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Parents often wonder: What can we do to keep our children healthy? Are there ways to boost the immune system and ward off illnesses?

The answer is yes — but there are no magic wands or magic supplements. The best way to keep the immune system healthy is, basically, to take necessary steps to keep healthy. As boring as that sounds, it’s tried and true.

Here’s what you can do to help keep your children healthy this school year.

Give them a healthy diet

By healthy I mean a diet with lots of fruits and vegetables (five servings a day are recommended, and they should take up half of every meal plate), whole grains, and lean protein. A healthy diet also has dairy or another source of calcium, and healthy fats like vegetable oils.

The foods to avoid are processed foods, foods with added sugar, and foods with unhealthy fats, like the saturated fats found in animal products. That doesn’t mean your child can’t ever eat cookies or ice cream. But if you want to your child to be healthy, they shouldn’t eat those foods every day. (The Academy of Nutrition and Dietetics has suggestions for healthier baked goods and other ways to make your family’s diet healthier).

There are many supplements that claim to boost your immune system. While the jury is still out as to whether most of them make a real difference, none of them take the place of a healthy diet. If you have a child who refuses vegetables or otherwise has a limited diet, a multivitamin with iron may make sense; talk to your doctor about whether vitamins or supplements are a good idea for your child.

Make sure they get enough sleep

We all need sleep to refresh and recharge our bodies, and that includes children. The amount of sleep a child needs varies by age (from 12 to 16 hours a day for infants to eight to 10 hours for teens), and also from child to child (some just need more than others). You can encourage healthy sleep by limiting screens — for teens, devices really should be shut off an hour or two before bedtime, and preferably not be in the bedroom at night — and keeping to a regular schedule.

Get them active

Exercise keeps us healthy and less likely to get sick. Children should really be active for an hour a day. “Active” doesn’t have to mean playing a sport or going to the gym; it could be playing at the playground or going for a walk. More is not necessarily better; if you have a child who is a serious athlete, exercising several hours a day, make sure that the exercise isn’t eating into sleep or causing burnout, both of which could cause problems with the immune system.

Manage stress

Stress makes us less healthy and more prone to infection. Make sure that kids have downtime to play, and access to activities and people that make them happy. Spend time together as a family, and create opportunities for your children to talk about anything that might be worrying them. If you have concerns about your child’s moods or emotional health, talk to your doctor.

Make sure they are up to date on important vaccines

Immunizations protect us from all sorts of illnesses. Check with your doctor to see if your child is up to date on immunizations. The flu shot is recommended yearly for all people 6 months of age or older.

Don’t forget the simple precautions

Everyone in the family can take simple precautions to help stay healthy. Wash your hands. Cover your coughs and sneezes with your elbow. Stay away from sick people to the extent that you can. Masks can help, too, especially in crowded indoor spaces.

If your child has a health problem that could make it harder to fight off an infection, talk to your doctor about any extra or different precautions you should take.

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

Heavy rains and sea level rise contribute to major flooding events that are one effect of climate change. Surging water rushing into buildings often causes immediate harms, such as drowning deaths, injuries sustained while seeking shelter or fleeing, and hypothermia after exposure to cold waters with no shelter or heat.

But long after news trucks leave and public attention moves on, flooding continues to affect communities in visible and less visible ways. Among the less visible threats is a higher risk of respiratory health problems like asthma and allergic reactions. Fortunately, you can take steps to minimize or avoid flooding, or to reduce respiratory health risks after flooding occurs.

How does flooding trigger respiratory health issues?

Flooding may bring water contaminated with toxic chemicals, heavy metals, pesticides, biotoxins, sewage, and water-borne pathogens into buildings. Afterward, some toxic contaminants remain in dried sediments left behind. When disturbed through everyday actions like walking and cleaning, this turns into microscopic airborne dust. Anything in that dried flood sediment — the toxic chemicals, the metals, the biotoxins — is now in the air you breathe into your lungs, potentially affecting your respiratory health.

Buildings needn’t be submerged during flooding to spur respiratory problems. Many homes we studied after Hurricane Ida suffered water intrusion through roofs, windows, and ventilation ducts — and some were more than 100 miles away from coastal regions that bore the brunt of the storm.

The growth of mold can also affect health

Another common hazard is mold, a fungal growth that forms and spreads on damp or decaying organic matter. Indoor mold generally grows due to extensive dampness, and signals a problem with water or moisture. Damp materials inside buildings following a flood create perfect conditions for rapid mold growth.

Mold can be found indoors and outdoors in all climates. It spreads by making tiny spores that float through the air to land in other locations. No indoor space is entirely free from mold spores, but exposure to high concentrations is linked with respiratory complications such as asthma, allergic rhinitis, and sinusitis. Thus, flooding affects respiratory health by increasing the risk of exposure to higher concentrations of mold spores outdoors and indoors.

For example, after Hurricane Katrina in New Orleans in 2005, the average outdoor concentration of mold spores in flooded areas was roughly double that of non-flooded areas, and the highest concentrations of mold spores were measured indoors. A study on the aftermath of Hurricane Katrina and the flooding in the UK in 2007 showed that water damage accelerated mold growth and respiratory allergies.

Children are especially vulnerable to health problems triggered by mold. All respiratory symptoms — including asthma, bronchitis, eye irritation, and cough — occurred more often in homes reporting mold or dampness, according to a study on the respiratory health of young children in 30 Canadian communities. Other research demonstrates that mold contributes to development of asthma in children.

