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Nasal cautery: Caring for your child at homeNNasal cautery: Caring for your child at homeNasal cautery: Caring for your child at homeEnglishOtolaryngologyPreschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)NoseNoseNon-drug treatmentCaregivers Adult (19+)NA2014-02-07T05:00:00ZMary-Elizabeth Vanderpost, RN BScN;Otolaryngology Clinic7.2000000000000067.1000000000000752.000000000000Health (A-Z) - ProcedureHealth A-Z<p>​Nasal cautery is a treatment for nosebleeds. Learn how the treatment works and how to care for your child as they recover at home. </p><figure> <span class="asset-image-title">Blood vessels in the nose</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_nasal_blood_vessels_EN.jpg" alt="Identification of nasal septum and blood vessels in a child’s nose" /> <figcaption class="asset-image-caption">The two nostrils are divided by a wall called the nasal septum. The septum is rich in blood vessels. If they bleed regularly, the blood vessels can be sealed with nasal cautery.</figcaption> </figure> <p>Nasal cautery is a type of surgery (operation) to treat nose bleeds. It involves using electricity to seal blood vessels in the nose that bleed regularly.</p><h2>Key points</h2> <ul> <li>Nasal cautery uses electricity to seal blood vessels in the nose that bleed regularly.</li> <li>After the surgery, your child's nose will be packed with a special sponge and Polysporin to protect it while it heals.</li> <li>Your child will feel congested and may have difficulty breathing through their nose for about a week after the procedure.</li> <li>For a week after surgery your child must not blow their nose, pick their nose, bend over or lift anything heavy, or take part in any activity that requires a lot of energy. </li> </ul><h2>When should I call a doctor?</h2> <p>Call your doctor if:</p> <ul> <li>your child has a fever (a temperature of 38°C (100°F) or higher)</li> <li>your child has a nose bleed that does not stop after 20 minutes of continuous pressure to the nose</li> <li>there is any vomiting with specks of blood</li> <li>a foul smell or green fluid comes from your child's nose.</li> </ul><h2>What happens during surgery?</h2> <p>Before the surgery, your child will have a special "sleep medicine" called a general anaesthetic. This will make sure your child sleeps through the operation and does not feel any pain.</p> <p>The surgeon will then use an instrument called an electrocautery needle to pass electricity to the area of the nosebleeds. The electricity burns the tissue slightly where bleeding usually occurs. When the tissue heals, it becomes thicker. This prevents further nosebleeds.</p><h2>What happens after surgery?</h2> <p>Once the surgery is finished, the surgeon will use a special sponge, such as Gelfoam or Surgicel, to pack your child's nose. The surgeon will also fill the nose with Polysporin. Together, the packing and Polysporin protect the burned tissue in your child's nose while it heals. The packing will dissolve after three to five days.</p> <p>Your child will usually then be sent home on the same day as the surgery.</p><h2>Does my child need to do anything to prepare for nasal cautery?</h2> <p>There is no special preparation for nasal cautery. The doctor examines each nostril to look for the bleeding point and any other possible causes of bleeding.</p><h2>At SickKids</h2> <p>If there are problems in the first 24 hours after the procedure, please call 416-813-7500 and ask for the ENT resident on call.</p> <p>For any other questions, you may call the ENT clinic nurse at 416-813-6452.</p>https://assets.aboutkidshealth.ca/AKHAssets/nasal_cautery_caring_for_child_at_home.jpg
Nasal congestion: How to clear your baby's dry, stuffy noseNNasal congestion: How to clear your baby's dry, stuffy noseNasal congestion: How to clear your baby's dry, stuffy noseEnglishNANewborn (0-28 days);Baby (1-12 months)NoseNoseConditions and diseasesCaregivers Adult (19+)Nasal congestion2019-02-04T05:00:00ZShawna Silver, MD, FRCPC, FAAP, PEng6.3000000000000074.70000000000001005.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Simple tips for parents on how to clear your baby's stuffy nose.</p><p>In the first few days of life, a newborn may sound like they have a stuffy nose because in the womb they were surrounded by fluid. Sometimes they sneeze for the first couple of days as they try to get rid of this leftover fluid in their nasal passages. A newborn with a stuffy nose may snort when breathing and sound "snuffly."</p><p>Stuffy nose or nasal congestion in babies happens when the tissues inside the nose swell or produce mucus. If your baby has a stuffy nose they may breathe through their mouth, which can make it harder for them to feed. In rare cases, a stuffy nose can cause breathing problems. Usually, nasal congestion goes away on its own within a week.</p><p>Extremely dry air can cause the sensitive lining of a baby's nose to dry up. The blood vessels inside a dry nose may break and bleed. If your baby's nose has not been injured but it bleeds, it may be because of a dry nose. This dryness may also make it easier for a baby to get a cold.</p><p>Nasal dryness often worsens during cold winter months, when heating makes the air inside the home dry.</p><h2>Key points</h2><ul><li>Newborns may sound like they have a stuffy nose because of leftover fluid in their nose from the womb.</li><li>Usually, newborn stuffy nose goes away on its own within a few days.</li><li>In babies, nasal congestion or stuffy nose happens when the tissues inside the nose swell.</li><li>Use salt water nasal drops or an infant nasal aspirator or suction bulb to help clear mucus from your baby's nose.</li><li>If your baby has trouble breathing, see your doctor right away. </li></ul><h2>What causes stuffy nose in babies?