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22q11 deletion syndrome (22q11DS)222q11 deletion syndrome (22q11DS)22q11 deletion syndrome (22q11DS)EnglishGeneticsChild (0-12 years);Teen (13-18 years)BodyNAConditions and diseasesAdult (19+) CaregiversNA2018-04-18T04:00:00ZCheryl Cytrynbaum, MS, CGC;Andrea Shugar, MS, CGC, CCGC10.200000000000045.7000000000000639.000000000000Health (A-Z) - ConditionsHealth 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
22q11 deletion syndrome: Genetics222q11 deletion syndrome: Genetics22q11 deletion syndrome: GeneticsEnglishGeneticsChild (0-12 years);Teen (13-18 years)BodyNAConditions and diseasesAdult (19+) CaregiversNA2018-04-18T04:00:00ZCheryl Cytrynbaum, MS, CGC;Andrea Shugar, MS, CGC, CCGC9.8000000000000048.6000000000000854.000000000000Health (A-Z) - ConditionsHealth 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
22q11 deletion syndrome: Medical features222q11 deletion syndrome: Medical features22q11 deletion syndrome: Medical featuresEnglishGeneticsChild (0-12 years);Teen (13-18 years)BodyNAConditions and diseasesAdult (19+) CaregiversNA2018-04-18T04:00:00ZCheryl Cytrynbaum, MS, CGC;Andrea Shugar, MS, CGC, CCGC11.000000000000042.90000000000001246.00000000000Flat ContentHealth 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="/Article?contentid=&3043language=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>
ADHD: Communicating with your child's schoolAADHD: Communicating with your child's schoolADHD: Communicating with your child's schoolEnglishPsychiatrySchool age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)BrainBrainNon-drug treatmentCaregivers Adult (19+)NA2017-06-16T04:00:00ZAlice Charach, MD, MSc, FRCPC;Rosemary Tannock, PhD9.1000000000000061.40000000000001180.00000000000Health (A-Z) - ProcedureHealth 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
ADHD: How to help your child at homeAADHD: How to help your child at homeADHD: How to help your child at homeEnglishPsychiatrySchool age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)BrainBrainNon-drug treatmentCaregivers Adult (19+)NA2017-06-16T04:00:00ZAlice Charach, MD, MSc, FRCPC;Rosemary Tannock, PhD10.000000000000055.20000000000001262.00000000000Health (A-Z) - ProcedureHealth 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
ADHD: Signs and symptomsAADHD: Signs and symptomsADHD: Signs and symptomsEnglishPsychiatrySchool age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)BrainBrainConditions and diseasesCaregivers Adult (19+)NA2017-06-16T04:00:00ZAlice Charach, MD, MSc, FRCPC;Rosemary Tannock, PhD10.600000000000051.80000000000001690.00000000000Health (A-Z) - ConditionsHealth 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
ADHD: Treatment with medicationsAADHD: Treatment with medicationsADHD: Treatment with medicationsEnglishPsychiatrySchool age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)BrainBrainDrug treatmentCaregivers Adult (19+)NA2017-06-16T04:00:00ZAlice Charach, MD, MSc, FRCPC;Rosemary Tannock, PhD9.9000000000000051.60000000000001309.00000000000Health (A-Z) - ProcedureHealth 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.</p>https://assets.aboutkidshealth.ca/AKHAssets/ADHD_treatment_with_medications.jpg
Abnormal-looking stoolAAbnormal-looking stoolAbnormal-looking stoolEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)Large Intestine/ColonLarge intestine;RectumConditions and diseasesAdult (19+)NA2010-10-14T04:00:00ZMark Feldman, MD, FRCPC6.7000000000000065.9000000000000555.000000000000Health (A-Z) - ConditionsHealth A-Z<p>An easy-to-understand overview of the signs, symptoms, and medical options for children with unusual feces.</p><h2>What causes abnormal-looking stool?</h2><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> <br><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 breast-fed babies.</li> <li>Pale stool accompanied by yellowish skin and eyes, or dark urine may indicate hepatitis. Seek medical attention right away.</li> <li>Red and jelly-like stool is considered an emergency. Call 911 or go to the nearest Emergency Department. Do not give your child anything to eat or drink while waiting for the ambulance.</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 baby has green, runny stool but is bottle-fed only</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 while waiting for the ambulance</li> <li>your child has yellowish skin or yellowish whites of the eyes</li> <li>your child has dark urine (brown or black in colour)</li> <li>your child's stool is an abnormal colour after taking medication</li> </ul> https://assets.aboutkidshealth.ca/AKHAssets/abnormal_looking_stool.jpg
About blood and marrow transplant researchAAbout blood and marrow transplant researchAbout blood and marrow transplant researchEnglishHaematology;Immunology;OncologyChild (0-12 years);Teen (13-18 years)BodyImmune systemNAAdult (19+)NA2010-03-05T05:00:00ZJohn Doyle, MD, FRCPC, FAAPChristine Armstrong, RN, MScN, NP Peds9.1000000000000056.80000000000001074.00000000000Flat ContentHealth 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>
About blood and marrow transplantsAAbout blood and marrow transplantsAbout blood and marrow transplantsEnglishHaematology;Immunology;OncologyChild (0-12 years);Teen (13-18 years)BodyImmune systemNAAdult (19+)NA2010-02-12T05:00:00ZJohn Doyle, MD, FRCPC, FAAPChristine Armstrong, RN, MScN, NP Peds8.9000000000000062.1000000000000296.000000000000Flat ContentHealth 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
About genetics and the heartAAbout genetics and the heartAbout genetics and the heartEnglishCardiologyChild (0-12 years);Teen (13-18 years);Adult (19+)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2009-12-04T05:00:00ZSarah Bowdin, MD, MSc, MRCPCH(UK)8.7000000000000056.40000000000001465.00000000000Flat ContentHealth A-Z<p>Learn about genetics, inheritance, and genetic and chromosomal disorders.<br></p><p> This page explains how inherited genetic material — and spontaneous changes to it — determines who we are. </p><h2> Key points </h2> <ul><li> Genetics is the study of heredity and changes in genetic material, or the units that we inherit from our parents that make up who we are. </li> <li>Genetics is important for understanding congenital heart disease, as certain conditions and heart-related symptoms can either be passed from parent to child or occur spontaneously due to a change in genetic material.</li></ul>https://assets.aboutkidshealth.ca/akhassets/Chromosomal_translocation_MED_ILL_EN.jpg
About heart conditionsAAbout heart conditionsAbout Heart ConditionsEnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2010-01-15T05:00:00ZJennifer Russell, MD, FRCPCFraser Golding, MD, FRCPC10.600000000000043.9000000000000911.000000000000Flat ContentHealth 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
About leukemiaAAbout leukemiaAbout LeukemiaEnglishOncologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemConditions and diseasesAdult (19+)NA2018-03-06T05:00:00ZOussama Abla, MDDanielle Weidman, MDKarin Landenberg, MD8.9000000000000056.9000000000000234.000000000000Flat ContentHealth 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>
About painAAbout painAbout painEnglishPain/AnaesthesiaChild (0-12 years);Teen (13-18 years)BodyCentral nervous system;Peripheral nervous system;Autonomic nervous systemSymptomsCaregivers Adult (19+)Pain2009-09-15T04:00:00ZSimon Beggs, PhD9.4000000000000062.40000000000001743.00000000000Flat ContentHealth 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>
About premature babiesAAbout premature babiesAbout premature babiesEnglishNeonatologyPrenatal;PrematureNANANAPrenatal Adult (19+)NA2009-10-31T04:00:00ZJonathan Hellmann, MBBCh, MHSc, FCP(SA), FRCPC12.500000000000045.60000000000001344.00000000000Flat ContentHealth 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
About scoliosisAAbout scoliosisAbout scoliosisEnglishOrthopaedics/MusculoskeletalChild (0-12 years);Teen (13-18 years)Vertebrae;SpineMuscular system;Skeletal systemConditions and diseasesAdult (19+)NA2008-06-01T04:00:00ZSandra Donaldson, BA;Reinhard Zeller, MD, ScD, FRCSC8.8000000000000055.3000000000000823.000000000000Flat ContentHealth A-Z<p>This page describes scoliosis and the difference between small, medium, and large scoliosis curves. It also explains the three different types of scoliosis: congenital scoliosis, neuromuscular scoliosis, and idiopathic scoliosis.</p><p> Not all scoliosis looks the same. Learn about the type of scoliosis your teen has and how it might be treated.</p><h2> Key points </h2> <ul><li> Teens with scoliosis have a spine that is curved sideways.</li> <li>There are three main types of scoliosis: congenital scoliosis, neuromuscular scoliosis, and idiopathic scoliosis. </li> <li> Congenital scoliosis means that the bones in your teen's spine were not shaped properly since birth. Neuromuscular scoliosis means that a muscle disease or condition has caused the spine to curve. Idiopathic scoliosis means that there is no known cause for the spine's curve. </li> <li> This website focuses on idiopathic scoliosis that requires surgery.</li></ul>https://assets.aboutkidshealth.ca/akhassets/scoliosis_03_MED_ILL_EN.jpg
Abscess drainage using image guidanceAAbscess drainage using image guidanceAbscess drainage using image guidanceEnglishOtherChild (0-12 years);Teen (13-18 years)BodyNAProceduresCaregivers Adult (19+)NA2016-02-09T05:00:00ZMichelle Cote, BScN, RN;Joao Amaral, MD8.3000000000000061.70000000000001209.00000000000Health (A-Z) - ProcedureHealth 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
Abscess drainage: Caring for your child at home after the procedureAAbscess drainage: Caring for your child at home after the procedureAbscess drainage: Caring for your child at home after the procedureEnglishOtherChild (0-12 years);Teen (13-18 years)BodyNANon-drug treatmentCaregivers Adult (19+)NA2013-03-27T04:00:00ZJoao Amaral, MD;Adam Rapoport, MD, FRCPC;Candice Sockett, RN(EC), MN:APN8.3000000000000063.1000000000000462.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Your child has had an abscess drained. The information provided in this brochure will help you to properly care for them at home after the procedure.</p><p>​Your child has had an <a href="/Article?contentid=2439&language=English">abscess drained</a>. This brochure explains how to look after your child at home after the procedure, 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 Band-Aid.</li> <li>Give your child acetaminophen for pain.</li> <li>Your child can go to school and resume regular activity 48 hours after the drainage procedure.</li> <li>If your child develops bright red bleeding or pus at the site, vomits, is 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 these symptoms: </p> <ul> <li><a href="/Article?contentid=30&language=English">fever</a> over 38°C (100.4°F)</li> <li>throwing up (<a href="/Article?contentid=746&language=English">vomiting</a>) that does not stop</li> <li>severe <a href="/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>At SickKids</h2> <p>If you have any concerns in the first 48 hours, call the IGT clinic during working hours at (416) 813-6054 and ask to speak to an IGT nurse. After 48 hours, please call your referring doctor. If you have concerns and it is after working hours, see your family doctor or go to the nearest Emergency Department, or call the Hospital for Sick Children switchboard at (416) 813-1500 and ask them to page your specialist or the interventional radiologist on call.</p>https://assets.aboutkidshealth.ca/AKHAssets/abscess_drainage_caring_for_your_child_at_home.jpg
