| Prebiotics and probiotics | Prebiotics and probiotics | Prebiotics and probiotics | P | English | Gastrointestinal | Child (0-12 years);Teen (13-18 years) | Stomach;Small Intestine;Large Intestine/Colon | Stomach;Small intestine;Large intestine | Non-drug treatment | Caregivers
Adult (19+) | NA | | 2016-10-19T04:00:00Z | | Peggy Marcon, MD, FRCPC;Inez Martincevic, MSC, RD | | | | 9.40000000000000 | 48.2000000000000 | 449.000000000000 | | Health (A-Z) - Procedure | Health A-Z | <p>Learn how prebiotics and probiotics help keep your gut healthy and which foods are good sources.<br></p> | <p>The human <a href="/article?contentid=1467&language=English">digestive system</a>, or gut, contains trillions of microorganisms, which make up the gut flora. These microorganisms include bacteria, viruses and fungi. Bacteria are an important part of the gut flora. Some bacteria are good for your body because they help the gut break down certain types of foods and help create certain vitamins. However, some bacteria can be harmful.</p>
<p>Increasing the amount of good bacteria can be helpful in:</p>
<ul>
<li>reducing the severity and length of some types of <a href="/Article?contentid=7&language=English">diarrhea</a> (e.g. <a href="/Article?contentid=820&language=English">antibiotic-associated diarrhea</a>)</li>
<li>symptoms of <a href="/Article?contentid=295&language=English">colic</a> in infants</li>
<li>improving the symptoms of <a href="/Article?contentid=823&language=English">irritable bowel syndrome</a> (IBS)</li>
<li>improving <a href="/Article?contentid=6&language=English">constipation</a> and related abdominal bloating</li>
<li>improving symptoms associated with lactose intolerance.</li>
</ul>
<p>Prebiotics and probiotics can help improve the balance between the good bacteria and harmful bacteria.</p> | | <h2>Key points</h2>
<ul>
<li>Pre- and probiotics promote the growth of healthy gut flora.</li>
<li>Prebiotics are naturally found in foods or can be taken as a supplement.</li>
<li>Probiotics are naturally found in fermented foods or can be taken as a supplement.</li>
<li>Not all sources of probiotics are the same.<br></li>
</ul> | | | | | | | | | | | | | | | | | | | | | <h2>The difference between prebiotics and probiotics</h2>
<h3>Prebiotics</h3>
<p>Prebiotics include non-digestible food matter that support the growth of the good bacteria that is already living in your gut. As a prebiotic passes through the gut, it is not digested and becomes food for the microorganisms living in your gut. Prebiotics help these microorganisms thrive. The prebiotic is then passed as stool.</p>
<p>Good food sources of prebiotics include:</p>
<ul>
<li>asparagus</li>
<li>artichokes</li>
<li>bananas</li>
<li>berries</li>
<li>flax</li>
<li>onions</li>
<li>garlic</li>
<li>leeks</li>
<li>legumes</li>
<li>whole grains</li>
</ul>
<p>Other prebiotics seen on the market include inulin and fructooligosaccharides (FOS). Inulin is a soluble dietary fibre made up of many simple sugars bound together. FOS is a sweet tasting fibre made up of multiple fructose molecules bound together.</p>
<h3>Probiotics</h3>
<p>Probiotics are live microorganisms. They can be taken as a dietary supplement in the form of capsules, tablets, powder, liquids or liquid drops. Probiotics can also be found in many fermented foods including:</p>
<ul>
<li>beets</li>
<li>cabbage</li>
<li>kefir</li>
<li>soy</li>
<li>yogurt</li>
</ul>
<p>Eating probiotics increases the amount of good bacteria in the gut.</p>
<p>Not all sources of probiotics are the same. There are differences in:</p>
<ul>
<li>The probiotic type, also known as strain. The strain of the bacteria is how bacteria are classified/named.</li>
<li>The number of different strains in one product.</li>
<li>Manufacturing of the probiotic, i.e. the food or medium the microorganism is grown on.</li>
<li>The concentration of probiotic. This is the number of microorganisms per serving. Probiotics need to survive the acidic stomach and reach the lower gut to have a benefit so more microorganisms per serving may mean more benefit.</li>
<li>Shelf life and storage requirements.</li>
</ul> | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/Prebiotics_and_probiotics.jpg | | | |
| Fetal and neonatal alloimmune thrombocytopenia (FNAIT) | Fetal and neonatal alloimmune thrombocytopenia (FNAIT) | Fetal and neonatal alloimmune thrombocytopenia (FNAIT) | F | English | Haematology | Newborn (0-28 days);Prenatal | NA | Cardiovascular system | Conditions and diseases | Adult (19+)
Caregivers | NA | | 2017-11-09T05:00:00Z | | Lani Lieberman, MD, FRCPC;Mark Fung, MD, PhD;Nadine Shehata, MD, MSc, FRCPC;Stacy Corke | | | | 6.40000000000000 | 69.6000000000000 | 930.000000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>Find out about fetal and neonatal alloimmune thrombocytopenia (FNAIT), including its causes, symptoms, diagnosis, prevention and treatment. <br></p> | <h2>What is FNAIT?</h2><p>Fetal and neonatal alloimmune thrombocytopenia (FNAIT) occurs when the mother’s immune system attacks her fetus’ or newborn’s platelets. Platelets are a type of blood cell that have proteins on their surface and are involved in blood clotting. If a fetus or newborn has a low platelet count then they will have an increased risk of bleeding. In most cases the effects of FNAIT are mild, however, if bleeding occurs in the brain, there may be long-term effects.</p><h3>Other names for FNAIT</h3><p>FNAIT is also called NAIT, AIT, FMAIT (fetal maternal alloimmune thrombocytopenia), NAT or NATP (neonatal alloimmune thrombocytopenic purpura).</p> | | <h2>Key points</h2><ul><li>Fetal and neonatal alloimmune thrombocytopenia (FNAIT) occurs when the mother’s immune system attacks her fetus’ and/or newborn’s platelets, the blood cells that help stop bleeding.</li><li>Doctors may suspect a baby has FNAIT if there is bruising, bleeding, a specific pinpoint rash and/or a low platelet count on a blood test.</li><li>The main treatment for a baby with FNAIT is platelet transfusions.</li><li>If the mother becomes pregnant again in the future, her doctor should refer her to a hospital that specializes in fetal-maternal medicine for monitoring and treatment.</li></ul> | | | <h2>Why does FNAIT happen?