</h2><ul><li>dry air</li><li>irritants such as dust, cigarette smoke, or perfumes</li><li>viral illnesses (such as a cold)</li></ul> <p>Try the measures below to help your baby's dry or stuffy nose. If your baby keeps having difficulty breathing or feeding, check with your baby's doctor to rule out any infection or condition that may be causing the stuffy nose.</p><h2>How to soothe your baby's dry nose</h2><p>If a dry or irritated nose seems to be bothering your baby, try these tips:</p><h3>Moisten your baby's nose</h3><p>You can buy salt water (saline) drops at the drug store.</p><ol><li>Lay your child on their back. Place a rolled towel or a small blanket beneath their shoulders or gently press on the tip of the nose to make it easier for the drops to go in.</li><li>Put two or three saline drops into each nostril. Wait 30 to 60 seconds before draining your baby's nose.</li></ol><h3>Run a humidifier or cool-mist vaporizer near your baby's crib</h3><p>If your baby has a dry nose they may also have a stuffy nose. Water vapor can help moisten and loosen the mucus inside your baby's nose. Clean out and re-fill the vaporizer every day.</p><h2>How to clear your baby's stuffy nose</h2><p>In addition to running a humidifier or vaporizer near your baby's crib, you can also clear the mucus using saline nose drops.</p><h3>Clearing mucus using saline nose drops</h3><ol><li>Lay your child on their back. Place a rolled towel or a small blanket beneath their shoulders or gently press on the tip of the nose to make it easier for the drops to go in.</li><li>Put two or three saline nose drops into each nostril. Wait 30 to 60 seconds.</li><li>Turn your child onto their stomach to help their nose drain. Catch the mucus outside the nostril with a tissue or swab. Your baby might cough or sneeze the mucus and saline out.</li><li>Roll the swab or tissue around the outside of the nostril to draw the fluid out of the nose. Do not insert a cotton swab into your child's nostrils.</li></ol><h3>Clearing mucus using an infant nasal aspirator or nasal suction bulb</h3><p>If you have trouble removing the mucus, try using an infant nasal aspirator or nasal suction bulb. A nasal aspirator is a tube that is placed in your baby’s nostril, while you inhale through the mouthpiece of the tube to draw out any mucus. The mucus is then caught in a filter. A suction bulb is inserted into your baby’s nostril and acts as a vacuum to remove mucus. Suction bulbs are generally less effective in clearing mucous and secretions.</p><p>How to use a nasal aspirator:</p><ol><li>Before the first use, rinse the aspirator with hot water and dry thoroughly.</li><li>Place a clean filter in the filter chamber and reconnect the aspirator.</li><li>Lay the child on their back with their head tilted to the right. Carefully place one to two saline drops into the nostril. Follow the same procedure in the opposite nostril after turning the child’s head to the left.</li><li>Place the nasal aspirator soft tip at the entrance of the baby’s nostril. Inhale through the mouthpiece to gently draw out the mucus. Mucus will be collected in the hygienic filter and cannot pass through the inhalation tube. Repeat in the other nostril. Gently lift the baby to allow any remaining mucus to drain out or their nose.</li><li>Soak a tissue or cotton ball in saline solution and use it to gently wipe the child’s nostrils.</li><li>After each use, unclip the aspirator at its base, remove and discard the used filter, rinse the nasal aspirator with hot water and dry. Do not sterilize or boil the nasal aspirator. </li></ol><p>How to use a nasal suction bulb: </p><ol><li>Pinch the air out of the bulb.</li><li>Gently place the tip into the nostril, just inside the opening. Do not go too deep or you can cause damage to the inner part of the nose. Let the air come back into the bulb, pulling the mucus out of the nose with it.</li><li>Release the mucus onto a tissue.</li><li>Rinse the bulb well with fresh water before and after each use.</li></ol><div class="asset-video"> <iframe src="https://www.youtube.com/embed/0gQqI2gz0Z4?rel=0" frameborder="0"></iframe> </div><h2>When to see a doctor</h2><p>Call your doctor if your child develops any of the following symptoms.</p><ul><li><a href="/Article?contentid=30&language=English">Fever</a></li><li>Rash</li><li>A stuffy nose together with swelling of the forehead, eyes, side of the nose or cheek</li><li>A stuffy nose that lasts longer than two weeks</li><li>Difficulty breathing or breathing quickly</li><li>Significant trouble feeding or not interested in feeding</li><li>Your baby is extremely fussy or seems to be in pain</li></ul>congestedbabyhttps://assets.aboutkidshealth.ca/AKHAssets/nasal_congestion.jpg
Nasal polypectomy: Removing nasal polypsNNasal polypectomy: Removing nasal polypsNasal polypectomy: Removing nasal polypsEnglishOtolaryngologyChild (0-12 years);Teen (13-18 years)NoseNoseProceduresCaregivers Adult (19+)NA2009-11-10T05:00:00ZDenise Kipling, RN, BScN;Megan Bunch, RN, BScN;Brenda Howson, RN, BScN;Tomka George, RN;Pauline Lackey, RN;Adrian James, MA, BM BCh, FRCS, FRCS(ORL-HNS)6.6000000000000071.10000000000001317.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Nasal polyps are growths in the nose that impair breathing. Learn about nasal polypectomy, the surgical removal of nasal polyps and recovery after surgery.</p><p>Your child needs an operation to remove polyps (say: PAUL-ips) from their nose. This operation is called a nasal polypectomy (say: NAY-sull paul-ip-ECK-toe-mee). </p> <p>This page explains what happens during the operation and how to take care of your child after the operation. Use this information to explain to your child what will happen, using words they can understand. </p><h2>Key points</h2> <ul> <li>Nasal polyps are smooth, round, ball-like growths inside the nose.