| 22q11 deletion syndrome (22q11DS) | 2 | 22q11 deletion syndrome (22q11DS) | 22q11 deletion syndrome (22q11DS) | | English | Genetics | Child (0-12 years);Teen (13-18 years) | Body | NA | Conditions and diseases | Adult (19+)
Caregivers | NA | | 2018-04-18T04:00:00Z | | | | | | 10.2000000000000 | 45.7000000000000 | 639.000000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>22q11 deletion syndrome (22q11DS) is a genetic condition. Learn what causes it, how it's diagnosed and treated.</p> | <h2>What is 22q11 deletion syndrome?</h2><p>22q11 deletion syndrome (22q11DS) is a genetic condition that affects about 1 in 2000 to 1 in 4000 children. 22q11DS is known by several other names including velo-cardio-facial syndrome (VCFS) and DiGeorge syndrome. 22q11DS is the second most common genetic condition after Down syndrome. </p><p>People with VCFS, DiGeorge syndrome and 22q11DS all have the
<a href="/Article?contentid=3044&language=English">same genetic cause</a>: a small missing piece of genetic material (DNA) on one of their two copies of chromosome 22. This missing genetic material is called a deletion.</p>
<figure class="asset-c-80">
<span class="asset-image-title">22q11 deletion</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/22q11_microdeletion_EN.jpg" alt="Chromosome 22 with missing genetic material" />
<figcaption class="asset-image-caption">This chromosome 22 pair shows a complete chromosome (A) and a chromosome with a deletion (B). </figcaption> </figure>
<p>In most cases, 22q11DS is the result of a new genetic change that occurs when a baby is conceived. This is called a de novo deletion and occurs by chance in either the mom’s egg or the dad’s sperm. A de novo deletion is not caused by anything the parents did before or during the pregnancy. </p><p>In some people with 22q11DS (about 10%), the deletion is inherited from a parent. Sometimes a parent might not know that they have 22q11DS until after they have a child diagnosed with this condition. </p> | <h2>Key points</h2><ul><li>22q11DS is known by many names such as velo-cardio-facial syndrome and DiGeorge syndrome.</li><li>22q11DS is a genetic disorder. It results from a small missing piece of genetic material (DNA) on a specific part of chromosome 22. This is called a deletion.</li><li>The 22q11 deletion happens most of the time by chance. In some families, the 22q11 deletion can be inherited from a parent. </li><li>People with 22q11DS may experience one or more of the associated symptoms. The most common symptoms seen are heart defects, low calcium levels, immune deficiency, speech and language impairments, and learning disabilities.</li><li>There is no cure for 22q11DS but your child’s symptoms can be treated and managed. With appropriate support, your child can lead a happy, productive life.</li></ul> | <h2>Symptoms of 22q11DS</h2><p>A syndrome is a group of signs and symptoms that occur together due to a common underlying cause. 22q11DS can affect <a href="/Article?contentid=3045&language=English">many parts of the body</a> and each person with 22q11DS can be affected in a different way. Some of the common features of 22q11DS include:</p><ul><li>heart defects</li><li>palate differences</li><li>immune deficiency</li><li>feeding and swallowing problems</li><li>low levels of calcium in the blood</li><li>growth delay</li><li>kidneys that are smaller, or formed differently</li><li>speech and language impairments</li><li>learning disabilities </li><li>psychiatric disorders (anxiety, attention deficit, depression, psychosis) </li></ul><p>Some individuals will experience many of the symptoms while others may experience only a few. Every person is different.</p> | | <h2>How 22q11DS is diagnosed</h2><p>22q11DS is diagnosed by a blood test. Three different genetic tests can detect 22q11DS: </p><ul><li>Fluorescent In Situ Hybridization (FISH) is a test that looks specifically for a deletion on chromosome 22. This test can miss small or atypical 22q11 deletions.</li><li>Chromosome microarray is a test that looks for extra or missing pieces across all the chromosomes. This test can detect small or atypical 22q11 deletions.</li><li>MLPA is a DNA test that looks for missing or extra pieces in chromosome region 22q11. This test can detect small or atypical 22q11 deletions.</li></ul><p>Only one of these tests is typically needed to make a diagnosis of 22q11DS. The test that is ordered by your child's doctor is chosen based on your child’s presentation.</p><p>It usually takes several weeks to get these test results back depending on the test chosen and the laboratory. Ask your health-care provider about your specific situation.</p> | <h2>Treatment of 22q11DS</h2><p>Although there is no cure for 22q11DS, symptoms can be treated and managed. People with 22q11DS may need continued support in some aspects of their life throughout adulthood. With this support, people with 22q11DS can lead happy, productive lives.</p> | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/akhassets/22q11_microdeletion_EN.jpg | | | Main |
| 22q11 deletion syndrome: Genetics | 2 | 22q11 deletion syndrome: Genetics | 22q11 deletion syndrome: Genetics | | English | Genetics | Child (0-12 years);Teen (13-18 years) | Body | NA | Conditions and diseases | Adult (19+)
Caregivers | NA | | 2018-04-18T04:00:00Z | | | | | | 9.80000000000000 | 48.6000000000000 | 854.000000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>Learn about the genetic causes of 22q11 deletion syndrome, risk factors and confirming diagnosis.</p> | <h2>What is 22q11 deletion syndrome?</h2><p>
<a href="/Article?contentid=3043&language=English">22q11 deletion syndrome (22q11DS)</a> is a genetic condition that affects about 1 in 2000 to 1 in 4000 children. 22q11DS is known by several other names including velo-cardio-facial syndrome (VCFS) and DiGeorge syndrome.</p><p>22q11DS can affect many parts of the body
<a href="/Article?contentid=3045&language=English">including</a>:</p><ul><li>the heart</li><li>the immune system</li><li>the palate (roof of the mouth).</li></ul><p>It can also affect how a person learns.</p> | <h2>Key points</h2><ul><li>22q11DS is known by many names such as velo-cardio-facial syndrome and DiGeorge syndrome.</li><li>22q11DS is a genetic disorder. It results from a small missing piece of genetic material (DNA) on chromosome 22. This is called a deletion.</li><li>The 22q11 deletion happens most of the time by chance. In some families, the 22q11 deletion can be inherited from a parent.</li><li>Genetic testing on a small blood sample can help to make a diagnosis.</li><li>A genetic counsellor can help you understand the genetics of 22q11DS and the chances for it to happen in a child.</li></ul> | | <h2>Causes of 22q11DS</h2><div class="akh-series"><div class="row"><div class="col-md-12">
<figure>
<span class="asset-image-title">The organization of genetic material</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/What_is_a_gene_MED_ILL_EN.jpg" alt="Cell with chromosomes, which contain DNA strands with genes and nucleotides" />
</figure>
<h3>Chromosome deletion</h3><p>DNA carries a person’s
<a href="https://pie.med.utoronto.ca/htbw/module.html?module=genetics">genetic information</a>. DNA is organized into structures called chromosomes. Each cell of the body contains the same number of chromosomes and all of a person’s genetic information. Humans have 46 chromosomes arranged in 23 pairs, with two copies of each chromosome. </p><p>Chromosomes carry all of our genes. Genes determine how a person will grow and develop. Missing genetic information (such as a chromosome deletion) can lead to medical and developmental problems. How a person’s development or health will be affected depends on which genetic material is missing. </p></div></div></div><p>All chromosomes have a long (q) arm and a short (p) arm. People typically have two copies of chromosome 22. People with 22q11DS have a small piece of genetic material (genes) missing on the q arm of one of their two copies of chromosome 22. This is sometimes called a deletion. Even though it is small, the deletion of the 22q11.2 chromosome region involves many genes and can affect many parts of the body.</p>
<figure class="asset-c-80">
<span class="asset-image-title">22q11 deletion</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/22q11_microdeletion_EN.jpg" alt="Chromosome 22 with missing genetic material" />
<figcaption class="asset-image-caption">This chromosome 22 pair shows a complete chromosome (A) and a chromosome with a deletion (B).</figcaption> </figure>
<h3>How did your child get 22q11DS? </h3><p>Most of the time, 22q11DS is the result of a new genetic deletion that occurs when a baby is conceived. This is called a de novo deletion and occurs by chance in either the mom’s egg or the dad’s sperm. A de novo deletion is not caused by anything the parents did before or during the pregnancy. For parents who have a child with a de novo deletion, the chance of having another child with 22q11DS is low. </p>
<figure class="asset-c-80">
<span class="asset-image-title">
<em>De novo</em> deletion of 22q11DS</span><img src="https://assets.aboutkidshealth.ca/akhassets/22q11_de_novo_deletion_EN.jpg" alt="Chromosome distribution from unaffected parents resulting in spontaneous new gene deletion before baby is conceived" />
<figcaption class="asset-image-caption">Most of the time, 22q11DS is the result of a new genetic deletion in the egg or sperm before the baby is conceived. This is called a
<em>de novo</em> deletion and occurs by chance.</figcaption>
</figure>
<p>In some people with 22q11DS (about 10%), the deletion is inherited from a parent. Sometimes a parent might not know that they have 22q11DS until after they have a child diagnosed with this condition. A person who has 22q11DS has a 50% chance (1 in 2) of having a child with 22q11DS.</p>
<figure class="asset-c-80">
<span class="asset-image-title">22q11DS inherited from a parent</span>
<img src="https://assets.aboutkidshealth.ca/AKHAssets/IMD_22q11_inheritance_EN.jpg" alt="Chromosome distribution from an affected parent with 22q11 DS and an unaffected parent, producing two possible combinations" />
<figcaption class="asset-image-caption">22q11DS is caused by a deletion in chromosome 22. A person will have 22q11DS if one chromosome 22 in the pair has the deletion. In this example, the parent with 22q11DS has one chromosome 22 with a deletion and one intact chromosome 22 (without a deletion). If the baby inherits the intact chromosome 22, then the baby will not have 22q11DS. If the baby inherits the chromosome 22 with a deletion, then the baby will have 22q11DS.</figcaption>
</figure>
<p>You can speak to a genetic counsellor to discuss information regarding how 22q11DS happened in your family and your chances of having a child with 22q11DS.</p> | <h2>How 22q11DS is diagnosed</h2><p>If the doctor <a href="/Article?contentid=3043&language=English">suspects that a child has 22q11DS</a>, they may order genetic testing. Today, three different tests are able to detect 22q11DS. Each requires a small sample of blood. Some tests look for the 22q11 deletion; others look generally at the chromosomes structures for any deletion or duplication of genetic material. </p><p>Only one of these tests is typically needed to make a diagnosis of 22q11DS. The test that is ordered by your child's doctor is chosen based on your child’s presentation. </p><p>It usually takes several weeks to get these test results back depending on the test chosen and the laboratory. Ask your health-care provider about your specific situation.</p><p>These tests include:</p><h3>FISH (fluorescent in situ hybridization)</h3>
<p>Fluorescent In Situ Hybridization (FISH) is a test that looks specifically for a deletion on chromosome 22. This test can miss small or atypical 22q11 deletions.</p><h3>Chromosomal microarray </h3><p>Chromosome microarray is a test that looks for extra or missing pieces across all the chromosomes. This test can detect small or atypical 22q11 deletions.</p><h3>MLPA</h3><p>MLPA is a DNA test that looks for missing or extra pieces in chromosome region 22q11. This test can detect small or atypical 22q11 deletions.</p> | | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/akhassets/What_is_a_gene_MED_ILL_EN.jpg | | | Main |
| 22q11 deletion syndrome: Medical features | 2 | 22q11 deletion syndrome: Medical features | 22q11 deletion syndrome: Medical features | | English | Genetics | Child (0-12 years);Teen (13-18 years) | Body | NA | Conditions and diseases | Adult (19+)
Caregivers | NA | | 2018-04-18T04:00:00Z | | | | | | 11.0000000000000 | 42.9000000000000 | 1246.00000000000 | | Flat Content | Health A-Z | <p>22q11DS is a genetic condition with a wide range of symptoms. Learn about some of the more common medical features of 22q11DS.</p> | <h2>What is 22q11 deletion syndrome</h2><p>
<a href="https://www.aboutkidshealth.ca/Article?contentid=3043&language=English">22q11 deletion syndrome (22q11DS)</a> is a genetic condition that affects about 1 in 2000 to 1 in 4000 children. 22q11DS is known by several other names including velo-cardio-facial syndrome (VCFS) and DiGeorge syndrome. 22q11DS is the second most common genetic condition after Down syndrome. </p><p>People with 22q11DS, VCFS and DiGeorge syndrome all have the same
<a href="/Article?contentid=3044&language=English">genetic cause</a>: a small missing piece of genetic material (DNA) on one of their two copies of chromosome 22. This missing genetic material is called a deletion.
<br></p> | <h2>Key points</h2><ul><li>22q11DS is a genetic disorder caused by missing genes in a specific part of chromosome 22.</li><li>The clinical features of 22q11DS vary greatly from child to child.</li><li>This condition can affect an individual’s medical health, as well as their development and learning.</li><li>Ask for help and guidance if your child experiences changes in their mood, personality or behavior. </li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| ADHD: Communicating with your child's school | A | ADHD: Communicating with your child's school | ADHD: Communicating with your child's school | | English | Psychiatry | School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years) | Brain | Brain | Non-drug treatment | Caregivers
Adult (19+) | NA | | 2017-06-16T04:00:00Z | | | | | | 9.10000000000000 | 61.4000000000000 | 1180.00000000000 | | Health (A-Z) - Procedure | Health A-Z | <p>Find out how to work with your child's school to support your child with ADHD.</p> | <p>
<a href="/Article?contentid=1922&language=English">ADHD</a> affects children both at home and at school. To ensure your child with ADHD does as well in school as they can, you need to build a solid relationship with your child's teachers. To do this, you need to communicate clearly and often.</p><p>Communication helps you to:</p><ul><li>discuss initial concerns about your child's
<a href="/Article?contentid=1923&language=English">ADHD symptoms</a></li><li>develop school-based interventions</li><li>monitor your child's progress</li><li>make sure you and your child's teacher are using the same approaches to help your child</li><li>share information about
<a href="/Article?contentid=1998&language=English">medication</a> and other treatments.</li></ul> | <h2>Key points</h2>
<ul>
<li>A solid relationship based on clear and frequent communication with teachers will help your child do as well at school as they can.</li>
<li>Your child’s teacher should know if your child is being assessed for ADHD so that they support your child as early as possible.</li>
<li>If your child is diagnosed with ADHD, meet your child’s teacher soon afterwards to discuss your child’s treatment plan and how you and the school can work together. </li>
<li>If you need to advocate for your child’s needs, learn about the school system, remain positive and see yourself and your child’s school as partners in your child’s care.</li>
</ul> | | | | | | | | | | | | | | | <h2>What you need to know from your child's teacher</h2>
<h3>During assessment</h3>
<p>Your child's teacher may be the first person to suspect that a child has ADHD. They can help the doctor or psychologist assess your child's behaviour and academic achievement, for example by describing or explaining:</p>
<ul>
<li>your child's symptoms in class and how long they have had them</li>
<li>whether your child's symptoms are better in some settings than in others</li>
<li>how your child is doing academically</li>
<li>your child's language abilities</li>
<li>how your child is doing socially</li>
</ul>
<h3>After diagnosis</h3>
<p>After your child has been diagnosed, your child's teacher can provide important information about their progress, including:</p>
<ul>
<li>the approaches they are using at school to help your child</li>
<li>the <a href="/Article?contentid=1997&language=English">approaches you can use at home</a> to help your child with schoolwork and homework</li>
<li>how well the different approaches are working</li>
</ul> | <h2>What your child's teacher needs to know</h2>
<h3>During assessment</h3>
<p>While your child is being assessed for ADHD, let your child's teacher know that:</p>
<ul>
<li>your child is being assessed</li>
<li>the doctor or psychologist may need information from the teacher to help with diagnosis</li>
</ul>
<p>Some parents may be concerned about sharing a potential ADHD diagnosis with their child's teacher for fear that it will have a negative impact on their child at school. However, because of the range of research that has been conducted and shared about ADHD, there is less stigma associated with the condition. In addition, the earlier your child's teacher knows that your child is being assessed for ADHD, the better they can help with a diagnosis and support your child to do as well as they can in school.</p>
<h3>After diagnosis</h3>
<p>After your child has been diagnosed, meet with your child's teacher to:</p>
<ul>
<li>discuss the treatment plan</li>
<li>explain what interventions (ADHD supports) your child is receiving</li>
<li>discuss changes the teacher can make in the classroom to help your child</li>
<li>discuss how the teacher can help monitor the success of the treatment plan</li>
<li>discuss what you are doing at home to help your child</li>
<li>discuss how to be consistent with rules and consequences at home and at school</li>
<li>explain the medication your child is taking, if any, and what to look out for</li>
</ul> | | | | <h2>Further information</h2><p>For more information on ADHD, please see the following pages:</p><p>
<a href="/Article?contentid=1922&language=English">ADHD: Overview</a></p><p>
<a href="/Article?contentid=1923&language=English">ADHD: Signs and symptoms</a></p><p>
<a href="/Article?contentid=1997&language=English">ADHD: How to help your child at home</a></p><p>
<a href="/Article?contentid=1998&language=English">ADHD: Treatment with medications</a></p><h2>Resources</h2><p>The following websites offer support if a child has ADHD.</p><p>
<a href="http://www.ldao.ca/" target="_blank">Learning Disabilities Association of Ontario</a></p><p>
<a href="https://caddac.ca/adhd/" target="_blank">Centre for ADHD Awareness, Canada - CADAC</a><br></p> | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/ADHD_communicating_with_your_childs_school.jpg | | Main |
| ADHD: How to help your child at home | A | ADHD: How to help your child at home | ADHD: How to help your child at home | | English | Psychiatry | School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years) | Brain | Brain | Non-drug treatment | Caregivers
Adult (19+) | NA | | 2017-06-16T04:00:00Z | | | | | | 10.0000000000000 | 55.2000000000000 | 1262.00000000000 | | Health (A-Z) - Procedure | Health A-Z | <p>Find out how structure, consistency and clear communication can help you support a child with ADHD symptoms.</p> | <p>Many families prefer to start helping a child with
<a href="/Article?contentid=1923&language=English">ADHD symptoms</a> through behavioural treatment at home. Children with ADHD often respond well to this approach. It can be useful for reinforcing other at-home interventions such as consuming a
<a href="/Article?contentid=639&language=English">balanced diet</a>, maintaining
<a href="/Article?contentid=645&language=English">proper sleep hygiene</a> and limiting
<a href="/Article?contentid=643&language=English">screen time</a>.</p> | <h2>Key points</h2>
<ul>
<li>Behavioural treatment for ADHD involves parents and teachers working together to create a structured environment for a child based on consistent rules and clear communication.</li>
<li>To set your child up for success, use clear and concise instructions, reminders and prompts for desired behaviours and positive body language.</li>
<li>To help your child handle social situations, play games that require co-operation with others, give positive feedback as soon as possible and focus on your child’s talents and strengths.</li>
</ul> | | | | | | | | | | | | | | | <h2>What is involved in behavioural treatment for ADHD?</h2>
<p>Behavioural treatment for ADHD involves a number of interventions directed at the child, the parents and teachers. It centres on:</p>
<ul>
<li>organization</li>
<li>structure</li>
<li>consistency</li>
<li>clear communication</li>
</ul>
<p>Because ADHD affects all areas of a child's life, it is important to set up a consistent environment in which the child receives similar support both from family and teachers. This may be more challenging if children are living in two households, for instance if parents are divorced or separated.</p>
<p>The goal of behavioural treatment is to help parents and teachers better manage the behaviour of a child with ADHD. It helps a child become responsible for their own behaviour and support them in the process. Many of the strategies used in behavioural treatment for ADHD can be used with all children.</p> | <h2>What types of behavioural treatments can I use with my child?</h2>
<p>The main types of behavioural treatment strategies, or methods, help "set your child up for success". The strategies centre on:</p>
<ul>
<li>setting up a supportive environment</li>
<li>using routines, schedules and rules</li>
<li>giving positive, specific feedback about the things your child does well.<br></li>
</ul>
<h3>Creating a supportive physical environment</h3>
<p>To create a supportive physical environment for your child:</p>
<ul>
<li>set aside a quiet place to study after school</li>
<li>create an area where your child can prepare everything they need for the next day at school, such as snacks, sports equipment, homework and permission slips</li>
<li>keep visual reminders of things your child needs to do, including checklists, to-do lists, a notebook for homework assignments and a calendar; pictures depicting each task within a routine can be helpful</li>
<li>store toys, art supplies and school supplies in the same places for ease of access</li>
<li>label or colour-code belongings and storage containers</li>
<li>limit <a href="/Article?contentid=643&language=English">screen time</a>, especially at night.<br></li>
</ul>
<h3>Using rules, routines and prompts</h3>
<p>To help your child remember what they need to do:</p>
<ul>
<li>set positive expectations for your child, and praise them when they meet them</li>
<li>use reminders and prompts to encourage your child rather than a list of "don'ts"</li>
<li>set reasonable, consistent rules and make sure your child understands them</li>
<li>create routines for the morning time, homework, dinner time, bed time, chores and other regular events.</li>
</ul>
<h3>Encouraging your child</h3>
<p>To help support your child:</p>
<ul>
<li>stay positive and upbeat</li>
<li>be generous with encouragement and praise when your child does something right, even if not everything has been done perfectly, such as "I'm so proud of you for remembering to put all your homework in your bag! Remember to take your lunch too — it's in the fridge."</li>
<li>give specific feedback about good behaviour as soon as possible </li>
<li>model appropriate behaviour, for example showing your child that you are listening by being quiet, looking at them and not being distracted </li>
<li>involve your child in solving problems and finding ways to remember what they are supposed to do.<br></li>
</ul> | | | | <h2>Further information</h2><p>For more information on ADHD, please see the following pages:</p><p>
<a href="/Article?contentid=1922&language=English">ADHD: Overview</a></p><p>
<a href="/Article?contentid=1923&language=English">ADHD: Signs and symptoms</a></p><p>
<a href="/Article?contentid=1999&language=English">ADHD: Communicating with your child's school</a></p><p>
<a href="/Article?contentid=1998&language=English">ADHD: Treatment with medications</a></p><h2>Resources</h2><p>The following websites offer support if a child has ADHD. </p><p>
<a href="http://www.ldao.ca/" target="_blank">Learning Disabilities Association of Ontario</a></p><p>
<a href="https://caddac.ca/adhd/" target="_blank">Centre for ADHD Awareness, Canada - CADAC</a></p> | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/ADHD_how_to_help_your_child_at_home.jpg | | Main |
| ADHD: Signs and symptoms | A | ADHD: Signs and symptoms | ADHD: Signs and symptoms | | English | Psychiatry | School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years) | Brain | Brain | Conditions and diseases | Caregivers
Adult (19+) | NA | | 2017-06-16T04:00:00Z | | | | | | 10.6000000000000 | 51.8000000000000 | 1690.00000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>Discover the main sign and symptoms of ADHD in school-aged children and teens.</p> | <h2>What are the main symptoms of ADHD in children?</h2><p>The main symptoms of
<a href="/Article?contentid=1922&language=English">ADHD </a>are difficulties controlling attention, behaviour and emotions, as expected for age.</p><h3>Difficulty controlling attention</h3><p>A child who has difficulty controlling attention may make careless mistakes or fail to pay attention to detail, not seem to listen when spoken to, have trouble organizing tasks and activities and be easily distracted. Sometimes they may focus very well (over-focus) on tasks of high interest such as video games but not on tasks that may be difficult, require more effort or be less interesting to them, such as school work.</p><h3>Difficulty controlling behaviour and emotions</h3><p>A child who finds it difficult to control their behaviour might show symptoms of hyperactivity. They may often fidget, have trouble playing quietly, be "on the go" or talk too much. If a child has symptoms of impulsivity, they may have trouble waiting for their turn and frequently interrupt others.</p> | <h2>Key points</h2>
<ul>
<li>The main symptoms of ADHD are difficulty controlling attention, behaviour and impulses. This can appear as inattention, over-focusing, hyperactivity and impulsivity.</li>
<li>Symptoms usually become more obvious from age seven to nine but can sometimes appear as late as age 13 to 15.</li>
<li>ADHD is diagnosed when a child’s symptoms are excessive, last for a number of months and occur in two or more settings. </li>
<li>An ADHD diagnosis is made by a qualified health-care professional, based on a thorough clinical history, a physical examination and descriptions of symptoms by the parent and teacher.</li>
</ul> | <h2>How ADHD appears in school-age children</h2><p>One of the key times for diagnosing children is when they are aged seven to nine years old. At this age, parents and teachers often start to notice problems with the child's school work and friendships.</p><h3>School performance</h3><p>Many children with ADHD may also have more difficulties than their peers with learning to read, spell or do math. But even without any specific learning difficulty (such as dyslexia), ADHD can interfere with a child’s ability to learn, follow classroom routines and complete school work. They may have trouble understanding how the classroom works and may find it hard to give focused, organized answers to a teacher's questions. Homework can also be a challenge, as ADHD may make it difficult for a child to write down homework, remember to take the necessary books home and start or complete homework by themselves.</p><p>The website
<a href="http://www.teachadhd.ca/Pages/default.aspx" target="_blank">TeachADHD</a> offers more information on how ADHD affects children in the classroom and offers a range of guidelines for teachers. </p><h3>Social emotional abilities</h3><p>Children with ADHD often have more social and emotional problems than other children. This is true for both boys and girls. For instance, ADHD is linked with being a victim of bullying and being rejected by peers.</p><p>In terms of emotions, children with ADHD can experience sudden mood swings, which may appear as over-reactions to small issues or becoming frustrated very quickly. They may also have a strong need for instant satisfaction.</p><p>These social and emotional issues can occur because of a child’s:</p><ul><li>difficulty reading social cues, for example failing to read facial expressions accurately or interpreting neutral behaviour or comments as negative</li><li>problems with conversation skills, problem-solving or other social skills</li><li>trouble controlling behaviour, for instance interrupting or not taking turns, which may irritate other children</li><li>difficulty controlling their emotions, for example reacting angrily or inappropriately when they are upset</li></ul><h2>How ADHD appears in teens</h2><p>While a diagnosis of ADHD is usually confirmed by age nine, some older children may not be diagnosed until they transition to high school. This is because the transition and adjustment to high school usually place new demands on a child's organizational skills and reveal difficulties with controlling attention that might have been hidden previously.</p><h3>School performance</h3><p>Many of the school difficulties experienced by younger children with ADHD continue into the teen years. Compared with their peers, teens with ADHD are three times more likely to drop out of school. However, many students with ADHD do graduate from high school and go on to higher education, which is encouraging. They may still face challenges with learning and academic performance, however, so proper supports remain essential.</p><h3>Social emotional abilities</h3><p>Teens with ADHD may have:</p><ul><li>more negative moods, such as anger,
<a href="/Article?contentid=18&language=English">anxiety</a> and stress</li><li>fewer positive moods, such as happiness, alertness and a sense of wellbeing</li></ul><p>In teenage boys, ADHD may contribute to risky behaviours such as gambling and addictions, including substance abuse and video addiction. In girls, ADHD is more likely to be associated with obesity,
<a href="/Article?contentid=19&language=English">depression</a>,
<a href="/Article?contentid=18&language=English">anxiety</a>,
<a href="/Article?contentid=291&language=English">suicide</a> and
<a href="/Article?contentid=289&language=English">self-harm</a>, and eating disorders such as
<a href="/Article?contentid=268&language=English">anorexia</a>,
<a href="/Article?contentid=282&language=English">bulimia</a> and
<a href="/Article?contentid=277&language=English">binge eating</a>. For older teens, there is increased risk of driving offences and accidents.</p> | | <h2>How is ADHD diagnosed?</h2>
<p>There is no specific test for ADHD. Usually, your doctor or another qualified health-care professional will examine your child and ask questions about:</p>
<ul>
<li>your child’s developmental history</li>
<li>how your child behaves at home and in other situations</li>
<li>how long your child has had symptoms and whether they cause problems</li>
<li>whether your child is experiencing problems at school or with school work</li>
</ul>
<p>The health-care professional will usually ask you to fill in some structured questionnaires so they can learn about your child’s general behaviour at home. If you have any concerns that the doctor has not asked about, such as problems with your child’s nutrition or sleep, make sure to discuss them. It might help to write down your questions before your child’s appointment.</p>
<p>Often families seek advice from a doctor after they and/or the child’s teacher have expressed concerns about the child’s symptoms.</p>
<p>Once your child is in school, the health-care professional can find out if they are inattentive, impulsive or hyperactive in that setting as well as at home. Your child’s teacher will likely be asked to fill in structured questionnaires or rating scales as well as report cards to provide the information the health-care professional needs. A child will be diagnosed with ADHD only if their symptoms are excessive and persistent and cause difficulties at home and at school.</p>
<h2>Will a diagnosis be made right away?</h2>
<p>It will probably take two or three visits to the doctor to diagnose ADHD, as they will need time to collect information from your child's teacher and consider all the information that has been gathered.</p> | <h2>What happens after a diagnosis of ADHD?</h2>
<p>Once your child is diagnosed with ADHD, treatment can begin. You, your child's doctor or psychologist and the school will need to work together on a plan to manage your child’s ADHD.</p>
<p>This plan will begin with a thorough discussion about ADHD and possible treatments and supports for parents and for your child or teen. Next, a treatment plan is developed based on a clear discussion with you and your child about your needs and preferences.</p>
<p><a href="/Article?contentid=1998&language=English">Medication</a> is often an important part of treatment, but it is rarely enough to help a child do their best. Before starting a child on medication, many parents prefer to engage with other forms of treatment, such as <a href="/Article?contentid=1997&language=English">adapting their parenting style</a> for challenging behaviour and <a href="/Article?contentid=1999&language=English">working with the child’s school</a> to develop an individual education plan (IEP).</p> | | | | | | | | | | | | | | | | <h2>Further information</h2><p>For more information on ADHD, please see the following pages:</p><p>
<a href="/Article?contentid=1922&language=English">ADHD: Overview</a></p><p>
<a href="/Article?contentid=1997&language=English">ADHD: How to help your child at home</a></p><p>
<a href="/Article?contentid=1999&language=English">ADHD: Communicating with your child's school</a></p><p>
<a href="/Article?contentid=1998&language=English">ADHD: Treatment with medications</a></p><h2>Resources</h2><p>The following resources offer support and additional information on ADHD.</p><h3>Websites</h3><p>
<a href="http://www.ldao.ca/" target="_blank">Learning Disabilities Association of Ontario</a></p><p>
<a href="https://caddac.ca/adhd/" target="_blank">Centre for ADHD Awareness, Canada - CADAC</a><br></p><h3>Journal articles<br></h3><p>Cortese, S. & Tessari, L. (2016).