What can you do to protect against the health harms of flooding?

Our research in New Orleans, LA after Hurricane Ida in 2021 identified common factors — both in housing and flooding events — with great impact on respiratory health. Preliminary results suggest two deciding factors in whether substantial indoor mold appeared were the age of a building’s roof and how many precautionary measures people took after flooding from the hurricane. The impact on respiratory health also varied with flood water height, days per week spent at home, and how many precautionary measures were taken after Ida swept through.

Informed by this and other research, we offer the following tips — some to tackle before flooding or heavy rains, and some to take afterward. While you may not be able to entirely prevent flooding from hurricanes or major storms, taking these and other steps can help.

Before seasonal storms, flooding, or heavy rains start: Protect against water intrusion

• Repair the roof, clean gutters, and seal around skylights, vent pipes, and chimneys to prevent leaks. These are some of the most vulnerable components of a building during storms and hurricanes.
• Declutter drains and empty septic tanks.
• Construct barriers and seal cracks in outer walls and around windows, to prevent heavy rain and floodwater from entering.
• Install a sump pump to drain water from the basement, and backflow valves on sewer lines to prevent water from backing up into the home.

After flooding or major rainstorms: Move quickly to reduce dampness and mold growth

The Environmental Protection Agency recommends limiting contact with flood water, which may have electrical hazards and hazardous substances, including raw sewage. Additionally:

• Minimize your stay in flooded regions (particularly after hurricanes) or buildings until they are dry and safe.
• Check building for traces of water intrusion, dampness, and mold growth immediately after flooding.
• Drain floodwater and dispose of remaining sediment.
• Remove affected porous materials. If possible, dry them outdoors under sunlight.
• Increase the ventilation rate by leaving all windows and doors open, or use a large exhaust fan to dry out the building as fast as possible.
• Use dehumidifiers in damp spaces such as basements.
• Upgrade the air filters in your HVAC system to at least MERV 13, or use portable air cleaners with HEPA filters to reduce your exposure to airborne mold spores.

What to do if you spot mold growth

• Wear a well-fitted N95 face mask, gloves, and rubber boots to clean.
• Clean and disinfect anything that has been in contact with water using soap, detergents, and/or antibacterial cleaning products.
• Dispose of moldy materials in sealed heavy-duty plastic bags.

Taking steps like these — before and after a major storm — goes a long way toward protecting your respiratory health.

Read Flooding Brings Deep Trouble in Harvard Medicine magazine to learn more about the health hazards related to floods.

About the Authors

Parham Azimi, PhD, Contributor

Dr. Parham Azimi is a research associate in the department of environmental health at the Harvard T.H. Chan School of Public Health, investigating the indoor environment’s impact on occupant health and wellness and strategies to improve … See Full Bio View all posts by Parham Azimi, PhD

Joseph Allen, DSc, MPH, CIH, Contributor

Dr. Joseph Allen is an associate professor in the department of environmental health at the Harvard T.H. Chan School of Public Health, and the director of Harvard’s Healthy Buildings Program. He is the coauthor of Healthy … See Full Bio View all posts by Joseph Allen, DSc, MPH, CIH

Ready to address excessive drinking in your life? Many people find peer support helps them take steps toward recovery. Two well-known self-help organizations built around peer support are Alcoholics Anonymous (AA) and Self-Management and Recovery Training (SMART Recovery). While some people seeking recovery even attend both programs, others forego both options.

Why do people choose those different paths — and what do they like, dislike, and find helpful about their chosen option? To find out, researchers questioned 80 participants enrolled in a two-year study about recovery from alcohol use disorder (20 each in AA, SMART Recovery, both, or neither).

Dr. John F. Kelly, professor of psychiatry in addiction medicine at Harvard Medical School, led the study, which was published in the Journal of Substance Use and Addiction Treatment. Here he explains key findings and shares his perspective and advice for people seeking peer support to stop problematic drinking.

Camaraderie: A common theme for both groups

The most striking finding was that for people attending either group, camaraderie was by far the most important aspect.

“There’s something about the connection with other people with similar experiences that helps decrease the self-stigma and shame that people have around this issue,” says Dr. Kelly, who founded the Recovery Research Institute at Massachusetts General Hospital. “Seeing role models of people who found solutions and a way out, and championing these examples of successful recovery, is very powerful,” he adds.

What else do people appreciate about AA?

Founded in 1935, AA has been around far longer than SMART Recovery, which began in 1990. AA’s popularity makes it easy to find meetings, which was one benefit cited in the study. “Within a 45-minute drive of downtown Boston, there are 1,800 AA meetings a week, compared with just 30 SMART meetings,” says Dr. Kelly.

You can also find a wider variety of specialized AA meetings, including those catering to different age groups, women, or LGBTQ+ people, for example. Larger metropolitan areas may have meetings conducted in different languages, as well.

AA follows a 12-step program, defined as a set of spiritual principles that help people achieve sobriety. Yet hardly anyone in the study mentioned spirituality in their responses, says Dr. Kelly. In fact, other research suggests that about half the people attending AA don’t seem to have a strong sense of needing to believe in a formal deity or higher power. “Some people say that connection with other people is what makes it a spiritual experience,” he says.

What else draws people to SMART Recovery?

The study results confirm years of anecdotal reports about why people choose SMART Recovery over AA, says Dr. Kelly. “What attracts people to SMART Recovery is the organization’s focus on science and clinical evidence,” he says.

