barbarahealth

Want your child to grow up healthy, happy, smart, capable, and resilient? Play with them. Infants and toddlers thrive on playful games that change as they grow.

Why does play matter during the first few years of life?

More than a million new nerve connections are made in the brain in the first few years of life. And pruning of these neural connections makes them more efficient. These processes literally build the brain and help guide how it functions for the rest of that child’s life. While biology — particularly genetics — affects this, so does a child’s environment and experiences.

Babies and children thrive with responsive caregiving. Serve and return, a term used by the Harvard Center on the Developing Child, describes this well: back-and-forth interactions, in which the child and caregiver react to and interact with each other in a loving, nurturing way, are the building blocks of a healthy brain and a happy child, who will have a better chance of growing into a healthy, happy, competent, and successful adult.

Play is one of the best ways to do responsive caregiving. To maximize the benefits of play:

• Bring your full attention. Put the phone down, don’t multitask.
• Be reciprocal. That’s the “serve and return” part. Even little babies can interact with their caregivers, and that’s what you want to encourage. It doesn’t have to be reciprocal in an equal way — you might be talking in sentences while your baby is just smiling or cooing — but the idea is to build responsiveness into the play.
• Be attuned to developmental stages. That way your child can fully engage — and you can encourage their development as well.

Great games to play with infants: 6 to 9 months

The Center for the Developing Child has some great ideas and handouts for parents about specific games to play with their children at different ages.

6-month-olds and 9-month-olds are learning imitation and other building blocks of language. They are also starting to learn movement and explore the world around them.

Here are some play ideas for this age group:

• Play peek-a-boo or patty-cake.
• Play games of hiding toys under a blanket or another toy, and then “find” them, or let the baby find them.
• Have back-and-forth conversations. The baby’s contribution might just be a “ma” or “ba” sound. You can make the same sound back, or pretend that your baby is saying something (“You don’t say! Really? Tell me more!”).
• Play imitation games: if your baby sticks out their tongue, you do it too, for example. Older babies will start to be able to imitate things like clapping or banging, and love when grownups do that with them.
• Sing songs that involve movement, like “Itsy Bitsy Spider” or “Trot, Trot to Boston” with words and motions.
• Play simple games with objects, like putting toys into a bucket and taking them out, or dropping them and saying “boom!”

Great games to play with toddlers

Between 12 months and 18 months, young toddlers are gaining more language and movement skills, and love to imitate. You can:

• Play with blocks, building simple things and knocking them down together.
• Do imaginative play with dolls or stuffed animals, or pretend phone calls.
• Use pillows and blankets to build little forts and places to climb and play.
• Play some rudimentary hide-and-seek, like hiding yourself under a blanket next to the baby.
• Continue singing songs that involve movement and interaction, like “If You’re Happy And You Know It.”
• Go on outings and explore the world together. Even just going to the grocery store can be an adventure for a baby. Narrate everything. Don’t worry about using words your baby doesn’t understand; eventually they will, and hearing lots of different words is good for them.

Older toddlers, who are 2 or 3 years old, are able to do more complicated versions of these games. They can do matching, sorting, and counting games, as well as imitation and movement games like “follow the leader” (you can get quite creative and silly with that one).

As much as you can, give yourself over to play and have fun. Work and chores can wait, or you can actually involve young children in chores, making that more fun for both of you. Checking social media can definitely wait.

Playing with your child is an investment in your child’s future — and a great way to build your relationship and make both of you happy.

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

Over the course of a lifetime, as many as seven in 10 adults in the United States will directly experience or witness harrowing events. These include gun violence, car accidents, and other personal trauma; natural or human-made disasters, such as Hurricane Katrina and the 9/11 terrorist attacks; and military combat. And some — though not all — will experience post-traumatic stress disorder, or PTSD.

New guidelines released in 2024 can help guide effective treatment.

What is PTSD?

PTSD is a potentially debilitating mental health condition. It’s marked by recurrent, frightening episodes during which a person relives a traumatic event.