</li> <li>If nasal polyps grow large enough to block the passageway through the nose, then your child will need an operation called a nasal polypectomy to remove them.</li> <li>Your child will need to have an anaesthetic. Your child will need to stay in the hospital for one to two days.</li> </ul><h2>When to call the doctor</h2> <p>Please call your child's doctor, the otolaryngology clinic, a walk-in clinic, or your family doctor right away if your child has any of these signs after going home: </p> <ul> <li>fever of 38.5°C (101°F) or higher </li> <li>blood from the nose </li> <li>vomiting (throwing up) that does not stop </li> <li>pain that gets worse </li> <li>foul-smelling, greenish-yellow drainage from the nose </li> </ul> <p>If this is an emergency or you are worried, do not wait. Take your child to the closest emergency department right away.</p><h2>What happens during the operation</h2> <p>Your child will be given a special "sleep medicine" called a <a href="/Article?contentid=1261&language=English">general anaesthetic</a>. This makes sure your child will sleep through the operation and will not feel any pain. </p> <p>The doctor will use a special tool to remove the polyps through the nose. Then the doctor will put packing inside the nose to keep pressure on the area. This keeps the nose from bleeding after the polyps are removed. Your child will not have any cuts on the outside of their nose. </p> <p>The operation takes around one to two hours. It depends on how many polyps your child has.</p><h2>Making your child comfortable after the operation</h2> <p>If your child has pain after the operation, we will give them pain medicine, either through the IV tube in their arm or by a pill or liquid to swallow. If you think your child is in pain, tell the nurse. </p> <p>Here are some other ways to make your child more comfortable:</p> <ul> <li>Cold compresses and sitting upright may help to reduce swelling. </li> <li>Mouth rinses and a humidifier at the bedside will help make your child's mouth less dry. Your child will be breathing through their mouth while the packing is in place. </li> </ul> <h3>Eating and drinking</h3> <p>Your child will probably ask for sips of water two to three hours after the operation. When your child can tolerate liquids, we will start adding soft foods. </p> <h2>Your child will stay in the hospital for one to two days</h2> <p>Your child will stay in the hospital for one to two days after the operation. You will be able to stay overnight with your child in their room. </p><h2>Before the operation</h2> <p>Several hours before the operation, your child will need to stop eating and drinking. The doctor or nurse will tell you when your child must stop eating and drinking. </p> <h3>Write this information down here:</h3> <p>The date and time of the operation:</p> <p>When your child must stop eating:</p> <p>When your child must stop drinking clear fluids:</p> <p>Other things to remember:</p> <p> </p> <h2>Important phone numbers</h2> <p>My child's doctor is:</p> <p>The doctor's phone number is:</p> <p>The otolaryngology clinic nurse's number is: </p>https://assets.aboutkidshealth.ca/akhassets/Nasal_polypectomy_MED_ILL_EN.jpg
Nasal stent after cleft lip surgery: Caring for your child at homeNNasal stent after cleft lip surgery: Caring for your child at homeNasal stent after cleft lip surgery: Caring for your child at homeEnglishPlasticsNewborn (0-28 days);Baby (1-12 months)NoseNoseNon-drug treatmentCaregivers Adult (19+)NA2013-12-06T05:00:00ZCindy Guernsey, RN, BScN5.8000000000000080.3000000000000906.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Your child will have a small tube, called a nasal stent, placed in their nostrils after surgery. Learn how to take care of your child at home.</p><h2>What is a nasal stent? </h2> <p>A nasal stent (also called a nostril splint) is a pair of small soft tubes, each about as thick as a straw. The stent is placed in your child's nostrils after <a href="/Article?contentid=33&language=English">cleft lip surgery</a> to help the nostrils keep their shape while the surgery wound is healing.</p> <p>Your child will need to use the nasal stent for up to a year after cleft lip surgery. Your child's surgeon will give you more details. </p><h2>Key points</h2> <ul> <li>A nasal stent is a pair of small soft tubes placed in your child's nostrils. Your child will need to use the nasal stent for about a year after cleft lip surgery.</li> <li>Usually the nasal stent is only removed before feeding your child or cleaning their face.</li> <li>Make sure you insert the stent right side up and that it is secured in place with tape.</li> </ul><h2>At SickKids</h2> <p>If you find it difficult to re-insert the stent, call the plastic surgery resident on call at 416-813-7500 and be prepared to take your child to the hospital.</p> <p>If you have any other concerns, please call your plastic surgeon's office or the co-ordinator of the Cleft Lip and Palate Program at 416-813-7491 for instructions.</p> <p>Your child's first nasal stent is free, but if it is lost or damaged, you will need to pay for a replacement. Each stent costs at least $200.</p>https://assets.aboutkidshealth.ca/akhassets/IMD_nasal_stent_insertion_07_EN.jpg
