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Developmental paediatriciansDevelopmental paediatriciansDevelopmental paediatriciansDEnglishOtherChild (0-12 years);Teen (13-18 years)NANAHealth care professionalsCaregivers Adult (19+)NA2015-08-17T04:00:00ZJennifer Das, MD;​​​Janine A. Flanagan, HBArtsSc, MD, FRCPC​​​​​14.000000000000031.0000000000000702.000000000000Flat ContentHealth A-Z<p>Developmental paediatricians are doctors who specialize in child development. Learn what they do and how they can help your child.</p><h2>What is a developmental paediatrician?</h2> <p>Developmental paediatricians are doctors who specialize in child development. They see children with a wide variety of developmental, learning and behavioural issues from infancy to young adulthood.</p><h2>Key Points</h2> <ul> <li>Developmental paediatricians are doctors who have completed extra training in the field of child development.</li> <li>Developmental paediatricians assess all aspects of development, including language, social communication and interaction skills, play behavior, motor skills and some cognition. </li> <li>Developmental paediatricians work together with other care providers to help ensure their patients are getting the extra support they need in a variety of different settings. </li> <li>If you are concerned that your child is having delays in their development, speak with your doctor.</li> </ul><h2>What types of patients are seen by developmental paediatricians?</h2><p>Developmental paediatricians assess, diagnose and support children who have problems with any aspect of their development. This may include:</p><ul><li>Gross motor skills (e.g. sitting, walking, climbing)</li><li>Fine motor skills (e.g. feeding, printing)</li><li>Speech and language (e.g. articulation, pronunciation, receptive and expressive language delays)</li><li>Social communication and interaction skills, play and behaviour (e.g. developmental delay, <a href="/autism">Autism Spectrum Disorder (ASD)</a><br></li><li>Attention, hyperactivity, impulsivity (e.g. <a href="/Article?contentid=1922&language=English">ADHD</a>)</li><li>Cognitive (e.g. Global Developmental Delay (GDD), Intellectual Disabilities (ID), Learning Disabilities (LD)</li></ul><p>Many children will have problems in more than one aspect of their development. Some children may have problems with their development as a result of a medical condition or a brain injury. Other children are healthy, but develop differently than other children their age. Common conditions that developmental paediatricians treat are <a href="/Article?contentid=21&language=English">Autism Spectrum Disorder (ASD)</a>, <a href="/Article?contentid=847&language=English">Cerebral Palsy (CP)</a> and <a href="/Article?contentid=653&language=English">Learning Disabilities (LDs)</a>. </p><h2>What does a developmental paediatrician do?</h2><p>On your child’s visit to a developmental paediatrician, the doctor will talk to you about your concerns and then ask a lot of questions about your child and their development. This will include questions about the pregnancy and birth, early development such as babbling, first words, gestures, social skills (joint attention, smiling), play skills and interests, behaviours, motor skills and overall medical health. They may ask you to fill out a questionnaire regarding your child’s development. If your child is daycare- or school-aged, then information will also be collected from caregivers and teachers. Additional reports from other therapists your child may be seeing (resource educator, early childhood consultant, speech and language pathologist, psychologist, occupational therapist) will also be collected and interpreted.</p><p>Depending on your child’s challenges, the developmental paediatrician will interact with and observe your child playing and/or ask them to participate in some play-based evaluations. The developmental paediatrician will use these evaluations in combination with the history to assess your child and determine their developmental needs. Often these evaluations take place over two or even three assessment times. This allows for a more balanced view of your child’s skills (instead of doing it all at one setting especially if your child is having a difficult day) and is also done so your child does not become too tired. Some of these evaluations may involve a team of other health professionals including a psychologist, speech language pathologist, occupational therapist.</p><p>At the end of your visits, the developmental paediatrician will summarize what they have learned. They will help you identify some of the developmental problems that your child is having. Sometimes a diagnosis is made. If required, they will then make referrals for different therapies your child might benefit from (e.g. speech or language therapy, physiotherapy, occupational therapy) although many children may have already had these in advance or as part of the assessment. In some cases blood work and other tests (hearing, vision, psychological testing) may be warranted.</p><p>Developmental paediatricians work closely with these other health professionals, as well as teachers, parents, day care workers and other care providers to help them develop strategies to deal with the different concerns a child might be having. In certain cases a diagnosis is needed to access additional services like behavioural therapy, funding support etc.</p><h2>How do I find a developmental paediatrician?</h2><p>If you are concerned about your child’s development, you should speak with your primary care doctor. They may refer you to a general paediatrician first for further assessment or directly to a developmental paediatrician if your doctor feels that your child’s challenges require further help and expertise.</p>https://assets.aboutkidshealth.ca/AKHAssets/developmental_paediatricians.jpg
Prebiotics and probioticsPrebiotics and probioticsPrebiotics and probioticsPEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)Stomach;Small Intestine;Large Intestine/ColonStomach;Small intestine;Large intestineNon-drug treatmentCaregivers Adult (19+)NA2016-10-19T04:00:00ZPeggy Marcon, MD, FRCPC;Inez Martincevic, MSC, RD9.0000000000000047.0000000000000431.000000000000Health (A-Z) - ProcedureHealth 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
Other late effects of diabetesOther late effects of diabetesOther late effects of diabetesOEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)Pancreas;Foot;HeartEndocrine system;Cardiovascular system;Nervous systemConditions and diseasesAdult (19+)NAhttps://assets.aboutkidshealth.ca/akhassets/nerves_EN.jpg2017-11-20T05:00:00ZCatherine Pastor, RN, MN, HonBScVanita Pais, RD, CDEAndrea Ens, MD, FRCPCJennifer Harrington, MBBS, PhD000Flat ContentHealth A-Z<p>Learn about other complications that can occur as a result of diabetes including neuropathy, foot problems, heart disease and stroke.</p><p>In addition to eye damage and kidney disease, there are several other complications that can result from diabetes. These include nerve damage (neuropathy), foot problems (peripheral vascular disease), heart disease and stroke.</p><h2>Key points</h2> <ul><li>Over time, nerve damage, foot problems, heart disease and stroke can all occur as a result of diabetes.</li> <li>Proper diabetes management and blood sugar control can help prevent these complications.