<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5247534/" target="_blank">Attention-Deficit/Hyperactivity Disorder (ADHD) and Obesity: Update 2016</a>.
<em>Current Psychiatry Reports </em>19 (4) doi: 10.1007/s11920-017-0754-1.</p><p>Heinonen, K. et al (2010).
<a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-10-91" target="_blank">Behavioural symptoms of attention deficit/hyperactivity disorder in preterm and term children born small and appropriate for gestational age: A longitudinal study</a>.
<em>BMC Pediatrics</em>. Dec 15 2010 10:91. doi: 10.1186/1471-2431-10-91.</p><p>Sucksdorff, M. et al (2015).
<a href="https://pediatrics.aappublications.org/content/136/3/e599..info" target="_blank">Preterm Birth and Poor Fetal Growth as Risk Factors of Attention-Deficit/ Hyperactivity Disorder</a>.
<em>Pediatrics</em> Sept 2015 136 (3) e599-e608. doi:10.1542/peds.2015-1043.</p> | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/ADHD_signs_and_symptoms.jpg | | Main |
| ADHD: Treatment with medications | A | ADHD: Treatment with medications | ADHD: Treatment with medications | | English | Psychiatry | School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years) | Brain | Brain | Drug treatment | Caregivers
Adult (19+) | NA | | 2017-06-16T04:00:00Z | | | | | | 9.90000000000000 | 51.6000000000000 | 1309.00000000000 | | Health (A-Z) - Procedure | Health A-Z | <p>Find out how medications can work with behavioural treatment to help a child with ADHD symptoms.</p> | <p>Medications are often an important part of the treatment plan for ADHD, but they are not recommended for pre-school age children.</p><p>On their own, medications can be very helpful in treating the core
<a href="/Article?contentid=1923&language=English">symptoms of ADHD</a>, but they often do not address the range of other possible problems that can contribute to poor functioning, such as irritability,
<a href="/Article?contentid=18&language=English">anxiety</a> and
<a href="/Article?contentid=1925&language=English">oppositional defiant disorder</a>. These other problems respond best to behavioural treatments in addition to medication.</p><p>Medications also cannot make up for any gaps in learning before a child started ADHD treatment. It is very important that children with ADHD get the
<a href="/Article?contentid=1999&language=English">right academic support</a> to help them reach their full potential.</p> | <h2>Key points</h2>
<ul>
<li>Medications work well to treat the core symptoms of ADHD but work best with behavioural treatments for any related emotional, learning or behavioural issues.</li>
<li>In most cases, ADHD is treated with stimulants. Common, mild side effects include headaches, difficulty falling asleep, irritability and jitteriness. Rare but more serious side effects include allergies, severe agitation, heart problems and suicidal thinking.</li>
<li>Your child will be prescribed a low dose of medication that their doctor will monitor and adjust over time to make sure it continues working.</li>
<li>Your child’s doctor may change the dose schedule or recommend a "drug holiday" to minimize the side effects.</li>
</ul> | | | | | | | | | | | | | | | | <h2>What types of medications treat ADHD?</h2>
<p>In most cases, ADHD is treated with stimulants. These have been widely used for ADHD for more than 40 years. They are effective for at least two-thirds of children with ADHD and have relatively few side effects.</p>
<h3>How stimulants treat ADHD</h3>
<p>Stimulants increase levels of brain chemicals called dopamine and norepinephrine. These chemicals affect a person’s mood, alertness, memory, level of attention and response to stress. Increasing the levels of these chemicals reduces inattention, hyperactivity and impulsivity. However, symptoms return as the stimulants wear off.</p>
<p>There is strong evidence to support the short-term benefits of stimulants for the core ADHD symptoms, but evidence for long-term benefits is more limited. As a result, it is important to monitor ADHD medications closely to make sure that they are still helpful for your child as they grow older. It is also common for ADHD symptoms to return when medications are stopped.</p>
<h2>Types of stimulants</h2>
<p>There are two main types of stimulant medications:</p>
<ul>
<li>methylphenidate</li>
<li>amphetamines</li>
</ul>
<p><em>Methylphenidate</em></p>
<p>The brands of methylphenidate that are available in Canada include:</p>
<ul>
<li>Biphentin</li>
<li>Concerta</li>
<li>Ritalin</li>
</ul>
<p><em>Amphetamines</em></p>
<p>The brands of amphetamines that are available include:</p>
<ul>
<li>Adderall XR</li>
<li>Dexedrine Spansule</li>
<li>Vyvanse</li>
</ul>
<p>Both types of stimulants come in pills or capsules that must be swallowed whole or capsules that can be opened and mixed with food.</p>
<h2>How long do stimulants last?</h2>
<p>Stimulants fall into two categories: short-acting and longer-acting.</p>
<h3>Short-acting stimulants</h3>
<p>These stimulants last for three to five hours. They start to take effect usually within 15 to 30 minutes of taking the first dose.</p>
<p>The effects of a stimulant taken first thing in the morning may start to wear off before lunchtime. If your child needs these medications for school, they will usually need to take at least one stimulant during the school day.</p>
<h3>Longer-acting stimulants</h3>
<p>Longer-acting stimulants last for eight to 14 hours. A child can take one dose in the morning and not need to take another dose at school. Longer-acting stimulants can also help children get through after-school activities.</p>
<p>The disadvantage of longer-acting stimulants is that they are sometimes slow to take effect and may interfere with sleep.</p>
<h2>How does my child's doctor know if the medication is working?</h2>
<p>Your child’s doctor will likely start your child on a small dose and gradually increase it until there is an effect on the target symptoms. The doctor might ask you and your child’s teacher to fill in rating scales at various doses of the stimulants to help them compare the effectiveness of different doses on your child's symptoms.</p>
<p>If the first stimulant does not have a positive effect or has too many side effects after a few doses, the doctor will try another stimulant. Children can react differently to medications, but most children will respond well to at least one of them.</p>
<p>If your child's symptoms still do not improve after trying three or more different medications, the doctor may reassess your child. It is possible that a diagnosis of ADHD may not be correct or that your child may have other conditions with ADHD.</p> | | | | <h2>Further information</h2><p>For more information on ADHD, please see the following pages:</p><p>
<a href="/Article?contentid=1922&language=English">ADHD: Overview</a></p><p>
<a href="/Article?contentid=1923&language=English">ADHD: Signs and symptoms</a></p><p>
<a href="/Article?contentid=1997&language=English">ADHD: How to help your child at home</a></p><p>
<a href="/Article?contentid=1999&language=English">ADHD: Communicating with your child's school</a></p><h2>Resources</h2><p>The following resources offer support and additional information on ADHD.</p><h3>Websites</h3><p>
<a href="http://www.ldao.ca/" target="_blank">Learning Disabilities Association of Ontario</a></p><p>
<a href="http://www.caddac.ca/cms/page.php?2" target="_blank">Centre for ADHD Awareness, Canada - CADAC</a></p><h3>Journal articles</h3><p>Chang, Z., et al. (2014).
<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147667/">Stimulant ADHD medication and risk for substance abuse</a>.
<em>J Child Psychol Psychiatr.</em> 55: 878–885. doi:10.1111/jcpp.12164.</p><p>Dalsgaard, Søren, et al. (2014).
<a href="http://www.sciencedirect.com/science/article/pii/S0306460313002608?via%3Dihub" target="_blank">ADHD, stimulant treatment in childhood and subsequent substance abuse in adulthood—a naturalistic long-term follow-up study</a>.
<em>Addictive Behaviors</em> 39 (1): 325-328. doi:10.1016/j.addbeh.2013.09.002.<br></p><p></p><h3>Virtual care services for children<br></h3>
<p>Boomerang Health was opened by SickKids to provide communities in Ontario with greater access to community-based services for children and adolescents. For more information on virtual care services in Ontario to support ADHD, visit
<a href="http://www.boomeranghealth.com/services/consulting-paediatrics/">Boomerang Health</a> powered by SickKids.<br></p> | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/ADHD_treatment_with_medications.jpg | | Main |
| Abnormal-looking stool | A | Abnormal-looking stool | Abnormal-looking stool | | English | Gastrointestinal | Child (0-12 years);Teen (13-18 years) | Large Intestine/Colon | Large intestine;Rectum | Conditions and diseases | Adult (19+) | NA | | 2023-03-30T04:00:00Z | | | | | | 6.90000000000000 | 66.2000000000000 | 589.000000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>An easy-to-understand overview of the signs, symptoms and medical options for children with unusual feces.</p> | <h2>What causes changes in the appearance of stool?</h2><p>Breastfed babies usually produce a mustard-yellow coloured stool. They may also produce green, runny stool. This is normal. It should not be a concern.</p><p>Most changes in a child's stool (feces) are due to a change in diet. Changes in diet may cause changes in:</p><ul><li>colour</li><li>smell</li><li>consistency</li><li>amount of stool</li></ul><p>Many medicines can affect what stool looks like. If your baby or child is taking medication, ask your pharmacist if you should expect a change in stool. Some changes that last more than a few days may require medical attention.</p> | <h2>Key points</h2><ul><li>Most changes in stool are due to a change in diet.</li><li>Runny green or mustard-coloured stool is common in breastfed babies.</li><li>Pale stool accompanied by yellowish skin and eyes or dark urine may indicate a liver problem. Seek medical attention right away.</li><li>Red and jelly-like stool is an emergency. Call 911 or go to the nearest Emergency Department. Do not give your child anything to eat or drink until they are seen by a doctor.</li><li>Small amounts of blood lining the stool are common in children who are constipated. This is not an emergency.</li></ul> | | | | | | <h2>When to see a doctor</h2>
<p><strong>Make an appointment with your child's doctor if:</strong></p>
<ul>
<li>your child seems sick and the stool does not return to its normal colour in a few days</li>
<li>your child has blood in the stool and constipation is not the reason</li>
<li>your child's stool continues to be very pale</li>
<li>your baby has green, runny stool and seems sick with other symptoms</li>
<li>your child's stool is an abnormal colour after taking medication<br></li>
</ul>
<p><strong>See a doctor right away, or go to the nearest Emergency Department, if:</strong></p>
<ul>
<li>your baby or child has red and jelly-like stool. Do not give your child anything to eat or drink until they are seen by a doctor<br></li>
<li>your child has pale stool and yellowish skin or yellowish whites of the eyes</li>
<li>your child has dark urine (brown or black in colour)<br></li>
</ul>
| | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/abnormal_looking_stool.jpg | | Main |
| About blood and marrow transplant research | A | About blood and marrow transplant research | About blood and marrow transplant research | | English | Haematology;Immunology;Oncology | Child (0-12 years);Teen (13-18 years) | Body | Immune system | NA | Adult (19+) | NA | | 2010-03-05T05:00:00Z | | | | | | 9.10000000000000 | 56.8000000000000 | 1074.00000000000 | | Flat Content | Health A-Z | <p>Learn about research and clinical trials related to your child's blood and marrow transplant.</p> | <p>You may be asked to allow your child to participate in a research project that is being run on children undergoing a blood and marrow transplant (BMT). </p>
<p>If you are asked to take part in a study, you may listen to the project description and decide if you want to participate. When making a decision about whether or not to participate, make sure that the researcher: </p>
<ul>
<li>answers all of your questions to your satisfaction </li>
<li>explains the reasons for the study and what they hope to accomplish </li>
<li>explains what is expected of your child and your family</li></ul> | <h2>Key points</h2>
<ul><li>Research studies and clinical trials are conducted to improve on and find better ways of preventing, diagnosing and treating specific medical conditions.</li>
<li>If your child is asked to participate in a trial, make sure you understand what will be involved before giving consent.</li>
<li>Choosing not to participate or withdrawing from the study will not impact the care your child receives.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| About blood and marrow transplants | A | About blood and marrow transplants | About blood and marrow transplants | | English | Haematology;Immunology;Oncology | Child (0-12 years);Teen (13-18 years) | Body | Immune system | NA | Adult (19+) | NA | | 2010-02-12T05:00:00Z | | | | | | 8.90000000000000 | 62.1000000000000 | 296.000000000000 | | Flat Content | Health A-Z | <p>Learn about blood and marrow transplants (BMT), the reasons for BMT, how the marrow and immune system work, and the BMT health-care team.</p> | <p>Learning that your child needs a blood and marrow transplant (BMT) is distressing. Along with dealing with your child’s illness and treatment, you may feel overwhelmed with the complex information you need to learn over a short period of time. For example, you want to understand how the transplant works, the types of medicines your child has to take, and the various medical procedures involved. For most families, coping with a child’s disease and treatment will be the most challenging experience they have to face.</p> | <h2>Key points</h2><ul><li>Each year in Canada, approximately 200 children undergo a blood and marrow transplant.</li><li>There are two types of BMT, allogeneic stem cell transplant and autologous stem cell transplant.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/about_blood_and_marrow_transplants.jpg | | Main |
| About heart conditions | A | About heart conditions | About Heart Conditions | | English | Cardiology | Child (0-12 years);Teen (13-18 years) | Heart | Cardiovascular system | Conditions and diseases | Adult (19+) | NA | | 2010-01-15T05:00:00Z | | | | | | 10.6000000000000 | 43.9000000000000 | 911.000000000000 | | Flat Content | Health A-Z | <p>Learn about heart conditions that afflict children. Examples, possible causes, methods of detection and prevention of heart disease are discussed.<br></p> | <p>Heart conditions can be congenital (present at birth) or acquired, meaning they developed over time, usually later in life. Some conditions develop during childhood and are temporary, such as those caused by infection, while others last a lifetime. Many heart conditions are chronic; that is, they last for a long period of time or even a lifetime. Others are acute; they happen suddenly, with variable severity, and end quickly.</p> | <h2> Key points </h2>
<ul><li>Heart conditions can be congenital (present at birth) or acquired over time. </li>
<li>Heart conditions can be chronic (long-lasting) or acute (end quickly).</li>
<li>Congenital heart conditions are not necessarily hereditary, although family history seems to increase the risk.</li>
<li>Heart conditions tend to occur early in fetal development.</li>
<li>Congenital heart disease cannot be prevented, but steps can be taken to minimize environmental risks.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/about_heart_conditions.jpg | | Main |
| About kidney transplants | A | About kidney transplants | About kidney transplants | | English | Transplant;Nephrology | Teen (13-18 years) | Kidneys | Renal system/Urinary system | Procedures;Conditions and diseases | Teen (13-18 years) | NA | | 2017-11-30T05:00:00Z | | | | | | 0 | 0 | 0 | | Flat Content | Health A-Z | <p>Read about the reasons you might need a kidney transplant and how a kidney transplant can affect your future.</p> | <p>The goal of a kidney transplant is to improve kidney function and have you feeling better.</p> | <h2>Key points</h2><ul><li>A kidney transplant is an operation that moves a kidney from one person (the donor) to another person (you, the recipient).</li><li>You will need a transplant if your kidneys are not working well enough to keep you healthy.</li><li>The disease that damaged your kidneys and caused them to fail is called your "primary kidney disease".</li><li>The best treatment for teenagers with end-stage kidney disease is a transplant.</li><li>Most kidney transplants are successful. On average, a kidney transplant will last 12 years, but it can last a lot longer.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Teens |
| About leukemia | A | About leukemia | About Leukemia | | English | Oncology | Child (0-12 years);Teen (13-18 years) | Body | Skeletal system | Conditions and diseases | Adult (19+) | NA | | 2018-03-06T05:00:00Z | | | | | | 8.90000000000000 | 56.9000000000000 | 234.000000000000 | | Flat Content | Health A-Z | <p>Leukemia is the general term for cancer of the blood. This resource centre will focus on the two most common forms of childhood leukemias: ALL and AML. </p> | <p>Hearing that your child has leukemia is traumatizing. You may feel overwhelmed with the information you are learning. It is important to remember that no one is to blame for the disease. </p> | <h2> Key points </h2>
<ul><li>Chronic leukemias often progress slowly, while acute leukemias usually develop more quickly.</li>
<li>Improvements in treatment have increased survival rates for children with ALL and AML.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| About liver transplants | A | About liver transplants | About liver transplants | | English | Transplant;Gastrointestinal | Teen (13-18 years) | Liver | Digestive system | Procedures;Conditions and diseases | Teen (13-18 years) | NA | | 2017-11-30T05:00:00Z | | | | | | 0 | 0 | 0 | | Flat Content | Health A-Z | <p>Read about the reasons you might need a liver transplant and how a liver transplant can affect your future.</p> | <p>The goal of a liver transplant is to improve liver function and have you feeling better.<br></p> | <h2>Key points</h2><ul><li>A liver transplant is an operation that moves a liver (or part of a liver) from one person (the donor) to another person (you, the recipient).</li><li>You will need a transplant if your liver is not working well enough to keep you healthy or if you have a metabolic condition that can be stabilized with a liver transplant.</li><li>The disease that causes you to need a liver transplant is often called your primary disease.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Teens |
| About pain | A | About pain | About pain | | English | Pain/Anaesthesia | Child (0-12 years);Teen (13-18 years) | Body | Central nervous system;Peripheral nervous system;Autonomic nervous system | Symptoms | Caregivers
Adult (19+) | Pain | | 2009-09-15T04:00:00Z | | | | | | 9.40000000000000 | 62.4000000000000 | 1743.00000000000 | | Flat Content | Health A-Z | <p>Learn about children with pain: how pain is defined, why we feel pain, how it works and how to relieve pain.</p> | <p>Pain is a part of everyday life. Typically, pain results when we are exposed to situations that are likely to lead to injury or tissue damage. In this respect, pain is a useful occurrence and a vital mechanism by which we protect ourselves from possible further damage and aid the healing process. A reflex flinching from a hot kettle or nursing a sore, bruised hand are examples of this function.</p>
<p>We each learn our own association with the word "pain" through our experiences of injury in early life. As such, pain will always be subjective. By definition it is unpleasant and it therefore always has an emotional association.</p> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| About parenteral nutrition (PN) | A | About parenteral nutrition (PN) | About parenteral nutrition (PN) | | English | Gastrointestinal | Child (0-12 years);Teen (13-18 years) | NA | Digestive system | Non-drug treatment | Caregivers
Adult (19+) | NA | | 2022-11-03T04:00:00Z | | | | | | 9.60000000000000 | 55.6000000000000 | 1673.00000000000 | | Health (A-Z) - Procedure | Health A-Z | <p>Parenteral nutrition is liquid nutrition that is given to your child through an intravenous (IV) infusion if their digestive system cannot absorb or tolerate adequate food or fluids by mouth or through a feeding tube to be able to grow and thrive.</p> | <h2>What is parenteral nutrition?</h2><p>Parenteral nutrition (PN), also called total parenteral nutrition (TPN), is a specialized form of liquid food. It is given to your child through a vein by intravenous (IV) infusion. PN provides liquid nutrients, including carbohydrates, proteins, fats, vitamins, minerals and electrolytes. </p><h2>Why does my child need parenteral nutrition?</h2><p>Your child will receive PN if they cannot absorb enough nutrition through their
<a href="/article?contentid=1467&language=english">gastrointestinal (GI) tract</a> or tolerate adequate food or fluids by mouth or through a
<a href="/tubefeeding">feeding tube</a>. Conditions that may require your child to have PN can include
<a href="/intestinalfailure">short bowel syndrome</a>,
<a href="/GHN?topic=GIhub">digestive system disorders</a>, bowel motility disorders, certain cancers, injury or trauma to the intestines and after surgery or procedures when a child cannot eat for a prolonged period.</p><p>PN can be given in addition to oral or tube feeding or as your child’s only source of nutrition. It will be provided at the hospital by your child’s health-care team or at home by a trained parent or caregiver. </p><h2>How long will my child receive parenteral nutrition?</h2><p>The length of time that your child may require PN can vary and depends on many different factors including their underlying diagnosis, age and intestinal anatomy. They may need to receive PN for a few weeks or months to several years. In some cases, they might require PN for life. </p> | <h2>Key points</h2><ul><li>Parenteral nutrition (PN) is liquid nutrition that is given to your child through intravenous (IV) infusion.</li><li>Your child will receive PN if they cannot absorb or tolerate adequate food or fluids by mouth or through a feeding tube.</li><li>PN solution includes carbohydrates, proteins, fats, vitamins, minerals and electrolytes.</li><li>Your child may need to receive PN for a few weeks or months to several years. In some cases, they might require PN for life.</li></ul> | | | | | <h2>Early complications</h2><h3>Central line–associated blood infection (CLABSI)</h3><p>Having a CVAD gives bacteria an easy route into the blood system, which can lead to blood infections. There is a risk of infections every time the CVAD is accessed. These infections are referred to as central line–associated blood infections (CLABSI). Using