Nasogastric (NG) Tube: How to insert your child's NG tubeNNasogastric (NG) Tube: How to insert your child's NG tubeNasogastric (NG) Tube: How to insert your child's NG tubeEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)Nose;Esophagus;StomachEsophagus;StomachNon-drug treatmentCaregivers Adult (19+)NA2017-06-08T04:00:00ZCeline Menezes, RN, MSN, Interprofessional Education Specialist;Karen Breen-Reid, RN, MN, Manager, Interprofessional Education5.5000000000000081.50000000000001172.00000000000Health (A-Z) - ProcedureHealth A-Z<p>A guide on how to insert your child's nasogastric tube and how to check to make sure the placement inside your child is correct.</p><figure> <img src="https://assets.aboutkidshealth.ca/akhassets/NG_tube_tape_infant_EQUIP_ILL_EN.jpg" alt="Child with a nasogastric tube" /> </figure> <h2>What is a nasogastric tube?</h2><p>A nasogastric (NG) tube is a long, thin, hollow tube which is passed through a nostril of the nose into the throat and down into the stomach. You can use the tube to feed your child if they are unable to take enough food by mouth or they are not safely able to take food by mouth. Liquid feeds pass through the tube into the stomach.</p><h2>Key points</h2><ul><li>A soft silastic nasogastric (NG) tube is a long, thin, hollow tube which is passed through a nostril of the nose into the throat and down into the stomach.</li><li>Each time you insert the tube, try to go from one nostril to the other with each change.</li><li>You must check the placement of the NG tube each time it is inserted, used for feeds or to give medications.</li><li>If the tube is in the airway, your child may choke, cough or have trouble breathing. If this happens, remove the NG tube right away. Let your child rest and start again once they feel better.</li></ul> <div class="pdf-page-break"><h2>How do you insert the tube?</h2><h3>Preparing the tube for insertion</h3><p>The steps are different for babies and children. Please follow the directions from your nurse.</p><ol><li>Gather the following equipment:</li><ul><li>silastic NG tube with guide wire, size _____</li><li>cut pieces of a non-allergenic tape, such as Hypafix</li><li>straw in a glass of water (for drinking) for a child or a soother for an infant</li><li>sterile water or water-soluble lubricant (for lubricating the tube)</li><li>permanent writing marker</li><li>10 mL syringe</li><li>pH test strip</li></ul><li>Place all supplies within close reach.</li><li>Wash your hands.</li><li>Measure the NG tube to find the correct length.</li><ul><li>Have your child sit up straight. For babies, lay your baby face up with their chin slightly raised. </li><li>Hold the end of the tube with the holes at your child’s nostril and begin measuring from the holes.</li><li>Measure the feeding tube from the nostril to the base of the ear lobe, then to about half way between the base of the chest bone and the umbilicus, or "belly button".<br></li></ul></ol> <figure class="asset-c-80"><span class="asset-image-title">Measuring the NG tube for correct length</span><img src="https://assets.aboutkidshealth.ca/akhassets/NG_tube_tube_length_EQUIP_ILL_EN.png" alt="Measurements on an infant and on an older child and location of base of chest bone and belly button on both" /> </figure> </div><div class="keep-together"><ol start="5"><li>Mark these measurements on the tube with the permanent marker.</li></ol> <figure class="asset-c-80"> <span class="asset-image-title">Marking measurements on the NG tube</span> <img src="https://assets.aboutkidshealth.ca/akhassets/NG_tube_tube_measurements_EQUIP_ILL_EN.jpg" alt="Markings on a NG tube with two ports and removable guarded wire at starting point and point on the tube below the chest bone" /></figure> </div><ol start="6"><li>Loosen the guide wire from the tube but do not remove it yet.</li></ol><h3>Inserting the tube</h3><p>Each time you insert the tube, try to go from one nostril to the other with each change. A soft silastic NG tube can remain in place for one month, remember to change it every month.</p><p>Every time you put an NG tube in your child, you must do the following steps:</p><ol><li>Have your child sit upright. If your child is a baby or very young, lay them down and bundle them in a blanket to help hold their arms and legs.</li><li>Dip the first 2 to 4 inches (5 to 10 cm) of the tube in the water or water-soluble lubricant (for example, KY or Muko Jelly). This will make it easier to pass the tube. Do not use petroleum jelly (e.g. Vaseline) for lubrication.</li><li>Insert the end of the tube into the nostril you have chosen and advance the tube slightly down and towards the ear on that side. Do not force the tube. </li><li>If your child is allowed to have water, they may sip the water through a straw. You can also give your infant a soother to help them swallow. If your child is not allowed to drink, tell them to swallow as the tube goes down.</li><li>Continue to advance the tube until the marked spot reaches the nostril. If the tube comes back out of your child’s mouth, pull it back, let your child recover and start again.</li><li>Secure the tube to your child’s face with a small piece of tape.</li></ol><div class="pdf-page-break"><ol start="7"><li>Be alert for accidental placement of the NG tube in the trachea (windpipe). If the tube is in the airway, your child may choke, cough or have trouble breathing. If this happens, REMOVE THE NG TUBE IMMEDIATELY. Let your child rest and start again once they feel better.</li><li>Check the correct tube placement before removing the wire and before giving any feeds or medicines. See the instructions below for checking the tube placement.</li></ol></div><p>If skin irritation occurs over time and you are not able to heal it, speak to your child’s doctor or nurse.</p><h3>Check the placement of the tube</h3><p>Check your child’s tube placement:</p><ul><li>before using the tube for feeds or medications</li><li>when a new tube is put in</li><li>when you are concerned that the tube may have come out</li><li>if your child is choking, vomiting, coughing or having trouble breathing</li></ul><p>Check the tube placement inside your child using the following method:</p><div class="akh-series"><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/NG_tube_check_placement_acid1_EQUIP_ILL_EN.jpg" alt="Two millilitres of liquid in a syringe attached to an NG tube" /> </figure> <ol><li>Attach the empty 10 mL syringe to the adapter and gently flush with air to clear the tube. Then pull back on the plunger to withdraw about 2 mL of stomach contents.