Human papilloma virus is a cause of warts that affect the genital areas of males and females. They can also cause infection of the mouth and throat.

HPV is the most common sexually transmitted disease in the United States.

HPV does not show symptoms for many people who are infected but it can lead to cancer of the cervix or penis. Every year approximately 17,500 women and 9,300 men will be affected by cancers that are caused by HPV.

HPV Vaccination

Fortunately, we now have a vaccine that prevents HPV. It was licensed for use in 2006 and targets four strains of the virus: 6, 11, 16 and 18. Types 6 and 11 account for 90 percent of genital warts and types 16 and 18 lead to cervical cancer.

Any time something is “new,” rumors abound. I was privy to an online discussion about HPV on Facebook this week ... because it’s not the best venue for having these discussions I had to hold my fingers (tongue).

But, here are some of the myths I saw that I felt needed to be addressed, beginning with the HPV vaccine has been proven ineffective.This myth takes on a few different forms. I’ll address each one.

HPV Vaccine Myths

1. Myth: The HPV vaccine does not decrease the amount of HPV disease.

Truth: In the United States, the percentage of cases of HPV caused by those strains in the vaccine dropped by 56 percent after the introduction of the vaccine. Other studies in the UK and Australia showed decreases in the number of HPV cases after introduction of the vaccine. The vaccine prevents HPV disease.

2. Myth: The effectiveness of the vaccine wears off over time.

Truth: This study in Pediatrics showed that, at the end of eight years of surveillance, those who received the vaccine continued to have antibodies to the virus. There is no indication that will decrease over time but studies continue. Even if we found a fall-off, a booster could be used to prolong coverage and if we could get protection for any period of time it would decrease the rates of HPV and cervical cancer.

3. Myth: Even if it prevents HPV, the vaccination has never been shown to prevent cancer so why get it?

Truth: Despite the logical conclusion that decreasing HPV infection rates should decrease the rate of cervical cancer, some challenge the HPV vaccine by saying that it has never been shown to decrease the rate of cervical cancer. This study in Denmark showed a 40 percent decrease in atypical cells found on Pap smears (a precursor to cervical cancer). I believe that more studies like this will show even more proof that it is preventing cancer.

4. Myth: The HPV vaccine is not safe.

Truth: This is perhaps the most pervasive of all the different myths about HPV vaccine. News reports and anecdotal stories of teenagers who have received the vaccine and then experience weird, otherwise unexplainable symptoms can be quite compelling. The problem with relying on those stories is that, even before the HPV vaccine, teenagers had events or health outcomes that were unexplainable. Even those who choose not to be vaccinated today have some of the same symptoms. Wouldn’t it be nice if we had some way to determine if these events were caused by the vaccine or were merely coincidental?

Fortunately, we do. If we look at a large population of teenagers who received the vaccine and compare them to another population who did not, we can see if the vaccine increased the risk for bad outcomes or if there were events that would have occurred anyway.

Multiple studies have done this. One of my favorites is one that included almost 200,000 girls who received one or more doses of HPV vaccine. It showed a slight increase in passing out after the shot (we ask girls to sit for a while after receiving it) and skin infection, but no other increase health risks. Another included almost 1 million and showed no increase in autoimmune, neurologic or blood clotting disorders.

I am not concerned about the safety of these vaccines. I understand that, with anything new, parents are going to have concerns but as more and more data come in, the safety of HPV vaccine is confirmed. My kids will get it when they are the right age.

5. Myth: The HPV vaccine allows or causes teenagers to be promiscuous. (Related: We shouldn’t vaccinate because it protects promiscuous kids.)

Truth: This is the most infuriating myth for me regarding the HPV vaccination debate. It angers me because it preys upon the fear of some parents that their child might take sexual risk as a result of something the parents have done. If that is a concern, it might be justifiable if it were true ... BUT it’s not.

Studies have shown that girls who receive the vaccine are no more likely to engage in risky sexual behavior or to have more sexually transmitted diseases. Using that myth to scare other parents is inappropriate, just stop.

6. Myth: Because I’ve raised my child “right,” they won’t be at risk for HPV.

Truth: What? This line of thinking has so many holes.

First of all, you won’t always know about your child’s activities. Trust me, you won’t always know. You may think you know, but I’ve diagnosed a pregnancy in more than one girl who “never had sex.” Stuff happens.

Protect your child even if you’re sure they’d never have sex or won’t until they meet “the one.” Why? You can’t predict you child’s future partner’s sexual behavior. Maybe your children will grow up, meet the partner of their dreams and only have sex with that person for their whole life. But, maybe their partner’s history isn’t the same. Their partner could carry HPV, could give it to your child and leave them at risk for cervical or penile cancer. Why risk it? By withholding the shot, you are only putting your child at risk.

