IV-line careIIV-line careIV-line careEnglishOtherChild (0-12 years);Teen (13-18 years)NAVeinsNon-drug treatmentCaregivers Adult (19+)NA2015-10-12T04:00:00ZDarlene Murray, BSN, MS(c)​;Vandana Tuszynska, RN, MN;Jessica Fernandes, RN, MN​​​7.1000000000000072.80000000000001115.00000000000Health (A-Z) - ProcedureHealth A-Z<p>IV lines can be an important part of your child's care. Learn about the importance of IV-line care and keeping your child safe.</p><p>Intravenous (IV) catheters, also known as "IV lines," can be an important part of your child's care. Keeping your child safe when they require an IV line is important to your child's healthcare providers. A child's safety is reinforced when parents and caregivers are informed and involved in their care.</p> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_IV_line_EN.jpg" alt="Child in bed with IV in back of hand" /> </figure> <h2>What is an IV line?</h2><p>IV lines are used to deliver different types of fluids, medications, and blood products to patients of all ages. The catheter or the "line" is a thin, flexible plastic tube. A trained health care provider inserts the line into a vein in the hand, arm, foot, leg, or scalp. Fluid flows through the line directly into the child's bloodstream.</p><h3>Inserting an IV line</h3><p>An IV line has a small needle inside the tube that helps get the tube into the vein. When the nurse or doctor inserts the needle and the surrounding tube into the vein, the needle is pulled out and the plastic tube stays in place. This area of the body where the IV line is inserted is known as the "IV site." Your child may feel a small pinch when the needle is inserted, but the pain will go away once the needle is removed. The IV line is held in place at the insertion site with clear tape.</p><h2>Key points</h2> <ul> <li>It is a nurse's responsibility to ensure the safe monitoring and management of your child's IV line.</li> <li>Nurses will be checking the IV at least once every hour, including throughout the night.</li> <li>Parents and caregivers can help with IV monitoring by ensuring their child does not pull the line, watching for pain or numbness, keeping the IV site dry, keeping the IV site visible and alerting the nurse when concerns or problems arise.</li> <li>Be aware of the signs of an IV line not working properly and the symptoms your child may experience.</li> </ul><h2>Complications</h2><p>If an IV line is not working properly, your child may experience any of the following symptoms:</p> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_IV_line_signs_of_complications_EN.jpg" alt="Hand with redness and leakage at IV site" /> </figure> <ul><li>General pain or pain to the touch at the IV site</li><li>Swelling of the area where the IV line is inserted</li><li>Numbness at the area</li><li>Redness</li><li>Bruising</li><li>Wetness at the area, suggesting that the IV line is leaking</li><li>Firmness at the area, which may be related to swelling</li><li>Warmth or coolness at the IV site</li></ul><p>The hourly assessments done by the nursing staff will ensure the IV line is working properly or let them know if there are problems.</p><h3>What happens if an IV line is pulled out?</h3><p>If your child's IV line is accidentally pulled out, call the nurse for help. While you are waiting, apply pressure to the area (where the IV line used to be) using gauze or tissue to stop any bleeding. Hold on to the IV line until the nurse arrives.</p><h3>What happens if the IV line stops working?</h3><p>If the IV line is not working properly, the fluid in the IV may leak into the surrounding tissues. Your child may experience some of the symptoms described above (e.g., pain, swelling). The IV line may need to be restarted, reinserted or switched if it is not working or if it has been accidentally removed. In this situation, your child's nurse or doctor will talk to you about the next course of action.</p><p>Parents and caregivers can speak to their nurse at any time if they have questions or concerns about the IV line.</p><h2>Caring for an IV line</h2><p>Intravenous lines must be properly checked and cared for to ensure the line is working properly and that there are no complications. It is the nurse's responsibility to ensure IV line safety, but parents and caregivers can assist in IV care by monitoring the line when the nurse is not present and alerting the nurse to any problems or concerns.</p><h3>What your nurse will do to care for the IV line</h3><p>It is the nurse's responsibility to check the IV site at least once every hour, including throughout the night.</p><p>Nurses will treat your child's IV line with <strong>TLC+<sup>1</sup></strong>, meaning they will do the following:</p><div class="akh-series"><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_IV_line_care_touch_EN.jpg" alt="Feeling hand for temperature change or leakage at IV site" /> </figure> <p> <strong>TOUCH</strong> for signs of temperature change (heat or warmth) or leakage at the IV site.</p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_IV_line_care_look_EN.jpg" alt="Nurse examining IV site with a flashlight" /> </figure> <p> <strong>LOOK</strong> to make sure the IV site is dry and visible at all times.</p></div></div><div class="row"><div class="col-md-12"> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_IV_line_care_compare_EN.jpg" alt="Comparing hand with IV to opposing hand" /> </figure> <p> <strong>COMPARE</strong> the IV site (such as the hand or leg) with the opposite limb to look for signs of swelling.</p></div></div><div class="row"><div class="col-md-12"> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_IV_line_care_communicate_EN.jpg" alt="Nurse speaking with child and mother" /> </figure> <p> <strong>+ENGAGE</strong> with patients, parents, and caregivers to ensure the best possible care. This means encouraging patients and families to:</p><ul><li>notify the nurse if they notice any symptoms of complications (outlined below)</li><li>ask questions or share concerns</li><li>assist and support nurses caring for the IV line.</li></ul></div></div></div><p>Nurses will try to minimize disruptions when checking the IV line (such as using a flashlight at night), but for safety reasons they must check the site, even when your child is asleep.</p><h3>What YOU can do to care for the IV line</h3><p>Parents and caregivers can help care for the IV line when the nurse is not around by doing the following:</p><ul><li> <strong>Help protect the IV line</strong>. Sometimes an IV line can accidentally come out if it is bumped. Make sure the IV line does not get pulled when your child is walking, playing, using the bathroom, or getting up from a bed or chair. Ask a nurse if you need help managing the IV line during these activities.</li><li> <strong>Speak with your child</strong>. Ask your child to tell you if the IV line hurts, or if the IV site feels tingly or numb. Remind them not to pull or tug on the IV line and to ask the nurses for help if they want to move.</li><li> <strong>Keep IV site visible (especially when your child is sleeping)</strong>. This will make it easier for the nurse to check the IV without waking your child.</li><li> <strong>Keep the IV site dry</strong>. The IV site should be kept dry at all times. This helps prevent infection and accidental IV line removal.</li><li> <strong>Call the nurse if you notice any signs of complications</strong>. These are outlined below.</li></ul><p><sup>1</sup>TLC+ adapted with permission from Cincinnati Children's TLC (Touch, Look, Compare) policy for peripheral intravenous catheter care.</p>https://assets.aboutkidshealth.ca/akhassets/IMD_IV_line_care_compare_EN.jpg
Idiopathic thrombocytopenia purpura (ITP)IIdiopathic thrombocytopenia purpura (ITP)Idiopathic thrombocytopenia purpura (ITP)EnglishHaematologyChild (0-12 years);Teen (13-18 years)BodyCardiovascular systemConditions and diseasesCaregivers Adult (19+)NA2011-06-02T04:00:00ZMelanie Kirby-Allen, MD, FRCPC9.1000000000000052.80000000000001613.00000000000Health (A-Z) - ConditionsHealth A-Z<p>A general overview or idiopathic thrombocytopenia purpura or ITP, an acquired blood disorder.</p><h2>What is ITP?</h2> <p>Idiopathic thrombocytopenia purpura (ITP) is an acquired disorder, resulting from an increase in the breakdown of platelets. ITP is not a cancer or malignancy. Platelets are small blood cells needed for normal blood clotting. In healthy people, old platelets are destroyed in the spleen by a type of white cell called a macrophage. With ITP, this process is much more rapid. Acute ITP occurs more frequently in children between the ages of two and nine, although it can occur in children of any age. ITP is found equally in boys and girls.</p><h2>Key points</h2> <ul> <li>Idiopathic thrombocytopenia purpura (ITP) is an acquired disorder. ITP is not a cancer or malignancy.</li> <li>Platelets, or thrombocytes, are blood cells produced in the bone marrow. Platelets circulate in the blood for approximately eight to 10 days.</li> <li>The most common sign of ITP is the appearance of numerous pinpoint haemorrhages, or petechiae, which look like tiny red spots under the skin.</li> <li>About 80% to 90% of patients recover spontaneously, usually within three months from the beginning of the illness.</li> <li>ITP can be treated in several ways: prednisone, intravenous immunoglobulin, intravenous Anti-D and splenectomy (removal of the spleen).</li> <li>Always check with your child's doctor before giving them any medication. Acetylsalicylic acid (ASA) or any medication that contains ASA should be avoided.</li> </ul><h2>Signs and symptoms of ITP</h2> <p>The most common sign of ITP is the appearance of numerous pinpoint haemorrhages, or petechiae, which look like tiny red spots under the skin. The presence of petechiae along with bruising is referred to as purpura. Both are caused by spontaneous bleeding in the skin and mucous membranes (surfaces in the skin and mouth). Except for signs of bleeding, your child may appear well.</p><h2>Causes of ITP</h2> <p>The onset of ITP is generally sudden. Most cases occur a few days or even weeks after a viral infection, such as chicken pox or a respiratory infection. Sometimes ITP can be caused by an unusual response in the body to a drug. Researchers think that antibodies formed naturally by the body's immune system attach themselves to the platelets. The platelets are then rapidly destroyed. If the body is unable to produce enough new platelets to replace those destroyed by the antibodies, the number of platelets in the blood will decrease.</p><h2>Diagnosing ITP</h2> <p>The doctor will take a careful history of your child's past health and current illness. If your child's doctor suspects ITP, a physical examination will be performed and a blood test will be ordered. Blood will be taken either by a finger prick or from a vein in the arm. The results of the physical examination and blood test will help confirm the diagnosis of ITP. In most cases, a sample of bone marrow will also be taken to rule out other causes of a low platelet count.</p> <p>Once ITP has been diagnosed, a daily blood test is usually ordered to assess the number of platelets in the blood.</p><h2>Treatment of ITP</h2><p>ITP can be treated in several ways. Your child's doctor will advise you on whether treatment is necessary. Treatment is the same for both acute and chronic ITP. The following treatments are most common:</p><h3>Prednisone</h3><p>Prednisone is a steroid. It is given in pill form and taken by mouth.</p><h3>Intravenous immunoglobulin</h3><p>This is a protein solution prepared from the plasma of many blood donors. This solution is given by infusion into a vein over several hours. It works by temporarily preventing platelet destruction in the spleen. The spleen is the body organ responsible for the rapid destruction of the platelets.</p><h3>Intravenous Anti-D</h3><p>Like <a href="/Article?contentid=161&language=English">intravenous immunoglobulin</a>, Anti-D is a protein solution prepared from blood plasma. The solution is given by infusion into a vein over a 20- to 30-minute period. It also works by temporarily preventing platelet destruction in the spleen.</p><h3>Splenectomy</h3><p>If ITP does not respond to medical treatment, or the side effects of the treatment are too severe, a splenectomy may be required. A splenectomy is the removal of the spleen by a surgical procedure. </p><p>Following treatment, the platelet count should rise. The petechiae and bruising will begin to disappear. Your child's doctor will probably want a few blood tests done, at regular intervals, to assess the platelet counts.</p><p>Medical treatment does not actually cure ITP. Instead, it raises the platelet count for a period ranging anywhere from a few weeks to even months. If your child's ITP does not clear up spontaneously during this time, the platelet count will fall again. More therapy will be required until the ITP disappears spontaneously.</p><h2>Side effects of medication</h2><h3>Prednisone</h3><p>The most common side effect is weight gain due to increased appetite. It is characterized by a "moon face," "pot belly" and fat deposits on the back of the shoulders. These symptoms are temporary and will disappear when the drug is stopped.</p><p>Other side effects associated with prednisone include:</p><ul><li>acne</li><li>increased blood pressure</li><li>a change in the level of blood sugar</li><li>mood swings ranging from euphoria to temper tantrums</li></ul><p>If your child is taking prednisone and comes into contact with chicken pox, seek medical attention right away. Your child's doctor may want to change the type of treatment.</p><h3>Intravenous immunoglobulin</h3><p>The most common side effects are headaches, fever, and nausea. In most cases, these side effects occur when two treatments are given back-to-back (12 hours apart). Give your child <a href="/Article?contentid=62&language=English">acetaminophen</a> to relieve their headache and/or fever. Similarly, give your child dimenhydrinate to treat nausea and vomiting. Within 24 hours after the second dose of <a href="/Article?contentid=161&language=English">intravenous immunoglobulin</a>, the symptoms should disappear. If only a single dose of intravenous immunoglobulin is given, the chance of these side effects occurring is small.</p><h3>Intravenous Anti-D</h3><p>The most serious side effect is a drop in the level of haemoglobin (red cells) in the blood. The biggest drop will occur seven to 10 days after the Anti-D has been given. Your child may appear tired and pale. In most cases, the haemoglobin does not drop low enough to require a transfusion.</p><h2>Medications to avoid</h2><p>If your child has ITP, always check with their doctor before giving them any medication. <a href="/Article?contentid=77&language=English">Acetylsalicylic acid</a> (ASA) or any medication that contains ASA should be avoided. This is because ASA interferes with platelet function for a period of seven to 10 days. If your child has a low platelet count, this may increase their risk of bleeding. All over-the-counter cough and cold medications should be carefully checked before being bought. If you are unsure if a medicine contains ASA or not, check with your pharmacist.</p><p>The following is a short list of medicines that should not be given to your child with ITP:</p><ul><li>ASA and all compounds that contain it</li><li>antihistamines</li><li>non-steroidal anti-inflammatory drugs (NSAIDs)</li><li>vitamin E</li><li>cod liver oil</li></ul>
Ileostomy: Dietary guidelines to help with stool consistencyIIleostomy: Dietary guidelines to help with stool consistencyIleostomy: Dietary guidelines to help with stool consistencyEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)Small Intestine;Large Intestine/ColonSmall intestine;Large intestineNon-drug treatmentCaregivers Adult (19+)NA2015-10-27T04:00:00ZBeth ​Haliburton, RD;Kimberly Colapinto, RN (EC)​​7.7000000000000067.10000000000001405.00000000000Health (A-Z) - ProcedureHealth A-Z<p>If your child has an ileostomy, learn what they should eat and drink to produce the proper texture of stool.</p><p>An ileostomy is one type of <a href="/Article?contentid=1027&language=English">ostomy</a>, which is an opening that connects the intestine to the abdomen (tummy). Stool passes through this opening into a pouch outside the body that is emptied and changed regularly.</p> ​ <h2>What is the goal of a special diet for a child with an ileostomy?</h2><p>The foods your child eats can change the consistency (texture) of their stool. The goal of a special diet is for your child to produce stool that is pasty but not too watery.</p><p>If stool is watery, your child may not absorb as many nutrients from their food. Watery stool also increases the risk of leaks and potential soiling from the pouch that is placed over their ileostomy.</p><p>There is no specific diet for children with ileostomies. However, some foods may be better tolerated than others.</p><ul><li>Some foods travel through the digestive tract quickly, which can make the stool output loose and more watery.</li><li>Some foods travel through the digestive tract slowly, which can make the stool output more like a thick paste.</li></ul><p>Eating foods that both increase and decrease stool output will help control the texture of your child’s stool. It will also make sure that your child is eating a varied, nutrient-rich diet.</p><p>Not all people react the same way to foods, so it may take time to learn what works best.<br></p><h2>Key points</h2> <ul> <li>A diet rich in soluble fibre and low in sugar can help your child’s stool achieve a paste-like texture. This texture helps the stool pass through your child’s ileostomy with a reduced risk of soiling.</li> <li>Have your child drink plenty of water and eat regularly to help them digest their food and replace any fluids lost through watery stool. </li> <li>Always talk to your child’s healthcare team before starting your child on any special diet and seek their advice about any sodium supplements.</li> <li>Keep a record of your child’s symptoms as you try different foods so you can learn what works best.</li> </ul><h2>Dietary guidelines for proper stool texture </h2><p>Important: Please tell your child’s healthcare team if your child is already on a special diet before you follow any of the guidelines below. </p><h3>Chew food well</h3><ul><li>Encourage your child to chew tough and fibrous foods well to reduce the risk of these foods blocking the stoma (opening).</li><li>If your child does not chew well, consider serving food that is softer or has been cooked for longer.</li></ul><h3>Eat regularly</h3><ul><li>Have three meals and one or two snacks each day.</li><li>Aim to eat every three hours. This will make your child’s bowel work throughout the day and may also help reduce the amount of <a href="/Article?contentid=822&language=English">gas</a> your child experiences.</li></ul><div class="akh-series"><div class="row"><div class="col-md-12"> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/INM_ileostomy_diet_avoid_sugar_EN.png" alt="Limit sugars" /> </figure> <h3>Limit simple sugars and sugar alternatives</h3><p>Sugars and sugar alternatives can increase gas and bloating. They can also cause very watery stool.</p><ul><li>Avoid sweets and sugary foods such as candies, cookies, soda, juice and syrup.<br></li><li>Avoid sugar alternatives such as sucrose (Splenda), sorbitol, xylitol and manitol.</li><li>Read the <a href="/Article?contentid=1442&language=English">labels of processed food</a> and chose foods and drinks with less than 10 g of sugar per serving.</li></ul></div></div><div class="row"><div class="col-md-12"> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/INM_ileostomy_diet_allowed_fibre_EN.png" alt="More soluble fibre" /> </figure> <h3>Eat a diet high in soluble fibre and limit insoluble fibre</h3><p>Soluble <a href="/Article?contentid=964&language=English">fibre</a> dissolves in water and helps to make stool more gel-like. Insoluble fibre (roughage) bulks up stool but can sometimes block the stoma. </p><ul><li>Introduce soluble fibre slowly. Introducing it too quickly may cause gas and bloating.</li><li>To increase soluble fibre, include foods such as oatmeal, pears and most cooked vegetables.</li><li>To reduce insoluble fibre:</li><ul><li>offer breads and cereals made from refined wheat, rye, corn and rice</li><li>remove skins from fruits and vegetables</li><li>use ripe, canned or cooked fruits without skin or seeds</li><li>avoid foods with dried fruit and visible seeds or nuts.</li></ul></ul></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/INM_ileostomy_diet_allowed_water_EN.png" alt="More water" /> </figure> <h3>Drink lots of water</h3><p>If a child has a lot of watery stool, they should drink enough water all day to stay hydrated. Drinking plenty of water can also help soluble fibre make stool output thicker. </p><ul><li>It is especially important for your child to drink water throughout the day during the hot summer months.</li><li>Your child’s healthcare team might sometimes recommend low-sugar drinks that contain electrolytes (mineral salts) if your child is losing a lot of water through their stool.</li></ul></div></div><div class="row"><div class="col-md-12"> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/INM_ileostomy_diet_avoid_lactose_EN.png" alt="Reduce lactose" /> </figure> <h3>Watch your child’s response to dairy products</h3><p>Milk and milk products contain a sugar called lactose. Reducing lactose intake can sometimes help to improve your child’s stool output.</p><ul><li>Try lactose-free milk or low sugar fortified dairy-alternative drinks such as soy or hemp milk.</li><li>Offer your child yogurt and firmer cheese such as parmesan, cheddar or mozzarella. They might find these easier to tolerate than other dairy products.</li></ul></div></div><div class="row"><div class="col-md-12"> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/INM_ileostomy_diet_allowed_salt_EN.png" alt="If allowed, add sodium" /> </figure> <h3>Add sodium to your child’s diet, if instructed</h3><p>Some children, especially babies, need extra sodium to help them replace the sodium they lose in their stool.<br></p><ul><li>Only add sodium to your child’s diet if instructed by your child’s healthcare team. They will check if your child needs more sodium by monitoring their electrolytes.<br></li><li>If your child needs extra sodium, the healthcare team will suggest which form is best. Options include table salt, salt tablets or a special sodium solution made in a pharmacy.</li></ul></div></div></div><p>You can find more guidelines in the table below.</p><table class="akh-table"><thead><tr><th>Food group</th><th>Foods to choose</th><th>Foods to avoid</th></tr></thead><tbody><tr><td>Vegetables and fruit</td><td><ul><li>Most tender cooked and canned vegetables</li><li>Leafy green vegetables – chew well</li><li>Fresh or frozen fruit, except for fruit with lots of seeds – limit to 1/2 to 1 cup per sitting</li><li>Lower-sugar fruits such as apples and pears (can be better tolerated)</li><li>Prunes<br></li></ul></td><td><ul><li>Stringy or tough vegetables (such as celery or corn)</li><li>Seeds in vegetables and fruit</li><li>Peels of vegetables and fruit</li><li>Berries</li><li>Citrus fruits with membranes</li><li>Dried fruit</li><li>Canned fruit in syrup, fruit cups, canned pie fillings</li><li>All fruit and vegetable juices</li></ul></td></tr><tr><td>Grain products</td><td><ul><li>Bread, toast, rolls, biscuits, muffins, crackers, pancakes and waffles</li><li>Crackers without obvious nuts, seeds</li><li>Refined cold cereals made from corn, rice or oats</li><li>Oatmeal, grits and farina</li><li>Enriched noodles and rice</li></ul></td><td><ul><li>Sweetened cereals</li><li>Donuts, cakes, cookies</li><li>Sweet rolls, pastries</li><li>Any baked goods with visible seeds, nuts or dried fruit</li><li>Wild rice</li></ul></td></tr><tr><td>Milk and alternatives</td><td><ul><li>Yogurt and hard cheeses</li><li>Lactose-free milk or soy milk (preferably unsweetened)</li></ul><p>Everyone tolerates dairy differently - please watch your child’s symptoms.</p></td><td><ul><li>Flavoured dairy milk or sweetened, flavoured alternatives such as vanilla or chocolate flavoured almond, rice or soy milk</li><li>Dairy with added seeds</li><li>Ice-cream, pudding, custard, sweetened yogurt</li></ul></td></tr><tr><td>Meat alternatives</td><td><ul><li>Tender, ground or well-cooked beef, lamb, ham, veal, pork, poultry, fish, shellfish and organ meats</li><li>Well-cooked legumes (such as beans, peas and lentils)</li><li>Eggs<br></li><li>Smooth nut butters (for example peanut, almond, hazelnut)</li></ul></td><td><ul><li>Tough fibrous meats or gristle</li><li>Clams, oysters and shellfish with tough connective tissue</li><li>Meat prepared with seeds or nuts</li><li>Uncooked legumes</li><li>Chunky peanut butter</li></ul></td></tr></tbody><thead><tr><th colspan="3">Other foods</th></tr></thead><tbody><tr><td>Fats and snacks</td><td><ul><li>Margarine, butter, vegetable oils, lard, mayonnaise, cream substitutes, crisp bacon, plain gravies and salad dressing</li><li>Potato chips, nacho chips, tortilla shells</li></ul></td><td><ul><li>Any snack made with seeds, nuts, coconut or dried fruit</li><li>Popcorn</li><li>Pastries or pies with seeds, nuts or dried fruit</li><li>Snacks or desserts made with a lot of sugar</li><li>Candy, chocolate bars</li></ul></td></tr><tr><td>Drinks</td><td><ul><li>Water</li></ul></td><td><ul><li>Carbonated (fizzy) drinks</li><li>Drinks containing sugar, sorbitol, manitol, xylitol or sucralose (Splenda), such as soda, chocolate milk or ice tea</li><li>Drinks containing caffeine</li><li>Fruit and vegetable juice</li></ul></td></tr><tr><td>Other</td><td><ul><li>Bouillon, broth or strained cream soups made with allowed ingredients</li><li>Salt, soy sauce, lemon juice, vinegar</li><li>Ketchup, sweet and sour sauce, teriyaki sauce, plum sauce (smooth, with no fibrous pieces of fruit) in small amounts – most condiments and dipping sauces contain sugar</li><li>Spices, in moderation</li><li>Vanilla and other flavouring extracts</li></ul></td><td><ul><li>Corn soup</li><li>Sorbitol, manitol, xylitol, sucralose (Splenda)</li><li>Sugar added to cereal or decaffeinated coffee and tea</li><li>Syrup, jam, honey<br><br></li></ul></td></tr></tbody></table>https://assets.aboutkidshealth.ca/AKHAssets/ileostomy_dietary_guidelines.jpg
