When should a parent disclose? How should they tell them? What will a child ask? Will they ever forgive the parents who infected them? Are silence and secrecy justified to protect a child from a painful diagnosis?

Two pioneers who have peered into the disclosure cauldron are Lori W. Wiener, coordinator of the Pediatric HIV Psycho-Social Support and Research Program at the National Institutes of Health, and Heidi Haiken, coordinator of Social Work at the Francois Xavier Bagnoud Center in Newark, N.J., an innovative program that works with parents and children with HIV.

For more than 10 years, Haiken and Wiener have worked with hundreds of families infected with and affected by HIV on the emotional and social issues related to the disease. Wiener, who has a PhD, has researched and written about the impact of disclosure on family members.

Their combined experiences have produced two cardinal rules for parents of children infected with chronic, viral infectious diseases:

1. Never lie. You don’t have to name the disease if children are very young, but never, never lie. The damage to the parent-child relationship will surpass any short-lived benefits gained by deceit.
2. Disclose as early as you can, especially once kids start asking questions. The longer you wait, the harder it gets and the greater your chance of undermining your child’s trust in you.

“We even tell parents who come to the center that if they don’t tell the kids by the time they reach sexual maturity, we will,” Haiken said. “But of course it’s much, much healthier to have this information come from the parents.”

Both women acknowledge that disclosing is very traumatic for parents. “For some parents, it’s just devastating,” said Haiken. “They feel guilt because they infected the child because of their past sexual behavior or drug use. They feel guilt that the child has to suffer. Even for parents of children who contracted it from transfusions or are adopted, disclosure is extremely difficult.”

Wiener, who has written several research papers on this topic, found the longer parents withheld the diagnosis, the more embedded the lies became and the harder it became to disclose the truth. “Parents often fear that once they disclose new and different information, that their child will no longer trust them,” she said. “Following disclosure, many of these children feel embarrassed that other people in their family have been aware of the diagnosis before they had been informed. Once disclosure takes place, these issues and feelings can be successfully dealt with in individual and group counseling sessions with parents and children.”

Haiken and other social workers at the center work hard to help parents work through their guilt, or at least face it without flinching, before they disclose.

“I tell them you didn’t mean for this to happen, it’s clear you never wanted to hurt your child, look at all the wonderful things you’ve done for your child,” said Haiken. “After a while they get there, they see it, but it’s still very difficult. No parent ever wants to infect her child. It’s something they felt they had no control over.”

In terms of disclosure, parents who are themselves living with HIV have additional challenges to face. They fear disclosing their own life-threatening disease to their children. But generally, says Wiener, by the time children reach ages 6 to 10, they realize the consequence and finality of death. It is useless to shield children this age from the knowledge that their parents have a serious or terminal illness.

The disclosure process, timetable and style are often dictated by the parents’ health. Can they focus on their kids and execute disclosure, or are their own health problems overwhelming? Are they getting the support and time they need or are their own medications, insurance forms and other factors too overwhelming?

“Foster or adoptive parents have the luxury of not having to worry about their own illnesses, so the emotional and financial stress on the entire family may not be as intense,” noted Haiken.

The journey to disclosure begins early, says Wiener. “The child and parent should first have a sense of trust—that is the highest priority.” Disclosure occurs little by little in age-appropriate ways as soon as a child can communicate. Just like talking about adoption, it’s always on the table, though not all the details or medical terms may be exposed just yet.

Ideally, when the parent discloses the conversation should go something like this, suggests Wiener.

“Do you remember when I told you that you had a germ in your blood? That’s why we have blood work done every year. (And) Do you remember I told you that you got the germ from blood? Well, that germ is a virus that is called HIV or hepatitis….”

“You see, the disclosure dialogue is a constant building process,” she said. “If the child asks why the parent didn’t tell them earlier, the parent needs to be able to say, ‘I never lied to you, I told you what was wrong, I just hadn’t told you name of the virus.”

It may take a child weeks, months or years to absorb the diagnosis. “Try to be where the child is at when they ask questions,” wrote Wiener. “Let the child know that no matter how difficult the subject matter, he or she can always ask questions or share feelings. Be careful, however, not to provide more information than the child wants or is prepared for. They may not be ready for a virology discussion.

“You never want to be in the position of telling a 12 year-old about his or her disease that you have never even referred to before,” she added. “That is my main concern in the disclosure process. We’ve interviewed a lot of children who have been disclosed to. Most felt they had been told at the right age and by the right person except those whose parents had a doctor tell them. Those were the only kids who remained upset about the disclosure process.”

