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Tips of the Week for August, 2016

Babys First Tooth: 7 Facts Parents Should Know

​​​​By: Dina DiMaggio, MD, FAAP & Julie Cernigliaro, DMD

1.  Most babies will develop teeth between 6 and 12 months.

There is a wide range of variability of when a first tooth may appear—some babies may not have any teeth by their first birthday! Around 3 months of age, babies will begin exploring the world with their mouth and have increased saliva and start to put their hands in their mouth. Many parents question whether or not this means that their baby is teething, but a first tooth usually appears around 6 months old. Typically, the first teeth to come in are almost always the lower front teeth (the lower central incisors), and most children will usually have all of their baby teeth by age 3.

2.  Fluoride should be added to your child's diet at 6 months of age.

Fluoride is a mineral that helps prevent tooth decay by hardening the enamel of teeth. The good news is that fluoride is often added to tap water. Give your baby a few ounces of water in a sippy or straw cup when you begin him or her on solid foods (about 6 months of age). Speak with your pediatrician to see if your tap water contains fluoride or whether your child needs fluoride supplements. Fluoride is not typically found in most bottled water. See FAQ: Fluoride and Children for more information.

3.  Massaging sore gums, offering something cold, or acetaminophen, on an occasional rough night, can help soothe your baby's teething pain.

Usually teething doesn't cause children too much discomfort, however, many parents can tell when their baby is teething. Babies may show signs of discomfort in the area where the tooth is coming in, the gums around the tooth may be swollen and tender, and the baby may drool a lot more than usual.

Parents can help ease teething pain by massaging their baby's gums with clean fingers, offering solid, not liquid-filled, teething rings, or a clean frozen or wet washcloth. If you offer a teething biscuit, make sure to watch your baby while he or she is eating it. Chunks can break off easily and can lead to choking. Also, these biscuits are not very nutritious and most contain sugar and salt.

A baby's body temperature may slightly rise when teething; however, according to a 2016 study in Pediatrics, a true fever (temperature over 100.4 degrees Fahrenheit or 38 degrees Celsius) is not associated with teething and is actually a sign of an illness or infection that may require treatment. If your baby is clearly uncomfortable, talk with your pediatrician about giving a weight-appropriate dose of acetaminophen (e.g., Tylenol) or if over 6 months, ibuprofen (e.g., Advil, Motrin). Make sure to ask your pediatrician for the right dose in milliliters (mL) based on your child's age and weight.

Many children, however, will have no problems at all when their teeth come in!

4.  Do not use teething tablets, gels with benzocaine, or amber teething necklaces.

Stay away from teething tablets that contain the plant poison belladonna and gels with benzocaine. Belladonna and benzocaine are marketed to numb your child's pain, but the FDA has issued warnings against both due to potential side effects.

In addition, amber teething necklaces are not recommended. Necklaces placed around an infant's neck can pose a strangulation risk or be a potential choking hazard. There is also no research to support the necklace's effectiveness. See Amber Teething Necklaces: A Caution for Parents for more information.

5.  You should brush your child's teeth twice a day with fluoride toothpaste.

Once your child has a tooth, you should be brushing them twice a day with a smear of fluoride toothpaste the size of a grain of rice, especially after the last drink or food of the day. Remember not to put your baby to bed with a bottle—it can lead to tooth decay.

Once your child turns 3, the American Academy of Pediatrics (AAP), the American Dental Association (ADA), and the American Academy of Pediatric Dentistry (AAPD)recommend that a pea-sized amount of fluoride toothpaste be used when brushing. When your child is able, teach him or her to spit out the excess toothpaste. It is best if you put the toothpaste on the toothbrush until your child is about age 6. Parents should monitor and assist their child while brushing until he or she is around 7 or 8 years old. When your child can write his or her name well, he or she also has the ability to brush well.