Imaging tests (X-rays) and JIAIImaging tests (X-rays) and JIAImaging tests (X-rays) and JIAEnglishRheumatologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemTestsAdult (19+)NA2017-01-31T05:00:00ZJennifer Stinson RN-EC, PhD, CPNPLori Tucker, MDAdam Huber, MSc, MD, FRCPC5.9000000000000074.9000000000000392.000000000000Flat ContentHealth A-Z<p>Discover how X-rays are used to rule out conditions that may be similar to arthritis. X-rays are also used to monitor bone damage in arthritis.</p><p>An X-ray is a type of radiation that passes through the body. The amount of radiation that passes through the body in an X-ray is very small. An X-ray leaves a shadow of one's bones on a photograph. It gives the doctor information on the size, shape, and location of the bones and certain organs. This information can help diagnose a condition. It is also called radiography.</p><h2>Key points</h2> <ul><li>X-rays allow doctors to see the size, shape and location of the bones and certain organs.</li> <li>X-rays are not used to diagnose JIA but to exclude other conditions.</li> <li>X-rays will not cause damage to your child's body.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/imaging_tests_x-rays_and_JIA.jpg
Imaging tests: X-ray, MRI and CT scanIImaging tests: X-ray, MRI and CT scanImaging tests: X-ray, MRI and CT scanEnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartCardiovascular systemTestsAdult (19+)NA2009-12-11T05:00:00ZAndrew N. Redington, MD, FRCP (UK), FRCPC6.1000000000000075.90000000000002067.00000000000Flat ContentHealth A-Z<p>Learn about imaging tests such as X-rays, MRI and CT. These tests give pictures of the inside of your child's body.</p><p>Imaging tests are ways of taking pictures of the inside of the body. Different types of imaging are useful in different situations.</p><h2> Key points </h2> <ul> <li>X-rays are a kind of radiation. X-rays passing through the body give a two-dimensional picture of the inside of the body.</li> <li>Magnetic resonance imaging (MRI) uses a strong magnet and radio signals to take pictures.</li> <li>Computed tomography (CT) scans use X-rays and a computer to take cross-sectional pictures.</li> <li>Sometimes a liquid called contrast medium is used to give more information or more detailed pictures of certain parts of the body.</li></ul>https://assets.aboutkidshealth.ca/akhassets/NEURO_MRI1_EQUIP-PHO_EN.jpg
Immediate risks of scoliosis surgeryIImmediate risks of scoliosis surgeryImmediate risks of scoliosis surgeryEnglishOrthopaedics/MusculoskeletalChild (0-12 years);Teen (13-18 years)Vertebrae;SpineMuscular system;Skeletal systemProceduresAdult (19+)NA2008-06-01T04:00:00ZSandra Donaldson, BA;Andrew Howard, MD, MSc, FRCSC;James G. Wright, MD, MPH, FRCSC7.4000000000000064.3000000000000976.000000000000Flat ContentHealth A-Z<p>Read about some of the complications that can arise after having scoliosis surgery. Trusted answers from The Hospital for Sick Children.</p><p>Immediate risks of surgery are those risks that can occur within the few weeks after surgery. </p><h2>Key points</h2><ul><li>Possible complications after scoliosis surgery include complications from blood transfusions, neurologic complications, infection, lung complications, intestinal blockage, blood clots in the thighs or leg, pain where the bone chips are removed.</li><li>The risk of most of these complications is between 1 % to 2%.</li></ul>
Immune thrombocytopenia (ITP): What happens after diagnosisIImmune thrombocytopenia (ITP): What happens after diagnosisImmune thrombocytopenia (ITP): What happens after diagnosisEnglishHaematologyChild (0-12 years);Teen (13-18 years)BodyCardiovascular systemConditions and diseasesCaregivers Adult (19+)NA2012-12-20T05:00:00ZSickKids ITP Working Group:;Carolyn Beck MD, MSc, FRCPC;Victor Blanchette MD, FRCPC;Michaela Cada MD, MPH, FRCPC;Manuel Carcao MD, MSc, FRCPC;Patricia Parkin MD, FRCPC;Stephen Porter MD, FAAP7.8000000000000062.50000000000001376.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Find out about living with ITP and the treatment options you can discuss with your child's health care team. </p><p>Your child has been diagnosed with the condition <a href="/Article?contentid=842&language=English">immune thrombocytopenia </a>(ITP).</p><p>In ITP, the small cells needed for normal blood clotting (called platelets) are too low. When platelets are low, the body has trouble healing wounds and cuts.<br></p><p>You will meet with your child's health care team to decide what treatment option is best. This brochure outlines the information you need to help prepare for that meeting. It will help you and your child's doctor make an informed decision together.</p> <figure class="asset-c-80"> <span class="asset-image-title">Blood cells and components</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Blood_cells_MED_ILL_EN.jpg" alt="White blood cells, red blood cells, plasma and platelets" /> </figure> <h2>Key points:</h2> <ul> <li>ITP happens when the body's immune system attacks a person's platelets (cells needed for blood to clot), causing them to be low.</li> <li>In most children, ITP will get better by itself over a few months.</li> <li>Until ITP gets better, there is a small but important risk of bleeding.<br></li> <li>There are three options for treatment: observation, IVIG or prednisone.</li> <li>Talk to your doctor about the treatment choices and which one is best for your child and family.</li> <li>While your child's platelets are low, avoid contact sports and rough play.</li> <li>While your child's platelets are low, avoid acetylsalicylic acid, ibuprofen and other anti-inflammatory medicines.</li> <li>Talk to your doctor or nurse about other everyday advice for your child's care.</li> </ul><h2>Signs of ITP</h2> <figure> <span class="asset-image-title">Petechiae and bruises</span> <img alt="Bruising and small red spots on an arm" src="https://assets.aboutkidshealth.ca/akhassets/PMD_ITP_petechiae_EN.jpg" /> </figure> <p>Your child may bruise easily or develop tiny red spots on the skin (called petechiae). Less often, children may bleed from the nose or gums or have blood in their stool.<br></p><p>Most bleeding is mild and only involves the skin (bruising or petechiae). Mild bleeding at the skin does not put your child at serious risk.</p><p>The most serious type of bleeding is in the brain. This is extremely rare: less than two out of every 1,000 children diagnosed with ITP develop bleeding in the brain. </p><p>Apart from these physical signs of ITP, your child looks well and acts normally.</p><h2>What causes ITP?</h2> <p>Usually, a child develops ITP after a viral infection such as a cold. The virus triggers a normal immune response, meaning that the immune system starts destroying the virus. But the immune system also starts destroying healthy platelets. It is not clear why this happens.</p><h2>Treatment for ITP</h2><p>There are three options to consider. Each option is a reasonable choice and has its own advantages and disadvantages. Your child's health care team will discuss these options to help you decide which is best.</p><p>All children with ITP will need to be monitored after they leave hospital and all children whose platelet counts are low are at risk for bleeding from falls and injuries. As long as your child's bleeding is limited to the skin (for example bruising, petechiae or mild bleeding that stops on its own), there is no rush to make a decision.</p><p>Different families have different preferences when it comes to making medical decisions. We want to include your values in the decision-making process. A team of paediatricians and haematologists (blood specialists) will meet you to discuss your child's case and the available options and answer any questions. Together, it is possible to make a decision that best suits your child and your family.</p><h2>Option 1: Observation</h2><p>During observation, your child is not given any medicines. Instead, the doctors will book follow-up appointments to closely monitor your child.</p><p>Observation is an acceptable choice for managing ITP when bleeding only happens on the skin (for example bruising, petechiae, or mild bleeding that stops on its own).</p><p>If your child has persistent bleeding from the nose or gums, they will likely need to start a different treatment option.</p><h3>What are the advantages of observation?</h3><p>Observation avoids the risks and side effects of medicines. Your child also gets to go home earlier.</p><h3>What are the disadvantages of observation?</h3><p>During observation, the number of platelets remains low for longer. As long as the platelet count is low, your child's doctors will recommend avoiding activities that can cause serious falls and injuries.</p><p>If your child is especially prone to injuries, observation may not be a good option.</p><h2>Option 2: Treat with intravenous immunoglobulin (IVIG)</h2><p>Your child is treated with a <a href="/Article?contentid=1107&language=English">blood product</a> called <a href="/Article?contentid=161&language=English">immunoglobulin (IVIG)</a>.</p><p>In ITP, the immune system releases antibodies that destroy the platelets. Immunoglobulin blocks these antibodies and protects the platelets. It is part of our immune system and is extracted from donated blood.</p><p>While your child is in the hospital, IVIG is given intravenously (into the vein) over a few hours.</p><h3>What are the advantages of IVIG?</h3><p>Platelets usually start to increase as early as 12 to 24 hours after receiving IVIG, but it may take as long as three days.</p><h3>What are the disadvantages of IVIG?</h3><p>IVIG requires an intravenous tube (IV) and must be given inside a hospital. Most children are monitored for at least 24 hours after it is given.</p><p>There is a small chance that this treatment may cause your child's red blood cells to break down (haemolysis). The doctor monitors your child to check for this. Usually it gets better on its own. Only in rare cases, your child may need a blood transfusion.</p><p>Some children may develop side effects, which include:</p><ul><li>headaches (some children can get bad headaches the next day)</li><li>nausea</li><li>vomiting</li><li>rash, fever, and chills (rarely).</li></ul><p>Antihistamines or <a href="/Article?contentid=62&language=English">acetaminophen</a> can be used to treat most of these symptoms. These side effects all go away eventually.</p><p>IVIG is safe and always cleaned. Since it is a blood product, its risks are similar to other blood transfusions. Talk to your child's doctor if you have any questions or concerns.</p><h2>Option 3: Treat with prednisone</h2><p> <a href="/Article?contentid=221&language=English">Prednisone</a> is a steroid medicine. It is not the same steroid as the one taken by some athletes. Instead, prednisone is similar to a steroid that occurs naturally inside the human body.</p><p>Doctors have been using prednisone for decades to treat different conditions. For ITP, prednisone helps the immune system stop destroying platelets.</p><p>Your child takes two to three doses of prednisone by mouth each day for four days.</p><h3>What are the advantages of prednisone?</h3><p>Your child does not need an IV and can take prednisone at home.</p><p>Platelets can start to increase as early as 24 to 48 hours after starting prednisone, but it may take as long as one week.</p><h3>What are the disadvantages of prednisone?</h3><p>Some children do not like the taste of liquid prednisone. You can try mixing it with food to make it easier for your child.</p><p>Some children may experience side effects, which include:</p><ul><li>mood swings</li><li>increased appetite.</li></ul><p>These side effects usually happen when prednisone is taken for a long time (longer than a week). Your child will probably not experience any of these side effects during the short time (four days) they are taking prednisone.</p><h2>At SickKids</h2> <p>Before your child leaves the hospital, your health care provider will arrange a follow-up appointment with the Haematology Clinic within five to seven days.</p> <p>You will also get contact information for a Haematology Clinic nurse. You can contact the nurse with any questions or concerns (Monday to Friday from 9 a.m. to 5 p.m.).</p> <p>You will also get a contact number to call in case of emergencies in the evenings or weekends.</p>https://assets.aboutkidshealth.ca/akhassets/Blood_cells_MED_ILL_EN.jpg
Immunization "catch-up" for children who have not been fully immunizedIImmunization "catch-up" for children who have not been fully immunizedImmunization "catch-up" for children who have not been fully immunizedEnglishPreventionChild (0-12 years);Teen (13-18 years)NANADrug treatmentCaregivers Adult (19+)NA2010-05-07T04:00:00ZSheila Jacobson, MBBCh, FRCPC9.8000000000000044.4000000000000793.000000000000Health (A-Z) - ProcedureHealth A-Z<p>An overview of immunization for children who have not been fully immunized according to the standard schedule.</p><p>Immunization (vaccines) protects your child against several serious, life-threatening infectious diseases. Your child should have "shots" according to the schedule recommended for your province, state or country. Your child should also have a written record of which immunizations they have had and when.</p> <p>Children who are new to Canada - immigrant, refugee or adopted children - may not be vaccinated according to Canada's standards.</p><h2>Key points</h2> <ul> <li>Immunization protects your child against disease.</li> <li>In Canada, children normally receive vaccines according to a schedule. </li> <li>There are several reasons why a child may not be fully immunized, including illness or being new to Canada.</li> <li>If your child has not been immunized according to the normal schedule, speak to your child’s doctor.</li> <li>Your child should have a written immunization record.</li> </ul><h2>Canada's immunization schedule</h2> <p>In Canada, children normally receive vaccines at the following ages:</p> <ul> <li>2 months</li> <li>4 months</li> <li>6 months</li> <li>12 months</li> <li>15 months</li> <li>18 months</li> <li>4 to 6 years </li> <li>9 to 13 years</li> <li>14 to 16 years</li> </ul> <h2>If your child has not been fully immunized</h2> <p>There are several reasons why children may not be fully immunized, such as:</p> <ul> <li>missing one or more appointments</li> <li>illness during the time they should have had a shot</li> <li>being new to Canada: immigrant, refugee and internationally adopted children may not have been immunized according to Canada’s schedule or some vaccines may not be available where they come from</li> </ul> <p>These children could be at risk of catching a harmful disease. If your child has not been fully immunized for any reason, talk to your doctor or other health-care provider about making sure that her shots are up to date. </p> <p>If your child has not been in your care since birth, it may be hard to determine their vaccine history. If your child has a written immunization record, show it to your doctor.</p> <p>All children who have not been fully immunized, or who do not have a written immunization record, should start receiving vaccines on a routine schedule. This schedule depends on your child’s age. Speak to your doctor about what is right for your child.</p> <p>It is always preferable to give a vaccine if unsure of the child's history. There is no harm to repeating any immunization, unless the child has had an allergic reaction to the vaccine in the past, or has an underlying disease that could affect the response to the vaccine. </p> <p>Sometimes your doctor will do a blood test to see which antibodies are missing from your child’s blood. This will tell him which vaccines your child still needs. </p> <p>As with all vaccines, if your child has a severe illness or a fever, you may need to wait to give your child a vaccine.</p><h2>References</h2> <p>Aronson J. Medical evaluation and infectious considerations on arrival. Pediatric Annals 2000;29(4):218-23.</p> <p>Barnett ED. Infectious disease screening for refugees resettled in the United States. Clinical Infectious Diseases 2004;39(6):833-41.</p> <p>Canadian Immunization Guide Seventh Edition – 2006 Part 3 Recommended Immunization. Immunization of Persons New to Canada: Last accessed March 2010.</p> <p>Canadian Paediatric Society. Children and youth new to Canada: a health care guide. Ottawa: CPS, 1999.</p> <p>Centers for Disease Control and Prevention. Travelers' health: yellow book. Health information for international travel, 2005-2006. Atlanta, GA: US Department of Health and Human Services, Public Health Service, 2005; chapter 8.</p> <p>Chen LH, Barnett ED, Wilson ME. Preventing infectious diseases during and after international adoption. Annals of Internal Medicine 2003;139:371-78.</p> <p>Immunization of Children and Adults with Inadequate Immunization Records. Last accessed March 2010.</p> <p>Stauffer WM, Kamat D, Walker PF. Screening of international immigrants, refugees and adoptees. Primary Care 2002;29(4): 879-905.</p> <p>Vaccination and your child. Reviewed by the CPS Infectious Diseases and Immunization Committee. Last updated: October 2009. Last accessed March 2010.</p><p></p>https://assets.aboutkidshealth.ca/AKHAssets/immunization_catch_up.jpg
Immunization scheduleIImmunization scheduleImmunization scheduleEnglishPreventionChild (0-12 years);Teen (13-18 years)NANADrug treatmentCaregivers Adult (19+)NA2018-07-26T04:00:00ZShawna Silver, MD, FRCPC, FAAP, PEng10.500000000000043.70000000000001116.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Read about types of immunizations that are recommended during a child's first year of life and onward.</p><p>Immunizations protect your child against several serious, life-threatening infectious diseases. Your child should receive their immunizations according to the schedule recommended for your province, state, or country. For more specific information, contact your child's health care provider, or the local public health unit for your community.</p><h2>Key points</h2> <ul> <li>Immunizations protect against serious, life-threatening infectious diseases.</li> <li>Children should be immunized according to the schedule recommended by their province, state or country.</li> </ul><p>The following chart is the recommended schedule of immunizations during childhood for the <a href="http://www.health.gov.on.ca/en/pro/programs/immunization/docs/immunization_schedule.pdf" target="_blank">province of Ontario</a> as of December 2016. For the most current recommendations according to the National Advisory Committee on Immunization and for each province and territory go to the <a href="https://www.canada.ca/en/public-health/services/provincial-territorial-immunization-information/provincial-territorial-routine-vaccination-programs-infants-children.html" target="_blank">Government of Canada</a> website.</p> <figure class="asset-c-100"> <img src="https://assets.aboutkidshealth.ca/AKHAssets/immunization_table_EN.png" alt="Immunization schedule chart" /> </figure> <h2>Descriptions of immunizations</h2><h3>DTap-IPV-Hib: Diphtheria, tetanus, acellular pertussis, inactivated polio virus, haemophilus influenzae type B vaccine</h3><p>Immunization against diphtheria, tetanus, and pertussis (whooping cough) is important, since all of these diseases can be deadly. Pertussis is a serious disease, especially for young babies. Children who get pertussis can have spells of violent coughing. The cough can cause children to stop breathing for brief periods of time. The cough can last for weeks and makes it difficult for children to eat, drink and breathe. The risk of children getting pertussis increases if fewer children are immunized.</p><p>The polio vaccine protects children from this now rare but crippling disease. Polio can cause nerve damage and can paralyze a person for the rest of their life. The inactivated polio vaccine is now recommended for all polio doses.</p><p>Haemophilus influenzae is a type of bacteria that causes several life-threatening diseases in young children such as meningitis, epiglottitis, and pneumonia. Before the vaccine was available, a large number of children developed H. influenzae meningitis each year. Some died and others developed learning or developmental problems such as blindness, deafness, or cerebral palsy. Because of the vaccine, H. influenzae type B infection is now uncommon. The Hib vaccine does not protect against pneumonia and meningitis caused by viruses.</p><p>For more information, see "<a href="/article?contentid=759&language=english">Tetanus</a>," "<a href="/article?contentid=754&language=english">Pertussis</a>," and "<a href="/article?contentid=149&language=english">Haemophilus Influenzae Type B Vaccine</a>."</p><h3>Pneu-C-13: Pneumococcal conjugate (13-valent) vaccine</h3><p>Pneumococcal infections are serious bacterial infections that may cause pneumonia, bloodstream infections, and meningitis. The pneumococcal vaccine protects against the thirteen types of pneumococcal bacteria that cause most of these serious diseases. The vaccine also prevents a small percentage of ear infections caused by pneumococci.</p><p>Routine use of pneumococcal vaccine is now recommended for babies and toddlers. Some older children with serious illnesses, such as sickle cell anemia, may also benefit from the vaccine.</p><h3>Rota: Rotavirus oral vaccine</h3><p>Rotavirus is a condition that causes vomiting and diarrhea. Sometimes the diarrhea is so severe, children need to be hospitalized. It is very contagious and spreads easily between children. Vaccines active against rotavirus became available at the beginning of 2006. The rotavirus vaccine is given by mouth.</p><h3>Men-C-C: Meningococcal conjugate C vaccine</h3><p>Meningococcal infections are serious bacterial infections that cause bloodstream infections or meningitis. </p><h3>MMR: Measles, mumps, and rubella vaccine</h3><p>This is a three-in-one immunization that protects against measles, mumps and rubella. It is given in infancy and then again at pre-school age.</p><p>For more information, see "<a href="/article?contentid=752&language=english">Measles</a>," "<a href="/article?contentid=753&language=english">Mumps</a>," and "<a href="/article?contentid=758&language=english">Rubella</a>."</p><h3>Var: Varicella (chickenpox) vaccine</h3><p>This vaccine is 70% to 90% effective in preventing chickenpox. If vaccinated children get chickenpox, they have a much milder form of the disease.</p><p>For more information, see "<a href="/article?contentid=760&language=english">Chickenpox (Varicella)</a>."</p><h3>Men-C-ACYW-135: Meningococcal conjugate ACYW-135 vaccine</h3><p>Students in Grade 7 are eligible to receive a single dose of this vaccine. Students who were eligible in Grade 7 and have not yet received the vaccine are eligible for a single dose of Men-C-ACYW.</p><h3>HB: Hepatitis B vaccine</h3><p>Vaccination against hepatitis B prevents this type of hepatitis and the severe liver damage that can occur 20 or 30 years after a person is first infected. A significant number of adults die each year from hepatitis-related liver cancer or cirrhosis. The younger the person is when the infection occurs, the greater the risk of serious problems. Students in Grade 7 are eligible to receive this vaccine.</p><h3>HPV: Human papillomavirus vaccine</h3><p>HPV is a virus that can lead to different types of cancers in females and males. Both males and females are eligible to receive this vaccine starting in Grade 7.</p><p>For more information, see "<a href="/article?contentid=25&language=english">Human Papilloma Virus (HPV) and Genital Warts</a>" and "<a href="/article?contentid=151&language=english">Human Papilloma Virus (HPV): What You Need to Know</a>"</p><h3>Inf: Seasonal influenza vaccine</h3><p>Influenza is a common respiratory virus in the fall and winter. It can lead to pneumonia and hospitalization, especially in young children and children with underlying medical conditions. All children and youth are encouraged to get the seasonal influenza vaccine.</p><p>For more information, see "<a href="/article?contentid=763&language=english">Influenza (Flu)</a>."</p><h2>Other vaccines</h2><h3>Hepatitis A vaccine</h3><p>The hepatitis A vaccine is recommended for children and teenagers in selected geographic regions, and for certain people at high risk. Talk to your health care provider or local public health unit for more information.</p><p>For more information, see "<a href="/article?contentid=819&language=english">Hepatitis A</a>."</p>immunizationhttps://assets.aboutkidshealth.ca/AKHAssets/immunization_schedule.jpg