</h2><p>Platelets have many proteins on their surface. Each person has a different set of proteins, which are inherited from their parents. Sometimes a baby inherits a protein that is found on their father’s platelets but is absent from their mother’s platelets. When this happens the mother's immune system may respond by developing an antibody to fight against the protein the baby inherited from their father. This is called an alloimmune response.</p><p>The antibody may pass from the mother’s blood into the baby’s blood through the placenta and attach to the baby’s platelets. This antibody destroys the baby’s platelets, resulting in a low platelet count and an increased risk of bleeding for the baby.</p><p>The mother’s antibodies can remain in the baby’s blood stream for weeks, and bleeding can occur in the baby before birth (fetal), during birth or after birth (neonatal).</p><p>There are a number of proteins that can cause FNAIT but the most common one is human platelet antigen (HPA)-1a.</p><p>FNAIT does not occur because of anything the mother does, eats or drinks. It has not been linked to any environmental or dietary exposures.</p><h3>How common is FNAIT?</h3><p>FNAIT is rare. It occurs in about one in every 2,000 births.</p> | | <h2>How is FNAIT diagnosed?</h2><p>Doctors may suspect a baby has FNAIT if there is:</p><ul><li>bleeding or bruising</li><li>a low platelet count on a blood test after birth</li><li>a specific pinpoint rash (called petechiae)</li></ul><p>The diagnosis of FNAIT can be confirmed by taking blood samples from the mother, the father and possibly the baby. If the baby’s platelet count is very low, doctors may look for possible bleeding in the brain using ultrasound.</p><h3>Why blood tests in pregnancy do not show that the baby may have FNAIT?</h3><p>Because FNAIT is rare, doctors do not usually screen for it. Doctors may first suspect a baby has FNAIT when they are born with bruises or a rash.</p> | <h2>How is FNAIT treated?</h2><p>Babies with FNAIT may need to be admitted to the neonatal intensive care unit for close monitoring.</p><p>The main treatment for FNAIT is platelet transfusions. These transfusions will help to prevent and treat the bleeding.</p> | | | <h2>What can be done to prevent FNAIT in future pregnancies?</h2><p>It is possible that FNAIT will occur in future pregnancies. This will depend on which platelet proteins the baby inherits from their mother and father.</p><p>If a woman becomes pregnant again, their doctor should refer them to a hospital that specializes in fetal-maternal medicine. If a woman is known to be at risk of FNAIT, their pregnancy should be followed by a multidisciplinary team of specialists including an obstetrician and a hematologist with expertise in FNAIT.</p><p>Doctors will closely monitor the pregnancy and may start treatment as early as 12 to 16 weeks of gestation. This treatment includes intravenous immunoglobulin (IVIG) and possibly steroids. Treatment is based on several factors that should be discussed with their doctor. Treatment will likely be needed to prevent a low platelet count in the fetus and newborn.</p><h3>Does FNAIT affect the mother during pregnancy?</h3><p>FNAIT does not directly affect the mother’s health, but once FNAIT is diagnosed in a baby, the mother’s future pregnancies should be followed by a specialist who may recommend preventative treatments for the mother.</p><h3>Should the mother's brother or sister be tested for FNAIT?</h3><p>A woman's sisters may have the same rare platelet protein combination and therefore should be tested. Other relatives do not need to be tested.</p> | | <h2>What to expect</h2><h3>If a baby has FNAIT can they still be breastfed?</h3><p>If the baby's pediatrician says they are well enough to feed then breastfeeding them is safe.</p><h3>Will a baby with FNAIT always be at risk of having a low platelet count as they grow older?</h3><p>No, a baby's low platelet count should only last until a few weeks after their birth.</p><h3>Does having FNAIT mean a baby will have a weak immune system when they are older?</h3><p>No. There is no known association between FNAIT and a weak immune system.</p> | | | | | | | | | | | | | | | | <h2>Where can I get more information?</h2><p>Visit <a href="https://www.naitbabies.org/">www.naitbabies.org</a>.</p><p>This document was created by the International Collaboration for Transfusion Medicine Guidelines (ICTMG), a group of international transfusion experts brought together to create and promote evidence-based guidelines to optimize transfusion care. For more information, visit the website at <a href="https://www.ictmg.org/">www.ictmg.org</a>.</p> | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/iStock-901666764.jpg | | | |
| Reusable nebulizers: Use and maintenance | Reusable nebulizers: Use and maintenance | Reusable nebulizers: Use and maintenance | R | English | Respiratory | Child (0-12 years);Teen (13-18 years) | Lungs | Lungs | Drug treatment | Caregivers
Adult (19+) | NA | https://assets.aboutkidshealth.ca/AKHAssets/reusable_nebulizers_promo.png | 2017-04-26T04:00:00Z | | Rebecca Wengle, RN | | | | 9.50000000000000 | 51.4000000000000 | 670.000000000000 | | Health (A-Z) - Procedure | Health A-Z | <p>Learn about the importance of cleaning and disinfecting a reusable nebulizer and follow the step-by-step instructions to learn how to do it.</p> | <h2>What is a reusable nebulizer?</h2>
<p>Using a reusable nebulizer is another way of giving a medication. A reusable nebulizer allows certain medications to be converted from a liquid into an aerosol (mist) form so they can be breathed in. It is important to clean and disinfect your child's nebulizer after every use to prevent the growth of germs in and on the device. This will help to reduce the risk of your child getting a lung infection.</p> | <h2>Cystic fibrosis and reusable nebulizers</h2><p>