<br></li></ol></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/NG_tube_check_placement_acid2_EQUIP_ILL_EN.jpg" alt="pH test papers and a pH colour guide" /> </figure> <ol start="2"><li>Wet pH testing paper with the stomach fluid and compare the color with the label on the container. For the majority of children, the colour on the strip should be less than 4. For children who are on stomach acid suppressing medications or who have just fed, the colour on the strip should be less than 6. Ask your health-care provider what colour to expect. The colour on the strip should match a number no higher than _____.</li></ol></div></div><div class="row"><div class="col-md-12"><ol start="3"><li>If you believe the NG tube is not correctly placed, remove it and try again. If you have trouble pulling back some stomach fluid to do the pH test, try the following: </li><ul><li>Use a larger syringe and draw back more gently to prevent collapsing the tube.<br></li><li>Push in 1 to 2 mL of water or air through the NG tube into the stomach and gently draw back on the syringe.</li><li>Change your child’s position by having them lie on their right or left side for a few minutes to move the position of the tube in the stomach.</li></ul></ol></div></div></div><div class="pdf-page-break"><h3>Removing the guide wire</h3><ol><li>Once you are satisfied that the tube is in the stomach, place tape across the tube to secure it to the cheek.</li><li>To remove the guide wire, start by flushing 1 to 2 mL of water through the tube. This lubricates the guide wire and makes it easier to remove. Hold the NG tube at your child’s nostril and pull gently, but firmly, on the guide wire to remove it. Close the end of the tube. Do not throw away the guide wire. Save it in a safe place for future use.<br></li></ol></div><p>For more information, please see <a href="/Article?contentid=2457&language=English">Nasogastric (NG) tube: Feeding your child</a> and <a href="/Article?contentid=2456&language=English">Nasogastric (NG) tube feeding: Common problems</a></p>https://assets.aboutkidshealth.ca/akhassets/NG_tube_tape_infant_EQUIP_ILL_EN.jpg
Nasogastric (NG) tube feeding: Common problemsNNasogastric (NG) tube feeding: Common problemsNasogastric (NG) tube feeding: Common problemsEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)Nose;Esophagus;StomachEsophagus;StomachNon-drug treatmentCaregivers Adult (19+)NA2017-06-08T04:00:00ZCeline Menezes, RN, MSN;Karen Breen-Reid, RN, MN4.7000000000000080.4000000000000629.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn how to treat common problems with your child's nasogastric (NG) tube feeding. </p><p>Learn about some of the common problems with nasogastric (NG) tube feeding, why they happen, how to treat them and how to prevent them.</p><h2>Key points</h2> <ul> <li>Problems that occur when putting in the NG tube include choking, coughing, trouble breathing and turning pale.</li> <li>Problems that occur during feeding can include vomiting and stomach bloating.</li> <li>Sometimes the NG tube may have moved and the mark you made on it is no longer at the nostril.</li> <li>Your child has diarrhea that could be due to the speed of the feeds or a stomach infection.</li> <li>Sometimes the tape on your child's face is irritates their skin.</li> </ul><p>The following table outlines some of these problems that you may encounter while feeding your child using their nasogastric (NG) tube.</p> <table class="akh-table"> <thead> <tr><th>Problem</th><th>May be due to</th><th>How to treat</th><th>How to prevent</th></tr> </thead> <tbody> <tr> <td>Your child chokes, coughs, has trouble breathing, or turns pale while you are putting in the NG tube.</td> <td>NG tube</td> <td><ul><li>Immediately remove the tube.</li><li>Let your child or infant relax and recover.</li><li>Remeasure the tube length.</li><li>Try to insert again, following the steps.</li><li>If your child does not recover, call their doctor or 9-1-1 right away.</li></ul></td> <td><ul><li>Measure the length and mark it on the tube.</li><li>Insert the tube gently and smoothly.</li><li>Encourage your child to swallow while the NG tube is going down.</li><li>Give your infant a soother to suck while you are putting in the tube.</li></ul></td> </tr> <tr> <td>Your child vomits or stomach is bloated during the feeding.</td> <td>Too much formula in the tube or air in the stomach.</td> <td><ul><li>Stop the feed for 10 to 15 minutes and start again more slowly.</li><li>If your child still has problems, call your dietitian or doctor.</li><li>Vent the NG tube.</li></ul></td> <td><ul><li>Run the feed at the rate to give the feed as instructed.</li><li>Make sure you are giving the correct amount.</li></ul></td> </tr> <tr> <td>The mark you made on the tube is no longer at the nostril.</td> <td>The tube may have moved too far in or out of your child.</td> <td><ul><li>If you cannot see the mark on the tube then pull back the tube and re-tape.</li><li>Check the tube placement.</li><li>If the mark is farther away from the child, then remove the tube, re-measure and put it in again.</li><li>Secure it well with tape.</li></ul></td> <td><ul><li>Make sure the tube is taped securely so it will not move.</li><li>Place the outside of the tube into the child’s shirt to prevent pulling.</li></ul></td> </tr> <tr> <td>Your child has diarrhea.</td> <td><ul><li>The feeds maybe going too fast.