Immunizations for children and teens with suppressed immune systemsIImmunizations for children and teens with suppressed immune systemsImmunizations for children and teens with suppressed immune systemsEnglishPreventionChild (0-12 years);Teen (13-18 years)NANADrug treatmentCaregivers Adult (19+)NA2011-04-18T04:00:00ZAnne Griffiths, MD, FRCPC;Michelle Bridge, MD;Upton Allen, MBBS, MSc, FRCPC, FAAP;Karen Frost, BScN, RN, MN, NP-Peds9.6000000000000053.70000000000001045.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Treatment to suppress the immune system affects how your child’s body responds to routine immunizations. This guide discusses how to keep your child healthy while taking immune-suppressing treatment.</p><p>Your child is starting treatment that will suppress the immune system. This will affect how your child’s body responds to routine immunizations that protect your child against disease.</p><p>This guide explains how different vaccines interact with immune-suppressing treatment. It also discusses special situations like travel to other countries. You will need to work with your child’s regular health-care provider to make sure that your child is up-to-date on all necessary immunizations and to help keep your child healthy while taking immune-suppressing treatment.</p><p>If you have any questions, speak to your child’s doctor or the treatment team.</p><h2>Key points </h2> <ul> <li>Immune-suppressing treatment can make inactivated vaccines work less well and can make live vaccines cause disease. </li> <li>Your child should be up-to-date on all inactivated vaccines at least two weeks before starting immune-suppressing treatment. </li> <li>Your child should be up-to-date on all live vaccines at least four to six weeks before starting immune-suppressing treatment. </li> <li>Family members should be up-to-date on most vaccines, to help keep your child healthy.</li> <li>Work with your child’s doctor and the treatment team to make sure your child’s immunizations and immune-suppressing treatment work well together.</li> </ul><h2>Inactivated vaccines </h2> <p>Inactivated or "killed" vaccines do not contain any live viruses or bacteria that can cause disease. This means they are safe for patients whose immune system is suppressed. </p> <p>The main concern with these vaccines is that a suppressed immune system may not respond to them, so they may not work as well. Therefore, the goal with inactivated vaccines is to make sure that your child has had all of the necessary vaccines at least two weeks before starting immune-suppressing treatment.</p> <p>Inactivated vaccines include: </p> <ul> <li>tetanus and diphtheria (Td) or tetanus, diphtheria and acellular pertussis (Tdap) </li> <li>inactivated polio virus vaccine (IPV) </li> <li><a href="/Article?contentid=149&language=English">haemophilus influenzae type B</a> (Hib) </li> <li><a href="/Article?contentid=151&language=English">human papillomavirus</a> (HPV) </li> <li>pneumococcus </li> <li>meningococcus </li> <li>hepatitis A and/or B </li> <li>influenza</li> </ul> <p>For hepatitis B vaccine, your child’s doctor may need to take a blood test to find out if your child has responded to the vaccine.</p> <p>If your child is already taking immune suppression treatment and there are no plans to stop the treatment, your doctor can give inactivated vaccines according to the regular schedule. In some circumstances, changes to the routine schedule may be needed.</p> <h2>Live vaccines</h2> <p>Live vaccines contain live viruses or bacteria that can cause disease. Patients whose immune system is suppressed should not take live vaccines.</p> <p>Your child should have any necessary live vaccines four to six weeks before starting immune-suppressing treatment.</p> <p>Live vaccines include: </p> <ul> <li>measles, mumps and rubella (MMR) </li> <li>varicella (chickenpox) </li> <li>live influenza vaccine given as a nasal spray (FluMist) </li> <li>rotavirus</li> </ul><p>This patient information pamphlet was developed through the collaborative efforts of the Inflammatory Bowel Disease Program and the Infectious Diseases Program, and sponsored by an unrestricted educational grant from Abbott Canada.</p>https://assets.aboutkidshealth.ca/AKHAssets/immunizations_for_children_with_supressed_immune_systems.jpg
ImmunophenotypingIImmunophenotypingImmunophenotypingEnglishOncologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemTestsAdult (19+)NA2018-03-06T05:00:00ZOussama Abla, MDDanielle Weidman, MDKarin Landenberg, MD10.500000000000043.3000000000000287.000000000000Flat ContentHealth A-Z<p> Learn how immunophenotyping is performed and how it can determine your child's particular leukemia.</p><p> Immunophenotyping is a technique that helps distinguish between different types of leukemia. For this reason, it can be used to determine whether your child has acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). It also distinguishes between each leukemia subtype. </p><h2> Key points </h2><ul><li>Immunophenotyping can determine whether your child has acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) and distinguish leukemia subtypes. </li><li> This technique can detect the different antigens on bone marrow cells.</li></ul>
Immunosuppression: Protecting your child from infection when the immune system is loweredIImmunosuppression: Protecting your child from infection when the immune system is loweredImmunosuppression: Protecting your child from infection when the immune system is loweredEnglishImmunologyChild (0-12 years);Teen (13-18 years)BodyImmune systemNon-drug treatmentCaregivers Adult (19+)NA2012-01-23T05:00:00ZNA7.6000000000000063.40000000000001463.00000000000Health (A-Z) - ProcedureHealth A-Z<p>If your child has a low immune system learn how to protect them against infection.</p><h2>What is immunosuppression?</h2><p>Infections in children are common. They can contract infections both inside and outside the home. When a child gets an infection, the immune system usually works to fight it off. Some medicines or diseases can weaken the immune system (immunosuppression). When the immune system is weak, a child is more vulnerable to infection. They will also have a difficult time recovering. </p><p>If your child is on a medicine that lowers her immune system, it is important to protect against infection as much as possible. You may not be able to prevent your child from getting an infection. However, following these steps may reduce the risk.</p><h2>Key points </h2> <ul> <li>Be aware of possible sources of infection and protect your child against infection as much as possible.</li> <li>Hand washing is the most important step in preventing the spread of infections.</li> <li>Keep your house clean and prepare and store food safely. </li> <li>Limit your child's exposure to people with infection, pets, and second-hand smoke.</li> <li>Ensure all family members are immunized.</li> <li>Know what to do if your child gets an infection.</li> </ul><h2>What do I do if my child gets an infection?</h2> <p>If your child has any of the following, contact your paediatrician or family doctor within 24 hours. Go to the local emergency department or walk-in clinic if your doctor is unavailable.</p> <ul> <li><a href="/Article?contentid=30&language=English">Fever</a>. An oral temperature of 38.3°C or a temperature of 38°C that lasts for one hour or more. It also includes temperature under the arm of 37.8°C or a temperature of 37.5°C that last for one hour or more. It is not recommended to use a thermometer that is placed in the ear.</li> <li>Cough, runny nose, breathing problems</li> <li>Nausea, <a href="/article?contentid=746&language=English">vomiting</a> or loss of appetite</li> <li><a href="/article?contentid=7&language=English">Diarrhea</a> (loose, watery, foul smelling bowel movements)</li> <li>Foul smelling urine, pain when voiding (peeing), frequent voiding</li> <li>Thrush (white specks in the mouth or on the diaper area)</li> <li>Rash</li> <li>Increased sleepiness</li> </ul> <h2>What do I do if my child comes into contact with someone who has chickenpox?</h2> <p>Your child may need to take the treatment called Varicella Zoster Immune Globulin (VZIG). VZIG has a large number of antibodies to help prevent chickenpox. It is given by injection (a needle). A health care professional must give your child VZIG within 96 hours (four days) of the exposure to chickenpox. If your child comes into contact with chickenpox, call your health care team to discuss whether your child needs VZIG. This is particularly important if your child has been in contact with the infected person (family member, classmate or playmate) for 1 hour or more indoors. Very close contact outdoors (e.g., playing with another child in a sandbox) can also place your child at risk. If your child gets chickenpox, they may need to take a medicine that makes it less serious. </p><h2>Practice and promote good hand washing<br></h2> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/Suppository_wash_hands_EQUIP_ILL_EN.jpg" alt="Handwashing" /> </figure> <p>Recent studies have found that <a href="/Article?contentid=1981&language=English">hand washing</a> is the most important step in preventing the spread of infections. Hand washing is especially important after:<br></p><ul><li>using the toilet</li><li>changing diapers</li><li>handling garbage<br></li><li>using a cleaning cloth or soiled dishcloth</li><li>handling raw food (meat, eggs)</li><li>touching a pet</li><li>blowing or touching the nose</li><li>contact with other body fluids such as vomit or blood</li></ul><p>As soon as someone enters your home, ask them to immediately wash their hands or use a hand sanitizer. Anyone who has <a href="/Article?contentid=7&language=English">diarrhea</a> should thoroughly wash their hands with soap and water. Always wash your hands before:</p><ul><li>touching your child</li><li>preparing food</li><li>eating</li></ul><h2>Keep your home clean</h2><ul><li>Dust and vacuum your house weekly.</li><li>Wash your child's bed linens, bathroom towels, and pajamas at least once a week.</li><li>Wash all dishes and utensils in hot water or in the dishwasher.</li><li>Wash surfaces in common areas such as the bathroom, kitchen, and living room with a disinfectant. Pay particular attention to surfaces that are touched frequently such as handles on doors, the refrigerator, the oven, cupboards, sink taps, toilet handles and seat, telephones, and computers. Clean these surfaces regularly.</li><li>Clean toys before your child touches them.</li><li>Do not use humidifiers unless you clean them daily.</li></ul><h2>Limit contact with those who have an infection</h2><p>The following suggestions are for children with severe immunosuppression. These are not required for all children receiving immunosuppressive treatment. Talk to your child's health care team and ask if you need to take these precautions:</p><ul><li>Keep your child away from crowds. Try to avoid stores, markets, parties, etc.</li><li>Keep your child out of daycare and group play activities during the treatment period.</li><li>Avoid communal play areas such as play parks, sandboxes, and public swimming pools.</li><li>Limit sharing of household items such as toys, towels, drinking glasses, and eating utensils.</li><li>All visitors should be screened for illness. They should not visit if they are sick or have recently been directly exposed to someone who is sick. In the event that this cannot be avoided, the sick family member should wash their hands thoroughly before coming in direct contact with your child.</li><li>If you must be in a public place, use a plastic cover on the stroller and choose times when there is less likely to be crowds. An older child may wear a mask.</li><li>When at a clinic, doctor's office or medical lab, advise them of your child's lowered immune system and request to be put in a room right away or ask for an appointment at the beginning or end of the day. Avoid waiting rooms as much as possible.</li></ul><h2>Ensure family members are immunized</h2><p>Immunizations reduce the risk of many serious infections. Family members you live with should update their immunizations. This includes having annual flu vaccines. Immunizations make it less likely they will get sick and expose your child to one of these serious infections.<br></p><p>In general, it is safe for family members to be vaccinated during your child's treatment period. However, be cautious with two vaccines:</p><ul><li> <a href="/Article?contentid=760&language=English">Chickenpox (varicella)</a>: About 5% of people who receive this vaccine develop a rash. If this happens, your child should avoid contact with this person. Also contact your child's doctor because your child may need treatment to prevent infection.</li><li>Rotavirus: It is possible that people who receive this vaccine may have live virus in their feces. If a family member receives the rotavirus vaccine, wash hands thoroughly and often.</li></ul><p>Try to have your child's vaccinations updated four to six weeks before starting treatment. It is safe for your child to have 'inactivated' vaccines while immunosuppressed. However, they may not work well. The vaccine may need to be repeated at a later date. Talk to your child's health care team before your child has any vaccinations.</p><p>For more information, see <a href="/Article?contentid=1987&language=English">Immunizations for Children and Teens with Suppressed Immune Systems</a>.</p>https://assets.aboutkidshealth.ca/akhassets/Suppository_wash_hands_EQUIP_ILL_EN.jpg
Impact of cancer on sexualityIImpact of cancer on sexualityImpact of cancer on sexualityEnglishAdolescent;OncologyPre-teen (9-12 years);Teen (13-15 years);Late Teen (16-18 years)NANANAAdult (19+) CaregiversNA2019-09-03T04:00:00ZNA12.000000000000039.0000000000000339.000000000000Flat ContentHealth A-Z<p>Learn how to start a conversation with your teenager about sexuality, and how having cancer and going through treatment can impact their sexuality.</p><p>Part of normal teenage development is the development of sexuality. Sexuality means having sexual feelings and experiences. Having cancer can have a major effect on a teenager’s developing sexuality by:</p><ul><li>changing how a teenager sees themselves and altering their body image and self-esteem</li><li>causing them to feel different from their peers</li><li>affecting sexual development (treatments may affect hormones or how sexual organs function, either temporarily or permanently) </li><li>changing interest in, or desire for, sexual experiences</li><li>causing them to feel a sense of isolation</li><li>affecting a relationship with their partner<br></li></ul><h2>Key points</h2><ul><li>Sexuality means having sexual feelings and experiences.</li><li>Cancer can impact a teen's sexuality by changing how they see themselves and altering their self-esteem, affecting sexual development, and causing a sense of isolation.</li><li>The health-care team will discuss issues related to sexuality with your teenager, but it is important for parents and caregivers to encourage open dialogue.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/The_impact_of_cancer_on_sexuality.jpg
Impact of painIImpact of painImpact of painEnglishPain/AnaesthesiaChild (0-12 years);Teen (13-18 years)BodyCentral nervous system;Peripheral nervous system;Autonomic nervous systemSymptomsCaregivers Adult (19+)Pain2009-09-18T04:00:00ZJennifer Tyrrell, RN, MN, CNeph9.2000000000000060.40000000000001966.00000000000Flat ContentHealth A-Z<p>Impacts of chronic pain on children are discussed, including impact on mood, school, socializing, hobbies, sleep, and family.</p><p>Pain can have a huge impact on a child’s life and all their family members. How much impact will depend on a number of factors, including the type and duration of the pain, the treatments required, and the disease or injury that is causing it. How well your child and family learn to cope with the changes demanded of them will also be important.</p> <p>Chronic pain may require permanent lifestyle adjustments, and may make your child susceptible to depression. Shorter bouts of acute pain can cause social disruption for both the child and family. But, because it is by definition temporary, things will generally resolve themselves in the short term. </p> <p>Most of this section is focused on how to deal with the impact of chronic or recurrent non-cancer pain. However, many of the principles outlined are relevant to those parents whose children are suffering from acute pain. </p>
ImpetigoIImpetigoImpetigoEnglishDermatologyBaby (1-12 months);Toddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years)SkinSkinConditions and diseasesCaregivers Adult (19+)NA2010-03-05T05:00:00ZSheila Jacobson, MBBCh, FRCPC6.7000000000000062.9000000000000616.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Impetigo is a common skin infection that is caused by bacteria. Learn what to look for, and what you and your doctor can do to care for your child.</p><h2>What is impetigo?</h2> <p>Impetigo is a bacterial skin infection. It spreads easily. It is very common in young children, especially babies. Without treatment, impetigo can last for several months. It can develop into something more severe. </p><h2>Key points</h2> <ul> <li>Impetigo is a skin infection. It is caused by a bacteria.</li> <li>Symptoms of impetigo include small or large blisters. The blisters appear on a red background. They are filled with pus. They occur around the mouth or nose area. They may also occur in the diaper area.</li> <li>Impetigo is caused by bacteria. The bacteria enters the body through a cut or cracked skin.</li> <li>An antibiotic ointment is usually enough to treat the infection.</li> <li>Impetigo spreads easily by touch. Keep your child away from other children until the infection clears. </li> </ul><h2>Signs and symptoms of impetigo</h2> <p>The symptoms of impetigo change over time:</p> <ul> <li>At first, the child develops small or large blisters on a red background. The blisters contain pus. They appear around the mouth or nose. They may also appear in the diaper area.</li> <li>The blisters then split open. They form irregular sores. The sores may grow larger.</li> <li>The surface of the sore dries. Honey-coloured crusts form on the sore.</li> <li>The sores become itchy after the blisters burst.</li> </ul><h2>Causes of impetigo</h2> <p>Impetigo is caused by bacteria. The bacteria enter the body through a cut, open sore, insect bite or cracked skin. Impetigo is usually caused by <em>Staphylococcus aureus</em>. This is called a staph infection. Impetigo may also be caused by <em>Streptococcus pyogenes</em>. This is called a strep infection.</p> <p>Your child is more likely to get this infection if they have:</p> <ul> <li>dry or flaky skin</li> <li><a href="/Article?contentid=773&language=English">eczema</a></li> <li>burns, scratches, splinters, cuts or scrapes</li> <li>other skin infections </li> <li>spider or insect bites</li> </ul><h2>What your child's doctor can do</h2> <h3>Physical examination</h3> <p>Usually the doctor can see if your child has impetigo just by looking at the skin. The doctor may also suggest blood or other tests. However, these tests are usually not needed. </p> <h3>Antibiotics</h3> <p>Your child's doctor will likely prescribe an antibiotic ointment. The ointment will be effective against the bacteria. You will need to spread the ointment on the sores a few times a day. </p> <p>The impetigo should improve after a few days. However, even if your child feels better, do NOT stop giving the antibiotics before finishing the full amount prescribed. This infection can come back, especially if the complete treatment is not given. </p> <p>If your child's impetigo is more severe or getting worse, your child may need an oral antibiotic (taken by mouth).</p><h2>When to see a doctor</h2> <p>Book an appointment immediately with your child's doctor if your child is showing symptoms of impetigo.</p> <p>See your doctor again if:</p> <ul> <li>your child cannot take the prescribed oral antibiotic medication because they are throwing up often</li> <li>your child does not seem to be improving with antibiotic ointment or oral medication</li> </ul>impetigo
Importance of skin-to-skin contactIImportance of skin-to-skin contactImportance of skin-to-skin contactEnglishNeonatologyNewborn (0-28 days)SkinNANAAdult (19+)NA2009-10-18T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPC11.100000000000053.7000000000000376.000000000000Flat ContentHealth A-Z<p>Learn about the benefits of skin-to-skin contact between you and your newborn baby directly after birth. Answers from Canadian Paediatric Hospitals.</p><p>Skin-to-skin contact with your baby is important for developing connections, soothing your baby and allowing them to move freely.</p><h2>Key points</h2> <ul><li>Babies who are placed in skin-to-skin contact with their mother cry very rarely in the first hour or two of life, have less of a chance of their temperature dropping and maneuver towards their mother's nipple and start to suck.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/importance_of_skin_to_skin_contact.jpg
In the hospital: AMLIIn the hospital: AMLIn the Hospital: AMLEnglishOncologyChild (0-12 years);Teen (13-18 years)BodySkeletal systemConditions and diseasesAdult (19+)NA2018-03-06T05:00:00ZOussama Abla, MDDanielle Weidman, MDKarin Landenberg, MD8.0000000000000067.7000000000000377.000000000000Flat ContentHealth A-Z<p> Learn how to help your child get used to staying in the hospital.</p><p>After being diagnosed with acute myeloid leukemia (AML), your child will spend most of the time in hospital during their treatment. Getting used to the hospital setting can be challenging for many children and teens. </p> <p>Children with ALL may require intermittent hospitalizations throughout their treatment.</p> <p>It is important to keep as much of your child’s home routine as possible. Maintaining a daily routine will help your child get used to the hospital room being their temporary home. If you can, try to create some "safe" time for your child in the day, where they have no tests, medications, or dealings with the health care team. </p><h2> Key points </h2> <ul><li>Having a routine for your child during their leukemia treatment can help them feel like their hospital room is their home for the time being.</li> <li> Arranging activities and maintaining contact with friends and other people your child is comfortable with can help improve their time in hospital.</li></ul>
In-hospital hemodialysisIIn-hospital hemodialysisIn-hospital hemodialysisEnglishNephrologyChild (0-12 years);Teen (13-18 years)KidneysCardiovascular systemNon-drug treatmentCaregivers Adult (19+)NA2014-07-30T04:00:00ZElizabeth Piva, RN;Susan Ackerman, RN;SickKids Home Dialysis Program9.9000000000000051.0000000000000548.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Find out what is involved in in-hospital hemodialysis and its benefits.</p><p>In-hospital <a href="/Article?contentid=44&language=English">hemodialysis</a> is a dialysis option offered in a hospital setting. It is a rapid type of dialysis that removes any toxins and fluid that have built up in your child's body over the previous day or two.</p><h2>Key points</h2> <ul> <li>In-hospital hemodialysis is a type of dialysis that is done over three to four hours in a hospital setting.</li> <li>Your child will usually receive in-hospital dialysis as an outpatient three or four times a week. </li> <li>In-hospital hemodialysis means you do not need to store any equipment at home and lets your child meet other patients and have immediate access to medical care.</li> <li>Your child must take time away from school for in-hospital appointments, follow a strict diet and take more medications than with other types of dialysis.</li> </ul><h2>How often does my child need in-hospital hemodialysis?</h2> <p>Your child receives this dialysis as an outpatient in a hospital (they do not stay overnight). The dialysis is usually done three or four times a week, including holidays. Each treatment lasts three or four hours. You may stay with your child during the treatment.</p><h2>Things to consider when deciding on in-hospital hemodialysis</h2> <p>Coming to the hospital for dialysis may mean less responsibility, but it may affect other areas of your child's life. To help you decide if in-hospital dialysis is suitable for your child, please consider the following points.</p> <h3>Impact of in-hospital hemodialysis on your child's routine</h3> <ul> <li>Your child will need dialysis on a fixed schedule every week.</li> <li>Your child will miss a lot of school to attend the treatments.</li> <li>Your child will need to follow a strict diet, including fluids.</li> <li>Your child will need to take more medications than if they had <a href="/Article?contentid=42&language=English">peritoneal dialysis</a> or <a href="/Article?contentid=41&language=English">home hemodialysis</a>.</li> </ul> <h3>Impact of in-hospital hemodialysis on your family's routine</h3> <ul> <li>You or another family member must take time off work to be with your child for the dialysis treatments.</li> <li>You will need travel to and from the hospital and cover any related transportation expenses such as gas, parking or transit.</li> </ul> <h3>How your child feels during and after in-hospital hemodialysis</h3> <ul> <li>Your child might feel unwell during dialysis (light headed, cramps, headache and nausea).</li> <li>Your child will have less energy and need more time to recover after each treatment.</li> </ul><h2>At SickKids</h2> <p>The Dialysis Unit at SickKids is open Monday through Saturday and can offer dialysis in the morning or afternoon.</p> <p>Your child can eat one meal during the dialysis treatment. If you wish, they can also be taught by a teacher from the Toronto District School Board to help them keep up with their school work. We can also arrange physiotherapy for your child on request.</p> <p>For more information or a tour of the Dialysis Unit, please contact 416-813-7563.</p>
Incentive spirometry or bubbles: Encouraging deep breathing to clear the lungsIIncentive spirometry or bubbles: Encouraging deep breathing to clear the lungsIncentive spirometry or bubbles: Encouraging deep breathing to clear the lungsEnglishRespiratoryPreschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)LungsLungsNon-drug treatmentCaregivers Adult (19+)NA2014-06-25T04:00:00ZDeena Savlov, MD, FRCPCSejal Patel-Modi, BSc, MPT8.0000000000000068.3000000000000703.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn how your child can exercise their lungs to reduce the risk of breathing problems.</p><p>An incentive spirometer is a device that provides exercise to the <a href="https://pie.med.utoronto.ca/htbw/module.html?module=lung-child">lungs</a>. It does this by encouraging deep breaths with the movement of the diaphragm, the muscle between the lungs and abdomen (tummy).</p><p>Deep breathing exercises help open the air sacs in the lungs and may reduce the risk of:</p><ul><li>breathing problems such as <a href="/Article?contentid=784&language=English">pneumonia</a> after surgery</li><li>acute chest syndrome in patients with <a href="/Article?contentid=745&language=English">sickle cell disease</a>.</li></ul> ​<h2>Key points</h2> <ul> <li>An incentive spirometer is a device that helps your child exercise their lungs.</li> <li>Deep breaths with an incentive spirometer reduce the risk of breathing problems such as pneumonia after surgery or, in patients with sickle cell disease, acute chest syndrome.</li> <li>If your child can use an incentive spirometer, they should take 10 deep breaths every hour.</li> <li>Your child may need to avoid using an incentive spirometer if they are in too much pain or need more oxygen after using the device. A physiotherapist may need to assess your child before using an incentive spirometer if they have a history of asthma or they are wheezing.</li> <li>If your child is under age five or cannot use an incentive spirometer for another reason, they should blow bubbles for two to three minutes every hour.</li> </ul><h2>How to use an incentive spirometer</h2> <ol> <li>Have your child sit up straight.</li> <li>Hold the incentive spirometer in an upright position. The incentive spirometer has different levels and contains a ball that rises when your child takes a deep breath in.</li> <li>Have your child place the mouthpiece in their mouth and hold it there with their lips closed tightly.</li> <li>Starting at level 0, have your child take 10 slow, deep belly breaths while they keep their head and shoulders still. For each breath, your child should raise the ball in the incentive spirometer to the top and hold it there for two seconds before breathing out.</li> <li>After your child takes the 10 deep breaths in and out, have them cough to help clear any mucus. If it hurts your child to cough, you can hold a pillow firmly against their chest to help ease any pain.</li> </ol> <p>Your child should take 10 breaths every hour that they are awake.</p> <h2>When it may not be appropriate to use an incentive spirometer</h2> <p>Your child may need to avoid using an incentive spirometer if:</p> <ul> <li>their breathing is more difficult when they use the device</li> <li>they need more oxygen after using the device</li> <li>they are in too much pain</li> <li>they do not know how to use the device.</li> </ul><h2>When a physiotherapist should assess your child before using an incentive spirometer</h2> <p>Sometimes a physiotherapist will first need to check that an incentive spirometer is the right option for your child. Your child will be assessed if:</p> <ul> <li>they are wheezing</li> <li>they have a history of asthma</li> <li>they have pneumothorax (air around the lungs) when they are due to use the device</li> <li>there is not enough oxygen in their lungs (the oxygen level is 90 per cent or less when they are breathing room air, without receiving extra oxygen).</li> </ul> <p>If your child is under age five or cannot use the spirometer for one of the reasons listed above, bubbles might be more appropriate for them.</p>https://assets.aboutkidshealth.ca/AKHAssets/incentive_spirometry.jpg
Infantile hemangiomasIInfantile hemangiomasInfantile hemangiomasEnglishDermatologyNewborn (0-28 days);Baby (1-12 months);Toddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years)SkinSkinConditions and diseasesCaregivers Adult (19+)NA2019-11-07T05:00:00ZElena Pope, MD, MSc, FRCPC;Michelle Lee, RN;Jackie Su, RN; Rebecca Levy, MD, FRCPC; Hoi Ling Wong, MD8.6000000000000059.00000000000001001.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn about common growths, called infantile hemangiomas. Also, learn when they are tested and treated by doctors.</p><h2>What is an infantile hemangioma?</h2> <figure><span class="asset-image-title">Hemangiomas</span><img src="https://assets.aboutkidshealth.ca/akhassets/Hemangioma_MEDIMG_PHO_EN.jpg" alt="Raised red spots on a person's back" /> </figure> <p>Infantile hemangiomas are the most common, non-cancerous growths in babies. They are caused by extra growth of cells lining the small blood vessels in the skin. These cells are called endothelial (say: en-doh-THEE-lee-ull) cells. </p><p>Infantile hemangiomas present with red-purple skin changes, which are flat or raised. They are soft to touch and do not cause pain unless the skin above is broken (ulceration). About 60% of hemangiomas occur on the head and neck, but they can occur anywhere on the body. Rarely, they can occur inside the body as well.</p><p>Infantile hemangiomas normally appear in the first two weeks of life. Deeper hemangiomas may not appear until two to three months of age. About 30% to 40% of hemangiomas appear at birth as a barely visible spot, either slightly dusky or coloured differently than the skin around them.<br></p><h2>Key points</h2> <ul> <li>Infantile hemangiomas are common growths in babies. </li> <li>They are not cancerous. </li> <li>Hemangiomas usually get smaller as the child gets older. </li> <li>Doctors will run tests and treat the hemangioma if it affects breathing, vision or other organs. </li> </ul><h2>Who is at risk of having an infantile hemangioma?</h2><p>Infantile hemangiomas are more common in girls, twins, premature babies and babies who are born with a low birth weight.</p><h2>Testing for hemangiomas</h2> <p>Usually, your child's doctor can diagnose an infantile hemangioma by looking at it. Tests are not needed in most cases. The doctor may run tests or ask for a consultation from other specialists to make sure the hemangioma does not affect breathing and eyesight and to assess the depth of the hemangioma. </p> <p>The doctor may order some tests like ultrasound or magnetic resonance imaging (MRI). They help the doctor see how much the hemangioma affects other parts of your child's body. </p><h2>Treatment for hemangiomas</h2><p>Most infantile hemangiomas require no treatment or workup as most go away on their own and are not associated with other problems. Your child's doctor may suggest a "wait and see" approach. This means waiting to see what happens on its own before treating the hemangioma.</p><p>If your child's hemangioma requires treatment, they may be referred to a dermatologist. Your child's doctor will decide if the hemangioma needs to be treated by considering:</p><ul><li>location of the hemangioma on the body </li><li>size of the hemangioma </li><li>age of your child </li><li>risk and benefits of treatment </li></ul><p>Medicine, surgery and laser treatments are options at different stages of hemangiomas, if needed. They can be discussed with your child's primary care provider or dermatologist. </p><p>Treatment options for hemangiomas that are growing may include the following medicines:</p><ul><li>topical gel known as timolol (an eye drop that can help to shrink small hemangiomas)<br></li><li>beta-blockers (propranolol, nadolol) taken by mouth</li><li>laser treatment may be helpful to stop bleeding hemangiomas or to help heal ulcerated hemangiomas. It may also help to improve redness or fine blood vessels if they persist after the hemangioma has gone away or involuted</li></ul><h2>Complications of infantile hemangiomas</h2><p>If your child has an infantile hemangioma on or near the eyes, nose, ears, lips or neck, it might affect their ability to see or breathe. </p><p>Infantile hemangiomas may cause bleeding or become infected and cause pain, especially if they are near diaper areas, skin folds and the lips. </p><p>Infantile hemangiomas may leave a change in skin colour or a change in the skin texture, which can be a cosmetic concern for some people.</p><p>Talk to your doctor if your child has any of these problems.</p><h3>Treating bleeding</h3><p>If your child's hemangioma starts to bleed, follow these steps:</p><ul><li>Apply pressure to the site for 15 minutes. </li><li>If the bleeding does not stop after 15 minutes, take your child to the closest emergency department. </li></ul>https://assets.aboutkidshealth.ca/AKHAssets/hemangiomas.jpg
Infantile osteopetrosisIInfantile osteopetrosisInfantile osteopetrosisEnglishGeneticsChild (0-12 years);Teen (13-18 years)BodyBonesConditions and diseasesCaregivers Adult (19+)NA2011-09-01T04:00:00ZLucie Dupuis, MSc, MS, CGC;Ayeshah Chaudhry, MBBS;Roberto Mendoza-Londono, MD, MS, FACMG, FCCMG10.300000000000044.90000000000001627.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Information for parents about infantile osteopetrosis, a rare genetic condition that may cause fractures, short stature (height), recurrent infections, hearing loss and vision problems.</p><h2>What is infantile osteopetrosis?</h2> <p>Infantile osteopetrosis (say: oss-tee-oh-peh-TRO-siss) is a genetic condition that may result in: </p> <ul> <li>fractures</li> <li>short stature (height)</li> <li>recurrent infections</li> <li>hearing loss</li> <li>vision problems</li> </ul> <p>Other names you may hear for this condition are early onset osteopetrosis and malignant infantile osteopetrosis. </p> <p>This condition is quite rare and is believed to affect about one in 200,000 people. </p> <p>There are several different forms of osteopetrosis: infantile, juvenile and adult onset. In general, infantile osteopetrosis is the most severe form, while adult-onset osteopetrosis is the mildest form.<br></p><h2>Key points</h2> <ul> <li>Infantile osteopetrosis is a genetic condition that may result in fractures, short stature, recurrent infections, hearing loss and vision problems.</li> <li>Children with infantile osteopetrosis need to be followed carefully by a health care team made up of different specialists because they may develop health problems.</li> <li>Genetic counselling can help families understand infantile osteopetrosis, the options for managing it, and the chances that other children will also be affected.</li> </ul><h2>Osteopetrosis is a genetic condition</h2><p>Genetic means related to genes. Each of us inherits our genes from our parents. They provide our bodies with instructions that influence our health, looks and behaviour. In general, each person has two copies of every gene. </p><p>Infantile osteopetrosis is caused by a mutation (change) in each copy of a gene. One mutation is inherited from the mother and the other from the father. To date, there are several genes known to cause infantile osteopetrosis, including CLCN7, OSTM1, TCIRG1, TNFSF11, PLEKHM1 and TNFRSF11A. </p><p>Infantile osteopetrosis is inherited in an autosomal recessive pattern. This means that:</p><ul><li>A person with infantile osteopetrosis has a mutation in each copy of the gene.</li><li>Each parent carries a mutation in one copy of the gene. The other copy of the gene works normally and because of this, the parent does not show signs and symptoms of infantile osteopetrosis. This person is called a carrier of infantile osteopetrosis.</li></ul> <figure class="asset-c-100"> <span class="asset-image-title">Inheritance of infantile osteopetrosis</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Infantile_osteopetrosis_Inheritance_MED_ILL_EN.jpg" alt="Chromosome distribution from parents each carrying a gene with a mutation" /> <figcaption class="asset-image-caption">Infantile osteopetrosis is caused by mutations in both copies of one of the genes known to cause this condition. In this example, both healthy parents are carriers of the gene with a mutation. Their baby can inherit one of the following gene combinations: one, two or no copies of the gene with a mutation. If a baby inherits no copies or just one copy of the gene with a mutation, the baby will not have infantile osteopetrosis. It is only when a baby inherits two copies of the gene with a mutation that the baby will have infantile osteopetrosis.</figcaption> </figure> <p>To learn more about genetics, visit: <a href="/Article?contentid=343&language=English">Genetic counselling</a>.</p><h2>Diagnosing infantile osteopetrosis</h2><p>A diagnosis of infantile osteopetrosis is made on the basis of physical examination and X-ray findings. X-rays shows thickening and increased density of bones and bone-within-bone appearance. The diagnosis may be confirmed by DNA testing (blood test).</p><h3>Infantile osteopetrosis can be diagnosed before birth</h3><p>Before birth, infantile osteopetrosis can be diagnosed by testing DNA taken from the fetus. This can be obtained in one of the following ways:</p><ul><li>by amniocentesis after the 15th week of pregnancy </li><li>by chorionic villus sampling (CVS) between the 11th and 14th week of pregnancy</li></ul><p>These methods are used for high-risk pregnancies, for instance if the parents have another child diagnosed with infantile osteopetrosis. </p><p>To be eligible for this testing, the mutations in the gene responsible for causing infantile osteopetrosis must be known. This means that the child with the condition must have genetic testing.<br></p><p>Infantile osteopetrosis may also be diagnosed before birth using ultrasound as early as 14 weeks' gestation. However, it is possible to have a normal ultrasound and still have a baby with infantile osteopetrosis. </p> <figure class="asset-c-100"> <span class="asset-image-title">X-ray of healthy vs. infantile osteopetrotic thigh bones</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Infantile_osteopetrosis_Xray_MED_ILL_EN.png" alt="X-ray of thighs with healthy bone thickness and density and x-ray of thighs with increased bone thickness and density" /> <figcaption class="asset-image-caption">The thigh bones in the right X-ray show the effects of infantile osteopetrosis. The bones are thicker and have a higher bone density making them appear whiter on the X-ray. </figcaption> </figure><h2>Treatment of infantile osteopetrosis</h2><p>Children with infantile osteopetrosis need attentive, informed care from their parents and health-care providers. </p><p>The goals of treatment are:</p><ul><li>to help children with infantile osteopetrosis adapt socially and physically</li><li>to treat the symptoms</li></ul><h3>Transplantation of hematopoietic stem cells</h3> <p>The most effective treatment option available for infantile osteopetrosis is the transplantation of hematopoietic stem cells. These are the blood stem cells that come from the bone marrow or blood. It is a life-saving procedure with some risks. When successful, it prevents the progression of symptoms and improves bone health. Other problems like vision loss and dental and orthopaedic problems can still happen. </p><p>For more information, please see the <a href="/Article?contentid=2477&language=English">Blood and Marrow Transplant Resource Centre</a> on AboutKidsHealth.ca.</p><h3>Calcium supplements</h3><p>People with infantile osteopetrosis need to have the calcium levels in their blood and urine monitored. If your child's calcium levels are low, your child will need supplements. </p><h3>Transfusions</h3><p>Your child should have a complete blood count at least once every year. Depending on the levels, your child may need transfusions of red blood cells and platelets. </p><p>For more information, please see the <a href="/Article?contentid=1107&language=English">blood transfusion</a> and <a href="/Article?contentid=32&language=English">blood donation</a> articles on AboutKidsHealth.ca.</p> <h3>Treatment of infections</h3><p>If your child often has infections, your child may need antibiotics. </p><h3>Treatment of vision problems</h3><p>Your child should have an eye examination at least once a year. Children with vision problems may need surgery to release the compression of the optic nerve. </p><h3>Treatment of fractures</h3><p>Recurrent fractures need management by an orthopaedic surgeon. Special attention is needed because the fracture may take a long time to heal. Patients may need medication for joint pains. </p><h3>Treatment of dental problems</h3><p>Children with osteopetrosis are more likely to have dental problems like abscesses, cysts and teeth that take longer to come in. Your child should see a dentist regularly.</p><h2>How infantile osteopetrosis affects the body</h2><h3>Bone and dental problems</h3><p>Osteopetrosis is a disorder of bone development in which the bones become thickened. Normally, small areas of bone are constantly being broken down by special cells called osteoclasts, then made again by cells called osteoblasts. This is called bone remodeling, and it helps keep the bones healthy.</p> <figure class="asset-c-100"> <span class="asset-image-title">Bone remodeling cells</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Infantile_osteopetrosis_bone_cells_MED_ILL_EN.jpg" alt="Osteoclast and osteoblast on bone" /> <figcaption class="asset-image-caption">Within our bones are special cells that constantly break down bone and build new bone. Osteoclasts break down bone and osteoblasts make new bone.</figcaption> </figure> <p>In osteopetrosis, the cells that break down bone (osteoclasts) do not work properly, so there is an imbalance between these two functions. This leads to the bones becoming thicker and not as healthy. This can lead to: </p><ul><li>bone fractures </li><li>less overall bone growth, causing short stature</li><li>a thicker skull bone, which may cause teeth to come out later than expected</li><li>larger head size</li></ul> <figure class="asset-c-100"> <span class="asset-image-title">Osteopetrotic bone</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Infantile_osteopetrosis_bone_cycle_MED_ILL_EN.jpg" alt="Osteopetrotic bone with abnormal osteoclasts compared to a healthy bone" /> <figcaption class="asset-image-caption">Normally, our bones are constantly being broken down by osteoclasts and made again by osteoblasts. In osteopetrosis, the osteoclasts are abnormal and cannot break down bone but osteoblasts continue to make new bone. This imbalance results in thicker bones that are not as healthy.</figcaption> </figure> <h3>Problems with bone marrow and blood cells </h3><p>Bone marrow makes new blood cells. It is found inside the bones. In people with infantile osteopetrosis, because the cells that break down bone do not work properly, the space where the bone marrow is found is smaller or even missing. This means there is less bone marrow, so fewer blood cells are made. This can lead to:</p><ul><li>Anemia because of low red blood cells. Symptoms of anemia include pale skin and lack of energy.</li><li>Bleeding problems because of low platelets. Platelets are blood cells needed for clotting to help stop bleeding.</li><li>Many infections due to low white blood cells. White blood cells are needed to fight infections. </li></ul><h3>Problems due to thickening of skull bones</h3><p>The skull bone of people with infantile osteopetrosis is thickened, which can lead to: </p><ul><li>compression of some nerves, causing vision problems and weakness of facial muscles </li><li>narrow nasal sinus, causing chronic nasal congestion</li></ul><p>Thickening of the bones of the ear can cause compression of the nerves, resulting in hearing loss.</p><h3>Calcium and parathyroid levels</h3><p>Children with infantile osteopetrosis have lower levels of calcium and parathyroid hormone in their blood than normal. This may sometimes lead to increased irritability and seizures if it is not managed. These seizures are often the first sign of infantile osteopetrosis. </p><h3>Life expectancy</h3><p>With bone marrow failure and recurrent infections, some babies with infantile osteopetrosis may die before two years of age. Without treatment, most die by the age of ten. Transplantation of hematopoietic stem cells (see below) is the most promising treatment for long-term survival. <br></p><h2>Resources and support</h2><p>The following organizations and sites can offer more information, support and contact with other affected individuals and their families.</p><h3>The OsteoPETrosis Society (OPETS)</h3><p> <a href="http://www.osteopetrosis.org/">www.osteopetrosis.org</a>.</p><h3>Osteopetrosis Support Trust</h3><p> <a href="https://www.osteopetrosis-support-trust.org.uk/">www.osteopetrosis-support-trust.org.uk</a>.</p><h3>National Institute of Arthritis and Musculoskeletal and Skin Diseases</h3><p> <a href="https://www.niams.nih.gov/">www.niams.nih.gov</a>.</p><h3>The Paget Foundation</h3><p> <a href="https://www.iofbonehealth.org/national-societies/1284">www.iofbonehealth.org/national-societies/1284</a>.</p>https://assets.aboutkidshealth.ca/akhassets/Infantile_osteopetrosis_Xray_MED_ILL_EN.png
Infantile spasmsIInfantile spasmsInfantile spasmsEnglishNeurologyNewborn (0-28 days);Baby (1-12 months)BodyNervous systemConditions and diseasesCaregivers Adult (19+)NA2013-11-19T05:00:00ZJennifer Boyd, RN, MHSc, CNN(C);Shelly K. Weiss, MD, FRCPC7.3000000000000069.60000000000003240.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn about infantile spasms, a type of epilepsy. Learn how infantile spasms are diagnosed and treated, and who can help you and your baby.</p><p>Infantile spasms are a type of epilepsy. You may also hear infantile spasms called West syndrome after Dr. William West, who described infantile spasms in his own son in the 1840s. </p> <h2>What are infantile spasms?</h2> <p>Infantile spasms usually begin in the first year of life. Spasms are a type of seizure. When your baby has a spasm, any of the following things may happen:</p> <ul> <li>arms and legs jerk up quickly </li> <li>head drops forward </li> <li>arms fly out </li> <li>legs go up to the chest </li> <li>muscles become stiff and then relax </li> <li>eyes look to the side or up </li> <li>breathing changes </li> </ul> <p>Babies experiencing infantile spasms will sometimes look as though they have severe stomach pain or <a href="/Article?contentid=295&language=English">colic</a>, but they are not in pain. Spasms usually happen when the baby is waking up, but they can happen at other times. The baby may have one spasm at a time, or many spasms in a row. Many spasms in a row are called a cluster. Each spasm usually lasts less than 10 seconds. A cluster or severe spasms can last for minutes. </p> <p>After a spasm, the baby may cry or laugh. The spasms do not cause pain, but the baby may cry because the quick jerking movement surprises them.</p> <h3>After infantile spasms start, the baby may stop developing</h3> <p>Once the spasms start, parents often notice that their babies stop developing. They stop doing the things they did before, such as smiling, rolling over or sitting. They may also stop following things with their eyes (tracking) and looking at people in the eyes. They do not learn to do new things. </p><h2>Key points</h2> <ul> <li>Infantile spasms are a type of epilepsy that usually begins in the first year of life. </li> <li>Infantile spasms do not cause your baby pain, but they must be treated as soon as possible, or your baby will stop developing and learning new things.</li> <li>After being diagnosed with infantile spasms, your baby may need tests to help find the cause of the infantile spasms. Your baby may need to have an MRI of the brain or have blood and urine tested for chemical changes or changes in the genes. </li> <li>Your baby’s infantile spasms will be treated with medicine. Your baby will be treated with vigabatrin first. If vigabatrin does not work then your baby will be treated with ACTH or prednisolone or another anti-seizure medicine.</li> <li>Many babies who have infantile spasms will develop other seizures later in life. </li> </ul><h2>Signs and symptoms of infantile spasms</h2> <p>Your doctor will diagnose your baby with infantile spasms if they experience all of the symptoms below:</p> <ul> <li>Your baby has the type of seizures usually seen in infantile spasms that are described above. </li> <li>Your baby's EEG (electroencephalogram) test shows a pattern of brain waves called hypsarrhythmia.</li> <li>Your baby has stopped developing or has stopped learning to do new things since the seizures started.</li> </ul><h2>What causes infantile spasms?</h2><p>Infantile spasms can happen because of many different problems. Sometimes they happen in babies who experience delayed development. These babies may already have a known problem with their brains. These problems can start:</p><ul><li>Before they are born. </li><ul><li>If the brain does not form properly during fetal development</li><li>If there is a chromosomal abnormality that causes a disorder that affects the brain, such as <a href="/Article?contentid=9&language=English">Down Syndrome</a> or Tuberous Sclerosis, and increases the risk of getting infantile spasms </li><li>If there is a problem with the body's metabolism, causing too much or too little of necessary body chemicals</li><li>If there is damage to the brain from a clot or bleeding in the brain or an infection<br></li></ul><li>Around the time they are born. </li><ul><li>If they do not receive enough oxygen at birth</li><li>If they experience trauma during birth</li></ul><li>In the first few months of life. </li><ul><li>Due to brain infection</li><li>Due to brain injury </li></ul></ul><p>Sometimes babies are developing normally when they start having infantile spasms and the cause is unknown.</p><p>Infantile spasms are divided into three groups:</p><ul><li>Symptomatic: When we know what has caused the spasms. </li><li>Cryptogenic: When a baby had problems with development before the spasms started, but we cannot find a cause. </li><li>Idiopathic: When a baby's development was normal before the spasms started and we cannot find a cause. </li></ul><h2>Tests to diagnose infantile spasms</h2><p>Your baby will need various tests before and after being diagnosed with infantile spasms.</p><h3>Electroencephalogram</h3><p>Your baby will have an (EEG). This test looks at the patterns of electricity that the brain cells make. It does not hurt. </p><p>A technologist will put small gold discs called electrodes on your baby's scalp. Sometimes your baby will need medicine to sleep during the EEG. </p><p>The EEG helps the doctor decide if your baby has infantile spasms. The EEG will also be used to check how well the treatment is working. </p><h3>CT scan and MRI of the brain</h3><p>Most babies with infantile spasms will have a CT scan or MRI of the brain.</p><ul><li> A CT scan is a special X-ray that uses a computer to take pictures of the brain. </li><li> An MRI uses a magnet, radio signals and a computer to make pictures of the brain.</li></ul><p>These pictures help the doctors see if your baby's brain looks normal or not. This may help the doctor find the cause of your baby's infantile spasms. </p><h3>Other tests</h3><p>The doctors may also do other tests to look for the cause of the infantile spasms:</p><ul><li> The doctors may test your baby's blood and urine to look for infections and chemical changes. </li><li>If the doctors cannot find the cause of the infantile spasms using these tests, they may do a blood test to look at your baby's genes to see if there are any abnormalities.</li><li>The doctors may look at your baby's skin using a Woods lamp. Some conditions that cause infantile spasms also cause changes in the skin. This lamp uses a special light to show these changes. </li></ul><p>Because there are so many causes of infantile spasms, the tests will be different for each baby. The doctors and nurses will explain any other tests your child may need. </p><h2>Infantile spasms are treated with medicine</h2><p>Two medicines are the best at stopping infantile spasms. One is called <a href="/Article?contentid=260&language=English">vigabatrin</a> (Sabril) and the other is called ACTH (Synacthen).</p><p>At SickKids, the doctor will probably put your baby on vigabatrin first. Usually, after two to three weeks of treatment, your baby will have an EEG and be seen by the neurologist. If the spasms have not stopped or the hypsarrhythmia pattern on the EEG does not go away, the neurologist may decide to start your baby on ACTH or sometimes another medicine called prednisolone or another anti-seizure medicine.</p><p>Treatment will stop the infantile spasms in most children, but in some children the spasms will not stop.</p><h2>Vigabatrin</h2><p>Vigabatrin (Sabril) is medicine that is given by mouth. It comes as a pill that can be crushed and mixed with small amounts of liquid such as a spoonful of water, milk or juice, or a spoonful of food such as apple sauce or baby cereal. It also comes as a powder called a sachet that can be dissolved in a liquid. Make sure that your baby takes all of the liquid or food so that they get all of the medicine. For suggestions on how to give the medicine to your baby see the AboutKidsHealth <a href="https://www.youtube.com/watch?v=Q0ewm7bgtTA">Medicines Video: How to Give Your Child Liquid Medicines at Home</a>. </p><p>Keep the medicine at room temperature in a dry place.</p><p>The amount of medicine you give is increased each day over a few days to a very high dose. If the vigabatrin stops the spasms, your baby will stay on it for at least six months. Your doctor will tell you when your baby is ready to stop taking the medicine. </p><p>Here is what to do if your baby throws up the medicine or if you forget a dose:</p><ul><li>If your baby throws up the medicine within 30 minutes after taking it, give the dose again. </li><li>If your baby throws up more than 30 minutes after taking the medicine, do not give any more until the next time it is supposed to be given. </li><li>If the medicine is not given on time, give it as soon as you remember or can, unless the next dose is scheduled within four hours. </li><li>If the next dose of the medicine needs to be given in less than 4 hours, do not give the dose you forgot. Give the next dose a little earlier and then return to giving the medicine at the usual times after that. Do not give 2 doses at the same time.</li></ul><h3>Side effects of vigabatrin</h3><p>Your baby may have some of the following side effects:</p><ul><li>changes in how well the baby can see, in particular loss of peripheral or side vision, which is sometimes called tunnel vision </li><li>wanting to sleep more than usual, especially in the first few days to 3 weeks of treatment </li><li>upset stomach</li><li> <a href="/Article?contentid=6&language=English">constipation</a> </li><li>hyperactivity, restlessness, always wanting to move </li><li>being awake a lot in the middle of the night </li><li>irritability, fussiness, hard to make happy </li><li>weight gain </li><li>arms and legs become floppy, also called decreased muscle tone or hypotonia </li></ul><p>Not all babies get these side effects. Your baby may get some of these side effects and not others.<br></p><h3>A note on tunnel vision</h3><p>Doctors at The Hospital for Sick Children have monitored many children taking vigabatrin to see how vigabatrin affects their eyesight. They have found that: </p><ul><li>Changes in eyesight because of vigabatrin happen in fewer than 10% of children who are younger than 2 years old. </li><li>It is very rare to see eye changes in children who have been taking vigabatrin for less than six months. </li><li>Serious changes to the eyes are more likely to happen after one to two years of treatment, but they are still uncommon. </li><li>Most children will not have their eyesight changed by vigabatrin. </li></ul><h3>How to deal with side effects of vigabatrin</h3><ul><li>Changes in eyesight: Your baby will have an eye test called an electroretinogram (ERG) within a short time after starting on vigabatrin. Vigabatrin can sometimes cause narrowing of the peripheral vision, which means that a child cannot see as well to the side. The ERG will help the doctor know if this is a problem for your child. An ERG will be done every three to six months while your child is taking vigabatrin to see if there are any changes. One more ERG will be done after your child stops taking vigabatrin.</li><li>Sleepiness: Your baby will become less sleepy over time as he or she gets used to the medicine. Make sure your baby gets enough to eat and drink. Wake your baby up if it is time to feed them. If your baby is very sleepy and will not eat or drink, call the doctor who gave you the prescription for vigabatrin. </li></ul><h2>ACTH</h2><p>ACTH (Synacthen) is given by needle into the leg. We will arrange for a nurse to come to your home to give this medicine to your baby. </p><p>ACTH is started at a high dose. At SickKids the dose is lowered slowly over six weeks and then the treatment is stopped. </p><p>The side effects are usually worse at first when the dose is higher. The side effects will go away after the ACTH is stopped.</p><p>The nurse must check your baby's blood pressure before giving the medicine. Your baby's blood needs to be tested every one to two weeks and the urine tested two times a week. </p><p>Sometime doctors will suggest using prednisolone instead of ACTH. It is a similar type of drug as ACTH and causes the same side effects, but the dose is not as high and it is given by mouth. </p><h3>Side effects of ACTH</h3><p>Your baby may have some of the following side effects:</p><ul><li>increased chance of getting a serious infection </li><li>not sleeping well, although some babies are more sleepy and lethargic </li><li>irritability: your baby may be very fussy and hard to calm down </li><li>hunger or wanting to eat more </li><li>weight gain </li><li>puffy-looking face </li><li>upset stomach, such as vomiting (throwing up) or stomach pain </li><li>high blood pressure </li><li>changes in the chemicals of the body, such as high sugar or high salt </li><li>acne: red, raised bumps on the face</li><li>tremor (mild shaking) </li><li>rarely, thinning of the bones that makes them easy to break </li><li>very rarely, thickening of the heart muscle </li></ul><p>Not all babies get these side effects. Your baby may get some of these side effects and not others. These side effects will go away after the ACTH or <a href="/Article?contentid=221&language=English">prednisolone</a> is stopped.</p><h3>How to deal with the side effects of ACTH and prednisolone </h3><ul><li>Chance of a serious infection: Wash your hands well with soap before touching or holding your baby. You may want to buy soap that has 'anti-bacterial' written on the label. Ask everyone who comes into your home to wash his or her hands. Anyone with an infection such as a cold or flu should not touch or hold your baby. We suggest that your baby not be in a day care while taking ACTH. It is very important that you take your baby to see your paediatrician or family doctor right away if he or she shows any signs of an infection. Some signs of infection are fever, runny nose, cough, diarrhea (watery bowel movements), bad smelling urine, and change in alertness. For more information, please see "Immunosuppression: Protecting Your Child from Infection." </li> <li>Severe irritability or fussiness: If it is really hard for your baby to sleep, the doctor may suggest you give your baby a medicine to help him or her sleep at night. You will be given a prescription for this. Ask for help from family or friends to take turns caring for your baby so that you can get some rest. Hold, rock, swing, give warm baths, play music, or do anything that seems to make your baby feel better. Sometimes, no matter what you do, your baby will not stop crying or being fussy. </li><li>Increased appetite: Feed your baby the type and amount of food that is usually fed to a baby your child's age. Ask your baby's nurse for the information on 'What to Feed Your Baby in the First Year of Life' or speak to your paediatrician for information about the type and amount of food that is best for your baby. We can also arrange for you to speak with a dietitian. </li><li>Upset stomach: The doctor will give you a prescription for a medicine that will help settle your baby's stomach. </li><li>High blood pressure: The nurse will check your baby's blood pressure before giving ACTH. If your baby is taking prednisolone then their blood pressure should be checked at least once a week by your paediatrician. Blood pressure is a measurement of how strongly and how often the heart pushes blood around the body. If the blood pressure is above a certain level, the doctor may have you give a medicine to your baby that lowers the blood pressure. </li><li>Changes in chemicals of the body: Your baby's blood will be tested every 1 to 2 weeks. Your baby's urine will be tested 2 times a week. The blood can be tested through your paediatrician or family doctor. The nurse who comes into your home will test the urine. The doctor will give you a prescription for medicine to treat any problems. </li></ul><h2>When should I call a doctor or nurse?</h2><p>Call your baby’s neurologist or neurology clinic nurse if:</p><ul><li>your child has side effects to the medicine that are hard to deal with </li><li>your child is not eating or drinking enough </li><li>your child is sleeping most of the day and is hard to wake up </li><li>your child shows any signs of an allergic reaction, such as hives, rash or wheezing<br></li><li>your child has more spasms than usual </li></ul><p>Call your baby’s paediatrician or family doctor if your baby has any signs of infection or you have any other worries about your baby’s health. </p><h2>Resources to help you cope</h2><p>There are many people who can help you.</p><ul><li>Social workers can support you and your family to help you adjust to your child’s condition. They can also help with getting community supports and finding money to help pay for your child’s medicine.</li><li>Occupational therapists help with the development of your baby. They will check how your baby is developing, give treatment as needed and teach you how to help your baby learn new things. We often call this infant stimulation. </li><li>Family, friends and your religious community may help support you in different ways. </li><li>Being in touch with other parents who also have a child with infantile spasms may help. </li></ul>
Infants, toddlers, and preschoolers with diabetesIInfants, toddlers, and preschoolers with diabetesInfants, toddlers, and preschoolers with diabetesEnglishEndocrinologyNewborn (0-28 days);Baby (1-12 months);Toddler (13-24 months);Preschooler (2-4 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​8.9000000000000061.30000000000001064.00000000000Flat ContentHealth A-Z<p>Find out what to expect when your infant, toddler or preschooler has diabetes, and what you need to know to manage it.</p><p>​​Babies and toddlers — whether they have <a href="/Article?contentid=1717&language=English">diabetes</a> or not — generally:</p> <ul><li>determine thoughts by what they see and hear</li> <li>begin to develop a sense of themselves, first by gaining a trust in their environment as infants, and then by testing this environment in the next few years</li> <li>enhance their knowledge of the world around them by constantly exploring, asking questions, and developing language</li> <li>become more curious and independent, choosing some activities and rejecting others.</li></ul><h2>Key points</h2> <ul><li>The target blood glucose range for infants and toddlers is a pre-meal level between 6 and 10 mmol/L.</li> <li>Challenges in diabetes care at this age include changing eating habits and keeping a child still during insulin injections and finger pricks.</li> <li>Signs of a healthy infant or toddler include normal growth, good energy and no symptoms of high blood sugar levels.</li> <li>The routines and tasks needed for good diabetes care may influence and sometimes interfere with normal child development.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/infants_toddlers_preschool_diabetes.jpg
Infection and the immune system of a premature babyIInfection and the immune system of a premature babyInfection and the immune system of a premature babyEnglishNeonatology;ImmunologyPremature;Newborn (0-28 days);Baby (1-12 months)BodyImmune systemNAPrenatal Adult (19+)NA2009-10-31T04:00:00ZAndrew James, BSc, MBChB, FRACP, FRCPCAideen Moore, MD, FRCPC, MRCPI, MHSc13.700000000000035.0000000000000695.000000000000Flat ContentHealth A-Z<p>Read about infections and the immune system of premature babies. A premature baby is susceptible to infection because their immune system is immature.</p><p>Premature babies are typically more vulnerable to infections because their immune systems are immature. The lack of antibodies and immunity in a premature baby's immune system means they can't fight off bacteria, viruses or fungi in the same way that full-term babies may be able to.</p><h2>Key points</h2> <ul><li>Over time, the immune system is exposed to different bacteria, viruses, and fungi, and develop antibodies to respond to these invading organisms and develop immunities to their effects.</li> <li>Usually, a mother's antibodies cross through the placenta during the third trimester of pregnancy, which gives a newborn some immunity to diseases it has not yet been exposed to.</li> <li>Premature babies may not have received enough antibodies from the mother, and may also have difficulty producing white blood cells and antibodies to fight off infection.</li> <li>Infection in a premature baby can come from many sources including the womb, the birth canal, or the Neonatal Intensive Care Unit (NICU) environment.</li></ul>https://assets.aboutkidshealth.ca/akhassets/mom_looking_in_isolette_BRA_EN.jpg
Infection in newborn babiesIInfection in newborn babiesInfection in newborn babiesEnglishNeonatologyNewborn (0-28 days)BodyNAConditions and diseasesAdult (19+)Pain;Fatigue;Fever2009-10-18T04:00:00ZHazel Pleasants, RN, MNAndrew James, MBChB, FRACP, FRCPC10.100000000000052.70000000000001285.00000000000Flat ContentHealth A-Z<p>Learn about the symptoms, causes, diagnosis and treatment of infections in newborn babies. Trusted Answers provided by Canadian Paediatric Hospitals.</p><p>Newborn babies have weak immune systems. This is one reason why breastfeeding is so important: it provides the newborn baby with antibodies to help fight infection. As a result, breastfed infants have fewer infections than babies who are bottle fed. </p><h2>Key points</h2> <ul><li>Most infections in newborns are caused by bacteria, while some are caused by viruses.</li> <li>Symptoms of infection include temperature above 38.0 degrees C, poor feeding, irritability, excessive sleepiness, rapid breathing and change in behaviour.</li> <li>Your newborn's infection may be treated with antibiotics, or they may need to go to the hospital for special care including IV fluids or a feeding tube.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/infection_in_newborn_babies.jpg
Infections after a blood and marrow transplantIInfections after a blood and marrow transplantInfections after a blood and marrow transplantEnglishHaematology;Immunology;OncologyChild (0-12 years);Teen (13-18 years)BodyImmune systemConditions and diseasesAdult (19+)NA2010-01-06T05:00:00ZJohn Doyle, MD, FRCPC, FAAPChristine Armstrong, RN, MScN, NP Peds8.5000000000000057.6000000000000926.000000000000Flat ContentHealth A-Z<p>Information for parents about infections that may occur after a child's blood and marrow transplant (BMT).</p><p>Everything we contact in daily life potentially contains organisms which can cause infection. These include:</p><ul><li>bacteria, which are microscopic organisms that invade tissues and grow very quickly. They cause infections anywhere in the body.</li><li>fungi, which are primitive organisms that we encounter everywhere, such as bread mold. Some harmless forms reside inside our bodies.</li><li>viruses, which are parasites that are smaller than bacteria. They need another host, such as human cells, to survive and grow. </li></ul><p>These daily sources of infection are not a major issue for a healthy person. Our immune system protects us from becoming infected.</p><h2>Key points</h2><ul><li>High-dose chemotherapy or radiation destroys both weak and healthy cells, weakening the immune system.</li><li>It is common for BMT patients to have fevers while in hospital, caused by infection, chemotherapy, radiation, or blood transfusions.</li><li>Your child will be given some medicines before the transplant to decrease their risk of infection; other medicines will be given to treat the infection.</li></ul>
Infective endocarditis (IE)IInfective endocarditis (IE)Infective endocarditis (IE)EnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartHeartConditions and diseasesCaregivers Adult (19+)NA2010-10-25T04:00:00ZGrace Nugent, RN, MN;Jennifer Russell, MD, FRCPC;Cindy Wasyliw, BNSc, RN;Jennifer Kilburn, RN, MN7.0000000000000069.30000000000001216.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Some children with heart problems are at risk for developing a serious infection called infective endocarditis. Learn about the prevention and treatment of infective endocarditis. </p><p>Some children with heart problems are at risk for developing a serious infection called infective endocarditis (IE). This condition was previously known as subacute bacterial endocarditis or bacterial endocarditis. </p> <h2>What is infective endocarditis?</h2> <p>IE is a serious infection of the heart. It is caused by germs such as bacteria and fungi. These germs may get into child's blood in different ways, such as: </p> <ul> <li>from an operation</li> <li>through invasive medical procedures</li> <li>through very deep cuts from an accident</li> <li>from having work done on the teeth</li> </ul> <p>Usually, a child's body fights the bacteria and they do not get sick. However, if the blood does not flow through your child's heart or valves smoothly, your child may get IE. The chance of your child getting IE is low. However, because IE can be serious, it is important that you and your child know how to prevent it. </p><h2>Key points</h2> <ul> <li>Infective endocarditis (IE) is a serious infection of the heart that can affect some children with heart problems.</li> <li>The signs of infective endocarditis are similar to those of the flu.</li> <li>It is better and easier to prevent infective endocarditis than to treat it.</li> <li>Take good care of your child's teeth, including proper brushing and flossing and regular visits to the dentist.</li> <li>Make sure your child gets antibiotics for certain dental procedures, ONLY if recommended by your child's cardiologist.</li> <li>Get your child a Medic Alert bracelet if needed.</li> </ul><h2>The signs of infective endocarditis are similar to the flu</h2> <p>The signs of IE are like the signs of flu. This can make it hard to know if your child has IE. Take your child to the doctor if they have some of these signs and they do not go away. </p> <ul> <li>a slight fever of 37.5°C to 38.5°C that you cannot explain and that lasts for five to seven days</li> <li>sweating</li> <li>loss of appetite</li> <li>pain in the muscles and joints, such as the knees, shoulders or knuckles</li> <li>loss of weight</li> <li>a skin rash</li> <li>headaches</li> <li>a general feeling of weakness</li> </ul><h2>A doctor will test your child for infective endocarditis</h2> <p>There are several tests that can help the doctors find out if your child has IE. These tests are:</p> <ul> <li>blood tests to check for bacteria; your child may need to have several blood samples taken at different times</li> <li>a urine test, which tests your child's urine (pee) for bacteria</li> <li>an echocardiogram, which is a recording of the positions and movement of the walls of the heart or the parts inside the heart, such as the valves</li> </ul><h2>Treating infective endocarditis with antibiotics</h2> <p>If your child has IE, the doctor will give them antibiotics, which are medicines that kill germs. These antibiotics will be given to your child through an intravenous tube (IV). An IV is a small tube that is put in a vein in an arm or leg.</p> <p>Your child may need antibiotics for six weeks or longer. If your child needs antibiotics for a long time, they will have to stay in the hospital for the first few days or weeks. Your child may be able to finish receiving the antibiotics at home with the support of nurses from a service called Community Care Access.</p><h2>At SickKids</h2> <p>Our dentists at SickKids like children to visit the dentist first when they are six months old. The dental clinic at SickKids is available for the dental care of some children with special needs up until the age of 18 years.</p>https://assets.aboutkidshealth.ca/AKHAssets/infective_endocarditis.jpg
Inflammation and the immune systemIInflammation and the immune systemInflammation and the immune systemEnglishImmunologyChild (0-12 years);Teen (13-18 years)BodyImmune systemConditions and diseasesCaregivers Adult (19+)NA2013-05-13T04:00:00ZSusanne Benseler, MD;Manisha Sickand, MSc;Marinka Twilt, MD9.7000000000000050.3000000000000646.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Inflammation is the body's protective response against infection. Learn about the signs and symptoms of inflammation and how your body fights it.</p><h2>What is inflammation?</h2><p>Inflammation is the body's normal response to injuries or infections. You may often hear the words infection and inflammation together, but they mean very different things. Infection refers to the invasion and multiplication of a pathogen within the body, while inflammation is the body's protective response against infection. Inflammation is a complex process involving various types of immune cells, clotting proteins and signaling molecules, all of which change over time.</p> <figure class="asset-c-100"> <span class="asset-image-title">Inflammation</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_inflammation_EN.jpg" alt="Splinter in the skin causing pain, warmth, redness and swelling" /> <figcaption class="asset-image-caption"> Inflammation is the normal response of your body’s immune system to injuries and harmful things that enter your body. Immune cells quickly react to the damaged area to fix the problem. During the process, you may feel symptoms like pain, warmth, swelling and redness.</figcaption> </figure><h2>Key points</h2><ul><li> Inflammation is the body's normal response to injuries or infections. Cells of the immune system travel to the site of injury or infection and cause inflammation.</li> <li>The four signs of inflammation include warmth, redness, swelling and pain.</li><li>Long-term inflammatory conditions include asthma, colitis and Crohn's disease, arthritis, vasculitis and nephritis.</li><li>Different types of cells involved in our immune system include lymphocytes, antibodies and proteins secreted from B cells, neutrophils, monocytes, eosinophils and basophils.</li></ul><h2>Signs of inflammation</h2> <p>The cells of our immune system immediately travel to the site of injury or irritation and cause inflammation. This includes a widening of local blood vessels that result in an outflow of fluid and immune cells into surrounding tissues. This process often causes temporary discomfort, resulting in what physicians refer to as the four cardinal signs of inflammation:<br></p> <ul> <li>warmth </li> <li>redness </li> <li>swelling </li> <li>pain.<br></li> </ul> <p>Normally, inflammation disappears on its own after the irritation has been removed and the body is adequately protected. In some conditions, however, inflammation is the disease; it starts in the absence of harmful irritations and continues with no resolution. This leads to organ function problems. Examples of long-term inflammatory conditions include: </p> <ul> <li>Inflammatory airway disease: <a href="https://akhpub.aboutkidshealth.ca/article?contentid=1470&language=English">Asthma</a></li> <li><a href="https://akhpub.aboutkidshealth.ca/article?contentid=821&language=English">Inflammatory bowel disease</a>: <a href="https://akhpub.aboutkidshealth.ca/article?contentid=924&language=English">Colitis</a> and <a href="https://akhpub.aboutkidshealth.ca/article?contentid=923&language=English">Crohn's disease</a></li> <li>Inflammatory joint disease: <a href="/article?contentid=1049&language=English">Arthritis</a><br></li> <li>Inflammatory blood vessel disease: <a href="https://akhpub.aboutkidshealth.ca/article?contentid=914&language=English">Vasculitis</a> </li> <li>Inflammatory kidney disease: Nephritis </li> </ul>https://assets.aboutkidshealth.ca/akhassets/IMD_inflammation_EN.jpg
Inflammatory bowel disease (IBD)IInflammatory bowel disease (IBD)Inflammatory bowel disease (IBD)EnglishGastrointestinalPre-teen (9-12 years);Teen (13-18 years)Small Intestine;Large Intestine/ColonSmall intestine;Large intestineConditions and diseasesCaregivers Adult (19+)NA2010-02-18T05:00:00ZAndrew James, MBChB, FRACP, FRCPC;Meaghan Wright, BA;Karen Frost, BScN, RN, MN, NP-Peds6.5000000000000067.8000000000000401.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn about the signs and symptoms of inflammatory bowel disease (IBD) and the two different types.</p><h2>What is inflammatory bowel disease?</h2> <p>Inflammatory bowel disease (IBD) is a condition where the small or large intestine becomes inflamed. </p><h2>Key points</h2> <ul> <li>IBD is an inflammation of part of the digestive system. Crohn's disease and ulcerative colitis are two types of IBD.</li> <li>IBD comes and goes.</li> <li>Your child may need anti-inflammatory drugs. In severe cases, children with IBD may need to have a liquid diet or surgery.<br></li></ul><h2>Sign and symptoms</h2><p>The main symptoms of IBD are <a href="/Article?contentid=7&language=English">diarrhea</a>, bloating, stomach pain, cramping and weight loss. IBD comes and goes. It can "flare up" and your child will have symptoms. At other times, your child will not have symptoms. This is called remission. Flare-ups and remission will occur at different times for different people. </p><h3>There are two types of IBD: Crohn's disease and ulcerative colitis.</h3><ul><li> <a href="/Article?contentid=923&language=English">Crohn's disease</a> is inflammation in any part of the digestive system from the mouth to the anus. </li><li> <a href="/Article?contentid=924&language=English">Ulcerative colitis </a>is inflammation in the large intestine only. </li></ul><p>Inflammatory bowel disease is not the same as <a href="/Article?contentid=823&language=English">irritable bowel syndrome</a>.</p><h2>Causes<br></h2><p>The cause of IBD is unknown. Family history of this disease and other immune-related factors may increase risk. IBD is not caused by eating certain foods. IBD is not caused by food poisoning. </p> <figure class="asset-c-80"> <span class="asset-image-title">Digestive system</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Digestive_system_MED_ILL_EN.jpg" alt="Salivary and parotid glands, esophagus, stomach, pancreas, small and large intestines, rectum, appendix, gallbladder, liver" /> </figure><h2>What a doctor can do to help your child</h2> <p>Take your child to the doctor if symptoms persist for more than a few days. The doctor will conduct tests of the intestines if IBD is suspected. Your child may have to swallow a white chalky liquid called barium for an X-ray. </p><h2>Treatment</h2> <p>Anti-inflammatory drugs may be prescribed depending on your child's diagnosis. In severe cases of Crohn's disease, your child may have to have a liquid diet or drugs or food may be given intravenously. Most children can live a healthy life by eating a well balanced diet. In severe cases of ulcerative colitis, surgery may be needed to remove the damaged colon. </p> <p>Claims have been made that some diets help control IBD. But none of these diets has been proven to help. If your child is on a special diet or avoids certain foods, speak to their doctor or dietitian. They will help make sure your child is still getting the nutrients they need for good health. Your child's diet will depend on their needs. </p>https://assets.aboutkidshealth.ca/AKHAssets/inflamatory_bowel_disease.jpg
Inflammatory brain diseaseIInflammatory brain diseaseInflammatory brain diseaseEnglishNAChild (0-12 years);Teen (13-18 years)BrainImmune systemConditions and diseasesCaregivers Adult (19+)NA2013-01-11T05:00:00ZSusanne Benseler, MD;Manisha Sickand, MSc;Marinka Twilt, MD12.800000000000029.6000000000000629.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Inflammatory brain disease is a condition that causes the brain and/or spinal cord to become inflamed.</p><h2>What is inflammatory brain disease?</h2><p>Inflammatory brain disease, also referred to as inflammatory disease of the central nervous system (CNS), is a condition where the <a href="https://pie.med.utoronto.ca/htbw/module.html?module=brain-child">brain</a> and/or spinal cord become inflamed. <a href="/Article?contentid=926&language=English">Inflammation</a> in the brain causes irritation and swelling of brain tissue or blood vessels.</p><p>Brain inflammation can occur for a variety of reasons. By definition, all inflammatory brain diseases are due to primary processes in which inflammation occurs without a normal trigger. For example, immune system malfunction leads to unnecessary inflammation and continues with no resolution if not treated. This can lead to brain damage over the long term.</p> <figure class="asset-c-100"> <span class="asset-image-title">Areas of the brain affected by inflammatory brain disease</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_inflammatory_brain_disease_nervous_system_EN.jpg" alt="Brain and spinal cord in a child and close-ups of brain tissue, blood vessels and meninges, and of neuron and myelin sheath" /> </figure> <h3>Examples of primary inflammation in the brain include:</h3><ul><li> <a href="/Article?contentid=914&language=English">CNS vasculitis</a>, a condition marked by inflammation of the brain's blood vessels. CNS vasculitis is the most common inflammatory brain disease in children.</li><li> <a href="/Article?contentid=927&language=English">Antibody-mediated inflammatory brain diseases</a>, conditions in which antibodies attack structures in the brain and lead to inflammation of surrounding brain tissue.</li><li>Demyelinating conditions, such as multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM), are often the result of inflammation in the brain. Demyelination is the destruction of myelin, the protective nerve sheath, resulting in impaired electrical conduction.</li><li>Very rare inflammatory diseases of the CNS, such as Rasmussen's encephalitis and neurosarcoidosis, are caused by particular immune cells functioning abnormally.</li></ul><p>Secondary inflammation occurs second to another disease in the body. For example, inflammation occurs as part of the immune response to infection of the meninges (the membranes that surround the CNS) in <a href="/Article?contentid=761&language=English">meningitis</a>.</p><h2>Key points</h2> <ul> <li> Inflammatory brain disease occurs when the brain and/or spinal cord become inflamed. Inflammation in the brain causes irritation and swelling of brain tissue or blood vessels.</li> <li>Inflammatory brain diseases are due to primary processes in which inflammation occurs without a normal trigger. Secondary inflammation occurs second to another disease in the body.</li> <li>Treatment includes medications to control inflammation, to control symptoms and to control side effects from treatment.</li> </ul><h2>Signs and symptoms of inflammatory brain disease </h2><p>The signs and symptoms of inflammatory brain disease can be quite varied depending on what part of the brain is affected. When inflammation occurs at a distinct location in the brain, it results in focal deficits such as:</p><ul><li>stroke: sudden onset of muscle weakness, <a href="/Article?contentid=29&language=English">headache</a>, dizziness or lack of coordination</li><li>parathesia: the loss of normal sensation</li><li>vision loss</li><li>speech impairment</li></ul><p>When inflammation occurs over a widespread area in the brain, it results in diffuse deficits such as: </p><ul><li>memory loss </li><li>decreased alertness</li><li>changes in concentration and behavior</li></ul><p>Inflammation in the brain can also present with psychiatric symptoms such as:</p><ul><li>hallucinations</li><li>distortions in thought</li><li>confusion<br></li><li>mood swings</li></ul><p> <a href="/article?contentid=2104&language=English">Seizures</a> and headaches are also quite common depending on the extent and location of brain inflammation. </p><h2>How a doctor can help?</h2><p>A physician will conduct various tests to help figure out what is causing your child's new symptoms. This might involve blood tests, a <a href="/article?contentid=1336&language=English">spinal tap</a>, an <a href="/Article?contentid=1277&language=English">electroencephalogram (EEG)</a> and different imaging procedures.<br></p><h2>Treatment for inflammatory brain disease?</h2> <p>Treatment will vary depending your child's symptoms and the underlying cause of brain inflammation. The following are different types of therapies your child may be prescribed: </p> <ul> <li>Inflammatory control: Therapies that control inflammation are usually first in line to prevent inflammation-induced organ destruction. Examples include immunosuppressants such as <a href="/Article?contentid=1201&language=English">Prednisone</a>, IVIG, and plasmapheresis. </li> <li>Symptom control: Some medications are prescribed to control your child's symptoms. These medications include anti-seizure agents like Keppra or anti-clotting agents like <a href="/Article?contentid=77&language=English">acetylsalicylic acid (ASA)</a>. </li> <li>Side-effect control: Many treatments that attempt to control the immune system also come with some unfortunate side effects. As a result, medications may also be prescribed to promote bone health such as <a href="/Article?contentid=1970&language=English">Vitamin D and calcium</a>, or to prevent infection by using antibiotics.</li> </ul>https://assets.aboutkidshealth.ca/akhassets/IMD_inflammatory_brain_disease_nervous_system_EN.jpg
Influenza (flu): An overviewIInfluenza (flu): An overviewInfluenza (flu): An overviewEnglishInfectious DiseasesChild (0-12 years);Teen (13-18 years)BodyImmune systemConditions and diseasesCaregivers Adult (19+)Cough;Fever;Headache;Sore throat2019-12-04T05:00:00ZLaurie Streitenberger, RN, BSc, CIC;Anne Matlow, MD, FRCPC; Shaun Morris, MD, MPH, FRCPC, FAAP, DTM&H​​7.1000000000000070.10000000000001335.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Although the flu is very common, it can be dangerous for some people including young children, the elderly, and those with compromised immune systems or other underlying diseases. Learn more about the flu and how to protect against it.</p><h2>What is influenza?</h2><p>Influenza (flu) is a lung infection caused by specific influenza viruses. People can get the flu at any time of year, but it is more common in the fall and winter. <br></p><h2>Key points</h2><ul><li>Influenza (flu) is not the same as the common cold. </li><li>Flu is caused by the influenza virus. </li><li>Most people who get the flu do not get seriously ill and will have symptoms for two to seven days. </li><li>You can reduce your risk of getting the flu by getting a flu shot each year and washing your hands frequently. </li><li>If your child has the flu they should stay home and rest. If they do not start to feel better after a few days or if symptoms get worse, call your child’s primary care provider. </li></ul><h2>Common symptoms of the flu</h2><p>People who get the flu usually have some or all of the following symptoms:</p><ul><li> <a href="/article?contentid=30&language=english">fever</a></li><li>muscle aches</li><li> <a href="/article?contentid=29&language=english">headache</a></li><li> <a href="/article?contentid=748&language=english">sore throat</a></li><li> <a href="/article?contentid=774&language=english">cough</a></li><li>fatigue and weakness</li></ul><p>Most of these symptoms usually last for two to seven days. Rare but serious complications of the flu include bacterial pneumonia and influenza infection of the brain. </p><h2>The flu can be serious for some people</h2><p>Most people who have the flu will not become seriously ill. But the flu can be more serious for some people. Typically, those most at risk are in one of the following groups:</p><ul><li>Children under two years of age</li><li>People 65 years of age or older</li><li>People living in long-term care facilities such as a nursing home, a home for the aged or a chronic care hospital </li><li>People with chronic heart, lung or kidney disease</li><li>People with diabetes, cancer, immune system problems or sickle cell anaemia</li><li>Children and teenagers aged six months to 18 years who have been treated with <a href="/article?contentid=77&language=english">acetylsalicylic acid (ASA)</a> for long periods </li><li>People who have trouble clearing mucus from their nose and throat because of weakness or underlying illness</li></ul><p>These groups, and anyone who lives or works with people from these groups, should generally be immunized each year with the flu vaccine (flu shot). That way, people from these high-risk groups are less likely to be infected with the flu. </p><h2>Treating the flu</h2><p>If you or your child have the flu, stay home and rest. Usually, treatment is focused on the symptoms the person is feeling. For example, if your child has a fever, you can give them acetaminophen or ibuprofen to reduce fever. </p><p>Do not give <a href="/article?contentid=77&language=english">acetylsalicylic acid (ASA)</a> to a child under 16 years of age. Do not give cough medicines to children under six years of age. Always read the label before giving any medicine.</p><p>In addition to fluids and pain medicine, other ways to treat flu symptoms include:</p><ul><li>applying heat on painful areas for short periods of time using a hot water bottle or heating pad to reduce muscle pain</li><li>taking a warm bath</li><li>gargling with a glass of warm water</li><li>using saline drops or spray and suction to clear a stuffy nose</li><li>keeping your home smoke free</li></ul><p>Call your child’s primary care provider if the above measures do not relieve your child's flu symptoms and your child feels worse or if you are worried.</p><h2>If your child has the flu in the hospital </h2><p>Your child will be placed in a single room and will not be able to visit the playroom until they are feeling better. Ask the child life specialist to bring toys and supplies to your child’s room.</p><p>Hospital staff will be wearing a mask, eye protection, gloves and gowns when they visit.</p><p>Wash your hands often, either with alcohol-based hand rubs or soap and water, before and after touching your child and before leaving your child's room. Hospital staff should wash their hands as well.</p><p>If you or anyone else who has visited becomes ill with symptoms of the flu, let your child's doctor or nurse know. </p><h2>When to seek medical attention</h2><p>Go see a doctor or to hospital if your baby is less than three months old and:</p><ul><li>has a fever</li><li>has fast or difficult breathing</li><li>is vomiting or not feeding</li></ul><p>Go see a doctor if your child:</p><ul><li>is more sleepy than usual</li><li>is more fussy than usual</li><li>is not drinking enough fluids or has not peed at least every six hours when awake</li><li>is vomiting</li><li>is having chest or stomach pain</li><li>is not feeling better after five days or gets better but then suddenly gets worse</li></ul><p>Call 911 or go to the nearest emergency department immediately if your child:</p><ul><li>is breathing quickly, or seems to be working hard to breathe</li><li>is very weak, dizzy, hard to wake up or does not respond well</li><li>is very fussy or cannot be comforted</li><li>is limping or refusing to walk</li><li>has bluish or dark-coloured lips or skin</li><li>has a stiff neck, severe headache or a seizure</li><li>has a very fast heart rate, even when the fever is down</li></ul><p>If you have any concerns, call your doctor or your local public health agency. In Ontario, you can also call TeleHealth Ontario at 1-866-797-0000.</p><p>If you or your child is in a high-risk group, call your doctor right away when you get flu symptoms. There are specific anti-viral medicines available to help treat flu. These medicines must be started early in the illness to be effective. Contact your child's doctor for more information. </p>https://assets.aboutkidshealth.ca/AKHAssets/influenza_overview.jpg
Informed choice and informed consentIInformed choice and informed consentInformed choice and informed consentEnglishPregnancyAdult (19+)BodyReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00ZChristine Newman, MD, FRCPCNicolette Caccia, MEd, MD, FRCSCZan Manning, RN, JD, MA10.100000000000057.10000000000001251.00000000000Flat ContentHealth A-Z<p>Learn about informed choice and informed consent, as they pertain to pregnancy. The mother's rights and responsibilities are discussed.</p><p>If you are pregnant, you have a responsibility to yourself and your unborn baby to make informed decisions about your pregnancy, childbirth, and the time after birth. The decisions you make influence the type of care you receive. Informed choice leaves you, not your caregiver, as the primary decision maker, in contrast to the traditional medical model of informed consent that leaves the choice of possible treatment in the hands of the health-care providers. </p><h2>Key points</h2> <ul><li>Informed choice is when a person is given options to choose from several diagnostic tests or treatments, knowing the details, benefits, risks and expected outcome of each.</li> <li>Informed consent is when a person agrees to the test or treatment they have been offered, knowing the details, benefits, risks and expected outcome.</li> <li>Your caregiver has the right to agree or disagree to provide the care that you request.</li> <li>In the case of an emergency when there is no time to obtain informed consent, a doctor can decide whether to go ahead without consent.</li></ul>
Informed consentIInformed consentInformed consentEnglishNeonatologyPremature;Newborn (0-28 days);Baby (1-12 months)NANANAPrenatal Adult (19+)NA2009-10-31T04:00:00ZJonathan Hellmann, MBBCh, MHSc, FCP(SA), FRCPC10.700000000000049.7000000000000712.000000000000Flat ContentHealth A-Z<p>Read about informed choice, which is the option a person has to allow or not allow a procedure to happen once the procedure has been completely explained.</p><p>Informed choice is the option a person has to allow or not allow a procedure to happen once the procedure has been completely explained. In most cases except in emergencies, informed choice and informed consent will be obtained from parents or caregivers before treatment begins.</p><h2>Key points</h2> <ul><li>Informed choice is the option a person has to allow or not allow a test or procedure to happen after they have been informed of the benefits and risks of the options involved.</li> <li>Informed consent is when a person voluntarily agrees to a procedure after they know what the benefits and risks are.</li> <li>If treatment cannot wait for informed consent, the doctor can decide whether to go ahead without consent. This may vary depending on the hospital.</li></ul>
Informed consent for brain tumoursIInformed consent for brain tumoursInformed consent for brain tumoursEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemNAAdult (19+)NA2009-07-10T04:00:00ZEric Bouffet, MD, FRCPCUte Bartels, MD10.900000000000051.8000000000000938.000000000000Flat ContentHealth A-Z<p>An in-depth discussion of the issue of informed consent for children who are undergoing medical procedures.</p><p>Informed choice is the option a person has to allow or not allow something to happen, like diagnostic procedures or treatment, after they have been informed of the benefits and risks of the options involved. If the person agrees, they give informed consent. </p><h2>Key points</h2> <ul><li>Informed choice is the option to allow or not allow something to happen after being informed of all the benefits and risks of all options involved.</li> <li>Agreeing to a specific procedure or treatment is giving informed consent.</li> <li>A parent or guardian usually gives informed consent, unless it is an emergency and the guardian cannot be contacted.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/informed_consent_for_brain_tumours.jpg
Informed consent for treatment and researchIInformed consent for treatment and researchInformed consent for treatment and researchEnglishNAChild (0-12 years);Teen (13-18 years)NANANon-drug treatmentCaregivers Adult (19+)NA2009-12-04T05:00:00ZChristine Harrison, MA, PhD10.300000000000055.3000000000000969.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn about informed consent, or the option a person has to allow or not allow something like treatment, after she has been informed of the situation.</p><h2>What is informed choice or informed consent?</h2><p>Informed choice is the option a person has to allow or not allow something to happen, like treatment, after they have been informed of the benefits and risks of the options involved. If the person agrees, they give informed consent.</p> <br><h2>Key points</h2> <ul> <li>Informed choice is the option a person has to allow or not allow something to happen, after they have been informed of the benefits and risks of the options. If the person agrees, they give informed consent. </li> <li>Different provinces have different rules about who gives informed consent.</li> <li>In Ontario, children who are fully capable of understanding their care have the right to make decisions about their treatment. Children who are partly capable of understanding decisions about their care have the right to participate in those decisions.</li> <li>You have the right to ask questions and express your concerns about treatment.</li> </ul><h2>What is assent?</h2> <p>Children who are partially able to understand treatment or research issues have a right to participate in decisions about their care or participation in research. After having the treatment or research explained in a way they can understand, they will be asked for their assent, or agreement, which can involve signing an assent form. </p> <p>If a child refuses to assent to treatment, and the doctor and guardian believe treatment is necessary, treatment will usually be provided. If a child refuses to assent to participate in research, they should not be included in the research. </p> <h2>What does informed consent to undergo treatment such as surgery involve?</h2> <p>Consent before surgery or other treatment is an example of the informed consent process. Before your child is scheduled for a procedure or surgery, you, as the parent or guardian, need to decide whether or not the doctor can go ahead, unless your child is capable of deciding themselves. The doctor will discuss with you the risks involved with the surgery, treatment or procedure under anaesthetic before you sign a consent form. The doctor is required to tell you about any potential problems that could occur and to ensure that you understand the general nature of the procedure. They should also explain why they think the surgery is required, and the problems that might occur if the surgery does not go ahead.</p> <p>This discussion provides an opportunity to ask any questions you may have about the procedure or express any concerns you have. Brace yourself to hear about the potential negative outcomes. This is usually very difficult to hear, but you should try to stop yourself from thinking the worst. </p> <p>In the case of surgery and some other procedures, by signing the form you will also be consenting to the use of anaesthetic if necessary. At some hospitals, you may be asked to give a separate consent for the use of anaesthetic. Usually you are also agreeing to any additional investigation or treatment that the doctor may decide is immediately necessary during the surgery. This would only happen if the doctor finds something they were not expecting to find, and needs to do something about it right away. The consent forms will be kept in your child's medical record. </p> <h2>What does informed consent to take part in research or a clinical trial involve?</h2> <p>A clinical trial is a type of research study that involves treatment. In Ontario, a child that is able to understand fully or partially may decide whether or not to take part in a research study or a clinical trial. The health care team member must make certain you and your child have a full understanding of the purpose of study, the results expected, how the study works, any risks or benefits, and in the case of a clinical trial, the other treatments available. You may ask questions about the study and receive information about the results when the study is finished. </p> <p>After explaining this, they will ask you or your child to make a decision about taking part in the study. To give consent to take part, you or your child will sign a document called a consent form describing the research and the risks and benefits to your child. </p> <p>If you decide not to take part in a research study or clinical trial, your child will continue to receive the same quality of care from your child's health care team and the hospital. If you do decide to take part in the study or trial, signing a consent form is not a contract. You can change your mind and withdraw at any time. </p> <p>For more information, please read <a href="/Article?contentid=1264&language=English">Clinical trials and your child</a>.</p>https://assets.aboutkidshealth.ca/AKHAssets/consent_giving_informed_consent.jpg
Ingrown toenailIIngrown toenailIngrown toenailEnglishDermatologyChild (0-12 years);Teen (13-18 years)SkinSkinConditions and diseasesCaregivers Adult (19+)NA2016-07-07T04:00:00ZCarmen Liy Wong, MD;Irene Lara-Corrales, MSc, MD7.5000000000000068.30000000000001082.00000000000Health (A-Z) - ConditionsHealth A-Z<p>An ingrown toenail occurs when a side of the nail grows into the surrounding skin. Learn what causes this condition and how it can be treated.</p><h2>What is an ingrown toenail?</h2><p>An ingrown toenail occurs when a side of the nail grows into the surrounding skin instead of straight outward. Since the nail cuts into the skin, it is common for the area to become infected or inflamed.</p><p>Ingrown toenails cause a lot of discomfort and can be very painful. They are a common problem, especially in teenagers and young adults.</p> <figure class="asset-c-80"> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_ingrown_toenail_EN.png" alt="Illustration of a healthy toenail and an ingrown toenail" /> </figure><h2>Key points</h2> <ul> <li>An ingrown toenail occurs when the toenail grows into the surrounding skin, causing pain and discomfort.</li> <li>The causes of ingrown toenails include tight footwear, poorly trimmed nails and repeated bumps to the toes.</li> <li>The early signs and symptoms of an ingrown toenail include redness and tenderness as well as pain.</li> <li>Early on, an ingrown toenail can be treated by improving footwear, trimming nails straight across and applying an antiseptic cream, if needed.</li> <li>Later signs of ingrown toenail include pus, a bad smell or a fever. If your child has these signs and symptoms, they should see a doctor because they may need antibiotics.</li> </ul><h2>How does an ingrown toenail affect the body?</h2><p>An ingrown toenail is most likely to occur on the big toe, but any toe can be affected.</p><p>At first, the skin around the ingrowing nail may become red and feel slightly tender. Small openings in the skin can then allow bacteria to enter, which can cause the area to become infected.<br></p><p>If an infection occurs, the skin may become more swollen, red and painful. Some yellow or green pus (fluid) may start oozing from around the nail. The area may also produce a bad smell. Over time, the skin around the nail can overgrow, causing more pain.</p><p>If left untreated, an ingrown toenail can lead to <a href="/article?contentid=801&language=English">cellulitis</a>, a type of skin infection. In extremely rare cases, it can lead to <a href="/article?contentid=2311&language=English">osteomyelitis</a>, an infection of the bone.</p><h2>What causes an ingrown toenail?</h2><p>An ingrown toenail can have a number of causes, including:</p><ul><li>poorly-fitting shoes</li><li>inadequate trimming of the nails</li><li>tearing or picking at the nail</li><li>repeated pressure or impact on the nail</li><li>unusual feet, toes or nails.</li></ul><h3>Shoes</h3><p>Shoes that are too narrow or those that put pressure over the nails are more likely to cause ingrown toenails.</p><h3>Nail trimming</h3><p>Trimming the nails too much or rounding the edges instead of cutting right across can lead to ingrown toenails.</p> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_toenail_trimming_EN.png" alt="Illustration of correct toenail trimming and incorrect toenail trimming" /> </figure> <h3>Picking at nails</h3><p>Ingrown toenails are more likely in children who pick at their toenails.</p><h3>Pressure or impact on the nail</h3><p>An ingrown toenail is more likely to occur following a bump or other injury to the toe. For example, active, sporty people may be more likely to develop ingrown toenails because their feet might be more prone to pressure and injury. The increased sweating that results from physical activity also makes it easier for bacteria to thrive and cause an infection.</p><h3>Unusual feet, toes or nails</h3><p>Sometimes deformities of the foot or toes can place extra pressure on the nails. In addition, some people are born with curved nails that grow downward. Others have toenails that are too big for their toes. Some of these conditions may improve on their own over time.</p><h2>How is an ingrown toenail diagnosed?</h2> <p>A doctor can diagnose an ingrown toenail by examining your child and asking questions about how they feel when they walk.</p> <p>Inspect your child’s feet often to look for any signs of an ingrown toenail. One early sign is redness and swelling of the skin near the edge of the nail. If the ingrown nail is infected, your child may develop a fluid-filled blister. Your child may also complain that their foot hurts or may limp or wince when they walk.</p><h2>How is an ingrown toenail treated?</h2> <figure> <span class="asset-image-title">Ingrown toenail: Early treatment with tape</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_ingrown_toenail_tape_treatmetreatment.png" alt="Attaching tape to skin beside toenail, pulling to move skin away from toenail, then wrapping tape around to attach the ends" /><figcaption class="asset-image-caption">1) Attach one end of a piece of tape to the skin beside the ingrown toenail. 2) Move skin out of the way by gently pulling the tape was you start to wrap it around the toe. 3) Stick the two ends of the tape together at the front of the toe, near the cuticle.</figcaption> </figure> <p>Several options are available to treat an ingrown toenail.</p><p>The early signs can be resolved by:</p><ul><li>wearing wider or open-toed footwear</li><li>trimming nails properly</li><li>finding ways to allow the nail to grow out of the skin, for example by using tape to pull the skin beside the nail out of the way.</li></ul><p>Other treatments for ingrown toenails include soaking the foot in a mix of lukewarm water and mild soap before applying an antiseptic or topical antibiotic. During the day, while your child is wearing shoes, the toenail would be covered with a bandage. At night, the bandage would be removed to allow the toenail to "air out" in bed.</p><p>If an infection develops, your child will need to take antibiotics to treat it and prevent complications. In rare cases, your child might need surgery to resolve the problem.</p><div class="akh-series"><div class="row"><div class="col-md-12"> <figure> <span class="asset-image-title">Ingrown toenail surgery</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_ingrown_toenail_surgery_EN.png" alt="Illustration of incision line over an ingrown toenail and of toenail with ingrown nail section removed" /> </figure> <h3>How to treat repeated episodes of ingrown toenail</h3> <p>If your child experiences ingrown toenail repeatedly, they may need surgery (an operation) to remove part of their nail. This involves a number of steps.</p><ol><li>Your child is injected with a local anaesthetic into the base of their toe to numb it.</li><li>A surgeon cuts their toenail the long way (towards the cuticle), just a few millimetres from the problem edge.</li><li>If the nail bed has been exposed a number of times, the surgeon may apply some medication to help stop the edge of the nail from re-growing and causing another ingrown toenail.<br></li><li>The surgeon dresses the nail with a bandage.<br></li></ol><p>The surgeon will tell you how to care for the area around the nail as it heals.</p></div></div></div><h2>When to see a doctor for ingrown toenail</h2> <p>See your child’s doctor if:</p> <ul> <li>you have checked your child and noticed early signs of an ingrown toenail but would like a clear diagnosis</li> <li>your child’s symptoms continue after you have treated the early signs of an ingrown toenail</li> <li>your child complains of pain across the toe</li> <li>your child shows signs of infection beside the nail, such as redness, pus or a bad smell</li> <li>your child has a fever</li> </ul><h2>Further information</h2><p>For more information about ingrown toenails, visit <a href="https://www.foothealthfacts.org/" target="_blank">Foot Health Facts</a>, from the American College of Foot and Ankle Surgeons, or the <a href="https://cop.org.uk/foot-health/common-foot-problems/ingrowing-toenail/" target="_blank">website of the UK College of Podiatry</a>.​</p>https://assets.aboutkidshealth.ca/akhassets/IMD_ingrown_toenail_surgery_EN.png
Insect bitesIInsect bitesInsect bitesEnglishDermatologyChild (0-12 years);Teen (13-18 years)SkinSkinConditions and diseasesCaregivers Adult (19+)NA2014-05-30T04:00:00Z​Shawna Silver, MD, FRCPC, FAAP, PEng7.9000000000000061.0000000000000797.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Discover how to recognize, treat and prevent insect bites and bee stings, and when to seek medical attention. </p> <p>Insect bites and stings occur when an insect feeds off a person's skin or tries to defend itself.</p><p>Different insects bite and sting in different ways. Common biting or stinging insects include mosquitoes, blackflies, bed bugs, fleas, ticks, fire ants, bees and wasps. Bees often leave stingers in the wound.</p><p>Insect bites usually cause mild swelling, redness and itchiness limited to the small area around the bite or sting. Some children, however, can experience potentially life-threatening reactions. This is called an anaphylactic reaction and requires immediate medical attention. In children who are at risk, <a href="/Article?contentid=781&language=English">anaphylaxis</a> is most commonly caused by bees, wasps and hornets. Other insects can transmit disease. For example, some mosquitoes can transmit malaria or West Nile virus and some ticks can transmit <a href="/Article?contentid=909&language=English">Lyme disease</a>.</p><h2>Key points</h2> <ul> <li>Insect bites often cause swelling and redness. Some children experience severe and potentially life-threatening reactions.</li> <li>Common biting or stinging insects include mosquitoes, blackflies, bees and wasps.</li> <li>Some children respond well to antihistamine medication; others may just need some ice.</li> <li>Prevent insect bites and stings by covering the body with light-coloured clothing and applying insect repellent to exposed skin.</li> <li>DEET is a very effective insect repellent, but use it carefully according to your child's age. If using sunscreen and insect repellent, apply sunscreen first.</li> </ul><h2>Signs and symptoms of an insect bite or sting</h2><p>Signs and symptoms of insect bites and stings vary according to the type of insect and your child's reaction.</p><p>Normally, an insect bite or sting causes:</p><ul><li>a small, red, raised bump, pimple or blisters</li><li>itchiness and irritation around the bump.</li></ul><p>The symptoms can last from a few hours up to two days.<br></p><p>Some children develop a big firm swollen area around the bite. This is not an allergic reaction. It is known as a large local reaction and rarely leads to a skin infection.</p><p>If your child has an anaphylactic reaction, they may develop <a href="/article?contentid=789&language=English">hives</a>, facial or mouth swelling, or breathing problems or they may collapse. Use an epinephrine auto-injector, if your child has one, and call for emergency assistance.</p><h2>How to treat insect bites and stings</h2> <ul> <li>Cold, damp compresses or ice can relieve some of the swelling.</li> <li>Over-the counter topical medications (medications you put on the skin) may also help to relieve the itch.</li> </ul> <p>Some children may respond well to antihistamine medication for itching, but this medication can cause drowsiness.</p><h2>When to see a doctor after an insect bite or sting</h2> <p>If your child has been bitten or stung, see a doctor right away if:</p> <ul> <li>you are in an area where the insects are known to transmit diseases</li> <li>your child develops an unusual rash, a <a href="/Article?contentid=30&language=English">fever</a> or other symptoms.</li> </ul>insectbiteshttps://assets.aboutkidshealth.ca/AKHAssets/insect_bites.jpg
Insulin dose adjustment on a multiple daily routineIInsulin dose adjustment on a multiple daily routineInsulin dose adjustment on a multiple daily routineEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemDrug treatmentAdult (19+)NA2016-10-17T04:00:00ZCatherine Pastor, RN, MN, HonBSc;Vanita Pais, RD, CDE;Jennifer Harrington​, MBBS, PhD​11.300000000000051.0000000000000858.000000000000Flat ContentHealth A-Z<p>Find out how to adjust insulin doses at home using the sliding scale when your child is on a multiple daily injections (MDI) routine</p><p>The following guidelines will help you adjust <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=1728&language=English">insulin</a> dosages at home. With practice and experience, this will soon become second nature. If you have any questions, or if adjusting the insulin dosage does not seem to help achieve <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=1724&language=English">target blood glucose (sugar) levels</a>, contact your primary diabetes care team.</p><h2>Key points</h2><ul><li>An MDI regimen allows for insulin changes based on the sliding scale, which adjusts the dose of rapid-acting insulin before meals and snacks based on blood sugar levels.</li></ul>https://assets.aboutkidshealth.ca/akhassets/IMN_blood_glucose_target_range_EN.png
Insulin in diabetes managementIInsulin in diabetes managementInsulin in diabetes managementEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemDrug treatmentAdult (19+)NA2016-10-17T04:00:00ZCatherine Pastor, RN, MN, HonBSc;Vanita Pais, RD, CDE;Jennifer Harrington​, MBBS, PhD​8.2000000000000064.2000000000000650.000000000000Flat ContentHealth A-Z<p>Insulin allows sugar to be stored as energy. Learn what role insulin plays in diabetes management.</p><p>Our bodies require insulin to allow cells to have energy and to allow extra sugar to be stored as energy. This section will cover the important role insulin plays in diabetes management.</p><h2>Key points</h2> <ul><li>Insulin is a hormone produced by the beta cells of the pancreas that allows cells to use sugar for energy and allows the extra sugar to be stored as energy for future use.</li> <li>Without enough insulin, sugar cannot be taken up and used by most of the body cells.</li> <li>Patients with diabetes must administer their own insulin.</li><ul></ul></ul>
Insulin injection management during illnessIInsulin injection management during illnessInsulin injection management during illnessEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemHealthy living and preventionAdult (19+)NA2016-10-17T04:00:00ZCatherine Pastor RN, MN, HonBSc;Vanita Pais RD, CDE;​​Sanjukta Basak MSc, MD CM, FRCPC;​​Ruth Slater Ph.D., C. Psych​7.9000000000000062.5000000000000654.000000000000Flat ContentHealth A-Z<p>Find out how to manage insulin injections while your child is sick.</p><p>​When children are sick, they still need their long-acting insulin at their usual times. In fact, they may need extra injections of <a href="/Article?contentid=1729&language=English">rapid-acting insulin</a> as often as every four hours if they have <a href="/Article?contentid=1723&language=English">high blood glucose (sugar) levels</a> or if <a href="/Article?contentid=1727&language=English">ketones</a> show up in their urine.</p><h2>Key points</h2><ul><li>To decide how much insulin to give, check blood sugar and urinary ketone levels every four hours.</li><li>To determine the total daily dose (TDD) of insulin, you must add all amounts of insulin from the past 24 hours including both long/intermediate and rapid-acting insulin.<br></li></ul>
Insulin injectionsIInsulin injectionsInsulin injectionsEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemDrug treatmentAdult (19+)NA2016-10-17T04:00:00ZCatherine Pastor, RN, MN, HonBSc;Vanita Pais, RD, CDE;Jennifer Harrington​, MBBS, PhD​8.5000000000000059.20000000000001452.00000000000Flat ContentHealth A-Z<p>Giving insulin injections can be stressful. Find out how to safely prepare and inject insulin into your child.<br></p><p></p><p>​Injecting a child with <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=1728&language=English">insulin​</a> is probably one of the biggest challenges parents face. Many are nervous about needles, so it can be hard to think of giving one to their own child. Some children are also frightened of needles, which makes the adjustment difficult. With practice, however, children and parents quickly grow comfortable with administering insulin. And increasingly, children prefer to receive their insulin using pre-loaded injectable pens.<br></p><h2>Key points</h2><ul><li>Insulin is injected using a syringe, available in various sizes.</li><li>Some children require single-type insulin, while most will require two different types in one injection.</li><li>Carefully follow the instructions on how to inject insulin.<br></li></ul>https://assets.aboutkidshealth.ca/akhassets/IMD_syringe_insulin_EN.png
Insulin pumpsIInsulin pumpsInsulin pumpsEnglishEndocrinologyChild (0-12 years);Teen (13-18 years)PancreasEndocrine systemDrug treatmentAdult (19+)NA2016-10-17T04:00:00ZCatherine Pastor, RN, MN, HonBSc;Vanita Pais, RD, CDE;Jennifer Harrington​, MBBS, PhD​8.6000000000000059.80000000000001714.00000000000Flat ContentHealth A-Z<p>Learn how insulin pumps work, if they're right for your child and what the potential concerns are.</p><p> <a href="/Article?contentid=1728&language=English">Insulin​</a> pumps continuously deliver insulin. Their formal name is continuous subcutaneous insulin infusion pump. The pump is about the size of a phone pager, and is worn on the belt or kept in a pocket. An insulin pump allows your child to get as much insulin as needed without having to get a new needle each time.<br></p><h2>Key points</h2><ul><li>Insulin pumps continuously deliver insulin, allowing your child to get as much as needed without having to get a new needle each time.</li><li>Users can change the amount of insulin released based on their needs.</li><li>Insulin pumps have several advantages and disadvantages that will need to be considered.</li><li>Always carry back up supplies in case there is a problem with the insulin pump.<br></li></ul>https://assets.aboutkidshealth.ca/akhassets/IMD_insulin_pump_EN.jpg
Intellectual development and children with heart diseaseIIntellectual development and children with heart diseaseIntellectual development and children with heart diseaseEnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2009-12-14T05:00:00ZRoss Hetherington, PhD, C.Psych13.700000000000028.7000000000000427.000000000000Flat ContentHealth A-Z<p>Read about how the development of a child's intellect may be affected by a congenital heart condition.</p><p> This page explains how severe heart conditions may affect a child's mental development.</p><h2> Key points </h2> <ul><li> The majority of children with mild congenital heart defects will not experience negative effects on their intellectual development.</li> <li>Some aspects of the condition may influence the child's mental development and affect their attention, language development, or executive function memory. </li> <li>Most children with CHD have similar psychological and emotional development to children without CHD.</li> <li>Psychological or emotional problems surface more often during adolescence. </li></ul>https://assets.aboutkidshealth.ca/AKHAssets/intellect_of_children_with_heart_disease.jpg
Interrupted aortic archIInterrupted aortic archInterrupted aortic archEnglishCardiologyChild (0-12 years)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2009-12-04T05:00:00ZFraser Golding, MD, FRCPC10.200000000000049.0000000000000366.000000000000Flat ContentHealth A-Z<p>Learn about interrupted aortic arch in children. This is a defect of the aorta not developing properly, and causes congestive heart failure.</p><p>Interrupted aortic arch is a defect that results when the aorta does not develop properly. With this condition, oxygen-rich blood from the left side of the heart cannot reach all areas of the body because of the defective aorta. The heart manages to get enough blood to the body by way of the ductus arteriosus, which has stayed open after birth. It usually occurs with a large atrial or ventricular septal defect. </p><h2> Key points </h2><ul><li> A child with an interrupted aortic arch will have symptoms as the ductus arteriosus begins to close.</li><li>An interrupted aortic arch will be treated with drugs and open heart surgery during the first few days of life.</li> <li>Complete repair of the defect results in a very high survival rate.</li></ul>
InterventionIInterventionInterventionEnglishDevelopmentalPremature;Newborn (0-28 days);Baby (1-12 months);Toddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years)NANANAPrenatal Adult (19+)NA2009-10-31T04:00:00ZAndrew James, MBChB, FRACP, FRCPCHilary Whyte, MSc, MB, BCh, BAO, MRCPI, FRCPC14.300000000000032.5000000000000442.000000000000Flat ContentHealth A-Z<p>Read about how, if there is a concerted effort on the part of parents, educators, and others, a positive change will be made in a premature baby's life.</p><p>For most premature babies, going home is a happy milestone. For some, going home is the beginning of more treatments, specifically, therapies designed to minimize the impacts of disability. While physical disabilities are generally known before a baby leaves the NICU, intellectual and developmental disabilities may not become apparent until months or years after discharge.</p><h2>Key points</h2> <ul><li>Parents should be vigilant about watching their child's development as early identification and intervention are keys to minimizing a disability.</li> <li>Developmental problems can affect body movement and coordination, vision, hearing, understanding, behaviour, learning and emotions.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/intervention_premature_babies.jpg
Interventional RadiologyIInterventional RadiologyInterventional RadiologyEnglishOtherChild (0-12 years);Teen (13-18 years)NANANAAdult (19+) CaregiversNALanding PageLearning Hub<p>Interventional radiology uses image guidance to perform minimally invasive procedures such as biopsies, bone ablation and myelogram. They also insert G and GJ tubes, and central venous access devices.</p><p>Interventional radiology uses image guidance to perform minimally invasive procedures such as biopsies, bone ablation, myelogram and treatment of vascular anomalies. They also insert G and GJ tubes, and central venous access devices.</p>igthttps://assets.aboutkidshealth.ca/AKHAssets/interventional_radiology_learning_hub.jpg
Intestinal parasitesIIntestinal parasitesIntestinal parasitesEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)Stomach;Small Intestine;Large Intestine/Colon;RectumStomach;Small intestine;Large intestine;Rectum;AnusConditions and diseasesCaregivers Adult (19+)NA2010-05-07T04:00:00ZMark Feldman, MD, FRCPC8.0000000000000058.80000000000001254.00000000000Health (A-Z) - ConditionsHealth A-Z<p>An overview of the causes, symptoms and treatments of the protozoa (such as giardiasis) or worms (such as pinworms or tapeworms) that can get into your child's body.</p><h2>What is a parasite?</h2><p>A parasite is an organism, or small animal, that lives in or on and takes its nourishment from another organism. A parasite cannot live by itself. Parasites include fleas, <a href="https://akhpub.aboutkidshealth.ca/article?contentid=795&language=English">lice</a> and worms. Parasitic diseases include infections by protozoa (single-cell organisms such as malaria), helminthes (worms) and arthropods (such as <a href="/Article?contentid=797&language=English">scabies</a>).</p><h2>Key points</h2> <ul><li>An intestinal parasite will live in the intestine or other parts of the body and often reproduce. </li> <li>Poor sanitation and unsafe water increase the risk of catching intestinal parasites. </li> <li>For children who do get sick, symptoms may include watery diarrhea, tiredness, and nausea. </li> <li>Treatment may include oral medication. </li> <li>The best defence against parasites is good hygiene.</li></ul><h2>Giardiasis</h2><p>Giardiasis is a waterborne disease. Your child can catch the infection if they drink from a contaminated water source. Children are more likely to catch giardiasis in areas with inadequate water and sanitation facilities or places where many people are in close contact, such as child care centres.</p><p>Giardiasis is also known as beaver fever because it may be acquired from drinking untreated lake water. </p><h3>Signs and symptoms of giardiasis</h3><p>While some children may never develop signs or symptoms, they can still carry the parasite and spread it through their stool.</p><h3>For children who do get sick, symptoms may include:</h3><ul><li>watery <a href="/Article?contentid=7&language=English">diarrhea</a></li><li>soft, greasy stools </li><li>tiredness </li><li>stomach cramps</li><li>bloating</li><li>nausea</li><li>severe weight loss</li></ul><p>Blood and mucus in stool does not occur in giardiasis. Symptoms usually show about two weeks after infection. With treatment, the symptoms can improve in six weeks. Most children will never require treatment.</p><h3>Causes of giardiasis</h3><p>Its parasites can be found in rivers, streams, and lakes or municipal water supplies, swimming pools and spas. The infection can also be passed on through infected food or person-to-person contact. The parasites can also be found in animal feces.</p><h3>Potential complications of giardiasis</h3><p>Severe <a href="/Article?contentid=7&language=English">diarrhea</a>, which is quite rare, can lead to <a href="/Article?contentid=776&language=English">dehydration</a>.</p><h3>How giardiasis is diagnosed</h3><p>To find out if your child has giardiasis, your doctor will likely test your child's stool. Your child may have to repeat this test over a few days to ensure accuracy. </p><h3>Treating giardiasis</h3><p>There are some medicines used to treat the parasite. Your child's doctor will determine which treatments best suit your child's needs. </p><h2>Pinworm</h2><p>Pinworms are tiny, white, thread-like worms that live in the rectum. At night, the worm crawls out of the anus and lays eggs in nearby skin. This can cause a terrible itch. Pinworm can be unpleasant but it does not cause disease.</p><p>Pinworm eggs are very persistent. Pinworm eggs can live for up to two weeks outside the body, on clothing, bedding or other objects. </p><h3>Signs and symptoms of pinworm</h3><p>In general, children with pinworm do not usually have symptoms. They may get very itchy around the anus, especially at night. They may lose sleep. They may also be cranky from the irritation. </p><p>You may or may not see the adult worm around your child's anus, in underwear or diapers, or in the toilet after going to the bathroom.</p><h3>Causes of pinworm</h3><p>Pinworm can spread easily between children. When a child scratches an infected area, they get eggs on their fingers or under the fingernails. Transmission of the infection happens when the infected child passes the eggs to another child, and the child unknowingly swallows the eggs. </p><p>Pinworm can also be transmitted indirectly. Eggs from an infected person can stick to toys, toilet seats, clothes or bedding. A child will catch the infection when they touch the eggs and then put them in their mouth. Children are more likely to catch pinworms in milder climates and in child care centres.</p><h3>How pinworms are diagnosed</h3><p>To diagnose pinworms, the doctor may recommend a tape test to look for pinworm eggs. A tape test can be performed by you or your child's doctor. Cellophane tape is pressed against the skin around the anus. The tape is then examined under a microscope for pinworm eggs. If doing the test at home, it is best to do it in the morning before your child bathes or goes to the bathroom. Take the tape sample to your child's doctor.</p><p>Another way to test for pinworm is if you see the adult worm around your child's anus, in underwear or diapers, or in the toilet after going to the bathroom. Remember, they are white and only about a centimetre long. </p><h3>Treating pinworms</h3><p>If diagnosed, your child's doctor may prescribe an oral medication. The medicine usually takes about two weeks to work. The itching may continue for one week. </p><p>If one family member is diagnosed with pinworm, other family members should be examined and treated. </p><h2>Other common parasites in children</h2><h3>Blastocystis hominis</h3><p>Blastocystis hominis is a tiny parasite that is found in the stools of healthy or children with diarrhea or stomach pain. This infection usually clears up on its own. </p><h3>Dientamoeba</h3><p>Dientamoeba lives in the intestines. It is spread through infected food or water. Dientamoeba does not cause disease. </p><h3>Ascariasis</h3><p>Ascariasis (say: as-kuh-RI-uh-sis) is a type of roundworm infection. The worms can grow as long as 41 centimetres. This parasite is only serious when the body becomes infested with hundreds of worms. Your child will develop symptoms. </p><h3>Amebiasis</h3><p>Amebiasis occurs when amoeba get into your child's system and multiply. This infection may not show symptoms. Severe infection, which is rare, will lead to symptoms like fever, diarrhea, jaundice or weight loss. </p><h3>Tapeworm</h3><p>A tapeworm infection is caused by contaminated food or water. The swallowed tapeworm eggs move from your child's intestines to form cysts in body tissues and organs. Eaten tapeworm larvae can grow into adult tapeworms, which live in the intestine. </p><h2>When to seek medical assistance</h2> <h3>See your child's regular doctor if: </h3> <ul> <li>your child's diarrhea or nausea lasts longer than two weeks</li> <li>your child becomes dehydrated</li> </ul> <p>Be sure to tell the doctor if your child is in child care, has recently travelled to another country, or may have drunk contaminated water.</p>https://assets.aboutkidshealth.ca/AKHAssets/intestinal_parasites.jpg
Intracystic therapy for craniopharyngiomasIIntracystic therapy for craniopharyngiomasIntracystic therapy for craniopharyngiomasEnglishNeurology;OncologyChild (0-12 years);Teen (13-18 years)BrainNervous systemDrug treatment;Non-drug treatmentAdult (19+)NA2009-07-10T04:00:00ZEric Bouffet, MD, FRCPCUte Bartels, MD11.100000000000038.0000000000000372.000000000000Flat ContentHealth A-Z<p>An in-depth look at a specific type of chemotherapy known as intracystic therapy, used to treat some cystic craniopharyngiomas.<br></p><p>Chemotherapy treatment for craniopharyngioma is usually given orally or intravenously.</p><p>However, some cystic craniopharyngiomas can be treated with local administration of chemotherapy or other agents. This means that the chemotherapy is given directly into the cyst. It is also referred to as intracystic therapy. An Ommaya reservoir is used for intracystic therapy. </p><h2>Key points</h2><ul><li>Some cystic craniopharyngiomas can be treated by injecting chemotherapy directly into the cyst. This is known as intracystic therapy.</li><li>An Ommaya reservoir is used to give intracystic chemotherapy.</li><li>Your child will have regular checkups with the treatment team during intracystic therapy.<br></li></ul>
Intramuscular injections: Injecting at homeIIntramuscular injections: Injecting at homeIntramuscular injections: Injecting at homeEnglishPharmacyChild (0-12 years);Teen (13-18 years)NANADrug treatmentCaregivers Adult (19+)NA2019-10-04T04:00:00ZSharifa Habib, RN(EC), MN, NP-Paeds;Brenda Graydon, RN;Celine Menezes, RN; Shawna Silver, MD, FRCPC, FAAP, PEng6.4000000000000072.00000000000001946.00000000000Health (A-Z) - ProcedureHealth A-Z<p>A guide on giving your child injections into the muscle (intramuscular) at home.</p><figure> <img src="https://assets.aboutkidshealth.ca/akhassets/Injection_intramuscular_BDsyringe_layers_EQUIP_ILL_EN.jpg" alt="Cross-section of skin, subcutaneous tissue and muscle with needle injected at a ninety-degree angle" /> </figure> <h2>What are intramuscular injections?</h2><p> An intramuscular (IM) injection is a medicine that is injected into the muscle. Medicines can also be given into the skin (intradermal), just below the skin (subcutaneous) or into a vein (intravenous).</p><h2>Key points</h2> <ul> <li>An intramuscular (IM) injection is giving medicine with a needle into the muscle.</li> <li>The injection site varies with the age of your child.</li> <li>The size of the needle depends on the weight of your child and the type of drug they are taking.</li> <li>When injecting, hold the shaft of the syringe in dart fashion. Insert needle directly through the skin at a right angle (90° angle) into the muscle.</li> <li>Give the injection quickly, and do not pull back on the plunger before injecting as this causes more pain.</li> <li>Discard the needle and syringe in a thick, plastic bottle or sharps container with a lid. Bring it to your local pharmacy for disposal.</li> <li>Do not discard the needle in your regular garbage.</li> </ul><h2>What does it mean if there is bruising at the injection site?</h2> <p>This can happen from time to time. It is not harmful. It usually means the needle has nicked a tiny blood vessel. To reduce the chance of bruising, apply gentle pressure to the site with a dry piece of cotton or a clean finger after injecting. Also, remember not to insert the needle too slowly. If you have too much bruising, consult your health-care team. </p> <h2>What would happen if an air bubble was accidentally injected into your child?</h2> <p>It is not harmful to inject an air bubble under the skin. However, if you are injecting air rather than medicine, your child may not be getting the full dose of medicine.</p><h2>When to call the doctor</h2> <p>Call the doctor if your child experiences:</p> <ul> <li><a href="/Article?contentid=30&language=English">fever</a> or chills</li> <li>swelling or redness at the injection site that does not go away</li> </ul><h2>Premature infants</h2><p>For newborns, the IM injection site is the front outer side of the thigh. To inject into the thigh, the needle length must be 16 mm. Use a 23- to 25-gauge needle. </p> <figure> <span class="asset-image-title">Thigh injection site</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Injection_site_baby_thigh_EQUIP_ILL_EN.jpg" alt="Lower body of baby with marking on thigh" /> </figure> <h2>Infants (up to 2 years of age)</h2><p>For infants, the IM injection site is the front outer side of the thigh. Do not use the inner thigh or back of the thigh. Divide the thigh into thirds; the injection site is in the middle third section. </p><p>To inject into the site, the needles must be 16mm to 22 mm long. Use a 22- to 25-gauge needle. Your baby's doctor may give you a longer needle depending on the size of your child. The needle must be long enough so that it will reach deep into the muscle. It should reach past the tissue just above the muscle, which is the subcutaneous (SC) tissue. This helps to reduce irritation to the subcutaneous tissue which can cause pain associated with IM injections. </p><h2>Toddler (1 to 3 years of age)</h2><p>For toddlers, use 22- to 25-gauge needles. There are two possible injection sites:</p><ul><li>Deltoid muscle: This is the top, upper part of the arm. Only inject in this site if your health-care provider tells you that this is an appropriate injection site for your child. To inject into the deltoid, the needle size must be 16 mm. However, needle sizes from 22 mm to 25 mm can be used for older children: The nurse or doctor will advise which needle size is appropriate for your child. Only give injections that are less than 0.5 mL into the deltoid.</li><li>Front, outer side of the thigh. Do not use the inner thigh or back of the thigh. Divide the thigh into thirds; the injection site is in the middle third section.</li></ul><p>You may be given a longer needle depending on the size of your child. The needle must be long enough so that it will reach deep into the muscle. It should reach past the tissue just above the muscle, which is the subcutaneous (SC) tissue. This helps to reduce irritation to the SC tissue which can cause pain associated with IM injections.</p> <figure> <span class="asset-image-title">Deltoid injection site</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Injection_intramuscular_deltoid_older_child_EQUIP_ILL_EN.jpg" alt="Upper body of child with marking on upper arm near the shoulder" /> </figure> <h2>Children (3 to 18 years)</h2><p>For all children, use 22- to 25-gauge needles. There are two possible injection sites:</p><ul><li>Deltoid muscle: This is the top, upper part of the arm. The nurse or doctor will advise which needle size is appropriate for your child. To inject into the deltoid, the needle size must be 16 mm. However, needle sizes from 22 mm to 25 mm can be used for older children. Only give injections that are less than 0.5 mL into the deltoid. </li><li>Thigh: The middle of the front outer side of the thigh. Do not use the inner thigh or back of the thigh. Divide the thigh into thirds; the injection site is in the middle third section. To inject into the thigh, the needle size must be at least 16 mm long but may need to be longer depending on your child's size. </li></ul><p>For older children, the size of the needle depends on the sex and weight of your child. Generally, a needle that is 25 mm to 38 mm long can be used for adolescents.</p><ul><li>Use 25 mm needles for females who weigh over 60 kg and males up to 118 kg. </li><li>Use 38 mm needles for females who weigh over 90 kg and males over 118 kg.</li></ul><h2>Injection sites and needle sizes </h2> <p>The injection site depends on your child's age. The size of the needle also influences the location of the injection site. The size of the needle depends on the weight of your child and the type of drug they are taking. </p> <p>The diameter of the needles also varies depending on your child's age. This size is described in units called "gauge numbers". Needles with larger diameters have smaller gauge numbers. </p> <p>The length of the needle is ________.</p> <p>You child's injection site is ________.</p> <p>The needle gauge number is ________.</p> <p>If the injection you are giving is more than 1 mL in volume, check with your health-care provider about which location is appropriate for your child.</p>https://assets.aboutkidshealth.ca/akhassets/Injection_intramuscular_BDsyringe_layers_EQUIP_ILL_EN.jpg
Intraventricular hemorrhage (IVH) in premature babiesIIntraventricular hemorrhage (IVH) in premature babiesIntraventricular hemorrhage (IVH) in premature babiesEnglishNeonatology;NeurologyPremature;Newborn (0-28 days);Baby (1-12 months)BrainNervous systemConditions and diseasesPrenatal Adult (19+)NA2009-10-31T04:00:00ZHilary Whyte, MSc, MB, BCh, BAO, MRCPI, FRCPC12.000000000000047.9000000000000973.000000000000Flat ContentHealth A-Z<p>Read about intraventricular hemorrhage (IVH), or bleeding in the brain. It varies in severity and can result in brain damage for a premature baby.</p><p>Intraventricular hemorrhage (IVH) is bleeding into the ventricles of the brain. One characteristic of the immature brain is a weakness of the blood vessels next to the ventricles. The ventricles are cavities that store cerebrospinal fluid (CSF) which nourishes the brain. Of particular concern is a collection of tiny and fragile blood vessels in the germinal matrix, which is the area of brain adjacent to the floor of the ventricles. This is a part of the brain that is active during fetal development but that disappears at about the 35th week of pregnancy. These blood vessels are thin and vulnerable to fluctuations in blood flow through them, which can cause them to rupture and bleed. The younger and smaller the baby, the higher the risk these blood vessels may be ruptured, usually in the first few days of life. A rupture causes blood to flow into a ventricle or ventricles of the brain. </p><h2>Key points</h2> <ul><li>Intraventricular hemorrhage is bleeding into the ventricles of the brain, caused by weakness of the blood vessels next to the ventricles which can rupture and bleed.</li> <li>About 50% of extremely premature babies will sustain an IVH whereas only about 15% of older premature babies will have an IVH.</li> <li>IVH may affect the flow of cerebral spinal fluid in the ventricles and it may cause damage to brain tissue adjacent to the ventricles, which cannot be reversed.</li> <li>Complications and long-term effects will depend on the severity of the IVH, though many babies who have a mild IVH go on to develop normally with only minimal learning disabilities.</li></ul>

Thank you to our sponsors

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