AboutKidsHealth

 

 

CARDCCARDCARDEnglishPain/AnaesthesiaPre-teen (9-12 years)NANANon-drug treatmentAdult (19+) Caregivers Pre-teen (9-12 years) EducatorsNA2019-03-26T04:00:00ZLanding PageLearning Hub<p>Getting vaccinated can be scary and painful for children. The CARD system provides resources such as videos and handouts that give students strategies they can use to help them prepare for and cope during a vaccination at school.</p><p>Getting vaccinated can be scary and painful for children. The CARD system gives students strategies they can use to help them cope during vaccination. The system consists of resources such as videos and handouts for students, parents and teachers that will help to prepare students for a vaccination at school.</p>CARDhttps://assets.aboutkidshealth.ca/AKHAssets/iStock-695656414.jpg
CHARGE syndromeCCHARGE syndromeCHARGE syndromeEnglishGeneticsChild (0-12 years);Teen (13-18 years)NANAConditions and diseasesCaregivers Adult (19+)NA2015-06-12T04:00:00ZReena Pabari, MD, MSc, HBSc;Rosanna Weksberg, MD, PhD, FRCPC, FCCMG, FACMG​;Cheryl Cytrynbaum, MS, CGC7.8000000000000066.2000000000000605.000000000000Health (A-Z) - ConditionsHealth A-Z<p>The effects of CHARGE syndrome differ from one child to the next. Find out how this genetic condition is caused and treated. </p><h2>What is CHARGE syndrome?</h2> <p>CHARGE syndrome is a condition that occurs in one in every 10,000 births worldwide. It is a complex condition that affects many different parts of the body. Children with CHARGE syndrome have medical issues and may also have delays in their development.</p><h2>Key points</h2> <ul> <li>The signs and symptoms of CHARGE syndrome vary from child to child. They include problems with seeing, hearing, breathing, growing and learning.</li> <li>CHARGE syndrome is usually caused by a mutation in the CHD7 gene on chromosome 8.</li> <li>With the right support and medical treatment, a child with CHARGE syndrome can lead a happy and healthy life.</li> </ul><h2>Signs and symptoms of CHARGE syndrome</h2><p>The symptoms of CHARGE syndrome vary greatly from one child to the next.</p><p>The name "CHARGE" is an acronym for some of the common features seen in children with the syndrome. Specifically, the features are:</p><ul><li> <strong></strong><strong></strong><strong>c</strong>oloboma of the eye (a hole in one part of the eye, usually the iris)</li><li> <strong>h</strong>eart <a href="/Article?contentid=1767&language=English">defects</a><br></li><li> <strong>a</strong>tresia of the choanae (blocked or narrowed airways between the back of the nose and the throat)</li><li> <strong>r</strong>etarded (delayed) growth or development</li><li> <strong>g</strong>enital or urinary abnormalities</li><li> <strong>e</strong>ar abnormalities, for example low cub-shaped ears or deafness.</li></ul><p>This list combines major and minor features of CHARGE syndrome. Major features are extremely common in CHARGE syndrome and rare in other conditions. Minor features are common in CHARGE syndrome and present in other conditions. The list does not include all the important features seen in CHARGE syndrome (for example facial palsy).</p><h2>Causes of CHARGE syndrome</h2> <p>About two-thirds of children with CHARGE have a mutation (change) in a gene called CHD7 on chromosome 8. In most cases, this mutation is a new change in the child, meaning that it is not found in either parent. So if a couple has a child with CHARGE syndrome, it is very unlikely that any of their future children will have CHARGE syndrome.</p> <p>The cause of CHARGE syndrome in the one-third of children who do not have a CHD7 mutation is not yet known. Researchers are investigating other potential causes.</p> <p>A mutation in the CHD7 gene will confirm a doctor’s diagnosis of CHARGE syndrome. However, if a child with CHARGE features is not found to have a mutation in CHD7, it does not mean that they do not have CHARGE syndrome. Rather, it suggests that the cause is not yet known. </p><h2>How CHARGE syndrome is diagnosed</h2> <p>A doctor knowledgeable about CHARGE syndrome will diagnose it based on a child’s features. The diagnosis is based on the presence of major and minor features.</p><h2>How to treat CHARGE syndrome</h2> <p>Each child with CHARGE syndrome is unique and will need extra help in different ways. Children with CHARGE syndrome can lead happy and healthy lives with the right help and support.</p> <p>Based on your child’s physical symptoms and needs, your doctor will involve specialists to evaluate, monitor and support your child in areas such as hearing, vision, breathing, growth and learning. Children with CHARGE syndrome often need medical and educational supports to address their specific needs right through their life.</p><h2>How to learn more about CHARGE syndrome</h2> <p>If you have a child with CHARGE syndrome, you will likely have many questions about what to expect in the years to come. Websites such as that for the <a href="http://www.chargesyndrome.org/" target="_blank">CHARGE Syndrome Foundation</a> are a useful source of information and support. Your child’s doctor will also be able to answer questions and give you advice about where to find the information and support you need.</p>
CNS vasculitisCCNS vasculitisCNS vasculitisEnglishHaematologyChild (0-12 years);Teen (13-18 years)BrainArteries;Veins;Capillaries;BrainConditions and diseasesCaregivers Adult (19+)NA2009-11-06T05:00:00ZSusanne Benseler, MD;Holly Convery, RNEC, BScN6.5000000000000069.30000000000001158.00000000000Health (A-Z) - ConditionsHealth A-Z<p>CNS vasculitis is the inflammation of blood vessels in the brain resulting in restricted blood flow. Read about the diagnosis of CNS vasculitis. </p><h2>What is CNS vasculitis?</h2><p>The brain and the spinal column make up the central nervous system (CNS). Vasculitis is an inflammation of the blood vessels. Blood vessels are the veins and arteries that carry blood around the body including the brain. So CNS vasculitis is an inflammation of blood vessels in the brain. </p> <figure class="asset-c-80"> <span class="asset-image-title">Vessel anatomy of the brain</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Vessel_anatomy_MED_ILL_EN.jpg" alt="Large blood vessel in the brain and close-up of brain tissue with microscopic blood vessels" /> <figcaption class="asset-image-caption">There are many blood vessels in the brain. Some are large vessels and they can be seen on an angiogram. The brain has many small vessels that can only be seen with a microscope. A biopsy is needed to examine these smaller vessels.</figcaption> </figure> <p>Inflammation (irritation and swelling) is a normal process. It is how our immune systems protect our bodies from bacteria and viruses that cause infection. But in CNS vasculitis, there is no infection. Instead, the immune system wrongly attacks normal cells causing inflammation. This type of problem is called an autoimmune disease. So far, we do not understand what causes these problems. </p><h2>Key points</h2> <ul> <li>CNS vasculitis is a condition where the immune system attacks the blood vessels in the brain. </li> <li>CNS vasculitis can cause headaches, irritability, learning problems, vision problems, weakness on one side of the body, seizures, or stroke. </li> <li>If you think your child may have CNS vasculitis, contact your family doctor and ask her to examine your child. </li> </ul><h2>Signs and symptoms of CNS vasculitis</h2> <p>The first signs of CNS vasculitis are usually one or more of the following:</p> <ul> <li>headaches </li> <li>irritability </li> <li>learning problems </li> <li>eyesight (vision) problems </li> <li>problems dealing with loud sounds or bright lights </li> </ul> <p>Most children are not diagnosed with CNS vasculitis when these symptoms first appear. Usually, a child is diagnosed with CNS vasculitis after having one of these serious problems: </p> <ul> <li>numbness, weakness, or paralysis of one side of the body (hemiplegia) </li> <li>seizure </li> <li>stroke </li> </ul><h2>There are several steps to diagnosing CNS vasculitis</h2><h3>Medical history and physical exam</h3><p>First, the doctor will ask about your child's symptoms and medical history. The doctor will do a physical exam to see if your child has any symptoms of brain inflammation. </p><h3>Blood sample and spinal tap</h3><p>Next, the doctor will take samples of your child's blood and cerebrospinal fluid (CSF). CSF is the fluid that surrounds the brain and spinal cord. To get a sample of CSF, your child will need to have a spinal tap (lumbar puncture). </p><p>Your child's blood and CSF will be tested to see if they contain certain substances that can show if your child has inflammation somewhere in the body. </p><h3>MRI scan</h3><p>Next, the doctor will order an MRI scan. This test makes special pictures of the brain, using radio waves and a strong magnet. The doctor will look at these pictures to see if your child's brain has either of these: </p><ul><li>areas of brain inflammation </li><li>areas where not enough blood is flowing (ischemia or stroke) </li></ul> <figure class="asset-c-80"> <span class="asset-image-title">MRI of CNS vasculitis</span> <img src="https://assets.aboutkidshealth.ca/akhassets/MRI_cnsv_MEDIMG_PHO_EN.jpg" alt="MRI of brain with inflammation" /> </figure> <h3>Angiograms</h3><p>If the MRI shows problems, the doctor will order two kinds of angiogram. An angiogram is a test that gives pictures of the large blood vessels. The two types are as follows: </p><ul><li>A magnetic resonance angiogram (MRA) uses the same machine as an MRI. It gives a 3-dimensional picture of the large blood vessels. </li><li>An X-ray angiogram gives a picture of the large blood vessels. Your child will have a special dye injected into his blood. This dye is called contrast fluid. It helps blood vessels show up on the X-ray. </li></ul> <figure class="asset-c-80"> <span class="asset-image-title">Angiogram of CNS vasculitis</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Angiogram_largevessel_MEDIMG_PHO_EN.jpg" alt="An angiogram of the brain with a thin blood vessel and a normal blood vessel" /> <figcaption class="asset-image-caption">An angiogram shows what the large blood vessels look like.</figcaption> </figure> <p>Angiograms will show if your child has large vessel CNS vasculitis. But they do not show the small blood vessels. So even if these tests do not show any problems, your child could still have small vessel CNS vasculitis. </p><h3>Brain biopsy</h3><p>The only way to find small vessel CNS vasculitis is with a test called a brain biopsy. A neurosurgeon will take a tiny sample from your child's brain. The sample is only the size of a needle. Another doctor will look at it under a microscope. </p><p>This test will show if your child has small vessel vasculitis. It can also help tell CNS vasculitis apart from other diseases, such as infections or brain tumours. </p><h2>CNS vasculitis is treated with medicine</h2> <p>The <a href="/Article?contentid=1173&language=English">treatment of CNS vasculitis </a>aims to do these things:</p> <ul> <li>improve the blood supply to the brain </li> <li>prevent further complications </li> <li>prevent blood clots from forming </li> </ul> <p>CNS vasculitis is treated with medicine that stops the immune system from working so hard. This stops the inflammation and protects the brain. Your child will also need to take medicine to prevent blood clots. </p> <p>A full course of treatment takes about two years.</p><h2>CNS vasculitis can harm the brain</h2><p>The inflammation caused by CNS vasculitis can harm the brain. When they are inflamed, the walls of the blood vessels get thicker and the space inside them gets smaller. This means that less blood can flow through them. Parts of the brain get less blood than they need. Sometimes they get no blood at all. When this happens, two major problems can result: </p><ul><li>Brain tissue around the inflamed blood vessel becomes irritated or damaged. This is also called brain inflammation. </li><li>Brain tissue around inflamed blood vessels does not get enough oxygen. This can cause a stroke. </li></ul><p>CNS vasculitis is treated with medicine. This helps to prevent new damage. It also gives blood vessels time to heal.</p> <figure class="asset-c-80"> <img src="https://assets.aboutkidshealth.ca/akhassets/Flow_comparison_cnsv_MED_ILL_EN.png" alt="Blood vessels with normal blood flow and blood vessels with restricted blood flow from irritated vessel wall and brain tissue" /> <figcaption class="asset-image-caption">Inflammation causes the blood vessel walls to swell, restricting the space inside, and reducing blood flow.</figcaption> </figure>https://assets.aboutkidshealth.ca/akhassets/Flow_comparison_cnsv_MED_ILL_EN.png
CNS vasculitis: Coping with illnessCCNS vasculitis: Coping with illnessCNS vasculitis: Coping with illnessEnglishHaematologyChild (0-12 years);Teen (13-18 years)BrainArteries;Veins;Capillaries;BrainSupport, services and resourcesCaregivers Adult (19+)NA2009-11-06T05:00:00ZSusanne Benseler, MD;Holly Convery, RNEC, BScN9.5000000000000059.3000000000000985.000000000000Flat ContentHealth A-Z<p>When a child is ill, all of the family members are affected by the stress. Read about effective coping techniques for the families of sick children. </p><h2>CNS vasculitis can be stressful for parents</h2><p>Chronic disease comes with turmoil for you, your child and your other children. Most parents are already very busy caring for children, maintaining the household and usually working at their jobs. It is only natural that taking care of a sick child will make you feel overwhelmed. You may also be worried about money or strained relationships.</p> <p>It is extremely important to ask for support wherever you can:</p><ul><li>Friends and family can help by coming to appointments, doing household chores, caring for other children or just buying you a cup of coffee.</li><li>Your employer can give you time off work for a stress leave. Social workers can help contact employers and arrange this time off.</li><li>Your family doctor can help you stay in good health. It may be tempting to overlook yourself to take care of your child, but if you get sick you will not be able to help at all. If you take care of your own body, your child will learn to do the same.</li><li>Social workers at the hospital can help you and your child deal with personal, family or social problems that are related to your child's illness.</li></ul><h2>Key points</h2> <ul> <li>Take care of yourself. Ask friends, work and your family doctor for support. A social worker can also help you. </li> <li>Your other children may feel neglected, guilty or anxious. Try to spend time with them and remind them that their brother or sister's disease is not their fault. </li> <li>You may be able to get financial support. </li> <li>Ask your social worker or doctor if you would like to get in touch with another family whose child has had CNS vasculitis.</li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/CNS_vasculitis_coping.jpg
CNS vasculitis: Lifestyle changesCCNS vasculitis: Lifestyle changesCNS vasculitis: Lifestyle changesEnglishHaematologyChild (0-12 years);Teen (13-18 years)BrainArteries;Veins;Capillaries;BrainNon-drug treatmentCaregivers Adult (19+)NA2009-11-06T05:00:00ZSusanne Benseler, MD;Holly Convery, RNEC, BScN8.0000000000000061.9000000000000455.000000000000Flat ContentHealth A-Z<p>A child who has CNS vasculitis will need to deal with several lifestyle changes. Find out how you can help your child cope through the treatment period. </p><p>CNS vasculitis and its treatment can affect your child's home and school life. Treatment for CNS vasculitis takes about two years. During this time, your child will be taking several kinds of medicine. They will also need to visit the hospital often. All these things can affect their day-to-day life. </p> <p>This page discusses the changes in your child's life and suggests ways to cope. These suggestions come from children, teens and parents who have experienced CNS vasculitis.</p><h2>Key points</h2> <ul> <li>CNS vasculitis is treated with medicine to suppress the immune system. Treatment takes about two years. </li> <li>The medicines your child takes for CNS vasculitis will make them hungrier and more tired than usual. They will gain weight. They may have trouble concentrating at school. </li> <li>If you or your child need help dealing with the effects of treatment, ask a member of the treatment team for help.</li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/CNS_vasculitis_lifestyle_changes.jpg
CNS vasculitis: Lifestyle changes for school-aged childrenCCNS vasculitis: Lifestyle changes for school-aged childrenCNS vasculitis: Lifestyle changes for school-aged childrenEnglishHaematologyChild (0-12 years);Teen (13-18 years)BrainArteries;Veins;Capillaries;BrainNon-drug treatmentCaregivers Adult (19+)NA2009-11-06T05:00:00ZSusanne Benseler, MD;Holly Convery, RNEC, BScN5.2000000000000081.0000000000000474.000000000000Flat ContentHealth A-Z<p>Children may find it difficult to attend school while they are being treated for CNS vasculitis. Learn how you can support your child through treatment. </p><p>CNS vasculitis and its treatment can affect your child's home and school life. For example:</p> <ul> <li>Your child may have trouble swallowing pills. </li> <li>They may forget to take their medicine at the right time. </li> <li>They may need to miss school because of appointments. </li> <li>They may feel sick when they are at school. </li> </ul> <p>Your child will need help with the effects of treatment. This page discusses the changes in your child's life and suggests ways to cope. These suggestions come from children, teens and parents who have experienced CNS vasculitis. </p><h2>Key points</h2> <ul> <li>Your child will need to take medicine for CNS vasculitis. They may find pills hard to swallow or they may forget to take their medicine. </li> <li>Your child may have to miss school to go to the hospital. They may feel sick when they are at school. </li> <li>If you or your child need help, speak to a member of the treatment team or to your child's teacher. </li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/CNS_vasculisits_changes_school-aged.jpg
CNS vasculitis: Lifestyle changes for teenagersCCNS vasculitis: Lifestyle changes for teenagersCNS vasculitis: Lifestyle changes for teenagersEnglishHaematologyChild (0-12 years);Teen (13-18 years)BrainArteries;Veins;Capillaries;BrainNon-drug treatmentTeen (13-18 years)NA2009-11-06T05:00:00ZSusanne Benseler, MD;Holly Convery, RNEC, BScN5.7000000000000072.8000000000000445.000000000000Flat ContentHealth A-Z<p>Teenagers with CNS vasculitis face unique challenges. Read about ways to cope with CNS vasculitis, including being involved in your healthcare. </p><p>CNS vasculitis can complicate life for teenagers. Here are some issues that you may want to discuss with your doctor. These suggestions come from other teens who have experienced CNS vasculitis.</p><h2>Key points</h2> <ul> <li>Treatment for CNS vasculitis involves medicine. Make sure you know what each pill is for. </li> <li>If you have trouble with side effects, talk to your doctor. </li> <li>Do not smoke or drink alcohol while you are taking medicine for CNS vasculitis.</li> <li>If you are planning to have sex, talk to your doctor about birth control. </li> </ul>
CNS vasculitis: Tips from experienced parentsCCNS vasculitis: Tips from experienced parentsCNS vasculitis: Tips from experienced parentsEnglishHaematologyChild (0-12 years);Teen (13-18 years)BrainArteries;Veins;Capillaries;BrainNon-drug treatmentCaregivers Adult (19+)NA2009-11-06T05:00:00ZSusanne Benseler, MD;Holly Convery, RNEC, BScN6.6000000000000074.0000000000000865.000000000000Flat ContentHealth A-Z<p>As a parent of a sick child, there are things you can do to remain involved in your child's care. Read about being an advocate for your child. </p><p>This page contains strategies recommended by parents whose children have had CNS vasculitis. To help yourself and your child get through the illness, you should: </p><ul><li>advocate for your child</li><li>keep track of your child's progress</li><li>help your child deal with symptoms</li><li>ask your child's school for support</li><li>educate your child about her illness</li></ul> <br><h2>Key points</h2> <ul> <li>You are a vital member of your child's health care team. Speak up for your child if you believe there is a problem. </li> <li>Use a method that works for you to keep track of your child's progress, symptoms and any questions you have for the doctor. </li> <li>Your child may be irritable and sensitive to noise, light and touch. You can help them by keeping the lights in their room dim and giving them earplugs.</li> <li>Your child's school can help your child keep in touch with friends, keep up with school work and remember medications when they go back to school. </li> <li>Keep things simple when educating your child about their illness.</li> </ul>