At NIH, counselors work intensely with parents of HIV-infected children to prepare them for the disclosure discussion. Social workers even have parents write out what they will tell their children and then play the part of the child in role-play situations. Generally, parents should be prepared to answer the following questions, depending on the child’s age and development. (Some questions apply if the parent is infected also.)

Why did this happen to you?

Where did you get it from?

Are you going to die?

Am I the reason you got sick?

Who else in the family has it?

Why do I have it?

Why don’t (siblings) have it?

Am I going to die?

Will this hurt?

Who else knows I have this?

Who can I tell?

What will happen to me and (siblings)?

Can I get married?

Can I have children?

Here are some general guidelines Wiener has identified for parents to consider as they prepare for the disclosure discussion.

Where do you want to make the disclosure and who should be part of the discussion?  

“You don’t want to have a ton of people there, just those whom the child trusts and feels most comfortable with,” cautioned Wiener. “Try to anticipate the child’s response based on his or her emotional age and maturity. Be careful never to disclose when you’re angry, or during an argument. Have the discussion in a safe, comfortable environment.”

What is the most important message you want your child to walk away with from this discussion?  

Possibilities include: Nothing is going to change… I am just now giving you the name of the virus… We will always be there for you… I will never lie to you… Nothing you did caused this disease.

How exactly will you disclose the actual diagnosis?  

“We have parents write out how they’d like it to happen, and they always start out with, ‘Do you remember?’ Weave in pertinent aspects of the child’s life and pick up the threads of your past discussions about infections,” suggested Wiener. “Rehearse the questions and answers, including ‘How did I get it? Can I get married? Can I have kids? Who else knows about it?’”

If the diagnosis is to be kept secret, who else can the child talk to?  

“If parents tell a child not to tell anyone, the first thing a child will do is go tell someone,” said Wiener. “They’ll feel resentful if they have no one to talk to. Parents need to find others in the community for the child to talk to. If there isn’t anyone nearby and the child wants to tell his or her best friend, I would tell them to talk with me, the parent, first. I would explain that not everyone is as educated as we are, and it’s important that we make a plan and educate the friend about this infection first. After all, we don’t want anyone to treat us badly.”

Give child a journal or diary or a way to express their feelings about the infection.  

Encourage the child to use art or writing to express feelings. “If HIV had a face, what would it look like? Or start a discussion with, ‘If I had a million dollars, I would get rid of this virus. What would you do with a million dollars?’ Keep those discussions going,” Wiener suggested.

“It is usually not until days or weeks after disclosure that the child has the courage to ask more questions,” she added. However, after finally making the disclosure, some parents feel so relieved and so exhausted from the ordeal that they may not have the emotional energy to talk about it again. This blocks open communication at a time when sharing concerns about the disease and its impact on the family is most important.

Red flags to look for in a child following disclosure.  

These include difficulty sleeping, changes in appetite, withdrawal, ticks, new fears, mood changes, difficulty concentrating or hoarding things.

If you see any such problems, talk to your child and if necessary, seek help from a social worker or psychotherapist. Remember, disclosure is not a one-time event and a child needs constant reassurance that they did not cause the disease.

Don’t forget siblings in the disclosure process.

Whether or not a sibling is told depends on age, said Wiener. “If the sibling is close in age, I don’t make it a choice, the sibling must be told. But, I do give them a choice of whether the infected child tells the sibling or if the parents tell the sibling. You need to give the child a sense of control. Living with secrets in the home does not promote a healthy emotional climate. I try to minimize the amount of secrets or lying that’s going on. However, if there’s a medical procedure or if they’re on interferon which makes them grouchy, it’s important that siblings know why.”

Even after disclosure is made, the full reality of the diagnosis may not come about for years. “It may not be until someone dies, or they get sick for the first time or they can’t go to a party and drink like everyone else that the reality really sinks in,” said Wiener. “At that point, it becomes an emotional reality, not just an intellectual reality.”

Wiener finds most parents do feel relief after making disclosure. The burden of secrecy is lifted, and children who already intuitively know something is wrong often feel better after they are told of their diagnosis. Siblings, especially if they are older, are also relieved when the veil of secrecy is lifted.