Absence seizuresAAbsence seizuresAbsence seizuresEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesCaregivers Adult (19+) EducatorsNA2010-02-04T05:00:00ZElizabeth J. Donner, MD, FRCPC9.3000000000000054.20000000000001118.00000000000Flat ContentHealth 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>
Accident benefits after a motor vehicle collisionAAccident benefits after a motor vehicle collisionAccident benefits after a motor vehicle collisionEnglishNAChild (0-12 years);Teen (13-18 years)NANANon-drug treatmentCaregivers Adult (19+)NA2007-09-10T04:00:00ZDorothy McDowall, RN, BScN, CNN(C);Lynne Harford, MSW, RSW8.3000000000000061.1000000000000889.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Accident benefits are available to help people with the cost of hospitalization and rehabilitation after a crash. Find out how to make an insurance claim. </p><p>This page is about getting insurance benefits after a car crash in Ontario. This process is different from province to province and from state to state. The information here outlines the major issues and processes involved. </p><h2>Key points</h2> <ul> <li>In the province of Ontario anyone who has been injured in a motor vehicle crash can claim for accident benefits.</li> <li>If you want to make an insurance claim after a car accident you need to call the insurance company within seven days of the crash. 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 right certificates you will need.</li> </ul><h2>Making an insurance claim</h2> <p>Within seven days of the crash, you must call the vehicle insurer to tell them that you want to apply for accident benefits. The sooner you call, the better. Your child may need special services or equipment when they leave the hospital. If you call the insurer early, it will make the transition smoother. </p> <p>If you do not call the insurer within seven days, you may not get your benefits right away.</p> <h2>Getting help at the hospital</h2> <p>Most hospitals employ a social worker who is trained to help with insurance matters for patients injured in a car crash. Ask hospital staff who this person is. See about getting their help filling out the forms and certificates that you will need to make a claim. </p> <h2>Calling the insurers</h2> <p>Call the first insurer on the list below that applies to you:</p> <ul> <li>the insurer of the child's parent/guardian's vehicle </li> <li>the insurer of the vehicle in which the injured child was an occupant </li> <li>the insurer of the at-fault driver or owner </li> <li>the insurer of any other vehicle involved in the accident </li> <li>the Motor Vehicle Accident Claims Fund: in Canada, call 1-800-268-7188 </li> </ul> <p>When you call the insurer, tell them that you want to start an accident benefits claim on behalf of your child and/or any other injured person in your family. </p> <p>The insurer will ask you for some basic information, including the following:</p> <ul> <li>name and age of the injured child </li> <li>injuries to your child </li> <li>your insurance policy number and vehicle information </li> <li>basic details about the crash </li> </ul> <h2>After you have spoken with the insurer</h2> <p>Once you have talked with the insurer, they will send you an application for accident benefits. An adjuster will be assigned to your file. The adjuster will call you with a claim number and will be your main contact at the insurance company. </p> <p>Within 30 days of getting an application for accident benefits, you must send the completed application to the accident benefit insurer. If the form is not filled out and sent in, you will not get any money. </p> <p>The application for accident benefits will include a disability certificate. Wherever possible, a completed disability certificate should be given to the insurer right away. </p> <h2>Getting a lawyer</h2> <p>Because insurance can be hard to understand, some families may want to ask a lawyer to help them decide what to do. A lawyer who knows personal injury laws involving children is the best person to help you with your accident benefits claim. Most lawyers will talk with you, free of charge, the first time you call. </p> <h2>For your reference</h2> <p>Date of accident</p> <p>Insurance company name: </p> <ul> <li>Telephone number:</li> <li>Policy number: </li> </ul> <p>Accident benefits adjuster name:</p> <ul> <li>Telephone number: </li> <li>Claim number: </li> </ul> <p>Investigating police officer name:</p> <ul> <li>Badge number: </li> <li>Region/Division: </li> <li>Telephone number: </li> </ul> <p>Lawyer name:</p> <ul> <li>Company: </li> <li>Telephone number: </li> </ul> <p>Notes:</p> <p> </p><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</li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/accident_benefits_after_motor_vehicle_collision.jpg
Acetaminophen, Aspirin, and NSAIDsAAcetaminophen, Aspirin, and NSAIDsAcetaminophen, Aspirin, and NSAIDsEnglishPain/AnaesthesiaChild (0-12 years);Teen (13-18 years)BodyCentral nervous system;Peripheral nervous system;Autonomic nervous systemSymptomsCaregivers Adult (19+)Pain2009-09-21T04:00:00ZAnna Taddio, PhD10.800000000000049.3000000000000548.000000000000Flat ContentHealth A-Z<p>Learn about pain relief medications. Acetaminophen (Tylenol) and NSAIDs (ibuprofen).</p>
Acne (acne vulgaris)AAcne (acne vulgaris)Acne (acne vulgaris)EnglishDermatologyPre-teen (9-12 years);Teen (13-18 years)SkinSkinConditions and diseasesCaregivers Adult (19+)NA2015-01-14T05:00:00ZMiriam Weinstein, MD, FRCPC8.2000000000000058.50000000000001522.00000000000Health (A-Z) - ConditionsHealth 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 </span> <span class="asset-image-title">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</figcaption> <figcaption class="asset-image-caption"> occurs when the sebaceous glands produce more oil, clogging different parts of skin tissue.</figcaption> </figure> <p>The skin is formed by many layers of tissue, containing hair, glands, muscles, sensory receptors and blood vessels. During puberty, a group of hormones are released called androgens. Androgens allow the sebaceous glands in the skin to produce an oily substance called sebum. Acne is in part caused by this increase in sebum that naturally occurs during puberty.<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
Activities after a blood and marrow transplantAActivities after a blood and marrow transplantActivities after a blood and marrow transplantEnglishHaematology;Immunology;OncologyChild (0-12 years);Teen (13-18 years)BodyImmune systemNAAdult (19+)NA2010-01-06T05:00:00ZJohn Doyle, MD, FRCPC, FAAPChristine Armstrong, RN, MScN, NP Peds8.2000000000000064.4000000000000371.000000000000Flat ContentHealth 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>
Activity and contact with others after a blood and marrow transplantAActivity and contact with others after a blood and marrow transplantActivity and contact with others after a blood and marrow transplantEnglishHaematology;Immunology;OncologyChild (0-12 years);Teen (13-18 years)BodyImmune systemNAAdult (19+)NA2010-03-19T04:00:00ZJohn Doyle, MD, FRCPC, FAAPChristine Armstrong, RN, MScN, NP Peds7.6000000000000067.1000000000000825.000000000000Flat ContentHealth 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
Activity recommendations for your infant after heart surgeryAActivity recommendations for your infant after heart surgeryActivity recommendations for your infant after heart surgeryEnglishCardiologyBaby (1-12 months);Newborn (0-28 days);Toddler (13-24 months)NANANon-drug treatmentAdult (19+) CaregiversNA2018-05-22T04:00:00ZMaggie Harkness, MSc (OT);Ryan Ireland, MSc(PT);Sandy Spence, MSc(OT);Kate Turner, MSc(OT)12.300000000000041.2000000000000771.000000000000Flat ContentHealth 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
Acute cerebellar ataxia (acute post-infectious cerebellar ataxia)AAcute cerebellar ataxia (acute post-infectious cerebellar ataxia)Acute cerebellar ataxia (acute post-infectious cerebellar ataxia)EnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainBrainConditions and diseasesCaregivers Adult (19+)NA2015-03-19T04:00:00ZJulia Sorbara, MD;Elizabeth Berger, BA, MD, FRCPC, FAAP, MHPE​10.100000000000047.6000000000000980.000000000000Health (A-Z) - ConditionsHealth 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 <a href="/Article?contentid=909&language=English">Lyme disease</a>.</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>
Acute lymphoblastic leukemia: An overviewAAcute lymphoblastic leukemia: An overviewAcute Lymphoblastic Leukemia: An OverviewEnglishOncologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemConditions and diseasesAdult (19+)NA2018-03-06T05:00:00ZOussama Abla, MDDanielle Weidman, MDKarin Landenberg, MD11.500000000000043.4000000000000722.000000000000Flat ContentHealth 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><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>
Acute lymphoblastic leukemia: Radiation therapyAAcute lymphoblastic leukemia: Radiation therapyAcute Lymphoblastic Leukemia: Radiation TherapyEnglishOncologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemNon-drug treatmentAdult (19+)NA2018-03-06T05:00:00ZOussama Abla, MDDanielle Weidman, MDKarin Landenberg, MD10.700000000000039.5000000000000578.000000000000Flat ContentHealth 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>
Acute lymphoblastic leukemia: Risk categoriesAAcute lymphoblastic leukemia: Risk categoriesAcute Lymphoblastic Leukemia: Risk CategoriesEnglishOncologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemConditions and diseasesAdult (19+)NA2018-03-06T05:00:00ZOussama Abla, MDDanielle Weidman, MDKarin Landenberg, MD10.700000000000046.5000000000000414.000000000000Flat ContentHealth 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>
Acute lymphoblastic leukemia: bone marrow transplantAAcute lymphoblastic leukemia: bone marrow transplantAcute Lymphoblastic Leukemia: Bone Marrow TransplantEnglishOncologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemNon-drug treatmentAdult (19+)NA2018-03-06T05:00:00ZOussama Abla, MDDanielle Weidman, MDKarin Landenberg, MD10.100000000000057.4000000000000174.000000000000Flat ContentHealth 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>
Acute lymphoblastic leukemia: chemotherapy phasesAAcute lymphoblastic leukemia: chemotherapy phasesAcute Lymphoblastic Leukemia: Chemotherapy PhasesEnglishOncologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemDrug treatmentAdult (19+)NA2018-03-06T05:00:00ZOussama Abla, MDDanielle Weidman, MDKarin Landenberg, MD10.000000000000052.80000000000001312.00000000000Flat ContentHealth 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>
Acute myeloid leukemia: An overviewAAcute myeloid leukemia: An overviewAcute Myeloid Leukemia: An OverviewEnglishOncologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemConditions and diseasesAdult (19+)NA2018-03-06T05:00:00ZOussama Abla, MDDanielle Weidman, MDKarin Landenberg, MD8.4000000000000054.5000000000000611.000000000000Flat ContentHealth 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>
