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Earlier this year, US defense secretary Lloyd Austin was hospitalized for complications resulting from prostate cancer surgery. Details of his procedure, which was performed on December 22, were not fully disclosed. Press statements from the Pentagon indicated that Austin had undergone a minimally invasive prostatectomy, which is an operation to remove the prostate gland. Minimally invasive procedures are performed using robotic instruments passed through small “keyhole” incisions in the patient’s abdomen.

Just over a week later, Austin developed severe abdominal, hip, and leg pain. He was admitted to the intensive care unit at Walter Reed Hospital on January 2 for monitoring and further treatment. Doctors discovered that Austin had a urinary tract infection and fluid pooling in his abdomen that were impairing bowel functioning. The defense secretary was successfully treated, but then readmitted to the ICU on February 11 for what the Pentagon described as “an emergent bladder issue.” Two days after undergoing what was only described as a “non-surgical procedure performed under general anesthesia,” Austin was back at work. His cancer prognosis is said to be excellent.

Austin’s ordeal was covered extensively in the media. Although we cannot speculate about his specific case, to help our readers better understand the complications that might occur after a prostatectomy, I spoke with Dr. Boris Gershman, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston. Dr. Gershman is also a member of the advisory and editorial board for the Harvard Medical School Guide to Prostate Diseases.

How common are urinary tract infections after a prostatectomy?

Minimally invasive prostatectomy is generally well tolerated. In one study that examined complications among over 29,000 men who had the operation, the rate of urinary tract infections was only 2.1%. The risk of sepsis — a more serious condition that occurs if the body’s response to an infection damages other organs — is much lower than that.

How would a urinary tract infection occur?

Although urinary tract infections are rare after prostatectomy, bacteria can travel into the urinary system through a catheter. An important part of a prostatectomy involves connecting the urethra — which is a tube that carries urine out of the body — directly to the bladder after the prostate has been taken out. As a last step in that process, we pass a catheter [a soft silicone tube] through the urethra and into the bladder to promote healing. Infection risks are minimized by giving antibiotics both during surgery and then again just prior to removing the catheter one to two weeks after the operation.

How do you treat urinary infectious complications when they do happen?

It’s not unusual to find small amounts of bacteria in the urine whenever you use a catheter. Normally they don’t cause any symptoms, but if infectious complications do occur, then we’ll admit the patient to the hospital and treat with broad-spectrum antibiotics that treat many different kinds of bacteria at once. We’ll also obtain a urine culture to identify the bacterial species causing the infection. Based on culture results, we can switch to different antibiotics that attack those microbes specifically. The course of treatment generally lasts 10 to 14 days.

Lloyd Austin also had gastrointestinal complications. Why might that have occurred?

Although I cannot speculate about Austin’s specific case, in general gastrointestinal complications are very rare — affecting fewer than 2% of patients treated using robotic methods. However, a few different things can happen. For instance, the small intestine can “fall asleep” after surgery, meaning it temporarily stops moving food and wastes through the bowel.

This is called an ileus. It can be due to multiple reasons, including as a result of anesthetics or pain medications. An ileus generally resolves on its own if patients avoid food or water by mouth for several days. If it causes too much pressure in the bowel, then we “decompress” the stomach by removing accumulated fluids through a nasogastric tube, which is threaded into the stomach through the nose and throat.

Some patients develop a different sort of surgical complication called a small bowel obstruction. We treat these the same way: by withholding food and water by mouth and removing fluids with a nasogastric tube if necessary. If the blockages are caused by scar tissues, in rare cases this may require a second surgery to fix the obstructing scar tissue.

Fluids might also collect in the pelvis after lymph nodes are removed during surgery. What’s happening in these cases?

Pelvic lymph nodes that drain the prostate are commonly removed during prostatectomy to determine if there is any cancer spread to the lymph nodes. A possible risk from lymph node removal is that lymph fluid might leak out after the procedure and pool up in the pelvis. This is called a lymphocele. Most lymphoceles are asymptomatic, but infrequently they may become infected. When that happens, we treat with antibiotics, and we might drain the lymphocele using a percutaneous catheter [which is placed through the skin]. Fortunately, newer surgical techniques are helping to ensure that lymphoceles occur very rarely.

Are there individual factors that increase the risk of prostatectomy complications?