“The demands of keeping the family secret is a heavy burden for a young sibling and may threaten healthy development,” Wiener wrote in a study of siblings of HIV-infected children. “As inquisitive peers begin asking siblings why their brother or sister is sick, it becomes increasingly difficult not to tell the secret. One 9-year-old girl describes: ‘I want to tell people. Right when I almost say it, I remember in my head I’m not allowed to.’”

Resentment of the special treatment given to the sick sibling may cause the healthy sibling to feel less loved, Wiener explained, particularly if no explanation for the preferential treatment is provided.

Heidi Haiken, who has worked with more than 400 HIV-infected kids, has found disclosure to be beneficial to parents and kids alike. “By and large, the kids do well and are glad they’ve been told,” she said.

But disclosure is just a step in the journey. Parents must be prepared to ask, probe and continue the dialogue about health safety, standard precautions, medical treatments, good nutrition and the fundamentals of safer sex with their infected children.

“In our program, we start teaching safer sex at age 10 to 13,” said Haiken. “We give out condoms, talk about masturbation and how to keep yourself and your partner safe. We don’t deny they’re sexual beings, we focus on how to be safe with it, how drugs and alcohol can make you do things that aren’t safe.”

That safer sex discussion is just one more elaboration on the discussion that began when parents tell their infected toddlers never to touch anyone’s “boo-boos.”

Most parents of infected children and teens don’t have a Heidi Haiken or Lori Wiener in their hometowns. And, they can’t count on local schools to teach standard precautions or to delve into the nitty gritty of safer sex procedures. Most parents must be open and honest as they continue these discussions, no matter how painful or awkward, throughout their children’s lives.

By PKIDs staff

Dr. Paul Offit, Director, VEC

The science of vaccines can be . . . daunting. The lists of ingredients and potential side effects make us want to second guess ourselves and our children’s providers. We need to be sure we’re making safe choices.

And the complicated schedules! They’re enough to make sane people pound their heads.

The folks at the Vaccine Education Center (VEC) at Children’s Hospital of Philadelphia have a gift for presenting the complexities of vaccines and attending issues in a way that’s easy to understand yet comprehensive in scope.

The VEC website has a special section for parents and adults of all ages.  While there, you can sign up for the Parents PACK newsletter to get monthly immunization updates.  In the March issue, there’s a timely post on measles and the dangers of rubella parties.

You’ll also find age-specific information on vaccines and the diseases they prevent. There are FAQs, but if you can’t find your question, you can send it in via a form provided on the site.

The VEC has created a library of educational materials on specific vaccines and commonly asked questions. These resources range from information sheets to more consumer-friendly bookmarks and brochures.

They also maintain essential tools, including vaccine schedules, facts about vaccine preventable diseases, and the latest in vaccine science.

To keep information fresh, the VEC pens a monthly “Ask the VEC” on a myriad of topics.

Starting in 2011, the VEC will present three or four webinars a year addressing evolving issues, recent ACIP meetings, new science and media reports.

There are layers and layers of information available on the website, for those of us who feel more is better.  And what parent doesn’t?

The VEC staff constantly works at sifting vaccine fact from fiction and explaining the difference in ways we can all understand.  If you have questions, they’re worth checking out.

Photo Credit: James Gathany, CDC

“Sweet spring is your time is my time,” wrote poet e.e. cummings. It also happens to be the time for ticks that harbor the bacteria that cause Lyme disease, and sweet springs that harbor Giardia lamblia, an intestinal parasite guaranteed to get your intestines roiling.

Beautiful weather and warming temperatures draw people to the great outdoors, where they’ll put hiking boot to path in many places where these threats lie in wait. Borrelia burgdorferi, the bacterium responsible for Lyme disease, lurks in the blood of two of its hosts, mice and deer. Ticks take up the microbe along with their blood snack, and when they snack on you, the microbe transfers along with some tick saliva. Ewww.

While you are most at risk of encountering a Borrelia-toting tick in the northeastern United States, the ticks that carry it live throughout the country, anywhere their hosts and good weather await.

If you find a tick, gently tweeze it out by grasping it near the head (that old “match to the tick” solution will only singe your body hair). Watch for the telltale signs of a Lyme infection, which can include a bullseye rash that forms around the bite. Note also that you can pick up a tick bite not only from hiking or hunting where ticks occur, but also from walking in tall grasses, gardening, or from a pet that’s carrying them around.