After a disturbing event, it’s normal to have upsetting memories, feel on edge, and have trouble sleeping. For most people, these symptoms fade over time. But when certain symptoms persist for more than a month, a person may be experiencing PTSD.

These symptoms include

• recurring nightmares or intrusive thoughts about the event
• feeling emotionally numb and disconnected
• withdrawing from people and certain situations
• being jumpy and on guard.

The National Center for PTSD offers a brief self-screening test online, which can help you decide whether to seek more information and help.

Who is more likely to experience PTSD?

Not everyone who experiences violence, disasters, and other upsetting events goes on to develop PTSD. However, military personnel exposed to combat in a war zone are especially vulnerable. About 11% to 20% of veterans who served in Iraq or Afghanistan have PTSD, according to the National Center for PTSD.

What about people who were not in the military? Within the general population, estimates suggest PTSD occurs in 4% of men and 8% of women — a difference at least partly related to the fact that women are more likely to experience sexual assault.

What are the new guidelines for PTSD treatment?

Experts from the U.S. Department of Veterans Affairs and Department of Defense collaborated on new guidelines for treating PTSD. They detailed the evidence both for and against specific therapies for PTSD.

Their findings apply to civilian and military personnel alike, says Dr. Sofia Matta, a psychiatrist at Harvard-affiliated Massachusetts General Hospital and senior director of medical services at Home Base, a nonprofit organization that provides care for veterans, service members, and their families.

The circle of care is widely drawn for good reason. “It’s important to recognize that PTSD doesn’t just affect the person who is suffering but also their families and sometimes, their entire community,” Dr. Matta says. The rise in mass shootings in public places and the aftermath of these events are a grim reminder of this reality, she adds.

Which treatment approaches are most effective for PTSD?

The new guidelines looked at psychotherapy, medications, nondrug therapies. Psychotherapy, sometimes paired with certain medicines, emerged as the most effective approach.

The experts also recommended not taking certain drugs due to lack of evidence or possible harm.

Which psychotherapies are recommended for PTSD?

The recommended treatment for PTSD, psychotherapy, is more effective than medication. It also has fewer adverse side effects and people prefer it, according to the guidelines.

Which type of psychotherapy can help? Importantly, the most effective therapies for people with PTSD differ from those for people with other mental health issues, says Dr. Matta.

Both cognitive processing therapy and prolonged exposure therapy were effective. These two therapies teach people how to evaluate and reframe the upsetting thoughts stemming from the traumatic experience. The guidelines also recommend mindfulness-based stress reduction, an eight-week program that includes meditation, body scanning, and simple yoga stretches.

Which medications are recommended for PTSD?

Some people with severe symptoms need medication to feel well enough to participate in therapy. “People with PTSD often don’t sleep well due to insomnia and nightmares, and the resulting fatigue makes it hard to pay attention and concentrate,” says Dr. Matta.

Three medicines commonly prescribed for depression and anxiety — paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor) — are recommended. Prazosin (Minipress) may help people with nightmares, but the evidence is weak.

Which medications are not recommended for PTSD?

The guidelines strongly recommended not taking benzodiazepines (anti-anxiety drugs often taken for sleep). Benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin) offer no proven benefits for people with PTSD. They have several potential harms, including negative cognitive changes and decreased effectiveness of PTSD psychotherapies.

What about cannabis, psychedelics, and brain stimulation therapies?

Right now, evidence doesn’t support the idea that cannabis helps ease PTSD symptoms. And there are possible serious side effects from the drug, such as cannabis hyperemesis syndrome (severe vomiting related to long-term cannabis use).

There isn’t enough evidence to recommend for or against psychedelic-assisted therapies such as psilocybin (magic mushrooms) and MDMA (ecstasy). “Because these potential therapies are illegal under federal law, the barriers for conducting research on them are very high,” says Dr. Matta. However, recent legislative reforms may make such studies more feasible.

