DMSA renal scanDDMSA renal scanDMSA renal scanEnglishOtherChild (0-12 years);Teen (13-18 years)KidneysKidneysTestsCaregivers Adult (19+)NA2013-12-06T05:00:00Z6.3000000000000076.1000000000000705.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn how a DMSA renal scan is done and how it shows how the kidneys work. </p><h2>What is a DMSA renal scan?</h2><p>A DMSA renal scan is a test to look at your child's kidneys and how they work. DMSA is the short name for the small amount of radioactive medicine that is used for this test.</p> <figure class="asset-c-80"><img alt="Left and right kidneys in a DMSA renal scan" src="https://assets.aboutkidshealth.ca/AKHAssets/PMD_DMSA_renal_scan_EN.jpg" /></figure><h2>Key points</h2> <ul> <li>A DMSA renal scan is a test to look at how the kidneys are working. It takes three to four hours in total.</li> <li>Your child will first be injected with a very small amount of radioactive medicine, which will mix with their blood and go to their kidneys. After two to three hours, they will have the scan.</li> <li>A nuclear medicine doctor will send the results of the scan to your family doctor or paediatrician (child's doctor) within two working days. The person who does the scan cannot give the results.</li> </ul><h2>How long does the DMSA renal scan take?</h2> <p>The DMSA renal scan takes three to four hours in total. This includes the time to inject your child, waiting time after the injection, and about an hour for the scan itself. Please add half an hour to the total time if your child has a topical anaesthetic first.</p><h2>Will I be able to stay with my child during the scan?</h2><p>One parent or guardian may stay in the room during the scan, but no other children are allowed.</p><h2>How is the scan done?</h2> <figure> <span class="asset-image-title">Kidney location</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Kidneys_location_male_MED_ILL_EN.jpg" alt="Location of ribcage, kidney and spine in a boy" /> <figcaption class="asset-image-caption">Most people have two kidneys, one on each side of the spine. They are found just under the rib cage towards the back of the body.</figcaption> </figure> <p>The scan is done by a nuclear medicine technologist. It has two parts.</p><ol><li>Your child will be given a small needle (injection) into a vein in their arm or the back of their hand.<br></li><li>The technologist will do a scan to take pictures of your child's kidneys.</li></ol><h3>Injection</h3><p>The injection contains a very small amount of radioactive medicine. This mixes with your child's blood and will go to their kidneys. It takes two or three hours for enough medicine to collect in the kidneys before the pictures are taken.</p><p>Note: The injection before the scan is not painful, but your child's hand or arm can still be numbed first with a topical anaesthetic (a special cream or cooling spray). If you would like this option, it is best to arrive at least 30 minutes before your appointment to allow the anaesthetic to take effect.</p><h3>Scan</h3><p>Your child will lie down on a narrow table and a safety belt will go across their stomach to keep them safely in place. They can usually watch a movie while the scan is being done.</p><h2>Must my child stay in the hospital between the injection and the DMSA scan?</h2><p>Your child can leave the hospital after the injection, but they must return for the scan at the time given by the technologist.</p><h2>Does my child need to do anything special to prepare for the scan?</h2> <p>No, your child can eat and drink as usual.</p> <p>Some children need a blood or urine test before the scan. Your doctor's office will tell you if your child needs one.</p><h2>At SickKids</h2> <p>If your child needs a blood test before the DMSA scan, it can be done in the Ambulatory Centre on the main floor near Shoppers Drug Mart. Please arrive at the hospital early to allow enough time for the test and be on time for the DMSA renal scan.</p> <p>If you have any questions or concerns about the scan or if you need to change your appointment, please call the Nuclear Medicine Department at 416-813-6065.</p>https://assets.aboutkidshealth.ca/akhassets/Kidneys_location_male_MED_ILL_EN.jpgMain
Daily care after a blood and marrow transplantDDaily care after a blood and marrow transplantDaily care after a blood and marrow transplantEnglishHaematology;Immunology;OncologyChild (0-12 years);Teen (13-18 years)BodyImmune systemNAAdult (19+)NA2010-01-06T05:00:00Z7.3000000000000066.5000000000000343.000000000000Flat ContentHealth A-Z<p>Learn about your child's daily routine in the hospital after a blood and marrow transplant.</p><p>After your child's blood and marrow transplant (BMT), the health care team will perform a number of daily procedures to make sure your child stays as healthy as possible. You may want to help your child with some of these procedures as well.</p><h2>Key points</h2><ul><li>Your child will require special care after the BMT including bathing with an anti-bacterial soap and maintaining good mouth care.</li></ul>Main
Dark circles under the eyesDDark circles under the eyesDark circles under the eyesEnglishDermatologyChild (0-12 years)EyesSkinConditions and diseasesCaregivers Adult (19+)NA2010-09-30T04:00:00Z6.8000000000000066.4000000000000237.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn what causes dark circles under your child's eyes.</p><p>While adults usually have dark under-eye circles, children sometimes get this condition. It does not mean your child has poor health or bad sleeping habits. </p><h2>Key points</h2> <ul> <li>Dark under-eye circles may not reflect poor health or bad sleeping habits.</li> <li>Sometimes, allergies cause dark circles. Other causes include chronic sinus infections or heredity.</li> <li>In general, your child's dark circles will not need medical attention.</li> <li>You can help your child by removing allergens from the home or treating sinus infections </li> </ul><h2>Causes of dark circles under the eyes</h2> <p>Sometimes called "allergic shiners", dark under-eye circles are usually caused by allergies. When the nose is blocked, blood might not be able to flow through. This expands and darkens the veins that drain from the eyes to the nose. </p> <p><a href="/Article?contentid=778&language=English">Congestion</a> can also cause blood to sit in the area under the eyes. </p> <p>Often, doctors cannot find a cause for your child's under-eye circles.</p> <p>Other causes may include:</p> <ul> <li>chronic sinus infections</li> <li><a href="/Article?contentid=831&language=English">enlarged adenoids</a>, causing nose blockage</li> <li><a href="/Article?contentid=773&language=English">eczema</a></li> <li>heredity: dark under-eye circles can run in families</li> <li>uneven pigmentation, especially in children of African and Asian descent</li> </ul><h2>Treatment for dark circles under the eyes</h2> <p>Most of the time, your child's dark circles will not need medical attention. The goal is to relieve your child's <a href="/Article?contentid=804&language=English">allergies</a> or nasal congestion.</p> <p>If your child has allergies, try to remove the allergen from the home. </p>https://assets.aboutkidshealth.ca/AKHAssets/dark_circles_under_eyes.jpgMain
Dealing with bullyingDDealing with bullyingDealing with bullying-CANEnglishRheumatology;AdolescentPre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years)NANANAPre-teen (9-12 years) Teen (13-15 years) Late Teen (16-18 years)NA2017-01-31T05:00:00Z000Flat ContentHealth A-Z<p>Bullying is repeated, aggressive behaviour towards one person from another person or a group of other people. Bullying is hurtful. It can occur in many different forms. Bullies can hurt someone physically, verbally, socially (through exclusion or spreading rumours) or electronically (see cyber bullying below).</p>https://assets.aboutkidshealth.ca/AKHAssets/dealing_with_bullying_JIA_US.jpgTeens
Dealing with teasing and bullying after a transplantDDealing with teasing and bullying after a transplantDealing with teasing and bullying after a transplantEnglishTransplant;NephrologyTeen (13-18 years)KidneysRenal system/Urinary systemProcedures;Conditions and diseasesTeen (13-18 years)NA2017-11-30T05:00:00Z000Flat ContentHealth A-ZTeens
Deceased donor kidney transplant: Tests when you arrive at the hospitalDDeceased donor kidney transplant: Tests when you arrive at the hospitalDeceased donor kidney transplant: Tests when you arrive at the hospitalEnglishTransplant;NephrologyTeen (13-18 years)KidneysRenal system/Urinary systemProcedures;Conditions and diseasesTeen (13-18 years)NA2017-11-30T05:00:00Z000Flat ContentHealth A-Z<p>You already learned that you could be <a href="/Article?contentid=2686&language=English">called in for your transplant</a> at any time of the day or night.</p>Teens
Deceased donor liver transplant: Tests when you arrive at the hospitalDDeceased donor liver transplant: Tests when you arrive at the hospitalDeceased donor liver transplant: Tests when you arrive at the hospitalEnglishTransplant;GastrointestinalTeen (13-18 years)LiverDigestive systemProcedures;Conditions and diseasesTeen (13-18 years)NA2017-11-30T05:00:00Z000Flat ContentHealth A-ZTeens
Deciding about a blood and marrow transplantDDeciding about a blood and marrow transplantDeciding about a blood and marrow transplantEnglishHaematology;Immunology;OncologyChild (0-12 years);Teen (13-18 years)BodyImmune systemNAAdult (19+)NA2010-02-12T05:00:00Z7.8000000000000067.8000000000000329.000000000000Flat ContentHealth A-Z<p>Deciding about a blood and marrow transplant (BMT) is a difficult decision to make. Parents can learn some tips that may help.</p><p>Deciding whether your child should go through a transplant is a challenging decision for many families. A blood and marrow transplant (BMT) is a long and intense process that will be both physically and emotionally demanding. You will need to consider many life-altering circumstances such as leaving home, caring for other children, and taking time off work. At the same time, you will look at the various challenges involved with choosing BMT. You may feel frustrated about having to balance several difficult options.</p><h2>Key points</h2> <ul><li>When considering a BMT for your child, it is important to ask lots of questions until you understand and can make an informed decision.</li> <li>Talk to parents of children who have been through the same procedure, and involve your child in the process if you can.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/deciding_about_a_blood_and_marrow_transplant.jpgMain
Deciding about epilepsy surgery: Points to considerDDeciding about epilepsy surgery: Points to considerDeciding about epilepsy surgery: Points to considerEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemProceduresCaregivers Adult (19+) EducatorsNA2010-02-04T05:00:00Z10.300000000000049.10000000000001256.00000000000Flat ContentHealth A-Z<p>Learn some important things to keep in mind when making a decision about epilepsy surgery, such as surgery goals, risks and possible complications.<br></p><p>If the results of the pre-surgical evaluation suggest that your child will benefit from <a href="https://akhpub.aboutkidshealth.ca/article?contentid=2091&language=English">epilepsy surgery</a>, the medical and surgical team will create a surgical plan and discuss it with you. If they are old enough, your child should be involved in the discussion as well. This discussion will include: </p> <ul> <li>the likelihood of your child becoming seizure-free after the surgery</li> <li>the risk that your child will develop new problems from the surgery, such as weakness, language or memory problems, or seizures that are worse.<br></li> </ul> <p>Before deciding on surgery, you and your child should think it over carefully. You will need to consider the possible improvements from the surgery, the risks of surgery, the risks if your child does not have the surgery, and any alternative treatments. </p><h2>Key points</h2> <ul><li>Surgery may result in complete seizure control or <q>partial</q> seizure control with less need for medication.</li> <li>The risks of surgery can include infection, bleeding and fluid build-up, problems with memory, speech or movement and surgery failure. </li> <li>The benefits of surgery include a reduced risk of brain damage and neurological impairment from seizure activity and reduced need for medications to control seizures.</li></ul>Main
Deciding whether to have scoliosis surgeryDDeciding whether to have scoliosis surgeryDeciding whether to have scoliosis surgeryEnglishOrthopaedics/MusculoskeletalChild (0-12 years);Teen (13-18 years)Vertebrae;SpineMuscular system;Skeletal systemConditions and diseasesTeen (13-18 years)NA2008-06-01T04:00:00Z5.0000000000000077.0000000000000798.000000000000Flat ContentHealth A-Z<p>The Ottawa personal decision guide is a useful decision-making tool, which can be used when deciding whether or not to have scoliosis surgery.</p><h2>The Ottawa personal decision guide: For people facing tough health decisions*</h2> <p>*Decisional Conflict Scale; 2006 O'Connor<br>*Ottawa Personal Decision Guide; 2006 O'Connor, Jacobsen, Stacey, University of Ottawa Health Research Institute, Canada </p> <p>This guide was developed to help people who are making any health-related decision, such as whether or not to have scoliosis surgery. If you are a teen, work through the guide and talk to your parents about what you discover. If you are a parent, help your teen to work through the guide.</p><h2>Key points</h2><ul><li>This guide aims to help people make health-related decisions through four steps: clarify the decision, identify your decision-making needs, explore your needs and plan the next steps.</li><li>You should work through the guide and talk to your parents about your responses. Your parents can also help you answer the questions.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/deciding_whether_to_have_scoliosis_surgery.jpgTeens
Decision making in the NICUDDecision making in the NICUDecision making in the NICUEnglishNeonatologyPremature;Newborn (0-28 days);Baby (1-12 months)NANANAPrenatal Adult (19+)NA2009-10-31T04:00:00Z11.600000000000048.50000000000001184.00000000000Flat ContentHealth A-Z<p>Learn about difficult decisions that parents of babies in the NICU must make. To make matters worse, these decisions often must be made quickly.</p><p>Parents of babies in the NICU may have to make difficult decisions for their child's treatment. These decisions often must be made quickly. Parents may have a limited understanding of the total situation and are often under emotional, financial, and physical duress. Although in many ways final decisions are ultimately left to the parents, decisions and recommendations are based on information that come from medical staff. Understanding why medical staff might hold certain beliefs and make certain recommendations is important for parents when making decisions. </p><h2>Key points</h2> <ul><li>Parents of babies in the NICU may have to make difficult decisions about their baby's treatment, based on recommendations and information that come from the health-care team.</li> <li>Parents should try to become as informed and knowledgeable about their baby's situation as possible so that they have a better understanding when it comes to decision making.</li> <li>The challenge is to consider what is in the baby’s best interest and to get an understanding of what the long-term implications are for the baby, the parents, and the rest of the family, without having feelings of guilt for making a certain decision.</li></ul>https://assets.aboutkidshealth.ca/akhassets/parents-baby-incubator-BRAN_EN.jpgMain
Decision-making in pregnancyDDecision-making in pregnancyDecision-making in pregnancyEnglishPregnancyAdult (19+)BodyReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00Z10.000000000000048.6000000000000361.000000000000Flat ContentHealth A-Z<p>Learn about handling decisions during pregnancy. Calm, clear decision-making and various expert opinions will ensure the best outcome.</p><p>Pregnancy usually proceeds along smoothly and without complications. However, if complications arise during your pregnancy, your health-care provider may need to discuss diagnostic and treatment options with you. If you have been seeing a midwife or family physician, they may need to refer you to an obstetrician to take over your prenatal care.</p><h2>Key points</h2> <ul><li>You have the right to complete information about every possible approach, even if they are experimental.</li> <li>The final decision about diagnostic procedures and treatment is up to you, including the right to refuse procedures or treatment and seek a second opinion.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/decision_making_in_pregnancy.jpgMain