Acute myeloid leukemia: bone marrow transplantAAcute myeloid leukemia: bone marrow transplantAcute Myeloid Leukemia: Bone Marrow TransplantEnglishOncologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemNon-drug treatmentAdult (19+)NA2018-03-06T05:00:00ZOussama Abla, MDDanielle Weidman, MDKarin Landenberg, MD8.8000000000000058.0000000000000328.000000000000Flat ContentHealth 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>
Acute painAAcute painAcute painEnglishPain/AnaesthesiaChild (0-12 years);Teen (13-18 years)BodyNervous systemSymptomsCaregivers Adult (19+)Pain2019-01-25T05:00:00ZRebecca Pillai Riddell, PhD, CPsych8.9000000000000058.0000000000000612.000000000000Flat ContentHealth A-Z<p>Learn how the body experiences acute pain. <br></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.<br></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.<br></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><br></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
Acute pain: Effecting parenting for teensAAcute pain: Effecting parenting for teensAcute pain: How parenting can support the 3P approach with teensEnglishPain/AnaesthesiaTeen (13-18 years)NANervous systemConditions and diseases;Symptoms;Non-drug treatmentAdult (19+) CaregiversPain2019-01-25T05:00:00ZRebecca Pillai Riddell, PhD, CPsych10.400000000000050.2000000000000639.000000000000Flat ContentHealth 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.<br></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 cope with pain.</li><li>Try not to let your worries or fears about your teen's pain affect your teen's wellbeing.<br></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><a> </a> <br></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><br> </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><br></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><br></p>https://assets.aboutkidshealth.ca/AKHAssets/depression_psychotherapy.jpg
Acute pain: How to assess in infants and toddlersAAcute pain: How to assess in infants and toddlersAcute pain: How to assess in infants and toddlersEnglishPain/AnaesthesiaNewborn (0-28 days);Baby (1-12 months);Toddler (13-24 months)NANervous systemSymptomsAdult (19+) CaregiversPain2019-01-25T05:00:00ZRebecca Pillai Riddell, PhD, CPsych10.500000000000042.50000000000001136.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Find out how your infant's or toddler's acute pain is assessed at home and in medical settings.<br></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.<br></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:<br></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, 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. <br></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 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.<br></p><p><span aria-hidden="true"></span>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. <br></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
Acute pain: How to assess in older childrenAAcute pain: How to assess in older childrenAcute pain: How to assess in older childrenEnglishPain/AnaesthesiaSchool age child (5-8 years);Pre-teen (9-12 years)NANervous systemConditions and diseases;SymptomsSchool age child (5-8 years) Pre-teen (9-12 years)Pain2019-01-25T05:00:00ZRebecca Pillai Riddell, PhD, CPsych9.6000000000000055.30000000000001116.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Discover how to assess acute pain in an older child (age six to 12) at home and in medical settings. <br></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.<br></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.<br></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 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.<br></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 don't 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><br></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><br></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.<br></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> <a href="https://doi.org/10.1002/14651858.CD005179.pub3"> </a> <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.<br></p>https://assets.aboutkidshealth.ca/AKHAssets/anorexia_treatment_options.jpg
Acute pain: How to assess in teensAAcute pain: How to assess in teensAcute pain: How to assess in teensEnglishPain/AnaesthesiaTeen (13-18 years)NANervous systemConditions and diseases;SymptomsAdult (19+) CaregiversPain2019-01-25T05:00:00ZRebecca Pillai Riddell, PhD, CPsych9.7000000000000055.00000000000001112.00000000000Health (A-Z) - ConditionsHealth 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. <br></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.<br></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.<br></li><li>In medical settings, healthcare 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 healthcare 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 healthcare 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).<br></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.<br></li></ul><h2>Assessing acute pain in medical settings</h2><p>In the hospital, your teen's healthcare 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.<br></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 healthcare 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 healthcare professionals want them to behave rather than express how they are feeling.<br></p><h2>Websites<br></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><br></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><br></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.<br></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><br></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
Acute pain: How to assess in young childrenAAcute pain: How to assess in young childrenAcute pain: How to assess in young childrenEnglishPain/AnaesthesiaPreschooler (2-4 years);School age child (5-8 years)NANervous systemConditions and diseases;SymptomsAdult (19+) CaregiversPain2019-01-25T05:00:00ZRebecca Pillai Riddell, PhD, CPsych10.100000000000053.70000000000001624.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Find out how to assess acute pain in your young child (age two to five) at home and in medical settings. <br></p><h2>What causes acute pain in young children?<br></h2>In young children (ages two to five), acute pain is typically caused by:<p></p><ul><li>routine vaccinations by needle</li><li>earaches and sore throats</li><li>everyday bumps and bruises<br></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).<br></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 like 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.<br></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.  <br></li><li>In medical settings, health-care providers assess your child's pain with tools such as the Faces Pain Scale-Revised. <br></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.<br></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 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 </span><span class="asset-image-title">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</figcaption><figcaption class="asset-image-caption"> 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.<br></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 don't, 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.<br></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><br></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><br></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><br></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><br></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.<br></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
Acute pain: How to treat and manage in infants and toddlersAAcute pain: How to treat and manage in infants and toddlersAcute pain: How to treat and manage in infants and toddlersEnglishPain/AnaesthesiaBaby (1-12 months);Newborn (0-28 days);Toddler (13-24 months)NANASymptoms;Non-drug treatment;Drug treatment;ProceduresAdult (19+) CaregiversPain2019-01-25T05:00:00ZRebecca Pillai Riddell, PhD, CPsych9.7000000000000049.50000000000001600.00000000000Health (A-Z) - ProcedureHealth 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.<br></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.<br></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 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.<br></li></ul><h2>Psychological and physical strategies - ABCD approach<br></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). <br></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.<br></p><h3>B: Belly breathe if you are stressed<br></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". <br></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.<br></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. <br></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. The approach reduces pain-related distress in pre-term infants (36 weeks gestation or less) and will also help you feel empowered.<br></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.<br></li></ul><h3>D: Distract your young child <br></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 healthcare 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 should when your baby is in acute pain, not when they have general irritability.<br></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 healthcare professional if your infant is less than six months old.<br></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 healthcare team may prescribe opioids such as morphine, oxycodone or hydromorphone, generally for short-term use.<br></p><table cellspacing="0" class="ms-rteTable-default"><tbody><tr><td class="ms-rteTable-default">​​Opioids have risks and side effects, which can be serious. Always talk to your child's healthcare provider for advice on taking, storing and disposing of opioids safely.</td></tr></tbody></table><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.<br></p><h3>B: Belly breathe if you are stressed<br></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". <br></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.<br></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. The 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.<br></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 should 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>