</li></ul><h2>​​Nerve damage (neuropathy)</h2><p>Electrical signals travel along nerves. Over time, repeated <a href="/Article?contentid=1724&language=English">blood glucose (sugar) levels</a> above target can affect the nerves in many areas of the body. Some people with <a href="/Article?contentid=1717&language=English">diabetes</a> develop symptoms and signs of more severe nerve damage, called neuropathy. This is very rare in children or teens.<br></p> <figure class="asset-center"> <p class="AssetTitle">Nerves</p> <img src="https://assets.aboutkidshealth.ca/akhassets/nerves_EN.jpg" alt="Nerve pathways in the body shown with close up view on the specific parts of the nerve cell labelled" /> <figcaption>There are countless nerves running throughout the body. These nerves provide a pathway for electrical signals to travel. This allows for the brain and spinal cord to communicate with other tissues and organs.</figcaption> </figure> <p>When nerves in the arms or legs are affected people may have: </p><ul><li>tingling</li><li>numbness</li><li>painful burning or freezing sensations, particularly in the feet</li><li>throbbing.</li></ul><p>Excellent blood sugar control can help prevent <a href="http://guidelines.diabetes.ca/CDACPG/media/documents/patient-resources/diabetes-peripheral-neuropathy.pdf">nerve damage</a>.</p><h2 id="foot">Foot problems (peripheral vascular disease)</h2><p>Children and teens rarely suffer from foot problems from diabetes. In adults, foot problems develop because of poor blood flow and nerve damage, which can increase the risk of infection and slow healing. A person with neuropathy can get a cut or blister on the foot and not even feel it. Even small blisters can become a serious problem if not recognized early. Adults with diabetes should have regular feet checks by a health-care provider.</p><h2 id="heart">Heart disease and stroke </h2><p>As people age, so do their blood vessels. Fat in the blood can build up on blood vessels. This makes the blood vessels more narrow and may block blood flow. A blockage in the heart can lead to a heart attack; a blockage in the brain’s blood vessel can lead to a stroke. People with diabetes have a higher risk of heart disease and <a href="/Article?contentid=854&language=English">stroke</a>. Fortunately, this almost never happens to children or teens.</p><p>To help prevent future problems, your child should:</p><ul><li>keep excellent blood sugar control</li><li>keep blood pressure in check</li><li> <a href="/Article?contentid=1753&language=English">exercise regularly</a></li><li>eat a <a href="/Article?contentid=1740&language=English">healthy diet​</a></li><li>not smoke</li><li>maintain healthy blood fats levels (cholesterol and triglycerides).</li></ul><p>In teens with diabetes, blood cholesterol and triglycerides levels are measured to screen for problems. Blood fats levels outside of the normal range is called dyslipidemia.</p>
Reusable nebulizers: Use and maintenanceReusable nebulizers: Use and maintenanceReusable nebulizers: Use and maintenanceREnglishRespiratoryChild (0-12 years);Teen (13-18 years)LungsLungsDrug treatmentCaregivers Adult (19+)NAhttps://assets.aboutkidshealth.ca/AKHAssets/reusable_nebulizers_promo.png2017-04-26T04:00:00ZRebecca Wengle, RN9.0000000000000052.0000000000000625.000000000000Health (A-Z) - ProcedureHealth 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="" style="max-width:100%;" /> </td><td style="text-align:center;"> <img src="https://assets.aboutkidshealth.ca/akhassets/reusable_nebulizer_PariLCPlus.jpg" alt="" /> </td><td style="text-align:center;"> <img src="https://assets.aboutkidshealth.ca/akhassets/reusable_nebulizer_PariLCSprint.jpg" alt="" /> </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>
Fracture: How to treat a buckle fracture of the distal radiusFracture: How to treat a buckle fracture of the distal radiusFracture: How to treat a buckle fracture of the distal radiusFEnglishOrthopaedics/MusculoskeletalChild (0-12 years);Teen (13-18 years)Lower armBonesNon-drug treatmentCaregivers Adult (19+)NAhttps://assets.aboutkidshealth.ca/akhassets/PST_splint_wrist_EN.jpg2017-02-16T05:00:00ZKathy Boutis, MD, FRCPC, MSc​​7.0000000000000075.00000000000001043.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn about buckle fractures and how to treat them with a splint.</p><div class="akh-series"><div class="row"><div class="col-md-12"> <figure> <span class="asset-image-title">Buckle fracture of the distal radius</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_fracture_buckle_EN.jpg" alt="" /> <figcaption class="asset-image-caption">The most common buckle fracture in children occurs in the distal radius. Sometimes a child will also have a minor fracture of the ulna.</figcaption> </figure> <h2>What is a buckle fracture?</h2><p>A buckle fracture occurs when a bone “buckles”, or slightly crushes in on itself. The most common type of buckle fracture in children occurs in the forearm, near the wrist, usually after a child falls onto an outstretched arm. The injury affects the radius bone in particular.</p></div></div></div><h2>Where is the radius?</h2> <p>The radius runs from the elbow to the hand. It makes up the forearm along with the ulna, the bone that runs alongside it. The ‘distal’ part of the radius is the part furthest away from the centre of the body, in other words, nearest the wrist.</p> <p>Buckle fractures occur only in children and are very common. Children’s <a href="/Article?contentid=1938&language=English">bones</a> are softer than adult bones and able to bend and compress without fully breaking. Although the bone does not fully break, the fracture can still cause pain.</p><h2>Key points</h2> <ul> <li>A buckle fracture of the distal radius is a partial break of the bone and is the most common fracture in children.</li> <li>Almost all children recover very well within four weeks with the aid of a removable splint for pain control and protection.</li> <li>Your child should avoid all physical activity that could re-injure the wrist for at least three weeks after the splint is removed (typically six to eight weeks from date of injury).<br></li></ul><h2>When should my child wear their splint?</h2> <p>Your child should wear their splint during the day but may remove it at bath time. For the first week, most children also wear the splint at night for comfort, but you can remove it at bedtime once it is no longer needed for pain control.</p> <h2>How do I remove the splint?</h2> <p>When removing the splint:</p> <ul> <li>take your time and pay full attention</li> <li>make sure that your child is calm</li> <li>allow your child to gently and slowly move their wrist</li> </ul> <h2>Can my child go back to school or playgroup with the splint on?</h2> <p>Your child may return to school or playgroup while wearing the splint the day after they hurt their wrist. Make sure staff know that the arm is injured so they can take appropriate care.</p> <h2>When will my child be able to move their wrist and hand normally again?</h2> <p>Most children start to use their wrist and hand again while still wearing their splint. Your child may use their injured arm as it heals but should rest it if they feel pain.</p> <h2>When can my child stop wearing the splint?</h2> <p>Depending on your child’s healing, they can usually stop wearing the splint after two or three weeks. A few children need to wear the splint for up to four to six weeks for comfort.</p> <p>You should only remove the splint completely when your child’s wrist is no longer in pain. If their wrist is still painful, replace the splint for another week. Repeat this step until the pain disappears.