As a nurse, I think about things like “febrile seizures,” or brain damage from fevers, and rush for Acetaminophen or Ibuprofen (popularly consumed as Tylenol® or Motrin®).

But is rushing for one of these items the smartest thing to do? Is it crucial to maintain a normal temperature? And how do you monitor and treat a fever for your child in the best possible way?
 

Signs of Fever

Signs of a high fever include:

• hot dry skin
• temperature above 41 Celsius
  (105.8 Fahrenheit)

Click here for more information about how to spot a fever in children.
 

Fever Research Update

In a Clinical Report put out by the American Academy of Pediatrics in 2011, some important guidelines were outlined based on research studies of general healthy children. The findings of this study included the following:

• Fever is common in children
• Fever is the body’s way of fighting infection
• Some fevers can actually help a child recover faster from viruses
• Fever cannot make an illness worse
• Fever cannot cause long-term neurological problems
• It is rare for high fevers to cause convulsions or comas

Click here for the official research study overview.
 

Treating a Child’s Fever

Taking your child’s temperature
Get a good thermometer and learn how to take your child’s temperature. 

• Tips for Taking a Baby’s Temperature

Maintaining Body Temperature

• Keep the room temperature between 70-74 degrees Fahrenheit
• Dress your child in light cotton pajamas
• If your child has chills, cover with an extra blanket and remove when the chills stop 

Watch Your Child
Observe your child for signs of serious illness. Call your pediatrician with any of the symptoms below and report the temperature as well.

Rest and Hydrate
Make sure your child gets plenty of rest and give your child plenty of fluids to prevent dehydration and help the body cool itself. Good choices for hydration during a fever are: water, clear soups, popsicles and jello.
 

Acetaminophen or Ibuprofen

Look for next week’s post, where I’ll treat you to the latest updates about moms alternating acetaminophen and ibuprofen as fever treatment. The answer may surprise you. In the meantime, thanks for reading.

Teenagers are a wondrous species:

• They are smart and funny, part child and part grown up.
• They are trying to pull away from parents, but very dependent on their peers.
• There is peer pressure to engage in risky behavior.

As a result, adolescents are at risk for injury and health problems. And for teens with chronic disease (some examples might be: asthma, transplants, cystic fibrosis and juvenile rheumatoid arthritis) who want to be responsible for their own health, there is an even greater danger.

The latest research on teenagers with chronic diseases and medication and treatment compliance indicates that, unfortunately, teens are less adherent than children when it comes to taking their medications for chronic diseases, especially when their medication regimens can be complicated and time-consuming.

My goal with this post is to help you keep your teenager out of the hospital due to medication non-compliance.

Reasons for Low Medication Compliance in Adolescents

First, you’ll want to know the real reasons that may be keeping your teen from complying with their medication regimens:

1. They may not understand the reason for all the medications.
2. They don’t want to be different from their friends. Some may even be teased or bullied.
3. They may feel isolated (e.g. low blood counts may prevent them from hanging out with friends or asthma may keep them from participating in sporting activities).
4. Some have low self-esteem and may be suffering depression or anxiety over their health.
5. They may also feel like their health is  unpredictable and frightening and that they are expected to be able to handle the stress and “know better.”

All of these things can contribute to a teenager not taking medications or treatments and having a hospitalization that is avoidable.

Helping Teens Cope and Comply

The good thing about the research is that I’ve also been able to read about strategies which have been effective in helping teenagers cope and comply with their treatments.

Education
Teenagers need individualized education to understand their diseases and medications, why they are necessary and when to take them.

• Make sure your teenager understands each medication and what it does for their health and their body.
• Next time you are at the doctor’s office, ask for individualized instruction for things like blood glucose checks, albuterol inhalers and, of course, medications.

Social Support
Social support is key for adolescents. They feel better when they can share with others who have the same conditions. Many parents have concerns about Facebook and social networking, but when teens feel isolated, Facebook could be the best medicine. If they can’t find a social network that fits their needs, encourage them to start a group. You may see your teen receiving moral support from peers and providing it for others as well.

Support from Mom and Dad
Try using tools your kids already use, such as text messaging, to send supportive reminders. Also, be realistic about compliance and monitor it in a non-judgmental way. Even though your teen wants to be independent, recognize that being a teenager makes non-compliance very likely. So, don’t leave it all up to them.

