Dr. Amy

Pediatrician and Mom
Parenting With Less Stress, More Kindness and More Fun

Are Your Kids Getting Enough Calcium?

Last week we considered “Are Your Kids Getting Enough Vitamin D” so let’s make sure our kids are also getting enough calcium. Calcium and vitamin D are an important team that work together for healthy bones. Many kids do not get the recommended amount of calcium. Bone mass increases through childhood and adolescence then stays about the same for a few decades. After the 40’s, it is a slow drain. So we want our kids to start out in an optimal state. What happens when kids don’t get enough calcium? How much calcium is recommended? Do calcium supplements work? What else can I do to optimize my child’s bone health?

  • What happens when kids don’t get enough calcium?

Bottom line is that kids who don’t get enough calcium (and vitamin D) likely have lower bone density. This may be linked to an increase risk of fractures in childhood/adolescence and also to osteoporosis later in life.

There is a lot of research being done on calcium’s role in health. There is some evidence that calcium may play a role in certain cancers (helpful for some, not helpful for others), cardiovascular health and weight management. Some studies link calcium supplements to kidney stones in adults.

Too much calcium can be dangerous but most kids don’t even come close to even getting enough. See table for upper limits of calcium intake.

  • How much calcium is recommended?

General guidelines are:

  • 1 to 3 years old — 700 milligrams of calcium daily
  • 4 to 8 years old — 1,000 milligrams of calcium daily
  • 9 to 18 years old — 1,300 milligrams of calcium daily

When considering how much calcium your child is getting, it is important to consider that not all calcium is perfectly absorbed. For example, spinach had very little absorbable calcium. The recommendations overshoot what your child actually needs to account for different absorptions. This graph is helpful to see how much of a food your child needs to eat to get the calcium in 8 ounces of milk.

UpToDate
Wolters Kluwer Health
©2016 UpToDate®
Dietary sources of absorbable calcium, in comparison to milk
Food Serving size* (g) Calcium content(mg) Fractional absorptionΔ, (percent) Estimated absorbable calcium(mg) Number of servings needed to equal 240 mL milk
Milk 240 300 32.1 96.3 1
Beans
Pinto 86 44.7 26.7 11.9 8.1
Red 172 40.5 24.4 9.9 9.7
White 110 113 21.8 24.7 3.9
Bok choy 85 79 53.8 42.5 2.3
Broccoli 71 35 61.3 21.5 4.5
Cheddar cheese 42 303 32.1 97.2 1
Cheese food 42 241 32.1 77.4 1.2
Chinese cabbage flower leaves 85 239 39.6 94.7 1
Chinese mustard greens 85 212 40.2 85.3 1.1
Fruit punch with calcium citrate malate 240 300 52 156 0.62
Kale 85 61 49.3 30.1 3.2
Spinach 85 115 5.1 5.9 16.3
Sweet potatoes 164 44 22.2 9.8 9.8
Rhubarb 120 174 8.54 10.1 9.5
Tofu with calcium 126 258 31 80 1.2
Yogurt 240 300 32.1 96.3 1
* Based on half-cup serving size (~85 g for green leafy vegetables) except for milk and fruit punch (1 cup or 240 mL) and cheese (1.5 ounces).
  • Do calcium supplements work?

Some studies (but not all) show a lasting effect of calcium supplements on bone density.  So we should make every effort possible to include calcium rich foods in our family’s diet. In an ideal world we would get all of our calcium from natural sources. But for kids with milk allergies and other special diets this can be really tough. So our only option is to use supplemented foods and drinks and/or a calcium supplement. Although there have not been many studies on which supplements are best for kids, in adults calcium citrate and calcium citrate malate are more bioavailable than is calcium carbonate.

Studies that show a lasting effect of calcium supplements.

Studies that do not show a lasting effect of calcium supplements.

  • What else affects bone health?

EXERCISE HELPS-ALOT!! Some studies show that exercise is even more important than calcium intake for reaching peak bone mass.

Carbonated beverages have been associated with an increase risk of fractures.

Alcohol and cigarettes have been linked to low bone mass.

Caffeine has not been definitively shown to help or hurt bone mass.

Depo-Provera (hormonal shot for birth control) has been shown to lower bone density.

Remember for the healthiest bones, have your kids:

  • Eat a well rounded diet with enough calcium and vitamin D
  • Exercise every day
  • Limit carbonated drinks and non- fortified sugar drinks
  • Avoid alcohol and cigarettes

Are Your Kids Getting Enough Vitamin D?