<a href="/Article?contentid=882&language=English">Cystic fibrosis</a> (CF) is a genetic disease. It affects mainly the lungs and digestive tract.</p><p>CF causes a build-up of thick mucus in the lungs, which can make breathing difficult. Having a build-up of mucus in the lungs also allows bacteria to grow and this can lead to infections. A child with CF may have cycles of infection.</p><p>For children with CF, the delivery of aerosolized medication multiple times per day is an important part of their daily therapy regime. Proper use of the nebulizer includes giving the correct medication through the correct nebulizer.</p><table class="AKH-zebra-table"><thead><tr><th style="width:25%;"></th><th style="text-align:center;width:25%;">Pari LC Star</th><th style="text-align:center;width:25%;">Pari LC Plus</th><th style="text-align:center;width:25%;">Pari LC Sprint</th></tr></thead><tbody><tr><td></td><td style="text-align:center;">
<img src="https://assets.aboutkidshealth.ca/akhassets/reusable_nebulizer_PariLCStar.jpg" alt="Pari LC Star nebulizer" style="max-width:100%;" />
</td><td style="text-align:center;">
<img src="https://assets.aboutkidshealth.ca/akhassets/reusable_nebulizer_PariLCPlus.jpg" alt="Pari LC Plus nebulizer" />
</td><td style="text-align:center;">
<img src="https://assets.aboutkidshealth.ca/akhassets/reusable_nebulizer_PariLCSprint.jpg" alt="Pari LC Sprint nebulizer" />
</td></tr><tr><td><p>
<strong>Amikacin</strong> (injection solution)</p></td><td><p style="text-align:center;">✔</p></td><td style="text-align:center;"></td><td></td></tr><tr><td><p>
<strong><br></strong></p><p>
<strong>Colistin</strong></p></td><td><p style="text-align:center;">✔</p><p style="text-align:center;">Either choice acceptable</p></td><td style="text-align:center;"><p>✔</p><div></div><p>Either choice acceptable</p></td><td></td></tr><tr><td><p>
<strong>Dornase alfa</strong></p><p>
<em>Note: Do not mix, use separate nebulizer for this medication</em></p></td><td><p style="text-align:center;">
<br>
<br>
</p><p style="text-align:center;">✔</p></td><td></td><td></td></tr><tr><td><p>
<strong>Hypertonic saline 7%</strong></p></td><td><p style="text-align:center;">✔</p></td><td><p style="text-align:center;">✔</p></td><td style="text-align:center;"><p>✔</p><div></div><p>First choice</p></td></tr><tr><td><p>
<strong>TOBI</strong></p><p>(300 mg/dose)</p></td><td></td><td><p style="text-align:center;">✔</p></td><td></td></tr><tr><td><p>
<strong>Tobramycin</strong></p><p>(80 mg/dose)</p></td><td><p style="text-align:center;">✔</p></td><td></td><td></td></tr><tr><td><p>
<strong>Vancomycin</strong></p><p>(80 mg/dose)</p></td><td></td><td><p style="text-align:center;">✔</p></td><td>
<br>
</td></tr></tbody></table> | <h2>Key points</h2>
<ul>
<li>It is important to administer the correct medication in the correct nebulizer to optimize therapy.</li>
<li>Reusable nebulizers must be cleaned and disinfected after every use.</li>
<li>Cleaning your nebulizer includes washing the pieces of the nebulizer with warm water, dish soap and clean paper towel.</li>
<li>Disinfecting your nebulizers using either heat or a special solution.</li>
<li>It is important to leave the nebulizer parts to air dry on a clean towel, away from the sink.</li>
</ul> | | | | | | | | | | | | | | | | | | | | | <h2>Cleaning and disinfecting the nebulizer</h2><p>Having a standard approach to cleaning and disinfecting reusable nebulizers reduces bacterial contamination and risk of infection. Cystic Fibrosis Canada guidelines recommend cleaning and disinfecting reusable nebulizers after every use.<br></p>
<a href="https://assets.aboutkidshealth.ca/akhassets/Nebulizer_hygiene.pdf"> <figure> <img alt="Download the reusable nebulizer hygiene tip sheet PDF." src="https://assets.aboutkidshealth.ca/akhassets/Nebulizer_hygiene_PDFdownload.jpg" /> </figure></a>
<p>During cleaning, dirt or foreign material is washed off. During disinfecting, germs such as bacteria and viruses are killed.</p><p>Download a <a href="https://assets.aboutkidshealth.ca/akhassets/Nebulizer_hygiene.pdf" target="_blank">one-page tip sheet</a> to help you remember the steps for cleaning and disinfecting your reusable nebulizer.</p><h3>Cleaning</h3><ol><li>Wash your hands with soap and water or use an alcohol based hand sanitizer before handling the nebulizer.</li><li>Take the nebulizer apart.</li><li>Scrub the pieces with clean paper towels using dish soap and water.</li><li>Rinse with sterile water. You can make your own sterile water by boiling tap water for 15 minutes and then allowing it to cool. Discard what you do not use.</li></ol><h3>Disinfecting</h3><ol start="5"><li><p>The next step is to disinfect the pieces of the nebulizer using a method that uses either heat or a special solution.</p><p>You can choose one of the following methods for heat disinfection.</p><ul><li>Put the pieces in boiling water for at least 10 minutes.</li><li>Put the pieces in a microwave (2.45 GHz) for five minutes.</li><li>Put the pieces in a dishwasher and run it without detergent on a cycle where the temperature is greater than 70°C (158°F), for 30 minutes.</li><li>Use an electric steam sterilizer.</li></ul><p>OR you can choose one of the following special solutions for disinfection.</p><ul><li>Soak the pieces in 70% isopropyl alcohol for five minutes.</li><li>Soak the pieces in 3% hydrogen peroxide for 30 minutes.</li></ul><p>Rinse all pieces with sterile water after using a special solution for disinfection.</p><p>You can purchase 70% isopropyl alcohol and 3% hydrogen peroxide at your local pharmacy, they will not need to be diluted.</p></li><li>After disinfecting the pieces of the nebulizer, place them on a clean, dry towel away from the sink to air dry. When the pieces are dry, store them in a sealed container or plastic bag.</li></ol> | | | | | | | | | | | | | | | | | | | |
| Addison's disease and diabetes | Addison's disease and diabetes | Addison's disease and diabetes | A | English | Endocrinology | Child (0-12 years);Teen (13-18 years) | Pancreas | Endocrine system | Conditions and diseases | Adult (19+) | Fatigue;Nausea;Abdominal pain;Joint or muscle pain | https://assets.aboutkidshealth.ca/akhassets/adrenal_gland_and_water_regulation_V2_EN.jpg | 2017-11-20T05:00:00Z | | Catherine Pastor, RN, MN, HonBScVanita Pais, RD, CDEAndrea Ens, MD, FRCPCJennifer Harrington, MBBS, PhD | | | | 8.00000000000000 | 63.7000000000000 | 295.000000000000 | | Flat Content | Health A-Z | <p>Addison's disease is a rare autoimmune disease. Learn about the signs and treatment and why it occurs more often in people with type 1 diabetes.<br></p> | <p>Addison’s disease is an autoimmune disease where the immune system attacks the adrenal glands. The adrenal glands are located above the <a href="https://pie.med.utoronto.ca/htbw/module.html?module=kidney-child">kidneys</a> and release many different hormones (chemical messenger) into the blood. This includes cortisol and aldosterone, two hormones that help respond to body stress and work to maintain a normal blood pressure. Damage to the adrenal glands decreases cortisol and aldosterone production. </p> | | <h2>Key points</h2>