Likewise, the evidence is mixed for a wide range of other nondrug therapies, such as brain stimulation therapies like repetitive transcranial magnetic stimulation or transcranial direct current stimulation.

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

One of the more unusual conditions affecting the hands and fingers is Dupuytren’s contracture (also called Dupuytren’s disease). Here, one or more fingers become curled, which can make it difficult to pick up or hold objects or perform everyday activities.

Legend says the condition originated with the Vikings of Northern Europe, although this is debated. It was later named after the 19th-century French surgeon Guillaume Dupuytren, who did the first successful operation on the condition. Fast-forward to the 21st century, and Dupuytren’s contracture now affects about one in 20 Americans.

What is Dupuytren’s contracture?

Fascia is a sheet of fibrous tissue beneath the skin of the fingers and the palm. Dupuytren’s contracture is a thickening and shortening of this tissue.

This thickened area begins as a hard lump called a nodule. Over years to decades, it may progress to a thick band called a cord that causes one or more fingers to curl toward the palm and become stuck in a bent position. This can make it difficult to grasp objects, button clothes, use a computer, or perform other daily tasks.

The condition does not always get progressively worse. It may be stable for years or even improve in some people.

Which fingers are most likely to be affected?

The ring and pinky fingers are most often affected. But the condition can strike all fingers and the thumb.

“In about half of cases, the condition can affect both hands,” says Dr. Phillip Blazar, an orthopedic surgeon and Division Chief of Hand and Upper Extremity at Harvard-affiliated Brigham and Women’s Hospital. Fortunately, it rarely causes pain.

What causes Dupuytren’s contracture?

Currently, the cause is unclear. Still, several factors can increase a person’s risk, such as

• Genetics: This condition is more common in people with Northern European, British Isles, or Scandinavian ancestry.
• Gender: Men are affected more often than women.
• Age: The condition often occurs after age 50.
• Family history of the disease.

People with diabetes and seizure disorders are also more likely to have Dupuytren’s. The condition may appear and/or worsen after trauma to the hand.

How is Dupuytren’s contracture treated?

Although there is no cure, treatments and occupational or physical therapy can help address symptoms and improve finger mobility. “Many people who have mild cases of Dupuytren’s find it has little impact on their ability to use their hands,” says Dr. Blazar.

However, moderate or severe cases can interfere with hand function. It’s possible to restore normal finger motion with nonsurgical treatments, such as:

• Collagenase injection. This procedure is done in the doctor’s office. An enzyme called collagenase is injected into the cords of your hand, which breaks down and dissolves the thickened tissue. At a follow-up visit, your doctor will give you local anesthesia and then snap the cords by manipulating and straightening your fingers in the direction in which they are unable to move.
• Needle aponeurotomy. This in-office procedure involves passing a hypodermic needle back and forth through the restrictive cords to weaken and break them.

“Your hand surgeon will discuss both treatment options to determine which is best for your situation,” says Dr. Blazar. “There are also some variations in the anatomy of the disease which may make one treatment or the other less favorable for a particular person or finger.” Both of these treatments don’t remove the cords, and the condition can return and require additional treatment.

What about surgical treatment?

If nonsurgical treatment does not relieve symptoms or you have a severe condition, surgery may be recommended. Surgical approaches include:

• Fasciotomy. An incision is made in your palm to divide the thickened tissue in the cord.
• Subtotal palmar fasciectomy. A zigzag incision is made along the creases in the hand to remove the abnormal tissue and cord. Occasionally, a skin graft may be needed to help the wound heal.

You wear a splint on the repaired hand during recovery. People should expect some pain, stiffness, and swelling afterward. The length of recovery varies for each individual, and also with how many fingers were operated on and which ones.

“Most people largely recover by three months, but some may not feel fully recovered for quite a bit longer,” says Dr. Blazar. Hand therapists can also help with strength and flexibility exercises to speed recovery.

Most people’s fingers move better after surgery. However, as with nonsurgical treatments, the contracture can come back, so some people may need additional surgery later on.

