It's normal for kids to feel anxious sometimes. When these feelings get too big and help is needed, experts often suggest cognitive behavioral therapy.  According to a recent study at Mayo Clinic, guiding kids through parent-coached exposure therapy can be more effective.

Dr. Stephen Whiteside, a psychologist with the Mayo Clinic Children's Center and lead author of the study, says exposure therapy helps kids face their fears more effectively than talk therapy, often requiring fewer sessions.

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"One of the most common fears that we see is social anxiety disorder," says Dr. Whiteside.

He says it's more than just a child being shy. For instance, they may fear people are going to judge them if they make mistakes.

"It makes it very hard for them to meet new kids and make friends. They're very nervous to talk in class or ask for help when they need it. They don't want to join activities because they're just so shy and afraid that something bad is going to happen," he says.

When exposure therapy is appropriate

If it is affecting daily life, exposure therapy may help.

"And so the treatment involves helping kids learn through their own experience that what they're afraid of is not as dangerous or not as bad as they think it's going to be," explains Dr. Whiteside.

He says kids will be more successful if they have someone to help them, typically a parent.

"Parent-coach exposure therapy is simply working with kids and parents together to help them learn how to help the child face their fears," Dr. Whiteside says.

The ultimate goal with exposure therapy is simple.

"We help kids face their fears very early in treatment so that we can help them get better as quickly as possible," says Dr. Whiteside.

Dr. Stephen Whiteside is the director of the Mayo Clinic Pediatric Anxiety Disorders Clinic and author of Anxiety Coach: A Parent’s Guide to Treating Childhood Anxiety and OCD.

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Hip dysplasia is a condition where the ball and socket of the joint don't fit together quite right. This can lead to joint instability, bone and cartilage damage, early arthritis, and a lot of pain.

"There was always that tradition for pediatric hip surgery for young children. And there's always the field of hip replacement surgery for elder patients. And with hip preservation, we're kind of bridging that gap," says Dr. Emmanouil Grigoriou, a Mayo Clinic orthopedic surgeon.

The goal, he adds, is "to allow patients to retain their own hip joint, their own cartilage, without any limitations or restrictions after surgery, enjoy years and years with their own native hip, and potentially even eliminate the need for any future hip replacement surgery."

Hip preservation surgery isn't for everyone, and outcomes are better when problems are diagnosed early when less arthritis is present. But for the right candidate, "we can take a patient from a fairly debilitating, painful state, to just giving their life back and their ability to be active and enjoy what they love," says Dr. Grigoriou.

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In this Mayo Clinic Minute, Dr. Megha Tollefson, a Mayo Clinic pediatric dermatologist, explains what caregivers should know if their child has a hemangioma.

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Some babies may develop bright red birthmarks called hemangiomas.

Dr. Tollefson says they're technically tumors, but parents shouldn't let that name or their stark appearance worry them.

"They're actually the most common tumor of infancy, happening anywhere from 1 in 20 to 1 in 50 babies. They are just a collection of blood vessels that grows in the first part of a baby's life," says Dr. Tollefson.

They're more common among babies born preterm. And they can appear anywhere on the body, but commonly involve the head and neck areas.

Another feature that might alarm parents is the rapid rate of growth. Dr. Tollefson says hemangiomas will continue to grow until children are about 6 to 9 months old. At that point, they typically stabilize, then go away slowly.

"About 90% of hemangiomas resolve — or involute is what we call it — by age 4. So it's a pretty slow process," says Dr. Tollefson.

Treatment usually isn't needed. However, Dr. Tollefson says if the hemangioma interferes with vision, other functions, has the potential to be cosmetically disfiguring, is large or is growing rapidly, babies should be evaluated for treatment.

"There are really two main treatments that we use now. The gold standard of treatment for a baby that needs a medicine by mouth is a heart medicine called propranolol."

"That type of medicine is called a beta blocker. There's also a topical form of that medicine, and there are some babies for whom that might be appropriate."