CNS vasculitis: TreatmentCCNS vasculitis: TreatmentCNS vasculitis: TreatmentEnglishHaematologyChild (0-12 years);Teen (13-18 years)BrainArteries;Veins;Capillaries;BrainDrug treatmentCaregivers Adult (19+)NA2009-11-06T05:00:00ZSusanne Benseler, MD;Holly Convery, RNEC, BScN6.6000000000000069.40000000000001731.00000000000Health (A-Z) - ProcedureHealth A-Z<p>​CNS vasculitis is treated with a combination of medications that reduce inflammation and suppress immune function. Learn about CNS vasculitis treatment. </p><h2>What is CNS vasculitis?</h2> <p><a href="/Article?contentid=914&language=English">CNS vasculitis</a> is an inflammation of blood vessels in the brain. Blood vessels are the veins and arteries that carry blood around the body. In CNS vasculitis, the immune system mistakes normal cells in the blood vessels for harmful intruders and attacks them. This makes the blood vessel walls swell and get thicker. </p> <p>CNS vasculitis can harm the brain. When the blood vessels are inflamed, less blood can flow through them. This means that the brain tissue around the inflamed blood vessels may be damaged, or it may not get enough oxygen. If CNS vasculitis is not treated, it can cause permanent damage. </p> <p>The treatment of CNS vasculitis aims to:</p> <ul> <li>improve the blood supply to the brain<br></li> <li>prevent further complications<br></li> <li>prevent blood clots from forming. </li> </ul><h2>Key points</h2> <ul> <li>CNS vasculitis is treated with medicine to suppress the immune system and prevent blood clots. Treatment takes about two years. </li> <li>While your child is being treated for CNS vasculitis, it is important to prevent infection and talk to your doctor about any side effects. </li> <li>You know your child best. Tell your child's doctor about any changes in behaviour or anything that seems unusual or important. </li> </ul><h2>Treatment for CNS vasculitis takes about two years</h2> <p>Treatment for CNS vasculitis is a slow process. The entire treatment plan takes at least two years.</p> <p>Not all types of childhood CNS vasculitis are treated the same way. Different children will need different medicines for different amounts of time. If the CNS vasculitis symptoms flare up, the doctors may decide to treat your child for longer. If the treatment works fast, the doctors will give less medicine. </p> <h3>Progressive large vessel CNS vasculitis and small vessel CNS vasculitis</h3> <p>Children with small vessel or progressive large vessel CNS vasculitis are usually treated in two stages:</p> <ul> <li>In the first stage, your child will take high doses of strong medicine. This is called the induction stage. The goal is to rescue the brain by treating the severe inflammation in your child's blood vessels. Your child will start with high doses of prednisone. The doctor will slowly lower the dose over the next nine months. </li> <li>Your child may also take cyclophosphamide. If so, they will take it every month for the first six months. </li> <li>In the second stage, your child will take a gentler combination of medicines for another 18 months. This is called the maintenance stage. The aim during this stage is to help stop CNS vasculitis from coming back while your child's brain is healing. The medicines are usually azathioprine or mycophenolate mofetil, plus low doses of prednisone. </li> </ul> <p>This type of treatment is called an induction-maintenance strategy.</p> <p>At the same time, your child will take a blood thinner to prevent blood clots.</p> <h3>Non-progressive CNS vasculitis</h3> <p>Children with non-progressive CNS vasculitis are usually treated with a high dose of prednisone for three months. Then your child will take smaller and smaller doses of prednisone over the next months. Taking smaller and smaller doses is called tapering.</p> <p>At the same time, your child will take a blood thinner to prevent blood clots.</p><h2>CNS vasculitis is treated with medicine</h2> <p>Your child will need to take different kinds of medicine for CNS vasculitis:</p> <ul> <li>Medicine to suppress the immune system and reduce the inflammation in the blood vessel walls. This includes prednisone, <a href="/Article?contentid=113&language=English">cyclophosphamide</a>, azathioprine and mycophenolate mofetil. </li> <li>Medicine to make the blood thinner and prevent blood clots. This includes low-dose <a href="/Article?contentid=77&language=English">ASA (acetylsalicylic acid)</a> and heparin. </li> </ul> <p>Your child will be taking these medicines for many months. You need to know about them and about the side effects that your child may have. These are described in more detail below. </p> <p>If you are worried about any side effects, talk to your child's doctor.<br></p> <h2>Heparin</h2> <p>Children with large vessel CNS vasculitis often take intravenous (IV) heparin at first. Intravenous means your child will take this medicine through a needle or a tube that puts it directly into their bloodstream. </p> <p>Later, your child may take low molecular weight heparin (LMWH). This medicine is given with a needle under your child's skin.</p> <h2>Acetylsalicylic acid (ASA)</h2> <p>If your child has large vessel CNS vasculitis, they will also take <a href="/Article?contentid=1173&language=English">ASA (acetylsalicylic acid)</a> for the whole time they are being treated. ASA makes your child's blood thinner. This helps your child's blood travel through the blood vessels. </p> <p>Your child will take a very low dose of ASA, between 2 and 5 mg per kilogram of body weight per day. At this dose, ASA has no major side effects. Some children may have an upset stomach. </p> <h2>Prednisone</h2> <p><a href="/Article?contentid=221&language=English">Prednisone</a> is a drug that suppresses the immune system. This means that it lowers the number of immune cells that are attacking your child's blood vessels. When your child takes prednisone for a long time, the immune system is able to "reset" itself and make a new set of healthy immune cells. The new immune cells will not attack your child's body. </p> <p>Your child will be taking a high dose of prednisone to start with. As the treatment goes on, the doctor will lower the dosage.</p> <p>Your child needs to take the amount of prednisone that the doctor prescribes. This is very important. If your child is taking high doses of prednisone and then suddenly stops, your child's body will not be able to adjust to the change. </p> <p>The side effects of prednisone are not pleasant, but there is no other way to treat CNS vasculitis. The effects are stronger at higher doses and with longer courses of treatment. The main side effects are: </p> <ul> <li>weight gain </li> <li>more risk of getting infections </li> <li>hair growth </li> <li>stretch marks </li> <li>acne </li> <li>mood swings </li> <li>upset stomach </li> <li>higher blood pressure </li> <li>higher blood sugar </li> <li>thinning bones (osteoporosis) </li> </ul> <p>These side effects are all temporary. They will go away as soon as your child stops taking the prednisone.</p> <h2>Cyclophosphamide</h2> <p><a href="/Article?contentid=113&language=English">Cyclophosphamide</a> also suppresses the immune system. It slows down or stops the growth of immune system cells. Your child will take cyclophosphamide once a month through an IV tube. </p> <p>Cyclophosphamide is also used to treat some kinds of cancer. But we use much lower doses for CNS vasculitis. This means that CNS vasculitis patients have fewer side effects than cancer patients. </p> <p>For children with CNS vasculitis, cyclophosphamide has three main side effects:</p> <ul> <li>more risk of getting infections </li> <li>more risk of bleeding </li> <li>upset stomach and vomiting (throwing up) </li> </ul> <p>A very large dose of cyclophosphamide can make it hard for girls or boys to have children later on. We will watch your child's treatment to make sure they do not reach this dose.</p> <h2>Azathioprine (Imuran)</h2> <p><a href="/Article?contentid=80&language=English">Azathioprine</a> also suppresses the immune system. It stops immune system cells from dividing.</p> <p>Common side effects include:</p> <ul> <li>stomach upset </li> <li>diarrhea </li> <li>allergic reactions </li> <li>a flu-like illness </li> <li>liver irritation </li> </ul> <p>To watch for problems, your child will need a blood test every month.</p> <p>Some people cannot remove azathioprine from their bodies. Before your child starts taking this medicine, they will need a blood test to find out if they can take it safely. </p> <h2>Mycophenolate mofetil (Cellcept)</h2> <p><a href="/Article?contentid=195&language=English">Mycophenolate mofetil (MMF)</a> also suppresses the immune system. It stops immune system cells from getting overactive.</p> <p>The most common side effect is stomach upset. To prevent this, your child should take the medicine with food.</p> <p>A more serious side effect is when MMF stops the body from making white blood cells, red blood cells and platelets. To watch the levels of these blood cells, your child will need regular blood tests. </p>https://assets.aboutkidshealth.ca/AKHAssets/CNS_vasculitis_treatment.jpg
CPR in a baby (0 to 12 months): First aidCCPR in a baby (0 to 12 months): First aidCPR in a baby (0 to 12 months): First aidEnglishNANewborn (0-28 days);Baby (1-12 months)Heart;LungsHeartNon-drug treatmentCaregivers Adult (19+)NA2016-10-17T04:00:00ZEmily Louca, BSc, RRT​​8.1000000000000062.8000000000000771.000000000000Health (A-Z) - ProcedureHealth A-Z<p>CPR is a life-saving technique that combines chest compressions and rescue breaths (mouth-to-mouth resuscitation). Along with hands-on CPR training, this information can help save your baby's life.</p><h2>What is CPR?</h2> <p>CPR stands for cardiopulmonary resuscitation. CPR is an emergency procedure that involves chest compressions (pushing hard down on the chest) and rescue breaths (mouth-to-mouth resuscitation). When given properly, CPR can help deliver oxygen to the brain and other organs until help arrives or until your baby recovers. Causes of cardiac arrest in babies are usually a result of a major injury or illness and rarely from underlying heart disease.</p><h2>Key points</h2> <ul> <li>Take an official course to learn real, hands-on CPR. </li> <li>CPR involves both chest compressions and rescue breathing (mouth-to-mouth resuscitation). Give 30 compressions and two rescue breaths; repeat this cycle until help arrives or your child recovers.</li> <li>If your baby is unresponsive and not breathing or only gasping despite stimulation, start CPR right away and have someone else call 911 and get an AED.</li> <li>Once your baby starts breathing, put them in the recovery position. This will keep their airway open.</li> </ul><h2>Giving CPR to your baby</h2><p>Check to see if your baby is unresponsive and not breathing or only gasping. You will need to begin CPR if your baby does not:</p><ul><li>breathe (or only gasps)</li><li>respond to your touch</li><li>move </li><li>wake up </li><li>become alert</li></ul><p>If you are not alone, have someone else call 911 and get an AED (automated external defibrillator) right away, if available, while you are doing CPR. </p><p>If you are alone and have a cell phone, start CPR while calling 911 from your cell phone on speaker. After two minutes of CPR (five cycles), go get an AED if available.</p><p>If you are alone and have no cell phone, start CPR for two minutes (five cycles) and then call 911 from a landline and get an AED if available.</p><ol class="akh-steps"><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_CPR_infant_chest_compressions_EN.jpg" alt="Positioning baby for CPR chest compressions" /> </figure> <h2>Chest compressions: Push hard, push fast</h2><p>Begin CPR by laying your baby down on a firm, flat surface. Do not spend time trying to find a pulse. Place your two fingers on the breastbone, just below the nipple line. Give your baby 30 quick chest compressions (push fast), pressing hard enough so their chest moves approximately 4 cm (1.5 inches) down (push hard).</p><p>Count out loud. You should deliver about 100-120 compressions a minute. Wait for the chest to come all the way back to its initial position between compressions. This will get the blood flowing to your baby's brain and other vital organs. </p></li><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_CPR_infant_open_airway_EN.jpg" alt="Opening baby’s airways for rescue breaths" /> </figure> <h2>Rescue breaths: Open the airway </h2><p>After the first 30 chest compressions, place the palm of your hand on your baby’s forehead. Place two fingers on the hard, bony tip of their chin and gently tilt their head back. This will open the airway.</p></li><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_CPR_infant_breathe_airway_EN.jpg" alt="Giving baby CPR rescue breaths" /> </figure> <h2>Two rescue breaths</h2><p>Place your mouth over your baby's nose and mouth, forming a tight seal, and give two breaths. Each breath should be just enough to make your baby’s chest rise and should be no more than one second in length. If your baby’s chest does not rise, reposition their head, form a tighter seal, and try again.</p></li><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_CPR_infant_chest_compressions_EN.jpg" alt="Repeating CPR chest compressions on baby" /> </figure> <h2>Repeat </h2><p>Give cycles of 30 chest compressions and two breaths during two minutes and repeat until the ambulance arrives or your baby starts breathing again. Two minutes usually allow for five cycles of 30 chest compressions and two breaths. A two-minute CPR cycle is usually tiring. If you are not alone, switch who is giving CPR every two minutes.</p></li><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_CPR_infant_recovery_position_EN.jpg" alt="Placing baby in recovery position" /> </figure> <h2>Recovery position</h2><p>Once your baby has recovered and started breathing again on their own, your baby may vomit and find it difficult to breathe. Simply put your baby in the <a href="/Article?contentid=1037&language=English">recovery position</a>: Their chin should point slightly away from the chest and their face should rest on the surface on which the baby is laying. Make sure nothing is blocking or covering your baby's mouth and nose. The recovery position will help keep your baby’s airway open.</p></li></ol>​​<h2>​At SickKids:</h2> <p>The <a href="http://www.sickkids.ca/" target="_blank">Hospital for Sick Children​</a> offers the Heart and Stroke Foundation’s <a href="http://www.cvent.com/events/hospital-for-sick-children-standard-first-aid-heart-stroke-foundation-/event-summary-d989cebc9ab14e1281c6db68ab161d7c.aspx" target="_blank">First Aid program​</a>. It provides CPR and resuscitation training for patients, families and the general public.​</p> ​https://assets.aboutkidshealth.ca/akhassets/IMD_CPR_infant_breathe_airway_EN.jpg
CPR in a child (from age 1 to puberty)CCPR in a child (from age 1 to puberty)CPR in a child (from age 1 to puberty): First aidEnglishNAToddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years)Heart;LungsHeartNon-drug treatmentCaregivers Adult (19+)NA2016-10-17T04:00:00ZEmily Louca, BSc, RRT​​7.6000000000000065.8000000000000770.000000000000Health (A-Z) - ProcedureHealth A-Z<p>CPR is a life-saving technique that combines chest compressions and rescue breaths (mouth-to-mouth resuscitation).<br></p><h2>What is CPR?</h2> <p>CPR stands for cardiopulmonary resuscitation. CPR is an emergency procedure that involves chest compressions (pushing hard down on the chest) and rescue breaths (mouth-to-mouth resuscitation). When given properly, CPR can help deliver oxygen to the brain and other organs until help arrives or until your child recovers.</p> <p>The method described on this page applies to children between one year of age and puberty. Once puberty has begun, children should receive CPR as adults.</p><h2>Key points</h2> <ul> <li>Take an official course to learn real, hands-on CPR. </li> <li>CPR involves both chest compressions and rescue breathing (mouth-to-mouth resuscitation). Give 30 compressions and two rescue breaths; repeat this cycle until help arrives or your child recovers.</li> <li>If your child is unresponsive and not breathing or only gasping despite stimulation, start CPR right away and have someone else call 911.</li> <li>Once your child starts breathing, put them in the recovery position. This will keep their airway open.</li> </ul><h2>Giving CPR to your child</h2><p>Check to see if your child is responsive by tapping them on the shoulder and asking loudly, “Are you OK?”. If your child does not answer, follow these instructions depending on your situation:<br></p><ul><li>If you are not alone, have someone else call 911 and get an AED (automated external defibrillator) right away, if available, while you are doing CPR. </li><li>If you are alone and have a cell phone, start CPR while calling 911 from your cell phone on speaker. After two minutes of CPR (five cycles), go get an AED if available.</li><li>If you are alone and have no cell phone, start CPR for two minutes (five cycles) and then call 911 from a landline and get an AED if available.</li></ul><ol class="akh-steps"><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_CPR_child_chest_compressions_EN.jpg" alt="Positioning child for CPR chest compressions" /> </figure> <h2>Chest compressions: Push hard, push fast</h2><p>Begin CPR by laying your child down on a firm, flat surface. Do not spend time trying to find a pulse. Place the heel of one or two hands over the lower third of your child's breastbone and give them 30 quick chest compressions (push fast). Be sure to push hard enough so their chest moves approximately 5 cm (2 inches) down (push hard). </p><p>Count out loud. You should deliver about 100-120 compressions a minute. Wait for the chest to come all the way back to its initial position between compressions. This will get the blood flowing to your child's brain and other vital organs.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_CPR_child_open_airway_EN.jpg" alt="Opening child's airway for rescue breaths" /> </figure> <h2>Rescue breaths: Open the airway</h2><p>After the first 30 chest compressions, place the palm of your hand on your child’s forehead. Place two fingers on the hard, bony tip of their chin and gently tilt their neck back. This will open your child's airway. </p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_CPR_child_breathe_airway_EN.jpg" alt="Giving child CPR rescue breaths" /> </figure> <h2>Two rescue breaths </h2><p>Pinch your child's nose and place your mouth over their mouth and give two breaths. Each breath should be just enough to make your child’s chest rise and should be no more than one second in length. Make sure you see your child's chest rise with each breath. </p></li><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_CPR_child_chest_compressions_EN.jpg" alt="Repeating CPR chest compressions" /> </figure> <h2>Repeat </h2><p>Give cycles of 30 chest compressions and two breaths during two minutes and repeat until the ambulance arrives or your child starts breathing again. Two minutes usually allow for five cycles of 30 chest compressions and two breaths.</p><p>A two-minute CPR cycle is usually tiring. If you are not alone, switch who is giving CPR every two minutes.</p></li><li> <figure class="”asset-c-100”"> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_CPR_child_recovery_position_EN.jpg" alt="Putting child in recovery position" /> </figure> <h2>Recovery position</h2><p>Once your child has recovered and started breathing again on their own, put them in the <a href="/Article?contentid=1037&language=English">recovery position</a> until help arrives. The recovery position will help keep your child’s airway open and prevent them from choking on their own vomit. If your child vomits, wipe it away. Make sure nothing is blocking or covering their mouth and nose. </p></li></ol><br>​​​​<p>The <a href="http://www.sickkids.ca/" target="_blank">Hospital for Sick Children​</a> offers the Heart and Stroke Foundation’s <a href="http://www.cvent.com/events/hospital-for-sick-children-standard-first-aid-heart-stroke-foundation-/event-summary-d989cebc9ab14e1281c6db68ab161d7c.aspx" target="_blank">First Aid program​</a>. It provides CPR and resuscitation training for patients, families and the general public.​</p> ​https://assets.aboutkidshealth.ca/akhassets/IMD_CPR_child_chest_compressions_EN.jpg
CT scanCCT scanCT scanEnglishOtherChild (0-12 years);Teen (13-18 years)BodyNATestsCaregivers Adult (19+)NA2015-06-04T04:00:00ZGuila BenDavid, MRTR5.8000000000000079.90000000000001885.00000000000Health (A-Z) - ProcedureHealth A-Z<p>A CT scan uses X-rays to produce images of the body. Learn about how CT scans work, when they are used, and what to expect during the procedure. </p><h2>What is a CT scan?</h2><p>A CT scan is used to take a picture of your child's body. A computer uses X-rays to make “slice-like” pictures of body parts and internal organs.</p><h2>Key points</h2> <ul> <li>A CT scan uses X-rays and a computer to take “slice-like” pictures of body parts and internal organs.</li> <li>If your child is having sleep medicine for the CT scan, you must follow the rules about what your child can eat and drink before the test. </li> <li>The scan will not hurt. Nothing touches your child. When the scan starts, your child will hear a funny sound. </li> </ul><h2>Information about the CT scan</h2> <p>Only one parent is allowed into the CT scan room during the test. You will be given a lead coat to wear. You will be able to hold your child's hand.</p> <p>If you are going to have a baby or think you might be pregnant, let the staff know before you go into the CT scan room.</p> <p>Your child will lie on a narrow bed. The technologist will make sure that your child is lying on the table in the correct position for the CT scan. Your child will be held with a safety strap. If your child is having a CT scan of the head, the technologist may place little pillows beside your child's ears and a headband over their forehead to keep their head still. </p> <p>The bed moves up and into the CT machine, which looks like a big donut. The camera moves around inside the machine and takes many pictures. The camera makes some noise when it takes a picture, but the camera will not touch your child. </p> <p>Your child needs to stay very still while the camera is taking pictures. Your child can sleep (or pretend to sleep), or you can read a story to help the time go faster. </p> <p>The technologist will be able to hear, see and speak to your child during the CT scan.</p> <p>Depending on the body part we are scanning, the scan can take anywhere from 10 minutes to 30 minutes from start to finish. When the scan is finished, the technologist or nurse will help your child off the table. </p> <p>If your child was given sleep medicine, usually they will sleep for up to one hour in the wake-up room after the CT scan. </p> <p>We will write down the kind and the amount of sleep medicine and explain how to take care of your child at home. </p><h2>Helping your child to lie still during the CT scan</h2> <p>To get clear pictures, your child cannot move during the scan. Movement during the scan creates blurry pictures, meaning the doctor cannot see the information they need. Most young children find it hard to stay still, so we try to take the pictures when they are asleep. </p> <h3>Babies under two months old</h3> <p>Keep your baby awake and do not feed them for three hours before your test time. Bring a bottle (unless you are breastfeeding), a favourite blanket or a soother if your child uses one. </p> <p>If your baby is tired and feeds just before the test, they will usually fall asleep for the test.</p> <h3>Children four months to five years old</h3> <p>If your child is less than five years old, they may find it very hard to hold still for a long time. We will give your child'sleep medicine for the CT scan.</p> <h3>Children five years and older</h3> <p>If your child is older than five years of age but you don’t think they will be able to stay still for at least 20 minutes during the test, please tell us before the test.</p> <h2>If your child is having X-ray dye</h2> <p>To get more information on certain parts of the body, we may give your child a special kind of medicine called contrast, also called X-ray dye. </p> <p>This dye outlines certain parts of the body so that they show up more clearly. The dye goes into the body through a needle into a vein. For some body parts, it can also be mixed into a drink for your child. </p> <p>We will give your child the dye before or during the test. This will depend on what body part we are taking pictures of.</p> <p>Sometimes the X-ray dye gives a feeling of being warm. It may also have a funny taste or smell. Most children say that it tastes like bananas. This taste goes away quickly.</p> <p>A few children do react to the dye. Tell the staff if your child has had any allergies or other reactions to X-ray dye in the past. </p> <p>You may notice a rash or hives up to 48 hours after the dye injection. Please call the nurse in the CT department to document this mild reaction on your chart.</p> <h2>If your child is having a needle</h2> <p>The CT scan does not hurt because nothing touches your child. However, your child may need to have a needle or a tube (also called an IV) for the X-ray dye. </p> <p>If your child is having sleep medicine for the test, this may also be given through a needle or an IV. The poke from the needle may hurt a little when it goes into the vein.</p> <p>EMLA and Maxilene are names for topical local anaesthetic creams or “magic creams” that freeze the skin if your child needs an IV so that your child does not feel any pain. If you want us to use this cream on your child, you must arrive at least one hour before your appointment (but no earlier than 8:00 in the morning). When you arrive for your appointment, please tell the receptionist you came early so that your child can have the EMLA cream.</p><h2>How to get ready for the CT scan</h2> <p>Usually you do not need to do anything special to prepare for the CT scan. However, some children need medicine to help them sleep (sedation or general anaesthetic) so that they can lie still for the scan. If your child is having sleep medicine, they will need to stop eating and drinking several hours before the CT scan. </p> <h3>What your child should wear for the CT scan</h3> <p>Children having a CT scan of the head can wear their own clothes. Remove all metal from your child, including accessories and on clothing, before the test. Your child cannot wear earrings, hair clips, hair bands or necklaces.</p> <p>If the scan is of the chest, back or belly, dress your child in clothing with no metal snaps or zippers.</p> <h3>What to do if your child is not feeling well</h3> <p>Please call the CT Scan Department one business day before the scan (or earlier) if your child has a high temperature, runny nose, cough or cold. </p> <h3>What to do if your child is taking medication</h3> <p>If your child is taking any medication, please tell the nurse before you come in for the test. On the day of the test, please call and speak with a CT scan nurse before you give your child any medication.</p> <h3>Other information we should know before the CT scan</h3> <ul> <li>Please tell us if your child has any special needs.</li> <li>Please tell us if your child has diabetes, a heart condition, breathing problems or any other chronic medical problems.</li> <li>Please tell us if your child is older than five years of age but you do not think they will be able to stay still for at least 20 minutes during the test.</li> </ul> <h2>How to help your child get ready for the CT scan</h2> <p>The CT department has a friendly and colourful environment to help your child feel less scared. There are video games, books, and movies in the waiting room. </p> <p>The size of the CT scan machine can scare some children. Be honest and talk openly with your child about what to expect. Explain what will happen. </p> <p>Show your child the picture of the scanner at the beginning of this brochure. You can describe it as a big camera that takes pictures of the inside of the body. It looks like a very big donut. </p> <p>Explain to your child that they will need to stay still for the camera, just like you need to hold still to have a picture taken with an ordinary camera. The difference is that this camera takes much longer to take a picture. </p> <p>Your child can practice lying very still while you read to them. Make a game out of being so still, just like a statue. Tell your child that you will read to them as the scanner takes the pictures. </p> <p>The scan does not hurt because nothing touches your child. When the scan starts, your child will hear a funny sound. Most children say it sounds like a washing machine. </p> <h2>If your child is having sleep medicine for the CT scan</h2> <p>To make the sleep medicine safe, your child must have an empty stomach. The nurse will call you to explain what your child can eat and drink before the sleep medicine. The table below also tells you when your child must stop eating or drinking. </p> <h3>What your child can eat and drink before the sleep medicine (sedation or general anaesthetic)</h3> <p>If your child does not follow these instructions, your child's CT scan will be cancelled.</p> <table class="akh-table"> <thead> <tr><th>Time before procedure</th><th>What you need to know</th></tr> </thead> <tbody> <tr> <td>Midnight before the procedure</td> <td><p>No more solid food. This also means no gum or candy.</p><p>Your child can still drink liquids such as milk, orange juice and clear liquids. Clear liquids are anything you can see through, such as apple juice, ginger ale or water.</p><p>Your child can also eat Jell-O or popsicles.</p></td> </tr> <tr> <td>6 hours</td> <td>No more milk, formula or liquids you cannot see through, such as milk, orange juice and cola.</td> </tr> <tr> <td>4 hours</td> <td>Stop breastfeeding your baby.</td> </tr> <tr> <td>2 hours</td> <td>No food or drink at all.</td> </tr> <tr> <td colspan="2">If you were given more instructions about eating and drinking, write them down here:<br></td> </tr> </tbody> </table><h2>At SickKids</h2> <p>On the day of the test, call the CT scan department:</p> <ul> <li>416-813-6070 from 7:30 in the morning to 3:00 in the afternoon (booking clerk)</li> <li>416-813-7654 EXT: 201499 from 8:00 in the morning to 6:30 in the evening</li> </ul> <h2>Other important information</h2> <ul> <li>The hospital is a busy place. There is pay parking underground but it can be hard to find a space. Please allow for extra time to get to your appointment. </li> <li>When coming for your CT scan appointment you must register first at the Diagnostic Imaging/CT Scan registration area, which is on the 2nd floor near the Burton Wing elevators. You may have to wait before someone can register you. Please allow for extra time. </li> <li>For more information about SickKids, including parking and directions, please read the brochure, "Welcome to our Clinics." </li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/NEURO_CT_EQUIP-PHO_EN.jpg