If a tick bites you, keep an eye out for symptoms for 30 days. The good news about Lyme is that most people with tick bites don’t develop it, and an antibiotic treatment will usually take care of the disease if you do get it.

Ticks can be practically invisible and difficult to avoid in some places, but you can always be careful about the water you drink. And careful you should be, because in many of the most beautiful places in the U.S., swimming in that cool mountain stream is a nasty little pathogen, Giardia lamblia. While it has been associated with food-borne outbreaks and oro-genital contact, in the wild, this unwelcome microscopic protist emerges from the intestines of woodland creatures via poop to end up in water sources.

If you drink that water without filtering it first, using a water filter that keeps G. lamblia out of your mouth, you’ll swallow Giardia cysts along with that cool drink. Giardia will take advantage of the homey environment of your intestines, and in a week or two will start reproducing. Your end of the bargain is debilitating intestinal symptoms that can last for weeks. Treatments are available, but giardiasis can often resolve on its own, if unpleasantly.

The history of anxiety about possible negative effects of vaccines is long, tracing back at least as far as Benjamin Franklin. Countering these worries is the fact that vaccines are one of the greatest public health successes of our time, saving millions of lives worldwide.

Now we know that vaccine benefits may extend beyond prevention of the target childhood disease.

An already recognized extra benefit comes with the vaccines for varicella. A varicella vaccine not only can prevent chickenpox in young people, but may also stop the occurrence of shingles in older folks.

Shingles, a neurological attack by the chickenpox virus decades after an infection, can cause a rash that leaves behind chronic, unbearable pain. Vaccination in childhood may protect against shingles, and according to a new study from a Texas group, published in The Journal of Pediatrics, childhood vaccines may offer reduced odds of childhood cancer.

The researchers, going on hints from earlier studies, looked at vaccine rates in specific areas and compared those numbers to childhood cancer rates in the same region. While childhood cancers are rare, they are, of course, devastating. The most common cancers in children are leukemia and brain and spinal cord cancers. According to previous studies, some common childhood infections might increase a child’s risk of leukemia, while vaccinations might reduce that risk. It’s not a nutty idea that some infections—especially viral infections—might be associated with cancer. Indeed, a few viral infections have an established association, including human papillomavirus (HPV, associated with cervical and anal cancers), hepatitis B (associated with liver cancer), and Epstein-Barr (the “mono” virus, linked to a type of lymphoma).

The researchers looked at the 2800 cases of childhood cancer diagnosed in Texas from 1995 to 2006, focusing only on cases diagnosed in children two years or older. For every child diagnosed with cancer, the team identified four more children who had not had cancer, matched for age and sex. As a final step, they then mapped how many children from each group had been born in Texas counties with high vaccination rates.

Their results showed that where hepatitis B vaccination rates were high, odds of all childhood cancers fell by almost 20%. Where rates of inactivated polio virus, hepatitis B, or a specific mix of childhood vaccinations were high, odds of finding cases of a common childhood leukemia, acute lymphoblastic leukemia (ALL), dropped by as much as 38%. The biggest dip in odds came with higher rates of Hib (Haemophilus influenzae type b) vaccine and ALL, with a 42% decrease in ALL odds where Hib vaccination rates were high.

It’s important to remember that the authors didn’t establish a cause–effect link here. This study is based on the numbers, and the take-home message here is a simple one. The authors put it best in their abstract: “Some common childhood vaccines appear to be protective against ALL at the population level.”

What a relief! As parents, this is what concerns us about our teens having sex.  “Sure,” we boast, “Hannah’s having sex, but  that little highschooler is cranking out As like there’s no tomorrow!”

This study, presented at a recent American Sociological Meeting, confirmed that teens having sex while in a “serious” relationship did much better in school than teens having casual sex.

Does this mean we should be rooting for a committed relationship for our kids? Or rooting for a time machine to take us back before these gosh darn people presented their findings?

What we really fear is that our teens will find out about this and adopt it as their new slogan: Sex = Good Grades!  Wootwoot!

This is a conundrum for us.  Our organization supports science-based information.  We applaud the study—the effort put forth to bring us this piece of information.  But, we are also parents, and many of our offspring are (gulp) teenagers.

We don’t care that having sex while in a “serious” relationship doesn’t affect grades.  It can affect one’s STI status, and make one a parent before the baby fat has gone from one’s cheeks.

This may sound strange but, moms and dads, if your pimply-faced darling’s grades start to improve, maybe it’s time to worry.

