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Iron deficiency anemia and protein-losing enteropathy related to excessive milk intakeIron deficiency anemia and protein-losing enteropathy related to excessive milk intakeIron deficiency anemia and protein-losing enteropathy related to excessive milk intakeIEnglishNutritionChild (0-12 years)NANAConditions and diseasesAdult (19+) CaregiversNA2019-01-16T05:00:00ZLaila Premji, MD, FRCPC;Zamin Ladha MD, MSc 9.0000000000000055.40000000000002219.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Milk can be a part of a healthy, balanced diet. However, drinking too much milk can lead to low levels of iron in the blood and some children can then lose protein from the gut.<br></p><h2>Excessive milk intake</h2><p>The recommended amount of cow’s milk for toddlers is 250 to 500 mL (1–2 cups or 8–16 oz.) per day. Some toddlers drink more milk than the recommended number of servings. This "milk diet" can lead to iron deficiency. A small group of these children also experience protein loss from the digestive system or gut. Iron deficiency can lead to anemia (low red blood cell count) and protein loss leads to hypoalbuminemia (low levels of albumin in the blood). Treatment usually requires limiting milk intake, offering iron rich solid food, and in children with moderate to severe anemia, iron supplements.</p> <p>Breast milk or formula is a good source of iron for the first six months of life. Iron stores in babies naturally decrease by four to six months of age. After six months, the amount of iron in breast milk is not enough, and solid foods are usually introduced.</p><p>When introducing solid foods, infants should start with meat or meat alternatives, in order to get enough iron and protein in their diet. Meat alternatives include fish, egg yolk, tofu, lentils and cheese. Iron-fortified cereals are also a good source of iron that can be started at four to six months of age. Breast milk and/or formula should continue until nine to 12 months of age, when homogenized (3.25%) cow’s milk may be started to complement solid food.</p><h3>Iron deficiency anemia</h3><p>Iron is an important mineral that we get from our diet that is needed to make haemoglobin. Haemoglobin is a protein in red blood cells that allows the cells to carry oxygen to the tissues in our body. Anemia occurs when you have low levels of haemoglobin in your body. When the anemia is caused by not having enough iron this is called iron deficiency anemia.</p><p>When a child has anemia, they are not getting enough oxygen delivered to the tissues in their body. This can cause them to look pale and tired, and cause weakness.</p><h3>Protein losing enteropathy</h3> <p>Drinking too much milk can also cause protein loss from the gut (protein losing enteropathy).</p><p>Children with protein losing enteropathy have severe protein loss through the gut and this results in low protein levels in the blood.</p><p>The main protein found in the blood is called albumin. Having low levels of the protein albumin in the blood (hypoalbuminemia) can cause the blood vessels to leak fluid into the tissue. Extra fluid in the tissue can cause swelling (edema) of the legs, back and face. Hypoalbuminemia also puts you at risk for infections.</p><p>Hypoalbuminemia and edema can be caused by other disorders. Your child’s doctor will ask questions about your child’s overall health, symptoms of diarrhea or blood in the stool, and family history of gut, liver, kidney or heart diseases.</p><p>If there are no other causes for protein loss, it is possible that too much milk is the cause.</p><h2>Key points</h2><ul><li>Too much milk can lead to iron deficiency anemia and protein loss from the gut.</li><li>Milk intake should be limited to a maximum of 500 mL (2 cups or 16 oz.) per day for toddlers and young children.</li><li>The main treatment for iron deficiency and protein loss from the gut due to excess milk intake is to reduce the amount of milk your child drinks and to increase the amount iron rich foods in their diet. For moderate to severe anemia, iron supplements are also needed.</li><li>See a doctor if your child drinks a lot of milk and is tired, weak, pale or has a swollen face, legs and feet.</li> </ul> <h2>Signs and symptoms of iron deficiency anemia and protein losing enteropathy</h2><p>Symptoms of anemia depend upon its severity, how fast the drop in levels of haemoglobin occurred and its cause. It also depends on how well a child’s body adapts to a low level of haemoglobin.</p><p>Symptoms of anemia include:</p><ul><li>pale skin</li><li>lack of energy</li><li>shortness of breath after exercise or play</li></ul><p>Protein losing enteropathy and hypoalbuminemia causes the blood vessels to leak fluid into surrounding tissue.<br></p><p>Symptoms of protein losing enteropathy and hypoalbuminemia include:</p><ul><li>progressive swelling of the feet, legs and face</li><li>muscle cramps or weakness</li><li>extra fluid around the lungs (pleural effusion)</li><li>swelling of the abdomen (ascites)</li></ul> <h2>Risk factors and prevalence of iron deficiency anemia</h2><p>Iron deficiency anemia is the most common type of anemia.</p><p>Around the world, iron deficiency anemia affects approximately 750 million children. In Canada, it is seen in 3.5% to 10.5% of the general population. Children have a greater risk of iron deficiency anemia due to their rapid growth, particularly in the first two years of life.</p><p>Children who are most at risk of developing iron deficiency anemia are those who are fed only breast milk or non-iron fortified cow’s milk formulas after six months of age, and those who drink an excess of cow’s milk. Children who are given cow’s milk before 12 months may also be at increased risk of developing iron deficiency anemia because their gut may not be ready to digest cow’s milk yet.</p> <h2>Cause of iron deficiency anemia and protein losing enteropathy</h2><h3>Iron deficiency anemia</h3><p>Iron deficiency anemia from excessive milk intake is caused by three things.</p><ul><li><strong>Not enough iron:</strong> Milk contains very little iron. In addition, if a child drinks too much milk, they will be too full to eat good amounts of iron rich foods.</li><li><strong>Poor iron absorption:</strong> Milk and other dairy products can interfere with the gut’s ability to absorb iron from other sources, such as meat and meat alternatives, and dark green vegetables.</li><li><strong>Microscopic bleeding:</strong> Too much milk can damage the lining of the gut (milk enteropathy). Milk enteropathy causes microscopic bleeding from the gut that you may not be able to see. Any type of bleeding from the body results in a loss of iron. Over time, this bleeding can cause very low levels of haemoglobin, contributing to the iron deficiency anemia.</li></ul><h3>Protein losing enteropathy</h3><p>It is not fully understood how milk intake leads to protein loss in the gut. One theory suggests a process called villous atrophy. The small intestine part of our gut has finger-like projections on its walls called villi. The villi play an important role in the absorption of nutrients. It is believed that an excess intake of cow’s milk can cause the villi to shrink (villous atrophy) and not absorb nutrients well. Villous atrophy causes the bowel walls to become leaky, allowing protein to leak through.</p><h2>Diagnosis of anemia and protein losing enteropathy</h2><h3>Iron deficiency anemia</h3><p>Iron deficiency anemia can be diagnosed by your child’s doctor. They will do a physical exam and ask about your child’s energy levels, general health, diet and family history.</p><p>A blood test, called a complete blood cell count (CBC), can make the diagnosis of anemia by measuring haemoglobin levels. When the anemia is caused by iron deficiency, the red blood cells will also look smaller and lighter in colour when seen under a microscope.</p><p>A ferritin test may also be done. Ferritin is a protein found in the body that stores iron. A low ferritin level can indicate iron-deficiency.</p><p>Additional useful tests that measure the body’s iron are called iron studies.</p><h3>Protein losing enteropathy</h3><p>Protein losing enteropathy and hypoalbuminemia are suspected in children with swelling and low albumin levels in the blood. Your child’s doctor will examine them for swelling of the legs, feet and face. They will also examine your child’s heart, lungs and abdomen for extra fluid.</p><p>A blood test is often done to check the blood albumin level. A urine test may also be done to make sure there is no protein loss from the kidneys. When the cause of low albumin is not clear, further tests may be done including stool tests. One of the stool tests that may be performed is a 24-hour collection of stool to check for a protein called alpha-1-antitrypsin. By comparing the amount of this protein in the stool to the amount in the blood, doctors can tell whether there is protein loss through the gut.</p> <h2>Treatment of iron deficiency</h2><h3>Diet</h3><p>Limiting milk intake to a maximum of 16 ounces per day is usually the only treatment needed. The iron levels will gradually rise and protein loss from the gut will decrease.</p><p>Iron rich foods can also help to treat iron deficiency. Many iron rich foods, such as meat and meat alternatives, are also high in protein. Offer your child foods such as meat and meat alternatives, and iron-fortified cereals a few times each day. From one year of age, young children should begin to have a regular schedule of meals and snacks. In general, you may follow the advice in <a href="https://food-guide.canada.ca/en/">Canada’s Food Guide</a>.</p><p>Limiting milk does not mean stopping it completely. It is known that milk is a good source of calcium, vitamin A and vitamin D. From one to two years of age, children should drink 250 to 500 mL (1–2 cups or 8–16 oz.) of homogenized (3.25% M.F.) cow’s milk per day. They should not drink more than 500 mL (2 cups or 16 oz.) per day.</p> <h3>Iron supplement</h3><p>Your child’s doctor might also prescribe iron supplements. After a few weeks, values such as the haemoglobin level generally start to improve. Treatment is usually continued for at least three months to fully replenish iron stores in the body.</p><p>Iron supplementation can cause an upset stomach. Your doctor might divide the dose in half and ask you to give it two times per day instead of as one large daily dose.</p><p>Dairy products (milk, cheese, yogurt) can have a negative effect on the absorption of iron. Try to give iron supplements two hours before or after eating or drinking any dairy products.</p><p>Vitamin C can help iron absorption from foods. Oranges and other citrus fruit are good sources of vitamin C. Be careful with offering too much juice, as it is high in sugar.</p><p>Protein losing enteropathy and hypoalbuminemia caused by too much milk gets better fairly quickly when the milk intake is limited to an appropriate amount.</p><h2>Complications of anemia and hypoalbuminemia</h2><p>Untreated anemia in children can have serious effects on a child’s growth. Untreated anemia can affect intellectual ability and overall development. This can lead to problems with attention, reading ability and school performance. In rare cases, extreme anemia can cause a stroke.</p><p>Hypoalbuminemia can also have serious effects on a child’s growth. Excess fluid around the lungs can cause problems with breathing. In rare cases, excess fluid can build up around the heart making it harder for the heart to pump. Protein loss in the gut can also cause a loss of the proteins needed to fight infection and prevent clots, putting children at risk of severe infections or blood clots.</p> <h2>Helping your child</h2><p>Limiting milk intake can be challenging. Many toddlers enjoy drinking milk in a bottle, and associate drinking milk with their bedtime ritual.</p><p>Here are some tips on how to help limit your child’s milk intake:</p><ul><li>If your child drinks more than 1200 mL (5 cups or 40 oz.) of milk per day, wean them slowly to smaller amounts. Cut the amount by half to start.</li><li>Offer solid foods first and only offer milk at the end of the meal. Alternatively, you could offer water with meals and milk only a couple of times a day with a snack. This way your child will not fill up on milk first.</li><li>Switch to a sippy cup early. This will prevent your child from taking the milk to bed and associating drinking milk with falling asleep.</li><li>Do not allow your child to sleep with a bottle of milk in bed. If you are having trouble with this then slowly start to dilute the milk with water until you are offering just water. This will also help in avoiding dental caries.</li> </ul> <h2>Follow-up</h2><p>Iron supplementation should be continued for at least three to six months to replenish the amount of iron that is stored in the body.</p><p>After starting treatment, your doctor will schedule a follow-up appointment. A repeat blood test is not always needed if your child’s symptoms improve with iron treatment and changes in diet.</p> <h2>References</h2><ol><li>Abdullah, K., Zlotkin, S., Parkin, P. & Grenier, D. Iron-deficiency Anemia in Children. Canadian Paediatric Surveillance Program, resource article, 2011 (Accessed December 3, 2017).</li><li>Allen, R.E. & Myers, A.L. Nutrition in Toddlers. American Family Physician. 2006; 74(9): 1526-1532.</li><li>Bondi, S.A. & Lieuw, K. Excessive Cow’s Milk Consumption and Iron Deficiency in Toddlers: Two Unusual Presentations and Review. Infant, Child, & Adolescent Nutrition. 2009; 1(3). DOI: 10.1177/1941406409335481.</li><li>Critch, J.N. Nutrition for healthy term infants, six to 24 months: An overview. Paediatric Child Health. 2014; 19(10): 547-549.</li><li>Food Sources of Iron. Dietitians of Canada. (Accessed December 3, 2017).</li><li>Grueger, B. Weaning from the Breast. Paediatric Child Health 2013; 18(4): 210.</li><li>Kazal, L.A. Prevention of Iron Deficiency in Infants and Toddlers. American Family Physician. 2002; 66(7): 1217-1224.</li><li>Rabinowitz, S. & Ebigbo, N. Pediatric Protein-Losing Enteropathy. Medscape, Pediatrics; General Medicine, 2017 < https://emedicine.medscape.com/article/931647-overview> (Accessed December 3, 2017).</li></ol> https://assets.aboutkidshealth.ca/AKHAssets/Drinks_for_your_toddler_or_preschooler.jpgExcessive milk intake Milk is part of a healthy diet. But too much milk can lead to low levels of iron in the blood and some children can lose protein from the gut.
