DEAR DOCTOR,

Our city has asked us to wear a face mask when we leave the house. Needless to say, my wife and I have never done this before. Does our 5-year-old son need a mask, too? Any guidance or how-tos would be greatly appreciated.

DEAR READER,

Your local government is following the updated recommendation from the Centers for Disease Control and Prevention, which urges people to wear a cloth covering over their nose and mouth whenever they go out in public. These face coverings don’t serve as protection from becoming infected with the virus. Rather, they are a physical barrier that may prevent someone who is infected from spreading it. This is particularly valuable in cases where someone is infected but has no symptoms.

This is very important, so imagine our voices as stern and serious when you reach the uppercase words in the next sentence. A face mask should only be used IN ADDITION TO and never INSTEAD OF the other important steps we’re all taking right now. These include social distancing, frequent and thorough hand-washing, not touching your face, and cleaning high-touch surfaces such as door handles, light switches, phones, eyeglasses and sunglasses. (And don’t forget about the handles of your car doors and your steering wheel.)

Face coverings should be snug but comfortable, fit against the sides of the face and beneath the chin, and allow for unrestricted breathing. They can be secured by ear loops or ties and should include multiple layers of fabric. Make sure the masks you choose can be washed and machine dried without damaging the mask or changing its shape.

When putting on a mask, start with clean hands. Always hold it by the strings or straps, not by the mask itself. Place it over your nose and mouth and adjust the straps so that you have a snug but comfortable fit. If your mask has a bendable metal clip over the bridge of the nose, gently adjust it to the contour of your face. If you wear glasses, put them on after the mask. It’s important that any facial covering you use, even if it’s just a bandanna, completely covers both your nose and mouth, and also the bottom of your chin. It’s helpful to practice at home to get optimal fit and comfort.

Before you remove your mask, clean your hands. Again, you’ll be handling it only by the ties or straps. If it’s disposable, throw it away. If it’s reusable, wash it with soap in hot water and machine dry thoroughly on medium or high heat. And please, never use medical-grade N95 masks. These are in short supply and are desperately needed to keep frontline workers safe.

Yes, your son should wear a mask in public as well. The CDC recommends everyone 2 years of age and older wear a mask that covers their nose and mouth. Due to the risk of suffocation, face coverings should not be used on anyone younger than 2. We hope this helps, and that you and your family stay vigilant, safe and healthy.

Heart Murmurs

DEAR DOCTOR,

My 7-year-old niece has been diagnosed with a heart murmur, and my brother says she won’t be receiving any kind of treatment. What is a heart murmur? Will it interfere with the activities she loves, like soccer and softball?

DEAR READER,

When someone has a heart murmur, it means an extra and unusual sound has been detected while their heart beats.

During the normal cycle of a heartbeat, blood is propelled through the chambers of the heart via muscle contractions, and its flow is directed by a series of valves that open and close in a specific sequence and pattern. The normal two-part sound of a heartbeat, which is often described as lub-DUB, is made by the heart valves as they close. When someone has a heart murmur, their heartbeat makes a whooshing or swishing sound. This is caused by turbulent blood either within or near the heart. We know that all of this can sound alarming, but a heart murmur isn’t necessarily dangerous and doesn’t automatically require treatment. A heart murmur may be congenital, which means you are born with it, or it can develop later in life.

The condition is divided into two categories — innocent or abnormal. Innocent heart murmurs, sometimes also referred to as functional or normal murmurs, don’t pose a danger to the individual and generally don’t require treatment. An innocent heart murmur is a common finding in children and infants. In the majority of cases, no structural abnormalities to either the heart or the vessels that serve it are present. In fact, researchers estimate that fewer than 1% of childhood heart murmurs are associated with congenital heart disease.

An abnormal heart murmur can be caused by structural problems that interfere with optimal cardiac function. These can include valve abnormalities or septal defects, which are holes in the heart. Infections, such as rheumatic fever, can lead to a heart murmur. So can endocarditis, which is an infection of the heart’s inner lining.

In some people, an abnormal heart murmur is accompanied by symptoms such as shortness of breath, a bluish tinge to the skin or lips, chest pain, rapid breathing, a chronic cough or light-headedness. Abnormal heart murmurs require treatment, which can range from medications to manage the condition, to surgery to repair the structural causes.

The fact that your niece has seen a doctor and won’t receive treatment suggests she has an innocent murmur. However, her doctor will continue to monitor the murmur throughout her childhood. If problems arise, she will be referred to a pediatric cardiologist, who may use an X-ray, electrocardiogram or echocardiogram to learn more about her heart and the murmur.

For the majority of children living with an innocent heart murmur, life goes on as normal. They can run, ride bikes, jump rope, go swimming and play sports. If she begins to exhibit any of the symptoms we mentioned earlier, then she will need to be reevaluated. But the good news is that in many cases, innocent heart murmurs resolve by themselves by adulthood.

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