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

Social media has a way of making the ho-hum seem fresh and novel. Case in point: exfoliation, the process of removing dead cells from the skin’s outer layer. Anyone scrolling through TikTok lately might be convinced this longtime skin care approach can transform something old — let’s say our aging epidermis — into like-new skin.

But a Harvard dermatologist says that’s asking too much.

“I don’t think exfoliation is going to fix anybody’s wrinkles,” says Rachel Reynolds, MD, interim chair of dermatology at Harvard-affiliated Beth Israel Deaconess Medical Center. While exfoliation offers definite benefits, it can also irritate and inflame the skin if you don’t do it carefully, or use tools or chemicals your skin doesn’t tolerate.

How is exfoliation done?

There are two main ways to exfoliate: mechanical and chemical. Each boasts specific advantages.

• Mechanical (or physical) exfoliation uses a tool such as a brush or loofah sponge, or a scrub containing abrasive particles, to physically remove dead skin cells. “Mechanical exfoliation can improve skin luster by taking off a dead layer of skin that can make it look dull,” Dr. Reynolds says. “And it can help unclog pores a bit, which can reduce some types of acne.”
• Chemical exfoliation uses chemicals — often alpha and beta hydroxy acids or salicylic acid — to liquify dead skin cells. “Chemical exfoliants work on a more micro-level to help dissolve excess skin cells and reduce uneven pigmentation sitting at the surface of the skin,” she explains. “They also restore skin glow, improve acne, and give the skin a little more shine.”

Why do skin care products so often promote exfoliation?

Perhaps hundreds of commercially available skin care products — from body washes to cleansers to face masks — are labeled as exfoliating, Dr. Reynolds notes. But she’s skeptical about why such a wide array of items plug this feature so prominently.

“It’s advantageous for a cosmetics company to sell consumers more products in a skin care line,” she says. “But it’s buyer beware, because this is a completely unregulated market, and cosmetic companies can make claims that don’t have to be substantiated in actual clinical trials.”

Do we need to exfoliate our skin?

No. “Nothing happens if you don’t exfoliate — you just walk around with bumpy or slightly dry skin, which is inconsequential except for cosmetic reasons,” Dr. Reynolds says.

“No one has to exfoliate, but it can be helpful to exfoliate the arms and legs,” she adds. “As we age, these areas get more dry than other parts of the body, and people notice they build up a lot more flaking skin and an almost fish-scale appearance.”

That phenomenon may or may not be a sign of keratosis pilaris, a common but harmless skin condition characterized by rough, bumpy “chicken skin” on the upper arms and thighs. Physical exfoliators are a good first choice because keratosis pilaris covers areas that have tougher skin than the face, she says. But it’s fine to use a cleanser or lotion containing a chemical exfoliant instead. Either type can improve skin texture and the skin’s appearance.

Can exfoliation harm our skin?

Yes. Both physical and chemical exfoliation techniques can do more harm than good, depending on several factors. Sensitive skin is more likely to become irritated or inflamed by any exfoliant. And overdoing it — whether by rubbing too hard or using a product with higher concentrations of acid — can trigger irritant contact dermatitis, which can look red, angry, and chapped.

“Physical exfoliation that’s done too harshly can also aggravate inflammatory acne, making it worse,” Dr. Reynolds says. “Also, exfoliating can make you more prone to sunburn.”

What are the safest ways to exfoliate?

Dr. Reynolds recommends chemical exfoliants over physical versions. “Sometimes the abrasives in those apricot scrubs, for example, can go too far, aggravating the skin and creating inflammation,” she says.

She offers these additional tips to exfoliate safely:

• If you haven’t exfoliated before, start with a simple washcloth to determine how well your skin responds to mild attempts at physical exfoliation.
• Then try gentler chemical exfoliants, such as lower concentrations of hydroxy acids or salicylic acid. Work your way up to stronger concentrations only if needed.
• If you’re hoping to eradicate stubborn skin problems such as melasma (brown facial patches) or comedonal acne (small, skin-colored bumps often on the forehead or chin), consider undergoing a chemical peel at a dermatologist’s office.