These are some of the common myths I’ve heard about HPV. I’m sure there are many more out there. But I urge you to go in with an open mind and talk with your doctor about your questions or concerns. We’d be happy to help!

The numerous health benefits of breastfeeding cannot be denied. Some of them might be overstated at times but, all in all, I believe that breastfeeding is best.

I know there are times when, for whatever reason, moms cannot or choose not to breastfeed. Fortunately, we have come a long way from the old days of evaporated milk formulas of the 1920s to where formula feeding is a very reasonable alternative for those moms. I believe that families should be properly educated and supported in their feeding decision no matter what it is.

If you chose to formula feed or plan to, you can stop reading now. This is not one of those articles meant to shame someone for their choice. This post is a message in support of moms and families who choose to breastfeed and need a little help to determine if everything is going OK.

“Seven percent is average, over 10 percent I start to get worried.”

Most moms know (or read or were taught) that babies lose weight in their first few days of life. If not, that one week checkup is pretty emotional when they place their babies on the scale and the number is lower than their birth weight. Think about it, a 10-pound baby can drop to as low as 9 pounds and still be considered normal weight loss, but you would certainly worry from the time the baby was weighed until I came in the room to tell you everything is OK.

I have been quoting this 7 percent/10 percent mantra since I started practice. It’s partially wrong, at least for breast fed babies. Why? They can actually lose more and still be normal.

A study released in Pediatrics in December showed that breastfed babies could lose more than 10 percent and still be normal, especially babies born via caesarean section. The graphs enable a pediatrician to look at a baby’s weight loss day-by-day and determine if the weight loss is excessive. The bottoms of the weight loss peak occur on day six for both vaginal and c-section but the peaks occur at 11 percent and 12 percent respectively.

Why does this matter?

Any mom who has had trouble getting their baby to grow on breastmilk knows the pressure to start formula that can be applied by doctor, nurses or family members. While, I don’t believe that having mom give formula when appropriate ruins her chances of breastfeeding, I certainly don’t want to be pushing families to supplement when it isn’t necessary. Therefore, I plan to start implementing these guidelines into my practice so that I can best support breastfeeding moms in their effort to breastfeed.

If you are having a baby and are planning to breastfeed, it might be helpful for you to be aware of them as well.

They are not caused by holding (or kissing) frogs but, instead, are caused by viruses.

The virus that causes warts is contagious, but that does not necessarily mean that if your child touches a wart they will get one.

Warts will go away on their own without treatment (Say it with me now.). It never feels like that when it’s your own child, but I promise they will. It may take 6 months to 2 years but they will go away.

There are many strategies for taking care of warts at home. 

Over-the-counter (OTC) Meds

1. Bath or shower
2. Use an emery board to file the dead skin on the surface
3. Apply the topical wart remover
4. Cover the wart with a band-aid

Duct Tape

Place a strip (or ring if on the finger/toe) over the wart. This strategy may take weeks or months of coverage to work, but it does work (studies even show it)

Wart removal can be done, but I only recommend it for warts that are painful or in a location that makes activities (writing, etc) difficult. 

The most common types of removal are freezing and laser therapy.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Listening to this conversation got me thinking about some of the other parenting research I have done as a pediatrician and to help with our kids as they have been growing up. We all want what is best for our children, but sometimes figuring that out is difficult. But, as a pediatrician who is interested in learning and development, that’s what I’m here for. 

I decided to share some things with you that you might not have thought about before. Some of the studies are common sense and others have some pretty surprising results. Either way, I plan to offer lots of practical advice about how you can use the study to help your child learn and develop well.

Here are some of the questions I will answer over the next few weeks:

Is calling your child smart really a bright idea?

Why should everyone homeschool (don’t jump to conclusions here…wait for the post)?

Why do you want your kid to point (even if it’s not “polite”)?

And many more!

What questions do you have about how you can help your child learn and develop? Leave a comment below. If I don’t have a post that answers it, I’ll write it.

It's no question that social media has changed the way that we interact with the world. We went to a museum exhibit recently and I kept getting dirty looks, chasing after my boys because I kept walking in front of people trying get the perfect picture on their phone ... there's no doubt that I "photo-bombed" lots of Facebook posts, tweets and Instagram accounts that day.

