Babies who get group B strep a week or so after birth may have signs such as: Decreased movement of an arm or leg. Pain with movement of an arm or leg. Breathing problems. Fever. Red area on the face or other part of the body. Pregnant women may have group B strep without symptoms. When they have symptoms, these may include: Having to urinate ...Meningitis is a disease caused by an inflammation of the meninges, the membranes that surround the brain and spinal cord. It's usually caused by a virus, although it can be caused by bacteria, a fungus, or tuberculosis. Treatment for meningitis depends on the specific cause of the disease. Vaccinations can prevent or minimize the incidence of ...Infants with meningitis can have a variety of symptoms, including: a fever. shivering. a stiff neck. arching of the back. cold hands and feet. turning away from light. excessive irritability, such ...In babies and toddlers, these additional symptoms may occur: swelling in the fontanelle; ... People of any age can get meningitis B. Over half of all cases occur in teenagers and young adults.Sep 2, 2022 · Meningitis is a serious illness that causes inflammation of the membranes around the spinal cord and neck. It can be fatal without prompt treatment. The meningitis vaccine is one of the best ways ... Do not administer meningococcal vaccines to: A person who has ever had a severe allergic reaction (e.g., anaphylaxis) after a previous dose; A person who has a severe allergy to any vaccine component; If otherwise indicated, vaccine providers may administer meningococcal vaccines to pregnant or breastfeeding women.Meningitis is an inflammation of the thin membranes that cover the brain and the spinal cord. It is most often caused by a bacterial or viral infection that moves into the cerebral spinal fluid. A fungus or parasite may also cause meningitis. Meningitis caused by a virus is more common and usually less severe.Apr 28, 2021 · Side effects linked to the vaccines are usually mild and tend to go away within a few days. Herd immunity is unlikely to prevent meningitis, so it is essential that people get vaccinated and have ... The baby was born with Apgar scores of 6 and 8 at 1 and 5 minutes, respectively. Her birth weight was 2.8 kg with a head circumference of 43.5 cm (>99th percentile). Her exam was notable for macrocephaly with bulging fontanelles, large bilateral cleft lip/palate, nasal encephalocele, and bilateral microphthalmia.Meningitis In Babies. Meningitis is an inflammation of the meninges, which is the tissue that surrounds and protects the brain and spinal cord. It’s most commonly caused by viral or bacterial infections. Meningitis is a serious condition that, left untreated, can be fatal in a short period of time and can cause life-altering complications in ... How is meningitis diagnosed in a child? Lumbar puncture (spinal tap). This is the only test that diagnoses meningitis. A needle is placed into the lower back, into the spinal canal. This is ... Blood tests. These can help diagnose infections that cause meningitis. CT scan or MRI. These are tests ... Stiff neck. Other symptoms that can occur with this disease: Agitation. Bulging fontanelles in babies. Decreased alertness. Poor feeding or irritability in children. Rapid breathing. Unusual posture, with the head and neck arched backward (opisthotonos) You cannot tell if you have bacterial or viral meningitis by how you feel.get plenty of rest; take painkillers for a headache or general aches; take anti-sickness medicine for any nausea or vomiting; If you feel unable to manage your symptoms at home or you feel worse, get further medical help. Preventing the spread of infection. The risk of someone with meningitis spreading the infection to others is generally low.Younger kids will need a vaccine if they're at a greater risk of getting meningitis because they: Have complement component deficiency, a rare immune system disease. Have spleen damage or had ...Signs and symptoms in people over the age of 2 may include: High fever that comes on suddenly. Stiff neck. Severe headache that seems unusual. Headache with nausea or vomiting. Confusion or ...Change in behavior – crying more than usual, irritable, more sleepy, confused. Hearing loss. Severe headaches. Bulging soft spot on their head – babies only. If you suspect your child’s bacterial meningitis is coming back or they are getting sicker, take them to the closest hospital emergency department or call 911.Extreme fatigue. Irritability. Blue color to the skin. Babies with group B strep bacteria could get serious complications like these: Pneumonia -- a lung infection. Meningitis -- inflammation in ...GBS disease can be very serious, especially for babies. In the United States, GBS bacteria are a leading cause of meningitis and bloodstream infections in a newborn’s first three months of life. Newborns are at increased risk for GBS disease if their mother tests positive for the bacteria late in pregnancy. 