<a href="/article?contentid=3391&language=english">aseptic non-touch technique (ANTT)</a> during central line care is essential to preventing the occurrence of a CLABSI. Recurrent episodes can affect many parts of the body and have a significant impact on quality of life due to prolonged admissions in hospital.</p><h3>Central line thrombosis</h3><p>A central line thrombosis is a blood clot that occurs in the veins that are used for CVAD placement. The development of clots related to central lines poses significant risk as CVADs are required for administration of PN. Some factors that contribute to the development of thrombosis include the location of the central line, the size of the line and the development of CLABSI.</p><h3>IFALD: Intestinal failure–associated liver disease</h3><p>Intestinal failure–associated liver disease (IFALD) can develop in children receiving TPN, and several risk factors contribute to its occurrence: </p><ul><li>infections</li><li>prematurity</li><li>absence of food through the GI system</li><li>the composition of the TPN</li></ul><h2>Late complications</h2><h3>Metabolic bone disease</h3><p>Metabolic bone disease is caused by changes in the way minerals are absorbed. Children on PN may not properly absorb minerals that are important to bone health such as calcium, magnesium and phosphorus. Other factors that contribute to bone disease include vitamin D deficiency, dehydration or loss of minerals (bicarbonate) in the stools. </p><h3>Renal disease</h3><p>Renal disease can occur due to long-term use of PN. Persistent dehydration, contamination of elements in TPN solutions and exposure to medications that are damaging to the kidneys are some of the factors that contribute to the development of renal disease. </p><h3>Micronutrient and vitamin deficiencies<br></h3><p>Children on PN may have decreased ability to absorb vitamins and minerals, which can lead to low levels of micronutrients. Deficiencies in micronutrients can occur with children on and off TPN support.</p><p>Standard and routine monitoring such as bloodwork and ultrasounds is very important to prevent complications on children who are on long-term TPN.</p> | | | | | | | | | | | <h2>How will my child receive parenteral nutrition?</h2><p>Your child’s PN will be customized to their individual nutritional needs. It will be provided at the hospital by your child’s health-care team or at home by a trained parent or caregiver. The PN will be delivered by a pump through an <a href="/article?contentid=2451&language=english">intravenous (IV) line</a> or a central venous access device (CVAD) directly to the blood stream. CVADs include:</p><ul><li>central venous lines (CVLs) inserted into either the <a href="/article?contentid=52&language=english">jugular</a> or <a href="/article?contentid=3819&language=english">femoral</a> vein</li><li><a href="/article?contentid=1012&language=english">peripherally inserted central catheters (PICCs)</a></li><li><a href="/article?contentid=1014&language=english">ports</a></li></ul><p>The type of device used to infuse PN depends on the length of treatment and the composition of TPN. Generally, short-term PN will be infused through an IV line, and long-term PN will be infused through a CVAD. PN administered at home will always be administered through a CVAD.</p><p>The number of days per week and hours per day that your child will receive PN will be customized to their needs and depend on several factors:<br></p><ul><li>your child's age<br></li><li>your child's ability to tolerate solid foods and fluid by gut</li><li>the number of calories your child requires</li><li>the amount of fluid your child requires</li><li>your child's ability to maintain normal glucose levels when off PN</li></ul><p>Younger children with high stool losses and poor tolerance of gut feeds will require more time on PN support. Children who are eating and tolerating some foods and fluids will be able to have more time off PN support. </p><h3>Cycling off parenteral nutrition</h3><p>The goal of treatment with PN will be to cycle your child off PN completely. The number of hours off PN or IV fluids will depend on your child’s status. Being cycled off PN is beneficial for the liver and quality of life. However, too much time off can lead to dehydration, which can damage the kidneys over time. Achieving a balance is especially important. </p><p>As your child’s intestine adapts to absorb more nutrients, the amount of nutrients required in the solution will decrease. Cycling your child off of PN will be begin slowly, stopping the PN infusion for a few hours of the day. Eventually, your child may be able to take days off until the PN is stopped completely. </p> | | | | | | | | | | | | | | Main |
| About premature babies | A | About premature babies | About premature babies | | English | Neonatology | Prenatal;Premature | NA | NA | NA | Prenatal
Adult (19+) | NA | | 2009-10-31T04:00:00Z | | | | | | 12.5000000000000 | 45.6000000000000 | 1344.00000000000 | | Flat Content | Health A-Z | <p>Learn about premature babies. While premature babies can be born and develop normally, some may suffer growth and developmental problems later on in life.</p> | <p>Normally, a fetus spends <a href="/Article?contentid=328&language=English">40 weeks growing and developing</a> in the womb before birth and entry into the world. This length of time is called term or full-term. According to the World Health Organization (WHO), babies born before completing 37 weeks in the womb are defined as preterm or premature. Although preemies, as premature babies are sometimes called, can be perfectly healthy at birth and develop normally both in body and mind, almost all will require some form of specialized supportive medical care after birth, and some will have continuing problems that will affect their growth and development.</p> | <h2>Key points</h2>
<ul><li>Babies born before 37 weeks in the womb are considered premature.</li>
<li>Many, but not all, premature babies will require some form of specialized supportive medical care after birth.</li>
<li>There are multiple causes of premature birth, including conditions of the mother, conditions of the fetus, and conditions of the uterus or placenta.</li>
<li>There are many medical concerns associated with premature birth, including breathing problems, immature heart, gastrointestinal tract and kidneys.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/about_premature_babies.jpg | | Main |
| About scoliosis | A | About scoliosis | About scoliosis | | English | Orthopaedics/Musculoskeletal | Child (0-12 years);Teen (13-18 years) | Vertebrae;Spine | Muscular system;Skeletal system | Conditions and diseases | Adult (19+) | NA | | 2020-09-08T04:00:00Z | | | | | | 8.70000000000000 | 59.3000000000000 | 1980.00000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>Scoliosis is a condition that causes your child’s spine to curve sideways. Learn about the different types of scoliosis, some of its causes, and the risk factors that can increase your child's chance of developing a more severe curve.</p> | <h2>What is scoliosis?</h2><p>Scoliosis is a condition that causes your child’s spine to curve sideways and twist. This curve can lead to changes in their shoulders, ribcage, pelvis, waist, and the overall shape of their back.</p>
<figure class="asset-c-80">
<span class="asset-image-title">Scoliosis</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/scoliosis_03_MED_ILL_EN.jpg" alt="Illustration of curve in spine" />
<figcaption class="asset-image-caption">With scoliosis, the spine curves to one side, usually to the right, resulting in one shoulder being higher than the other.</figcaption> </figure> | <h2> Key points </h2><ul><li>Children with scoliosis have a curve in their spine.</li><li>There are three main types of scoliosis: idiopathic, congenital and neuromuscular. The most common type of scoliosis is idiopathic scoliosis, which typically develops at the beginning of puberty.</li><li>The exact cause of idiopathic scoliosis is unknown. There are likely many different contributing factors.</li><li>There is a greater risk that your child’s curve will increase if they are diagnosed at a young age, before they have begun their menstrual periods and/or if their bones are still growing.</li></ul> | | <h2>What causes scoliosis?</h2><p>Most children with scoliosis have idiopathic scoliosis. Researchers do not know what causes idiopathic scoliosis. Genetics might be one cause. There are many other theories including hormonal problems, abnormal bone or muscle growth and other factors that have not been identified. It is not known if these factors cause the scoliosis or are the result of scoliosis. Most researchers agree that more than one factor causes scoliosis.</p><h3>Genetics</h3><p>Scoliosis tends to run in families. In one study, about one in 10 people with scoliosis had a first-degree relative with scoliosis. A first-degree relative is a parent, sibling, or child. In the same study, about two in 100 people with scoliosis had a second-degree relative with scoliosis. A second-degree relative is a grandparent, grandchild, aunt, uncle, niece, nephew, or half sibling.</p><h3>Growth issues</h3><p>Scoliosis gets worse during puberty when teenagers are rapidly growing. Scoliosis patients are generally taller than their peers in early puberty, around ages eight to nine. Once patients hit age 10 and up, their height is about the same as everyone else their age.</p><p>Most children have rapid growth at the time of puberty but most do not develop scoliosis. This supports the idea that more than one factor may cause scoliosis.</p><h2>How common is scoliosis?</h2><p>Most scoliosis occurs at the onset of puberty, around the ages of 10 to 16 years of age. Of children and teens in this age group, 2% to 3% will develop scoliosis. There are equal numbers of males and females with small curves of less than 10 degrees. However, females tend to outnumber males (10 to 1) in curves greater than 30 degrees. Less than 10% of patients diagnosed with scoliosis will require surgery.</p> | <h2>Diagnosis</h2><p>In order to diagnose scoliosis, your child requires an X-ray to view the bones in their back. These bones are called vertebrae. When viewed from the front or the back, the spine is normally in a straight line. If your child has scoliosis, the vertebrae will usually curve to form the shape of an S or C.</p><p>The size of your child’s curve will be measured. The curve may be small, medium, or large in size, and is measured by degrees:</p><ul><li>Small curves are 20 degrees or less.</li><li>Medium curves are between 20 and 50 degrees.</li><li>Large curves are greater than 50 degrees.</li></ul> | <h2>Will my child’s curve need treatment?</h2><p>The need for treatment depends on the type and size of your child’s curve. In general:</p><ul><li>If your child has a small curve of less than 20 degrees, they may only need to be observed over time.</li><li>If their curve is medium-sized, between 20 to 50 degrees, they may either be observed or treated with a <a href="https://www.aboutkidshealth.ca/Article?contentid=974&language=English">brace</a>.</li><li>If they have a larger curve, greater than 50 degrees, they may require surgery.</li></ul><p>There are many factors that your child’s surgeon will consider before recommending treatment:</p><ul><li>How old they are</li><li>How large their curve is</li><li>Whether your child is still growing</li><li>Whether they have an S-shaped or C-shaped curve</li><li>The progression of their curve: how fast the curve is increasing in size</li><li>How your child feels about the look of their back</li><li>Whether your child is experiencing complications, how severe they are, or is at risk of developing complications if the scoliosis is left untreated</li><li>Whether your child is unhappy with the appearance of their back (if their scoliosis is idiopathic)</li></ul><p>For more information about the treatment of scoliosis, see the "Treatment" section of the Scoliosis Learning Hub.</p> | <h2>Complications</h2><p>If your child has congenital scoliosis, they might have problems in other areas of their body. Almost 25% of children with congenital scoliosis have problems with their kidneys or urinary tract. Approximately 10% have <a href="https://www.aboutkidshealth.ca/heart?topic=congenitalheart">congenital heart disease</a>.</p><p>If your child has neuromuscular scoliosis, the curves in their spine may get larger and lead to more problems. For example, a child with neuromuscular scoliosis might find it hard to sit on their own. If they have a large curve and weak rib muscles, they may have problems with breathing.</p><h2>Does scoliosis cause pain?</h2><p>Sometimes scoliosis can be painful for patients. Researchers studying teens with scoliosis found that older teens, teens who had almost finished growing, and girls who had already started menstruating were more likely to have back pain associated with scoliosis. Factors that did <u><strong>not</strong></u> predict pain with scoliosis included family history of scoliosis and type and size of curve.</p><p>It is important to remember that 60% to 80% of the general population will have back pain in their lifetime. The stress involved with the diagnosis of scoliosis could expresses itself as back pain. Children with scoliosis need to talk with their doctor or orthopaedic surgeon about any pain they are experiencing.</p><h2>Does scoliosis affect the heart and lungs?</h2><p>Scoliosis can affect a person's ability to breath (lung function) because of the impact that it has on their ribcage. Lung function is how well the lungs are working. It is also called pulmonary function. For children with mild-moderate curves, their lung function is not typically severely affected. Your child’s lung function is assessed with tests done in a pulmonary function lab, and testing may be done if your child is booked for surgery. If your child has a mild-to-moderate curve, they will usually not require testing.</p><h3>How is lung function tested?</h3><p>Several tests can be done. In general, these tests look at:</p><ul><li>Lung capacity—how much air your child can move in and out of their lungs.</li><li>How fast they can move this air in and out of their lungs.</li><li>The stiffness of their lungs and chest wall. The chest wall includes the rib cage, diaphragm, and abdominal wall.</li></ul><h3>Can certain types of curves affect breathing?</h3><p>In general, only thoracic (mid-back) curves have the potential to affect your child’s breathing. Smaller thoracic curves that are between 20 and 45 degrees can cause decreased lung function during heavy exercise. Scoliosis is unlikely to affect your child’s ability to do daily activities or moderate exercise if they have a small curve.</p><p>Thoracic (mid-back) curves between 45 and 88 degrees can cause decreased lung function during moderate exercise. However, physical exercise programs designed to train the lungs can improve lung function significantly.</p><p>Patients presenting late with curves over 100 degrees can have a reduced lung capacity by 50%. Curves greater than 120 degrees can lead to right-sided heart failure, which is when the right chamber of the heart has difficulty pumping blood to the lungs. Curves greater than 120 degrees can also cause breathing difficulties in everyday activities.</p><h3>Early onset scoliosis can affect breathing</h3><p>Early onset scoliosis is scoliosis that occurs in children before the age of five years. The cause is not known. While many of these curves remain stable and even disappear on their own, others may increase in size quickly. Without treatment, early onset scoliosis can lead to deformity of the chest and spine. This can lead to problems with breathing. Active treatment, such as spinal casting, <a href="https://www.aboutkidshealth.ca/Article?contentid=974&language=English">spinal bracing</a>, or spinal growth guidance (growing rods), is needed for these cases.</p> | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/akhassets/scoliosis_03_MED_ILL_EN.jpg | | | Main |
| Abscess drainage using image guidance | A | Abscess drainage using image guidance | Abscess drainage using image guidance | | English | Other | Child (0-12 years);Teen (13-18 years) | Body | NA | Procedures | Caregivers
Adult (19+) | NA | | 2016-02-09T05:00:00Z | | | | | | 8.30000000000000 | 61.7000000000000 | 1209.00000000000 | | Health (A-Z) - Procedure | Health A-Z | <p>Learn what an abscess is and how it is drained using image guidance.</p> | <h2>What is an abscess?</h2><p>An abscess is a collection of infected fluid and dead cells (pus) somewhere in the body. It is often swollen and painful. Abscesses usually do not heal by themselves, and they may keep getting worse unless they are treated. Treatment starts with antibiotics. However, in some cases, an abscess cannot be cured with antibiotics alone. Instead, it may need to be opened so the pus can drain, allowing it to start healing.</p> | <h2>Key points</h2>
<ul>
<li>An abscess is a collection of pus somewhere in the body. Sometimes it needs to be drained. When the collection is deep, an interventional radiologist uses image guidance to drain the abscess.</li>
<li>Draining an abscess is usually a low-risk procedure.</li>
<li>You will be asked to sign a consent form before the procedure.</li>
<li>Your child will likely have a drain inserted in the abscess.</li>
<li>The procedure is done using local anaesthetic, and your child will receive a general anaesthetic or sedation.</li>
<li>Be calm, honest and tell your child what to expect. Children feel less nervous and scared when they are given information about what will happen to them.</li>
</ul> | | | | | | | | | | | | | | | <h2>Abscess drainage</h2>
<figure>
<span class="asset-image-title">Abscess drainage</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/IMD_abscess_drainage_EN.jpg" alt="Collection of pus exiting through a drainage tube in the small intestine" />
<figcaption class="asset-image-caption">An abscess can form in any part of the body. Using image guidance, a tube is placed into the abscess to drain it. This helps control the infection, prevents it from spreading and promotes healing.</figcaption>
</figure>
<p>An abscess drainage procedure is a way to remove pus from the abscess.</p><p>If the abscess is just under your child's skin, a doctor can usually open and drain it using a scalpel (surgical knife). However, if it is deep in your child's body, it will be drained by an interventional radiologist using image guidance.</p><p>Draining the pus will usually help the abscess heal and make your child feel better sooner. A sample of the pus is often sent to the laboratory to help find out what is causing the infection.</p> | <h2>On the day of the abscess drainage</h2>
<p>When your child arrives at the department they will be dressed in a hospital gown and assessed by a nurse. Your child may have an intravenous started and may have some freezing cream put on the skin near the abscess. You will also be able to speak to the interventional radiologist who will be draining the abscess and the anaesthetist or nurse who will be giving your child medication to make them comfortable during the procedure.</p>
<p>During the abscess drainage, you will be asked to wait in the surgical waiting area.</p>
<h2>Your child will have medicine for pain</h2>
<p>Children are given medicine for treatments that may be frightening, uncomfortable or painful. This includes <a>local anaesthesia</a>, <a href="/Article?contentid=1260&language=English">sedation</a> and/or <a href="/Article?contentid=1261&language=English">general anaesthesia</a>. The type of medicine that your child will have for the procedure will depend on your child’s condition.</p>
<h2>How an abscess is drained</h2>
<p>The interventional radiologist uses <a href="/Article?contentid=1290&language=English">ultrasound</a> or <a href="/Article?contentid=1272&language=English">computed tomography (CT)</a> to see where the abscess is. These pictures guide the interventional radiologist in directing a small needle through the best route into the abscess (usually through the skin).</p>
<p>Most often, a small soft tube (drain) is placed in the abscess using ultrasound and X-ray guidance. This drain is then attached to a drainage bag to allow the pus to drain away from the abscess. The drain will stay in your child's body until most of the pus has drained.</p>
<p>For most abscess drainages, your child will not need any stitches.</p>
<p>The procedure will usually take one hour.</p> | <h2>After the abscess drainage</h2>
<p>Once the abscess drainage is complete, your child will be moved to the recovery area. The interventional radiologist will come and talk to you about the details of the procedure. As soon as your child starts to wake up, a nurse will come and get you.</p>
<p>The interventional radiologist will come to see your child later on to ensure the drain is working properly. The drain usually stays in until most of the pus has drained out of the abscess. Most children stay in the hospital while the drain is in.<br></p>
<h2>Antibiotics</h2>
<p>Your child may require antibiotics following the drainage.</p>
<h2>Taking out the drain</h2>
<p>When the tube is no longer needed, it is removed at your child’s bedside. A small bandage is placed over the drain site.</p>
<h2>Going home<br></h2>
<p>In most cases, children go home only after the drain is removed. Your doctor will let you know when they are well enough to go home.