A new study “F as in Fat: How Obesity Threatens America’s Future 2010”  released by the Trust for America’s Health and the Robert Wood Johnson Foundation (RWJF) found that 1/3^rd of American children are now overweight or obese and nearly 10% of infants and toddlers are overweight. That is triple (triple!!) the childhood obesity rate of 1980.

Polls reveal that many parents believe that childhood obesity is a big problem, yet fail to recognize the problem within their own household. Obesity in children (defined as a body mass index, or BMI, between the 85^th and 96^th percentile for their age and gender) is reaching such epidemic proportions that Dr. James Marks, RWJF’s senior vice president says,“We’re in danger of raising the first generation of children who could live sicker and die younger than the generation before them” [emphasis added].

First Lady Michelle Obama is tackling the issue with the Let’s Move! campaign, a national effort to bring healthier food to schools and to low-income areas, and to get kids exercising.

From a health standpoint, there are few things a parent can do for a child that are more important than introducing a healthy lifestyle and eating habits.

According to the American Academy of Pediatrics (AAP), here are some actions parents and families can take to encourage healthier habits in kids:  

1. Make sure your child eats breakfast daily
2. Choose family meals together rather than eating out
3. Limit screen time (less than 2 hours per day is recommended)
4. Pay attention – relatively speaking your child may look “healthy,” but keep in mind that he/she may be surrounded by other overweight kids
5. Encourage your child to get at least one hour  of exercise each day

It’s been shown time and again that too much screen time, whether sitting in front of video games, television, phones, or computers, is linked to insufficient exercise and an overall sedentary lifestyle, which in turn can lead to overweight kids. Along with eating foods overly packed with fat and calories (such as fast food) American kids are spending too much time sitting around.

In the words of a Nike commercial, we need to get our kids up off the couch, get them outside, and inspire them (hopefully with our own active healthy example) to“Just Do It!”

Help your daughter enjoy the magic of summer reading by sharing these gems with her. Organized by grade, these five books are full of girl-power and sure to inspire your younger daughters.

1. Madeline by Ludwig Bemelmans (Preschool and Kindergarten)

Who can resist the picture-goodness of Madeline, the little French girl with a brave and adventurous spirit?  Madeline makes mischief, but also finds adventure and new friends as she travels around the great cities of Europe, including London, Paris and Rome. Madeline is for all the little girls with brave hearts.

2. Daisy Dawson is on Her Way by Steve Voake (1^st, 2^nd grade)

Daisy’s tendency to dawdle leads her on a great adventure with animals. Given the gift of talking to animals by a butterfly, Daisy soon grows close to a dog and a horse and many other animal friends. Join Daisy in this first book of a series, as she learns more about friendship on the road to many adventures.

3. Anne of Green Gables by L.M. Montgomery (3^rd, 4^th, 5^th grade)

Who doesn’t love an orphaned redhead with verbal precocity and a knack for getting into scrapes? Join Anne in the first of the series that follows her as she finds a family and makes friends and mischief on Prince Edward Island at the turn of the last century. Her fiercely independent spirit and creative resiliency are also captured in the Hallmark Hall of Fame movie version of the story, starring Megan Followes.

4. Harriet the Spy by Louise Fitzhugh (3^rd, 4^th, 5^th grade)

Harriet is not just a well-off little girl with a strict but loving governess living in Manhattan. She is, more importantly, a spy, with a daily “spy route” and an ever-present notebook. Her wry observations and stealthy adventures, including the often-told “dumbwaiter” exploits, will light the imaginings of any reader.

5. Wrinkle In Time by Madeleine L’Engle (6^th, 7^th, 8^th grade)

Many of us come to science fiction through the ominous opening line of this wonderful book by Ms. L’Engle (“It was a dark and stormy night…”). Join heroine Meg Murray, an incredibly bright but awkward girl making her way in a puzzling world, as she and her family are visited by a dark stranger, who has fallen through a “wrinkle in time” (a “tesserac”) on his way to another world. The first in a marvelous series your daughter will remember fondly when she’s older.

Any books we left out that you’d recommend?

Visit Your Libraries

Local Library

Check with your local library to see if they have the journal in question, or if they can get it in for you. This may be your only recourse for getting full articles at no cost, even if you have to wait awhile to get the journal.