</p> <h2>What should I do if my child keeps removing the splint?</h2> <p>For the first one to two weeks after injury, try securing the straps of the splint with sticky tape.</p> <p>If your child tries to remove the splint after the second week and appears to be pain-free and willing to use their arm and hand normally, leave the splint off and monitor them. At this stage, the buckle fracture has probably healed and is safe from re-injury except during contact sports.</p><h2>What should I expect when the splint comes off?</h2><p>Your child’s arm may be slightly stiff from being in a splint and your child may be a little unsure with their movements to start with. This should pass as the child uses their arm or wrist more.</p><h2>Once the splint is off, can my child return to all physical activities?</h2><p>For the first six weeks after their injury, or for about the first three weeks after the splint is removed, your child should avoid physical education, sports, climbing or other activities, such as swinging or using slides, where a fall could re-injure their wrist.</p><h2>When should my child see a doctor about their injury? </h2><p>It is not usually essential for a child to see a doctor about their injury after they leave the hospital. Most children with this wrist injury heal very well and return to their usual activities within four weeks.</p><p>If your child needs a follow-up visit to your family doctor or paediatrician, the doctor in the hospital emergency department will let you know.</p> <h2>What should I do with the splint once it is removed?</h2><p>It is best to keep the splint safe for a few days until you are sure your child no longer needs it.</p><h2>How are distal radius buckle fractures treated?</h2> <figure> <span class="asset-image-title">Splint</span> <img src="https://assets.aboutkidshealth.ca/akhassets/PST_splint_wrist_EN.jpg" alt="" /> </figure> <p>When your child goes to the hospital with an injured arm, they will be examined carefully. Often, the doctor will order an X-ray to check if there is an injury.</p><p>If there is a buckle fracture of the distal radius, the doctor will recommend a splint to treat it.</p><p>A buckle fracture is best treated with a splint rather than a full circular plaster cast. Because the bones are only partially broken, they heal very well within a few weeks with the support and protection that a splint provides. A splint also makes normal daily activities, such as bathing, easier and can often save extra visits to the doctor.</p><p>Once it is treated properly, a buckle fracture does not cause any long-term problems with the movement or appearance of your child’s arm or wrist.</p><h2>What should I expect in the first few days after my child’s injury?</h2> <p>Your child may have some pain in their wrist. If your child is in pain at home, give them <a href="/article?contentid=153&language=English">ibuprofen</a> or <a href="/article?contentid=62&language=English">acetaminophen</a> according to your doctor’s instructions.</p> <p>Your child’s wrist might also be slightly swollen due to the injured tissues and bones. This usually settles within the first one or two weeks. You can help ease swelling by elevating (raising) your child’s injured arm above their chest for the first two or three days. To do this, have your child lie down and place their injured arm on a large cushion or pillow.</p>
Acne (acne vulgaris)Acne (acne vulgaris)Acne (acne vulgaris)AEnglishDermatologyPre-teen (9-12 years);Teen (13-18 years)SkinSkinConditions and diseasesCaregivers Adult (19+)NA2015-01-14T05:00:00ZMiriam Weinstein, MD, FRCPC8.0000000000000059.00000000000001487.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Discover the different types and causes of acne and how they can be treated.</p><p>Acne, clinically known as acne vulgaris, is the most common skin disease. It affects 85% of teenagers, some as young as 12, and often continues into adulthood. It is also called "pimples," "zits" or "blemishes."</p><h2>Key points</h2><ul><li>Acne vulgaris is the most common skin disease in teenagers.</li><li>Acne occurs deep within the skin, and severity and outcomes vary from person to person.</li><li>Acne causes comedones (whiteheads and blackheads), papules, pustules or even nodules.</li><li>Picking, squeezing and popping can lead to scarring.</li><li>Acne is manageable with the appropriate treatment. Ask your doctor or your dermatologist about your options.<br></li></ul><h2>What causes acne?</h2> <figure><span class="asset-image-title">Anatomy of the skin</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_skin_anatomy_EN.jpg" alt="" /><figcaption class="asset-image-caption">Acne</figcaption><figcaption class="asset-image-caption"> occurs when the sebaceous glands produce more oil, clogging different parts of skin tissue.</figcaption></figure> <p>The skin is formed by many layers of tissue, containing hair, glands, muscles, sensory receptors and blood vessels. During puberty, a group of hormones are released called androgens. Androgens allow the sebaceous glands in the skin to produce an oily substance called sebum. Acne is in part caused by this increase in sebum that naturally occurs during puberty.</p><p>Normal amounts of sebum keep skin and hair from drying out. However, excess oil can mix with dead skin cells and clog hair follicles (the tiny tunnels that lead to the root of the hair) and pores (the opening in the skin where the hair passes through).</p><p>A common type of bacteria that lives on the skin, known as <em>Propionibacterium acnes</em>, sometimes contributes to acne by causing inflammation. The acne signals white blood cells to the area, which damage the tissue and cause an inflammatory response. This causes swelling and infection.</p><p>Acne leads to persistent redness and inflammation, especially on the face, scalp, back and chest, where the most sebum is produced.</p><p>Acne varies from mild to severe, depending on what kind of blemishes appear. The different types of acne include:<br></p><ul><li>comedones</li><li>papules</li><li>pustules</li><li>nodules</li></ul><p>Comedones are pores that are blocked with oil and dead skin cells. They can be open ("blackheads") or closed by the skin ("whiteheads").</p><p>A blackhead is generally level with the skin surface and cannot be removed by normal washing of the face.</p> <figure class="asset-c-80"><span class="asset-image-title">Open comedo (blackhead)</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_acne_blackhead_EN.png" alt="" /><figcaption class="asset-image-caption">The pore of a blackhead is open. When the sebum comes into contact with the air, oxygen exposure causes it to appear black.</figcaption> </figure> <p>A whitehead is slightly raised from the skin, but there is no inflammation.</p> <figure class="asset-c-80"><span class="asset-image-title">Closed comedo (whitehead)</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_acne_whitehead_EN.png" alt="" /><figcaption class="asset-image-caption">A whitehead is formed when pores are blocked with sebum and dead skin cells. The pore in a whitehead is not open at the top.</figcaption> </figure> <p>Papules are red, small, hard bumps that are slightly raised on the skin. In clusters, they can feel like sandpaper to the touch. White blood cells enter the follicle, causing inflammation.