For more details on how to care for your child after an abscess drainage, please see <a href="/Article?contentid=1221&language=English">Abscess drainage: Caring for your child at home after the procedure</a>.</p> | <h2>Giving consent before the procedure</h2>
<p>Before the procedure, the interventional radiologist will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks, and will help you weigh any benefits against the risks. It is important that you understand all of these potential risks and benefits of the abscess drainage and that all of your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.</p>
<h2>How to prepare your child for the procedure</h2>
<p>Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.</p>
<p>Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.</p>
<h2>Food, drink and medicines before the procedure</h2>
<ul>
<li><a target="_blank" href="http://www.sickkids.ca/VisitingSickKids/Coming-for-surgery/Eating-guidelines/index.html">Your child’s stomach must be empty</a> before sedation or general anaesthetic.</li>
<li>If your child has special needs during fasting, talk to your doctor to make a plan.</li>
<li>Your child can take their regular morning medicine with a sip of water two hours before the procedure.</li>
<li>Medicines such as <a href="/Article?contentid=77&language=English">acetylsalicylic acid (ASA)</a>, <a href="/Article?contentid=198&language=English">naproxen</a> or <a href="/Article?contentid=153&language=English">ibuprofen</a>, <a href="/Article?contentid=265&language=English">warfarin</a>, or <a href="/Article?contentid=129&language=English">enoxaparin</a> may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by their doctor and the interventional radiologist.</li>
</ul>
| <h2>At SickKids</h2><p>At SickKids, the interventional radiologists work in the
<a href="http://www.sickkids.ca/IGT/index.html">Department of Diagnostic Imaging – Division of Image Guided Therapy (IGT)</a>. You can call the IGT clinic at (416) 813-6054 and speak to the clinic nurse during working hours (8:00 to 15:00) or leave a message with the IGT clinic nurse.</p><p>For more information on fasting see
<a href="http://www.sickkids.ca/VisitingSickKids/Coming-for-surgery/Eating-guidelines/index.html">Eating and drinking before surgery</a>.</p><p>For more information on preparing your child for their procedure see
<a href="http://www.sickkids.ca/VisitingSickKids/Coming-for-surgery/index.html">Coming for surgery</a>.</p> | | | | | | | | https://assets.aboutkidshealth.ca/akhassets/IMD_abscess_drainage_EN.jpg | | | Main |
| Abscess drainage using image guidance: Caring for your child at home after the drainage tube removal | A | Abscess drainage using image guidance: Caring for your child at home after the drainage tube removal | Abscess drainage using image guidance: Caring for your child at home after the drainage tube removal | | English | Other | Child (0-12 years);Teen (13-18 years) | Body | NA | Non-drug treatment | Caregivers
Adult (19+) | NA | | 2020-11-16T05:00:00Z | | | | | | 8.70000000000000 | 68.5000000000000 | 614.000000000000 | | Health (A-Z) - Procedure | Health A-Z | <p>Learn how to properly care for your child at home after an abscess drainage tube removal.</p> | <p>Your child has had an
<a href="/Article?contentid=2439&language=English">abscess drained</a> using ultrasound and/or X-ray imaging guidance. The information on this page explains how to care for your child at home after the drainage tube has been removed, and when to call for help.</p> | <h2>Key points</h2><ul><li>Leave the dressing on for 24 hours before removing it. If it gets wet or soiled before then, replace it with a clean bandage.</li><li>Give your child <a href="https://www.aboutkidshealth.ca/Article?contentid=62&language=English">acetaminophen</a> for pain as directed by their health-care team.</li><li>Your child can go to school and resume regular activity 48 hours after the drainage tube is removed.</li><li>If your child develops bright red bleeding or pus at the site, vomits, becomes pale, tired or has severe pain, go to the nearest Emergency Department.</li></ul> | | | | | | <h2>When to see a doctor</h2><p>Call your child's doctor or go to the nearest Emergency Department right away if your child shows any of the following symptoms:</p><ul><li><a href="https://www.aboutkidshealth.ca/Article?contentid=30&language=English">Fever</a> over 38°C (100.4°F)</li><li>Throwing up (<a href="https://www.aboutkidshealth.ca/Article?contentid=746&language=English">vomiting</a>) that does not stop</li><li>Severe <a href="https://www.aboutkidshealth.ca/pain">pain</a> at or near the drainage site</li><li>Bleeding or swelling around the drainage site</li><li>Significant discharge through the drainage site</li><li>Dizziness</li><li>Pale skin</li><li>General weakness and feeling tired</li></ul> | | | | | | | | | | | <h2>Discharge from the hospital</h2><p>In most cases, children go home only after the drainage tube is removed. Your child’s doctor will let you know when your child is well enough to go home.</p> | | <h2>At SickKids</h2><p>If you have any concerns in the first 48 hours, call the <a href="http://www.sickkids.ca/IGT/index.html">Image Guided Therapy (IGT) clinic</a> at (416) 813-7654 ext. 201804. Speak to the IGT clinic nurse during working hours or leave a non-urgent message.</p><p>If you have concerns and it is after working hours, see your family doctor or go to the nearest Emergency Department. You can also call the Hospital for Sick Children switchboard at (416) 813-7500 and ask them to page a member of your child’s health-care team or the interventional radiology fellow on call.</p> | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/abscess_drainage_caring_for_your_child_at_home.jpg | | Main |
| Absence seizures | A | Absence seizures | Absence seizures | | English | Neurology | Child (0-12 years);Teen (13-18 years) | Brain | Nervous system | Conditions and diseases | Caregivers
Adult (19+)
Educators | NA | | 2010-02-04T05:00:00Z | | | | | | 9.30000000000000 | 54.2000000000000 | 1118.00000000000 | | Flat Content | Health A-Z | <p>Read about the symptoms and causes of absence seizures and how best to help your child when they have one.</p> | <p>Absence seizures are a type of generalized seizure. They involve short periods of unresponsiveness, often many times a day. They usually begin in childhood, although they can occasionally begin in adulthood; they are very rare in infants. There are several different types of absence seizures. The major divisions are typical or atypical. </p> | <h2>Key points</h2>
<ul><li>Absence seizures are one type of generalized seizure and usually last for about 10 seconds. </li>
<li>The symptoms of a typical absence seizure include staring blankly and not responding to speech or a touch on the arm. Sometimes they include symptoms of other seizures, such as muscle twitching or muscle stiffening.</li>
<li>Absence seizures are controlled with medications.</li>
<li>If you suspect your child is having an absence seizure, do not shout at them but instead touch them on the arm.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| Accessibility and support in higher education | A | Accessibility and support in higher education | Accessibility and support in higher education | | English | Oncology | Pre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years) | NA | NA | Support, services and resources | Pre-teen (9-12 years)
Teen (13-15 years)
Late Teen (16-18 years) | NA | | 2019-09-03T04:00:00Z | | | | | | 9.60000000000000 | 54.7000000000000 | 550.000000000000 | | Flat Content | Health A-Z | <p>Find out about the supports that are available to you to help you succeed in higher education.</p> | <p>There are a number of supports and options available to help you succeed in <a href="/Article?contentid=3583&language=English">higher education</a>. Make sure you explore all of your options—don’t just give up at the first hurdle. You never know what you can achieve with a bit of support and creativity.</p> | <h2>Key points</h2><ul><li>Depending on your needs, you may need accessibility support such as extra time for tests or access to supportive equipment.</li><li>Some schools may have counsellors who can help you clarify your goals and check in with you to help you stay on track.</li><li>Financial support may be available through scholarships or grants that you can find with help from your guidance counsellor or searching online.</li><li>If you move away from your home town, ask you health-care provider to help you find a new family doctor in your new town.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/Accessibility_and_support_in_higher_education.jpg | | Teens |
| Accessibility and support when working | A | Accessibility and support when working | Accessibility and support when working | | English | Oncology | Pre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years) | NA | NA | Support, services and resources | Pre-teen (9-12 years)
Teen (13-15 years)
Late Teen (16-18 years) | NA | | 2019-09-03T04:00:00Z | | | | | | 10.3000000000000 | 49.5000000000000 | 450.000000000000 | | Flat Content | Health A-Z | <p>Find out about the supports that are available to you to help you succeed at work.</p> | <p>Some work environments have supports available that can help cancer survivors succeed at <a href="/Article?contentid=3585&language=English">work</a>. Speak to your employer about what’s available in your workplace. You never know what you can achieve with a bit of support and creativity.</p> | <h2>Key points</h2><ul><li>Accomodations are changes that can help a person with physical or cognitive challenges and/or health conditions be able to work, such as flexible work hours or support with learning new tasks.</li><li>Discrimination in the workplace for any reason, including reasons related to health, violates your rights and is illegal.</li><li>If you feel you are facing discrimination, write down the details of what happened; talk about the situation with your employer or human resources; ask a legal expert for their input; and look for support from a cancer support group or your doctor.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/Accessibility_and_support_when_working.jpg | | Teens |
| Accessing cancer information online | A | Accessing cancer information online | Accessing cancer information online | | English | Oncology | Pre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years) | NA | NA | Health care professionals | Pre-teen (9-12 years)
Teen (13-15 years)
Late Teen (16-18 years) | NA | | 2019-09-03T04:00:00Z | | | | | | 7.30000000000000 | 65.2000000000000 | 619.000000000000 | | Flat Content | Health A-Z | <p>The internet is a useful resource to find information on cancer and treatments, but there is also a lot of misinformation. Find out tips to help you know where to go for reliable info and to help you think critically.</p> | <p>The internet is the top source of information for teenagers. You can get lots of information about cancer on the internet. There are websites, discussion forums, blogs, social networks, and many other places that internet users can talk about and learn about cancer. This is one of the great things about the internet: anyone and everyone can contribute to the information stored on the web. But this situation can also make it difficult to figure out what’s true or helpful and what isn’t. </p> | <h2>Key points</h2><ul><li>Anyone can create content on the internet, which makes it difficult to figure out what is true and what is not when looking at information online.</li><li>The acronym SCREEN can help you choose which information to trust. It stands for Source; Conflict of interest or bias; editorial Review process; Evidence-based; Extreme claims; and Not related.</li><li>If you are not sure about something you've read online, it is best to ask your health-care team for more information.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/Accessing_cancer_info_online.jpg | | Teens |
| Accessing medications for cystic fibrosis in Ontario | A | Accessing medications for cystic fibrosis in Ontario | Accessing medications for cystic fibrosis in Ontario | | English | Pharmacy | Child (0-12 years);Teen (13-18 years) | NA | NA | Support, services and resources | Adult (19+)
Caregivers | NA | | 2023-01-31T05:00:00Z | | | | | | 10.2000000000000 | 49.1000000000000 | 505.000000000000 | | Flat Content | Health A-Z | <p>There are several different ways cystic fibrosis patients can have their medications covered in Ontario. Learn what your child may qualify for and how to access these programs.</p><br> | <h2>How are medications paid for?</h2><p>Your child may qualify for several different kinds of <a href="https://www.aboutkidshealth.ca/Article?contentid=4101&language=English">medication coverage in Ontario</a>. For patients with cystic fibrosis, they include:</p><ul><li><em>Special Drugs Program (SDP)</em><br>
The Ontario Ministry of Health and Long-Term Care (MOHLTC) covers the cost of select medications used in the treatment of specific conditions such as CF. This program covers select medications for all CF patients in Ontario who are seen at a provincial CF clinic. For example, this plan covers enzymes.</li><li><em>Private medical insurance</em><br>
These are benefits that you and/or your employer pay for. Sometimes, insurance providers will only cover a medication if the health-care team fills out a Prior Authorization form. This is common for high-cost medications such as inhaled antibiotics (e.g., TOBI, Cayston), Pulmozyme and CFTR modulators (e.g., Trikafta, Kalydeco, Orkambi). If a Prior Authorization form is needed, send this to the clinic pharmacist.</li><li><em>Ontario Drug Benefits (ODB) program</em><br>
The ODB program is a drug benefit program for people who qualify for provincial medication coverage. There are several ways to qualify for provincial medication coverage (e.g., OHIP+, Trillium, etc.). See the <a href="https://www.ontario.ca/page/check-medication-coverage/">medication coverage in Ontario website</a> for information about who qualifies for provincial medication coverage and how medications are covered under ODB.</li></ul> | <h2>Key points</h2><ul><li>Medications for children with cystic fibrosis (CF) in Ontario may be covered by a few different programs or plans.</li><li>Different programs and plans may cover different medications.</li><li>It is important to understand how medications for your child are paid for and how to access that coverage.</li></ul>
| | | | | | | | | | | | | | | | | | | <h2>At SickKids</h2><p>If you need help, ask your health-care team to connect you with the SickKids Resource Navigators. They can help answer questions about the different drug programs and provide help with filling out the forms.</p><br> | | | | | | | | | | | Main |
| Accident benefits after a motor vehicle collision | A | Accident benefits after a motor vehicle collision | Accident benefits after a motor vehicle collision | | English | NA | Child (0-12 years);Teen (13-18 years) | NA | NA | Support, services and resources | Caregivers
Adult (19+) | NA | | 2021-05-21T04:00:00Z | | | | | | 9.40000000000000 | 55.7000000000000 | 1027.00000000000 | | Flat Content | Health A-Z | <p>Accident benefits are available to help people with the cost of hospitalization and rehabilitation after a collision. Find out how to make an insurance claim. </p> | <p>This page is about getting insurance benefits after a motor vehicle collision in Ontario. This process is different from province to province, from state to state and country to country. The information here outlines the major issues and processes involved and may not contain all of the details relevant in a particular case. </p> | <h2>Key points</h2><ul><li>In the province of Ontario anyone who has been injured in a motor vehicle collision, including pedestrians and bicyclists, can claim for accident benefits.</li><li>To make an insurance claim after a motor vehicle collision you should call the insurance company within 7 days of the collision. The sooner you call, the better.</li><li>Most hospitals have someone such as a social worker who can help you fill out the forms and get the certificates you will need.</li><li>If you or your child’s injuries are likely to have longer term consequences, then you may wish to consult with a lawyer to discuss how they may be able to help you through the insurance process and protect your rights.
</li></ul> | | | | | | | | | | | | | | | | | | | <h2>At SickKids</h2><p>
<strong>The Trauma social worker can do the following things:</strong></p><ul><li>Help you start the claim</li><li>Help you fill out the insurance forms</li><li>Answer any questions you have about accident benefits</li><li>Help you to plan for any other help you may need when you go home</li></ul><p>
<strong>The Trauma patient care coordinator can do the following things:</strong></p><ul><li>Help plan your child's care while in hospital</li><li>Be a contact person at the hospital after you go home</li><li>Help you with the insurance claim if the social worker is not available<br></li></ul> | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/accident_benefits_after_motor_vehicle_collision.jpg | | Main |
| Acetaminophen, Aspirin, and NSAIDs | A | Acetaminophen, Aspirin, and NSAIDs | Acetaminophen, Aspirin, and NSAIDs | | English | Pain/Anaesthesia | Child (0-12 years);Teen (13-18 years) | Body | Central nervous system;Peripheral nervous system;Autonomic nervous system | Symptoms | Caregivers
Adult (19+) | Pain | | 2009-09-21T04:00:00Z | | | | | | 10.8000000000000 | 49.3000000000000 | 548.000000000000 | | Flat Content | Health A-Z | <p>Learn about pain relief medications. Acetaminophen (Tylenol) and NSAIDs (ibuprofen).</p> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| Acne (acne vulgaris) | A | Acne (acne vulgaris) | Acne (acne vulgaris) | | English | Dermatology | Pre-teen (9-12 years);Teen (13-18 years) | Skin | Skin | Conditions and diseases | Caregivers
Adult (19+) | NA | | 2015-01-14T05:00:00Z | | | | | | 8.20000000000000 | 58.5000000000000 | 1522.00000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>Acne is the most common skin condition in teens. Discover the different types and causes and how they can be treated.<br></p> | <p>Acne, clinically known as acne vulgaris, is the most common skin disease. It affects 85% of teenagers, some as young as 12, and often continues into adulthood. It is also called "pimples," "zits" or "blemishes".</p> | <h2>Key points</h2><ul><li>Acne vulgaris is the most common skin disease in teenagers.</li><li>Acne occurs deep within the skin, and severity and outcomes vary from person to person.</li><li>Acne causes comedones (whiteheads and blackheads), papules, pustules or even nodules.</li><li>Picking, squeezing and popping can lead to scarring.</li><li>Acne is manageable with the appropriate treatment. Ask your doctor or your dermatologist about your options.<br></li></ul> | | <h2>What causes acne?</h2>
<figure>
<span class="asset-image-title">Anatomy of the skin</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/IMD_skin_anatomy_EN.jpg" alt="Identification of a hair, sebaceous gland, sweat gland and blood vessels in the skin" />
<figcaption class="asset-image-caption">Acne occurs when the sebaceous glands produce more oil, clogging different parts of skin tissue.</figcaption> </figure>
<p>The skin is formed by many layers of tissue, containing hair, glands, muscles, sensory receptors and blood vessels. During puberty, a group of hormones are released called androgens. Androgens allow the sebaceous glands in the skin to produce an oily substance called sebum. Acne is in part caused by this increase in sebum that naturally occurs during puberty.<br></p><p>Normal amounts of sebum keep skin and hair from drying out. However, excess oil can mix with dead skin cells and clog hair follicles (the tiny tunnels that lead to the root of the hair) and pores (the opening in the skin where the hair passes through).</p><p>A common type of bacteria that lives on the skin, known as
<em>Propionibacterium acnes</em>, sometimes contributes to acne by causing inflammation. The acne signals white blood cells to the area, which damage the tissue and cause an inflammatory response. This causes swelling and infection.</p><p>Acne leads to persistent redness and inflammation, especially on the face, scalp, back and chest, where the most sebum is produced.</p><p>Acne varies from mild to severe, depending on what kind of blemishes appear. The different types of acne include:<br></p><ul><li>comedones</li><li>papules</li><li>pustules</li><li>nodules</li></ul><p>Comedones are pores that are blocked with oil and dead skin cells. They can be open ("blackheads") or closed by the skin ("whiteheads").</p><p>A blackhead is generally level with the skin surface and cannot be removed by normal washing of the face.</p>
<figure class="asset-c-80">
<span class="asset-image-title">Open comedo (blackhead)</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/IMD_acne_blackhead_EN.png" alt="Cross section of skin with an oxidized sebum, which appears black at the top, and a surface view of skin with blackheads" />
<figcaption class="asset-image-caption">The pore of a blackhead is open. When the sebum comes into contact with the air, oxygen exposure causes it to appear black.</figcaption></figure>
<p>A whitehead is slightly raised from the skin, but there is no inflammation.</p>
<figure class="asset-c-80"><span class="asset-image-title">Closed comedo (whitehead)</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_acne_whitehead_EN.png" alt="Cross section of skin with a trapped sebum and clogged pore, and a surface view of skin with whiteheads" /><figcaption class="asset-image-caption">A whitehead is formed when pores are blocked with sebum and dead skin cells. The pore in a whitehead is not open at the top.</figcaption> </figure>
<p>Papules are red, small, hard bumps that are slightly raised on the skin. In clusters, they can feel like sandpaper to the touch. White blood cells enter the follicle, causing inflammation.</p>
<figure class="asset-c-80">
<span class="asset-image-title">Papule</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/IMD_acne_papule_EN.png" alt="Cross section of skin with inflammation and white blood cells around sebum, and surface view of skin with papules" />
<figcaption class="asset-image-caption">Papules are red, painful bumps caused by inflammation of the hair follicles.</figcaption></figure>
<p>When the white blood cells in a papule make it to the surface of the skin, a pustule is formed. Pustules appear as red, inflamed circles with a central, raised bump that is yellowish or white. The bump is filled with pus. Pus is the result of inflammation and contains white blood cells, dead skin cells and bacteria.</p>
<figure class="asset-c-80">
<span class="asset-image-title">Pustule</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/IMD_acne_pustule_EN.png" alt="Cross section of pus under the skin and white blood cells that have moved toward the surface, and surface view of pustules" />
<figcaption class="asset-image-caption">Pustules form a few days after the white blood cells in a papule make it to the surface of the skin. Pustules are typically called "pimples" or "zits".</figcaption></figure>
<p>When a papule or pustule expands, it can cause more severe inflammation in the surrounding skin. This can lead to nodules, which are deep, red, round bumps that can have a diameter of 6 to 20 mm. They are sometimes referred to as cysts.</p><p>Nodules are formed by irritated, inflamed hair follicles that have ruptured deep under the skin. They can be throbbing and painful, even without touching.</p>
<figure class="asset-c-80">
<span class="asset-image-title">Nodule</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/IMD_acne_nodule_EN.png" alt="Cross section of pus and inflammation under the skin with large swollen bump on skin surface, and surface view of nodule" />
<figcaption class="asset-image-caption">Nodules are often large, inflamed, red, swollen and painful to the touch.</figcaption></figure> | | <h2>Psychological impact of acne</h2>
<p>Acne can have a profound impact on a person's quality of life, particularly for teenagers. Reactions can range from minimal distress to more significant depression, anxiety and, less commonly, thoughts of suicide or self-harm. For these reasons, treating acne matters.</p>
<h2>Treatment of acne</h2>
<p>Treatment depends on the severity and type of acne. An effective treatment will help reduce future breakouts and improve the skin's appearance. Keep in mind that up to six weeks of treatment might be necessary to start noticing results.</p>
<p>In most cases, your doctor or dermatologist will prescribe topical treatments (applied directly on the skin). Sometimes the doctor may prescribe an oral treatment (taken by mouth).</p>
<h3>Cleansing skin</h3>
<p>Acne is a process deep within the skin. Washing your face regularly helps remove dead skin cells and excess oil, but does not play a significant role in the prevention or management of acne.</p>
<p>If you have acne, avoid scrubbing your face when washing, because this may worsen inflammation and irritation. Instead, gently wash your face with warm water. You may also use a mild cleansing product if you want.</p>
<h3>Topical retinoids</h3>
<p>Topical retinoids unplug comedones and improve the process of shedding the old cells. They may also help reduce any inflammation.</p>
<p>Some side effects may occur when using a topical retinoid. These include mild irritation, redness (erythema), dryness, peeling and sensitivity to sun. If you are pregnant, or thinking about having a baby, talk to your doctor or dermatologist before using a topical retinoid, as they should not be used during pregnancy.</p>
<p>Avoid skin damage, such as waxing or exfoliation (e.g., facials) when taking retinoids.</p>
<p>Common topical retinoids are available in cream and gel form. There are benefits to both creams and gels, depending on the severity of acne and the sensitivity of your skin. Retinoids are also available in many strengths and formulations. Therefore, there is no one better option; your doctor will recommend a retinoid most appropriate for you.</p>
<h3>Topical antimicrobials</h3>
<p>Topical antimicrobials are used to kill bacteria that contribute to inflammation. They also help fight inflammation directly. One option is benzoyl peroxide, which is available over the counter. When benzoyl peroxide touches the skin, oxygen is created. <em>P. acnes</em> cannot survive in the presence of oxygen.</p>
<p>Use caution when applying benzoyl peroxide because it is a potent bleaching agent that can damage fabrics. The pharmacist can answer any questions you might have.</p>
<h3>Oral antibiotics</h3>
<p>An oral antibiotic (taken by mouth) is sometimes used to treat more significant acne, especially in cases where the acne has spread to the back and chest. Such as topical treatments, oral antibiotics reduce inflammation.</p>
<p>Antibiotics can also stop <em>P. acnes</em> from multiplying. However, the use of antibiotics should be limited because bacteria can develop a resistance to them.</p>
<h3>Combined treatment</h3>
<p>A combined treatment can be an effective means of treating acne. In this case, a topical retinoid and an antimicrobial cream or gel can be used together. Sometimes they are combined into one product, while other times they are used separately. For example, a topical antimicrobial may be applied in the morning and a topical retinoid may be used at night.</p>
<p>Oral medications are also used in combination with a topical treatment. Most people taking a pill benefit from a topical cream or gel.</p>
<p>Your doctor or dermatologist will advise you on how and when to use a combined treatment for acne.</p>
<h3>Oral isotretinoin</h3>
<p>Isotretinoin (known as Accutane in North America; Clarus and Epuris in Canada; and Roaccutane in Europe) is a chemical compound related to vitamin A. In most cases, isotretinoin is used to treat severe nodular and scarring acne because:</p>
<ul>
<li>it reduces sebum secretion</li>
<li>it prevents the formation of comedones</li>
<li>it acts as an anti-inflammatory</li>
<li>it stops <em>P. acnes</em> from generating in hair follicles and sebaceous glands</li>
</ul>
<p>However, this type of acne treatment must be closely monitored because isotretinoin has a number of side effects. More common side effects include dry skin, lips, nose and eyes. All side effects will begin to disappear when treatment stops.</p>
<p>However, there are more severe side effects. For example, isotretinoin can interfere with the development of a fetus. If you are pregnant or thinking about having a baby, talk to your doctor or dermatologist about the side effects of isotretinoin. There are also concerns about depression, inflammatory bowel disease and impact on liver.</p>
<h3>Hormonal therapy</h3>
<p>Treating acne with female hormones is an effective treatment option for some female patients. This means taking an oral contraceptive (the birth control pill). This type of treatment limits sebum secretion by reducing androgen levels. Other topical and oral treatments can be used along with oral hormonal therapy.</p>
<p>Treating acne using hormones is not for everybody. For more information, talk to your doctor or dermatologist.</p> | | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/acne_vulgaris.jpg | | Main |
| Activities after a blood and marrow transplant | A | Activities after a blood and marrow transplant | Activities after a blood and marrow transplant | | English | Haematology;Immunology;Oncology | Child (0-12 years);Teen (13-18 years) | Body | Immune system | NA | Adult (19+) | NA | | 2010-01-06T05:00:00Z | | | | | | 8.20000000000000 | 64.4000000000000 | 371.000000000000 | | Flat Content | Health A-Z | <p>Learn about child-friendly activities in the hospital, after a blood and marrow transplant.</p> | <p>Once your child has the blood and marrow transplant (BMT), they will spend a lot of time as an inpatient in the hospital. This way, your health-care team can provide the best care for your child. Along with recovering from the transplant procedure itself, many children may find adapting to their new hospital environment stressful. </p>
<p>To help, it is important to continue some activities that your child enjoys. A Child Life Specialist will work with you and your child throughout the hospital stay. You can work together to engage your child in activities.</p> | <h2>Key points</h2>
<ul><li>A child life specialist will work with you and your child to help them adapt to the hospital environment and engage your child in activities.</li>
<li>Play therapy, school work and music therapy to help them recover, promote self-expression, and keep up with their studies.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| Activities that support CARD | A | Activities that support CARD | Activities that support CARD | | English | Pain/Anaesthesia | Child (0-12 years);Teen (13-18 years) | NA | NA | Non-drug treatment | Adult (19+)
Caregivers | NA | | 2023-03-22T04:00:00Z | | | | | | | | | | Flat Content | Health A-Z | <p>This page contains a series of links to activities and games that support the different strategies of the CARD system.</p> | <p>Some children feel anxious or afraid of vaccinations, but there are things they can do to help reduce the pain, fear and anxiety associated with vaccination. This page includes a series of links to activities and games that support the different strategies of the CARD system (Comfort, Ask, Relax, Distract). Your child can use these before and during vaccination to have a more positive experience. To learn more about CARD, go to <a href="https://www.aboutkidshealth.ca/card/">CardSystem.ca</a>.</p> | <h2>Key points</h2><ul><li>The CARD system can be used to provide a more positive vaccination experience for both you and your child.</li><li>Have your child play the online interactive CARD game for kids to help them learn strategies to improve their vaccination experience.</li><li>Using activities such as search and find games, colouring pages, connect the dots and mazes can help to distract your child before and during vaccination.</li></ul>
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| Activity and contact with others after a blood and marrow transplant | A | Activity and contact with others after a blood and marrow transplant | Activity and contact with others after a blood and marrow transplant | | English | Haematology;Immunology;Oncology | Child (0-12 years);Teen (13-18 years) | Body | Immune system | NA | Adult (19+) | NA | | 2010-03-19T04:00:00Z | | | | | | 7.60000000000000 | 67.1000000000000 | 825.000000000000 | | Flat Content | Health A-Z | <p>Learn how your child can minimize infection at home, after the blood and marrow transplant.</p> | <p>As your child recovers from the blood and marrow transplant (BMT), they are slowly building the natural defenses in their immune system. This means your child is still vulnerable to infection.</p> | <h2>Key points</h2><ul><li>It is important that you and your child take precautions such as avoiding crowds, in order to prevent infection as your child builds up their immune system again.</li><li>While your child is recovering from the transplant, they cannot receive any vaccines.</li><li>If you have pets, it is best to remove them for the first several months after your child’s BMT.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/activity_and_contact_with_others_after_a_blood_and_marrow_transplant.jpg | | Main |
| Activity recommendations for infants and toddlers after heart surgery | A | Activity recommendations for infants and toddlers after heart surgery | Activity recommendations for infants and toddlers after heart surgery | | English | Other | Newborn (0-28 days);Baby (1-12 months);Toddler (13-24 months) | Body | NA | Non-drug treatment | Caregivers
Adult (19+) | NA | | 2023-03-21T04:00:00Z | | | | | | 8.60000000000000 | 60.7000000000000 | 682.000000000000 | | Health (A-Z) - Procedure | Health A-Z | <p>Following heart surgery, children require extra care and attention. Learn which positions and activities infants and toddlers must avoid after heart surgery.</p> | <h2>Activity recommendations for infants and toddlers after heart surgery</h2><p>After your infant or toddler has heart surgery, it is important that they stay active, but there are certain positions and activities that you should be careful about. This article outlines recommendations to follow in the days and months, following heart surgery. It includes information on:</p><ul><li>How you can help to position your child after surgery to promote recovery.</li><li>How you can encourage normal development and play while in hospital and at home.</li></ul> | <h2>Key points</h2><ul><li>While your child is still in the hospital, they should be repositioned every two hours.</li><li>You are encouraged to bring an infant seat/stroller to the hospital, as well as your child’s favourite toys, comfort items and any feeding equipment they use at home.</li><li>Following these suggestions can help your child’s lungs to re-expand, improve alertness, and improve recovery time.</li><li>If your child needs extra support while in hospital, a rehabilitation specialist such as an occupational therapist or physiotherapist may be asked to work with them.