Certainly, patients can have risk factors for infection. Diabetes, for instance, can inhibit the immune system, especially when patients have poor glycemic or glucose control [a limited ability to maintain normal blood sugar levels]. If patients have autoimmune diseases, or if they’re taking immunosuppressive medications, they may also be at increased risk of infectious or wound healing complications with surgery, and in some cases, may instead be treated with radiation to avoid these risks.

Thanks for walking me through this complex topic! Any parting thoughts for our readers?

It’s important to discuss the potential risks of surgery with your doctor so you can be fully informed. That said, prostatectomy these days using the minimally invasive approach has a very favorable risk profile. The majority of patients do really well, and fortunately severe complications requiring hospital readmission are very rare.

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

When measles broke out in 31 states several years ago, health experts were surprised to see more than 1,200 confirmed cases –– the largest number reported in the US since 1992.

Measles is a very contagious, preventable illness that may cause serious health complications, especially in younger children and people who are pregnant, or whose immune systems aren’t working well. While a highly effective vaccine is available, vaccination rates are low in some communities across the US. This sets the stage for large outbreaks.

Here are four things that everyone needs to know about measles.

Measles is highly contagious

This is a point that can’t be stressed enough. A full 90% of unvaccinated people exposed to the virus will catch it. And if you think that just staying away from sick people will do the trick, think again. Not only are people with measles infectious for four days before they break out with the rash, but the virus can live in the air for up to two hours after an infectious person coughs or sneezes. Just imagine: if an infectious person sneezes in an elevator, everyone riding that elevator for the next two hours could be exposed.

It’s hard to know that a person has measles when they first get sick

The first symptoms of measles are a high fever, cough, runny nose, and red, watery eyes (conjunctivitis), which could be confused with any number of other viruses, especially during cold and flu season. After two or three days people develop spots in the mouth called Koplik spots, but we don’t always go looking in our family members’ mouths. The characteristic rash develops three to five days after the symptoms begin, as flat red spots that start on the face at the hairline and spread downward all over the body. At that point you might realize that it isn’t a garden-variety virus — and at that point, the person would have been spreading germs for four days.

Measles can be dangerous

Most of the time, as with other childhood viruses, people weather it fine, but there can be complications. Children less than 5 years old and adults older than 20 are at highest risk of complications. Common and milder complications include diarrhea and ear infections (although the ear infections can lead to hearing loss), and one out of five will need to be hospitalized, but there also can be serious complications:

• One in 20 people with measles gets pneumonia. This is the most common cause of death from the illness.
• One in 1,000 gets encephalitis, an inflammation of the brain that can lead to seizures, deafness, or even brain damage.
• One to three in 1,000 children who get it will die.

Another possible complication can occur seven to 10 years after infection, more commonly when people get the infection as infants. It’s called subacute sclerosing panencephalitis, or SSPE. While it is rare (four to 11 out of 100,000 infections), it is fatal.

Vaccination prevents measles

The measles vaccine, usually given as part of the MMR (measles-mumps-rubella) vaccine, can make all the difference. One dose is 93% effective in preventing illness; two doses gets that number up to 97%. 

• Usually, the first dose is given between ages 12 to 15 months.
• A second (booster) dose is commonly given between ages 4 to 6, although it can be given as early as a month after the first dose.
• If an infant ages 6 to 12 months will be going to a place where measles regularly occurs, a dose of vaccine can be given as protection. This extra dose will not count as part of the required series of two vaccines.

The MMR is overall a very safe vaccine. Most side effects are mild, and it does not cause autism. Most children in the US are vaccinated, with 91% of 24-month-olds having at least one dose and about 93% of those entering kindergarten having two doses.

Herd immunity occurs when enough people are vaccinated that it’s hard for the illness to spread. It helps protect those who can’t get the vaccine, such as young infants or those with weak immune systems. To achieve this you need about 95% vaccination, so the 93% isn’t perfect — and in some states and communities, that number is even lower. Most of the outbreaks we have seen over the years have started in areas where there are high numbers of unvaccinated children.

If you have questions about measles or the measles vaccine, talk to your doctor. The most important thing is that we keep every child, every family, and every community safe.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

When preschoolers are melting down or teens are slamming doors, parents face two difficult tasks: keeping themselves composed and supporting their kids’ ability to self-soothe while building skills to handle future challenges.