Deep brain stimulationDDeep brain stimulationDeep brain stimulationEnglishNeurologyChild (0-12 years)Head;BrainNervous systemProceduresAdult (19+) CaregiversNA2021-08-16T04:00:00Z9.1000000000000058.7000000000000Health (A-Z) - ProcedureHealth A-Z<p>Deep brain stimulation (DBS) is a treatment which involves surgery to insert electrodes into a specific target in the brain. It is used to treat movement disorders and some types of epilepsy. Learn more about the surgery, how DBS works and how to care for your child after surgery.</p><h2>What is deep brain stimulation? </h2><p>Deep brain stimulation (DBS) is a treatment option for certain conditions that involves surgery to place electrodes within a specific area of the brain. The electrodes are then used to deliver an electrical current to relieve neurological symptoms associated with conditions such as epilepsy or movement disorders. </p><p>DBS is used to treat a condition when other treatments, such as medications or special diets, do not work to relieve symptoms or if the treatments produce unwanted side effects. In adults, DBS is most commonly used to treat Parkinson’s disease and tremor. In children, DBS has been most commonly used to treat dystonia, chorea and epilepsy. DBS is not a cure for any of these conditions but can be an effective treatment to relieve symptoms and improve quality of life.</p><h2>Key points</h2><ul><li>DBS is a treatment that can help some children who still experience difficult symptoms despite having tried other treatments for their condition.</li><li>Once activated, DBS provides a mild electrical current to stimulate an area deep in the brain. The stimulation changes the activity of brain cells in a way that can relieve specific symptoms.</li></ul><h2>Complications from deep brain stimulation surgery </h2><p>Although many precautions are taken before, during and after surgery to minimize the risk, infection of the DBS hardware is possible. Below is a list of symptoms that may indicate infection. If you notice any of these signs or symptoms, please contact your child’s neurosurgeon or nurse practitioner as soon as possible: </p><ul><li>Redness or swelling at the incision site that is getting worse </li><li>Leaking (for example with yellow or green-like pus) from the incision site </li><li>Bleeding from the incision </li><li>Pain at the incision site that does not go away </li><li>Fever (temperature over 38 °C or 100.4 °F) </li></ul><p>There may also be side effects after starting stimulation. At the first programming session, you will hear from your child’s neurology team about the specific side effects of stimulation at your child’s deep brain target. Some commonly seen side effects include visual changes, changes to the voice, muscle contractions and numbness. These side effects are reversible by changing or turning off the stimulation. </p><h2>When to call your child’s neurosurgery team</h2><p>Contact your child’s neurosurgery team as soon as possible if you notice the following:</p><ul><li>Signs of infection</li><li>Problems with the incision site </li><li>Skin breakdown or erosion over the stimulator site </li></ul><h2>When to go to the emergency department after surgery </h2><p>Go to your nearest emergency department if you notice the following:</p><ul><li>Any sudden, unexpected change in your child’s health </li><li>Signs of infection </li></ul><h2>How does deep brain stimulation work? </h2><p>Implantation of the DBS system is a surgical procedure which is done by a neurosurgeon while your child is under <a href="/article?contentid=1261&language=english">general anaesthesia</a>. The front of your child’s hair is shaved and an incision approximately 5 inches (12.7cm) long is made behind the hairline. The neurosurgeon then places thin wires into a specific target in the brain. These wires are then tunneled under the skin and connected to an internal pulse generator (IPG). The IPG is like a battery which is placed under the skin in the chest area similar to a pacemaker. </p> <figure class="asset-c-80"> <span class="asset-image-title">Parts of the DBS system</span> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Deep_brain_stimulation.jpg" alt="Illustration of child showing placement of electrodes, extension wire and battery with external remote" /> </figure> <p>The different parts of the DBS system are explained below.</p><p> <strong>Electrodes</strong></p><ul><li>Very thin wires are placed deep inside your child’s brain.</li><li>The tip of each electrode is positioned in the specific part of the brain that is the source of a particular symptom.</li><li>The target area of the brain will depend on the symptoms being treated.</li></ul><p> <strong>Extension wires</strong></p><ul><li>Wires are placed under the skin of the scalp, neck and chest. </li><li>These wires connect the electrodes to the internal pulse generator (IPG).</li></ul><p> <strong>Internal pulse generator (IPG) or neurostimulator </strong></p><ul><li>A battery device is implanted under the skin in the chest, near the collarbone. </li><li>This battery can be rechargeable or non rechargeable. </li></ul><p>After 4-6 weeks, when your child is home and recovered from the procedure, they will return to clinic to start the process of having the device programmed. This means adjusting the electrical impulses to the setting that best relieves the symptoms with as few side effects as possible.</p><h2>What are the target areas for deep brain stimulation to treat dystonia and chorea?</h2><p>The most common target for <a href="/article?contentid=856&language=english">dystonia</a> or chorea treatment is a deep area in the brain called the globus pallidus pars interna (GPI). GPI plays an important role in movement control and coordination. By delivering a gentle electric current to the GPI, DBS can decrease dystonic movements, including repetitive or twisting movements. </p><p>Through a careful process the DBS system will be programmed to help your child have the most benefit from stimulation and minimize unwanted side effects. The potential side effects that can be seen with stimulation of GPI include problems with speaking, swallowing and walking. All these symptoms are reversible with adjusting the stimulation settings. </p><h2>What are the target areas for deep brain stimulation to treat epilepsy? </h2><p>The most common target for <a href="/article?contentid=845&language=english&hub=epilepsy">epilepsy</a> treatment is a deep structure in the brain called the thalamus. The thalamus is important in motor and sensory functions. The DBS team might choose different areas within the thalamus to control your child’s seizures (such as centromedian nucleus or anterior nucleus). This decision depends on the type of epilepsy that your child has. </p><p>The main side effects that can be seen from stimulation of the thalamus include depression and problems with memory. All of these symptoms are reversible with adjusting the stimulation settings.</p><p>Other targets for specific conditions such as repetitive self-harm are being researched at the Hospital for Sick Children.</p><h2>What happens on the day of the surgery? </h2><h3>Before surgery </h3><p>After you arrive at the hospital and check in, the nurses will help your child get ready for surgery. They will check your child’s blood pressure, pulse and temperature and will provide hospital clothing. You will meet the anaesthesiologist and surgical team. </p><h3>During surgery </h3><p>The procedure to implant a DBS system involves multiple steps, all of which will take place on the same day while your child is under anaesthesia. When everything is ready, your child will be taken to the operating room. The anaesthesiologist will provide medications to relax your child and begin the general anaesthesia. A breathing tube will also be inserted.</p><p>A frame will the be applied to your child's head. This frame is like a ruler which helps the surgical team measure the most accurate possible placement of the DBS electrodes. Your child will be asleep through this process and will not experience any pain. They will then undergo a head <a href="/article?contentid=1272&language=english">computed tomography (CT)</a> scan. After the CT scan, your child will be brought back to the operating room. </p><h3>Placing the electrodes</h3><p>The neurosurgeon will: </p><ul><li>Wash the head with a special soap that kills germs and shave a small amount of hair.</li><li>Make an incision (cut) on to the top of the head and two small round openings in the skull (about the size of a nickel). </li><li>Insert each electrode into the brain using image guidance to ensure that the tip is in the proper target area. </li><li>Stimulate the electrodes and measure how your child’s brain cells react. </li><li>Use plastic caps to close the holes and make sure the electrodes stay in place. The incision is closed with dissolvable sutures.</li><li>Remove the frame from the head.</li></ul><h3>Placing the extension wires and IPG </h3><p>Once the electrodes have been placed in the brain, the neurosurgeon will: </p><ul><li>Connect the electrodes in the head to extension wires that will then be tunnelled under your child’s skin, from the top of the head, behind the ear, down the neck to the chest.</li><li>Connect the extension wire to the IPG unit. </li><li>Implant the IPG under the skin below the collarbone. The IPG will remain turned off. </li><li>Close the incision in your child’s chest with dissolvable sutures. </li></ul><h3>MRI to check electrode placement</h3><p>Your child will have an MRI immediately after the IPG placement to confirm the location of the electrodes and to make sure there were no unexpected complications. This will be under the same general anaesthesia. After the MRI is complete, your child will return to the operating room where they will be woken up from anaesthesia and the breathing tube will be removed. </p><h2>After DBS surgery </h2><p>When the surgery is finished, your child will go the Post Anesthetic Care Unit (PACU) for 1 to 3 hours to recover. The nurses will monitor your child in the PACU and treat any immediate pain.</p><p>Your child’s neurosurgeon will meet you and discuss the surgery. </p><p>When you see your child, there will be a bandage covering the incision on their head and another bandage over the IPG site. </p><p>When your child is ready, they will be brought to the neurosurgery unit. The health-care team will continue to check your child’s condition and progress. In the evening, once they are feeling up to it, your child can start to drink and eat.</p><p>In the days following surgery your child may have symptoms such as pain or nausea which can be managed with medications if needed. </p><p>Your child will be given a course of antibiotics to decrease the risk of infection. This will be given by IV at first and then will be continued by mouth or feeding tube after discharge home.</p><h2>Going home after DBS surgery</h2><p>Your child can expect to go home 3 to 5 days after surgery once they are feeling well enough. Before you leave the hospital, the health-care team will tell you:</p><ul><li>how to take care of your child’s incisions </li><li>when the DBS system will be turned on</li><li>about future follow-up appointments</li></ul><h2>Recovering at home </h2><p>At home, your child’s medications will stay the same as they were at the hospital until their DBS system is turned on. </p><p>In the weeks following surgery, your child may feel a temporary improvement in their symptoms, even though the DBS system is not yet turned on. This is due to swelling caused by the electrodes. As the swelling goes away, their symptoms will likely return to their baseline (the same as before surgery).</p><p>To maximize recovery and minimize the chance of complications, it is important that your child avoid certain activities such as sports and roller coasters for a few months after surgery. It is also important to avoid swimming or submerging the incisions under water for several weeks. Your child’s health-care team will help you decide when it may be safe to resume some of these activities. </p><h2>Always carry your child’s DBS Registration Card </h2><p>Before you leave the hospital, your child will get a temporary registration card for their DBS system from the company that makes it. You will receive a permanent card in the mail that your child must always carry with them. </p><h2>Tell all your child’s health-care providers that they have a DBS system </h2><p>All your child’s health-care providers need to know that your child has a DBS system implanted in their body so they can take steps to keep your child safe. </p><p>Consider getting a MedicAlert bracelet for your child. In an emergency, the bracelet tells health-care professionals who do not know your child that your child has a DBS system. </p><h2>NEVER apply heat to your DBS system </h2><p>Do not put heat (i.e. a heating pack, heat source during surgery) on any part of your DBS system as this could damage it and harm your child. </p><p>Your child should not have diathermy treatments (heat therapy), which deliver energy to heat and heal tissues in your body. Some common surgeries may use this technique, so it is very important to notify the health-care team in advance that your child has a DBS system. </p><h2>Check with your child’s doctors before an MRI </h2><p>Whether it is safe to have an MRI of the brain or body depends on the type of DBS system your child has and the MRI services (in general, the DBS inserted at SickKids is compatible with brain MRI). Performing MRI images of other areas of your child’s body requires consultation with the DBS and MRI safety team and might not be possible. </p><h2>Check with your child’s doctor or the manufacturer of the device before having other medical procedures </h2><p>Most medical procedures (such as a CT scan, X-rays, most dental procedures) are safe for children with a DBS system, but some need extra precautions. Other procedures are not possible because they could cause serious harm or death.</p><h2>Deciding if deep brain stimulation is right for your child</h2><p>Every child and family are unique, and DBS may or may not be the best choice depending on your child’s needs and your family. Your child’s health-care team will help you make an individualized decision about whether DBS is a good option for your child. To gather the information needed to make this decision, your child will have screening assessment appointments to meet with the DBS team.</p><h2>Who is part of your child’s health-care team?</h2><h3>Neurologists </h3><p>The neurology team will perform a detailed neurologic exam at your child’s clinic visits. They will also monitor and adjust the stimulation settings after the surgery and teach you about how to manage the DBS remote. The neurologists will communicate with your child’s other physicians to help manage medications.</p><h3>Neurosurgeons </h3><p>The neurosurgery team will follow the recommendations from the whole team and perform the surgery if indicated. They will monitor your child’s incision after surgery. Your child’s neurosurgeon will change the IPG when appropriate. </p><h3>Nursing </h3><p>The nursing team is essential to the communication around your child’s health. A nurse practitioner may be your initial point of contact for coordinating tests, providing advice and supporting you and your child throughout the whole process.</p><h3>Psychology</h3><p>The psychology team may provide a detailed neuro-psychology assessment prior to the DBS surgery. They may also perform tests following surgery to assess if there are psychological effects from stimulation. </p><h3>Social worker</h3><p>You and your child may be referred to a <a href="/article?contentid=1168&language=english">social worker</a> to help you cope with emotional, financial and practical issues associated with illness, treatment or long stays at the hospital.</p><h2>What can I expect from my child’s first clinic visit? </h2><p>The initial visit is an opportunity for the health-care team to learn about your child and to begin the discussion about whether DBS may be helpful to manage their symptoms. During this visit a detailed medical history will be taken and physical examination will be performed. This first visit can be between 2-3 hours as many members of the team will meet with you and your child. </p><p>Videos may be taken to record and document parts of the assessment. These are stored on a private and secure internal hospital server and will help the team monitor progression and response to treatment over time. Once the initial evaluations have been completed you will have the opportunity to ask any questions that you may have about your child’s condition and about DBS.</p><h2>If surgery is recommended, what other assessments are needed? </h2><h3>MRI of the brain</h3><p>A <a href="/article?contentid=1270&language=english">magnetic resonance imaging (MRI)</a> appointment will be made if a recent MRI is not available. This MRI is necessary to help evaluate the brain structures and make the best decisions about treatment and electrode placement. <a href="/article?contentid=1260&language=english">Sedation</a> may be given to help your child lie still for the scans. If your child has a vagus nerve stimulator (VNS), it should be turned off for the MRI and turned back on afterwards. </p><h3>Neuropsychology assessment </h3><p>During this visit, the neuropsychiatrist will assess your child’s cognition and mental health and the risk of developing problems such as depression or anxiety after DBS surgery. The neuropsychologist will tell you if your child is at risk and may provide recommendations for how to prevent or manage these risks. </p><h3>Nursing assessment</h3><p>A nurse from the same-day admissions unit will meet with you and provide you with all the details about how to prepare for surgery and information about what to expect during your hospital stay.</p><h3>Pre-anaesthesia clinic </h3><p>You will be given an appointment to meet with anaesthesiologists to assess your child’s safety for general anaesthesia. Your child may have tests, such as <a href="/article?contentid=1646&language=english">blood tests</a>, an <a href="/article?contentid=1276&language=english">electrocardiogram (ECG)</a> and a <a href="/article?contentid=1647&language=english">chest X-ray</a>. Please bring a list of all the medicines taken by your child. </p><p>If your child is a patient at SickKids, please take a look at the following links:</p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=2423&language=English">Coming for surgery at SickKids</a></p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=856&language=English">Dystonia</a></p><p> <a href="https://www.aboutkidshealth.ca/epilepsy">Epilepsy</a></p><p>On the day of your child’s surgery, come to the Pre-Operative Care Unit (POCU) on the 2nd floor at 6:00am. Please bring: </p><ul><li>Your child’s Ontario Health Card (OHIP) </li><li>You may want to bring personal items, such as toys or blankets </li><li>Prepare for a day-long surgery </li></ul><p>Transition to adult care - At the age of 18, your child’s care will be transferred to Toronto Western Hospital. There will be a specialty neurology team that will continue care for the DBS programming. If there is a future need to replace the IPG battery, you will be connected to a neurosurgeon at Toronto Western Hospital who can perform the replacement. </p><p>If you have questions, please ask a member of your health-care team during your appointments or contact the clinic. </p><table class="akh-table"><thead><tr><th>Contact</th><th>Role</th><th>Phone/E-mail</th></tr></thead><tbody><tr><td>Neurologists</td><td><p>Dr. Alfonso Fasano</p><p>Dr. Carolina Gorodetsky</p></td><td><p><br></p></td></tr><tr><td>Neurosurgeons</td><td>Dr. George Ibrahim</td><td><p><br></p></td></tr><tr><td>DBS Nursing Team</td><td>Sara Breitbart, Nurse Practitioner</td><td>Sara.breitbart@sickkids.ca</td></tr><tr><td>Neurosurgery Clinic</td><td>For appointment changes and inquiries</td><td>416-813-5222</td></tr></tbody></table>Main