Their approach incorporates cognitive behavioral therapy (CBT) and motivational psychology into their support groups. The goal is to help participants to recognize and cope with the emotional and environmental triggers for their drinking. Still, in this study, people who chose SMART Recovery stayed with it for the social aspects, according to responses about what they like best about the program, says Dr. Kelly.

Compared to people who attended AA, study participants who chose SMART tended to have less severe problems with alcohol use. They had more education, higher rates of employment, and greater economic resources. They were also less likely to have had prior treatment or involvement with the criminal justice system. SMART may be a particularly good fit for people with that kind of profile.

People who attended both AA and SMART Recovery groups tended to be the most severely affected by their problems with alcohol, and were seeking anything and everything to get help. Those who attended neither program were less seriously affected.

What are other differences between AA and SMART Recovery?

While AA groups are led by members in recovery, SMART groups are led by trained facilitators who are not required to be in recovery themselves.

In the study, that lack of “lived experience” wasn’t perceived as a negative, although some people mentioned that they didn’t like some of the facilitators, Dr. Kelly says. However, a trained facilitator can gently stop and redirect members who engage in meandering, lengthy, and potentially irritating monologues (known as a “drunkalogue”) that may dominate group discussions. AA group leaders don’t intervene in that way and have no formal group facilitation training.

However, AA strongly encourages people who join the fellowship, as it is called, to have a sponsor. Sponsors are experienced members with at least one year of recovery who serve as mentors for new members and are available between meetings. SMART Recovery doesn’t have formal sponsors, but facilitators encourage people to swap phone numbers and reach out to each other between meetings.

Should you participate in a support group to stop drinking?

“When I’m counseling patients, I lay out the different options and let people decide which program seems like the best personal fit for them,” says Dr. Kelly.

Because AA has been around for much longer, he notes that there’s more evidence about what contributes most to success with this approach. Research shows the three factors that have the biggest positive effect on remission for alcohol misuse are:

• Having a sponsor. This is the single most important factor influencing recovery.
• Attending at least three meetings per week. Consistently showing up, especially during the first year, also appears to boost the odds of recovery.
• Speaking at meetings. Saying something aloud in the group meetings — even if it’s just a sentence or two — reinforces the likelihood of ongoing recovery. It also makes it easier to connect with other members in the “meeting after the meeting.”

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

Cancer treatment can involve difficult tradeoffs, and that's also true of the testosterone-blocking drugs used in treating prostate cancer. These drugs work in two different ways. Androgen deprivation therapies (ADT) shut down the body's production of testosterone, a hormone that fuels prostate cancer growth. A newer class of drugs called androgen-receptor signaling inhibitors (ARSIs) block testosterone by deflecting the hormone from its cell receptor.

ADT can slow or control prostate cancer, and mounting evidence shows that adding ARSIs also improves survival when the disease is in advanced stages. This treatment combination is called intensified ADT. Researchers are now testing intensified ADT for some men with early-stage prostate cancer as well.

However, all drugs that block testosterone have challenging side effects, including metabolic changes that can compromise cardiovascular health. In June, British researchers reported that cardiovascular risks worsen when ADT and ARSIs are given together. The authors concluded that men who get intensified ADT should be counseled about the risks, and monitored for signs of heart disease before and after the treatment begins.

Study goals and results

The findings were derived from a systematic review of 24 clinical trials that assessed ADT and ARSI treatment for prostate cancer. Published between 2012 and 2024, the trials enrolled a combined total of 22,166 men ages 63 to 77. Their diagnoses ranged across the prostate cancer spectrum, from nonmetastatic cancer with aggressive features to metastatic prostate cancer that no longer responded to ADT by itself.

The goal of the systematic review was to compare ADT and intensified ADT with respect to cardiac events, including hypertension, cardiac arrhythmias (abnormal heartbeats), blood clots, or — in the worst case — heart attack or stroke.

Results showed that adding an ARSI to ADT approximately doubles the risk of a cardiac event across all prostate cancer states. Risks for severe "grade 3" events that can require hospitalization ranged between 7.8% and 15.6%. Notably, giving two ARSIs — abiraterone acetate and enzalutamide — led to a roughly fourfold increase in cardiac risk. Mounting evidence shows that combining abiraterone acetate and enzalutamide worsens side effects without improving prostate cancer survival. The use of that combination is now broadly discouraged by expert groups around the world.

The authors emphasize that intensified therapy is riskier for men with pre-existing cardiac conditions than it is for healthier men. In an accompanying editorial, Dr. Katelyn Atkins, a radiation oncologist at Cedars-Sinai Medical Center in Los Angeles, noted that cardiovascular disease is the second leading cause of death among men with prostate cancer.

Candidates for traditional or intensified ADT, Dr. Atkins wrote, should be assessed for atherosclerosis, fatty plaques in coronary arteries that can accumulate asymptomatically. Fortunately, cardiac risk factors are treatable by lowering blood pressure, eating a heart-healthy diet, exercising, and in some cases using a cholesterol-lowering drug called a statin.

Experts comment

"More and more research shows that intensive therapy prolongs survival, and may in some men even evoke a cure," said Dr. David Crawford, head of urologic oncology at the University of Colorado Anschutz Medical Campus who was not involved in the study. "We have learned time and again from the treatment of many cancers that it is not one drug followed by another and another that results in the best outcomes. Rather, it is combining drugs more effectively to treat the cancer.