These abilities are at the heart of co-regulation, a parenting tool that requires patience and practice. But what exactly is involved, and how does it help support children and teens wrestling with big emotions?

What is co-regulation?

“Co-regulation is a supportive, interactive, and dynamic process,” says Lauren Marchette, a child, adolescent, and family psychologist and a lecturer in psychiatry at Harvard Medical School.

Through warm and responsive interactions, caregivers help young people learn better ways to regulate their emotions during the inevitable upsets and challenges of life. “At its heart, co-regulation is connecting with a child who’s in distress and being able to evaluate what that child needs in the moment to help calm themselves.”

But before a parent or trusted adult can help a child, they need to understand — and possibly expand — their own emotional skills and limitations. Emotions are often contagious, whether a person is upset or sharing a sense of calm.

“The tricky part of co-regulation is that adults have to recognize how they’re feeling and be able to regulate their own emotions in difficult moments so they can help children to gain these same skills,” Marchette says. “But this will be so important for kids to develop healthy relationships over time, and affects how people do in school, work, and life in general.”

How does building emotional skills help children and teens?

As children grow up, they learn different skills — how to build a block tower, play a sport, or solve a math equation. They also learn emotional skills: how to recognize and handle feelings of anger or anxiety, for example.

Known as self-regulation, such emotional skills are truly the basis of wellness in life, Marchette says. By consistently practicing co-regulation, parents and other trusted adults foster self-regulation skills in kids.

The list of self-regulation skills is wide-ranging, involving

• emotional awareness and literacy, including the ability to identify emotions
• emotional regulation skills such as self-soothing
• perspective-taking, or the ability to "walk in another’s shoes”
• social skills such as taking turns and practicing patience
• paying attention and remaining focused when needed
• problem-solving
• thinking flexibly
• time management skills
• goal-setting.

What are the potential benefits of co-regulation?

Co-regulation enables kids to eventually learn to

• handle stress
• resist immediate gratification
• avoid hasty, ill-informed decisions
• make and stick to plans
• solve problems
• adapt to challenges
• take healthy risks.

Some research suggests that having better self-regulation skills is linked to more positive outcomes in life, such as higher income and lower rates of substance use and violence.

Who might especially benefit from co-regulation?

Everyone wins when kids are better able to navigate frustrations and manage their reactions to their thoughts and feelings. Parents, teachers, coaches, guidance counselors, mentors, and other adults who interact closely with children also stand to benefit.

As for kids themselves, it’s hard to think of any whose lives won’t be improved by adults who have invested themselves in practicing co-regulation, Marchette says.

But practicing co-regulation skills with certain children and adolescents — including those whose families are experiencing economic hardship, substance abuse, divorce, or other distressing situations — can be especially important.

Is there evidence that co-regulation works?

“While co-regulation is built upon a solid theoretical framework, not many studies have delved into its effectiveness — at least across all age groups,” Marchette says. “Research that does focuses mainly on infants and preschoolers.”

“Much less is known about how co-regulation interventions work for older youth,” she says. “The research is trying to catch up to what we know from years of clinical experience.”

How can a parent coach a child through co-regulation?

Co-regulation doesn’t stand alone as a skill. It relies on fostering a warm, responsive relationship with children, providing structure, and setting limits. “Children benefit from consistent, predictable routines with clear expectations and consequences,” Marchette says.

When a child begins experiencing big emotions, a co-regulation response will look different depending on the child and circumstances. But the steps to take are similar.

“First, the parent needs to pause and self-regulate their own emotions, such as by taking a deep breath,” Marchette explains. “The next steps are validating the child’s feelings, observing the child’s response, and then deciding how to respond next, including verbally and nonverbally, such as with a touch.”

Marchette offers an example based on her own practice: 12-year-old “Eric” is tackling a writing assignment in his bedroom when his mother suddenly hears loud noises. She walks to his door and finds him throwing a stapler, notebook, and container of pens off his desk. “What’s wrong with me?” he yells. “I suck at writing and I hate school!” Then Eric puts his head down on his desk.