6.  Ask your pediatrician about your baby's teeth and fluoride varnish.

During regular well-child visits, your pediatrician will check your baby's teeth and gums to ensure they are healthy and talk to you about how to keep them that way.  The AAP and the United States Preventive Services Task Force also recommend that children receive fluoride varnish once they have teeth. If your child does not yet have a dentist, ask your pediatrician if he or she can apply fluoride varnish to your baby's teeth. Once your child has a dentist, the varnish can be applied in the dental office. The earlier your child receives fluoride varnish the better to help prevent tooth decay.

7.  Make your first dental appointment when the first tooth appears.

Try to make your baby's first dental appointment after the eruption of the first tooth and by his or her first birthday.

Both the AAP and the AAPD recommend that all children see a pediatric dentist and establish a "dental home" by age one. A pediatric dentist will make sure all teeth are developing normally and that there are no dental problems. He or she will also give you further advice on proper hygiene. If you don't have a pediatric dentist in your community, find a general dentist who is comfortable seeing young children.


Additional Information from


About Dr. DiMaggio: 

Dina DiMaggio, MD, FAAP, is a board certified pediatrician at Pediatric Associates of NYC and at NYU Langone Medical Center. She is the co-author of The Pediatrician's Guide to Feeding Babies and Toddlers, a comprehensive manual written by a team of medical, nutrition, and culinary experts. Follow her on Instagram @Pediatriciansguide.

About Dr. Cernigliaro:

Julie Cernigliaro, DMD, is a board certified pediatric dentist and the Associate Director of the Pediatric Dental Residency Program at Lutheran Medical Center in Brooklyn, NY. She holds a faculty position at NYU College of Dentistry and currently works in private practice at Happy Smile Pediatric Dentistry, PC in NYC.

Last Updated



American Academy of Pediatrics (Copyright © 2016)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


All information provided by  For additional information including links and audio, please to got the following website:


Meningococcal Disease: Information for Teens and College Students

Meningococcal disease is most common in very young infants, teens, and young adults, and those older than 65 years. College students, especially freshmen who live in dorms and military recruits, are at an increased risk for meningococcal disease caused by serogroups C and Y compared with others in this age group. Though there have been a number of meningococcal serogroup B outbreaks on college campuses in the past decade, college students are not at increased risk for meningococcal serogroup B disease. 

It's important to know how to protect yourself because meningococcal disease can be deadly. Read on for more information from the American Academy of Pediatrics about this serious illness, safe and effective vaccines, and how to stay healthy. 

What is meningococcal disease?

Meningococcal disease is caused by a bacterium called Neisseria meningitides (often called meningococcus). There are different serogroups (types) of meningococcus. The serogroups that most commonly cause disease worldwide are A, B, C, W, and Y. Serogroups B, C, and Y most commonly cause disease in the United States.  

Many people carry these bacteria in their nose or throat but never get sick. However, in a few individuals, presence of these bacteria in the nose or throat precedes 2 serious illnesses: meningococcemia and meningitis. Meningococcal disease can affect the bloodstream (meningococcemia) or brain and spinal cord (meningitis), and sometimes it affects both the brain and bloodstream. It can be life-threatening unless diagnosed and treated early. 

Each year in the United States, about 1,000 people get meningococcal disease. While it can strike anybody, the greatest risk is in individuals between 15 and 21 years of age. Also, students entering college and planning to live in dorms are at a higher risk than other people of the same age for meningococcal serogroup C and Y infections. It's easy for infections to spread in crowded dorms or enclosed areas where students often meet to smoke and drink alcohol. 

What are the symptoms of ­meningococcal disease?

The symptoms of meningococcal disease are often mistaken for other less serious illnesses such as the flu. Common symptoms include: 

  • Fever (usually above 101.4°F [38.6°C])
  • A flat, pink to red to purple rash is noticeable on any part of the skin. However, the rash stands out the most on the lower legs and feet, and the forearms and hands.
  • Nausea
  • Vomiting
  • Generalized muscle aches
  • Sudden, severe headache
  • Confusion
  • Sensitivity to light
  • Stiff neck along with headache and sensitivity to light (can signal the meningitis form of illness and should never be ignored)

It's important to get medical treatment right away. Meningococcemia or meningitis can get worse very quickly, even within a few hours from the start of symptoms. If untreated, the infection can be fatal (up to 20% of teens die) or cause kidney failure, hearing loss, limb amputation, or lifelong problems with the nervous system. 