We are more connected now with more people than ever before. The problem is the types of connections that these mediums tend to foster. Adults have a difficult time with many aspects of social media: deciphering true friendship, using caution when posting personal information and being careful not to say and do things because of the security and anonymity of being behind the computer. These three issues are even more difficult for teenagers to wrap their heads around.

So, when is the right age to let your child use social media? It depends.

It depends on so many things and there's not a simple answer but here are some questions you need to ask yourself.

1) What does your tween/teenager want to use it for?

I'm not sure what the answer you're looking for here is. My guess is that the most honest answer you would get from your child is," Everyone else has one." There are really different uses for some of the different platforms so you should probably weight each answer in the context of your child and the platform.

Facebook - You may not get many requests for using Facebook ... believe it or not, some reports say it is declining in use by our teenagers. Yogi Berra once said, "Nobody goes there anymore. It's too crowded." Facebook may be too crowded with adults to attract teenagers anymore. Nobody wants their parents to be able to see the pictures of them at a party. Many teenagers even say they have grown tired of Facebook because they are tired of the unneccessary drama that users are trying to stir. 

Twitter - Many tweens migrated to Twitter in 2012 and 2013. One of the most common reasons is that parents aren't there yet so it keeps them ahead of their parents' online presence. I think it also provides them a level of connection to celebrities that some of the other platforms don't provide. I got a picture of my boys retweeted by Vince Carter (@mrvincecarter15) last year and I have to admit I got a little bit of a rush from it. You can imagine what any amount of social recognition by one of your teen's heroes would provide. 

Instagram - Instagram seems to be a pretty quickly expanding social network. Teens seem to like the visual components to it and the rapidity with which they can post. It used to be popular because parents and adults weren't on the site, but we can get involved and ruin that pretty quickly (and it's started to happen already).

Snapchat - Snapchat is a way to share photos and share them with friends in a way that (in theory) cannot be stored on the phone. However, as with anything digital, there is always a loophoole and recipients can take a screen shot of the Snap and save it to their phone. When I ask my patients who have Snapchat about this, they say they only use it to take crazy or silly pictures of themselves and share them. Of course, no one I know is using them for sexting or anything less honorable (sarcasm intended).

2) Will you have access to the accounts any time you want?

Just like snooping on a cell phone, snooping around on your children's accounts without their knowledge doesn't work. What happens if you find something that concerns you? Do you address them directly, indirectly or just fret and worry about what you've found but not bring it up? You have to set a ground rule up front about what your level of supervision will be so that there are no surprises down the road.

3) How will you protect them from inappropriae content/behavior?

Social media has dangers and if we allow our children to be on them, we have to protect them from harm.

1) Predators - Unfortunately, this happens more commonly than it should. Your teenagers should not accept friend requests from people they don't know and should use caution about posting personal information.

2) Bullying - Your teeangers could be bullied online, but they could also be bullying others online. Teenagers often lose their inhibition when they are sitting at a keyboard and don't stop because they don't receive the feedback of a person getting upset like they would be if they were bullying in person.

3) Social acceptance - Teenagers commonly post things online in order to get acceptance from others. There is a growing trend of teenagers (especially girls) posting videos of themselves asking, "Am I Pretty or Ugly?" Of course, they get a mix of responses but many are aggressively negative and teenagers have a hard time moving past the negative responses or realizing that someone is simply responding to hurt them.

4) Social pressure - Teenagers have always had an intense anxiety to be cool. They have a desire to be wearing the "right" clothes, have the "right" friends and find themselves at the "right" parties. So, what has changed because of social media? All the same pressures are there but they are present in front of your teenagers 24 hours a day. They not only have to sort through all these issues, they have to post about them and read their friends posts about them, all the while struggling to keep up. It's exhausting just to think about it.

In summary, every teenager will eventually ask you for some form of social network access. Even if you don't have teenagers, it's important to start to think through some of these issues early so that you're prepared when the time comes. Discussing these issues with your teenagers before you give them access can prepare them to use social media in a healthy way.

Just in time, a new study released online in Pediatrics (the journal of the AAP) describes the risk of depression in fathers of young children (0-5). They started following males in adolescence and followed them for 23 years using a depression scale to document their level of depression.

The scales asked some fairly pointed questions regarding depression. Here are some examples:

• Were you were bothered by things that do not usually bother you?
• Did you feel depressed?
• Did you feel you were too tired to do things?
• Did you not enjoy life?
• Did you feel that people disliked you?

I found the results very interesting:

During the first 5 years of their child’s lives, fathers showed a 68 percent increase in depressive symptoms.

Does this surprise you or not?