The sixth grader’s mom knows he needs help calming down, so she pauses and takes a deep breath. Then she walks over and whispers his name, placing her hand on his shoulder. After more silence, Eric gradually starts sitting up in his chair. “I can tell how frustrated you are with this assignment,” she says to him, validating his feelings. “It must be a really challenging one.”

Eric’s mother knows he needs a break after he mutters, “I can’t do it.” She suggests a getting a glass of ice-cold water, and Eric glumly follows her to the kitchen. After the break, they can re-evaluate if Eric is ready to return to his homework or needs further coping strategies — like a walk outside or a round of jumping jacks — to get his frustration out.

What resources can help parents practice co-regulation?

The Administration for Children and Families offers a free Co-Regulation in Action video series. And some therapists — especially those who specialize in behavioral parent training or cognitive behavioral therapy — can help parents who feel their skills need a boost.

It’s worth noting that it can be hard to have sufficient resources — emotional, financial, and other supports — to practice co-regulation consistently. Those who wish to try should give themselves some grace as they learn the process. “Even parents who are thinking their own self-regulation skills aren’t where they want them to be should realize this is a muscle they can strengthen,” Marchette says. “It’s important to have that growth mindset.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Many health-conscious consumers have already cut back on hamburgers, steaks, and deli meats, often by swapping in poultry or seafood. Those protein sources are better than beef, and not just because they’re linked to a lower risk of heart disease, diabetes, and cancer. Chicken and fish are also better for the environment, as their production uses less land and other resources and generates fewer greenhouse gas emissions.

And choosing seafood that’s lower on the food chain — namely, small fish such as herring and sardines and bivalves such as clams and oysters — can amp up those benefits. “It’s much better for your health and the environment when you replace terrestrial food sources — especially red meat — with aquatic food sources,” says Christopher Golden, assistant professor of nutrition and planetary health at the Harvard T.H. Chan School of Public Health. But instead of popular seafood choices such as farmed salmon or canned tuna, consider mackerel or sardines, he suggests.

Why eat small fish?

Anchovies, herring, mackerel, and sardines are all excellent sources of protein, micronutrients like iron, zinc, and vitamin B12, and heart-healthy omega-3 fatty acids, which may help ease inflammation within the body and promote a better balance of blood lipids. And because you often eat the entire fish (including the tiny bones), small fish are also rich in calcium and vitamin D, says Golden. (Mackerel is an exception: cooked mackerel bones are too sharp or tough to eat, although canned mackerel bones are fine to eat).

Small fish are also less likely to contain contaminants such as mercury and polychlorinated biphenyls (PCBs) compared with large species like tuna and swordfish. Those and other large fish feed on smaller fish, which concentrates the toxins.

It's also more environmentally friendly to eat small fish directly instead of using them to make fish meal, which is often fed to farmed salmon, pork, and poultry. Feed for those animals also includes grains that require land, water, pesticides, and energy to produce, just as grain fed to cattle does, Golden points out. The good news is that increasingly, salmon farming has begun using less fish meal, and some companies have created highly nutritious feeds that don’t require fish meal at all.

Small fish in the Mediterranean diet

The traditional Mediterranean diet, widely considered the best diet for heart health, highlights small fish such as fresh sardines and anchovies, says Golden. Canned versions of these species, which are widely available and less expensive than fresh, are a good option. However, most canned anchovies are salt-cured and therefore high in sodium, which can raise blood pressure.

Sardines packed in water or olive oil can be

• served on crackers or crusty, toasted bread with a squeeze of lemon
• prepared like tuna salad for a sandwich filling
• added to a Greek salad
• tossed with pasta, either added to tomato sauce or with lemon, capers, and red pepper flakes.

Golden is particularly fond of pickled herring, which you can often find in jars in supermarkets, or even make yourself; here’s his favorite recipe.

Bivalve benefits

Bivalves are two-shelled aquatic creatures that include clams, oysters, mussels, and scallops. Also known as mollusks, they’re good sources of protein but are quite low in fat, so they aren’t as rich in omega-3’s as small, fatty fish. However, bivalves contain several micronutrients, especially zinc and vitamin B12. Zinc contributes to a healthy immune system, and vitamin B12 helps form red blood cells that carry oxygen and keep nerves throughout the body healthy. While most Americans get enough B12, some may not.

And from a planetary health perspective, bivalves are among the best sources of animal-based protein. “Bivalves can be ‘nature positive’ because they don’t require feed and they filter and clean up water,” says Golden.