<ul><li>Addison's disease is rare but tends to occur more often in people with type 1 diabetes than in the general population.</li>
<li>A blood test is used to help diagnose Addison's disease.</li>
<li>Addison's disease is treated with pills that your child will take for the rest of their life.<br><br></li></ul> | <h2>Signs and symptoms of Addison’s disease</h2><div class="akh-series"><div class="row"><div class="col-md-12">
<figure class="asset-right">
<span class="asset-image-title">Adrenal gland function<br></span>
<img src="https://assets.aboutkidshealth.ca/akhassets/adrenal_gland_and_water_regulation_V2_EN.jpg" alt="Location of the pituitary gland, adrenal glands, kidneys and bladder in the body labelled" />
<figcaption>The pituitary gland signals to the adrenal glands to produce hormones like cortisol and aldosterone that help our bodies with stress and illness.</figcaption>
</figure>
<p>Addison’s disease is rarely seen in the general population. It tends to occur more often in people with
<a href="/Article?contentid=1719&language=English">type 1 diabetes</a>, but it is still very rare. Symptoms of Addison’s disease include:</p><ul><li>frequent low blood glucose (sugar) levels</li><li>low insulin needs</li><li>severe fatigue</li><li>darkening of the skin</li><li>weight loss and decreased appetite</li><li>low blood pressure</li><li>fainting</li><li>salt craving</li><li>nausea or vomiting</li><li>belly pain</li><li>muscle or joint pain</li><li>mood changes</li><li>body hair loss.</li></ul></div></div></div><h2>Diagnosis of Addison’s disease</h2><p>A blood test for cortisol levels is used to help diagnose Addison’s disease.</p><h2>Treatment of Addison’s disease</h2><p>Treatment may consist of oral medications (pills) to replace the hormones cortisol and aldosterone. Your child will have to take these medications for the rest of their life.</p> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Elastic compression garments | Elastic compression garments | Elastic compression garments | E | English | Haematology | Child (0-12 years);Teen (13-18 years) | Arm;Legs | Cardiovascular system | Non-drug treatment | Adult (19+)
Caregivers | NA | https://assets.aboutkidshealth.ca/AKHAssets/compression_garments_damaged_veins_EN.jpg | 2017-09-25T04:00:00Z | | Leonardo Brandao, MD, MSc.;Jennifer Vincelli, RN (EC), BScN, MN;Maria Laura Avila, MD, PhD;Celeste Lumia, BKin;Madeline Montoya, BA;Talia Rahif | | | | 7.20000000000000 | 68.9000000000000 | 1458.00000000000 | | Health (A-Z) - Procedure | Health A-Z | <p>Elastic compression garments improve symptoms of deep vein thrombosis and post-thrombotic syndrome. Find out what they are and how to properly use them.</p> | <p>Elastic compression garments are used to improve symptoms of
<a href="/article?contentid=2534&language=English">deep vein thrombosis (DVT)</a> and
<a href="/article?contentid=2884&language=English">post-thrombotic syndrome (PTS)</a> by helping to transport blood back to the heart. They prevent fluid from pooling in the affected limb, as well as reduce swelling, pain and other symptoms.<br></p> | | <h2>Key points</h2><ul><li>Elastic compression garments are used to improve symptoms of deep vein thrombosis (DVT) and post-thrombotic syndrome (PTS) by helping to transport blood back to the heart.</li><li>Compression garments are available in different degrees of pressure, depending on your child’s needs.</li><li>Wearing the compression garment is especially important when participating in physical activity, while travelling, or when your child’s symptoms of PTS worsen. </li><li>Compression garments should be worn daily for however long they continue to ease and improve symptoms of DVT and PTS, which can vary by weeks, months or years.</li><li>Compression garments should be replaced every six months, if worn daily.</li></ul> | | | | | | | | | | <h2>When to see a doctor</h2><p>Stop using the compression garments and contact the thrombosis clinic or the thrombosis doctor in case of:</p>
<ul><li>increase in pain with the use of compression garments</li><li>change in the color and temperature of the skin with the use of compression garments: toes turn pale and cold or purple.<br></li></ul> | <h2>Washing instructions</h2><p>Follow the washing instructions on the label of the garments. Wash the garments after each use, if possible. This preserves the fabrics elasticity, and removes oils and dirt.</p><p>Do not use detergent! Wash only with mild soap.</p><h3>Tips for machine-washing</h3><p>The label of the garment will tell you whether machine washing and drying are permitted. Wash and dry according to the manufacturer’s instructions. </p><ul><li>It is best to use a mesh laundry bag for protection.</li><li>When setting the dryer settings, ensure you’ve chosen the delicate cycle.</li></ul><h3>Tips for hand washing</h3><ul><li>Wet the garment and apply soap.</li><li>Gently rub the fabric together. Try your best not to stretch it.</li><li>Rinse and repeat, if needed.</li><li>Pat the garment dry with a towel. Do not wring and twist it.</li><li>Let it air-dry.</li></ul><h2>When to replace elastic compression garments</h2><p>After each use, the fabric of the garment will lose some of its elasticity. Garments generally last about six months. You should contact the thrombosis clinic to get a new prescription before six months have passed, as it may take two to three weeks for the new garment to arrive after ordering. </p><h2>Where to purchase elastic compression garments</h2><p>Many medical supply companies and pharmacies sell elastic compression garments. Ask your health-care provider which company they recommend. It is best to talk to an expert garment fitter to check options and learn how to properly apply and remove the garments.</p><p>The garment fitter will take your child’s arm or leg measurements, to make sure they get a sock or sleeve that fits properly.
