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G/GJ tubes: Balloon G tubesGG/GJ tubes: Balloon G tubesG/GJ tubes: Balloon G tubesEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Abdomen;StomachDigestive systemProceduresAdult (19+) CaregiversNA2018-10-25T04:00:00ZHolly Norgrove, RN, BScN7.1000000000000073.60000000000002861.00000000000Health (A-Z) - ProcedureHealth A-Z<p>A balloon G tube is a type of feeding tube that has a balloon on the end to help prevent the tube from being accidentally pulled out. Learn how to care for your child’s balloon G tube and change it at home. </p><p>Gastrostomy tubes (G tubes) are feeding devices that provide liquid nutrition, medications and other fluids directly into the stomach. G tubes are placed through a surgical opening in your child's tummy (abdomen) called a stoma. The tunnel from the outside into the stomach is called the tract.</p><p>Balloon G tubes have a balloon on the end inside the stomach to keep the tube in place. These tubes may be non low-profile or low-profile.</p><h2>Key points </h2><ul><li>A balloon G tube is a type of feeding tube that has a balloon on the end inside the stomach to prevent it from being pulled out. </li><li>A non low-profile balloon G tube extends further out of the stomach and has a disk on the outside to keep the tube from moving too far into the stomach. A low-profile balloon G tube sits close to the skin and is easy to conceal. </li><li>Balloon G tubes should be changed at least every six to eight months to prevent the balloon from leaking which can cause the G tube to accidentally fall out. </li><li>The G tube feeding extension set should be changed every month. </li><li>Whenever you change or re-insert a G tube, before using it for feeds and medications, always check the pH of the fluids that come from the tube to make sure it is in the stomach. </li><li>You do not need to go to the emergency department if your child’s balloon is broken, blocked or the tube accidentally falls and you replace the tube or insert a Foley catheter. You will only need to go the emergency department if you cannot insert an emergency Foley catheter and there is nothing in the tract. </li></ul><h2>What to do if your child’s balloon G tube is pulled out or becomes blocked</h2><h3>If the tube is accidentally pulled out</h3><p>It is possible that the G tube may accidentally fall out or be pulled out. This may happen if the balloon is broken or does not have enough water in it.</p><p>To check if the balloon is broken, fill it with 5 mL of water. If you do not see a leak, remove the water from the balloon, wash the G tube with soap and water and reinsert it into the stoma as described above. Fill the balloon with the amount of water you normally use. Check the balloon every two to three days to be sure there are no further problems.</p><p>If the balloon is broken, replace it with a new tube as described above.</p><p>If you cannot replace the G tube, insert a temporary Foley catheter. To learn how to insert the Foley catheter, please see the article “<a href="/Article?contentid=2910&language=English">What to do if your child’s feeding tube is pulled out</a>”. You can use the Foley catheter for feeds and medication until a new G tube inserted. </p><h3>If the tube becomes blocked</h3><p>To learn what to do if your child’s G tube becomes blocked, please see the article “<a href="/Article?contentid=3039&language=English">What to do if your child’s feeding tube is blocked</a>”.</p><p>Remember to always carry an emergency kit that includes: </p><ul><li>a back-up G tube or Foley catheter</li><li>water-based lubricant or jelly</li><li>syringes</li><li>water</li><li>pH strips and colour reference guide</li><li>tape in case of unexpected tube changes.</li></ul><p><strong>You do not need to go to the emergency department if the tube falls out or becomes blocked and you replace the tube or insert a Foley catheter.</strong> You will only need to go the emergency department if you cannot insert an emergency Foley catheter and there is nothing in the tract.</p><h2>Caring for your child’s balloon G tube</h2><p>Keep the tube and stoma as dry and clean as possible, washing with soap and water daily. Your child’s stoma will not need a dressing.</p><p>Flush the tube with at least 5 to 10 mL of water before and after each feed and medication dose, and every four hours during continuous feeds. This helps prevent the tube from becoming blocked. </p><h3>The balloon</h3> <figure> <span class="asset-image-title">Balloon port</span><img src="https://assets.aboutkidshealth.ca/akhassets/Gtube_balloonport_labels.jpg" alt="Balloon and balloon inflation port at the end of a G tube" /> </figure> <p>The balloon at the end of your child’s tube is what keeps the tube in place and prevents it from being accidentally pulled out. The balloon is inflated with sterile or distilled water. The water is inserted through the balloon port, marked “BAL”. Do not fill the balloon with saline or air. Do not feed into the balloon port. </p><p>If you are unsure how much water your child’s balloon tube can safely hold, ask your G tube specialist (at SickKids this is the G Tube Resource Nurse) or refer to the chart below.</p> <table class="akh-table"><thead><tr><th>  </th><th colspan="2">Non-low profile<br></th><th colspan="2">Low-profile</th></tr></thead><tbody><tr><td></td><td>Mic-G</td><td>Kangaroo</td><td>Mic-Key</td><td>AMT miniONE</td></tr><tr><td>12FR</td><td>3-5mL (max 7mL)</td><td>5mL </td><td>3 to 5mL</td><td>2 to 3mL</td></tr><tr><td>14FR</td><td>3-5mL (max 7mL)</td><td>5mL </td><td>5 to 10mL</td><td>4 to 5mL</td></tr></tbody></table> <p>Filling the balloon with more or less water can affect the fit of the tube to the skin. Less water in the balloon makes the tube sit looser and stick out from the skin. More water in the balloon makes the tube sit tighter and closer to the skin. If the tube is so tight you can see an indent in your child’s skin, you can decrease the amount of water in the balloon. If the tube sticks out too much and is dangling from the stoma, you can increase the amount of water in the balloon. If adjusting the balloon volume does not help with the fit of your child’s tube, you may need to have the tract re-measured by your G tube specialist.</p><p>It is important to check the amount of water in the balloon at least once a week. This will help you to know if there is a problem with the balloon. Use a slip-tip syringe to check the balloon.</p><ol><li>Insert an empty syringe into the balloon port.</li><li>Remove all the water from the balloon. Throw away the old water. It is normal for the water to become discoloured (brown or yellow).</li><li>Re-inflate the balloon with new sterile or distilled water.</li></ol><p>It is normal for less water to be removed from the balloon than you originally put in. This is because some of the water might have evaporated. It is normal for there to be a difference of up to 0.5mL.</p><p>If there is a difference of more than 0.5 mL of water from what you put in and what you remove, the balloon may be damaged and the tube may need to be replaced. If this happens:<br></p><ul><li>Re-inflate the balloon with the amount of water you normally put in and check again in three to four hours. </li><li>If you get all the water back, the water may have simply evaporated quicker than usual. Re-inflate the balloon with the amount of water you normally put in and check the balloon volume every three to four days to be sure there are no further problems. </li><li>If you get less back again after three to four hours, the balloon is likely damaged and the tube will need to be replaced. </li><li>If you get more fluid than what you originally put in the balloon, and it looks like stomach contents or food, this means the balloon is definitely broken and the tube will need to be replaced. </li></ul><p>If you are concerned that the balloon is broken, there is a risk that the tube may be accidentally pulled out. Tape the tube in place until you can change the tube yourself or book an appointment with your G tube specialist to help you change the tube. Meanwhile, the tube is still in the stomach so you can continue to use the tube for feeding and medications. There is no need to go the emergency department if the balloon is broken. </p><h2>Feeding extension set for a low-profile balloon G tube</h2><p>The feeding port for a low-profile balloon G tube, where your child’s feeds will enter the tube and then go into their stomach, has a one-way valve to prevent stomach contents, feeds, water and medications from flowing back out of the tube. To open this one-way valve, and give feeds and medications, you must use a feeding extension set. Each brand has their own extension set. You will receive one in the box with your new low-profile balloon G tube. Replacement extension sets are purchased separately when needed. </p><div class="asset-2-up"> <figure><span class="asset-image-title">Extension set detached from tube</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/Gtube_extensionset_separate_labels.jpg" alt="Parts of an extension set detached from G tube" /> </figure><figure><span class="asset-image-title">Extension set attached to tube</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/Gtube_extensionset_attached_labels.jpg" alt="Parts of an extension set attached to G tube" /> </figure> </div><h3>Connecting the extension set to the tube</h3><ol><li>Open the plastic cover.</li><li>Make sure the clamp on the extension set is closed.</li><li>Match the line on the extension to the line on the tube and push the extension into the valve.</li><li>Holding the tube in place, turn the extension clockwise until you feel the extension lock into place. There is an arrow on the extension to show you which direction to turn it. </li><li>Attach your feeds, fluids and medications to the appropriate port at the end and open the clamp.</li><li>When you have finished using the extension, flush it and remove it from the tube.</li></ol><h3>Removing the extension from the tube</h3><ol><li>Make sure the clamp on the extension set is closed.<br></li><li>Holding the tube in place, turn the extension counter-clockwise (opposite to the arrow on the extension).</li><li>Match the line on the extension to the line on the tube and remove the extension.</li><li>Close the plastic cover. </li></ol><p>The extension set should be changed once every month, or if you notice the plastic is becoming stiff or there is formula, food or medications built up inside. It is important to flush the extension set with water between each use and clean it with soap and water once daily. Remove the extension set from the tube when it is not in use to prevent pulling.</p><h2>How to change the balloon G tube</h2><div class="asset-video"> <iframe src="https://www.youtube.com/embed/_qW4lemX3rE?rel=0" frameborder="0"></iframe> <br></div><h3>Supplies</h3><ul><li>New balloon G tube</li><li>Soap</li><li>Warm water</li><li>Washcloth</li><li>Sterile or distilled water</li><li>Four 5-mL slip-tip syringes</li><li>Water-based lubricant or jelly</li><li>Feeding extension set (for low-profile G tubes)</li><li>pH strips and colour reference guide</li></ul><h3>Procedure</h3><ol><li>Wash your hands with soap and water, and prepare your equipment and supplies.</li><li>Draw up the amount of water recommended to fill the balloon of your child’s tube into one syringe. Draw 5 mL of water into another syringe to flush the tube. Leave the other two syringes empty. You will use these to remove the old water from the balloon and checking the pH).</li><li>Prepare your washcloth with soap and water on one half of the cloth and non-soapy water on another part.</li><li>Check that the balloon of the new G tube is not broken by inflating the balloon with new water you have already drawn up. Gently squeeze the balloon to check for leaks caused by defects. Remove all the water from the balloon before continuing.</li><li>Remove the sterile or distilled water from the balloon of the old G tube using one of the empty syringes. Throw the water and syringe away.</li><li>Remove the old G tube. It is normal for the inner part of the tube to be brown or black. This is caused by acidic stomach contents. Throw away the old tube.</li><li>This is a great time to assess the stoma for any changes, such as redness, drainage, rash, or granulation tissue. Wash the stoma with soap and water and rinse it with non-soapy water. Then let it air dry.</li><li>Lubricate the tip of the new balloon G tube and, at a slight angle, insert it into the stoma, following the existing tract. The tube may be slightly resistant and it is okay to exert light force. Try to time insertion with when your child breaths in, as they are most relaxed at that time.</li><li>Once the tube is in place, inflate the balloon with the amount of sterile or distilled water you usually put in. Gently pull the tube until you feel resistance. This indicates that the balloon has reached the inside of the stomach wall.</li><li>Check that the tube is in the stomach by checking the pH as described below. Once you know the tube is in the stomach, by getting a pH of 6.0 or less, flush the tube with 5mL of water. If your child has a low-profile tube you will need to use the feeding extension set to flush the tube.</li><li>If your child has a non low-profile tube, adjust the outer disk so it sits snug against the skin. </li></ol><p>You may now use the tube for feeding and medications.</p><h2>Checking that the newly changed balloon tube is in the right spot</h2><p>Before using the newly changed tubes for feeds and medications, you will need to check that it is in the stomach by checking the pH of the contents that are pulled from the tube. </p><h3>How to check the pH</h3><p>You will need:</p><ul><li>One empty slip tip syringe</li><li>The feeding extension set for a low-profile balloon G tube (for low-profile tubes only)</li><li>pH strips</li><li>pH colour reference guide</li></ul><p>What to do:</p><ol><li>Once you have inserted the new tube, insert the empty syringe into the extension feeding set (for a low-profile balloon G tube) or directly into the tube’s medication port (for a non low-profile balloon G tube) and pull back a small amount of stomach contents. If you cannot get stomach contents, move your child side to side or sit them up.</li><li>Empty the stomach contents from the syringe onto the pH strip.</li><li>Compare the colours on the pH strip to the colours on the reference guide.</li></ol><p> <strong>If the pH is 6.0 or less</strong>, the tube is in the stomach and you can flush the tube and use it for feeding and medications.</p><p> <strong>If the pH is higher than 6.0</strong>, the tube may not be in the stomach. Medications and recent feedings can affect the pH. <strong>If you get a high reading, do not use the tube for feeding or medications and check the pH again one hour later.</strong> If the reading is still higher than 6.0, do not use the tube and contact your G tube specialist to have the position checked in an interventional radiology department. </p><h2>Resources</h2><p>For more information about the Mic-Key, visit <a href="https://www.mic-key.com/">www.mic-key.com</a>.</p><p>For more information about the AMT miniONE, visit <a href="https://www.appliedmedical.net/enteral/minione/balloon/">www.appliedmedical.net/enteral/minione/balloon/</a>.</p>https://assets.aboutkidshealth.ca/akhassets/Gtube_non_lowprofile_Kanga_labels.jpg
G/GJ tubes: Caring for your child and their G tubeGG/GJ tubes: Caring for your child and their G tubeG/GJ tubes: Caring for your child and their G tubeEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Abdomen;Stomach;Small IntestineDigestive systemNon-drug treatmentAdult (19+) CaregiversNA2011-03-29T04:00:00ZJulia Kelly, RN5.5000000000000077.5000000000000671.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn why some children need feeding tubes. Find an overview of the two types of feeding tubes, G and GJ tubes, how they are put in and how they are used.<br></p><p>Your child needs to be fed through a feeding tube. These feedings are called enteral feedings. An enteral feeding is a way of giving food and liquids through a tube directly into your child’s stomach or small bowel.<br></p> <figure class="asset-c-80"> <span class="asset-image-title">Feeding through gastrostomy tube (G tube)</span> <img src="https://assets.aboutkidshealth.ca/akhassets/G_tube_overview_MED_ILL_EN.jpg" alt="Child receiving formula through a G tube" /> <figcaption class="asset-image-caption">Some children have a medical condition which prevents them from eating or drinking enough by mouth. The G tube provides special food directly into the stomach (or small intestine) so they can receive proper nutrition.</figcaption> </figure> <div class="asset-2-up"> <figure> <span class="asset-image-title">Cook Mac-Loc G tube</span> <img src="https://assets.aboutkidshealth.ca/akhassets/G_tube_type_cook_mac_MED_ILL_EN.jpg" alt="Illustration of a Mac-Loc G tube" /> </figure> <figure> <span class="asset-image-title">Gastrojejunal tube (GJ tube)</span> <img src="https://assets.aboutkidshealth.ca/akhassets/G_tube_type_GJ_MED_ILL_EN.jpg" alt="Illustration of a gastrojejunal tube (GJ tube)" /> </figure> </div><p>If the tube enters into your child’s stomach, it is a gastrostomy tube (G tube). If the end of your child’s feeding tube is in your child’s small bowel, this tube is a gastrojejunal tube (GJ tube). </p><h2>Key points</h2><ul><li>If the tube enters into your child’s stomach, it is a gastrostomy tube (G tube). </li><li>If the end of your child’s feeding tube is in your child’s small bowel, this tube is a gastrojejunal tube (GJ tube).</li><li>Usually, a doctor who is specially trained to read X-rays and images (radiologist) will put in your child’s G tube.</li><li>While your child is having a feeding, they should sit quietly doing homework, watching TV or doing any other quiet activity.</li><li>Hold your baby for at least part of the time while your baby has their feeding.</li></ul><h2>How does your child get food through a feeding tube? </h2><p>Your child will get formula through the feeding tube:</p><ul><li>a volume of fluid given a few times a day, or</li><li>a small amount of fluid given each hour continuously</li></ul><h2>Cleaning your child’s feeding tube</h2><ul><li>Flush the G tube after all feedings and medicines with 5 to 10 mL of water. Use a 5-mL or 10-mL syringe to flush the tube. </li><li>Wash all equipment, including the feeding bag, with soap and water. </li><li>If your child’s feeding bag or infusion tubing is still not clean, wash with a mixture that is one part white vinegar and one part water. Make sure to rinse again with water.</li></ul><h2>How is your child’s feeding tube inserted? </h2><ul><li>Usually, a doctor who is specially trained to read <a href="/Article?contentid=1647&language=English">X-rays</a> and images (a radiologist) will put in your child’s G tube. This is done under <a href="/Article?contentid=1261&language=English">general anaesthesia</a>. </li><li>Sometimes a surgeon puts the feeding tube in. If a surgeon puts your child’s feeding tube in, your child may have a different kind of tube.</li></ul><h2>At SickKids</h2><p>Before your child gets their feeding tube, you must come to a class to learn all about your child’s feeding tube. We will tell you about coming to this class when we book the date for your child to get their feeding tube. This class also gives you a chance to ask questions. By the time your child is ready to go home, you should feel comfortable with all of your child’s care.</p>
G/GJ tubes: Corflo PEG J tubeGG/GJ tubes: Corflo PEG J tubeG/GJ tubes: Corflo PEG J tubeEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Abdomen;Stomach;Small IntestineDigestive systemProceduresAdult (19+) CaregiversNA2019-05-10T04:00:00ZTharini Paramananthan, RN, BScN, MScN;Silvana Oppedisano, MN, RN(EC);Holly Norgrove, RN, BScN​;Joao Amaral, MD;Holly Norgrove, RN, BScN8.4000000000000065.40000000000001410.00000000000Health (A-Z) - ProcedureHealth A-Z<p>A Corflo PEG Jejunal (J) tube is a type of feeding tube. Find out how it is inserted, how to care for it and what to do if it is accidentally pulled out.</p><p>A Corflo PEG J tube is a type of feeding tube that provides fluids, nutrition, and medication directly into the small intestine (jejunum). The Corflo PEG J tube is made up of two separate tubes: a Corflo PEG tube (a type of G tube) and a Silastic (silicon rubber) tube. The Silastic tube is threaded through the Corflo PEG tube, into the jejunum.</p><h2>Key points</h2><ul><li>A Corflo PEG J tube provides liquid nutrition, medication and other fluids directly into the small intestine (jejunum). It is made from a Corflo PEG tube that is in the stomach and a silicon rubber tube that is advanced through it into the jejunum.</li><li>The tube is placed by an interventional radiologist. Your child will be given a general anaesthetic before the primary tube insertion procedure.</li><li>If your child’s silicon rubber J tube has been pulled out or moved out of place, contact the G tube specialist or take your child to the Emergency Department.</li></ul><h2>When to seek medical attention</h2><p>Contact your G tube specialist or go to the nearest Emergency Department if you notice any of the following signs and symptoms:</p><ul><li>Your child's stoma site appears infected with redness, edema (swelling) and odorous discharge.</li><li>There is granulation tissue at the stoma, which is pink to bright red, bloody, raw, moist, oozing yellow sticky discharge and/or painful.</li><li>The stoma site is leaking intestinal or stomach contents and /or formula.</li><li>Your child experiences abdominal pain, distension, discomfort, vomiting and/or other signs of feeding intolerance.</li><li>Your child has signs of respiratory distress (i.e. higher breathing rate or difficulty breathing).</li><li>The tube appears to be damaged, broken, or dislodged.</li></ul><h2>Inserting the Corflo PEG J tube</h2> <figure> <span class="asset-image-title">Corflo PEG J tube</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Corflo_Jtube_full_labels.jpg" alt="Parts of the Corflo PEG J Tube" /> </figure> <h3>Corflo PEG tube insertion — G tube</h3><p>The <a href="/Article?contentid=2536&language=English">Corflo PEG tube</a> is placed by an interventional radiologist using image guidance. </p><p>The interventional radiologist will create an opening in your child's tummy (abdomen) called a stoma. The tunnel from the outside of the body into the stomach is called the tract.</p><p>The Corflo PEG tube will be placed through the mouth, into the stomach and out through the stoma. There is a round bolster on the inside of the stomach that helps prevent the tube from being pulled out. A fixation device on the outside of the stomach helps prevent the tube from moving too far into the stomach. The fixation device will be either a T-bar/crossbar or a white elbow fixation. The Corflo PEG tube ends in the stomach.</p><h3>Silastic tube insertion — J tube</h3><p>A Silastic tube is then used as a J tube. It is advanced through the Corflo PEG tube to access the jejunum. The tube passes through the Corflo PEG tube and continues through the stomach, duodenum and the first part of the small intestine. The tip of the Silastic tube ends in the first part of the small intestine, called the jejunum.</p><p>Together, the Corflo PEG tube and the Silastic J tube make up the Corflo PEG J tube.</p><h2>At SickKids</h2><h3>G Tube Resource Nurse Contact info </h3><p>Phone 416-813-7177 </p><p>Email: g.tubenurse@sickkids.ca </p><p>On weekend/afterhours, your child may need to come to the Emergency Department for an alternate method of feed/fluids/medications administration.</p>https://assets.aboutkidshealth.ca/akhassets/Corflo_Jtube_full_labels.jpg
G/GJ tubes: Corflo PEG tubeGG/GJ tubes: Corflo PEG tubeG/GJ tubes: Corflo PEG tubeEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Abdomen;StomachDigestive systemProceduresAdult (19+) CaregiversNA2019-05-10T04:00:00ZTharini Paramananthan, RN, BScN, MScN;Silvana Oppedisano, MN, RN(EC)​​;Holly Norgrove, RN, BScN9.1000000000000059.1000000000000790.000000000000Health (A-Z) - ProcedureHealth A-Z<p>A Corflo PEG tube is a type of feeding tube. Discover how to care for your child's tube and what to do if it's accidentally pulled out.</p><figure><img src="https://assets.aboutkidshealth.ca/AKHAssets/PMD_corpak_corflo_PEG_G_tube_0_EN.jpg" alt="" /> </figure> <p>Gastrostomy tubes (G tubes) are feeding devices that provide liquid nutrition, medication and other fluids directly into the stomach. G tubes are placed through a surgical opening in your child's tummy (abdomen) called a stoma. The tunnel from the outside into the stomach is called the tract. A Corflo™ PEG tube is one type of G tube.</p><div class="pdf-page-break"></div><h2>Key points</h2><ul><li>A Corflo PEG tube provides liquid nutrition, medication and other fluids directly into the stomach.</li><li>The tube will be placed by an interventional radiologist. Your child will be given a general anaesthetic before the tube insertion procedure.</li><li>The Corlock Corport Y-adaptor, attached to the end of your child's feeding tube, allows access for tube feeding, fluids, and medication administration. It can be changed if needed.</li><li>If your child's tube is accidentally pulled out, insert a Foley catheter and contact your child's G tube specialist.​​​​​​​​​​​​​</li></ul><h2>Inserting the Corflo PEG tube</h2><div class="asset-2-up"> <figure><span class="asset-image-title"> Elbow fixation device</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/PMD_corpak_corflo_PEG_G_tube_01_EN.jpg" alt="Elbow fixation device with round bolster" /> </figure> <figure> <span class="asset-image-title">T-bar/crossbar fixation device</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/PMD_corpak_corflo_PEG_G_tube_02_EN.jpg" alt="Y-adaptor, crossbar and round bolster on a T-bar/crossbar fixation device" /></figure></div> <p>The Corflo PEG tube is placed by an interventional radiologist using image guidance. There is a round bolster on the inside of the stomach that helps prevent the tube from being pulled out. A fixation device on the outside of the stomach helps prevent the tube from moving into the stomach. The fixation device will be either a T-bar/crossbar or a white elbow fixation.</p><h2>At SickKids</h2><p>For SickKids patients, to replace a Corflo PEG tube, an appointment must be made in IGT. Contact the G Tube Resource Nurse to schedule an appointment.</p><h3>G Tube Resource Nurse contact info: </h3><p>Phone 416-813-7177 </p><p>g.tubenurse@sickkids.ca </p><p>On the weekend/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.</p>https://assets.aboutkidshealth.ca/AKHAssets/PMD_corpak_corflo_PEG_G_tube_01_EN.jpg
G/GJ tubes: Granulation tissueGG/GJ tubes: Granulation tissueG/GJ tubes: Granulation tissueEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Stomach;Abdomen;Small IntestineDigestive systemNon-drug treatmentAdult (19+) CaregiversNA2019-05-22T04:00:00ZTharini Paramananthan, RN, BScN, MScN;Silvana Oppedisano, MN, RN(EC);Holly Norgrove, RN, BScN​6.7000000000000067.4000000000000648.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn what granulation tissue is, why it forms and how to treat it if you notice it around your child's stoma.</p><p>Granulation tissue (also known as hypergranulation tissue) is the new tissue that forms when a wound is healing. It is also the extra tissue that grows around the feeding tube. It is the most common skin issue that occurs in children with <a href="/article?contentid=2536&language=English">G or GJ tubes</a>.<br></p><h2>Key points</h2><ul><li>Granulation tissue is the new tissue that forms when a wound is healing, and it’s also the extra tissue that forms around the feeding tube.</li><li>Granulation tissue typically looks pink to dark red; it appears open, shiny or wet; bleeds easily; appears puffy; can be painful.</li><li>Causes of granulation tissue include too much movement of the feeding tube, the stoma is wet, too much pressure on the stoma, trauma to the stoma, or an infection.</li><li>To prevent granulation tissue from forming, tape the feeding tube to the skin to prevent movement, make sure your child’s tube is the correct size, keep the stoma clean and dry, and prevent infections.</li><li>Granulation tissue can be treated with hypertonic salt water soaks, hydrocortisone cream, antimicrobial foam dressing or silver nitrate.</li></ul><h2>Signs of granulation tissue</h2><p>Granulation tissue generally appears as follows. </p><ul><li>Usually pink to dark red tissue, but it does not spread like an infection</li><li>Can appear open, wet looking or shiny</li><li>Bleeds easily</li><li>Appears bubbly and puffy</li><li>Can be painful</li></ul><h2>Causes of granulation tissue</h2><p>Granulation tissue can form for several different reasons.</p><ul><li>The feeding tube moves in and out of stoma. This can happen when a <a href="/article?contentid=2908&language=English">low-profile tube</a> is incorrectly sized</li><li>The stoma is wet. This coud be from excessive leaking or because the stoma is covered with a dressing, so it is not able to dry completely</li><li>There is too much pressure on the stoma. This may be because a low-profile tube is too tight, the tube has been accidentally pulled out or there was a recent tube change</li><li>There has been trauma to the stoma</li><li>Granulation tissue may form when there is an <a href="/article?contentid=2906&language=English">infection</a>. Granulation tissue is <strong>not </strong>an infection</li><li>The stoma will usually look worse and granulation tissue may form when a child is sick, for example with a rerspiratory illness or gastroenteritis, of if they are recovering from surgery</li></ul><h2>Treatment of granulation tissue</h2><ul><li>Apply <a href="/article?contentid=2907&language=English">hypertonic salt water soaks</a> up to four times a day.</li><li>Use hydrocortisone cream for a week to help with skin inflammation. Hydrocortisone 0.5% cream is available over the counter. You may be able to find hydrocortisone 1% cream over the counter but usually it is only available by prescription. Hydrocortisone is a short-term treatment so only use it for one week at time.</li><li>Use an antimicrobial foam dressing on the stoma. At SickKids, you can purchase AMD foam dressing from the Specialty Food Shop.</li><li>Use <a href="/article?contentid=2909&language=English">silver nitrate</a> to burn away the extra tissue and promote healing. You will be taught in the clinic first and then you can continue to apply the silver nitrate at home.</li><li>Silver dressings may also help manage granulation tissue.</li></ul><p>Speak to your G tube specialist if the stoma does not improve or if the granulation tissue gets worse.</p><h2>At SickKids</h2><p>If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.</p><h3>G Tube Resource Nurse contact info:</h3><p>Phone: 416-813-7177</p><p>Email: g.tubenurse@sickkids.ca</p><p>On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.</p>
G/GJ tubes: Hypertonic salt water soaksGG/GJ tubes: Hypertonic salt water soaksG/GJ tubes: Hypertonic salt water soaksEnglishGastrointestinal;OtherAdult (19+);Teen (13-18 years)Abdomen;Stomach;Small IntestineDigestive systemNon-drug treatmentAdult (19+) CaregiversNA2019-05-10T04:00:00ZHolly Norgrove, RN, BScN5.0000000000000084.5000000000000470.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn about hypertonic salt water soaks, when they can be used and how to make your own.<br></p><p>A hypertonic salt water soak is a piece of gauze that has been saturated with extra salty water.</p><p>If you are having problems with your child’s stoma, such as <a href="/Article?contentid=2906&language=English">redness or swelling</a>, or if there is already <a href="/Article?contentid=3019&language=English">granulation tissue</a> (i.e., new tissue that forms when a wound is healing), applying hypertonic salt water soaks to the area may help.</p><p>The extra salt in a hypertonic salt water soak helps to pull moisture away from the stoma, dry the skin, and reduce the swelling and redness. This is the first step to prevent or treat granulation tissue.</p><p>Some people refer to these as “saline soaks,” but this is not correct because saline solution is not salty enough. If you see saline in the store for purchase, don’t buy it — it will not have the correct salt concentration.</p><p>The best way to obtain a hypertonic salt water soak is to make your own.</p><h2>Key points</h2><ul><li>A hypertonic salt water soak is a piece of gauze that has been saturated with extra salty water.</li><li>Hypertonic salt water soaks may help reduce redness and swelling, and help with granulation tissue.</li><li>Do not use saline solution as the salt concentration is too low.</li><li>You can apply soaks up to four times a day when your child is having problems with their stoma.<br></li></ul> <h2>Making your own hypertonic salt water soak</h2><p>Here’s how to make your own hypertonic water soak:</p><ol class="akh-steps"><li>Mix 2 teaspoons of table salt with 1 cup of warm water in a clean cup or bowl until the salt dissolves.</li> <li> <figure><img src="https://assets.aboutkidshealth.ca/AKHAssets/G_tube_dressing_application_01_MED_ILL_EN.jpg" alt="Cutting a y-shape into a square of gauze" /> </figure> <p>Cut the shape of a “Y” into a piece of gauze.</p></li><li>Soak the piece of gauze in the salt water. </li><li>Place the wet gauze on the skin around the feeding tube and leave it there until the gauze cools. This will take about 5 to 10 minutes. Do not let the gauze dry. If the gauze is too dry, it may pull at the stoma and cause pain when being removed.</li><li>Once the gauze is cool, remove it and leave the stoma open to the air to dry. You do not need to wash the salt off the skin afterward.</li></ol><p>You can apply soaks up to four times per day when your child is having problems with their stoma.</p><p>If there are signs of infection such as redness, swelling or pain at the site, call or visit your doctor for assessment.</p><h2>At SickKids</h2><p>If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.</p><h3>G Tube Resource Nurse contact info:</h3><p>Phone 416-813-7177</p><p>g.tubenurse@sickkids.ca</p><p>On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.</p>https://assets.aboutkidshealth.ca/AKHAssets/G_tube_dressing_application_01_MED_ILL_EN.jpg
G/GJ tubes: Making the decision to get a feeding tubeGG/GJ tubes: Making the decision to get a feeding tubeG/GJ tubes: Making the decision to get a feeding tubeEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)Abdomen;Small Intestine;StomachDigestive systemProceduresAdult (19+) CaregiversNA2018-03-12T04:00:00ZSilvana Oppedisano, RN(EC), MN;Holly Norgrove, RN, BScN;Mary Alicia Millar, RN;Niraj Mistry, MD6.2000000000000075.30000000000001401.00000000000Flat ContentHealth A-Z<p>Making the decision to get a feeding tube for your child is a personal and difficult choice. This page will provide you with information to help you decide if a feeding tube is the right choice for your child and your family.</p><div class="asset-video"> <iframe src="https://www.youtube.com/embed/ySWq2pJI1NE?rel=0" frameborder="0"></iframe> </div><h2>What are G and GJ tubes?<br></h2><p>Gastrostomy tubes (G tubes) and gastrojejunostomy tubes (GJ tubes) are feeding devices. A G tube gives liquid nutrition, medication and other fluids directly into the stomach. A GJ tube gives liquid nutrition, medication and other fluids directly into the small intestine (the jejunum). Both G tubes and GJ tubes are placed through a small opening in the stomach. This opening is called a "stoma." The tunnel from the outside of the body to the stomach is called the "tract."<br></p><h2>Key points</h2><ul> <li>The most common reason a child may need a feeding tube is to get the nutrition that they need to grow or get better if they are ill, because they cannot eat and drink enough or at all on their own.</li><li>It is your decision as the parent or caregiver to get a feeding tube for your child. Make sure you understand what you will need to do to care for your child’s tube, and whether it is the right decision for you and your family.</li><li>The G tube team will provide support and education to parents and caregivers who choose to proceed with a G or GJ tube.</li></ul>
G/GJ tubes: Managing a leaking stomaGG/GJ tubes: Managing a leaking stomaG/GJ tubes: Managing a leaking stomaEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Stomach;Abdomen;Small IntestineDigestive systemNon-drug treatmentAdult (19+) CaregiversNA2018-03-26T04:00:00ZTharini Paramananthan, RN, BScN, MScN;Silvana Oppedisano, MN, RN(EC);Holly Norgrove, RN, BScN​6.8000000000000071.2000000000000633.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn the difference between discharge and stoma leakage, and what to do if your child's stoma is leaking.</p><p>It is normal for the stoma to produce small amounts of thin, yellow-green discharge that gets crusty and sticks to the tube. This is not considered stoma leakage.</p><p>You may occasionally see small amounts of stomach contents, water or formula leaking from the stoma. This is especially common after tube changes.</p><p>If your child has a cold or another infection, their stoma may look redder or may leak more than usual. This should get better once your child is feeling better. </p><p>While small amounts of leakage are okay, too much leakage can cause <a href="/article?contentid=3018&language=English">skin irritation</a>, skin breakdown and enlargement of the stoma.<br></p><h2>Key points</h2><ul><li>It is normal for the stoma to produce small amounts of thin, yellow-green discharge that sticks to the tube.</li><li>Small amounts of stomach contents, water or formula leaking from the stoma are common but too much leakage can cause skin irritation, breakdown and enlargement of the stoma.</li><li>Leakage may be caused by tube movement, granulation tissue, a cracked tube, infection, and conditions that increase pressure in the stomach.</li><li>Prevent leakage by limiting movement of the stoma.</li></ul><h2>Causes of leakage</h2><p>Leakage can be caused by:</p><ul><li>Too much movement of the tube</li><li><a href="/article?contentid=3019&language=English">Granulation tissue</a></li><li>A cracked tube (you will see formula leaking from the stoma)</li><li><a href="/article?contentid=2906&language=English">Infection</a></li> <li>Conditions that increase pressure in the stomach, such as <a href="/article?contentid=817&language=English">GERD</a>, <a href="/article?contentid=6&language=English">constipation</a>, <a href="/article?contentid=822&language=English">gas</a>, poor digestion, and chronic <a href="/article?contentid=774&language=English">coughing</a> or <a href="/article?contentid=746&language=English">vomiting</a></li></ul><h2>When to see a doctor</h2><p>If your child’s leakage does not stop or gets worse, contact your child's health-care team or the G tube team. If the leakage becomes severe, contact the G tube team.</p><p>Speak to your child’s health-care team if your child experiences leaking and has one or more conditions that increase pressure in the stomach, such as GERD, constipation, gas, poor digestion, and chronic coughing or vomiting.</p> <h2>At SickKids</h2><p>If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.</p><h3>G Tube Resource Nurse contact info:</h3><p>Phone: 416-813-7177</p><p>Pager: 416-377-1271<br></p><p>Email: g.tubenurse@sickkids.ca</p><p>On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.</p>
G/GJ tubes: Mic-Key low-profile GJ tubeGG/GJ tubes: Mic-Key low-profile GJ tubeG/GJ tubes: Mic-Key low-profile GJ tubeEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Stomach;Small IntestineDigestive systemProceduresAdult (19+) CaregiversNA2019-05-22T04:00:00ZTharini Paramananthan, RN, BScN, MScN;Silvana Oppedisano, MN, RN(EC)​​;Holly Norgrove, RN, BSCN7.8000000000000066.40000000000001161.00000000000Health (A-Z) - ProcedureHealth A-Z<p>A low-profile GJ tube is a type of feeding tube. Learn how to care for your child's GJ tube and how to give feeds and medication.</p><figure> <span class="asset-image-title">Low-profile GJ tube with feeding extension set</span> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PMD_j_tube_mic_key_01_EN.jpg" alt="" /> </figure> <p>A low-profile GJ tube is a type of feeding tube that provides fluids, nutrition and medications directly to the small intestine (jejunum). It is called "low-profile" because it sits close to the skin and is very discreet. Low-profile GJ tubes are placed by an interventional radiologist using image guidance.<br></p><p>A Mic-Key™ low-profile GJ tube is not used for primary tube insertion, instead it is a transition tube. This means that your child will have had a different type of feeding tube before transitioning to the low-profile GJ tube.</p><p>The low-profile GJ tube is placed through an opening in your child's abdomen called a stoma. The tunnel from the outside through the stoma is called the tract.<br></p><h2>Key points</h2><ul><li>A low-profile GJ tube is a type of feeding tube that provides fluids, nutrition, and medication directly to the small intestine (jejunum). It is different than a surgical J tube, which is also inserted into the small intestine.</li><li>The feeding extension set should be cleaned between each use. It should be replaced as needed.</li><li>Check the volume of water in the balloon at least once per week.</li><li>Keep the stoma and surrounding skin clean and dry, and check for signs of infection, irritation, granulation tissue or leakage.</li><li>Contact the G tube team if the stoma site is infected or leaking, your child has abdominal pain or signs of respiratory distress, or if the tube is damaged.</li></ul><h2>When to seek medical attention</h2><p>Contact the G tube specialist if you notice any of the following signs and symptoms:</p><ul><li>Your child's stoma site appears infected with redness, edema (swelling) and odorous discharge.</li><li>There is granulation tissue, which is pink to bright red, bloody, raw, moist, oozing yellow sticky discharge and/or painful.</li><li>The stoma site is leaking intestinal or stomach contents and /or formula.</li><li>Your child experiences abdominal pain, distension, discomfort, vomiting and/or other signs of feeding intolerance.</li><li>Your child has signs of respiratory distress (i.e. higher breathing rate or difficulty breathing).</li><li>The tube appears to be damaged, broken, or dislodged.</li></ul><h2>If the tube has moved into the stomach</h2><p>If the Mic-Key low-profile GJ tube has moved out of the small intestine and into the stomach, your child may experience:</p><ul><li>increased vomiting</li><li>vomiting formula</li><li>gagging and retching</li><li>abdominal discomfort or pain</li><li>bloated stomach</li><li>diarrhea</li></ul><p>The position of the tip of GJ tube will need to be confirmed by an interventional radiologist using image guidance. Do not use the tube for feeding until the tube position is confirmed.</p><h3>Intussusception </h3><p> <a href="/Article?contentid=958&language=English">Intussusception</a> may occur around the tube. Intussusception refers to when one part of the small bowel slides into the next part. This may lead to a bowel obstruction at the tip of the GJ tube. Large GJ tubes and/or normal movements of the bowels may cause intussusception. </p><p>A child with intussusception will experience:</p><ul><li>discomfort and feeding intolerance (vomiting when fed)</li><li>vomiting bile (green fluid)</li><li>diarrhea or blood in the stool</li></ul><p>If your child’s tube has intussuscepted, contact your G tube specialist during business hours. After hours, on weekends or on holidays, take your child to the Emergency Department.</p><h2>Giving feeds, liquids and medication through the low-profile GJ tube</h2><p>Your child's tube feeds are to remain the same as with previous GJ tube exchanges.</p><p>A Mic-Key low-profile GJ tube extension set needs to be attached to the feeding port to administer feeds and medications. A slip-tip syringe can be attached directly to the feeding port; however, this is not recommended as the one-way valve can break with frequent access. The one-way valve is built inside the GJ tube and prevents the stomach content from flowing back out through the tube.</p><p>It is important to clean the extension set between each use and remove it from the low-profile GJ tube when it is not in use. The low-profile GJ tube's extension set should be replaced as needed (i.e. broken, rigid, stained).</p><p>Flush the low-profile GJ tube with at least 5 to 10 mL of water before and after each feed and medication dose, and every four hours during continuous feeds. This helps to prevent the low-profile GJ tube from becoming blo​cked. You may use <a href="/Article?contentid=3039&language=English">pancreatic enzymes</a> to unblock a low-profile GJ tube. This can be done at home.</p><p>For more information on what to do if your child's low-profile GJ tube is blocked, please see "<a href="/Article?contentid=3039&language=English">What to do if your child's feeding tube is blocked</a>."</p><h2>At SickKids</h2><p>If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.</p><h3>G Tube Resource Nurse contact info:</h3><p>Phone 416-813-7177</p><p>g.tubenurse@sickkids.ca</p><p>On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.</p>https://assets.aboutkidshealth.ca/AKHAssets/PMD_j_tube_mic_key_01_EN.jpg
G/GJ tubes: Permanent feeding tube removalGG/GJ tubes: Permanent feeding tube removalG/GJ tubes: Permanent feeding tube removalEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Stomach;Abdomen;Small IntestineDigestive systemProceduresAdult (19+) CaregiversNA2018-12-20T05:00:00ZHolly Norgrove, RN, BScN7.2000000000000073.30000000000001114.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn how you can help your child prepare for the removal of their G or GJ tube, how to remove the tube at home and care for your child's tract after the feeding tube removal.</p><p>A G or GJ tube may be a permanent way to feed some children. For others, it is temporary and may be removed in the future. You and your child’s health-care team will decide when to remove the feeding tube according to your child’s history.</p><h2>Key points</h2><ul><li>Your child must be able to take all their nutrition, fluids, and medications by mouth for at least two to three months before their G tube or GJ tube is removed.</li><li>If your child is scheduled for surgery or a procedure that may affect their ability to take nutrition, fluids, or medication by mouth, you should consider delaying the removal of the tube.</li><li>If your child has a balloon-type tube, you may remove the tube yourself.</li><li>Once the tube is removed, stomach contents will leak from the stoma and will continue to do so until the tract closes completely.</li><li>It may take more than two weeks for the feeding tube tract to heal and close, and it will leak during this time.</li><li>If the stoma is still leaking two weeks after the tube has been removed, call your G tube specialist for further assessment.</li><li>After tube removal, it is important to wash the stoma with soap and water daily to prevent infection. Do not submerge your child in water until the feeding tube tract has stopped leaking. </li></ul><h2>When to see a doctor</h2><p>Always watch for signs of <a href="/Article?contentid=2906&language=English">infection</a>, such as redness, swelling, pain, and fever. See your family doctor or paediatrician if your child is experiencing these symptoms.</p><p>If the stoma is still leaking two weeks after the tube has been removed, call your G tube specialist (at SickKids this is the G Tube Resource Nurse) for further assessment. Your child may need stitches to close the tract.</p><h2>Tube removal</h2><p>If your child has a <a href="/Article?contentid=2908&language=English">balloon-type tube</a>, you may remove the tube yourself or have your child’s doctor remove it. There are several different balloon-type tubes:</p><ul><li>Halyard Mic-G or Kangaroo G tube</li><li>Low-profile G or GJ tube (also known as a “button” tube), such as a Mic-Key, Nutriport, and AMT Mini One</li><li>Foley catheter</li></ul><p>The balloon will need to be emptied before the tube is removed. If possible, remove your child’s feeding tube before bed time. This will allow the stoma to heal for several hours without feedings and with minimal movement from your child while they sleep.</p><p>Once the tube is removed, stomach contents will leak from the stoma and will continue to do so until the tract closes completely.</p><h3>Removing a Mic-G, Kangaroo or Foley catheter</h3><p>Insert a slip-tip syringe into the hard plastic port and withdraw all the water from the balloon. Remove the tube. You may need to pull with a small amount of force to dislodge the tube.</p><h3>Removing a low-profile G or GJ tube</h3><p>Insert a slip-tip syringe into the balloon port – marked “BAL” – and withdraw all the water from the balloon. Remove the tube. You may need to pull with a small amount of force to dislodge the tube.</p><h2>After the feeding tube is permanently removed</h2><h3>Stoma and feeding tube tract healing process</h3><p>Your child’s tract will start to heal and close within hours of removing the feeding tube but it can take more than two weeks to close completely. It will leak during this time. After the tract closes, your child will have a small scar that may look like a dimple or a healed earring hole.</p><h3>How to protect your child’s skin</h3><p>To protect the skin from the acidic stomach contents, apply a zinc oxide barrier cream around the stoma and continue to apply a gauze dressing over the site, secured to the tummy with tape as long as it leaks. This dressing should be changed daily or when it is soaked. Do not be alarmed if you see some of the food and drink your child is eating on the gauze. This is normal. There are no food or drink restrictions for your child while their tract is healing. They can continue to eat and drink all of their regular food and beverages by mouth.</p><h3>Keeping the stoma clean</h3><p>Do not submerge your child in water until the tract is fully closed. This means no baths or swimming until there is no more leakage. Sponge baths and showers are okay during this time.</p><p>It is important to wash the stoma with soap and water daily to prevent <a href="/Article?contentid=2906&language=English">infection</a>. Be gentle; do not rub the stoma. Allow the soap, shampoo and water to lightly wash over the site.</p><p>Once the leaking stops, the stoma will scab over and your child will no longer need a gauze dressing.</p><h2>How long has it been since your child last used their feeding tube?</h2><p>Has your child taken all of their nutrition (food or formula), fluids (water), and medications by mouth for at least three months? Has your child used their feeding tube in the last three months? It is important to answer these questions to prove that:</p><ul><li>your child is no longer dependent upon their G or GJ tube</li><li>your child can take all their nutrition, fluids, and medications by mouth, even when they are sick </li></ul><p>Two to three months without using the G or GJ tube is generally enough time to know whether your child will continue to take everything by mouth in the future. However, this is only a general guideline and you should discuss your child’s personal history with their health-care team.</p><p>Many medications that have previously been given through the G tube or GJ tube taste very bitter. It is important to consider the taste of a medication and how well it will be tolerated by your child when switching to medications by mouth. There may be alternative medications that taste better. Speak to your child’s health-care provider about medication options.</p><h2>Some medical procedures may affect your child’s ability to feed</h2><p>Is your child scheduled for a major surgery or procedure that may affect their ability to take nutrition, fluids, or medications by mouth? If the answer to this question is 'yes', then it may be better to leave your child’s feeding tube in until your child recovers from this procedure. Your child’s health-care provider and the surgeon performing the procedure will be able to help you decide.</p><p>If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.</p><h3>G Tube Resource Nurse contact info:</h3><p>Phone: 416-813-7177</p><p>Email: g.tubenurse@sickkids.ca</p>
G/GJ tubes: Preventing and managing infectionGG/GJ tubes: Preventing and managing infectionG/GJ tubes: Preventing and managing infectionEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Abdomen;Stomach;Small IntestineDigestive systemNon-drug treatmentAdult (19+) CaregiversNA2019-05-10T04:00:00ZTharini Paramananthan, RN, BScN, MScN;Silvana Oppedisano, MN, RN(EC);Holly Norgrove, RN, BScN​6.4000000000000066.8000000000000588.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn how to keep your child's stoma healthy, and what to do if the stoma or surrounding area become infected.</p><h2>How to keep a healthy stoma</h2><p>To keep your child’s stoma healthy, you should:</p><ul><li><a href="/article?contentid=2536&language=English">Wash the stoma</a> daily with soap and water.</li><li>Allow the stoma to be open to the air.</li><li>Secure the tube well.</li><li>Avoid too much movement of the tube in the tract.</li><li>Address stoma leakage as soon as possible.</li><li>For a <a href="/article?contentid=2908&language=English">low profile tube</a>:</li><ul><li>Make sure your child’s tube is a proper fit.</li><li>Check the volume of the tube’s balloon weekly.</li></ul></ul><p>Despite your best efforts to keep your child’s stoma and the skin around it dry and clean, you may encounter some stoma issues with your child’s G or GJ tube, including infection.</p><h2>Key points</h2><ul><li>Signs of infection include increased redness; change in colour, thickness and smell of discharge; swelling around feeding tube; abscess formation; pinpoint rash; pain; fever.</li><li>Always wash your hands before handling the feeding tube and the stoma.</li><li>Mild infections may be treated with over-the-counter antibiotics, while a prescription may be needed for more severe infections.</li></ul><h2>Signs of infection</h2><p>Your child may have a stoma infection if you see any of these signs:</p><ul><li>Increased and/or spreading redness of the skin around the feeding tube (it may look “angry”)</li><li>A change in the colour and the thickness of the <a href="/article?contentid=3020&language=English">drainage leaking</a> around the feeding tube </li><li>Foul smelling discharge from the stoma</li><li>Swelling and/or a feeling of warmth around your child’s feeding tube</li><li> <a href="/article?contentid=792&language=English">Abscess</a> formation (collection of pus under the skin)</li><li>Pinpoint rash (may be due to a fungus)</li><li>Pain</li><li> <a href="/article?contentid=30&language=English">Fever</a></li></ul><p>It is important to note that granulation tissue is not the same thing as infection. Increased granulation tissue may happen when there is a stoma infection, along with the other symptoms described above. But, when there is only granulation tissue present, this does not mean the stoma is infected. Granulation tissue does not need antibiotic treatment. Learn more about <a href="/Article?contentid=3019&language=English">granulation tissue</a>.</p><h2>Treatment of infection</h2><p>For mild infections with a small increase in redness and discharge, you may apply an over-the-counter antibiotic ointment or cream, such as Polysporin, to the stoma.</p><p>If your child has any other signs of infection (spreading redness, fever and pain), have your family doctor or paediatrician look at the stoma and prescribe stronger antibiotics if necessary.</p><p>Prescription antibiotics that are used to treat the most common stoma infections are:</p><ol><li>A topical antibiotic such as fucidic acid. This is a cream that you will apply directly to the stoma.</li><li>An oral antibiotic such as <a href="/article?contentid=96&language=English">cephalexin</a>. This is a medication that your child will take by mouth or through the tube.</li></ol> <p>If the antibiotics are not working, your child will be sent for a swab of the stoma and may need to change the type of antibiotics that are being used.</p><p>An <a href="/article?contentid=1290&language=English">ultrasound</a> may be necessary to diagnose an abscess.<br></p><h2>At SickKids</h2><p>If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.</p><h3>G Tube Resource Nurse contact info:</h3><p>Phone: 416-813-7177</p><p>Email: g.tubenurse@sickkids.ca</p><p>On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.</p>
G/GJ tubes: Sensitivity and irritationGG/GJ tubes: Sensitivity and irritationG/GJ tubes: Sensitivity and irritationEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Stomach;Abdomen;Small IntestineDigestive systemNon-drug treatmentAdult (19+) CaregiversNA2018-03-26T04:00:00ZTharini Paramananthan, RN, BScN, MScN;Silvana Oppedisano, MN, RN(EC);Holly Norgrove, RN, BScN​8.3000000000000063.2000000000000591.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn how to prevent sensitivity or irritation around your child's stoma, and what to do if irritation does occur.</p><h2>How to keep a healthy stoma</h2><p>To keep your child’s stoma healthy, you should:</p><ul><li><a href="/article?contentid=2536&language=English">Wash</a> the stoma daily with soap and water.</li><li>Allow the stoma to be open to the air.</li><li>Secure the tube well.</li><li>Avoid too much movement of the tube in the tract.</li><li>Address stoma leakage as soon as possible.</li><li>For a <a href="/article?contentid=2908&language=English">low profile tube</a>:</li><ul><li>Make sure your child’s tube is a proper fit.</li><li>Check the volume of the tube’s balloon weekly.</li></ul></ul><p>Despite your best efforts to keep your child’s stoma and the skin around it dry and clean, you may encounter some stoma issues with your child’s G or GJ tube, including sensitivity and irritation.</p><h2>Key points</h2><ul><li>Your child’s skin may be sensitive or irritated if it is red, scaly, dry or itchy.</li><li>Common irritants include a sensitivity to the tape that holds the G or GJ tube to the skin, acidic stomach contents leaking from the stoma, feeding tube movement, and infection.</li><li>Removing the cause of the skin irritation will help your child’s skin get better.</li></ul><h2>Signs of sensitivity and irritation</h2><p>Some children have sensitive skin and may be more likely to experience irritation around the stoma than other children. Your child's skin may be irritated if you notice:</p><ul><li>break outs around the stoma (tiny bumps or pimples)</li><li>rashes</li><li>blotches</li><li>the skin becomes itchy when exposed to an irritant</li></ul><h2>Causes of sensitivity or irritation</h2><p>Your child’s skin may get sore and red because it touches an irritant. The following are common irritants:</p><ul><li>A sensitivity or allergy to the tape that holds the G or GJ tube to the skin of the stomach</li><li>Acidic stomach contents leaking onto your child’s skin around the feeding tube</li><li>The feeding tube moving around too much in the stoma</li><li>The plastic of the feeding tube — this is rare.</li></ul><h2>Protection of your child’s skin</h2><p>The most effective way to treat irritation and sensitivity around the stoma is to make sure your child's skin is protected from irritants.</p><ul><li>If the irritation is caused by the tape used to secure your child’s tube to their tummy, change the type of tape you use.</li><li>Use a barrier tape. This is a layer of soft, spongy, flexible, waterproof tape that acts like a second skin. Stick the original tape that may be causing the sensitivity on top of the barrier tape to prevent it from hurting your child’s skin.</li><li>Use unscented skin care and laundry products geared toward sensitive skin. Look out for changes to your child’s skin if you change laundry products.</li><li>If you have trouble taking the tape off your child’s skin, put a wet face cloth over the tape for a few minutes before removing it or use adhesive-remover products (available at your local pharmacy).</li><li>If the irritation is caused by <a href="/article?contentid=3020&language=English">stoma leakage</a>, use barrier creams such as zinc oxide or other diaper rash creams to protect the skin around the stoma.</li><li>To help with skin inflammation, <a href="/article?contentid=790&language=English">dryness</a> and/or rash, Hydrocortisone 0.5% cream is available over-the counter at your local pharmacy. A stronger concentration (1%) can be prescribed.</li><li>You may use a foam or G tube pad in-between the stoma.</li></ul><h2>At SickKids</h2><p>If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.</p><p> <strong>G Tube Resource Nurse contact info:</strong></p><p>Phone: 416-813-7177</p><p>Email: g.tubenurse@sickkids.ca</p><p>On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.</p>
G/GJ tubes: Using silver nitrate to treat granulation tissueGG/GJ tubes: Using silver nitrate to treat granulation tissueG/GJ tubes: Using silver nitrate to treat granulation tissueEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Abdomen;Stomach;Small IntestineDigestive systemNon-drug treatmentAdult (19+) CaregiversNA2015-09-07T04:00:00ZHolly Norgrove, RN, BScN7.4000000000000063.6000000000000803.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Silver nitrate can be used to help remove granulation tissue around your child's stoma. Learn more about silver nitrate and how to apply it to your child.<br></p><p>If your child has issues with <a href="/Article?contentid=3019&language=English">persistent granulation tissue</a> around the stoma (the opening in the stomach), your health care team may suggest applying silver nitrate to the area. Your first application should be done in a clinic or your doctor’s office, but you can continue the treatment on your own at home.<br></p><h2>Key points</h2><ul><li>Silver nitrate sticks are used to help treat and remove granulation tissue around your child’s stoma.</li><li>Do not use silver nitrate if your child has a sensitivity to silver.</li><li>Applying silver nitrate may be painful. Giving your child acetaminophen or ibuprofen before application may help your child stay comfortable.</li><li>Always protect your child’s healthy skin with a barrier cream before applying silver nitrate to the stoma.</li><li>Water activates the silver nitrate so it will start working.</li><li>Salt water, or saline, deactivates the silver nitrate so it will stop working. Only apply hypertonic salt soaks to the stoma on days you are not applying silver nitrate.</li><li>Avoid using antibiotic creams on the stoma if you are applying silver nitrate.</li><li>Contact your G tube specialist or doctor to assess the stoma after two weeks of applying silver nitrate.</li></ul><h2>How to apply silver nitrate to a child’s stoma</h2><ol><li>Always wash your hands with soap and water before touching your child’s skin.</li><li>Clean the stoma with soap and water and pat or let air dry.</li><li>Protect the healthy skin around the stoma by applying a barrier cream (i.e., zinc oxide, diaper rash cream, petroleum jelly).</li><li>Dip the silver nitrate stick into a small amount of sterile or distilled water. The water will activate the silver. Salt water, or saline, will deactivate the silver and stop it from working. Do not use salt water at this stage.</li><li>Roll the tip of the stick over the granulation tissue only—avoid healthy skin. One stick is usually enough for each application. The tissue may turn a grayish-black colour—this is normal. This colour will disappear slowly over time.</li><li>If you accidentally get silver nitrate on healthy skin, wash that portion of skin with saline solution or salt water right away to stop its effects.</li><li>Wash your hands with soap and water.</li></ol><p>Topical antibiotic cream or ointments can lessen the effect of silver nitrate, so you should avoid using silver nitrate and antibiotic creams at the same time.</p><p>Applying silver nitrate to your child’s stoma may be painful. Providing acetaminophen or ibuprofen before applying silver nitrate can help your child stay comfortable.</p><h2>At SickKids</h2><p>If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.</p><h3>G Tube Resource Nurse contact info:</h3><p>Phone: 416-813-7177</p><p>Email: g.tubenurse@sickkids.ca</p><p>On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.</p>
G/GJ tubes: What to do if your child’s feeding tube is blockedGG/GJ tubes: What to do if your child’s feeding tube is blockedG/GJ tubes: What to do if your child’s feeding tube is blockedEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)Abdomen;Small Intestine;StomachDigestive systemNon-drug treatmentAdult (19+) CaregiversNA2019-05-10T04:00:00ZTharini Paramananthan, RN, BScN, MScN;Silvana Oppedisano, MN, RN(EC);Holly Norgrove, RN, BScN7.0000000000000071.90000000000001554.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn what to do if your child's feeding tube becomes blocked.</p><p>If your child has a G or GJ tube, and it becomes blocked by formula or medications, it is important to try to unblock the tube as soon as possible. Leaving the tube blocked will delay or prevent food (i.e., formula), liquid, and medications from entering the stomach or jejunum (small intestine). The longer the tube remains blocked, the harder it may be to unblock.<br></p><h2>Key points</h2><ul><li>If your child’s tube becomes blocked, it is important to try to unblock the tube right away.</li><li>If your child’s tube has an adaptor, remove it first to check if it is the cause of the blockage.</li><li>Use a pulsing push-and-pull motion with warm water to try to unblock your child’s feeding tube. If this does not work, contact your G tube specialist.</li><li>If you have a prescription for pancreatic enzymes and sodium bicarbonate, try this method if warm water does not work.</li><li>If your child has a low-profile G tube, first try to flush the tube via the feeding port before removing the tube and unblocking it manually. If this does not work, change the low-profile tube or insert a Foley catheter.</li><li>Prevent tube blockage by flushing with 5 to 10 mL water before and after you give food or medication, and every four hours during continuous feeds.<br></li></ul><h2>How to unblock a feeding tube</h2><p>There are two different ways to unblock a feeding tube at home. Try using warm water first. If that doesn’t work, you can use activated pancreatic enzymes.<br></p><h3>Using warm water</h3><p>To unblock your child’s G tube or GJ tube, you will need a 1 mL and 5 mL slip-tip syringe and warm water.</p><ol><li>Fill the 1 mL and 5 mL slip-tip syringes with warm water.</li><li>If your child’s tube has an adaptor attached to the end of the tube, remove it.</li><li>Connect the 1 mL syringe directly to the feeding tube.</li><li>Using a pulsing push-and-pull motion, insert as much water into the tube as possible. This thrusting motion will help clear out any formula or medication that has built up inside the tube. You may have to try this a few times to unblock the tube.</li><li>When the tube is no longer blocked, flush with at least 5 mL of warm water.</li><li>If you removed the adaptor to attach the 1ml syringe directly to the tube, re-attach it to the tube to resume feeds and medication administrations.</li></ol><h3>Using activated pancreatic enzymes</h3><p>If you cannot unblock the feeding tube with warm water, you can try using pancrelipase (a combination of pancreatic enzymes) and sodium bicarbonate. This mixture works very well when the tube becomes blocked with formula. You will need a prescription from your physician or nurse practitioner to get the pancreatic enzymes from pharmacy. Your G tube specialist (at SickKids, this is the G Tube Resource Nurse) may provide you a prescription as well.</p><p>When using the pancreatic enzymes, please consider the following:</p><ol><li>Pancrelipase is made from pork products. Cultural and dietary considerations must be considered.</li><li>If your child has an allergy to pork products, do not attempt this.</li><li>There is a possibility of skin irritation and redness if the pancreatic enzymes are left on the skin. When opening the capsule, be careful not to spill the contents on the skin. If you do, simply wash the area with soap and water right away.</li></ol><p>To use the pancreatic enzymes, you will need one pancrelipase capsule, one sodium bicarbonate 325 mg tablet, sterile or distilled water, and two 5 mL syringes (one to mix the medications and one to flush).</p><p>This is what you can do:</p><ol><li>Wash your hands.</li><li>Open the pancreatic enzyme capsule.</li><li>Crush the sodium bicarbonate tablet.</li><li>Mix the two drugs together with 5 to 10 mL of warm sterile or distilled water.</li><li>Push as much of the mixture into the tube as possible; then let it sit in the tube for 30 minutes.</li><li>Attempt to flush the tube with at least 5 mL of sterile or distilled water.</li><ul><li>If your child is younger than 1 year, only try this procedure once.</li><li>If your child is older than 1 year, you can repeat the procedure twice. If you are unsuccessful in unblocking the tube, you may repeat this procedure immediately after the first attempt. Ensure you aspirate all the remaining pancreatic enzyme mixture in the tube prior to pushing the new mixture.</li></ul><li>If the tube has become unblocked, flush with at least 5 mL of sterile or distilled water and continue with your feeds and medications.</li></ol><p>If warm water or activated pancreatic enzymes do not unblock the feeding tube, and if your child has a G tube or GJ tube that cannot be replaced by you at home, contact your child’s G tube specialist to have your child’s tube replaced in hospital.</p><h2>If your child’s low-profile tube is blocked</h2><p>Low-profile balloon type G tubes, such as the Mic-Key button or AMT MiniONE, rarely block because they are much shorter than other types of G tubes. Ensure the extension tubing is not blocked by flushing it with 5 to 10 mL of warm sterile water. If the extension tubing is blocked, replace it with new extension tubing. If you have been trained to change your child’s low-profile balloon type G tube, you may replace the feeding tube with a new one.</p><ol><li>Wash your hands with soap and water.</li><li>Use a slip tip syringe to deflate the balloon of the tube. Throw this water away.</li><li>Remove the tube from the stoma.</li><li>You may see a physical blockage in the tube. Use your index finger and thumb to squeeze the tube at the site of the blockage. Flush the tube with at least 5 mL of water to attempt to remove the blockage.</li><li>If you are successful at unblocking the low-profile G tube, and the tube is not broken, wash the low-profile G tube with soap and water, lubricate the tip of the low-profile G tube and re-insert it into the stoma. Once inserted, inflate the balloon with the amount of sterile or distilled water you normally use.</li><li>Confirm that the tube is in the stomach by checking the pH of the stomach contents. A pH of 6.0 or less means the tube is correctly in the stomach. To learn how to check the pH, please see the article <a href="/Article?contentid=2908&language=English">Balloon G tubes</a>.</li><li>If you are unsuccessful at unblocking the low-profile tube, or the tube is broken, insert a new low-profile G tube or a Foley catheter. If you have inserted the Foley catheter, contact your G tube specialist to arrange for the low-profile tube to be replaced.</li></ol><h2>How do you know if a feeding tube is blocked?</h2><ul><li>If your child receives a feed continuously via the feeding pump, the feeding pump may beep, saying there is an occlusion or flow error. This may be a problem with the pump, the feeding bag, or the tube itself.</li><li>If your child receives feed via gravity using a feeding bag, you may notice the feed stops dripping in the dripping chamber of feeding bag system.</li><li>When you are flushing your child’s tube, it may feel hard to push and only a small amount of fluid will go into the tube. This is a called a “partial blockage.”</li><li>When you are flushing your child’s tube, you may not be able to get any fluid at all into the tube. This usually means the tube is completely blocked.</li></ul><p>If your child’s G or GJ tube has any adaptors at the end of their tube, remove them and flush with water to ensure patency of adaptor. If you remove the adaptor and stomach contents flow back from the tube, your tube is not truly blocked. Rather, the adaptor was blocked and it can be washed or replaced. However, if the G tube or GJ tube does not flow back after removing the adaptor, this means the tube is blocked.</p><h2>At SickKids</h2><p>If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.</p><h3>G Tube Resource Nurse contact info:</h3><p>Phone 416-813-7177</p><p>g.tubenurse@sickkids.ca</p><p>On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.</p>
G/GJ tubes: What to do if your child’s feeding tube is pulled outGG/GJ tubes: What to do if your child’s feeding tube is pulled outG/GJ tubes: What to do if your child’s feeding tube is pulled outEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Abdomen;Stomach;Small IntestineDigestive systemNon-drug treatmentAdult (19+) CaregiversNA2019-05-10T04:00:00ZHolly Norgrove, RN, BScN7.7000000000000067.00000000000001138.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn what to do if your child's G tube or GJ tube is accidentally pulled out. </p><p>If your child’s feeding tube is accidentally pulled out, you may re-insert it if you have learned how to do so.</p><p>If your child has a G or GJ tube (anything other than a <a href="/Article?contentid=2908&language=English">low-profile G tube</a>), and it is accidentally pulled out, it is important to insert an emergency tube in the tract as soon as possible to prevent it from closing.</p><p>The emergency tube you will use is called a Foley catheter. It will be one size smaller than your child’s G or GJ tube. For example, if your child has a 12 FR tube, the Foley catheter will be 10 FR.</p><p>The sooner you insert the Foley catheter, the easier it will be. You will need to carry your emergency supplies with you at all times in case the tube is accidentally pulled out.</p><p>You will need the following emergency supplies:</p><ul><li>A Foley catheter one size smaller than your child’s tube</li><li>Water-based lubricating jelly</li><li>Tape</li><li>Sterile or distilled water</li><li>3 x 5mL slip-tip syringes – 1 to fill the balloon, 1 to check the pH and 1 to flush the tube </li><li>pH strips</li><li>pH colour reference guide</li><li>An adaptor or extension set</li></ul><div class="asset-video"> <iframe src="https://www.youtube.com/embed/iY51r4UKYE8?rel=0" frameborder="0"></iframe> </div><h2>Key points</h2><ul><li>If your child’s G tube or GJ tube is accidentally pulled out, you must insert a Foley catheter into the tract as soon as possible.</li><li>You must keep your emergency supplies with you at all times, wherever you go.</li><li>The Foley catheter will be one size smaller than your child’s G tube or GJ tube.</li><li>If your child’s tube is accidentally pulled out within 8 weeks of when it was put in, insert the Foley catheter but do not feed or inflate the Foley catheter’s balloon. Have an emergency plan.</li><li>If your child’s tube is accidentally pulled out after 8 weeks, insert the Foley catheter, inflate the balloon, and feed for as long as one month.</li><li>Stop feeding your child with the Foley catheter if he or she has a hard bloated stomach, severe stomach pain, vomiting, gagging, high fever, trouble breathing, or diarrhea.</li></ul><h2>When to get medical help</h2><p>Stop feeding and seek medical help if your child has any of the following problems after the Foley catheter is inserted:</p><ul><li>a hard bloated stomach</li><li>severe pain in the stomach</li><li>vomiting, coughing or gagging</li><li>sudden high fever</li><li>diarrhea</li><li>problems with food and liquids getting into the lungs (aspiration)</li><li>problems breathing</li></ul><h2>Inserting the emergency Foley catheter</h2><p>The steps for inserting the Foley catheter differ if your child’s G tube is new or if they have had it for a while. If the G tube is new, the tract might not be healed (this usually takes eight weeks). If your child has a GJ tube, it will be treated like a new tube no matter how long it has been in.</p><h3>Within eight weeks of getting the tube</h3><p>The first eight weeks after your child first gets their tube is the most important time for healing.</p><p>If your child’s G tube is accidentally pulled out within eight weeks of when it was put in, do the following.</p><ol><li>Gather your Foley catheter, lubricating jelly and tape.</li><li>Wash your hands and the skin around your child’s feeding tube with soap and water.</li><li>Lubricate the tip of the Foley catheter with the lubricating jelly. If you do not have lubricating jelly, you can wet the tip of the Foley catheter with water.</li><li>Measure the Foley catheter against your index finger. If your child weighs less than 3kg (6.6 lbs), measure about 3 to 4 cm in length. This is about half the length of your index finger. If your child weighs more than 3 kg, the tube should measure 4 to 6 cm. This is the full length of your index finger.</li><li>Insert this amount into the stoma and into your child’s stomach.</li><li>Tape the Foley catheter to your child’s stomach.</li></ol><p>Do not use the Foley catheter to give your child food, liquids or medications. If your child cannot eat or drink by mouth, you may insert a <a href="/Article?contentid=984&language=English">nasogastric tube</a> if you have been trained to do this. If not, go to the closest emergency room as soon as possible.</p><h3>Eight or more weeks after getting the tube</h3><p>If your child’s tube is pulled out eight or more weeks after getting the tube, do the following.</p><ol><li>Gather your Foley catheter, lubricating jelly, tape, and syringe with water.</li><li>Wash your hands and the skin around your child’s feeding tube with soap and water.</li><li>Lubricate the tip of the Foley catheter with the lubricating jelly.</li><li>Measure the Foley catheter against your index finger. If your child weighs less than 3 kg (6.6 lbs), measure about 3 to 4 cm in length. This is about half the length of your index finger. If your child weighs more than 3kg, the tube should measure 4 to 6 cm. This is the full length of your index finger.</li><li>Insert this amount into the stoma and into your child’s stomach.</li><li>Tape the Foley catheter to the skin.</li><li>Confirm that the tube is in the stomach by checking the pH of the stomach contents as described below. </li><li>Once you confirm the tube is in the stomach, by getting a pH of 6.0 or less, flush the tube with 5 mL of water to ensure it is working well.</li><li>Once the Foley catheter is in place, fill the balloon with the amount of water recommended on the tube - sterile or distilled water. This will help to keep the tube in place while you are feeding your child.</li><li>You will likely see stomach contents coming from the end of the Foley catheter. If you do not see stomach contents, using an adaptor or extension, connect a syringe to the end of the Foley catheter and pull back.</li><li>After you see stomach contents, flush the tube with sterile or distilled water.</li><li>Close the Foley catheter with either a catheter plug, the plunger of the syringe or an extension set.</li></ol><p>Do not use the Foley catheter to feed or give liquids or medications until you know it is in the right place. If you cannot get stomach contents back from the Foley catheter, contact your G tube specialist before feeding.</p><h2>Checking that the newly changed tube is in the right spot</h2><p>Before using the newly changed tube for feeds and medications, you will need to check that it is in the stomach by checking the pH of the contents that are pulled from the tube.</p><h3>How to check the pH</h3><p>You will need:</p><ul><li>One empty slip tip syringe</li><li>The feeding extension set for a low-profile balloon G tube (for low-profile tubes only)</li><li>pH strips</li><li>pH colour reference guide</li></ul><p>What to do:</p><ol><li>Once you have inserted the new tube, insert the empty syringe into the extension feeding set (for a low-profile balloon G tube) or directly into the tube’s medication port (for a non low-profile balloon G tube) and pull back a small amount of stomach contents. If you cannot get stomach contents, move your child side to side or sit them up.</li><li>Empty the stomach contents from the syringe onto the pH strip.</li><li>Compare the colours on the pH strip to the colours on the reference guide.</li></ol><p>If the pH is 6.0 or less, the tube is in the stomach and you can flush the tube and use it for feeding and medications.</p><p>If the pH is higher than 6.0, the tube may not be in the stomach. Medications and recent feedings can affect the pH. If you get a high reading, do not use the tube for feeding or medications and check the pH again one hour later. If the reading is still higher than 6.0, do not use the tube and contact your G tube specialist to have the position checked in an interventional radiology department.</p>
G/GJ tubes: What to do if your child’s feeding tube movesGG/GJ tubes: What to do if your child’s feeding tube movesG/GJ tubes: What to do if your child’s feeding tube movesEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Abdomen;Small Intestine;StomachDigestive systemNon-drug treatmentAdult (19+) CaregiversNA2019-05-22T04:00:00ZTharini Paramananthan, RN, BScN, MScN;Silvana Oppedisano, MN, RN(EC);Holly Norgrove, RN, BScN6.8000000000000073.3000000000000963.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Find out how to prevent your child's G tube from moving in and out of the stoma, and what to do if you suspect it has moved.</p><p>Gastrostomy tubes (G tubes) and gastrojujenostomy tubes (GJ tubes) are feeding devices. A G tube gives liquid nutrition, medication and other fluids directly into the stomach. A GJ tube gives liquid nutrition, medication and other fluids directly into the small intestine (the jejunum). Both G tubes and GJ tubes are placed in a surgical opening in your child's tummy (abdomen) called the stoma. The tunnel from the outside into the stomach is called the tract.<br></p><h2>Key points</h2><ul><li>If your child’s G tube looks longer or shorter than normal, it may have moved out of position.</li><li>If you child has a G tube inserted by a radiologist using image guidance, it can be re-positioned to sit in the stomach.</li><li>If your child has a GJ tube that moved out of position, you will need to contact the G tube Resource Nurse immediately or visit the emergency department as the tube cannot be re-positioned at home. An image guidance will be required to re-position the tube in the jejunum.</li><li>Always secure the tube properly to prevent it moving in and out of the stoma.</li></ul><p><a href="/Article?contentid=2536&language=English">Corflo PEG tubes</a> and MacLoc G tubes are types of feeding tubes placed by an interventional radiologist using image guidance. Low-profile balloon type G tubes are placed by a G tube specialist (at SickKids this is the G Tube Resource Nurse). If your child’s G tube looks longer or shorter than normal, it may have moved out of position. Depending on the type of G tube your child has, the instructions for moving the tube back into place may be different.</p><h2>Corflo PEG tube</h2><p>A Corflo PEG tube has a round bolster inside the stomach that helps prevent the tube from being pulled out. There is a crossbar or white elbow fixation device at the stoma that helps prevent the tube from moving into the stomach. If the crossbar or elbow fixation device is not sitting at your child’s stoma, the tube may have moved out of position.</p><p>If the Corflo PEG tube has moved farther into the stomach your child may experience the following signs and symptoms.</p><ul><li>Vomiting</li><li>Discomfort or pain</li><li>Diarrhea</li><li>Bloated stomach</li></ul><p>If any of these signs occur, contact your G tube team.</p><h3>Preventing your child’s Corflo PEG tube from moving</h3><p>To prevent your child’s Corflo PEG tube from moving:</p><ul><li>Always secure the tube</li><li>A crossbar or elbow fixation device is used to prevent the tube moving from in and out of the stoma</li><li>Ensure proper fit of the crossbar or elbow fixation device at the stoma</li></ul><p>For the first two weeks after tube insertion, do not adjust the crossbar or elbow fixation device. Contact your G tube team if you have concerns about the placement of the cross bar or elbow fixation device. </p><p>Two weeks after the initial insertion of the Corflo PEG tube, you may adjust the crossbar or elbow fixation device to sit at the stoma.</p><p>How to re-position your child’s Corflo PEG tube:</p><ol><li>Wash your hands with soap and water.</li><li>Remove any tape used to secure the tube to abdomen.</li><li>Pull the tube back gently until resistance felt. This means the bolster is at the end of stoma tract.</li><li>Stop pulling when resistance felt, then adjust the crossbar or elbow fixation device to sit at the stoma.</li><li>Re-tape the tube to the skin if preferred and secure the tube well.</li></ol><h3>What to do if the Corflo PEG tube is partially pulled out</h3><p>Although it is very unlikely, your child's Corflo PEG tube may be pulled out part way, which can cause the bolster on the end of the tube to become stuck in the tract. If this has happened, you may notice the following.</p><ul><li>Significant pain in the G tube area</li><li>A visible hard plastic bulge (the bolster) that does not go away when you move the tube</li><li>You may be able to feel a hard bulge (the bolster) in the tract or stoma</li><li>Formula leaking from the stoma</li><li>If you are concerned that the tube has been partially pulled out and the bolster is stuck, call your G tube specialist right away. On the weekend/after hours, go to the Emergency Department</li></ul><h2>Low-profile balloon type G tube</h2><p>If your child has a <a href="/Article?contentid=2908&language=English">low-profile balloon type G tube</a>, it will not move farther into the stomach. This is a skin level tube that extends through the stoma. There is a balloon filled with water at the end of the tube that is in the stomach. This balloon holds the tube in place. Check the amount of water in the balloon at least once a week; if there is less water in the balloon, the tube may be able to move slightly in the tract. Use sterile or distilled water to refill the balloon.</p><h2>MacLoc G tube</h2><p>If your child has a MacLoc type G tube that looks longer or shorter than normal, it may have moved out of position.</p><p>If the MacLoc type G tube has moved farther into the stomach, your child may experience the following signs and symptoms:</p><ul><li>Vomiting</li><li>Discomfort or pain</li><li>Diarrhea</li><li>Bloated stomach.</li></ul><p>If any of these signs occur, contact your child's G tube team.</p><h3>Preventing your child’s MacLoc G tube from moving<br></h3><p>To prevent your child’s MacLoc type G tube from moving:</p><ul><li>Always secure the tube in place with tape</li><li>Mark the outside part of your child’s feeding tube where it meets the stoma.</li></ul><p>How to mark your child's MacLoc G tube:</p><ol><li>Wash your hands with soap and water</li><li>Remove the tape securing the tube to the skin</li><li>Pull back on the tube gently</li><li>When you feel resistance, stop pulling. Push the tube into the stomach 1–2 cm. </li><li>Re-tape the tube to the skin and mark the tube where it meets the stoma. Use a permanent marker so it will not wash off with your daily soap and water cleaning.</li></ol><p>You may also measure the length of the outside part of the feeding tube, from stoma to adaptor. Make sure to mark this number down somewhere you will remember.</p><h2>At SickKids</h2><p>If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.</p><h3>G Tube Resource Nurse contact info:</h3><p>Phone 416-813-7177</p><p>g.tubenurse@sickkids.ca</p><p>On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.</p>
G6PD deficiencyGG6PD deficiencyG6PD deficiencyEnglishGeneticsChild (0-12 years);Teen (13-18 years)NACardiovascular systemConditions and diseasesCaregivers Adult (19+)NA2009-11-06T05:00:00ZMelanie Kirby-Allen, MD, FRCPC8.5000000000000062.0000000000000900.000000000000Health (A-Z) - ConditionsHealth A-Z<p>G6PD deficiency can cause haemolysis and anaemia. Learn what this has to do with blood, the problems it can cause and what medicines you should avoid.</p><h2>What is G6PD deficiency?</h2> <p>Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme that helps red blood cells to work properly. Some people have less than the usual amount of G6PD in their red blood cells. This is called G6PD deficiency, or favism. </p> <p>Most people with G6PD deficiency have completely normal health, but sometimes it can cause problems. This guide explains the problems G6PD deficiency may cause and what to do if your child has problems. </p><h2>Key points</h2> <ul> <li>G6PD is an enzyme that helps protect red blood cells. </li> <li>Most people who have G6PD deficiency are healthy, but sometimes fever or certain medicines and foods can break down their red blood cells (haemolysis) and cause anaemia. </li> <li>Your child with G6PD deficiency should avoid certain medicines and foods.</li> <li>Tell your pharmacist, nurse and doctor that your child has G6PD deficiency.</li> <li>If your child has symptoms of anaemia, call your family doctor or take your child to the nearest Emergency Department. </li> </ul><h2>G6PD deficiency is passed on from parents to children</h2> <p>G6PD deficiency is an inherited disorder, which means it is passed from one or both parents to the child. It affects males more often than females.</p> <p>About 400 million people worldwide have G6PD deficiency. Anyone can have G6PD deficiency, but it is most common in people whose families came from Africa or other areas where malaria has been common, such as the Mediterranean, Caribbean and South-East Asia. G6PD deficiency is usually milder in people of African origin and more severe in people of Mediterranean and Asian origin.</p><h2>Your child should not take certain medicines</h2> <p>If your child has G6PD deficiency, they should not take any of the following medicines:</p> <ul> <li><a href="/Article?contentid=77&language=English">acetylsalicylic acid (ASA)</a></li> <li>ascorbic acid (Vitamin C) </li> <li>chloramphenicol </li> <li>chloroquine </li> <li><a href="/Article?contentid=119&language=English">dapsone</a> </li> <li>dimercaprol </li> <li><a href="/Article?contentid=120&language=English">doxorubicin</a> </li> <li>mepacrine </li> <li>methylene blue </li> <li>methyldopa</li> <li>nalidixic acid </li> <li>naphthalene </li> <li><a href="/Article?contentid=201&language=English">nitrofurantoin</a> </li> <li>phenazopyridine </li> <li><a href="/Article?contentid=222&language=English">primaquine</a> </li> <li>quinine </li> <li>sulfacetamide </li> <li>sulfadiazine </li> <li>sulfamethoxazole (Co-trimoxazole, Septra) </li> <li>sulfanilamide </li> <li>sulfapyridine </li> <li><a href="/Article?contentid=243&language=English">sulfisoxazole</a> (Pediazole) </li> <li>toluidine blue </li> </ul> <p>This list only contains the names of drugs that are more likely to cause haemolysis in patients with G6PD deficiency. The list may change at a later time. Sometimes medicines that are not on this list can also cause problems. Tell your pharmacist, nurse and doctor that your child has G6PD deficiency and ask them to check before giving your child any medicine, including herbal remedies. </p> <p>If your child's doctor feels that your child needs to take one of the medicines on the list, your child will have their blood tested while taking the medicine. </p> <p>The risk and severity of haemolysis is almost always dose-related. This means that if your child takes a higher dose of one of these medicines, they are more likely to develop haemolysis and it is more likely to be severe. </p> <h2>Your child should avoid mothballs and certain foods</h2> <p>Your child should not come in close contact with mothballs (naphthalene).</p> <p>Your child should not eat fava beans. Some people should also avoid red wine, all beans, blueberries, soya products, tonic water and camphor. </p><h2>G6PD deficiency can cause problems</h2> <h3>Problems for newborn babies</h3> <p>If a mother carries G6PD deficiency, she may pass it on to one or more of her children. Some babies may get jaundiced (yellow) shortly after they are born. This is more likely for baby boys. </p> <p>Severe jaundice can be serious for newborn babies if it is not treated. It is usually treated by putting the baby under a special light for a few days. </p> <p>Many babies with G6PD deficiency are diagnosed because they have jaundice soon after birth. Once the jaundice has passed, they should not get other problems from G6PD deficiency, as long as they avoid fava beans and certain medicines. </p> <h3>Problems for children and adults</h3> <p>Most people with G6PD deficiency have completely normal health, but sometimes it can cause problems.</p> <p>Some children and adults with G6PD deficiency may develop haemolysis and <a href="/Article?contentid=841&language=English">anaemia</a> after they are exposed to any of these triggers:</p> <ul> <li>if they get a fever </li> <li>if they take certain medicines listed later in this guide </li> <li>if they eat fava beans; this is called favism </li> </ul> <p>If your child is exposed to a trigger that causes haemolysis, sometimes there are no symptoms at all. In more serious cases, your child may have one or more of the following symptoms of <a href="/Article?contentid=841&language=English">anaemia</a>: </p> <ul> <li>pale skin </li> <li>fatigue </li> <li>rapid heartbeat </li> <li>rapid breathing </li> <li>shortness of breath </li> <li>jaundice (yellowing of the skin and eyes) </li> <li>backache </li> <li>dark, tea-coloured urine </li> </ul> <p>If your child is experiencing any of these symptoms, call your family doctor or go to the nearest Emergency Department.</p> <p>Once the trigger is removed or resolved, the symptoms of G6PD deficiency usually go away fairly quickly, usually within a few weeks. </p>
GI tractGGI tractGI tractEnglishNutritionChild (0-12 years);Teen (13-18 years)AbdomenDigestive systemHealthy living and preventionCaregivers Adult (19+) Educators Hospital healthcare providers Community healthcare providers Remote populations First nationsNA2013-09-27T04:00:00ZElly Berger, BA, MD, FRCPC, FAAP, MHPE7.3000000000000066.0000000000000813.000000000000Flat ContentHealth A-Z<p>Learn how the different parts of the GI tract work together to digest food.</p><figure><span class="asset-image-title">GI tract</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_digestive_system_V3_EN.jpg" alt="Salivary glands, esophagus, stomach, liver, gallbladder, pancreas, small and large intestines, and anus" /> </figure> <p>When you eat, your body turns the food into energy and extracts vitamins, minerals and other nutrients to help it work properly. This process is called digestion. The parts of the body that are involved in digestion are called the digestive system.</p><h2>Key points</h2> <ul><li>The digestive system includes the GI tract and the accessory organs of the liver, gall bladder and pancreas.</li> <li>The GI tract is divided into the upper GI tract, which runs from the mouth to the stomach, and the lower GI tract, which includes the small and large intestines.</li> <li>Together, the GI tract and accessory organs use mechanical digestion and chemical digestion to break down food.</li></ul>https://assets.aboutkidshealth.ca/akhassets/IMD_digestive_system_V3_EN.jpg
Gaining too much weight during brain tumour treatmentGGaining too much weight during brain tumour treatmentGaining too much weight during brain tumour treatmentEnglishNeurology;NutritionChild (0-12 years);Teen (13-18 years)BrainNervous system;Digestive systemNAAdult (19+)NA2009-08-14T04:00:00ZMary Barron, MSc, RD6.6000000000000064.5000000000000265.000000000000Flat ContentHealth A-Z<p>In-depth information concerning the issues that may arise for your child if he gains too much weight as a side effect of his brain tumour treatment.</p><p>A number of factors can cause weight gain in children with brain tumours:</p> <ul><li>Steroid use: some of the weight gained is caused by water retention, which will be lost when steroid use is stopped. </li> <li>The treatment or type of tumour: children with a tumour located near the hypothalamus may develop uncontrollable appetites. The hypothalamus is a part of the brain that controls eating and appetite. </li> <li>Untreated or undiagnosed hypothyroidism: low levels of thyroid hormones cause the body's metabolism to slow down. </li></ul><h2>Key points</h2> <ul><li>Children with brain tumours may gain weight due to steroid use, tumour type, hypothyroidism.</li> <li>Try to maintain a healthy weight by being as active as possible and establish healthy eating patterns.</li></ul>
Gastric emptying scanGGastric emptying scanGastric emptying scanEnglishOtherChild (0-12 years);Teen (13-18 years)Stomach;Small IntestineStomach;Small intestineTestsCaregivers Adult (19+)NA2013-12-06T05:00:00ZMandy Kohli, Clinical Co-ordinator, Nuclear Medicine7.6000000000000069.0000000000000691.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn how a gastric emptying scan is done and how it shows how quickly food leaves the stomach. </p><h2>What is a gastric emptying scan?</h2><p>A gastric emptying scan is a test to see how long it takes for food to empty from the stomach and enter the small intestine.</p><h2>Key points</h2> <ul> <li>A gastric emptying scan shows how quickly food moves from the stomach to the small intestine. It takes about 2.5 hours.</li> <li>The test involves adding a tiny amount of radioactive material to some food or liquid before giving it to your child. A special camera then takes pictures at set times to check how fast the food or liquid is moving through your child's stomach.</li> <li>Your child must not eat or drink anything for three to four hours before a scan using liquid or for four to six hours before a scan using solid food.</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 scan take?</h2> <p>The scan (both solid and liquid) takes about 2.5 hours.</p><h2>How is the gastric emptying scan done?</h2> <figure> <span class="asset-image-title">Digestive system</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_digestive_system_V3_EN.jpg" alt="Salivary glands, esophagus, stomach, liver, gallbladder, pancreas, small and large intestines and anus" /> </figure> <p>A gastric emptying scan is carried out by a nuclear medicine technologist.<br></p><p>The test involves adding a small amount of radioactive material to some food or liquid. When your child has the food or liquid, the material will cause it to show up clearly inside your child's stomach during the scan. The food or liquid will not taste any different to your child.</p><p>If your child is having a solid gastric emptying scan (a scan with solid food), they will be given an egg sandwich to eat.</p><p>If they are having a liquid gastric emptying scan, they will, depending on their age, have infant formula or milk, apple juice or a liquid meal replacement.</p><p>Your child can take the liquid in different ways:</p><ul><li>orally (by mouth)</li><li>through a gastric tube (a tube that goes directly into their stomach)</li><li>through a naso-gastric tube (a tube that goes through their nose, past their throat, and down into their stomach).</li></ul><p>When your child has taken the sandwich or had the liquid, a special camera will take pictures at set times to check how fast your child's stomach is emptying. In most cases, your child can watch a movie as the scan is being done.</p><h2>Do I need to supply the food or liquid for the scan?</h2><p>If your child needs formula for this scan, please bring it with you from home. The hospital will provide all other liquids and any food.</p><h2>Does my child need to do anything special to prepare for the scan?</h2> <p>Your child will not be able to eat or drink anything for a while before the scan, even food that is not normally swallowed (such as chewing gum or sucking candy).</p> <ul> <li>For a solid scan, your child must not eat or drink anything four to six hours before the test.</li> <li>For a liquid scan, your child must not eat or drink anything three to four hours before the test.</li> </ul><h2>At SickKids</h2> <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><h2>Source</h2> <p>Alliance for Radiation Safety in Pediatric Imaging (2013). <a href="http://www.imagegently.org/Roles-What-can-I-do/Parent/Nuclear-Medicine" target="_blank"><em>Image Gently: Nuclear Medicine - What can I do as a parent?</em></a><br></p>
Gastroesophageal reflux diseaseGGastroesophageal reflux diseaseGastroesophageal reflux diseaseEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)Esophagus;StomachEsophagus;StomachConditions and diseasesCaregivers Adult (19+)NA2010-05-07T04:00:00ZMark Feldman, MD, FRCPC9.5000000000000056.6000000000000850.000000000000Health (A-Z) - ConditionsHealth A-Z<p>An overview of how you can help your child with the condition that causes the backwards movement of food and acid from the stomach into the esophagus.</p><h2>What is gastroesophageal reflux? </h2> <p>"Reflux" means "backwards movement." The esophagus is the tube that leads from the mouth to the stomach. So, gastroesophageal reflux is the backwards movement of food and acid from the stomach into the esophagus.</p> <p>Burping, and spitting up are common after a baby feeds. Most babies spit up to some degree without discomfort and it usually fades by the first or second year. This is called gastroesophageal reflux (without "disease").</p> <p>Gastroesophageal reflux disease (GERD) occurs when there are symptoms of discomfort, or poor weight gain.</p> <p>Older children and adolescents may also get GERD. </p><h2>Key points</h2> <ul> <li>Most babies experience some regurgitation after feeding. </li> <li>Most children outgrow symptoms of GERD by the time they can eat solid foods. </li> <li>Gastroesophageal reflux disease (GERD) occurs when the irritable and painful symptoms are frequent and persistent or leads to poor weight gain.</li> <li>Complications can include bleeding in the esophagus or difficulty breathing.</li> </ul><h2>Signs and symptoms of GERD</h2> <p>In a baby, symptoms of GERD may include:</p> <ul> <li>effortless spitting up of food or feedings with discomfort</li> <li>coughing, when regurgitated food gets into the trachea (breathing tube)</li> <li>irritability before feeding; the baby will arch back, twist their neck or pull away from feeding</li> <li>crying before or during feeding</li> <li>poor weight gain</li> </ul> <p>In older children, signs and symptoms may include:</p> <ul> <li>dental cavities, caused by stomach acid </li> <li>heartburn</li> <li>a sour taste in the mouth</li> <li>stomach and chest discomfort</li> </ul><h2>Causes of GERD</h2> <p>GERD occurs when the lower esophageal sphincter, which sits at the connection between the esophagus and the stomach, fails to properly close or relaxes incorrectly. This faulty valve allows food to travel all the way up the esophagus, causing "spit-up." When the food only travels partly up the esophagus, it may cause a burning sensation.</p><h2>How a doctor can help your child</h2> <p>Since vomiting and regurgitation are very common in babies in the first years of feeding, the doctor will need to determine whether the condition is simply GER (without 'D') or severe enough to warrant a GERD diagnosis and the relevant treatment. There are numerous ways your child's doctor can diagnose GERD.</p> <h3>Barium swallow</h3> <p>This test requires the infant to drink barium, a chalky white liquid that shows the functioning of the esophagus, sphincter and stomach in X-ray images. The flow of the liquid is shown in X-ray pictures and allows the doctor to observe any mechanical problems. </p> <p>This is not the best way to diagnose GERD. If an infant does not reflux during the test, it does not mean that they do not have GERD. </p> <h3>pH probe</h3> <p>In the pH probe, a small wire with an acid sensor is placed through the baby's nostril, passed down the esophagus, and rests just before the entry of the stomach near the lower esophageal sphincter. The probe monitors how often the lower esophagus is exposed to the backward-flowing stomach contents and how long this lasts. </p> <h3>Endoscopy</h3> <p>Rarely, the doctor will order an inspection of the esophagus and the stomach using an endoscope while your child is asleep under anaesthetic. An endoscope is a small instrument inserted through the mouth or nose that allows the doctor to see the tissue using a tiny fibre-optic camera. During the procedure, doctors may also biopsy a small sample of the lining of the esophagus to determine the cause of the symptoms. </p><h2>Complications</h2> <p>Repeated exposure to stomach acid can lead to complications in some infants and children with GERD. These complications can include: </p> <ul> <li>poor weight gain or weight loss</li> <li>bleeding in the esophagus</li> <li>difficulty breathing or swallowing</li> <li>irritation of the esophagus (esophagitis)</li> </ul><h2>When to seek medical assistance</h2> <p>Make an appointment with your child's doctor if your child:</p> <ul> <li>is failing to gain weight because of poor feeding sessions</li> <li>is crying or extra irritable during feedings or while spitting up (effortless and painless spitting up is usually not a problem if gaining weight)</li> <li>coughs during or after feeds</li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/gastroesophageal_reflux_disease.jpg
Gastrointestinal infections in babiesGGastrointestinal infections in babiesGastrointestinal infections in babiesEnglishNABaby (1-12 months)Stomach;Small Intestine;Large Intestine/Colon;RectumDigestive systemConditions and diseasesAdult (19+)Abdominal pain;Constipation;Diarrhea;Vomiting;Fever;Nausea;Fatigue2009-10-18T04:00:00ZAndrew James, MBChB, FRACP, FRCPC Douglas Campbell, MD, FRCPC11.000000000000043.20000000000001996.00000000000Flat ContentHealth A-Z<p>Read about the symptoms and treatment of various gastrointestinal infections that can arise during infancy, including rotavirus and Norwalk virus.<br></p><p>Gastrointestinal problems can arise from time to time in infancy. They are usually caused by a viral infection in the stomach. Rotavirus and Norwalk virus infection are common causes of gastroenteritis in babies and children. <em>Escherichia coli</em>, campylobacter, and salmonella are important bacterial causes of gastroenteritis. Some of the more common causes of gastrointestinal upset are described below, along with their symptoms and treatment. </p><h2>Key points</h2> <ul><li>Gastrointestinal infections are usually caused by a virus or bacterial infection.</li> <li>Some of the common causes of gastrointestinal upset are rotavirus, Norwalk virus, <em>Escherichia coli</em>, campylobacter and salmonella infections.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/gastrointestinal_infections.jpg
General anaesthesiaGGeneral anaesthesiaGeneral anaesthesiaEnglishPain/AnaesthesiaChild (0-12 years);Teen (13-18 years)BodyNervous systemDrug treatmentCaregivers Adult (19+)NA2009-11-17T05:00:00ZSilvana Oppedisano, RN, MN;James Robertson, MD, FRCPC;Nancy Rudyk, RN, BScN8.7000000000000059.80000000000001462.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Your child's stomach must be empty before a general anaesthetic. Follow these instructions to help your child get ready for an operation, test or treatment.</p><h2>What is general anaesthesia?</h2> <p>General anaesthesia (say: an-iss-THEES-ee-a) is a mix of medicines that helps your child fall into a deep sleep. This means your child will not feel pain or remember the operation. General anaesthesia may be used when your child has an operation, test or treatment.</p> <p>This information will help you and your child prepare for general anaesthesia. Please read this information carefully and explain it to your child, using words they can understand. Knowing what to expect will help your child feel less nervous. You can also contact the pre-anaesthesia clinic to help you and your child prepare.</p><h2>Key points</h2> <ul> <li>Your child's stomach must be empty during and after general anaesthesia. If your child's stomach is not empty, your child could vomit and damage their lungs. If you do not follow these instructions, your child's operation, test or treatment will be delayed or cancelled. </li> <li>Starting at <strong>midnight</strong> before your child's operation, test or treatment, your child must not eat or drink any solid food, gum, candy, milk or orange juice. Your child must only have clear liquids such as water, ginger ale or clear apple juice until three hours before the anaesthesia.</li> <li><strong>Three hours</strong> before the operation, test or treatment, stop giving your child anything to drink.</li> <li>There is a small chance your child may have serious side effects from the general anaesthesia. The anaesthesiologist will watch your child carefully to deal with these problems if they happen.</li> </ul><h2>If you have any questions</h2> <p>On the day of your child's operation, test or treatment, the anaesthesiologist will meet with you to talk about any questions and concerns you may have. If you have questions before then, call the anaesthesia department.</p> <p>The team will work with you to make this the best possible experience for you and your child. Please call if you have any questions or concerns.</p> <h2>How general anaesthesia is given</h2> <p>Your child is given general anaesthesia either through a face mask or through a small tube in a vein called an intravenous line (IV).</p> <p>If your child is very nervous, they may be given some medicine before the general anaesthesia. This will help calm your child so they can be less anxious about getting the general anaesthesia.</p> <h3>Who gives the general anaesthesia</h3> <p>The doctor who will give your child the general anaesthesia is called an anesthesiologist. An anesthesiologist is a doctor who helps with surgery and other painful or anxiety-provoking procedures by giving sedatives, painkillers and anaesthetic drugs so that your child will sleep and will not be aware of anything during the procedure.</p> <p>The anesthesiologist will care for your child and help your child cope with the effects of the general anaesthesia. During your child's operation, test or treatment, the anaesthesiologist will be checking your child's breathing, heartbeat, temperature and blood pressure. After the procedure, the anesthesiologist makes sure your child is comfortable and recovering well.</p><h2>Your child may have side effects from the general anaesthesia</h2> <p>After general anaesthesia, your child may have minor side effects (problems), including:</p> <ul> <li>fatigue (tiredness)</li> <li>dizziness</li> <li>irritability</li> <li>sore throat</li> <li>cough</li> <li>nausea (feeling sick to the stomach)</li> <li>vomiting (throwing up); if this happens, your child will get medicine to help them feel better</li> </ul> <h3>Serious side effects are rare</h3> <p>There is a very small chance that there will be a serious problem during or after your child's general anaesthesia. These problems are rare but may include:</p> <ul> <li>an allergic reaction to a drug</li> <li>brain injury</li> <li>cardiac arrest, which means the heart stops beating; this can cause death</li> </ul> <p>The anaesthesiologist will watch your child very closely during the operation, test or treatment. They are trained to deal with these problems if they happen.</p> <p>If your child has a serious problem, they may need to stay in the hospital for a longer time.</p> <h2>After the operation, test or treatment</h2> <p>Your child will go to the Post-Anaesthetic Care Unit (PACU) or recovery room. Specially trained nurses will regularly check your child's breathing, heartbeat, temperature and blood pressure. Your child will wake up soon after the operation, test or treatment. You can be with your child as soon as they wake up.</p> <h2>If your child has pain</h2> <p>Before your child wakes up from the general anaesthesia, they will get medicine for pain.</p> <p>Managing your child's pain is important to help your child get better after the operation, test or treatment. If you think your child is in pain, talk to your child's nurse or doctor so that they can help.</p><h2>What to feed your child before general anaesthesia</h2><p>Your child's stomach must be empty before general anaesthesia. If your child has even a small amount of food or drink in the stomach, your child could vomit (throw up) during the anaesthesia and damage his or her lungs. An empty stomach lowers the chance that your child will vomit.</p><p>Follow these instructions to make sure your child's stomach is empty. If you do not follow these instructions, your child's operation, test or treatment will be delayed or cancelled.</p><ul><li>At <strong>midnight</strong> before the anaesthesia, your child must stop eating solid food, gum, candy, milk or orange juice. Your child can still drink clear liquids up until three hours before the anaesthesia. Clear liquids means liquids you can see through like a window. Clear liquids include water, ginger ale and clear apple juice.</li><li> <strong>Three hours</strong> before the anaesthesia, your child must stop drinking clear liquids. Your child should not take anything by mouth until after they wake up.</li><li>If your child needs to take prescription medicine, talk to your child's doctor before giving the medicine.</li></ul><p>Your child is having general anaesthesia at this time: ________________________</p><p>Your child must stop drinking clear liquids at this time: ___________________</p><h3>For babies</h3><p>If your baby is breastfeeding, stop breastfeeding your baby four hours before the anaesthesia, at this time: ___________</p><p>If your baby drinks formula, stop giving formula six hours before the anaesthesia, at this time: _____________</p><h3>Summary: Eating and drinking before general anaesthesia</h3><table class="akh-table"><thead><tr><th>Time</th><th>What your child can eat and drink</th></tr></thead><tbody><tr><td>Midnight before the anaesthesia</td><td><p>Stop giving your child solid food, including gum, candy and orange juice. Your child must not eat anything until they wake up from the anaesthetic.</p><p>Your child may drink clear liquids, including clear apple juice, water and ginger ale. If your child only drinks water, you may give them Pedialyte.</p></td></tr><tr><td>6 hours before the anaesthesia<br></td><td>Stop giving your baby formula.</td></tr><tr><td>4 hours before the anaesthesia</td><td>Stop giving your baby breast milk.</td></tr><tr><td>3 hours before the anaesthesia</td><td>Stop giving your child clear liquids. Your child must not drink anything until they wake up from the anaesthetic.</td></tr><tr><td colspan="2">If your child takes prescription medicine, ask your child's doctor when and how to give the medicine.</td></tr></tbody></table><h2>Assessing your child before general anaesthesia</h2><p>Before your child's general anaesthesia, a nurse will call you to ask about your child's health. You may be asked to bring your child to the Pre-Anaesthesia Assessment Clinic. At this clinic, you and your child will talk with a nurse or an anaesthesiologist about the general anaesthesia. To reduce the risk of the procedure, the anesthesiologist needs to know about any medical conditions or problems your child has. You and your child will also talk with a nurse in the clinic about the care your child will need in the hospital before and after the operation.</p><p>Please bring a list of your child's medicines to the clinic.</p><h3>Your child may need tests before general anaesthesia</h3><p>The anaesthesiologist or your child's physician may decide that your child needs to have some lab tests before the general anaesthesia. This will depend on your child's medical history and why your child is having the general anaesthesia.</p><p>All girls aged 12 and over will have a urine test before receiving general anaesthesia.</p><h2>If your child is sick before the operation, test or treatment</h2><p>Your child needs to be as healthy as possible before having a general anaesthesia.</p><p>If your child is sick at any time in the week before the operation, test or treatment, call your child's doctor at the hospital right away. Call if your child has any of the following:</p><ul><li>wheezing</li><li> <a href="/Article?contentid=774&language=English">cough</a></li><li> <a href="/Article?contentid=30&language=English">fever</a></li><li>runny nose</li><li>vomiting</li><li>generally feeling unwell</li></ul><h2>At SickKids</h2><p>If you have questions or concerns before your child's anaesthesia, call the Pre-Anaesthesia Clinic at 416-813-7654, ext. 3058. You can make an appointment or speak with an anaesthesiologist.</p><p>SickKids offers a Pre-Admission Program for children between the ages of three and 12 to help them get ready for an operation at the hospital. Your child can play with stethoscopes, hospital gowns, masks and hats. To register your child for the Pre-Admission Program, please call 416-813-5819.</p>https://assets.aboutkidshealth.ca/AKHAssets/general_anaesthesia.jpg
Generalized epilepsy syndromesGGeneralized epilepsy syndromesGeneralized epilepsy syndromesEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesCaregivers Adult (19+) EducatorsNA2010-02-04T05:00:00ZElizabeth J. Donner, MD, FRCPC10.800000000000043.0000000000000876.000000000000Flat ContentHealth A-Z<p>Read about the causes, symptoms and treatments for generalized epilepsy syndromes.</p><p>Generalized epilepsy syndromes include seizures with myoclonic and tonic features. They can be idiopathic, cryptogenic or symptomatic.</p><h2>Key points</h2> <ul><li>Generalized epilepsy syndromes include benign myoclonic epilepsy in infancy, epilepsy with myoclonic astatic seizures, epilepsy with myoclonic absences and epilepsy with generalized tonic-clonic seizures on awakening.</li> <li>Seizures can begin as early as four months old to as late as 20.</li> <li>Causes of these syndromes can include a family history of epilepsy, sleep deprivation and photosensitivity.</li> <li>Most seizures can be treated with anti-epilepsy medications.</li></ul>
Genes and ALLGGenes and ALLGenes and ALLEnglishOncologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemConditions and diseasesAdult (19+)NA2018-03-06T05:00:00ZOussama Abla, MDDanielle Weidman, MDKarin Landenberg, MD9.8000000000000050.0000000000000515.000000000000Flat ContentHealth A-Z<p> Learn how gene changes can cause acute lymphoblastic leukemia (ALL).</p><p>Acute lymphoblastic leukemia (ALL) can develop because of gene changes inside leukemic stem cells. These changes can include chromosome translocations or changes in the number of chromosomes.</p><h2> Key points </h2> <ul><li>Chromosome translocations or a change in the number of chromosomes will often occur in a child with ALL's leukemic cells.</li></ul>
Genetic counsellingGGenetic counsellingGenetic counsellingEnglishPregnancyAdult (19+)BodyReproductive systemHealthy living and preventionPrenatal Adult (19+)NA2009-09-11T04:00:00Z11.500000000000043.20000000000001842.00000000000Flat ContentHealth A-Z<p>This page discusses genetic counselling during pregnancy. It includes a description of genetics, genes, mutations, birth defects, who is at risk for genetic disorders, how genetic disorders are tested, and genetic counselling.</p><p>In health care, genetics is important because some diseases, or the risk of getting some diseases, can be passed from parent to child but may also be caused by a spontaneous change in genetic material. Doctors can do genetic testing to see if an unborn child is at risk of being born with a genetically determined disorder or to confirm a disorder after birth. Genetic counselling involves meeting with a professional with training in genetics who can provide medical information about genetically determined disorders and supportive counselling for individuals faced with difficult choices.</p><h2>Key points</h2> <ul><li>Genetics is the area of biology that studies heredity and spontaneous changes in genetic material.</li> <li>People with a family history of a genetic disorder, may be at high risk of passing the genetic disorder to their baby.</li> <li>Amniocentesis is a diagnostic test that can indicate chromosomal disorders in the unborn baby.</li> <li>Genetic counsellors can provide medical information about genetically determined disorders and supportive counselling for individuals faced with difficult choices.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/neurofibromatosis_genetic_counselling.jpg
Genetically determined disorders in newbornsGGenetically determined disorders in newbornsGenetically determined disorders in newbornsEnglishNeonatologyNewborn (0-28 days)BodyNAConditions and diseasesAdult (19+)NA2009-10-18T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPC12.400000000000035.70000000000001984.00000000000Flat ContentHealth A-Z<p>Read about genetic disorders that can affect a newborn baby. Genetic disorders such as phenylketonuria, sickle cell, and cystic fibrosis are discussed.</p><p>Many congenital abnormalities and diseases are inherited. If both the mother and father carry the trait for a genetically determined abnormality or disease, the baby has at least a one in four chance of inheriting that condition. </p><h2>Key points</h2> <ul><li>Genetically determined disorders include metabolic disorders, blood disorders, cystic fibrosis, congenital hypothyroidism, congenital hyperplasia and congenital hearing loss.</li> <li>Genetic tests can be done before and during pregnancy to determine if the mother and father carry traits for these diseases.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/genetically_determined_disorders_newborn.jpg
Genetics and heart conditionsGGenetics and heart conditionsGenetics and heart conditionsEnglishCardiologyChild (0-12 years);Teen (13-18 years);Adult (19+)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2009-12-04T05:00:00ZSarah Bowdin, MD, MSc, MRCPCH(UK)12.000000000000038.60000000000001364.00000000000Flat ContentHealth A-Z<p>Learn about the role that genetics plays in many heart conditions that afflict children.<br></p><p>Congenital heart conditions can have many causes. In fact, the same condition in two different children could have completely different origins. Congenital heart conditions may be the result of spontaneous genetic changes in the body, genetic mutations that are inherited by a child from a parent, changes caused by external or environmental influences, or a combination of these factors. </p><p>Genetic disorders can result in isolated heart conditions or heart conditions within the context of a syndrome that affects the body and its organs and functions in different ways. In some cases, a heart condition may be the first clue that a patient has a syndrome. As a result, children with heart conditions should be assessed to see whether their heart condition is just one part of a syndrome. </p><p>This page gives examples of some specific genetic disorders and syndromes that can result in heart conditions. In some cases, syndromes are discussed in more detail in the section on Understanding Diagnosis. For more detailed information, please consult your doctor or a genetic counsellor. </p><h2> Key points </h2> <ul><li>Spontaneous genetic changes in the body, genetic mutations, and external or environmental influences can all result in a congenital heart condition. </li> <li> Heart conditions can be a part of a genetic disorder or syndrome.</li></ul>
Genetics of epilepsyGGenetics of epilepsyGenetics of epilepsyEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesCaregivers Adult (19+) EducatorsNA2010-02-04T05:00:00ZBerge Minassian, MD, FRCPC12.100000000000035.80000000000002857.00000000000Flat ContentHealth A-Z<p>Find out how genetics play a part in many types of epilepsy. </p><p>Epilepsy often runs in families. Family studies have shown that some epilepsy syndromes are completely determined by genetics, and genes are a major factor in other syndromes. Some inherited metabolic conditions also raise the likelihood of having seizures, as do some chromosomal disorders.</p><h2>Key points</h2> <ul><li>Genetic disorders can cause epilepsy alone, or can result in a syndrome with a number of different effects on the organs and functions of the body, including epilepsy.</li> <li>Epilepsy can arise directly or indirectly (as a symptom of another condition) from genetic disorders related to a specific gene, a combination of genetics and environmental factors, mutations in the DNA in mitochondria, missing or mutated chromosomes or changes in the activity of genes.</li> <li>Mutations in certain genes have been identified as causes of brain malformations, which can lead to epilepsy.</li></ul>
Genetics of neurofibromatosis type 1 (NF1)GGenetics of neurofibromatosis type 1 (NF1)Genetics of neurofibromatosis type 1 (NF1)EnglishGeneticsChild (0-12 years);Teen (13-18 years)Eyes;SkinSkin;NervesConditions and diseasesCaregivers Adult (19+)NA2010-03-05T05:00:00ZElena Pope, MD, MSc, FRCPC;Patricia Parkin, MD, FRCPC;Stephen Meyn, MD, PhD, FRCPC, FACMG;Andrea Shugar, MS, CGC, CCGC6.3000000000000073.8000000000000768.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Neurofibromatosis Type 1 (NF1) occurs because of a mutation to the NF1 gene. About half of cases are spontaneous mutations, while the other half are inherited from a parent to a child.</p><h2>What is a gene?</h2> <figure> <span class="asset-image-title">What are genes?</span> <img src="https://assets.aboutkidshealth.ca/akhassets/What_is_a_gene_MED_ILL_EN.jpg" alt="Cell, chromosome, DNA strand, gene and DNA building blocks or nucleotides" /> <figcaption class="asset-image-caption">Genes are made of long strings of nucleotides on a section of DNA. Groups of genes are packed tightly in a chromosome.</figcaption></figure> <p>Our bodies are made up of billions of cells. The cells work together to make our bodies work. Different cells have different jobs, but they all have one thing in common: each contains genes. </p><p>Genes are the instructions that our cells use to make proteins. Genes tell our cells how to work and what to do. For example, one gene may determine the colour of your hair or your blood type. </p><p>Genes are packaged in the form of chromosomes. The information in a gene is coded in a chemical called DNA.</p><p>There are about 30,000 genes inside every cell. Each person carries two copies of each gene. A child gets (inherits) one copy from their mother and the other from their father.</p><p>For more information about genes, please see the AboutKidsHealth section on <a href="/En/HowTheBodyWorks/GeneticsIntroduction" target="_blank">How the Body Works: Genetics.</a></p><h2>What causes NF1?</h2><p>Every person has two copies of the NF1 gene. This gene codes for a protein called neurofibromin (say: noor-oh-fie-BROH-min).</p><p>Neurofibromin's job in the body is to make sure that certain cells divide and grow in a controlled way. In particular, it stops certain cells that support the nerves from growing too much. These cells are called nerve sheath cells. </p><p>A mutation (a change in the genetic code) in the NF1 gene leads to a neurofibromin protein that does not work properly. This leads to symptoms of NF1. </p><h2>Key points</h2> <ul> <li>A person can get NF1 in one of two ways. Half of cases happen completely by chance. The rest of the time, NF1 is inherited or passed down from parent to child.</li> <li>In some cases, the signs or symptoms of NF1 are so mild that a parent may not find out they have NF1 until a child is diagnosed. </li> <li>A person with NF1 has a 50% (one in two) chance to have an affected child with each pregnancy. </li> <li>Adults may benefit from genetic counselling to understand their risks and choices regarding planning and family. </li> </ul><h2>There are two ways to get NF1<br></h2><p>There are two ways a person can get NF1: as a new mutation, or by inheriting it from a parent.</p><h3>A new (spontaneous) mutation</h3><p>Half of all cases of NF1 occur by chance. This is called a new or spontaneous mutation. A change occurs in the NF1 gene at the time of, or shortly after, conception. Conception is the time when the father's sperm and the mother's egg join and the egg is fertilized. </p><p>In this case, neither parent of the affected child will have NF1. Spontaneous gene mutations are not inherited from either parent. </p><h3>Inherited from a parent with NF1</h3><p>The other half of people with NF1 inherited it from one of their parents. This means that a parent with a mutation in the NF1 gene passed the mutated gene to the child. </p><p>In some cases, the signs or symptoms of NF1 are so mild that a parent may not find out they have NF1 until their child is diagnosed. </p><h2>How NF1 is inherited</h2><p>Genes come in pairs, as do the chromosomes that carry them. When we have children, each parent passes half of their genetic material to their children, meaning one gene from each pair of genes. </p> <figure class="asset-c-80"> <span class="asset-image-title">Heredity of neurofibromatosis (NF1)</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Neurofibromatosis_genetics_MED_ILL_EN.jpg" alt="Chromosome distribution from an affected parent with one chromosome with NF1 gene mutation an unaffected parent" /> <figcaption class="asset-image-caption">Every person has 2 copies of the NF1 gene, one on each chromosome. If a person has one mutated NF1 gene, he or she may develop the conditions of neurofibromatosis. An affected parent has a 50% chance of passing the mutated gene on to his or her child.</figcaption> </figure> <p>NF1 is inherited as a dominant condition. Dominant means the mutated gene is stronger than the normal gene. This means that only one NF1 gene needs to be mutated for the person to develop NF1. </p><p>If a person has NF1, they have one normal NF1 gene and one NF1 gene with a mutation. When this person has a child, they can pass on either the normal NF1 gene or the NF1 gene with the mutation. In other words, a person with NF1 has a 50% (one in two) chance of passing on NF1 to their children. </p><p>Adults with NF1 who are planning a family may wish to seek genetic counselling so that they can understand their risks and choices. </p>https://assets.aboutkidshealth.ca/akhassets/What_is_a_gene_MED_ILL_EN.jpg
Genetics teamGGenetics teamGenetics teamEnglishNAChild (0-12 years);Teen (13-18 years)NANAHealth care professionalsAdult (19+) CaregiversNA2009-12-04T05:00:00ZJennifer Russell, MD, FRCPC11.100000000000045.9000000000000967.000000000000Flat ContentHealth A-Z<p>Geneticists and genetic counsellors can provide information and support if a child has been diagnosed with a genetic condition or if the family is at high risk.</p><p> This page explains how members of the genetics team assess the risk of having a condition with a genetic component.</p><h2> Key points </h2><ul><li> Genetic counsellors assess and counsel individuals and families with a medical history of a genetic disorder, who themselves have a genetic disorder, or who may be at an increased risk of having a child with a genetic disorder.</li><li>A geneticist is a specialized medical doctor who investigates the cause of a genetic disorder or birth defect.</li><li>Your child's doctor will refer you to the genetics team or clinic if they think your child has a condition with a genetic component. </li></ul>
Genital problemsGGenital problemsGenital problemsEnglishPregnancyAdult (19+)Body;Uterus;Ovaries;Penis;Scrotum;TesticleReproductive systemConditions and diseasesPrenatal Adult (19+)NA2009-09-10T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC Andrew James, MBChB, MBI, FRACP, FRCPC9.9000000000000049.8000000000000990.000000000000Flat ContentHealth A-Z<p>Learn about the various genital abnormalities that can arise in a developing fetus during pregnancy. Answers from Canadian Paediatric Hospitals.<br></p><p>Some babies are born with congenital abnormalities, or birth defects, in their genital tract. These abnormalities form as the result of something going wrong with the development of the baby’s genital tract during pregnancy. It is important to keep in mind that these abnormalities are rare, and can sometimes be treated with surgery. </p><h2>Key points</h2> <ul><li>Genital tract abnormalities can occur in both boys and girls; they are usually rare and may sometimes be treated with surgery.</li> <li>Problems with sexual differentiation are a result of chromosomal issues. They can affect the gender of your child.</li></ul>https://assets.aboutkidshealth.ca/akhassets/Undescended_testes_MED_ILL_EN.png
Germ cell tumoursGGerm cell tumoursGerm cell tumoursEnglishNeurology;OncologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesAdult (19+)NA2009-07-10T04:00:00ZEric Bouffet, MD, FRCPC9.4000000000000057.0000000000000962.000000000000Flat ContentHealth A-Z<p>This page gives an overview of the different types and causes of germ cell tumours, and what the medical symptoms of germ cell tumours are.<br></p><p>Germ cell tumours occur mostly in the area above the pituitary gland (suprasellar region) or in the pineal region of the brain. There are two main types of germ cell tumours: germinomas and non-germinomatous germ cell tumours. The most common type is the germinoma. About 60% to 70% of germ cell tumours are pure germinomas.</p><h2>Key points</h2> <ul><li>There are two main types of germ cell tumours: germinomas and non-germinomatous germ-cell tumours.</li> <li>During normal development of a baby, a germ cell develops into an egg cell (in a girl) or a sperm cell (in a boy), then migrating to the wrong part of the body and producing a tumour.</li> <li>Symptoms of germ cell tumours depend on the part of the brain where the tumour is located.</li></ul>
Getting help when your child is in hospitalGGetting help when your child is in hospitalGetting help when your child is in hospitalEnglishNAChild (0-12 years);Teen (13-18 years)NANASupport, services and resourcesCaregivers Adult (19+)NA2012-06-13T04:00:00ZNA8.1000000000000066.9000000000000619.000000000000Flat ContentHealth A-Z<p>Coping with your child's illness as a parent means taking care of yourself. Learn practical stress relief approaches for parents.</p><p>Most people are not in a position to be able to suddenly drop everything in their lives and be with their <a href="/Article?contentid=1161&language=English">sick child in the hospital</a> 24 hours a day. Even parents who may be independently wealthy will have to make arrangements that will require more than just money. For example, there may be other children in the family who still require competent and trustworthy care.</p><p>All families will have to keep on with many aspects of their lives, no matter what. Income and other financial matters cannot be ignored for long; children need to be cared for, and transportation needs to be arranged. Juggling all of this while still visiting a child, perhaps for extended periods in the hospital, will be difficult. You cannot do it all yourself. There will certainly be resources and other help that can be accessed at the hospital which you should take advantage of. But do not stop there. Draw on whatever other resources you have. </p> ​<h2>Key points</h2> <ul> <li>If you have a sick child in the hospital you will still need to keep up with other aspects of your daily life such as caring for other children and meeting work and financial obligations. Draw on the resources you have and get the help that you need.</li> <li>You may be able to get some help from the hospital and community health services for certain things, but do not be afraid to ask family, friends and neighbours for help especially with the day-to-day tasks around the home.</li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/getting_help_when_your_child_is_in_hospital.jpg
Getting pregnantGGetting pregnantGetting pregnantEnglishPregnancyAdult (19+)BodyNANAPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCAndrew James, MBChB, FRACP, FRCPC9.5000000000000058.1000000000000929.000000000000Flat ContentHealth A-Z<p>Important information to consider when thinking of getting pregnant, including the benefits and drawbacks of getting pregnant in your 20s, 30s, or 40s.<br></p><p>Getting pregnant is not as easy as you might think. A healthy couple at the prime reproductive age has about a 25% chance of conceiving each month. Only about half of all couples get pregnant within six months of trying, but most – 85% – do become pregnant within a year. Becoming pregnant takes time; don’t assume it will happen right away.</p><h2>Key points</h2> <ul><li>If you want to become pregnant, see your doctor first for advice on health before pregnancy.</li> <li>If you are planning to become pregnant, you will need to stop your birth control</li> <li>The return of your fertility will depend on the type of contraception you were using.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/getting_pregnant.jpg
Getting through the teen yearsGGetting through the teen yearsGetting through the teen yearsEnglishAdolescent;RheumatologyPre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years)NANANAAdult (19+)NA2017-01-31T05:00:00ZJennifer Stinson RN-EC, PhD, CPNP;Lori Tucker, MD;Tonya Palermo, PhD;Miriam Granger, MSW, RSW;Laurie Horricks, FN, MN;Lynn Spiegel, MD, FRCPC9.5000000000000055.0000000000000928.000000000000Flat ContentHealth A-Z<p>This page contains information to help parents cope with their increasingly independent teen.</p><p>Your teenager is changing both developmentally and physically. Sometimes this can create tension between you and your teenager. As frustrating as it can be, remember that this is normal. Despite your conflicts, your teenager needs your help to grow into a responsible and independent individual.</p><h2>Key points</h2> <ul><li>As your teenager moves through adolescence, they will become more independent and begin to assert themselves.</li> <li>Talk to your child early about the physical and developmental changes ahead of them.</li> <li>Choose your battles wisely, communicate with your child and respect their privacy.</li> <li>Although a certain amount of change occurs during adolescence, any drastic or long-lasting changes in your teenager’s personality or behaviour may be a sign of trouble.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/getting_through_the_teen_years.jpg
Giving birth: An overviewGGiving birth: An overviewGiving birth: An overviewEnglishPregnancyAdult (19+)BodyReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC8.8000000000000059.0000000000000432.000000000000Flat ContentHealth A-Z<p>Information about childbirth and pregnancy and labour. Learn about natural labour and delivery, epidural or caesarean section.</p><p>This is it! After nine months of wondering about your baby, the time for holding them in your arms is drawing near. But first there is the issue of labour and delivery. If you are a first-time mother, this is probably the event that you have been most anxious and worried about. If you have had a baby before, you may still be nervous about the pain. Try to keep in mind that labour and delivery lasts for a day, maybe two. After you are done, you will have a most precious reward for your efforts.</p><h2>Key points</h2> <ul><li>Familiarize yourself with the signs of labour so you know when you are in real labour as opposed to false labour.</li> <li>Vaginal birth, also called labour and delivery, is divided into three stages, although every woman experiences these stages differently.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/giving_birth_overview.jpg