2 to 3 in every 50 babies (4–6% ...Meningitis in children. Meningitis becomes more common in children as they grow older and reach high school and college ages. Symptoms of viral and bacterial meningitis in children are similar to ...Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges). It can affect anyone, but is most common in babies, young children, teenagers and young adults. Meningitis can be very serious if not treated quickly. It can cause life-threatening blood poisoning ( sepsis) and result in permanent damage ... Side effects linked to the vaccines are usually mild and tend to go away within a few days. Herd immunity is unlikely to prevent meningitis, so it is essential that people get vaccinated and have ...The pneumococcal vaccine offers protection against serious infections caused by pneumococcal bacteria, including meningitis. Babies are offered the pneumococcal vaccine as 2 separate injections at 12 weeks with a booster given at 1 year of age. A single dose is offered to adults aged 65 or over. Find out more about the pneumococcal vaccine.Feb 6, 2023 · Meningitis is an infection of the membranes that cover the brain and spinal cord. While meningitis affects people in all age groups, children 2 and younger are most at risk. Without prompt treatment, infants with meningitis can suffer permanent brain damage or even death. Learn more about the causes, symptoms, and treatment of this dangerous ... Jun 15, 2023 · Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges). It can affect anyone, but is most common in babies, young children, teenagers and young adults. Meningitis can be very serious if not treated quickly. It can cause life-threatening blood poisoning (septicaemia) and result in permanent ... Herpes meningoencephalitis is an infection of the brain and brain covering (meninges) caused by the herpes simplex virus. It is a medical emergency that requires treatment right away. Symptoms can include headache, fever, changes in consciousness, confusion, neck stiffness, sensitivity to light, seizures, and changes in mood, personality, or ... Do not administer meningococcal vaccines to: A person who has ever had a severe allergic reaction (e.g., anaphylaxis) after a previous dose; A person who has a severe allergy to any vaccine component; If otherwise indicated, vaccine providers may administer meningococcal vaccines to pregnant or breastfeeding women.Apr 18, 2020 · The baby was born with Apgar scores of 6 and 8 at 1 and 5 minutes, respectively. Her birth weight was 2.8 kg with a head circumference of 43.5 cm (>99th percentile). Her exam was notable for macrocephaly with bulging fontanelles, large bilateral cleft lip/palate, nasal encephalocele, and bilateral microphthalmia. Meningitis is an infection of the membranes that cover the brain and spinal cord. While meningitis affects people in all age groups, children 2 and younger are most at risk. Without prompt treatment, infants with meningitis can suffer permanent brain damage or even death. Learn more about the causes, symptoms, and treatment of this dangerous ...Extreme fatigue. Irritability. Blue color to the skin. Babies with group B strep bacteria could get serious complications like these: Pneumonia -- a lung infection. Meningitis -- inflammation in ...Meningitis signs and symptoms in babies. Your baby might not experience the same meningitis symptoms as adults (like headache, neck stiffness and nausea) and it can be hard to tell even if they are. Some signs of meningitis you can look for in babies include: Bulging “soft spot” (fontanelle) on baby’s head. Poor eating.Mar 22, 2022 · Meningitis in children. Meningitis becomes more common in children as they grow older and reach high school and college ages. Symptoms of viral and bacterial meningitis in children are similar to ... Jun 15, 2023 · Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges). It can affect anyone, but is most common in babies, young children, teenagers and young adults. Meningitis can be very serious if not treated quickly. It can cause life-threatening blood poisoning (septicaemia) and result in permanent ... Summary. Meningitis is inflammation of the thin tissue that surrounds the brain and spinal cord, called the meninges. There are several types of meningitis. The most common is viral meningitis. You get it when a virus enters the body through the nose or mouth and travels to the brain. Bacterial meningitis is rare, but can be deadly.Children can develop meningitis from close contact with a person who has the infection or through surfaces and inanimate objects infected with the germ that causes meningitis. A simple cold or...Dec 22, 2022 · It might surprise you how quickly your baby is picking up