</p> <figure class="asset-c-80"><span class="asset-image-title"></span><span class="asset-image-title"></span> <span class="asset-image-title"></span> <span class="asset-image-title">Papule</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_acne_papule_EN.png" alt="" /><figcaption class="asset-image-caption">Papules</figcaption><figcaption class="asset-image-caption"></figcaption><figcaption class="asset-image-caption"></figcaption><figcaption class="asset-image-caption"> are red, painful bumps caused by inflammation of the hair follicles.</figcaption> </figure> <p>When the white blood cells in a papule make it to the surface of the skin, a pustule is formed. Pustules appear as red, inflamed circles with a central, raised bump that is yellowish or white. The bump is filled with pus. Pus is the result of inflammation and contains white blood cells, dead skin cells and bacteria.</p> <figure class="asset-c-80"><span class="asset-image-title"></span><span class="asset-image-title"></span> <span class="asset-image-title"></span> <span class="asset-image-title">Pustule</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_acne_pustule_EN.png" alt="" /><figcaption class="asset-image-caption">Pustules</figcaption><figcaption class="asset-image-caption"></figcaption><figcaption class="asset-image-caption"></figcaption><figcaption class="asset-image-caption"> form a few days after the white blood cells in a papule make it to the surface of the skin. Pustules are typically called "pimples" or "zits".</figcaption> </figure> <p>When a papule or pustule expands, it can cause more severe inflammation in the surrounding skin. This can lead to nodules, which are deep, red, round bumps that can have a diameter of 6 to 20 mm. They are sometimes referred to as cysts.</p><p>Nodules are formed by irritated, inflamed hair follicles that have ruptured deep under the skin. They can be throbbing and painful, even without touching.</p> <figure class="asset-c-80"><span class="asset-image-title"></span><span class="asset-image-title"></span> <span class="asset-image-title"></span> <span class="asset-image-title">Nodule</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_acne_nodule_EN.png" alt="" /><figcaption class="asset-image-caption">Nodules</figcaption><figcaption class="asset-image-caption"></figcaption><figcaption class="asset-image-caption"></figcaption><figcaption class="asset-image-caption"> are often large, inflamed, red, swollen and painful to the touch.</figcaption> </figure><h2>Psychological impact of acne</h2> <p>Acne can have a profound impact on a person's quality of life, particularly for teenagers. Reactions can range from minimal distress to more significant depression, anxiety and, less commonly, thoughts of suicide or self-harm. For these reasons, treating acne matters.</p> <h2>Treatment of acne</h2> <p>Treatment depends on the severity and type of acne. An effective treatment will help reduce future breakouts and improve the skin's appearance. Keep in mind that up to six weeks of treatment might be necessary to start noticing results.</p> <p>In most cases, your doctor or dermatologist will prescribe topical treatments (applied directly on the skin). Sometimes the doctor may prescribe an oral treatment (taken by mouth).</p> <h3>Cleansing skin</h3> <p>Acne is a process deep within the skin. Washing your face regularly helps remove dead skin cells and excess oil, but does not play a significant role in the prevention or management of acne.</p> <p>If you have acne, avoid scrubbing your face when washing, because this may worsen inflammation and irritation. Instead, gently wash your face with warm water. You may also use a mild cleansing product if you want.</p> <h3>Topical retinoids</h3> <p>Topical retinoids unplug comedones and improve the process of shedding the old cells. They may also help reduce any inflammation.</p> <p>Some side effects may occur when using a topical retinoid. These include mild irritation, redness (erythema), dryness, peeling and sensitivity to sun. If you are pregnant, or thinking about having a baby, talk to your doctor or dermatologist before using a topical retinoid, as they should not be used during pregnancy.</p> <p>Avoid skin damage, such as waxing or exfoliation (e.g., facials) when taking retinoids.</p> <p>Common topical retinoids are available in cream and gel form. There are benefits to both creams and gels, depending on the severity of acne and the sensitivity of your skin. Retinoids are also available in many strengths and formulations. Therefore, there is no one better option; your doctor will recommend a retinoid most appropriate for you.</p> <h3>Topical antimicrobials</h3> <p>Topical antimicrobials are used to kill bacteria that contribute to inflammation. They also help fight inflammation directly. One option is benzoyl peroxide, which is available over the counter. When benzoyl peroxide touches the skin, oxygen is created. <em>P. acnes</em> cannot survive in the presence of oxygen.</p> <p>Use caution when applying benzoyl peroxide because it is a potent bleaching agent that can damage fabrics. The pharmacist can answer any questions you might have.</p> <h3>Oral antibiotics</h3> <p>An oral antibiotic (taken by mouth) is sometimes used to treat more significant acne, especially in cases where the acne has spread to the back and chest. Such as topical treatments, oral antibiotics reduce inflammation.</p> <p>Antibiotics can also stop <em>P. acnes</em> from multiplying. However, the use of antibiotics should be limited because bacteria can develop a resistance to them.</p> <h3>Combined treatment</h3> <p>A combined treatment can be an effective means of treating acne. In this case, a topical retinoid and an antimicrobial cream or gel can be used together. Sometimes they are combined into one product, while other times they are used separately. For example, a topical antimicrobial may be applied in the morning and a topical retinoid may be used at night.</p> <p>Oral medications are also used in combination with a topical treatment. Most people taking a pill benefit from a topical cream or gel.</p> <p>Your doctor or dermatologist will advise you on how and when to use a combined treatment for acne.</p> <h3>Oral isotretinoin</h3> <p>Isotretinoin (known as Accutane in North America; Clarus and Epuris in Canada; and Roaccutane in Europe) is a chemical compound related to vitamin A. In most cases, isotretinoin is used to treat severe nodular and scarring acne because:</p> <ul> <li>it reduces sebum secretion</li> <li>it prevents the formation of comedones</li> <li>it acts as an anti-inflammatory</li> <li>it stops <em>P. acnes</em> from generating in hair follicles and sebaceous glands</li> </ul> <p>However, this type of acne treatment must be closely monitored because isotretinoin has a number of side effects. More common side effects include dry skin, lips, nose and eyes. All side effects will begin to disappear when treatment stops.</p> <p>However, there are more severe side effects. For example, isotretinoin can interfere with the development of a fetus. If you are pregnant or thinking about having a baby, talk to your doctor or dermatologist about the side effects of isotretinoin. There are also concerns about depression, inflammatory bowel disease and impact on liver.</p> <h3>Hormonal therapy</h3> <p>Treating acne with female hormones is an effective treatment option for some female patients. This means taking an oral contraceptive (the birth control pill). This type of treatment limits sebum secretion by reducing androgen levels. Other topical and oral treatments can be used along with oral hormonal therapy.</p> <p>Treating acne using hormones is not for everybody. For more information, talk to your doctor or dermatologist.</p><h2>Scar prevention</h2> <p>If left untreated, some acne can cause scarring. It is not always easy to predict which acne will cause scarring; it is a complex problem.</p> <p>Handle acne with care. Manipulating, squeezing and popping increases the likelihood of scarring. The best way to prevent scarring is to actively treat the acne. Treatment is not only for those who have severe acne; no matter how little or how much acne you might have, you can seek treatment for your skin.</p><img alt="" src="https://assets.aboutkidshealth.ca/AKHAssets/acne_vulgaris.jpg" style="BORDER:0px solid;" />https://assets.aboutkidshealth.ca/AKHAssets/acne_vulgaris.jpg