What Works in Your Family?

Do you have a special system that works in your family? If so share it here so others can benefits, especially teens.

Have you ever listened to a song that took you back to the memory of a specific time in your life, reminded you of a special person, made you feel relaxed or gave you energy?

There is definitely a certain power associated with music. Music can bring up emotions, memories, or special connections that link us socially or spiritually. For children, music can be a fun way to learn, relax and get through tough emotional or physical situations. It can help with communication, social skills and with other abilities. In fact, it’s also been shown to reduce stress, which can help keep your immune system healthy.

The idea of using music to heal patients has been around since ancient times. The modern practice of using music in hospitals started after World War I and II when local musicians would travel to Veteran Hospitals to play for soldiers. The music helped lift their spirits and made them feel better. The first official music therapy degree program was offered at Michigan State University in 1944.

Defining Music Therapy

The American Music Therapy Association, founded in 1998, defines music therapy as, “an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals.” There is definitely a healing power associated with music.

Benefits of Music Therapy

Stress Relief and Pain Management

As I mentioned earlier, calm, quiet music can be used to reduce stress and encourage relaxation. It has been documented that the state of relaxation caused by certain types of music can change brain wave patterns. Studies show that calming music can help stabilize blood pressure if listened to before, during and after surgery.

Speech and Language Improvement

Music uses pitch, rhythm and words, which are all part of speech and language. Learning to play instruments can help increase self-esteem and help patients develop hand and finger coordination. Listening to certain types of music can even assist a developing brain. Research has shown that music therapy encourages a type of learning that results in growth in the auditory and motor areas in the brain.

Coping Skills

Goals of music therapy are to make patients feel more at ease and assist them in getting through a traumatic experience. As the American Association of Music Therapy notes, “A therapist can talk with a client, but a qualified music therapist can use music to actively link a client to their psycho-emotional state quickly.”

By doing so, a music therapist is able to help patients improve emotional adjustment, reduce anxiety and depression. Music therapy can help kids cope with loss and grief and help with their communication and social skills.

Overall, music therapy can improve coping abilities, manage pain and help with stressors associated with being a kid in the hospital. 

Music Therapy at Children’s Hospital Los Angeles

At Children’s Hospital Los Angeles, licensed professional music therapists provide musical activities for our patients that include creating, singing, moving to and listening to music. This therapy provides ways for children to communicate and can facilitate rehabilitation.

Registered therapists work on our patient care units, in music workshops and with individual patients to provide diversions and distraction from medical stressors. The therapists and visiting musicians also use music to entertain patients. All these activities help patients deal with the stress that can be associated with illness and hospitalization. At Children’s Hospital Los Angeles, kids can listen to soothing music before medical procedures or surgery to help decrease anxiety.

Music therapy here at Children’s Hospital has been shown to decrease distress by 20 percent and decrease pain by approximately 10 percent. In 2007, there were 933 music therapy sessions provided at Children’s Hospital. In 2010, there were 1,731  sessions and 4,479 sessions in 2011.

For more information about music therapy at Children’s Hospital Los Angeles, visit the webpage for The Mark Taper and Johnny Mercer Artists Program. Parents and families can ask their child’s nurse to make a referral for music therapy.

Additionally, those interested in learning more about the music therapy profession can learn more about our expressive arts therapy internship.

It can be very difficult for children using inhalers to coordinate pressing the inhaler and breathing in at the same time.

Using a spacer with an inhaler can help your child get the proper amount of medicine into his or her lungs.

A spacer looks like a round plastic tube that fits on the mouthpiece of your child’s inhaler. Typically, spacers are prescribed by doctors.

Benefits of Using a Spacer

• Helps your child to breathe at his or her own rate
• More medicine gets into the lungs
• Prevents medicine from leaking into the air

How to Properly Use a Spacer

The spacer looks easy to use but there are steps you can take to ensure your child is using it correctly and that it is cleaned properly. They are as follows:

1. Shake the inhaler for several seconds.
2. If this is the first time using this inhaler, prime it as you normally would by pressing down on it and spraying it into the air away from you several times.
3. Insert the mouthpiece of the inhaler snugly into the spacer.
4. Exhale (breathe out) fully through your mouth.
5. Put the spacer in your mouth with your lips and teeth around the mouthpiece.
6. Press down on the inhaler ONE time only.
7. Inhale (breathe in) slowly and deeply for 3 to 5 seconds.
8. Hold your breath for at least 10 seconds.
9. Exhale.
10. Repeat dose as ordered.