new skills. Infant development milestones for a 7- to 9-month-old include sitting, standing and laughing. As your baby becomes more mobile and curious, infant development takes off. It might seem that your baby learns something new every day. Prevention. Treatment. Bacterial meningitis is inflammation of the layers of tissue surrounding the brain and spinal cord (meninges) caused by bacteria . Newborns with bacterial meningitis are usually irritable, vomit, or may have seizures. The diagnosis is based on the results of a spinal tap and blood tests.Meningitis is when the membranes that surround and protect the brain and spinal cord become inflamed and swollen. This usually happens because the membranes, called the meninges, have become infected from bacteria or a virus. The inflammation can then cause damage to the brain or nerves. Among adults 60 years of age and older, the more common signs and symptoms of hydrocephalus are: Loss of bladder control or a frequent urge to urinate. Memory loss. Progressive loss of other thinking or reasoning skills. Difficulty walking, often described as a shuffling gait or the feeling of the feet being stuck.Trust your instincts and do not wait for all the symptoms to appear or until a rash develops. Symptoms of meningitis and sepsis include: a high temperature. cold hands and feet. vomiting. confusion. breathing quickly. muscle and joint pain. pale, mottled or blotchy skin (this may be harder to see on brown or black skin)Specific Immunization Reactions. Pain or swelling at the shot site for 1 to 2 days. (20% of children) Mild fever lasting 1 to 3 days begins 14 to 28 days after the shot (10%). Give acetaminophen or ibuprofen for fever over 102° F (39°C). Never give aspirin for fever, pain or within 6 weeks of getting the shot.Feb 27, 2018 · Viral meningitis is the most common type, but it’s not usually life-threatening. The enteroviruses that cause meningitis can spread through direct contact with saliva, nasal mucus, or feces ... Jun 21, 2021 · through feces, saliva, nasal mucus, sputum, and blister fluid. Epstein-Barr virus: This virus can spread. Trusted Source. through bodily fluids such as saliva. A person can also get it after organ ... Causes Several types of bacteria can cause meningitis. Leading causes in the United States include Streptococcus pneumoniae Group B Streptococcus Neisseria meningitidis Haemophilus influenzae Listeria monocytogenes Escherichia coliExtreme fatigue. Irritability. Blue color to the skin. Babies with group B strep bacteria could get serious complications like these: Pneumonia -- a lung infection. Meningitis -- inflammation in ...Meningococcal bacteria. Meningococcal disease is caused by the bacterium Neisseria meningitidis. There are several different groups of meningococcal bacteria including groups A, B, C, Y and W (previously called W135). These groups of bacteria can be further divided into specific strains. Most cases in New Zealand are caused by group B.purple-red skin rash or bruising. pale or blotchy skin. seizures (fits) The most common symptoms of meningitis in older children and adults are: fever. sensitivity to light. very bad headache and stiff or sore neck. nausea or vomiting and loss of appetite. tiredness and drowsiness. Do not administer meningococcal vaccines to: A person who has ever had a severe allergic reaction (e.g., anaphylaxis) after a previous dose; A person who has a severe allergy to any vaccine component; If otherwise indicated, vaccine providers may administer meningococcal vaccines to pregnant or breastfeeding women.Sep 21, 2021 · In infants, illness caused by group B strep can be within six hours of birth (early onset) — or weeks or months after birth (late onset). Signs and symptoms might include: Fever. Low body temperature. Difficulty feeding. Sluggishness, limpness or weak muscle tone. Difficulty breathing. Irritability. Jitteriness. Having convulsions (seizure) Babies who get group B strep a week or so after birth may have signs such as: Decreased movement of an arm or leg. Pain with movement of an arm or leg. Breathing problems. Fever. Red area on the face or other part of the body. Pregnant women may have group B strep without symptoms.Having convulsions (seizure) Babies who get group B strep a week or so after birth may have signs such as: Decreased movement of an arm or leg. Pain with movement of an arm or leg. Breathing problems. Fever. Red area on the face or other part of the body. Pregnant women may have group B strep without symptoms.Meningitis is an inflammation of the thin membranes that cover the brain and the spinal cord. It is most often caused by a bacterial or viral infection that moves into the cerebral spinal fluid. A fungus or parasite may also cause meningitis. Meningitis caused by a virus is more common and usually less severe. Feb 6, 2023 · Meningitis