Mental healthMental healthMental healthMEnglishPsychiatryChild (0-12 years);Teen (13-18 years)NANANACaregivers Adult (19+)NALanding PageLearning Hub<p>This hub offers resources on supporting your child's mental health through physical activity, sleep and nutrition. It also offers information on recognizing, treating and coping with a range of mental health conditions.<br></p><p>This hub includes resources for parents on how to support your child's mental health and general wellbeing through physical activity, sleep and nutrition. It also provides information on the signs, symptoms and treatments of different mental health conditions, including anxiety, bipolar disorder, depression, behavioural disorders, anorexia nervosa and attention deficit hyperactivity disorder.<br></p><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Wellbeing<br></h2></div><div class="panel-body list-group" style="display:none;"><p>The everyday pressures of growing up can put a strain on any child's mental wellbeing. Find out how physical activity, a healthy sleep routine, screen time limits and balanced nutrition can boost your child's mental health and support them through difficult times.</p></div><ol class="list-group" style="display:none;"><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h3>Physical Activity</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=642&language=English">Physical activity: Guidelines for children and teens</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=641&language=English">Physical activity: Benefits of exercise for health and wellbeing</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h3>Sleep</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=645&language=English">Sleep: Benefits and recommended amounts</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=646&language=English">How to help your child get a good night's sleep</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=647&language=English">How to help your teen get a good night's sleep</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h3>Screen time</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=643&language=English">Screen time: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=644&language=English">How to help your child set healthy screen time limits</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h3>Nutrition</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=639&language=English">Nutrition: How a balanced diet and healthy eating habits can help your child's mental health</a></li></ol></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Anxiety disorders<br></h2></div><div class="panel-body list-group" style="display:none;"><p>Every child feels anxiety at some point as a natural part of growing up. An anxiety disorder, however, is when anxious feelings interfere with a child's everyday routine. Learn more about the signs, symptoms and range of anxiety disorders and how they ​are treated.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=18&language=English">Anxiety: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=271&language=English">Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=270&language=English">Types of anxiety disorders</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=701&language=English">Treatment with medications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=702&language=English">Psychotherapy and lifestyle changes</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Obsessive compulsive disorder<br></h2></div><div class="panel-body list-group" style="display:none;"><p>Obsessive compulsive disorder (OCD) occurs when a person suffers from troubling and intrusive thoughts and/or follows repetitive or strict routines to feel less worried. Learn about the causes, signs and impact of this disorder and how you can help your child.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=285&language=English">Obsessive compulsive disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=288&language=English">Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=286&language=English">How OCD affects your child's life</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=709&language=English">Psychotherapy and medications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=287&language=English">How to help your child at home</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Depression<br></h2></div><div class="panel-body list-group" style="display:none;"><p>Depression is an illness that causes someone to feel deep sadness or a lack of interest in activities that they once enjoyed. Discover how this condition affects a child's mood, sleep, concentration and energy levels, and how it can be treated.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=19&language=English">Depression: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=284&language=English">Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=707&language=English">Treatment with medications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=708&language=English">Psychotherapy and lifestyle changes</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Bipolar disorder</h2></div><div class="panel-body list-group" style="display:none;"><p>When a person has bipolar disorder, they alternate between low and elevated moods for days, weeks or months at a time. Learn about the bipolar disorder spectrum, the symptoms of manic and depressive episodes and how medications, therapy and lifestyle changes can help.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=279&language=English">Bipolar disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=280&language=English">Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=704&language=English">Treatment with medications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=705&language=English">Psychotherapy and lifestyle changes</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Suicide and self-harm</h2></div><div class="panel-body list-group" style="display:none;"><p>A child who experiences thoughts of suicide or self-harm is often suffering from overwhelming emotional pain. Find out how to help your child cope with difficult emotions, how to support and protect your child and where to find professional help.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=291&language=English">Suicide in children and teens: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=289&language=English">Self-harm in children and teens: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=290&language=English">Signs and symptoms of suicide risk</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=293&language=English">How to help your child with difficult emotions</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=292&language=English">How to protect your child from harm</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Eating disorders<br></h2></div><div class="panel-body list-group" style="display:none;"><p>An eating disorder not only risks your child's health but can also disrupt family life. Find out about the symptoms and treatment of anorexia, bulimia, avoidant/restrictive food intake disorder and binge eating disorder and how you can help your child recover.