Properly Cleaning an Inhaler

The medicine from your inhaler can create a film on your spacer. Over time, this residue can block medicine from getting into your child’s lungs. It is important to properly clean your child’s spacer. Always follow the manufacturer’s cleaning instructions. Below, find some basic cleaning instructions:

• Take the rubber backpiece and mouthpiece of your spacer off the round plastic tube. Take off the mask if you have one.
• Soak all parts for 15-20 minutes in a bowl of lukewarm water and a bit of dishwashing soap.
• Move around in the water very gently.
• Rinse parts thoroughly in warm water.
• Shake out any excess water from all parts and air dry completely.
• Make sure all parts are completely dry before reassembling the spacer.
• Clean your spacer weekly and after any sickness.
• Wipe the mouthpiece and/or mask off after each use.

 If you follow these steps then your child will get more medicine into his/her lungs, and feel better much quicker!

I’m talking about good hand washing.

You may have heard from your doctor and news reports, especially during flu season, just how important it is to wash your hands.

In fact, proper and regular hand-washing can also prevent sicknesses like most types of infectious diarrhea, hepatitis A and meningitis.

However, you only enjoy these benefits if you’re washing your hands correctly. Now, you might be saying to yourself, “Wait a minute. There’s a right and a wrong way to wash my hands?” And the answer is, “Yes, there is!”

But, you’re not alone. Most people don’t know how to effectively wash their hands to prevent the spread of germs. Luckily, it’s easy to learn the proper technique. I’ve put together a video to help both you and your children learn how to wash your hands to help prevent the spread of disease.

Washing Your Hands Correctly

You can read the steps below while you watch. Download the one-page instructions here.

1. Wet your hands with warm water.
2. Apply enough soap to make a really good lather.
3. Rub your hands palm to palm.
4. Rub your palms around your hands.
5. Clean between your fingers by interlocking your fingers and pushing your palms up and down.
6. Rub the back of your fingers on your palms.
7. Rub the tips of your fingers and nails on your palms.
8. Grab your thumb with your other hand and rub in a rotational circle backwards and forwards.
9. Rub around your wrists.
10. Rinse your hands thoroughly.
11. Dry your hands thoroughly with a single paper towel.
12. Use the towel to turn off the water faucet.

Whistle While You Wash

So what do I mean by, “Whistle While You Wash?” To help you and your family remember how long the hand washing process should take, you can whistle or sing the lyrics to the Yankee Doodle song twice. The Happy Birthday song works just as well. The total time spent washing should add up to about 30 seconds.

With everything in life, practice leads to improvement, so be sure to take full advantage of opportunities to rehearse these steps with your children. It will help you to remember the steps and will reinforce them for your kids too. Now, enjoy your clean hands and know you have just done the single most important thing to prevent yourself from getting sick!

Also, don’t forget to get your family immunized for the flu this season. Here are some tips for preparing your kids for a trip to the doctor for shots, which should help make your appointment go that much smoother.

Here are links you can explore to learn more about the importance of hand-washing:

• Center for Disease Control and Prevention—Handwashing
• Henry the Hand – Champion Handwasher
• Global Handwashing Day

For parents, it’s often a shock when their child’s pediatrician returns with a diagnosis of asthma. They can feel overwhelmed because as of yet, asthma cannot be cured. However, parents and children alike should take heart in the knowledge that with preventative measures and appropriate treatment, asthma can be controlled.

Treating Asthma

Many asthma patients do not believe they need to take medications daily if they are feeling OK. The truth is that if your child has asthma, his or her airways are inflamed every day, so the asthma needs to be managed every day. Asthma attacks can be prevented or lessened by avoiding triggers (allergens, pet dander and cigarette smoke) but isn’t always enough. This is why it’s so important to take asthma medication as prescribed by your child’s pediatrician.

Understanding Asthma Medications

There are two approaches to treating asthma: preventing asthma attacks with controller medications and stopping asthma attacks when they occur with a fast-acting inhaler or “rescue” medication.