How is meningococcal disease treated?

Meningococcal disease is treated with antibiotics. When given shortly after the start of symptoms, these antibiotics may prevent the disease from getting worse. 

Because this infection spreads to others in close contact, all those who have been in contact with someone diagnosed as having meningococcal infection should contact their doctor. In many cases, an individual who has been in contact with someone with meningococcal infection may be given an antibiotic to help prevent meningococcal disease. Ideally, this antibiotic should be given within 24 hours of exposure to the person with meningococcal infection. 

Are there vaccines to help prevent meningococcal disease?

There are 3 types of meningococcal vaccines available in the United States that may protect against certain serotypes. Two types of meningococcal vaccines are given to teens and young adults. 

  1. Meningococcal conjugate vaccines (MCV4)—Licensed for people 55 years and younger. May protect against serogroups A, C, W, and Y or C and Y.
  2. Serogroup B meningococcal vaccines (MenB)—Licensed for people 10 years or older who are at increased risk for serogroup B meningococcal infections. May protect against serogroup B.
  3. Meningococcal polysaccharide vaccine (MPSV4)—Licensed for people of all ages, but it is not recommended for children younger than 2 years. May protect against serogroups A, C, W, and Y.

Your doctor will recommend the type of vaccine for you on the basis of your age and health, and if you are at increased risk of infection. 

These vaccines are safe. However, there may be mild side effects, such as redness and swelling at the injection site or a slight fever. These symptoms are usually mild and resolve in a few days. Teens and young adults who receive any vaccine have an increased risk for fainting. Teens who receive any meningococcal vaccine should sit for about 15 minutes after they receive the vaccine. 

Which vaccines are recommended for teens and young adults?

Meningococcal conjugate vaccines (MCV4) 

  • Preteens should be routinely immunized at 11 through 12 years of age and given a booster at 16 years of age.
  • Teens who receive their first dose at age 13 through 15 years should receive a booster at 16 through 18 years or up to 5 years after their first dose.
  • Teens who receive their first dose of MCV4 at or after 16 years of age do not need a booster.
  • Unvaccinated or incompletely vaccinated first-year college students living in residence halls should receive 1 dose of MCV4.
  • Teens who are unvaccinated or incompletely vaccinated may need to receive an MCV4 if they travel to areas with high rates of meningococcal disease, such as the northern areas of sub-Saharan Africa, or are participants in the Hajj.
  • Anyone 2 months or older with certain medical conditions, such as a damaged or removed spleen or persistent complement component deficiency (an immune system disorder).

Serogroup B meningococcal vaccines (MenB) 

  • Teens and young adults 16 through 23 years of age, to provide short-term protection against diverse strains of serogroup B meningococcus. The preferred age for MenB vaccination is 16 through 18 years of age.
  • Anyone 10 years or older with certain medical conditions, such as a damaged or removed spleen or persistent complement component deficiency (an immune system disorder).

Note: Make sure to let your doctor know if you are not feeling well, are pregnant or breastfeeding, or have any severe, life-threatening allergies before receiving any vaccine. 

Take care of yourself

It's important you see your pediatrician for your annual checkup. If you are 11 to 12 years of age, you will benefit by receiving MCV4 and the human papillomavirus (HPV) vaccine. You may need a booster of other vaccines, such as the vaccines that prevent pertussis, tetanus, and diphtheria. At the same visit, your pediatrician can give you advice about keeping healthy. Your pediatrician will also let you know about scheduling any booster dose that may be appropriate. 

If you are a student about to start college, here are some health tips:

  • Reduce your risk of getting meningitis by reducing your exposure to smoking, drinking alcohol, excessive stress, and upper respiratory tract infections. Even if you don't smoke, being in a smoking environment (secondhand smoke) can still increase your risk of getting meningococcal disease.
  • Strengthen your immune system by living a healthy lifestyle that includes enough sleep, exercise, and a balanced diet.
  • Avoid sharing eating utensils or drinking glasses, cover your mouth when you cough or sneeze, and wash your hands often.
  • Get familiar with your college's student health services. Find out who to call or where to go if you get sick.
  • Remember that your pediatrician is available to answer any questions you may have about your health.

Additional Information from


Last Updated



Meningococcal Disease—Information for Teens and College Students (Copyright © 2015 American Academy of Pediatrics, Updated 06/2016)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


All information provided by For additional information including links and audio, please go to the following website:


Back-to-School Tips

The following health and safety tips are from the American Academy of Pediatrics (AAP).

Making the First Day Easier 

  • If your child seems nervous, remind him or her that there are probably a lot of students who are uneasy about the first day of school. This may be at any age. Teachers know that students are nervous and will make an extra effort to make sure everyone feels as comfortable as possible. 
  • Point out the positive aspects of starting school to create positive anticipation about the first day. Your child will see old friends and meet new ones. Refresh his or her positive memories about previous years, when he or she may have returned home after the first day with high spirits because of a good time. 
  • Find another child in the neighborhood with whom your student can walk to school or ride on the bus.
  • If it is a new school for your child, attend any available orientations and take an opportunity to tour the school before the first day.   
  • If you feel it is needed, drive your child (or walk with him or her) to school and pick him or her up on the first day.

Backpack Safety

  • Choose a backpack with wide, padded shoulder straps and a padded back. 
  • Pack light. Organize the backpack to use all of its compartments. Pack heavier items closest to the center of the back. The backpack should never weigh more than 10 to 20 percent of your child’s body weight. Go through the pack with your child weekly, and remove unneeded items to keep it light. 
  • Always use both shoulder straps. Slinging a backpack over one shoulder can strain muscles. 
  • Adjust the pack so that the bottom sits at the waist. 
  • If your school allows, consider a rolling backpack. This type of backpack may be a good choice for students who must tote a heavy load. Remember that rolling backpacks still must be carried up stairs, they may be difficult to roll in snow, and they may not fit in some lockers. 

Traveling To and From School

Review the basic rules with your child. 

School Bus 

  • Children should always board and exit the bus at locations that provide safe access to the bus or to the school building.​
  • Remind your child to wait for the bus to stop before approaching it from the curb. 
  • Make sure your child walks where he or she can see the bus driver (which means the driver will be able to see him or her, too).
  • Remind your child to look both ways to see that no other traffic is coming before crossing the street, just in case traffic does not stop as required.  
  • Your child should not move around on the bus.​
  • If your child’s school bus has lap/shoulder seat belts, make sure your child uses one at all times when in the bus. (If your child’s school bus does not have lap/shoulder belts, encourage the school system to buy or lease buses with lap/shoulder belts). See Where We Stand: Safety Restraints on the School Bus for more information. 
  • Check on the school's policy regarding food on the bus. Eating on the bus can present a problem for students with food allergies and can also lead to infestations of insects and vermin on the vehicles.
  • If your child has a chronic condition that could result in an emergency on the bus, make sure you work with the school nurse or other school health personnel to have a bus emergency plan.​


  • All passengers should wear a seat belt and/or an age- and size-appropriate car seat or booster seat. 
  • Your child should ride in a car seat with a harness as long as possible and then ride in a belt-positioning booster seat. Your child is ready for a booster seat when he or she has reached the top weight or height allowed for his or her seat, his or her shoulders are above the top harness slots, or his or her ears have reached the top of the seat. 
  • Your child should ride in a belt-positioning booster seat until the vehicle's seat belt fits properly (usually when the child reaches about 4' 9" in height and is between 8 to 12 years of age). This means that the child is tall enough to sit against the vehicle seat back with her legs bent at the knees and feet hanging down and the shoulder belt lies across the middle of the chest and shoulder, not the neck or throat; the lap belt is low and snug across the thighs, and not the stomach. 
  • All children younger than 13 years of age should ride in the rear seat of vehicles. If you must drive more children than can fit in the rear seat (when carpooling, for example), move the front-seat passenger’s seat as far back as possible and have the child ride in a booster seat if the seat belts do not fit properly without it.
  • Remember that many crashes occur while novice teen drivers are going to and from school. You should require seat belt use, limit the number of teen passengers, and do not allow eating, drinking, cell phone conversations (even when using hands-free devices or speakerphone), texting, or other mobile device use to prevent driver distraction. Limit nighttime driving and driving in inclement weather. Familiarize yourself with your state’s graduated driver’s license law and consider the use of a parent-teen driver agreement to facilitate the early driving learning process. For a sample parent-teen driver agreement, click here.


  • Always wear a bicycle helmet, no matter how short or long the ride. 
  • Ride on the right, in the same direction as auto traffic and ride in bake lanes if they are present. 
  • Use appropriate hand signals. 
  • Respect traffic lights and stop signs. 
  • Wear bright-colored clothing to increase visibility. White or light-colored clothing and reflective gear is especially important after dark. 
  • Know the "rules of the road." 

Walking to School 

  • Make sure your child's walk to school is a safe route with well-trained adult crossing guards at every intersection. 
  • Identify other children in the neighborhood with whom your child can walk to school. In neighborhoods with higher levels of traffic, consider organizing a "walking school bus," in which an adult accompanies a group of neighborhood children walking to school. 
  • Be realistic about your child's pedestrian skills. Because small children are impulsive and less cautious around traffic, carefully consider whether or not your child is ready to walk to school without adult supervision. 
  • If your children are young or are walking to a new school, walk with them or have another adult walk with them the first week or until you are sure they know the route and can do it safely.
  • Bright-colored clothing will make your child more visible to drivers. 

Eating During the School Day 

  • Studies show that children who eat a nutritious breakfast function better. They do better in school, and have better concentration and more energy.
  • Most schools regularly send schedules of cafeteria menus home and/or have them posted on the school's website. With this advance information, you can plan on packing lunch on the days when the main course is one your child prefers not to eat. 
  • Many school districts have plans which allow you to pay for meals through an online account. Your child will get a card to "swipe" at the register. This is a convenient way to handle school meal accounts. 
  • Look into what is offered inside and outside of the cafeteria, including vending machines, a la carte, school stores, snack carts, and fundraisers held during the school day. All foods sold during the school day must meet nutrition standards established by the US Department of Agriculture (USDA). They should stock healthy choices such as fresh fruit, low-fat dairy products, water, and 100% fruit juice. Learn about your child's school wellness policy and get involved in school groups to put it into effect.  
  • Each 12-ounce soft drink contains approximately 10 teaspoons of sugar and 150 calories. Drinking just one can of soda a day increases a child's risk of obesity by 60%. Choose healthier options (such as water and appropriately sized juice and low-fat dairy products) to send in your child's lunch.


Bullying or cyberbullying is when one child picks on another child repeatedly. Bullying can be physical, verbal, or social. It can happen at school, on the playground, on the school bus, in the neighborhood, over the Internet, or through mobile devices like cell phones.

When Your Child Is Bullied

  • Alert school officials to the problems and work with them on solutions. 
  • Teach your child when and how to ask a trusted adult for help. 
  • Recognize the serious nature of bullying and acknowledge your child's feelings about being bullied. 
  • Help your child learn how to respond by teaching your child how to:
    • Look the bully in the eye.
    • Stand tall and stay calm in a difficult situation.
    • Walk away. 
  • Teach your child how to say in a firm voice. 
    • "I don't like what you are doing."
    • "Please do NOT talk to me like that."
    • "Why would you say that?" 
  • Encourage your child to make friends with other children. 
  • Support activities that interest your child.
  • Make sure an adult who knows about the bullying can watch out for your child's safety and well-being when you cannot be there.
  • Monitor your child’s social media or texting interactions so you can identify problems before they get out of hand.