</p></div><ol class="list-group" style="display:none;"><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h3>Anorexia nervosa</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=268&language=English">Anorexia nervosa: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=269&language=English">Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=267&language=English">Medical complications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=700&language=English">Treatment options</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=266&language=English">How to help your child at home</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h3>Bulimia nervosa</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=282&language=English">Bulimia nervosa: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=283&language=English">Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=281&language=English">Medical complications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=706&language=English">Treatment options</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=294&language=English">How to help your child at home</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h3>Avoidant/restrictive food intake disorder (ARFID)</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=274&language=English">Avoidant/restrictive food intake disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=275&language=English">Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=273&language=English">Medical complications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=703&language=English">Treatment options</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=272&language=English">How to help your child at home</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h3>Binge eating disorder (BED)</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=277&language=English">Binge eating disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=278&language=English">Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=640&language=English">Obesity: Medical complications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=276&language=English">How to help your child at home</a></li></ol></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Attention deficit hyperactivity disorder (ADHD)</h2></div><div class="panel-body list-group" style="display:none;"><p>Attention deficit hyperactivity disorder (ADHD) involves difficulties with controlling attention and regulating behaviour. Discover the main symptoms of ADHD in children and teens, how the disorder is diagnosed and how to help your child at home and at school.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1922&language=English">Attention deficit hyperactivity disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1923&language=English">Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1997&language=English">How to help your child at home</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1999&language=English">Communicating with your child's school</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1998&language=English">Treatment with medications</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Behavioural disorders</h2></div><div class="panel-body list-group" style="display:none;"><p>Behavioural disorders include oppositional defiant disorder and conduct disorder. Learn how these disorders differ from typical misbehaviour, how therapy and medications can help and how you can manage problematic behaviour at home.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1924&language=English">Behavioural disorders: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1925&language=English">Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=2000&language=English">Treatment with psychotherapy and medications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=2001&language=English">How to help your child at home</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Post-traumatic stress disorder (PTSD)</h2></div><div class="panel-body list-group" style="display:none;"><p>Post-traumatic stress disorder (PTSD) is triggered by experiencing or witnessing a terrifying event. Learn about the main symptoms of PTSD, how the condition is diagnosed and how psychotherapy and medications can help your child.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1927&language=English">Post-traumatic stress disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1928&language=English">Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=2005&language=English">Treatment with psychotherapy and medications</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Brain disorders and mental health</h2></div><div class="panel-body list-group" style="display:none;"><p>A brain disorder includes a condition, illness or injury that affects the brain and how it develops before or after birth. Find out how a brain disorder can affect your child's learning, mood and social skills, how its impact on mental health is assessed and how to help your child cope.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1926&language=English">Brain disorders and mental health: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=2002&language=English">Assessing your child for neuropsychological difficulties</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=2003&language=English">How to help your child cope</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=2004&language=English">Common treatments</a></li></ol></div>https://assets.aboutkidshealth.ca/AKHAssets/Mental_health_landing-page.jpgmentalhealthhealthyliving
Screen time: OverviewScreen time: OverviewScreen time: OverviewSEnglishPreventionBaby (1-12 months);Toddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)NANAHealthy living and preventionCaregivers Adult (19+)NA2016-07-18T04:00:00ZSamantha Metler, MA;Suneeta Monga, MD, FRCPC000Flat ContentHealth A-Z<p>Learn how screen time affects children and how much screen time they should have each day.</p><h2>What is screen time?</h2><p>Screen time is the amount of time your child spends using a device that has a screen. It includes time spent watching television, browsing the internet, using a cell phone and playing video games. But regardless of the device, most screen time limits a child’s opportunities to get active outside the home. Over time, this low level of <a href="/Article?contentid=642&language=English">physical activity</a> can threaten their health.</p><h2>Key points</h2> <ul> <li>Screen time is the amount of time your child spends using a device that has a screen such as a TV, computer, games console, tablet or smartphone.</li> <li>The recommended amount of screen time depends on a child’s age. Children under two should not have any screen time and those under aged five and under should have less than two hours a day.</li> <li>Spending too much time in front of a screen can negatively impact your child’s mental health. Signs include feeling sad, overly tired, withdrawn or uninterested in other activities.