First, I’ll provide an overview of the types of controller medications that are available for the long-term treatment of asthma. They are intended to minimize attacks and lessen the need for rescue medications.

Controller Medications

These are the most important drugs for most people with asthma. Anti-inflammatory drugs reduce swelling and mucus production in the airways. As a result, airways are less sensitive and less likely to react to triggers. These medications need to be taken daily and may need to be taken for several weeks before they begin to control asthma.

• Controller medications are taken daily and include inhaled corticosteroids (fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex), ciclesonide (Alvesco), flunisolide (Aerobid), beclomethasone (Qvar) and others).
• Combination inhalers contain an inhaled corticosteroid plus a long-acting beta-agonist (LABA). LABAs should never be prescribed as the sole therapy for asthma. Combination medications include fluticasone and salmeterol (Advair Diskus, Advair HFA), budesonide and formoterol (Symbicort) and mometasone and formoterol (Dulera).

• Leukotriene modifiers are oral medications that include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo, Zyflo CR).

Rescue Medications

Rescue medications are also called quick-relief or fast-acting medications. They work immediately and should be taken when symptoms like chest tightness, difficulty breathing or wheezing occur. Some doctors will prescribe these medicines to be taken before exercise.  The more asthma is controlled, the less “rescue” meds will be needed. 

If you need rescue meds more than twice a week, talk to your doctor about getting on a controller. 

Short-acting beta-agonists (SABAs) like albuterol, are used to quickly open the airways and relieve  symptoms during asthma “attacks.” For more information, check out this recommended reference site for asthma medications.

Staying Healthy

Work closely with your child’s pediatrician and specialist so that both you and your child will be better informed about how to manage asthma on a daily basis. Helping your child to remember to take their medication is a great step forward in teaching them how to manage their asthma as an adult.

Learn more about The Division of Clinical Immunology and Allergy at Children’s Hospital Los Angeles.

Anaphylaxis

My daughter told me during a phone call that she wasn’t feeling well. She was away at college and told me there had been sandwiches at a party she’d attended.

“I ate one and now I don’t feel good at all,” she confessed.

My nurse antennae went up because, in addition, to being allergic to penicillin, my daughter has food allergies. She is particularly allergic to nuts and shellfish. Typically, when she has eaten one of the offending foods, she feels a tingling in her tongue and on occasion, nausea. We had experienced small episodes before, once with a store-bought cookie and another time after she’d eaten a french fry from my plate. Unbeknownst to us, fish juice had splashed on it from my fish taco. Both times, she started to feel her tongue tingle and on each occasion, she took Benadryl and felt better.

I asked her what was in the sandwich, but she didn’t know, felt nauseated and had already taken a Benadryl. This time though, my daughter was scared. She was alone in a house where she was staying.  The dorms had closed.  And her roommate was not home.

Her face was hot and she felt sick, which hadn’t happened during her previous reactions. An Internet search for the signs and symptoms of anaphylaxis made her suspect she was in danger.  Read on to find out about her trip to the medical center where it we confirmed anaphylaxis.

What is an anaphylactic reaction?

Anaphylaxis is a severe allergic reaction that can be life-threatening and can occur immediately after coming into contact with a subject to which the body is allergic, or can be delayed.

It is caused by exposure in the past to the substance causing the reaction called an antigen, which prepares the body to be sensitive to the substance.

What are some signs and symptoms?

• itchiness, rash, hives
• nausea or bowel pain
• itching or swelling tongue
• wheezing, difficulty breathing, gasping, pursed lip breathing
• slurring words, confusion, inability to speak
• weakness
• pale color

If your child exhibits any of the symptoms of food allergy listed above when eating any foods or around any allergen, make sure to schedule an appointment with an allergy specialist.

At Children’s Hospital Los Angeles, our Division of Clinical Immunology and Allergy combines innovative treatment,
research, education and outreach in the care of children with severe allergic disease, asthma, primary immune deficiency disorders and HIV/AIDS.

You can learn more about their asthma and allergy services online.

Quick Thinking in an Emergency

Once my daughter suspected anaphylaxis, she called her college’s emergency student number, then her roommate and took out her EpiPen (an epinephrine autoinjector).

