How to Protect Your Children During a Measles Outbreak

Recent measles outbreaks have many parents concerned. Most of the people who have gotten sick were not vaccinated against measles. This is a stark reminder of the importance of making sure your children are fully vaccinated.

(See "Teen to Teen: Speaking Up for Our Health" below.)

Here are answers to questions that many parents have about measles outbreaks.

I thought measles was a mild illness, so why the alarm now?

Measles was once a common childhood disease and almost an expected part of growing up. While most children recovered from the measles without problems, many others did not. In some children, the infection caused pneumonia and in a few, encephalitis (infection of the brain) and even death. Of every 1,000 people who got measles, 1 to 2 would die.

Before the measles vaccine was available, every year an average of 450 people died from measles; most of them were healthy children.

Thanks to the success of the measles vaccine, we are now able to protect children from the measles. However, in recent years some parents have refused or delayed vaccinating their children out of fear or misinformation about the safety of the measles vaccine. This means there are more unvaccinated children, teens and adults in our communities.

The recent measles outbreaks in the United States have been in unvaccinated people. Choosing to not vaccinate your children not only leaves them susceptible to measles, but also exposes other children to measles. This includes infants who are too young to be vaccinated and those who are unable to be vaccinated due to other health conditions.

How is measles spread?

The measles virus spreads easily through the air when an infected person sneezes or coughs and someone nearby inhales the infected droplets. It can also be transmitted by direct contact with fluids from the nose or mouth of an infected person.

Measles is one of the most contagious infectious diseases known. The virus can live for up to two hours in the air where infected people have coughed or sneezed, or on surfaces they may have touched. As a result, anyone in crowded, public spaces may come into contact with measles.

Is the measles vaccine safe?

Yes. Occasional side effects of the measles vaccine include fever, tenderness at the injection site and rash. Rare side effects include a temporary decrease in blood platelets. The measles vaccine does not cause autism. Getting the measles vaccine is much safer than getting the measles infection.

What are the signs and symptoms of measles?

The most recognizable measles symptom is a very high fever accompanied by a red or brownish blotchy rash, although this is not the only symptom.

Before the rash appears, children with measles develop cold-like symptoms, including:

• Cough

• Runny nose

• Fever

• Red, watery eyes

These symptoms tend to get worse during the first 1 to 3 days of the illness.

When do children need to get the measles vaccine?

The American Academy of Pediatrics (AAP), the Centers for Disease Control and Prevention, and the American Academy of Family Physicians all recommend children receive the measles, mumps and rubella (MMR) vaccine at age 12-15 months, and again at 4-6 years. Children can receive the second dose earlier if it is at least 28 days after the first dose.

There is a combination vaccine called MMRV that contains both chickenpox and MMR vaccines. MMRV is an option for some children 12 months through 12 years of age.

High immunization rates in a community protects those who are too young to be vaccinated, including infants under 12 months of age. These infants are at the highest risk of serious illness, hospitalization, and death due to measles. Find information on vaccines for infants age 6-12 months old during an outbreak or before international travel to a location with an active measles outbreak.

How long does the measles vaccine provide protection?

The measles vaccine is very effective in protecting against measles. However, no vaccine is 100% protective so very rarely, people who are vaccinated may develop measles. About 95 of every 100 people will be protected after getting one dose of the MMR vaccine. Two doses of MMR protect 97-99 of every 100 people.

I'm not sure if I've received measles vaccine. Do I need a booster?

If you are not sure if you or your children have been fully vaccinated against measles, talk with your doctor to see if anyone in your family needs to be vaccinated. There is no risk to receiving measles vaccine if you have been immunized before. Measles is a live vaccine so children with immune problems or receiving medications that suppress the immune system should not receive the measles vaccine. Your pediatrician is your best source of advice on vaccinations.

Hand Washing: A Powerful Antidote to Illness

How many times have you and your child washed your hands today? You might not have given it much thought. It’s either part of your routine, done frequently without thinking, or maybe you don’t do it much at all. But as your pediatrician may have told you, hand washing may be the single most important act you and your child have for disease prevention.