"Still, we need to tackle the challenges of prostate cancer treatment and focus on preventing cardiovascular events and other side effects of ADT. As clinicians and in clinical studies, we have seen that men who maintain their weight, exercise, expand muscle mass, and maintain normal lipids and blood pressure do much better than men who gain weight and have a lot of cardiovascular risk factors."

"This important study re-emphasizes the necessity to keep a patient’s cardiovascular history front and center when treatment choices are made, " said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor-in-chief of the Harvard Medical School Guide to Prostate Diseases.

"Intensification of treatment — that is, adding several drugs earlier and earlier in prostate cancer management — is to be both encouraged and cautioned. The caution is for physicians to consider and discuss pre-existing risk factors and how to modify them when deciding upon treatment programs. The ARSI class of drugs have greatly improved outcomes. The goal is to maximize the best outcomes while minimizing the side effects."

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

Dementia usually develops in people ages 65 years and older. So-called young-onset dementia, occurring in those younger than age 65, is uncommon. Now, a new study published in December 2023 in JAMA Neurology has identified 15 factors linked to a higher risk of young-onset dementia.

Let’s see what they found, and — most importantly — what you can do to reduce your own risks.

Are early dementia and young-onset dementia the same?

No. Experts think of early dementia as the first stage in dementia. Mild cognitive impairment and mild dementia are forms of early dementia. So, someone age 50, 65, or 88 could have early dementia.

Young-onset dementia refers to the age at which dementia is diagnosed. A person has young-onset dementia if symptoms and diagnosis occur before age 65.

What has previous research shown?

A previous study of men in Sweden identified some risk factors for young-onset dementia, including high blood pressure, stroke, depression, alcohol use disorder, vitamin D deficiency, drug use disorder, and overall cognitive function.

What to know about the new study

In the new study, a research team in the Netherlands and the United Kingdom looked at data from the UK Biobank. The biobank follows about half a million individuals in the United Kingdom who were 37 to 73 years old when they first joined the project between 2006 and 2010. Most participants identified as white (89%), and the remaining 11% were described only as “other.” Slightly more than half of the participants (54%) were women.

The researchers excluded anyone age 65 or older and people who already had dementia at the start of the study, leaving 356,052 participants for the analyses. Over roughly a decade, 485 participants developed young-onset dementia. The researchers compared participants who did and did not develop young-onset dementia to identify possible risk factors.

What did the researchers learn about risks for young-onset dementia?

In reviewing the results, I think it is helpful to group the risk factors into several categories, and then to examine each of them. These risks may act on the brain directly or indirectly.

Eight factors that we know or strongly suspect cause dementia:

• Genes: Carrying two apolipoprotein E (APOE) ε4 alleles is a major genetic risk factor for Alzheimer’s disease. The risk is thought to be caused by the APOE ε4 protein not clearing amyloid efficiently from the brain. This allows amyloid to accumulate and cause plaques, which starts the cascade to cell death and Alzheimer’s disease.
• Being diagnosed with alcohol use disorder (AUD) has been associated with damage to several parts of the brain, including the frontal lobes, which leads to trouble with executive function and working memory. When combined with poor nutrition, AUD also harms small regions connected to the hippocampus that are critical for forming new memories.
• Being socially isolated is a major risk factor for dementia. Although the exact mechanism is unknown, it may be because our brains evolved, in large part, for social interactions. Individuals with fewer social contacts have fewer social interactions, and simply don’t use their brains enough to keep them healthy.
• Not getting enough vitamin D can lead to more viral infections. A number of studies suggest that certain viral infections increase your risk of dementia.
• Not hearing well increases your risk for dementia, as I discussed in a prior post. This is likely because of reduced brain stimulation and reduced social interactions. Using hearing aids lessens that risk.
• Previously having had a stroke is a risk factor because strokes damage the brain directly, which can lead to vascular dementia.
• Having heart disease is a major risk factor for strokes, which can then lead to vascular dementia.
• Having diabetes if you’re a man can lead to dementia in many different ways. Why only if you’re a man? The researchers suggest that it is because middle-aged men are more likely to have a diabetes-related ministrokes than middle-aged women, which can, again, lead to vascular dementia.

Two factors that reduce cognitive reserve

Cognitive reserve can be described as our capacity to think, improvise, and problem-solve even as our brains change with age. These two risk factors make it more likely that dementia symptoms will show up at a younger age.

• Having less formal education may affect your familiarity with the items on the pencil-and-paper cognitive tests that are used to diagnose dementia.
• Having lower socioeconomic status may be related to lower-quality education.

Is every factor identified in the study a clear risk?

No, and here’s why not: Sometimes research turns up apparent risk factors that might be due to reverse causation. It’s possible, for example, that symptoms of impending dementia appear to be risk factors because they become noticeable before obvious dementia is diagnosed.

• Lower handgrip strength is a sign of frailty, which is often associated with dementia.
• No alcohol use is a risk factor because people may stop drinking when they develop memory loss (also known as the “healthy drinker effect” in dementia).
• Depression is a risk factor because many people get sad when they have trouble remembering or when they are worried about having dementia.

Lastly, there are risk factors that could be either a contributing cause or a result of the impending dementia.

• High C-reactive protein is a sign of inflammation.
• Orthostatic hypotension is an abnormal drop in blood pressure when a person stands up after lying down or sitting. While this condition can lead to brain damage and dementia, it can also be a result of some types of dementia, such as Parkinson’s disease dementia and dementia with Lewy bodies.

What can you do to prevent young-onset dementia?