Acute pain: How to treat and manage in older childrenAAcute pain: How to treat and manage in older childrenAcute pain: How to treat and manage in older childrenEnglishPain/AnaesthesiaSchool age child (5-8 years);Pre-teen (9-12 years)NANervous systemDrug treatment;Non-drug treatment;SymptomsAdult (19+) CaregiversPain2019-01-25T05:00:00ZRebecca Pillai Riddell, PhD, CPsych9.2000000000000059.30000000000002024.00000000000Health (A-Z) - ProcedureHealth A-Z<p>​Find out how you can use the 3Ps of pain management to support your older child (age six to 12).</p><p>There is a lot that you can do as a parent to help your older child in <a href="/Article?contentid=2982&language=English">acute pain</a>. The most effective way to manage pain is with a combination of psychological, physical and pharmacological (medications) strategies. Together, these are termed the 3Ps of pain control. Like three legs of a stool, the 3Ps are complementary, or supportive, to one another.<br></p> <figure class="asset-c-80"><span class="asset-image-title">3P approach to managing your older child's pain</span> <img alt="Circles listing physical, psychological and pharmacological approaches to pain" src="https://assets.aboutkidshealth.ca/AKHAssets/AcutePain_3Ps_OlderChildren.png" /> <figcaption class="asset-image-caption">The 3P approach combines psychological, physical and pharmacological strategies to manage pain. Each strategy is described below.</figcaption></figure><h2>​Key points</h2><ul><li>The 3P approach to pain management is a mix of psychological, physical and pharmacological methods to treat and manage pain.</li><li>Psychological methods include distraction, breathing exercises and ways of talking to your child to best prepare them for a painful procedure.</li><li>Physical approaches include cold and heat packs, rest, elevating the injured area and massage to relieve any muscle tension.</li><li>Pharmacological approaches include over-the-counter and prescription pain relievers.<br></li></ul><h2>​Psychological strategies</h2><p>As a parent, you are the main source of encouragement for older children who are coping with pain. At this age, explaining to your child why they are in pain can help reduce their anxiety or worry and let them know that the pain will not last forever. You also have a role in helping your child set realistic expectations for their pain, for example by being honest about the likelihood of some pain after surgery.</p><p>Children often base their own coping strategies on the way they see you respond to painful situations. No matter how old your child, it is important to try to be calm yourself and support your child with the strategies listed below.</p><h3>Distraction</h3><p>Distraction can be a particularly helpful psychological strategy when a child is experiencing acute pain. Distract your child with an activity or item that interests them. Active distraction, such as doing an activity or talking, is better than passive distraction such as watching TV.</p><p>Research shows that virtual reality (VR) technology can also help distract a child during some acutely painful procedures like burn dressing changes. Relatively inexpensive options include mobile apps that your child can use with simple VR glasses or headsets.</p><h3>Guided imagery</h3><p>To use guided imagery, ask your child to imagine that they are in a calm, peaceful environment or to remember a pleasant experience from their past. Encourage your child to describe what they see, as well as any smells, sounds or other sensations. There are online scripts that you can print and go through with your child. You can also download online guided imagery scripts that your child can follow on a smartphone or other mobile device during a painful procedure.</p> <figure> <span class="asset-image-title">Belly breathing</span> <div class="asset-animation">src="https://www.aboutkidshealth.ca/Style%20Library/akh/animation/belly_breathing_SCD_EN_TEST.aspx"</div> </figure> <h3>Breathing exercises</h3><p>Breathing exercises help your child slow down their breathing and become more relaxed. Encourage your child to take a few slow deep breaths into their belly, breathing in through their nose and out through their mouth.</p><p>They can place their hands over their belly to check that it is rising with every in-breath and falling with every out-breath.</p><h3>Powerful parent behaviours</h3><p>What you say, and do not say, can also influence how older children cope with pain. In fact, research has shown that not saying the "wrong" things helps your child more than saying the "right" things! The guidelines below have been shown to be very helpful.</p><ul><li> <strong>Do not reassure</strong>. It might sound strange, but it is better not to reassure your child when they are distressed. Telling a child, "It's ok" or "You are fine" over and over when they know they are obviously not fine (scared, crying, screaming) can actually make your child more stressed and therefore experience more pain.</li><li> <strong>Do not criticize</strong>. Do not use your child's experience of pain to try to improve their behaviour or tell them they can do better. Saying things such as "Brave girls don't cry", "Your brother didn't cry this much" or "This needle isn't that big a deal" makes children more upset, which leads to more pain.</li><li> <strong>Do not apologize</strong>. It is not your fault that your child is having a medical procedure, so do not say sorry for it or their pain. Some researchers believe that apologizing to your young child tells them that you are distressed. This in turn will make your child more distressed.</li><li> <strong>Decide if your child would benefit from having choices during a procedure</strong>. Young children tend to be overwhelmed by an upcoming painful procedure, so asking them is usually not helpful. <p></p><p>However, as children age, getting control may be helpful. If you think your child could benefit from having some control, well before the procedure (such as before you leave your home for the procedure), ask your child questions such as:</p><ul><li>whether they would like to have a needle in their right or left arm or leg</li><li>where and how would they like to be positioned for the procedure</li><li>how they want to be distracted during the procedure</li><li>what would they like to do after the procedure</li><li>whether they want to hold your hand.</li></ul></li><li> <strong>Do tell the truth</strong>. If your child asks if a procedure is going to hurt, and you think it will, let them know it may hurt a small or medium amount but that it will be over soon. Research shows that children who are less upset before a needle show less pain after a needle.</li></ul><h2>Physical strategies</h2><h3>Cold and heat</h3><p>If your child has any swelling or other signs of inflammation, it can be helpful to apply cold (such as a wrapped ice pack) to the area. This not only reduces signs of inflammation but can also help control pain. About 24 to 28 hours after an acute (sudden) injury, it can be helpful to apply heat (for example with a heating pad or a hot water bottle).</p><p>Be careful to avoid injury with heat and cold packs. Only apply them for short periods at a time (say, 10 minutes on/10 minutes off) and monitor the area closely. Your child should be able to move the heat or cold pack away on their own or tell you if it is uncomfortable.</p><h3>Elevating the injured area</h3><p>If your child has pain and swelling after an acute injury, it can be helpful to elevate (raise) the painful body part to a level above their heart. Elevating a painful arm or leg, for instance on a pillow while your child lies down, allows any excess fluid to drain. This in turn reduces pressure and pain in the injured area.</p><h3>Resting or modifying movement</h3><p>If your child injures themselves, it is often a good idea to rest the injured area or at least modify (change) any essential movements for a short time. This gives the injured area time to heal and protects it from further damage.</p><p>Be sure to talk to a healthcare professional first because complete inactivity may sometimes increase swelling in the area and/or lead to loss of motion and muscle strength.</p><h3>Massage</h3><p>Massage can be a helpful form of physical therapy for acute pain caused by cramps or sports injuries.</p><h2>Pharmacological strategies (medications)</h2><p>Pain medications can also manage your older child's acute pain. Some children in this age group may not understand why they should take medication. You can help your child by explaining what the medication is for and how it will help them.</p><p>Acute pain medications often come in different forms (for example liquid, tablets by mouth or through a needle). If your child prefers one form of medication to another, make sure they play a key role in deciding which option is best for them.</p><p>Below is an outline of some common medications for acute pain. Because they treat different types of acute pain, some of them may be used together, if directed by your child's healthcare team.</p><p>Always talk to a healthcare professional before you use pain medications, especially if you are not sure which medication to use or which form of medication might work best for your child. They can advise you if a pain medicine 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 or blood tests. Apply the cream to the area where the needle will be injected 30 to 60 minutes before the procedure. Ask for directions from your pharmacist or healthcare team.</p><h3>Over-the-counter medications</h3><p>It may also be helpful for your child to take <a href="https://www.aboutkidshealth.ca/article?contentid=62&language=English">acetaminophen</a> or <a href="https://www.aboutkidshealth.ca/article?contentid=153&language=English">ibuprofen</a> before or after a painful procedure. Taking these medications 30 to 40 minutes before a procedure is sometimes recommended.</p><p>These medications can often last four to six hours, so can be particularly good for acute pain such as an earache or pain after an injury.</p><h3>Opioid medications</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 acute painful procedures. If your older child is in moderate to severe acute pain, their healthcare team may prescribe opioids (such as morphine, oxycodone and hydromorphone) 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 healthcare provider for advice on taking, storing and disposing of opioids safely.</td></tr></tbody></table><p>​Children aged six to 12 are going through a unique stage of development. They may be experimenting with coping by themselves, with less help from you as their parent or caregiver. Sometimes your child may want you close and holding their hand but other times want you to stand back and let them cope on their own. Do your best to learn what type of support they need and follow their lead. Ask them and be prepared for them to change their mind.</p><p>Give your older child a role in deciding how their pain will be managed by, for example, encouraging them to discover what helps them, what makes their pain worse and when they are feeling better. Your child's health-care team can also help you and your child decide which combination of the 3Ps might work best.</p><br><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="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 (with sample scripts)<br><a href="http://academic.laverne.edu/~ear/gsp/2012/AdamHerro_GuidedImagery_CL_Handbook.pdf" target="_blank">http://academic.laverne.edu/~ear/gsp/2012/AdamHerro_GuidedImagery_CL_Handbook.pdf</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://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><br></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><br></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><br></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. Journal of Pediatric Psychology, 2017; <a href="https://doi.org/10.1093/jpepsy/jsx129" target="_blank">https://doi.org/10.1093/jpepsy/jsx129</a></p><p>Jaaniste T, Hayes B, von Baeyer CL. Providing children with information about forthcoming medical procedures: A review and synthesis. Clinical Psychology: Science and Practice, 2007;14(2): 124-143</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>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. Cochrane Database of Systematic Reviews <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.<br></p>