When Your Child Is the Bully 

  • Be sure your child knows that bullying is never OK
  • Set firm and consistent limits on your child's aggressive behavior
  • Be a positive role model. Show children they can get what they want without teasing, threatening, or hurting someone. 
  • Use effective, non-physical discipline, such as loss of privileges. 
  • Develop practical solutions with the school principal, teachers, school social workers or psychologists, and parents of the children your child has bullied.

When Your Child Is a Bystander

  • Encourage your child to tell a trusted adult about the bullying. Encourage your child to join with others in telling bullies to stop.  
  • Help your child support other children who may be bullied. Encourage your child to include these children in activities. 

Before and After School Child Care 

  • During early and middle childhood, children need supervision. A responsible adult should be available to get them ready and off to school in the morning and supervise them after school until you return home from work. 
  • If a family member will care for your child, communicate the need to follow consistent rules set by the parent regarding discipline and homework. 
  • Children approaching adolescence (11- and 12-year-olds) should not come home to an empty house in the afternoon unless they show unusual maturity for their age. 
  • If alternate adult supervision is not available, parents should make special efforts to supervise their children from a distance. Children should have a set time when they are expected to arrive at home and should check in with a neighbor or with a parent by telephone. 
  • If you choose a commercial after-school pro​gram, inquire about the training of the staff. There should be a high staff-to-child ratio, trained persons to address health issues and emergencies, and the rooms and the playground should be safe.

Developing Good Homework & Study Habits 

  • Create an environment that is conducive to doing homework starting at a young age. Children need a consistent work space in their bedroom or another part of the home that is quiet, without distractions, and promotes study.
  • Schedule ample time for homework; build this time into choices about participation in after school activities. 
  • Establish a household rule that the TV and other electronic distractions stay off during homework time. 
  • Supervise computer and Internet use.
  • By high school, it's not uncommon for teachers to ask students to submit homework electronically and perform other tasks on a computer. If your child doesn't have access to a computer or the Internet at home, work with teachers and school administration to develop appropriate accommodations. 
  • Be available to answer questions and offer assistance, but never do your child's homework for him or her. 
  • Take steps to help alleviate eye fatigue, neck fatigue and brain fatigue while studying. It may be helpful to close the books for a few minutes, stretch, and take a break periodically when it will not be too disruptive. 
  • If your child is struggling with a particular subject, speak with your child's teacher for recommendations on how you or another person can help your child at home or at school. If you have concerns about the assignments your child is receiving, talk with his or her teacher. 
  • If your child is having difficulty focusing on or completing homework, discuss this with your child's teacher, school counselor, or health care provider. 
  • For general homework problems that cannot be worked out with the teacher, a tutor may be considered.  
  • Some children need help organizing their homework. Checklists, timers, and parental supervision can help overcome homework problems.
  • Some children may need help remembering their assignments. Work with your child and his or her teacher to develop an appropriate way to keep track of his or her assignments--such as an assignment notebook. 
  • Establish a good sleep routine. Insufficient sleep is associated with lower academic achievement in middle school, high school and college, as well as higher rates of absenteeism and tardiness. The optimal amount of sleep for most adolescents (13 to 18 years of age) is in the range of 8 to 10 hours per night. See Healthy Sleep Habits: How Many Hours Does Your Child Need? for more information. 

Additional Information from 



8/8/2016 12:00 AM


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As a parent, you may have questions about vaccines for your preteen. Below are frequently asked questions and answers you need from the American Academy of Pediatrics (AAP) to be confident about your decision to vaccinate.

HPV Vaccine FAQs

Why is the HPV vaccine recommended at age 11 or 12 years?

  • Studies show that kids who complete all three doses of HPV vaccines by age 14 have much lower rates of cervical pre-cancer and genital warts than those who are vaccinated later.  Pre-teens make more antibodies from the vaccine shots, which may translate into better protection. 

Why does my son need HPV vaccine if it protects against cervical cancer?

  • ​ HPV vaccine can protect both males and females by preventing genital warts and cancers of the mouth, throat, anus, and genitals. HPV vaccine also prevents cervical cancer, which, of course, only females can get. A preteen boy who receives HPV vaccine can also protect his future spouse. Men and women infected with HPV often have no symptoms. Women can get cervical cancer screening, but there is no such test for men. Men who are infected and don’t know it can spread HPV to their partners.

