Information on feeding infants and toddlers, from birth to 24 months of age.
This page provides facts and recommendations about breastfeeding.
This page provides information about feeding foods and drinks to 6 to 24 month olds.
This page provides information to know if your baby is getting enough breastmilk in the first weeks.
How environmental exposures, diet, and medical conditions affect breastfeeding.
Developmental monitoring is observing how a child grows and changes over time to see whether they are reaching developmental milestones in how they play, learn, speak, act, and move at each age. Parents, grandparents, early childhood providers, and other caregivers can participate in developmental monitoring. You can use a brief checklist of milestones to see how a child is developing. If you notice that your child is not meeting a milestone, talk with your child’s doctor.
When you take your child to their doctor for each well-child visit, talking about child development is important. Your child’s healthcare provider will ask questions about their development while interacting with your child to see if they are meeting milestones that most children their age can do. A missed milestone could be a sign of a developmental delay. If your child is missing a milestone, or if either of you have concerns about how they are developing, the doctor may do a developmental screening test as the next step. By asking questions and sharing any concerns you might have with your child’s doctor, you can understand how your child is doing, and learn ways to support your child’s development.
Developmental screening takes a closer look at how your child is developing. The tools used for developmental screening are formal questionnaires or checklists based on research that ask questions about a child’s development, including language, movement, thinking, behavior, and emotions. Developmental screening can be done by your child’s health care provider, and by other professionals in healthcare, early childhood education, community, or school settings who have been trained in using these tools.
Developmental screening is more formal than developmental monitoring and is recommended for all children at specific ages.
The American Academy of Pediatrics (AAP) recommends developmental screening for all children during regular well-child visits at least at these ages1:
In addition, AAP recommends that all children be screened specifically for autism during regular well-child visits at:
If your child misses one of these well-child visits, or a screening was not done at those times, it should be completed at the next visit. Your child should also receive a screening at other times if you or your child’s doctor have a concern about their development.
If your child’s healthcare provider does not periodically check your child with a developmental screening test, you can ask them to do so.
Identifying developmental delays and disabilities early helps children and families. Developmental monitoring and screening work together to help identify developmental concerns, so that children and families can get the services and supports they need as early as possible.
Early developmental intervention services support the child, helping them at home, in school, and in the community.
Developmental disabilities are common. In the United States, about 1 in 6 children aged 3 to 17 years has one or more developmental disabilities, such as autism or attention-deficit/hyperactivity disorder.
When a developmental concern is identified, further evaluation through the state’s early intervention system is often the next step. Healthcare providers, and anyone who works with young children, can refer families to early intervention for assessment. Families can also refer themselves directly.
Connecting to the early intervention system will lead to more steps to assess the child’s development. Depending on those results, the child may be eligible to receive services from the program to help the family support their child’s development.
Each state and territory has their own system for children who are eligible.
This early intervention page provides a brief overview of services and eligibility processes, along with key contacts for each state and territory.
Although early intervention is important, intervention at any age can be helpful. Contact your child’s doctor or your state program if you have any concerns about your child’s development.
Anal cancer is a type of cancer that forms in the tissues of the anus.
The anus is the end of the large intestine. It is where stool (solid waste) leaves the body. The anus is formed partly from the outer skin layers of the body and partly from the intestine. The anus is connected to the rectum by the anal canal, which is about 1 to 1½ inches long. This area is controlled by two ring-like sphincter muscles, which contract to hold stool in and relax to allow its passage out of the body.
Anal cancer can start in the lining of the anal canal, called the mucosa, or in the perianal skin, the squamous cells outside of the anus that contain hair follicles and sweat glands.
Tumors of the perianal skin that do not involve the anal sphincter are usually treated the same as anal cancers, although local therapy (treatment directed to a limited area of skin) may be used for some.
Squamous cell carcinoma is the most common type of anal cancer. In the United States, squamous cell carcinoma is the most common type of anal cancer. Studies show that human papillomavirus (HPV) infection is the main cause of this type of anal cancer.