Later in life, laser surgery may be an option to treat residual hemangiomas. But Dr. Tollefson says that is not always needed.

Related posts:

• "Mayo Clinic Minute: Tips for protecting babies from harmful UV rays"

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A recent study published by the American Academy of Pediatrics reveals that some mothers are aware of safe sleep guidelines for infants, but they regularly engage in nonrecommended practices with the goal of improving their own and their baby's sleep.

In this Mayo Clinic Minute, Dr. Angela Mattke, a pediatrician with Mayo Clinic's Children's Center, discusses the most current safe sleep recommendations.

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Sleep can be a big challenge for parents with infants.

"I think as parents, we're all desperate to get our children to sleep at night," says Dr. Mattke, who warns parents to be aware of products that are not safe for sleep.

"There's lots of different products that are marketed towards families and parents to help guarantee to improve their sleep. But most of those products have been shown to not be safe for infants to be sleeping in specifically anything that has an incline," says Dr. Mattke.

Other products, like loungers and weighted blankets, also are not safe for sleep.

Dr. Mattke says, when it comes to baby's sleeping space, keep it simple.

"Make sure the infant is sleeping on their back with no fluffy stuff around them. They should be the cutest thing in their bassinet in their crib," she says.

Sharing a bedroom with baby, especially for the first six months of life, can decrease the risk of sleep-related death by up to 50%. But the key is sharing a bedroom, not a bed.

"We want them sleeping in their own flat, safe sleeping environment with no fluffy blankets or things that could get in the way and risk their breathing," says Dr. Mattke.

American Academy of Pediatrics recommendations on creating a safe sleep environment include:

• Place infants on their backs for sleep in their own sleep space with no other people. 
• Use a crib, bassinet or portable play yard with a firm, flat mattress and a fitted sheet. Avoid sleep on a couch, armchair or in a seating device, like a swing or car safety seat (except while riding in the car). 
• Keep loose blankets, pillows, stuffed toys, bumpers and other soft items out of the sleep space. 
• Breastfeed if possible and avoid smoking.

Other recommendations include:

• Offer a pacifier at naptime and bedtime.
• Do not use home monitors or commercial devices, including wedges or positioners, marketed to reduce the risk of SIDS.
• Infants should receive all recommended vaccinations.
• Supervised, awake tummy time is recommended daily to facilitate development.

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If you've been bit by a stomach bug lately, you're not alone. The Centers for Disease Control and Prevention (CDC) is reporting significant norovirus activity across the country, especially in the West and Northeast. 

The latest trend reports show that in the West region, more than 12% of tests for norovirus were coming back positive, while that number was more than 13% in the Northeast. Activity in the Midwest and Southern regions was slightly lower, with around 10% of tests coming back positive.

Noroviruses are usually more widespread in the fall and winter, but you can get sick from the virus any time of the year. The Centers for Disease Control and Prevention (CDC) says norovirus is the leading cause of vomiting and diarrhea from acute gastroenteritis in the U.S.

Norovirus infection, sometimes referred to as stomach flu, is unrelated to the flu caused by the influenza virus. Dr. Nipunie Rajapakse, a pediatric infectious diseases physician with the Mayo Clinic Children's Center, says it's a virus that causes gastroenteritis.

"Norovirus is a type of virus that causes gastroenteritis or stomach flu. Usually, it presents with symptoms like vomiting and diarrhea. Most healthy people will have recovery over a few days. But for people with a weakened immune system, for example, their symptoms can last longer than that," she says.

Watch: Dr. Nipunie Rajapakse explains norovirus and how to avoid it

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Dehydration is a concern, especially for young children, older adults, and those with other health issues or who are pregnant. Those symptoms can include decreased urination, dry throat and mouth, and feeling dizzy when standing up.  

Transmission

"Norovirus is spread through contact with the virus. People sick with norovirus shed the virus in high amounts in their vomit and stool, so coming into contact with the virus is how you get sick. This can be through direct contact or through contaminated food, or you can pick it up from a surface. That's why hand-washing is important and the best way to prevent getting sick with norovirus," says Dr. Rajapakse.