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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">Anorexia: Signs and symptoms</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=267&language=English">Anorexia: Medical complications</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=700&language=English">Anorexia: Treatment options</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=266&language=English">Anorexia: 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">Bulimia: Signs and symptoms</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=281&language=English">Bulimia: Medical complications</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=706&language=English">Bulimia: Treatment options</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=294&language=English">Bulimia: 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">ARFID: Signs and symptoms</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=273&language=English">ARFID: Medical complications</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=703&language=English">ARFID: Treatment options</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=272&language=English">ARFID: 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">BED: 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">BED: 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">ADHD: Signs and symptoms</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=1997&language=English">ADHD: How to help your child at home</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=1999&language=English">ADHD: Communicating with your child's school</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=1998&language=English">ADHD: 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">Behavioural disorders: Signs and symptoms</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2000&language=English">Behavioural disorders: Treatment with psychotherapy and medications</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2001&language=English">Behavioural disorders: 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">PTSD: Signs and symptoms</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2005&language=English">PTSD: 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">Brain disorders: Assessing your child for neuropsychological difficulties</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2003&language=English">Brain disorders: How to help your child cope</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2004&language=English">Brain disorders: Common treatments</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">Parenting a child with a chronic condition</h2></div><div class="panel-body list-group" style="display:none;"><p>A chronic conditions can affect a child's mental health and everyday routines. Discover how parents and caregivers can help manage both their child's health care and routines, and support their own mental health.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3400&language=English">Living with a chronic condition: Overview</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3401&language=English">Living with a chronic condition: Helping your child manage their health</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3402&language=English">Living with a chronic condition: Maintaining your child's everyday routines</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3403&language=English">Living with a chronic condition: Supporting yourself as a caregiver</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">Substance use disorder</h2></div><div class="panel-body list-group" style="display:none;"><p>Substance use is the use of alcohol, tobacco and other drugs for pleasure or enjoyment. Learn about the signs and symptoms of substance use and how you can help your teen if you suspect they have a substance use disorder.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3663&language=English">Substance use disorder: Overview</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3664&language=English">Substance use disorder: Signs and symptoms</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3665&language=English">Substance use disorder: How to help your teen 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">Understanding somatization</h2></div><div class="panel-body list-group" style="display:none;"><p>Somatization involves expressing distress through physical symptoms. Find out about the mind-body connection, signs of somatization and the various ways to support your child or teen.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3667&language=English">Mind-body connection</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3668&language=English">Somatization: Signs and symptoms</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3669&language=English">Somatization: Common treatments</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3770&language=English">Somatization: How to help your child or teen cope</a></li></ol></div>https://assets.aboutkidshealth.ca/AKHAssets/Mental_health_landing-page.jpgmentalhealthhealthyliving
Celiac disease: Tips to maintain the gluten-free dietCeliac disease: Tips to maintain the gluten-free dietCeliac disease: Tips to maintain the gluten-free dietCEnglishGastrointestinalBaby (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)Small IntestineSmall intestineNon-drug treatmentCaregivers Adult (19+)NA2017-02-06T05:00:00ZPeggy Marcon, MD, FRCPC;Inez Martincevic, MSc, RD;Catharine Walsh, MD, MEd, PhD, FAAP, FRCPC8.9000000000000057.00000000000001725.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Children with celiac disease must follow a strict gluten-free diet. This article contains tips to help your child maintain their special diet.</p><h2>What is celiac disease?</h2><p><a href="/Article?contentid=816&language=English">Celiac disease</a> is an autoimmune condition in which contact with gluten (a family of food proteins) triggers a reaction by the body’s defense (immune) system. The immune response to gluten—no matter where in the body the contact happened—damages the lining of the gut (small intestine) making it difficult to absorb nutrients.</p><p>Common symptoms of celiac disease include <a href="/article?contentid=7&language=English">diarrhea</a>, <a href="/article?contentid=6&language=English">constipation</a>, <a href="/article?contentid=29&language=English">headaches</a>, tiredness and <a href="/article?contentid=841&language=English">anemia</a>. Some people experience no symptoms at all.<br></p><p>Celiac disease is a life-long condition. There is no medication for celiac disease. The only treatment is a strict gluten-free diet for life. The gluten-free diet will help heal the gut, improve symptoms that may have been present, and keep your child healthy.<br></p><figure class="asset-small"><img src="https://assets.aboutkidshealth.ca/akhassets/gluten_free_symbol_EN.jpg" alt="" /> </figure> <h2>What is the gluten-free diet?</h2><p>A strict <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=956&language=English">gluten-free diet</a> means no trace amounts of gluten. Gluten is naturally found in all forms of:</p><ul><li>wheat</li><li>rye</li><li>barley</li><li>triticale (rye and barley mix).</li></ul><p>Wheat-based products, such as breads, pasta and baked goods, are obvious sources of gluten. However, there are also many foods where gluten is hidden, such as soups, salad dressings and ice creams. </p><p>Always read the labels of all foods and non-food items (such as medications) to find out if they contain any sources of gluten.</p><h2>Key points</h2><ul><li>Celiac disease is an autoimmune condition in which any contact with gluten (a family of food proteins) triggers a reaction from the body’s defense (immune) system.</li><li>Gluten is found in rye, barley, triticale and all forms of wheat.</li><li>The only treatment for celiac disease is a strict <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=956&language=English">gluten-free diet</a> for life. The gluten-free diet will help heal the gut, improve symptoms that may have been present, and keep your child healthy.</li><li>To maintain a strict gluten-free diet, you should avoid cross-contamination (gluten transferred from one food or object to a gluten-free food or object) at home and outside your home.</li><li>When eating out, make sure everyone understands that your child’s gluten-free diet is the only medical treatment for celiac disease.</li></ul><br><h2>Tax credit</h2> <p>The purchase of gluten-free products for a person with celiac disease is considered a medical expense and can be filed as such with your taxes with <a href="http://www.cra-arc.gc.ca/menu-eng.html">Canada Revenue Agency</a>. You will be required to have the following documentation:</p> <ul> <li>a letter from a health-care practitioner certifying that the person requires gluten-free products due to celiac disease</li> <li>a summary of each item purchased during the 12-month period for which the expenses are being claimed</li> <li>a receipt to support the cost of each gluten-free product claimed</li> </ul> <p>For more information, visit the <a href="http://www.cra-arc.gc.ca/menu-eng.html">Canada Revenue Agency</a> website. <br></p><h2>How to avoid cross-contamination</h2><p>Cross-contamination occurs when gluten is not intentionally (not on purpose) transferred from one food or object to another food or object. It is important to avoid all sources of cross-contamination.</p><h3>At home</h3><p>Washing:</p> <ul><li> <a href="/Article?contentid=1981&language=English">Wash hands</a> between handling gluten-containing and gluten-free foods.</li><li>Wash hands and toys that have been contaminated with gluten.</li><li>Wash the counters carefully before preparing a gluten-free meal.</li><li>Clean all pots, pans, utensils and counter tops with soap between uses.</li></ul><p>In the kitchen:</p><ul><li>Keep gluten-free foods separated from foods that contain gluten.</li><li>Use a separate toaster, grill, colander and cutting board for all gluten-free products. If you use your grill for foods that contain gluten, wrap the gluten-free item in foil before cooking.</li><li>Use plastic or metal baking utensils and cutting boards instead of wooden ones because gluten sticks to wood.</li><li>Use condiments from a squeeze bottle when available or have separate containers for those used with gluten-free products (for example, butter or margarine dish).</li></ul><p>Avoid foods potentially contaminated with gluten: </p><ul><li>Do not buy foods that have no nutrition or allergy information on the label.</li><li>Do not eat gluten-free foods that are on the same plate as gluten-containing food (for example trays with fruits, cheese and gluten-containing crackers).</li></ul><h3>Outside of the home</h3><p>You have no control over your environment when you and your family are outside your home. Keep in mind that:</p><ul><li>Toys and play surfaces at day cares, school or others’ homes may be contaminated with gluten. Avoid touching or placing your child’s food on these surfaces.</li><li>Do not buy foods from bulk bins. Products in bulk bins can become contaminated when scoops are used in more than one bin. There is no assurance that the other customers will be as cautious as you.</li><li>Do not buy foods from stores where no nutrition or allergy information are on the label. This may happen with foods imported from other countries.</li><li>Contact food companies when in doubt about processing and gluten contamination.</li><li>Choose packaged deli meats. At the deli counter gluten-free meats are cut using the same slicer without cleaning between uses, which is a source of contamination.</li><li>Avoid buffets as foods may become contaminated with gluten when customers use the same serving utensils between dishes.</li><li>Avoid french fries and other gluten-free foods if they have been cooked in oil which has been contaminated with gluten. This may be the case if battered foods or seasoned foods have been fried in the same fryer.</li><li>Meat can become contaminated if it is cooked on a grill which is also used to cook gluten-containing foods.</li></ul><p>At school</p><ul><li>Speak to your child’s school about the need for your child to be on a strict gluten-free diet.</li><li>Ask the school about gluten-free menu options. It is important to check directly with the food provider about potential sources of contamination.</li><li>Make sure your child understands why they should not trade food with other students.</li></ul><h3>Before going out to eat</h3><p>Call the restaurant beforehand. Tell them that your child’s gluten-free diet is medical treatment for celiac disease, and not an intolerance or sensitivity.</p><p>Visit the restaurant’s website to check its menu, list of ingredients and allergy warnings.</p><p>Select a restaurant where communication will be easy and where the specifics of the strict gluten-free diet will be understood. For example, you should make sure that language will not be a barrier to communication.</p><p>If you do not have time to call ahead, inform your server and the chef of the strict gluten-free diet when you arrive. Try to go to restaurants during hours when it is less busy. With more time, restaurant staff may have more resources to focus on the specifics of the strict gluten-free diet.