Making hand washing a habit

As early as possible, get your child into the habit of washing their hands often and thoroughly. All day long, your child is exposed to bacteria and viruses—when touching a playmate, sharing toys, or petting the cat. Once their hands pick up these germs, they can quickly infect themselves by:

• Rubbing their eyes

• Touching their nose

• Placing their fingers in their mouth

The whole process can happen in seconds, and cause an infection that can last for days, weeks, or even longer.

When to wash hands

Hand washing can stop the spread of infection. The key is to encourage your child to wash their hands throughout the day. For example, help or remind them to wash their hands:

• Before eating (including snacks)

• After a trip to the bathroom

• Whenever they come in from playing outdoors

• After touching an animal like a family pet

• After sneezing or coughing if they cover their mouth

• When someone in the household is ill

Studies on hand washing in public restrooms show that most people don't have very good hygiene habits. "Hand washing" may mean just a quick splash of water and perhaps a squirt of soap, but not nearly enough to get their hands clean.

Steps to proper hand washing

So what does a thorough hand washing involve? The Centers for Disease Control and Prevention (CDC) recommends the following steps:

• Wet your child’s hands.

• Apply clean bar soap or liquid soap to the hands, and then place the bar on a rack where it can drain before the next hand washing.

• Rub hands vigorously together. Scrub every surface completely.

• Keep rubbing and scrubbing for 20 seconds to effectively remove the germs.

• Rinse the hands completely, then dry them.

About antibacterial soaps

Drugstore shelves are full of trendy antibacterial soaps, but studies have shown that these antibacterial products are no better at washing away dirt and germs than regular soap. Some infectious disease experts have even suggested that by using antibacterial soaps, you may actually kill off normal bacteria and increase the chances that resistant bacteria may grow.

The best solution is to wash your child’s hands with warm water and ordinary soap that does not contain antibacterial substances (eg, triclosan). Regular use of soap and water is better than using waterless (and often alcohol-based) soaps, gels, rinses, and hand sanitizer rubs when your child’s hands are visibly dirty (and with children, there usually is dirt on the hands!). However, when there is no sink available (eg, the car), hand rubs can be a useful alternative.

How long to wash hands

Keep in mind that although 20 seconds of hand washing sounds like an instant, it is much longer than you think. Time yourself the next time you wash your hands. Watch your child while they're washing their hands to make sure they are developing good hygiene behaviors. Pick a song that lasts for 20 seconds and sing it while you wash. Encourage your child to wash their hands not only at home, but also at school, at friends’ homes and everywhere else. It’s an important habit to get into, and hopefully one that’s hard to break.

Why It’s Important to Take Care of Baby Teeth

Seeing your baby's first tooth is an exciting milestone! Most little ones will get their first (primary) teeth around 6 months of age, though tiny teeth can emerge as early as 3 months.

Did you know that cavities can develop as soon as your baby has teeth? Since baby teeth will eventually fall out, it might not seem all that important to take good care of them. But as it turns out, your child's first teeth are essential to the health of their permanent teeth—and the foundation for lifelong health.

These are just some of the reasons to take extra-good care of your child's first (primary) teeth. Read on to learn more.

How do cavities develop in baby teeth?

Cavities can form when the shiny surface of our teeth—the enamel—is harmed by common bacteria living in our mouths. The bacteria feed on sugary substances left behind from what we eat and drink. In the process, they create acids that attack tooth enamel, opening the door for tooth decay to start.

Even the natural sugars in breast milk and formula can kick-start the process of tooth decay. And even though primary teeth start falling out when kids are around 6 years old, what happens before then will influence your child's dental health over the long term. Research shows that diet and dental hygiene habits during a child's infant and toddler years reduces the risk of tooth decay as they become older.

Why it's crucial to take good care of baby teeth

Even though we've made great strides in preventing tooth decay, it is the most common chronic health problem seen in children. In fact, 23% of all kids will get cavities before their 5th birthday. Consider that:

• Decayed baby teeth may need to be taken out by the dentist, which can be painful and frightening for your child (and costly for your family).

• Missing baby teeth leave gaps, causing nearby teeth to shift around. This can keep your child's permanent teeth from coming in correctly, which might mean braces later on.