</li> </ul><p>The technology children have access to today is changing their world and providing them with endless opportunities. The downside is that it is very easy for children (and even adults) to experience an overload of information and forget about other fun and healthy activities.</p> <p>Recent research from the Healthy Active Living and Obesity Research Group in the Children’s Hospital of Eastern Ontario indicates that Canadian school-aged children spend 65 to 80 percent of their waking hours engaging in sedentary behaviour. Another study found that Canadian children and youth aged six to 19 spend 62 percent of their waking hours being sedentary.</p> <p>Together, these studies show that most young children engage in activities that involve little physical movement or use of energy. This pattern can be partly explained by the increasing amount of screen time in our daily lives.</p> <h2>How screen time affects physical and mental health</h2> <p>Screen time has been linked to lower levels of physical fitness and problems with mental health and social development.</p> <ul> <li>Children who spend more time in front of a screen tend to have higher obesity rates than children who spend less time in front of a screen.</li> <li>Children and teens who watch more than two hours of TV a day have lower scores of self-esteem.</li> <li>Higher levels of screen time have been linked to lower school performance. This is partly because those who watch higher amounts of TV tend to spend less time doing homework.</li> </ul> <p>High levels of screen time can also affect a child’s nutrition. Although not all children eat or snack while they watch television or use other devices, screen time can sometimes encourage unhealthy eating habits. For instance, if your child is distracted by a television show or video game while they eat, they may not be able to recognize when they are full. It is also easy for your child to associate screen time with enjoying a favourite food.</p> <p>While active video games are advertised as a good way to encourage physical activity, children and teens quickly learn how to play using minimal gestures (for example using wrist movement only). This greatly reduces the amount of energy they use.</p> <h2>How much screen time is ‘too much’?</h2> <p>Daily screen time recommendations largely depend on the age of the child. The Canadian Paediatric Society and the Canadian Society for Exercise Physiology (CSEP) recommend the following daily limits.</p> <ul> <li>Children under age two: no screen time</li> <li>Children aged two to four: less than one hour a day of screen time</li> <li>Children and teens aged 5 to 17: maximum of two hours a day of recreational screen time (watching television, messaging friends or playing computer games)</li> </ul> <p>Screen time is an important and unavoidable part of your child’s life, especially as they get older. For instance, older children may need to spend more time on a computer to complete homework or on their phone to stay in touch with friends. There are also different types of screen time: ;using a phone or computer to video call a family member has a different effect on a developing brain than watching a stream of videos.</p> <p>Associations such as the American Academy of Pediatrics have taken account of the growing presence of technology from the early years. Rather than set daily limits by age group, its recommendations now focus on the role of parents to set limits, use their judgment about the quality of screen time and model healthy behaviour. It is likely that more research into screen time will be needed as technology continues to evolve.</p> <h2>How to calculate your child’s current daily screen time</h2> <p>Calculating the amount of time your child spends looking at a screen on a normal day will help you find out if you need to <a href="/Article?contentid=644&language=English">set limits on screen time​</a> and encourage them to spend more time on other activities.</p> <p>Screen time for a normal day means the amount of time your child spends looking at a screen from the time they wake up until the time they go to bed. You can calculate this by adding up the time spent on the following activities.</p> <table class="akh-table"> <thead> <tr><th>Screen time activity</th><th>Examples</th></tr> </thead> <tbody> <tr> <td>Watching television</td> <td><ul> <li>Watching cartoons, reality shows, sports, documentaries, news, game shows, talk shows, movies</li> </ul></td> </tr> <tr> <td>Using the internet</td> <td><ul> <li>Watching videos</li> <li>Watching streamed TV shows or movies</li> <li>Instant messaging</li> <li>Downloading music</li> <li>Playing online games</li> <li>Using social media websites and apps</li> <li>Downloading music</li> </ul></td> </tr> <tr> <td>Using a computer or tablet</td> <td><ul> <li>Reading or writing documents</li> <li>Playing a computer game</li> <li>Creating a drawing in a computer program</li> <li>Browsing or editing photos</li> <li>Listening to or organizing music files</li> <li>Writing computer programs</li> </ul></td> </tr> <tr> <td>Using a cell phone or smart watch</td> <td><ul> <li>​Reading and writing text messages</li> <li>Playing games</li> <li>Using apps</li> <li>Listening to music</li> </ul></td> </tr> <tr> <td>Playing games</td> <td><ul> <li>​​​Using a gaming station</li> <li>Using a children's camera with built-in games</li> </ul></td> </tr> </tbody> </table> <h2>How to tell if your child has too much screen time</h2> <p>Screen time becomes unhealthy when your child is glued to a screen for most of the day. If your child’s screen time falls outside the recommended limits for their age, you may notice some telltale signs.</p> <p>Children and teens who spend too much time in front of a screen may seem:</p> <ul> <li>lonely</li> <li>sad</li> <li>overly tired</li> <li>stressed or fearful</li> <li>isolated from friends or family</li> <li>withdrawn</li> <li>nervous</li> <li>agitated or tense</li> <li>aggressive or angry.</li> </ul> <p>They may also experience emotional outbursts and have difficulties making and keeping friends.</p> <p>Some children also have difficulties concentrating and lose interest in school, following rules or doing other activities. The lack of physical activity that results from too much screen time can also cause frequent back pain, headaches or stomach aches.</p> <p>Some of these issues may have causes other than excessive screen time. See your child’s doctor if you have any concerns about your child’s physical or mental health.</p><img alt="" src="https://assets.aboutkidshealth.ca/AKHAssets/screen_time_overview.jpg" style="BORDER:0px solid;" />https://assets.aboutkidshealth.ca/AKHAssets/screen_time_overview.jpg