Taking these five steps can reduce your risk for developing dementia before age 65:

• Don’t drink alcohol in excess.
• Seek opportunities to socialize with others regularly.
• Make sure that you’re getting enough vitamin D. You can make your own vitamin D if your skin (without sunblock) is exposed to sunlight. But in northern climates you might need to take a supplement, especially in the winter. Because vitamin D can interact with other medications, ask your doctor about this option.
• Make sure you are hearing well and use hearing aids if you are not.
• Exercise regularly, eat a healthy diet, maintain a healthy body weight, and work with your doctor to reduce your risk of strokes, heart disease, and diabetes.

About the Author

Andrew E. Budson, MD, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Andrew E. Budson is chief of cognitive & behavioral neurology at the Veterans Affairs Boston Healthcare System, lecturer in neurology at Harvard Medical School, and chair of the Science of Learning Innovation Group at the … See Full Bio View all posts by Andrew E. Budson, 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

Ever heard of mpox? Wondering why it’s back in the news?

Many of us first learned about mpox (formerly called monkeypox) in 2022, when the largest known outbreak spread to nearly 100,000 people in more than 100 countries. While mpox often circulates in central and western Africa, the 2022 outbreak quickly spread from the Democratic Republic of the Congo (DRC) to places it had never been detected before. In the US alone, it caused more than 32,000 infections and 58 deaths.

Now, a new outbreak of mpox has put it back in the news. What should you know — and do — about this latest international health emergency? What are your risks? Are vaccines available? If you get mpox, how can you avoid spreading it?

What’s different about the 2024 mpox outbreak?

This time, a new strain of the virus (called Clade 1b) is spreading quickly. That’s why the World Health Organization (WHO) declared a second mpox global health emergency in August 2024.

Already, more than 15,600 cases and 500 deaths have been reported, mostly in the DRC. And mpox has been found in countries that previously hadn’t identified any cases, including Burundi, Kenya, Rwanda, and Uganda. Recent cases diagnosed in Sweden and Thailand have public health officials bracing for additional international spread, including to Asia, Europe, and the US.

6 things to know about mpox

What is mpox and how does it spread?

Mpox is a viral infection caused by the same family of viruses as smallpox. In central and western Africa it’s common in certain animals, including squirrels and rats. People can become infected after contact with infected animals. Mpox can spread from person to person through close physical contact, including sex.

What are the symptoms of mpox?

Mpox causes flulike symptoms, fever, headache, enlarged lymph nodes, and a unique rash. The rash usually begins a few days into the illness as small flat spots. The spots evolve over a week or two to become small fluid-filled bumps (vesicles) similar to chickenpox, and then larger pus-filled blisters. Over another week or two, the blisters scab over and heal. Once that happens, a person is no longer contagious.

Although the disease is usually mild, some people develop complications. Serious complications include pneumonia, vision loss due to eye infection, and sepsis, a life-threatening infection.

What is your risk of getting mpox?

Location and activities factor into your risk for developing mpox.

Risk increases if you

• have close physical contact with an infected animal or person
• have contact with bedding, clothes, or other objects or surfaces touched by an infected person
• live in or visit a place where the mpox virus is endemic — that means present in the environment, such as in the soil or infected animals or people
• are a man who has sex with men
• have many sexual partners.

When people get mpox, risk factors for experiencing more severe disease or complications like pneumonia include:

• pregnancy
• young age (especially children younger than age 1)
• having a weakened immune system
• having eczema (because this weakens the protective skin barrier).

Why is the new mpox outbreak so worrisome?

The new outbreak of mpox is especially worrisome because the strain of the virus is deadlier than in 2022. The virus is spreading more quickly and reaching places where mpox had not previously been found.

In addition, the new outbreak has disproportionately affected kids and teens in resource-poor countries. Many are already suffering with malnutrition, or other infections such as cholera.

It’s worth noting that the strain of mpox from the 2022 outbreak (Clade 1) is still circulating at a low level in the US. Right now, fewer than 15 people a week are diagnosed with it and treatment is available.

Are there mpox vaccines and treatments?

There are two vaccines available to prevent mpox in the US:

• Jynneos is approved to prevent mpox and smallpox. It requires two doses four weeks apart.
• A vaccine called ACAM2000 is approved for preventing smallpox and is considered effective for mpox. It could be made available if needed, but its potential side effects make it a second choice.

Resource-poor countries in Africa, Asia, and elsewhere have had limited access to vaccines. Even in resource-rich countries like Europe and the US, vaccine hesitancy has been an obstacle to containing the outbreak. In one study, only half of a vulnerable population in Illinois received the initial dose of the mpox vaccine, and only a quarter received both recommended doses.

An antiviral drug called tecovirimat is approved to treat smallpox. Animal studies suggest it may be effective in treating mpox as well. Now being investigated as an mpox treatment, the drug may be available by enrolling in a study. A 2024 study found tecovirimat did not reduce the length of time adults and children with Clade 1 mpox had symptoms. However, the death rate (1.7%) was half of what was expected. But it’s unclear whether the low death rate was actually due to drug treatment.

How can someone with mpox avoid spreading it?

If you are diagnosed with mpox, it’s important to take these measures to avoid infecting others:

• Avoid close contact with others until your skin lesions have healed.
• Wear a well-fitting medical mask while near others; those visiting you should wear a mask as well.
• Stay several feet or more away from others.
• Use a separate bedroom and bathroom.
• Clean all surfaces you’ve touched.
• Don’t share eating utensils, towels, or bedding with others.
• Increase room ventilation by opening windows or using a high-efficiency particulate air (HEPA) purifier.

