Stephen J. Schueler, M.D.

Overview Conditions Evaluation guideline 2 to 6 years guideline 7 to 12 years guideline infants guideline teens Prevention diet exercise vaccines chicken pox DTaP hepatitis a hepatitis b HIB influenza IPV MMR prevnar

Children's Health Prevention

General guidelines for disease prevention in children include:

Children's Health Diet

Infants will grow faster in the first year of life than in any other time. The growth of babies and children is a reflection of the adequacy of their diet and is the single most important factor in the evaluation of nutritional status.

The infant's birth weight doubles in four months, from approximately 7 to 14 pounds, and another 7 pounds is added in the next eight months. By the end of the first year, the growth rate has decreased and the weight gain during the upcoming year may only be 5 to 7 pounds.

Unlike the formula fed baby, the infant who is breast-fed does not need supplements. Breast milk and the infant's own internal energy stores will meet most of the nutritional needs for the first 6 months of life. Exceptions to this could include vitamin D, fluoride, and iron supplementation.

General Recommendations for First Foods for Infants

Age (months)Food or Drink
0-4infant formula or breast milk
4-6iron fortified rice cereal, may add other cereals as tolerated
5-7strained vegetables and/or fruits and their juices, one at a time
6-8protein foods- cheese, yogurt, meat, fish, chicken, egg yolk
9finely chopped meat, toast, teething crackers
12whole milk may be introduced

Children's Daily Food Pattern for Good Nutrition
Children 1-3 years of age:
Milk and cheese4 servings/day (1/2 cup per serving)
Eggs1 serving/day (1 egg per serving)
Lean meat, fish, and poultry3+/day (1 tablespoon per serving)
Fruits and vegetables4+/day (1/3 cup per serving)
Breads4+ serving/day (1/2-1 slice per serving)
Cereals4+ serving/day (1/2 ounce per serving)
Fatsshould not exceed 1 tablespoon

Children 4-5 years of age:
Milk and cheese4 servings/day (3/4 cup per serving)
Eggs1 serving/day (1 egg per serving)
Lean meat, fish, and poultry3+/day (4 tablespoon per serving)
Fruits and vegetables4+/day (1/2 cup per serving)
Breads4+/day (1-1.5 slices per serving)
Cereals4+/day (1 ounce per serving)
Fatsshould not exceed 1 tablespoon

Children 6-12 years of age:
Milk and cheese4 servings/day (3/4 - 1 cup per serving)
Eggs1 serving/day (1 egg per serving)
Lean meat, fish, or poultry3+/day (1/2 cup per serving)
Fruits and vegetables4+/day (1/2 cup per serving)
Breads4+/day (1-2 slices per serving)
Cereals4+/day (1 ounce per serving)
Fatsshould not exceed 2 tablespoon

Snacks that Promote Dental Health
  • Juicy foods:
    • Apples
    • Berries
    • Oranges
    • Dill Pickles
    • Grapes
    • Peaches
    • Pears
    • Plums

  • Crunchy foods:
    • Carrots
    • Cauliflower
    • Celery
    • Apples
    • Cabbage
    • Cucumber Slices
    • Popcorn

  • Thirst quenchers:
    • Buttermilk
    • Diet Drinks
    • Milk
    • Tomato Or Unsweetened Juice

  • Hunger satisfiers:
    • Cheese Cubes Or Slices
    • Eggs
    • Meat Cubes Or Slices
    • Milk
    • Nuts
    • Sardines

Foods that Increase the Risk of Dental Disease
  • Juicy foods:
    • Dried Fruits
    • Jams
    • Jelly
    • Sweetened fruits and juices
    • Sweetened yogurt
    • Syrups

  • Crunchy foods:
    • Candy
    • Cookies
    • Sugared Cereals
    • Candied Apples

  • Thirst quenchers:
    • Ice Cream
    • Sweetened fruits and juices
    • Sweetened milk
    • Sweetened Yogurt

  • Hunger satisfiers:
    • Cake
    • Cookies
    • Ice Cream
    • Pie

Food portions:
  • Food portions should be adjusted appropriately for the age of the child. The child needs the same foods selected from the basic food groups as an adult, but in smaller quantities.
  • A good rule of thumb for quantities is to serve 1 tablespoon of cooked food per year of age (one serving). Frequency of offering food is important in fulfilling energy requirements as well as increasing nutrients. Foods should be offered 5 to 6 times per day at 2 to 2 and 1/2 hour intervals.
  • New foods should be served in small portions at meal times when the child is hungry. A new food introduced in small portions is less likely to be rejected.

General strategies for a healthy diet include:
  • Limit your intake of fat to 30% of your total calories.
  • 10% to 15% of your total calories should be in the form of monounsaturated fats, such as olive oil, canola oil and peanut oil.
  • Consume only unsaturated fats that are low in cholesterol.
  • Consume less than 300 milligrams of cholesterol a day.
  • Eat dietary fiber: whole grains are best.
  • Avoid fad diets.
  • Children should take a balanced multi-vitamin daily

Key Dietary Recommendations for Chronic Disease Prevention
Energy (calories)to maintain BMI < 25
Total fats< or = to 30% of total daily calories
Saturated fats< 7% of total daily calories
Polyunsaturated fats< 10% of total daily calories
Monounsaturated fats< 13% of total daily calories
Cholesterol< or = to 300 mg per day
Dietary fiber25-30 grams per day
Fiber type3:1 insoluble to soluble fiber
Sodium< or = to 1,500 mg per day
Calcium 9-24 yrs1,200-1,500 mg per day
Calcium 25-50 yrs1,000 mg per day
Calcium 51-65 yrs1,200 mg per day
Calcium >65 yrs1,500 mg per day
Vitamin D 9-50 yrs200 IU per day
Vitamin D 51-70 yrs400 IU per day
Vitamin D >70 yrs600 IU per day
Folic acid400 micrograms (ug) per day
Fruits & vegetables5-7 servings per day

Children's Health Exercise

Regular exercise is just as important for children as it is for adults.

What is exercise?
Exercise is physical work that keeps the body healthy. Regular exercise has been found to prolong your life. Many people perform hard physical labor, but are not "physically fit".

What is fitness?
Fitness is a sense of well being. You feel energetic, relaxed, and strong when you are physically fit. Your body is usually trim, flexible, and coordinated. Regular exercise is an important part of physical fitness. A healthy diet and lowering stress also help you to be physically fit. Exercise can also reduce stress that allows you to be more "mentally fit".

Exercise affects your body in very complicated ways. Scientists have found that exercise is good for your body in many respects. In children, it may help prevent and treat some illnesses, such as:

How will exercise make me feel?
You must perform regular exercise in order to become physically fit. As you exercise, your body adapts to (becomes used to) the work it must perform. You are then able to tolerate more strenuous activity without tiring. When it becomes a habit, you will feel stronger and more relaxed during normal activities. You will probably sleep better. The exercise may even allow you to lose weight if you follow a proper diet.

What are the benefits of exercise?
There are tremendous benefits to regular exercise. Exercise can:

How do you start an exercise program?
Unfortunately, few Americans get regular exercise. You are more likely to adopt a regular exercise program if you choose activities that you enjoy. An exercise program should include:

What makes up an exercise program?
  • Type: there are a few major types of exercise:
    • Aerobic: constant exercise for a prolonged time (walking, biking, swimming)
    • Stretching: makes you more flexible
    • Weight lifting: increases muscle tone and strength
  • Intensity: how difficult (strenuous) the exercise is:
    • Usually followed by your pulse (heart rate) during the exercise
    • Your doctor should recommend a pulse that is right for you
  • Duration: how long the exercise lasts:
    • 25-45 minutes for each session
  • Sessions: what you do during the exercise time:
    • 3-5 minutes for warm-up
    • 15-40 minutes for aerobics or weight training
    • 2-5 minutes for cool-down
  • Frequency: how often you exercise:
    • Daily if you exercise less than 30 minutes or your intensity is low
    • Every other day if you exercise greater than 30 minutes or your intensity is high
  • Progression: how you increase your exercise difficulty or time
    • Start out slowly
    • Keep your pulse in the target range
    • Use a logbook to keep track of progress

What are some moderate vs high intensity activities?
Moderate Intensity ActivitiesHigh Intensity Activities
Walking briskly (3 to 4 mph)Aerobics
Toning exercisesTai-bo
Mowing lawnCycling (racing)
Golf (pulling or carrying clubs)Climbing hills
Home repairCross country skiing
Fishing, standing/castingFitness walking
Jogging (medium pace)Swimming
Swimming (medium pace)Roller skating
Cycling (< 10 mph)Tennis
Canoeing (2-4 mph)Soccer
House paintingJumping rope
CarpentryJogging or running

What are calories?
Food supplies our bodies with energy. Calories are the units we use to measure the energy that food contains. Some types of exercise tend to burn more "calories". Also, you have to exercise harder or longer to burn more calories.

How many calories are burned by certain activities?
ActivityNumber of Calories Burned
Walking (brisk)100 calories burned per mile
Jogging120 calories burned per mile
Swimming100 calories burned in 20 minutes
Bicycling (easy pace)100 calories burned in 20 minutes
Aerobic exercise to music100 calories burned in 20 minutes
Gardening (vigorous)100 calories burned in 30 minutes

What are some tips on how to exercise?
  • Always use a mat under you when doing floor exercises.
  • Always wear the right shoes for each activity. They must fit well. If they are too loose, you may suffer blisters. If they are too tight, you may injure your feet. Your socks should pad the skin and absorb sweat well.
  • Avoid exercising outdoors in very warm or very cold weather.
  • Avoid exercising right after you eat. Wait at least two hours after eating before heavy exercise.
  • Do not wear loose jewelry.
  • Drink plenty of fluids before and after exercising.
  • Keep a sugared drink nearby:
  • Exercise in a room with good air circulation. The room should be slightly cool at the start. Then you will be more comfortable when your body heats up.
  • Exercise only when feeling well.
  • Exercise with a friend.
  • Find an exercise routine, teacher, and program that you like.
  • Music may help you enjoy your workout. However, be sure that you can hear cars if you are near the road.
  • Set realistic and safe goals for yourself.
  • Take your pulse at the wrist. Do not take your pulse at the neck. Pressure on the carotid artery in the neck may make you faint.
  • Try to exercise at the same time each day so it becomes routine.
  • Wear loose, layered clothing. As you warm up, you can take off the layers.
  • Performing strenuous exercise while wearing "sweats" can be dangerous. Your body naturally tries to cool itself by sweating. Wear only enough clothing so that you are warm during the exercise.

When should you stop exercising?
You should stop exercising if you do not feel well or have any of the following:

In summary, diseases are not caused by a lack of exercise. But physical fitness will improve general health and help slow aging. Talk to your doctor about an exercise program that is right for you. Most importantly, choose an activity that you enjoy!

Children's Health Vaccines

The following tables provide information regarding current vaccine recommendations in the United States for infants, younger children, and pre-teens. Consult your doctor for additional vaccine recommendations.

Recommended Vaccines for Healthy Infants

DTaPdiphtheria, tetanus, pertussis2, 4, 6,15-18 mo. & 4-6 yr
HBVhepatitis Bat birth, 1-2 mo. & 4-6 mo.
HIBhaemophilus influenza b2, 4, 6, & 12-15 mo.
MMRmumps, measles, rubella12 - 15 mo.
IPVinactivated polio vaccine2, 4, & 15 mo.
Varivaxchicken pox12-15 mo.
Hepatitis A (Havrix)hepatitis A2, 4 & 15 mo.
Prevnarpneumonia2, 4, 6 & 12 - 15 mo.
Influenza vaccineinfluenzasingle dose if 6-23 months

Recommended Vaccines for Healthy Children 2 to 6 Years
DTPdiphtheria, tetanus, pertussisonce, from 4-6 yrs.
MMRmumps, measles, rubellaonce, from 4-6 yrs.
IPVinactivated polio vaccineonce, from 4-6 yrs.
Havrixhepatitis Aif needed
Varivaxchicken poxif needed
Influenza vaccineinfluenza2 doses if never vaccinated

Recommended Vaccines for Healthy Children 7 to 12 Years
Vaccines (make-up)Frequency
Hepatitis B vaccine11-12 years of age
Influenza vaccine2 doses if not immunized and less than 9 years
Second MMR7-12 years of age
Tetanus booster11-16 yrs & every 10 years thereafter
Papillomavirus vaccine11 and 12 year old girls

For teens and young adults see

Children's Health Chicken Pox

The chickenpox vaccine, marketed under the trade name Varivax, was approved by the FDA for use in 1995. Most people who receive this vaccine will not get chickenpox.

Those who have had a serious allergic reaction to gelatin or neomycin should not receive this vaccine.


  • This vaccine is given in one dose to infants, usually at the same time as the MMR. It may however, be given anywhere from 12 months of age to 18 months of age.
  • Varivax is given in two divided doses to children (and adults) over 12 years. Adolescents and adults 13 years of age and older should receive a 0.5 ml dose administered subcutaneously at elected date and a second 0.5 ml dose 4 to 8 weeks later.

Side Effects
Mild problems:

Moderate problems:
  • Seizure, usually caused by fever (less than 1 out of 1,000)

Serious problems:

Children's Health Dtap

The DTP, or what is now the newer DTaP vaccine, provides protection against diphtheria, tetanus, and pertussis. The newest form of DTP is the DTaP (Certiva or Infanrix), which contains an acellular pertussis component that is reported to have fewer side effects than older forms of the pertussis vaccine.

Due to increasing concerns about the amounts of mercury in a stabilizing agent called thimerosal, a new DTP vaccine called Tripedia has been developed. This vaccine has little or no thimerosal and was approved by the FDA in March 2001. In 2002, a new vaccine called PEDIARIX, which contains DTP, polio and hepatitis B, was approved. PEDIARIX only requires 3 shots instead of 9 for protection against these five diseases.

The DTaP should be administered at 2, 4, and 6 months. A fourth booster should be given anywhere from 15 to 18 months. The fourth dose may be administered as early as 12 months of age, provided six months have elapsed since the third dose and the child is unlikely to return at age 15 to 18 months.

Side Effects
Most reactions to the DTP are minor and usually start in the first 3 days after the booster and do not last long. Most people do not have serious reactions to this vaccine, although there are very rare cases of severe allergic reactions and death that have been reported.

Mild reactions include:

More severe reactions include:
  • Non-stop crying for 3 hours or more (100 out of every 10,000 doses)
  • Fever of 105 degrees F. or higher (30 out of every 10,000 doses)
  • Seizures (6 out of every 10,000 doses)
  • Child becomes limp, pale, and less alert (6 out of every 10,000 doses).

The most severe reactions are:

Children's Health Hepatitis A

Hepatitis A vaccine can prevent hepatitis A.

Common brand names of this vaccine include:

  • Avaxim
  • Epaxal
  • Havrix
  • Hepatyrix
  • Vaqta Paediatric
  • ViATIM

Indications for Hepatitis A Vaccine
  • Persons 2 years of age and older traveling to or working in countries with high or intermediate prevalence of hepatitis A, such as those located in Central or South America, the Caribbean, Mexico, Asia (except Japan), Africa, and eastern Europe.
  • Children and adolescents who live in states or communities where routine vaccination has been recommended.
  • Men who have sex with men.
  • Persons who use street drugs.
  • Persons with chronic liver disease.
  • Persons who are treated with clotting factor concentrates.
  • Those traveling to an area where hepatitis A is common.

Anyone who moderately or severely ill at the time the shot is scheduled should probably wait until they recover. Ask your doctor or nurse. People with a mild illness can usually get the vaccine.

Primary immunization for adults consists of single dose. Primary immunization for children (2 to 18 years of age) consists of 2 doses, given 1 month apart.

Side Effects
Getting hepatitis A vaccine is much safer than getting the disease.

Mild problems:

Serious problems:
Severe allergic reactions to hepatitis a vaccine are very rare. Signs of a serious allergic reaction can include:

Children's Health Hepatitis B

The hepatitis B vaccine protects against infection with the hepatitis B virus. Everyone who is under 18 years of age should get hepatitis B vaccine. Unimmunized children younger than 18 years may begin the series at any age. Adults should get the hepatitis B vaccine if they are at risk for infection.

Indications for use

  • Dialysis nurses
  • Dialysis patients
  • Health care workers
  • Infants with hepatitis B infected mothers
  • Institutionalized patients
  • Intravenous drug users
  • Male homosexuals.
  • Sexually promiscuous persons
  • Geographical area; your risk is also higher if your parents were born in:
    • Southeast Asia
    • Africa
    • Amazon Basin in South America
    • Pacific Islands
    • Middle East

Those who have had a serious reaction to baker's yeast in the past should not receive this vaccine.

Complete immunity to hepatitis B virus will require the administration of three boosters:
  • In most cases the first booster may be administered anywhere from birth to through the second month of life. Infants born to hepatitis B infected mothers should receive vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth at separate sites.
  • The second booster should be administered at least one month after the first dose. Infants born to hepatitis B infected mothers should receive the second dose at least one month after the first dose.
  • The third booster should be given at least 2 months after the second, but not before six months of age. Infants born to hepatitis B infected mothers should receive their third dose at least four months after the first and two months after the second, but not before 6 months of age.
  • Illness may require a shot to be delayed. Only your doctor can make this determination.

Side Effects
Mild problems:
  • Soreness at the vaccination site (1 out of 11 children)
  • Mild to moderate fever ( 1 out of 14 children)

Severe problems:
Severe allergic reactions to HIB are very rare. Signs of a serious allergic reaction can include:

Children's Health HIB

Haemophilus influenza B (HIB) is important cause of pneumonia and blood-borne disease (sepsis) in the newborn. Vaccination against HIB has significantly reduced these infections. Many more children would get HIB without the HIB vaccine.

Children who are over 5 years of age usually do not require this vaccination. Older children and adults who have a poorly functioning immune system may be candidates for HIB vaccine.

Brand names of this vaccine include:

  • The HIB vaccine should be delayed if the child is ill at the time the shot is scheduled. Only your doctor can determine if the shot should be delayed.
  • The HIB vaccine should be administered at 2, 4, and 6 months of age. A final dose is administered at 12 to 15 months of age.
  • If the PedvaxHIB (Merck) is used then the 6-month dose may be skipped as long as the 2 and 4-month doses were administered.
  • COMVAX should be administered no earlier than 6 weeks of age. Current vaccination recommendations include three doses administered at 2 months, 4 months, and then 12 to 15 months of age.

Side Effects
The HIB is one of the safest of all the vaccines and may be associated with redness, warmth or swelling where the shot was administered for 2 to 3 days (1 out of 4 doses). Acetaminophen or ibuprofen may be used to control pain. Do not use aspirin.

Other less common reactions (1 out of every 100 doses) include:

Severe allergic reactions to HIB are very rare. Signs of a serious allergic reaction can include:

Children's Health Influenza

Influenza season is from November through April in the US. Each year, the influenza virus changes after an outbreak. A new influenza vaccine must be manufactured each year, in order to be effective against the new virus. Influenza vaccinations are given at the beginning of each flu season. Although the vaccine does not guarantee protection from infection, the risk of infection is reduced greatly.

There are two types of vaccine:

Annual influenza vaccine is recommended for the following:

This vaccine should not be given to certain people. These include:

Side Effects
Side effects from influenza vaccination in adults are relatively rare. In children, side effects may be more common. Influenza vaccine cannot cause influenza. The most commonly reported effect is soreness around the vaccination site for several days after the vaccination. This can occur in about one out of every three people getting this vaccine.

Other reported side effects include:

They are most common in those who have not been exposed to the influenza vaccines, such as young children. These reactions begin 6 to 12 hours after vaccination and can last for 1 or 2 days. Minor symptoms can be treated with acetaminophen or ibuprofen. Avoid the use of aspirin in children because of the risk of Reye's syndrome.

Allergic Reactions
Immediate allergic responses to flu vaccine occur very rarely. When they do occur it is usually within minutes to hours of receiving the shot. Severe allergic reactions may cause hives, breathing problems, horse voice, paleness, dizziness, and low blood pressure. There have been rare reports of Guillain-Barre syndrome (GBS) after a flu vaccine.

Despite a small chance of a serious reaction, there is no doubt that the vaccination is safer than the risks of influenza. Vaccination is also far less expensive and more effective than using anti-flu medicines for a flu infection or exposure.

Home care of minor influenza vaccine reactions:

Notify your doctor if:
  • You become very weak, confused or disoriented after the vaccine
  • You develop a high fever or persistent vomiting after the vaccine
  • You develop a new seizure or fit after the vaccine
  • You develop a widespread rash after the vaccine
  • You develop increasing pain, redness and swelling of the injection site that does not respond to home care
  • You develop a boil or draining pus from the injection site
  • You develop worsening weakness in the legs after the vaccine

Children's Health IPV

On January 1st, 2000 the OPV (oral polio vaccine) was discontinued, forcing all physicians to use the IPV (inactivated poliovirus vaccine) only regimen. Unlike the old OPV, the IPV cannot cause polio because the virus contained in it is dead (inactivated). Most adults do not need this vaccine because they received it as children. Adults who have never been vaccinated against polio should receive the vaccine only if they are considered to be at high risk for infection.

Risk factors include:

  • Travel to an area where polio is endemic
  • Laboratory workers who may be handling the polio virus
  • Health care workers who may be treating patients who have polio

Four doses of the IPV are given for complete immunization against polio infection. Doses are usually given at:
  • 2 months
  • 4 months
  • 6-18 months
  • Booster dose at 4-6 years

Adults who require vaccination can get their first dose at any time; however the second dose should be administered 1-2 months later. The third and final dose should be given 6-12 months after the second dose.

Side Effects
There is a small risk of an allergic reaction with the IPV. Serious allergic reactions are fortunately rare.

More serious allergic symptoms include:

Children's Health MMR

The mumps, measles, and rubella (MMR) vaccine prevents mumps, measles, and rubella. All children should receive this vaccination to prevent these illnesses.


  • The first dose of MMR should be administered at 12 to 15 months of age.
  • The second dose of MMR should be administered at 4-6 years of age.


Side Effects
The risks associated with the MMR vaccine are very small, when compared to the risk associated with not receiving the vaccine. Rarely, the MMR vaccine causes a severe allergic reaction.

Side effects of the MMR vaccine include:

Home Care

Children's Health Prevnar

Pneumococcal disease is a serious infection caused by bacteria called streptococcal pneumoniae. Pneumococcal vaccine is available for use in children to prevent pneumococcal disease, such as pneumonia, meningitis, and otitis media. The new pneumococcal vaccine is marketed under the name Prevnar 13. Prevnar 13 protects against 13 different types of pneumococcal bacteria. The older version of Prevnar only protected against 7 strains.

The Centers for Disease Control recommends Prevnar 13 for children 2 months to 5 years of age (prior to sixth birthday). Children, who have started their vaccination schedule using the original Prevnar vaccine, may conclude it with the newer Prevnar 13. In addition, children from 15 months to 5 years who have received all 4 doses of the original Prevnar can get the additional coverage of Prevnar 13 with one additional dose.

Health experts believe that becoming infected with pneumococcal disease (such as pneumonia or meningitis) is more dangerous to your child's health than receiving the vaccine. Like any vaccine, Prevnar 13 may not provide protection from disease in every person. Be sure to ask your child's doctor about the benefits and risks of Prevnar 13.

Four doses of the Prevnar 13 vaccine are given for complete immunization against pneumococcal infection.

Doses are usually given at:

  • 2 months
    • First dose no sooner than 6 weeks
    • Should have 2 months between each injection
  • 4 months
  • 6 months
  • 12-15 months

If your child is already 6 months or older, he or she can receive Prevnar 13 on the following schedule:
  • 7-11 months:
    • Two injections at least 4 weeks apart
    • A third injection after the child turns 1 year; at least 2 months after the second injection
  • Age 12-23 months
    • Two injections at least 2 months apart
  • Age 2-9 years:
    • One injection

Side Effects
Mild problems:

More serious problems:

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