CVL/PICC cap changeCCVL/PICC cap changeCVL/PICC cap changeEnglishOther;Other(diagnostic imaging, bloodwork, picc line, procedures�.)Child (0-12 years);Teen (13-18 years)BodyVeinsProceduresAdult (19+) CaregiversNA2018-11-01T04:00:00ZStephanie Chu, RN, BScN, MNHealth (A-Z) - ProcedureHealth A-Z<p>If your child has a CVL/PICC, you will be taught how to change the cap before your child is discharged from hosptial. Learn the steps you need to follow for a CVL/PICC cap change. </p><p>Cap changes are done to reduce the risk of infection and leakage. Residue may build up in the cap or the cap may break down. Cap changes are done once a week or if you see residue or blood in the fluid pathway (the inside of the cap) or around the fluid pathway of the cap.</p><h2>Key points</h2><ul><li>To avoid residue build up, cap changes for CVL/PICC should be done once a week or as needed.</li><li>During a cap change procedure, everyone in the room must wear a mask, including your child.</li></ul><h2>Supplies you will need</h2><ul><li>Antiseptic wipes</li><li>Masks for anyone in the room during the procedure, including your child</li><li>2 sterile drapes</li><li>1 pair of sterile gloves</li><li>1 pair of clean (non-sterile) gloves</li><li>New sterile cap(s)</li><li>2 large alcohol swabs</li><li>A second person to assist in the procedure. They can help to calm and hold your child</li></ul>
CVL/PICC dressing change procedureCCVL/PICC dressing change procedureCVL/PICC dressing change procedureEnglishOther;Other(diagnostic imaging, bloodwork, picc line, procedures�.)Child (0-12 years);Teen (13-18 years)BodyVeinsProceduresAdult (19+) CaregiversNA2018-11-01T04:00:00ZStephanie Chu, RN, BScN, MNHealth (A-Z) - ProcedureHealth A-Z<p>If your child has a CVL or PICC, the dressing must be changed regularly to prevent infection. Learn how to change your child's CVL or PICC dressing using antiseptic non-touch technique.</p><p>Dressing changes are done regularly to keep the exit site clean and prevent infection. Unless given specific instructions from the health-care team, you will need to change the dressing every seven days for a clear dressing and every two days for a gauze dressing. Change the dressing when it becomes wet or loosened.<br></p><h2>Key points</h2><ul><li>The dressing will need to be changed every seven days, unless otherwise specified.</li><li>It is important to follow the instructions exactly as they are given to you in order to keep the site clean and prevent infection.</li></ul><h2>Supplies you will need</h2><ul><li>Antiseptic wipes containing alcohol</li><li>Sterile transparent (clear) dressing (e.g. Tegaderm™, IV 3000™)</li><li>2-3 chlorhexidine gluconate (CHG) 2% swabsticks or 2-3 ChloraPrep® sponges </li><li>Securement device (e.g. Statlock™)</li><li>1 pair sterile gloves </li><li>2 pairs clean (non-sterile) gloves</li><li>Masks for everyone in the room including the child</li><li>A second person to assist in the procedure. They can help to calm and hold your child</li><li>If using a gauze dressing, use 1 sterile gauze 5 cm × 5 cm and 1 piece of 10 cm ×10 cm Mefix tape</li></ul>
Caesarean sectionCCaesarean sectionCaesarean sectionEnglishPregnancyAdult (19+)Body;UterusReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC11.500000000000046.70000000000001464.00000000000Flat ContentHealth A-Z<p>Important information regarding Caesarean sections: why it may be required, how it is done, what the complications are, and potential effects.</p><p>Caesarean section, sometimes referred to as C-section, is the surgical delivery of a baby through incisions in the abdomen and uterus. Sometimes caesarean section is done after a long labour that has not progressed properly. Caesarean section may also be performed in emergency situations where the mother or baby’s life is in jeopardy. Other times, a caesarean section may be planned because the mother had a previous caesarean section or has a condition that makes labour dangerous.</p><h2>Key points</h2> <ul><li>Caesarean section is major abdominal surgery where the incision is made through the skin, the underlying fat, and into the abdomen and uterus.</li> <li>Complications of caesarean section include hemorrhaging, pain, infection, blood clots or damage to the uterus.<br></li> <li>Caesarean section is generally a safe procedure for the baby however they are at a slightly higher risk for breathing problems, and trauma due to surgical cuts.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/caesarean_section.jpg
Café-au-lait macules (CALMs)CCafé-au-lait macules (CALMs)Café-au-lait macules (CALMs)EnglishDermatologyChild (0-12 years);Teen (13-18 years)SkinSkinConditions and diseasesCaregivers Adult (19+)NA2015-05-06T04:00:00ZCarmen Liy Wong, MD;Irene Lara-Corrales, MSc, MD​7.6000000000000062.2000000000000552.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Café-au-lait macules are flat marks on the skin. Find out how CALMs are diagnosed, how they affect the body and how they are treated.<br></p><h2>What are café-au-lait macules?</h2> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/PMD_CALM_light_brown_EN.jpg" alt="Café au lait macules on light skin" /> </figure> <p>Café-au-lait macules (CALMs), or café-au-lait spots, are flat, oval lesions (marks) on the skin. Café-au-lait means "coffee with milk" in French. The name refers to the colour of the spots, as they are at least a shade darker than your child’s skin tone.<br></p><p>Café-au-lait macules commonly appear at birth but may develop later, during the first year of life. Their colour varies from light brown to dark brown.</p><h2>Key points</h2> <ul> <li>Café-au-lait macules are harmless light to dark brown, oval, well-defined spots.</li> <li>They are normally present from birth and can increase in number and size over time.</li> <li>Multiple café-au-lait macules are associated with different genetic disorders.</li> <li>See a doctor if your child has undefined hyperpigmented lesions, more than six CALMs or has CALMs with lumps and bumps on the skin.</li> </ul><h2>How do CALMs affect the body?</h2> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/PMD_CALM_dark_brown_EN.jpg" alt="Café au lait macules on darker skin" /> </figure> <p>CALMs are benign (harmless). They do not hurt or itch and never progress to anything serious such as skin cancer. The spots can become darker throughout childhood or with sun exposure, but this is not a cause for concern.</p><h2>How common are CALMs?</h2> <p>The size and number of café-au-lait macules vary from child to child. About one in five healthy children have one or two CALMs. Up to one in 100 children have three CALMs.</p><h2>How are CALMs diagnosed?</h2> <p>CALMs are easily diagnosed by a skin examination. "Typical" CALMs range from light to dark brown and are well defined, even coloured and often round or oval. They vary in size and can appear anywhere on the skin, although they rarely appear on the face.</p><h2>How are CALMs treated?</h2> <p>No therapy is needed for CALMs. If your child is concerned about how their CALMs look, you can consider covering the CALMs with camouflage make-up to make them less noticeable. Some people consider laser treatment to reduce the colour, but this is painful and expensive. It also carries side effects and may not be very effective in reducing the colour of the CALMs. </p><h2>Are CALMs ever a feature of another condition?</h2> <p>CALMs can sometimes indicate an underlying genetic disorder. See your child’s doctor if your child has:</p> <ul> <li>six or more CALMs measuring more than 5 mm before puberty</li> <li>six or more CALMs measuring more than 15 mm during puberty</li> </ul> <p>If a genetic disorder is present, tiny CALMs, which look like freckles, may be visible under the arms or around the groin.</p> <p>The most common genetic disorder linked with multiple CALMs is <a href="/Article?contentid=864&language=English">neurofibromatosis type 1 (NF-1)</a>. Other conditions with CALMs as a symptom include McCune-Albright syndrome, tuberous sclerosis, Noonan syndrome, Legious syndrome and Fanconi anaemia.</p><h2>When to see a doctor for CALMs</h2> <p>See your child’s doctor or dermatologist if your child has:</p> <ul> <li>an undiagnosed pigmented lesion</li> <li>more than six café-au-lait macules measuring more than 5mm before puberty or more than 15 mm after puberty<br></li> <li>freckling around the armpit or groin</li> <li>CALMs with lumps and bumps on the skin</li> <li>other family members with multiple CALMs or a diagnosis of NF-1</li> <li>many CALMs with any learning problems or speech, language or other developmental delays<br></li> </ul><h2>​Further information</h2><p> <a href="https://www.ctf.org/" target="_blank">Children's Tumor Foundation</a></p><p> <a href="https://www.dermnetnz.org/" target="_blank">Dermnet New Zealand Trust: Facts about the skin</a></p><p> <a href="http://www.nfon.ca/" target="_blank">Neurofibromatosis Society of Ontario</a></p>https://assets.aboutkidshealth.ca/akhassets/PMD_CALM_light_brown_EN.jpg
CalciumCCalciumCalciumEnglishNutritionChild (0-12 years);Teen (13-18 years)NADigestive systemHealthy living and preventionCaregivers Adult (19+) Educators Hospital healthcare providers Community healthcare providers Remote populations First nationsNA2013-09-27T04:00:00ZTheresa Couto, RD;Elly Berger, BA, MD, FRCPC, FAAP, MHPE;Francy Pillo-Blocka RD, FDC9.1000000000000057.8000000000000224.000000000000Flat ContentHealth A-Z<p>Discover the role of calcium in the body.</p><p></p><p>Calcium is the main building block of our bones and teeth. If we do not get enough calcium in the diet, the body draws on the calcium reserves in the bones, making them weaker. </p><h2>Key points</h2> <ul><li>Calcium works with vitamin D to strengthen bones and teeth.</li> <li>It is mostly found in green leafy vegetables, sardines, almonds, milk, cheese and yogurt.</li> <li>Calcium supplements are usually not needed, but a doctor may recommend them if a child has osteoporosis, rheumatoid arthritis or celiac disease. </li></ul>https://assets.aboutkidshealth.ca/AKHAssets/INM_NRC_track1-8-3_illustration_food_calcium.jpg
Calorimetry testingCCalorimetry testingCalorimetry testingEnglishMetabolicChild (0-12 years);Teen (13-18 years)BodyNATestsCaregivers Adult (19+)NA2009-11-06T05:00:00ZKaren Chapman, RN, PhD(c)5.6000000000000079.1000000000000557.000000000000Health (A-Z) - ProcedureHealth A-Z<p>A calorimetry test measures a child's resting metabolic rate. Learn about what happens during a calorimetry test as well as how to prepare your child. </p><h2>What is a calorimetry test?</h2> <p>A calorimetry test measures your child's resting metabolic rate. A resting metabolic rate shows how much energy (calories) the body burns when at rest. The body must burn energy at rest to keep up normal functions such as breathing and heart rate. This metabolic rate can be measured by looking at your child's breathing. With this information, health-care professionals can plan what your child can eat and drink. </p><h2>Key points</h2> <ul> <li>A calorimetry test measures how much energy the body burns while at rest. </li> <li>Your child must be able to lie still for about 12 to 30 minutes to have the test. </li> <li>Results of the test can be used to find the right diet for your child. </li> </ul><h2>During a calorimetry test</h2> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/Calorimetry_EQUIP_ILL_EN.jpg" alt="Person lying on back with plastic hood over the head that is attached to a machine by a tube" /> </figure> <p>During the test, your child will spend about 12 to 30 minutes lying quietly on a bed or sitting in a large chair.</p><p>Your child will need to lie quietly under the plastic hood. The hood is open to room air.</p><p>A machine called a calorimeter will take a sample of air from the hood and analyze it. If your child is calm and comfortable, the test will take less time. Your child needs to lie still for at least 12 minutes under the hood to be able to get a sample of the air. If your child is moving around or upset, the test will take longer.</p><p>Your child can watch TV or a video to help them lie quietly. They should not read, sleep, talk, laugh or move around during the test.</p><p>If your child has a favourite video or DVD, you can bring it along to help them relax and be more comfortable.</p><p>If your child is calm and comfortable, the test will take less time than if your child is moving around.</p><h2>Before a calorimetry test</h2> <p>Tell your child not to worry about the test. It will not hurt and there are no needles. Your child will have to have a clear plastic hood put over their head. The hood is open to room air. It may be a good idea to let your child know about the hood before the test. Parents often encourage their children to imagine themselves as an astronaut while they are under the hood. This may help your child relax and stay calm for the test. </p> <p>Your child needs to have an empty stomach.</p> <ul> <li>If your child is less than two years old, they cannot have anything to eat or drink two hours before the test. </li> <li>If your child is more than two years old, they cannot eat or drink for at least four hours before the test. It is best if your child does not eat anything the day of the test.</li> <li>Your child can still drink plain water. </li> </ul><h2>At SickKids</h2> <p>The Calorimetry Unit is on the fifth floor Atrium in Room 5D12. On the fifth floor, follow the signs to 5D. When you reach the round reception desk, please turn down the hall to your right for room 5D12. If you are not sure, ask at 5D reception.</p> <p>If you have questions or need to cancel or reschedule your child's test, please call 416-813-6151.</p>https://assets.aboutkidshealth.ca/akhassets/Calorimetry_EQUIP_ILL_EN.jpg
Campomelic dysplasia (CD)CCampomelic dysplasia (CD)Campomelic dysplasia (CD)EnglishGeneticsChild (0-12 years);Teen (13-18 years)BodyNAConditions and diseasesCaregivers Adult (19+)NA2012-08-19T04:00:00ZNA8.8000000000000057.10000000000001542.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Information about campomelic dysplasia, a genetic condition that affects the development of the skeleton and reproductive system.</p><h2>What is campomelic dysplasia (CD)? </h2> <p>Campomelic dysplasia (say: cam-po-MELL-ick diss-PLAY-zee-ah) is a genetic condition that affects: </p> <ul> <li>the development of the skeleton </li> <li>the development of the reproductive system </li> </ul> <p>It is characterized by: </p> <ul> <li>distinctive facial appearance </li> <li>Pierre Robin sequence with cleft palate (see below) </li> <li>bowing and shortening of long bones </li> <li>club feet </li> </ul> <p>Many babies are born with genitalia that are not clearly male or female (ambiguous genitalia). </p> <p>CD is often life-threatening in the first few weeks of life due to a problem with the airway called laryngotracheomalacia. </p> <p>Other names you may hear for the condition are camptomelic dysplasia, campomelic dwarfism, campomelic syndrome or camptomelic dwarfism. </p> <p>It is not known how many babies are born with CD. It is thought that perhaps one in every 40,000 to 80,000 babies is born with CD.</p><h2>Key points </h2> <ul> <li>CD is a genetic condition that results in distinctive facial appearance, Pierre Robin sequence with cleft palate, shortening and bowing of long bones and club feet. </li> <li>Many babies do not survive because of breathing problems at birth.</li> <li>Children with CD need to be followed carefully by a health care team due to the possible complications.</li> <li>Genetic counselling can help families understand CD, the options for managing it, and the chances that other children will also be affected.</li> </ul><h2>How campomelic dysplasia affects the body </h2><h3>Facial appearance </h3><p>People with CD have a relatively large head with a flat face. They have prominent eyes, a flat nasal bridge (the area at the top of the nose between both eyes) and a small chin. </p><h3>Pierre Robin sequence </h3><p>This is the name given to the following birth defects if they appear together: </p><ul><li>small lower jaw </li><li>tongue that is pushed up and back towards the roof of the mouth (palate) and throat; this prevents the proper closure of the palate </li><li> <a href="/Article?contentid=380&language=English">cleft palate</a></li></ul><p>Many infants with CD are born with Pierre Robin sequence. This can lead to difficulties with feeding and you may need to speak to a feeding consultant. </p><h3>Height and body shape </h3><p>Children with CD have shorter arms and legs than normal. Some babies have bowed bones during the prenatal period and may be short from birth, whereas others are born with a normal length. In general, people with CD may also have bowing of the long bones of the arms and legs. This is usually seen more in the legs than the arms. The hip joints are unstable and easy to dislocate. <a href="/Article?contentid=1192&language=English">Club feet</a> are quite common in babies with CD. </p><p>During childhood, the long bones of the arms and legs grow at a slower pace than usual. This leads to short stature (height) as well as relatively shorter limbs. </p><p>The ribs are also affected. People with CD usually have 11 pairs of ribs, instead of the usual 12 pairs. Scoliosis (curvature of the back) is also seen in people with CD. </p><h3>Abnormal development of sex organs </h3><p>People with CD often have ambiguous genitalia (not clearly male or female). Often a person who has male chromosomes (46,XY) will have complete female genitalia to ambiguous genitalia. On the inside, they can have both male internal genitalia (testes) and female internal genitalia (ovaries). Both boys and girls can have CD. </p><h3>Laryngotracheomalacia </h3><p>Laryngotracheomalacia (say: la-RING-go-TRAY-kee-oh-ma-LAY-sha) is a condition where the larynx (voice box) and trachea (wind pipe) are softer than expected. This leads to airway obstruction and difficulty breathing. Many babies die as a result of this complication.</p> <figure class="asset-c-80"> <span class="asset-image-title">Laryngotracheomalacia</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Campomelic_dysplasia_Laryngotracheomalaica_MED_ILL_EN.jpg" alt="A normal larynx and constricted larynx and a normal trachea and collapsed trachea in a baby" /> <figcaption class="asset-image-caption">Laryngotracheomalacia is a condition where the tissues of the larynx (voice box) and trachea (wind pipe) collapse inward. This causes airway obstruction and difficulty breathing.</figcaption> </figure> <h3>Deformities of the spine </h3><p>Instability of the back bone at the level of the neck (cervical spine) is quite common. Progressive <a href="/scoliosis">scoliosis</a> (curvature of the spine) is also a feature. </p><h3>Hearing loss </h3><p>People with CD have a higher chance of hearing loss. </p><h3>Intellectual development </h3><p>Children with CD have normal intelligence. </p><h2>Campomelic dysplasia is a genetic disorder </h2><p>Genetic means related to genes. Each of us inherits our genes from our parents. They provide our body with instructions that influence our health, looks and behaviour. In general, each person has two copies of every gene. One copy is inherited from the mother and the other from the father. </p><p>CD occurs due to a mutation (change) in one copy of the gene known as SOX9. Most cases are new in a family and not passed on by a parent. This is the result of a new mutation that happens by chance in the egg or the sperm cell that created the child. </p><p>CD is inherited as an <a href="https://pie.med.utoronto.ca/htbw/module.html?module=genetics/simplesinglegeneinheritance/autosomaldominantinheritance/pages/default.aspx">autosomal dominant</a> condition. This means that: </p><ul><li>Only one copy of the SOX9 gene needs to have a mutation for a person to have CD. The other copy of the gene works normally but is not enough to prevent a person from having CD. </li><li>A person with CD has a 50% chance during each pregnancy of passing this genetic condition on to the child. </li><li>The risk to the sibling (brother or sister) of a person with CD depends on whether the parent has CD or not.</li></ul> <figure class="asset-c-80"> <span class="asset-image-title">Inheritance of CD</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Campomelic_dysplasia_Inheritance_MED_ILL_EN.jpg" alt="Chromosome distribution from an affected parent with CD and an unaffected parent" /> <figcaption class="asset-image-caption">CD is caused by a mutation in the SOX9 gene. Every person has two copies of this gene. A person will have CD if one copy of the gene has a mutation. In this example, the parent with CD has one copy of one of the genes with a mutation and the other has none. If the baby does not inherit the mutation then the baby will not have CD. If the baby inherits the copy of the gene with a mutation, then the baby will have CD.</figcaption> </figure><h2>Campomelic dysplasia can be diagnosed before or after birth </h2> <p>Before birth, CD can be diagnosed by testing DNA taken from the fetus. This can be obtained in one of the following ways: </p> <ul> <li>by amniocentesis after the 15th week of pregnancy </li> <li>by chorionic villus sampling (CVS) between the 11th and 14th week of pregnancy</li> </ul> <p>These methods are used for high-risk pregnancies, for instance if the parents have another child diagnosed with CD or one of the parents has CD. </p> <p>To be eligible for this testing, the mutation in the SOX9 gene responsible for causing CD in the family must be known. This means genetic testing (a blood test) must be done on the person in the family with CD. </p> <p>CD can sometimes be diagnosed by ultrasound in pregnancy. However, a normal ultrasound does not guarantee that a baby will not have CD. </p> <p>After birth, the diagnosis of CD is based on X-ray findings and physical examination. A diagnosis of CD can sometimes be confirmed by DNA testing of the SOX9 gene (a blood test). </p><h2>Treatment of campomelic dysplasia</h2> <p>Children with CD can lead fulfilling lives if they receive attentive, informed care from their parents and health-care providers. They should be carefully followed because of the risk of complications. </p> <p>The goals of treatment are: </p> <ul> <li>to help children with CD adapt socially and physically </li> <li>to treat any complications </li> </ul> <p>Various specialists work together as a team to help children with CD.</p> <h3>Treatment of cleft palate </h3> <p>A team of specialists called the craniofacial team takes care of children with cleft palate (opening in the roof of mouth). <a href="/Article?contentid=34&language=English">Cleft palate is usually treated with an operation to close the opening</a>. </p> <h3>Treatment of bone and joint problems </h3> <p>Club feet and hip dislocations are managed by orthopaedic surgeons. These often require use of splints, casts and sometimes surgery. </p> <h3>Treatment of spine deformities </h3> <p>Spine deformities like instability of the cervical (upper) spine and progressive scoliosis must be monitored. In some cases, an operation may be considered. </p> <h3>Management of patients with ambiguous genitalia </h3> <p>When the internal genitalia do not match the chromosomes' makeup, the gonads (testes or ovaries) are sometimes removed. This is because there is an increased risk of development of cancer (called gonadoblastoma) later in life. </p> <h3>Treatment of hearing loss </h3> <p>Children with CD require periodic hearing assessments to monitor any worsening of hearing. Some children may benefit from wearing hearing aids.</p><h2>Resources and support </h2><p>The following organizations and sites can offer more information, support and contact with other affected individuals and their families. </p><ul><li>The Human Growth Foundation: <a href="http://hgfound.org/" target="_blank">www.hgfound.org</a> </li><li>Little People of Canada: <a href="https://comdir.bfree.on.ca/lpc/" target="_blank">comdir.bfree.on.ca/lpc/</a> </li><li>Little People of Ontario: <a href="https://www.littlepeopleofontario.com/" target="_blank">www.littlepeopleofontario.com/</a> </li><li>Little People of America: <a href="https://www.lpaonline.org/" target="_blank">www.lpaonline.org</a></li><li>The Magic Foundation: <a href="https://www.magicfoundation.org/" target="_blank">www.magicfoundation.org</a> </li><li>MUMS (Mothers United for Moral Support) National Parent-to-Parent Network: <a href="http://www.mums-network.org/" target="_blank">www.mums-network.org</a> </li></ul>https://assets.aboutkidshealth.ca/akhassets/Campomelic_dysplasia_Inheritance_MED_ILL_EN.jpg