Every brand uses different methods of measurement, the most common being measuring the diameter along the patient’s leg or arm at various locations.</p><p>There are many ready-made socks or sleeves you can buy, which come in various sizes. Garments can also be custom made for your child. For small children, a custom sleeve or sock is usually necessary.</p><p>Socks are usually sold in pairs, but it is only necessary to wear the garment on the affected limb.</p><h3>Insurance coverage</h3><p>The cost of elastic compression garments depends on the compression level, brand, style and place of purchase. Customized fittings tend to be more expensive.</p><p>Some insurance companies do cover compression garments. It is best to consult your insurance benefits. Some companies require a letter from the doctor mentioning they prescribed the garment. Ask the thrombosis doctor who prescribed your child’s garment to provide you with a letter.</p> | | | | | | | | | <h2>What are elastic compression garments?</h2><p>Elastic compression garments are made of breathable elastic fabrics such as nylon, cotton, spandex or natural rubber. They are occasionally referred to as “graduated compression garments”. The stockings are tightest at the ankle (where the most pressure is put by the body) and become less tight as the garment moves up the leg. A compression sleeve is tightest at the wrist and becomes less tight as it moves up the arm.</p>
<figure class="asset-c-80">
<span class="asset-image-title">Effect of elastic compression garments on damaged veins</span>
<img src="https://assets.aboutkidshealth.ca/AKHAssets/compression_garments_damaged_veins_EN.jpg" alt="A damaged vein with backward blood flow and a damaged vein with compression garment allowing for better blood flow" />
<figcaption class="asset-image-caption">A deep vein thrombosis (DVT) can damage a vein. As a result, the vein wall does not function properly and the vein valves open wider than usual. This results in backward blood flow, away from the heart. Compression garments gently compress the muscle and expanded vein wall, allowing the valves to close once again, resulting in healthier blood flow towards the heart.</figcaption>
</figure>
<p>Compression garments are typically available in several different lengths and sizes. Stockings can come up to the knee, thigh, or waist, with an option of open or closed toe. Your doctor will prescribe the appropriate garment length, but knee-high stockings are the most commonly prescribed in children with PTS in the legs.</p><p>For the arms, sleeves are only made in a full-length style. The sleeve ends about two fingers below the underarm and begins either at the wrist (sleeve-style), the thumb (gauntlet-style) or midway through the fingers (glove-style).</p><p>Elastic compression garments gently compress the muscles in the affected limb as well as the expanded vein walls. With the vein walls being less stretched, the vein valves are able to close once again, resulting in healthier overall circulation.</p><h3>Class of compression</h3><p>Compression garments are available in various degrees of pressure, or classes of compression. Compression is measured in millimetres of mercury (mmHg), with the highest compression at the ankle or wrist joints. The higher the pressure is, the tighter the garment will fit. There are different compression levels (15-20 mmHg, 20-30 mmHg, 30-40 mmHg and +40 mmHg) depending on what your child needs. </p> | <h2>How to wear elastic compression garments</h2><p>Elastic compression garments are intended to be tight. This can make putting them on difficult, especially when putting them on your child. The following tips will make it easier to put on the garments:</p><ul><li>Wash the garment before the first use, to decrease its stiffness. </li><li>Ensure the limb is dry. It is important to apply moisturizing cream to the skin after each use because garments can cause dry skin. Applying creams at the end of the day, when the garment is removed, ensures that moisturizers are completely absorbed before putting on the garment the following day. This will increase the lifespan of the garment. </li><li>Do not pull the stocking by the top (as with a normal sock), since that will make application more difficult and will take more time. Instead, invert (turn inside out) the stocking halfway and insert the foot until the stocking is over the heel. Next, using your palm rather than fingers, gradually unfold the stocking moving up the leg. </li><li>For sleeves: Invert the sleeve halfway and put the hand through it until the bottom part of the sleeve is at the level of the wrist. Then, use the palm of your hand to glide the sleeve up toward the underarm.</li><li>Technique to remove garments: Holding the top of the garment, peel the sleeve or stocking down the limb. The garment should be inside out once removed.</li><li>After properly applying the knee-high stockings or sleeve, the top of the garment should be approximately one-inch below the bend of the knee or underarm.</li></ul><p>An expert garment fitter can show you some tricks and devices to help apply the stocking or sleeve, such as using a donning glove (or a rubber cleaning glove) to make putting on the garment easier.</p><p>The length or size of the garment may be wrong for your child if:</p><ul><li>They want to fold or roll the top of the garment down, away from the bend in the knee or underarm.</li><li>The stocking continuously slides or rolls down on its own.</li></ul> | <h2>How long to wear compression garments</h2><p>Although the standard recommendation is to wear the garment from the time your child wakes up, until just before they go to sleep, wearing the garment is especially important when participating in physical activity, travelling, or when your child’s symptoms of PTS worsen. </p><p>If swelling is a major concern, it might be best to put the compression garment on when your child wakes up, because the limb will be less swollen then.</p><p>Your child does not need to wear their garment at night. Remember that the pressure in the garment, particularly the socks, has been designed for someone that is walking. </p><p>Generally, the compression garments are to be worn every day for however long they ease and improve symptoms, which can vary by weeks, months or years. </p><p>Expect to return to the thrombosis clinic every year, to check the duration of the treatment.</p> | | | | | | | | | | | | | | | | | | |