If my child is not sexually active, why is the HPV vaccine needed?

  • Because if we wait until someone is sexually active, the vaccine won’t work as well.  Vaccines only work before someone is exposed to a disease, and the HPV vaccine seems to last a lifetime—so it can never be too early to vaccinate, only too late. At least half of people will test positive for HPV within two years of their first sexual experience, and many acquire the virus while they are still virgins from kissing and touching. People need all 3 doses of the vaccine before ever coming into contact with the virus in order to be protected. People need all 3 doses of the vaccine before ever coming into contact with the virus in order to be protected.
  • Studies show that 50-80% of people test positive for HPV within 2-3 years of the first time they engaged in sexual activity, making it important that preteens receive the full series of 3 doses before first sexual activity. The Centers for Disease Control and Prevention (CDC) reports that as many as 64% of teen or preteen girls may be infected with HPV, and 75% of new cases of HPV are found in persons age 15-24 years. Even if your child waits until he is married and or only has one partner in the future, your child could still be exposed to HPV by that partner.

Will receiving HPV vaccine give my child permission to engage in sexual activity?

  • As pediatricians, we understand this concern — we want teens to be mature before sexual activity. Studies show that children who receive HPV vaccine do not have sex any earlier than those who only received other teen vaccines. This tells us that children do not see this vaccine as a license to have sex.

Don’t condoms prevent the spread of HPV?

  • ​Using condoms can prevent pregnancy and protect against several sexually transmitted infections. While condoms reduce the risk of HPV transmission, they do not eliminate the risk. ​​HPV can be spread by intimate skin-to-skin contact and oral sex, not just sexual intercourse. Condoms only cover a limited amount of skin and HPV can be spread even if a condom is used every time a person has sex. For the best protection against HPV, parents should have their children vaccinated.

FAQs About All Preteen Vaccines 

Do adolescent vaccines have serious side effects?

  • Pain: Pediatricians do not like to cause discomfort to children of any age. Even though shots may hurt, getting a vaccine is not as bad as suffering from a serious disease such as meningitis or cancer. Talk with your pediatrician about ways to reduce pain during vaccination. Stroking the skin or applying pressure to the skin before the shot reduces the pain. In some offices, medication to numb the skin may be available.
  • Fainting:  Your pediatrician may ask your child to sit for 15 minutes after getting any​ shot in case your child faints (syncope). Staying seated for 15 minutes reduces the main risk from fainting -- getting hurt from falling.
  • Vaccination at sick visits: Many families are busy and it is hard to find time to visit the pediatrician’s office to get a shot. It is smart to get any vaccines that are due when your child is in the pediatrician’s office. This will reduce the chance that your child has to miss school, work, or other activities to receive vaccines.
  • Safety: All vaccines routinely recommended for preteens have been licensed by the Food and Drug Administration and found to be safe. The safety of each vaccine continues to be checked after it is licensed. Your pediatrician can provide you with a Vaccine Information Statement that explains the mild side effects that can occur after receiving shots.

Why is more than one dose of vaccine needed?

  • HPV vaccine: It is recommended that your child receives 3 doses of HPV vaccine at ages 11-12 for full protection. All 3 doses of the HPV vaccine are needed for the body to build up enough immunity to protect against infection. This is also true of many of the vaccines that babies get.
  • Meningococcal vaccine: One dose of meningococcal vaccine protects a person, but immunity may wane over time. A booster dose can “boost” immunity so that your child is still fully protected. Children should receive meningococcal vaccine as preteens to be fully protected for a few years and another dose at age 16 to boost immunity levels.
  • Tdap: Recently, there have been several outbreaks of pertussis (whooping cough) throughout the United States. One study has shown that this is due, in part, to waning immunity. It is possible that booster doses of pertussis vaccine (in Tdap) will be recommended in the future. Studies are still underway to determine exactly if and when they will be needed.