My 12 year old has broken two bones in the past year. He is allergic to milk and generally a picky eater so it has me thinking about vitamin D in kids. In the summer, our kids likely get the vitamin D they need by making it in their skin with the help of sunlight. But what about as the days shorten and we need to rely on dietary sources? The rate of vitamin D deficiency in kids in the US has been increasing since the 1980’s. Recent studies report that 15% of kids are have a low measured vitamin D. Low vitamin D can affect bone health and is associated with many medical conditions including certain cancers, diabetes, food allergies, and asthma. The  most at risk are kids are those who get little sunlight and breastfed babies. But kids who do not get enough vitamin D in their diet are also at risk. So why is vitamin D so important? How can you make sure your children are getting enough vitamin D?

Why is vitamin D so important?

  1. In the US, kids with low vitamin D have more respiratory infections, food allergies, asthma and cavities. They also are at a higher risk for hypertension and high blood glucose. Studies suggest that vitamin D deficiency may be associated with certain cancers, including breast, prostate and colon. Vitamin D deficiency may also be associated with many immune conditions such as type 1 diabetes, rheumatoid arthritis, inflammatory bowel disease, mood disorders and cardiovascular disease.
  2. Vitamin D helps with calcium absorption from the intestines. Without enough calcium, children can get rickets (bow legs and problems with the liver and spleen). And if kids don’t get enough calcium in childhood, they are at risk for osteomalacia (soft bones that fracture easily) as adults.
  3. Vitamin D is involved in many biochemical reactions in the body. Without enough vitamin D, other chemical levels change and this can lead to muscle weakness and discomfort. Kid’s bone growth plates may not develop normally. In severe cases, vitamin D deficiency can lead to seizures, apnea, breathing problems and low muscle tone, especially in very young children.
  4. Although it is not clear if low vitamin D increases the risk of fractures in kids, a study did show that kids who received vitamin D supplementation had fewer stress fractures.

How do I know if my child is getting enough vitamin D?

Babies need 400 international units (IU) daily. Breast fed (and some formula fed babies) need a supplement to get the needed vitamin D.

Children age 1-18 need 600 international units (IU) daily.

Natural vitamin D is found in oily fish (salmon, mackerel, sardines), tuna fish, cod liver oil, liver, and egg yolk. Since this list is not usually among kid’s favorite foods, luckily there are many vitamin D fortified foods. These include milk, milk products, orange juice and cereals. Milk and orange juice are fortified with 400 IU per LITER. A liter is a little more than 4 cups.

Sun lets vitamin D be formed in the skin. How much sun? Depends on the amount of pigment in your skin and where you live. For light-skinned kids in most seasons, about 10-15 minutes outside on a sunny day is sufficient. For darker skinned kids or those living in less sunny areas, other sources of vitamin D are often needed. It is important to balance sun protection with clothing and sunscreen with the need for vitamin D. How much sunscreen blocks UVB rays needed for vitamin D production is unclear. But most studies show that although sunscreen can significantly reduce the production of vitamin D, regular sunscreen use does not generally lead to vitamin D deficiency. This is a parental common sense issue and you need to take into account your child’s skin tone, family history of skin cancer, time of day/year, etc.

What should I do if I am worried my child is not getting enough vitamin D?

Vitamin D supplements (D2 or D3) are available at the store without a prescription in liquid, pill and capsule form. Babies can take 400 IU in liquid form. Kids can take 400-600 IU in whichever form they prefer.

10 Tips for Traveling With Kids

Ready to head to the beach?  Or maybe dreaming about what vacation was like BEFORE kids?  I remember crying with my sister-in-law on our first vacation with babies. This was NOT a vacation AT ALL!  It was the same work in a new place and babies ALWAYS get new teeth, fevers and diarrhea on vacation!! Okay, maybe a slight exaggeration but that is how it felt!  So what can you do to be prepared and actually enjoy your getaways?

1.  Adjust your expectations.  Lying on the beach when you have young children is unpleasant at best.  Sand eating, sunburn, hat hating and wandering are just some experiences that will need your constant attention. Try to divide up the vacation childcare with your spouse or a trusted caregiver so that you can get some rejuvenation.  Even an hour a day can be delightfully refreshing when you spend the other 23 hours tending to others needs.

2.  Let go of the routine.  In theory, it would be best to keep the same eating and sleeping schedule for our children but realistically it is not likely to happen.  We have all been with that traveller who can’t alter the schedule of their children and it can be very stressful for everyone.  I know the kids get fussy but they will probably get fussy anyway from the change in environment.  Having a go with the flow attitude can make the trip more pleasant for all.  Believe me I know you work hard for that routine but you will get back once you return home.  Think of it as helping your baby/child develop resiliency to change.