Deep vein thrombosisDDeep vein thrombosisDeep vein thrombosisEnglishHaematologyChild (0-12 years);Teen (13-18 years)NACardiovascular systemConditions and diseasesAdult (19+) CaregiversNA2017-09-25T04:00:00Z9.9000000000000056.30000000000002038.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn what blood clots are, how they form, how they are treated, and complications that can occur because of them.</p><h2>​​What is deep vein thrombosis (DVT)?</h2><p>Deep vein thrombosis (DVT) is caused by a blood clot (thrombus) that occurs in the deep venous system. Deep veins are located within the muscles and are very important as they transport the blood back to the heart with the assistance of both vein valves and muscle contractions. Valves are found throughout the veins, especially in the legs, and help push the blood from the periphery of the body through the veins toward the heart. Hence, valves prevent backward blood flow, away from the heart. DVT can occur in the deep veins of the legs or arms. The blood clot fills the interior of the vein, obstructing the blood flow and causing several complications.</p> <figure class="asset-c-80"> <span class="asset-image-title">Deep vein thrombosis (DVT)</span> <img src="https://assets.aboutkidshealth.ca/AKHAssets/deep_vein_thrombosis_DVT_EN.jpg" alt="Side-by-side of normal blood flow in vein and deep vein thrombosis" /> <figcaption>Normally, blood flows easily through the deep veins of the body with the help of both vein valves and muscle contractions. Although less common than in adults, a child might also get a blood clot in a deep vein. The blood clot (thrombus) can fill the inside of the vein obstructing blood flow. </figcaption> </figure><h2>Key points</h2><ul><li>Deep vein thrombosis (DVT) is caused by a blood clot that occurs in the deep venous system.</li><li>DVTs are rare in healthy children, but may occur more commonly in children that are hospitalized. Children at higher risk include those with central lines, have a family history of increased clotting, or have certain anatomic variants that affect their veins.</li><li>Signs and symptoms of DVT include swelling, pain, and changes in skin colour of the affected limb.</li><li>Diagnosis of DVT is usually confirmed with an imaging test such as an ultrasound.</li><li>Treatment for DVT includes waiting and watching to see what happens, medication, thrombolysis, or surgery.</li><li>Rarely, DVT can cause a pulmonary embolism or a stroke. The most common chronic complication of DVT is known as post-thrombotic syndrome.</li></ul><h2>Signs and symptoms of DVT</h2> <p>DVTs located in the arms or the legs can be accompanied by limb swelling, pain, and changes in the color of the skin (red or bluish color).</p><h2>Causes of DVT</h2><p>DVTs are less common in children than in adults. Until recently, there was very little information describing the risk factors for DVT in children. However, some of the following risk factors found in adults are thought to also affect children who have DVT. Recent work by international research groups is helping to clarify risk factors for the development of DVT in children. Children admitted to a pediatric hospital are at the highest risk for thrombosis, which is largely due to the use of catheters or to their underlying health problem. </p><h3>Blood vessel damage</h3><p>DVT can be seen in children that have a central venous line or catheter that is used to give medications inside the deep venous system. In most cases, micro damage to the vein caused by the line causes platelets and clotting factors to start a clot. Blood also flows more slowly around the line. As a result, blood cells stick to the clot causing it to grow. </p><h3>Anatomic variants and exercise-induced DVT</h3><p>Changes in the anatomy or arrangement of blood vessels or the muscles close to blood vessels can lead to DVT in teens and young adults. These changes may cause tight corners within the blood vessels, which slow down the blood flow. Some anatomic changes can cause trauma to blood vessels during repetitive and intense exercise, resulting in blood clots. </p><h3>Medical and genetic conditions</h3><p>Certain infectious conditions (such as <a href="/article?contentid=2311&language=English">osteomyelitis</a>) and inflammatory conditions (such as antiphosphospholipid syndrome) can also trigger the clotting system. These conditions provide a false signal similar to the one that happens when an injury occurs, therefore increasing the risk of clot in the deep veins. </p><p>Similarly, conditions such as vasculitis (inflammation of the blood vessels) and some medications, such as chemotherapy, can lead to DVT.</p><p>In addition to medical conditions or medications, blood clots may appear in children whose blood clotting system produces clots more easily than those of other children. For example, some children may inherit genes from one or both of their parents that can increase their risk for developing a blood clot. In some cases, there can be a significant family history of clots, which present themselves in the form of DVT, heart attacks (myocardial infarction), strokes, or clots in the lungs (pulmonary embolism), and multiple miscarriages from clots in the placenta.</p><h3>Age</h3><p>As a person ages, the walls of their veins become less elastic and more susceptible to venous problems. Similarly, the circulating clotting factors rise with age, making clotting more common in older adults than in neonates and children.</p><h3>Immobility</h3><p>If a person is immobile (confined to a bed, unable to walk or spending large parts of the day in a bed or chair), the skeletal-muscle pumps, which help blood in the deep veins to return to the heart, are at rest. This leads to a slow blood flow inside of the deep veins of both legs, increasing the risk of blood clots. </p><p>In adults, there is a small risk of thrombosis when being relatively immobile when travelling by plane, train, car, bus or boat. The risk for DVT while travelling is higher for people affected by one or more of the other risk factors listed.</p><h3>Obesity</h3><p>Obesity is associated with conditions that may increase the risk of DVT. </p><h3>Dehydration</h3><p>When the body is dehydrated, the blood has a tendency to thicken, which increases the risk for developing DVT. </p><h3>Hormone therapy</h3><p>Birth control pills, patches or rings that contain estrogen increase the risk of DVT, particularly during the first year of usage.</p> <h2>Diagnosis of DVT</h2><p>Blood clots are suspected when the obstruction of a vein results in problems. For example, a leg with a blood clot in the deep veins becomes swollen, red, and painful. To confirm this suspicion, blood clots are usually diagnosed with an <a href="/article?contentid=1290&language=English">ultrasound</a>. An ultrasound is a medical test that uses sound waves to obtain images of structures inside the body, such as blood flow through a vein. In some cases, other imaging tests may be required. For example, to diagnose a clot in the lungs, a tomography (a special type of X-ray of the lungs) or a ventilation-perfusion scan (which measures the air and blood supply to the lungs) might be required. </p><p>In addition, children usually undergo blood tests when a clot is suspected to make sure it would be safe to start treatment, if required.</p><p>The thrombosis team is responsible for diagnosis, initial management, and follow up. The team will also coordinate your child’s future follow up in the thrombosis clinic, where the blood clot will continue to be monitored over time.</p><h2>Treatment of DVT</h2><p>There are four different treatments that can be done when a child is diagnosed with DVT.</p><h3>Wait and watch</h3><p>In some cases, your child’s doctor may decide not to treat the clot right away. This could happen if the clot is old, or if your child’s doctor determines that the risk of treatment outweighs the benefit. In those situations, it is reasonable not to give medications to help with the clot and to monitor your child closely. Your child’s doctor may take new imaging scans to evaluate if the clot is growing in the absence of treatment.</p><h3>Anticoagulant drugs</h3><p>Anticoagulants (blood thinners) can be prescribed to treat DVT. This treatment helps stabilize the clot, preventing growth and new clot formation so the body can use its own natural mechanisms to break down the clot. </p><p>These drugs include the anticoagulants from the family named heparinoids (standard heparin, <a href="/article?contentid=253&language=English">tinzaparin</a>, dalteparin, reviparin, nadroparin and <a href="/article?contentid=129&language=English">enoxaparin</a>), ultralow heparin (fondaparinux), or the family named oral <a href="/article?contentid=1937&language=English">vitamin K</a> antagonists (OVKA; <a href="/article?contentid=265&language=English">warfarin​</a>, acenocumarol, phenprocoumon). Heparinoids are administered through the veins (standard heparin) or as injections through the skin (subcutaneous injections; tinzaparin, dalteparin, reviparin, nadroparin, enoxaparin). Fondaparinux is also administered subcutaneously, whereas OVKA are administered by mouth. In all cases, anticoagulation medications in children due to a DVT are usually given for three months. Exceptions may occur for very young children (newborns and infants; six week-duration may be considered), or for patients that have a long-lasting thrombosis risk factor (duration longer than three months).<br></p><h3>Thrombolysis<br></h3><p>Thrombolysis is the process by which the clot is broken down either mechanically, or with the aid of a “clot-busting” medication. This option is considered only when there is an extensive blood clot, or when there is loss of blood supply to an organ or limb because of the clot’s presence, causing a risk of organ or limb loss. </p><p>Thrombolysis can be given in the hospital as an infusion, where the patient will be closely monitored. Thrombolysis may also be performed by an interventional radiologist using image guidance. The interventional radiologist uses a catheter to break up the blood clot, and monitors the procedure with X-ray imaging.</p><h3>Surgery</h3><p>In rare cases, surgery will be performed to remove the blood clot. Surgery as a treatment is rare and usually only used in emergency situations.<br></p><h2>Complications of blood clots and DVT</h2><p>Fresh clots like to grow within the deep venous system. Occasionally, a smaller portion of the clot breaks off and is transported into different locations of the body, depending on where it originated. Sometimes, the fragmented blood clot travels all the way to the lungs. When this happens, it is called a pulmonary embolism. </p> <figure class="asset-c-80"> <span class="asset-image-title">Pulmonary embolism</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/pulmonary_embolism_EN_XL.jpg" alt="Piece of a blood clot breaking free in the leg, traveling through the vein and getting stuck in a blood vessel in the lung" /><figcaption>1) A small piece of a fresh blood clot in a vein can break free (embolus). 2) The embolus travels through the veins of the body to the heart and into the lung. 3) The embolus gets stuck in a blood vessel in the lung. This blocks blood flow to a part of the lung.</figcaption> </figure> <p>Very rarely, when a small hole in the heart is present, the blood flow of the right side of the heart may travel to the left side. This allows the blood clot to enter the left side of the heart, which provides blood to the brain. This increases the risk of a paradoxical embolism or stroke.</p><p>Other potential complications of clots are recurrence (when the clot comes back or there is a new clot somewhere else) and <a href="/Article?contentid=2884&language=English">post-thrombotic syndrome</a>. </p><p>It is highly unlikely that part of a blood clot left in the vessel after some time will travel to a new location in the body. After about six weeks, the clot starts to become “old” and calcifies, becoming part of the vessel. At this point the clot is considered to be stable and unlikely to cause further damage.</p><h2>At SickKids</h2><p>​​The thrombosis team at SickKids includes a nurse practitioner (NP), staff physicians, thrombosis fellows, and research staff.</p><p>If you are a SickKids patient, you will attend follow-up appointments in the thrombosis out-patient clinic, open Mondays, Wednesdays, and Fridays.</p><p>For SickKids patients, please see below for contact information in non-urgent and urgent situations:</p><ul><li>For non-urgent clinical matters, contact the Nurse Practitioner at: 416-813-8514</li> <li>For appointment clarification or rescheduling, contact the Thrombosis Clinic Coordinator at: 416-813-5453 extension 2</li><li>For after-hours clinical emergencies, contact the Thrombosis Fellow on-call at: 416-813-7500</li></ul><p>For more information on thrombosis, post-thrombotic syndrome and the management of these conditions, please visit the <a href="/thrombosis">Thrombosis Learning Hub</a>.<br></p>https://assets.aboutkidshealth.ca/AKHAssets/deep_vein_thrombosis_DVT_EN.jpgMain