Another type of anal cancer, called anal adenocarcinoma, is very rare and is not discussed in this summary.
Illnesses caused by respiratory viruses like COVID-19, flu, and RSV can make anyone sick. However, there are a range of risk factors that can increase a person’s chances of getting very sick (severe illness). Generally, people at higher risk of severe illness from respiratory viruses are
Preventing respiratory illness and its potentially serious complications is especially important for people who are higher risk for getting very sick. Vaccination remains the most important tool for prevention. Talk to your healthcare provider about what’s recommended for you.
If you believe you may have a respiratory virus (if you feel sick or tested positive for one) and you have risk factors for severe illness, seek health care right away for testing and/or treatment. If you have flu or COVID-19, treatment may be an option to make your symptoms less severe and shorten the time you are sick. Treatment needs to be started within a few days of when your symptoms begin.
As people get older, their immune systems can change and weaken over time, which can increase the risk for complications from respiratory illnesses. Older adults are also more likely to have underlying health conditions. Most deaths from respiratory viruses occur in people older than 65, with risk increasing sharply with advancing age. For more specific information by type of respiratory illness, read more:
The Eldercare Locator, a national resource funded by the Administration for Community Living, can help older adults find local vaccination clinics, connect with accessible transportation, and provide other assistance in accessing vaccinations.
Young children, particularly infants, have immune systems that are still developing. In addition, their lungs and airways are smaller, making viruses that affect airways more of a threat. For more specific information by type of respiratory illness, read more:
Certain medical conditions like chronic lung disease, heart disease, diabetes, or chronic kidney disease might increase your risk for getting very sick from respiratory viruses. These conditions can weaken the body’s ability to fight off infection or they affect organs also impacted by the respiratory illness. For more specific information by type of respiratory illness, read more:
People with weakened immune systems (immunocompromise) have lower defenses against infections. Their bodies may have a harder time building lasting protection from past immunization or infection. People can be immunocompromised either because of a medical condition or because they receive immunosuppressive medications or treatments. Examples of medical conditions or treatments that may result in moderate to severe immunocompromise include, but are not limited to, cancer treatment, organ transplant with immunosuppressive therapy, and primary immunodeficiency.
For more specific information by type of respiratory illness, read more:
It can take longer than average for people with weakened immune systems to recover from respiratory viruses. This includes a possible longer duration during which you can spread a respiratory virus to others. If you are immunocompromised, be aware of this when choosing precautions after you return to normal activities following time at home sick.
Some disabilities can raise a person’s risk of getting very sick from respiratory viruses. For example, some people with disabilities are more likely to have underlying medical conditions, live in congregate settings, or experience factors and conditions stemming from social determinants of health. For more specific information by type of respiratory illness, read more:
The Disability Information and Access Line (DIAL) can help people with disabilities find local vaccination clinics, connect with accessible transportation, and provide other assistance in accessing COVID-19 vaccinations or setting up a vaccination appointment.
Changes in the immune system, heart, and lungs during pregnancy can raise the risk of getting very sick from respiratory viruses. In addition, while immunizations received during pregnancy can provide protection to the pregnant woman, they can also help lower the risk for the baby after birth. For more specific information by type of infection, read more:
Food processing is any change made to a food from its natural state. It involves processes like washing, heating, cooling, grinding, refining, and packaging. Food processing also includes adding ingredients like salt, sugar, oils, or other fats to help the food last longer and taste better.
Nova is a food classification system that groups foods by how much they are changed or processed:
UPFs AND YOUR HEALTH
UPFs are formulated to taste too good, so you want to keep eating them. Because they are low in fiber, UPFs are digested quickly, so you still feel hungry. These factors make it easy to overeat these foods. UPFs also provide very little nutrition. They are:
Because of their convenience, taste appeal, and the fact that they are easily available, UPFs make up a large portion of many people’s diets.