Acute pain: How to treat and manage in teensAAcute pain: How to treat and manage in teensAcute pain: How to treat and manage in teensEnglishPain/AnaesthesiaTeen (13-18 years)NANervous systemNon-drug treatmentAdult (19+) CaregiversPain2019-01-25T05:00:00ZRebecca Pillai Riddell, PhD, CPsych10.500000000000049.00000000000001282.00000000000Health (A-Z) - ProcedureHealth A-Z<p>​Find out how the 3Ps of pain management can help your teen manage their acute pain.</p><p>​Most teens can manage their <a href="/Article?contentid=2982&language=English">acute pain</a> with a combination of psychological, physical and pharmacological (medicines) strategies, or methods. Together, these are termed the 3Ps of pain control. Like three legs of a stool, the 3Ps are complementary, or supportive, to one another.</p> <figure class="asset-c-80"><span class="asset-image-title">3P approach to managing pain for </span><span class="asset-image-title">teens</span><img alt="Circles listing examples of physical, psychological and pharmacological approaches to pain" src="https://assets.aboutkidshealth.ca/AKHAssets/AcutePain_3Ps_Teens.png" /><figcaption>The</figcaption><figcaption> 3P approach combines psychological, physical and pharmacological strategies to manage pain. Each strategy is described below.</figcaption> </figure> <h2>Key points</h2><ul><li>The 3Ps of pain management are a mix of psychological, physical and pharmacological strategies, or methods, to treat and manage pain.</li><li>Helpful psychological strategies include distraction, guided imagery and breathing exercises.</li><li>Physical approaches include heat and cold packs, rest, raising the injured area and massage.</li><li>Pharmacological approaches include over-the-counter and prescription pain relievers.</li></ul><h2>Psychological strategies</h2><h3>Distraction </h3><p>Distraction can be a particularly helpful psychological strategy when a teen is experiencing acute pain. Active distraction, such as doing an interesting activity, talking or playing a video game, is better than passive distraction such as watching TV. </p><p>Research shows that virtual reality (VR) technology can also help distract a teen during some acutely painful procedures like burn dressing changes. Relatively inexpensive options include mobile apps that your teen can use with simple VR glasses or headsets. </p><h3>Guided imagery </h3><p>To use guided imagery, ask your teen to imagine that they are in a calm, peaceful environment or to remember a pleasant experience from their past. Encourage your teen to describe what they see, as well as any smells, sounds or other sensations. Teens can also download online guided imagery scripts and follow them on their smartphone or other mobile device on their own during a painful procedure.<br></p> <figure><span class="asset-image-title">Belly breathing</span> <div class="asset-animation">src="https://www.aboutkidshealth.ca/Style%20Library/akh/animation/belly_breathing_SCD_EN_TEST.aspx"</div> </figure> <h3>Breathing exercises</h3><p>Breathing exercises help your teen slow down their breathing and become more relaxed. Encourage your teen to take a few slow deep breaths into their belly, breathing in through their nose and out through their mouth. </p><p>They can place their hands over their belly to check that it is rising with every in-breath and falling with every out-breath. </p><h2>Physical strategies</h2><h3>Cold and heat</h3><p>If your teen has any swelling or other signs of inflammation, it can be helpful to apply <em>cold</em> (such as a wrapped ice pack) to the area. This not only reduces signs of inflammation but can also help control pain. About 24 to 28 hours after an acute (sudden) injury, it can be helpful to apply <em>heat</em> (such as with a heating pad or a hot water bottle). </p><p>Be careful to avoid injury with heat and cold packs. Only apply them for short periods at a time (say, 10 minutes on/10 minutes off) and monitor the area closely. Your teen should be able to move the heat or cold pack away on their own or tell you if it is uncomfortable. </p><h3>Elevating the injured area</h3><p>If your child has pain and swelling after an acute injury, it can be helpful to elevate (raise) the painful body part to a level above their heart. Elevating a painful arm or leg, for instance on a pillow while your teen lies down, allows any excess fluid to drain. This in turn reduces pressure and pain in the injured area. </p><h3>Resting or modifying movement </h3><p>If your teen injures themselves, it is often a good idea to rest the injured area or at least modify (change) any essential movements for a time. This gives the injured area time to heal and protects it from further damage. </p><p>Be sure to talk to a healthcare professional first because complete inactivity may sometimes increase swelling in the area and/or lead to loss of motion and muscle strength.</p><h3>Massage</h3><p>Massage can be a helpful form of physical therapy for acute pain due to cramps or sports injuries.</p><h2>Pharmacological strategies (medications)</h2><p>Pain medications can also help manage your teen's acute pain. These medications often come in different forms (for example liquid, tablets by mouth or through a needle). If your teen prefers one form of medication to another, have them play a key role in deciding which option is best for them. </p><p>Below is an outline of some common medications for acute pain. Because they treat different types of acute pain, some of them may be used together, if directed by your child's healthcare team. </p><p>Always talk to a healthcare professional before you use pain medications, especially if you are not sure which medication to use or which form of medication might work best for your teen. They can advise you if a pain medicine is safe and effective for your teen'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 or blood tests. Apply the cream to the area where the needle will be injected 30 to 60 minutes before the procedure. Ask for directions from your pharmacist or healthcare team.</p><h3>Over-the-counter medications</h3><p>It may also be helpful for your child to take <a href="https://www.aboutkidshealth.ca/article?contentid=62&language=English">acetaminophen</a> or <a href="https://www.aboutkidshealth.ca/article?contentid=153&language=English">ibuprofen</a> before or after a painful procedure. Taking these medications 30 to 40 minutes before a procedure is sometimes recommended. </p><p>These medications can often last four to six hours, so they can be particularly good for acute pain such as an earache or pain after an injury.</p><h3>Opioid medications</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 acute painful procedures. If your older child is in moderate to severe acute pain, their healthcare 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 healthcare provider for advice on taking, storing and disposing of opioids safely.</td></tr></tbody></table><h2>Websites<br></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.<br></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><br></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>
Acute pain: How to treat and manage in young childrenAAcute pain: How to treat and manage in young childrenAcute pain: How to treat and manage in young childrenEnglishPain/AnaesthesiaPreschooler (2-4 years);School age child (5-8 years)NANervous systemSymptoms;Drug treatment;Non-drug treatmentAdult (19+) CaregiversPain2019-01-25T05:00:00ZRebecca Pillai Riddell, PhD, CPsych8.5000000000000064.30000000000003290.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Find out how you can use the 3P approach to support your child in acute pain.<br></p><p>There is a lot that you can do as a parent to help your young child in <a href="/Article?contentid=2982&language=English">acute pain</a>. The most effective way to manage pain is with a combination of psychological, physical and pharmacological (medications) strategies, or methods. Together, these are termed the 3Ps of pain control. Like three legs of a stool, the 3Ps are complementary, or supportive, to one another.<br></p> <figure class="asset-c-80"> <span class="asset-image-title">3P approach to managing your young child's pain</span> <img alt="Circles showing the 3P approach to pain management" src="https://assets.aboutkidshealth.ca/AKHAssets/AcutePain_3Ps_YoungChildren.png" /> <figcaption class="asset-image-caption">The 3P approach combines psychological, physical and pharmacological strategies to manage pain. Each strategy is described below.</figcaption> </figure> <p>No single strategy will likely be the answer for your child's pain. Your health-care professional can help you decide which combination might work best for your child.</p> <br><h2>Key points<br></h2><ul><li>The 3P approach to pain management is a mix of psychological, physical and pharmacological strategies, or methods, to treat and manage pain.</li><li>Psychological strategies include the 'ABCD approach' and ways of talking to your child to best prepare them for a painful procedure.</li><li>Physical strategies include cold and heat packs, rest and elevating the injured area.</li><li>Pharmacological strategies include over-the-counter and prescription pain relievers.</li></ul><br><h2>Psychological strategies</h2><p>One helpful way to soothe your young child 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 toddlers but can also work for young children up to age five. If your child's pain is moderate or severe, you can easily combine the ABCD approach with pharmacological strategies.</p><h3>ABCD approach</h3><h4>A: Assess your own anxiety</h4><p>When you are calm, your young child is calmer and less likely to be distressed after a painful procedure or other cause of acute pain.<br></p><h4>B: Belly breathe if you are stressed</h4><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 young child in your arms, will also slow down their heart rate and breathing. When young children are in a parent's arms, parental heartbeats and breathing can help them feel less distressed before a painful procedure. Young children who are less distressed before a needle feel less pain afterwards. </p><h4>C: Use a calm, close cuddle with your young child</h4><p>Close physical contact between a parent and child can reduce a child's pain-related distress. </p><p>During a procedure, your young child may want to:</p><ul><li>stand between your legs while you are seated </li><li>sit on an examining table in your arms</li><li>have you massage their head while they are lying down. </li></ul><p>Think about what your child would want and work out a way to keep them close to you while allowing the healthcare professional to do their work.