Karen Dahl, MD, is a pediatric infectious disease specialist at Helen DeVos Children's Hospital. She is our guest blogger this week.

Some parents have been contacting Helen DeVos Children's Hospital, wanting to know more about the resurgence of pertussis-the bacterial infection also known as whooping cough-here in Michigan. It's good to know parents are getting informed about the issue and want to take action and help protect their children as well as help prevent the infection from spreading to others.

Here are some facts you should know:

• Anyone can get whooping cough, but it is more common in infants and children-and is especially serious in infants, since they do not complete their primary vaccine series until they are six months of age. Infants may turn blue with a coughing spell or even stop breathing.
  
• Whooping cough causes uncontrollable coughing in unimmunized persons-in fact, a child may cough so hard that he or she has choking spells or vomits.
  
• The "whooping" part of the name comes from the sound that's often made when the child takes a deep breath in after a coughing spell.
  
• Pertussis in adolescents and adults is less dramatic and often goes undiagnosed, but is still contagious. Young children and older partially immunized people usually don't make the "whoop" sound.
  
• Pertussis is one of the few infections that doesn't cause a fever, and many people think that a cough without fever isn't serious. However, any cough that has lasted more than two weeks should be evaluated.

To understand what's happening with the resurgence of whooping cough in the U.S., it's helpful to know some history: In the 1920s and 1930s, before there were pertussis vaccinations, there were approximately 250,000 cases each year. Then vaccines came on the scene, and by 1976, the incidence of whooping cough in the U.S. had decreased by over 99%. Since 1980, though, the incidence of whooping cough has risen, with epidemics occurring about every three to five years in the U.S. This increase may be due to adolescents and adults with waning immunity, and also to parents opting to delay or decline immunization of their infant children.

California, Pennsylvania, New York, South Carolina, as well as Michigan, have experienced whooping cough outbreaks this year. So what's happening?

The real issue is that parents aren't getting the necessary booster shots for their children and themselves, and the vaccine loses its effectiveness over time. Should you be worried? If you and your child are immunized and up to date on boosters, you have done everything you can to prevent infection and disease. However, be aware that the pertussis vaccine isn't 100% effective, so even immunized people can get sick, but usually this is a milder illness.

About immunization:

• Check your hosusehold's pertussis vaccine records. Children should receive pertussis-containing vaccines at 2, 4, 6 and 15-18 months, as well as at 4-6 years of age.
  
• A booster is given at 11-12 years of age, and every 10 years after that (combined with a tetanus booster).
  
• Pertussis is now part of what used to be called the tetanus/diphtheria "Td" booster-but now it is called "Tdap" and includes pertussis.
  
• If you are expecting a baby in your household soon, or if you have a young child, make sure everyone's immunizations are up to date, especially adult care givers.

Pertussis boosters are being offered to women either during the second or third trimester or post partum to help protect their infants. If you are offered this vaccine, remember the purpose is to protect your newborn infant.

Whooping cough in older children isn't serious, but they should still stay up to date on their immunizations. This is because when they come in contact with infants under 6 months of age, they put that infant at risk.

Antibiotics can help shorten the duration of illness if given early in the disease. However, antibiotics are prescribed even if the diagnosis is delayed to help prevent transmission to others. If there is a case of pertussis in your household, all household members should receive antibiotics to help prevent whooping cough. If there is a case in daycare, antibiotic prophylaxis is recommended for all children in that daycare.

If your child needs a pertusiss immunization, schedule an appointment now. If you believe your infant has pertusiss, see your doctor right away.

- Dr. Dahl

Kimberly Slendak is a licensed master social worker with the Helen DeVos Children's Hospital Healthy Weight Center. She is our guest blogger this week.

Did you experiencing bullying when you grew up? Even if you weren't involved yourself, it's likely you witnessed bullying by others. Unfortunately, today, bullying is still common behavior. One study reports that 86 percent of children ages 12 to 15 said they get teased or bullied at school-that makes bullying more prevalent than smoking, alcohol use, drugs, or sex among that same age group.

But, some people argue, isn't bullying just a normal part of growing up? My answer is absolutely not. In my experience, children who are involved with bullying are exposed to an environment of aggression. They may be stunted in their peer relationship growth and may suffer academically. Bullying not only causes harm in the moment, but can also have life-long effects on a person's self-esteem and confidence levels. So, whereas occasional peer conflict is inevitable, bullying is not the same and is much more serious. In a conflict, both sides have equal power. But bullying involves the intentional, one-sided use of power to control another.

There are some myths around bullying that I'd like to address before offering tips on how to help your child avoid it:

Myth #1: My child would tell me if he or she was being bullied.
Maybe, but maybe not. Children may not tell for a number of reasons: they believe adults won't be able to stop the bullying; they may not even recognize that they are being bullied; they are afraid; and they may think that telling an adult will result in worse treatment from the child bullying them.

Myth #2: Most bullying is physical.
The most common form of bullying, for both boys and girls, is verbal bullying such as name calling. It is also common for kids to bully each other through social isolation. And, if you are a parent, you should also be aware that bullying not only is still a reality in the schoolyard, but it's moved into cyberspace-online chat rooms, e-mail, and text-messaging-and is rapidly increasing.

Myth #3: Obese children are always the victims.
A 2004 study showed that overweight and obese school-aged children are more likely to be the victims and perpetrators of bullying behaviors than their normal-weight peers. Another study reported that younger obese boys were more likely to be victims of bullying, whereas older obese boys were more likely to carry weapons and be the bully, compared to boys of normal weight.

Fortunately, as a parent, you can teach your child new behaviors that will help him or her navigate bullying situations. It all begins with becoming more aware yourself, so I'd like to start with a short assessment. Have you noticed any of the following behaviors in your child? If so, they could indicate your child is being bullied:

• Changes in diet, overeating or under eating, leading to weight changes
• Changes in the amount of exercise or physical activity your child participates in
• Fear of riding the school bus
• Cuts or bruises
• Damaged clothing or belongings
• Frequent "lost" lunch money
• Frequent requests to stay home from school
• Frequent unexplained minor illnesses
• Depression or lack of enthusiasm for hobbies or friends
• Decline in school performance
• Changes in sleep patterns
• Heightened anxiety, lack of concentration, panic attacks

If you suspect your child is the victim of bullying, ask him or her to tell you what's going on. Be sure to explain in advance that you know he or she is not to blame, and that it is the right thing to tell you. Here are some ways to help your child cope if he is she is being bullied:

• Encourage your child not to fight back.
  Bullying lasts longer and becomes more severe when children fight back. Physical injuries are often the result. Also, tell your child to stay near a supervising adult when bullying is likely to occur.
• Tell your child to report all bullying incidents that happen at school to a teacher, the school guidance counselor or a school administrator.
  Know your school's policies and explain to your child that these rules are in place to protect students from harassment, bullying, and physical violence. Talk to your child's teacher or other school staff so they are aware of the situation.
• Help your child be specific in describing bullying incidents.
  Being specific, and even documenting bullying incidents by writing them down can be helpful in determining patterns and gaining control.
• To help your child regain a sense of safety, have him or her to extend invitations for friends to play at your home or to attend activities together.
  It may also be helpful to involve your child in other social activities outside of school.
• Notify the police if your child is assaulted.
  Also, keep in mind that restraining orders are not just for adults. You can get a restraining order so that the bully is required by law to have no contact with your child. 

Finally, don't hesitate to talk with your child's pediatrician, your family physician, school counselor or another professional for help-remember, bullying is not normal and a professional can help you develop new strategies and coping mechanisms.

- Kimberly Slendak, LMSW