Studies have shown that a high intake of UPFs is linked to certain health conditions, including:
NOT ALL PROCESSED FOODS ARE BAD
Health experts agree that whole foods are the foundation of a healthy diet. However, some processed foods also have a place. Food processing has important benefits:
Processed foods can be safe and healthy if they are low in fat, salt, sugar, and additives. On the other hand, UPFs are never a healthy option and should be consumed sparingly.
TIPS TO HELP YOU MAKE HEALTHY CHOICES
It can be tricky to know which processed foods are good for you and which are not. Here are some tips to help you identify UPFs and make healthy choices:
Whenever I meet someone who happened to grow up as a twin, I always ask if there was anything he would have preferred his parents to have done differently. Most of the time the response I hear is some variation on a similar theme: I wish our parents didn’t…“give us the same thing for our birthday,” “dress us in identical outfits,” “expect us to share everything.”
While some people assume all twins are the same, others take it to the other extreme. Many people ask me if my twin sons are opposites—is one social while the other is a recluse? Is one more talkative and the other quiet? Or, my favorite, “Which is the good one?” These questions imply that each twin’s character traits are defined as the opposite of those of his twin brother. Of course this is not the case—they are individuals, and each child is complete on his own.
Any individual can be similar to another in some respects and different in other ways. Everybody, whether born as a twin or not, desires to be treated as an individual. Parents of all twins, identical or same-sex twins more so, need to think about this on a daily basis. You’re a busy parent and it may be quicker or more efficient at times to treat your twins as a unit, but I encourage you to treat your twins as 2 children who happen to have been born on the same day.
A great way to treat your twins as individuals is to read their bedtime stories to them individually at night. When our twin boys were babies and toddlers, we were operating in survival mode, so we usually read to them simultaneously. As the years progressed and our twins were easier to care for, we saw that it would benefit both boys to have their bedtime stories read to them one-on-one. Reading to each twin separately boosts early reading skills and creates a calmer atmosphere in which to quiet down and settle in with a good book. The time and work to read to your twins individually is well worth the effort. The twins don’t distract each other and they get a lot more out of the experience. Try to alternate which twin reads with which parent each night. Be realistic, though, and on late nights or if one parent is handling bedtime solo, gather everyone to snuggle up for the bedtime stories.
Twins know how to share well, having shared their parents with each other since they were newborns, but expecting twins to share all their things all the time is unrealistic. You’ll want to have a system to give each child her own personal space. Even if your twins share a bedroom, you can provide each twin with a distinctly colored box that they can keep their special things in—a rock collection, a favor from a friend’s party, whatever they decide is important to them.
Remind each twin to respect their siblings’ personal space—older and younger siblings’ space as well, as twins can outnumber an older brother and confiscate a special toy by sheer manpower alone. Give each twin her own distinct-looking piggy bank to collect loose coins. Institute a house rule that you can only check your own piggy bank’s contents!
In your living and play areas, create separate play stations so that there are interesting things to do at different places in the home—one twin can play Lincoln Logs in one area while the other goes in the other room to listen to a kids’ CD player. Don’t expect your twins to play with the same items all the time. Give each child some space and breathing room, and your days will be more harmonious.
On birthdays and holidays, give each child distinctive presents. At 3 and 4 years of age, each child has particular interests—pick up on these differences and use them as inspiration for giving separate gifts. Adult twins groan when they remember all the times that they received 2 of the same item, maybe in different colors. When our twins were 3 years old, we noticed that sharks fascinated Ryan and Andrew was interested in fire trucks, so on their birthday we ran with these themes. The shark-themed books and toys lived on as Ryan’s, and Andrew’s new fire truck was Andrew’s. Emphasize to gift-giving family members to look for distinctive gifts for your twins—they’ll likely appreciate a little coaching.
All toys that enter your home will eventually get shared extensively—after all, playing with all the cumulative toys, rather than just your own portion, is more fun! But initially, on gift-giving occasions, give each child at least a day or two with his new toy before he is expected to share with others. After the first couple of days or a period that seems appropriate, the new items can become part of the public domain, fair game for all.