</li><li>Your child may have a stomach infection.</li></ul></td> <td><ul><li>Talk to your child’s doctor about treatment.</li><li>Throw away equipment and start with new equipment. </li><li>Wash your hands well before and after handling the equipment.</li></ul></td> <td><ul><li>Make sure the feeds run as instructed.</li><li>Make sure the formula is prepared in a clean way and the equipment cleaned well after every use.</li></ul></td> </tr> <tr> <td>The skin on your child’s face is irritated by the tape.</td> <td><ul><li>Too much tape.</li><li>Sweating, drooling that gets the tape wet.</li><li>Sensitivity to tape.</li></ul></td> <td><ul><li>Talk to your doctor or nurse about other kinds of tapes that may help.</li><li>Secure tape to different locations on the face to allow skin to recover.</li></ul></td> <td><ul><li>Use only enough tape to keep the tube in place.</li><li>Use only hypoallergenic tape.</li><li>Keep your child’s skin clean with mild soap and water and dry well before putting on tape.</li><li>Replace wet or dirty tape right away.</li></ul></td> </tr> </tbody> </table><p>For more information, please see <a href="/Article?contentid=984&language=English">Nasogastric (NG) tube: How to insert your child's NG tube</a> and <a href="/Article?contentid=2457&language=English">Nasogastric (NG) tube: Feeding your child</a>.</p>
Nasogastric (NG) tube: Feeding your childNNasogastric (NG) tube: Feeding your childNasogastric (NG) tube: Feeding your childEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)Nose;Esophagus;StomachEsophagus;StomachNon-drug treatmentCaregivers Adult (19+)NA2017-06-08T04:00:00ZCeline Menezes, RN, MSN;Karen Breen-Reid, RN, MN5.2000000000000080.5000000000000524.000000000000Health (A-Z) - ProcedureHealth A-Z<p>A guide on how to feed your child through a nasogastric tube, when to flush the tube and how to clean the equipment.</p><p>The following information provides instructions on feeding your child through their nasogastric (NG) tube. When at home, feeding through the NG tube should be done by gravity.</p><h2>Key points</h2> <ul> <li>Flush the tube at the end of every feed and after each medicine.</li> <li>Clean the feeding bag and tubing with warm soapy water.</li> </ul><h2>Feeding your child through the NG tube</h2><div class="akh-series"><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/NG_tube_feeding_by_gravity_EQUIP_ILL_EN.jpg" alt="Connect tubes and roller clamp on infusion tubing for attaching a feeding bag to a child’s NG tube" /> </figure> <ol><li>Gather the following equipment:</li><ul><li>adapters</li><li>5 or 10 mL syringe</li><li>prepared formula</li><li>feeding bag</li><li>infusion tubing</li><li>IV pole</li></ul><li>Wash your hands.</li><li>Check the correct tube placement.</li></ol></div></div><div class="row"><div class="col-md-12"> <figure> <span class="asset-image-title">Closing the clamp on the infusion tubing</span> <img src="https://assets.aboutkidshealth.ca/akhassets/NG_tube_infusion_tube_clamp_EQUIP_ILL_EN.jpg" alt="An open clamp and a closed clamp on infusion tubing" /> <figcaption class="asset-image-caption">Roll the wheel downward on the clamp of the infusion tubing to close off the tube. Roll the wheel back up to open the tube again.</figcaption> </figure> <figure> <span class="asset-image-title">Handling the feeding bag</span> <img src="https://assets.aboutkidshealth.ca/akhassets/NG_tube_feeding_bag_EQUIP_ILL_EN.jpg" alt="Pouring formula into feeding bag and closing the seal on the feeding bag" /> </figure> <ol start="4"><li>Close the clamp on the infusion tubing.</li><li>Pour the prepared formula into the feeding bag, close the seal tightly and hang the bag on the IV pole.</li><li>Open the clamp to allow the feeding solution to push all the air out of the infusion tubing. Close the clamp once you see the fluid drip out of the end of the tubing.</li><li>Connect the tubing to your child’s NG tube. The air in your child’s NG tube will not cause problems.</li><li>Open the clamp far enough to get the desired rate of flow. To do this watch how fast the formula drips - a faster drip means the feed will go in quicker.</li><li>When the feed is done, close the clamp and remove the infusion tubing from the NG tube. Set it aside.</li><li>Cap off the NG tube.</li><li><p>If your child keeps their feeding tube in, flush the tube with 5 mL of water to clear any formula residue between feeds. Use the attached plug to close the tube.</p><p>If your child does not keep their feeding tube in all the time, about 30 minutes after the feed, hold up the end the tube so that it can drain into the child. Remove the tape and gently remove the tube.</p></li></ol></div></div></div><p>For more information, please see <a href="/Article?contentid=984&language=English">Nasogastric (NG) tube: How to insert your child's NG tube</a> and <a href="/Article?contentid=2456&language=English">Nasogastric (NG) tube feeding: Common problems</a>.</p>https://assets.aboutkidshealth.ca/akhassets/NG_tube_feeding_by_gravity_EQUIP_ILL_EN.jpg