</li></ul> | | | | | | | | | | | | | | | | <h2>Positioning your child during in-hospital recovery</h2><p>After heart surgery, it is important that your child be repositioned throughout the day and night to ensure that their lungs stay well expanded and free of mucous. This will also help them to recover their movement. While your child is still in the hospital, they will need to be repositioned every two hours.</p><div class="pdf-page-break"></div>
<p>When you first reposition your child, it is important to ask your nurse for assistance. The nurse will make you aware of specific precautions related to your child’s status. This will help you to feel more comfortable and ensure that you are following the activity recommendations after surgery.</p><div class="akh-series"><div class="row"><div class="col-md-12">
<figure>
<img src="https://assets.aboutkidshealth.ca/AKHAssets/IMD_baby_lay_side_sternal_incision_EN.jpg" alt="Baby laying on their side with sternal incision, which is a recommended position" />
<figcaption class="asset-image-caption">Lay your child on their side.</figcaption> </figure>
<p>Lay your child on their side if the incision is on the front of the chest (sternotomy). If their incision is on the side of their ribcage (thoracotomy), avoid lying your child on that side. However, you may lay them on the side without the incision.</p></div></div><div class="row"><div class="col-md-12">
<figure>
<img src="https://assets.aboutkidshealth.ca/AKHAssets/Physio_after_heart_surgery_Baby_in_arms.jpg" alt="Parent holding infant with NG tube in arms chest to chest" /></figure>
<p>Good positions at this time include turning your child onto their side, onto their back, holding them in your arms, and placing them into an infant seat. This will help your child recover sooner so that they can go home.</p></div></div><div class="pdf-page-break"></div><div class="row"><div class="col-md-12">
<figure>
<img src="https://assets.aboutkidshealth.ca/akhassets/IMD_infant_seat_EN.jpg" alt="Baby placed correctly in infant seat" />
<figcaption class="asset-image-caption">Put your child in an infant seat to help them recover faster.</figcaption> </figure>
<p>Placing your child in an infant seat will help to improve their alertness and overall recovery. Your nurse will advise you when it is safe to move to this stage and will help you learn to do this safely post surgery.</p><p>As the number of infant seats available in the hospital is limited,
<strong>we strongly encourage parents to bring their own</strong>.</p><p>If your child is too big for an infant seat, their physiotherapist or occupational therapist can provide you with a more appropriate seating option.</p></div></div></div> | <div class="pdf-page-break"></div><h2>Post-sternotomy: Incision at the centre of the chest</h2><h3>Activity guidelines for babies</h3><table class="akh-table"><thead><tr><th>Time period</th><th>Activity recommendations</th></tr></thead><tbody><tr><td>For the first
<strong>2</strong> weeks after surgery</td><td><p>Avoid activities that might disturb the wound.</p><p>Avoid lying on the tummy. After 2 weeks, lying on the tummy is encouraged for normal development.</p></td></tr><tr><td>For the first
<strong>6</strong> weeks after surgery</td><td><p>Take care of the chest muscles and bone during all activity.</p><p>Avoid lifting under the arms. Instead, lift your baby under head/neck and bottom.</p></td></tr></tbody></table><div class="pdf-page-break"></div><h3>Activity guidelines for toddlers</h3><table class="akh-table"><thead><tr><th>Time period</th><th>Activity recommendations</th></tr></thead><tbody><tr><td>For the first
<strong>2</strong> weeks after surgery</td><td><p>Avoid activities that might disturb the wound.</p><p>Avoid lying on tummy. </p></td></tr><tr><td>For the first
<strong>6</strong> weeks after surgery</td><td><p>Take care of the chest muscles and bone during all activity.</p><p>Avoid lifting toddlers and children under the arms. Instead, lift them under head/neck and bottom.</p><p>Avoid pushing or pulling heavy objects.</p><p>Avoid doing push-ups, sit-ups or pulling themselves up on furniture.</p><p>Avoid backward arm circle movements.</p><p>Gym class can be resumed but avoid contact sports. </p></td></tr><tr><td>Continuing from
<strong>6 to 12</strong>weeks after surgery</td><td><p>Take care of the chest bone during all activity.</p><p>Avoid activities that could cause a blow to the chest. These include rough play, ball throwing, football, hockey, karate, or other contact sports.</p></td></tr></tbody></table><div class="pdf-page-break"></div>
<h2>Post-thoracotomy: Incision on the side of the chest</h2><h3>Activity guidelines for babies</h3><table class="akh-table"><thead><tr><th>Time period</th><th>Activity recommendations</th></tr></thead><tbody><tr><td>For the first
<strong>2</strong> weeks after surgery</td><td><p>Avoid activities that might disturb the wound such as lying on that side.</p></td></tr><tr><td>For the first
<strong>6</strong> weeks after surgery</td><td><p>Avoid lifting or pulling your baby on the side with the incision. </p></td></tr></tbody></table><h3>Activity guidelines for toddlers</h3><table class="akh-table"><thead><tr><th>Time period</th><th>Activity recommendations</th></tr></thead><tbody><tr><td>For the first
<strong>2</strong> weeks after surgery</td><td><p>Avoid activities that might disturb the wound such as lying on that side.</p></td></tr><tr><td>For the first
<strong>6</strong> weeks after surgery</td><td><p>Avoid lifting or pulling on the arm on the side with the incision (i.e., during carrying or dressing). </p><p>Avoid pushing or pulling heavy objects with the affected arm.</p><p>Avoid contact sports and rough play. </p></td></tr></tbody></table><h2>If your child needs extra support while in hospital, a therapist may work with them</h2><p>After your child's procedure, they may have trouble expanding their lungs, or getting rid of mucus on their own. If your child is having trouble, their physiotherapist will need to work with them to help re-expand the lungs and loosen the mucus. Additionally, if they are having issues with feeding, movement, thinking or speech, they may also be seen by the appropriate member of the rehabilitation team.</p> | | | | | | | | | physioafterheartsurgery | https://assets.aboutkidshealth.ca/akhassets/IMD_infant_seat_EN.jpg | | | Main |
| Activity recommendations for your infant after heart surgery | A | Activity recommendations for your infant after heart surgery | Activity recommendations for your infant after heart surgery | | English | Cardiology | Baby (1-12 months);Newborn (0-28 days);Toddler (13-24 months) | NA | NA | Non-drug treatment | Adult (19+)
Caregivers | NA | | 2018-05-22T04:00:00Z | | | | | | 12.3000000000000 | 41.2000000000000 | 771.000000000000 | | Flat Content | Health A-Z | <p>If your infant has heart surgery, there are specific activity recommendations you must follow. Learn how to help your infant recover after heart surgery.</p> | <p>After your infant has heart surgery, it is important that they avoid certain positions and activities, while still remaining active. This article outlines recommendations to follow in the days and months after heart surgery. It includes information on:</p><ul><li>Positioning and handling your child after surgery to promote recovery</li><li>Encouraging <a href="/Article?contentid=296&language=English">tummy time</a> with your baby</li><li>Activities to promote fine motor and thinking skills<br></li></ul> | <h2>Key points</h2><ul><li>After heart surgery, there are certain positions that you should avoid with your baby until enough time has passed since their surgery.</li><li>To avoid the risk of sudden infant death syndrome (SIDS), your baby should always sleep on their back.</li><li>To avoid positional plagiocephaly and promote healthy development, position your baby on their tummy, supported sitting or up in your arms throughout the day.</li><li>If you are concerned about your baby’s development, speak to your child’s family doctor or paediatrician.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/Activity_recommendations_for_your_infant_after_heart_surgery.jpg | | Main |
| Acute cerebellar ataxia (acute post-infectious cerebellar ataxia) | A | Acute cerebellar ataxia (acute post-infectious cerebellar ataxia) | Acute cerebellar ataxia (acute post-infectious cerebellar ataxia) | | English | Neurology | Child (0-12 years);Teen (13-18 years) | Brain | Brain | Conditions and diseases | Caregivers
Adult (19+) | NA | | 2015-03-19T04:00:00Z | | | | | | 10.1000000000000 | 47.6000000000000 | 980.000000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>This page outlines what you need to know about acute cerebellar ataxia</p> | <h2>What is acute post-infectious cerebellar ataxia?</h2><p>Ataxia is a movement disorder, which is a condition where body movements are difficult to control or occur involuntarily. These disorders occur when areas of the brain that are used for movement, sensation and speech are damaged. Some causes of ataxia in children include: infection, head injury, prescription drugs, and toxins such as illicit drugs, lead poisoning and carbon monoxide.</p><p>Acute post-infectious cerebellar ataxia is the most common form of acute ataxia found in children.</p><p>The following definitions can be helpful in understanding the term acute post-infectious cerebellar ataxia:</p><ul><li>Acute — all signs and symptoms appear within a short period of time, in this case within two days.</li><li>Post-infectious — occurring after an infection.</li><li>Cerebellar — coming from the cerebellum. The cerebellum is a part of the brain important in controlling movement.</li></ul><p>It is most commonly seen between the ages of two and five, but can also occur in older children.</p> | <h2>Key points</h2>
<ul>
<li>Ataxia is a movement disorder that can occur in children.</li>
<li>Acute post-infectious cerebellar ataxia is the most common cause of acute ataxia in children and is diagnosed after more serious conditions have been excluded.</li>
<li>Most children return to normal without treatment.</li>
<li>Seek medical attention for any major changes to your child’s movements or changes to their level of consciousness.</li>
</ul> | <h2>Signs and symptoms of ataxia</h2><p>A child with ataxia has difficulty controlling their movements and may appear clumsy or awkward. They may have some of the following symptoms:</p><ul><li>falling while trying to walk or stand</li><li>difficulty walking in a straight line</li><li>bending forwards while walking</li><li>walking with feet spread wide apart</li><li>difficulty speaking </li><li>slurred or unclear speech</li><li>abnormal eye movements</li><li>
<a href="/Article?contentid=29&language=English">headache</a></li><li>
<a href="/Article?contentid=746&language=English">vomiting</a></li></ul> | <h2>What causes acute post-infectious cerebellar ataxia?</h2><p>When a child has an infection, the body’s immune system produces antibodies that act to destroy viruses and bacteria. Sometimes the antibodies act against the cerebellum, mistaking it for a virus or bacteria. The antibodies can also sometimes trigger other parts of the immune system to affect the cerebellum. In both cases, the child’s cerebellum is temporarily affected by the immune system and does not work properly. As a result, the child will not be able to control their movements normally, leading to ataxia. </p><p>The typical timeline of acute post-infectious cerebellar ataxia is as follows: </p><ul><li>A child will get an infection, usually with a fever.</li><li>The infection and fever get better.</li><li>A few days to three weeks later ataxia starts to develop. Difficulty with walking is the most common symptom. </li><li>Ataxia develops quickly, usually over the course of one to two days. </li></ul><p>Acute post-infectious cerebellar ataxia can occur after many types of infections. About 20% of cases have been linked to
<a href="/Article?contentid=760&language=English">varicella (chicken pox)</a>, but it can also develop after other viral infections, some types of
<a href="/Article?contentid=784&language=English">pneumonia</a>, and Lyme disease.</p><p>Some viruses that can cause post-infectious cerebellar ataxia are prevented with routine vaccinations. Therefore, keeping
<a href="/Article?contentid=1986&language=English">vaccines up to date</a> can help to prevent this condition. </p> | <h2>How is acute post-infectious cerebellar ataxia diagnosed?</h2>
<p>There is no specific test for acute post-infectious cerebellar ataxia. Instead, it is diagnosed by a process of elimination, where more serious types of ataxia are first excluded. </p>
<p>Your child’s history, or the description of recent events leading up to the ataxia, will help their medical team make this diagnosis. They will be looking for a recent infection, as well as acute onset of your child’s ataxia. The medical team may also ask about other signs or symptoms, such as persistent fever, seizures or neck pain, which could point to a different cause of the ataxia.</p>
<p>Your child will undergo a physical exam, with a focus on their nervous system. The medical team will look for the signs and symptoms of ataxia. They will also look for symptoms that could suggest a different diagnosis.</p>
<p>Based on your child’s history and physical exam, their medical team may suggest more tests. These can include blood work or imaging the brain using a CT scan or MRI.</p> | <h2>Treatment of acute post-infections cerebellar ataxia</h2>
<p>Post-infectious cerebellar ataxia usually goes away on its own, and does not require treatment.</p>
<p>However, your child may be sent home from the hospital while still experiencing symptoms of ataxia. In this case, special precautions must be taken to keep your child safe.</p>
<h3>Taking care of your child at home</h3>
<p>Your child may be sent home before their ataxia has gone away. Your child may have difficulty walking and may fall easily. It is very important to make sure the home environment is safe for your child during this time. You may have to supervise your child at all times throughout the day. Please talk to your child’s doctor if you need a letter to stay home from work or school to supervise your child.</p>
<p>It is important that you are comfortable taking your child home before they can walk or move normally. Please talk to your child’s medical team if you are worried about keeping your child safe at home.</p>
<h3>Will my child go back to normal? When?</h3>
<p>In the majority of cases, acute post-infectious cerebellar ataxia goes away completely in two to three weeks. Most children have no lasting problems with walking or with other movements.</p> | | <h2>When to see a doctor</h2><p>Make an appointment with your child’s doctor if:</p><ul><li>your child’s ataxia is not improving after two weeks</li><li>your child’s ataxia returns after it has gone away</li><li>your child develops a
<a href="/Article?contentid=30&language=English">fever</a> (temperature taken by mouth of 37.8°C (100°F) or higher)</li></ul><h3>Go to your nearest Emergency Department or call 911 if:</h3><ul><li>your child becomes confused or disoriented</li><li>your child becomes unresponsive, or very sleepy and difficult to wake up</li><li>your child has new abnormal movements that could be seizures</li><li>your child develops severe neck pain and a fever</li><li>your child develops a severe headache</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | Main |
| Acute lymphoblastic leukemia (ALL) | A | Acute lymphoblastic leukemia (ALL) | Acute lymphoblastic leukemia (ALL) | | English | Oncology | Pre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years) | Body | Skeletal system | Conditions and diseases | Pre-teen (9-12 years)
Teen (13-15 years)
Late Teen (16-18 years) | NA | | 2019-09-03T04:00:00Z | | | | | | 7.70000000000000 | 66.5000000000000 | 430.000000000000 | | Flat Content | Health A-Z | <p>Acute lymphoblastic leukemia is the most common type of leukemia in teenagers and young children. Learn about the different types of ALL and possible symptoms.</p> | <h2>What is acute lymphoblastic leukemia (ALL)?</h2><p>Acute lymphoblastic leukemia (ALL) is the most common type of leukemia, a cancer of the blood, in teenagers and younger children. We can get some information about this type of cancer from the different parts of its name.</p><ul><li>
<strong>Acute</strong> means quick or short. ALL usually develops quickly and can get worse quickly if it is not treated.</li><li>
<strong>Lymphoblastic</strong> comes from the name of the cell that ALL comes from. Remember that leukemia starts with a mutation or change in the DNA of the immature blood cell. In ALL, this mutation is in the cell that would normally mature into a specific white blood cell called the lymphocyte (say: lim-foe-sites). The new, mutated cell is called a lymphoblast or leukemic blast. </li><li>In leukemia, the lymphoblasts do not mature and so they cannot do the job of the white blood cell, which is to fight infection. The mutation causes them to divide out of control and so the lymphoblasts fill up the bone marrow and stop the bone marrow from making healthy blood cells.</li></ul><div class="asset-animation">
<iframe src="https://teens.aboutkidshealth.ca/Style%20Library/AKH/animations/DevelopmentOfALL_Teen/Development_ALL_teen_canvas_AMD_EN.html"></iframe> </div> | <h2>Key points</h2><ul><li>ALL is the most common type of leukemia in children and teenagers.</li><li>ALL starts with a change in DNA in a white blood cell called the lymphocyte. The mutated cells are called lymphoblasts or leukemic blasts.</li><li>Types of ALL include B-cell ALL, and T-cell ALL.</li><li>Symptoms of ALL may include fever, feeling tired, feeling out of breath when exercising, bruising or bleedin easily and bone pain.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Teens |
| Acute lymphoblastic leukemia (ALL): Radiation therapy | A | Acute lymphoblastic leukemia (ALL): Radiation therapy | Acute Lymphoblastic Leukemia (ALL): Radiation Therapy | | English | Oncology | Child (0-12 years);Teen (13-18 years) | Body | Skeletal system | Non-drug treatment | Adult (19+) | NA | | 2018-03-06T05:00:00Z | | | | | | 10.7000000000000 | 39.5000000000000 | 578.000000000000 | | Flat Content | Health A-Z | <p> Learn how radiation therapy is used to treat acute lymphoblastic leukemia (ALL).</p> | <p>A small percentage of children with Acute Lymphoblastic Leukemia (ALL) receive chemotherapy and radiation therapy to the brain, called cranial radiation therapy (CRT). Some boys may also need radiation to the testes. This is because chemotherapy medicines may not adequately treat leukemic cells in the brain or testes. Talk to your child’s doctor to see if your child requires radiation therapy.</p>
<p>If your child requires radiation therapy, you will meet with a pediatric radiation oncologist.</p> | <h2> Key points </h2>
<ul><li>A minority of children with acute lymphoblastic leukemia (ALL) will require radiation therapy if chemotherapy cannot adequately treat leukemic cells in the brain or testes.</li>
<li>Radiation uses ray beams to damage and destroy leukemic cells.</li>
<li> Radiation is fractioned into separate small daily treatments over a period of weeks.</li>
<li> Radiation has some short-term side effects.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| Acute lymphoblastic leukemia (ALL): bone marrow transplant | A | Acute lymphoblastic leukemia (ALL): bone marrow transplant | Acute Lymphoblastic Leukemia (ALL): Bone Marrow Transplant | | English | Oncology | Child (0-12 years);Teen (13-18 years) | Body | Skeletal system | Non-drug treatment | Adult (19+) | NA | | 2018-03-06T05:00:00Z | | | | | | 10.1000000000000 | 57.4000000000000 | 174.000000000000 | | Flat Content | Health A-Z | <p> Learn why a child with acute lymphoblastic leukemia may need a bone marrow transplant.</p> | <p>A bone marrow transplant (BMT), also known as a stem cell transplant, is a procedure that places (transplants) healthy blood stem cells into a body where the stem cells have been destroyed by chemotherapy or radiation. It may be seen as a method to “rescue” your child from the severe side effects of high dose chemotherapy and radiation. When the stem cells come from another person, the procedure is called an allogeneic BMT. </p> | <h2> Key points </h2><ul><li>Children with acute lymphoblastic leukemia (ALL) may need an allogeneic BMT if their ALL is high-risk, if they do not respond well to chemotherapy, or if they relapse.<br></li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| Acute lymphoblastic leukemia (ALL): chemotherapy phases | A | Acute lymphoblastic leukemia (ALL): chemotherapy phases | Acute Lymphoblastic Leukemia (ALL): Chemotherapy Phases | | English | Oncology | Child (0-12 years);Teen (13-18 years) | Body | Skeletal system | Drug treatment | Adult (19+) | NA | | 2018-03-06T05:00:00Z | | | | | | 10.0000000000000 | 52.8000000000000 | 1312.00000000000 | | Flat Content | Health A-Z | <p> Learn what happens during each of the five phases of chemotherapy for acute lymphoblastic leukemia (ALL).</p> | <p>The goal of treatment is to completely destroy leukemic cells and stop the bone marrow from producing any more cancerous cells.</p>
<p>To treat ALL, your child’s chemotherapy is divided into five different phases.</p> | <h2> Key points </h2>
<ul><li> Chemotherapy for children with acute lymphoblastic leukemia (ALL) is divided into induction, consolidation, interim maintenance, delayed intensification, and maintenance phases.</li>
<li> There is a high likelihood that leukemia will return if maintenance phase is not completed.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| Acute lymphoblastic leukemia: An overview | A | Acute lymphoblastic leukemia: An overview | Acute Lymphoblastic Leukemia: An Overview | | English | Oncology | Child (0-12 years);Teen (13-18 years) | Body | Skeletal system | Conditions and diseases | Adult (19+) | NA | | 2018-03-06T05:00:00Z | | | | | | 11.5000000000000 | 43.4000000000000 | 722.000000000000 | | Flat Content | Health A-Z | <p>Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Learn about how this cancer develops and what factors may affect the development of the disease.</p> | <h2>What is acute lymphoblastic leukemia (ALL)?</h2><p>ALL is a cancer of the white blood cells that originates in the bone marrow, the spongy tissue inside the bones. Without treatment, ALL can progress rapidly. Depending on the patient, untreated ALL can lead to severe infections, bone pain, bleeding, and cardiac decompensation (when symptoms of heart failure suddenly worsen) due to anemia.</p><div class="asset-video">
<iframe src="https://www.youtube.com/embed/_Mls5TViEhg" frameborder="0"></iframe>
</div> | <h2> Key points </h2><ul><li> ALL is the most common childhood cancer.</li><li>ALL happens when a mutated cell multiplies and divides rapidly, accumulating into cells called leukemic blasts.</li><li>Genetics influence the development of ALL, but research is also exploring how the environment, viral infections, and immunodeficiencies may cause it.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| Acute lymphoblastic leukemia: Risk categories | A | Acute lymphoblastic leukemia: Risk categories | Acute Lymphoblastic Leukemia: Risk Categories | | English | Oncology | Child (0-12 years);Teen (13-18 years) | Body | Skeletal system | Conditions and diseases | Adult (19+) | NA | | 2018-03-06T05:00:00Z | | | | | | 10.7000000000000 | 46.5000000000000 | 414.000000000000 | | Flat Content | Health A-Z | <p>Learn how acute lymphoblastic leukemia (ALL) is classified into different risk categories.</p> | <p>Some types of leukemia are easier to treat than others. This depends on a variety of different factors which classify your child’s acute lymphoblastic leukemia (ALL) into a certain risk category: standard risk, high-risk, or very high-risk.</p>