Canada's Food GuideCCanada's Food GuideCanadas Food GuideEnglishNutritionChild (0-12 years);Teen (13-18 years)NADigestive systemHealthy living and preventionCaregivers Adult (19+) Educators Hospital healthcare providers Community healthcare providers Remote populations First nationsNA2013-09-27T04:00:00ZTheresa Couto, RD;Elly Berger, BA, MD, FRCPC, FAAP, MHPE;Francy Pillo-Blocka RD, FDC9.3000000000000060.5000000000000380.000000000000Flat ContentHealth A-Z<p>Discover the four main food groups in Canada's Food Guide and learn how to use the guide's recommendations for your family. </p><p> <a target="_blank" href="https://food-guide.canada.ca/en/">Canada's Food Guide</a> is a general guide to nutrition for healthy people aged two and older. There is also a <a href="https://www.canada.ca/en/health-canada/services/food-nutrition/reports-publications/eating-well-canada-food-guide-first-nations-inuit-metis.html" target="_blank">food guide for First Nations, Inuit and Metis.</a><br></p><h2>Key points</h2><ul><li>Canada's Food Guide offers guidelines on nutrition for healthy people aged two and older. </li><li>The guide includes recommended serving sizes for four groups: vegetables and fruit, grain products, milk and alternatives and meat and alternatives.</li><li>It is important to get a balance of nutrients from all four food groups and adapt the guidelines to individual nutritional needs.<br></li></ul>
CancerCCancerCancerEnglishOncologyChild (0-12 years);Teen (13-18 years)NANANAAdult (19+) CaregiversNA2019-09-03T04:00:00ZLanding PageLearning Hub<p>A child's cancer diagnosis and treatment impacts the entire family. This learning hub will help you learn strategies to support your child, yourself and your family; how to support your teen to learn to manage their own health care; and how to manage cancer-related pain in younger children.</p><p>A child's cancer diagnosis and treatment impacts the entire family. This learning hub will help you learn strategies to support your child, yourself and your family; how to support your teen to learn to manage their own health care; and how to manage cancer-related pain in younger children.</p>managingcancerhttps://assets.aboutkidshealth.ca/AKHAssets/Coping_with_cancer_diagnosis.jpg
Cancer and pregnancyCCancer and pregnancyCancer and pregnancyEnglishPregnancyAdult (19+)BodyReproductive systemConditions and diseasesPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC11.100000000000046.5000000000000431.000000000000Flat ContentHealth A-Z<p>Learn about the two types of cancer in pregnancy: cervical cancer and breast cancer. Treatment of cancer during pregnancy is discussed.</p><p>Cancer is a disease where cells grow out of control, forming a tumour that can spread to other parts of the body. There are more than 250 different types of cancer. Breast cancer is the most common type of cancer in women of reproductive age, and cervical cancer is the most commonly diagnosed cancer in pregnancy. </p><h2>Key points</h2> <ul><li>Symptoms of cervical cancer include abnormal vaginal discharge and vaginal bleeding.</li> <li>About 1% to 3% of women with cervical cancer are diagnosed during pregnancy.</li> <li>Pregnant women should have their breasts examined as part of routine care during pregnancy and any suspicious lumps should be promptly investigated.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/cancer_and_pregnancy.jpg
Cancer research and your teenagerCCancer research and your teenagerCancer research and your teenagerEnglishAdolescent;OncologyPre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years)NANANAAdult (19+) CaregiversNA2019-09-03T04:00:00ZNA10.900000000000052.80000000000001255.00000000000Flat ContentHealth A-Z<p>Learn about ongoing cancer research and your teenager's role in research and clinical trials.</p><p>Just as your teen should have a say in their care, they should also be given the opportunity to know more about and discuss any research study they are taking part in. Your teenager will learn about <a href="https://teens.aboutkidshealth.ca/Article?contentid=3589&language=English">research</a> in the teen program.</p><h2>Key points</h2><ul><li>Clinical trials are research studies that your teenager may enroll in during their treatment.</li><li>New treatments typically go through three trial phases before they are approved. Teenagers are most commonly enrolled in Phase 3 trials.</li><li>Always understand your teenagers role in research and the risks and benefits of the research study they are being asked to enroll in.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/Cancer_research_and_your_teenager.jpg
Cancer-related pain in childrenCCancer-related pain in childrenCancer-related pain in childrenEnglishOncology;Pain/AnaesthesiaChild (0-12 years)BodyNAConditions and diseasesCaregivers Adult (19+)Pain2019-09-03T04:00:00ZLindsay Jibb, RN, M.Sc.;Jennifer Tyrrell, RN, MN, CNeph(c)8.7000000000000062.3000000000000935.000000000000Flat ContentHealth A-Z<p>Learn about the different types of pain a child with cancer may experience and what may cause pain.</p><h2>What is pain?</h2><p>Pain is felt when special nerve fibres in the body sense something unpleasant, such as a pin prick or extreme pressure, and send a message to the brain, which reads it as pain. Although pain is unpleasant, can be a useful warning sign from our bodies telling us that something is wrong. </p><p>Patients and their caregivers are often very concerned and scared about the pain associated with cancer. They may think that if someone has cancer, they are bound to have pain and that nothing can be done to relieve it. But this isn’t true. </p><p>Cancer-related pain can be managed. With the help of your child’s health-care team, cancer-related pain can be prevented or reduced so that your child can do the activities that are important to them. Never think that it is “weak” or a burden when asking for help with your child’s pain. Nobody will think you are just complaining. The sooner you speak up about your child’s pain, the easier it is to treat! There are also specialized pain services available to help if needed.</p><h2>Key points</h2><ul><li>Pain is felt when the body's tissues are damaged from injuries, infections or painful procedures.</li><li>Your child might experience pain from the tumour, painful procedures, side effects of treatment, mucositis, or nerve damage.</li><li>Acute pain is a temporary pain that your child might feel from a needle poke or an inflamed joint, while chronic pain typically lasts longer than three months, even after an injury or illness have passed .</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/Cancer-related_pain_in_children.jpg
Cancer-related pain: Parenting strategies to support the 3PsCCancer-related pain: Parenting strategies to support the 3PsCancer-related pain: Parenting strategies to support the 3PsEnglishOncology;Pain/AnaesthesiaChild (0-12 years)BodyNASupport, services and resourcesCaregivers Adult (19+)Pain2019-09-03T04:00:00ZLindsay Jibb, RN, M.Sc.;Jennifer Tyrrell, RN, MN, CNeph(c)9.9000000000000060.1000000000000501.000000000000Flat ContentHealth A-Z<p>Find out how you can use effective parenting strategies to support the 3Ps of pain management for your child with cancer-related pain.</p><h2>Keeping routines </h2><p>Forming routines or going back to old routines can help a child in terms of their <a href="/Article?contentid=3813&language=English">cancer-related pain</a>. For example, playing favorite games at playtime, having a specific snack time, going to school as regularly as possible or going to bed at the same time every night.</p><p>Pain tends to improve once function improves, so encourage your child to continue with their routines and provide rewards when they do so.</p><h2>Key points</h2><ul><li>Help your child keep to their regular routines as much as possible and offer them rewards for doing so.</li><li>Encourage good sleep habits in your child, such as having a regular bedtime and a relaxing routine in the evening.</li><li>Be sure to look after yourself so you can support your child. If you have any concerns about your or your child's wellbeing, seek professional help.</li><li>Make sure you understand your child's pain management plan and the role your play in helping to manage your child's cancer-related pain.</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><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>Website designed to help children get control of their pain (German Paediatric Pain Centre)<br><a href="http://www.deutsches-kinderschmerzzentrum.de/en/" target="_blank">http://www.deutsches-kinderschmerzzentrum.de/en/</a></p><p>Website where children can learn the Canadian 24-Hour Movement Guidelines the fun way<br><a href="http://buildyourbestday.participaction.com/en-ca/tutorial" target="_blank">http://buildyourbestday.participaction.com/en-ca/tutorial</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>Learning how to manage pain from medical procedures (Stanford Children's Health) (12 mins 58 secs)<br><a href="https://www.youtube.com/watch?v=UbK9FFoAcvs&feature=youtu.be" target="_blank">https://youtu.be/UbK9FFoAcvs</a></p><p>How does your brain respond to pain<br><a href="https://www.youtube.com/watch?v=I7wfDenj6CQ" target="_blank">https://www.youtube.com/watch?v=I7wfDenj6CQ</a></p><p>Video explaining the power of the brain and chronic pain<br><a href="https://www.mycarepath.ca/understanding-pain/brain-and-nervous-system-change" target="_blank">https://www.mycarepath.ca/understanding-pain/brain-and-nervous-system-change</a></p><p>Video describing pacing<br><a href="https://www.mycarepath.ca/managing-pain/paced-practiced-and-increasing-activities" target="_blank">https://www.mycarepath.ca/managing-pain/paced-practiced-and-increasing-activities</a></p><p>Sesame Street song that teaches belly breathing<br><a href="https://www.youtube.com/watch?v=_mZbzDOpylA" target="_blank">https://www.youtube.com/watch?v=_mZbzDOpylA</a></p><h2>References</h2><p>Coakley, R., & Schechter, N. (2013). Chronic pain is like… The clinical use of analogy and metaphor in the treatment of chronic pain in children. Pediatric Pain Letter, 15(1), 1-8.</p><p>Coakley, R. (2016). When Your Child Hurts: Effective Strategies to Increase Comfort, Reduce Stress, and Break the Cycle of Chronic Pain. Yale University Press.</p><p>Carney, C., Carney, C.E., & Manber, R. (2009). Quiet Your Mind & Get to Sleep: Solutions to Insomnia for Those with Depression, Anxiety, Or Chronic Pain. New Harbinger Publications.</p><p>Mayo Clinic: Understanding Pain (<a href="http://www.mayoclinic.org/understanding-pain/art-20208632?pg=1" target="_blank">http://www.mayoclinic.org/understanding-pain/art-20208632?pg=1</a>)</p><p>Mindell, J.A., & Owens, J.A. (2003). Sleep problems in pediatric practice: clinical issues for the pediatric nurse practitioner. <em>Journal of Pediatric Health Care</em>, <em>17</em>(6), 324-331.</p><p>Paruthi, S., Brooks, L.J., D'Ambrosio, C., Hall, W.A., Kotagal, S., Lloyd, R.M., ... & Rosen, C.L. (2016). Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 12(6), 785.</p><p>Ruskin, D., Amaria, K., Warnock, F., & McGrath, P. (2011). Assessment of pain in infants, children, and adolescents. Handbook of pain assessment, 213-241.</p><p>Solodiuk, J., & Curley, M.A. (2003). Pain assessment in nonverbal children with severe cognitive impairments: the Individualized Numeric Rating Scale (INRS). Journal of Pediatric Nursing, 18(4), 295-299.</p><p>Valrie, C.R., Bromberg, M.H., Palermo, T., & Schanberg, L.E. (2013). A systematic review of sleep in pediatric pain populations. <em>Journal of developmental and behavioral pediatrics: JDBP</em>, <em>34</em>(2), 120.</p>https://assets.aboutkidshealth.ca/AKHAssets/Cancer-related_pain--Parenting_strategies.jpg
Canker soresCCanker soresCanker soresEnglishDermatologyBaby (1-12 months);Toddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)MouthMouthConditions and diseasesCaregivers Adult (19+)Pain2010-05-14T04:00:00ZMark Feldman, MD, FRCPC7.0000000000000067.0000000000000500.000000000000Health (A-Z) - ConditionsHealth A-Z<p>An overview of the signs, symptoms, treatments and medical options for canker sores.</p><h2>What is a canker sore?</h2> <p>Canker sores are common sores that appear on your child's tongue or mouth lining. The sores can make eating and drinking difficult for your child.</p> <p>Canker sores are different than <a href="/article?contentid=793&language=English">cold sores</a> or fever blisters. Canker sores may not be caused by a virus and do not appear to spread from one person to another.</p> <p>Canker sores are also called aphthous ulcers.</p><h2>Key points</h2><ul><li>Canker sores are different than cold sores or fever blisters.</li><li>Canker sores do not appear to spread from person to person.</li><li>Signs of canker sores include painful, red spots across the tongue or on the mouth lining.</li><li>You can help your child by not feeding soft drinks or spicy, acidic or salty foods.</li></ul><h2>Signs and symptoms of canker sores</h2> <p>Signs and symptoms may include:</p> <ul> <li>painful, red spots up to one inch across</li> <li>the area may tingle a few days before the sore appears</li> <li>the sore will develop into whitish-grey sore with a white or yellow coating</li> <li>sores may appear alone or in bundles</li> </ul> <p>Toddlers and young children may refuse to eat because of the sore's pain and irritation. Some children and adolescents may have fever, swollen lymph nodes and a tired or ill feeling. </p><h2>Causes of canker sores</h2> <p>Doctors are not certain of the causes of canker sores. There may be many factors, including:</p> <ul> <li>diet</li> <li>trauma</li> <li>stress</li> <li>nutritional deficiencies (such as <a href="/Article?contentid=1449&language=English">folic acid</a>, <a href="/Article?contentid=1446&language=English">vitamin B12</a>, and <a href="/article?contentid=1450&language=English">iron</a>)</li> <li>infection<br></li> <li><a href="/Article?contentid=299&language=English">menstruation</a></li> <li><a href="/article?contentid=804&language=English">allergies</a></li> <li>drug reaction</li> </ul> <p>Sometimes, canker sores appear more often in children with weak or over active immune systems but usually appear in children with normal immune systems.</p> <p>Most children with cankers have no identifiable cause for their cankers as these usually appear in healthy children.</p><h2>How your doctor can help your child with canker sores</h2> <p>Most children suffering from canker sores can be treated at home. However, in some cases your child should see a doctor.</p> <h3>Seek medical assistance right away if:</h3> <ul> <li>Your child is continually getting canker sores. The doctor or other health provider can look into whether your child is getting a balanced diet or if they are missing a certain vitamin. Your child's doctor may also examine your child for an underlying medical condition.</li> <li>The sores are not settling down or disappearing after 10 days. </li> <li>Some doctors may recommend an anti-inflammatory topical steroid cream or gel to help the healing. </li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/canker_sore.jpg
Car seat safety for babies and childrenCCar seat safety for babies and childrenCar seat safety for babies and childrenEnglishNABaby (1-12 months)NANANAAdult (19+)NA2009-10-18T04:00:00ZHazel Pleasants, RN, MNAndrew James, MBChB, FRACP, FRCPC6.9000000000000075.60000000000001511.00000000000Flat ContentHealth A-Z<p>Important information concerning car seat safety for babies and children. After your child reaches 22 pounds, they may be moved to a forward-facing seat.</p><p>Babies and young children need to be placed in a car seat from the time that they are newborns until they outgrow the weight and height limits of a booster seat. Remember that car seats and booster seats are safest when they are installed in the back seat of the car.</p><h2>Key points</h2> <ul><li>Rear-facing baby seats must be used for babies under one year of age or who weigh less than 10 kg (22 lbs).</li> <li>Older babies can sit in forward-facing child seats until they reach the maximum weight and height limits.</li> <li>Several provinces in Canada have booster seat laws that require children to ride in a booster seat until they meet either the height, weight or age restrictions.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/car_seat_safety_for_babies_children.jpg
Car seat safety for newborn babiesCCar seat safety for newborn babiesCar seat safety for newborn babiesEnglishNeonatologyNewborn (0-28 days)NANANAAdult (19+)NA2009-10-18T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPC6.7000000000000076.1000000000000622.000000000000Flat ContentHealth A-Z<p>Read about how to choose a car seat, where to install a car seat, and car seat safety precautions to take for your newborn baby.</p><p>If you plan to transport your baby in any car, you must use a rear-facing infant seat until your baby is at least 1 year old and weighs 10 kg (22 lbs), depending on the brand of car seat. If your baby outgrows their rear-facing seat before the age of one, choose a convertible car seat that can be used up to a higher height and weight limit. The longer you use a rear-facing infant seat that fits correctly, the safer your child will be in a crash.</p><h2>Key points</h2> <ul><li>A rear-facing car seat protects your baby’s head, neck, and spine.</li> <li>Make sure the car seat meets safety standards, is properly installed and never leave your baby alone in the car seat.</li> <li>If your baby has special health concerns, you may need a special type of car seat to transport them.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/car_seat_safety_for_newborn_babies.jpg
CarbohydrateCCarbohydrateCarbohydrateEnglishNutritionChild (0-12 years);Teen (13-18 years)NADigestive systemHealthy living and preventionCaregivers Adult (19+) Educators Hospital healthcare providers Community healthcare providers Remote populations First nationsNA2013-09-27T04:00:00ZTheresa Couto, RD;Elly Berger, BA, MD, FRCPC, FAAP, MHPE;Francy Pillo-Blocka RD, FDC7.8000000000000063.6000000000000413.000000000000Flat ContentHealth A-Z<p>Discover the discover the types of carbohydrates and how they affect the body.<br></p><p>Carbohydrate is an important source of energy for the whole body. </p><h2>Key points</h2><ul><li>Carbohydrates are mostly found in vegetables and fruit, grain products and milk and alternatives.</li><li>Simple carbohydrates are found in milk, fruit, sugar, candy and honey. They increase blood sugar levels quickly, giving a short-term energy spike.</li><li>Complex carbohydrates are found in grains, vegetables and legumes. Because they include fibre, they increase blood sugar levels only slightly and keep them stable for longer.</li><li>Good sources of complex carbohydrates include unprocessed grains such as brown rice, whole wheat flour and barley.</li></ul>https://assets.aboutkidshealth.ca/akhassets/INM_NRC_track1-5_nutrient_sources.png
Cardiology treatment teamCCardiology treatment teamCardiology treatment teamEnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartCardiovascular systemHealth care professionalsAdult (19+)NA2009-12-04T05:00:00ZJennifer Russell, MD, FRCPC10.600000000000044.9000000000000958.000000000000Flat ContentHealth A-Z<p>Learn about cardiology treatment teams, which focus on treating children with heart conditions. The specific role of each team member is discussed.<br></p><p>If your child has a heart condition, there will be several doctors involved in their care. This page explains the role of each health professional on a cardiology treatment team.</p><h2> Key points </h2> <ul><li>There are three kinds of heart specialists: cardiologists, paediatric cardiologists, and cardiovascular surgeons.</li> <li>A heart specialist, or staff doctor, will always look after your child.</li> <li>Your child may encounter be seen by medical students, interns, residents, or fellows.</li> <li>A paediatric cardiologist specializes in heart problems in children and helps prevent and treat heart conditions</li> <li>A cardiovascular surgeon is a medical doctor who operates on heart and blood vessels.</li> <li>To be a specialist a doctor must do a residency and rotate through different areas within their specialty.</li></ul>
Care-by-parent before a child is discharged from hospitalCCare-by-parent before a child is discharged from hospitalCare-by-parent before a child is discharged from hospitalEnglishNAChild (0-12 years);Teen (13-18 years)NANASupport, services and resourcesCaregivers Adult (19+)NA2014-08-11T04:00:00Z5A Nursing Practice Council8.8000000000000060.50000000000001146.00000000000Flat ContentHealth A-Z<p>Learn how "care-by-parent" prepares you to care for a child with complex needs when they are discharged from hospital. </p><p>If your child has a complex medical condition that requires treatment in hospital for a period of time, your child's health-care team will include a period of "care-by-parent" in your child's discharge plan.</p><p>Care-by-parent involves a child's primary caregivers providing all personal and medical care for a child independently within the hospital before the child is discharged.</p><p>The goal of care-by-parent is to allow a child's caregivers to:</p><ul><li>practise the skills that they have learned</li><li>feel confident in their abilities to care for their child independently at home.</li></ul> ​<h2>Key points</h2> <ul> <li>Care-by-parent allows the main caregivers of a child with complex medical needs to care for their child independently before the child is discharged from hospital.</li> <li>The care-by-parent period takes place over 12 to 48 hours, including overnights, in a single patient room.</li> <li>Caregivers must be fully trained in their child's personal and medical care and have all the medication and working equipment they need before care-by-parent can start.</li> <li>Nursing staff will not monitor the child as closely during the care-by-parent period, but they are available if caregivers need help or have questions.</li> </ul><h2>At SickKids</h2> <p>The hospital allows up to four visitors in the room at the same time. All visitors must be in good health.​​</p>https://assets.aboutkidshealth.ca/AKHAssets/care_by_parent_before_child_discharged.jpg
Caring for a child with a brain tumourCCaring for a child with a brain tumourCaring for a child with a brain tumourEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemNAAdult (19+)NA2009-07-10T04:00:00ZDavid Brownstone, MSW, RSWDeborah S. Berlin-Romalis, BSW, MSW, RSWHeather Young, MSW, RSWLaura Janzen, PhD, CPsych, ABPP-CN8.0000000000000065.0000000000000970.000000000000Flat ContentHealth A-Z<p>In-depth information and suggestions concerning the strain that caring for a child with a serious illness may have on the relationship between parents.</p><p>Taking care of a child who has a brain tumour can have a huge impact on the relationship between you, your partner if you have one, and your other family members and caregivers. In some families, caregivers can include step-parents and blended family members. Even if your relationships are strong, it is normal for each caregiver to react differently.</p><h2>Key points</h2> <ul><li>Remember to spend time alone with your partner when you can, take care of your own physical and mental health, and find help and support.</li> <li>Respite workers and support groups can help you and your other caregivers manage.</li> <li>Counselling can be beneficial for you, your partner, your family or your children.</li></ul>
Caring for a sick child: Sharing the responsibilityCCaring for a sick child: Sharing the responsibilityCaring for a sick child: Sharing the responsibilityEnglishNAChild (0-12 years);Teen (13-18 years)NANASupport, services and resourcesCaregivers Adult (19+)NA2012-06-13T04:00:00ZNA8.0000000000000062.0000000000000432.000000000000Flat ContentHealth A-Z<p>Helpful tips on sharing responsibility when caring for a sick child. </p><p>Whenever possible, it is important that both parents share the responsibility of caring for a sick child. Both should help with your child’s care routines. Feelings of resentment, fatigue and stress can build up if one parent has to do all the planning and work. Working together can help prevent "burnout" by sharing the load. Give each other time away from care duties. It also helps to plan time together, apart from your child or children, just as you did before. Your child will also benefit from growing up in a household where health care responsibilities are shared evenly.</p><p>In single-parent families, try and arrange for another family member or a close friend to help with your child’s care from time to time. Maybe they can provide relief by babysitting. Ensure that babysitters and other caregivers know about your child’s condition and in particular, what to do in case of an emergency. Most health care teams will provide education for such caregivers.</p><h2>Key points</h2><ul><li>It is important that both parents share the responsibility of caring for a sick child.</li><li>Make sure that other caregivers know about your child’s condition and in particular, what to do in case of an emergency. </li><li>Find ways to fit your child's needs into your lifestyle instead of letting it control your life.<br></li></ul>https://assets.aboutkidshealth.ca/AKHAssets/caring_for_a_sick_child_sharing_responsibility.jpg
Caring for parents and familiesCCaring for parents and familiesCaring for parents and familiesEnglishNeonatologyPremature;Newborn (0-28 days);Baby (1-12 months)NANASupport, services and resourcesPrenatal Adult (19+)NA2009-10-31T04:00:00ZThe Reverend Michael Marshall, M. Div. M11.600000000000045.5000000000000432.000000000000Flat ContentHealth A-Z<p>Learn about the immediate experience of neonatal intensive care, which is a very emotional, physical, and practical challenge for parents and families.</p><p>Having a premature baby in the Neonatal Intensive Care Unit (NICU) is probably one of the most stressful events any family, and any relationship, can go through. Although the vast majority of premature babies go on to thrive as normal healthy children, the immediate experience of neonatal intensive care is a very emotional, physical, and practical challenge for all involved.</p><h2>Key points</h2> <ul><li>The wellbeing of a premature baby is the primary focus in the NICU, however health-care professionals can still offer help for parents and families.</li> <li>Staff in the NICU can provide support to parents and families as well as information about government and non-government services.</li> <li>Parents are encouraged to ask for help from hospital, family, friends and any other support groups they may have.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/caring_for_parents_and_families.jpg
Caring for the very ill newborn babyCCaring for the very ill newborn babyCaring for the very ill newborn babyEnglishNeonatologyNewborn (0-28 days)BodyNANAAdult (19+)NA2009-10-28T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPC13.100000000000032.2000000000000324.000000000000Flat ContentHealth A-Z<p>In-depth information regarding birth defects and other physical problems in newborn babies. Trusted answers from Canadian Paediatric Hospitals.</p><p>In rare circumstances, things can go wrong with a baby’s growth or development during pregnancy. The baby may be born with developmental problems in one or more of their organ systems. These are called congenital abnormalities, otherwise known as birth defects. Babies with birth defects will require special care.</p><h2>Key points</h2> <ul><li>Congenital abnormalities, or birth defects, are developmental problems in one or more of the baby's organ systems.</li> <li>Children with congenital abnormalities will face many health-care challenges throughout their lives and will require care from specialized health-care professionals.</li></ul>https://assets.aboutkidshealth.ca/akhassets/mom_looking_at_preemie2_BRA_EN.jpg
Caring for your child at home after a blood and marrow transplantCCaring for your child at home after a blood and marrow transplantCaring for your child at home 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 Peds7.1000000000000069.9000000000000671.000000000000Flat ContentHealth A-Z<p>Learn about your child's care at home, after a blood and marrow transplant.</p><p>While recovering from the blood and marrow transplant (BMT), your child’s immune system is still weak. Make sure to clean your home thoroughly and have everything prepared before your child returns from the hospital.</p><h2>Key points</h2><ul><li>It is important to thoroughly clean your home before your child returns to minimize the risk of infection.</li><li>Try to return to a child's usual routine as much as possible to help your child adjust.</li><li>Call the treatment team if you notice any abnormal symptoms such as fever, cough or cold, or changes to the skin.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/caring_for_your_child_at_home_after_a_blood_and_marrow_transplant.jpg
Caring for your child at home after brain tumour surgeryCCaring for your child at home after brain tumour surgeryCaring for your child at home after brain tumour surgeryEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemNAAdult (19+)NA2009-07-10T04:00:00ZEric Bouffet, MD, FRCPCKaren Drybrough, RNLaura Janzen, PhD, CPsych, ABPP-CN7.1000000000000071.7000000000000877.000000000000Flat ContentHealth A-Z<p>In-depth information concerning steps after your child's brain surgery, including going home and medication.</p><p>Caring for your child when they get home from hospital will take a lot of time and energy. If you have other children at home you may need extra help. Think about the following questions: </p> <ul> <li> Who will be caring for your child when they come home?</li> <li> Will you or a helper be able to lift or carry your child from the bed to a chair or the toilet if needed?</li> <li> Do you have family or friends who will be able to help you if needed? You may need help with things like grocery shopping, cleaning, and laundry. </li> <li> Are there community supports that you can access, and funding available? For example, in Ontario, there are the Community Care Access Centre (CCAC), Special Services at Home (SSAH), and the Assistant for Children with Severe Disabilities (ACSD) program. Similar types of support may be available in your area. </li></ul><h2>Key points</h2> <ul><li>Your child will need time to rest and recover before beginning their normal daily routine and activities.</li> <li>Consider how easy it will be for your child to get around the house if you have stairs in your home.</li></ul>
Caring for yourselfCCaring for yourselfCaring for yourselfEnglishAdolescent;OncologyPre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years)NANANAAdult (19+) CaregiversNA2019-09-03T04:00:00ZNA6.8000000000000070.7000000000000440.000000000000Flat ContentHealth A-Z<p>In order to help the people you love, and meet life’s many obligations, you need to take care of yourself. Ignoring your needs can make you become more irritable, negative, short-tempered or resentful. </p><p>Now that you know some of the <a href="/Article?contentid=3597&language=English">signs of depression and anxiety</a>, it can help to practice recognizing when you are stressed and finding ways to deal with that stress in various situations. </p><h2>Key points</h2><ul><li>It is important to understand your limits and when you may be feeling stressed or overwhelmed.</li><li>When you are feeling stressed, take time for yourself, even if it is just a few minutes.</li><li>Try to get enough sleep, eat well and exercise, so that you are do not burn yourself out.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/Caring_for_yourself_TTC_Cancer.jpg
Cartilage-hair hypoplasia (CHH)CCartilage-hair hypoplasia (CHH)Cartilage-hair hypoplasia (CHH)EnglishGeneticsChild (0-12 years);Teen (13-18 years)BodyNAConditions and diseasesCaregivers Adult (19+)NA2011-12-13T05:00:00ZAyeshah Chaudhry, MBBS;Lucie Dupuis, MSc, MS, CGC;Roberto Mendoza-Londono, MD, MS, FACMG, FCCMG8.7000000000000055.60000000000001443.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Information about cartilage-hair hypoplasia, a genetic condition that may cause short stature (height), shorter arms and legs than expected, fine, sparse hair and problems with blood and the immune system.</p><h2>What is cartilage-hair hypoplasia?</h2> <p>Cartilage-hair hypoplasia (say: hie-po-PLAY-zee-a), or CHH, is a genetic condition that results in:</p> <ul> <li>short stature (height)</li> <li>shorter arms and legs than expected</li> <li>fine, sparse hair</li> <li>anemia, a low number of red blood cells</li> <li>problems with the immune system</li> </ul> <p>Another name you may hear for this condition is metaphyseal chondrodysplasia, McKusick type. </p> <p>CHH is quite rare in the general population. In some populations, it is more common. In the Old Order Amish population about one in 1,300 newborns have CHH. In people of Finnish descent, it affects one in 20,000 newborns.</p><h2>Key points</h2> <ul> <li>CHH is a genetic condition that may cause short stature; shorter arms and legs; fine, sparse hair; and problems with blood and the immune system. Children with CHH have normal intelligence.</li> <li>Children with CHH need to be followed carefully by the health care team with different specialists because they may develop health problems.</li> <li>Genetic counselling can help families understand CHH, the options for managing it, and the chances that other children will also be affected.</li> <li>With the right care and support, children with CHH can lead fulfilling lives.</li> </ul><h2>How cartilage-hair hypoplasia affects the body</h2> <h3>Height and body shape</h3> <p>Babies with CHH are born with shorter arms and legs than normal. During childhood, the long bones of the arms and legs grow at a much slower pace than usual. This leads to short stature (height) as well as relatively shorter limbs. The ribs are also affected, leading to flaring of the lower chest. People with CHH may also have bowed legs, be more flexible than usual, and have shorter hands and feet. Average adult height is between 40 and 60 inches (3 feet 4 inches to 5 feet).</p> <h3>Hair</h3> <p>The scalp hair, eyebrows, and lashes of people with CHH are sparse, fine and light-coloured because the core of the hair, which contains the pigment, is missing. </p> <h3>Blood and the immune system</h3> <p>Most people with CHH have problems with the function of the immune system. These problems vary from mild to severe and may include the following:</p> <ul> <li>Impairment of specialized cells called T-cells, which play an important role in helping the body's immune system to fight infection. This is called cellular immunodeficiency.</li> <li>Abnormally low levels of certain white blood cells (neutropenia and lymphopenia).</li> <li>Lower resistance to certain infections, such as chickenpox.</li> </ul> <p>Because of their low levels of specialized immune cells, people with CHH get infections more often. However, as they grow older, people with CHH become more able to resist infections.</p> <p>In early childhood, most people with CHH have severe anemia because they have low levels of red blood cells. Symptoms of anemia include paler skin and decreased energy.</p> <h3>Gastrointestinal problems</h3> <p>Some people with CHH have gastrointestinal problems. These problems may include:</p> <ul> <li>an inability to absorb nutrients properly</li> <li>celiac disease, an intolerance of a protein called gluten that is found in wheat and other grains</li> <li>Hirschsprung disease, an intestinal disorder that causes severe constipation, intestinal blockage and enlargement of the colon</li> <li>narrowing of the anus (anal stenosis) </li> <li>blockage of the esophagus, the passage that brings food from the mouth to the stomach (esophageal atresia) </li> </ul> <h3>Cancer risk</h3> <p>People with CHH have a higher risk of developing cancer, particularly certain skin cancers (basal cell carcinomas), cancer of blood-forming cells (leukemia) and cancer of immune system cells (lymphoma).</p> <h3>Intellectual development</h3> <p>Children with CHH have normal intelligence and attend regular schools. They may need some modifications because of their height, such as sitting at the front of the classroom.</p><h2>Cartilage-hair hypoplasia is a genetic disorder</h2><p>Genetic means related to genes. Each of us inherits our genes from our parents. They provide our bodies with instructions that influence our health, looks and behaviour.</p><p>CHH occurs due to a mutation (change) in a gene known as RMRP gene. Each person has two copies of the RMRP gene, one inherited from their mother and the other from their father.</p><p>CHH is inherited in an autosomal recessive pattern. This means that:</p><ul><li>A person with CHH has a mutation in both copies of the RMRP gene.</li><li>Each parent carries a mutation in one copy of the RMRP gene. The other copy of the RMRP gene works normally and because of this, the parent does not show signs and symptoms of CHH. This person is called a carrier of CHH.</li></ul> <figure class="asset-c-80"> <span class="asset-image-title">Inheritance of cartilage-hair hypoplasia</span> <img src="https://assets.aboutkidshealth.ca/akhassets/CHH_Inheritance_MED_ILL_EN.jpg" alt="Chromosome distribution from carrier parents" /> <figcaption class="asset-image-caption">CHH is caused by mutations in both copies of the RMRP gene. In this example, both healthy parents are carriers of the RMRP gene with a mutation. Their baby can inherit one of the following gene combinations: one, two, or no copies of the RMRP gene with a mutation. If a baby inherits no copies or just one copy of the RMRP gene with a mutation, the baby will not have not have CHH. It is only when a baby inherits two copies of the gene with a mutation that the baby will have CHH.</figcaption> </figure><h2>Cartilage-hair hypoplasia diagnosis</h2> <p>A diagnosis of CHH is made on the basis of the physical examination and X-ray findings. This can be confirmed by DNA testing of the RMRP gene (blood test).</p> <h3>CHH can sometimes be diagnosed before birth</h3> <p>Before birth, CHH may be diagnosed by testing DNA taken from the fetus. This can be obtained in one of the following ways:</p> <ul> <li>by amniocentesis after the 15th week of pregnancy </li> <li>by chorionic villus sampling (CVS) between the 11th and 14th week of pregnancy</li> </ul> <p>These methods are used for high-risk pregnancies, for instance if the parents have another child diagnosed with CHH. In these cases, the mutations in the RMRP gene must be known. This means that genetic testing on the child must be done.</p> <p>CHH can sometimes be diagnosed before birth using ultrasound. Babies with CHH have shortening and bowing of the thighbone, which can sometimes be seen on ultrasound.</p><h2>Treatment of cartilage-hair hypoplasia</h2> <p>Children with CHH can lead fulfilling lives if they receive attentive, informed care from their parents and health-care providers. They should be carefully followed because of the possibility of serious infections and cancer.</p> <p>The goals of treatment are:</p> <ul> <li>to help children with CHH adapt socially and physically</li> <li>to prevent and treat any complications </li> </ul> <p>Various specialists work together as a team to help children with CHH. Your child may need to see an immunologist, an orthopaedic surgeon, a physical therapist and a geneticist from time to time.</p> <h3>Treatment for problems with blood and the immune system</h3> <p>A few people with CHH develop severe anemia and may need several blood transfusions.</p> <p>Children with CHH should not be immunized with live vaccines until they have had a complete evaluation by an immunologist. Live vaccines include chickenpox vaccine and measles, mumps and rubella (MMR) vaccine. Speak to your doctor for more information. Chickenpox (varicella) and shingles (herpes zoster) infections need to be managed by the treatment team. </p> <p>In some cases, bone marrow transplantation can be done to correct severe immune deficiency and anemia, but it has no influence on bone changes.</p> <h3>Treatment of bone and joint problems</h3> <p>Surgical correction of leg deformities might be considered, but people with CHH need extra post-operative care to avoid infections. Physiotherapy can help with limited joint movements. People with CHH may need pain medicine to help with joint pain. This will be carefully monitored by the doctor.</p> <h3>Treatment of gastrointestinal problems</h3> <p>Gastrointestinal problems are treated according to their symptoms. If the person has Hirschsprung disease, they will probably need surgery (an operation).</p><h2>Resources and support</h2><p>The following organizations and sites can offer more information, support, and contact with other affected individuals and their families.</p><h3>The Human Growth Foundation</h3><p> <a href="http://hgfound.org/">www.hgfound.org</a>.</p><h3>Little People of Canada</h3><p> <a href="https://comdir.bfree.on.ca/lpc/">www.comdir.bfree.on.ca/lpc</a>.</p><h3>Little People of Ontario</h3><p> <a href="https://www.littlepeopleofontario.com/">www.littlepeopleofontario.com</a>.</p><h3>Little People of America</h3><p> <a href="https://www.lpaonline.org/">www.lpaonline.org</a>.</p><h3>Immune Deficiency Foundation</h3><p></p><p> <a href="https://www.lpaonline.org/">www.lpaonline.org</a>.</p><h3>The Magic Foundation</h3><p> <a href="https://www.magicfoundation.org/">www.magicfoundation.org</a>.</p><h3>MUMS (Mothers United for Moral Support) National Parent-to-Parent Network</h3><p> <a href="http://www.mums-network.org/">www.mums-network.org</a>.</p> <br> <br>https://assets.aboutkidshealth.ca/akhassets/CHH_Inheritance_MED_ILL_EN.jpg
Cast care: Arm or leg castCCast care: Arm or leg castCast care: Arm or leg castEnglishOrthopaedics/MusculoskeletalChild (0-12 years);Teen (13-18 years)Arm;LegsSkeletal systemNon-drug treatmentCaregivers Adult (19+)NA2019-04-02T04:00:00ZPreeti Grewal, RN, MN, APN;Jean Hohs, RTOrthopaed;Catharine Bradley, MSc, BSc (PT);Benjamin A. Alman, MD, FRCSC;Charlotte Grandjean-Blanchet, MD;Anne Murphy, NP, MN;Derek Gauthier, RT(Orthopaed)4.3000000000000087.6000000000000884.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Read about how to take care of your child's arm or leg cast and learn the warning signs of a problem.</p><div class="asset-video"> <iframe src="https://www.youtube.com/embed/tP_fq26Bxz8?rel=0" frameborder="0"></iframe> </div><h2>About your child's cast</h2><p>Casts and splints hold a part of the body in place. They are used to treat a suspected injury, a fracture or other medical conditions. Casts are put on by an orthopaedic technologist or doctor. All casts are made of plaster or fibreglass with soft cotton underneath to protect the skin. </p><h3>The plaster cast</h3><ul><li>When applied, the plaster may feel warm at first. This is normal.</li><li>The cast will feel firm to touch in 10 to 15 minutes, but it will take up to 48 hours (2 days) to dry all the way through.</li><li>While drying, the cast may feel cold and clammy until it dries all the way through.</li><li>Plaster casts are not waterproof or water resistant. </li><li>Plaster casts and splints are covered by your provincial health insurance in Ontario. </li></ul><h3>The fibreglass cast</h3><ul><li>Fibreglass is applied the same way as plaster.</li><li>Fibreglass dries in about 1 hour. It is lighter in weight and stronger than plaster.</li><li>Fibreglass casts are water resistant but are NOT waterproof. </li><li>In some cases, fibreglass casting may be used with waterproof liner to make a waterproof cast. Ask your orthopaedic technologist if your child may be eligible for a waterproof cast. </li><li>There is a charge for fibreglass casts and other orthopaedic devices. </li></ul><h2>Key points</h2><ul><li>Your child's cast may be made of plaster or fibreglass.</li><li>Look at your child's cast four or five times a day.</li><li>There may be a problem with your child's cast if your child's fingers or toes are blue, white or swollen; if your child cannot bend or straighten the fingers or toes; if your child's arm or leg is numb or tingles; if there is a bad smell coming from the cast; if the cast feels tight to your child; or if the cast is soft or broken.</li></ul><h2>Signs of a problem with your child's cast</h2><p>Look at your child’s cast four or five times per day. Seek urgent medical advice if your child has any of the following complications:</p><h3>Fingers or toes that are blue, white or very swollen</h3><p>Your child’s fingers or toes should be warm and normal in colour. You can compare the temperature, colour and size with your child’s other arm or leg.</p> <figure class="asset-c-80"> <img src="https://assets.aboutkidshealth.ca/akhassets/Signs_of_tight_cast_EQUIP_ILL_EN.jpg" alt="Discoloured hand in a cast compared to non-injured hand" /> <figcaption class="asset-image-caption">If a cast is too tight, the skin may appear pale or bluish beyond the end of the cast when compared with the skin of a non-injured area. </figcaption></figure> <p>Your child should not wear nail polish or rings while wearing a cast. You need to be able to see if the nails are blue.</p><h3>Smells and odours from the cast</h3><p>It is normal for casts to start to smell if they have been in place for a long time. We worry about bad or foul smells, as they may indicate an infection under the cast.</p><h3>A cast that feels tight to your child</h3><p>If your child’s cast feels tight, it may mean that the arm or leg is swollen inside the cast. The swelling can make it difficult for blood to circulate through the arm or leg.</p><h3>A cast that is causing pain to your child </h3><p>If your child is complaining of a persistent pain, often described as burning, pushing or squeezing, it may mean that there is pressure against the skin underneath the cast. This may be in a different location than your child’s injury. </p><h3>A cast that is soft or broken</h3><p>If the cast is soft or broken, it may need to be repaired or replaced.</p><h2>What to do if you have concerns</h2><p>Take your child to see your family doctor or paediatrician for all non-urgent concerns. </p><h2>When to return to the Emergency Department</h2><p>You should go to the Emergency Department or see your orthopaedic team immediately in the following situations:</p><ul><li>You cannot control your child’s pain with pain medications</li><li>There is new, increased swelling or skin discolouration</li><li>New numbness or tingling that doesn’t resolve with regular movement </li><li>There is a foul smell coming from the cast</li><li>If the cast becomes very wet, breaks or falls off</li></ul><h2>At SickKids:</h2><p>You may contact the orthopaedic clinic directly <strong>only if your child has already been seen</strong> in the orthopaedic or fracture clinics. If your child has only been seen in the emergency department, you may contact the emergency department or your primary care provider for assistance. The orthopaedic team may be reached as follows: </p><ul><li>Orthopaedic Clinic: fracture.clinic@sickkids.ca</li><li>Ward 5A (if your child was admitted): 416-813-6948</li><li>More information regarding the Orthopaedic Clinic can be found at: <a href="http://www.sickkids.ca/areas-of-care/clinics/orthopaedic-clinic.html">www.sickkids.ca/areas-of-care/clinics/orthopaedic-clinic.html</a></li></ul>casthttps://assets.aboutkidshealth.ca/AKHAssets/cast_care_arm_leg_cast.jpg
CataractCCataractCataractEnglishOphthalmologyChild (0-12 years);Teen (13-18 years)EyesNervous systemConditions and diseasesCaregivers Adult (19+)NA2012-12-12T05:00:00ZYasmin Shariff, RN;Asim Ali, MD, FRCSC;Nasrin Najm-Tehrani, MD, FRCSC;Kamiar Mireskandari, MD, FRCSC8.0000000000000065.90000000000002825.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Discover how cataracts develop in children and how they can be treated.</p><h2>What is a cataract?</h2> <p>A cataract is a cloudy area over the lens of the eye. Cataracts can affect one or both eyes. Childhood cataracts are rare: they occur in one to three in 10,000 children.</p><h2>Key points</h2> <ul> <li>A cataract is a cloudy area over the lens of the eye. In children under nine, it stops the eye's vision from developing normally and can cause amblyopia.</li> <li>If the cataract is mild, the doctor may decide to prescribe eye drops to make the pupil bigger or not to treat it at all if the vision is not affected. If the cataract is serious, the only way to treat it is to remove all or some of the lens during surgery.</li> <li>After surgery, your child will need a corrective device such as a contact lens, intra-ocular lens or, in rare situations, eye glasses. Your child will also need to wear a patch to help both eyes develop equally strong vision.</li> <li>Your eye doctor will need to check your child's vision regularly after surgery. It is extremely important that you keep all follow-up appointments.</li> <li>Please call the eye doctor if your child has increased pain, swelling or sensitivity to light after surgery or if their corrective device causes any redness, swelling, discharge, pain or other unusual symptoms.</li> </ul><h2>Causes of cataract</h2> <p>A cataract can be congenital (a person is born with it) or can be acquired or developmental (it appears later in childhood or in adulthood).</p> <p>Common causes include:</p> <ul> <li>heredity (inheriting a cataract from a parent)</li> <li>trauma (injury) to the eye</li> <li>radiation (treatment for cancer)</li> <li>medication (for example steroids)</li> <li>other illnesses or conditions (for example Down syndrome)</li> <li>infection (for example German measles).</li> </ul> <p>In many cases, however, the cause of a cataract is not known.</p><h2>How to tell if your child has a cataract</h2> <p>Have your child's eyes examined by an ophthalmologist (say: op-thal-MOL-o-jist), a medical eye doctor, if:</p> <ul> <li>you notice a white spot on your child's eye(s)</li> <li>a parent or sibling had a cataract as a child (not as an older adult)</li> <li>your child has eye problems or another disease or condition in which cataracts are likely to be present</li> <li>your family doctor or paediatrician recommends an eye exam because of a concern about possible cataracts</li> <li>your child's eyes are crossed</li> <li>there is a concern about your child's vision.</li> </ul> <p>If there is a family history of cataracts in childhood, bring your child to an ophthalmologist before they are two weeks old.</p> <h2>Checking your child's eyes for cataracts</h2> <p>The ophthalmologist will carefully examine your child's eyes. Here is what you can expect during the exam.</p> <ul> <li>Your child will have special eye drops to make their pupils bigger. These drops sting at first but only for about 10 seconds. They may be repeated.</li> <li>Since your child needs to be very still when the eyes are checked, they may be wrapped in a blanket and held down gently, especially if they are very young or too upset to stay still on their own.</li> <li>When the drops start to work, usually after about 30 minutes, the ophthalmologist will shine a bright light into your child's eyes and use different instruments to help check them.</li> </ul> <p>Being held down and having a bright light shone in their eyes will make your child uncomfortable, but they should not feel any pain.</p> <p>After the exam, the eye doctor will explain the condition of your child's eyes. If there is a cataract, the doctor will tell you and talk to you about the best treatment for your child.</p><h2>Treatments for cataracts</h2> <p>Cataracts do not go away by themselves, except in a few rare situations.</p> <h3>Mild cataract</h3> <p>If the cataract is small and does not affect your child's vision, the doctor may decide not to treat it at all or may prescribe special eye drops to dilate (widen) the pupil to allow more light to enter the eye. If your child needs eye drops, make sure you carefully follow the instructions for <a href="/Article?contentid=995&language=English">putting them in</a>.</p> <h3>Serious cataract</h3> <p>If the cataract is more serious, your child will need surgery to remove it. Cataracts cannot be removed with medication or lasers.</p> <h2>Why it is important to have surgery to remove a serious cataract</h2> <p>Surgery is important because it will allow your child's vision to develop as normally as possible. It is especially important for children aged under nine because their vision is still developing.</p> <p>If your child has a cataract and they are aged under nine, there is a risk that they will develop <a href="/Article?contentid=835&language=English">amblyopia</a> if the cataract is not removed. Amblyopia is sometimes called "lazy eye" and can occur when the affected eye does not get enough stimulation from light rays.</p> <p>All children aged under nine should be operated on as soon as possible, whether they are born with a cataract or develop one later. If your child develops a cataract when he is aged nine or over, the timing of the surgery is more flexible because their vision has fully developed.</p> <h2>What happens during cataract surgery</h2> <p>Before the surgery, your child will have special drops to dilate (widen) the pupil of the eye. These drops sting at first but only for about 10 seconds. They may need to be repeated once or twice.</p> <p>The eye drops are usually applied right before the surgery in the hospital. If your child needs them before then, your eye doctor will give you a prescription for the drops and explain when to start putting them in.</p> <p>Your child will have a special "sleep medicine" called a general anaesthetic for the surgery. This will make sure they sleep through the operation and do not feel any pain.</p> <p>The surgeon takes out the cataract by removing the lens of the affected eye(s). Your eye doctor will tell you before the surgery if it is best to remove the whole lens or only part of it.</p> <p>The surgeon will use special stitches to repair the eye wound. These stitches are absorbable, meaning that that they do not need to be taken out. They will dissolve on their own over the first six to eight weeks after surgery.</p> <p>In young children with cataracts in both eyes, surgery is often done on the second eye as soon as possible after the first eye. This is to make sure that the vision in both eyes develops evenly.</p> <p>At times, surgery may be done on both eyes on the same day. Your eye doctor will explain exactly when your child will have surgery and, if it applies, when each eye will be done.</p> <p>The operation is usually done as a day surgery if your child is over 12 weeks old. If your child was born prematurely or if the surgery is within the first 12 weeks of life, they will usually stay in the hospital overnight.</p> <h2>What to expect after the surgery</h2> <h3>Eye patch and shield</h3> <p>Immediately after surgery, an eye patch will be placed over the operated eye. The eye patch is covered with a plastic or metal shield for protection. Your child's patch will be removed the next day by the ophthalmologist when they return to the eye clinic. If the patch comes off at home, you can leave it off, but make sure you put the eye shield back on.</p> <p>Your child will continue to wear the shield over the operated eye to protect it while they are sleeping. Your doctor will tell you when your child can stop wearing the shield.</p> <h3>Pain or discomfort</h3> <p>Your child may experience some pain or discomfort in the operated eye. Please ask your doctor what medication you can give your child at home to relieve the discomfort or pain.</p> <p>The nurses in the recovery room will watch your child for signs of pain or discomfort and will be able to give medication if your child needs it.</p> <p>Before your child is discharged from hospital, please ask the nurse when your child last had any pain relief medication. This way, you can monitor your child's pain and give medication safely as needed.</p> <h3>Redness, swelling, and discharge</h3> <p>The operated eye will be red and slightly swollen after the surgery. It will also produce a clear discharge. These should decrease over the next few days.</p> <h3>Blurred vision</h3> <p>Without the lens, your child's eye is no longer able to focus clearly, but be assured that your child will not be blind. Objects will be very blurry at first until your child receives a corrective device to improve their vision. You can read more about corrective devices below.</p><h2>When to call your doctor</h2> <p>Call your doctor immediately if:</p> <ul> <li>your child feels more pain or sensitivity to light</li> <li>your child's eyelid becomes redder or more swollen from day to day</li> <li>your child complains of or shows any signs of decreased vision</li> <li>there is any yellowish or greenish discharge from the eyes</li> <li>your child shows any other changes that concern you</li> </ul> <h2>Follow-up appointments after cataract surgery</h2> <p>Follow-up appointments are as important as the surgery itself. These appointments are usually scheduled:</p> <ul> <li>one day after surgery</li> <li>one week after surgery</li> <li>four weeks after surgery</li> </ul> <p>Every time the eye doctor sees your child, they will tell you when to come back again.</p> <p>It is very important to keep these appointments.</p> <p>Write the date and time of the first appointment here: ______________________</p> <h2>Corrective devices after cataract surgery</h2> <p>A corrective device is something that your child wears to repair their vision. Before the surgery, your child's ophthalmologist will discuss the best device for your child. The main options are:</p> <ul> <li>contact lens</li> <li>intra-ocular lens</li> <li>eye glasses.</li> </ul> <p>Your child's eye may also need to be patched. Patching is described in the next section.</p> <h3>Contact lens</h3> <p>A contact lens is an artificial lens made of special material, which can be either soft or hard. It is placed on the child's eyeball.</p> <p>Once your child's eye has healed enough, they will be fitted for a lens, usually in the eye clinic. Sometimes a child will need to be sedated (calmed with medicine) for the fitting or may even need a general anaesthetic.</p> <p>The eye doctor will start the fitting by putting an anaesthetic drop in the operated eye.</p> <p>The doctor will then place a sample contact lens on the eyeball and measure the child's contact lens prescription for strength and fit. Your doctor will explain the strength of contact lens your child is prescribed and the reason for it.</p> <p>The eye doctor or your optician or optometrist (where you buy the contact lens), will teach you how to insert and take out the contact lens as well as how to clean and store it. Make sure you understand these instructions.</p> <p>Your child's vision will need to be checked regularly (by an ophthalmologist) with the contact lens on. Because your child's eyes are still growing, they will get a new prescription to adjust the contact lens strength and fit.</p> <p>Younger children may be prescribed glasses to wear as a back-up when not using the contact lens. Older children may need glasses or bifocals in addition to their contact lenses.</p> <p>Although it might seem like a major change, babies and children adjust to contact lenses more quickly than adults do.</p> <h3>Intra-ocular lens</h3> <p>An intra-ocular lens is an artificial lens placed in the eye. Most times this is done during the surgery to remove the lens, but it can sometimes be done later. If your child needs this type of lens, the doctor will tell you when it will be fitted.</p> <p>Unlike the normal lens in the eye, an intra-ocular lens does not change its focusing power. Your ophthalmologist will decide what power of intra-ocular lens your child needs.</p> <p>Your child may also need bifocal eye glasses. Your doctor will discuss this with you. </p> <h3>Eye glasses</h3> <p>Eye glasses are prescribed only if no other device is suitable. This because the lenses are thick and would distort, or interfere with, your child's vision and the glasses feel heavy to wear. However, the vision will develop with glasses just as well as with another corrective device.</p> <p>If a baby needs eye glasses, the prescription will be for near vision, as they spend their waking hours focusing on things up close (for example food, toys or a parent's or caregiver's face).</p> <p>When the baby gets older and needs distant vision, they will get a prescription for bifocals (lenses that allow the eyes to focus on things that are close and far away).</p> <h3>Remember to have regular check-ups</h3> <p>Whatever corrective lens is prescribed, your child will still require regular check-ups with the ophthalmologist. Please call your eye doctor between appointments if your child develops:</p> <ul> <li>any discomfort or pain</li> <li>discharge, redness or swelling of the eye</li> <li>decrease in vision</li> <li>any unusual signs or symptoms.</li> </ul> <h2>Eye patching</h2> <p>When a child has cataract(s), the vision in the affected eye does not develop properly, which can lead to amblyopia.</p> <p>If there is any difference in vision between the eyes, even if both eyes were operated on, the doctor will order an <a href="/Article?contentid=57&language=English">eye patch</a>. Blocking the vision of your child's stronger eye with a patch will help to strengthen the weaker eye.</p> <p>If your child's eye needs patching, your eye doctor will explain:</p> <ul> <li>which eye needs to be patched</li> <li>how long and how often your child should wear the patch</li> <li>when a follow-up appointment is needed to check your child's vision.</li> </ul><h2>At SickKids</h2> <p>If the eye doctor who operated on your child's eye(s) is not available, call 416-813-7500 and ask for the eye doctor on call.</p>https://assets.aboutkidshealth.ca/akhassets/Cataracts_normal_eye_MED_ILL_EN.jpg
Categorizing brain tumoursCCategorizing brain tumoursCategorizing brain tumoursEnglishNeurology;OncologyChild (0-12 years);Teen (13-18 years)BrainNervous systemNAAdult (19+)NA2009-08-14T04:00:00ZEric Bouffet, MD, FRCPC7.3000000000000063.8000000000000547.000000000000Flat ContentHealth A-Z<p>A step-by-step introduction to the different types of childhood brain tumors. Answers from Canadian Paediatric Hospitals.</p><p>There are more than 100 different types of brain tumours. Tumours are usually named after the type of cell they develop from. One example is a glioma, which grows out of glial cells. Tumours may also be described based on their location, such as a brainstem glioma. Sometimes the same tumour may have different names, which can be confusing. The name of a tumour can change as researchers learn more details about tumour cells.</p><h2>Key points</h2> <ul><li>A primary brain tumour develops directly in the brain while a secondary tumour develops elsewhere in the body and spread to the brain.</li> <li>A benign tumour is not cancerous and grows slowly.</li> <li>A malignant tumour is cancerous, grows quickly, and can spread to other parts of the body.</li></ul>
Catheter ablation in the heart catheterization labCCatheter ablation in the heart catheterization labCatheter ablation in the heart catheterization labEnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartHeart;Arteries;VeinsProceduresCaregivers Adult (19+)NA2009-11-06T05:00:00ZRobert Hamilton, MD, FRCPC;Susan Johnston, RN, BScN;Carrie Morgan, RN, MN;Jennifer Kilburn, RN, MN;Cindy Wasyliw, RN, BNSc8.4000000000000059.1000000000000961.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Catheter ablation is a treatment for children with certain types of tachycardia (rapid heart rate). Treatment involves destroying an abnormal circuit.<br></p><h2>What is catheter ablation?</h2><p>Catheter ablation is done in the cardiac (heart) catheterization laboratory to correct tachyarrhythmias.</p> <figure class="asset-c-80"> <span class="asset-image-title">Catheter </span> <span class="asset-image-title"> </span> <span class="asset-image-title">ablation</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Catheter_ablation_MED_ILL_EN.jpg" alt="A heart with an ablation catheter inserted and an abnormal electrical pathway" /> <figcaption class="asset-image-caption">Energy</figcaption> <figcaption class="asset-image-caption"></figcaption> <figcaption class="asset-image-caption"> is delivered through a catheter inserted in the heart to eliminate an abnormal electrical pathway.</figcaption> </figure> <h2>What are tachyarrhythmias?</h2><p>Tachyarrhythmias (say: tack-ee-a-RITH-me-uz) are fast (racing) heartbeats that are abnormal. These rapid heart rates are caused by abnormal electrical circuits in the heart. Sometimes these arrhythmias are treated with medication, and sometimes they need to be treated with catheter ablation.</p><h2>What is heart catheterization?</h2><p>During heart catheterization, the doctor carefully puts a long, thin tube called a catheter into a vein or artery in your child's neck or groin. The groin is the area at the top of the leg. Then, the catheter is threaded through the vein or artery to your child's heart.</p><p>The doctor who does the procedure is a cardiologist, which means a doctor who works on the heart and blood vessels. This may not be your child's regular cardiologist.</p><p>To learn about heart catheterization, please see <a href="/Article?contentid=59&language=English">Heart catheterization: Getting ready for the procedure</a>.</p><h2>Key points</h2> <ul> <li>Catheter ablation is a treatment for children with certain types of rapid heart rate. Hot or cold temperature is used to destroy abnormal electrical circuits in the heart and correct the problem. </li> <li>There is a small risk that your child will have complications from the procedure. Your child's doctor will explain the risks to you before the procedure. </li> <li>Your child will need to have an anaesthetic. Your child will need to stay overnight in the hospital after the procedure. </li> <li>Your child will need to take <a href="/Article?contentid=77&language=English">ASA</a> to prevent blood clots after the procedure. </li> </ul><h2>What happens during the procedure</h2> <p>The procedure is performed while your child is under a general anaesthetic. This means that your child will be asleep during the procedure. </p> <h3>Finding the abnormal circuit</h3> <p>The doctor threads a special catheter through your child's blood vessels to the heart. A special type of X-ray called fluoroscopy lets the doctor see where the catheter is located. </p> <p>Electrical signals sent by the heart travel through the catheters. These signals give information about the heart's electrical system. The doctor also uses the catheters to trigger the rapid heart rate. This helps the doctor find the abnormal area in the heart. </p> <h3>Destroying the abnormal circuit</h3> <p>After the cardiologist finds the circuit that causes your child's heart to beat fast, they use hot or cold temperature to get rid of the circuit. When the circuit is destroyed, the rapid heart rate should not happen anymore. </p> <h2>The procedure will take three to six hours</h2> <p>The procedure lasts three to six hours. After the procedure, your child will go to the recovery room to wake up from the anaesthetic. Then your child will go back to the inpatient unit. </p><h2>After the procedure</h2> <p>The cardiologist will let you know when your child can go home. Your child will probably need to stay in the hospital overnight after the procedure. Your child may have an echocardiogram or a Holter monitor test before they can go home. </p> <p>For information on what to do after your child goes home, please see <a href="/Article?contentid=1214&language=English">Heart catheterization: Caring for your child after the procedure</a>.</p> <h3>If your child has a racing heartbeat after the procedure, call the cardiologist</h3> <p>After the ablation, children often feel that their heart is about to race. This feeling is normal. It is caused by single early beats that may have started the heart racing before the procedure. However, these events should no longer cause the heart to race. If your child does have a racing heartbeat, call the cardiologist. </p>https://assets.aboutkidshealth.ca/akhassets/Catheter_ablation_MED_ILL_EN.jpg
Catheter drainage for pleural effusion (PleurX drainage system)CCatheter drainage for pleural effusion (PleurX drainage system)Catheter drainage for pleural effusion (PleurX drainage system)EnglishOtherChild (0-12 years);Teen (13-18 years)LungsLungsProceduresAdult (19+) CaregiversNA2019-07-25T04:00:00ZDalia Bozic, MN, RN(EC), NP-PHC7.8000000000000066.40000000000001728.00000000000Health (A-Z) - ProcedureHealth A-Z<p>A drainage catheter is a soft flexible tube placed into the pleural space around the lung. The tube drains fluid that is compressing the lung and restricting breathing. Learn about the insertion procedure and how to care for the drainage catheter.</p><h2>What is pleural effusion?</h2><p>The lungs are surrounded by a membrane called the pleura:</p><ul><li>The parietal pleura is the outside membrane.</li><li>The visceral pleura is the inside membrane, attached to the lungs.</li></ul><p>Between the pleural membranes, in the area surrounding the lungs, is the pleural space. Sometimes, there can be a build-up of fluid in the pleural space. This is called a pleural effusion. This build-up of fluid can put pressure on the lungs and make breathing more difficult.</p> <figure class="asset-c-80"><span class="asset-image-title">Lung pleura and pleural space</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/IGT_PleuralCavity_EN.jpg" alt="Right lung covered with pleura and inside view of left lung" /><figcaption class="asset-image-caption">The pleura is made up of two thin layers of tissue that cover the lungs and inner chest wall. The space between the two layers is called the pleural space. The pleura aids the lungs during breathing.</figcaption></figure> <figure> <span class="asset-image-title">Pleural drainage</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/IGT_PleuralEffusion_CatheterDrainage_PleurX_EN.jpg" alt="" /><figcaption class="asset-image-caption">A drainage catheter is a soft flexible tube placed into the pleural space around the lung. The tube drains fluid from the pleural space that is compressing the lung and restricting breathing.</figcaption></figure> <h2>Catheter drainage for pleural effusion</h2><p>A catheter is a small tube. For a pleural effusion, a catheter is inserted into the pleural space to drain the fluid that is making your child feel short of breath. The goal of inserting the catheter is to allow your child to remain as active as possible, and to improve their quality of life. Your child’s health-care team will teach you how to connect the catheter to the drainage collection system so that you can drain the fluid from around your child’s lung. They will also provide you with <a href="https://www.bd.com/en-us/offerings/capabilities/interventional-specialties/peritoneal-and-pleural-drainage/about-the-pleurx-drainage-system/patient-information-pleurx-system">information</a> about ordering equipment, making dressing changes, changing the catheter adaptor, and who to contact if you require more information.</p><h2>Key points</h2><ul><li>A drainage catheter meant for a pleural effusion is a small tube inserted into the pleural space that will drain the fluid that is making your child feel short of breath.</li><li>The drainage catheter helps children manage recurrent build up of fluid in the pleural space at home.</li><li>Your child may be given local anaesthesia, sedation or general anaesthesia depending on their age and condition.</li></ul><h2>Potential drainage catheter complications at home</h2><h3>No drainage</h3><p>If fluid stops draining, it could be because:</p><ul><li>there is no fluid left in the pleural space</li><li>the catheter or system drainage line is blocked</li></ul><p>It is uncommon for either the catheter or the system drainage line to become blocked. If you think the catheter or drainage line may be blocked, squeeze them gently. If drainage does not start again, <a href="https://www.bd.com/documents/guides/directions-for-use/IS_PleurX-Drainage-Procedure_DF_MU.pdf">follow the instructions</a> that came with your drainage system for how to change to another bottle. If drainage does not start when you switch to a second bottle, call your health-care team. The doctor may order a test (such as an ultrasound or <a href="/Article?contentid=1272&language=English">CT scan</a>) to determine how much fluid is in the pleural space, if medication is needed to unblock the catheter, or if the catheter needs to be changed or removed.</p><h3>Site issues</h3><ul><li>Some discomfort and mild redness is expected after insertion but should not worsen or last longer than one week.</li><li>If the catheter is pulled out, or the catheter cuff becomes exposed, cover the exit site with a sterile self-adhesive dressing and seek immediate medical attention.</li><li>If your child’s dressing is wet or loose, change it using the sterile technique you have been taught by your health-care team.</li></ul><h3>Damaged, cut or broken catheter</h3><p>Pinch the catheter closed between your fingers if the catheter becomes damaged, cut or broken. If you have a slide clamp provided in your drainage system kit, slip it over the catheter and tighten the clamp. If you do not have a slide clamp, bend the catheter and tape it in this position. Call your doctor immediately.</p><h3>Disconnected valve or valve malfunction</h3><p>If there are problems with the catheter valve, get a new valve cap and wipe it with an alcohol pad. Place it over the catheter valve and twist it clockwise until it clicks and locks. A damaged valve may allow air into your child's body or let fluid leak out through the valve.</p><h2>When to seek medical assistance</h2><p>After the catheter has been inserted and you are home, you should call your doctor or nurse, or go to the nearest Emergency Department if your child develops any of the following:</p><ul><li>Your child has a fever 37.8°C under the arm or higher, or 38.3°C orally.</li><li>There is a change in the colour, consistency or amount of fluid draining from your child’s chest.</li><li>Your child has pain when you are draining fluid from their chest or pain that continues after draining.</li><li>Your child has redness, swelling, drainage or pain at the catheter insertion site or in the region of the catheter.</li><li>You damage, break or cut the catheter, or it becomes dislodged.</li><li>You see fluid leaking from the valve or catheter.</li></ul><h2>How are drainage catheters inserted?</h2><p>The drainage catheter is placed by an interventional radiologist in the location that will result in the best fluid drainage. The drainage catheter helps children manage recurrent build up of fluid in the pleural space at home. The system includes a catheter that is inserted into the body, and vacuum bottles that allow fluid to be drained quickly, effectively and safely.</p><p>More than one tube may be placed if there is fluid around both lungs, or if there are large, separate pockets of fluid. <a href="/Article?contentid=3001&language=English">Local anaesthetic</a> will be used (even if your child has been given a <a href="/Article?contentid=1261&language=English">general anaesthetic</a> and is asleep), as it helps reduce the amount of pain your child will feel after the tube(s) are placed.</p><p>A small needle is placed into the fluid around the lungs with the assistance of <a href="/Article?contentid=1290&language=English">ultrasound</a>. Two small incisions are then made in the skin, one where the needle goes in and another further down the chest or abdomen where the catheter comes out. The catheter is placed under the skin and into the pleural space. The position of the catheter is then checked with X-rays. Once in the correct place, the catheter is secured with a dressing to protect it. If your child is staying in the hospital, the catheter may be attached to a drainage box or bottle.</p><h2>On the day of the drainage catheter insertion for pleural effusion</h2><h3>Your child will have medicine for pain</h3><p>It is important that your child is as comfortable as possible for the procedure. They may be given local anaesthesia, sedation or general anaesthesia. The type of medicine that your child will have for the procedure will depend on your child’s age and condition.</p><p>During the catheter insertion, you will be asked to wait in the waiting area.</p><h2>After the drainage catheter insertion</h2><p>Once the catheter insertion 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. If it was done under sedation or general anaesthesia, as soon as your child starts to wake up, a nurse will come and get you.</p><p>Some children feel local pain or discomfort after the catheter is placed. Your child will be closely monitored and given pain medicine as needed. After a day, most children feel no pain with the catheter.</p><p>The tube can be connected to a drainage collection system, or a collection bottle; or the tube may be closed with a cap if enough fluid was removed during the procedure. Your health-care team will teach you how to connect the catheter to the drainage collection system so that you can drain the fluid from around your child’s lung every day (or as directed by your child’s doctor).</p><h2>Preparing for a drainage catheter insertion</h2><h3>Giving consent before the procedure</h3><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 them. It is important that you understand all of these potential risks and benefits of the drainage catheter insertion 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><h3>How to prepare your child for the procedure</h3><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 them 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><h3>Food, drink, and medicines before the procedure</h3><ul><li>Your child’s stomach must be empty prior and during <a href="/Article?contentid=1260&language=English">sedation</a> 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></ul><p>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 your child’s doctor and the interventional radiologist.</p><h2>At SickKids</h2><p>If you have any concerns related to your child’s drainage catheter, please ask your home visiting nurses first; or contact your child’s Oncology clinic nurse during working hours. If you have concerns and it is after working hours, call The Hospital for Sick Children switchboard at <strong>(416) 813-7500</strong> and ask them to page the Oncology fellow on call.</p><h2>Resources</h2><p>SickKids uses a brand of drainage catheters called PleurX drainage systems. For more information on the PleurX drainage system, visit the <a href="https://www.bd.com/en-us/offerings/capabilities/interventional-specialties/drainage/about-the-pleurx-drainage-system/pleurx-drainage-system">PleurX drainage system website</a>.</p><p>For patient education material about the PleurX drainage system, visit the <a href="https://www.bd.com/en-us/offerings/capabilities/interventional-specialties/drainage/about-the-pleurx-drainage-system/patient-information-pleurx-system">PleurX patient information page</a>.</p><p>Watch a video on <a href="https://www.bd.com/en-us/company/video-gallery?video=4507949508001">how to drain pleural effusions at home</a>.</p>
Cause and effect relationshipCCause and effect relationshipCause and effect relationshipEnglishDevelopmentalPremature;Newborn (0-28 days);Baby (1-12 months);Toddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years)NANANAPrenatal Adult (19+)NA2009-10-31T04:00:00ZVirginia Frisk, Ph.D., C. Psych9.6000000000000053.7000000000000649.000000000000Flat ContentHealth A-Z<p>Cause and effect issues have to do with difficulty in inferring relationships. For example, if your child is outside and you ask them, "Why are all the streets and sidewalks wet?" and they cannot figure it out.</p><p>Cause and effect issues have to do with difficulty in inferring relationships. For example, if your child is outside and you ask them “why are all the streets and sidewalks wet?” and they cannot figure it out. Difficulty recognizing cause-effect relationship can become a serious problem since many dangerous behaviours are prevented by a proper understanding of cause-effect relationships. For example, putting your hand on a hot stove (the cause) will produce a burn (the effect). Children with cause-effect relationship problems will have much more trouble learning that it is not a good idea to put your hand on the stove. </p><h2>Key points</h2> <ul><li>When a child has trouble understanding cause and effect relationships, they don't have a proper understanding of the consequence of actions, which can be dangerous.</li> <li>This lack of understanding can affect your child's safety, learning and social skills.</li> <li>There are multiple things parents can do and resources they can use to help their child learn impulse control and cause and effect relationships.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/cause_and_effect_relationship.jpg
Causes and prevention of premature birthCCauses and prevention of premature birthCauses and prevention of premature birthEnglishNeonatologyPrenatal;PrematureNANAHealthy living and preventionPrenatal Adult (19+)NA2009-10-31T04:00:00ZNicolette C. Caccia, MD FRCSCAndrew James, MBChB, FRACP, FRCPC10.500000000000049.1000000000000963.000000000000Flat ContentHealth A-Z<p>Read about various factors that can contribute to premature labour, such as smoking and infections. Steps can be taken to avoid premature labour.</p><p>Preterm birth, or premature birth, is usually an unplanned event. Depending on the causes of the birth and how premature the baby is, it may also be an emergency. This section explores the causes of premature birth, the signs of premature birth, and strategies to delay premature birth. In many cases, premature birth cannot be avoided.</p><h2>Key points</h2> <ul><li>Some premature births can be caused by problems with the fetus, the mother or both.</li> <li>Certain events can stimulate the onset of premature labour including placental abruption, incompetent cervix, hormonal changes or infection.</li> <li>There are multiple risk factors for premature birth including having a previous premature birth, pregnancy with multiple babies, infection, drug or alcohol use, and age.</li> <li>While some risk factors cannot be changed, there are a few general ways to reduce the odds of having a premature birth.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/causes_prevention_premature_birth.jpg
Cecostomy tube insertion using image guidanceCCecostomy tube insertion using image guidanceCecostomy tube insertion using image guidanceEnglishOtherChild (0-12 years);Teen (13-18 years)Large Intestine/ColonLarge intestineProceduresAdult (19+) CaregiversNA2018-02-08T05:00:00ZDalia Bozic BScN, MN, NP-PHC;Michelle Cote BScN RN;Prakash Muthusami, MD;Joao Amaral, MD8.8000000000000061.60000000000002168.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Find information about what a cecostomy tube (C-tube) is and why it is used. Also learn about how a C-tube is inserted, the risks and how to care for it once it is inserted.</p><h2>What is a cecostomy tube</h2><p>A cecostomy tube (C-tube) is a thin plastic tube that is placed through the opening on the abdomen and directly into the cecum (first part of the large intestine). A cecostomy tube is inserted by an interventional radiologist using image guidance. A cecostomy tube is placed to help your child empty their bowel.</p> <figure class="asset-c-80"> <span class="asset-image-title">Cecum location</span><img src="https://assets.aboutkidshealth.ca/akhassets/cecum_location_EN.jpg" alt="Location of cecum in the large intestine" /> <figcaption class="asset-image-caption">The cecum is the first part of the large intestine (colon).</figcaption></figure> <h2>Who should receive a cecostomy tube?</h2><p>C-tubes can help patients who have issues such as fecal incontinence (soiling) and severe constipation to be independent in their bowel management.</p> <figure> <span class="asset-image-title">Antegrade continence enema</span> <img src="https://assets.aboutkidshealth.ca/akhassets/antegrade_continence_enema_EN.jpg" alt="Child sitting on toilet with their cecostomy tube attached to an irrigation bag" /> <figcaption class="asset-image-caption">An antegrade continence enema uses an irrigation bag attached to the cecostomy tube to flush the large intestine (colon) from above the stool. Your child should be sitting on a toilet when the antegrade enema is given.</figcaption></figure> <p>When a patient has a C-tube the bowel is flushed out using an enema. Usually an enema is given by placing liquid into the rectum to help empty the bowel. This is called a retrograde enema. But when using the C-tube, fluid is given through the tube, this fluid passes into the cecum and washes out the stool from above. This is called an antegrade enema. However, for an antegrade enema to be successful, it will require a lot of time and patience from the patient and their family. For this reason, getting a C-tube is not an option for all patients.</p><p>Your child may be a candidate for a C-tube if they:</p><ul><li>experience fecal incontinence with troublesome soiling.</li><li>have experienced long-term severe constipation.</li><li>do not respond well to rectal enemas or other methods.</li></ul><p>Your child may not be a candidate for a C-tube if they:</p><ul><li>have had previous abdominal surgery.</li><li>have excessive soft tissue between the skin surface and the cecum.</li><li>are unable to sit for a prolonged period of time on the toilet.</li></ul><h2>Key Points</h2><ul><li>A cecostomy (C-tube) is used to help your child empty their bowel and to decrease the incidence of fecal incontinence (soiling).</li><li>For the first 10 days after the C-tube insertion, your child should not use the C-tube and will continue with their regular bowel regime.</li><li>The dressing over the C-tube needs to be changed daily or as needed (for example if it gets soiled or becomes loose) for the first two weeks until the retention suture is removed.</li><li>C-tube irrigation should begin 11 days after the C-tube insertion.</li><li>Six weeks after the temporary C-tube insertion, your child will have an appointment to have the temporary C- tube changed to a long-term Chait trapdoor C-tube.</li><li>C-tubes are changed yearly in the interventional radiology department.</li></ul> <h2>During the procedure</h2><p>During the procedure, you will be asked to wait in the surgical waiting room.</p><h2>Your child will have medicine for pain</h2><p>It is important that your child is as comfortable as possible for the procedure. Children will have a <a href="/Article?contentid=1261&language=English">general anaesthesia</a> for C-tube insertion.</p><h2>How is a cecostomy tube inserted?</h2><p>At first, a temporary C-tube is inserted through your child’s abdomen, into the cecum. A small hole is made in your child’s abdomen (most of the time on the right lower abdomen). The temporary C-tube is then inserted using ultrasound and X-ray to guide it into the correct position in the cecum. The entire procedure takes 60 to 90 minutes. This temporary tube is straight with a curly end, like a pig’s tail, that keeps it in place. One or two small pieces of medical wire attached to a thread, called a retention suture, are used to hold the cecum close to the abdominal wall. This retention suture stays in for two weeks while the C-tube tract heals. The temporary tube will remain 3 to 4 inches outside of the body and is fastened to the skin with tape. A dressing will cover the insertion site for two weeks after the procedure. About six weeks after the temporary C-tube is inserted it will be replaced with a long-term Chait trapdoor C-tube.</p> <figure class="asset-c-80"> <span class="asset-image-title">Cecostomy tube (C-tube) types</span> <img src="https://assets.aboutkidshealth.ca/akhassets/cecostomy_tube_types_EN.jpg" alt="Illustration of a temporary C-tube in the cecum and a chait trapdoor C-tube in the cecum" /> <figcaption class="asset-image-caption">A cecostomy tube (C-tube) is a thin plastic tube that is placed through an opening on the abdomen directly into the cecum to help your child empty their bowel. At first a temporary C-tube will be inserted. After six weeks, a long-term Chait trapdoor C-tube will replace the temporary one.</figcaption> </figure> <h2>After the cecostomy tube insertion</h2><p>Once the C-tube insertion 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. Your child will be closely monitored and medication for pain will be given when needed.</p><h2>Going home</h2><p>Your child will stay in hospital for three to five days after they have had a C-tube inserted. Your child can go home when the doctor feels it is safe for them to do so. Further teaching and instruction on how to use and care for the C-tube will be provided prior to your child's discharge home.</p><p>During the first two weeks after the procedure, your child should not go into the water and they should avoid taking a bath or going swimming. After two weeks, the retention suture will be cut (this is a painless procedure) and the skin around the C-tube will be assessed. Further support will also be provided to you and your child.</p><p>About six weeks after the temporary C-tube is inserted, you will return to the interventional radiology department to have the tube replaced with a long-term Chait trapdoor C-tube. This tube is less visible than the temporary C-tube and lies almost flush to the skin. It takes only 15 to 30 minutes and your child will not have to stay in hospital overnight or have a general anaesthetic. These tubes are then changed yearly in the interventional radiology department.</p><h2>Visiting the interventional radiologist before the procedure</h2><p>Your child will have a clinic visit in the interventional radiology department before the procedure. This visit will usually take about two hours.</p><p>During the clinic visit you should expect:</p><ul><li>A health and nutrition history and a physical examination will be performed by the clinic nurse and registered dietician.</li><li>An explanation of the procedure, and a review of the consent form with the interventional radiologist.</li><li>A review of fiber and fluid intake with the registered dietician.</li><li>Information on how to care for and use a C- tube with the clinic nurse.</li><li>Information on transition of care from a pediatric institution to an adult facility that would be begin at 16 years of age.</li></ul><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 the benefits against the risks. It is important that you understand all of the potential risks and benefits of the C-tube insertion 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>If your child becomes ill within two days before the procedure</h2><p>It is important that your child is healthy on the day of the procedure. If your child starts to feel unwell or has a fever within two days before the C-tube insertion, let your doctor know. Your child's procedure may need to be rebooked.</p><h2>Food, drink, and medicines before the procedure</h2><p>Your doctor will tell you if your child will be required to clear their bowel beginning two days prior to the C-tube insertion. If required, the bowel is cleared in the following way for a cecostomy tube insertion:</p><ol><li>Two days before the procedure your child will start a clear fluid diet. They cannot have any solid food or milk during this time. <table class="akh-table"><thead><tr><th colspan="2">Clear fluids</th></tr></thead><tbody><tr><td>Chicken, beef or other clear broth (without noodles)</td><td>Kool-Aid</td></tr><tr><td>clear apple juice</td><td>Pedialyte</td></tr><tr><td>Gatorade</td><td>popsicles</td></tr><tr><td>ginger ale</td><td>water</td></tr></tbody></table><p>Jell-O is not a clear fluid and is not included. Your child will continue a clear fluid diet until after the procedure and until the doctors tell you that it is alright to for them to eat solid food. If your child has special needs during fasting, please talk to your referring doctor in advance. Your child may need to be admitted to the hospital for a bowel washout.</p></li><li>Your child will also need to take a medication called Pico-Salax to help clear their bowel before the procedure. Ask your referring doctor or the clinic nurse for instructions on how and when your child will need to take the medication.</li><li>After your child develops nearly clear rectal outflow, they should continue drinking clear fluids. This is important to prevent dehydration. Your child can have clear fluids up to three hours prior to the booked procedure time.</li><li>On the day of the procedure please give your child their regular morning medicines with a sip of water.</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></ol><p>If you have any concerns about your child after they are discharged home, call the IGT clinic at (416) 813-7654 ext. 201804 and speak to the clinic nurse during working hours or leave a non-urgent message with the IGT clinic nurse.</p><p>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) 813-7500 and ask them to page your referring doctor or the interventional radiology fellow on call.</p><p>For more information on transitioning to adult care see the <a target="_blank" href="http://www.sickkids.ca/good2go/">Good 2 Go Transition Program</a>.</p><p>For more information on fasting see <a target="_blank" 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 target="_blank" href="http://www.sickkids.ca/VisitingSickKids/Coming-for-surgery/index.html">Coming for surgery</a>.</p>https://assets.aboutkidshealth.ca/AKHAssets/cecostomy_tube_types_EN.jpg
Cecostomy tube: Changing your child’s dressingCCecostomy tube: Changing your child’s dressingCecostomy tube: Changing your child’s dressingEnglishOtherChild (0-12 years);Teen (13-18 years)Large Intestine/ColonLarge intestineNon-drug treatmentAdult (19+) CaregiversNA2018-02-08T05:00:00ZDalia Bozic BScN, MN, NP-PHC;Michelle Cote BScN RN;Prakash Muthusami, MD;Joao Amaral, MD7.0000000000000072.70000000000001026.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn how to change your child’s dressing if they have a cecostomy tube (C-tube). Also learn about the retention suture and when it will be cut.</p><h2>What is a cecostomy?</h2><p>A cecostomy is an opening from the outside of the body on the abdomen to the cecum, the first part of the large intestine. A cecostomy tube (C-tube) is placed through the abdomen into the cecum to help your child empty their bowel and decrease the incidence of fecal incontinence (soiling). C-tubes are inserted using image guidance.</p><p>Please see the <a href="/Article?contentid=3382&language=English">Cecostomy tube insertion using image guidance</a> and <a href="/Article?contentid=3383&language=English">Cecostomy tube: Common problems</a> for more information.<br></p> <figure class="asset-c-80"> <span class="asset-image-title">Cecostomy tube (C-tube)</span> <img src="https://assets.aboutkidshealth.ca/akhassets/cecostomy_tube_EN.jpg" alt="A cecostomy tube in the cecum, which is part of the large intestine" /> <figcaption class="asset-image-caption">A cecostomy tube (C-tube) is a thin plastic tube that is placed in the cecum to help your child empty their bowel.</figcaption> </figure> <h2>Dressing covering the cecostomy site</h2><p>After the C-tube is first inserted your child will need to have a dressing covering the site for two weeks. The first dressing must stay on for 24 hours. After this, you will need to change the dressing once a day or more often if it gets wet or soiled. You will do this for fourteen days or until the retention suture is cut. Your nurse will show you how to change the dressing before your child goes home.</p><p>Changing the dressing daily helps you to monitor for any signs of infection.</p><p>Your child cannot go into the water while they have the dressing on, so avoid swimming and baths. They can have a sponge bath or shower, but the dressing must stay dry at all times. If the dressing gets wet, it needs to be changed.</p><h2>Retention suture</h2><p>When the interventional radiologist inserts the tube into your child’s cecum, they will also place a small piece of medical wire attached to a thread (retention suture) to hold the cecum against the wall of the abdomen. Until the retention suture is ready to be cut, your child cannot get wet, and they cannot have a bath or go swimming. Instead, you can sponge bath your child.</p><h2>Key points</h2><ul><li>A cecostomy is an opening from the outside of the body on the abdomen to the cecum, the first part of the large intestine.</li><li>A cecostomy tube (C-tube) is placed in the opening to help your child empty their bowel.</li><li>After the first 24 hours post-insertion, the cecostomy tube dressing must be changed daily and the skin around the C-tube must be washed with soap and water.</li><li>Your child needs a dressing covering the cecostomy site for two weeks.</li><li>When the doctor inserts the tube into your child's cecum, they will also insert a small piece of medical wire attached to a thread (retention suture). You will have an appointment to have the retention suture removed.</li></ul><h2>How do you change your child’s dressing?</h2><p>You will need the following:</p><ul><li>a clean face cloth</li><li>warm water</li><li>soap</li><li>a clean cloth for drying the skin</li><li>two squares of gauze that are 2 inches by 2 inches</li><li>scissors</li><li>one piece of tape about 4 inches long</li><li>extra tape</li></ul><ol class="akh-steps"><li><p>Wash your hands.</p></li><li><p>Remove the old dressing around the C-tube. The retention suture bundle will be between the two pieces of gauze. Be careful not to pull the bundle when removing the dressing as it is attached to your child.<br></p></li><li><p>Look at the skin under the dressing for any signs of redness, swelling, liquid drainage, tissue growth or bleeding. A small amount of yellow-green liquid at the site is normal.</p></li><li><p>Wet half of the face cloth in clean warm water. Put soap on the wet part of the cloth and gently clean the skin around the C-tube. Starting at the insertion site, wash the skin in a circular motion, moving away from the tube.</p></li><li><p>Using the other half of the face cloth, rinse the skin well with clean warm water. Pat the skin dry with a clean cloth. It is important to make sure the skin area around the C-tube is dry before putting the new dressing on. Moist areas can lead to infection and tissue granulation.</p></li><li><p>If there is liquid leaking out from around the C-tube that makes the skin burn and feel itchy, then protect the skin with a zinc-based barrier cream. You can use creams such as Zincofax or Ihle’s paste.</p></li><li><p>Change the position of the tube by moving it clockwise around the insertion site. For example, if the tube is positioned at 12 o’clock on day 1, then move it to 3 o’clock on day 2, 6 o’clock on day 3 and 9 o’clock on day 4, etc. This helps to create a round hole. Use tape to hold the C-tube to the skin on your child’s stomach.</p></li><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/G_tube_dressing_application_01_MED_ILL_EN.jpg" alt="Cutting a y-shape into a square of gauze" /> </figure> <p>Cut the shape of a "Y" in one gauze piece. Leave the second gauze piece intact.<br></p></li><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/G_tube_dressing_application_02_MED_ILL_EN.jpg" alt="Placing gauze with y-cut around C-tube" /> </figure> <p>Place the gauze with the Y-cut on your child’s skin around the C-tube. Fit the gauze around the C-tube so that the tube and retention suture come through the opening.</p></li><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/G_tube_dressing_application_03_MED_ILL_EN.jpg" alt="Placing whole square of gauze over the first piece of gauze" /> </figure> <p>Put the second piece of gauze over the first piece of gauze.</p></li><li><p>Stick the gauze down with the 4-inch piece of tape.<br></p></li></ol><p>If you have any concerns about your child after they are discharged home, call the IGT clinic at (416) 813- 7654 ext. 201804 and speak to the clinic nurse during working hours or leave a non-urgent message with the IGT clinic nurse.</p><p>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) 813-7500 and ask them to page your referring doctor or the interventional radiology fellow on call.</p> https://assets.aboutkidshealth.ca/akhassets/G_tube_dressing_application_02_MED_ILL_EN.jpg
Cecostomy tube: Common problemsCCecostomy tube: Common problemsCecostomy tube: Common problemsEnglishOtherChild (0-12 years);Teen (13-18 years)Large Intestine/Colon;SkinLarge intestine;SkinNon-drug treatmentAdult (19+) CaregiversNA2018-02-08T05:00:00ZDalia Bozic BScN, MN, NP-PHC;Michelle Cote BScN RN;Prakash Muthusami, MD;Joao Amaral, MD7.3000000000000072.10000000000002005.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn about some of the problems your child may have if they have a cecostomy tube (C-tube). Problems can include the C-tube moving, falling out, getting blocked or causing skin problems.</p><p>A cecostomy is an opening from the outside of the body on the abdomen to the cecum, the first part of the large intestine. A cecostomy tube (C-tube) is placed through the abdomen into the cecum to help your child empty their bowel and decrease the incidence of fecal incontinence (soiling).</p><p>Learn about some common problems you may encounter while caring for your child and their cecostomy tube (C-tube) and how to deal with them.</p><p>Please see the <a href="/Article?contentid=3382&language=English">Cecostomy tube insertion using image guidance</a> and <a href="/Article?contentid=3384&language=English">Cecostomy tube: Changing your child's dressing</a> for more information.</p> <h2>Key points</h2><ul><li>A cecostomy is an opening from the outside of the body on the abdomen to the cecum, the first part of the large intestine.</li><li>A cecostomy tube (C-tube) is placed in the opening to help your child empty their bowel.</li><li>If your child's C-tube falls out, try to insert a Foley catheter to keep the hole to your child's intestine open.</li><li>If your child's C-tube gets blocked you can try to clear it using a 10 mL syringe and warm water.</li><li>A C-tube may cause skin problems such as redness and infection.</li><li>Warm salt water soaks can be used three to four times a day to help your child when they have a skin problem around the C-tube.<br></li></ul><h2>What to do if your child's C-tube moves</h2><p>If the tube looks longer or shorter, it may have moved. This can happen because the C-tube comes in three sizes (small, medium, long), and often children are in between sizes. If the tube is sitting high off the skin, you can push it back in. If there is resistance when you try to push it back in, there may be a coil in the tract. This is not an emergency, but your child should be assessed in the interventional radiology department.</p><h2>What to do if your child's C-tube falls out or gets pulled out</h2><p>If your child's C-tube falls out, try to insert a Foley catheter to keep the hole to your child's intestine open until a new C-tube can be put in. The first six weeks after your child first gets their C-tube is the most important time for healing. If your child's C-tube falls out within two weeks of when it was put in, you can try to insert a Foley catheter to stop the hole from closing. This is not an emergency, but the tube needs to be reinserted as soon as possible.</p><h2>Putting the Foley catheter in when your child's C-tube comes out</h2><p>In your supplies, you should have a soft tube called a Foley catheter. It will be one size smaller than your child's C-tube. Try to put the Foley catheter into the hole (opening) following the directions below. The sooner you try to put the Foley catheter into the hole the easier it will be. The longer the tube is out, the smaller the hole will become. If you cannot put the Foley catheter in, call the interventional radiology department during working hours. Go to the emergency department on holidays, weekends or at night.</p><p>You will need:</p><ul><li>lubricating jelly</li><li>8 French Foley catheter</li><li>tape</li><li>catheter plug with a protector cap</li></ul><ol><li>Wash your hands and the skin around your child's cecostomy gently but thoroughly with soap and water.</li><li>Wet the tip of the catheter with a lubricating jelly such as K-Y Jelly or Muko. DO NOT use petroleum jelly (Vaseline).</li><li>Put the tip of the Foley catheter about 2 or 3 inches (4 to 6 centimetres) into the hole in your child's abdomen where the C-tube was. Measure the tube against your index finger.</li><li>Tape the Foley catheter to your child's stomach. Plug it or bend it so stool will not leak out.</li><li>You can use the Foley catheter to give your child their bowel clean-out.</li><li>Call the interventional radiology department on the next working day to make an appointment for a C-tube reinsertion. This is done as an outpatient. Your child will not need to stay overnight in the hospital.</li></ol><h3>When to seek medical help</h3><p>Go to the emergency department if your child has any of the following problems after the Foley catheter is inserted:</p><ul><li>severe pain in the tummy</li><li>sudden high fever</li><li>diarrhea</li><li>severe abdominal distention</li></ul><h2>What to do if your child's temporary C-tube gets blocked </h2><p>To unblock your child's temporary C-tube, you will need:</p><ul><li>a 10 mL syringe</li><li>warm water</li></ul><ol><li>Fill a 10 mL syringe with warm water.</li><li>Connect the syringe to the end of the C-tube.</li><li>Push and pull on the plunger of the syringe to move the liquid in and out of the C-tube. That will help clear out any fecal material that might be in the way. You may have to try this a few times before the C-tube is no longer blocked.</li><li>When the C-tube is no longer blocked, fill the syringe with 10 mL of water and push it into the tube.</li><li>Take the syringe off the cecostomy tube and close it up.</li></ol><p>If you are not able to unblock the temporary C-tube, or your child's trapdoor is blocked you will need to have the tube replaced in the interventional radiology department on the next working day. Call the IGT clinic nurse to arrange this.</p><p>If you have any concerns about your child after they are discharged home, call the IGT clinic at (416) 813- 7654 ext. 201804 and speak to the IGT clinic nurse during working hours or leave a non-urgent message with the IGT clinic nurse.</p><p>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) 813-7500 and ask them to page your referring doctor or the Interventional Radiology fellow on call.</p>
Celiac diseaseCCeliac diseaseCeliac diseaseEnglishGastrointestinalBaby (1-12 months);Toddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)Small IntestineSmall intestineConditions and diseasesCaregivers Adult (19+)NA2017-02-06T05:00:00ZPeggy Marcon, MD, FRCPC;Inez Martincevic, MSc, RD;Catharine Walsh, MD, MEd, PhD, FAAP, FRCPC9.2000000000000055.80000000000001618.00000000000Health (A-Z) - ConditionsHealth A-Z<p>An overview of the causes, signs, treatment, and gluten-free diet tips for children diagnosed with this medical condition. </p><h2>What is celiac disease?</h2><p>In people with celiac disease, any contact with gluten (a family of food proteins) triggers a reaction from the body’s defense (immune) system. This immune response to gluten—no matter where in the body the contact happened—mainly results in damage to the gut (small intestine) lining. This is why celiac disease is called an autoimmune disease.</p><p>A healthy small intestine is lined with tiny finger-like projections (called villi) that stick up from the surface. Villi increase the area available to absorb nutrients from food. When children with celiac disease are exposed to gluten, the resulting immune reaction damages villi, which become flat. As a result:</p><ul><li>It becomes difficult to absorb nutrients. This is called malabsorption.</li><li>Lack of nutrients due to malabsorption may affect growth and development.</li><li>It also may cause digestive system (gastrointestinal) symptoms, such as <a href="/Article?contentid=7&language=English"> diarrhea</a> and stomach pain.</li></ul> <figure class="asset-c-100"> <span class="asset-image-title">Celiac disease: Villi damage</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_celiac_disease_EN.jpg" alt="Inside view of small intestine, comparing behaviours of nutrients in intestine with healthy villi to one with celiac disease" /> <figcaption class="asset-image-caption">With celiac disease, the finger-like projections (villi) found in the small intestine become damaged and flattened. This makes absorbing nutrients difficult.</figcaption> </figure> <h3>What is gluten?</h3><p>Gluten is the name of a family of proteins found in grains. Gliadin and glutenin are the two main gluten proteins.</p><p>Gluten is found in:</p><ul><li>all forms of wheat (including durum, semolina, spelt, kamut, einkorn and farro)<br></li><li>rye</li><li>barley</li><li>triticale (rye and barley mix).</li></ul><h2>Key points</h2> <ul> <li>Celiac disease is an autoimmune condition in which any contact with gluten (a family of food proteins) triggers a reaction from the body’s defense (immune) system.</li> <li>Gluten is found in rye, barley, triticale and all forms of wheat.</li> <li>In celiac disease, the lining of the small intestine is damaged by the immune system reaction. This means that it will be harder for your child’s body to get nutrients from foods.</li> <li>Common symptoms of celiac disease include diarrhea, constipation, tiredness, headaches and poor growth. Some people experience no symptoms at all.</li> <li>The only treatment for celiac disease is following a strict gluten-free diet for life. Never get your child to start a gluten-free diet before your doctor confirms the diagnosis.</li> </ul><h2>Signs and symptoms of celiac disease</h2><p>Some people with celiac disease may have no symptoms at all.</p><p>However, many people with celiac disease experience some symptoms. When a person with celiac disease is exposed to gluten, they may have trouble with their digestive system, malabsorption-related issues and other symptoms. Below are some common symptoms of celiac disease. Some people may only have one of these symptoms, while others may experience multiple symptoms.<br></p> <a href="https://assets.aboutkidshealth.ca/AKHAssets/Poster_celiac_symptoms_ENG.pdf"><figure class="asset-small"><img alt="Download celiac symptoms poster PDF" src="https://assets.aboutkidshealth.ca/akhassets/celiac_symptoms_PDFdownload.jpg" /> </figure> </a> <h3>Digestive system symptoms</h3><p>When a person with celiac disease is exposed to gluten, they may experience one or more of the following digestive system symptoms:</p><ul><li> <a href="/Article?contentid=822&language=English">excessive gas</a></li><li>diarrhea</li><li> <a href="/Article?contentid=6&language=English">constipation</a></li><li> <a href="/Article?contentid=823&language=English">irritable bowel</a> symptoms</li><li>stomach cramps and/or tummy pain</li><li>nausea</li><li> <a href="/Article?contentid=746&language=English">vomiting</a></li><li>bloating of the abdomen (tummy)</li><li>abdominal distension (expansion)</li><li>decrease in appetite</li><li>indigestion</li></ul><h3>Malabsorption-related symptoms</h3><p>They may also experience one or more symptoms that are not related to the digestive system but are due to nutrient malabsorption. These may include:</p><ul><li> <a href="/Article?contentid=841&language=English">anemia</a> (low blood haemoglobin from iron malabsorption)</li><li>fatigue</li><li>poor growth (being shorter than expected)</li><li>weight loss or poor weight gain</li><li>delayed puberty</li><li> <a href="/Article?contentid=1453&language=English">vitamin or mineral </a>deficiencies (e.g. <a href="/Article?contentid=1448&language=English">calcium</a>, <a href="/Article?contentid=1446&language=English">B12</a>, vitamins A, <a href="/Article?contentid=1447&language=English">D</a>, E and K)</li></ul><h3>Brain</h3><p>A person with celiac disease may experience one or more symptoms affecting their mental health including:</p><ul><li> <a href="/Article?contentid=29&language=English">headaches</a> or migraines</li><li>difficulty concentrating</li><li> <a href="/Article?contentid=19&language=English">depression</a></li><li> <a href="/Article?contentid=18&language=English">anxiety</a></li><li>mood swings and irritability</li></ul><h3>Skin</h3><p>People with celiac disease may also experience skin conditions including:</p><ul><li>skin rash (dermatitis herpetiformis)</li><li>brittle nails</li></ul><h3>Mouth</h3><p>Symptoms of celiac disease that affect the mouth include:</p><ul><li>mouth sores</li><li>tooth enamel defects</li></ul><h3>Reproductive</h3><p>Both males and females with celiac disease may experience issues related to reproduction including:</p><ul><li>infertility (difficulty conceiving children, in both men and women)</li><li>miscarriage</li><li>menstrual irregularities</li></ul><h3>Body</h3><p>Other celiac disease symptoms that could affect parts of the body include:</p><ul><li>osteopenia (mild) or <a href="/Article?contentid=948&language=English">osteoporosis </a> (more serious bone density problem)</li><li>joint pain</li><li>fatigue</li><li>liver and biliary tract disorders</li></ul><h2>Causes of celiac disease</h2> <p>Celiac disease affects about 350,000 Canadians (roughly 1 in 100). It occurs in people all over the world and at any age. People develop celiac disease because of a combination of a genetic susceptibility and environmental factors. If the two conditions are met, some people will develop the condition.</p> <p>People with a relative with celiac disease or who have certain genetic conditions (such as <a href="/Article?contentid=9&language=English">Down syndrome</a> or <a href="/Article?contentid=869&language=English">Turner syndrome</a>) are at higher risk of developing celiac disease.</p> <p>People who already have one autoimmune condition, such as <a href="/Article?contentid=1719&language=English">type 1 diabetes</a>, are at higher risk for developing other autoimmune conditions, such as celiac disease.</p><h2>How celiac disease is diagnosed</h2><h3>Blood tests</h3><p>Doctors can order blood tests to screen for celiac disease. These blood tests look for immune proteins (called auto-antibodies) that the body has made in response to gluten in people with celiac disease.</p><p>The possible blood tests include:</p><ul><li>Anti-tissue transglutaminase (TTG) antibodies</li><li>Anti-deamidated gliaden peptide (DGP) antibodies</li><li>Anti-endomysial antibodies (EMA)</li></ul><p>Your doctor does not need to order all of these blood tests to screen for celiac disease. </p><p>Depending on the results, your doctor or health-care provider will talk to you about further testing to confirm celiac disease. </p><h3>Upper endoscopy</h3><p>An <a href="/Article?contentid=2472&language=English">upper endoscopy</a> may help confirm the diagnosis. An upper endoscopy is a procedure that allows doctors to see the upper part of your child’s digestive system (from the mouth to the top part of the small intestine). Never start your child on a gluten-free diet before you know for sure whether an upper endoscopy is needed to confirm the diagnosis of celiac disease.</p> <figure class="asset-c-80"> <span class="asset-image-title">Upper endoscopy</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_endoscope_EN.jpg" alt="The esophagus, stomach and duodenum are identified with endoscope inserted through the mouth and esophagus into the stomach" /> <figcaption class="asset-image-caption">During an upper endoscopy, a thin flexible tube with a camera on the end is inserted into the mouth and down the esophagus to look at the esophagus, stomach, and duodenum (top part of the small intestine).</figcaption> </figure> <h3>Biopsy of the small intestine</h3><p>During an upper endoscopy, small pieces of tissue (biopsies) of the small intestine are taken; they will be examined under a microscope. If your child has celiac disease, the biopsy will show changes to villi in the sample from the small intestine.</p><p>Never start your child on a gluten-free diet without first getting a confirmed diagnosis of celiac disease. If a biopsy is done after your child starts a gluten-free diet, your child’s villi may look normal because they will have had a chance to heal since the immune response will have stopped. The biopsy may give a false negative result, which means that the result is negative even though your child has celiac disease.</p><p>Talk to your child’s doctor for more information about screening for celiac disease.</p><h2>Treatment of celiac disease</h2><p>Celiac disease is a life-long condition. There is no cure or medication for celiac disease. The only treatment is a strict gluten-free diet for life. The diet will help with the symptoms and will keep your child healthy.</p><p>Even if your child has no symptoms, once diagnosed your child must follow a strict gluten-free diet for life for treatment of the disease. </p><p>Your child must also limit skin contact with <a href="/Article?contentid=956&language=English">gluten-containing products</a>. Gluten-containing products can include food or non-food items (for example, hand cream). Contact with gluten can trigger skin reactions in some people with celiac disease. It is also possible for people with celiac disease to transfer gluten from their skin to their mouth and gut when they are in contact with gluten, which is not safe.</p><h3>Starting treatment: The gluten-free diet</h3><p>Once gluten is removed from your child’s diet, the small intestine will start to heal. Your child should start to feel better and symptoms should improve after about six months of being strictly gluten-free. </p><h3>Maintaining treatment: Sticking to a gluten-free diet</h3><p>Do not stop the gluten-free diet if your child’s symptoms improve. Your child is feeling better because the gluten-free diet is working. If you stop the gluten-free diet, the symptoms are going to come back and the villi will flatten. Even if your child has no symptoms, stopping the gluten-free diet will damage the villi and any previous symptom is going to return.</p><p>If your child’s symptoms of celiac disease do not improve after six months, contact your doctor.</p><p>These <a href="/Article?contentid=957&language=English">tips and resources</a> can help you and your child stick to a strict gluten-free diet.</p><h3>What happens without a gluten-free diet?</h3><p>Gluten is toxic to people with celiac disease because it triggers an immune reaction even if your child shows no symptoms.</p><p>If your child continues to be exposed to gluten, celiac disease may lead to future health problems including:</p><ul><li>low bone density (osteopenia or osteoporosis)</li><li>some small bowel cancers</li><li>other autoimmune diseases (for example thyroid problems)</li><li> <a href="/Article?contentid=1453&language=English">vitamins and mineral</a> deficiencies because of malabsorption</li><li> <a href="/Article?contentid=2499&language=English">premature delivery</a> if pregnant</li></ul><p>If your child follows a strict gluten-free diet, their chances of getting these conditions become the same as the general healthy population.</p><h2>When to see a doctor</h2> <p>See your child’s doctor if:</p> <ul> <li>your child’s symptoms remain after more than six months of following a strict gluten-free diet</li> <li>your child’s symptoms worsen</li> </ul> <p>Your child’s doctor may refer you to a dietitian. A dietitian can give you more advice about celiac disease, how to plan a gluten-free diet, and how to get a balance of nutrients while following a gluten-free diet.</p>https://assets.aboutkidshealth.ca/akhassets/IMD_celiac_disease_EN.jpg

Thank you to our sponsors

AboutKidsHealth is proud to partner with the following sponsors as they support our mission to improve the health and wellbeing of children in Canada and around the world by making accessible health care information available via the internet.