| The insulin regimen | The insulin regimen | The insulin regimen | T | English | Endocrinology | Child (0-12 years);Teen (13-18 years) | Pancreas | Endocrine system | Drug treatment | Adult (19+) | NA | | 2016-10-17T04:00:00Z | | Catherine Pastor, RN, MN, HonBSc;Vanita Pais, RD, CDE;Jennifer Harrington, MBBS, PhD | | | | 10.1000000000000 | 50.8000000000000 | 812.000000000000 | | Flat Content | Health A-Z | <p>Patients with type 1 diabetes and some with type 2 must receive insulin manually. Learn what an insulin regimen is and the different routines.</p> | <p>Patients with <a href="/Article?contentid=1719&language=English">type 1 diabetes</a> do not produce their own <a href="/Article?contentid=1729&language=English">insulin</a>, so they must receive it manually from an external source. Some patients with <a href="/Article?contentid=1721&language=English">type 2 diabetes</a> also need to be given insulin. Insulin can be administered using a <a href="/Article?contentid=1732&language=English">pen</a>, a <a href="/Article?contentid=1731&language=English">syringe</a>, or an <a href="/Article?contentid=1733&language=English">insulin pump</a>.</p> | | <h2>Key points</h2>
<ul><li>An insulin regimen is how much insulin your child gets (dosage) and how often they get it (frequency).</li>
<li>Depending on your child's needs there are different insulin regimens including multiple daily injections (MDI), three-times-a-day (TID) insulin routine, and twice-a-day (BID) insulin routine.</li></ul> | <h2>What is an insulin regimen</h2><p>At first, your diabetes team will decide how much insulin your child gets (the dosage) and how often they get it (the frequency). This is the insulin regimen. </p><p>It can take a few days to a few weeks of fine-tuning to figure out exactly how much insulin your child needs. The amount of insulin depends on the amount of glucose (sugar) in the blood and the type of insulin used, as different formulations act on the body in different ways. </p><p>Because a child’s insulin needs are affected by their growth and development, appetite, physical activity, and stress or illness, no fixed dose will work forever. The dose will need to be adjusted frequently to provide the best blood sugar control.</p><p>Over time,
<a href="/Article?contentid=1723&language=English">blood sugar levels</a> become stable and families gain more experience. Most parents and teens become quite skilled at taking charge and making decisions about changing their insulin doses. The diabetes team is always there for advice and backup. </p><h2>Multiple daily injections (MDI)</h2><p><a href="/Article?contentid=1738&language=English">Multiple daily insulin (MDI</a>) is a proactive approach to diabetes management. It requires careful attention to
<a href="/Article?contentid=1741&language=English">meal planning</a> and exercise, but allows for more flexible mealtimes and a bigger variety of activities. It requires matching insulin doses to carbohydrate intake and blood sugar levels, and follows your child’s specific
<a href="/Article?contentid=1742&language=English">insulin-to-carbohydrate ratio</a> (I:C). </p><p>The I:C is the amount of carbohydrates (in grams) that one unit of
<a href="/Article?contentid=1729&language=English">rapid-acting insulin</a> makes available to the body cells to consume. In other words, one unit of rapid-acting insulin “covers” for a specific amount of carbohydrates. The I:C is expressed as 1 unit: X grams of carbohydrates.</p><p>For example, an I:C of 1:10 means that 1 unit of insulin makes 10 grams of carbohydrates consumed. Each child has a specific I:C that your dietitian will help you determine.</p><p>This insulin regimen involves:</p><ul><li>injecting a
<a href="/Article?contentid=1729&language=English">long-acting insulin</a> once or twice daily as the basal dose (keeping baseline blood sugar levels stable), and</li><li>having further injections of rapid-acting insulin before each meal (to regulate blood sugar levels after post-meal spikes). You can figure out what amount of insulin to inject by following your child’s I:C.</li></ul><p>With four or five daily injections, MDI offers a steady stream of insulin throughout the day. As long as meals are spaced three to four hours apart so that doses of rapid-acting insulin are spaced three to four hours apart, this routine most closely matches how the pancreas would normally release insulin.</p><h3>Challenges to using MDI</h3><p>There are many reasons for using the basal/bolus approach in people with type 1 diabetes, including younger children. However, some special considerations must be given before implementing this routine:</p><ul><li>Children require rapid-acting insulin before each meal; parents must ensure that another caregiver is available during working hours to administer the injection, whether at school or daycare or at home.</li><li>Some young children find needles very difficult; a routine requiring fewer injections per day might be preferable at first.</li><li>The risk of
<a href="/Article?contentid=1723&language=English">hypoglycemia</a> is increased when a person tries to keep blood sugar levels close to normal; however, with practice and by using conservative targets, the risk of frequent or severe hypoglycemia is quite low.</li></ul><p>Despite these challenges MDI is most commonly the standard of care for children, especially teens, with type 1 diabetes.</p><h2>Three-times-a-day (TID) insulin routine</h2><p>This involves giving insulin at <a href="/Article?contentid=3021&language=English">three separate times of the day</a>. Usually younger children are on this regimen because it does not require an insulin injection at lunchtime. Timing for insulin involves:</p><ul><li>Intermediate-acting insulin and a rapid-acting insulin just before breakfast</li><li>a rapid insulin just before dinner</li><li>an intermediate or long-acting insulin just before bedtime.</li></ul><p>Timing of meals and snacks for this regimen must be routine and consistent.</p><h2>Twice-a-day (BID) insulin routine</h2><p><a href="/Article?contentid=3021&language=English">Twice daily insulin</a> routine involves administering two kinds of insulin: </p><ol><li>long-acting