is an infection of the membranes that cover the brain and spinal cord. While meningitis affects people in all age groups, children 2 and younger are most at risk. Without prompt treatment, infants with meningitis can suffer permanent brain damage or even death. Learn more about the causes, symptoms, and treatment of this dangerous ... Sep 15, 2022 · About 2,000 cases of serious disease (bacteremia, pneumonia with bacteremia, and meningitis) occur each year in children under 5 years old in the United States. These illnesses can lead to disabilities like deafness, brain damage, or loss of arms or legs. About 1 out of 12 children who get pneumococcal meningitis dies. Disease can be localized to skin, eye and mouth (SEM disease), involve the central nervous system (CNS) or manifest as disseminated infection involving multiple organs. Most surviving infants in the latter two categories have neurological sequelae, and the mortality rate in the absence of therapy is very high (80%) for babies in the latter ...Bacterial meningitis. Acute bacterial meningitis must be treated right away with intravenous antibiotics and sometimes corticosteroids. This helps to ensure recovery and reduce the risk of complications, such as brain swelling and seizures. The antibiotic or combination of antibiotics depends on the type of bacteria causing the infection.Babies are at high risk of bacterial meningitis and often have symptoms that mimic other illnesses. Parents should be on the lookout for meningitis symptoms such as high fever, stiff neck, rigid extremities, vomiting, diarrhea, or a skin rash with lots of pinpoint-sized dots ( petechiae ) that are associated with invasive meningococcal disease .Abstract. Group B streptococcus (GBS) infection remains a leading cause of sepsis, pneumonia, and meningitis in infants. Rates of GBS early onset disease have declined following the widcespread use of intrapartum antibiotic prophylaxis; hence, late-onset infections (LOGBS) are currently a common presentation of neonatal GBS dicsease.Feb 26, 2018 · Protecting newborns Seeing a doctor Meningitis is a condition that causes inflammation in the meninges, which protect the brain and spinal cord. Meningitis is most often caused by a virus or... We’re happy to have these conversations for you – it’s our job to make sure you and your baby are safe under our care. When possible, avoid taking your baby to crowded public places for a few months after birth. Herpes infection from incidental touching of strangers or development of other infections from respiratory germs might occur.Meningococcal meningitis and bloodstream infections can be very serious, even deadly. The infections progress quickly. Someone can go from being healthy to very ill in 48 hours or less. Even if they get treatment, about 10 to 15 in 100 people with meningococcal disease will die from it.Causes Several types of bacteria can cause meningitis. Leading causes in the United States include Streptococcus pneumoniae Group B Streptococcus Neisseria meningitidis Haemophilus influenzae Listeria monocytogenes Escherichia coliSpecific Immunization Reactions. Pain or swelling at the shot site for 1 to 2 days. (20% of children) Mild fever lasting 1 to 3 days begins 14 to 28 days after the shot (10%). Give acetaminophen or ibuprofen for fever over 102° F (39°C). Never give aspirin for fever, pain or within 6 weeks of getting the shot.Jul 6, 2023 · Meningitis during the neonatal period is a potentially devastating condition with dire long-term consequences. Despite advances in preventive and critical care medicine, bacterial meningitis continues to have an adverse outcome rate of 20 to 60% among its survivors.[1] Although the incidence and mortality have declined over the past few decades, it remains challenging to diagnose due to ... Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges). It can affect anyone, but is most common in babies, young children, teenagers and young adults. Meningitis can be very serious if not treated quickly. It can cause life-threatening blood poisoning ( sepsis) and result in permanent damage ...Meningitis is a disease caused by an inflammation of the meninges, the membranes that surround the brain and spinal cord. It's usually caused by a virus, although it can be caused by bacteria, a fungus, or tuberculosis. Treatment for meningitis depends on the specific cause of the disease. Vaccinations can prevent or minimize the incidence of ...Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges). It can affect anyone, but is most common in babies, young children, teenagers and young adults. Meningitis can be very serious if not treated quickly. It can cause life-threatening blood poisoning ( sepsis) and result in permanent damage ... The ways a person can get meningitis depend on what has caused it. Causes include bacteria, viruses, fungi, parasites, amebas, trauma, and medications. Infants can also get bacterial meningitis ...Side effects linked to the vaccines are usually mild and tend to go away within a few days. Herd immunity is unlikely to prevent meningitis, so it is essential that people get vaccinated and have ...Meningitis is an inflammation of the meninges (the membrane covering the brain and spinal cord). Meningitis is caused by either a bacterial infection or a viral infection. Bacterial meningitis can get worse very quickly. If your child is showing signs of meningitis, seek immediate medical attention. Most people recover from meningitis, although ...Here we offer helpful, doctor-approved info about fever, coughs, colds, flu, rashes, allergies, and many other health concerns. Explore our guides to doctor visits, vaccines, and medication, get advice on teething and dental care, and learn how to keep your child safe at home and beyond. Photo credit: iStock.com / FatCamera.Bacterial meningitis, which took the life of famed guitar player Jeff Beck, is a potentially deadly infection that can strike quickly. Learn about the causes, what puts you at risk, and how to ...Older children and adolescents have a stiff neck with a fever, headache, and confusion, and newborns and young infants are usually irritable, stop eating, vomit, or have other symptoms. The diagnosis is based on the results of a spinal tap and blood and urine tests. Some children die of meningitis even after receiving appropriate treatment. Bacterial meningitis in newborns usually results from an infection of the blood ( sepsis ). The infection is most commonly caused by the following bacteria: Group B streptococci Escherichia coli Listeria monocytogenes A number of other bacteria may cause meningitis as well. Having convulsions (seizure) Babies who get group B strep a week or so after birth may have signs such as: Decreased movement of an arm or leg. Pain with movement of an arm or leg. Breathing problems. Fever. Red area on the face or other part of the body. Pregnant women may have group B strep without symptoms. Enteroviruses can be spread when an infected person sneezes or coughs droplets into the air or on surfaces. A child may then breathe in droplets or touch a contaminated surface and touch their eyes, mouth, or nose. The viruses are treated with supportive care, such as fever or pain medicine, rest, and fluids.Meningitis is a disease caused by an inflammation of the meninges, the membranes that surround the brain and spinal cord. It's usually caused by a virus, although it can be caused by bacteria, a fungus, or tuberculosis. Treatment for meningitis depends on the specific cause of the disease. Vaccinations can prevent or minimize the incidence of ... Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges). It can affect anyone, but is most common in babies, young children, teenagers and young adults. Meningitis can be very serious if not treated quickly. It can cause life-threatening blood poisoning ( sepsis) and result in permanent damage ... Meningitis is an inflammation of the meninges (meh-NIN-jeez), the membranes that cover the brain and spinal cord. Some types of meningitis (meh-nen-JYE-tis) can be dangerous and even life-threatening. Routine vaccinations can help prevent it. Quick treatment of meningitis usually is successful. So it's important to know what symptoms it can ...Serogroup B meningococcal vaccines, such as Bexero or Trumenba. All children should be vaccinated at 11 or 12 with one of the conjugate vaccines, with a booster dose at age 16. As for the serogroup B vaccine, teens should definitely get it if. they have a complement deficiency (this is something that is generally diagnosed by the teenage years).Signs and symptoms in people over the age of 2 may include: High fever that comes on suddenly. Stiff neck. Severe headache that seems unusual. Headache with nausea or vomiting. Confusion or ...Enteroviruses can be spread when an infected person sneezes or coughs droplets into the air or on surfaces. A child may then breathe in droplets or touch a contaminated surface and touch their eyes, mouth, or nose. The viruses are treated with supportive care, such as fever or pain medicine, rest, and fluids.Bacterial meningitis in newborns usually results from an infection of the blood ( sepsis ). The infection is most commonly caused by the following bacteria: Group B streptococci Escherichia coli Listeria monocytogenes A number of other bacteria may cause meningitis as well. Feb 26, 2018 · Protecting newborns Seeing a doctor Meningitis is a condition that causes inflammation in the meninges, which protect the brain and spinal cord. Meningitis is most often caused by a virus or... Dec 30, 2022 · Specific Immunization Reactions. Pain or swelling at the shot site for 1 to 2 days. (20% of children) Mild fever lasting 1 to 3 days begins 14 to 28 days after the shot (10%). Give acetaminophen or ibuprofen for fever over 102° F (39°C). Never give aspirin for fever, pain or within 6 weeks of getting the shot. How meningitis is spread. The viruses and bacteria that cause meningitis can be spread through: sneezing. coughing. kissing. The infection is usually spread by people who carry these viruses or bacteria in their nose or throat, but are not ill themselves. The infection can also be spread by someone with meningitis, although this is less common.
Pregnant women who are at increased risk for serogroup A, C, W, or Y meningococcal disease may get MenACWY vaccines. Pregnant or breastfeeding women who are at increased risk for serogroup B meningococcal disease may get MenB vaccines. However, they should talk with a doctor to decide if the benefits of getting the vaccine outweigh the risks .... 24 hour booking mobile county metro jail
Older children and adolescents have a stiff neck with a fever, headache, and confusion, and newborns and young infants are usually irritable, stop eating, vomit, or have other symptoms. The diagnosis is based on the results of a spinal tap and blood and urine tests. Some children die of meningitis even after receiving appropriate treatment.Mar 16, 2022 · Serogroup B meningococcal vaccines, such as Bexero or Trumenba. All children should be vaccinated at 11 or 12 with one of the conjugate vaccines, with a booster dose at age 16. As for the serogroup B vaccine, teens should definitely get it if. they have a complement deficiency (this is something that is generally diagnosed by the teenage years). May 22, 2023 · To help comfort your baby, you can: give them a cuddle; offer them extra cool drinks (if you're breastfeeding, your child may feed more often) take them for a walk in the fresh air; If the injection site is red, swollen or tender, put a clean cold cloth to the area for about 5 to 10 minutes – this may help to soothe your baby. After the MMR ... Sep 27, 2022 · Protects your child from Hib disease, which can cause lifelong disability and be deadly. Protects your child from the most common type of Hib disease, meningitis (an infection of the lining of the brain and spinal cord). Keeps your child from missing school or child care, and you from missing work. How meningitis is spread. The viruses and bacteria that cause meningitis can be spread through: sneezing. coughing. kissing. The infection is usually spread by people who carry these viruses or bacteria in their nose or throat, but are not ill themselves. The infection can also be spread by someone with meningitis, although this is less common.Spinal meningitis is inflammation of the brain and spinal cord due to an infection. Types of meningitis include viral, bacterial, fungal, parasitic, amoebic, and noninfectious. Symptoms typically include headache, fever, and neck stiffness. Treatment depends on the type of meningitis but can include antibiotics, pain relievers, or hospitalization.Email Meningitis Infections in Infants and Children Meningitis is a swelling (inflammation) of the tissues that cover the brain and spinal cord. Sometimes, the swelling affects the brain. Meningitis can be caused by medications, injuries, and conditions such as cancer and lupus, but the most common cause is infection.Protecting newborns Seeing a doctor Meningitis is a condition that causes inflammation in the meninges, which protect the brain and spinal cord. Meningitis is most often caused by a virus or...Bacterial meningitis, which took the life of famed guitar player Jeff Beck, is a potentially deadly infection that can strike quickly. Learn about the causes, what puts you at risk, and how to ...Jun 15, 2023 · Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges). It can affect anyone, but is most common in babies, young children, teenagers and young adults. Meningitis can be very serious if not treated quickly. It can cause life-threatening blood poisoning (septicaemia) and result in permanent ... Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or altered consciousness, nausea, vomiting, and an inability to tolerate light or loud noises.Prevention. Treatment. Bacterial meningitis is inflammation of the layers of tissue surrounding the brain and spinal cord (meninges) caused by bacteria . Newborns with bacterial meningitis are usually irritable, vomit, or may have seizures. The diagnosis is based on the results of a spinal tap and blood tests.Mar 16, 2022 · Serogroup B meningococcal vaccines, such as Bexero or Trumenba. All children should be vaccinated at 11 or 12 with one of the conjugate vaccines, with a booster dose at age 16. As for the serogroup B vaccine, teens should definitely get it if. they have a complement deficiency (this is something that is generally diagnosed by the teenage years). .