<p>Knowing the risk group of your child’s illness helps doctors design the most effective treatment for your child.</p> | <h2> Key points </h2><ul><li>Acute lymphoblastic leukemia (ALL) can be considered standard risk, high-risk, or very high-risk.</li>
<li>Your child's age, initial white blood cell count, presence of leukemic cells inside the CNS, ALL subtype, chromosome changes in leukemic cells, leukemic cells in testes and response to induction therapy at day 29 will determine their risk category and appropriate treatment.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| Acute myeloid leukemia (AML) | A | Acute myeloid leukemia (AML) | Acute myeloid leukemia (AML) | | English | Oncology | Pre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years) | Body | Skeletal system | Conditions and diseases | Pre-teen (9-12 years)
Teen (13-15 years)
Late Teen (16-18 years) | NA | | 2019-09-03T04:00:00Z | | | | | | 7.60000000000000 | 68.5000000000000 | 366.000000000000 | | Flat Content | Health A-Z | <p>Acute myeloid leukemia is a type of leukemia. Find out how AML starts, diagnosis and possible symptoms.</p> | <h2>What is acute myeloid leukemia (AML)?</h2><p>Acute myeloid leukemia (AML) is a type of leukemia, a cancer of the blood. It is less common than
<a href="/Article?contentid=3421&language=English">acute lymphoblastic leukemia (ALL)</a>. We can get some information about this type of cancer from the different parts of its name.</p><ul><li>
<strong>Acute</strong> means quick or short. AML usually develops quickly and can get worse quickly if it is not treated.</li><li>
<strong>Myelogenous</strong> (say: my-uh-LOH-jen-us) comes from the name of the cell that AML develops from. Remember that leukemia starts with a mutation or change in the DNA of an immature white blood cell. In AML, this mutation is in a cell that would normally become a myeloid white cell. When it changes, it is called a myeloblast. </li></ul><p>In AML, the mutation causes the myeloblasts to divide out of control and so they fill up the bone marrow and stop the bone marrow from making healthy blood cells.</p><div class="asset-animation">
<iframe src="https://teens.aboutkidshealth.ca/Style%20Library/AKH/animations/DevelopmentOfAML_Teen/Development_AML_teen_canvas_AMD_EN.html"></iframe>
<br></div> | <h2>Key points</h2><ul><li>AML starts with a change in a cell that would normally become a myeloid white cell. The changed cell is called a myeloblast.</li><li>Myeloblasts divide out of control, filling up the bone marrow and stopping the production of healthy blood cells.</li><li>The type of AML is diagnosed through a bone marrow aspirate.</li><li>Symptoms of AML may include fever, weight loss, bruising or bleeding easily and swollen lymph nodes.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Teens |
| Acute myeloid leukemia: An overview | A | Acute myeloid leukemia: An overview | Acute Myeloid Leukemia: An Overview | | English | Oncology | Child (0-12 years);Teen (13-18 years) | Body | Skeletal system | Conditions and diseases | Adult (19+) | NA | | 2018-03-06T05:00:00Z | | | | | | 8.40000000000000 | 54.5000000000000 | 611.000000000000 | | Flat Content | Health A-Z | <p>Learn about how acute myeloid leukemia (AML) develops and what factors may affect the development of the disease.</p> | <h2>What is acute myeloid leukemia (AML)?</h2>
<p>AML is a cancer of the blood and the bone marrow, which is the spongy tissue inside the bones. Without treatment, AML can progress rapidly and can be fatal. </p> | <h2>Key points </h2><ul><li>In AML, a mutated cell multiples and forms leukemic myeloblasts, which cannot do the same job as normal blood cells.</li><li>It is unclear as to what causes AML, but certain environmental factors and genetic and acquired syndromes may increase the change of developing it.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| Acute myeloid leukemia: bone marrow transplant | A | Acute myeloid leukemia: bone marrow transplant | Acute Myeloid Leukemia: Bone Marrow Transplant | | English | Oncology | Child (0-12 years);Teen (13-18 years) | Body | Skeletal system | Non-drug treatment | Adult (19+) | NA | | 2018-03-06T05:00:00Z | | | | | | 8.80000000000000 | 58.0000000000000 | 328.000000000000 | | Flat Content | Health A-Z | <p> Learn which children with acute myeloid leukemia are recommended for a bone marrow transplant (BMT).</p> | <p>A bone marrow transplant (BMT), also known as a stem cell transplant, is a procedure that places (transplants) healthy blood stem cells into a body where the stem cells have been destroyed by chemotherapy or radiation. It may be seen as a method to ‘rescue’ your child from the severe side effects of high dose chemotherapy and radiation. When the stem cells come from another person, the procedure is called an allogeneic BMT.</p>
<p>Your child may be recommended to have a BMT, depending on whether they have high-risk or low-risk AML. The risk category of your child’s AML depends on the type of chromosome changes that occur inside leukemic cells. </p> | <h2> Key points </h2>
<ul><li>A bone marrow transplant (BMT) transplants blood stem cells into a body where the stem cells have been destroyed by chemotherapy or radiation.</li>
<li>A BMT is not usually recommended for low-risk groups of AML.</li>
<li> Children with high-risk AML re recommended for a BMT.</li></ul> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Main |
| Acute pain | A | Acute pain | Acute pain | | English | Pain/Anaesthesia | Child (0-12 years);Teen (13-18 years) | Body | Nervous system | Symptoms | Caregivers
Adult (19+) | Pain | | 2019-01-25T05:00:00Z | | | | | | 8.90000000000000 | 58.0000000000000 | 612.000000000000 | | Flat Content | Health A-Z | <p>Learn how the body experiences acute pain.</p> | <p>Acute pain is usually described as sharp or stinging pain. It typically comes and goes quickly and provides a warning signal to the body that something is wrong.</p> | <h2>Key points</h2><ul><li>Pain occurs when the body's tissues are damaged from injuries, infections or painful procedures.</li><li>Acute pain tends to come on quickly and last a short time. It affects each child differently.</li></ul> | | | | | | | | | | | | | | | | | | | | <h2>Websites</h2><p>Jokes to help distract toddlers and preschoolers<br><a href="https://kidsactivitiesblog.com/24447/jokes-for-kids/" target="_blank">https://kidsactivitiesblog.com/24447/jokes-for-kids</a></p><p>Preparing your child with cancer for painful procedures<br><a href="https://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures" target="_blank">https://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures</a></p><p>Managing needle pain for your child with cancer<br><a href="https://cancerkn.com/tips-manage-childs-needle-pain/" target="_blank">https://cancerkn.com/tips-manage-childs-needle-pain/</a></p><h2>Videos</h2><p>Pain management at SickKids<br><a href="https://www.youtube.com/watch?v=_9_OQFo2APA" target="_blank">https://www.youtube.com/watch?v=_9_OQFo2APA</a></p><p>Reducing the pain of vaccination in children (2 mins 18 secs)<br><a href="https://www.youtube.com/watch?v=KgBwVSYqfps" target="_blank">https://www.youtube.com/watch?v=KgBwVSYqfps</a></p><p>Reducing the pain of vaccination in children (20 mins 52 secs)<br><a href="https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I" target="_blank">https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I</a></p><p>Learning how to manage pain from medical procedures (Stanford Children's Health) (12 mins 58 secs)<br><a href="https://www.youtube.com/watch?v=UbK9FFoAcvs&feature=youtu.be" target="_blank">https://youtu.be/UbK9FFoAcvs</a></p> | <p>Content developed by Rebecca Pillai Riddell, PhD, CPsych, OUCH Lab, York University, Toronto, in collaboration with:<br>Lorraine Bird, MScN, CNS, Fiona Campbell, BSc, MD, FRCA, Bonnie Stevens, RN, PhD, FAAN, FCAHS, Anna Taddio, BScPhm, PhD<br> Hospital for Sick Children</p><h3>References</h3><p>Blount, R. L., Cohen, L. L., Frank, N. C., Bachanas, P. J., Smith, A. J., Manimala, M. R., & Pate, J. T. (1997). The Child-Adult Medical Procedure Interaction Scale–Revised: An assessment of validity. Journal of Pediatric Psychology, 22(1), 73-88.</p><p>Campbell, L., DiLorenzo, M., Atkinson, N., & Riddell, R. P. (2017a). Systematic Review: A Systematic Review of the Interrelationships Among Children's Coping Responses, Children's Coping Outcomes, and Parent Cognitive-Affective, Behavioral, and Contextual Variables in the Needle-Related Procedures Context. Journal of Pediatric Psychology, 42(6), 611-621. <a href="https://academic.oup.com/jpepsy/article/42/6/611/3073481" target="_blank">https://doi.org/10.1093/jpepsy/jsx054</a></p><p>Campbell, L., Riddell, R. P., Cribbie, R., Garfield, H., & Greenberg, S. (2017b). Preschool children's coping responses and outcomes in the vaccination context: Child and caregiver transactional and longitudinal relationships. <em>Pain</em><em></em><em></em>. <a href="https://insights.ovid.com/crossref?an=00006396-201802000-00015" target="_blank">https://doi.org/10.1097/j.pain.0000000000001092</a></p><p>Merkel, S., Voepel-Lewis, T., Shayevitz, J. R., & Malviya, S. (1997). The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs, 23, 293-7.</p><p>Taddio A., McMurtry, C. M., Shah, V., Pillai Riddell, R. et al. Reducing pain during vaccine injections: clinical practice guideline. CMAJ 2015. DOI:10.1503 /cmaj.150391</p><p>Uman, L.S., Birnie, K.A., Noel, M., Parker, J.A., Chambers, C.T., McGrath, P.J., Kisely, S.R. (2013) Psychological interventions for needle-related procedural pain and distress in children and adolescents. <em>Cochrane Database of Systematic Reviews</em> 2013, Doi: 10.1002/14651858.CD005179.pub3</p><p>von Baeyer, C.L., Jaaniste, T., Vo, H.L.T., Brunsdon, G., Lao, AH-C, Champion, G.D. Systematic review of self-report measures of pain intensity in 3- and 4-year-old children: Bridging a period of rapid cognitive development. <em>Journal of Pain</em>, 2017; 18(9):1017-1026.
<a href="https://www.sciencedirect.com/science/article/pii/S1526590017305199?via%3Dihub" target="_blank">https://doi.org/10.1016/j.jpain.2017.03.005.</a></p> | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/bleeding_first_aid.jpg | | Main |
| Acute pain: Effective parenting for teens | A | Acute pain: Effective parenting for teens | Acute pain: How parenting can support the 3P approach with teens | | English | Pain/Anaesthesia | Teen (13-18 years) | NA | Nervous system | Conditions and diseases;Symptoms;Non-drug treatment | Adult (19+)
Caregivers | Pain | | 2019-01-25T05:00:00Z | | | | | | 10.4000000000000 | 50.2000000000000 | 639.000000000000 | | Flat Content | Health A-Z | <p>Find out how you can use effective parenting to support the 3Ps of pain management for your teen with acute pain.</p> | <p>The teenage years are a period of development that comes with unique challenges such as the desire for independence, figuring out one's identity, navigating the parent-teen relationship and dealing with the increased influence of peer relationships.</p> | <h2>Key points</h2><ul><li>Encourage your teen's independence, in spite of any pain they are feeling, and ask them what helps them cope with pain.</li><li>Try not to let your worries or fears about your teen's pain affect your teen's wellbeing.</li><li>Support your teen in looking up credible sources of online information about pain management.</li></ul> | | | | | | | | | | | | | | | | | | | | <h2>Websites</h2><p>Distraction toolkit<br><a href="http://ken.caphc.org/xwiki/bin/view/Paediatric+Pain/Distraction+Toolkit" target="_blank">http://ken.caphc.org/xwiki/bin/view/Paediatric+Pain/Distraction+Toolkit</a></p><p>Using guided imagery and breathing exercises<br><a href="http://academic.laverne.edu/~ear/gsp/2012/AdamHerro_GuidedImagery_CL_Handbook" target="_blank">http://academic.laverne.edu/~ear/gsp/2012/AdamHerro_GuidedImagery_CL_Handbook</a></p><p>Managing your child's pain from braces<br><a href="https://1stfamilydental.com/reducing-braces-pain/" target="_blank">https://1stfamilydental.com/reducing-braces-pain/</a></p><p>Managing your child's pain from sports injuries<br><a href="http://www.stanfordchildrens.org/en/topic/default?id=tackling-kids-sports-injuries-1-4288" target="_blank">http://www.stanfordchildrens.org/en/topic/default?id=tackling-kids-sports-injuries-1-4288</a></p><p>Preparing your child with cancer for painful procedures<br><a href="http://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures" target="_blank">http://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures</a></p><p>Managing needle pain for your child with cancer<br><a href="https://cancerkn.com/tips-manage-childs-needle-pain/" target="_blank">https://cancerkn.com/tips-manage-childs-needle-pain/</a></p><h2>Videos</h2><p>Pain management at SickKids (2 mins 49 secs)<br><a href="https://www.youtube.com/watch?v=_9_OQFo2APA" target="_blank">https://www.youtube.com/watch?v=_9_OQFo2APA</a></p><p>Reducing the pain of vaccination in children (Centre for Pediatric Pain Research) (2 mins 18 secs):<br><a href="https://www.youtube.com/watch?v=KgBwVSYqfps" target="_blank">https://www.youtube.com/watch?v=KgBwVSYqfps</a></p><p>Reducing the pain of vaccination in children (Dr. Taddio) (20 mins 52 secs):<br><a href="https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I" target="_blank">https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I</a></p><p>Learning how to manage pain from medical procedures (Stanford Children's Health) (12 mins 58 secs)<br><a href="https://youtu.be/UbK9FFoAcvs"></a>
<a href="https://youtu.be/UbK9FFoAcvs" target="_blank">https://youtu.be/UbK9FFoAcvs</a></p> | <p>Content developed by Rebecca Pillai Riddell, PhD, CPsych, OUCH Lab, York University, Toronto, in collaboration with:<br>Lorraine Bird, MScN, CNS, Fiona Campbell, BSc, MD, FRCA, Bonnie Stevens, RN, PhD, FAAN, FCAHS, Anna Taddio, BScPhm, PhD<br> Hospital for Sick Children</p><h3>References</h3><p>Gold, J.I., Mahrer, N. E. (2017). Is Virtual Reality Ready for Prime Time in the Medical Space? A Randomized Control Trial of Pediatric Virtual Reality for Acute Procedural Pain Management. <em>Journal of Pediatric Psychology</em>, 2017; DOI: <a href="http://dx.doi.org/10.1093/jpepsy/jsx129" target="_blank">10.1093/jpepsy/jsx129</a></p><p>Henderson, E. M., Eccleston, C. (2015). An online adolescent message board discussion about the internet: Use for pain Journal of Child Health Care 2015, Vol. 19(3) 412–418</p><p>McMurtry, C. M., Chambers, C. T., McGrath, P. J., & Asp, E. (2010). When "don't worry" communicates fear: Children's perceptions of parental reassurance and distraction during a painful medical procedure. Pain, 150(1), 52-58.</p><p>National Network of Libraries of Medicine. Downloaded on March 29, 2018. <a href="https://nnlm.gov/initiatives/topics/health-websites" target="_blank">https://nnlm.gov/initiatives/topics/health-websites</a></p><p>Uman, L.S., Birnie, K.A., Noel, M., Parker, J.A., Chambers, C.T., McGrath, P.J., Kisely, S.R. (2013). Psychological interventions for needle-related procedural pain and distress in children and adolescents. <em>Cochrane Database of Systematic Reviews</em> 2013, Doi: 10.1002/14651858.CD005179.pub3</p><p>Taddio, A., McMurtry, C.M., Shah, V., Pillai Riddell, R. et al. Reducing pain during vaccine injections: clinical practice guideline. CMAJ 2015. DOI: <a href="http://dx.doi.org/10.1503/cmaj.150391" target="_blank">10.1503/cmaj.150391</a></p> | | | | | | | | | Main |
| Acute pain: How to assess in infants and toddlers | A | Acute pain: How to assess in infants and toddlers | Acute pain: How to assess in infants and toddlers | | English | Pain/Anaesthesia | Newborn (0-28 days);Baby (1-12 months);Toddler (13-24 months) | NA | Nervous system | Symptoms | Adult (19+)
Caregivers | Pain | | 2019-01-25T05:00:00Z | | | | | | 10.5000000000000 | 42.5000000000000 | 1136.00000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>Find out how your infant's or toddler's acute pain is assessed at home and in medical settings.</p> | <h2>What causes acute pain in infants and toddlers?</h2><p>In infants and toddlers, common causes of acute pain include:</p><ul><li>teething</li><li>a bump or fall</li><li>ear infections</li><li>vaccinations by needle</li><li>heel lances to obtain a blood sample</li><li>procedures such as inserting a catheter (thin tube) or doing a lumbar puncture</li></ul><p>As a rule, anything that causes pain in older children or adults (such as inserting a needle or catheter) will also cause pain in your infant or toddler. So if your young child is having a procedure that you would find painful, they are likely experiencing at least as much pain as you would experience.</p><p>Indeed, certain procedures may be more painful for young children because their brains cannot yet help them cope with pain, for example by using distraction. Never discount your young child's pain-related distress even if they have an injury or procedure that you would not find painful.</p> | <h2>Key points</h2><ul><li>In infants and toddlers, common causes of acute pain include teething, bumps or falls, and vaccinations by needle.</li><li>Signs of acute pain in this age group include irritability, whimpering, sudden changes to facial expression and flailing of arms or legs.<br></li><li>In medical settings, health-care providers assess pain by using standard tools and checking your baby's heart and breathing rate, and their oxygen levels.</li><li>Always feel free to share your own opinion and any concerns about your child's pain with the health-care team.</li></ul> | <h2>Assessing acute pain at home </h2><p>Because your young child cannot speak yet, you can only tell how much pain they are experiencing through the painful situation and their behaviour. In this case, the context means thinking about whether the procedure would be painful for an older child or could be painful for a young child even if not painful for someone older. Based on this information, you would then watch for any changes in your child's behaviour.</p><p>Behavioural signs of acute pain include:</p><ul><li>irritability</li><li>sharp changes in facial expressions (for example grimacing with eyes shut and brow bulging)</li><li>crying or whimpering</li><li>flailing or thrashing arms or legs</li><li>changes in their feeding, playing and/or sleeping routines</li><li>rigidness or limpness</li><li>changes in breathing</li><li>changes in how they interact with people and things around them</li></ul> | | <h2>Assessing acute pain in medical settings</h2><p>In the hospital, your child's health-care team uses a range of tools to determine how much pain an infant is feeling. </p><p>In the NICU setting, one of the most common tools for assessing pain in infants is the
<a href="https://www.semanticscholar.org/paper/The-premature-infant-pain-profile-revised-%28PIPP-R%29:-Stevens-Gibbins/76e49d44432665d7dffd5a9a7a2fdd55466f7f32/figure/0" target="_blank">Premature Infant Pain Profile-Revised (PIPP-R)</a>. This tool rates many of the behaviours that a child might display at home as well as physiological signs (signs inside the body), such as your infant's:</p><ul><li>heart rate<br></li><li>oxygen saturation (how much oxygen is in their blood)<br></li><li>breathing rate</li></ul><p>For older infants and children aged up to two, health-care providers usually use the
<a href="http://www.olchc.ie/Healthcare-Professionals/Nursing-Practice-Guidelines/Pain-FLACC-Behavioural-Pain-Assessment-Scale-2015.pdf" target="_blank">Faces, Legs, Activity, Cry and Consolability (FLACC) scale</a>. This tool looks at several of the behaviours described above.</p>
<p>In medical settings, your child's health-care team plays an important role in clarifying the level and cause of pain, but feel free to share your opinions and concerns about your infant's pain with them.</p> | | | | | | | | | | | | | | | | | <h2>Websites</h2><p>Comforting Your Baby in Intensive Care<br>
<a href="http://familynursing.ucsf.edu/comforting-your-baby-intensive-care" target="_blank">http://familynursing.ucsf.edu/comforting-your-baby-intensive-care</a></p><h2>Videos</h2><p><a href="https://www.youtube.com/watch?v=9OgCQKOnn-I" target="_blank">Bringin' up Baby: Soothing the Pain</a> (3 mins 50 secs)<br>Psychological and physical strategies for parents to reduce vaccination pain in healthy infants</p><p><a href="https://www.youtube.com/watch?v=5Oqa1Fag5eQ" target="_blank">Reduce the pain of vaccination in babies</a> (13 mins 08 secs)<br> Tips for parents on helping healthy infants get through vaccinations</p><p><a href="https://www.youtube.com/watch?v=-Y49FOGtmwo" target="_blank">Easing your baby's pain: A mother's story</a> (3 mins 07 secs)<br> Three ways to instantly reduce your infant's pain in the NICU</p><p><a href="https://www.youtube.com/watch?v=3nqN9c3FWn8" target="_blank">The Power of a Parent's Touch</a> (2 mins 40 secs)<br> How breastfeeding and skin-to-skin contact can help when an infant is experiencing a painful procedure</p> | <p>Content developed by Rebecca Pillai Riddell, PhD, CPsych, OUCH Lab, York University, Toronto, in collaboration with:<br>Lorraine Bird, MScN, CNS, Fiona Campbell, BSc, MD, FRCA, Bonnie Stevens, RN, PhD, FAAN, FCAHS, Anna Taddio, BScPhm, PhD<br> Hospital for Sick Children</p>
<h3>References</h3><p>Anand, K.J.S. (2012). Assessment of neonatal pain. In J. A. Garcia-Prats & M. S. Kim (Eds.), UpToDate. UpToDate: Waltham, MA.</p><p>International Association for the Study of Pain (2010) Fact Sheet on Mechanisms of Acute Pain. <a href="https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/AcutePainFactSheets/3-Mechanisms.pdf" target="_blank">https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/AcutePainFactSheets/3-Mechanisms.pdf</a> [Accessed March 29, 2018]</p><p>Mathew, P.J., & Mathew, J.L. (2003). Assessment and management of pain in infants. Postgraduate Medical Journal, 79(934), 438-443.</p><p>McGrath, P.J. (1985). CHEOPS: a behavioral scale for rating postoperative pain in children. Adv Pain Res Ther, 9, 395.</p><p>Merkel, S., Voepel-Lewis, T., & Malviya, S. (2002). Pain Assessment in Infants and Young Children: The FLACC Scale: A behavioral tool to measure pain in young children. AJN The American Journal of Nursing, 102(10), 55-58.</p><p>Ohlsson, A., & Shah, P.S. (2015). Paracetamol (acetaminophen) for prevention or treatment of pain in newborns. Cochrane Database Syst Rev, 6(6).</p><p>Pillai Riddell, R., Lisi, D., Campbell, L. (2013). Pain Assessment in Neonates. In Encyclopedia of Pain, 2<sup>nd</sup> edition.</p><p>Pillai Riddell, R.R, Racine, N.M., Gennis H.G., Turcotte, K., Uman, L.S., Horton, R.E., Ahola Kohut, S., Hillgrove Stuart, J., Stevens, B., & Lisi, D.M. (2015). Non-pharmacological management of infant and young child procedural pain. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD006275</p><p>Pillai Riddell, R., O'Neill, M., Campbell, L., Taddio, A., Greenberg, S., Garfield, H. (2018). The ABCDs of Pain Management: A Double-Blind Randomized Controlled Trial for a Brief Educational Video for Parents of Young Children undergoing Vaccination.