Natural health products and cancer treatmentNNatural health products and cancer treatmentNatural health products and cancer treatmentEnglishOncologyChild (0-12 years);Teen (13-18 years)BodyImmune systemNon-drug treatmentCaregivers Adult (19+)NA2013-10-21T04:00:00ZEkaterina Blinova, RPh, ACPR, BScPhm;Elyse Zelunka, BScPhm, RPh, ACPR10.300000000000043.6000000000000912.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn about possible interactions between cancer treatments and natural health products</p><p>Children receiving cancer treatment (chemotherapy and/or radiation) can experience side effects caused by their treatment. Many patients and families would like to use complementary and alternative medicines such as natural health products to help with these symptoms.</p> ​<h2>What are natural health products?<br></h2><p>Natural health product is a term used to refer to a group of health products including:</p><ul><li>vitamins and minerals </li><li>herbal remedies </li><li>homeopathic medicines </li><li>Chinese medicines or Ayurvedic medicines (East Indian) </li><li>probiotics </li><li>other products like amino acids and essential fatty acids </li></ul><p>These products may be natural but they can cause side effects. They may also interact with cancer chemotherapy, radiation therapy or other medicines.</p><h2>Key points</h2> <ul> <li>Natural health products include vitamins and minerals; herbal remedies; homeopathic medicines; Chinese medicines or Ayurvedic medicines; probiotics; and other products like amino acids and essential fatty acids.</li> <li>Natural health products can cause side effects and can interact with cancer chemotherapy, radiation therapy or other medicines.</li> <li>Before you give a natural health product to your child, talk to your child's health-care provider to review its safety.</li> </ul><h2> Is it true that some natural health products can be used to treat side effects of chemotherapy or radiation therapy?</h2> <p>There are some natural health products which have been studied in humans and have shown to help reduce some of the side effects caused by cancer treatment. However, some of these natural health products may also decrease how well the chemotherapy works. We recommend that the use of any natural health products be discussed with a health-care provider.</p> <h2>Can I give my child antioxidants to prevent the side effects of chemotherapy or radiation therapy?</h2> <p>Some people think that antioxidants, such as vitamin C, might protect normal cells from cancer therapy. However, vitamin C and other antioxidants may reduce the effectiveness of cancer therapy. We recommend that antioxidants like vitamin C not be given as a supplement during radiation or chemotherapy that relies on oxidation to work properly. Please discuss with your child's health-care provider whether it is safe to give an antioxidant to your child during their cancer therapy.</p> <h2>Can I give my child a multivitamin during their chemotherapy or radiation therapy?</h2> <p>Various ingredients in multivitamin products may interact with cancer therapy or may be unsafe during cancer treatment (for example, vitamin C, vitamin E, folic acid, iron). Before giving your child a multivitamin, ask your health-care provider to review if a multivitamin is safe and beneficial for your child during cancer therapy.</p> <h2>While my child receives cancer therapy, should I avoid spices and herbs in cooking?</h2> <p>No. Spices that are used in normal amounts in cooking do not pose a risk for an interaction with chemotherapy.</p> <h2>While my child receives cancer therapy, can I give my child a probiotic supplement?</h2> <p>No. Probiotic supplements are natural health products which contain purified bacteria in large quantities and may not be safe for children during cancer therapy.</p> <h2>While my child receives cancer therapy, can I give my child foods that contain probiotics such as yogurt, infant formula and cereals?</h2> <p>Yes. The amounts of probiotics found in foods supplemented with probiotics should not pose a risk to your child.</p> <h2>How do I know if a natural health product can interact with chemotherapy drugs or other prescription drugs?</h2> <p>It is important to talk to the health-care providers that your child sees at the hospital or cancer clinic before giving your child any natural health product.</p><p>Health Canada. (2011, November 14). Drugs and Health Products. Retrieved January 2013 from http://www.hc-sc.gc.ca/dhp-mps/prodnatur/applications/licen-prod/lnhpd-bdpsnh-eng.php</p> <p>Memorial Sloan-Kettering Cancer Center. (n.d.). About Herbs, Botanicals & Other Products. Retrieved January 2013 from http://www.mskcc.org/cancer-care/integrative-medicine/about-herbs-botanicals-other-products</p> <p>Reynolds, S. (2009). Dietary Supplements and Cancer Treatment: A Risky Mixture. <i>NCI Cancer Bulletin</i>, <i>6</i>(16), 6. Retrieved from http://www.cancer.gov/ncicancerbulletin/archive/2009/081109/page6</p> <p>Jellin JM, Gregory PJ et al. (2004). Pharmacist's Letter/Prescriber's Letter Natural Medicines Comprehensive Database. 12th ed. Stockton, CA: Therapeutic Research Faculty.</p>https://assets.aboutkidshealth.ca/AKHAssets/natural_health_products_cancer_treatment.jpg
Nausea and vomitingNNausea and vomitingNausea and vomitingEnglishPregnancyAdult (19+)BodyReproductive systemConditions and diseasesPrenatal Adult (19+)Nausea;Vomiting2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC11.600000000000042.3000000000000820.000000000000Flat ContentHealth A-Z<p>Read about nausea and vomiting during pregnancy, including a severe form of nausea and vomiting called hyperemesis gravidarum.</p><p>Nausea and vomiting affect about 50% to 90% of women who are pregnant. This condition, commonly referred to as “morning sickness,” is usually mild or moderate. Nausea and vomiting usually starts between weeks four and seven of pregnancy, and continues for much of the first trimester. Most women are free of symptoms by week 20.</p><h2>Key points</h2> <ul><li>Most women will experience mild or moderate nausea or "morning sickness," however some women may experience a severe form called hyperemesis gravidarum.</li> <li>Nausea and vomiting, including hyperemesis gravidarum, does not appear to have an adverse effect on the outcome of pregnancy or the baby’s health as long as the mother can keep hydrated.</li> <li>The treatment of nausea and vomiting in pregnancy depends on how severe the symptoms are.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/nausea_and_vomiting.jpg