Even though she’d never had to use it before, she was familiar with how to do so and carried one at all times. Despite her fear of needles, she quickly opened the EpiPen and jabbed it into her leg.

Firemen arrived in minutes, started an IV and brought her to the medical center. She was given steroids and observed for several hours, but, thanks to the steps she took, she was in stable condition the entire time.

I was many miles away and my daughter was alone.  But her quick thinking and decisive action saved her life.  Thankfully, she had her EpiPen and knew she had to use it.

Now, she is going to get a medic alert bracelet (and I am kicking myself for not thinking of this).  But she is smarter and wiser than I am!

Prepare Yourself

Make sure you always have Benadryl on hand. Your child should have an unexpired EpiPen at all times and know how to use it. You will have to show the prescription to your child’s school staff members for them to allow the pen at school. A medic alert bracelet is a great idea as well.

Allergies are nothing to sneeze at!  The reactions can be mild at first, but they can change and become more severe and even become life-threatening.

I, for one, am proud of my daughter and very grateful she had that EpiPen and the courage to use it. By taking the proper precautions, you can help your children know what to do if they find themselves in a similar situation.

You can also read more on the subject of food allergies in Raising a Child with Food Allergies.

In my post, Talking with Teens about Drugs and Alcohol, I provided parents with some tips to help get the conversation started with their teen. This post goes into detail about what strategies parents can impart to their teens to help them cope with peer pressure.

Give instructions to call you.

Tell your teenager that no matter the situation, they can call you to pick them up. Let them know if they or their friends have been drinking, it is not safe to drive. Remind them frequently that you would rather see them drunk than injured or dead. In some communities there is even a safe driving program or services that will give teens a safe ride home, no questions asked. Research and find out if there are any in your area.

Discuss refusal techniques.

Find a few excuses to give your child they can use for not participating. A good example would be, “My parents conduct random drug tests.” Teach your teenagers it’s OK to go against what everyone is doing. Tell them people who push them to do things they do not really want to do don’t really “have their back.” Encourage them to do what is best for them and they will feel better for it in the end. Even though they might not believe you now, let them know that someday they will be respected for their strength.

Monkey see, monkey do.

Be careful of sending mixed messages. It is very confusing for teenagers if their parents are drinking or doing drugs but telling their children that this behavior is wrong or dangerous for them. Be careful when coming home from a bad day of work and saying, “I need a drink.” This behavior demonstrates to your child that drinking is a way to relieve stress and relax.  Set an example: use alcohol moderately and never drink and drive. Be careful when sharing stories about yourself drinking as a teen that portray drinking as fun and “the thing to do.”

Know your teen’s friends.

Encourage qualities in friends that have meaning and are valuable, such as trustworthiness and kindness. Have your teen’s friends visit your home so you can get to know them. Encourage activities that are fun and challenging. Boredom can lead to alcohol and drug experimentation.

Some more tips:

• Do not supply teens with drugs or alcohol.
• Do not let your house be the “party house.”
• Have an open mind to help have open conversations.
• Set a good example for your children—parents who drink heavily usually have teens who also drink heavily.

Recognize the signs of drug and alcohol use.

Pay attention to how your teen appears physically before and after going out with friends. The following signs in your teen should act as a red flag.

• Changes in appearance
• Red or flushed cheeks
• Changes in attitude
• Clenching teeth more often
• Avoiding eye contact
• Using lots of gum or mints to hide smell
• Asking for money
• Avoidance of family members
• Poor communication and short temper

For additional information, I encourage you to check out the following websites:

• Teenage Drinking – How To Information | eHow.com
• Teenage Alcoholism – Getting the Right Treatment
• Alcohol, Peer Pressure, Teenage Underage Drinking | The Cool Spot
• Teen Alcohol Abuse Causes, Symptoms, Signs, Risk Factors and Treatment on Medicine.Net.com

Most teens prefer not to talk to their parents about drinking alcohol and experimenting with drugs. Generally, these are activities they discuss (and/or engage in) with their friends, and keep very private. Parents can really never know for sure what their teens are doing.

However, one thing parents can do is give their teenagers information to help them make safe decisions. Teenagers are naturally curious about adult behaviors, but don’t want to ask parents for fear of being punished or receiving (GASP!) a dreaded lecture.