DehydrationDDehydrationDehydrationEnglishNAChild (0-12 years);Teen (13-18 years)BodyNAConditions and diseasesCaregivers Adult (19+)NA2019-02-11T05:00:00Z8.7000000000000060.10000000000001370.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Dehydration occurs when the body does not have enough water to function properly. Learn how illness can cause dehydration and how it is treated. </p><h2>What is dehydration?</h2><p>Every day, we lose body fluids (water and other liquids) in our urine, stool, sweat and tears. We replace the lost fluids by eating and drinking. Normally, the body balances these processes carefully, so we replace as much water as we lose. Minerals in the body, such as sodium, <a href="/Article?contentid=220&language=English">potassium</a> and chloride, help to keep a healthy fluid balance.</p><p>Dehydration happens when more fluid leaves the body than enters it. This can happen when a child does not drink enough fluid or when they lose more body fluid than normal. When a child is sick, fluid is lost through <a href="/Article?contentid=746&language=English">vomiting</a>, <a href="/Article?contentid=7&language=English">diarrhea</a> and <a href="/Article?contentid=30&language=English">fever</a>. The imbalance of losing fluid without replacing it results in dehydration.</p><p>Dehydration can happen slowly or quickly, depending on how the fluid is lost and the age of the child. Younger children and babies are more likely to become dehydrated. This is because their bodies are smaller and they have smaller fluid reserves. Older children and teens can more easily handle minor fluid imbalances.​</p><h2>Key points</h2><ul><li>Babies and younger children are at greater risk of dehydration.</li><li>Early, appropriate treatment can prevent dehydration.</li><li>Children with mild dehydration can be managed at home.</li><li>Children with moderate to severe dehydration should be seen by a doctor.</li></ul><h2>Common signs and symptoms of dehydration</h2><p>Your child may show one or more of the following symptoms of dehydration:</p><ul><li>dry, cracked lips and a dry mouth</li><li>passes less urine than normal, no urine for eight to 12 hours, or dark-coloured urine</li><li>drowsiness or irritability</li><li>cold or dry skin</li><li>low energy levels, seeming very weak or limp</li><li>no tears when crying</li><li>sunken eyes or sunken soft spot (fontanelle) on baby's head</li></ul><h2>Causes of dehydration</h2><p>The most common causes of dehydration are:</p><ul><li>poor fluid intake during an illness</li><li>fluid losses from <a href="/Article?contentid=7&language=English">diarrhea</a> and/or <a href="/Article?contentid=746&language=English">vomiting</a>.<br></li></ul><p>Healthy children can vomit or have loose stools once in a while without becoming dehydrated. When a child is sick, dehydration can happen quickly and be very dangerous, especially for babies and young children. If children are vomiting, have diarrhea and are not able to drink, they can lose fluids quickly and become very sick.</p><h2>Measuring dehydration</h2><p>The Clinical Dehydration Scale is used by health-care professionals to determine the severity of dehydration. Parents and caregivers can use it at as well. Using this scale can help to guide you as to whether your child is getting better, staying the same or getting worse. A doctor may use more findings to assess dehydration, but this scale is a good place to start. If you have any concerns, see a doctor to get your child checked.</p><p>The chart assigns points for certain signs or symptoms you observe in your child. The higher the point total, the worse the dehydration.</p><h3>To calculate your child's dehydration status:</h3><ol><li>mark down your child's symptoms</li><li>for each symptom, find the point value in the chart</li><li>add up the points to get a score for your child's level of dehydration. </li></ol><p>For example, if your child has dry mucous membranes* (2 points), decreased tears (1 point), and a sweaty appearance (2 points), the total point value is 5 points. A score of 5 points means your child has moderate to severe dehydration. </p><h3>Clinical Dehydration Scale</h3><table class="akh-table"><thead><tr><th> </th><th>0</th><th>1</th><th>2</th></tr></thead><tbody><tr><td> <strong>General appearance</strong></td><td>Normal</td><td>Thirsty, restless, or lethargic but irritable when touched</td><td>Drowsy, limp, cold, sweaty</td></tr><tr><td> <strong>Eyes</strong></td><td>Normal</td><td>Slightly sunken</td><td>Very sunken</td></tr><tr><td> <strong>Mucous membranes*</strong></td><td>Moist</td><td>Sticky</td><td>Dry</td></tr><tr><td> <strong>Tears</strong></td><td>Present</td><td>Decreased</td><td>Absent</td></tr></tbody></table><p>*Mucous membranes include the moist lining of the mouth and the eyes.</p><p>Score of 0 = no dehydration</p><p>Score of 1 to 4 = some dehydration</p><p>Score of 5 to 8 = moderate to severe dehydration</p><p>(Goldman, 2008)</p><h2>Treatment of dehydration</h2><p>The treatment of dehydration is based on how dehydrated your child is. Over-the-counter medications to treat vomiting and diarrhea are not recommended for children.</p><h3>Moderate to severe dehydration (score of 5 to 8 on the Clinical Dehydration Scale)</h3><p>Take your child to see a doctor or go to the nearest hospital for assessment and treatment right away.</p><h3>Mild dehydration (score of 1 to 4 on the Clinical Dehydration Scale)</h3><p>Offer your child diluted apple juice, followed by their prefered drink or <a href="/Article?contentid=982&language=English">oral rehydration solutions</a> to replace the water and salts your child has lost. Oral rehydration solutions such as Pedialyte, Gastrolyte, Enfalyte or other brands contain a properly balanced amount of water, sugars and salts to help the body absorb the fluid.</p><p>Giving your child water on its own is not enough because water lacks sugars and salts, which are needed to treat dehydration.<br></p><p>Give your child 5 to 10 mL (1 to 2 teaspoons) every five minutes. Slowly increase this amount to reach the amount your child will tolerate. If your baby is breastfeeding, continue to breastfeed. If your baby refuses to breastfeed, see a doctor immediately. </p><h3>No dehydration (score of 0 on the Clinical Dehydration Scale)</h3><p>Continue to offer your child fluids and an age-appropriate diet. If your child has vomiting or diarrhea, give diluted apple juice, their preferred drink or oral rehydration solution for each diarrhea or vomiting episode. Give 60 – 120 mL (1/4 to ½ a cup) for toddlers and 120 mL (1/2 a cup) for older kids. Continue to offer your child small frequent feedings.</p><h2>Treatment after rehydration</h2><p>Once your child is better hydrated, the next step is to work toward getting them back to what they normally eat. This can usually happen about four to six hours after the last episode of vomiting. Offer your child the usual foods and drinks they enjoy.</p><p>You do not need to give your child a restrictive diet such as BRAT (bananas, rice, apple sauce, toast). However, avoid offering your child foods that have a high sugar content, fried or high-fat foods, and spicy foods until they have recovered. These foods can be more difficult to digest.</p><p>Do not dilute your child's formula or milk with water, oral rehydration solution or any other fluid.</p><p>If your child has ongoing diarrhea or vomiting, give diluted apple juice, your child's preferred drink or oral rehydration solution for each stool or vomiting episode. Give 60 – 120 mL (1/4 to 1/2 a cup) for toddlers and 120 mL (1/2 a cup) kids. You can also offer them the usual foods and drinks they enjoy. Even if there is diarrhea, it is usually better to continue offering nutritious foods your child's body needs to recover and to heal. </p><h2>When to see a doctor</h2><p>Go to the nearest Emergency Department or call 911 if:</p><ul><li>your child does not appear to be recovering or is becoming more dehydrated</li><li>there is blood in the diarrhea or vomit, or the vomit turns green in colour</li><li>your child has pain that you cannot manage easily or that is making them unable to take in enough fluids</li><li>your child refuses to take oral rehydration solution or preferred drink, even with a syringe</li><li>your child has persistent vomiting or diarrhea and is unable to drink enough fluids to keep up with the losses</li><li>your child does not make urine for more than 6 hours (if a baby) or 12 hours (if an infant)</li><li>your child is very sleepy or very irritable </li></ul>dehydrationhttps://assets.aboutkidshealth.ca/AKHAssets/dehydration.jpgMain
Delivery of twins and multiple babiesDDelivery of twins and multiple babiesDelivery of twins and multiple babiesEnglishPregnancyAdult (19+)Body;UterusReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00Z10.300000000000050.4000000000000441.000000000000Flat ContentHealth A-Z<p>Learn about the delivery of twins and multiple babies. Precautions, complications, and general considerations are provided.</p><p>Twins and multiple babies are associated with a higher risk of childbirth complications, as well as premature birth. About half of all twins deliver at 36 weeks or less. Half of triplets deliver before 32 weeks. Many mothers of twins and multiple babies go into premature labour spontaneously. Others may need to have premature labour induced because of fetal growth restriction, hypertension in the mother, or placental abruption, where the placenta pulls away from the walls of the uterus. </p><h2>Key points</h2> <ul><li>With multiple babies, precautions should be taken including giving birth in a hospital, a trained obstetric should remain with the mother, and an anaesthetist should be present in case a C-section is required.</li> <li>In very rare cases where the first twin was born prematurely, contractions can stop altogether and the second twin may be born days or weeks later.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/delivery_of_twins_multiple_babies.jpgMain
Dental care and JIADDental care and JIADental care and JIA-CANEnglishRheumatology;Adolescent;DentalPre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years)Teeth;MouthSkeletal systemNon-drug treatment;ProceduresPre-teen (9-12 years) Teen (13-15 years) Late Teen (16-18 years)NA2017-01-31T05:00:00Z000Flat ContentHealth A-Z<p>JIA can affect your neck or jaw, and this can affect your dental health. If you have difficulty moving your jaw or neck, it can make brushing and or flossing your teeth difficult. To help with this, your dentist may suggest different types of toothbrush handles, electric toothbrushes or floss holders to help maintain healthy teeth and gums. </p>https://assets.aboutkidshealth.ca/AKHAssets/dental_care_JIA_US.jpgTeens
Dental care for JIADDental care for JIADental care for JIAEnglishRheumatology;DentalChild (0-12 years);Teen (13-18 years)Teeth;MandibleSkeletal systemNon-drug treatmentAdult (19+)NA2017-01-31T05:00:00Z8.0000000000000066.9000000000000470.000000000000Flat ContentHealth A-Z<p>This page describes how arthritis can affect dental health. It also explains how your dental check-ups may change if you have arthritis. Your arthritis may also be an important consideration if you need to have dental surgery.</p><p>JIA can affect a child's neck or jaw, and this can affect their dental health. If a child has difficulty moving their jaw or neck, it can make brushing and or flossing their teeth difficult. To help with this, their dentist may suggest different types of toothbrush handles, electric toothbrushes, or floss holders to help maintain healthy teeth and gums.</p><h2>Key points</h2> <ul><li>JIA can cause pain in the temporomandibular joint, causing pain and stiffness in the jaw.</li> <li>Your child's dentist should be kept informed about the status of the JIA and medications your child is taking, since they can also affect oral health.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/dental_care_for_JIA.jpgMain
Dental check-up and cancer treatmentDDental check-up and cancer treatmentDental check-up and cancer treatmentEnglishOncologyPre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years)BodyNATestsPre-teen (9-12 years) Teen (13-15 years) Late Teen (16-18 years)NA2019-09-03T04:00:00Z7.9000000000000066.0000000000000158.000000000000Flat ContentHealth A-Z<p>It is important to visit the dentist for a check-up before beginning cancer treatment. Read on for information on the importance of a check-up and dental cleaning before treatment.</p><p>Before treatment starts (if there is time), it is important to visit the dentist for a check-up and to have your teeth cleaned. Check-ups are also important during treatment because some therapies or side-effects (such as vomiting) can damage your teeth. </p><h2>Key points</h2><ul><li>If there is time, you should see your dentist for a check-up and cleaning before starting cancer treatment.</li><li>Some cancer treatments and side effects may damage your teeth.</li><li>Your dentist will give you tips to help care for and protect your teeth during treatment.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/Dental_check-up_and_cancer.jpgTeens
Depression and depressive disordersDDepression and depressive disordersDepression and depressive disordersEnglishAdolescent;PsychiatryTeen (13-18 years)NANAConditions and diseasesTeen (13-18 years)NA2021-09-30T04:00:00Z9.5000000000000055.00000000000001192.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn about depression, its signs and symptoms, how it is diagnosed and ways to manage and treat it.</p><h2>What is depression?</h2><p>Everybody feels sad or ‘down’ from time to time. But when someone has depression, they feel a constant sadness and usually lose interest in activities they used to enjoy. These feelings can last weeks or months and stop you from going about your day-to-day routine.</p><h2>What is a depressive disorder?</h2><p>A depressive disorder is a more formal/clinical term for depression. We often use the term “depression” in society to casually describe when we are feeling glum, but depression is a clinically diagnosable mood disorder that can cause serious emotional and physical symptoms. If you suspect you have a depressive disorder, many treatment options are available to help improve how you feel.</p><h2>Key points</h2><ul><li>Sadness is a normal part of life, but if it prevents you from doing fun or important things or lasts weeks or months, it could be part of a depressive disorder.</li><li>Depressive disorders can sometimes occur with other disorders, most often anxiety disorders.</li><li>Talk to your parents and see a health-care provider if you are unable to attend school or take part in activities you used to look forward to.</li><li>Talk to your parents and go to your nearest Emergency Department if you are having thoughts of suicide and a plan of how you would do it.</li></ul><h2>What are the signs and symptoms of a depressive disorder?</h2><p>Each person can experience depression differently. That said, there are a number of typical symptoms. These include:<br></p><ul><li>general low mood or irritability (feeling “on edge”)</li><li>feeling that you are not good enough or not important</li><li>feeling hopeless about the future</li><li>thinking about hurting yourself, death or suicide</li><li>loss of interest in or avoiding activities you used to enjoy</li><li>low energy</li><li>difficulty concentrating</li><li>eating more or less than usual </li><li>sleeping less or more than usual</li><li>feeling slowed down</li><li>feeling tense and restless</li></ul><div class="symptoms-container" id="symp-depression"> <a href="#" class="symp-fullscreen"> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Signs%20and%20Symptoms/Depression/landing_screen_mobile.png" alt="Click anywhere to learn more" /></a> <a href="#" class="symp-close-full material-icons pull-right">close</a> <div class="instruction-container"><div class="thumbnail-col"> <span class="symp-title">EMOTIONAL</span></div><div class="thumbnail-col"><div class="symp-title"> <span class="symp-title">PHYSICAL</span> </div></div><div class="anim-instructions"> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Signs%20and%20Symptoms/Depression/speech_bubbles_depession.png" alt="Click on the icons to learn more or press the home button to return here" /> </div></div><div class="symptoms-info"> <span class="symp-title">EMOTIONAL SIGNS</span><button type="button" class="symp-close"><i aria-hidden="true" class="material-icons">home</i></button> <div class="info-card"><div class="desc"> <span class="card-title">Low mood and irritability</span> <p>Common feelings such as ongoing sadness, low self-worth or hopelessness can all contribute to a low mood. Feelings of frustration, with themselves or their situation, may cause more irritability.</p></div> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Signs%20and%20Symptoms/Depression/low-mood-and-irritability.png?RenditionID=10" alt="Low mood and irritability" /> </div><div class="info-card"> <span class="card-title">Difficulty concentrating</span> <p>If someone has many unwanted thoughts and feelings about themselves or their life, they may find it hard to concentrate on day-to-day tasks and remember details.</p> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Signs%20and%20Symptoms/Depression/difficulty-concentrating.png?RenditionID=10" alt="Difficulty concentrating" /> </div><div class="info-card"> <span class="card-title">Feeling helpless</span> <p>A person with depression may feel unable to control their thoughts and play an active role in their own life. They may also struggle with feelings of emptiness and have trouble making decisions.</p> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Signs%20and%20Symptoms/Depression/feeling-helpless.png?RenditionID=10" alt="Feeling helpless" /> </div><div class="info-card"> <span class="card-title">Avoiding enjoyable activities</span> <p>Someone with depression may lose interest in certain hobbies or activities. This can sometimes mean skipping activities that they would normally enjoy.</p> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Signs%20and%20Symptoms/Depression/avoiding-enjoyable-activities.png?RenditionID=10" alt="avoiding enjoyable activities" /> </div><div class="btn-container"> <button type="button" class="symp-prev"><i class="material-icons">chevron_left</i></button><button type="button" class="symp-next"><i class="material-icons">chevron_right</i></button> </div></div><div class="symptoms-info"> <span class="symp-title">PHYSICAL SIGNS</span><button type="button" class="symp-close"><i aria-hidden="true" class="material-icons">home</i></button> <div class="info-card"><div class="desc"> <span class="card-title">Low energy and changes in sleep</span> <p>Depression can make someone feel slowed down and lethargic and in need of more sleep than usual. Other times, it can make it harder for someone to fall asleep or stay asleep through the night.</p></div> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Signs%20and%20Symptoms/Depression/low-energy-and-changes-in-sleep.png?RenditionID=10" alt="Excessive worrying" /> </div><div class="info-card"> <span class="card-title">Changes in appetite</span> <p>Depressive feelings can lead someone to eat more than usual, for instance to have more energy or find comfort in food. On the opposite side, they can also cause someone to lose interest in food.</p> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Signs%20and%20Symptoms/Depression/changes-in-appetite.png?RenditionID=10" alt="Difficulty meeting new people" /> </div><div class="info-card"> <span class="card-title">Ongoing health concerns</span> <p>The sleep problems, low energy, ongoing stress and changes in appetite that are part of depression can make someone more prone to health concerns such as recurring headaches, and aches and pains.</p> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Signs%20and%20Symptoms/Depression/ongoing-health-concerns.png?RenditionID=10" alt="" /> </div><div class="info-card"> <span class="card-title">Feeling restless</span> <p>Stressful events can make someone with depression feel frequently “on edge”, as if they are consistently waiting for something bad to happen.</p> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Signs%20and%20Symptoms/Depression/feeling-restless.png?RenditionID=10" alt="Avoiding fun activities" /> </div><div class="btn-container"> <button type="button" class="symp-prev"><i class="material-icons">chevron_left</i></button><button type="button" class="symp-next"><i class="material-icons">chevron_right</i></button><br></div></div><h3 class="main-title">DEPRESSION <span class="symp-subtitle">Common Signs</span></h3></div> <br><h2>How common are depressive disorders?</h2><p>Many children and teens experience depressive disorders. In Canada, about 2 per cent of children under 12 and 8 per cent of teenagers are affected.</p><h2>What causes depressive disorders?</h2> There is no single cause for depressive disorders. They usually occur from a mix of genetics, psychological factors and stressful life events. <h3>Genetics</h3><p>A child or teen is at greater risk for developing a depressive disorder if a family member, especially a parent or sibling, has one. After puberty, depression appears more common in females than males.</p><h3>Psychological factors</h3><p>Another factor is how you respond to stress. Depression is more likely if you experience more negative emotions when you are stressed.</p><h3>Stressful life events</h3><p>It’s not unusual for a depressive disorder to emerge if you have been dealing with stressful events in your life. These might include living with a chronic condition, losing a parent or loved one, divorce, family poverty, neglect, abuse, bullying, school difficulties and problems with friends or other relationships.<br></p><h2>How is a depressive disorder diagnosed?</h2><p>There is no specific medical test to diagnose a depressive disorder. Instead, a physician, nurse practitioner or psychologist will meet you and your parents or caregivers to talk about your everyday life and how you are feeling.</p><p>The health-care provider will ask about your general health and typical routine, including your family life, and about any stressors that might be making life difficult. They will also ask about any concerns and symptoms that are preventing you from going about your day-to-day life, and about your family’s mental health history.</p><p>To help them make a clear diagnosis, your health-care provider might ask you to fill in specific questionnaires.</p><h2>How is a depressive disorder treated?</h2><p>There are many treatment options for depressive disorders.</p><p>To start, ask yourself if you are getting enough sleep, regularly eating healthy foods and doing regular physical activity. Good sleep habits, nutrition and exercise all help improve your mood.</p><p>Other ways to treat depressive disorders include therapy and medications.</p><h2>Therapy</h2><p>One common therapy is cognitive behavioural therapy (CBT). This is a type of talk therapy in which you work with a therapist to learn how your thoughts affect your feelings and behaviour. A CBT therapist can help you learn the signs of depression and how different ways of thinking might help you feel less sad or less on edge. CBT can also help you come up with ideas and approaches to return to the enjoyable activities that you might have stopped. Depending on your own situation, other therapies, such as family therapy, may also help.</p><h2>Medications</h2><p>If your symptoms are more severe, a doctor might suggest antidepressants. These don’t necessarily ‘cure’ depression, but they can reduce symptoms by targeting chemicals in the brain that affect your mood.</p><p>Different types of antidepressants are available. The most common ones are selective serotonin reuptake inhibitors (SSRIs). You and your doctor may need to try a couple of types of antidepressants to find the right one for you.</p><p>Your doctor will tell you if antidepressant medication might help you. It is important to follow your doctor’s instructions around the medication.</p><h2>When to see a health-care provider about depression</h2><p>It is important to see a health-care provider if your sadness and low mood stop you doing fun or important things, such as going to school, spending time with friends or doing extra-curricular activities.</p><h2>Resources</h2><h3>Kids Help Phone – <a href="https://kidshelpphone.ca/">kidshelpphone.ca</a></h3><p>Kids Help Phone is a 24/7 e-mental health service offering free, confidential support to young people.</p><p> <a href="https://kidshelpphone.ca/get-info/how-cope-thoughts-suicide/">How to cope with thoughts of suicide</a></p><p> <a href="https://kidshelpphone.ca/get-info/self-injury-positive-coping-strategies/">Self-injury: What it is and how to cope</a></p><p> <a href="https://kidshelpphone.ca/get-info/8-ways-foster-hope-your-daily-life/">8 ways to foster hope in your daily life</a></p><p> <a href="https://kidshelpphone.ca/get-info/letter-writing/">Need to share what’s on your mind? Try letter writing!</a></p> <h3>Centre for Addiction and Mental Health (CAMH) – <a href="http://www.camh.ca/">camh.ca</a></h3><p>CAMH is a mental health and addiction teaching and research hospital that provides a wide range of clinical care services for patients of all ages and families.</p><p> <a href="https://youtu.be/6xONySz9XLk">Mood Matters: Describing Depression</a></p><p> <a href="https://youtu.be/qMnQFTy3t30">Mood Matters: How Food, Movement & Sleep Can Have an Impact on You</a></p>Teens
Depression: OverviewDDepression: OverviewDepression: OverviewEnglishPsychiatryPreschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)NABrainConditions and diseasesCaregivers Adult (19+)NA2020-04-02T04:00:00Z9.5000000000000053.4000000000000692.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn how depression is different from sadness. Also learn about what causes depression, how common it is in children and teens, and what you can do to help your child.</p><h2>What is depression?</h2><p>Depression is an illness that involves a person feeling deep sadness or a lack of interest in activities that they previously enjoyed.</p><p>Every child and teen experiences sadness at some point in their life. Often this is a result of common stressors such as a big change, disappointment or the loss of a loved one.</p><p>Depression differs from this type of sadness because it:</p><ul><li>lasts longer (from weeks to months)</li><li>interferes with everyday functioning.</li></ul><p>Depression also affects a person’s <a href="/Article?contentid=645&language=English">sleep</a>, concentration and appetite and can also lead to feelings of guilt, hopelessness, worthlessness and, in severe cases, <a href="/Article?contentid=291&language=English">suicide</a>.</p><h2>Key points</h2> <ul> <li>Sadness in response to big changes or losses can be normal, but it can be a sign of depression if it lasts for weeks to months and begins to interfere with everyday activities.</li> <li>Depression has a number of risk factors, including a person's genetics, the way they respond to stress and their family or school environment.</li> <li>See your doctor if your child is no longer attending school or extra-curricular activities. Go to the nearest emergency department if your child is expressing thoughts of suicide with a plan.</li> <li>Depression can occur with a number of other disorders, most frequently anxiety disorders.</li> </ul> <h2>What causes depression?</h2><p>A number of risk factors contribute to depression.</p><h3>Biological factors</h3><p>Biological factors include our genes, as depression is more likely when there is a history of it in the family. After puberty, it is also more common in girls than boys.</p><h3>Psychological factors</h3><p>Psychological factors include how a person tends to respond to stress. Someone who experiences more negative emotions in response to a stressor is more likely to experience depression.</p><h3>Social factors</h3><p>Social factors include various stressors in a child’s or teen’s environment, such as the loss of a parent or caregiver, divorce, bullying, poverty, difficulties at school and abuse or neglect.</p><h2>How common is depression in children and teens?</h2><p>Currently, about 2 per cent of children and 8 per cent of teens in Canada experience depression.</p><p>Previous research suggested that people often experienced their first episode of depression in their mid-20s. However, more recent research suggests that most adults with depression actually experience their first symptoms of depression as children and teens.</p><h2>Does depression occur with other conditions?</h2><p>Depression commonly occurs with other conditions, especially <a href="/Article?contentid=270&language=English">anxiety disorders</a>. It can also occur with:</p><ul><li><a href="/Article?contentid=285&language=English">obsessive compulsive disorder (OCD)</a></li><li><a href="/Article?contentid=1927&language=English">post-traumatic stress disorder (PTSD)</a></li><li><a href="/Article?contentid=1922&language=English">attention deficit hyperactivity d​isorder (ADHD)</a></li><li>eating disorders such as <a href="/Article?contentid=268&language=English">anorexia</a>, <a href="/Article?contentid=282&language=English">bulimia</a> or <a href="/Article?contentid=277&language=English">binge eating disorder</a></li><li>substance use disorders</li><li><a href="/Article?contentid=1925&language=English">oppositional defiant disorder and conduct disorder​</a></li><li>learning disorders</li></ul><h2>When to see a doctor for your child’s depression</h2><p>See a doctor if:</p><ul><li>your child’s low mood or irritability prevents them from going to school, spending time with friends, playing sports, pursuing hobbies or doing other everyday activities</li><li>your child expresses thoughts of <a href="/Article?contentid=289&language=English">self-harm</a> or <a href="/Article?contentid=291&language=English">suicide</a></li><li>you have (or suspect you have) depression or another mental health condition and it is preventing you from offering enough help to your child on your own<br></li></ul><p>Your doctor can diagnose depression, if appropriate, based on <a href="/Article?contentid=284&language=English">typical signs and symptoms</a>.</p><p>If your child has voiced thoughts of suicide with a plan, <a href="/Article?contentid=292&language=English">protect your child</a> by going with them to your nearest emergency department.</p><h2>Further information</h2><p>For more information on depression, please see the following pages:</p><p> <a href="/Article?contentid=284&language=English">Depression: Signs and symptoms</a></p><p> <a href="/Article?contentid=707&language=English">Depression: Treatment with medications</a></p><p> <a href="/Article?contentid=708&language=English">Depression: Treatment with psychotherapy and lifestyle changes</a></p><p> <strong>Virtual care services for children:</strong></p><p>Boomerang Health was opened by SickKids to provide communities in Ontario with greater access to community-based services for children and adolescents. For more information on virtual care services in Ontario to support depression, visit <a href="http://www.boomeranghealth.com/services/child-psychology/">Boomerang Health</a> powered by SickKids.</p>https://assets.aboutkidshealth.ca/AKHAssets/depression_overview.jpgMain
Depression: Signs and symptomsDDepression: Signs and symptomsDepression: Signs and symptomsEnglishPsychiatrySchool age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)NANAConditions and diseasesCaregivers Adult (19+)NA2016-07-15T04:00:00Z9.4000000000000056.2000000000000632.000000000000Health (A-Z) - ConditionsHealth A-Z<p>​Discover the signs and symptoms of depression in children and teens.</p><h2>What are the main signs and symptoms of depression in children and teens?</h2> <p>The main signs and symptoms of depression fall into the following categories:</p><ul><li>emotional</li><li>cognitive (mental)</li><li>behavioural</li><li>physical</li></ul><h2>Key points</h2> <ul> <li>Depression has a number of emotional, physical, cognitive and behavioural symptoms. They need to be present for two weeks or longer in order for the diagnosis to be made.</li> <li>Your child's doctor will conduct an interview, and possibly have you and your child fill out rating scales in order to confirm the diagnosis.</li> <li>Your child's doctor might recommend that your child see another mental health professional for therapy or further evaluation, and may recommend medications or lifestyle changes.</li> </ul><h2>Symptoms of depression in children and teens?</h2><h3>Emotional symptoms</h3><p>If your child or teen is depressed, they will likely experience:</p><ul><li>a general low mood</li><li>irritability</li><li>feelings of guilt, hopelessness or worthlessness</li></ul><h3>Cognitive symptoms</h3><p>A child or teen who experiences depression may:</p><ul><li>have generally negative or distorted thoughts about themselves or their environment</li><li>think about <a href="/Article?contentid=289&language=English">self-harm​</a> or <a href="/Article?contentid=291&language=English">suicide</a></li> </ul><h3>Behavioural symptoms</h3><p>If a child or teen is depressed, they may change their behaviour or routine by:</p><ul><li>losing interest in or avoiding activities they previously enjoyed</li><li>avoiding school</li></ul><h3>Physical symptoms</h3><p>Depression can have a number of physical effects on a child or teen, including:</p><ul><li>low energy</li><li>trouble with concentration</li><li>decreased or increased appetite</li><li>sleeping less or more than usual</li><li>feeling physically slowed down</li><li>feeling tense and restless</li></ul><h2>How children experience depression</h2><p>Children may experience depression as an increase in irritability, for instance through more frequent temper tantrums and crying. They are also likely to start avoiding previously enjoyed activities.</p><p>Young children may not be able to express how they are thinking or feeling but may complain more often of vague physical complaints such as nausea or stomach aches. They might also experience a change in their appetite. Some children may voice thoughts of suicide or the wish to no longer be around.</p><h2>How teens experience depression</h2><p>The physical symptoms of depression are similar in teenagers and children. However, teens tend to have different cognitive and behavioural symptoms. For instance, teens with depression may express thoughts of <a href="/Article?contentid=291&language=English">suicide</a> more often than younger children. They may also become more withdrawn and choose to spend more time by themselves rather than attend school, spend time with friends or take part in extra-curricular activities (such as sports or hobbies). Some teens may also <a href="/Article?contentid=289&language=English">self-harm</a> as part of depression.</p><h2>How depression is diagnosed</h2> <p>Your child's doctor will speak to you and your child or teen and ask you both about:</p> <ul> <li>your concerns and symptoms that are interfering with your child's everyday routine</li> <li>any current stressors in your child's life</li> <li>any event that could have triggered your child's depressive symptoms</li> <li>your child's development (from pregnancy onwards)</li> <li>your family's mental health history</li> <li>general family functioning and any stressors that might contribute to your child's symptoms</li> </ul> <p>The doctor might ask you and your child, if they are old enough, to fill out rating scales to help them make a diagnosis. If the doctor identifies a number of signs and symptoms over a certain time (two weeks or longer), your child might meet the criteria for depression.</p><h2>What your child's doctor can do for depression</h2> <p>If your child is diagnosed with depression, you, your child and the doctor will decide together on the best treatment plan. This decision may need input from other members of your family or your child's teachers.</p> <p>Your doctor may also suggest that your child see a therapist or a <a href="/Article?contentid=708&language=English">psychiatrist and make lifestyle changes</a>. They may also recommend <a href="/Article?contentid=707&language=English">medications​</a>.</p><h2>Further information</h2><p>For more information on depression, please see the following pages:</p><p><a href="/Article?contentid=19&language=English">Depression: Overview</a></p><p><a href="/Article?contentid=707&language=English">Depression: Treatment with medications</a></p><p><a href="/Article?contentid=708&language=English">Depression: Treatment with psychotherapy and lifestyle changes</a></p>https://assets.aboutkidshealth.ca/AKHAssets/depression_warning_signs.jpgMain
Depression: Treatment with medicationsDDepression: Treatment with medicationsDepression: Treatment with medicationsEnglishPsychiatrySchool age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)NANADrug treatmentCaregivers Adult (19+)NA2016-07-15T04:00:00Z9.3000000000000053.3000000000000666.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn how antidepressants treat the symptoms of depression.</p><p>Depression can be treated with medications, <a href="/Article?contentid=708&language=English">therapy and lifestyle changes</a>, depending on your child's needs and their healthcare provider's recommendations. This page describes the medications that are most commonly prescribed to treat depression.</p><h2>Key points</h2> <ul> <li>SSRIs work by increasing the level of serotonin in the brain, which reduces depression and anxiety.</li> <li>SSRIs usually take two to four weeks to start working. They should be taken for at least six months to a year after a person starts feeling well.</li> <li>Common side effects of SSRIs include nausea, headaches and restlessness. Other side effects, some of which are rare, include reduced sexual interest and suicidal thoughts.</li> <li>SSRIs are effective for treating moderate to severe depression in children and teens. Other medications may be considered if SSRIs do not work.</li> </ul><h2>What type of medication is usually prescribed for depression?</h2> <p>If your child needs medication to treat depression, they will most likely be prescribed a class of medications called <a href="/Article?contentid=701&language=English">selective serotonin reuptake inhibitors (SSRIs)</a>.</p> <p>A large volume of evidence supports the use of SSRIs in children and teens. They are especially useful when depression significantly disrupts a child's routine, such as difficulty with attendance at school, poor sleep patterns and reduced appetite.</p> <p>Examples of SSRI medications include <a href="/Article?contentid=142&language=English">fluoxetine</a>, fluvoxamine, sertraline, citalopram and escitalopram. They are available only with a prescription.</p><h2>How SSRIs treat depression</h2><p>SSRIs work by increasing levels of the chemical serotonin in the brain. This chemical is involved with feelings of general wellbeing and happiness. A person with depression typically has lower levels of serotonin than someone without these disorders.</p><p>SSRIs can reduce <a href="/Article?contentid=284&language=English">symptoms of depression</a>. They can sometimes provide a faster and additional benefit to psychotherapy.</p><h2>How long do SSRIs take to start working?</h2><p>SSRIs typically take two to four weeks to start working. Sometimes they can take up to six weeks.</p><p>Of the range of SSRIs that exist, fluoxetine has the most evidence for effectiveness in children and teens with depression and <a href="/Article?contentid=18&language=English">anxiety​</a>​. Citalopram, escitalopram and sertraline also have studies showing benefits over not taking medication at all.</p><p>Because people can have different responses to different SSRIs, your child may need to try more than one medication before achieving the desired effect. Children and teens usually start on very low dose of SSRIs, so they may also need to increase their dose over time.</p> <h2>How long might my child need to take an SSRI?</h2><p>It is usually recommended that a person continue taking an SSRI until they are feeling well for six to 12 months.</p><h2>What are the side effects of SSRIs?</h2><p>Like other medications, SSRIs have side effects. Some of these effects, such as nausea, headaches, dizziness and restlessness, resolve within one to two weeks. Your child or teen's doctor will monitor your child closely to watch for these effects.</p><p>Most teens tolerate SSRIs well, without any side effects. However, some teens on higher doses can experience lower interest in sexual activity and reduced sexual responsiveness as well as other side effects. These can be addressed by adjusting the medication.</p><p>Some children and teens may find that an SSRI will make them feel worse in some ways at first, but it is important to be patient and give the medication a chance to work.</p><p>Rare but serious side effects include an increase in <a href="/Article?contentid=291&language=English">suicidal thoughts​</a>. This occurs in up to 2 per cent of teens treated with SSRIs, usually when treatment starts or the dose is increased.</p><h2>Further information</h2><p>For more information on depression, please see the following pages:</p><p> <a href="/Article?contentid=19&language=English">Depression: Overview</a></p><p> <a href="/Article?contentid=284&language=English">Depression: Signs and symptoms</a></p><p> <a href="/Article?contentid=708&language=English">Depression: Treatment with psychotherapy and lifestyle changes</a></p><h2>Resources</h2><p>Emslie, G., et al (2006). <a href="https://www.jaacap.org/article/S0890-8567%2809%2961801-3/fulltext?showall=true=" target="_blank">Treatment for Adolescents with Depression Study (TADS): safety results</a>. <em>Journal of the American Academy of Child & Adolescent Psychiatry</em>. 45(12):1440-1455. doi:10.1097/01.chi.0000240840.63737.1d</p><p>Bridge, J.A., et al (2007). <a href="https://jamanetwork.com/journals/jama/fullarticle/206656" target="_blank">Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials</a>. <em>Journal of the American Medical Association</em>. 297(15):1683-1696. doi:10.1001/jama.297.15.1683</p>https://assets.aboutkidshealth.ca/AKHAssets/depression_medication.jpgMain
Depression: Treatment with psychotherapy and lifestyle changesDDepression: Treatment with psychotherapy and lifestyle changesDepression: Treatment with psychotherapy and lifestyle changesEnglishPsychiatrySchool age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)NANANon-drug treatmentCaregivers Adult (19+)NA2016-07-15T04:00:00Z11.500000000000040.6000000000000952.000000000000Health (A-Z) - ProcedureHealth A-Z<p>​Find out how different types of psychotherapy and lifestyle changes can help ease depression.</p><p>​​If your child or teen is diagnosed with depression, they may be prescribed <a href="/Article?contentid=707&language=English">medications</a> and may be advised to undertake psychotherapy or make lifestyle changes. The type of treatment your child receives depends on the severity of their depression.</p><h2>Key points</h2> <ul> <li>Psychotherapy can help a child with depression by offering support, teaching coping skills or exploring relationships.</li> <li>Cognitive behavioural therapy is an effective psychotherapy. By focusing on the relationship between thoughts, feelings and behaviour, it can help patients recognize signs of depression and change their thinking and behaviour.</li> <li>Other forms of psychotherapy include interpersonal psychotherapy, family therapy, behavioural therapy and mindfulness and acceptance-based therapies.</li> <li>Children and teens may also benefit from at least eight to 10 hours sleep a night, eating a balanced diet and getting regular exercise. A family doctor or pediatrician can offer advice if a child has difficulty making lifestyle changes.</li> </ul><h2>How psychotherapy can help treat depression</h2><p>Psychotherapy, also known as "talk therapy", involves a trained therapist working one-to-one with a patient or a group of people on common objectives. Depending on the type of psychotherapy, the therapist can offer support, teach coping skills or help the patient(s) explore their relationships.</p><h3>How to access psychotherapy</h3><p>Based on your child's diagnosis and the severity of their symptoms, your doctor may suggest a therapist or centre that is right for your child. You can also access psychotherapy through:</p><ul><li>a mental health agency</li><li>a recommendation from a trusted friend or family member</li><li>an employee or family assistance program</li></ul><p>Fees for psychotherapy vary. Some costs might be covered through public health agencies or plans or through private insurance.</p><p>The therapy that has been shown to be most effective for depression is cognitive behavioural therapy.</p><h3>Cognitive behavioural therapy</h3><p>Cognitive behavioural therapy, or CBT, is a structured form of therapy involving one session a week usually for 10 to 16 weeks. CBT can be effective for a range of mental health issues.</p><p> <em>How CBT works</em></p><p>CBT is based on cognitive theory, the idea that our thoughts influence our feelings and our behaviours. When it is focused on treating depression, it helps children:</p><ul><li>recognize their signs of depression</li><li>develop "cognitive strategies" (different ways of thinking) for the things that make them sad</li><li>practise "exposure" or "behavioural strategies" to help them gradually re-engage in activities that they might have avoided because of the depression</li></ul><p>CBT helps a person with depression look at some of the thoughts behind their avoidant or other poor coping behaviours. It also teaches them how to have more balanced thoughts and how to cope with depression with relaxation techniques.</p><p>Over time, CBT can include exposure therapy. This typically involves experiments that gradually expose a patient to activities that they have avoided because of their depression. The patient would usually start with the easiest activity and work up to the most difficult.</p><p>CBT can be done one on one with a therapist or with a group of patients and a therapist. It can be conducted with a child on their own or with their parent(s) or caregiver(s) present. Some parent participation is usually encouraged.</p><p>Teens and parents can also work through self-help CBT resources on their own.</p><h3>Interpersonal psychotherapy for adolescents (IPT-A)</h3><p>Interpersonal psychotherapy is a form of therapy for depression that has been adapted for teens. It is more helpful for people that have depression without anxiety. Typically, it involves attending weekly sessions over 16 to 20 weeks.</p><p>The therapy is based on a standard set of written guidelines. It usually explores important relationships in a teen's life within one of the four following areas:</p><ul><li>role transitions (for example, transitioning to high school or university or entering puberty)</li><li>grief (a significant loss, typically a death)</li><li>interpersonal disputes (typically poor relations with a parent or caregiver)</li><li>interpersonal sensitivities (difficulties establishing relationships).</li></ul><p>The therapist will use different techniques, including analyzing communication in detail and role playing other ways the teen can communicate with others.</p><h3>Other forms of psychotherapy</h3><p>Sometimes patients and families choose other psychotherapies based on:</p><ul><li>availability</li><li>the presence of other difficulties or disorders</li><li>their own preferences, for example a shared language or culture</li></ul><p>Other therapies include:</p><ul><li>family therapy, if there is a lot of family tension or conflict</li><li>trauma-specific therapy, if there is a history of trauma</li><li>behavioural approaches, for example if a child or teen has depression with <a href="/Article?contentid=1922&language=English">attention deficit hyperactivity disorder (ADHD)</a> or <a href="/Article?contentid=1925&language=English">oppositional defiant disorder</a></li> <li>mindfulness and acceptance based therapies, which involve learning to live in the moment and experience life without judgment</li></ul><h3>Importance of patient/therapist relationship</h3><p>Psychotherapy is more helpful when there is a good relationship between the therapist and the child. If there is a poor fit, you may need to talk to the therapist or else switch to another therapist.</p><h2>Further information</h2><p>For more information on depression, please see the following pages:</p><p><a href="/Article?contentid=19&language=English">Depression: Overview</a></p><p><a href="/Article?contentid=284&language=English">Depression: Signs and symptoms</a></p><p><a href="/Article?contentid=707&language=English">Depression: Treatment with medications</a></p>Main
DermatologyDDermatologyDermatologyEnglishDermatologyChild (0-12 years);Teen (13-18 years)SkinSkinConditions and diseasesCaregivers Adult (19+)NA2018-01-19T05:00:00Z000Landing PageLearning Hub<p>Information about common skin conditions such as eczema, diaper rash, sunburn, warts, head lice, hair loss, birthmarks and more. Also learn about first aid and everyday care so your child can have healthy hair, skin and nails.</p><p>Information about common skin conditions such as eczema, diaper rash, sunburn, warts, head lice, hair loss, birthmarks and more. Also learn about first aid and everyday care so your child can have healthy hair, skin and nails.<br></p><br> <div class="asset-video"> <iframe src="https://www.youtube.com/embed/videoseries?list=PLjJtOP3StIuXJh-Edu78v4AlsBO5p6n6f" frameborder="0"></iframe><br></div><p>Above is our dermatology video playlist. To view other AboutKidsHealth videos, please visit the <a href="https://www.youtube.com/user/Aboutkidshealth">AboutKidsHealth YouTube channel</a>.</p>dermatologyhttps://assets.aboutkidshealth.ca/AKHAssets/dermatology_learning_hub.jpgMain
Developing an ASD program for your childDDeveloping an ASD program for your childDeveloping an ASD program for your childEnglishNeurologyChild (0-12 years)NANervous systemConditions and diseasesAdult (19+)NA2009-03-09T04:00:00Z11.000000000000046.8000000000000380.000000000000Flat ContentHealth A-Z<p>Information about the components of a good treatment program for autism spectrum disorder.</p> <br><p>Information about autism spectrum disorder (ASD) is growing fast. You may find it difficult to know which programs and services are the best for your child. No single treatment offers the solution. But studies show that children with ASD respond well to highly structured, specialized education programs that meet the specific needs of the child.</p><h2> Key points </h2> <ul><li>Studies show that children with ASD respond well to highly structured, specialized education programs.</li> <li>An effective program may include behavioural teaching, communication therapy, training in social skills development, sensory motor therapy.</li> <li> A program should be constantly changing to teach appropriate social communication needed at every stage of development.</li> <li> You know your child best and your understanding of your child is important to develop a program that will effectively meet their needs.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/developing_an_ASD_program_for_your_child.jpgMain
Development of attachmentDDevelopment of attachmentDevelopment of attachmentEnglishNABaby (1-12 months)BodyNANAAdult (19+)NA2009-09-22T04:00:00Z7.8000000000000066.0000000000000692.000000000000Flat ContentHealth A-Z<p>Learn about the development of a baby's system of attachment over the first year of life. Attachment will solidify as a baby's memory develops.</p><p>Your baby’s system of attachment will slowly emerge over the first eight months of life. As your child gets older, their sense of attachment will influence how they perceive and interact with other people. This page describes how your baby’s system of attachment develops over the first year or so. </p><h2>Key points</h2> <ul><li>In the first three months, babies will form attachments to their caregivers based on experiences of touch, feeding, smell and faces.</li> <li>By three to six months, a baby will begin to seek out their primary caregivers and will be soothed more easily by their caregivers than by strangers.</li> <li>Between seven and 12 months, a baby will begin to be quite discerning in terms of who they respond to; they may try several different ways to get their caregivers attention; and may become upset when separated from their primary caregivers.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/development_of_attachment.jpgMain
Development of speech and languageDDevelopment of speech and languageDevelopment of speech and languageEnglishDevelopmentalBaby (1-12 months);Toddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years)NANANAPrenatal Adult (19+)NA2009-10-31T04:00:00Z8.6000000000000055.0000000000000699.000000000000Flat ContentHealth A-Z<p>It is helpful to know the usual developmental stages a child goes through when learning speech and language. Individual babies, toddlers, and children achieve different skills at different times within the range. Some characteristic features of language development are listed below for each developmental stage.</p><p>It is helpful to know the usual developmental stages a child goes through when learning speech and language. Keep in mind that these stages are ranges, and the ranges are approximate. Individual babies, toddlers, and children achieve different skills at different times within the range. Some characteristic features of language development are listed below for each developmental stage.</p><h2>Key points</h2> <ul><li>Individual babies, toddlers and children achieve different skills at different times within a range.</li> <li>Children first develop receptive language, which is understanding the expressions and words of others.</li> <li>Expressive language is the child's ability to express themselves.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/development_of_speech_and_language_premature_babies.jpgMain
Developmental dysplasia of the hipDDevelopmental dysplasia of the hipDevelopmental dysplasia of the hipEnglishOrthopaedics/MusculoskeletalNewborn (0-28 days);Baby (1-12 months);Toddler (13-24 months)HipSkeletal systemConditions and diseasesCaregivers Adult (19+)NA2010-03-05T05:00:00Z6.7000000000000068.4000000000000659.000000000000Health (A-Z) - ConditionsHealth A-Z<p>An overview of the signs, symptoms, causes and treatment of developmental dysplasia of the hip.</p><h2>What is developmental dysplasia of the hip (DDH)? </h2> <p>Developmental dysplasia of the hip (DDH) is a condition in which the hip joint is abnormal. Some babies are born with the condition. The head of the thigh bone (femur) does not fit properly into the joint. It can lead to limping and pain. In more severe cases, this condition can be disabling. </p> <p>This condition affects about one in 1,000 babies. A slight instability of the hip can be seen in as many as one in three newborns. Girls are more likely to develop dysplasia of the hip. The condition can run in families.</p><h2>Key points</h2><ul><li>Developmental dysplasia of the hip (DDH) means that the head of the thigh bone is not properly inserted into the hip joint.</li><li>Babies who are breech or have a family history of DDH are more likely to have this condition.</li><li>Signs include a baby's inability to move the thigh outward at the hip and, later on, difficulty walking and pain.</li><li>The Pavlik harness orthosis is used to correct DDH.</li> <li>About one in 20 babies with DDH may need surgery to correct the condition.</li></ul><h2>Signs and symptoms of DDH</h2> <p>A baby with DDH may not show signs of the condition. The signs may be very subtle. They may vary depending on the age of the child. Some of the signs your doctor will look for include the following:</p> <ul> <li>an audible "clunk" during the opening and closing of the hips</li> <li>inability to move the thigh outward at the hip</li> <li>one leg shorter than the other</li> <li>unevenness in the fat folds of the thigh around the groin or buttocks</li> <li>limping or walking on the toes of one foot in older children</li> <li>a spine curve in older children</li> </ul><h2>Causes of developmental dysplasia of the hip</h2> <p>Doctors do not know exactly what causes DDH. Some risk factors can increase your child's chances of being born with DDH. These risk factors include:</p> <ul> <li>family history of DDH</li> <li><a href="/article?contentid=412&language=English">breech position</a> when the baby was born</li> <li>a decrease of amniotic fluid in the womb</li> <li>problems with the muscular or skeletal system </li> </ul><h2>How a doctor can help your child</h2> <p>The family doctor will do a physical examination. If they think your child has DDH, they may refer your child to an orthopaedic surgeon. An ultrasound or X-ray will usually be done. </p><h2>Treatment</h2> <p>Treatment depends on your child's age and how severe the DDH is. Mild cases correct without any treatment after a few weeks. More serious cases will need treatment.</p> <h3>Harness</h3> <p>If a diagnosis is made early enough, the doctor may order your child to wear a device called the <a href="/Article?contentid=971&language=English">Pavlik harness orthosis</a>. This is a set of soft straps that keep your child in a "frog-like" position. It allows the hip joint to develop normally. Your orthopaedic surgeon will tell you how long your baby should wear the orthosis. </p> <p>About one in 20 babies with DDH need more than the Pavlik harness to correct the condition.</p> <h3>Surgery</h3> <p>Older children may need one of two treatments.</p> <p>Closed reduction is usually performed on children younger than 18 months. This treatment manually puts the bone back into the hip socket while the child is under <a href="/article?contentid=1261&language=English">anaesthesia</a>. </p> <p>Open reduction is usually done with children 18 months or older. During this surgery, muscles and tissues around the hip are loosened while the hip is realigned and the thigh bone is placed back into the socket. The muscles and tissues are tightened once the hip is realigned. </p><h2>Complications</h2> <p>If DDH is not treated early, the hip joint does not form properly. This will result in difficulty moving the hips normally. This may become obvious when the child starts to walk. It may cause pain as they grow older.</p><h2>When to seek medical assistance</h2> <p>If you suspect your child's hips are not developing properly, see a doctor as soon as possible.</p><h2>​Virutal care services for children<br></h2><p>Boomerang Health was opened by SickKids to provide communities in Ontario with greater access to community-based services for children and adolescents. For more information on virtual care services in Ontario to support dysplasia of the hip, visit <a href="http://www.boomeranghealth.com/services/orthopaedic-surgery/">Boomerang Health</a> powered by SickKids.<br></p>Main
Developmental paediatriciansDDevelopmental paediatriciansDevelopmental paediatriciansEnglishOtherChild (0-12 years);Teen (13-18 years)NANAHealth care professionalsCaregivers Adult (19+)NA2015-08-17T04:00:00Z13.300000000000032.1000000000000722.000000000000Flat ContentHealth A-Z<p>Developmental paediatricians are doctors who specialize in child development. Learn what they do and how they can help your child.</p><h2>What is a developmental paediatrician?</h2> <p>Developmental paediatricians are doctors who specialize in child development. They see children with a wide variety of developmental, learning and behavioural issues from infancy to young adulthood.</p><h2>Key points</h2> <ul> <li>Developmental paediatricians are doctors who have completed extra training in the field of child development.</li> <li>Developmental paediatricians assess all aspects of development, including language, social communication and interaction skills, play behavior, motor skills and some cognition. </li> <li>Developmental paediatricians work together with other care providers to help ensure their patients are getting the extra support they need in a variety of different settings. </li> <li>If you are concerned that your child is having delays in their development, speak with your doctor.</li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/developmental_paediatricians.jpgMain
DextrocardiaDDextrocardiaDextrocardiaEnglishCardiologyChild (0-12 years)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2009-12-04T05:00:00Z8.1000000000000060.0000000000000123.000000000000Flat ContentHealth A-Z<p>Learn about dextrocardia, a condition that involves the position of the heart. If the heart has developed normally, it does not pose any problems.</p><p>Normally, the heart is found on the left side of the chest. Dextrocardia means that the heart is on the right side of the chest. </p><h2> Key points </h2> <ul><li>Even if the heart is on the right side of the chest, no treatment is needed if it has developed normally.</li></ul>Main
DiabetesDDiabetesDiabetesEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasPancreasConditions and diseasesCaregivers Adult (19+)NA2018-01-19T05:00:00Z000Landing PageLearning Hub<p>This resource contains information, illustrations and animations to help you understand diabetes, from symptom recognition, to diagnosis, treatment and long-term outcomes. Learn about managing and living with diabetes on a daily basis.</p><p>This resource contains information about diabetes, from symptom recognition, to diagnosis, treatment and long-term outcomes. Learn about managing and living with diabetes on a daily basis. Throughout the resource you will find many illustrations and animations to help you understand the condition, its management and long-term consequences.</p>diabeteshttps://assets.aboutkidshealth.ca/AKHAssets/diabetes_learning_hub.jpgMain
Diabetes and exerciseDDiabetes and exerciseDiabetes and exerciseEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemHealthy living and preventionAdult (19+)NA2016-10-17T04:00:00Z9.0000000000000057.7000000000000883.000000000000Flat ContentHealth A-Z<p>Exercise will have an impact on your child's blood sugar levels. Learn how to adjust insulin accordingly.<br></p><p>The following tips are general activity guidelines for children and teens with diabetes. Every child responds to activity differently, and some child​ren may have more vigorous exercise demands than others. Therefore, always discuss your child’s activity levels with your diabetes care team to ensure optimal diabetes control.​​<br></p><h2>Key points</h2><ul><li>Exercise lowers blood sugar levels and makes the body more sensitive to insulin.</li><li>Give extra food when your child is going to exercise, or lower the dose of insulin.</li><li>Monitor blood sugar levels for several hours after exercising.</li><li>Children with an insulin pump can exercise but should take caution to protect the insertion site and catheter.<br></li></ul>https://assets.aboutkidshealth.ca/AKHAssets/diabetes_and_exercise.jpgMain
Diabetes and pregnancyDDiabetes and pregnancyDiabetes and pregnancyEnglishPregnancyAdult (19+)BodyReproductive systemConditions and diseasesPrenatal Adult (19+)NA2009-09-11T04:00:00Z11.400000000000045.10000000000001142.00000000000Flat ContentHealth A-Z<p>Learn about diabetes and pregnancy. Gestational diabetes, which is diabetes that arises for the first time in pregnancy, is also discussed.</p><p>Diabetes is a chronic metabolic disorder where the pancreas does not secrete enough insulin or the body does not use insulin properly. Diabetes is a common disease and its incidence is increasing. The main symptoms of diabetes include excessive thirst and urination, weight loss, and the presence of too much sugar in the urine and blood. Sometimes, diabetes first arises during pregnancy. This is known as gestational diabetes.</p><h2>Key points</h2><ul><li>The different types of diabetes are type 1, type 2 and gestational diabetes.</li><li>Pregnancy in women with diabetes is considered high risk, therefore women with diabetes must take special care to manage their diabetes while pregnant.</li><li>Gestational diabetes is diabetes that first arises during pregnancy and can cause complications for the mother and unborn baby.</li> <li>Women with gestational diabetes have an increased risk for developing type 2 diabetes in the future.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/diabetes_and_pregnancy.jpgMain
Diabetes and sick day managementDDiabetes and sick day managementDiabetes and sick day managementEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemHealthy living and preventionAdult (19+)NA2016-10-17T04:00:00Z9.1000000000000060.10000000000001388.00000000000Flat ContentHealth A-Z<p>Being sick can impact your child's blood sugar levels. Find tips on how to manage diabetes on sick days.</p><p>In ​a person with diabetes, illnesses — even common ones such as a <a href="/Article?contentid=12&language=English">cold</a>, a sore throat, or the <a href="/Article?contentid=969&language=English">flu</a> — can trigger imbalance in <a href="/Article?contentid=1723&language=English">blood glucose (sugar) levels​</a>. At first, blood sugar levels usually go up with an illness. However, because appetites tend to fall with illness, the blood sugar levels may fall too.<br></p><h2>Key points</h2><ul><li>Your child should continue to take insulin even if they are sick and not eating.</li><li>Monitor blood sugar levels carefully while your child is sick as blood sugar levels may go up or down, depending on the illness.</li><li>If your child vomits twice or more within 12 hours, call your diabetes team​ for advice.</li><li>If you are worried about the sugar in medications, ask your pharmacist to suggest preparations that are sugar-free.<br></li></ul>Main
Diabetes and vacationsDDiabetes and vacationsDiabetes and vacationsEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemHealthy living and preventionAdult (19+)NA2017-09-25T04:00:00Z9.5000000000000057.90000000000001262.00000000000Flat ContentHealth A-Z<p>Find out what you need to know about managing diabetes while on vacation or while your child is away at camp.</p><p>Your child’s <a href="/Article?contentid=1717&language=English">diabetes</a> should not discourage you from travelling with your child, even abroad. Careful planning will ensure a safe and enjoyable holiday.</p><h2>Key points</h2><ul><li>Make sure you have all the supplies necessary to manage your child's diabetes while on vacation. Always be prepared in case of an emergency.</li><li>If your child is going away without you, make sure they are prepared to manage their own care. If your child is young, inform a parent or camp counsellor of your child's condition, and make sure they know how to manage it.<br></li></ul>https://assets.aboutkidshealth.ca/AKHAssets/diabetes_and_vacations.jpgMain
Diabetes in the classroomDDiabetes in the classroomDiabetes in the classroomEnglishEndocrinologyPreschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)PancreasEndocrine systemHealthy living and preventionAdult (19+)NA2017-09-25T04:00:00Z10.400000000000054.20000000000001530.00000000000Flat ContentHealth A-Z<p>An overview of what to expect when a child with diabetes starts school and how it will impact their life at school.</p><p>The demands of <a href="/Article?contentid=1717&language=English">diabetes​</a> management may have an impact on school life; therefore, you should inform school personnel that your child has diabetes.</p><h2>Key points</h2> <ul><li>Inform your child's teachers and other school staff about your child's diabetes diagnosis, and any specific care instructions they need to know.</li> <li>Talk to your child about who they feel comfortable telling about diabetes.</li> <li>With proper planning, your child should be able to participate in physical activity and field trips at school.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/diabetes_classroom.jpgMain
Diabetes insipidus after brain tumour treatmentDDiabetes insipidus after brain tumour treatmentDiabetes insipidus after brain tumour treatmentEnglishNeurology;EndocrinologyChild (0-12 years);Teen (13-18 years)Brain;Kidneys;BladderNervous system;Endocrine system;Renal system/Urinary systemConditions and diseasesAdult (19+)NA2022-01-10T05:00:00Z9.8000000000000051.1000000000000613.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Find out what diabetes insipidus is, what can cause this rare condition and what the impact may be on your child's future.<br></p><h2>What is diabetes insipidus</h2> <figure> <span class="asset-image-title">Water retention</span> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Water_retention_ADH.jpg" alt="ADH is sent from the pituitary gland to the kidney signalling it to conserve water" /> <figcaption class="asset-image-caption">The hypothalamus and pituitary gland produce hormones that are involved in controlling thirst and the need to urinate. These hormones trigger the kidneys to conserve water.</figcaption> </figure> <p>Diabetes insipidus (DI) is a condition that reflects the body’s inability to retain water. As a result, if not treated, large amounts of dilute (colourless) urine are produced, leading to the need to urinate (pee) frequently. It may also cause intense feelings of thirst. DI is rare. It may happen when the <a href="/article?contentid=1306&language=english&hub=braintumours">brain tumour</a> is near the <a href="/article?contentid=1307&language=english&hub=braintumours">hypothalamus or pituitary gland</a>, or if there is damage to these areas during surgery.</p><p>The hypothalamus is our "thirst centre," and senses when we need to drink. This helps ensure our body has enough water and does not become dehydrated. The hypothalamus produces a hormone called antidiuretic hormone (ADH), which is also called vasopressin. ADH helps the body retain water. It is stored and released from the pituitary gland. It then acts on kidneys. The kidneys concentrate our urine to help conserve water. Without ADH, DI develops, and the kidneys cannot retain water and the urine becomes dilute or watery. This causes children with DI to pee a large amount and may cause them to be extremely thirsty to encourage them to replace the water that was lost in the urine. If your child does not act on the feeling of thirst and drink enough fluids, they may become dehydrated.</p><p>Some children with brain tumours lose their sense of thirst and may need to carefully monitor fluid intake and output to remain healthy.</p><h2>Key points</h2><ul><li>Diabetes insipidus is different than diabetes associated with high blood sugar (diabetes mellitus).</li><li>Diabetes insipidus reflects the body’s inability to retain water and results in large amounts of dilute urine.</li><li>Diabetes insipidus may be caused by a brain tumour or by the surgery to treat it.</li><li>Diabetes insipidus is usually treated with a synthetic form of antidiuretic hormone called desmopressin (DDAVP).</li><li>If the condition is not treated it can lead to dehydration and an electrolyte imbalance.</li><li>In some cases, diabetes insipidus may go away a few weeks after surgery, but often it is permanent. </li></ul><h2>What causes diabetes insipidus?</h2><p>There are two possible causes of diabetes insipidus:</p><ul><li>The tumour: If a tumour is pressing on the hypothalamus or pituitary gland, it may affect the production of antidiuretic hormone (ADH).</li><li>The surgery: The pituitary stalk may be cut or damaged during removal of the tumour. This affects the production of ADH for a few weeks, or in some cases permanently.</li></ul><h2>How do we screen for diabetes insipidus?</h2><p>The health-care team will monitor the amount of urine production. If there is concern for DI, urine tests will be done to check concentration and water balance in the body, particularly during and after surgery.</p><h2>How can diabetes insipidus be treated?</h2><p>DI related to brain tumours can be treated with a synthetic form of ADH (also called <a href="/article?contentid=122&language=english">desmopressin</a> or DDAVP). It is typically taken as a pill or as a tablet that melts beneath the tongue to replace the ADH produced by the pituitary gland.</p>Main
Diabetic ketoacidosisDDiabetic ketoacidosisDiabetic ketoacidosisEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemConditions and diseasesAdult (19+)Fatigue;Abdominal pain;Nausea;Vomiting2016-10-17T04:00:00Z8.4000000000000059.0000000000000685.000000000000Flat ContentHealth A-Z<p>Diabetic ketoacidosis occurs when there is a serious lack of insulin in the body. Learn why this happens, symptoms, and how to prevent it.</p><p>Diabetic ketoacidosis (DKA) is life threatening, but preventable. DKA develops when there is a serious lack of insulin in the body.</p><h2>Key points</h2><ul><li>Diabetic ketoacidosis develops when there is a serious lack of insulin in the body.</li><li>DKA can be avoided by careful attention to all aspects of the diabetes treatment plan.<br></li><li>Symptoms of DKA include high blood sugar levels and ketones in the urine, excessive thirst, fruity-smelling breath, signs of dehydration.</li><li>Urinary ketones can be tested using a strip test at home.</li></ul>https://assets.aboutkidshealth.ca/akhassets/INM_DKA_symptoms_EN.pngMain
Diagnosing JIADDiagnosing JIADiagnosis of JIA-CANEnglishRheumatology;AdolescentPre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years)BodySkeletal systemTestsPre-teen (9-12 years) Teen (13-15 years) Late Teen (16-18 years)NA2017-01-31T05:00:00Z000Flat ContentHealth A-Z<p>Several exams and tests are done in order to diagnose arthritis. A complete medical history, physical exam, blood tests, and imaging studies such as MRI and X-rays are needed.</p><div class="asset-video"> <iframe src="https://www.youtube.com/embed/cU4bDdEJ1g0" frameborder="0"></iframe> <br></div><p>There is no single test to diagnose JIA in young people. Since arthritis may be a part of many different illnesses, it is important to exclude those other conditions. Your doctor will do a complete evaluation to make sure your joint pain and swelling are not due to some other cause. It may take some time for your doctor to make sure that you have JIA. Your doctor will also need to determine what <a href="/Article?contentid=2554&language=English">type of JIA</a> you have. </p><h2>Key points</h2><ul><li>There is no single test to diagnose JIA.</li><li>Diagnosis of JIA usually includes a review of your medical history, physical exam, blood tests, and imaging tests.</li></ul>Teens
Diagnosing cancerDDiagnosing cancerDiagnosing cancerEnglishOncologyPre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years)BodyNATestsPre-teen (9-12 years) Teen (13-15 years) Late Teen (16-18 years)NA2019-09-03T04:00:00Z7.5000000000000065.4000000000000591.000000000000Flat ContentHealth A-Z<p>Diagnosing cancer can involve lots of questions, a physical exam and multiple tests. Find out what to expect during the process of diagnosis and about some of the specialists you may see.</p><div class="asset-video"> <iframe width="560" height="315" src="https://www.youtube.com/embed/GfAMXdrt9tg?rel=0" frameborder="0"></iframe> <br></div><p>For more videos regarding teens and cancer, please visit the <a href="https://youtube.com/playlist?list=PLjJtOP3StIuVPUkVxvdZfVGhAY_Dj-Vb7">Teens Taking Charge Cancer playlist.</a> </p><h2>What does diagnosis mean?</h2><p>Doctors use a process called "making a diagnosis" to figure out what type of cancer you have and where the cancer cells are in your body. At the end of this process, they will tell you what type of cancer you have. This is called your diagnosis. For example, you might have a diagnosis of leukemia or a solid tumour, such as osteosarcoma (bone cancer). </p><h2>Key points</h2><ul><li>Cancer symptoms are sometimes similar to symptoms for more common illnesses, so it may take your doctors some time to diagnose you.</li><li>Diagnosis usually starts with answering questions and a physical exam. The doctor may refer you for tests including blood tests and scans.</li><li>If your doctor thinks that you may have cancer, they will refer you to an oncologist, who is a doctor who specializes in cancer.</li></ul>Teens
Diagnosing causes of seizures through blood, cerebrospinal fluid and urine testsDDiagnosing causes of seizures through blood, cerebrospinal fluid and urine testsDiagnosing causes of seizures through blood, cerebrospinal fluid and urine testsEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemTestsCaregivers Adult (19+) EducatorsNA2010-02-04T05:00:00Z7.1000000000000069.90000000000001770.00000000000Flat ContentHealth A-Z<p>To diagnose a child's seizures, the treatment team may need to do tests on samples of blood, cerebrospinal fluid or urine. Read about collecting procedures.</p><p>To help diagnose your child’s seizures, the treatment team may need to do tests on samples of your child’s blood, cerebrospinal fluid, or urine. The procedures for collecting these samples are described on this page. </p><h2>Key points</h2> <ul><li>Blood work is usually required to test for diabetes, other metabolic problems and abnormal levels of certain minerals and other substances in the blood, all of which can cause seizures.</li> <li>A lumbar puncture is done to get a sample of cerebrospinal fluid from your child's lower back. It is used to rule out meningitis or other infections in children aged under 18 months with febrile seizures and to help with diagnosis in older children.</li> <li>A urine test may be done to look for infections, metabolic disorders or abnormal levels of drugs, which may be responsible for seizures.</li></ul>https://assets.aboutkidshealth.ca/akhassets/Lumbar_puncture_MED_ILL_EN.jpgMain
Diagnosing hemophiliaDDiagnosing hemophiliaDiagnosing hemophiliaEnglishHaematologyChild (0-12 years);Teen (13-18 years)NAArteries;VeinsConditions and diseasesTeen (13-18 years)NA2019-03-13T04:00:00Z10.000000000000050.0000000000000670.000000000000Flat ContentHealth A-Z<p>Learn how doctors diagnose hemophilia, a bleeding disorder that mostly affects males. </p><p>Doctors will ask about your family history to find out if you have inherited a mutation in one of your hemophilia genes. To do this, they look at your family tree. Doctors can diagnose hemophilia either before a baby is born or afterwards.</p>Teens
Diagnosis of an immature gastrointestinal (GI) tract in premature babiesDDiagnosis of an immature gastrointestinal (GI) tract in premature babiesDiagnosis of an immature gastrointestinal (GI) tract in premature babiesEnglishNeonatology;GastrointestinalPremature;Newborn (0-28 days);Baby (1-12 months)Esophagus;Stomach;Small Intestine;Large Intestine/ColonDigestive systemNAPrenatal Adult (19+)NA2009-10-31T04:00:00Z10.100000000000051.3000000000000593.000000000000Flat ContentHealth A-Z<p>Learn about the immature gastrointestinal (GI) tract. Although a fetus's GI tract is fully formed at 20 weeks, it is nowhere near ready to work properly.</p><p>A fetus's gastrointestinal (GI) tract is fully formed at 20 weeks, however it is not fully functional at that time. How well a baby's GI tract functions is related to the baby's gestational age. Diagnosing an immature GI tract, is a diagnosis of elimination, meaning similar conditions must first be ruled out.</p><h2>Key points</h2> <ul><li>A fetus's gastrointestinal (GI) tract is fully formed at 20 weeks of pregnancy, however it does not function properly until later in pregnancy.</li> <li>Diagnosing an immature GI tract is a diagnosis of elimination; since signs and symptoms may be similar to those of other digestive conditions, those conditions must be ruled out first.</li> <li>Diagnostic procedures including X-rays, blood tests and various metabolic tests are conducted to rule out other conditions.</li></ul>Main
Diagnosis of anemia of prematurityDDiagnosis of anemia of prematurityDiagnosis of anemia of prematurityEnglishNeonatology;HaematologyPremature;Newborn (0-28 days);Baby (1-12 months)NANANAPrenatal Adult (19+)NA2009-10-31T04:00:00Z11.900000000000043.1000000000000496.000000000000Flat ContentHealth A-Z<p>Learn about diagnosing anemia of prematurity. Over a period of weeks, a premature baby with anaemia of prematurity will likely appear pale and lethargic.</p><p>Over a period of weeks, a premature baby with anaemia of prematurity will likely appear pale and lethargic. Blood work will be done to confirm a diagnosis.</p><h2>Key points</h2> <ul><li>A premature baby will have a normal drop in red blood cells (RBCs) following their birth; frequent blood tests can cause or worsen anemia.</li> <li>Over a period of weeks, a premature baby with anemia of prematurity will appear pale and lethargic.</li> <li>Blood work including hemoglobin level and reticulocyte count will be obtained to confirm diagnosis.</li></ul>Main
Diagnosis of apnea of prematurityDDiagnosis of apnea of prematurityDiagnosis of apnea of prematurityEnglishNeonatology;RespiratoryPremature;Newborn (0-28 days);Baby (1-12 months)LungsRespiratory systemNAPrenatal Adult (19+)NA2009-10-31T04:00:00Z10.400000000000048.2000000000000405.000000000000Flat ContentHealth A-Z<p>Learn about diagnosing apnea of prematurity. If breathing intervals between breaths extend for longer than 20 seconds, a baby is having apnea.</p><p>If a premature baby has breathing intervals between breaths that extend for longer than 20 seconds, the baby is having apnea. Diagnosis of apnea involves ruling out other possible conditions.</p><h2>Key points</h2> <ul><li>If intervals between breaths extend for longer than 20 seconds, a baby is considered to be having apnea.</li> <li>Apnea can be a condition on its or it may be a symptom of other conditions.</li> <li>A diagnosis of apnea will attempt to rule out other possible conditions by conducting blood work, a head ultrasound and in some cases, a lumbar puncture.</li></ul>Main
Diagnosis of asphyxia in premature babiesDDiagnosis of asphyxia in premature babiesDiagnosis of asphyxia in premature babiesEnglishNeonatology;NeurologyPremature;Newborn (0-28 days);Baby (1-12 months)BrainNervous systemNAPrenatal Adult (19+)NA2009-10-31T04:00:00Z11.000000000000042.3000000000000518.000000000000Flat ContentHealth A-Z<p>Read about the diagnosis of asphyxia in premature infants. Asphyxia has many causes and a diagnosis often requires a head ultrasound (HUS).</p><p>Asphyxia is an inadequate delivery of oxygen to the brain. There are many causes of asphyxia and a diagnosis often requires a head ultrasound (HUS).</p><h2>Key points</h2> <ul><li>Asphyxia is an inadequate delivery of oxygen to the brain.</li> <li>Asphyxia can be caused by reduced blood flow in the womb; low maternal blood pressure; placental abruption; and reduced oxygen flow during labour.</li> <li>Diagnostic techniques such as head ultrasound (HUS), CT scan and MRI will reveal areas of the brain that have been affected.</li></ul>Main
Diagnosis of brain and behaviour problems in premature babiesDDiagnosis of brain and behaviour problems in premature babiesDiagnosis of brain and behaviour problems in premature babiesEnglishNeonatology;NeurologyPremature;Newborn (0-28 days);Baby (1-12 months)Brain;SkullNervous systemNAPrenatal Adult (19+)NA2009-10-31T04:00:00Z10.500000000000050.9000000000000752.000000000000Flat ContentHealth A-Z<p>Read about diagnosing brain injuries in premature babies. It can be complex; problems can be subtle and may not be apparent immediately following birth.</p><p>Diagnosing brain injuries in premature babies can be complex. Problems may be subtle or have no obvious signs, and symptoms of a longer-term disability may not be apparent for some time.</p><h2>Key points</h2> <ul><li>In premature babies, blood vessels surrounding the brain ventricles are thin and weak, making them vulnerable to injury.</li> <li>Diagnosing brain injuries can be complex, as brain injuries can cause symptoms in other parts of the body, or they may have no obvious signs.</li> <li>Diagnosing and predicting the outcome of longer-term effects can be difficult in the early days of a premature baby's life.</li> <li>Imaging technology such as head ultrasound (HUS) and magnetic resonance imaging (MRI) will be used to make a definitive diagnosis of a brain injury.</li></ul>https://assets.aboutkidshealth.ca/akhassets/preemie_inside_isolette1_BR_EN.jpgMain
Diagnosis of breathing problems in premature babiesDDiagnosis of breathing problems in premature babiesDiagnosis of breathing problems in premature babiesEnglishNeonatology;RespiratoryPremature;Newborn (0-28 days);Baby (1-12 months)LungsRespiratory systemNAPrenatal Adult (19+)NA2009-10-31T04:00:00Z12.200000000000042.3000000000000464.000000000000Flat ContentHealth A-Z<p>Read about diagnosis of breathing problems, which is the first step in treating the breathing difficulties of a premature baby. </p><p>Lung problems are some of the most common complications of prematurity. Diagnosis of breathing problems is the first step in treating lung conditions in a premature baby.</p><h2>Key points</h2> <ul><li>The lungs are among the last organs to become fully functional as a baby grows in the womb, which means lung problems are a common complication of prematurity.</li> <li>A premature baby may have trouble breathing because their lungs are immature and not fully developed, not because there is something wrong with the lungs.</li> <li>Premature babies with breathing problems are given a blood gas test to measure the amount of oxygen, carbon dioxide and acid in the blood, which indicate the severity of the respiratory distress.</li> <li>Other measurements of oxygen and carbon dioxide in the blood include transcutaneous measurements and pulse oximetry.</li></ul>https://assets.aboutkidshealth.ca/akhassets/bonnet-baby-with-hand-BRAND_EN.jpgMain
Diagnosis of chronic lung disease in premature babiesDDiagnosis of chronic lung disease in premature babiesDiagnosis of chronic lung disease in premature babiesEnglishNeonatology;RespiratoryPremature;Newborn (0-28 days);Baby (1-12 months)Lungs;HeartRespiratory systemNAPrenatal Adult (19+)NA2009-10-31T04:00:00Z10.500000000000053.3000000000000665.000000000000Flat ContentHealth A-Z<p>Read about chronic lung disease (CLD). CLD comes as a result of respiratory distress syndrome (RDS) and the use of mechanical ventilation.</p><p>Chronic lung disease (CLD) comes as a result of respiratory distress syndrome (RDS) and the use of mechanical ventilation.</p><h2>Key points</h2> <ul><li>A premature baby is considered to have chronic lung disease (CLD) if they need supplemental oxygen, the chest X-ray is consistent with chronic changes or injury, the continued use of ventilation has produced an abnormal growth of tissue within the lungs.</li> <li>CLD is usually diagnosed with X-ray and a blood gases test, which will show a lowered level of oxygen and elevated carbon dioxide in the blood.</li> <li>CLD may be complicated by pulmonary hypertension, which is an increase in blood pressure in the lungs.</li></ul>https://assets.aboutkidshealth.ca/akhassets/Chronic_lung_disease_XRAY_MEDIMG_PHO_EN.pngMain

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