<em>Journal of Pediatric Psychology.</em> Volume 43, Issue 3, 1 April 2018, Pages 224-233,
<a href="https://doi.org/10.1093/jpepsy/jsx122" target="_blank">https://doi.org/10.1093/jpepsy/jsx122</a></p><p>Pillai Riddell, R.R., Racine, N.M., Gennis, H.G., Turcotte, K., Uman, L.S., Horton, R.E., ... & Lisi, D.M. (2015). Non‐pharmacological management of infant and young child procedural pain. The Cochrane Library.</p><p>Stevens, B., Yamada, J., Campbell-Yeo, M. Gibbins, S., Harrison D., Dionne, K., Taddio, A., McNar C Willan, A., Ballantyne, M., Widger, K., Sidani, S., Estabrooks, C., Synnes, A., Squires J., Victor, C., and Riahi, S. (2018). The minimally effective dose of sucrose for procedural pain relief in neonates: a randomized controlled trial.
<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5824554/" target="_blank">BMC Pediatr</a>. 2018; 18: 85.</p><p>Stevens, B.J., Gibbins, S., Yamada, J., Dionne, K., Lee, G., Johnston, C., & Taddio, A. (2014). The premature infant pain profile-revised (PIPP-R): initial validation and feasibility. The Clinical journal of pain, 30(3), 238-243. </p><p>Stevens, B.J., Abbott, L.K., Yamada, J., Harrison, D., Stinson, J., Taddio, A., & Campbell, F. (2011). Epidemiology and management of painful procedures in children in Canadian hospitals.
<em>Canadian Medical Association Journal</em>,
<em>183</em>(7), E403-E410.</p><p>Stevens, B., Yamada, J., Lee, G.Y., & Ohlsson, A. (2013). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev, 1(1).</p><p>Taddio, A., McMurtry, C.M., Shah, V., Riddell, R.P., Chambers, C.T., Noel, M., & Lang, E. (2015). Reducing pain during vaccine injections: clinical practice guideline.
<em>Canadian Medical Association Journal</em>, <em>187</em>(13), 975-982.</p> | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/ear_infections_sore_throat_babies.jpg | | Main |
| Acute pain: How to assess in older children | A | Acute pain: How to assess in older children | Acute pain: How to assess in older children | | English | Pain/Anaesthesia | School age child (5-8 years);Pre-teen (9-12 years) | NA | Nervous system | Conditions and diseases;Symptoms | School age child (5-8 years)
Pre-teen (9-12 years) | Pain | | 2019-01-25T05:00:00Z | | | | | | 9.60000000000000 | 55.3000000000000 | 1116.00000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>Discover how to assess acute pain in an older child (age six to 12) at home and in medical settings.</p> | <h2>What causes acute pain in older children?</h2><p>In older children (ages six to 12), common causes of
<a href="/Article?contentid=2982&language=English">acute pain</a> include:</p><ul><li>routine vaccinations by needle</li><li>earaches and sore throats</li><li>injuries from everyday physical activities</li><li>dental treatments such as cavity fillings</li><li>procedures such as blood work, lumbar punctures or intravenous starts</li><li>surgeries (operations)</li><li>complex health conditions such as cancer or juvenile arthritis</li></ul> | <h2>Key points</h2><ul><li>In older children, common causes of acute pain include routine vaccinations, infections, surgeries and complex health conditions.</li><li>At this age, children can self-report their pain rather than have a parent or health-care professional speak for them.</li><li>In medical settings, health-care providers may still want to assess your child's pain with tools such as the Faces Pain Scale - Revised or other tools if your child cannot express their pain in words.</li><li>Help your child feel safe to report their pain so they can receive the most appropriate assessment and treatment.</li></ul> | <h2>Assessing acute pain at home</h2><p>Older children can usually "self-report" their pain (describe it in their own words or rate how bad it is) rather than have a parent or health-care professional speak for them.</p><p>One reason is that they can use specific pain words (such as "aching", "burning" or "stabbing") to better explain their experience and where exactly in the body their pain is coming from. Older children can also start reporting what can make their pain better or worse.</p><p>But it is important to remember that children at the younger end of this age group may be too fearful or stressed to self-report their pain accurately.<br></p> | | <h2>Assessing acute pain in medical settings</h2><p>At this age, it is usually best for a child who can talk about their pain to self-report it in the hospital.</p><p>Most children in this age group can rate their level of pain using pain scales. Children around the age of six may use words like "small", "medium" or "a lot" to rate their pain or be able to use a picture pain scale such as the Faces Pain Scale - Revised.</p>
<figure class="asset-c-100">
<span class="asset-image-title">Faces Pain Scale - Revised</span>
<img alt="Six faces showing increasing discomfort from left to right" src="https://assets.aboutkidshealth.ca/AKHAssets/PN_faces_scale_MISC_IMG_EN.jpg" />
<figcaption class="asset-image-caption">Faces Pain Scale - Revised. Copyright ©2001,
<a href="https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1519" target="_blank">International Association for the Study of Pain</a>. Reproduced with permission.</figcaption>
</figure>
<p>Older children in this group can use numeric rating scales, for example by verbally rating their pain from 0 to 10, where 0 is 'no pain' and 10 is the worst or strongest pain they can imagine. With repeated use, these scales can reveal if your child's pain is changing (getting better or worse) over time.</p><p>Body diagrams can also be helpful tools for assessing an older child's pain. Older children can point at the diagram and share exactly where they are feeling pain in their body.</p>
<figure class="asset-c-100">
<span class="asset-image-title">Sample body diagram</span>
<img alt="Body diagram to allow child to pinpoint pain" src="https://assets.aboutkidshealth.ca/AKHAssets/SuperKidz%20pain%20assessment%20body%20diagram%20age%204-8.PNG" />
<figcaption class="asset-image-caption">Body diagram used as part of SUPER-KIDZ pain measurement tool ©2012, Stinson, J. et al. Reproduced with permission.</figcaption>
</figure> | | <h2>Factors affecting pain assessment</h2><p>A developmental disability or intellectual disability may make it difficult for your child to express their pain in words. In this case, their health-care team will use standard pain assessment tools to look at their behaviour. One such tool is the
<a href="http://www.community-networks.ca/wp-content/uploads/2015/07/PainChklst_BreauNCCPC-R2004.pdf" target="_blank">NCCPC</a>, which helps make caregivers more aware if a child's behaviour may be different than usual due to pain.</p><p>Gender can affect how children express pain and how accurately their pain might be assessed. For instance, older boys may put a lot of effort into making sure they do not cry, especially if others are around. On the other hand, young girls may cry more because this behaviour is deemed more acceptable in some cultures. Or, the opposite may happen. It is important to ask a child about their pain and not make assumptions based on gender or sex.</p>
<p>Cultural differences can also account for a wide variety of reactions to situations. Some cultures may express themselves freely, but others may repress their emotions or respond to pain in unexpected ways. Some children may adopt the role of a "good patient" and behave the way they believe health-care professionals want them to behave rather than express how they are feeling.</p> | | | | | | | | | | | | | | | <h2>Websites</h2><p>Faces Pain Scale-Revised<br><a href="https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1519" target="_blank">https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1519</a></p><p>Distraction toolkit<br><a href="https://ken.childrenshealthcarecanada.ca/xwiki/bin/view/Paediatric+Pain/Distraction+Toolkit" target="_blank">https://ken.childrenshealthcarecanada.ca/xwiki/bin/view/Paediatric+Pain/Distraction+Toolkit</a></p><p>Reducing the pain of vaccination in children and teens (PDF)<br><a href="https://immunize.ca/sites/default/files/Resource%20and%20Product%20Uploads%20%28PDFs%29/Products%20and%20Resources/Pain%20Management/Parents/painreduction_kidsandteens_web_e.pdf" target="_blank">https://immunize.ca/sites/default/files/Resource%20and%20Product%20Uploads%20%28PDFs%29/Products%20and%20Resources/Pain%20Management/Parents/painreduction_kidsandteens_web_e.pdf</a></p><p>Managing your child's pain from braces<br><a href="https://blog.1stfamilydental.com/reducing-braces-pain/" target="_blank">https://blog.1stfamilydental.com/reducing-braces-pain/</a></p><p>Managing your child's pain from sports injuries<br><a href="https://www.stanfordchildrens.org/en/topic/default?id=tackling-kids-sports-injuries-1-4288" target="_blank">https://www.stanfordchildrens.org/en/topic/default?id=tackling-kids-sports-injuries-1-4288</a></p><p>Preparing your child with cancer for painful procedures<br><a href="https://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures" target="_blank">https://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures</a></p><p>Managing needle pain for your child with cancer<br><a href="https://cancerkn.com/tips-manage-childs-needle-pain/" target="_blank">https://cancerkn.com/tips-manage-childs-needle-pain/</a></p><h2>Videos</h2><p>Pain management at SickKids (2 mins 49 secs)<br><a href="https://www.youtube.com/watch?v=_9_OQFo2APA" target="_blank">https://www.youtube.com/watch?v=_9_OQFo2APA</a></p><p>Reducing the pain of vaccination in children (Centre for Pediatric Pain Research) (2 mins 18 secs)<br><a href="https://www.youtube.com/watch?v=KgBwVSYqfps" target="_blank">https://www.youtube.com/watch?v=KgBwVSYqfps</a></p><p>Reducing the pain of vaccination in children (Dr. Taddio) (20 mins 52 secs)<br><a href="https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I" target="_blank">https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I</a></p><p>Learning how to manage pain from medical procedures (Stanford Children's Health) (12 mins 58 secs)<br><a href="https://www.youtube.com/watch?v=UbK9FFoAcvs&feature=youtu.be" target="_blank">https://you.tube/UbK9FFoAcvs</a></p> | <p>Content developed by Rebecca Pillai Riddell, PhD, CPsych, OUCH Lab, York University, Toronto, in collaboration with:<br>Lorraine Bird, MScN, CNS, Fiona Campbell, BSc, MD, FRCA, Bonnie Stevens, RN, PhD, FAAN, FCAHS, Anna Taddio, BScPhm, PhD<br> Hospital for Sick Children</p><h3>References</h3><p>Gold, J.I., Mahrer, N.E. (2017) Is Virtual Reality Ready for Prime Time in the Medical Space? A Randomized Control Trial of Pediatric Virtual Reality for Acute Procedural Pain Management. <em>Journal of Pediatric Psychology</em>, 2017;
<a href="https://academic.oup.com/jpepsy/article/43/3/266/4558507" target="_blank">https://doi.org/10.1093/jpepsy/jsx129</a></p><p>Hicks, C.L., von Baeyer, C.L., Spafford, P., van Korlaar, I., Goodenough, B. (2001). The Faces Pain Scale - Revised: Toward a common metric in pediatric pain measurement.
<em>Pain</em> 2001;93:173-183.</p><p>McMurtry, C.M., Chambers, C.T., McGrath, P.J., & Asp, E. (2010). When "don't worry" communicates fear: Children's perceptions of parental reassurance and distraction during a painful medical procedure. Pain, 150(1), 52-58.</p><p>Uman, L.S., Birnie, K.A., Noel, M., Parker, J.A., Chambers, C.T., McGrath, P.J., Kisely, S.R. (2013) Psychological interventions for needle-related procedural pain and distress in children and adolescents.
<em>Cochrane Database of Systematic Reviews. </em><a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005179.pub3/full" target="_blank">https://doi.org/10.1002/14651858.CD005179.pub3</a></p><p>Taddio, A., McMurtry, C.M., Shah, V., Pillai Riddell. R. et al. Reducing pain during vaccine injections: clinical practice guideline. CMAJ 2015.
<a href="http://www.cmaj.ca/content/187/13/975" target="_blank">https://doi.org/10.1503/cmaj.150391</a></p><p>von Baeyer, C.L. (2009). Children's self-report of pain intensity: what we know, where we are headed. Pain Research and Management, 14(1), 39-45.</p> | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/anorexia_treatment_options.jpg | | Main |
| Acute pain: How to assess in teens | A | Acute pain: How to assess in teens | Acute pain: How to assess in teens | | English | Pain/Anaesthesia | Teen (13-18 years) | NA | Nervous system | Conditions and diseases;Symptoms | Adult (19+)
Caregivers | Pain | | 2019-01-25T05:00:00Z | | | | | | 9.70000000000000 | 55.0000000000000 | 1112.00000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>Find out how to recognize the signs of acute pain at home and how your teen's pain is assessed in medical settings.</p> | <h2>What causes acute pain in teens?</h2><p>In teens, common causes of acute pain include:</p><ul><li>routine vaccinations by needle</li><li>dental or orthodontic treatments (such as cavity fillings or tightening braces or retainers)</li><li>injuries from sports (such as bruises, sprains or fractures)</li><li>menstruation</li><li>procedures such as blood work, lumbar punctures, intravenous starts</li><li>surgeries (operations)</li><li>complex health conditions such as cancer or juvenile arthritis</li></ul> | <h2>Key points</h2><ul><li>Common causes of acute pain in teens include dental or orthodontic treatments, sports injuries, menstruation and complex health conditions.</li><li>Teens are usually well able to self-report their pain, but other signs of pain include swift mood changes, difficulty moving and withdrawal from social activities.</li><li>In medical settings, health-care professionals will assess your teen's pain based mostly on your teen's self-report and may use pain scales to help your teen pinpoint the severity of their pain.</li><li>Encourage and support your teen to express their pain to health-care providers confidently and precisely so they can receive the most appropriate treatment.</li></ul> | <p>Most teens are well equipped to "self-report" their
<a href="/Article?contentid=2982&language=English">acute pain</a> (describe it in their own words or rate how bad it is) rather than have a parent or health-care professional speak for them. At this age, teens can also easily distinguish between acute physical pain and emotional distresses (for instance feeling scared or anxious).</p><h2>Assessing acute pain at home</h2><p>Aside from self-reports, you may know when your teen is in pain through changes in their behaviour. For example, your teen may:</p><ul><li>be more irritable</li><li>display stronger and quicker changes in mood than normal</li><li>have difficulty moving normally</li><li>withdraw from socializing</li></ul> | | <h2>Assessing acute pain in medical settings</h2><p>In the hospital, your teen's health-care team may use pain measurement scales that use words or numbers.</p><p>All professionals agree that a teen's self-report of pain takes priority over observation by others. In other words, even if a teen can laugh or sleep or otherwise does not <em>look</em> like they are in pain, if they <em>say</em> they are in pain it must be taken seriously.</p><p>Most teens can rate the severity (level) of their pain using the same pain scales that adults use. One common tool is a numeric rating scale that allows patients to verbally rate their pain from 0 to 10, where 0 is 'no pain' and 10 is the worst or strongest pain they can imagine.</p>
<p>When this tool is used with a teen for the first time, they may be asked to point to a number from 0 to 10 on paper. This encourages them to limit their rating to whole numbers on the scale. With repeated use, the numeric rating scale can reveal if pain is changing (getting better or worse) over time.</p> | | <h2>Factors affecting pain assessment</h2><p>A developmental disability or intellectual disability may make it difficult for your teen to express their pain in words. In this case, their health-care team will use standard pain assessment tools to look at their behaviour. One such tool is the
<a href="http://www.community-networks.ca/wp-content/uploads/2015/07/PainChklst_BreauNCCPC-R2004.pdf" target="_blank">NCCPC</a>, which helps make caregivers more aware if a teen's behaviour may be different than usual due to pain.</p><p>Gender can have affect how teens express pain and how accurately their pain might be assessed. Teenage boys may put a lot of effort into making sure they do not cry, especially if others are around. On the other hand, teen girls may cry more because this behaviour is deemed more acceptable in some cultures. Or the reverse may be true.</p><p>Cultural differences can also account for a wide variety of reactions to situations. Some cultures may express themselves freely, but others may repress their emotions or respond to pain in unexpected ways. Some teens may adopt the role of a "good patient" and behave the way they believe health-care professionals want them to behave rather than express how they are feeling.</p> | | | | | | | | | | | | | | | <h2>Websites</h2><p>Distraction toolkit<br><a href="http://ken.caphc.org/xwiki/bin/view/Paediatric+Pain/Distraction+Toolkit" target="_blank">http://ken.caphc.org/xwiki/bin/view/Paediatric+Pain/Distraction+Toolkit</a></p><p>Using guided imagery and breathing exercises<br><a href="http://academic.laverne.edu/~ear/gsp/2012/AdamHerro_GuidedImagery_CL_Handbook" target="_blank">http://academic.laverne.edu/~ear/gsp/2012/AdamHerro_GuidedImagery_CL_Handbook</a></p><p>Managing your child's pain from braces<br><a href="https://1stfamilydental.com/reducing-braces-pain/" target="_blank">https://1stfamilydental.com/reducing-braces-pain/</a></p><p>Managing your child's pain from sports injuries<br><a href="http://www.stanfordchildrens.org/en/topic/default?id=tackling-kids-sports-injuries-1-4288" target="_blank">http://www.stanfordchildrens.org/en/topic/default?id=tackling-kids-sports-injuries-1-4288</a></p><p>Preparing your child with cancer for painful procedures<br><a href="http://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures" target="_blank">http://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures</a></p><p>Managing needle pain for your child with cancer<br><a href="https://cancerkn.com/tips-manage-childs-needle-pain/" target="_blank">https://cancerkn.com/tips-manage-childs-needle-pain/</a></p><h2>Videos</h2><p>Pain management at SickKids (2 mins 49 secs)<br><a href="https://www.youtube.com/watch?v=_9_OQFo2APA" target="_blank">https://www.youtube.com/watch?v=_9_OQFo2APA</a></p><p>Reducing the pain of vaccination in children (Centre for Pediatric Pain Research) (2 mins 18 secs)<br><a href="https://www.youtube.com/watch?v=KgBwVSYqfps" target="_blank">https://www.youtube.com/watch?v=KgBwVSYqfps</a></p><p>Reducing the pain of vaccination in children (Dr. Taddio) (20 mins 52 secs)<br><a href="https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I" target="_blank">https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I</a></p><p>Learning how to manage pain from medical procedures (Stanford Children's Health) (12 mins 58 secs)<br><a href="https://youtu.be/UbK9FFoAcvs" target="_blank">https://youtu.be/UbK9FFoAcvs</a></p> | <p>Content developed by Rebecca Pillai Riddell, PhD, CPsych, OUCH Lab, York University, Toronto, in collaboration with:<br>Lorraine Bird, MScN, CNS, Fiona Campbell, BSc, MD, FRCA, Bonnie Stevens, RN, PhD, FAAN, FCAHS, Anna Taddio, BScPhm, PhD<br> Hospital for Sick Children</p><h3>References</h3><p>Gold, J.I., Mahrer, N.E. (2017) Is Virtual Reality Ready for Prime Time in the Medical Space? A Randomized Control Trial of Pediatric Virtual Reality for Acute Procedural Pain Management. <em>Journal of Pediatric Psychology</em>, 2017 <a href="https://doi.org/10.1093/jpepsy/jsx129" target="_blank">https://doi.org/10.1093/jpepsy/jsx129</a></p><p>Henderson, E.M., Eccleston, C. (2015). An online adolescent message board discussion about the internet: Use for pain Journal of Child Health Care 2015, Vol. 19(3) 412–418</p><p>McMurtry, C.M., Chambers, C.T., McGrath, P.J., & Asp, E. (2010). When "don't worry" communicates fear: Children's perceptions of parental reassurance and distraction during a painful medical procedure. Pain, 150(1), 52-58.</p><p>National Network of Libraries of Medicine. Downloaded on March 29, 2018 <a href="https://nnlm.gov/initiatives/topics/health-websites" target="_blank">https://nnlm.gov/initiatives/topics/health-websites</a></p><p>Taddio, A., McMurtry, C.M., Shah, V., Pillai Riddell. R. et al. Reducing pain during vaccine injections: clinical practice guideline. CMAJ 2015. <a href="https://doi.org/10.1503/cmaj.150391" target="_blank">https://doi.org/10.1503/cmaj.150391</a></p><p>Uman, L.S., Birnie, K.A., Noel, M., Parker, J.A., Chambers, C.T., McGrath, P.J., Kisely, S.R. (2013) Psychological interventions for needle-related procedural pain and distress in children and adolescents. <em>Cochrane Database of Systematic Reviews </em><a href="https://doi.org/10.1002/14651858.CD005179.pub3" target="_blank">https://doi.org/10.1002/14651858.CD005179.pub3</a></p><p>von Baeyer, C.L. (2009). Children's self-report of pain intensity: what we know, where we are headed. Pain Research and Management, 14(1), 39-45.</p> | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/transplant_motivating_your_teen_to_develop_new_skills.jpg | | Main |
| Acute pain: How to assess in young children | A | Acute pain: How to assess in young children | Acute pain: How to assess in young children | | English | Pain/Anaesthesia | Preschooler (2-4 years);School age child (5-8 years) | NA | Nervous system | Conditions and diseases;Symptoms | Adult (19+)