One of the most important steps you can take as a parent is to find out what your teen already knows. Stay open minded during this discussion and let your teen talk about their concerns. Refrain from jumping in and starting to lecture. By simply listening, you will find out what they are thinking and possibly doing.

Get the conversation started.

The subject of drinking and drugs is not something that is discussed only once.  Remember to listen to your teenager’s point of view and try not to lecture. Here are some questions you can pose your teenager during a discussion.

• Is it OK for you or your friends to drink in any situation?
• How do you feel about parents providing alcohol or drugs to teenagers?
• How much drinking is too much? (This is a good time to mention that throwing up is a sign of having too much to drink, no matter how old you are!)
• What do you do if you are at a party and you or your friends have had too much to drink?
• Do you drink or do drugs to help with stress and to relax?

Be realistic.

Parents who have a more realistic preventative approach to their child drinking and/or using drugs are more able to take appropriate measures than parents who state that their teen “will never drink.” 

As a parent, you can’t be with your teenager all the time, but you can be aware of who their friends are and what they may be doing.

It’s all right to tell your child that you never want them to drink or do drugs, but be prepared for the possibility that they will experiment.

Maintain an ongoing conversation.

If your teenager becomes accustomed to discussing drug and alcohol use with you before they are faced with the temptation to try either, you’ll establish an open line of communication about the subject. Hopefully, the tips listed above will give you a starting point for this discussion with your child. In my next post, I’ll go into more detail about what tools parents can use to help their child avoid uncomfortable situations in regard to experimenting with drugs and alcohol.

Some of my favorite memories of childhood are of picnics in the park, barbeques in the backyard and potlucks at church. I loved the fun and sharing of friendships, families and conversation around delicious food. What I didn’t know is that sometimes, we were also sharing bacteria!

The bacteria were not invited to the party, but often showed up anyway. In fact, the Center for Disease Control and Prevention (CDC) estimates that every year, about 1 in 6 Americans (or 48 million people) gets sick, 128,000 are hospitalized and 3,000 die from foodborne illness, or what is commonly called food poisoning.

What is food poisoning?

Food poisoning can cause symptoms such as nausea, vomiting, diarrhea or fever. It is caused by eating food that has not been properly stored, prepared or cooked. There is a common misunderstanding that you can only get sick from bacteria found in improperly prepared or undercooked meats, but bacteria can be lurking on unwashed fruits and veggies too! I once got food poisoning from an unwashed watermelon. Slicing the unwashed fruit dragged the bacteria from the skin to the inside of the watermelon riding on the edge of the knife.

Potato and pasta salads are common at a lot of picnics and barbeques. Contrary to popular belief, store bought mayonnaise is not usually the culprit that causes spoilage because the eggs are pasteurized. Instead, bacteria seem to prefer homemade dishes that include eggs, potatoes as well as other ingredients.

Salmonella is the most common bacterial cause of diarrhea in food poisoning deaths. It is most often found in raw and undercooked eggs, undercooked poultry and meat, fresh fruits and vegetables.

How do I avoid food poisoning?

Bacteria grow best between 40 and 140 degrees Fahrenheit. This is what is known as the “danger zone.” To keep food poisoning from ruining a perfectly good picnic, follow these simple tips. Use the same basic rules for preparing and serving food outside as you would inside your kitchen.

Mind the Temperature

• Keep cold foods cold. Bring a cooler with plenty of ice or freezer packs to the event.
• Keep hot foods hot.
• Separate hot foods from cold foods.

Follow the Two Hour Rule

• Serve cooked food within two hours of preparation. Don’t let food sit for more than two hours on the table (exceptions are cookies, chips or cracker-type foods).

Divide and Conquer

• Separate cooked meats from uncooked meats.
• Do not use the same plates, cutting boards or utensils to prepare the meats that you do to serve them once they are cooked.
• Do not use the same plates or utensils to prepare raw meats and other types of food.

There are four basic principles that can help keep your picnics and barbeques safe and fun:

1. CLEAN—Wash hands and surfaces often.
2. SEPARATE—Don’t cross-contaminate!
3. COOK—Cook to proper temperature.
4. CHILL—Refrigerate promptly.

Follow these simple precautions and your summer parties will be filled with fun and great food, and you can avoid any trouble from that little microscopic party-crasher called bacteria!