Risk factors

The CDC says that around half of food-related sickness outbreaks caused by norovirus are linked to restaurants or food-related environments. This happens when infected food workers and staff touch food or when it is contaminated.

Dr. Rajapakse says food that is contaminated with norovirus usually looks, smells and tastes normal so it can be difficult to tell it is contaminated.

Norovirus can quickly spread, especially in confined spaces, such as day care centers, nursing homes, schools and cruise ships. These viruses are tough to eliminate since they can endure high and low temperatures and most disinfectants.

"One of the common places that we see norovirus outbreaks occur is in close confined settings, like cruise ships, for example, where you have a lot of people eating from the same places and living in close proximity to each other," says Dr. Rajapakse. "Even one case of norovirus on a cruise ship can spread quickly to others there. That's why it's crucial to make sure that you're washing your hands well, especially before you eat."

Preventing norovirus infection

Antibiotics won't help because it's a viral infection, not bacterial. The best protection is prevention.

Tips to prevent the spread of norovirus:

• Wash hands with soap and water for at least 20 seconds.
• Avoid food and water that might be contaminated.
• Clean fruits and vegetables before eating.
• Cook seafood thoroughly.
• If you're sick, stay home and avoid others.
• Avoid preparing food for others if you are sick with vomiting/diarrhea.
• Disinfect surfaces and counters that may be contaminated.

And use caution when traveling. The CDC tracks outbreaks of norovirus and other diseases. You can learn more on their website. 

The CDC says outbreaks from norovirus are usually more common in the winter months. In countries above the equator, outbreaks are most common from November to April, while they are most common from May to September in countries below the equator. 

Related post:

• Mayo Clinic Minute: What to do when sick with norovirus or ‘stomach flu’

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Evelyn Owens' brave battle with cancer is capturing the hearts of everyone around her.

At only 6 years old, Evelyn was diagnosed with rhabdomyosarcoma, a rare form of childhood cancer.

Evelyn's family traveled from their home in Oregon to Mayo Clinic Comprehensive Cancer Center in Arizona where doctors are using cutting-edge technology that's revolutionizing cancer treatment for many patients like her.

Fighting cancer is tough.

Evelyn proved she's tougher.

Watch: Cancer is tough. Evelyn Owens is tougher

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Fighting cancer with the spirit of a warrior and a smile

No matter what life throws at her, Evelyn's parents say she just keeps on smiling. "That's how she looks 99% of the time even if she doesn't feel good," says her mom, Claire Owens. Evelyn's dad agrees. "She's very, very tough," says Austin Owens.

Evelyn's toughness was put to the test when pathology results revealed she had cancer.

"Everybody thought it was a cyst," recalls Claire. "Even after surgery they said it was a cyst, and then the pathology came back as cancer."

What is rhabdomyosarcoma?

Additional tests showed the cancer was rhabdomyosarcoma. RMS begins as a growth of cells in soft tissue, like muscle. It can start anywhere in the body. RMS most often occurs in children younger than the age of ten. Symptoms depend on where the cancer starts and can include lumps under the skin, redness, swelling, and pain.

As part of her treatment, Evelyn's doctors recommended radiation with innovative cancer-fighting technology called proton beam therapy. Her family traveled from their home in Oregon to Mayo Clinic in Arizona so Evelyn could receive the cutting-edge therapy.

Fighting cancer with proton beam therapy

"Proton therapy allows us to treat the area we need to treat completely while protecting many of the normal tissues nearby," says radiation oncologist, Dr. Safia Ahmed. "And for pediatric patients that's very important because all of their tissues are growing."

Proton beam therapy attacks and destroys cancer cells with radiation by targeting the precise location in the body where the cancer is located. "And by minimizing radiation dose and radiation dose side effects to these tissues as they are growing is key. It improves their (patients) quality of life," says Dr. Ahmed.

Evelyn underwent 24 treatments of proton beam therapy over six weeks. Her parents say through it all, she stayed tough and positive.

"I can't imagine going through this with anybody else but you," says Austin about his daughter. "You should be the poster child for going through cancer and cancer treatments. I'm so proud of you and love you so much," he adds.

Evelyn is now 7 years old and back home in Oregon with her family. She will still require some chemotherapy treatment. Doctors say her prognosis looks good. Evelyn will undergo regular monitoring to make sure the cancer does not come back.

These days Evelyn is back to enjoying the things she loves most, like riding ponies with her brother, Henry, and taking her dog, Duke, on walks.

Evelyn's smile is bigger and brighter than ever.

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Watch: Dr. Nusheen Ameenuddin shares screen time recommendations

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"The key thing that I would want all parents to know is that screens aren't all good or all bad. A lot of this depends on how you use screens," says Dr. Ameenuddin.

Screen time recommendations

Dr. Ameenuddin says there's no evidence that television shows or screen time for young kids have any benefit. Therefore, it's best to try to avoid screen time for kids under 2 years old, with the exception of video chatting with grandparents or other relatives.

"For kids who are between 2 and 5 years of age, no more than about one hour of high-quality educational content, ideally with little to no commercial time," she says.

For kids 5 and older, it's a little more nuanced.

"Once kids are 5 years and older, and they're in school, we used to say no more than two hours of screen time a day of noneducational content. But we understand that that's hard to do. And then oftentimes kids are using screens for really good reasons, for doing schoolwork. So really, what we've started to say is let's make sure it is not taking the place of other important activities, whether that's schoolwork or physical activity, and certainly sleep," says Dr. Ameenuddin.

Potential benefits

"There is potentially a benefit for children in the preschool age with high-quality educational content. There are wonderful shows that have been around for decades that are really focused on teaching kids," she says.

Dr. Ameenuddin says a little bit of high-quality television can help kids learn about other people and cultures.

"There was actually a study done, and as much as we talk about how we don't want to spend a lot of time in front of screens, there is a benefit. There can be diversity enhancement. When children see children of other backgrounds playing with each other, they're actually more likely to say, when shown a group of pictures, that they might want to play with a child of a different background from what they might be used to or from their own background," says Dr. Ameenuddin.

Resources

One of the resources Dr. Ameenuddin recommends for finding quality media content is Common Sense Media. It's a resource that includes ratings and reviews of TV shows, movies, video games, podcasts and more.

Related posts:

• Mayo Clinic Minute: How much screen time is too much for your kids?
• Mayo Clinic Minute: Screen time do's and don'ts for your toddler's brain

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Some areas of the U.S. –and abroad – are seeing an uptick in whooping cough (pertussis) cases – including in parts of Wisconsin.

Whooping cough is an infectious respiratory illness caused by Bordetella pertussis bacteria. It spreads through the air when an infected person coughs or sneezes. 

"This is an infection that causes quite a significant cough," says Dr. Nipunie Rajapakse, a pediatric infectious diseases expert with the Mayo Clinic Children's Center. "It can start like a cold with some runny nose, which then turns into a cough."

Watch: Dr. Nipunie Rajapakse explains pertussis, or whopping cough

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The infection is characterized by a severe hacking cough followed by a high-pitched intake of breath that sounds like "whoop."

"Generally, the kids who have it can have bouts of coughing where they can't catch their breath. And then after the coughing is finished, they take a big, deep breath to catch their breath from it, and that's where that whooping sound comes from," Dr. Rajapakse says.

Early symptoms of whooping cough

• Runny nose.
• Nasal congestion.
• Red, watery eyes.
• Fever.
• Cough.

 Later symptoms of whooping cough

• Vomiting during or after coughing fits.
• Struggling to breathe.
• Extreme fatigue or exhaustion.
• Ending with a high-pitched "whoop" sound during the next breath of air.

