Viral Meningitis

Viral meningitis is a fairly common and less severe version that is rarely fatal, although infections involving arbovirus, herpesviruses, or polio may be more severe.

Causes Viral meningitis is usually caused by an enterovirus, a type of virus that infects only humans and is spread by the fecal-oral route. Enteroviruses live in human intestines; the two most common are echoviruses and coxsackievirus. The virus is spread by direct contact with infected feces, or nose or throat secretions. Most children are carriers without symptoms; the virus spreads most easily among young children in a group. Viral meningitis usually strikes young children in the summer and early fall. Scientists do not know why so few children who are exposed to the disease come down with symptoms; those who are well fed, well rested, and healthy are less likely to become infected.

Symptoms Symptoms usually appear quite suddenly, with a high fever, severe headache, nausea and vomiting, and stiff neck. There may be sensitivity to light and noise, sore throat, or eye infections. There also may be accompanying neurological problems, such as blurred vision. Most people recover completely within two weeks, although there may be muscle weakness, tiredness, headache, muscle spasms, insomnia, or personality changes such as an inability to concentrate for months afterward. These are rarely permanent.

Diagnosis Viral meningitis can be diagnosed by a spinal tap.

Treatment There is no cure for viral meningitis; eventually the immune system will develop antibodies to destroy the virus. Hospitalization with intravenous fluids and painkillers may be necessary for the severe headache, dehydration, nausea, and vomiting. Patients should drink clear fluids, eat a bland diet, and get plenty of rest. A few weeks after recovery, children's hearing should be tested.

Complications Increased pressure on the brain from a buildup of fluid in the meninges is a serious complication. Some infants who have meningitis early in life experience delayed language development. Patients with a weakened immune system may have chronic infections with enterovirus.

Prevention A vaccine to prevent meningitis due to S. pneumoniae is not effective in children under two years of age but is recommended for all persons over 65 years of age and younger persons with certain chronic medical problems.

meningoencephalitis An inflammation of both the brain and the meninges, usually caused by a bacterial infection.

menstruation The reproductive cycle that begins when an ovary releases an egg. At the same time, estrogen is released, stimulating the lining of the uterus to thicken with blood. If an egg is not fertilized, progesterone levels drop and blood vessels constrict, the uterine lining sheds, and the menstrual flow begins. This cycle repeats itself about every 28 days until interrupted by pregnancy or ended by menopause.

Normally, menstruation begins at some point between the ages of 11 and 13, although a delay through age 17 is still considered to be normal. A girl who is older than 17 and has never had a menstrual period should see a doctor. Lack of weight gain, stress, or hormone irregularities all can contribute to a delayed period.

mental health Good mental health allows children to think clearly, develop socially, and learn new skills. Mental health can be fostered by making sure a child has some good friends and receives encouraging words from adults. All this is important in helping children develop self-confidence, high self-esteem, and a healthy emotional outlook on life. In order to develop good mental health, a child needs:

• unconditional love

• self-confidence and high self-esteem

• the opportunity to play with other children

• encouraging teachers

• supportive caretakers

• safe surroundings

• guidance and discipline

Unconditional Love

For optimum mental health, a child should find love, security, and acceptance at home among the family. Children need to understand that their parents' love does not depend on accomplishments, and mistakes should be expected and accepted.

Self-Confidence

A child becomes more confident in a family that expresses unconditional love and affection. Children should be praised and encouraged so that they develop a desire to explore and learn about their surroundings. Parents who actively participate in children's activities help build their self-confidence and self-esteem.

Parents should not hide failures from their children, because it is important for them to know that everyone makes mistakes.

Encouragement

Encouragement helps children strive to do their best and enjoy the process of achievement. Trying new activities teaches children about teamwork, self-esteem, and new skills.

Playtime

Playtime is as important to a child's development as food and good care, because play teaches children to be creative, to learn problem-solving skills, and to have self-control. Running and exercise help children be physically and mentally healthy. By playing with others, children discover their strengths and weaknesses, develop a sense of belonging, and learn how to get along with others. Parents can be playmates, too; playing a board game or coloring with a child gives parents a great opportunity to share ideas and spend time together in a relaxed setting. This also helps teach children that winning is not as important as being involved and enjoying the activity. One of the most important questions to ask children is "Did you have fun?" not "Did you win?"