Don’t exfoliate every day. “At most, do it two or three times a week,” Dr. Reynolds says. “Your skin needs to repair itself in between exfoliation episodes.”

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

Need a little motivation and structure to ramp up your walking routine? Want to wake up your workouts but not quite ready for a mud run? Consider trying a couch-to-5K program.

Dr. Adam Tenforde, medical director of the Spaulding National Running Center at Harvard-affiliated Spaulding Rehabilitation Network and a sports medicine physician at Mass General Brigham Sports Medicine, shares tips on what to know and do before lacing up your sneakers.

What is a couch-to-5K program?

These free or low-cost coaching plans are designed to help would-be runners train for a 5-kilometer race, which is about 3.1 miles. The programs are available online, or as apps or podcasts. They typically feature timed walking and running intervals that gradually phase out the walking over a period of about nine weeks.

Why try a couch-to-5K program?

“One purpose of a couch-to-5K program is to give you time to acclimate and start to enjoy the benefits of running and the sense of accomplishment of completing a distance safely,” says Dr. Tenforde. Running provides many cardiovascular benefits, such as lower blood pressure and a reduced cholesterol level, as well as an enhanced sense of well-being, he adds.

What’s more, adding even short bursts of running or other vigorous physical activity to a workout — a practice known as high-intensity interval training or HIIT — appears to help improve mental health, according to a study that pooled findings from 58 randomized trials of HIIT.

Are you ready to tackle a couch-to-5K?

Even though the couch-to-5K programs sound as though they’re geared for completely sedentary couch potatoes, that’s not necessarily true, Dr. Tenforde cautions. These programs often assume you can walk continuously for 30 minutes, which doesn’t apply to everyone.

For some people, an even easier, more gradual training regimen may be more appropriate. Also, keep in mind that you don’t have to run to do a 5K. Many of these races also encourage walkers to participate as well. You’ll still reap the other rewards from committing to a race, such as being more challenged and motivated — and possibly more connected to your community. Many charitable “fun runs” benefit local schools or needy families. Some are in memory of people affected by illness or tragedy. Visit Running in the USA to find 5K races near you.

What to do before you start

If you’re planning to walk or run your first 5K, get your doctor’s approval before you start training. That’s especially important if you have heart disease or are at risk for it.

Comfortable walking or running shoes are a wise investment. Shoes that are too old or too tight in the toe box can cause or aggravate a bunion, a bony bump at the outer base of the big toe. Despite suggestions that people with flat feet or high arches need specific types of shoes, studies have found that neutral shoes (designed for average feet) work well for almost everyone. Walk or jog around the store when you try them on to make sure they feel good and fit properly.

You don’t need to buy special clothes; regular sweat pants or comfortable shorts and a t-shirt will suffice. Women should consider getting a supportive sports bra, however.

Go slow and steady when training

• Always include a warm-up and cool-down — a few minutes of slow walking or jogging — with every exercise session.
• If you haven’t been exercising regularly, start by walking just five or 10 minutes a day, three days a week. Or, if you’re already a regular walker, add some short stints of jogging to each walking session.
• Gradually add minutes and days over the following four to six weeks.
• Once you’re up to 30 minutes a day, check how far you’re traveling. Keep increasing your distance every week until you reach 5 kilometers. Then slowly phase in more jogging and less walking over your route if you like.

Remember that you can always repeat a week. You’re less likely to sustain an injury if you make slow, steady progress. Pay close attention to your body and don’t push yourself too much, Dr. Tenforde advises. Former athletes who haven’t run in years may think they can pick up where they left off, but that’s not a smart move — they should also start low and go slow.

For a good couch-to-5K guide, try this beginner’s program from the United Kingdom’s National Health Service.