What is the cost of these vaccines? I’m not sure if I can afford them or if my insurance will cover them.

  • Pediatricians realize that healthcare can be costly for families. The Affordable Care Act (ACA) requires insurance companies to cover the cost of all recommended vaccines, which include those for teens and preteens. If your insurance plan has been unchanged since March 23, 2010, it may not have to follow these new rules. If this is the case, your insurance plan may require you to pay part of the vaccination cost or meet your deductible before it will pay for vaccinations. Talk with your pediatrician about options for paying this.
  • If your child does not have health insurance, has Medicaid or insurance that does not cover vaccines, or is American Indian or Alaskan Native, she qualifies to receive vaccines at no cost through the Vaccines for Children (VFC) Program. Most pediatricians provide VFC vaccines. If your pediatrician is not a VFC provider, your child should be able to receive vaccines at your local health department.
  • Speak with your child’s pediatrician to learn more about the VFC program.
  • To contact your VFC state, city or territory coordinator click here​.

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American Academy of Pediatrics (Copyright © 2015)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


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Video Games: Establish Your Own Familys Rating System

Video gaming is a multibillion-dollar industry bringing in more money than movies and DVDs. Parents have a key role to play in determining the nature of their children and teens' video game use, both in terms of monitoring content and the amount of time spent playing them.

So, What Should Parents Do?

  • Familiarize yourself with a video game's content before allowing your child or teen to buy it, download it, or play it on- or offline. Parents and caregivers are often unaware of the content of video games, including factors such as virtual violence and mature sexual content. Studies of children exposed to violent media have shown that they may become numb to violence, imitate the violence, and show more aggressive behavior
  • Check the Electronic Software Ratings Board (ESRB) ratings. Thousands of video games are available at retailers on and offline, making it hard to learn the content of each one. The video game equivalent of movie ratings, ESRB ratings are a great starting point for choosing games appropriate for your family. They are featured prominently on the game packaging.
  • Ask your local retail outlets to enforce policies prohibiting the sale or rental of "T" (teen) or "M" (mature) videos to underage children. Video games, violent ones especially, have caused such concern that the issue of whether the sale or rental of such games to children should be prohibited was brought before the Supreme Court in 2011. "Video games," the court declared, "communicate ideas – and even social messages." However, the debate continues as real-life tragedies and violence continue to bring attention to the subject.
  • Do not allow video games that are at odds with your family's values inside your home. Explain to your children that they cannot play a new video game until you've had an opportunity to look the product over and determine whether or not it is suitable. It is a parents' choice to implement a personal rating system in their home, even if your child's friends or neighbors choose different standards. A conversation with other parents about your family's rules is reasonable, especially if your child might be exposed to video games that don't meet your standards.
  • Keep gaming in a common family area. Keep an eye on your children while they are playing video games, just as you would if they were using the Internet or watching TV. Consider making any handheld gaming consoles "family property" rather than "owned" by each child. 
  • Limit game-playing time to a maximum of 1 hour per day. Time spent playing video games can crowd out time spent in healthier activities, such as exercise, playing outside, reading, or doing school work. Screen time close to bedtime can also lead to disruptions in sleep patterns. See How to Make a Family Media Use Plan for more information and tips.
  • Encourage your child or teen to choose games that involve multiple players and play with their friends. Technology is a poor substitute for personal interaction. Playing with friends can eliminate problems with harassment, social isolation, and cyberbullying. But, make sure your child's friends play by the same rules expected in your home. 
  • If you can't beat 'em, join 'em. Playing a video game with your child or teen will expose you to the lingo of "their world." Multiple player video games within a home such as virtual sports or music activities can also allow siblings and parents to engage in active virtual play together.

Have Concerns or More Questions?

If you continue to have concerns about your child's video gaming habits or if your child is having difficulty with mood or behavior, ask your child's pediatrician for help. He or she may referral you to a trained and qualified mental health professional.  

Additional Information from


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Council on Communications and Media (Copyright © 2016 American Academy of Pediatrics)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


All information provided by  For additional information including links and audio, please go to


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