Nearest Medical Library

If your local library doesn’t have or cannot get the journal or article you want, contact your nearest medical library. Call the National Network of Libraries of Medicine at 800-338-7657 or visit their website to locate your nearest library. (You can’t call this number to get help finding information, but they can help you locate a library.)

Order Online Through PubMed

Loansome Doc

PubMed is primarily for medical students and professionals, which is why it provides a service called Loansome Doc that enables you to 1) find medical libraries in your state serving the general public, and 2) easily and conveniently order journal articles through PubMed.

When viewing an article’s abstract, clicking on the “Send To” link opens a box from which you can select “Order.” Clicking the “Order articles” button will direct you to enter your Loansome Doc login information.

Ordering option for Loansome Doc

Registration for Loansome Doc is free; you only pay when you order an article. To sign up for Loansome Doc, visit the Loansome Doc signup page.  The first step will help you locate a medical library near you. You will need to contact the medical library of your choice to get signed up with them.

If you are not a healthcare provider or student, the medical library will consider you an “unaffiliated user.” Each library will have different criteria regarding unaffiliated users, pricing, and document delivery formats (hardcopy vs. electronic, e.g.).

LinkOut

If you click on an article’s title in your PubMed search results, you can click “LinkOut” at the bottom of the abstract to see online sources providing full text. You do not need a Loansome Doc account for these, but you may have to set up an account on the website of the online source to place an order.

Viewing options for ordering under LinkOut

So to sum up:

• Try your local library or visit a medical library (if you have one close to you).
• If you are planning to order articles on a relatively frequent basis, sign up for Loansome Doc so you can place all your orders from within PubMed.
• If you are planning to order articles relatively infrequently, try ordering from a LinkOut service.

What’s MeSH? Sounds messy.

MeSH (Medical Subject Heading Terms) terms are medically-oriented keywords. Because PubMed is indexing medical journal articles, you will generate better search results if you use medical terms used by PubMed. Previously, our approach was:

1. Enter keywords into PubMed
2. Get results

Using MeSH terms, our approach will be:

1. Enter keywords in MeSH to find MeSH terms
2. Enter those MeSH terms into PubMed
3. Get more targeted results

Great! How do I do this?

First, go to the MeSH homepage. Then enter a keyword in the search box, and click the “Go” button. In this example, we’ve entered “hepatitis” and the results are displayed below the term.

Click to enlarge

Every term or phrase listed here by number is a MeSH search term. Below each term is the definition for that term. Find the terms that most closely match what you have in mind, and check the box next to them. Then click the “Send to” drop-down box and choose “Search Box with AND.” A second search box appears above your search results with the MeSH term inside.

Click to enlarge

Now you can add additional MeSH terms to further refine your search. Try entering “child” in the field at the top, and click “Go” to get MeSH terms related to “child.” Then click the box(es) next to your desired terms, and send them to the search box as you did in the step above.

If you want to exclude a term, choose “Search Box with NOT.”

If you want to search for articles that contain at least one of the terms you’ve sent to the search box, but not necessarily all of them, choose “Search Box with OR.”

Once you’ve sent your desired MeSH terms to the search box, click the “PubMed Search” button directly below it. You will then see a page of results, like the example below:

Click to enlarge

You can now interact with the search results as we discussed in our previous PubMed article. Watch the blog for future articles on PubMed searching.

If you’re ready to dig deep, you can turn to journal articles for more information and research. One way to search journal articles is to visit NIH’s PubMed website.

You can enter keywords into the search box at the top of the page, and you will get results. But you’ll get a lot of them, and some won’t really be as targeted as you’d like. There are a number of ways to get better results, and we’ll be discussing these in upcoming posts, but today we’re going to show you the most economical: Filter by free text!

First, enter some keywords to search by and click the “Search” button. In our demo shots below, we use “chronic pediatric hepatitis.”

PubMed homepage

The next page will shows you some results. Depending on your personality, you’re either happy to see the 488 results returned by this search, or reeling with shock at the thought of sifting through 488 results! But for today’s purposes, we’re going to narrow our results the thrifty way, by clicking on “Free Full Text” on the right side of the screen.

Search results for "chronic pediatric hepatitis"

Below you can see the 61 free, full text articles available to you. Click on the “Free article” link under the citation.

Search results showing only those with free full text available

PubMed shows you services on the right that provide the article’s text free online. Choose one and start reading!

Links to free full text

Watch the blog for more posts on conducting targeted searches and finding full-text articles both on and offline.