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

You’re in a doctor’s office with a clipboard and a pile of medical forms on your lap. For the umpteenth time, you must now jot down your medical history — conditions, ongoing symptoms, past procedures, current medications, and even the health of family members.

But how much information should you include? Which details are most important? And why are you slogging through paper forms when a digital version likely exists? Put down your pen for a moment and take a breath. We have some answers.

Do you actually need to fill out the forms again?

In many cases, you do need to fill out medical history forms. That can be true even if you already have a digital record on file, known as an electronic medical record (EMR) or electronic health record (EHR).

The reason for collecting new information could be due to a variety of reasons:

• The health care provider might want an update, since information like medications or new health problems can change over time, or you might have missing or inaccurate information in your record.
• Different specialists need to know about different aspects of your health.
• Your EMR at one provider’s office might not be accessible to others because practices don’t always have compatible computer software.
• Some practices don’t want to rely on records created by other practices. They may not trust that they’re accurate.

What if you don’t want to fill out the forms?

“You don’t have to,” says Dr. Robert Shmerling, a rheumatologist and senior faculty editor at Harvard Health Publishing. “But the response from the practice might be, ‘How can we provide the best care if you don't provide the information?’ And if you persist, you run the risk of marking yourself — unfairly, perhaps — as uncooperative.”

What are the most important details in your medical history?

The most important details of your medical history include

• chronic or new symptoms and conditions
• past surgeries
• family medical history
• insurance information
• current prescription and over-the counter medicines, supplements, vitamins, and any herbal remedies or complementary medicines you use
• medication allergies
• vaccination history
• any screening tests you’ve had, so they won’t be prescribed unnecessarily
• any metal implants you have, which could affect screenings.

If you don’t know all of the details, try to get them from a previous doctor or hospital you’ve visited.

“In some cases, not having the information could be a problem. For example, I need to know if my patients have had certain vaccines or if they have medication allergies,” says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Which information might be less important?

Sometimes, leaving out certain details might not matter, depending on the purpose of your health visit. For example, your eye doctor doesn’t need to know that you broke your wrist when you were 18, had the flu last year, or had three C-sections. But they should know which medicines and supplements you take, and whether you have certain health conditions such as diabetes or high blood pressure.

Not sure what to leave in or out of your history? Dr. Salamon suggests that you at least focus on the big stuff: chronic symptoms and conditions that need ongoing treatment, medications and supplements you’re taking, and your family medical history.

“If you can, bring a copy of your medical history to all new doctor appointments. It could be written or printed from your patient portal or kept handy on a digital health app. That way, you’ll have it handy if you need to fill out medical forms or if the physician asks you questions about your medical history during an appointment,” Dr. Salamon advises.

How secure is the information you’re providing?

We trust health care professionals with our lives and our most private information, including our social security numbers (SSNs). SSNs are used to double-check your identity to avoid medical errors, and to make sure your insurance information is accurate and practices get paid.

Is it really safe to hand over the information? It’s supposed to be. A federal law called the Health Insurance Portability and Accountability Act (HIPAA) protects your health information with very strict rules about who can access it and how it can be shared.

“Medical practices take this very seriously,” Dr. Shmerling says. “They have lots of safeguards around personal health information, and routinely warn medical staff about not looking at or sharing information inappropriately — with the threat of being fired immediately if they do. Electronic health records usually track those who look at our information, so it's often not hard to enforce this.”

But no hospital or other entity can guarantee that your information is protected. That’s true of all information, especially with the constant threat of cyberattacks.

“So if you feel strongly about it, you can try saying that you’d rather not provide certain information and ask whether the practice can explain why it’s necessary,” Dr. Shmerling says. “It takes a certain amount of trust in the system that personal health information will be kept private, even though that may feel like taking a leap of faith.”

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

By the time boys are 8 or 10, they’re steeped in Marvel action heroes with bulging, oversized muscles and rock-hard abs. By adolescence, they’re deluged with social media streams of bulked-up male bodies.