Some experts recommend avoiding contact with pets or other animals because they could become infected and spread the disease to new animal species in new places.

The bottom line

Will mpox be the next pandemic? That’s unlikely. The virus that causes mpox spreads mainly by direct contact — unlike the virus that causes COVID-19, which spreads through small respiratory droplets that are easily breathed in. Also, people with mpox who are contagious typically have obvious symptoms, so they can take steps to avoid spread.

Currently, the risk mpox poses to most people in the US appears to be quite low. To help make sure it stays that way and to help countries where mpox is common, US public health officials are working with their counterparts in other countries to contain the outbreak. To be successful, we’ll need a robust. well-coordinated international effort, including financial support to resource-poor countries to fund educational programs, vaccination, testing, and treatment.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Global average temperatures have soared in 2024, surpassing records set just last year. Extreme heat poses numerous health risks, some of which are visible on our skin. Understanding how heat affects your skin can help you take measures to prevent or ease heat rash, eczema, rosacea, the discoloration of melasma, and many other skin conditions sparked or worsened by high temperatures.

How does heat affect your skin?

Heat waves can provoke or worsen several skin conditions.

• Heat rash (miliaria) occurs due to obstruction of sweat ducts on the skin, which are responsible for helping the body maintain a normal temperature by releasing water to the surface of the skin. As these sweat glands get blocked with excessive sweat on an extremely hot day, they do not function properly and red itchy bumps develop.
• Grover disease, a rash of small, red, itchy bumps on the chest and back, can also be triggered or worsened by excessive heat and sweating. Often this clears up within a few weeks or months. Less often symptoms may persist for years, with flares during the summer months.
• Eczema is a chronic skin condition characterized by dry, itchy plaques that affects millions of people in the United States. Increased sweating during heat waves can lead to skin irritation and inflammation, aggravating eczema symptoms. Dehydration caused by fluid loss through sweating can make the skin more susceptible to eczema flare-ups.
• Rosacea, which causes facial redness, visible blood vessels, and acne-like bumps, is also heat-sensitive. Heat causes blood vessels to dilate as the body attempts to cool itself, resulting in visible redness and flushing. High temperatures, especially combined with sun exposure, can cause flare ups.
• Melasma. Hyperpigmentation disorders like melasma also worsen with heat. Melasma is characterized by irregular dark patches on the face and is often triggered by UV exposure from the sun. Heat can increase the activity of melanocytes, the cells that produce pigment, making these patches more pronounced. Additionally, the combined effects of heat and UV radiation accelerate collagen and elastin degradation, leading to premature aging and loss of skin elasticity.
• Skin cancer risk rises with increased exposure to UV radiation. Heat waves — now beginning earlier, ending later, and lasting longer — contribute to UV exposure, particularly among people who work outdoors. And preliminary research suggests prolonged exposure to high temperatures may further boost skin cancer risk. This could be of particular concern for firefighters, who face extended exposure to extreme heat.

Heat waves, air pollution, and skin

During heat waves, levels of environmental pollutants like ozone and particulate matter can rise. And reactions between these pollutants, heat, and UV radiation spawn secondary pollutants such as peroxyacetyl nitrates (PANs). Pollutants like these can irritate the skin and contribute to inflammation through oxidative stress and DNA damage, so inflammatory conditions such as eczema and rosacea may worsen.

Can heat affect medications?

High temperatures compromise the effectiveness of certain medications. For instance, EpiPens, which are crucial for managing life-threatening allergic reactions, can lose their potency when exposed to high temperatures. Check the instructions on all of your medicines to see which ones should be stored in a cool, dry place or refrigerated. If you’re not sure which medicines might be affected by heat, talk to your pharmacist or doctor.

Retinoids in skin care products, antibiotics taken for acne, and immunomodulators for autoimmune diseases can make skin more susceptible to sun damage. This can lead to severe sunburns or rashes known as photodermatoses. If you experience this, contact your health care team for advice.

Protect your skin when temperatures climb

Keep skin cool

• Wear light, breathable clothing. Choose natural fibers like cotton and linen to help regulate body temperature and prevent sweat-induced skin issues. Avoid synthetic fabrics, which can trap heat and moisture.
• Take cool baths or showers. Use cool or tepid water to bathe. Avoid hot showers, which can strip the skin of natural oils, leading to dryness and irritation.
• Find cool spaces. If your home is not air-conditioned, seek out cooler places and ways to cool off during heat waves.

Keep skin hydrated

• Drink ample water and eat water-rich foods. Foods like watermelon and cucumbers can provide additional hydration.
• Moisturize your skin. Apply light, non-comedogenic moisturizers immediately after bathing. Look for ingredients such as hyaluronic acid and glycerin, which are beneficial for enhancing skin hydration.

Limit exposure to sun and pollution

• Use protective clothing. Wear wide-brimmed hats, UV-blocking sunglasses, and long-sleeved shirts to shield the skin from harmful radiation.
• Wear sunscreen. Apply broad-spectrum mineral sunscreens containing zinc oxide, titanium dioxide, or iron oxide to protect against UV radiation and pollutants.
• Use topical antioxidants. Use products like vitamin C in your morning skin care routine to mitigate oxidative stress.
• Wash up. Cleansing face and body at the end of the day may help you limit skin exposure to pollutants while also rinsing off any sunscreen residue.