• Kids (and adults) need healthy teeth to speak clearly and chew their food thoroughly, the first step in healthy digestion. A bright, shining smile gives a child confidence, too—an essential part of making friends, getting along in school and enjoying life.

9 everyday steps for keeping your child's teeth healthy

Here are steps recommended by the American Academy of Pediatrics (AAP) for preventing cavities in babies and young children.

• No bottles in bed. Putting your child to sleep with a bottle allows the sugars found in formula and breast milk to linger on teeth, setting the stage for tooth decay. (In fact, many doctors and dentists refer to early cavities as baby bottle tooth decay).

• Handle pacifiers, spoons and cups with care. Tooth decay-causing bacteria can easily move from mouth to mouth. So, for example, you should avoid putting a pacifier in your mouth and then giving it to your child, or tasting your baby's food before offering them a bite from the same spoon.

• Cleanse little mouths after each meal. Even before your infant's first teeth break through, it is important to get into a healthy routine. Wipe the gums with a clean, damp washcloth or gauze pad after each feeding. When baby teeth come in, switch to a soft-bristled toothbrush with a smear (about the size of a grain of rice) of fluoride toothpaste. Around your child's first birthday, create a healthy routine of brushing 2 times daily for 2 minutes each time. Consider setting up a bedtime routine of brushing your child's teeth after their last feed, reading them a book and then getting them to bed at a regular bedtime—brush, book, bed.

Studies suggest that breastfeeding during a child's first year can help reduce the risk of tooth decay by half. This may be because of other effects breast milk has the immune system or microbiome (the balance of good and bad bacteria). Still, whether you give your baby breast milk or formula, you should wipe their gums and any erupting teeth after feedings to minimize risk of decay.

• Introduce a cup around your child's first birthday. Teaching young ones to drink from a cup can help prevent tooth decay. Plan to begin moving your child from the breast or bottle to a lidded cup around 12 months. Milk, breast milk and formula can be given at mealtimes, but fill your child's cup with plain water in between.

• Avoid using cups or bottles to soothe your child. When little ones get fussy, it's tempting to offer them a little formula or milk, but this exposes little teeth to sugars for long periods. Use a regular pacifier to calm your child, but be sure not to dip it in honey or any other sweetener.

• Skip the sugary drinks. Fruit juice, soda and sweetened drinks aren't good for your little one's teeth. In fact, the AAP does not recommend juice for babies under 12 months. After that, limit juices to 4 ounces per day and mix them with water (half-water, half-juice is best). See "Recommended Drinks for Children Age 5 & Younger.")

• Limit sticky fruits and treats. Some foods can cling to a child's teeth, giving bad-guy bacteria plenty of sugar to feast on. Sticky foods that promote tooth decay include raisins and other dried fruits, gummy candies, taffy, fruit roll-ups and snack bars with honey or molasses. Try to limit these foods in your child's diet and have kids brush or rinse with plain water after eating them.

• Make water the family drink of choice. Regular tap water, which usually contains fluoride to strengthen tooth enamel, is the healthiest drink for your child's teeth. Drinking plenty of water cleanses your child's mouth and helps maintain saliva flow, which also washes away decay-causing bacteria.

• Learn more about fluoride. Decades of studies have shown that fluoride is a superhero in fighting tooth decay. Most kids get the fluoride they need from tap water and toothpaste that delivers fluoride. Your pediatrician or dentist may also apply a fluoride varnish to your child's teeth, a helpful step 2-4 times a year that can continue as your child grows.

Not sure if your local water supply has fluoride? Use this online map to find out. If you're wondering about fluoride safety, read what a dentist who's also a mom has to say.

When should I take my child to the dentist?

When your baby's first tooth appears, it's time to schedule their first dental visit. This is the ideal time to learn more about dental care for kids and what you'll need to do as they grow.

Over time, your dentist can help you set up a healthy family routine, explaining everything from how to teach little hands to brush and floss to fitting young athletes with the right mouthguard.

The role your pediatrician plays

Since babies see the doctor several times before their first birthday, pediatricians have the opportunity to check inside little mouths. It can be difficult to spot warning signs in baby teeth, so your pediatrician's expert eye is especially helpful.

As your child grows, your pediatrician will offer tips and suggestions that support the expert care your family dentist will provide. They can also apply fluoride varnish to your child's teeth in partnership with your child's dentist. In addition, In addition, pediatricians can help parents learn more about special risks that make some children more cavity-prone. For example, preemies often have weaker tooth enamel than babies born at full term. Certain health conditions and medicines can reduce saliva flow, making brushing and flossing even more important.

Making cavity prevention a family priority

Kids learn from the adults around them. That's why parents and caregivers should take excellent care of their own teeth. As one dentist puts it: "Bad teeth don't necessarily run in the family, but bad dental habits do."

Set a positive example by letting little ones watch while you brush and floss. Explain that this is something we do twice a day, morning and night, even when we're away from home. Mark dental appointments on the family calendar, which shows kids that regular checkups are a top priority. Some children benefit from going to the dentist more than every 6 months to help them avoid getting cavities or keep cavities that have already started from getting worse.

Encourage good habits by adding fun to your child's routine. Toddlers and preschoolers may enjoy brushing to music or marking their progress on a tooth care calendar. The American Dental Association offers free coloring and craft sheets you can download and share, too.

Remember

Healthy baby teeth set the stage for a lifetime of good dental health. Teeth play a crucial role in helping us speak clearly, smile confidently and chew our food thoroughly, which nourishes our bodies for overall good health.

Setting a good example helps prevent tooth decay now and in the future.

Along with your family dentist, your pediatrician plays a key role in caring for your child's mouth and teeth.

When Can Kids Get the Updated COVID Vaccine?

COVID vaccines are our best hope to move forward from the COVID pandemic. Nearly all kids age 6 months and older are eligible for the 2023-2024 COVID vaccine.

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) recommend updated COVID vaccines for everyone age 6 months and older. The vaccine equips your child's immune system to recognize and resist the virus. This helps to prevent serious disease and hospitalization from COVID.

Recommended dose & type of vaccine

COVID mRNA vaccines from Pfizer-BioNTech and Moderna are available for kids age 6 months and older. If your child is at least 12 years old and cannot receive the mRNA vaccines, they may be eligible for the updated protein subunit COVID vaccine from Novavax.

Babies and young children usually need more doses than older children and teens. (See the chart below for details.) Parents should note that additional doses of the 2023-2024 COVID vaccine may be recommended if a child has certain medical conditions or takes medicines that weaken the immune system.

When is my child up to date?

Children age 6 months through 4 years: They are up to date when they get 3 doses of Pfizer-BioNTech vaccine or 2 doses of Moderna vaccine. At least 1 dose should be an updated Pfizer-BioNTech or Moderna COVID vaccine.

Children age 5 through 11 years are up to date when they get: 

1 dose of updated Pfizer-BioNTech vaccine.

—OR—

When they get 1 dose of updated Moderna COVID vaccine.

Adolescents age 12 through 17 years are up to date when they get:

1 dose of updated Pfizer-BioNTech or Moderna COVID vaccine.

—OR—

2 doses of updated Novavax vaccine.

—OR—

1 dose of any updated COVID vaccine after any original or bivalent COVID vaccine.

Source: AAP Pediatric COVID-19 Vaccine Dosing Quick Reference Guide, https://aap.org/covidvaccineguide

If your child has a medical condition or takes medicines that affect their immune system, ask your pediatrician whether your child's recommended schedule is different.

Do kids need to wait to get the vaccine if they had COVID?

Talk to your pediatrician about the best timing for vaccination following infection. If your child has an active COVID infection or had COVID between doses, they should wait to get vaccinated until they've recovered and are no longer contagious.

Children who recently had COVID can consider delaying a COVID vaccine by up to 3 months. This is because there is a lower risk of getting sick with COVID again during that time.

Don't let COVID slow your family down this fall. Pediatricians urge everyone to keep your immune system updated by getting the 2023-2024 COVID vaccine.