The underlying messages about power and worth prompt many boys to worry and wonder about how to measure up. Sometimes, negative thoughts and concerns even interfere with daily life, a mental health issue known body dysmorphic disorder, or body dysmorphia. The most common form of this in boys is muscle dysmorphia.

What is muscle dysmorphia?

Muscle dysmorphia is marked by preoccupation with a muscular and lean physique. While the more extreme behaviors that define this disorder appear only in a small percentage of boys and young men, it may color the mindset of many more.

Nearly a quarter of boys and young men engage in some type of muscle-building behaviors. “About 60% of young boys in the United States mention changing their diet to become more muscular,” says Dr. Gabriela Vargas, director of the Young Men’s Health website at Boston Children’s Hospital. “While that may not meet the diagnostic criteria of muscle dysmorphia disorder, it’s impacting a lot of young men.”

“There’s a social norm that equates muscularity with masculinity,” Dr. Vargas adds. “Even Halloween costumes for 4- and 5-year-old boys now have padding for six-pack abs. There’s constant messaging that this is what their bodies should look like.”

Does body dysmorphic disorder differ in boys and girls?

Long believed to be the domain of girls, body dysmorphia can take the form of eating disorders such as anorexia or bulimia. Technically, muscle dysmorphia is not an eating disorder. But it is far more pervasive in males — and insidious.

“The common notion is that body dysmorphia just affects girls and isn’t a male issue,” Dr. Vargas says. “Because of that, these unhealthy behaviors in boys often go overlooked.”

What are the signs of body dysmorphia in boys?

Parents may have a tough time discerning whether their son is merely being a teen or veering into dangerous territory. Dr. Vargas advises parents to look for these red flags:

• Marked change in physical routines, such as going from working out once a day to spending hours working out every day.
• Following regimented workouts or meals, including limiting the foods they’re eating or concentrating heavily on high-protein options.
• Disrupting normal activities, such as spending time with friends, to work out instead.
• Obsessively taking photos of their muscles or abdomen to track “improvement.”
• Weighing himself multiple times a day.
• Dressing to highlight a more muscular physique, or wearing baggier clothes to hide their physique because they don’t think it’s good enough.

“Nearly everyone has been on a diet,” Dr. Vargas says. “The difference with this is persistence — they don’t just try it for a week and then decide it’s not for them. These boys are doing this for weeks to months, and they’re not flexible in changing their behaviors.”

What are the health dangers of muscle dysmorphia in boys?

Extreme behaviors can pose physical and mental health risks.

For example, unregulated protein powders and supplements boys turn to in hopes of quickly bulking up muscles may be adulterated with stimulants or even anabolic steroids. “With that comes an increased risk of stroke, heart palpitations, high blood pressure, and liver injury,” notes Dr. Vargas.

Some boys also attempt to gain muscle through a “bulk and cut” regimen, with periods of rapid weight gain followed by periods of extreme calorie limitation. This can affect long-term muscle and bone development and lead to irregular heartbeat and lower testosterone levels.

“Even in a best-case scenario, eating too much protein can lead to a lot of intestinal distress, such as diarrhea, or to kidney injury, since our kidneys are not meant to filter out excessive amounts of protein,” Dr. Vargas says.

The psychological fallout can also be dramatic. Depression and suicidal thoughts are more common in people who are malnourished, which may occur when boys drastically cut calories or neglect entire food groups. Additionally, as they try to achieve unrealistic ideals, they may constantly feel like they’re not good enough.

How can parents encourage a healthy body image in boys?

These tips can help:

• Gather for family meals. Schedules can be tricky. Yet considerable research shows physical and mental health benefits flow from sitting down together for meals, including a greater likelihood of children being an appropriate weight for their body type.
• Don’t comment on body shape or size. “It’s a lot easier said than done, but this means your own body, your child’s, or others in the community,” says Dr. Vargas.
• Frame nutrition and exercise as meaningful for health. When you talk with your son about what you eat or your exercise routine, don’t tie hoped-for results to body shape or size.
• Communicate openly. “If your son says he wants to exercise more or increase his protein intake, ask why — for his overall health, or a specific body ideal?”
• Don’t buy protein supplements. It’s harder for boys to obtain them when parents won’t allow them in the house. “One alternative is to talk with your son’s primary care doctor or a dietitian, who can be a great resource on how to get protein through regular foods,” Dr. Vargas says.