<strong>or</strong> intermediate-acting insulin</li><li>
<strong>and</strong> short acting insulin before breakfast and before dinner.</li></ol><p>This is the least ideal routine because it can be challenging to achieve good blood sugar control. This routine is chosen for different reasons; for example, for infants and young children who go to sleep close to supper time, or for older children who may struggle with taking insulin.</p> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/the_insulin_regimen.jpg | | | |
| Von Willebrand disease | Von Willebrand disease | Von Willebrand disease | V | English | Haematology | Child (0-12 years);Teen (13-18 years) | Body | Cardiovascular system | Conditions and diseases | Caregivers
Adult (19+) | NA | | 2017-05-08T04:00:00Z | | Vanessa Bouskill, MN, RN(EC), NP;Manuel Carcao, MD, FRCP(C), FAAP, MSc | susan.ball@sickkids.ca | Susan Ball | 693A30232E777C7369636B6B6964735C737573616E2062616C6C i:0#.w|sickkids\susan ball | | | 7.80000000000000 | 65.9000000000000 | 1436.00000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>Von Willebrand disease is a condition that affects the blood’s ability to clot properly. Learn about the different types of this disease and how they are treated.</p> | <h2>What is von Willebrand disease?</h2><p>Von Willebrand disease (VWD) is an inherited condition that affects the blood’s ability to clot effectively. It is a very common bleeding disorder that affects girls and boys equally.</p><p>When a person gets a cut, a type of cell in the blood called a platelet, and a protein called von Willebrand factor (VWF), stick to the wound to plug the cut. Proteins in the blood called clotting factors then bind together to form chains called fibrin. These chains then form a net around the platelets and VWF. This holds the clot together and helps to seal the wound.</p><p>In a person with VWD, there is either not enough VWF or it does not work properly. In either case, a blood clot cannot form properly, and the injured area will continue to bleed.</p>
<p>VWF also protects and maintains levels of clotting factor VIII, one of the proteins involved in blood clotting. Therefore, people with VWD may have low levels of factor VIII in addition to low levels of VWF.</p> | <h2>Types and severity of von Willebrand disease</h2><p>People with VWD have increased bleeding episodes depending on the severity of their disease. When they have a bleeding episode, they bleed for a longer period of time than a person without VWD.</p><p>There are several types of VWD: Type 1, Type 2 and Type 3. These vary in severity of symptoms and not all people will experience all symptoms. Some people will have minimal symptoms or have no symptoms at all.</p><table class="AKH-zebra-table"><thead><tr><th style="width:25%;"> </th><th style="text-align:center;width:25%;">Diagnosis</th><th style="text-align:center;width:25%;">Severity</th><th style="text-align:center;width:25%;">Symptoms</th></tr></thead><tbody><tr><td><strong>Type 1</strong></td><td>Low levels of VWF; may have slightly low factor VIII levels</td><td>Mild bleeding symptoms</td><td>Nosebleeds, mouth bleeds and heavy menstrual bleeding</td></tr><tr><td><strong>Type 2</strong></td><td>Levels of VWF may be normal, but it does not work properly</td><td>Mild to severe bleeding symptoms</td><td>Same as in Type 1, but more severe; Type 2N can experience joint and muscle bleeds</td></tr><tr><td><strong>Type 3</strong></td><td>Absent or extremely low levels of VWF; factor VIII levels will also be very low</td><td>Severe bleeding symptoms</td><td>In addition to Type 1 symptoms, will experience joint and muscle bleeds</td></tr></tbody></table><h3>Type 2 subtypes</h3><p>Type 2 VWD has four subtypes; treatment varies for each of these subtypes.</p><table class="AKH-zebra-table"><thead><tr><th style="width:25%;">Type 2 subtype</th><th style="text-align:center;width:75%;">Description</th></tr></thead><tbody><tr><td><strong>Type 2A</strong></td><td>This is the most common subtype. In this subtype, VWF does not work properly to bind platelets together.</td></tr><tr><td><strong>Type 2B</strong></td><td>In people with Type 2B, the VWF is “extra sticky” and it binds to platelets in the blood stream rather than at the site of the wound. This causes a shortage of platelets in areas where they are needed. Sometimes this type of VWD is misdiagnosed as a low platelet count such as <a href="/Article?contentid=842&language=English">idiopathic thrombocytopenia purpura (ITP)</a>.</td></tr><tr><td><strong>Type 2N</strong></td><td>In this subtype, the VWF binds to platelets at the site of the wound in the same way that it would in healthy people. However, while VWF normally transports clotting factor VIII, this does not occur in people with Type 2N. As a result, low levels of factor VIII lead to poor blood clot formation. Because of low levels of factor VIII, Type 2N VWD may be misdiagnosed as <a href="/Article?contentid=844&language=English">hemophilia</a>.</td></tr><tr><td><strong>Type 2M</strong></td><td>In this subtype, VWF does not bind properly to platelets. This subtype is similar to type 2A but is distinguished through various specialized laboratory tests.</td></tr></tbody></table> | <h2>Key points</h2><ul><li>The first signs of VWD are usually prolonged nosebleeds, easy bruising and in females, heavy periods.</li><li>VWD is a lifelong condition that is usually passed down from parents to children. It equally affects both girls and boys.</li><li>Severity of VWD can vary, and thus treatments do as well. Options will be discussed between you and your child’s comprehensive health-care team.</li></ul> | | <h2>Signs that your child may have von Willebrand disease</h2><p>If your child experiences any of the following symptoms, you should talk to your doctor about the possibility that your child may have VWD:</p><ul><li>bleeding from the gums</li><li>easy bruising</li><li>prolonged bleeding after cuts or bloodwork</li><li>frequent and prolonged nosebleeds</li><li>blood in the stool or urine</li><li>heavy or prolonged menstrual bleeding (menorrhagia) in girls</li><li>soft tissue/joint bleeding (in more severe forms).<br></li></ul><p>As VWD is usually inherited, it is possible that after a child in a family is diagnosed with VWD that other family members may be tested as well.</p> | <h2>How is von Willebrand disease inherited?</h2><p>VWD is a genetic condition and it is most often passed on from one or both parents to their children. Occasionally, VWD may occur when one of the child’s genes changes randomly; this is called a spontaneous genetic mutation.</p>