3.  Pack a General Health Kit:

* medications that are specific to your child’s medical needs like epi pens, inhalers, etc.

* ibuprofen (brand name Motrin, Advil)

* acetaminophen (brand name Tylenol)

* Benadryl

* hand sanitizer

* sunscreen (click here for the best one for your family)

* insect repellent

* diarrhea medicine for the older child/adolescent

* pediatrician’s phone number

4.  Bring a change of clothes for children and of course more diapers/wipes than you think you will need on most outings and definitely on flights.  Potty accidents, motions sickness, vomiting, spills, they will all happen so a change of clothes can make things much easier. When our middle son threw up with a vengeance on a flight we had to open a credit card in the airport to get a t-shirt because I didn’t pack extra clothes.

5.  Don’t feel like a failure if you slip a pull up on your newly trained toddler for air travel.  Just explain the situation to your child and get them back into underwear as soon as you arrive!

6.  If your child takes a pacifier be sure to have it for flights, it can ease the ear pain from pressure changes.  Older children can have gum or even a lollipop to help.

7.  For the brave souls that travel overseas or to other countries with young children, remember to check with your pediatrician at least a year before take off to ensure that your child has all the necessary immunizations.  There are immunizations that are not in the routine pediatric schedule that are recommended for travel to certain areas.

8.  Do not give your child Benadryl for flights in an attempt to make them sleepy. This can backfire and make your child more excitable.  If your child is recovering from a recent ear infection, talk to your pediatrician about giving acetaminophen or ibuprofen an hour before flying to ease ear pain associated with pressure changes.

9.  Pack games/toys/entertainment that are appropriate for your child’s age. Have a movie downloaded on your computer or pack some travel games.  Give your child some headphones, it is half the fun!  Don’t forget some snacks.

10.  If your child is prone to motion sickness try to encourage them to look out the window to normalize what their eyes are seeing and their ears are feeling. Maintain a light, bland diet and stay prepared with the vomit receptacle.  Most kids give little warning!  Try sea bands (acupressure bands), ginger, and talk to your pediatrician about medication if necessary.

Bon Voyage!!

Health Updates

It can be difficult to keep up to date on the latest research concerning your children’s health.  Here are some study results that you may find interesting.

1.  Thumb sucking and nail biting may decrease a child’s risk of environmental allergies later in life. study in Pediatrics this month showed that kids who sucked their thumbs and bit their nails were less likely to have positive allergy skin testing at 13 and 32 years of age.

2. HPV related cancers are increasing and most are preventable with the HPV vaccine. The CDC reports that there are over 30,000 new cases every year in the U.S. If your child is 11 years or older, get him or her the HPV vaccine.

3. The intranasal flu vaccine will not be offered this year. Studies showed it was not effective over the past 3 years. The flu shot IS effective in preventing many cases of the flu and should be given to most children over 6 months.

4. The use of e-cigarettes in increasing in teens:

Most teens (and parents!) are not aware of the known and emerging risks from e-cigarettes. Most e-cigarettes contain nicotine which is addictive. Whether this will lead to more smoking of regular cigarettes is unclear but certainly possible. Talk to your kids about the risks of e-cigarettes.

5.  Early antibiotic use may contribute to obesity. A recent study showed a correlation between antibiotic use before 6 months and an increased body mass later in childhood, between 10 months and 3 years of age. Researchers warned that the increase was modest on an individual level but has implications for the obesity epidemic. It is thought that antibiotics may alter how the microbes that exist in our intestine metabolize food. Not a reason to avoid antibiotics for babies and children, just another reminder to only use antibiotics when necessary.

6.  Alzheimer’s Disease may be a form of diet related diabetes. Poor diet and obesity can lead to diabetes which is when your body does not produce or respond to insulin. One of the many complications when your body is not responding to insulin is impaired cognition and formation of the plaques in your brain associated with Alzheimer’s. Eating habits are established early so provide your family with a diet full fresh fruits and vegetables, skip the processed foods (including lunch meat and most fast food), moderate your animal protein intake and incorporate exercise into your daily life.

More Info:

Alzheimer’s: Diabetes of the Brain?

More on the role of diet in Alzheimer’s Disease.