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

As wildfires become more frequent due to climate change and drier conditions, more of us and more of our communities are at risk for harm. Here is information to help you prepare and protect yourself and your family.

How does wildfire smoke affect air quality?

Wildfire smoke contributes greatly to poor air quality. Just like fossil fuel pollution from burning coal, oil, and gas, wildfires create hazardous gases and tiny particles of varying sizes (known as particulate matter, or PM10, PM2.5, PM0.1) that are harmful to breathe. Wildfire smoke also contains other toxins that come from burning buildings and chemical storage.

The smoke can travel to distant regions, carried by weather patterns and jet streams.

How does wildfire smoke affect our health?

The small particles in wildfire smoke are the most worrisome to our health. When we breathe them in, these particles can travel deep into the lungs and sometimes into the bloodstream.

The health effects of wildfire smoke include eye irritation, coughing, wheezing, and difficulty breathing. The smoke may also increase risk for respiratory infections like COVID-19. Other possible serious health effects include heart failure, heart attacks, and strokes.

Who needs to be especially careful?

Those most at risk from wildfire smoke include children, older adults, outdoor workers, and anyone who is pregnant or who has heart or lung conditions.

If you have a chronic health condition, talk to your doctor about how the smoke might affect you. Find out what symptoms should prompt medical attention or adjustment of your medications. This is especially important if you have lung problems or heart problems.

What can you do to prepare for wildfire emergencies?

If you live in an area threatened by wildfires, or where heat and dry conditions make them more likely to occur:

• Create an evacuation plan for your family before a wildfire occurs.
• Make sure that you have several days on hand of medications, water, and food that doesn't need to be cooked. This will help if you need to leave suddenly due to a wildfire or another natural disaster.
• Regularly check this fire and smoke map, which shows current wildfire conditions and has links to state advisories.
• Follow alerts from local officials if you are in the region of an active fire.

What steps can you take to lower health risks during poor air quality days?

These six tips can help you stay healthy during wildfire smoke advisories and at other times when air quality is poor:

• Stay aware of air quality. AirNow.gov shares real-time air quality risk category for your area accompanied by activity guidance. When recommended, stay indoors, close doors, windows, and any outdoor air intake vents.
• Consider buying an air purifier. This is also important even when there are no regional wildfires if you live in a building that is in poor condition. See my prior post for tips about pollution and air purifiers. The EPA recommends avoiding air cleaners that generate ozone, which is also a pollutant.
• Understand your HVAC system if you have one. The quality and cleanliness of your filters counts, so choose high-efficiency filters if possible, and replace these as needed. It's also important to know if your system has outdoor air intake vents.
• Avoid creating indoor pollution. That means no smoking, no vacuuming, and no burning of products like candles or incense. Avoid frying foods or using gas stoves, especially if your stove is not well ventilated.
• Make a "clean room." Choose a room with fewer doors and windows. Run an air purifier that is the appropriate size for this room, especially if you are not using central AC to keep cool.
• Minimize outdoor time and wear a mask outside. Again, ensuring that you have several days of medications and food that doesn't need to be cooked will help. If you must go outdoors, minimize time and level of activity. A well-fitted N95 or KN95 mask or P100 respirator can help keep you from breathing in small particles floating in smoky air (note: automatic PDF download).

About the Author

Wynne Armand, MD, Contributor

Dr. Wynne Armand is a physician at Massachusetts General Hospital (MGH), where she provides primary care; an assistant professor in medicine at Harvard Medical School; and associate director of the MGH Center for the Environment and … See Full Bio View all posts by Wynne Armand, MD