People still should get the 2023-2024 COVID vaccine even if they had COVID. This is because COVID vaccines have been shown to provide the strongest, broadest and most long-lasting protection, both in people who have and who have not had COVID infection previously. Some people who become infected also may be at higher risk of long-term effects from their infection (known as long COVID or post-COVID conditions).

One thing is certain: COVID vaccines are preventing severe illness, hospitalization and death for billions of people who've received them. We are relieved that almost all children and teens can get the vaccines, so they can stay healthy and thrive.

More information

• Getting My COVID Vaccine: A Picture Story for Kids

• COVID Vaccine Checklist for Kids

RSV, Flu & COVID: How Are These Respiratory Illnesses Different?

​Your child has a stuffy nose, cough and fever. Is it the flu? COVID? Or are they symptoms of respiratory syncytial virus (RSV)?

Let's look at four common childhood illnesses caused by viruses—COVID, flu, the common cold and respiratory syncytial virus (RSV). All of them share some similar symptoms. Here are some clues to help tell them apart.

RSV symptoms may include fever, cough, fatigue, stuffy nose, shortness of breath, sneezing, fast/short breaths, flaring nostrils, wheezing and grunting, poor feeding/no appetite. You may also notice their head bobbing or chest caving in between and under their ribs with each breath. Symptoms are usually the worst on days 3 through 5 and last about 7 to 14 days.

Flu symptoms may include fever, chills, headache, body aches, dry cough, fatigue, stuffy nose and sore throat. Some children may throw up and have diarrhea. Symptoms show up about 1 to 4 days after being exposed to a sick person.

• COVID symptoms may include fever, cough, fatigue, muscle or body aches, congestion, shortness of breath, sore throat, headache, sneezing, vomiting/diarrhea, or loss of taste/smell. Symptoms show up 2 to 14 days after infection.

• Cold symptoms may include fever, cough, fatigue, stuffy nose, sore throat, sneezing, slightly swollen glands. Colds are upper respiratory infections that can be caused by many viruses. Healthy children get about 6-10 colds a year.

Call your pediatrician if your child has any of the following symptoms:

• Rapid breathing, flaring nostrils, wheezing and grunting

• Chest caving in with each breath

• Shortness of breath/difficulty breathing

• Vomiting for more than 24 hours

• Bloody diarrhea

• Very ill or drowsy

• Poor feeding

• Dehydration

• Fever above 104 °F in any child; fever above 100.4 °F in a child under 2 months old; fever above 103 °F for more than 24 hours.

Is it possible to be infected by two viruses at once?

Yes. For example, children can be infected by the flu and COVID at the same time. And it is not unusual for children to develop a secondary illness. For example, they may have bronchiolitis or pneumonia and other health problems like an ear infection or sinus infection.

Some of the symptoms of flu, COVID and other respiratory illnesses are similar. Your child's pediatrician may order a test if it is necessary to confirm a diagnosis.

How to avoid getting sick when these viruses are spreading

Immunizations are an effective tool to prevent serious illness from numerous preventable diseases. Staying up to date on routine immunizations also helps others—including people at high risk if they get infected.

• Flu vaccines are recommended for everyone 6 months and older each year. Get your child vaccinated as soon as the vaccine is available so they are protected throughout flu season, which can last until the end of May.

• The updated COVID vaccine is recommended for everyone 6 months and older. Ask your pediatrician when your child should receive an updated COVID vaccine.

• Nirsevimab is an RSV immunization recommended for babies younger than 8 months of age in their first RSV season and some children age 8 to 19 months who are entering their second RSV season and are at high risk of getting very sick from RSV.

• RSVpreF is a vaccine for pregnant people​ to protect their infants from RSV.

Remind your child about other ways to avoid illness. Children should learn to cover their mouths and noses with a tissue when they cough or sneeze (and then put the tissue in the trash right away). They can wear a mask in public to avoid the spread of germs to and from others. Everyone should be encouraged to wash their hands with soap and water or use an alcohol-based hand sanitizer.

Remember

If your child is sick and you have any questions or concerns about their symptoms, don't hesitate to call your pediatrician. And, it is important for all children to stay up to date on immunizations, sports physical examinations and routine care.