</p><p>Bring gluten-free breads, crackers and favourite condiments—including salad dressing—to the restaurant.</p><h3>At the restaurant</h3><p>Remember to always ask about cross-contamination. You may want to explain what cross-contamination is. You can say, “Cross-contamination happens when gluten from one food or object comes in contact with another food or object.” Ask for food to be prepared on clean surfaces with clean utensils and gloves.</p><p>Avoid all seasonings, sauces (for instance soy sauce), croutons, soups and gravies. Be specific when ordering. You can say “I want no gravy on my plate.” </p><p>Ask what food is deep fried in the same oil or fryer. You can explain that french fries, tofu, nachos and wings cooked in the same oil as nuggets or onion rings (which are sources of gluten) will be cross-contaminated and are unsafe for your child.</p><p>Ask for allergy or nutrition information lists.</p><p>Avoid buffets.</p><h2>Tips for calling food companies</h2><h3>Finding contact information</h3><p>If you are not sure about a food product or an ingredient in a non-food product, call the company. Find and write down or take a picture of the contact information for the company from the package. In Canada, this is usually a 1-800 phone number.</p><p>If you cannot find a contact phone number, record the name of the company. You can look for the company’s name in the phonebook or search for the contact information on the Internet.</p><p>Record the name of the product and the UPC code number; this is the number at the bottom of the bar code.</p><h3>What to ask</h3><p>Call the company and ask to speak with customer service. Ask specific questions about the product, such as “Is this product gluten-free?” or “Does the product contain oats, barley, wheat, rye, triticale, or any components of these ingredients?”</p><p>If the company is unable to confirm that the product is gluten-free, then do not eat or use that product. Remember that ingredient lists change and you may need to update this information at a later date. </p><p>Some companies maintain a list of products that are considered “gluten-free”. The company can send you the list at your request. Some companies list gluten-free information on their website. Make sure that the information has been recently updated (within the last year). </p><h2>Resources</h2> <h3>Websites</h3> <p>The <a href="http://www.celiac.ca/">Canadian Celiac Association</a> and its local chapters offer many resources to help maintain a gluten-free diet and more.</p> <p>The <a href="http://www.glutenfreecert.com/about-us/gluten-free-certification-program/">Gluten-Free Certification Program</a> provides information about gluten-free products that are safe to eat for people with celiac disease.</p> <h3>Handbook</h3> <p><em>Acceptability of Foods and Food Ingredients for Gluten-free Diets</em> is a pocket dictionary published by the Canadian Celiac Association. It references food ingredients and additives under "allowed" or "not allowed" categories to guide people on gluten-free diets.</p> <h3>App</h3> <p><em>Acceptability of Foods and Food Ingredients for Gluten-free Diets</em> pocket dictionary is also available as an iTunes application. Search “<a href="http://www.glutenfree247.ca/">Gluten free 247</a>” for the version created by the Canadian Celiac Association.</p> <p>Other apps to help manage celiac disease are available. Check each app review and ask other families for their opinion to choose an app best suited for your needs.</p> <h3>Books</h3> <p><strong>Celiac disease</strong></p> <ul> <li><em>Managing Diabetes and Celiac Disease Together</em>, by the Canadian Celiac Association</li> <li><em>Gluten-Free Diet: A Comprehensive Resource Guide</em>, by Shelley Case</li> </ul> <p><strong>Children’s books</strong></p> <ul> <li><em>Growing up Celiac</em>, by the Canadian Celiac Association</li> <li><em>Eating Gluten-Free with Emily: A Story for Children with Celiac Disease</em>, by Bonnie J. Kruszka (5 year olds)</li> <li><em>No More Cupcakes and Tummy Aches: A Story for Parents and their Celiac Children to Share</em>, by Jax Peters Lowell (3-8 year olds)</li> <li><em>Kids with Celiac Disease: A Family Guide to Raising Happy, Healthy, Gluten-Free Children</em>, by Danna Korn</li> <li><em>The GF Kid: A Celiac Disease Survival Guide</em>, by Melissa London (8-12 year olds)</li> </ul> <p><strong>Cook books</strong></p> <ul> <li><em>Incredible Edible Gluten-Free Foods for Kids: 150 Family-tested recipes</em>, by Sheri L. Sanderson</li> <li><em>Great Food Gluten Free</em>, by Jeanette Mahoney</li> <li><em>Gluten Free on a Shoestring</em>, by Nicole Hunn</li> <li><em>The How Can It Be Gluten Free Cookbook</em>, by America’s Test Kitchen</li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/Nutrition_and_JIA.jpgMaintaining a gluten-free diet Children with celiac disease must follow a strict gluten-free diet. This article contains tips to help your child maintain their special diet.
Substance use and substance use disorder: Overview Substance use and substance use disorder: Overview Substance use and substance use disorder: OverviewSEnglishAdolescent;PsychiatryPre-teen (9-12 years);Teen (13-18 years)NANAConditions and diseasesAdult (19+) CaregiversNA2019-01-30T05:00:00ZKaren Leslie, MD, MEd, BSc9.9000000000000055.1000000000000990.000000000000Health (A-Z) - ConditionsHealth A-Z<p>​Substance use is the use of alcohol, tobacco and other drugs for pleasure or enjoyment. Find out which substances teens use most often, and why, and what to do if you are concerned about substance use.</p><h2>What substances do pre-teens and teenagers use most often?</h2><p>Over the past decade, alcohol and cannabis have become teens’ and pre-teens’ most frequently used substances.</p><p>A concerning trend is that more teens are now also using e-cigarettes (or ‘vaping’). In recent research, more teens reported vaping than smoking a cigarette over the previous year.</p><p>Teens also seek to ‘get high’ with over-the-counter cold medications and prescription medications, including painkillers, ADHD medications and sedatives.</p><h2>When do children and teens begin to try substances?</h2><p>Research indicates that the average age of first use of alcohol is 15.8 years. For cannabis, the average age of first use is 15.4 years.</p><p>A smaller percentage of younger teens report using substances. For example, an Ontario school-based study shows that, over the previous year, one in 10 grade 7 students (about age 12) reported drinking alcohol and one in 50 grade 7 students used cannabis.</p><p>Binge drinking (having five or more drinks at one time) is common among teens and often takes place during drinking games. In a recent Ontario study, almost 40 per cent (two in five) of grade 12 students reported binge drinking in the previous month.</p><p>Some children may try a small amount of alcohol or tobacco at a younger age as part of their family’s cultural or religious practices. There is little evidence to say that drinking at a younger age either prevents or promotes future problematic substance use.<br></p><h2>​Key points</h2><ul><li>Alcohol and cannabis are the substances most frequently tried by adolescents.</li><li>Teens with other mental health illness, including depression and anxiety, are at increased risk of having a substance use disorder.</li><li>As a parent, you are key in noticing changes in your teen's behaviour and in bringing your concerns to your teen in a non-judgmental way.</li></ul><h2>At what point should I become concerned that my child has a substance use disorder?</h2><p>The more regularly a teen uses a substance, the more likely they are to experience related <a href="/Article?contentid=3664&language=English">problematic signs and symptoms</a>.</p><p>Firstly, regular substance use can be associated with a range of physical and mental health problems, difficulties at school and at home and trouble with the law. The health risks of substance use increase when a person uses more than one substance at a time, especially with alcohol.</p><p>Secondly, substance use can lead to dependence. When someone is physically dependent on a substance, they build up a tolerance to it and must use more of it over time to get the same effect. If they stop or try to use less of the substance, they experience physical symptoms (also known as withdrawal symptoms). The level of dependence is based on the substance, the amount your child or teen takes and how frequently they use it.</p><p>In addition, teens who have substance use disorders:</p><ul><li>miss school, work or other responsibilities due to substance use</li><li>crave whatever substance(s) they are using</li><li>fail to quit using despite trying to.<br></li></ul><h2>Does anything make a substance use disorder more likely?</h2><p>A substance use disorder is more likely to develop if: </p><ul><li>a child or teen has a mental health condition (see below)</li><li>there is a family history of addiction</li><li>there is a history of abuse or other adverse childhood experience (also referred to as ACE) </li><li>a child or teen identifies as LGBTQ2+</li><li>a teen is street-involved (homeless).</li></ul><h2>Do issues with substance abuse occur with other mental health conditions?</h2><p>About one-third to half of young people with a mental health condition such as <a href="https://www.aboutkidshealth.ca/Article?contentid=19&language=English">depression</a>, <a href="https://www.aboutkidshealth.ca/Article?contentid=18&language=English">anxiety</a> or <a href="https://www.aboutkidshealth.ca/Article?contentid=1922&language=English">ADHD</a> will also develop a substance use disorder. This is called as a concurrent disorder. Of teens with a substance use disorder, one third to half will develop a concurrent mental health condition.<br></p><h2>What should I do if I am concerned that my child or teen has a problem with substance use?<br></h2><p>Monitor your child's behaviour and have an open conversation with them about anything you have observed and your concerns that they might be using drugs or alcohol. When <a href="/Article?contentid=3665&language=English">addressing substance use with your child or teen</a>, focus your concerns on their health and wellbeing.<br></p><h2>When to see a doctor or health professional for specific help<br></h2><p>If you have any concerns about problematic substance use, encourage your teen to see, or bring your teen for an assessment by, a health professional or another helping professional such as a guidance counsellor.</p><p>Let your teen know that you understand they may not want to share certain things with you as their parent or caregiver but that they can get information about their health and raise any concerns privately with their doctor.</p><p>As teens are generally healthy as a group, they may not see the need for an annual check-up. But it is a good idea to encourage your teen to have a check-up with their doctor or nurse practitioner to review their general physical, mental and social health. The check-up is an opportunity to identify the factors that might put your teen at risk for problematic substance use. It also allows a teen to talk to their health-care provider about any aspect of their health.</p><h2>References<br></h2><p>Boak, A., Hamilton, H.A., Adlaf, E.M., & Mann, R.E. (2017). Drug use among Ontario students, 1977-2017: Detailed findings from the Ontario Student Drug Use and Health Survey (OSDUHS). <em>CAMH Research Document Series No. 46</em>. Retrieved from <a href="https://www.camh.ca/-/media/files/pdf---osduhs/drug-use-among-ontario-students-1977-2017---detailed-findings-from-the-osduhs.pdf?la=en&hash=2B434CDAAD485834497E3B43F2264BDEB255F29F">https://www.camh.ca/-/media/files/pdf---osduhs/drug-use-among-ontario-students-1977-2017---detailed-findings-from-the-osduhs.pdf?la=en&hash=2B434CDAAD485834497E3B43F2264BDEB255F29F</a></p><p>Canadian Centre on Substance Use and Addiction (n.d.). <em>The Real Deal on Youth and Drugs</em>. Retrieved from <a href="http://www.ccsa.ca/Eng/topics/Children-and-Youth/Real-Deal-on-Youth-and-Drugs/Pages/default.aspx">http://www.ccsa.ca/Eng/topics/Children-and-Youth/Real-Deal-on-Youth-and-Drugs/Pages/default.aspx</a></p><p>Canadian Centre on Substance Use and Addiction (2016). <em>Marijuana: Fact and Fiction</em>. Retrieved from <a href="http://www.ccdus.ca/Resource%20Library/CCSA-Marijuana-Fact-and-Fiction-Infographic-2016-en.pdf">http://www.ccdus.ca/Resource%20Library/CCSA-Marijuana-Fact-and-Fiction-Infographic-2016-en.pdf</a></p><p>Canadian Centre on Substance Use and Addiction (2017). <em>Canadian Drug Summary: Alcohol</em>. Retrieved from <a href="http://www.ccsa.ca/Resource%20Library/CCSA-Canadian-Drug-Summary-Alcohol-2017-en.pdf">http://www.ccsa.ca/Resource%20Library/CCSA-Canadian-Drug-Summary-Alcohol-2017-en.pdf</a></p><p>Health Canada (2018). <em>Canadian Student Tobacco, Alcohol and Drugs Survey 2016-2017</em>. Retrieved from <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey.html">https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey.html</a></p>https://assets.aboutkidshealth.ca/AKHAssets/hemophilia_and_cigarette_smoking.jpgSubstance use disorder: Overview Find out which substances teens use most often, and why, and what to do if you are concerned about your teen’s substance use.
Cystic fibrosis (CF)Cystic fibrosis (CF)Cystic fibrosis (CF)CEnglishGeneticsChild (0-12 years);Teen (13-18 years)Lungs;PancreasPancreas;LungsConditions and diseasesCaregivers Adult (19+)NA2014-04-25T04:00:00ZFelix Ratjen, MD, PhD, FRCPC;Louise Taylor, RN(EC), MN, NP7.4000000000000067.00000000000001341.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn what causes cystic fibrosis, what the signs and symptoms are, and what treatments are available.</p><h2>What is cystic fibrosis?</h2><p>Cystic fibrosis or CF is a disease that mainly affects the <a href="https://pie.med.utoronto.ca/htbw/module.html?module=lung-child">lungs</a> and digestive system (or digestive tract). Although CF can be treated and CF patients can usually lead fairly normal lives, there is no cure for CF. Today, half of Canadians with CF live into their 40s and beyond.</p> <figure> <span class="asset-image-title">Cystic fibrosis</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Cystic_fibrosis_MED_ILL_EN.jpg" alt="Stomach, pancreas, small intestine and lung identified in upper body of a child, with a close-up showing mucus in the airways" /> <figcaption class="asset-image-caption">In cystic fibrosis, mucus in the lungs and digestive tract is stickier than normal. Mucus builds up and causes lung congestion and problems with digestion.</figcaption> </figure> <h3>CF affects the lungs</h3><p>Normal mucus is thin and slippery. It keeps the lungs clean by removing dirt and germs from the lungs' airway tubes. In CF, mucus is sticky and clogs the tubes. This can make breathing difficult. Bacteria can collect in the tubes because the mucus cannot clear as quickly as it should. This leads to cycles of infection and inflammation (swelling in the airway tubes). These infections can damage the lung tissues.</p><h3>CF may also affect the digestive system</h3><p>CF may also affect the digestive system, especially the pancreas. The pancreas is an organ just below the stomach that makes enzymes to help digest food in the small intestine. Enzymes help with digestion and break down the food particles small enough to be absorbed. In CF, mucus blocks the ducts (tube-like channels that carry fluid) of the pancreas.</p><p>When the ducts from the pancreas to the small intestine are blocked by mucus, the enzymes cannot reach the small intestine. This means food is not properly digested. When this happens, a child with CF does not get enough nutrition from their food. As a result, a child with CF may take replacement enzymes in order to grow normally and may have to eat a bit more food.</p><h2>Key points</h2> <ul> <li>CF is a genetic disease that affects the lungs and digestive system.</li> <li>It is not contagious.</li> <li>With treatment and regular follow-up, most children with CF can live fairly normal lives.</li> </ul><h2>Signs and symptoms of cystic fibrosis</h2> <p>In most children, CF mainly affects both the lungs and the digestive system. The symptoms of CF are variable ranging from mild to severe.</p> <h3>Signs and symptoms of CF include:</h3> <ul> <li>trouble breathing</li> <li>cough that produces thick mucus</li> <li>difficulty gaining weight</li> <li>bowel movements that are bulky, frequent and foul-smelling</li> <li>skin that tastes salty</li> <li>repeated lung infections</li> <li>delayed passage of <a href="/Article?contentid=1115&language=English">meconium</a> or meconium ileus (a blockage in the small intestine by the newborn's feces)</li> </ul> <p>The symptoms of CF are often confused with other conditions such as asthma, chronic bronchitis, pneumonia or celiac disease because they have similar symptoms as CF.</p><h2>Cystic fibrosis is a genetic disease</h2><p>About one in every 3,600 children are born with CF. CF is a genetic disease, meaning it is passed from parents to their children. About one in every 25 Canadians carries the mutated gene that can cause CF. The probability may be lower depending on your ethnic background.</p><p>A gene is a section of DNA that gives an instruction to a cell. Most of the time, the instruction is a "recipe" for making a protein.</p><p>CF is caused by a mutation in the gene for the CFTR (cystic fibrosis transmembrane conductance regulator) protein. CF is a recessive genetic condition. This means that a person needs to have two copies of the mutated gene to develop CF. People with only one copy of the CF mutation are called "carriers" and do not have symptoms. Most parents do not know they are carriers of the CF gene. To develop CF, a child must inherit two copies of the CF gene, one from each parent.<br></p><p>Two parents with the CF gene may have children with CF, children who are carriers or children who are not. The risk of having a child with CF is the same with each pregnancy.</p><p>CF is not contagious. You cannot catch it from someone else.</p> <figure class="asset-c-80"> <span class="asset-image-title">Inheritance of cystic fibrosis</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Cystic_fibrosis_inheritance_MED_ILL_EN.jpg" alt="Chromosome distribution from parents carrying cystic fibrosis" /> <figcaption class="asset-image-caption">In this example, both parents are carriers of one normal cystic fibrosis (CF) gene and one mutated CF gene. Their children may inherit one, two, or no copies of the CF gene. If a baby inherits one copy of the mutated gene, they will be carriers like their parents, but will not have CF. If a baby inherits two mutated copies, they will have CF.</figcaption> </figure><h2>How cystic fibrosis is diagnosed</h2> <p>In almost all of Canada, babies are diagnosed with CF in the first two weeks of life through the <a href="http://www.sickkids.ca/CGenetics/What-we-do/Newborn-screening-program/index.html">Newborn Screening Program</a>.</p> <ul> <li>Genetic tests are used to diagnosis CF. Genetic tests can diagnose CF before a child is born.</li> <li>Shortly after a baby is born, the doctor may take a small sample of blood from the baby as part of the newborn screening program. Testing starts by looking for an enzyme called IRT. If the level of IRT is high, the doctor will perform a DNA test looking for the most common CF mutations. If the screen is positive, the doctor will refer your child to a specialist centre for confirmation and follow-up.</li> <li>Doctors usually order a sweat test if they suspect CF. This is a simple test that measures the amount of salt in the sweat. It will not hurt your child. Heat or medicine is applied to a local (small) area of the skin. If the sweat contains more salt than usual, this may mean your child has CF.</li> <li>Doctors may perform a test to check for enzymes in the intestine.</li> </ul><h2>How cystic fibrosis is treated</h2> <p>There is no cure for CF. With appropriate treatment and regular follow-up, most children with CF can live fairly normal lives up to at least their 40s.</p> <p>CF treatment is tailored to your child's needs. It also depends upon the stage of the disease and which organs are affected.</p> <h3>Treating the lungs</h3> <p>A lot of CF treatments focus on the lungs. The treatments work to loosen and thin the mucus that clogs the airways. Chest X-rays may be taken to see if there are any changes in the lungs.</p> <h3>Treatments followed at home may include:</h3> <ul> <li>Physiotherapy is done by tapping or "clapping" on the chest in different positions twice a day for babies and young children.</li> <li>PEP (positive expiratory pressure) mask therapy is taught to older children and adults with CF to help clear their lungs.</li> <li>Other forms of chest physiotherapy to help loosen the mucus that clogs the lungs can also be taught by the clinic physiotherapist.</li> <li>Oral (through the mouth), inhaled (breathing) or intravenous (IV or using a needle) antibiotics are often used when someone with CF has a lung infection.</li> <li><a href="/Article?contentid=1973&language=English">Exercise</a>.</li> <li>Medications to help open the airways and thin mucus are inhaled using a puffer or a small compressor machine with a nebulizer, which makes the medication easy to inhale through a mask or a mouthpiece.</li> </ul> <h3>To avoid infection, children with CF should also:</h3> <ul> <li>Avoid contact with people with a cold or illness</li> <li>Avoid contact with other people with CF</li> <li>Have their usual <a href="/Article?contentid=1986&language=English">immunizations</a> (shots)</li> </ul> <p>In some cases, when treatments can no longer maintain a person's health or organ function, the person may require a lung transplant.</p> <h3>Treatments for the digestive tract include:</h3> <ul> <li>taking pancreatic enzymes with meals to help digestion</li> <li>taking supplements and special CF vitamins to promote good nutrition</li> <li>eating a special diet with increased calories and fat</li> <li>adding salt to the diet to replace the excess amounts lost by sweating</li> </ul><h2>Activity</h2> <p>Children with CF are encouraged to play games and sports. Ask your child's doctor how much activity they can do. Sports such as running and swimming are often helpful because they help clear the lungs of mucus.</p> <p>Children with CF lose a lot of salt during exercise and hot weather, more than people without CF do. It is important to make sure your child replaces fluids and salt by drinking enough and eating enough salt.</p><h2>For more information</h2><p>Visit:</p><ul><li> Cystic Fibrosis Canada: <a href="http://www.cysticfibrosis.ca/">www.cysticfibrosis.ca</a></li><li> The Cystic Fibrosis Foundation: <a href="http://www.cff.org/">www.cff.org</a></li><li> Canadian Society for Exercise Physiology: <a href="http://www.csep.ca/english/view.asp?x=804/">www.csep.ca</a>; see Physical Activity option.</li><li> Newborn Screening for Cystic Fibrosis: <a href="http://www.cysticfibrosis.ca/advocacy/newborn-screening/">www.cysticfibrosis.ca/advocacy/newborn-screening</a><br></li></ul><img alt="" src="https://assets.aboutkidshealth.ca/AKHAssets/cystic_fibrosis.jpg" style="BORDER:0px solid;" />https://assets.aboutkidshealth.ca/AKHAssets/cystic_fibrosis.jpg May is Cystic Fibrosis Month. Learn what causes cystic fibrosis, what the signs and symptoms are, and what treatments are available.

 

 

Nutrition before and during pregnancyNutrition before and during pregnancyNutrition before and during pregnancyNEnglishPregnancyAdult (19+)NANANon-drug treatmentAdult (19+)NA2016-12-22T05:00:00ZStacey Segal, BScA, MSc, RD;Daina Kalnins, MSc, RD​​10.400000000000052.70000000000002043.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Find out how to get the right nutrients to support you and your baby before and during pregnancy.</p><p>Eating a balanced diet, before becoming pregnant and during pregnancy, can help you make sure that you receive the right nutrients to support a healthy pregnancy. Healthy eating can also help to reduce your risk of developing conditions that can affect pregnancy, such as high blood pressure, diabetes and obesity.</p><p>The time when you begin planning a pregnancy is a great opportunity to think about how you can maximize your health through wise food choices and regular exercise. It is also a good time to start a multivitamin supplement. Speak to your health-care provider about choosing the right prenatal multivitamin supplement for you.</p><p>It is important to eat nutritious food <strong>before</strong> you become pregnant because good nutrition supports your baby during the first trimester (three months) as their lungs, heart, brain and other important organs start to develop.</p><p>Learning about good nutrition will benefit you and your baby through your pregnancy and have long-term benefits for your child as they grow.</p><h2>Key points</h2> <ul> <li>Good nutrition is important for gaining the recommended amount of pregnancy weight, supporting fetal development and reducing the risk of complications during pregnancy and birth.</li> <li>Eat a variety of foods from the four food groups, adding more servings from each of these food groups if pregnant with multiples.</li> <li>Important nutrients in pregnancy include folic acid, calcium, iron, protein, iodine, vitamin C, vitamin B12 and vitamin D.</li> <li>Make sure you are taking in enough folic acid from folate-rich foods and a prenatal multivitamin with folic acid from before (or as soon as you suspect) you are pregnant until four to six weeks after giving birth or as long as breastfeeding continues.</li> <li>If eating fish, choose varieties with low levels of methyl mercury, such as sole, haddock, salmon and trout.</li> </ul><h2>General healthy eating recommendations for women of childbearing age</h2> <p>Consuming a healthy diet involves choosing a variety of items from the four food groups listed in <a href="/Article?contentid=1436&language=English">Canada’s Food Guide</a>.</p> <ul> <li><a href="/Article?contentid=1437&language=English">Vegetables and fruit</a>: Choose seven to eight servings a day, making sure to include dark green and orange vegetables and orange fruit.</li> <li> <a href="/Article?contentid=1438&language=English">Grain products</a>: Choose six to seven servings a day, including whole grain and enriched products.</li> <li> <a href="/Article?contentid=1439&language=English">Milk products and alternatives</a>: Choose four servings a day and include lower-fat products.</li> <li><a href="/Article?contentid=1440&language=English">Meat and alternatives</a>: Choose two to three servings a day of lean meat, poultry or fish or alternatives such as peas, tofu, beans and lentils.</li> </ul> <p>To make sure that both you and your baby get enough nutrition, Health Canada recommends adding an <strong>extra two to three servings of food a day</strong> during your second and third trimester, and while breastfeeding.</p> <p>If you are pregnant with twins or other multiples, you will need even more calories and nutrients to help them develop their bones, brain and organs. Health Canada recommends adding an extra two to three servings for <strong>each</strong> baby during the second and third trimester.</p> <h3>Fluids</h3> <p>You may find that you are very thirsty during pregnancy. This is partly because of the increase in blood volume. Drinking plenty of fluids will help you quench your thirst and help with constipation and swelling.</p><h2>Key nutrients for pregnancy</h2> <h3>Calcium</h3> <p>Your developing baby will need <a href="/Article?contentid=1448&language=English">calcium</a> to grow strong bones and teeth, a healthy heart, nerves and muscles.</p> <p>To help you get enough calcium from your diet, choose at least four servings a day from the milk and alternatives food group. Use milk in puddings, soups, pancakes and casseroles. If you are lactose intolerant, try lactose-reduced milk. You can also get calcium from edamame, tofu, almonds, dark leafy vegetables and tahini. Some women may benefit from calcium supplements in addition to a prenatal multivitamin.</p> <h3>Iron</h3> <p>Both you and your baby will need <a href="/Article?contentid=1450&language=English">iron</a> during pregnancy. Iron requirements increase throughout pregnancy and peak in the third trimester. If you do not take in enough iron, you could become <a href="/Article?contentid=1450&language=English">anaemic</a>, which could cause complications during pregnancy and childbirth.</p> <p>To increase iron in your diet, choose the recommended servings of meat and meat alternatives as well as whole and enriched grains.</p> <p><strong>Note:</strong> The body can better absorb iron from animal sources, such as beef, than from non-animal sources, such as vegetables or beans. To help your body absorb iron from non-animal sources, eat foods rich in vitamin C at the same time. For example, eat an orange with a lentil dish.</p> <p><strong>Health Canada recommends that pregnant women should take a prenatal multivitamin that has 16-20 mg of iron</strong>. Some women may need an additional low-dose iron supplement.</p> <h3>Folic acid</h3> <p><a href="/Article?contentid=1449&language=English">Folic acid</a>, also known as folate, is a B vitamin that protects against neural tube defects (defects that affect the brain and spinal cord), such as spina bifida.</p> <p><a href="/Article?contentid=371&language=English">Neural tube defects</a> develop in the first month of pregnancy. For this reason, it is very important to take enough folic acid both <strong>before conceiving and throughout pregnancy</strong>.</p> <ul> <li>Start taking folic acid two to three months before becoming pregnant.</li> <li>Continue it until at least four to six weeks after giving birth, or as long as you are breastfeeding.</li> </ul> <p>If you did not take folic acid before becoming pregnant, start taking it as soon as you suspect you are pregnant.</p> <p>For the <strong>general population</strong>, the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommends:</p> <ul> <li>a diet high in folate-rich foods</li> <li>a daily multivitamin supplement that contains 0.4 mg to 1 mg folic acid and 2.6ug vitamin B12</li> </ul> <p>You can find folate naturally in broccoli, spinach, peas, Brussels sprouts, corn, lentils and other legumes, oranges and as an ingredient in fortified white wheat flour and enriched grain products such as pasta.</p> <p>Some people have a <strong>higher-than-average risk</strong> of having a baby with a neural tube defect. If your doctor tells you that are at higher risk, the SOGC recommends:</p> <ul> <li>a diet high in folate-rich foods</li> <li>a daily multivitamin supplement that contains 1 mg or 4 mg folic acid, depending on whether you are at moderate or high risk, and 2.6 ug vitamin B12. Take this multivitamin supplement from three months before becoming pregnant until the end of your first trimester. After that, take a multivitamin supplement containing 0.4 mg to 1 mg folic acid.</li> </ul> <p>Health Canada and the SOGC advise women to avoid taking more than one multivitamin supplement a day in an attempt to consume a higher dose of supplemental folic acid. In large doses, some substances in multivitamins could be harmful. This is especially true of vitamin A in retinol form (including retinyl palmitate and retinyl acetate).</p> <p>Speak to your health-care provider about finding the right prenatal multivitamin supplement for you.</p><h2>Other important nutrients in pregnancy</h2><ul><li> Protein: Dietary <a href="/Article?contentid=1444&language=English">protein</a> is required to help the unborn baby grow and to develop the placenta, uterus and breast tissue. Protein is found in meat, fish, eggs, milk products and plant sources such as tofu, beans and nuts.</li><li>Iodine: Iodine is required to help an unborn baby’s brain and nervous system develop. Iodized salt is the most common source of iodine.</li><li>Vitamin C: Vitamin C supports the immune system, has a role in growth and repair of tissues and also helps the body absorb iron from plant based foods. Try to eat foods rich in vitamin C, such as citrus fruit, red peppers or tomatoes, at the same time as foods rich in animal sources of iron, such as meat.</li><li>Vitamin B12: <a href="/Article?contentid=1446&language=English">Vitamin B12</a> helps to make healthy red blood cells and keep nerves working properly. The food groups that are sources of vitamin B12 are milk and alternatives and meat and alternatives. If you do not eat meat, you may need to include vitamin B12-fortified foods in your diet.</li><li> Vitamin D: <a href="/Article?contentid=1447&language=English">Vitamin D</a> works with calcium to help maintain healthy bones. Pregnant women should take 600 IU a day. You can usually find this in a prenatal multivitamin supplement.</li></ul><h2>Fish and omega-3 fatty acids</h2><p>Fish is an excellent source of protein, vitamin D, iron, selenium, zinc and omega-3 fatty acids. Omega-3 fatty acids are essential fats (fats that we can only get from our diet) that play an important role in the unborn baby’s growth and development.</p><p>Health Canada suggests that all women of childbearing age, in particular those who are pregnant or breastfeeding, pay special attention to the types of fish they eat. This is because some fish contain methyl mercury, a metal that builds up in the bloodstream over time and can damage an unborn baby’s nervous system. Though the body removes methyl mercury naturally, it can take a year for it to drop to safe levels.</p><p>Health Canada recommends eating at least 150 grams (5 oz.) of cooked fish (with low mercury) each week during pregnancy. The table below lists the fish to choose and fish to avoid before and during pregnancy.</p><table class="akh-table"><thead><tr><th>Fish with low levels of methyl mercury (eat 5 oz. a week)</th><th>Fish with higher levels of methyl mercury (eat <em>less than</em> 5 oz. a month)*</th></tr></thead><tbody><tr><td>Salmon</td><td>Tuna (fresh or frozen)</td></tr><tr><td>Trout</td><td>Shark</td></tr><tr><td>Herring</td><td>Swordfish</td></tr><tr><td>Haddock</td><td>Marlin</td></tr><tr><td>Canned light tuna</td><td>Orange roughy</td></tr><tr><td>Pollock (Boston bluefish)</td><td>Escolar</td></tr><tr><td>Sole</td><td></td></tr><tr><td>Flounder</td><td></td></tr><tr><td>Anchovy</td><td></td></tr><tr><td>Char</td><td></td></tr><tr><td>Hake</td><td></td></tr><tr><td>Mullet</td><td></td></tr><tr><td>Smelt</td><td></td></tr><tr><td>Atlantic mackerel</td><td></td></tr><tr><td>Lake white fish</td><td></td></tr></tbody></table><p>*These fish are all predatory (they hunt other fish), so they tend to accumulate methyl mercury from their diet as well as the surrounding water.</p><h2>Caffeine</h2><p>Health Canada recommends limiting caffeine to 200 to 300 mg a day. Consuming this amount of caffeine a day will not negatively affect a woman’s fertility or pregnancy or a baby’s development. However, it is important to stay within this limit because there are very few – and often conflicting – findings about the effects of consuming more than 300 mg of caffeine a day.</p><p>This table lists the typical caffeine content of common drinks.</p><table class="akh-table"><thead><tr><th>Drink</th><th>Caffeine level</th></tr></thead><tbody><tr><td>8 oz. cup of brewed coffee</td><td>150 mg</td></tr><tr><td>8 oz. cup of regular tea</td><td>35 mg</td></tr><tr><td>12 oz. can of cola</td><td>30-100 mg</td></tr></tbody></table><h2>Artificial sweeteners</h2><p>Moderate use of some artificial sweeteners is safe during pregnancy. Certain other sweeteners are not considered safe.</p><table class="akh-table"><thead><tr><th>Approved sweeteners during pregnancy</th><th>Unsafe sweeteners during pregnancy</th></tr></thead><tbody><tr><td> Aspartame (NutraSweet, Equal)</td><td> Cyclamates (Sweet'N Low, Sugar Twin)</td></tr><tr><td> Acesulfame potassium (Ace K)</td><td></td></tr><tr><td> Sucralose (Splenda)</td><td></td></tr><tr><td> Saccharin</td><td></td></tr><tr><td>Stevia</td><td></td></tr><tr><td> Sugar alcohols</td><td></td></tr></tbody></table><h2>Alcohol during pregnancy</h2><p>The Society of Obstetricians and Gynecologists of Canada (SOGC) recommends that you completely avoid alcohol during pregnancy. There is not enough evidence to confirm how much harm even small amounts may cause your baby.</p><h2>Managing your weight during pregnancy</h2><p>During pregnancy, it is important to gain a steady amount of weight by eating a balanced diet. Pregnancy is not a time to restrict food unless instructed by your doctor or dietitian.</p><p>The amount of weight you should gain is based on your body mass index (BMI)* before you became pregnant.</p><p>Health Canada and the Institute of Medicine recommend the following rates of weight gain during pregnancy.</p><table class="akh-table"><thead><tr><th>Pre-pregnancy BMI</th><th>Second and third trimester weight gain</th><th>Recommended total weight gain</th></tr></thead><tbody><tr><td>Underweight (BMI less than 18.5)</td><td>1 lb (about half a kilogram) a week</td><td>28 to 40 lbs (about 12 to 18 kilograms)</td></tr><tr><td>Normal weight (BMI 18.5 to 24.9)</td><td>1 lb (about half a kilogram) a week</td><td>25 to 35 lbs (about 11 to 16 kilograms)</td></tr><tr><td>Overweight (BMI 25.0 to 29.9)</td><td>0.6 lbs (about 300 g) a week</td><td>15 to 25 lbs (about 7 to 11 kilograms)</td></tr><tr><td>Obese (BMI greater than 30)</td><td>0.5 lbs (about 250 g) a week</td><td>11 to 20 lbs (about 5 to 9 kilograms)</td></tr></tbody></table><p>*Your BMI is the ratio between your weight and your height. To calculate your BMI, divide your weight in kilograms (kg) by your height in metres squared. For example, a woman who is 5 feet 6 inches (1.676 meters) at 135 lbs (61.4 kg) has a BMI of 21.8 → 61.4/(1.676 x 1.676 ) = 21.8.</p><p>Pregnant women who eat a nutritious, balanced diet and gain at least their recommended amount of weight can reduce the risk of premature birth and a low birth weight baby. In contrast, excessive weight gain is linked to high birth weight, longer labour, birth trauma and <a href="/Article?contentid=406&language=English">caesarean section</a>.</p><p><a href="/Article?contentid=313&language=English">Exercise</a> can also support a healthy pregnancy. According to the SOGC, all women should do regular aerobic and strength exercises as part of a healthy lifestyle during pregnancy, unless there is a medical reason to avoid it.</p>https://assets.aboutkidshealth.ca/AKHAssets/nutrition_before_and_during_pregnancy.jpg
Eye examination for your childEye examination for your childEye examination for your childEEnglishOphthalmologyChild (0-12 years);Teen (13-18 years)EyesNervous systemNon-drug treatmentCaregivers Adult (19+)NAhttps://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-lens_EN.jpg2014-05-22T04:00:00ZAgnes Wong, MD, PhD, FRCSC;Maryam Rezvani, OD;Helen Siomos, RO8.8000000000000059.20000000000001790.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn about eye examinations, the optometrist’s role and the equipment used, so you can prepare your child, and yourself, for the vision test.</p><h2>What is an eye examination?</h2><p>An eye examination consists of a series of tests performed by a licensed eye care professional (for example an ophthalmologist or optometrist) to check your child’s eye health.<br></p><h2>The vision care team</h2> <p>According to the Canadian Ophthalmological Society your vision care team includes ophthalmologists, optometrists and opticians.</p> <h3>Ophthalmologists</h3> <p>Ophthalmologists are highly-trained eye doctors and surgeons, the medical leaders in the eye care team. They are licensed medical specialists in eye and vision care, surgery and medical interventions, and in diagnosing, treating and preventing serious eye disease. Ophthalmologists perform comprehensive eye exams, conduct surgery, prescribe and give medication and determine the ideal prescription for corrective lenses.</p> <p>Ophthalmologists are physicians who, when they graduate from medical school, do several years of post-graduate training in diagnosing and treating diseases of the eye.</p> <h3>Optometrists</h3> <p>Optometrists are primary health-care providers who specialize in examining, diagnosing, treating, managing and preventing disease and disorders of the visual system and the eye and associated structures. They also diagnose ocular manifestations of systemic conditions.</p> <p>A four-year doctor of optometry degree program follows a university degree.</p> <h3>Opticians</h3> <p>Registered opticians are specially trained to design, fit and dispense eyeglasses, contact lenses, low vision aids and prosthetic ocular devices. They interpret written prescriptions from ophthalmologists (medical doctors) and optometrists (non-medical eye care professionals) to determine the specifications of ophthalmic appliances necessary to correct a person’s eyesight.</p><h2>Key points</h2> <ul> <li>An eye examination is performed by a licensed eye care professional, either an ophthalmologist or optometrist, who checks your child’s eye health and vision.</li> <li>If you suspect your child has a vision problem, ask a licensed eye care professional’s opinion.</li> <li>When choosing glasses for your child, make sure they like their glasses and they are going to wear them.</li> </ul><h2>Eye examinations</h2><p>Ophthalmologists and optometrists are both professionals that are licensed to perform eye examinations. The Canadian Paediatric Society recommends vision screening by your child’s primary health-care provider at all infant and well-child visits. If there are any risk factors (for example prematurity, certain genetic syndromes) or vision complaints, they should be seen by a licensed eye care professional. Keep in mind that the sooner a condition is discovered, the sooner treatment can be started.</p> <figure><img alt="An optometrist’s office" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-office_EN.jpg" /> </figure> <h3>Signs that your child needs to see a licensed eye care professional</h3><p>There are a number of signs that parents should look for that may indicate their child is having a visual problem. Here are a few examples.</p> <figure><img alt="An optometrist holds up a lens" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-lens_EN.jpg" /> </figure> <ul><li>If, when you look at your child, you notice that one eye is not aligned.</li><li>Your child has trouble focusing or squints a lot.</li><li>Your child holds books too close or loses their place when reading.</li><li>Your child turns or tilts their head when they want to look at something.</li><li>Your child covers an eye when stepping into sunlight.</li><li>One of your child's eyes is whiter and brighter than the other eye in a picture taken head on.</li><li>Your child moves to the front of the classroom to see the blackboard better.</li></ul><p>Your child may not complain about not seeing correctly because they are unaware there is a problem. Only you, as a parent, can make sure that any visual problem your child may have is caught early on.</p><h2>Eye examinations for children aged two and over</h2><p>A licensed eye care professional often uses toys to get a child’s attention or may involve the parents. It also helps if one of the parents has an eye examination while the child watches. To lessen your child’s anxiety, explain what is going to happen in a simple way they can understand.</p> <figure><img alt="An optometrist uses a toy to get a child’s attention" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-toys_EN.jpg" /> </figure> <h3>What tests are performed during an eye examination?</h3><p>A licensed eye care professional will first review your child’s history and will ask about any health issues or conditions that may affect your child’s eye health. The will then ask parents questions such as:</p><ul><li>Have you noticed any visual problems, such as squinting, tilting/turning their head or holding books too close?</li><li>Was your baby premature? Did anything happen during the birth of your baby? Was it a difficult delivery? Was the baby hurt during the delivery?</li><li>What is your child's development like?</li><li>Is there any history of eye turn or <a href="/Article?contentid=835&language=English">lazy eye</a> in the family?</li></ul><p>Remember to bring to your appointment any documents that can help you answer these types of questions. Your child will then have a series of tests to check their vision. None of them are uncomfortable, painful, invasive or risky. They include (but are not limited to) the following tests.</p><div class="akh-series"><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-vis-acuity_EN.jpg" alt="An optometrists chart for a young child" /> </figure> <h3>Visual acuity</h3><p> <a href="/Article?contentid=1941&language=English">Visual acuity</a> is how clearly and sharply your child can see objects that are far away and close up. Your child will cover one eye and read the letters or pictures projected on a wall or on a chart. They will then cover the other eye and do the same. This tests vision at a distance.</p></div></div><div class="row"><div class="col-md-12"> <figure><img alt="An optometrist’s chart for measuring near sight" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-reading_EN.jpg" /> </figure> <p>To test your child’s near vision, your child will be asked to read lines of text or pictures that become smaller and smaller on a hand-held chart.</p></div></div><div class="row"><div class="col-md-12"> <figure><img alt="An optometrist checks a patients binocular vision" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-binocular_EN.jpg" /> </figure> <h3>Binocular vision</h3><p>Binocular vision is seeing with both eyes. The licensed eye care professional makes sure that, up close and at a distance, the eyes are aligned and there is no eye turn.</p></div></div><div class="row"><div class="col-md-12"> <figure><img alt="Light-testing pupil movement" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-light_EN.jpg" /> </figure> <h3>Pupil response</h3><p>Pupil response is tested with a moving light in front of the eyes. The pupils (the black circle in the centre of the iris) should get smaller when they are exposed to light and get larger when the light is removed.</p></div></div><div class="row"><div class="col-md-12"> <figure><img alt="Testing for colour-blindness" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-colour_EN.jpg" /> </figure> <h3>Colour blindness</h3><p>Colour blindness is the inability to distinguish between colours in normal light conditions. Colour blindness can be as extreme as seeing only in black and white (very uncommon) or it could just mean being unable to distinguish different shades of colours (for example different reds). To test colour vision, your child will look at a chart with drawings, letters or numbers represented only with colours.</p></div></div><div class="row"><div class="col-md-12"> <figure><img alt="An optometrist measures eye turn" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-eyeturn_EN.jpg" /></figure> <h3>Eye turn and extraocular motility</h3><p>Eye turn (or <a href="/Article?contentid=836&language=English">strabismus</a>) is when the eyes are not aligned. The eyes can be turning in ("crossed") or turning out ("wall eye") or one can be higher than the other. A prism bar measures the angle of an eye turn.</p><p>Extraocular motility is your child's ability to move their eyes in different directions.</p></div></div><h3>Eye convergence</h3><p>Eye convergence (or eye crossing) is the inward movement of both eyes toward each other. The licensed eye care professional holds a stick in front of your child and asks them to follow it with their eyes. By moving the stick closer to your child’s face, your child’s eyes move inward toward each other to maintain focus on the stick. This is an important skill that is required for reading. When reading, the eyes converge for long periods of time. Reading for 20 minutes is going to be uncomfortable for your child if their eyes do not move towards each other properly. As a result, your child may avoid reading.</p><div class="akh-series"><div class="row"><div class="col-md-12"> <figure><img alt="An optometrist assessing prescription lenses" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-retinoscopy_EN.jpg" /> </figure> <h3>Retinoscopy</h3><p>Retinoscopy is a light test to see if your child needs corrective glasses (or prescription lenses). With an adult, the licensed eye care professional tests different lenses and asks the patient whether they can see well. It is difficult for a child, as they cannot understand what “seeing better or worse” means.</p></div></div><div class="row"><div class="col-md-12"> <figure><img alt="The optometrist places eye drops to dilate the pupils" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-drops_EN.jpg" /> </figure> <h3>Focusing ability</h3><p>To test focusing ability, the licensed eye care professional may put two drops of a drug in each eye to dilate the pupil. This prevents accommodation, the ability to see an object clearly at different distances. The eye drops mean that your child cannot see up close clearly. Putting the drops in does not hurt and their effect will wear off in a few hours. It may take six to eight hours to recover the focusing ability. Pupils can stay dilated for up to 24 hours.</p></div></div> <div class="row"><div class="col-md-12"> <figure><img alt="Dilated fundus examination" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-dfe_EN.jpg" /> </figure> <h3>Dilated fundus</h3><p>Dilated fundus examination checks the retina at the rear of the eye and makes sure it is healthy. Your child places their chin on the device and rests their forehead against it. The device is moved around your child’s head to allow the licensed eye care professional to see the entire retina.</p></div></div><div class="row"><div class="col-md-12"> <figure><img alt="An optometrist looks into a patient’s eye" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-ret-test_EN.jpg" /> </figure> <p>If your child is uncomfortable around such an intimidating device, the licensed eye care professional may use a smaller device instead.</p></div></div><div class="row"><div class="col-md-12"> <figure><img alt="An optometrist wearing special glasses for an examination" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-op-glasses_EN.jpg" /> </figure> <h3>General eye health</h3><p>The licensed eye care professional looks at the cornea, lens and blood vessels to make sure that each part of your child’s eye is healthy. They use different objects such as a portable lens and even wears special glasses to perform this check.</p></div></div></div></div><h2>Eye examinations for children aged under two </h2> <p>Different tests are used to check an infant’s visual acuity. These tests are used to assess your child’s eye and vision development.</p> <p> “Preferential looking” tests for vision problems in children aged under two. For example, a licensed eye care professional may use a board with a small hole in the middle to look at the child without the child seeing them and being distracted. The board has two halves: one is a grey square, the other has black and white stripes. The licensed eye care professional will want to check if the child looks at the stripes, as this is what babies will normally choose to do. </p> <p>The infant's visual acuity is tested as the stripes become smaller and closer together and look more like the grey side. </p> <p>If a problem is suspected, further tests will be carried out, and your child might be given prescription lenses or referred to a paediatric ophthalmologist. A paediatric ophthalmologist is a doctor specialized in eye conditions in children.</p> <p>Remember that, when children are born, they do not have <a href="/Article?contentid=1941&language=English">perfect vision (20/20)</a>. It takes some time to get there.</p> <p>When booking an appointment, make sure to tell the licensed eye care professional your child’s age so they can prepare the appropriate tests and material.</p><h2>How to choose glasses for your child<br></h2><p>Ask your optician to help you find glasses that will fit your child properly. Involve your child in the process if they are old enough to understand. Remember, they are your child’s glasses not yours. If your child does not like the glasses, they are not going to wear them. Instead your child may hide or break the glasses or do whatever they can to not wear them.</p> <figure> <img alt="Choosing a pair of glasses" src="https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkuph-glasses_EN.jpg" /> </figure><h2>Help your child prepare for their eye examination</h2><p>To help you be ready for your child's visit to the licensed eye care professional, you and your child can watch this video together.</p> <div class="asset-video"> <iframe src="https://www.youtube.com/embed/-VassqhXmQw?rel=0" frameborder="0"></iframe> </div> <br><h2>References</h2><p>Canadian Ophthalmological Society. <em><a href="http://www.cos-sco.ca/vision-health-information/your-ophthalmologist/">Your Ophthalmologist & The Vision Care Team</a>. </em>Retrieved May 23, 2014. <br></p> Canadian Paediatric Society. <a href="https://www.cps.ca/en/documents/position/children-vision-screening" target="_blank"><em>Vision screening in infants, children and youth</em></a> (2014, February 1)<br> <p>Retrieved May 23, 2014. <br></p>https://assets.aboutkidshealth.ca/akhassets/PMD_eye-checkup-girl_EN.jpgEye examinations
Tonsil surgery or tonsil and adenoid surgery: Caring for your child after the operationTonsil surgery or tonsil and adenoid surgery: Caring for your child after the operationTonsil surgery or tonsil and adenoid surgery: Caring for your child after the operationTEnglishOtolaryngologyToddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)Nose;MouthMouth;Lymph nodes;NoseNon-drug treatmentCaregivers Adult (19+)NAhttps://assets.aboutkidshealth.ca/akhassets/Tonsils_adenoid_MED_ILL_EN.jpg2019-01-24T05:00:00ZKathy Eres, RN;Tomka George, RN;Pauline Lackey, RN;Paolo Campisi, MSc, MD, FRCSC, FAAP6.1000000000000074.10000000000001710.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Tonsils and adenoids may be removed if they become enlarged. Read about surgery to remove tonsils and adenoids and how to help your child recover.<br></p><p>Your child needs an operation to take out their tonsils. Your child may also need an operation to take out their adenoids at the same time. These operations are called <a href="/Article?contentid=1019&language=English">tonsillectomy</a> and <a href="/Article?contentid=1210&language=English">adenoidectomy</a>.</p><h2>What are tonsils?</h2><p>The tonsils are small pieces of tissue at the back of the mouth, beside the tongue. They help fight germs. There is one tonsil on either side of the throat. </p><h2>What are adenoids?</h2><p>Adenoids are lumps of tissue up behind the nose. You cannot see your child's adenoids when looking in the mouth.</p> <figure class="asset-c-80"> <span class="asset-image-title">Tonsils and adenoids</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Tonsils_adenoid_MED_ILL_EN.jpg" alt="Location of adenoid and tonsil" /> <figcaption class="asset-image-caption">Tonsils and adenoids are made of lymphatic tissue and are part of the body's defense system against infection. They may become enlarged after repeated infections.</figcaption> </figure><h2>Key points</h2> <ul> <li>Your child will have an operation to take out their enlarged tonsils and possibly their adenoids. </li> <li>Your child will be asleep and feel no pain when their tonsils and adenoids are removed. </li> <li>Most children can go home on the same day as the operation. </li> <li>It will take about a week to 10 days before your child can go back to their regular activities and diet.</li> </ul><h2>Caring for your child at home</h2><h3>Pain</h3><p>Your child will have some pain after the operation.</p><p>Your child will have a sore throat. They may also have an earache, which is caused by the sore throat. Five or six days after the operation, your child's sore throat or earache may get worse for a short time. This is normal. </p><p>Your child may also have a stiff neck. If this does not improve, call your doctor.</p><p>You may give your child medicine for pain.</p><p>You may receive a prescription for pain medication before you leave the hospital. Follow the dosage instructions given to you by the pharmacist. Although these prescription pain medications can be beneficial, they are also potentially very dangerous if not used properly.</p><p>When using these medications, if you notice any changes in either breathing or level of drowsiness that concern you, stop the medication and seek medical attention. If your child is unresponsive, call 911 immediately.</p><p>Do not give your child over-the-counter medicine that may have a sedative effect (makes people sleepy) while giving the prescription for pain medicine. Examples of these medicines are decongestants and antihistamines. Discuss these medications with your pharmacist.</p><p>You may give your child <a href="/Article?contentid=62&language=English">acetaminophen</a> and/or <a href="/Article?contentid=153&language=English">ibuprofen</a> if they have pain. Give the dose printed on the bottle for your child's weight. Do not give your child <a href="/Article?contentid=77&language=English">acetylsalicylic acid (ASA)</a> for two weeks after the surgery. ASA could increase your child's risk of bleeding after the operation. Check with the nurse or doctor first before giving these medicines to your child.</p><h3>Drinking</h3><p>It is very important that your child have lots to drink after the operation. Try to get your child to drink at least four glasses of liquid a day over the first few days after the operation. Let your child drink as much liquid or liquidy foods, such as Jell-O and yogurt, as they want.</p><p>Do not let your child have orange, lemon or grapefruit juices or other citrus fruits for seven to 10 days. These contain acid, and your child may find them painful to drink. </p><h3>Eating</h3><p>When your child can drink liquids without throwing up, they may eat soft foods such as noodles, eggs and yogurt. When your child can eat soft foods comfortably, they may eat regular foods. </p><p>Your child should not eat hard foods, such as toast or pizza crust, for two weeks after the operation. These foods may scratch their throat and cause pain and bleeding. </p><h3>Mouth care</h3><p>Your child's mouth may smell different for two weeks after the operation. Have your child rinse their mouth with water or gently brush their teeth. Do not let your child gargle or swish anything around in the back of their throat.</p><p>Your child may have white patches where the tonsils were for several days. This does not mean that your child has an infection. To protect your child's throat, make sure your child tries not to cough, talk loudly or clear their throat a lot for seven to 10 days. Teach your child to sneeze with their mouth open. Do not let your child blow their nose for at least one week after the operation. They should dab their nose with a tissue if it is dripping.</p><p>To help your child breathe more comfortably, you can use a machine called a humidifier. This machine makes the air moist with a cool mist. Put it at your child's bedside. </p><p>To reduce swelling and make your child more comfortable, try raising your child's head and shoulders.</p><p>If your child also had their adenoids taken out, their voice may sound as if they are talking through their nose. This is normal. This may last for a few weeks or up to three months, if the adenoids were very large. </p><h3>Activity</h3><p>Your child should limit their activity for about a week after the operation. Do not let your child play rough sports or contact sports. </p><p>Your child can shower or bathe as usual. Your child should stay away from crowds and people with infections and colds.</p><p>Your child can go back to school or day care in seven to 10 days after the operation. You should not let your child go on long trips out of town for two weeks after the operation. </p><h2>Reasons to call the doctor</h2> <p>Please call your child's otolaryngologist, the otolaryngology clinic nurse or your family doctor if your child has any of the following signs after going home: </p> <ul> <li>fever of 38.5°C (101°F) or higher </li> <li>vomiting (throwing up) that does not stop </li> <li>pain that gets worse </li> <li>refusing to drink </li> <li>child does not urinate (pee) within 12 hours of the operation </li> <li>fresh blood in the nose or mouth. </li> </ul> <p>If your child is bleeding, having trouble breathing, or if you have other concerns, take your child to the closest emergency department right away. </p> <h3>Write down contact information here:</h3> <p>Otolaryngologist's name and number:</p> <p>Otolaryngology clinic nurse's number:</p> <p>Family doctor's name and number:</p><h2>Your child may need a follow-up appointment</h2> <p>If your otolaryngologist has asked to see your child again in the clinic, the clinic will make you an appointment for your child. </p><h2>Removing enlarged tonsils and adenoids</h2> <p>After many infections, the tonsils and adenoids often become enlarged. This can interfere with breathing. Enlarged adenoids can also affect the tubes that connect the middle ears and the back of the nose. When tonsils or adenoids become too large, they may need to be taken out.</p> <p>Removing the tonsils and adenoids improves breathing. It may also help your child have fewer ear and throat infections.</p> <p>An otolaryngologist/head and neck surgeon will do the operation. An otolaryngologist is a doctor who specializes in problems of the ears, nose and throat.</p><h2>Surgery to remove the tonsils and adenoids</h2> <p>The doctor will give your child a special sleep medicine called a <a href="/Article?contentid=1261&language=English">general anaesthetic</a>. This will make sure your child sleeps through the operation and does not feel any pain. </p> <p>While your child is asleep, the doctor will remove the tonsils through your child's mouth. If your child is also having an adenoidectomy, the doctor will take out your child's adenoids at the same time. Your child will not get stitches. </p> <p>The operation usually takes from 45 to 60 minutes.</p> <h2>You will be able to see your child as soon as they are fully awake</h2> <p>A volunteer from the Surgical Waiting Room will bring you to see your child.</p><h2>After the operation</h2> <p>After the operation, we will take your child to the recovery room, also called the <a href="/Article?contentid=1262&language=English">Post Anaesthetic Care Unit (PACU)</a>. This is where your child will wake up. Your child will stay in the <a href="/Article?contentid=1262&language=English">PACU</a> for about one hour. We will then move your child to a room on the nursing unit.</p> <h2>Your child will be closely monitored on the nursing unit</h2> <ul> <li>Your child will be encouraged to take fluids by mouth. Your child will start with sips of clear fluids (liquids you can see through, such as water or apple juice), ice chips or freezies. Once your child can take sips, they can then drink liquids from a cup.</li> <li>Your child's temperature and vital signs will be taken regularly.</li> <li>Your child will still have an intravenous (IV) tube in their arm. It will remain in place until discharge.<br></li> <li>Your child will be given pain medicine when needed.</li> <li>The nursing staff will watch your child for vomiting (throwing up) or bleeding.</li> <li>The nurses will tell the doctor if there are any complications.</li> <li>When your child is fully awake, they can get up with help to use the washroom. </li> <li>Your child may throw up thick, brownish-coloured liquid if they swallowed some blood during or after the operation. This is normal. If your child keeps throwing up, they will receive medicine through the IV to help settle their upset stomach. </li> </ul> <h2>Managing your child's pain after the operation</h2> <p>When your child has pain after the operation, they will be given pain medicine either:</p> <ul> <li>by liquid, to swallow</li> <li>if they cannot swallow, by a suppository that goes into your child's rectum.</li> </ul> <p>These are ways nurses can help make your child more comfortable:</p> <ul> <li>humidified air to keep the throat moist</li> <li>raising your child's head and shoulders to help reduce swelling. </li> </ul> <h2>Usually just one day in the hospital</h2> <p>Most children are ready to go home from the hospital about six to eight hours after the operation. Sometimes, children need to stay for a longer time. </p> <p>You should take your child home in a car or a taxi. For your child's comfort and safety, do not take your child home by bus or subway. </p><h2>Before the operation</h2> <p>Several hours before the surgery, your child will need to stop eating and drinking. The doctor or nurse will tell you exactly when this must happen.</p> <p>Write this information down here:</p> <ul> <li>The date and time of the operation: </li> <li>When your child must stop eating: </li> <li>When your child must stop drinking clear fluids: </li> <li>Other things to remember: </li> </ul>Tonsil and adenoid surgery: Care at home
Hepatitis BHepatitis BHepatitis BHEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)LiverImmune systemConditions and diseasesCaregivers Adult (19+)NAhttps://assets.aboutkidshealth.ca/akhassets/IMD_liver_EN.jpg2014-06-02T04:00:00ZConstance O'Connor, NP;Simon Ling, MD9.3000000000000057.00000000000002227.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Hepatitis B is a liver disease caused by a virus. Discover the signs and symptoms, causes and treatment for hepatitis B. </p><h2>What is hepatitis?</h2> <figure><span class="asset-image-title">Liver</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_liver_EN.jpg" alt="Identification of the liver in a girl’s digestive system" /> <figcaption class="asset-image-caption">The liver is an organ that is part of our digestive system. It helps us get rid of toxins, digest food, and store energy from food.</figcaption> </figure> <p>Hepatitis B is a <a href="/Article?contentid=1468&language=English">liver</a> disease caused by a virus.</p><p>The liver is an organ in our abdomen (belly). It helps our bodies remove toxins and waste. It also helps us digest food and store the energy we get from food.<br></p><p>The word "hepatitis" means that there is inflammation of the liver. Inflammation of the liver can affect the liver's ability to work properly. Hepatitis can be caused by infections (virus, bacteria or parasites), drugs or toxins (including alcohol). There are several types of viruses that can cause hepatitis. One of these viruses is the hepatitis B virus. The hepatitis B virus is sometimes referred to as HBV.</p><h2>Key Points</h2> <ul> <li>Hepatitis B is an infection due to a virus called hepatitis B virus. You can protect yourself and your family from hepatitis B by getting the proper vaccination.</li> <li>Children can get hepatitis B if they come in contact with the blood or bodily fluids of someone who has hepatitis B. This can happen around the time of birth, by having unprotected sexual contact, contact with contaminated needles or, very rarely, by sharing items which may be contaminated with blood (such as toothbrushes, nail clippers and razors).</li> <li>Hepatitis B cannot be spread to other people by hugging, kissing, sneezing, coughing or breastfeeding. However, if you are breastfeeding and have cracked or bleeding nipples, talk to your health-care team.</li> <li>When the infection stays in the body for a long time, this is called chronic hepatitis B. Many children with chronic hepatitis B will not have any symptoms unless they have developed liver damage.</li> <li>If your child has chronic hepatitis, they should be seen by a health-care provider regularly to monitor their general health and the health of their liver. As your child gets older, your healthcare provider can help to provide teaching for your child about hepatitis B.</li> </ul><h2>Signs and symptoms of hepatitis B</h2> <h3>Acute hepatitis</h3> <p>Many people who become infected with hepatitis B, especially children, do not have any symptoms at the time of infection and never feel sick. Others get a brief illness with fatigue, decreased appetite and their eyes may turn yellow (jaundice).</p> <h3>Chronic hepatitis</h3> <p>A hepatitis B infection that lasts for more than six months is called chronic hepatitis. Infants and young children infected with hepatitis B have a high likelihood of developing chronic hepatitis. Most teenagers and adults are able to clear the virus on their own and develop life-long protection against it. Almost all children with chronic hepatitis B have no symptoms and grow normally.</p><h2>How do people get hepatitis B?<br></h2> <p>People may get the hepatitis B virus if they come in contact with the blood or other bodily fluid of someone who has hepatitis B. The virus then infects the liver. </p> <p>Here are some ways that children can be infected with the hepatitis B virus:</p> <ul> <li>Most children with hepatitis B were born to mothers who are also infected with the virus. The hepatitis B virus is passed to the baby either during pregnancy or delivery. It is possible to lower the risk of infection for the baby by using medicines and vaccination. This is why all pregnant women should be tested for hepatitis B during pregnancy. It is safe for a woman with hepatitis B to breastfeed her child because the virus does not pass through breast milk. However, if a mom has cracked and bleeding nipples, she should discuss breastfeeding with her health-care provider.</li> <li>Very rarely, children can get hepatitis B if they share personal items that may have the blood of someone with hepatitis B on them (such as toothbrushes, nail clippers or razors). The virus on these items may get into the children's bodies through tiny cuts and openings on the skin.</li> <li>Children can get hepatitis B if they use needles that are contaminated with the hepatitis B virus. This happens when they use the same needles that were already used by someone with hepatitis B. This includes body piercing, tattooing, acupuncture, accidental needle stick injuries or intravenous drug use. </li> <li>The chance that a child can get hepatitis B from blood transfusion or organ transplantation in Canada is extremely small. All blood products and donated organs are tested for hepatitis B infection before they are given to patients. In some other parts of the world, this is a more common problem.</li> <li>Anyone can get hepatitis B by having unprotected sexual contact with someone who has hepatitis B. </li> </ul> <p>It is important to know that children with hepatitis B can live normally. Many people live their whole lives with hepatitis B without significant damage to their liver because of the virus.</p><h2>How easily can hepatitis B be spread to other people?</h2> <p>The risk of getting hepatitis B infection is very low in regular day-to-day activity. If someone in your home has hepatitis B then all other people living there should be immunized against it. </p> <p>If your child has hepatitis B, they should not share personal items that may have traces of blood on them (toothbrush, nail clippers or razors). Your child should be taught not to let other people touch their blood if they have an accident and they should not touch the blood of others.</p> <p>Because the amount of virus in saliva is low, the risk to pass the virus is minimal. It is unnecessary to have two sets of eating utensils or dishes at home. Your child and the rest of the family can safely use the same sets.</p> <p>There is no risk of passing the virus to others by:</p> <ul> <li>breastfeeding, unless you have cracked and bleeding nipples. In this case, discuss the problem with your health-care provider. They may advice you to use breast shields or to stop breastfeeding.</li> <li>sneezing and coughing around other people</li> <li>hugging and kissing</li> </ul> <p>To protect your child's health and others, it is important to teach your child about good general health routines such as washing their hands, and not touching blood and bodily fluids. It is best to inform your child of their hepatitis B status when they are mature enough to understand the information. Talk to your child before they start to have romantic relationships or be tempted to experiment with alcohol or drugs. Teenagers should be taught about the importance of practicing safe sex, including the use of condoms, to reduce the risk of passing on hepatitis B to others.</p><h2>Tests for diagnosis and monitoring of hepatitis B</h2><h3>Hepatitis B serology</h3><p>Serology is the study of the blood and its content, in particular immune system components. The first test your child will have looks for markers in the blood indicating that they have hepatitis B. The test looks for surface components of the outer "coat" of the hepatitis B virus. These components are called antigens. If this test is positive, this means your child has hepatitis B infection. If it continues to be positive for longer than six months, this means your child has chronic hepatitis B.</p><p>Your child may also have a test that looks for the specific reaction of the immune system to the hepatitis B virus. The immune system makes antibodies that recognize the hepatitis B surface antigens. This test measures the protective antibodies that your child developed against the hepatitis B virus. A positive result may mean that your child is immune to the hepatitis B virus, either because they have recovered from a past infection or received the vaccination.</p><h3>Viral load</h3><p>A second test may be used to see what amount of hepatitis B virus is present in your child's blood. This is called the "hepatitis B viral load".</p><h3>Liver enzymes</h3><p>Blood tests called ALT and AST (liver enzymes) tell how active the disease is and other blood tests indicate if the liver is working properly.</p><h3>Monitoring hepatitis B</h3><p>Many children have a high viral load because their immune system does not recognize and control the hepatitis B virus. As long as the liver enzymes are normal and your child has regular checkups, a high viral load is common and does not mean your child will be unwell.</p><p>High levels of liver enzymes in your child's blood usually mean that your child's immune system has recognized the virus and is trying to fight it. The immune system may eventually be able to reduce the amount of hepatitis B virus in the blood. This is good because it means the risk of damage to the liver from scarring because of hepatitis B is reduced.</p><p>This inflammation of the liver may go away on its own over a short period of time without causing a reduction in the amount of the virus in the blood. In children where the liver enzymes are high for a long time (six to 12 months) your doctor may recommend treatment to help stop the inflammation in the liver before scarring can develop.</p><p>Many people live their whole lives without significant damage to their liver due to hepatitis B. However, as people age, the risk of scarring in the liver increases. Mild scarring in the liver does not usually affect the way the liver works. Severe scarring (cirrhosis) may make it difficult for the liver to work properly. Cirrhosis only rarely happens in children with hepatitis B. Chronic hepatitis B infection also increases the risk for liver cancer, especially if it has caused bad liver scarring. Liver cancer is very rare in children with hepatitis B.</p><p>It is important that your child have regular medical follow-up throughout life. This allows problems in your child's liver to be identified and treated early, which may prevent or delay development of liver scarring or cirrhosis and liver cancer.</p><h2>Treatment for hepatitis B </h2> <p>There is currently no cure for hepatitis B. For chronic hepatitis B, there are medications which may reduce the amount of inflammation and/or damage the virus may cause to the liver. If your child's hepatitis B is chronic and progressing or if there are other health problems, your doctor may recommend medication to treat the hepatitis B infection.</p> <p>For acute hepatitis B infection, there are no medications. Treatment will help relieve symptoms.</p> <h3>Immunization</h3> <p>As for any illness, the best treatment is prevention. There are very effective vaccines to prevent hepatitis B. In Canada, this vaccine is part of the <a href="/Article?contentid=1986&language=English">routine immunization schedule</a>. This means that all children are protected against hepatitis B if they get all their required shots from the doctor or at school. Children and teenagers are immunized at various ages depending on the province in which they live.</p> <p>When a pregnant woman has hepatitis B, sometimes she needs to take medication to lower her viral load before delivering her baby. When the baby is born, they receive the first dose of the hepatitis B vaccine and another medicine to protect them from the virus. This medicine is called the hepatitis B immune globulin or HBIG. The baby will need at least two additional doses of the hepatitis B vaccine at one month and six months of age.</p> <h3>How to care for your child at home</h3> <p>Many people live their whole lives with hepatitis B but do not experience significant damage to their liver. However, the risk of scarring in the liver increases with age. That is why if your child has chronic hepatitis B, your health-care provider will see your child regularly.</p><h2>Who to tell about your child's hepatitis B status?</h2> <p>It is up to you who you tell about your child's hepatitis B infection.</p> <p>You should tell people who look after your child's general health, like dentists, doctors and nurses.</p> <p>Sometimes people who work with children, including teachers, sports coaches and other volunteers do not really know about hepatitis B. In some communities, there may be a stigma associated with hepatitis B infection. Therefore, you may wish to discuss strategies with your child's health-care team before you tell others about your child's hepatitis B infection.</p> <h2>What can I do to help keep my child's liver healthy?</h2> <p>There are many things that help your child's liver stay healthy:</p> <ul> <li>A <a href="/Article?contentid=1435&language=English">healthy diet</a> with plenty of fresh vegetables and fruit helps provide antioxidants that protect the liver from the bad effects of inflammation.</li> <li>Regular physical activity when combined with a healthy diet keeps weight under control. Being overweight will often cause extra difficulty for the liver.</li> <li>Be careful with herbal, natural or other alternative or complimentary treatments. Check with your health-care provider before giving any herbal medications as some of these may be harmful to the liver.</li> <li>Be careful about other medications. Some medications are processed by the liver. If your child needs medication for other health conditions, it is important to follow the instructions carefully. Ask for advice from your health-care provider or pharmacist.</li> <li>Get immunized against other infectious diseases. There are no benefits from getting immunized against hepatitis B if your child already has it. Your child should have all of the recommended immunizations available and should be immunized against hepatitis A. However, the rest of the family and care-givers should be immunized against hepatitis B.</li> <li>Explain to your child and/or teen why they should avoid alcohol and other types of drugs which may cause damage to the liver.</li> </ul>

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