Glomerular filtration rate (GFR) scanGGlomerular filtration rate (GFR) scanGlomerular filtration rate (GFR) scanEnglishOtherChild (0-12 years);Teen (13-18 years)KidneysKidneysTestsCaregivers Adult (19+)NA2013-12-06T05:00:00ZMandy Kohli, Clinical Co-ordinator, Nuclear Medicine7.3000000000000071.1000000000000778.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn how a GFR scan is done and how it shows how well the kidneys filter blood.</p><h2>What is a renal scan and GFR?</h2> <p>A renal scan and GFR (glomerular filtration rate) is a test to look at how well the kidneys filter blood. </p><h2>Key points</h2> <ul> <li>A renal scan and GFR (glomerular filtration rate) is a test to look at how well the kidneys filter blood. It can take three about hours.</li> <li>Your child will be injected with a small amount of radioactive medicine and have pictures taken of their kidneys. They will then give two samples of blood at set times to show how well the kidneys are filtering the medicine.</li> <li>Your child may be asked to drink one or two extra glasses of water or juice before the scan so they are well hydrated.</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 test take?</h2> <p>The test can take about three hours in total. This includes the time to inject your child, do the scan of their kidneys and wait for the blood samples to be taken. Please add half an hour to the total time if your child has a topical anaesthetic before the injection.</p><h2>Will I be able to stay with my child during the test?</h2> <p>One parent or guardian may stay in the room with the child, but no other children are allowed.</p> <h2>How is the test done?</h2> <p>The test is done by a nuclear medicine technologist. It has four parts.</p> <ol> <li>Your child will be given a small injection (needle) into a vein in the arm or back of hand.</li> <li>The technologist will do a scan to take pictures of your child's kidneys.</li> <li>The technologist will take a blood sample 1.5 hours after the injection.</li> <li>The technologist will take a second blood sample 2.5 hours after the injection.</li> </ol> <h3>Injection</h3> <p>The injection contains a very small amount of radioactive medicine that mixes with the blood.</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 time to allow the anaesthetic to take effect.</p> <h3>Scan</h3> <p>Your child will then lie down on a narrow bed and a special camera will take pictures for 30 minutes right after the injection. This is to see how your child's kidneys filter the medicine. In most cases your child can watch a movie as the scan is being done.</p> <h3>Blood samples</h3> <p>The blood samples are taken to check how well the kidneys can remove waste products at set intervals.</p> <h2>Must my child stay in the hospital between the scan and the blood samples?</h2> <p>Your child can leave the hospital between the scan and the blood samples, but they must return at the time(s) given by the technologist.</p><h2>Does my child need to do anything special to prepare for the test?</h2> <p>Your child can eat and drink as usual, but they may be asked to drink one or two extra glasses of water or juice before the scan so they are well hydrated.</p> <p>Some children need a blood or urine test before the test. 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 renal scan and GFR, 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 scan.</p> <p>If you have any questions or concerns about the test or if you need to change your appointment, please call the Nuclear Medicine Department at 416-813-6065.</p>
Going homeGGoing homeGoing homeEnglishNeonatologyPremature;Newborn (0-28 days);Baby (1-12 months)NANANAPrenatal Adult (19+)NA2009-10-31T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPC8.8000000000000062.50000000000001101.00000000000Flat ContentHealth A-Z<p>Read about issues that parents and caregivers must address in order to prepare for a premature baby's departure from the hospital, and arrival at home.</p><p>There are many things to consider when taking your baby home. Depending on your baby's medical needs you may need to purchase special medical equipment or medications. There will also be a certain level of stress on the parents who will be caring for their baby at home without a medical team for the first time. Take time to think about and plan what you need to do to get ready to take your baby home.</p><h2>Key points</h2> <ul><li>Before your baby goes home, think about who will care for your child and provide help, how you will get your baby home, and if you need to purchase special medications or medical equipment.</li> <li>It is important to bring your baby for follow-up appointments so that the health-care team can continue to monitor them and diagnose any potential complications or long-term health effects.</li> <li>Some parents will have a difficult time adjusting to having their baby at home after the trauma of witnessing their baby in the NICU.</li></ul>https://assets.aboutkidshealth.ca/akhassets/twins-in-pink-NICU-BRAND-PH_EN.jpg
Going home after a blood and marrow transplantGGoing home after a blood and marrow transplantGoing home after a blood and marrow transplantEnglishHaematology;Immunology;OncologyChild (0-12 years);Teen (13-18 years)BodyImmune systemNAAdult (19+)NA2010-03-19T04:00:00ZJohn Doyle, MD, FRCPC, FAAPChristine Armstrong, RN, MScN, NP Peds8.5000000000000065.1000000000000477.000000000000Flat ContentHealth A-Z<p>Learn how to care for your child at home, after the blood and marrow transplant.</p><p>When your child is ready to leave the hospital, they will return home to continue the rest of their recovery from their blood and marrow transplant (BMT).</p> <ul> <li>For children undergoing autologous transplant, this is usually between three to six months.</li> <li>For children undergoing allogenic transplant, this period of time is at least six months.</li></ul> <p>Some children leave the hospital and return easily to their normal daily routines, but many others take longer to get over the effects of being in the hospital.</p><h2>Key points</h2> <ul><li>Your child may experience several behavioural or physical changes when going home after a blood and marrow transplant.</li> <li>Your child’s immune system is still recovering from the transplant so it is important to minimize exposing your child to any possible sources of infection.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/going_home_after_a_blood_and_marrow_transplant.jpg
Going home after brain tumour surgeryGGoing home after brain tumour surgeryGoing home after brain tumour surgeryEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemNAAdult (19+)NA2009-07-10T04:00:00ZEric Bouffet, MD, FRCPCKaren Drybrough, RNLaura Janzen, PhD, CPsych, ABPP-CNUte Bartels, MD9.2000000000000057.90000000000001368.00000000000Flat ContentHealth A-Z<p>In-depth answers on what happens when your child goes home after brain tumour surgery, and when to call the treatment team.</p><p>Your child will need care and support from you and the treatment team during and after treatment. Before you leave the hospital with your child, the treatment team will explain: </p> <ul><li>what to expect during the first few weeks</li> <li>what side effects and complications to watch for</li> <li>how you can help your child when they are in pain</li> <li>when your child needs to come back for a clinic visit to check on their recovery and overall progress</li> <li>what kind of rehabilitation therapy your child will need </li> <li>when your child will be able to return to school</li> <li>who to contact if you have any questions</li></ul><h2>Key points</h2> <ul><li>Behaviour changes in your child are normal after they leave the hospital.</li> <li>There may be side effects or complications from a surgery or procedure that you will need to watch for in your child.</li></ul>
Good nutrition during leukemia treatmentGGood nutrition during leukemia treatmentGood Nutrition During Leukemia TreatmentEnglishOncologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemConditions and diseases;Non-drug treatmentAdult (19+)NA2018-03-06T05:00:00ZOussama Abla, MDDanielle Weidman, MDKarin Landenberg, MD7.1000000000000066.30000000000001038.00000000000Flat ContentHealth A-Z<p> Learn why good nutrition during leukemia is so important and how to manage nutritional side-effects of chemotherapy.</p><p>Good nutrition is an important part of your child’s leukemia therapy. While your child is being treated for leukemia, your child’s height and weight will be regularly checked and compared to the growth of other children the same age. This helps your child’s health care team make the best decisions when it comes to your child’s nutritional needs.</p><h2> Key points </h2> <ul><li>Children often feel nauseous or vomit while taking chemotherapy medication, but there are certain foods they can eat and avoid to help reduce these side effects.</li> <li>Children can lose weight from chemotherapy, so high-calorie, high-protein food is best to make every bite count.</li> <li>Chemotherapy and other leukemia medications may cause constipation, weight gain and changes to taste.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/good_nutrition_during_leukemia_treatment.jpg
Graft-versus-host disease after a blood and marrow transplantGGraft-versus-host disease after a blood and marrow transplantGraft-versus-host disease after a blood and marrow transplantEnglishHaematology;Immunology;OncologyChild (0-12 years);Teen (13-18 years)BodyImmune systemConditions and diseasesAdult (19+)NA2010-03-06T05:00:00ZJohn Doyle, MD, FRCPC, FAAPChristine Armstrong, RN, MScN, NP Peds8.4000000000000061.3000000000000896.000000000000Flat ContentHealth A-Z<p>Learn about how graft-versus-host disease is prevented and treated, after an allogeneic transplant.</p><p>After an allogeneic blood and marrow transplant (BMT), some children may develop a common complication, called graft vs host disease (GVHD).</p><h2>Key points</h2><ul><li>Graft vs host disease (GVHD) occurs when the new bone marrow stem cells recognize your child as different from what they expect.</li><li>Acute GVHD develops early after the transplant, while chronic GVHD develops later.</li><li>Children who develop GVHD usually take a combination of medicines including prednisone, cyclosporine, and methotrexate.</li></ul>https://assets.aboutkidshealth.ca/akhassets/Graft_vs_Host_Disease_MED_ILL_EN.jpg
Grain productsGGrain productsGrain productsEnglishNutritionChild (0-12 years);Teen (13-18 years)NADigestive systemHealthy living and preventionCaregivers Adult (19+) Educators Hospital healthcare providers Community healthcare providers Remote populations First nationsNA2013-09-27T04:00:00ZTheresa Couto, RD;Elly Berger, BA, MD, FRCPC, FAAP, MHPE;Francy Pillo-Blocka RD, FDC6.1000000000000081.2000000000000160.000000000000Flat ContentHealth A-Z<p>Learn about the nutrients in and recommended serving sizes for grain products, one of the four food groups in Canada's Food Guide.<br></p><h2>Key points</h2><ul><li>Grain products are a source of fibre, B vitamins and iron. </li><li>A single serving is one slice of whole grain bread, half a cup of dry pasta or 30 g of cereal. </li><li>Eat a variety of grain products, making sure half of them are whole grains.<br></li><li>Source of fibre</li><li>Low in fat</li><li>Good source of B vitamins and iron</li></ul>
Grief and lossGGrief and lossGrief and lossEnglishPregnancyAdult (19+)BodyReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC7.5000000000000066.1000000000000948.000000000000Flat ContentHealth A-Z<p>How to effectively deal with grief after the loss of your baby during pregnancy. Ideas are provided about ways to remember your baby.</p><p>If you have lost a baby due to miscarriage, removal of an ectopic pregnancy, stillbirth, or therapeutic abortion, you will probably be overwhelmed with a range of emotions. Losing a baby is one of the most difficult losses to deal with, regardless of when the loss actually happened and what the circumstances were. You may feel sad one minute and angry the next. You may feel shock, denial, and depression. Sometimes you may feel these emotions altogether or one after the other. Often they come without warning.</p><h2>Key points</h2> <ul><li>Allow yourself to grieve your loss and remember that grief is cyclical and emotions may come and go for weeks, months or years.</li> <li>Remember to take care of yourself both physically and mentally by getting enough sleep, eating well, exercising and catching up with friends and family when you're ready.</li> <li>If you find yourself sinking into a depression or unable to cope, seek out the help of a counsellor or bereavement group.</li></ul>
Grief and loss after losing a babyGGrief and loss after losing a babyGrief and loss after losing a babyEnglishNeonatologyNewborn (0-28 days)NANASupport, services and resourcesCaregivers Adult (19+)NA2009-10-28T04:00:00ZChristine Newman, MD, FRCPC6.9000000000000067.90000000000001643.00000000000Flat ContentHealth A-Z<p>This page describes the feelings of grief and loss that parents face when they lose a baby. Ways to cope with grief and remember their baby are discussed.</p><p>You will probably be overwhelmed with a range of emotions. Having a child die is one of the most difficult types of grief to deal with. No parents expect to outlive their child. You may feel sad one minute and angry the next. You may feel shock, denial, and depression. Sometimes you will feel these emotions altogether or one after the other. Often they may come without warning. You may also experience a tremendous emotional release if you've been holding your emotions in throughout the course of your child’s illness. </p><h2>Key points</h2> <ul><li>Allow yourself time to grieve and remember that everyone grieves in their own way, and there is no time limit on grief.</li> <li>If you find yourself sinking into a depression and unable to cope, seek out help from a counsellor or bereavement group.</li></ul>
GrievingGGrievingGrievingEnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartCardiovascular systemNAAdult (19+)NA2010-05-19T04:00:00ZLaura Beaune, RNChristine Newman, MD, FRCPC6.6000000000000070.4000000000000911.000000000000Flat ContentHealth A-Z<p>Losing a child is one of the most difficult losses to deal with. This page describes common reactions to grief and suggests some ways to cope.</p><p>You may be overwhelmed with a range of emotions after the loss of your child. Losing a child is one of the most difficult losses to deal with. No parent expects to outlive their child. You may feel sad one minute and angry the next. You may feel shock, denial, and depression. Sometimes you feel these emotions all together or one after the other. Often they come without warning. You may also experience a tremendous emotional release if you've been holding your emotions in throughout the course of your child's illness. </p><h2> Key points </h2> <ul><li> It is normal to feel overwhelmed with different emotions after losing a child.</li> <li> It is healthy to express your emotions and ask for help after the death of a child.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/grieving.jpg
Growing independence for children with heart diseaseGGrowing independence for children with heart diseaseGrowing independence for children with heart diseaseEnglishCardiologyTeen (13-18 years)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2009-12-14T05:00:00ZRoss Hetherington, PhD, C.Psych11.300000000000049.10000000000001267.00000000000Flat ContentHealth A-Z<p>Learn about encouraging self-care in children with congenital heart disease.<br></p><p> This page outlines how you can prepare teenagers with heart disease to look after themselves as they grow up.</p><h2> Key points </h2> <ul><li>Ensure your teen is knowledgeable about their heart condition and knows their medical history. </li> <li>Encourage teens to see the cardiologist on their own so they can become more independent when it comes to their care and can discuss issues without parental involvement.</li> <li>Involve a health professional such as a social worker or psychologist if your teen is experiencing psychological problems or needs support.</li> <li>Teens who know about their condition and the repercussions of not taking care of themselves can be trusted to look after themselves.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/growing_independence_congenital_heart_disease.jpg
Growth and developmentGGrowth and developmentGrowth and developmentEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemHealthy living and preventionAdult (19+)NA2017-09-25T04:00:00ZCatherine Pastor, RN, MN, HonBScVanita Pais, RD, CDESanjukta Basak, MSc, MD CM, FRCPCRuth Slater, PhD, C. PsychJennifer Harrington, MBBS, PhD​8.4000000000000065.5000000000000373.000000000000Flat ContentHealth A-Z<p>Find out what it's like for a child with diabetes to adjust to different challenges of managing the condition at different ages and stages.</p><p>Each age and stage of life has a <a href="http://www.childrenwithdiabetes.com/">different set of challenges</a>. A chronic disorder brings additional challenges. It might seem that as soon as your family has found ways to negotiate the rocky course of one stage of development, the next stage has arrived.</p><p>For example, parenting an infant or toddler can be much different from parenting a school-aged child. Likewise, being a teenager with diabetes is different from being nine or 10 years old and living with the disorder. As teenagers reach adulthood, they are faced with new issues that further affect their diabetes care.</p><p>Your family and the <a href="/Article?contentid=2511&language=English">diabetes team​</a> can both help smooth your child’s road to adulthood by helping your child develop a strong sense of identity and self-worth and empowering them to take responsibility for their diabetes management.</p><h2>Key points</h2> <ul><li>Diabetes care will change depending on your child's age and lifestyle. Both of these things must be factored in to a diabetes management plan.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/growth_and_development.jpg
Growth and stature of children with heart diseaseGGrowth and stature of children with heart diseaseGrowth and stature of children with heart diseaseEnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2009-12-14T05:00:00ZRoss Hetherington, PhD, C.Psych12.300000000000042.2000000000000725.000000000000Flat ContentHealth A-Z<p>Learn about how growth and stature are affected by congenital heart disease.</p><p> This page explains how a child with congenital heart disease can be expected to grow and physically develop as they get older. Physical and occupational therapists can work with children to overcome physical challenges.</p><h2> Key points </h2> <ul><li>Children with congenital heart disease may grow and develop more slowly than healthy children.</li> <li>Good nutrition will need to be an essential part of your child's care if they are not reaching growth milestones.</li> <li>After surgery, physiotherapists and occupational therapists may help ensure that children are reaching growth milestones and developing properly.</li> <li>Many children with congenital heart disease display motor deficits, which can be addressed through physical or occupational therapy.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/growth_and_stature_of_children_with_heart_disease.jpg

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