About the Authors

Kathyana P. Santiago Mangual, Contributor

Kathyana P. Santiago Mangual is a clinical research fellow in dermatology at Massachusetts General Hospital and Harvard Medical School. She is also a medical student at the University of California, Los Angeles, and will be graduating … See Full Bio View all posts by Kathyana P. Santiago Mangual

Arianne Shadi Kourosh, MD, MPH, Contributor

Arianne Shadi Kourosh, MD, MPH, is a board certified dermatologist and associate professor of dermatology at Harvard Medical School. She is a graduate of the Harvard T.H. Chan School of Public Health and the University of … See Full Bio View all posts by Arianne Shadi Kourosh, MD, MPH

Ever ridden an e-scooter or e-bike? The convenience, affordability, and flat-out fun of these “micromobility” modes of transportation are undeniable. But did it also seem a bit dangerous?

In fact, the rate of accidents involving e-bikes and e-scooters is climbing. Maybe that shouldn’t be surprising given their dramatic jump in popularity. And then there’s the way riders often use them: at high speed, near cars and pedestrians, and on roads and sidewalks that weren’t designed for them.

Disruptive innovations, such as e-bikes and e-scooters, inevitably come with downsides. So, how can we minimize risks for accidents?

E-bikes, e-scooters, and injuries

Between 2018 and 2022, sales of e-bikes rose from around 250,000 per year to more than a million. E-bike and e-scooter rentals have also increased dramatically. As their popularity grows, emergency rooms are seeing many more people injured while riding e-bikes and e-scooters.

A 2024 study in JAMA Network Open highlights this. Researchers drew data from the National Electronic Injury Surveillance System, which is run by the US Consumer Product Safety Commission. They analyzed ER care between 2017 and 2022 for people injured while riding an e-bike or e-scooter, compared with people injured while riding conventional bikes and scooters.

What did the study find?

During the six-year study period, roughly three million people riding e-bikes, e-scooters, or their conventional counterparts sought care in the ER, including about 45,500 e-bike riders and 190,000 e-scooter riders, and about 2.5 million conventional bike riders and 305,000 conventional scooter riders.

Certain themes emerged around e-micromobility:

ER care spiked upward

• E-bike injuries more than doubled every year, going from 751 in 2017 to 23,493 in 2022.
• E-scooter injuries increased by more than 45% every year, going from 8,566 in 2017 to 56,847 in 2022.

More risky behavior

• 43% of e-bike and e-scooter riders wore helmets versus 52% for conventional micromobility riders
• 7% of e-bike riders and 9% of e-scooter riders were drinking before their accidents versus 4% of conventional bike riders and 3% of conventional scooter riders.

More accidents occurred in urban areas compared with rural settings:

• 83% of e-bike and e-scooter accidents
• 71% of conventional bike and scooter accidents.

All riders experienced similar types of injuries: scrapes, bruises, broken bones, and head and neck injuries were most common.

What are the limitations of this study?

This study only included people evaluated in an ER, so it excluded people with less severe injuries — and even those with significant injuries who didn’t go to an ER. Some may have sought no care at all, or gone to a primary care practice or walk-in clinic to avoid costly ER care or for other reasons.

Nor did the study count injuries suffered by pedestrians injured by e-bike or e-scooter riders. Property damage, such as damage to a car, wasn’t calculated.

And ultimately the study cannot compare the safety of e-bikes and e-scooters with conventional options. That’s because no data were collected on the number of miles traveled using a particular mode of transportation, or over how much time.

How can you avoid e-bike or e-scooter injuries?

Ten common-sense precautions can help you avoid injuries and ER visits:

• Wear a helmet. If you’re renting an e-bike or e-scooter, you may need to bring your own since many rental systems do not provide helmets.
• Practice. E-bikes are much heavier than conventional bicycles and may handle differently. And many adults have not ridden a scooter since elementary school! So if you aren’t familiar with riding an e-bike or e-scooter, practice in a safe location where there’s no traffic or pedestrians.
• Follow road rules. Ride on available bike lanes and avoid sidewalks. On an e-bike, use arm signals to alert those nearby of your intentions to turn or change lanes. (On an e-scooter, it’s best to keep both hands on the handle bars at all times.).
• Slow down. Some e-bikes approach speeds of 30 miles per hour. The faster you go, the less time you have to react to unexpected potholes or veering vehicles, and the more serious an injury is likely to be if you have an accident.
• Lower risks. Don’t ride while under the influence of alcohol or drugs, or use your phone while moving.
• Go it alone. Don’t add riders. Most e-bikes and e-scooters are built for one rider at a time.
• Ride defensively. Watch out for potholes or opening car doors.
• Reflect. Wear reflective clothing or attach a light if riding at night.
• Call out. Announce your presence to others. For example, shout “on your left!” as you approach pedestrians or slower riders that you intend to pass.
• Lobby. Reach out to local politicians to create bike lanes and other infrastructure to make micromobility safer.

The bottom line

Whether it’s part of your daily commute, an occasional quick zip from point A to point B, or just a ride for the fun of it, e-bikes and e-scooters are a great way to get around. Though they do come with some risk, you can do a lot to minimize the odds of wrapping up your travels with a trip to an ER.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Ever wonder if every medical test or treatment you've taken was truly necessary? Or are you inclined to get every bit of health care you can? Maybe you feel good about getting the most out of your health insurance. Perhaps a neighborhood imaging center is advertising discounted screening tests, your employer offers health screens as a perk, or you're intrigued by ads touting supplements for a seemingly endless number of conditions.

