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The most common cause of chronic stomach pain in children isn’t anything you can find on a test or cure with a medicine. And that can make it very challenging to diagnose — and treat.

You may not have ever heard of functional abdominal pain. Yet it ranks as the most common cause of stomach pain lasting two months or more in children and teens.

What is functional abdominal pain?

The mind and the body are tightly connected in ways that we are still working to understand, and this is particularly true of the mind and the gastrointestinal tract. Stress — particularly chronic stress, depression, and anxiety — can lead to pain that is very real. Sometimes the pain is the only symptom of stress, especially in children who are high-achieving or tend to hide their emotions.

Sometimes the pain doesn’t start from stress but from an infection or other illness, and stays once the illness is gone or adds additional pain to the illness while it is being treated. Worry about the pain and its possible cause can make things worse. The nervous system of the gut can go into overdrive.

What are common symptoms of functional abdominal pain?

Children with functional abdominal pain can have mild symptoms that just show up occasionally, or they can have more severe symptoms that interfere with daily life. Along with stomachaches, they can have nausea, vomiting, constipation, or diarrhea — or some combination of all of them. They may have a poor appetite or complain of feeling full very quickly.

When should you contact your child’s doctor?

It’s important to check in with your doctor if your child is having chronic stomachaches. They should have a physical examination, and your doctor may want to do some testing, such as blood or stool tests, as there are many medical conditions that can cause chronic stomachaches.

It’s particularly important to call your doctor if your child

• is losing weight
• has blood in their stool
• has severe pain
• has fever, rashes, sore joints, or other signs of illness.

If your doctor finds that your child’s examination and tests are normal, and they aren’t losing weight, chances are that your child has functional abdominal pain.

For some families, getting this diagnosis sounds like the doctors are saying that it is all in the child’s head. But nothing could be further from the truth. It is very real pain — but it is not being caused by something dangerous, which is very good news.

How can you help a child diagnosed with functional abdominal pain?

There are many ways to help a child who has functional abdominal pain once the diagnosis is made. They include:

• Understanding and managing stressors in the child’s life, if there are any
• Medications recommended by your health care team can help with symptoms, such as laxatives for constipation
• Cognitive behavioral therapy, which is a kind of therapy that teaches strategies for managing pain, as well as managing any stress or sadness that can be contributing
• Meditation, yoga, and other ways for a child to relax and regulate how they react to their world
• For some children, a low-FODMAP diet can be helpful
• Probiotics, peppermint oil preparations, and some other supplements are sometimes used to help soothe and prevent pain.

Most children with functional abdominal pain can receive care from their pediatrician. Regular visits are a good idea, to check in to see how things are going and adjust any treatments. If things aren’t getting better, a referral to a gastroenterologist can be helpful.

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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

The first two weeks of July were the Earth’s hottest on human record, and people across the country continue to suffer from lingering, suffocating heat waves. The US Centers for Disease Control and Prevention has issued repeated warnings and tips about recognizing and preventing heat-related illnesses, like heat stroke, heat exhaustion, and heat cramps.

But one heat-related illness that people do not always recognize is heat rash.

“Heat rash can indicate that your exposure to excessive heat could lead to other serious heat-related issues, if not addressed,” says Dr. Abigail Waldman, a dermatologist with Harvard-affiliated Brigham and Women’s Hospital. "While heat rash is not dangerous in itself, sustained exposure to high heat can lead to heat exhaustion and heat stroke, so it's important to note any early signs that your body is struggling with the heat.”

What are the signs of heat rash?

Heat rash is also known as miliaria or prickly heat. It is caused when ducts from eccrine sweat glands that lead to the skin's surface are blocked or inflamed.

Eccrine sweat glands help your body maintain a steady temperature. When your internal temperature rises, these glands release water that rises to the surface of your skin through tiny ducts. There, it quickly evaporates, cooling your skin and the blood beneath.

However, sweat ducts may get blocked when you sweat excessively in hot temperatures, particularly if skin folds or tight-fitting clothes hinder their function.

Sweat is then trapped beneath the skin. This triggers inflammation, which leads to the appearance of small, itchy red bumps, similar to tiny pimples or blisters. In people with darker skin tones, these small, itchy bumps may not appear red, but will look slightly darker than surrounding skin.

Where and when is heat rash likely to occur?

Heat rash can appear on the neck, scalp, chest, groin, or elbow creases.

“Heat rash can occur any time the body sweats, so it is common in hot, humid climates, during hospitalizations, from fever, and during exercise,” says Dr. Waldman.

Heat rash also can occur in newborns, as their eccrine sweat glands are not fully developed. In newborns, heat rash looks like very thin blisters or water drops widely distributed on the face, trunk, arms, and legs. Call your pediatrician for advice if you notice a rash like this.

How can you treat heat rash?

Heat rash in adults is easy to treat with home remedies. “The techniques to relieve symptoms also can help prevent heat rash for adults and babies,” says Dr. Waldman.

• Cool down. The first step is to get out of the heat and cool and dry your skin. Use a fan or air conditioner, take a cool shower, or apply cool compresses to the affected areas. It's important to know that some people are more vulnerable to heat, and to make plans to help stay safe when temperatures are dangerously high.
• Prevent irritation. To prevent skin irritation, avoid wearing clothes made from synthetic materials, which can trap heat. (While dry-fit clothing helps to wicks away moisture from the skin, it often can be too tight fitting.) Instead, wear light, loose-fitting cotton clothing that allows airflow over your skin. If a heat rash occurs around your groin area, avoid wearing undergarments until it clears up.
• Try anti-itch products. Use an over-the-counter topical corticosteroid cream or calamine lotion for itching. However, avoid baby powder, oily or greasy moisturizers, and sunscreen, as they can further block sweat ducts.

Heat rash typically goes away within one to two days once you cool down your body. More severe heat rashes can last a week or longer. See your doctor (or follow up with your pediatrician) if a heat rash has not cleared up after a week. Also seek immediate care if you experience pain, intense itching, or the rash appears infected.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

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

Three months into the year is a good time to recalculate if you’ve been slacking on your resolution to eat healthy. And if you’ll be leaving home base or school soon and foraging for yourself (plus or minus roommates), it’s a great time to learn about healthy, low-cost choices for your grocery list.

The basics: A weekly shop

A healthy diet is rich in vegetables, fruits, legumes (beans or lentils), whole grains, nuts, seeds, lean proteins, and low-fat dairy products. Trying to fill your cart with all of those goodies can feel overwhelming. But just think in terms of twos.

“Get two fruits and two vegetables of different colors, and two types of lean protein — such as fresh, frozen, or canned fish, chicken or lean ground turkey, or plant-based options,” suggests Nancy Oliveira, a registered dietitian and manager of the Nutrition and Wellness Service at Harvard-affiliated Brigham and Women’s Hospital.

Oliveira also recommends getting two foods in each of these categories on your weekly shopping trip:

• plant proteins, such as canned or dried beans, tofu, tempeh, veggie burgers, or unsalted nuts or seeds
• whole grains, such as whole-grain bread, whole-grain pasta, brown or black rice, quinoa, or farro
• dairy or nondairy milk items, such as nonfat Greek yogurt or cheese.

Go ahead and add one or two healthy treats or snacks, such hummus or dried apricots.

Do you need to choose organic foods?

Organic produce is grown without synthetic fertilizers and pesticides, which are linked to many health problems. While US scientists debate whether foods grown with organic fertilizers (such as animal waste) are safer for your health, other countries, including European Union nations, have banned or phased out synthetic pesticides still used in the United States.

That doesn’t mean that everything you buy must be organic. But try to stay away from conventionally grown produce with thin skins, such as strawberries, spinach, kale, peaches, and grapes. They tend to absorb more chemicals compared to produce with thick skins, such as avocados or pineapples.

The Environmental Working Group creates an annual list to help shoppers avoid high-pesticide produce, and another one that highlights the least contaminated produce.

Buying cost-conscious fresh food and staples

Healthy food, especially organic produce, has a reputation for being expensive. But it doesn’t have to be. Just do a little comparison shopping, and follow Oliveira’s tips to save money on a grocery run:

• Shop in a smaller store with fewer choices.
• Never enter a store hungry, since you might buy more than you normally would.
• Carry a shopping list and stick to it.
• Go directly to the aisles you need. Avoid browsing elsewhere, which may lead to extra purchases.
• Be flexible, have several options within your food categories, and go with sale items.
• Always check the day-old produce cart that offers perfectly edible fresh produce at 50% to 75% off regular prices.
• Buy unseasoned canned or frozen whole foods such as vegetables, chicken, or fish (salmon, sardines, tuna), which are often cheaper than fresh versions.
• Wait for sales of healthy nonperishable staples like quinoa, brown rice, whole-grain pasta, and high-fiber cereals.
• Use coupons and coupon apps.

Easy healthy snacks to reach for

Move on from easy grab-n-go snacks, which are typically processed foods. They often contain unhealthy ingredients and promote overeating. Instead, Oliveira suggests keeping healthy snacks on hand, such as:

• unsalted mixed nuts
• string cheese
• grapes and berries (rinse before eating)
• clementines, bananas, or other fruits that don’t need washing
• a rice cake with nut butter or hummus
• fat-free Greek yogurt
• a peeled hard-boiled egg.

“To save money, buy certain foods in larger amounts when possible, such as an 8-ounce bar of cheese that you slice into small cubes and store in a sealed container in the fridge,” Oliveira says.

Crowdsource shopping tips and savings

Don’t be shy about asking for shopping tips from friends and family members who’ve already developed shortcuts, and grocery store staffers who can offer insider advice.

You can also turn to apps for help. Oliveira recommends two faves:

• Mealime is a meal-planning app with simple, healthy plant-based recipes that automatically create grocery lists for the ingredients.
• List Ease creates lists for grocery runs. You can search for items to add or scan barcodes to add to lists.

“And if you prefer not to use apps, just jot down notes after a quick pantry or fridge inventory, or text yourself every time you remember something you need,” Oliveira advises. “With a little practice, you’ll quickly work out the best system for you.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

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

Colon cancer is the second-deadliest form of cancer after lung cancer. If recent messages about colon cancer screening have left you a little confused, that's understandable. In August, the American College of Physicians (ACP) released updated guidance for colon cancer screening that differs from other major organizations, including recommendations from the American Cancer Society (ACS) and the US Preventive Services Task force (USPSTF).

So, what do you need to know?

How does the advice differ?

First, please note that this advice applies only to people at average risk without a family history of colon cancer. If you have family history, or if other health issues put you at higher-than-average risk for colorectal cancer, talk to your doctor about the best course of action for you.

The main point of disagreement relates to the age at which people should start getting screened. The new ACP guidance says 50, while the other two organizations recommend 45. That earlier age is endorsed by the U.S. Multisociety Task Force on Colorectal Cancer. It's also endorsed by many physicians, including Harvard Medical School professor Dr. Andrew T. Chan, a gastroenterologist and director of epidemiology at Massachusetts General Hospital Cancer Center, who helps explain key facts below.

Why do experts suggest starting screening earlier?

"We're facing an unexplained and alarming increase in the incidence of colon cancer in people younger than 50," says Dr. Chan.

Overall, deaths from colon cancer dropped by 2% per year from 2011 to 2020. But that's not the case among people younger than 50. In that age group, deaths from colon cancer rose between 0.5% and 3% during the same time period, according to statistics published in 2023.

The rising rates of colon cancer in younger people are occurring in all racial and ethnic groups, with the steepest rises seen among Alaskan Natives and Native Americans. Overall, Blacks and African Americans are more likely to get and die from colon cancer than whites, and early-onset cases are higher in Black individuals than whites.

Efforts to encourage colon cancer screening began in the mid-1990s. Today, about 60% of adults over 50 follow the advice to receive a colonoscopy (described below) on a regular basis. This track record, while not perfect, likely explains the decline in deaths from colon cancer in older adults.

"I think that promoting earlier screening will help stem the rise in early-onset cases, at least for those in their 40s. We've also seen that earlier colonoscopies may be associated with lowering incidence of colon cancer even later in life, "says Dr. Chan.

What are the different screening tests for colon cancer?

The two most widely used screening tests are a standard colonoscopy and various stool-based tests.

Colonoscopy. For this test, a gastroenterologist or surgeon snakes a long, flexible tube with a camera on the end through your rectum and beyond to inspect the entire length of your colon. Considered the gold-standard test, this procedure can detect precancerous polyps called adenomas, and allow for their removal.

The test requires taking laxatives and drinking lots of fluids beforehand to clean all the fecal material (stool) out of your colon. Serious complications, which include perforation or bleeding, are rare, occurring in about three in 1,000 procedures. If no polyps are found, a repeat colonoscopy isn't recommended for another 10 years. If you have polyps, or your risk or symptoms change, this interval will be shorter.

Stool tests. The more worrisome colon polyps (adenomas) often shed tiny amounts of blood and abnormal DNA into the stool. This can be detected from samples you collect yourself at home.

• Two tests, the fecal occult blood test (FOBT) and fecal immunochemical test (FIT), check for blood. They require small stool samples that you put on a card or in a tube that's then mailed to a lab. These tests should be done every year.
• A third option, the FIT-DNA test, checks for both blood and abnormal DNA; it's usually repeated every three years.

Additionally, the guidelines from the American College of Physicians suggest another option: flexible sigmoidoscopy, which inspects only the lower part of the colon, once every 10 years, combined with a fecal FIT testing every two years. However, doctors in the United States rarely order sigmoidoscopy today.

If flexible sigmoidoscopy or any of these stool tests show evidence of a problem, a colonoscopy is needed to check for adenomas or cancer.

Why might stool-based screening make sense for younger adults?

Colonoscopy isn't necessarily the best initial screening test for everyone, says Dr. Chan. That's especially true for younger people, mainly because it's time-consuming and inconvenient.

"Maybe you just can't find time in your schedule or are worried about having a colonoscopy," he says. If that's the case, a stool-based test — which is noninvasive and takes very little time — is an appropriate option.

"The worst option is not doing anything, because early detection and treatment can prevent deaths," he says.

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

Ever see ads for products that promise to supercharge immunity? Activate your body’s natural defenses? Support a healthy immune system while delivering a potent boost derived from nature’s hottest immune-enhancing ingredients?

While the words may change to reflect the latest trends, the claims certainly sound amazing. But do the multitude of products promoted as immune boosters actually work? What steps can we take to support the immune system? Both are important questions, especially in the wake of a deadly pandemic and as flu and cold season arrives.

IV drips, supplements, cleanses, and superfoods

The lineup of immune-boosting products and advice includes:

• Home intravenous (IV) drips. Want a health professional to come to your home with IV fluids containing various vitamins and supplements? That’s available in many US cities, and some companies claim their formula is designed to supercharge immunity. These on-demand IV treatments aren’t risk-free and can be quite expensive.
• Vitamins and supplements. Popular options include turmeric, milk thistle, and echinacea, often in combination with various vitamins. Hundreds of formulations are available.
• Superfoods and foods to avoid. If you search online for “foods to boost the immune system” you’ll see thousands of articles touting blueberries, broccoli, spinach, dark chocolate, and other foods to keep infections away. There’s also a list of foods to avoid, such as sugary drinks or highly processed meats, because they’re supposed to be bad for your immune system.
• Cleanses and detox treatments. No doubt you’ve seen pitches for cleanses and detox products intended to remove toxins from the body. Their marketing warns that the environment is full of harmful substances that get into the body through the air, water, and food, which we need to remove. Advocates suggest that, among other harmful effects, these often unnamed toxins make your immune system sluggish.

Are the heavily marketed IV drips, supplements, or detox products endorsed by the FDA?

No. In fact, the standard disclaimer on supplements’ claims of immune-boosting properties says: “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”

Yet sellers are allowed to use phrases like “boosts immune function” and “supports immune health.” These terms have always seemed vague to me. More importantly, they’re confusing:

• Boosting immunity is what vaccinations do. They prime your immune system to help fight off a specific infectious organism (like the flu shot before each flu season).

• Immune support typically describes vitamins such as vitamin C, or other nutrients necessary for a healthy immune system. It’s true that a deficiency of vital nutrients can cause poor immune function. But that doesn’t mean a person with normal levels of nutrients can expect supplements to improve their immune system.

Can products marketed as immune boosters actually boost immunity?

Unless you have a deficiency in a key nutrient, such as vitamin C or zinc, the short answer is no.

That is, there’s no convincing evidence that any particular product meaningfully improves immune function in healthy people. For example, results of studies looking at various supplements for colds and other similar infections have been mixed at best. Even when taking a particular supplement was linked to reduced severity or duration of an infection like a cold, there’s no proof that the supplement boosted overall immune function.

This goes for individual foods as well. None has ever been shown to improve immune function on its own. It’s the overall quality of your diet, not individual foods, that matters most. A similar approach applies to advice on foods you should avoid, such as sugary drinks or highly processed meats: the best foods to avoid in support of your immune system are the same ones you should be limiting anyway.

How to get the most out of your immune system

It’s not a secret and it’s not a product. What’s good for your overall health is good for immune function. The best ways to keep your immune system at peak performance are:

• Eat well and follow a heart-healthy diet, such as the Mediterranean diet.
• Exercise regularly and maintain a healthy weight.
• Don’t smoke or vape.
• If you drink alcoholic beverages, drink only in moderation.
• Get plenty of sleep.
• Minimize stress.
• Get regular medical care, including routine vaccinations.
• Take measures to prevent infection such as frequent hand washing, avoiding people who might have a contagious illness, and wearing a mask when it’s recommended.

This list probably looks familiar. These measures have long been recommended for overall health, and can do a lot to help many of us.

Certain illnesses — HIV, some cancers, and autoimmune disorders — or their treatments can affect how well the immune system works. So some people may need additional help from medications and therapies, which could truly count as immune boosting.

The bottom line

Perhaps there will come a time when we’ll know how to boost immune function beyond following routine health measures. That’s simply not the case now. Until we know more, I wouldn’t rely on individual foods, detox programs, oral supplements, or on-demand IV drips to keep your immune system healthy, especially when there are far more reliable options.

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

It’s tempting at this time of year to let summer sleep schedules stay in place or let bedtimes slide, especially when parents feel tired out, too. But it’s important that children have a regular routine — and that they are sleeping during the dark hours and awake during the light ones, as our bodies do best that way. That’s true for families who are home-schooling, as well: even when the trip to school is just a walk to the kitchen table, allowing for more sleep than those catching an early bus may get, no child should be spending all morning in bed.

Sleep is crucial for all of us, and this is particularly true for children. Without enough quality sleep, children are more likely to have health and behavioral problems — and difficulty learning.

Here are a few simple things you can do to help your child get the sleep they need.

Have a regular schedule

Our bodies do best when we go to bed and wake up at roughly the same time every day.

• Children and teens need eight to 10 hours of sleep. Count back 10 hours from when your child needs to get up in the morning. That’s roughly the time they need to be getting ready for bed (for younger children, count back 11 hours).
• For example, if your teen needs to be up at 7, then they should be getting ready for bed by 9, and in bed by 10 (since most of us don’t fall asleep the moment our head hits the pillow). A younger child should start getting ready (bathing, etc.) by around 8.
• Understand that teens are biologically wired to fall asleep later and wake up later and will naturally have later bedtimes. Unfortunately, most school districts don’t accommodate to this, so you are often working against biology.
• While it’s okay to stay up a bit later on weekends, don’t let the bedtime vary by more than an hour or so.

Turn off the screens before bed

The blue light emitted by screens can keep us awake.

• It’s best if the screens can be off two hours before you want your child asleep. Use that time when they start getting ready for bed as the time that the screens go off.
• The only real way to achieve this is to get all devices out of the bedroom. (So true!)
• Teens will fight you on this. If you can, hold firm (and buy them an alarm clock if they say they need their phone for this). At the very least, be sure that the phone is on Do Not Disturb mode overnight.

Have an environment that encourages sleep

• Quiet things down. If you are watching TV, turn the volume down, and in general try to not make much noise after children go to bed.
• Consider a white noise machine, or a fan (or air conditioner if you live somewhere warm). There are also white noise apps for those teens who won’t give up their phones.
• Room-darkening curtains can make a difference for children who tend to wake up at the first light of dawn — or who can’t fall asleep if it’s not fully dark outside.

Know how other factors influence sleep

• Busy teens often have difficulty getting everything done in time to get enough sleep. Talk with your teen about their daily schedule and look for ways to help them get more shut-eye, such as getting homework done during the school day, or limiting video games or other activities that eat into homework time. Sleep needs to be the priority.
• Limit caffeine. It’s best not to have any, but certainly nothing from mid-afternoon on.
• Limit naps! For a tired older child naps may seem like a good idea, but they can interfere with nighttime sleep. Naptime is okay through preschool.
• Make sure your child gets exercise. It’s not only important for their health, it helps their sleep.
• Have calming routines before bed (not exercise!).

If your child is having trouble falling asleep, or is waking up at night, talk to your doctor. It’s also important to talk to your doctor if your child is snoring or having other breathing problems at night. Don’t ever ignore a sleep problem; always ask for help.

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

When was the last time you had your blood pressure checked? All adults should have this simple test at least once a year.

If a blood pressure reading at your doctor’s office is elevated — that is, higher than a healthy range — current guidelines from the US Preventive Services Task Force recommend repeating the measurement outside of a clinic setting before starting treatment. But that’s not the only reason why your doctor may suggest regularly tracking your blood pressure at home.

Why monitor blood pressure at home?

“Some people have blood pressure elevations only at the doctor’s office, which is known as white-coat hypertension,” says Dr. Stephen Juraschek, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. One of the best ways to know if your blood pressure is truly higher than normal is to measure it multiple times at home.

Home monitoring is also a good idea:

• if your doctor asks you to track readings to help decide if you need to start taking medication to lower blood pressure
• if you’ve been diagnosed with high blood pressure and need to adjust your medications to make sure you’re reaching your blood pressure target
• if you’re pregnant or had a baby in recent months and your health team is concerned about preeclampsia. This condition is a severe form of high blood pressure that can harm vital organs like the kidneys. When not promptly treated, it sometimes leads to seizures, stroke, or even death.

Which home blood pressure monitor should I buy?

• Look for a monitor that’s been validated, which means the device has been independently reviewed for accuracy.
• Avoid monitors that feature cuffs used on the wrist or fingertip. These aren’t as accurate as upper-arm cuffs.
• Choose and use the right size cuff. Measure the circumference of your upper arm midway between your elbow and shoulder. Most home monitor cuffs can accommodate arm circumferences of 9 to 17 inches, but smaller and larger cuffs are available. A too-small cuff can lead to an artificially high reading, while a loose cuff can give a falsely low reading. For example, a 2023 randomized study of automated blood pressure monitors tested a regular size cuff on adults who need a different size cuff. The researchers found systolic blood pressure readings increased 19.5 mm Hg for participants who should have used an extra-large cuff, and by 4.8 mm Hg for participants who should have used a large cuff.

Very basic models cost as little as $25. But more expensive models, which range from about $50 to $100, may be more convenient to use. They can store multiple readings and send the data to your computer or smartphone — or even directly to the patient portal at your doctor’s office.

Three key points about blood pressure readings

Home blood pressure monitoring is a bit more involved than some people assume. “It’s not something you just do sporadically or whenever you have time,” says Dr. Juraschek.

• Blood pressure fluctuates throughout the day, which means one isolated reading doesn’t provide accurate information.
• If you check your blood pressure when you’re upset or stressed, it’s likely to be high. If you take it again right away, you may get another high reading, which feeds a cycle of anxiety and elevated readings, he says.
• Consistent, repeated measurements provide a far more useful assessment than occasional measurements.

How often should you take your blood pressure at home?

Ask your doctor how often and what time of day to take your blood pressure.

“The gold standard for home monitoring is to take 28 separate measurements, which you can then average to get a representative reading,” says Dr. Juraschek.

That means taking your blood pressure four times a day — twice in the morning and twice in the evening — for seven days in a row. However, even 12 measurements over three days is reasonable, especially if you include one weekend day, Dr. Juraschek says. Your doctor can advise you about what makes the most sense for your situation.

How can you get an accurate blood pressure reading?

Common mistakes can raise your blood pressure reading by a few points, or as much as 10 or even up to 25 points in some cases. Here’s what to do or avoid — and why — for an accurate blood pressure reading.

Wait at least 30 minutes after smoking, consuming caffeine or alcohol, or exercising before taking blood pressure.

Why? Caffeine and nicotine constrict blood vessels and boost your heart rate, which can raise blood pressure. Alcohol dilates blood vessels, possibly lowering blood pressure. And exercise increases heart rate and blood pressure.

Empty your bladder.

Why? A full bladder can put pressure on and reduce blood flow to your kidneys. Your body’s natural response is to raise your blood pressure to make sure your kidneys are getting enough blood.

Sit comfortably, supporting your arm near heart height.

Sit back in your chair with your feet flat on the floor, legs and ankles uncrossed, and your arm extended, palm up, on a table so that your elbow is positioned roughly at heart height.

Why? Crossing your legs, especially at the knee, temporarily raises blood pressure. If your feet or your arm are not supported, your muscles will contract. Even this small amount of isometric exercise can raise your blood pressure. Also, supporting your arm below or above the level of your heart may affect the accuracy of the reading.

Wait a few quiet minutes before taking a reading.

First, wrap the proper size cuff around your bare arm about an inch above the crook of your elbow. Sit quietly for a few minutes without distractions like TV, reading, phone scrolling, or talking. Then start the machine to take your blood pressure.

Why? Putting the cuff over clothes — or pushing up your sleeve so that it’s tight around your upper arm — may interfere with an accurate reading, though evidence on this is mixed. Ideally, you want to record blood pressure while feeling relaxed, not distracted, because even minor stress or tension can raise your blood pressure.

This video from the American Heart Association demonstrates the correct technique.

Why is diagnosing high blood pressure so important?

Nearly half of all adults have high blood pressure, but about a third of these people aren’t even aware they have the problem. An accurate diagnosis and treatment is vital, says Dr. Juraschek. Few things in medicine have shown such consistent results as the harms of high blood pressure, which is a major cause of heart attacks, strokes, kidney disease, and cognitive decline.

“It’s called the silent killer for a reason. We don’t feel or experience any of high blood pressure’s effects until it’s too late,” he says.

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

The fall calendar doesn’t just warn us of impending cold temperatures: It also points toward seasonal upticks in cases of RSV (respiratory syncytial virus), COVID, and influenza. These respiratory viruses were dubbed a “tripledemic” last year. After they collided to overload health care systems across the country, hospitalizations rose in tandem for all three illnesses over the fall and winter months.

Warding off severe cases — which may lead to hospitalization or death — should be top of mind, especially for those who are most vulnerable, a Harvard expert says. And updated versions of all three vaccines are now available to help protect us.

Why do cases of flu, RSV, and COVID typically rise in fall?

“This is typically the time of year we start to see viral infections increase, which has a lot to do with kids going back to school,” says Dr. John Ross, an assistant professor of medicine at Harvard Medical School who is board-certified in infectious diseases.

“Also, we’re starting now to have weather that’s more favorable for viral transmission, particularly lower humidity. Viruses survive better in dry air. And drier air also affects our airways and makes them more vulnerable to being infected.”

Who is eligible for each shot?

Eligibility recommendations vary by age and vulnerability to serious illnesses. Additionally, some shots are designed to help protect specific groups against serious illness.

The CDC recommends these shots for the following groups.

RSV

• Babies under 8 months and older infants at risk of severe RSV: A new shot, nirsevimab (Beyfortus), provides antibodies that protect against RSV for about five months.
• If you’re pregnant: One vaccine (Abrysvo) is approved at 32 weeks to 36 weeks of pregnancy. Having this shot during pregnancy protects infants during the first six months of life.
• If you’re over 60: Two vaccines (Arexvy and Abrysvo) are approved. Ask your health provider if you should consider getting one.

COVID

• Everyone 6 months and older should consider getting one of the updated COVID boosters, which were approved and authorized for emergency use by the FDA in early September. 
• Age 5 and older: Regardless of prior vaccination, children and adults are eligible for one dose of an updated mRNA vaccine if it’s been at least two months since their last COVID vaccine, the FDA says.

Flu

• Everyone 6 months and older should receive a flu vaccine.
• Different vaccines are approved for different age groups and for people with certain health issues or allergies. Most protect against four strains of flu virus (quadrivalent vaccines) expected to circulate this season.
• Three vaccines could potentially be more effective for people over 65: Fluzone High-Dose Quadrivalent vaccine; Flublok Quadrivalent Recombinant vaccine; and Fluad Quadrivalent adjuvanted flu vaccine. If these are not available, it’s fine to get any other flu shot approved for your age and health issues or allergies.

Who is likely to benefit most?

Getting the right vaccines can help people avoid missed work or school days and running the risk of making others sick. And the protection offered by these shots is especially important for certain groups.

For all three viruses, the people most vulnerable to severe illness are similar, Dr. Ross says, including

• adults 65 and older
• those with compromised immune systems or underlying lung conditions such as COPD and asthma
• those who are pregnant.

“Certainly with COVID and flu, pregnancy outcomes are worse with those infections,” Dr. Ross says. “I’m not saying that RSV isn’t a risk for pregnant mothers, but there’s not much data. The reason pregnant women are offered RSV vaccination is so the maternal antibodies they produce protect the newborns, because they’re at very high risk for RSV with very bad outcomes.”

Additionally, an even wider range of people are more prone to complications from the flu, according to the CDC. This includes

• infants under 2
• people with heart disease, neurologic conditions, blood disorders, endocrine disorders such as diabetes, obesity, kidney disease, liver or metabolic disorders
• people who have had a stroke.

What else should you know about flu, COVID, and RSV shots?

Beyond broad guidance determining who’s eligible for each type of vaccine, Dr. Ross offers other useful insight that may guide your choices.

When is the best time to get a flu shot?

The CDC recommends getting a flu shot in September or October, and Dr. Ross agrees. “These are usually the months the flu vaccine becomes available and vaccine clinics are easiest to find,” he says. “My personal approach is just to get the vaccine when it’s available, so you don’t forget.”

Will the updated COVID vaccines protect against newer strains of the virus?

The latest mRNA shots by drugmakers Pfizer and Moderna are monovalent, meaning they protect against one variant — XBB.1.5, the most recent to descend from Omicron earlier in 2023. Though that strain is no longer dominant, the boosters should still guard against closely related subvariants that are now circulating, Dr. Ross says. “People can feel comfortable about their protection regardless,” he says.

What else should I know about RSV shots?

The version meant for infants, Beyfortus, isn’t a vaccine at all. It’s a monoclonal antibody product that directly delivers antibodies that protect babies for the duration of a single fall-winter RSV season. These antibodies can prevent RSV or lessen its severity.

Dr. Ross says adults over 60 considering RSV vaccination should be aware of the potential for two rare but potentially serious side effects of the nervous system: the autoimmune conditions Guillain-Barre syndrome and acute disseminated encephalomyelitis, or ADEM. Guillain-Barre can lead to bodywide paralysis, while ADEM can cause weakness and seizures. The risk of these side effects after RSV vaccination in adults is about one in 7,000 — far higher than occurs after flu vaccination, Dr. Ross notes.

“If you’re a totally healthy 60-year-old, I’m not sure it makes sense to get the RSV vaccine,” he says. “It’s a conversation you should have with your doctor.”

How should I schedule shots if I’m getting several vaccines?

Research suggests that it’s safe to get both flu and COVID vaccines at the same time. Reactions (such as muscle aches, fatigue, and headache) are slightly higher when flu vaccine and an mRNA COVID vaccine are combined, according to one study, though these reactions usually are mild and disappear quickly.

“Because RSV vaccines are newer, I don’t think we know much about combining these shots with other vaccines,” says Dr. Ross. Scheduling this vaccine separately is a good idea, although you should talk to your doctor about potential risks and benefits for your situation.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

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

Wriggling toes in the sand and wearing sandals are warm weather treats, unless you’d rather keep your toes under wraps due to thickened, yellowish nails. Nail fungal infections (known as onychomycosis) are common, affecting up to 14% of the general population. In advanced cases, nails can become brittle, crumbly, or ragged, or even separate from the nail bed.

While completely curing these fungal infections is difficult, the right treatments can discourage the problem from spreading and make your nails look better.

Do nail fungal infections only affect toenails?

No, fingernails can become infected, too. However, toenails are a more common target because of certain habits, including wearing shoes, so we’ll concentrate on them in this post.

How do people get toenail fungus?

“Feet are more likely to be sweaty and damp, which provides a better environment for the fungi, yeasts, and molds that are naturally present on your skin to flourish,” says Dr. Abigail Waldman, a dermatologist at Harvard-affiliated Brigham and Women’s Hospital.

People also can be exposed to various fungi, known as dermatophytes, by walking barefoot in locker rooms, spas, or near swimming pools, or getting a pedicure at a nail salon, she says. A fungal overgrowth can infect the area between your toes and the skin or your feet, causing athlete’s foot. The fungus can then spread to the toenails.

What makes toenail fungus hard to treat?

While antifungal creams can easily treat skin infections, toenails are another story.

“Nail tissue is harder and thicker, so these medications don’t penetrate very well,” Dr. Waldman explains. That’s also true for antifungal drugs taken as pills. Toenails grow slowly and the tissue isn’t very metabolically active. So although the medication gets into your bloodstream, only small amounts end up in your toenails. That’s why it’s hard to get rid of toenail fungus once it takes hold.

What counts as a cure?

Research reports so-called clinical cure rates between 60% to 80%, but this means only the absence of symptoms — that is, your toenails return to their normal appearance. The fungal infection may still be lurking under your nails, says Dr. Waldman.

In fact, in clinical trials when investigators recheck toenail clippings for any residual fungus after treatments applied to nails, only around 10% to 15% show no detectable fungal spores. As a result, recurrences of toenail fungal infections are fairly common.

Despite this, there’s a reasonable chance that different treatment approaches can improve your symptoms and the appearance of your toenails.

What works for treating toenail fungus?

Here is a rundown of the different treatment options, starting with Dr. Waldman’s go-to first-line suggestion, which uses inexpensive products you may already have in your home.

Home remedies

Soaking your toes to soften your nails before applying a fungus-fighting agent will help the remedy penetrate the nail. For the soak, Dr. Waldman recommends mixing one part white or apple cider vinegar to three parts warm water. Soak your toes for at least 10 minutes (but up to 40 minutes is better). Instead of vinegar, you can use Listerine, which contains thymol, the main compound in the herb thyme. Like vinegar, thymol has antifungal properties.

Then dry your feet well and apply an antifungal substance to all the affected nails. One option is a paste of crushed garlic, but most people will probably find the over-the-counter drugstore products listed below more convenient to use.

Over-the-counter products

The best evidence is for 100% tea tree oil, but another popular option is Vicks VapoRub (which also contains thymol and other essential oils that may fight fungus), Dr. Waldman says. Or you can use one of the various creams sold to treat athlete’s foot on your toenails.

Be sure to apply the product right after soaking. The clinical cure rates for each of these approaches vary between products, and depend on the severity and duration of the infection. But about 60% of people notice improvements after a few months of treatment, Dr. Waldman says.

Drugstores also carry several other toenail treatments, including a treated patch you put on your nails overnight. It contains urea, an acidic substance that improves the look of your nails by making them less brittle and discolored. Another product that promises similar results uses a tiny LED light that you clip onto your toenail after applying a liquid containing polyethylene glycol, which softens nails.

Prescription treatments to put on toenails

These topical products, which are best for milder infections, include amorolfine (Loceryl, others), efinaconazole (Jublia), tavaborole (Kerydin), and ciclopirox (Penlac). They are clear lacquers that you brush on your toenails once daily, usually for months. It may take as long as a year to see results. Clinical cure rates range from 35% to 60%.

Prescription pills

More severe infections may respond better to oral drugs, which include fluconazole (Diflucan), griseofulvin (Grifulvin), itraconazole (Sporanox), and terbinafine (Lamisil). These are taken daily in pill form for three months. While the clinical cure rates are higher (around 80%), these drugs have more side effects, including stomach upset, diarrhea, and (in rare cases) liver damage.

Laser therapy

Lasers penetrate and break down nail tissue, helping to destroy the fungus. There are many different types of lasers and protocols. Clinical cure rates are hard to pin down, but some have been reported as ranging between 60% and 75%.

Advice on toenail clippers, nail polish, new shoes, and more

During and after treatment, Dr. Waldman advises people to use two sets of toenail clippers — one for infected nails and one for noninfected nails — to prevent fungal spread. If you’re embarrassed by the appearance of your toenails, it’s okay to use nail polish for short periods of time, she says.

Once you finish treatment, buying new shoes will help avoid reinfection. “I also always recommend people do a diluted vinegar soak once or twice a week after finishing treatment, which helps prevent any lingering fungus from reinfecting the nail,” says Dr. Waldman.

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

Brittany Jordan-Arthur was at loggerheads with her 7-year-old daughter one recent morning. The little girl simply did not want to head out the door to summer camp, finding any and all excuses to hang back.

But instead of expressing exasperation or annoyance — knowing that would make her daughter dig in her heels even more — Jordan-Arthur, a psychologist at Harvard-affiliated McLean Hospital, decided to use a valuable communication technique: validation. Like many skills, the more you practice validation, the easier it becomes to apply when it’s most needed. Here’s what to know and do.

What is validation?

An approach that can help people feel heard and understood, validation is especially useful when navigating emotionally charged situations. Validating someone shows you understand their feelings and point of view, even when you disagree. It establishes trust, helping the other person feel supported and open to discussing solutions.

And that’s precisely what happened in Jordan-Arthur’s stalemate with her daughter.

“I just sat with her and said, ‘You really don’t want to go.’ It was a great example of saying, ‘I hear you,’ and ultimately I didn’t tell her she had to go or why — she came to that conclusion herself,” Jordan-Arthur says. “We walked out the door without all the need for explanations.”

Many try validation but don’t succeed

Validation is fundamental to a type of talk therapy called dialectical behavior therapy (DBT), which is geared toward people who experience emotions very intensely. Many people use some aspects of validation in everyday communications with family members, friends, and colleagues, but usually fall short, Jordan-Arthur says. How?

“They jump into problem-solving, saying something validating, but then immediately tell the person what they should have done or what they should do next,” she says. “They don’t let that validation sink in. It’s like putting on anti-itch cream and then immediately washing it off.”

How can you offer validation?

Jordan-Arthur shares these pointers for validating another person:

• Give them your full attention.
• Make eye contact and nod appropriately, saying “uh huh” while showing your interest.
• Reflect what you’ve heard by restating their message, such as, “It sounds like you feel worse about this situation today than yesterday.”
• Verbalize the unspoken, such as, “I hear that you feel you can’t get anything done because of this obstacle,” or “It sounds like you’re frustrated.”
• Give it time to work! Be sure to let the validation sink in before attempting to problem- solve.

Does validation condone troubling behavior?

Validation isn’t the same as condoning someone’s bad or frustrating behavior, Jordan-Arthur notes. It’s not akin to reassuring them when reassurance isn’t appropriate.

“You may be afraid you’re going to communicate that you approve of their behavior or agree with their actions or choices,” she says. “But if you slow down and validate how someone feels in the moment, before a poor decision is made, validating accomplishes exactly the opposite.”

Try this phrasing instead:

• “I hear that this is important to you.”
• “I can see how this has been so upsetting/difficult/scary for you.”

How can you validate teens?

Validating teenagers isn’t dissimilar from the tactics Jordan-Arthur used with her 7-year-old — the problems just tend to be bigger. For example, teens often feel stuck with teachers they don’t like or complain that teachers seem overly harsh.

“Parents have lots of urges to say, ‘Oh, the teacher isn’t that bad’ or ‘I’m sure they mean well,’ defending the teacher and his or her perspective,” Jordan-Arthur says. “The odds are, by the time a kid is a teen, they also have that skill, but it’s going to take them a moment to get there.”

Here’s what to say instead:

• “I hear that you don’t feel respected.”
• “It’s so hard to feel helpless.”
• “It’s difficult to feel your teacher has control over how well you do in class.”

“You can validate their feelings even if you feel the teacher is being respectful,” Jordan-Arthur adds.

How can you validate adults?

Validating other adults in your professional or personal life involves much the same approach. With a colleague who’s feeling undervalued at the office, for instance, try saying, “It makes total sense that you’re feeling really frustrated. I know how important your work is to you.”

If you’re arguing with a spouse or partner, you can believe them as being genuine, Jordan-Arthur says, despite a difference of opinion. Try saying, “I can tell that this issue feels really important to you and you want me to pay attention to what you’re saying.”

It’s also wise to pay attention to the other person’s body language during heated moments. After validating them — but before offering a potential solution to a problem — look for clues that they’re calming down, such as breathing and gesturing more slowly.

“I encourage people to count to 10 in their heads, because we still tend to jump the gun and not wait for the other person to feel that validation,” she says. “If we do that, they’ll often move past the idea that ‘this person wronged me’ and start solving the problem on their own.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

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