</p><h4>D: Distract your young child </h4><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. Toys, bubbles, books and songs are all good ways to distract very young children. If your child is a preschooler, you may want to ask them about something fun that is coming up or ask how hard they can squeeze your hand. Some children may also like to get a sticker after a painful procedure. </p><p>If you notice that distraction is making your young child more distressed, go back to cuddling. An extra 60 seconds of cuddling can do a lot to help your child calm down and become more open to distraction from their pain.</p><p>Do not feel that you have to be there during a painful procedure. For example, if the sight of a blood test makes you very nervous or unwell, it may be best to leave the room and let the healthcare team support your child. Don't feel ashamed by this; it is not unusual. When the test is over, you can come back in to give hugs and cuddles. A young child knows when a parent is distressed, so it is best to save them from any increase in their own anxiety.</p><h3>Powerful parent behaviours </h3><p>What you say, and do not say, can also help your young child cope with pain. In fact, research has shown that <em>not</em> saying the "wrong" things is more helpful for your child than saying the "right" things! The guidelines below have been shown to be very helpful.</p><ul><li> <strong>Do not reassure</strong>. It might sound strange, but it is better not to reassure your child when they are distressed. Telling a child "It's ok" or "You are fine" over and over when they know they are obviously not fine (scared, crying, screaming) can actually make your child more stressed.</li></ul><ul><li> <strong>Do not criticize</strong>. Do not use your child's experience of pain to try to improve their behaviour or tell them they can do better. Saying things such as "Brave girls don't cry", "Your brother didn't cry this much" or "This needle isn't that big a deal" makes children more upset, which leads to more pain.</li></ul><ul><li> <strong>Do not apologize</strong>. It is not your fault that your child is having a medical procedure, so do not say sorry for it or their pain. Some researchers believe that apologizing to your young child tells them that you are distressed. This in turn will make them more distressed. </li></ul><ul><li> <strong>Do not give your young child choices during a procedure.</strong> Young children tend to be overwhelmed by an upcoming painful procedure, so do not ask them right beforehand what side they would like the needle, for example. If they need to have the same painful procedure again, you can ask them what they would like well ahead of time.</li></ul><ul><li> <strong>Do tell the truth. </strong>If you child asks if a procedure is going to hurt, and you think it will, let them know it will but that it will be over soon. Tell them that scientists have shown that kids who are less upset before a needle show less pain after a needle.</li></ul><h2>Physical strategies</h2><h3>Cold and heat</h3><p>If your child has any swelling or other signs of inflammation, it can be helpful to apply <em>cold</em> (such as a wrapped ice pack) to the area. This not only reduces signs of inflammation but can also help control pain.</p><p>About 24 to 28 hours after an acute (sudden) injury, it can be helpful to apply <em>heat</em> (for example with a heating pad or a hot water bottle). </p><p>Be careful to avoid injury with heat and cold packs. Only apply them for short periods at a time (say, 10 minutes on/10 minutes off) and monitor the area closely. Your child should be able to move the heat or cold pack away on their own or tell you if it is uncomfortable. </p><h3>Elevating the injured area</h3><p>If your child has pain and swelling after an acute injury, it can be helpful to elevate (raise) the painful body part to a level above their heart. Elevating a painful arm or leg, for instance on a pillow while your child lies down, allows any excess fluid to drain. This in turn reduces pressure and pain in the injured area. </p><h3>Resting or modifying movement </h3><p>If your young child injures themselves, it is often a good idea to rest the injured area or at least modify (change) any essential movements. This gives the injured area time to heal and protects it from further damage. </p><p>Be sure to talk to a healthcare professional first because complete inactivity may sometimes increase swelling in the area and/or lead to loss of motion and muscle strength. </p><h2>Pharmacological strategies (medications)</h2><p>Pain medications can also manage your young child's acute pain. They often come in different forms but for younger children, liquids are often preferred. Work with your young child to figure out the best way to give them liquids such as spoons, medicine cups or syringes. </p><p>Below is an outline of some common medications for acute pain. Because they treat different types of acute pain, some of them may be used together, if directed by your child's healthcare team. </p><p>Always talk to a healthcare professional before you use pain medications, especially if you are not sure which medication to use or which form of medication might work best for your child. They can advise you if a 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 or blood tests. Apply the cream to the area where the needle will be injected 30 to 60 minutes before the procedure. Ask for directions from your pharmacist or healthcare team.</p><h3>Over-the-counter medications</h3><p>It may also be helpful for your child to take <a href="https://www.aboutkidshealth.ca/article?contentid=62&language=English">acetaminophen</a> or <a href="https://www.aboutkidshealth.ca/article?contentid=153&language=English">ibuprofen</a> before or after a painful procedure. Taking it 30 to 40 minutes before a procedure is sometimes recommended.</p><p>These medications can often last four to eight hours, so can be particularly good for acute pain such as an earache or pain after an injury.</p><h3>Opioid medications</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 healthcare team may prescribe opioids such as morphine, oxycodone or hydromorphone, generally for short-term use.</p> <br><h2>Psychological strategies</h2><p>One helpful way to soothe your young child 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 toddlers but can also work for young children up to age five. If your child's pain is moderate or severe, you can easily combine the ABCD approach with pharmacological strategies.</p><h3>ABCD approach</h3><h4>A: Assess your own anxiety</h4><p>When you are calm, your young child is calmer and less likely to be distressed after a painful procedure or other cause of acute pain.<br></p><h4>B: Belly breathe if you are stressed</h4><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 young child in your arms, will also slow down their heart rate and breathing. When young children are in a parent's arms, parental heartbeats and breathing can help them feel less distressed before a painful procedure. Young children who are less distressed before a needle feel less pain afterwards. </p><h4>C: Use a calm, close cuddle with your young child</h4><p>Close physical contact between a parent and child can reduce a child's pain-related distress. </p><p>During a procedure, your young child may want to:</p><ul><li>stand between your legs while you are seated </li><li>sit on an examining table in your arms</li><li>have you massage their head while they are lying down. </li></ul><p>Think about what your child would want and work out a way to keep them close to you while allowing the health-care professional to do their work.</p><h4>D: Distract your young child </h4><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. Toys, bubbles, books and songs are all good ways to distract very young children. If your child is a preschooler, you may want to ask them about something fun that is coming up or ask how hard they can squeeze your hand. Some children may also like to get a sticker after a painful procedure. </p><p>If you notice that distraction is making your young child more distressed, go back to cuddling. An extra 60 seconds of cuddling can do a lot to help your child calm down and become more open to distraction from their pain.</p><p>Do not feel that you have to be there during a painful procedure. For example, if the sight of a blood test makes you very nervous or unwell, it may be best to leave the room and let the health-care team support your child. Don't feel ashamed by this; it is not unusual. When the test is over, you can come back in to give hugs and cuddles. A young child knows when a parent is distressed, so it is best to save them from any increase in their own anxiety.</p><h3>Powerful parent behaviours </h3><p>What you say, and do not say, can also help your young child cope with pain. In fact, research has shown that <em>not</em> saying the "wrong" things is more helpful for your child than saying the "right" things! The guidelines below have been shown to be very helpful.</p><ul><li> <strong>Do not reassure</strong>. It might sound strange, but it is better not to reassure your child when they are distressed. Telling a child "It's ok" or "You are fine" over and over when they know they are obviously not fine (scared, crying, screaming) can actually make your child more stressed.</li></ul><ul><li> <strong>Do not criticize</strong>. Do not use your child's experience of pain to try to improve their behaviour or tell them they can do better. Saying things such as "Brave girls don't cry", "Your brother didn't cry this much" or "This needle isn't that big a deal" makes children more upset, which leads to more pain.</li></ul><ul><li> <strong>Do not apologize</strong>. It is not your fault that your child is having a medical procedure, so do not say sorry for it or their pain. Some researchers believe that apologizing to your young child tells them that you are distressed. This in turn will make them more distressed. </li></ul><ul><li> <strong>Do not give your young child choices during a procedure.</strong> Young children tend to be overwhelmed by an upcoming painful procedure, so do not ask them right beforehand what side they would like the needle, for example. If they need to have the same painful procedure again, you can ask them what they would like well ahead of time.</li></ul><ul><li> <strong>Do tell the truth. </strong>If you child asks if a procedure is going to hurt, and you think it will, let them know it will but that it will be over soon. Tell them that scientists have shown that kids who are less upset before a needle show less pain after a needle.</li></ul><h2>Physical strategies</h2><h3>Cold and heat</h3><p>If your child has any swelling or other signs of inflammation, it can be helpful to apply <em>cold</em> (such as a wrapped ice pack) to the area. This not only reduces signs of inflammation but can also help control pain.