Be aware, however, that bivalves can become contaminated from runoff, bacteria, viruses, or chemicals in the water. So be sure to follow FDA advice about buying and preparing seafood safely.

Although we tend to think of coastal cities as the best places to find seafood, it’s available throughout the United States. For less-common varieties, try larger Asian markets, which often carry a wide variety of fish and bivalves, Golden suggests.

Aquatic plant foods

You can even go one step further down the aquatic food chain by eating aquatic plant foods such as seaweed and kelp. If you like sushi, you’ve probably had nori, the flat sheets of seaweed used to make sushi rolls. You can also find seaweed snacks in Asian and many mainstream grocery stores. The truly adventurous may want to try kelp jerky or a kelp burger, both sold online.

Nutrients in seaweed vary quite a bit, depending on species (kelp is one type of brown seaweed; there are also numerous green and red species). But seaweed is low in calories, is a good source of fiber, and also contains iodine, a mineral required to make thyroid hormones. Similar to terrestrial vegetables, seaweeds contain a range of other minerals and vitamins. For now, aquatic plant foods remain fringe products here in the United States, but they may become more mainstream in the future, according to Golden.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Social media and stores are full of products that promise perfect skin. Increasingly, these products are being marketed not just to adults but to teens and tweens. Many are benign, but some can cause skin irritation — and can be costly. And even if these products are benign, does buying them support unhealthy notions about appearance and beauty?

It’s worth looking at this from a medical perspective. Spoiler alert: for the most part teens and tweens do not need specialized skin products, especially expensive ones. But let’s talk about when they may make sense.

When can a specialized skin product help tweens and teens?

So, when should your child buy specialized skin products?

• When their doctor recommends it. If your child has a skin condition that is being treated by a doctor, such as eczema or psoriasis, over-the-counter skin products may help. For example, with eczema we generally recommend fragrance-free cleansers and moisturizers. Always ask your doctor which brands to choose, and get their advice on how best to use them.
• If they have dry and/or sensitive skin. Again, fragrance-free cleansers are a good idea (look for ones recommended for people with eczema). So are fragrance-free, non-irritating moisturizers (look for creams and ointments rather than lotions, as they will be more effective for dry skin). If you have questions, or if the products you are buying aren’t helping, check in with your doctor.

What about skin products for acne?

It’s pretty rare to go through adolescence without a pimple. Many teens aren’t bothered by them, but if your child is bothered by their pimples or has a lot of them, it may be helpful to buy some acne products at your local pharmacy.

• Mild cleansers tend to be better than cleansers containing alcohol. You may want to check out cleansers intended for dry skin or eczema.
• Over-the-counter acne treatments usually contain benzoyl peroxide, salicylic acid, azelaic acid, or alpha-hydroxy acids. Adapalene can be helpful for more stubborn pimples.
• Steer away from astringents or exfoliants, which tend to irritate the skin.
• Talk to your doctor about what makes the most sense for your child — and definitely talk to them if over-the-counter products aren’t helpful. There are many acne treatments available by prescription.

Ask questions and help dispel myths

If your teen or tween doesn’t fall into one of these groups, chances are they don’t need anything but plain old soap and water and the occasional moisturizer if their skin gets dry.

If your child has normal, healthy skin yet is asking for or buying specialized skin products, ask them why. Do your best to dispel the inevitable marketing myths — like that the products will prevent problems they do not have. Let them know that should a problem arise, you will work with them — with the advice of their doctor — to find and buy the best products.

Use it as an opportunity, too, to talk about self-image and how it can be influenced by outside factors. This is an important conversation to have whether or not your child is pining for the latest cleanser they see on Instagram. Helping your child see their own beauty and strengths is a key part of parenting, especially for a generation raised on social media.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Headaches are very common in children and teens. In fact, more than half will suffer from headaches at some point, and by 18 years the majority of adolescents have had them. And while most headaches are part of a viral illness, some are migraines. In fact, recurring migraines affect as many as one in 10 children and teens overall.  

What should you know — and do — if you think your child or teen may be having migraines?

How early do migraines start to occur?

We don’t tend to think about migraines in children, but by age 10, one in 20 children has had a migraine. And migraines sometimes occur even earlier.