While the study did not specifically describe the rate of depression in the immediate period after the baby was born, I would suspect that many of these depressive symptoms began to emerge during that time.  I have done this new parenting thing a few times (3 times in 5 years).  Having a new baby in the house is incredibly exciting and brings so much unspeakable joy. However, that joy comes with many changes.

I never felt that my symptoms rose to the level of depression but there were, at times, feelings of sadness and loss. Let’s walk through some of the reasons and some potential solutions.
 

Loss of routine
I am a man of routine and consistency.I like waking up, having a cup of coffee, reading and getting ready to go to work. Staying home with my wife for a week after our babies were born was very important to me but I did start to miss my routine.

Try to keep some semblance of your normal routine if possible. Remember that your sleep at night will likely be broken up (I was always the water boy for my breastfeeding wife and the post-feed burper and rocker) so you might want to get to bed earlier than normal so you can keep your morning routine in some form or fashion.

Loss of autonomy
When you got married you might have realized that your decisions were no longer just about yourself anymore. For me, having a baby is that feeling, on steroids. You suddenly feel guilty for wanting to do anything for yourself anymore as if in some way you will miss something or will be needed and not be there.

It sounds like a line from a self-help book, but remember that in order to be a good provider, you have to take care of yourself to some degree first. Find some time to do something by and for yourself at least every few days. For you, that might look like going for a run or going to read a book at Starbucks. But, whatever it is, take a little time for yourself.

Loss of intimacy
Yes, I do mean in the physical way (those OBs and their rules - seriously follow those rules). But, it’s much more than that. All of the sudden, you realize that those deep conversations you had with your wife (that you might not have thought were important) are less frequent. You are both tired and have a singular focus that tends to dominate your conversations (When was the last feed? Did I start on the left or right side last time? Is this yellow, runny stool normal?)

Try to find the time and energy to start one deep conversation per day. One great conversation starter in this time period can be: “How are you doing with all of this?” Don’t settle for, “Fine.” Ask deeper questions. Then, after you’ve taken the time to hear mom out, you’ll probably get a chance to share some things yourself. You’ll be glad you did.

The overlying concern for these feelings is that you might begin to feel guilty about having them. You know in your brain that this time is supposed to be one of the happiest times of your life. This tension is common and normal. It might be helpful to seek out other fathers whose advice you feel you can trust to talk through it. They may have more specific advice that will work better for you. The important thing is to resist the urge to tough it out and do it on your own.

Ultimately, you may feel that you are passing over from feeling a little down to actually feeling depressed.  If you have concerns about this, it’s best to seek out professional help from your doctor or a counselor.

It’s that inevitable time of year where I see news story after news story where children are rewarded Oprah-style for their awesome record of perfect attendance:

“You get a bike and you get a bike and you get a bike.”

Yeah!!  It’s pretty heart-warming and exciting, right?

There are kids (and families) that blew their perfect attendance the first week of school and didn’t think twice about it, but there are some that are holding out hope that maybe this year will be their year to win the drawing for $100 or an iPad or a trip to Hawaii (I haven’t actually seen this one, but I want my kids to go to that school) or whatever their school dreams up.

I do have a question though. Is perfect attendance really the point?

You need to be at school to learn. I get that. Missing school for frivolous reasons is harmful to the student and the school. So incentives to get kids to school make sense from that standpoint. But, at what cost?

There is a tension going on right now in the minds of parents throughout our community. It might go something like this:

“He’s only coughing a little bit.  He did get a few hours sleep last night. His fever is only 101 and if I give him Tylenol® maybe he won’t have fever at school.”

Does this sound right?

Has this line of thought ever happened in your house?

Do you think it really happens at other houses?

I can assure you it does. Parents say something like this all the time, “Well, he was having fever last night, but I gave him some Motrin® this morning so he hopefully wouldn’t have one at school. But sure enough, he did and the nurse called me to pick him up.”

This clearly misunderstands the whole point of not wanting your child at school if he has fever. Not having fever is not the goal. Keeping your child away from others when they are sick is the goal. Whether your child’s fever is masked by medicine or not doesn’t make them less contagious.

What can we do about it?

What if we changed the goal from perfect attendance to responsible attendance?

Perfect attendance implies that you go to school no matter what.

Responsible attendance implies that you go to school when it is appropriate and don’t when it isn’t.

Perfect attendance puts your child’s classmates health at risk.

Responsible attendance puts your child’s and their classmate’s health above another goal.

I am an optimist, but not unrealistic. I’m pretty sure that we can’t change the school’s policies regarding perfect attendance awards.  Besides, how would you reward responsible attendance anyway?  But, we can make a decision to practice responsible attendance with our kids and teach them to do the same.