area in which dengue fever is known to occur, you have had a fever and you develop any of the warning signs. Warning signs include severe stomach pain, vomiting, difficulty breathing, or blood in your nose, gums, vomit or stools.