Von Willebrand diseaseVon Willebrand diseaseVon Willebrand diseaseVEnglishHaematologyChild (0-12 years);Teen (13-18 years)BodyCardiovascular systemConditions and diseasesCaregivers Adult (19+)NA2017-05-08T04:00:00ZVanessa Bouskill, MN, RN(EC), NP;Manuel Carcao, MD, FRCP(C), FAAP, MScsusan.ball@sickkids.ca | Susan Ball | 693A30232E777C7369636B6B6964735C737573616E2062616C6C i:0#.w|sickkids\susan ball7.5000000000000066.70000000000001410.00000000000Health (A-Z) - ConditionsHealth 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><div class="akh-series"><div class="row"><div class="col-md-12"> <figure> <span class="asset-image-title">Inheritance pattern of Type 1, 2A, 2B and 2M von Willebrand disease</span><img alt="Inheritance pattern of Type 1, 2A, 2B and 2M von Willebrand disease." 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></div></div><div class="row"><div class="col-md-12"> <figure> <span class="asset-image-title">Inheritance pattern of Type 2N and 3 von Willebrand disease</span><img alt="Inheritance pattern of Type 2N and 3 von Willebrand disease." 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></div></div><div class="row"><div class="col-md-12"> <figure> <span class="asset-image-title">Inheritance pattern of Type 2N von Willebrand disease</span><img alt="Inheritance pattern of Type 2N von Willebrand disease." 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></div></div><div class="row"><div class="col-md-12"> <figure> <span class="asset-image-title">Inheritance pattern of Type 3 von Willebrand disease</span><img alt="Inheritance pattern of Type 3 von Willebrand disease." 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></div></div></div><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
Pulmonary hypertensionPulmonary hypertensionPulmonary hypertensionPEnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartHeart;ArteriesConditions and diseasesCaregivers Adult (19+)NAhttps://assets.aboutkidshealth.ca/akhassets/pulmonary_arteries_EN.jpg2017-05-02T04:00:00ZTilman Humpl, MD, PhD9.2000000000000053.3000000000000752.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn about the symptoms, causes and treatment of pulmonary hypertension in children.</p><h2>What is pulmonary hypertension?</h2><p>The <a href="https://pie.med.utoronto.ca/htbw/module.html?module=heart">pulmonary artery</a> carries blood from the right side of the heart to the lungs. Pulmonary hypertension occurs when there is high pressure in this artery.</p><p>The pressure in the pulmonary arteries is higher when a baby is born, but it usually lowers over the next few hours or days. When the pressure stays high, it is called persistent pulmonary hypertension of the newborn and is usually treated successfully in hospital.</p> <figure> <span class="asset-image-title">Pulmonary arteries</span><img src="https://assets.aboutkidshealth.ca/akhassets/pulmonary_arteries_EN.jpg" alt="" /> </figure><h2>Key points</h2> <ul> <li>Pulmonary hypertension is high pressure in the pulmonary arteries.</li> <li>Over time, pulmonary hypertension can lead to problems such as heart failure, damage to the blood vessels or abnormal heart rhythms.</li> <li>Pulmonary hypertension is usually treated with medication to relieve the symptoms.</li> </ul><h2>Symptoms of pulmonary hypertension</h2> <p>Pulmonary hypertension is very rare in children, but it is serious. Because it is so rare, it can go undiagnosed for a long time. Symptoms may include decreased exercise tolerance, shortness of breath, chest pain and fainting or near fainting.</p><h2>Cause of pulmonary hypertension</h2> <p>Pulmonary hypertension may appear on its own and it is not clear what causes it. This kind of pulmonary hypertension is usually called idiopathic.</p> <p>There are other conditions that may result in pulmonary hypertension, for example:</p> <ul> <li>it may be associated with congenital heart disease</li> <li>chronic lung disease</li> <li>structural abnormalities of the lungs or lung vessels</li> <li>blood clots in the lung vessels</li> <li>sleep disorders</li> <li>chronic exposure to high altitude</li> <li>it may be drug and toxin induced</li> </ul><h2>Diagnosis of pulmonary hypertension</h2> <p>The doctor will take your child's medical history and do a physical exam. Then the doctor will do an electrocardiogram, chest X-ray and echocardiogram. Other tests may be necessary.</p> <p>Heart catheterization is the best test to confirm the diagnosis and assess how severe the condition is. It also lets the doctor give drugs during the procedure to see if the pressure in the pulmonary artery can be lowered.</p><h2>Treatment of pulmonary hypertension</h2> <p>Treatments for pulmonary hypertension are aimed at relieving symptoms. They include:</p> <ul> <li>oxygen to lower lung pressure to help the child breathe more easily</li> <li>drugs called diuretics to get rid of extra fluid in the body</li> <li>specific drugs given by mouth such as sildenafil (Revatio), bosentan (Tracleer) or macitentan (Opsumit), or prostacyclin type medication (Flolan, Remodulin, Uptravi) which may be given as a continuous infusion. These medications may lower the pressures in the pulmonary artery.</li> </ul> <p>Pulmonary hypertension is a challenging condition to treat. However, the good news is that treatments have become available that can slow down the disease, or even help reverse the damage to the lungs.</p> <p>In rare cases, children with pulmonary hypertension have needed a lung transplant.</p><h2>Long-term problems caused by pulmonary hypertension</h2> <p>Pulmonary hypertension can lead to various problems:</p> <ul> <li>The right ventricle of the heart needs to work harder to pump blood to the lungs. This makes the right side of the heart get bigger. In the long term, it can lead to heart failure.</li> <li>When the arteries are under high pressure for a long time, tissue in the arteries becomes stiff. As the disease goes on and the high pressure continues, the blood vessels get scarred. This makes them weak and at risk of tearing.</li> <li>The condition can also lead to abnormal heart rhythms because the right ventricle is stretched.</li> </ul><h2>What is Eisenmenger's syndrome?</h2><p>Eisenmenger's syndrome, is pulmonary hypertension resulting from a heart defect. Generally, it begins with a heart defect such as <a href="/Article?contentid=1600&language=English">ventricular septal defect</a> (VSD). Extra blood flows to the lungs through the VSD. Over time this causes high pressure in the lungs. Once the lung pressures are high enough the blood flow through the heart reverses. The high pressure causes the blood flow through the VSD in the heart to reverse and go from the pulmonary arteries to the body. Because this blood has not yet travelled to the lungs, it is "blue blood" and may cause cyanosis.</p><p>Eisenmenger's syndrome can develop in early childhood or take time to develop over the years. Symptoms are similar to those listed above, together with the appearance of cyanosis.</p><p>Once Eisenmenger's syndrome is diagnosed, it is too late to correct the VSD. Treatment involves the use of drugs to control symptoms and prevent the condition from getting worse.</p>
The insulin regimenThe insulin regimenThe insulin regimenTEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemDrug treatmentAdult (19+)NA2016-10-17T04:00:00ZCatherine Pastor, RN, MN, HonBSc;Vanita Pais, RD, CDE;Jennifer Harrington​, MBBS, PhD​000Flat ContentHealth 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 diabete​s 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
Addison's disease and diabetesAddison's disease and diabetesAddison's disease and diabetesAEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemConditions and diseasesAdult (19+)Fatigue;Nausea;Abdominal pain;Joint or muscle painhttps://assets.aboutkidshealth.ca/akhassets/adrenal_gland_and_water_regulation_V2_EN.jpg2017-11-20T05:00:00ZCatherine Pastor, RN, MN, HonBScVanita Pais, RD, CDEAndrea Ens, MD, FRCPCJennifer Harrington, MBBS, PhD000Flat ContentHealth 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><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> <h2>Signs and symptoms of Addison’s disease</h2><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><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> ​​

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