Before puberty, boys and girls are equally likely to have them. After puberty, migraines are more common in girls.

Which migraine symptoms are most common in children?

Migraines are often one-sided in adults. In children they are more likely to be felt on both sides of the head, either in both temples or both sides of the forehead.

While it’s not always easy to tell a migraine from another kind of headache, children

• often report throbbing pain
• may experience nausea and sensitivity to light and noise.

The flashing lights and other vision changes people often see as a migraine begins are less common in children. However, parents may notice that their child is more tired, irritable, or pale before a migraine begins — and takes a while to get back to normal after it ends.

What causes migraines in children?

We don’t know exactly what causes migraines. We used to think it had to do with blood flow to the brain, but that does not seem to be the case. It appears that migraines are caused by the nerves being more sensitive, and more reactive to stimulation. That stimulation could be stress, fatigue, hunger, almost anything.

Migraines run in families. In fact, most migraine sufferers have someone in the family who gets migraines too.

Can migraines be prevented?

The best way to prevent migraines is to identify and avoid triggers. The triggers are different in each person, which is why it’s a good idea to keep a headache diary.

When your child gets a headache, write down what was happening before the headache, how badly it hurt and where, what helped, and anything else about it you can think of. This helps you and your doctor see patterns that can help you understand your child’s particular triggers.

It’s a good idea to make sure your child gets enough sleep, eats regularly and healthfully, drinks water regularly, gets exercise, and manages stress. Doing this not only helps prevent migraines, but is also good for overall health!

How can you help your child ease a migraine?

When a migraine strikes, sometimes just lying down in a dark, quiet room with a cool cloth on the forehead is enough. If it’s not, ibuprofen or acetaminophen can be helpful; your doctor can tell you the best dose for your child.

It’s important not to give your child these medications more than about 14 days a month, as giving them more often can lead to rebound headaches and make everything worse!

Are there prescription medicines that can help children with migraines?

If those approaches aren’t enough, a class of medications called triptans can be helpful in stopping migraines in children ages 6 and up.

If a child experiences frequent or severe migraines, leading to missed days of school or otherwise interfering with life, doctors often use medications to prevent migraines. There are a number of different kinds, and your doctor can advise you on what would be best for your child.

Some girls get migraines around the time of their period. If that happens frequently, sometimes taking a prevention medicine around the time of menses each month can be helpful.

When to contact your doctor

If you think your child might be having migraines, you should call and make an appointment. Bring the headache diary with you. Your doctor will ask a bunch of questions, do a physical examination, and make a diagnosis. Together you can come up with the best plan for your child.

You should always call your doctor, or go to an emergency room, if your child has a severe headache, a stiff neck, trouble with coordination or movement, is abnormally sleepy, or isn’t talking or behaving normally.

The American Academy of Pediatrics has additional useful information about migraines, and how to treat and prevent them, on their website.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Chronic fatigue syndrome (CFS) –– or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), to be specific ––  is an illness defined by a group of symptoms. Yet medical science always seeks objective measures that go beyond the symptoms people report.

A new study from the National Institutes of Health (NIH) has performed more diverse and extensive biological measurements of people experiencing CFS than any previous research. Using immune testing, brain scans, and other tools, the researchers looked for abnormalities that might drive health complaints like crushing fatigue and brain fog. Let’s dig into what they found and what it means.

What was already known about chronic fatigue syndrome?

In people with chronic fatigue syndrome, there are underlying abnormalities in many parts of the body: The brain. The immune system. The way the body generates energy. Blood vessels. Even in the microbiome, the bacteria that live in the gut. These abnormalities have been reported in thousands of published studies over the past 40 years.

Who participated in the NIH study?

Published in February in Nature Communications, this small NIH study compared people who developed chronic fatigue syndrome after having some kind of infection with a healthy control group.

Those with CFS had been perfectly healthy before coming down with what seemed like just a simple “flu”: sore throat, coughing, aching muscles, and poor energy. However, unlike their experiences with past flulike illnesses, they did not recover. For years, they were left with debilitating fatigue, difficulty thinking, a flare-up of symptoms after exerting themselves physically or mentally, and other symptoms. Some were so debilitated that they were bedridden or homebound.

All the participants spent a week at the NIH, located outside of Washington, DC. Each day they received different tests. The extensive testing is the great strength of this latest study.