<figure class="asset-c-80"><span class="asset-image-title">Inheritance pattern of Type 1, 2A, 2B and 2M von Willebrand disease</span><img alt="Chromosomes in a parent with mutated VWF gene, in a parent with no mutated VWF gene, and in a child with VWD" src="https://assets.aboutkidshealth.ca/akhassets/von_willebrand_inheritance_1_2A_2B_2M_EN.jpg" /> </figure>
<p>The type of VWD depends on the mutation in the VWF gene. The parent may have mild symptoms or no symptoms at all. Types 1, 2A, 2B and 2M are usually inherited when one parent passes on the mutated VWF gene to their child.</p>
<figure class="asset-c-80"><span class="asset-image-title">Inheritance pattern of Type 2N and 3 von Willebrand disease</span><img alt="Chromosomes in parents who both have a mutated VWF gene and in a child with VWD" src="https://assets.aboutkidshealth.ca/akhassets/von_willebrand_inheritance_2N_3_EN.jpg" /> </figure>
<p>Types 2N and 3 VWD are usually inherited when both parents pass on the mutated gene to their child. A child receives two mutated genes, one from each parent. Each parent may have only mild symptoms or have no symptoms at all.</p>
<figure class="asset-c-80"><span class="asset-image-title">Inheritance pattern of Type 2N von Willebrand disease</span><img alt="Chromosomes in parent with Type 1 or 2N mutated VWF gene, parent with Type 2N mutated VWF gene, and child with Type 2N VWD" src="https://assets.aboutkidshealth.ca/akhassets/von_willebrand_inheritance_2N_EN.jpg" /> </figure>
<p>Type 2N VWD occurs when a child inherits one Type 1 (or Type 2N) gene from one parent and one Type 2N gene from the other parent.</p>
<figure class="asset-c-80"><span class="asset-image-title">Inheritance pattern of Type 3 von Willebrand disease</span><img alt="Chromosomes in parents who both have Type 1 mutated VWF gene and in child with Type 3 VWD" src="https://assets.aboutkidshealth.ca/akhassets/von_willebrand_inheritance_3_EN.jpg" /> </figure>
<p>Type 3 VWD occurs when a child inherits a gene responsible for Type 1 VWD from both parents. In most (but not all) cases parents of a child with Type 3 VWD, despite having a gene for type 1 VWD, usually have normal levels of VWF and show no signs of bleeding.</p> | | <h2>Diagnosis of von Willebrand disease</h2><p>While VWD has a genetic cause, VWF can also be affected by many other things such as blood type, age, stress, medications and hormone levels.</p><p>Often, the symptoms of Type 1 VWD are very mild. For this reason, it can take time to diagnose.</p><p>A diagnosis of VWD involves a series of blood tests measuring VWF levels and function as well as factor VIII levels in the blood. A physical exam, a review of family medical history and a bleeding questionnaire will also be performed.</p> | <h2>Treatment of von Willebrand disease</h2><p>Children diagnosed with VWD are cared for by a comprehensive team of health care specialists. This team will include a nurse co-ordinator, hematologist (blood doctor), physiotherapist, social worker, dentist and, for female teens and adults, a gynecologist.<br></p><h3>Medications may be used to treat all types of von Willebrand disease</h3><p><em><strong>Tranexamic acid</strong></em></p><p>Tranexamic acid is used to hold a blood clot together once it has already formed. It is often used when a person with VWD is undergoing a surgical or dental procedure, and for nosebleeds or mouth bleeds. For females, it can also be used for heavy periods.</p><p><em><strong>Fibrin glue</strong></em></p><p>Fibrin is the final product when a blood clot is formed. Fibrin glue is made up from several blood clotting agents. It is applied directly to wounds to stop bleeding. Fibrin glue is often used when people with VWD undergo surgical or dental procedures.</p><p><em><strong>Desmopressin (DDAVP)</strong></em></p><p>DDAVP is a chemical that helps to release factor VIII and VWF that is already stored in the blood. Before using this method, your child’s comprehensive care team will perform a “DDAVP Challenge”. This test is done to see if the use of DDAVP releases enough factor VIII and VWF in your child’s body to treat bleeds. If it does, your child is a "responder". Treatment of VWD with DDAVP is not recommended until your child is at least three years of age because of potential side effects. DDAVP does not work in some Type 2 subtypes and Type 3 VWD.</p><p><em><strong>Von Willebrand factor product</strong></em></p><p>Von Willebrand factor product is a plasma derived factor concentrate (a powder) that has been engineered from human plasma. It undergoes viral inactivation steps to make sure the product is safe. VWF product is used in more moderate or severe bleeds, to replace the VWF and FVIII in the body immediately to stop bleeding.</p><h3>Treatment by type</h3><p>Medical treatment of VWD will vary by patient, and should be discussed with your child’s healthcare team.</p><table class="AKH-zebra-table"><thead><tr><th style="width:50%;">Type of von Willebrand disease</th><th style="text-align:center;width:50%;">Most common treatment options</th></tr></thead><tbody><tr><td><strong>Type 1</strong></td><td>DDAVP (if a responder); von Willebrand factor product</td></tr><tr><td><strong>Type 2</strong></td><td>DDAVP (if a responder); von Willebrand factor product</td></tr><tr><td><strong>Type 3</strong></td><td>von Willebrand factor product</td></tr></tbody></table> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/von_willebrand_disease.jpg | | | |