</p><p>About 24 to 28 hours after an acute (sudden) injury, it can be helpful to apply <em>heat</em> (for example with a heating pad or a hot water bottle). </p><p>Be careful to avoid injury with heat and cold packs. Only apply them for short periods at a time (say, 10 minutes on/10 minutes off) and monitor the area closely. Your child should be able to move the heat or cold pack away on their own or tell you if it is uncomfortable. </p><h3>Elevating the injured area</h3><p>If your child has pain and swelling after an acute injury, it can be helpful to elevate (raise) the painful body part to a level above their heart. Elevating a painful arm or leg, for instance on a pillow while your child lies down, allows any excess fluid to drain. This in turn reduces pressure and pain in the injured area. </p><h3>Resting or modifying movement </h3><p>If your young child injures themselves, it is often a good idea to rest the injured area or at least modify (change) any essential movements. This gives the injured area time to heal and protects it from further damage. </p><p>Be sure to talk to a health-care professional first because complete inactivity may sometimes increase swelling in the area and/or lead to loss of motion and muscle strength. </p><h2>Pharmacological strategies (medications)</h2><p>Pain medications can also manage your young child's acute pain. They often come in different forms but for younger children, liquids are often preferred. Work with your young child to figure out the best way to give them liquids such as spoons, medicine cups or syringes. </p><p>Below is an outline of some common medications for acute pain. Because they treat different types of acute pain, some of them may be used together, if directed by your child's health-care team. </p><p>Always talk to a health-care professional before you use pain medications, especially if you are not sure which medication to use or which form of medication might work best for your child. They can advise you if a 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 or blood tests. Apply the cream to the area where the needle will be injected 30 to 60 minutes before the procedure. Ask for directions from your pharmacist or health-care team.</p><h3>Over-the-counter medications</h3><p>It may also be helpful for your child to take <a href="https://www.aboutkidshealth.ca/article?contentid=62&language=English">acetaminophen</a> or <a href="https://www.aboutkidshealth.ca/article?contentid=153&language=English">ibuprofen</a> before or after a painful procedure. Taking it 30 to 40 minutes before a procedure is sometimes recommended.</p><p>These medications can often last four to eight hours, so can be particularly good for acute pain such as an earache or pain after an injury.</p><h3>Opioid medications</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> <br><div></div><div><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><br></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><br></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><br></p></div><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><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</em><em></em><em></em><em></em><em></em><em> 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>
Addison's disease and diabetesAAddison's disease and diabetesAddison's disease and diabetesEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemConditions and diseasesAdult (19+)Fatigue;Nausea;Abdominal pain;Joint or muscle pain2017-11-20T05:00:00ZCatherine Pastor, RN, MN, HonBScVanita Pais, RD, CDEAndrea Ens, MD, FRCPCJennifer Harrington, MBBS, PhD8.0000000000000063.7000000000000295.000000000000Flat ContentHealth A-Z<p>Addison's disease is a rare autoimmune disease. Learn about the signs and treatment and why it occurs more often in people with type 1 diabetes.<br></p><p>Addison’s disease is an autoimmune disease where the immune system attacks the adrenal glands. The adrenal glands are located above the <a href="https://pie.med.utoronto.ca/htbw/module.html?module=kidney-child">kidneys</a> and release many different hormones (chemical messenger) into the blood. This includes cortisol and aldosterone, two hormones that help respond to body stress and work to maintain a normal blood pressure. Damage to the adrenal glands decreases cortisol and aldosterone production. </p><h2>Key points</h2> <ul><li>Addison's disease is rare but tends to occur more often in people with type 1 diabetes than in the general population.</li> <li>A blood test is used to help diagnose Addison's disease.</li> <li>Addison's disease is treated with pills that your child will take for the rest of their life.<br><br></li></ul>https://assets.aboutkidshealth.ca/akhassets/adrenal_gland_and_water_regulation_V2_EN.jpg
Adenoid surgery: Caring for your child after the operationAAdenoid surgery: Caring for your child after the operationAdenoid surgery: Caring for your child after the operationEnglishOtolaryngologyToddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)Nose;MouthMouth;Lymph nodes;NoseNon-drug treatmentCaregivers Adult (19+)NA2019-01-24T05:00:00ZKathy Eres, RN; Paolo Campisi, Msc, MD, FRCSC, FAAP; Tomka George, RN; Pauline Lackey, RN6.5000000000000071.50000000000001295.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Children may have their adenoids removed to relieve pressure or reduce infections. Learn about adenoid surgery and recovery following adenoid surgery. </p><p>Your child needs an operation called an adenoidectomy to take out their adenoids. Adenoids are lumps of tissue, up behind the nose. You cannot see your child's adenoids when looking in the mouth.<br></p><h2>Key points</h2> <ul> <li>Your child's enlarged adenoids will be removed in a surgical procedure.</li> <li>You child will be asleep and feel no pain when the adenoids are removed.</li> <li>Most children can go home the same day as the operation. </li> <li>It will take a few days before your child can return to their regular activities and food.</li> </ul><h2>When to see a doctor</h2> <p>Please call your child's otolaryngologist, the otolaryngology clinic nurse or your family doctor if your child has any of the following signs after going home: </p> <ul> <li>fever of 38.5°C (101°F) or higher</li> <li>vomiting (throwing up) that does not stop</li> <li>pain that gets worse</li> <li>refusing to drink</li> <li>child does not urinate (pee) within 12 hours of the operation</li> <li>fresh blood in the nose or mouth</li> </ul> <p>If your child is bleeding, having trouble breathing, or if you have additional concerns, take your child to the closest emergency department. </p> <h3>Write down contact information here:</h3> <p>Otolaryngologist's name and number:</p> <p>Otolaryngology clinic number:</p> <p>Family doctor's name and number:</p> <p> </p><h2>Removing enlarged adenoids</h2> <figure><span class="asset-image-title">Adenoids</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Adenoids_MED_ILL_EN.jpg" alt="Location of adenoid" /> <figcaption class="asset-image-caption">The adenoids are located behind the nose.</figcaption> </figure> <p>Your child may have had <a href="/Article?contentid=831&language=English">enlarged adenoids</a> since birth, or they may have grown too large from repeated infections. Enlarged adenoids can interfere with your child's breathing, especially at night when they are sleeping. Taking out adenoids improves breathing. </p><p>Enlarged adenoids can also affect the tubes that connect the middle ears and the back of the nose. If your child often has <a href="/Article?contentid=8&language=English">ear infections</a>, an adenoidectomy may help them have fewer ear infections. </p><p>An otolaryngologist/head and neck surgeon will do the surgery. An otolaryngologist (say: OH-toe-lar-ing-GOLL-oh-jist) is a doctor who specializes in problems of the ears, nose and throat. </p><h2>Surgery to remove the adenoids</h2><p>The doctor will give your child a special sleep medicine called a <a href="/Article?contentid=1261&language=English">general anaesthetic</a>. This will make sure your child sleeps through the operation and does not feel any pain. </p><p>While your child is asleep, the doctor will take out the adenoids through your child's mouth. Your child will not get stitches. The operation will take between 20 and 45 minutes.</p><h2>You will be able to see your child as soon as they are fully awake</h2><p>A volunteer from the Surgical Waiting Room will bring you to see your child.</p><h2>After the operation</h2> <p>After the operation, we will take your child to the recovery room, also called the <a href="/Article?contentid=1262&language=English">Post Anaesthetic Care Unit (PACU)</a>. This is where your child will wake up. Your child will stay in the <a href="/Article?contentid=1262&language=English">PACU</a> for about one hour. We will then move your child to a room on the nursing unit. </p> <h2>Your child will be closely monitored on the nursing unit</h2> <ul> <li>Your child will be encouraged to take fluids by mouth. Your child will start with sips of clear fluids (liquids you can see through), ice chips or freezies. Once your child can take sips, they can then drink liquids from a cup. </li> <li>Your child's temperature and vital signs will be taken regularly. </li> <li>Your child will still have an IV in their arm. When it is no longer needed for fluids or medicine, it will be taken out. </li> <li>Your child will be given pain medicine if needed. </li> <li>The nursing staff will watch your child for <a href="/Article?contentid=746&language=English">vomiting</a> (throwing up) or bleeding. </li> <li>The nurses will tell the doctor if there are any complications. </li> <li>When your child is fully awake, they can get up with help to use the washroom. </li> <li>Your child may throw up thick, brownish-coloured liquid if they swallowed some blood during or after the operation. This is normal. If your child keeps throwing up, we will give them medicine through the IV to help settle their upset stomach. </li> </ul> <h2>Managing your child's pain after the operation</h2> <p>If your child has pain after the operation, they will be given pain medicine by a liquid to swallow. Your child should have very little pain after the operation. </p> <h2>Your child will probably be able to go home on the same day</h2> <p>Most children are ready to go home from the hospital after about three hours in the nursing unit. Sometimes, children need to stay for a longer time. </p> <p>You should take your child home in a car or a taxi. For your child's comfort and safety, do not take your child home by bus or subway. </p><h2>Before the operation</h2> <p>Several hours before the operation, your child will need to stop eating and drinking. The doctor or nurse will tell you when your child must stop eating and drinking. </p> <h3>Write this information down here:</h3> <p>The date and time of the operation:</p> <p>When your child must stop eating:</p> <p>When your child must stop drinking clear fluids:</p> <p>Other things to remember:</p> <p> </p>https://assets.aboutkidshealth.ca/akhassets/Adenoids_MED_ILL_EN.jpg