If your twins are squabbling over who gets to play with a new item, use the egg timer trick. Give each child a timed turn with the toy, and rotate turns. The egg timer helps reassure your twins that the turns will be fair.
Another way to emphasize each twin’s individuality is to assign a signature color to each child. At the preschool age kids usually have preferred colors—use these colors for clothes, coats, toothbrushes, and backpacks to clearly indicate who the owner is and streamline the process of getting ready each day. The more distinct the twins’ personal items are, the less confusion as to whose coat is whose will occur. Ah, family harmony.
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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Rao SSC. Fecal incontinence. In: Chung RT, Rubin DT, Wilcox CM, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 12th ed. Philadelphia, PA: Elsevier; 2026:chap 19.
Wald A, Bharucha AE, Limketkai B, Malcolm A, Remes-Troche JM, Whitehead WE, Zutshi M. ACG clinical guidelines: management of benign anorectal disorders. Am J Gastroenterol. 2021 Oct 1;116(10):1987-2008. PMID: 34618700 pubmed.ncbi.nlm.nih.gov/34618700/.
It’s important for health care workers to stay on top of their vaccines. When you work directly with patients or handle body fluids, you’re more likely to get — and spread — serious diseases.
If you’re a doctor, nurse, pharmacist, lab technician, or other health care worker, protect yourself and your patients by getting vaccinated.
You need to be up to date on routine vaccines recommended for your age, like the chickenpox vaccine. You also need to get a flu shot every year — and you may need additional vaccines, like the hepatitis B vaccine.
To learn more:
Meningococcal disease is a name for any infection caused by bacteria called Neisseria meningitidis.
The two most common types of meningococcal infections are meningitis and bloodstream infections.
With meningococcal meningitis, the bacteria infect the lining of the brain and spinal cord and cause swelling.
With a meningococcal bloodstream infection, the bacteria enter the blood and damage the walls of the blood vessels. This causes bleeding in the skin and organs.
Symptoms are different for meningococcal meningitis and bloodstream infections. However, both are very serious and can be deadly.
Many factors affect someone’s risk for meningococcal disease, including age and certain medical conditions and medicines.
N. meningitidis are bacteria that can live in the back of the nose and throat. About 1 in 10 people have these bacteria in their throat and aren’t sick.
Sometimes the bacteria move to other parts of the body and cause infection.
People spread meningococcal bacteria to others by sharing respiratory and throat secretions (saliva or spit).
Generally, it takes close or lengthy contact to spread the bacteria.
They aren’t as contagious as germs that cause the common cold or the flu.
The best way to prevent meningococcal disease is to get vaccinated. CDC recommends meningococcal vaccination for
Talk with your doctor about getting vaccinated against meningococcal disease.
Close contacts of someone with meningococcal disease should receive antibiotics to prevent them from getting sick. A healthcare provider or health department generally decides who should get preventive antibiotics.
Although rare, people can get meningococcal disease more than once. People who get meningococcal disease twice should get tested to see if they have an underlying immune deficiency (weakened immune system).
Meningococcal disease can be difficult to diagnose because the signs and symptoms are often similar to other illnesses.
Healthcare providers who suspect meningococcal disease will collect samples of blood or cerebrospinal fluid (fluid near the spinal cord). They then send the samples to a lab for testing.
If bacteria are in the samples, laboratory workers can culture (grow) and test them. This helps healthcare providers know what’s causing the infection and which antibiotic will work best.
Other tests can sometimes detect and identify the bacteria if the cultures don’t.
Healthcare providers treat meningococcal disease with antibiotics. A patient will get antibiotics right away if a healthcare provider thinks they have meningococcal disease. Antibiotics help reduce the risk of dying.