Not everyone with the infection will develop a whoop-sounding cough, and infants may not cough at all. Instead, they may struggle to breathe, or they may even stop breathing temporarily.

Pertussis bacteria produce toxins that inflame the airway.

When to seek medical attention 

• Struggling to breathe.
• Turning blue or purpose.
• Coughing violently or rapidly.
• Not drinking enough fluids.

People of all ages can become infected. However, whooping cough is especially dangerous for babies, particularly those under 6 months. It can lead to severe breathing issues, which may require hospitalization.

Prevention

Whooping cough is a vaccine preventable disease. "Thankfully, this is an infection we have a vaccination for," says Dr. Rajapakse. 

There are two types of vaccine available:

• Diphtheria, tetanus, Pertussis (DTaP)
  This vaccine is for children younger than 7 years old.
• Tetanus, Diphtheria, Pertussis (Tdap)
  This vaccine is for older children and adults, including pregnant women.
  

Tdap is recommended for pregnant women in each pregnancy to provide babies with early protection against pertussis. This is crucial because the first few months of life pose the highest risk for serious illness, and babies don't receive their first pertussis vaccine dose until they're 2 months old.

Dr. Rajapakse says it's important for anyone in close contact with newborns and young infants, such as parents, grandparents or child care providers, to ensure they are up to date on their pertussis vaccination.

Practicing good hand hygiene also can help reduce the spread of respiratory infections.

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In this Mayo Clinic Minute, Dr. Nusheen Ameenuddin, a Mayo Clinic pediatrician who is an active member of the AAP, discusses the real effects of screen time on toddlers and if there's a certain amount of screen time that's OK.

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Smartphones, TVs, tablets … screens are everywhere, making it easier than ever for smaller screens to get into smaller hands.

"The main concern that we have with screens and younger children is the fact that screens oftentimes do not provide the same level of educational or interactive back-and-forth input that they need for language development," says Dr. Ameenuddin.

Studies have shown that even supposedly educational content for children under 2 years old can potentially have a detrimental effect on language development and ability to build social skills.

Dr. Ameenuddin says, while there's no strong benefit of technology to kids under 2, there are exceptions to the "no screen time" recommendation.

"That doesn't mean that families can't have video chats with relatives. That's just as important for grandparents and other relatives as it is for young children," says Dr. Ameenuddin. "We know that it's hard for parents, and I don't want anyone to feel bad or to feel guilty. I think the best thing to do is just remember that most things, in moderation, are OK."

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Dr. Angela Mattke, a pediatrician with Mayo Clinic Children's Center, says honey can help soothe coughs for adults and children. But, she says, never give honey to a child under 1.

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A spoonful of sugar might help the medicine go down, but the medicine is honey, in this case.

"Honey is safe for anyone ages 1 and above. And it's been shown to be effective and safe for both children and adults," says Dr. Mattke.

Adding honey to warm water or tea, or just a spoonful of honey itself can help with coughs.

"It has been shown to be more effective than over-the-counter cough medications," she says.

Honey helps by soothing the throat and coating cough receptors. Here are her recommendations for children over age 1. 

"You can start with half a teaspoon to a teaspoon, some type of warm liquid. As they get older and they're able to more easily swallow the honey, you can just give it to them directly on a teaspoon," Dr. Mattke says.

She recommends using a teaspoon every two hours. And this dosage applies equally to adults.

"And if you do choose to give honey for cough suppression, we would recommend that you use pasteurized honey," adds Dr. Mattke.

Honey and babies

Honey is generally safe for adults and children over the age of 1. Avoid giving honey, even in small amounts, to infants under the age of 1. Honey may lead to a rare but serious gastrointestinal condition known as infant botulism, triggered by exposure to Clostridium botulinum spores. The bacteria from these spores can thrive and multiply in a baby's intestines, producing a potentially harmful toxin.

Related posts:

• When is a cough a concern?
• Mayo Clinic Minute: Can cold weather cause a cold?
• Mayo Clinic Minute: Why do people get sick with viruses in the winter?

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