What are three important findings from the study?

The study had three key findings, including one important new discovery.

First, as was true in many previous studies, the NIH team found evidence of chronic activation of the immune system. It seemed as if the immune system was engaged in a long war against a foreign microbe — a war it could not completely win and therefore had to keep fighting.

Second, the study found that a part of the brain known to be important in perceiving fatigue and encouraging effort — the right temporal-parietal area — was not functioning normally. Normally, when healthy people are asked to exert themselves physically or mentally, that area of the brain lights up during an MRI. However, in the people with CFS it lit up only dimly when they were asked to exert themselves.

While earlier research had identified many other brain abnormalities, this one was new. And this particular change makes it more difficult for people with CFS to exert themselves physically or mentally, the team concluded. It makes any effort like trying to swim against a current.

Third, in the spinal fluid, levels of various brain chemicals called neurotransmitters and markers of inflammation differed in people with CFS compared with the healthy comparison group. The spinal fluid surrounds the brain and reflects the chemistry of the brain.

What else did study show?

There are some other interesting findings in this study. The team found significant differences in many biological measurements between men and women with chronic fatigue syndrome. This surely will lead to larger studies to verify these gender-based differences, and to determine what causes them.

There was no difference between people with CFS and the healthy comparison group in the frequency of psychiatric disorders — currently, or in the past. That is, the symptoms of the illness could not be attributed to psychological causes.

Is chronic fatigue syndrome all in the brain?

The NIH team concluded that chronic fatigue syndrome is primarily a disorder of the brain, perhaps brought on by chronic immune activation and changes in the gut microbiome. This is consistent with the results of many previous studies.

The growing recognition of abnormalities involving the brain, chronic activation (and exhaustion) of the immune system, and of alterations in the gut microbiome are transforming our conception of CFS –– at least when caused by a virus. And this could help inform potential treatments.

For example, the NIH team found that some immune system cells are exhausted by their chronic state of activation. Exhausted cells don’t do as good a job at eliminating infections. The NIH team suggests that a class of drugs called immune checkpoint inhibitors may help strengthen the exhausted cells.

What are the limitations of the study?

The number of people who were studied was small: 17 people with ME/CFS and 21 healthy people of the same age and sex, who served as a comparison group. Unfortunately, the study had to be stopped before it had enrolled more people, due to the COVID-19 pandemic.

That means that the study did not have a great deal of statistical power and could have failed to detect some abnormalities. That is the weakness of the study.

The bottom line

This latest study from the NIH joins thousands of previously published scientific studies over the past 40 years. Like previous research, it also finds that people with ME/CFS have measurable abnormalities of the brain, the immune system, energy metabolism, the blood vessels, and bacteria that live in the gut.

What causes all of these different abnormalities? Do they reinforce each other, producing spiraling cycles that lead to chronic illness? How do they lead to the debilitating symptoms of the illness? We don’t yet know. What we do know is that people are suffering and that this illness is afflicting millions of Americans. The only sure way to a cure is studies like this one that identify what is going wrong in the body. Targeting those changes can point the way to effective treatments.

About the Author

Anthony L. Komaroff, MD, Editor in Chief, Harvard Health Letter

Dr. Anthony L. Komaroff is the Steven P. Simcox/Patrick A. Clifford/James H. Higby Professor of Medicine at Harvard Medical School, senior physician at Brigham and Women’s Hospital in Boston, and editor in chief of the Harvard … See Full Bio View all posts by Anthony L. Komaroff, MD

Are online gambling and sports betting new to your area? Are gambling advertisements catching your eye? Have you noticed sports and news shows covering the spread? Recent changes in laws have made gambling widely accessible, and its popularity has soared.

Occasional bets are rarely an issue. But uncontrolled gambling can lead to financial, psychological, physical, and social consequences, some of which are extreme. Understanding whether gambling is becoming a problem in your life can help you head off the worst of these issues and refocus on having more meaning, happiness, and psychological richness in your life. Gambling screening is a good first step.

Can you screen yourself for problem gambling?