Guidance and Discipline

Parents should provide appropriate guidance and discipline because children need the opportunity to explore and develop new skills and independence. At the same time, they need to learn that certain behavior is unacceptable, and that they are responsible for the consequences of their actions.

Parents should be fair and consistent, being firm, kind, and realistic. Nagging, threats, and bribery should be avoided.

When to Seek Help

Caregivers are usually the first to notice if a child has problems with emotions or behavior. If a problem is suspected, parents should consult a pediatrician or mental health professional. The following signs may indicate the need for professional assistance or evaluation:

• decline in school performance

• poor grades despite strong efforts

• worry or anxiety

• repeated refusal to go to school or take part in normal activities

• hyperactivity or fidgeting

• persistent nightmares

• persistent disobedience or aggression

• frequent temper tantrums

• depression, sadness, or irritability

See also mental illness.

mental illness Mental health problems affect one in every five children and adolescents at any given time, and an estimated two-thirds of all young people with mental health problems are not getting the help they need. Estimates of the number of children who have mental disorders range from 7.7 million to 12.8 million.

If a child is having an emotional or behavioral problem, it is important to intervene as quickly as possible; often, a good therapist can recognize a problem and treat it effectively. Child and family psychologists are specifically trained to work with young children and teenagers. A child's pediatrician should first examine the child if there is a suspicion of depression or other emotional problems, because a doctor should rule out medical problems as a possible cause of symptoms.

Preschoolers could benefit from seeing a therapist if there is a significant delay in achieving developmental milestones (walking, language, and toilet training). Emotional difficulty in older children may well appear as problems at school, because behavior that may be tolerated at home may be recognized as inappropriate in a school setting. Although "normal" behavior varies depending on a child's age and maturity level, some of the signs that your child may be experiencing stress include:

• developmental delays

• behavioral problems (anger, acting out, or eating disorders)

• significant drop in grades, especially in a child formerly doing well

• prolonged or inappropriate sadness or depression

• social withdrawal or isolation

• decreased interest in previously enjoyed activities

• overly aggressive behavior

• appetite changes (particularly in adolescents)

• insomnia or fatigue

• school absenteeism or tardiness

• excessive physical complaints (especially headaches or stomachaches)

Finding a Therapist

Child psychologists, social workers, and child psychiatrists all diagnose and treat mental health disorders in youngsters. It is important to find a well-qualified, experienced therapist with whom your child can relate well, who seems friendly, warm, and approachable. Because the right therapist-client match is so important, it may require visits to several counselors before a final choice is made. A therapist who works with children should have a license and a professional degree in psychology, social work, or psychiatry.

A psychiatrist (M.D. or D.O.) is a medical doctor with advanced training and experience in mental illness and pharmacology. They are the only mental health providers who can prescribe medications. Clinical psychologists (Ph.D., Psy.D., or Ed.D.) are therapists with a doctorate that includes advanced training in the practice of psychology and psychotherapy. Many specialize in treating children and adolescents and their families. A clinical social worker (L.C.S.W., A.C.S.W., L.I.C.S.W., or C.S.W.) has a master's degree and specializes in clinical social work; an L.C.S.W. (licensed clinical social worker) is licensed by the state (accredited clinical social work-ers—A.C.S.W.—may also be accredited to work in more than one state). An L.I.C.S.W. is a licensed clinical social worker, which is a similar accreditation to the A.C.S.W., which means that these social workers can work in any state. A C.S.W. is a clinical social worker who is not yet licensed to practice.

Types of Therapy

There are many types of psychotherapy that may be most appropriate for a particular problem and a particular child and family. Therapists will often spend a portion of each session with the parents alone, with the child alone, and with the family together. Strategies include:

Individual therapy With this type of therapy, a therapist works one-on-one with a child on problems such as depression, social difficulties, or worry.

Family therapy With this technique, counseling sessions are scheduled with some or all family members as a way of improving communication skills. Family therapy can be helpful in many cases, especially if family members are having problems getting along. Treatment focuses on problem-solving techniques and can help parents reestablish their roles as authority figures.

Cognitive behavioral therapy This type of approach is often helpful with children over age 12 who are depressed, anxious, or having problems coping with stress. Cognitive behavioral therapy attempts to identify and alter maladaptive ways of thinking, restructuring negative thoughts into more positive ways of thinking.

Stress management If stress seems to trigger or worsen your child's condition, this type of therapy may help him learn ways to recognize stress and how to deal with it. Stress management may include relaxation training, a method that teaches children how to relax so they can better cope with stress. With this approach, children are encouraged to take responsibility for their own care, which can make them feel more in control of their situation.

Preparing a Child for Counseling

Parents should be honest with their child about a therapy session and why she or the family will be going, emphasizing that this type of doctor talks with children and families to help solve problems. Young children may need to be reassured that a visit to a therapist does not involve shots or physicals. Older children may need to be reassured that anything they say to the therapist is confidential and cannot be shared with anyone, including parents, without their permission (unless they indicate that are considering suicide or hurting someone).

mental retardation Below-average intellectual functioning abilities as determined by intelligence quotient (IQ) testing, and low adaptive functioning at home or in a work environment. An individual is considered to have mental retardation if IQ is below 70-75, there are significant limitations in two or more adaptive skill areas, and the condition is present from childhood.

Between 6.2 million and 7.5 million people have mental retardation, which is 10 times more common than cerebral palsy and 28 times more prevalent than neural tube defects such as spina bifida. Mental retardation cuts across the lines of racial, ethnic, educational, social, and economic backgrounds, so that one out of 10 American families is directly affected by mental retardation.

The effects of mental retardation vary considerably among people, just as the range of abilities varies considerably among people who do not have mental retardation. About 87 percent will be mildly affected and will be only a little slower than average in learning new information and skills. As children, their mental retardation is not easy to see and may not be identified until school age. The remaining 13 percent of people with mental retardation (those with IQs under 50) will have serious limits in function. However, with early intervention, a good education, and appropriate supports as an adult, all can lead satisfying lives in the community.

People with mental retardation may have trouble communicating, interacting with others, and being independent. There may also be concerns with regard to understanding health and safety issues. Not all skills are necessarily impaired, and children with mental retardation may learn to function independently in many areas. However, education programs, providing skilled assistance and ongoing support, are necessary for determining appropriate living and work environments.

Symptoms

Most parents tend to notice a problem within the first year or two of life. While all children develop different skills at different times, significant lags in several areas of development are an early warning sign. Children with mental retardation tend to reach developmental milestones later than youngsters of normal intelligence. They may not learn to sit, crawl, or walk until well after their second birthdays. Speech is likewise delayed, and some severely retarded children never learn to talk at all.

Cause

Mental retardation can be caused by any condition that impairs development of the brain before birth, during birth, or in the childhood years. Several hundred causes have been discovered, but about a third of the time the reason remains unknown. The three most common known causes of mental retardation are down syndrome, fetal alcohol

SYNDROME, and FRAGILE X SYNDROME.

Genetic conditions These conditions are caused by abnormal genes or from other disorders of the genes caused during pregnancy by infections, overexposure to X rays, and other factors. More than 500 genetic diseases are associated with mental retardation, such as:

• PKU (phenylketonuria) A single gene disorder caused by a defective enzyme

• Down syndrome A chromosomal disorder that happens sporadically, caused by too many chromosomes, or by a change in structure of a chromosome

• Fragile X syndrome A single gene disorder located on the X chromosome that is the leading inherited cause of mental retardation

Prenatal problems Using alcohol, drugs, or smoking during pregnancy can cause mental retardation. other risks include malnutrition, certain environmental contaminants, and illnesses of the mother during pregnancy, such as toxoplasmosis,

CYTOMEGALOVIRUS, GERMAN MEASLES, and SYPHILIS.

pregnant women who are infected with HIV and herpes may pass the virus to their child, leading to future neurological damage.

Problems at birth Although any unusual stress during birth may injure the infant's brain, prematurity and low birth weight are more likely to predict serious problems than any other conditions.

Problems after birth Childhood diseases such as WHOOPING COUGH, CHICKEN POX, MEASLES, and HIB disease (which may lead to meningitis and encephalitis) can damage the brain, as can accidents such as a blow to the head or near drowning. Lead, mercury, and other environmental toxins can cause irreparable damage to the brain and nervous system.

Socioeconomic Children in poor families may become mentally retarded because of malnutrition, disease-producing conditions, inadequate medical care, and environmental health hazards. Also, children in disadvantaged areas may be deprived of many common cultural and day-to-day experiences provided to other youngsters. Research suggests that such under-stimulation can result in irreversible damage and can serve as a cause of mental retardation.

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