But keep in mind: just because you could get a particular test or treatment or take a supplement doesn't mean you should. One study suggests that as much as 20% of all health care in the US is unneeded. In short: when it comes to health care, more is not always better.

Isn't it better to be proactive about your health?

We're all taught that knowledge is power. So it might seem reasonable to want to know as much as possible about how your body is working. And isn't it better to take action before there's a problem rather than waiting for one to develop? What's the harm of erring on the side of more rather than less?

The truth is that knowledge is not always power: if the information is irrelevant to your specific situation, redundant, or inaccurate, the knowledge gained through unnecessary health care can be unhelpful or even harmful. Unnecessary tests, treatments, and supplements come with risks, even when they seem harmless. And, of course, unnecessary care is not free — even if you're not paying a cent out of pocket, it drives up costs across health systems.

Screening tests, wellness strategies, and treatments to reconsider

Recommended screening tests, treatments, and supplements can be essential to good health. But when risks of harm outweigh benefits — or if proof of any benefit is lacking — think twice. Save your time, money, and effort for health care that is focused on the most important health threats and backed by evidence.

Cancer screening: When to stop?

Screening tests for some cancers are routinely recommended and can be lifesaving. But there's a reason they come with a recommended stop age. For instance, guidelines recommend that a person at average risk of colorectal cancer with previously normal colonoscopies stop having them once they turn 75. Similar limits apply to Pap smears (age 65) and mammograms (age 75). Studies suggest that beyond those ages, there is little benefit to continuing these screens.

Watch out for wellness marketing

Dietary supplements are a multibillion-dollar industry. And a whopping 70% or more of US adults take at least one, such as vitamin D, fish oil, or a multivitamin. People often consider them as insurance in case vital elements are missing from their diet, or they believe supplements can prevent dementia, heart disease, or another condition.

Yet little evidence supports a benefit of routine supplement use for everyone. While recent studies suggest a daily multivitamin might slow cognitive decline in older adults, there's no medical consensus that everyone should be taking a multivitamin. Fish oil (omega-3) supplements haven't proven to be as healthful as simply eating servings of fatty fish and other seafood low in toxic chemicals like mercury and PCBs. And the benefits of routinely taking vitamin D supplements remain unproven as well.

It's worth emphasizing that dietary supplements clearly provide significant benefit for some people, and may be recommended by your doctor accordingly. For example, if you have a vitamin or mineral deficiency or a condition like age-related macular degeneration, good evidence supports taking specific supplements.

Reconsider daily aspirin

Who should be taking low-dose aspirin regularly? Recommendations have changed in recent years, so this is worth revisiting with your health care team.

• Older recommendations favored daily low-dose aspirin to help prevent cardiovascular disease, including first instances of heart attack and stroke.
• New recommendations favor low-dose aspirin for people who've already experienced a heart attack, stroke, or other cardiovascular disease. Adults ages 40 to 59 who are at a high risk for these conditions and low risk for bleeding also may consider it.

Yet according to a recent study, nearly one-third of adults 60 and older without past cardiovascular disease take aspirin, despite evidence that it provides little benefit for those at average or low risk. Aspirin can cause stomach bleeding and raise risk for a certain type of stroke.

Weigh in on prostate cancer screening

Men hear about prostate cancer often. It's common, and the second leading cause of cancer deaths among men. But PSA blood tests and rectal exams to identify evidence of cancer in the prostate are no longer routinely recommended for men ages 55 to 69 by the United States Preventative Services Task Force.

The reason? Studies suggest that performing these tests does not reliably reduce suffering or prolong life. Nor do possible benefits offset downsides like false positives (test results that are abnormal despite the absence of cancer). That can lead to additional testing, some of which is invasive.

Current guidelines suggest making a shared decision with your doctor about whether to have PSA testing after reviewing the pros and cons. For men over age 70, no screening is recommended. Despite this, millions of men have PSA tests and rectal examinations routinely.

Not everyone needs heart tests

There are now more ways than ever to evaluate the health of your heart. But none are routinely recommended if you're at low risk and have no signs or symptoms of cardiovascular disease. That's right: in the absence of symptoms or a high risk of cardiovascular disease, it's generally safe to skip EKGs, stress tests, and other cardiac tests.

Yet many people have these tests as part of their routine care. Why is this a problem? Having these tests without a compelling reason comes with risks, especially false positive results that can lead to invasive testing and unneeded treatment.

Four more reasons to avoid unnecessary care

Besides the concerns mentioned already, there are other reasons to avoid unnecessary care, including:

• The discomfort or complications of testing. If you're needle-phobic, getting a blood test is a big deal. And while complications of noninvasive testing are rare (such as a skin infection from a blood test), they can occur.
• The anxiety associated with waiting to find out test results
• False reassurance that comes with false negatives (results that are normal or nearly so, suggesting no disease when disease is actually present)
• All treatments have side effects. Even minor reactions — like occasional nausea or constipation — seem unacceptable if there's no reason to expect benefit from treatment.

The bottom line

You may believe your doctor wants you to continue with your current schedule of tests and treatments, while they might think this is your preference! It's worth discussing if you haven't already, especially if you suspect you may be taking pills or getting tests you don't truly need.

If your doctor says you can safely skip certain tests, treatments, and supplements, it doesn't mean that he or she is neglecting your health or that you don't deserve great health care! It's likely that the balance of risks and benefits simply doesn't support doing these things.

Less unnecessary care could free up resources for those who need it most. And it could save you time, money, and unnecessary risks or side effects, thus improving your health. It's a good example of how less can truly be more.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD