Dear Doctors: My niece and nephew, ages 5 and 9, will be living with my wife and me this year. We have a good pediatrician for their vaccinations and checkups. What other health-related tasks should we be thinking about?

Dear Reader: Finding a good pediatrician for your niece and nephew was an important first step. These are doctors who specialize in the unique medical needs of infants, children and teens. In addition to preventive health care, which includes keeping up with age-appropriate vaccines and diagnosing and treating illnesses, your pediatrician will help track the children’s growth and development milestones. They can also offer guidance regarding nutrition and safety and keep an eye on changes to a child’s mental and emotional well-being.

Taking care of teeth and gums is another important part of health care. It is recommended that a child has their first dental visit when they get their first tooth, or they turn 1 year old, whichever comes first. After that initial visit, appointments should continue every six months. Baby teeth are blueprints for the permanent teeth to come, so tracking their progress and spotting potential problems is important. In order to preserve the children’s good oral health, you will want to establish a regular -- and enjoyable -- tooth-brushing routine. Your pediatric dentist can help you with this.

Another important evaluation that can be easy to forget is a visit to the eye doctor. Problems with vision can affect all aspects of a child’s development. They may even be misdiagnosed as behavioral issues, such as ADHD, or a learning disability, like dyslexia. An annual eye exam is recommended for children between the ages of 6 and 17. Timing this appointment with the start of the school year will ensure that any deficiencies in eyesight will be caught and corrected.

If either your niece or nephew has any allergies, it is important to let the school know about them. This includes the children’s teachers and coaches as well as the school nurse and administration. Some children require medication during the school day. When this is the case, the school will need your consent to provide them. Your pediatrician will be able to help you with the specifics of this authorization. If there are changes or additions to a child’s medication, it is important that the authorization held by the school be updated promptly.

In most states, children who plan to take part in school-sponsored sports are required to undergo a sports physical. This is sometimes referred to as a preparticipation physical evaluation, or PPE. It includes a medical history of the child and their parents, as well as an in-person physical exam. The goal is to identify any injuries or medical conditions that could put the child at risk of injury or illness.

Your niece and nephew are facing enormous change. So are you and your wife. We think it’s a good idea to explore the resources in your community that can support you all as you navigate this new life.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I am an adult woman, and I have an umbilical hernia. I want to decrease the amount of belly fat that I have. What kinds of exercises are safe to do when you have an umbilical hernia?

Dear Reader: A hernia is a gap in a muscle wall that allows tissues from one part of the body to push through and enter a space where they do not belong. The most common type of hernia occurs in the abdominal area. However, it is also possible for a hernia to develop in the diaphragm, the groin and in a surgical scar.

When someone has an umbilical hernia, it means the breach in the abdominal muscle has developed near the navel. This allows the fatty tissues within the abdomen, or the bowel itself, to protrude. Depending on its severity, an umbilical hernia may be barely visible, or it may look like a knob or a blob of tissue. It can vanish completely when lying down and can become larger in response to internal pressure, as when laughing, lifting or having a bowel movement.

Although umbilical hernias occur most often in newborns and infants, they are seen in adults as well. In about 10% of adult cases, the umbilical hernia has been present since birth. But the majority are the result of injury. Common causes of umbilical hernia in adults include the increased pressure on the abdominal wall that occurs during pregnancy, labor and delivery, or from physical activity that entails straining or heavy lifting.

It is not clear from your letter if your umbilical hernia is mild or severe, when it developed and if you have been evaluated by a medical professional. If you have not, it is very important to do so. Not all hernias will require an immediate surgical repair. Some, if they are small and do not cause symptoms, can be monitored and temporarily managed with lifestyle changes. However, this is an injury to the abdominal wall that can quickly and easily grow more severe. It is also possible for the tissues of the hernia to become trapped within the abdominal wall. If blood flow gets cut off -- this is called a strangulated hernia -- the trapped tissues can die and cause a life-threatening infection.

In theory, it is possible to exercise safely if you are living with a hernia that is small and does not cause any symptoms. But with each and every movement, you will be taking the risk of making the hernia worse. If your doctor evaluates your hernia and clears you to exercise, you will be instructed not to do anything that involves lifting weights, and not to engage in exercises that require pulling, pushing or any kind of straining. You will also be told to avoid all forms of contact sports. Even cycling, swimming and yoga can put pressure on the abdominal muscles.

Unfortunately, an umbilical hernia in an adult will not heal. It requires either a surgical repair or a lifetime of careful and watchful management.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I was sick for months with debilitating pain, extreme weight loss, fatigue and loss of appetite. I was diagnosed with C. diff related to an abdominal surgery. I’m being treated with antibiotics, but I worry about the effects on my gut microbiome. Is a fecal transplant an option?

Dear Reader: For those who are not familiar, C. diff is short for Clostridioides difficile, a potentially life-threatening bacterium. If it takes up residence in the large intestine, C. diff can cause a range of gastrointestinal symptoms. The most common are colitis, which is widespread inflammation of the colon, and persistent diarrhea. Additional symptoms include abdominal tenderness or pain, fever, nausea, loss of appetite and unintentional weight loss. Symptoms range from mild to severe and can lead to complications such as dehydration, bloody stool, low blood pressure, rapid heart rate and infection in the tissues of the colon.

C. diff infection is often associated with the use of broad-spectrum antibiotics, which disturb the equilibrium of the microbial colonies living in the colon. This disruption allows an overgrowth of opportunistic bacteria, such as C. diff, to occur. Inflammatory bowel diseases, which weaken the integrity of the colon, and reduced immunity are also risk factors.

C. diff spreads via the spores it produces. They are very hard to eradicate completely, which is why this infection is often seen in hospitals and long-term care settings.

Treatment depends on the severity of infection. For some people, stopping the broad-spectrum antibiotics that allowed C. diff to flourish can be adequate. When a C. diff infection is persistent, specific antibiotics, which target the bacterium, are prescribed.

The newest approach to aggressive or repeated C. diff infection is the fecal transplants you are asking about. Also known as fecal microbiota transplant, or FMT, the treatment involves inoculating the colon with healthy donor stool. This kick-starts the regrowth of the diverse colonies of intestinal flora that had previously kept adverse bacterial overgrowths in check.

The history of FMT dates back at least to fourth-century China, where written records detail the successful use of a fecal slurry to treat severe diarrhea. The modern version of the treatment, in which healthy stool is rigorously tested for safety and then specially treated for medical use, began in the mid-20th century.

When it comes to the success rate of FMT, the data are still not clear. This is a new approach, and treatment protocols have not yet been standardized. Initially, recovery rates were believed to be in the range of 90%. Newer data, which take into account repeat infections, suggest the success rate of FMT treatment for C. diff may be closer to 70%.

Your concerns about the antibiotic treatment you are undergoing are understandable. However, unlike broad-spectrum antibiotics, which suppress the entire gut microbiome, the drugs used in treatment of C. diff are targeted. At this time, FMT becomes an option when two rounds of antibiotic treatment fail to cure the infection. In cases of severe C. diff infection, or with recurrent infection, it may be a first-line treatment. Check with your internist to see if you may be a candidate.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)