Is Alzheimer’s Type 3 Diabetes? (New York Times)

Looking at the Big Picture

The overall tone of my home changes with the seasons. Hectic holidays and homework time. Slower summers. But sometimes we get out of sync. At a time for rejuvenation like summer, it is helpful to do a pulse check. Is your family using summer as a time to relax and connect? Or is the hectic tone of the school year still pulsing?  Is there something more subtle that is contributing to a tone in your home that does not feel right? Is the noise level too high? Is a sense of cooperation lacking? Are the emotional ups and downs disconcerting? Changing the overall tone of your home is a big task. Picking just one aspect that needs tweaking is a good place to start.

Pick one element that is regularly influencing the tone of your home. For example, for me there is a lot of emotionality. Emotionality from everyone! Happy that we’re home, sad that there’s homework, Mad that there is no time to go to the comic book store. Frustrated that one child is getting all the attention. Annoyance at the lingering to do list and the dog. Fear that it will not get better.

Other examples may be feeling perpetually overwhelmed or ineffective, the one child that sucks all of the family energy, or a constant tone of annoyance.

Whatever you choose, ask yourself the following two questions:

1. How am I contributing to this tone?

I know that even though my kids can be challenging, I sometimes bring my own energy to the table. If I am run down with a to do list that never ends, everything request feels monumental. So for me, it is helpful to check just one or two tasks off the list before I move into kid mode. And to remind myself that it is ok for my kids to entertain themselves or be bored while I get a few things accomplished. Helps them build resilience. Remembering to BREATHE is always a plus too.

If you are feeling frustrated about something at home, for example you feel like you are the only one contributing to household tasks, check your approach. Have you asked for help? Have you given your child the support needed to learn the task? Do you just do it yourself because it takes longer to have your child do it?

2. What is one thing that I can control about the tone?

If your child is naturally boisterous or quiet, easy or difficult about routine, more upbeat or lower energy, you need to work within this temperament. But there ARE things you can change. If your tone is too hectic, ask yourself, “Are my kids over scheduled?”.  If you are frustrated by the lack of help with chores, pick one chore and talk to the kids about how it is going to get done. If you always find yourself yelling, back up and see how you are getting to that point. Break it down. What feels like a small change can give you the energy and encouragement you need to create the home environment you want.

The Gift of Boredom

Our kids are over scheduled and over entertained. I don’t think this stops in summer for most of us. We run them from one activity to the next and barely stop to eat. They start the day with “What are we doing today?” and most of us have so much on the schedule that we need to consult our calendars to remember everything. What happens when the entertainment train stops? Often kids jump to screen time. They are so conditioned to be engaged and computers and video games are waiting, always with the lure of constant stimulation. But wait. What about having nothing to do? What about needing to come up with something for entertainment? Kids NEED to be bored. They NEED to have down time. It can trigger guilt in us that we aren’t being the super parent that we unrealistically aspire to be. But life can be boring and kids need to learn how to deal with it. And being bored leaves time for creativity and self discovery. So here are 5 tips for the next time your child groans, “I am B-O-R-E-D”!

  1. First of all, connect. If you are expecting your kids to find independent entertainment, they may need to check in first. Stop what you are doing and spend 5 minutes talking to your child. Give an outline of the day, including unstructured time (keep your own name for this and be sure your child understands that this is the time for free play/activity). When it is time for unstructured time, let your child own it. For example, “So Luke, this is free time for you to do something on your own. I will be working in the other room. I bet you can come up with something to do!”. If you wait a bit and your child has not come up with anything, offer, “Do you have something that you want to do or do you need help with some ideas?”.
  2. Practice gentle ignoring. Don’t monitor or comment unless safety is an issue. You may need to accept that free play for kids often involves making a mess. As long as it is not completely out of hand (like painting on the walls) and they work with you to clean it up, it is a good thing.
  3. Be prepared. Make a boredom basket in advance. Write down ideas with your child for times when your child may need help in finding something to do. For ex:
    • Play with bubbles
    • Sidewalk chalk
    • Make a fort out of an old appliance box
    • Read
    • Write a poem
    • Make a creation with toothpicks and wine corks, pipe cleaners, or play doh
    • Make a sock puppet
    • Write someone a nice note
  4. Be reasonable. Toddlers can practice independent play but it won’t last long and you need to be nearby to make sure they are safe. Start small with young children. For example, a 3-year-old could do play doh in the kitchen while you can watch and fold laundry in the next room. With practice, by the time your child is in kindergarten, he or she will already be able to play and work independently. Understand that different children have different baselines for independent play. Kids from the same family can differ vastly. Remember that you are teaching your child the valuable life skills of creativity and resourcefulness. It may take some effort on your part and initially the free time you hoped to gain may not happen. Stick with it!
  5. If they don’t come up with anything, invite them to help you. Even if you were hoping for your own engaging activity, you may need to change gears. “Oh I was just going to fold the laundry, I can give you a job to help me!” or “I am going to sweep the back porch, you can use the dust pan and throw it away!”. They may bite. Or, more likely, they may become suddenly inspired for finding something else to do!

Which Sunscreen?

Since my post The Best Sunscreen is a Shirt and Hat, many of my mom friends have lamented, “I have tried the ‘healthy sunscreens’ and the texture is so awful that my kids won’t let me put it on” or “UGH I just bought a Costco supply of Coppertone spray”. Yes sister I have been there. It is overwhelming. And we all love the spray. It is just so darn convenient. It is easy to forget the risks. I was on the beach with my family and saw a Dad spray his young son’s body and then as a finishing touch said, “Close your eyes tight” and sprayed directly into the kid’s face! I must say the boy was a really good sport and went along with the routine. My kids thought it was hysterical. But seriously, we really don’t know the effects of inhaling spray sunscreen so be careful. If you already bought some spray, use it up, then don’t buy it again. When using the spray, try really hard to keep your child from breathing it in and definitely don’t spray it into your child’s face. If your child is fair, know that it is VERY easy to miss a spot. There are better alternatives.

I have been through many bottles of sunscreen. My favorite is Blue Lizard Australian Sunscreen, Sensitive SPF 30+. It gets a very high ranking from the EWG. It also has a very nice texture and blends well. Has this funky bottle that turns blue in the sun. Probably not needed but kind of fun. It is not cheap at $17.84 for 5 ounces but it seems to last a long time.

I once tried COOLA products at a resort in Kiawah where we were staying for a medical conference. They were fabulous. But when I went to buy it the price tag was astronomical. $30 for 5 ounces. Yikes. I would rather stay in the shade.

Banana Boat Sport Performance Sunscreen SPF 15 is not too bad in terms of ratings. At only $6.44 for 8 ounces it is a bargain.

I love the sticks for the face. No more eye stinging. Badger (about $8) and Raw Elements (about $13) both have sticks. Both have an excellent EWG rating.

So get your sunscreen but remember THE BEST PROTECTION FROM THE SUN IS A LONG SLEEVED SHIRT AND A HAT.

Revised AAP Sleep Recommendations for Kids

Revised AAP Sleep Recommendations for Kids

As parents we all know the importance of sleep for our kids. A child who is tired is cranky and difficult. Getting enough sleep helps kids with focus, learning, memory, and emotional regulation. Kids who don’t get enough sleep are at an increased risk of injuries and accidents. We ask a lot of our children so make sure yours are getting enough sleep! Here are the new American Academy of Pediatrics (AAP) recommendations:

Ages 4 months to 12 months: Twelve to 16 hours of sleep per 24-hour period. This number includes naps.
Ages 1 to 2 years: Eleven to 14 hours of sleep per 24-hour period. This number includes naps.
Ages 3 to 5 years: Ten to 13 hours of sleep per 24-hour period. This number includes naps.
Ages 6 to 12 years: Nine to 12 hours of sleep per 24-hour period.
Ages 13 to 18 years: Teenagers should sleep 8 to 10 hours per 24-hour period.

Interestingly, regularly getting too much sleep has been associated with hypertension, diabetes, obesity, and mental health problems. So like so much in parenting-strike a balance.

Reference

Paruthi S,Brooks LJ, D’Ambrosio C, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine. 2016;12(6):785-786.

Summer Safety Checklist

Unintentional injuries are the leading cause of death in children 14 and under. These devastating events occur more frequently in the summer. Visits to the ER for minor injuries also escalate in the summer. Some aspects of our children’s health and safety are out of our control. However there are some risks that you can control, so take charge and help your child have a safe summer!

1. Water Safety

*All pools should be fenced (at least 4 feet high) on four sides with self latching gates.

*Remember that 9 out of 10 fatal events involving a pool happen in a very brief lapse of time, the child is usually missing less than 5 minutes. Never let your guard down.

*Always use personal flotation devices when boating.

*No diving in water less than 9 feet.

*Teach your child to swim and review pool safety regularly.

*Do not leave another child in charge of younger sibling or friend, even if he or she is a good swimmer. It is too easy to get distracted.

2. Bike Safety

*Bike helmets really do work!! When worn properly, they can decrease the risk of brain injury by 85%.

*Teach children to obey traffic laws and to cross at the cross walk.

3. Falls

*Assess your house for risk of falls. Do you have a balcony? A fire escape? Do you leave second story windows open? Make sure the children do not have access to these dangerous sites. If you like to leave windows open upstairs, be sure there is nothing near it that children could easily climb up like a chair or a bed. Install window guards (guards should have a safety latch in case of fire).

*Playgrounds should have at least 12 inches of protective ground cover like mulch or sand.

4. Car Safety

*Most of us are pretty consistent about restraining our infants and toddlers. It is the school age child who wants to be out of the booster seat that I most often see at risk. To be out of a booster seat your kids should be 4’9″ and 80-100 pounds. This usually is around 8-12 years old (most commonly about 10 years old). To graduate to the adult seat belt, the seat belt should fit snugly across their hips and shoulder and should not go across their neck. The right car seat, correctly installed decreases fatal injury for children less than 1 year by 71% and for toddlers by 54%. For children in booster seats the risk of fatal injury is decreased by 59%. So drag that booster seat out of the garage-this fight is worth the effort.

*Children 12 and under should be in the back seat.  Even if they are as big as some adults, it is still the safest place to be in the car.

*Lock your car when parked in your driveway. A game of hide and seek can quickly become deadly when a toddler gets into an unlocked car in the summer. They may not know how to open the door and/or the child safety lock may be engaged. It only takes a short time for a dramatic and deadly temperature rise.

*Get in the habit of walking around your car before you get in and start. It only takes two seconds and it could prevent a devastating accident. Children are very difficult to see behind a car especially a SUV or minivan.

5. Street Safety

*Do not allow children less than 10 years old to cross a busy street alone. They are not developmentally ready to be consistent and they are still easily distracted.

*Teach children to cross at the light, use cross walks and look left-right-left before crossing, even at a light.

*Use extra caution when walking through parking lots or playing in driveways.

6. Fireworks

*Leave fireworks to the professionals! Tell your children that under no circumstances should kids be playing with fireworks. Eye damage, skin burns and even loss of fingers are real dangers when lighting fireworks.

*Sparklers look safe but can reach 1800 degrees F and cause a nasty burn. Be sure that your children are closely supervised when using sparklers.

These are somber but necessary reminders. A few minor changes can help your family enjoy summer safely.

Another Zika Update

The Zika story continues to evolve. The most serious risk continues to be for babies whose moms were infected while pregnant. But there is some evidence that Zika virus can also cause Guillain-Barré syndrome (GBS). Do you know the answers to the following questions?

1.  What is Guillain-Barré syndrome (GBS)? How many people have been diagnosed with GBS from Zika in the U.S.? 

2.  Is Zika in the U.S.?

3.  Should I travel where I know there is Zika?

4. My husband travels to areas that have Zika and we are trying to get pregnant, do I need to worry?

Answers:

1.  What is Guillain-Barré syndrome (GBS)? How many people have been diagnosed with GBS from Zika in the U.S.? GBS is a rare disease that happens when someone’s own immune system attacks the nervous system. It can lead to muscle weakness and paralysis. It usually happens after an infection. There are some people who are infected with Zika who are developing GBS.  So scientists are looking for a possible link between Zika and GBS. In the U.S., one person has been diagnosed with GBS thought to be associated with Zika. There have been 8 people with GBS possibly from Zika in the U.S. territories.

2.  Is Zika in the U.S.? Yes, a little over 600 people in the U.S. have been diagnosed with Zika. But the Zika was acquired while traveling or from sexual contact. There have been no documented cases of Zika transmission from a mosquito in the U.S.

3.  Should I travel where I know there is Zika? If you are not thinking about getting pregnant then you can take steps to prevent mosquito bites while traveling.

If you are thinking about getting pregnant, the CDC recommends the following:

  1. Talk with your doctor or healthcare provider.
  2. Take steps to prevent mosquito bites.
  3. Take steps to prevent getting Zika through sex.

4. My husband travels to areas that have Zika and we are trying to get pregnant, do I need to worry? Unfortunately, yes. And for quite a while. If a man is diagnosed with Zika, he needs to use condoms or abstain from sex for 6 months or if his partner is pregnancy, for the duration of the pregnancy.  It is not clear how long Zika remains in semen at this time. Even if a man has not been diagnosed with Zika, if he is at high risk, precautions should be taken. Read more about preventing transmission of Zika from male partner.