Caregivers | Pain | | 2019-01-25T05:00:00Z | | | | | | 10.1000000000000 | 53.7000000000000 | 1624.00000000000 | | Health (A-Z) - Conditions | Health A-Z | <p>Find out how to assess acute pain in your young child (age two to five) at home and in medical settings.</p> | <h2>What causes acute pain in young children?</h2><p>In young children (ages two to five), acute pain is typically caused by:</p><ul><li>routine vaccinations by needle</li><li>earaches and sore throats</li><li>everyday bumps and bruises</li><li>injuries when learning how to walk, run and climb</li><li>dental treatments (such as cavity fillings)</li><li>procedures such as blood work, lumbar punctures or intravenous starts</li><li>surgeries (operations)</li><li>complex health conditions (such as cancer)</li></ul><p>Pain affects children differently. If your young child is undergoing a procedure that you would find painful, they are likely experiencing at least as much pain as you would experience. Indeed, certain procedures may be more painful for young children because their brains cannot yet help them cope with pain, for example through distraction or thinking positive coping thoughts.</p><p>At this age, it is hard for children to clearly tell the difference between distress from emotions (for example fear) and distress from pain when they experience procedures such as a needle poke. Research has shown that preschoolers who are more distressed before getting a needle express more pain right afterwards.</p><p>Never discount your young child's pain-related distress even if you feel that their injury or procedure would not be painful for you.</p> | <h2>Key points</h2><ul><li>In young children, common causes of acute pain include routine vaccinations, everyday bumps and bruises, infections, surgeries and procedures.</li><li>Behavioural signs of pain in this age group include muscle tension, squirming, arching the back and painful facial expressions.</li><li>In medical settings, health-care providers assess your child's pain with tools such as the Faces Pain Scale-Revised.</li><li>Be prepared for the pain your child might feel from procedures and encourage your child to express their pain so they can receive the most appropriate treatment.</li></ul> | <h2>Assessing acute pain at home</h2><p>You play an important role in recognizing if your young child is in pain. Watch for any changes in your child's behaviour and listen to what they say about their pain.</p><h3>Behavioural signs of acute pain</h3><p>These include:</p><ul><li>muscle tension or stiffness</li><li>squirming</li><li>arching the back</li><li>pained facial expressions (for example frowning, jaw clenching or grimacing)</li><li>drawing up the legs or kicking</li><li>guarding or protecting the painful area</li></ul><h3>Verbal and vocal signs of acute pain</h3><p>Verbal and vocal signs include whimpering, moaning or sobbing or sometimes being extra quiet or not wanting to talk. Depending on your child's ability with language, they may also be able to express their pain with words.</p><ul><li>Very young children (such as two-year-olds) may use simple words such as "ouchie" to express pain. They may also point to or protect a certain part of the body to show that it is hurting.</li><li>Through ages three and four, most children gradually learn to understand and describe around four levels of pain intensity ("none", "a little", "some" or "medium" and "a lot").</li></ul><p>When a child is aged four or five years, they are even better able to express their pain verbally. They might still confuse different types of hurt (for instance physical pain and hurt feelings), but that does not mean they do not have pain. They are learning and you need to help them understand different types of pain.</p> | | <h2>Assessing acute pain in medical settings</h2><p>In medical settings, such as the hospital, health-care professionals will work with you and your child to find the best way for your child to talk about their pain.</p><p>In a younger child, the health-care team will assess pain by looking at their behaviours as outlined above.</p><p>Some young children might be afraid to speak up about their pain for fear that they will get a needle or a medication that makes them feel sick. At first, it might be hard for young children to understand that painful procedures can make their pain better (for instance receiving pain medication through a needle). But you may encourage your child to talk about their pain without fear if you clearly explain why it is important for them to express pain and remind them about their positive experience with a painful procedure in the past.</p><p>Depending on your child's age and maturity, children around the age of four may be able to describe their pain using hands-on tools. With the Poker Chip Tool, for instance, caregivers can offer young children four poker chips and tell them each poker chip is a "piece of hurt". The more poker chips the child takes, the more pain they are feeling.</p><p>Some children as young as five can use pain scales such as the Faces Pain Scale - Revised to rate the intensity of their pain.</p>
<figure class="asset-c-100">
<span class="asset-image-title">Faces Pain Scale - Revised</span>
<img alt="Six faces showing increasing discomfort from left to right" src="https://assets.aboutkidshealth.ca/AKHAssets/PN_faces_scale_MISC_IMG_EN.jpg" />
<figcaption class="asset-image-caption">Faces Pain Scale - Revised. Copyright ©2001,
<a href="http://www.iasp-pain.org/fpsr" target="_blank">International Association for the Study of Pain</a>. Reproduced with permission.</figcaption> </figure>
<p>Other children at the upper end of this age group may be able to point to parts of their body or to body diagrams to show exactly where the pain is occurring.</p>
<figure class="asset-c-100">
<span class="asset-image-title">Sample body diagram</span>
<img alt="Body diagram to allow child pinpoint pain" src="https://assets.aboutkidshealth.ca/AKHAssets/SuperKidz%20pain%20assessment%20body%20diagram%20age%204-8.PNG" />
<figcaption class="asset-image-caption">Body diagram used as part of SUPER-KIDZ pain measurement tool ©2012, Stinson, J. et al. Reproduced with permission.</figcaption></figure>
<p>However, until a child is aged six or seven, you as their parent or caregiver would still need to help them report their pain and whether it is getting better or worse over time.</p> | | <h2>Factors that affect pain assessment</h2><p>A developmental disability or intellectual disability may make it difficult for your child to express their pain in words. In this case, their health-care team will use standard pain assessment tools to look at their behaviour. One such tool is the
<a href="http://www.community-networks.ca/wp-content/uploads/2015/07/PainChklst_BreauNCCPC-R2004.pdf" target="_blank">NCCPC</a>, which helps make caregivers more aware if a child's behaviour may be different than usual due to pain.</p><p>Gender can affect how children express pain and how accurately their pain might be assessed. For instance, small boys will cry, but older boys may put a lot of effort into making sure they do not, especially if others are around. On the other hand, young girls may cry more because this behaviour is deemed more acceptable in certain cultures. Or, the reverse could occur.</p><p>Cultural differences can also account for a wide variety of reactions to situations. Some cultures may express themselves freely, but others may repress their emotions or respond to pain in unexpected ways. Some children may adopt the role of a "good patient" and behave the way they believe health-care professionals want them to behave rather than express how they are feeling.</p> | | | | | | | | | | | | | | | <h2>Websites</h2><p>Jokes to help distract toddlers and preschoolers<br><a href="https://kidsactivitiesblog.com/24447/jokes-for-kids/" target="_blank">https://kidsactivitiesblog.com/24447/jokes-for-kids/</a></p><p>Preparing your child with cancer for painful procedures<br><a href="https://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures" target="_blank">https://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures</a></p><p>Managing needle pain for your child with cancer<br><a href="https://cancerkn.com/tips-manage-childs-needle-pain/" target="_blank">https://cancerkn.com/tips-manage-childs-needle-pain/</a></p><p>Faces Pain Scale - Revised<br><a href="https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1519" target="_blank">https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1519</a></p><h2>Videos</h2><p>Pain management at SickKids<br><a href="https://www.youtube.com/watch?v=_9_OQFo2APA" target="_blank">https://www.youtube.com/watch?v=_9_OQFo2APA</a></p><p>Reducing the pain of vaccination in children (2 mins 18 secs)<br><a href="https://www.youtube.com/watch?v=KgBwVSYqfps" target="_blank">https://www.youtube.com/watch?v=KgBwVSYqfps</a></p><p>Reducing the pain of vaccination in children (20 mins 52 secs)<br><a href="https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I" target="_blank">https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I</a></p><p>Learning how to manage pain from medical procedures (Stanford Children's Health) (12 mins 58 secs)<br><a href="https://www.youtube.com/watch?v=UbK9FFoAcvs&feature=youtu.be" target="_blank">https://youtu.be/UbK9FFoAcvs</a></p> | <p>Content developed by Rebecca Pillai Riddell, PhD, CPsych, OUCH Lab, York University, Toronto, in collaboration with:<br>Lorraine Bird, MScN, CNS, Fiona Campbell, BSc, MD, FRCA, Bonnie Stevens, RN, PhD, FAAN, FCAHS, Anna Taddio, BScPhm, PhD<br> Hospital for Sick Children</p><h3>References</h3><p>Blount, R. L., Cohen, L. L., Frank, N. C., Bachanas, P. J., Smith, A. J., Manimala, M. R., & Pate, J. T. (1997). The Child-Adult Medical Procedure Interaction Scale–Revised: An assessment of validity. Journal of Pediatric Psychology, 22(1), 73-88.</p><p>Campbell, L., DiLorenzo, M., Atkinson, N., & Riddell, R. P. (2017a). Systematic Review: A Systematic Review of the Interrelationships Among Children's Coping Responses, Children's Coping Outcomes, and Parent Cognitive-Affective, Behavioral, and Contextual Variables in the Needle-Related Procedures Context. Journal of Pediatric Psychology, 42(6), 611–621.
<a href="https://academic.oup.com/jpepsy/article/42/6/611/3073481" target="_blank">https://doi.org/10.1093/jpepsy/jsx054</a></p>
<a href="https://doi.org/10.1093/jpepsy/jsx054"></a>
<p>Campbell, L., Riddell, R. P., Cribbie, R., Garfield, H., & Greenberg, S. (2017b). Preschool children's coping responses and outcomes in the vaccination context: Child and caregiver transactional and longitudinal relationships. Pain.<a href="https://doi.org/10.1097/j.pain.0000000000001092" target="_blank">https://doi.org/10.1097/j.pain.0000000000001092</a></p><p>Hicks, C.L., von Baeyer, C.L., Spafford, P., van Korlaar, I., Goodenough, B. (2001). The Faces Pain Scale - Revised: Toward a common metric in pediatric pain measurement.
<em>Pain</em> 2001;93:173-183. </p><p>Merkel, S., Voepel-Lewis, T., Shayevitz, J. R., & Malviya, S. (1997). The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs, 23, 293-7.</p><p>Taddio A., McMurtry, C. M., Shah, V., Pillai Riddell, R. et al. Reducing pain during vaccine injections: clinical practice guideline. CMAJ 2015. DOI:10.1503 /cmaj.150391</p><p>Uman, L.S., Birnie, K.A., Noel, M., Parker, J.A., Chambers, C.T., McGrath, P.J., Kisely, S.R. (2013) Psychological interventions for needle-related procedural pain and distress in children and adolescents. <em>Cochrane Database of Systematic Reviews</em> 2013, Doi: 10.1002/14651858.CD005179.pub3</p><p>von Baeyer, C.L., Jaaniste, T., Vo, H.L.T., Brunsdon, G., Lao, AH-C, Champion, G.D. Systematic review of self-report measures of pain intensity in 3- and 4-year-old children: Bridging a period of rapid cognitive development. <em>Journal of Pain</em>, 2017;18(9):1017-1026.
<a href="https://www.sciencedirect.com/science/article/pii/S1526590017305199?via%3Dihub" target="_blank">https://doi.org/10.1016/j.jpain.2017.03.005.</a></p> | | | | | | | https://assets.aboutkidshealth.ca/AKHAssets/adjusting_to_a_diagnosis_of_ASD.jpg | | Main |
| Acute pain: How to treat and manage in infants and toddlers | A | Acute pain: How to treat and manage in infants and toddlers | Acute pain: How to treat and manage in infants and toddlers | | English | Pain/Anaesthesia | Baby (1-12 months);Newborn (0-28 days);Toddler (13-24 months) | NA | NA | Non-drug treatment | Adult (19+)
Caregivers | Pain | | 2019-01-25T05:00:00Z | | | | | | 9.70000000000000 | 49.5000000000000 | 1600.00000000000 | | Health (A-Z) - Procedure | Health A-Z | <p>As a parent, there is a lot that you can do to help treat your infant's or toddler's acute pain. Find out about the 3P approach to pain management.</p> | <p>The most effective way to manage your child's
<a href="/Article?contentid=2982&language=English">acute pain</a> is with a combination of physical, psychological and pharmacological (medication) strategies. Together, these are termed the 3Ps of pain control.</p><p>Like three legs of a stool, the 3Ps are complementary, or supportive, to one another. Your health-care professional can help you decide what might work best for your child.</p>
<figure class="asset-c-80">
<span class="asset-image-title">3P approach to managing your infant's or toddler's pain</span>
<img alt="3P approach to managing infant and toddler pain" src="https://assets.aboutkidshealth.ca/AKHAssets/AcutePain_3Ps_Infants.png" />
<figcaption class="asset-image-caption">Infants and toddlers benefit most from a combination of the ABCD approach (explained below), medications and sugar water.</figcaption>
</figure> | <h2>Key points</h2><ul><li>The 3P approach to pain management involves using psychological, physical and pharmacological methods to treat and manage pain.</li><li>Psychological and physical methods are centred on the 'ABCD approach', which involves assessing your own anxiety, belly breathing, comforting your child and providing distraction after their distress has passed its peak level.</li><li>Pharmacological approaches include numbing creams, sugar water and medications for mild to severe pain, as needed.</li></ul> | | | | | | | | | | | | | | | | <h2>Psychological and physical strategies — ABCD approach</h2><p>One helpful way to soothe your infant in pain is to use the ABCD approach. Parents have reported that it is easy to understand and a recent study shows that it helps to reduce pain in young children. If your child's acute pain is severe and lasts more than a few seconds, you can also easily combine the ABCD approach with pharmacological strategies (see below).</p><h3>A: Assess your own anxiety</h3><p>When you are calm, your infant or toddler is calmer and less likely to be distressed after a painful procedure or other cause of acute pain.</p><h3>B: Belly breathe if you are stressed</h3><p>Take a few calm and deep breaths down into your belly. This slows your own breathing and heart rate, which, if you are holding your infant in your arms, will also slow down their heart rate and breathing. When infants and toddlers are in a parent's arms, parental heartbeats and breathing can help them feel less distressed before a painful procedure. Younger children who are less distressed before a needle feel less pain afterwards.</p><h3>C: Use a calm, close, cuddle with your infant</h3><p>Holding your young child close, skin-to-skin if possible, reduces pain-related distress in infants. Skin-to-skin contact is also known as "kangaroo care".</p><ul><li>Hold your infant clothed only in a diaper and face them against your bare chest. Ideally, start this at least 15 minutes before the painful procedure, but even two minutes of contact beforehand can help. With toddlers, skin-to-skin is harder because they like to move around. Holding them close may mean holding the child on your lap.</li><li>Sucking helps soothe a young child. Breastfeeding before, during and after a painful procedure is a powerful way to reduce your infant's pain-related distress. If you are not breastfeeding, use a pacifier before, during and after a procedure instead. </li><li>If you cannot hold your baby, for instance because they are in an incubator or have wires connected to them, try a "hand cuddle". Your doctor or nurse may call this facilitated tucking. This involves placing your hands on your baby to help them tuck their arms and legs to their body. This approach reduces pain-related distress in pre-term infants (36 weeks gestation or less) and will also help you feel empowered.</li><li>Another option to reduce pain-related distress when you cannot hold your baby is to swaddle them in a blanket. This provides support for your infant and stops them moving around too much. When swaddling, gently bring your infant's hands together below their chin.</li></ul><h3>D: Distract your young child </h3><p>Distraction
<em>when your child's peak distress has passed</em> (about 30 to 45 seconds after a needle, once their crying dies down) can also help ease your child's pain. Use a normal tone of voice to talk about anything other than the pain or use toys, bubbles, books and songs.</p><p>If you notice that distraction is making your child more distressed, go back to cuddling. An extra 60 seconds of cuddling can sometimes make a big difference in helping your child calm down and become more open to distraction from their pain.</p><h2>Pharmacological strategies (medications)</h2><p>Pain medications also minimize your infant's or toddler's pain. Always talk to a health-care professional before you use them for your child. They can advise you if the pain medication is safe and effective for your child's type of pain.</p><h3>Numbing creams</h3><p><a href="https://www.aboutkidshealth.ca/Article?contentid=3627&language=English">Numbing creams</a> can be helpful for painful needle-related procedures such as vaccinations. Apply the cream to the area where the needle will be inserted 30 to 60 minutes before the procedure.</p><h3>Sugar water</h3><p>Giving your infant just a few drops (0.1 mL) of
<a href="https://www.aboutkidshealth.ca/Article?contentid=3628&language=English">sucrose (sugar water)</a> right before a painful procedure can also reduce their pain.</p><p>Using a syringe or dropper, place the sugar water, one drop at a time, onto the front of your baby's tongue. You can also dip your baby's pacifier into the sugar water.</p><p>Only use sugar water when your baby is in acute pain, not when they have general irritability.</p><h3>Over-the-counter medications</h3><p>Giving your infant
<a href="http://www.aboutkidshealth.ca/En/HealthAZ/Drugs/Pages/Acetaminophen.aspx">acetaminophen</a> or
<a href="http://www.aboutkidshealth.ca/En/HealthAZ/Drugs/Pages/Ibuprofen-for-Fever-or-Pain.aspx">ibuprofen</a> after a painful procedure can reduce any pain that persists. These medications can also be helpful for longer-lasting acute pain like that from teething. Speak to a health-care professional if your infant is less than six months old.</p><h3>Opioid medicines</h3><p>
<a href="https://www.aboutkidshealth.ca/Article?contentid=2999&language=English">Opioids</a> are among the strongest pain relievers and are often used after surgery or other major painful procedures. If your infant is in moderate to severe pain, their health-care team may prescribe opioids such as morphine, oxycodone or hydromorphone, generally for short-term use.</p>
<table class="akh-table"><tbody><tr><td>Opioids have risks and side effects, which can be serious. Always talk to your child's health-care provider for advice on taking, storing and disposing of opioids safely.</td></tr></tbody></table> | | | | <h2>Websites</h2><p>Comforting Your Baby in Intensive Care<br>
<a href="http://familynursing.ucsf.edu/comforting-your-baby-intensive-care" target="_blank">http://familynursing.ucsf.edu/comforting-your-baby-intensive-care</a></p><h2>Videos</h2><p><a href="https://www.youtube.com/watch?v=9OgCQKOnn-I" target="_blank">Bringin' up Baby: Soothing the Pain</a> (3 mins 50 secs)<br>
Psychological and physical strategies for parents to reduce vaccination pain in healthy infants</p><p><a href="https://www.youtube.com/watch?v=5Oqa1Fag5eQ" target="_blank">Reduce the pain of vaccination in babies</a>(13 mins 08 secs)<br>
Tips for parents on helping healthy infants get through vaccinations</p><p><a href="https://www.youtube.com/watch?v=-Y49FOGtmwo" target="_blank">Easing your baby's pain: A mother's story</a> (3 mins 07 secs)<br>
Three ways to instantly reduce your infant's pain in the NICU</p><p><a href="https://www.youtube.com/watch?v=3nqN9c3FWn8" target="_blank">The Power of a Parent's Touch</a> (2 mins 40 secs)<br>
How breastfeeding and skin-to-skin contact can help when an infant is experiencing a painful procedure</p> | <p>Content developed by Rebecca Pillai Riddell, PhD, CPsych, OUCH Lab, York University, Toronto, in collaboration with:<br>Lorraine Bird, MScN, CNS, Fiona Campbell, BSc, MD, FRCA, Bonnie Stevens, RN, PhD, FAAN, FCAHS, Anna Taddio, BScPhm, PhD<br> Hospital for Sick Children<br></p><h3>References</h3><p>Anand, K. J. S. (2012). Assessment of neonatal pain. In J. A. Garcia-Prats & M. S. Kim (Eds.), UpToDate. UpToDate: Waltham, MA.</p><p>International Association for the Study of Pain (2010) Fact Sheet on Mechanisms of Acute Pain. <a href="https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/AcutePainFactSheets/3-Mechanisms.pdf" target="_blank">https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/AcutePainFactSheets/3-Mechanisms.pdf</a> [Accessed March 29, 2018]<br></p><p>Mathew, P. J., & Mathew, J. L. (2003). Assessment and management of pain in infants. Postgraduate Medical Journal, 79(934), 438-443.</p><p>McGrath, P. J. (1985). CHEOPS: a behavioral scale for rating postoperative pain in children. Adv Pain Res Ther, 9, 395.</p><p>Merkel, S., Voepel-Lewis, T., & Malviya, S. (2002). Pain Assessment in Infants and Young Children: The FLACC Scale: A behavioral tool to measure pain in young children. AJN The American Journal of Nursing, 102(10), 55-58.</p><p>Ohlsson, A., & Shah, P. S. (2015). Paracetamol (acetaminophen) for prevention or treatment of pain in newborns. Cochrane Database Syst Rev, 6(6).</p><p>Pillai Riddell, R., Lisi, D., Campbell, L. (2013). Pain Assessment in Neonates. In Encyclopedia of Pain, 2<sup>nd</sup> edition.</p><p>Pillai Riddell, R. R, Racine, N. M., Gennis H. G., Turcotte, K., Uman, L. S., Horton, R. E., Ahola Kohut, S., Hillgrove Stuart, J., Stevens, B., & Lisi, D. M. (2015). Non-pharmacological management of infant and young child procedural pain. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD006275</p><p>Pillai Riddell, R., O'Neill, M., Campbell, L., Taddio, A., Greenberg, S., Garfield, H (2018). The ABCDs of Pain Management: A Double-Blind Randomized Controlled Trial for a Brief Educational Video for Parents of Young Children undergoing Vaccination. <em>Journal of Pediatric Psychology.</em> Volume 43, Issue 3, 1 April 2018, Pages 224-233, <a href="https://doi.org/10.1093/jpepsy/jsx122" target="_blank">https://doi.org/10.1093/jpepsy/jsx122</a></p><p>Pillai Riddell, R. R., Racine, N. M., Gennis, H. G., Turcotte, K., Uman, L. S., Horton, R. E., ... & Lisi, D. M. (2015). Non‐pharmacological management of infant and young child procedural pain. The Cochrane Library.</p><p>Stevens, B., Yamada, J., Campbell-Yeo, M. Gibbins, S., Harrison D., Dionne, K., Taddio, A., McNar C Willan, A., Ballantyne, M., Widger, K., Sidani, S., Estabrooks, C., Synnes, A., Squires J., Victor, C., and Riahi, S. (2018). The minimally effective dose of sucrose for procedural pain relief in neonates: a randomized controlled trial. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5824554/" target="_blank">BMC </a>Pediatr. 2018; 18: 85.</p><p>Stevens, B. J., Gibbins, S., Yamada, J., Dionne, K., Lee, G., Johnston, C., & Taddio, A. (2014). The premature infant pain profile-revised (PIPP-R): initial validation and feasibility. The Clinical journal of pain, 30(3), 238-243.</p><p>Stevens, B. J., Abbott, L. K., Yamada, J., Harrison, D., Stinson, J., Taddio, A., & Campbell, F. (2011). Epidemiology and management of painful procedures in children in Canadian hospitals. <em>Canadian Medical Association Journal</em>, <em>183</em>(7), E403-E410.</p><p>Stevens, B., Yamada, J., Lee, G. Y., & Ohlsson, A. (2013). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev, 1(1).</p><p>Taddio, A., McMurtry, C. M., Shah, V., Riddell, R. P., Chambers, C. T., Noel, M., & Lang, E. (2015). Reducing pain during vaccine injections: clinical practice guideline. <em>Canadian Medical Association Journal</em>, <em>187</em>(13), 975-982.<br></p> | | | | | | | | | Main |