Yes. Screening yourself is easy. The Brief Biosocial Gambling Screen (note: automatic download) is a validated way to screen for gambling disorder. It has three yes-or-no questions. Ask yourself:

• During the past 12 months, have you become restless, irritable, or anxious when trying to stop/cut down on gambling?
• During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?
• During the past 12 months, did you have such financial trouble as a result of your gambling that you had to get help with living expenses from family, friends, or welfare?

What do your answers mean?

Answering yes to any one of these questions suggests that you are at higher risk for experiencing gambling disorder. Put simply, this is an addiction to gambling. Like other expressions of addiction, for gambling this includes loss of control, craving, and continuing despite bad consequences. Unique to gambling, it also often means chasing your losses.

A yes doesn’t mean that you are definitely experiencing a problem with gambling. But it might be valuable for you to seek a more in-depth assessment of your gambling behavior. To find an organization or person qualified to help, ask a health care provider, your local department of public health, or an advocacy group like the National Council on Problem Gambling.

Are you ready for change?

Your readiness to change a behavior matters when deciding the best first steps for making a change. If someone asks you whether you want to change your gambling, what would you say?

Depending on your answer, you might seek out different solutions. What’s most important initially is choosing a solution that feels like the right fit for you.

What if you don’t feel ready to change? If you haven’t thought about your gambling or only occasionally think about changing your gambling, you might explore lower intensity actions. For example, you could

• read more about how gambling could create a problem for you
• listen to stories of those who have lived experience with gambling disorder.

If you are committed to making a change or are already trying to change, you might seek out more engaging resources and strategies to support those decisions, like attending self-help groups or participating in treatment.

Read on for more details on choices you might make.

What options for change are available if you want to continue gambling?

If you want to keep gambling in some way, you might want to stick to lower-risk gambling guidelines:

• gamble no more than 1% of household income
• gamble no more than four days per month
• avoid regularly gambling at more than two types of games, such as playing the lottery and betting on sports.

Other ways to reduce your risk of gambling harm include:

• Plan ahead and set your own personal limits.
• Keep your entertainment budget in mind if you decide to gamble.
• Consider leaving credit cards and debit cards at home and use cash instead.
• Schedule other activities directly after your gambling to create a time limit.
• Limit your use of alcohol and other drugs if you decide to gamble.

What are easy first steps toward reducing or stopping gambling?

If you’re just starting to think about change, consider learning more about gambling, problem gambling, and ways to change from

• blogs, like The BASIS
• books like Change Your Gambling, Change Your Life
• podcasts like After Gambling, All-In, and Fall In, which offer expert interviews, personal recovery stories, and more.

Some YouTube clips demystify gambling, such as how slot machines work, the limits of skill and knowledge in gambling, and how gambling can become an addiction. These sources might help you think about your own gambling in new ways, potentially identifying behaviors that you need to change.

What are some slightly more active steps toward change?

If you’re looking for a slightly more active approach, you can consider engaging in traditional self-help experiences such as helplines and chatlines or Gamblers Anonymous.

Another option is self-help workbooks. Your First Step to Change is a popular workbook that provides information about problem gambling, self-screening exercises for gambling and related conditions like anxiety and depression, and change exercises to get started. A clinical trial of this resource suggested that users were more likely than others to report having recently abstained from gambling.

Watch out for gambling misinformation

As you investigate options, keep in mind that the quality of information available can vary and may even include misinformation. Misinformation is incorrect or misleading information. Research suggests that some common types of gambling misinformation might reinforce harmful beliefs or risky behaviors.

For example, some gambling books, websites, and other resources exaggerate your likelihood of winning, highlight win and loss streaks as important (especially for chance-based games like slots), and suggest ways to change your luck to gain an edge. These misleading ideas can help you to believe you’re more likely to win than you actually are, and set you up for failure.

The bottom line

Taking a simple self-screening test can start you on a journey toward better gambling-related health. Keep in mind that change can take time and won’t necessarily be a straight path.

If you take a step toward change and then a step back, nothing is stopping you from taking a step forward again. Talking with a care provider and getting a comprehensive assessment can help you understand whether formal treatment for gambling is a promising option for you.

About the Author

Debi LaPlante, PhD, Contributor

Dr. Debi LaPlante is director of the division on addiction at the Cambridge Health Alliance, and an associate professor of psychiatry at Harvard Medical School. She joined the division in 2001 and is involved with its … See Full Bio View all posts by Debi LaPlante, PhD