Depending on how serious the infection is, people with meningococcal disease may need other treatments, including:
By: Kenneth Ginsburg, MD, MS Ed, FAAP
As parents, we want to protect our children from all discomfort. At the same time, we know that preparing them to deal with challenges is important. It builds their
resilience and offers the best lifelong protection.
When parents know precisely the problem to face, they can make an action plan to help their child learn about and manage it. However, in unpredictable or uncertain times, it is harder for parents to know the best way to prepare their child.
Sometimes we go through uncertain times as a nation. Sometimes, uncertainty is felt most fully in your community or family. The only thing fully predictable in life is that we all will experience curveballs in our life. Humans have long experienced periods of uncertainty, and we can draw from our collective wisdom to get through unpredictable times.
Wisdom embedded in our DNA tells us that working to strengthen our relationships during uncertain times is key to building family and children’s resilience. We
can always offer reassurance by saying what so many of our grandparents said to us: “This too shall pass, and you’ll get through this with me by your side.”
The best way to protect our children is to shape the lessons gained during difficult times. We do so best when we intentionally manage our own feelings and experiences and show them how we cope with uncertainty.
Below are some of the feelings many of us experience during uncertain times. These are paired with the chance they offer us to model and teach lifelong resilience skills.
Perfection is never an option, and getting even closer to your goals is harder during unpredictable times. Know that if you forgive yourself and focus on the good in yourself through self-compassion, your child or adolescent will learn to be a bit gentler with themselves. That is lifelong protection.
One of the most respectful things we can do is genuinely understand someone else’s point of view. The best way for children to gain this perspective is by benefitting from it firsthand. You build their empathy for others by working to understand their thoughts, feelings and behaviors.
A time of uncertainty with heightened emotions is the time to show that emotions are not to be ignored. Our children must learn from us that:
You can love your child and still sometimes want to tear your hair out. We all have bad days when the stress load is high. We cannot control the outside world, but we create sanctuaries within our homes. With peace in our homes, we can better handle the outside world.
In moments when the future is unclear and our minds begin racing, the presence of a reassuring voice makes all the difference.
Say what you do know. Admit what you don’t.
Strong bodies support our minds to best navigate the circumstances we confront. Say out loud: “I’m going to exercise. If I don’t take care of my body, I can’t focus as well.”
Uncertainty can make our minds race to the worst possible outcome. Catch those thoughts and say, “I am imagining the worst. Let me focus on what is really happening.”
Young people can assume the worst because they have not yet had the experience to know that problems can come and go. Let them know, “You’ll get through this with me by your side.”
Few things create discomfort more than feeling like there is too much to do . . . or nothing you can do at all. And few things restore comfort more than tackling what you can. Model the importance of one of the most calming words: “Yet.”
“I’ll NEVER ______!” can transform into “I haven’t ______ yet.” Don’t accept failure or disappointment as permanent but instead view setbacks as opportunities to try
yet again.
Stay healthy, strong, and compassionate. Take care of those who are vulnerable. Let family members know they are precious. Do what it takes to keep a roof over your head and food on the table. Everything else can always wait.
Help your children see the difference they can make in others’ lives and how good it feels to give service. This may enhance their own resilience because they’ll learn the joy of giving. More importantly, they’ll learn there is no pity in receiving.
Focus on what you
can make a reality and what you
can do.
When times get tough, people unify. We hold those we love nearer and offer those who are vulnerable the extra support they deserve.
Resilience is about more than bouncing back. It is about adapting. Growing. Becoming stronger. Being ready for the next challenge, but also being prepared to savor all the good life has to offer.
Sometimes during challenging times, some people use divisive language. This is deeply unsettling to children and adolescents. We must reinforce our shared values and common humanity.
Uncertainty is frightening, but knowing that we are not alone to figure it out brings comfort. Any individual alone is vulnerable, but joined together we are stronger than the combination of each of our individual strengths. People together can take turns between drawing strength from others and being a source of strength. We overcome challenges when we come together to remind each other that we belong to one another.
About Dr. Ginsburg
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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.