Adenoidectomy with obstructive sleep apnea: Caring for your child after the operationAAdenoidectomy with obstructive sleep apnea: Caring for your child after the operationAdenoidectomy with obstructive sleep apnea: Caring for your child after the operationEnglishOtolaryngologyToddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)Nose;MouthMouth;Lymph nodes;NoseNon-drug treatmentCaregivers Adult (19+)NA2019-01-24T05:00:00ZKathy Eres, RN;Tomka George, RN;Pauline Lackey, RN;Paolo Campisi, MSc, MD, FRCSC, FAAP7.0000000000000067.80000000000001489.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Children undergoing an adenoidectomy with obstructive sleep apnea require extra attention following surgery. Read about adenoidectomy and recovery. </p><p>Your child needs an operation called an adenoidectomy (say: ADD-uh-noy-DECK-toe-mee) to take out their adenoids.</p><p>Your child also has <a href="/Article?contentid=1918&language=English">obstructive sleep apnea (OSA)</a>. This means your child will need to be closely watched after the operation. Your child may also have to stay in hospital longer than the other children having an adenoidectomy.</p><p>This page explains what to expect while your child is in the hospital and how to take care of your child at home.</p><div class="akh-series"><div class="row"><div class="col-md-12"> <figure> <span class="asset-image-title">Adenoids</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Adenoids_MED_ILL_EN.jpg" alt="Location of adenoid" /> <figcaption class="asset-image-caption">The adenoids are located behind the nose.</figcaption></figure> <h2>What are adenoids?</h2><p>Adenoids are lumps of tissue, up behind the nose. Adenoids cannot be seen when looking in the mouth.</p><p>Sometimes, adenoids become <a href="/Article?contentid=831&language=English">enlarged</a> and can cause breathing problems.</p></div></div></div><h2>What is obstructive sleep apnea?</h2><p>Sleep apnea (say: AP-nee-uh) means that your child goes through long pauses between breaths while sleeping. The obstructive part of <a href="/Article?contentid=1918&language=English">OSA</a> means that the pauses are caused by an obstruction or blockage. OSA can occur when the adenoids have become large enough to cause some blockage of your child's air passages.</p><h2>Key points</h2> <ul> <li>Your child will have an operation to remove their enlarged adenoids. </li> <li>You child will be asleep and feel no pain when the adenoids are removed. </li> <li>Most children can go home the morning after the operation. </li> <li>It will take a few days before your child can return to their regular activities and diet.</li> </ul><h2>Reasons to call the doctor</h2> <p>Please call your child's otolaryngologist, the otolaryngology clinic nurse or your family doctor if your child has any of the following signs after going home. </p> <ul> <li>fever of 38.5°C (101°F) or higher </li> <li>vomiting (throwing up) that does not stop </li> <li>pain that gets worse </li> <li>refusing to drink </li> <li>fresh blood in the nose or mouth </li> </ul> <p>If your child is bleeding, having trouble breathing, or if you have additional concerns, take your child to the closest emergency department.</p> <h3>Write down contact information here:</h3> <p>Otolaryngologist's name and number:</p> <p>Otolaryngology clinic number:</p> <p>Family doctor's name and number:</p><h2>Removing enlarged adenoids</h2><p>Your child may have had enlarged adenoids since birth, or their adenoids may have grown too large from repeated infections. The enlarged adenoids are interfering with your child's breathing, especially at night when they are sleeping. Taking out the adenoids will improve breathing. If your child often has ear infections, an adenoidectomy may help them have fewer ear infections. </p><p>An otolaryngologist (say: OH-toe-LAR-ing-GOLL-oh-jist) will do the operation. An otolaryngologist is a doctor who specializes in problems of the ears, nose and throat.<br></p><h2>Surgery to remove the adenoids</h2><p>The doctor will give your child a special sleep medicine called a <a href="/Article?contentid=1261&language=English">general anaesthetic</a>. This will make sure your child sleeps through the operation and does not feel any pain. </p><p>While your child is asleep, the doctor will take out the adenoids through your child's mouth. Your child will not get stitches. The operation will take between 20 and 45 minutes.</p><h2>You will be able to see your child when they are fully awake</h2><p>A volunteer from the Surgical Waiting Room will bring you to see your child.</p><h2>After the operation</h2><p>After the operation, we will take your child to the recovery room, also called the <a href="/Article?contentid=1262&language=English">Post Anaesthetic Care Unit (PACU)</a>. This is where your child will wake up. Your child will stay in the <a href="/Article?contentid=1262&language=English">PACU</a> for about one hour. Then your child will be taken to a special constant observation room on the otolaryngology inpatient unit. Your child will stay in this room overnight. A nurse will watch over your child at all times. </p><h3>Your child will be closely monitored overnight</h3><ul><li>An electronic monitor will be attached to your child to help the nurse watch your child's breathing. </li><li>Your child will be encouraged to take fluids by mouth. Your child will start with sips of clear fluids (fluids you can see through), ice chips or freezies. Once your child can take sips, they can then drink liquids from a cup. </li><li>Your child's temperature and vital signs will be taken regularly. </li><li>Your child will still have an IV in their arm. It may be needed for fluids or medicine.</li><li>Your child will be given pain medicine if needed. </li><li>The nursing staff will watch your child for vomiting or bleeding. </li><li>The nurses will notify the otolaryngologist if there are any complications. </li><li>When your child is fully awake, they may get up with help to use the washroom. </li><li>Your child may throw up thick liquid that is a brownish colour, if they have swallowed some blood during or after the operation. This is normal. If your child keeps throwing up, we will give them medicine through the IV to help settle their upset stomach. </li></ul><p>One parent may stay overnight with your child. However, there is no space for a parent's sleep cot in the constant observation room. </p><h2>Managing your child's pain after the operation</h2><p>If your child has pain after the operation, we will give them pain medicine by a liquid to swallow. Your child should have very little pain after the operation. </p><h2>Most children go home in the morning</h2><p>Your child will be seen by the otolaryngology doctors the afternoon of the operation and early the next morning. If your child is drinking and had no problems overnight, they should be able to go home in the morning. </p><h2>Before the operation</h2> <p>Several hours before the operation, your child will need to stop eating and drinking. The doctor or nurse will tell you when your child must stop eating and drinking. </p> <h3>Write this information down here:</h3> <p>The date and time of the operation:</p> <p>When your child must stop eating:</p> <p>When your child must stop drinking clear fluids:</p> <p>Other things to remember:</p> <p> </p>https://assets.aboutkidshealth.ca/akhassets/Adenoids_MED_ILL_EN.jpg
Adjusting insulin when using a TID or BID insulin routineAAdjusting insulin when using a TID or BID insulin routineAdjusting insulin when using a TID or BID insulin routineEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemDrug treatmentAdult (19+) CaregiversNA2016-10-17T04:00:00ZCatherine Pastor, RN, MN, HonBSc;Vanita Pais, RD, CDE;Jennifer Harrington​, MBBS, PhD​11.500000000000049.0000000000000903.000000000000Flat ContentHealth A-Z<p>Find out how to adjust insulin doses at home using the sliding scale when using a three-times-a-day insulin routine or two-times-a-day insulin routine.</p><p>A three-times-a-day (TID) insulin routine involves giving insulin at three separate times of the day. A twice-a-day (BID) insulin routine involves administering two kinds of insulin. The following guidelines will help you adjust <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=1728&language=English">insulin</a> dosages at home. If you have any questions, or if adjusting the insulin dosage does not seem to help achieve <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=1724&language=English">target blood glucose (sugar) levels</a>, contact your primary diabetes care team.</p><h2>Key points</h2><ul><li>TID and BID regimens allow for insulin changes based on the sliding scale, which adjusts the dose of rapid-acting insulin before meals and snacks based on blood sugar levels.</li><li>Insulin doses should be adjusted by about 10% at a time.</li></ul>
Adjusting insulin when using an insulin pumpAAdjusting insulin when using an insulin pumpAdjusting insulin when using an insulin pumpEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemDrug treatmentAdult (19+) CaregiversNA2016-10-17T04:00:00ZCatherine Pastor, RN, MN, HonBSc;Vanita Pais, RD, CDE;Jennifer Harrington​, MBBS, PhD​7.6000000000000067.6000000000000865.000000000000Flat ContentHealth A-Z<p>Find out how to adjust your child's insulin doses at home when using a pump.</p><p>Adjusting insulin when using an insulin pump follows the same rules as when on insulin injections. You will also be looking for patterns in blood sugar levels that fall outside your target range at the same time of the day. Remember that when adjusting insulin doses based on patterns, you are trying to prevent the problem with blood sugar level rather than correcting it afterward.</p><h2>Key points</h2><ul><li>When using an insulin pump, look for patterns in blood sugar levels that fall outside your target range at a specific time, and adjust accordingly.</li></ul>
Adjusting to a diagnosis of ASDAAdjusting to a diagnosis of ASDAdjusting to a diagnosis of ASDEnglishNeurologyChild (0-12 years)NANervous systemConditions and diseasesAdult (19+)NA2009-03-09T04:00:00ZJanice Mulligan MSW, RSWRadha MacCulloch, MSWWendy Roberts MD. FRCPCLee Steel10.300000000000052.1000000000000547.000000000000Flat ContentHealth A-Z<p>Information on how counselling can help when a child has autism spectrum disorder. Includes options available for counselling.</p><br><p> Receiving an official diagnosis of autism spectrum disorder (ASD) can be overwhelming. This page explains common reactions to a diagnosis and how to access support for yourself. </p><h2> Key points </h2><ul><li>Each family member will cope with a diagnosis of ASD differently.</li><li> It takes a long time to get an ASD diagnosis — it is normal to feel stressed and overwhelmed. </li><li>Talking to other parents, joining a support group, or speaking with a counsellor who has experience with ASD can be helpful when trying to find services for your child.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/adjusting_to_a_diagnosis_of_ASD.jpg
Adjusting to illness and activityAAdjusting to illness and activityAdjusting to illness and activityEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemHealthy living and preventionAdult (19+)NA2016-10-17T04:00:00ZCatherine Pastor RN, MN, HonBSc;Vanita Pais RD, CDE;​​Sanjukta Basak MSc, MD CM, FRCPC;​​Ruth Slater Ph.D., C. Psych​000Flat ContentHealth A-Z<p>Sometimes events occur that can disrupt your child's diabetes routine and impact their blood sugar levels. Find out what can impact them and what you can do.</p><p>You and your child have now settled in a routine in balancing food, exercise, and insulin or diabetes medication. However, occasional events can disrupt this routine and affect your child’s blood sugar levels.</p><h2>Key points</h2> <ul><li>Illness can have an effect on your child's blood sugar levels and ketones.</li> <li>Exercise lowers blood sugar levels and makes the body more sensitive to insulin.</li></ul>

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