Nausea and vomiting after a blood and marrow transplantNNausea and vomiting after a blood and marrow transplantNausea and vomiting 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 Peds7.4000000000000066.4000000000000469.000000000000Flat ContentHealth A-Z<p>Learn how you can help your child deal with nausea and vomiting, after a blood and marrow transplant (BMT).</p><p>Prior to your child’s blood and marrow transplant (BMT), they receive high-dose chemotherapy and/or total body irradiation (TBI). Both of these treatments can cause nausea and <a href="/article?contentid=746&language=English">vomiting</a>. </p> <p>Other causes of nausea and vomiting may include:</p> <ul> <li>infections</li> <li>medicines that treat infections (for example, Septra®)</li> <li>mucous drainage from mouth and sinuses</li></ul> <p>It is important to let your health care team know if your child is experiencing any discomfort. They rely on you for feedback and can help you find ways to relieve your child’s pain.<br></p><h2>Key points</h2> <ul><li>High-dose chemotherapy and total body irradiation (TBI) can cause nausea and vomiting.</li> <li>There are several ways to cope with nausea and vomiting including medications and non-medication methods.</li> <li>If your child is unable to eat or drink, they may be given a nutrition mixture called total parenteral nutrition (TPN).</li></ul>
Neck painNNeck painNeck painEnglishOrthopaedics/MusculoskeletalToddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)NeckSkeletal muscleConditions and diseasesCaregivers Adult (19+)NA2019-07-22T04:00:00ZElizabeth Berger, BA, MD, FRCPC, FAAP, MHPE; Shawna Silver, MD, FRCPC, FAAP, PEng7.0000000000000068.5000000000000572.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn how to identify neck pain in your child and properly care for them until they are feeling better.</p><h2>What is neck pain?</h2> <p>Neck pain can be caused by many different illnesses or conditions. It may be caused by a muscle strain. A less common cause of neck pain is <a href="/Article?contentid=777&language=English">swollen glands</a> reacting to a viral or other infection. Monitor your child's pain closely. Persistent or worsening neck pain can be a sign of a more serious problem.</p><h2>Key points</h2><ul><li>Neck pain is usually caused by a muscle strain.</li><li>Symptoms can include pain in the back of the neck and limited movement of the neck.</li><li>Give your child acetaminophen or ibuprofen as directed on the bottle to treat pain.</li><li>If your child has a stiff neck and a fever over 38°C (100.4°F), go to the nearest Emergency Department. These may be early signs of meningitis.</li></ul><h2>Signs and symptoms </h2> <ul> <li>pain in the back of the neck</li> <li>pain around the shoulder blades</li> <li>limited movement of the neck</li> <li>holding the head stiffly </li> <li>tilting the head slightly to one side</li> <li>swollen glands that are tender to the touch </li> </ul> <p>If your child has a stiff neck, they may find it difficult to touch their chest with their chin. A stiff neck and a fever may be early signs of <a href="/Article?contentid=761&language=English">meningitis</a>.</p><h2>Causes </h2> <p>Neck pain is most often caused by a muscle strain. Your child may have strained their neck by sleeping awkwardly or turning their head quickly. They may have been sitting in front of the computer for long periods of time, playing sports or doing other activities.</p> <p>If your child injured their neck in a car accident, trampoline fall, high-impact activity or other serious accident, call 911 right away.</p><h2>Treatment for neck pain caused by muscle strain</h2> <h3>Pain relief</h3> <p>Give your child <a href="/Article?contentid=62&language=English">acetaminophen</a> or <a href="/Article?contentid=153&language=English">ibuprofen</a> as directed by your child's doctor until they have 24 hours without any pain. </p> <h3>Heat</h3> <p>Apply a hot water bottle or heating pad to your child's neck for 20 minutes. This will help relieve muscle spasm. Repeat this up to six times daily if needed.</p> <h3>Sleeping position</h3> <p>Instead of using a pillow, have your child sleep with a "soft collar" or a rolled towel around their neck. This will stop their head from moving too much when they are sleeping. A "bean-bag" or buck-wheat-filled pillow may also help.</p> <h3>Exercise</h3> <p>Your child should avoid any neck exercises or physical activity until they are feeling better. Impact or high-risk sports should be avoided until they can move their neck without pain.</p> <h3>Prevention</h3> <p>Encourage your child to stretch the muscles in their neck before any physical activity. Helpful exercises include:</p> <ul> <li>touching the chin to each shoulder</li> <li>touching the ear to each shoulder</li> <li>slowly moving the head forward and backward</li> </ul> <p>Do not apply any resistance to the head during these exercises.</p><h2>When to see a doctor</h2> <p>Make an appointment with your child's doctor if:</p> <ul> <li>the pain is unexplained and lasts three or four days </li> <li>the pain disappears for short periods of time but keeps coming back</li> <li>your child finds it hard to carry out daily activities</li> </ul> <p>Go to the nearest Emergency Department or call 911 if:</p> <ul> <li>the pain is severe and lasts more than two hours after taking pain medication</li> <li>numbness occurs in the arms or back</li> <li>your child has a stiff neck and a fever over 38°C (100.4°F)</li> <li>your child is drooling excessively or has difficulty swallowing</li> <li>your child is acting very sick</li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/neck_pain.jpg
Necrotizing enterocolitis (NEC)NNecrotizing enterocolitis (NEC)Necrotizing enterocolitis (NEC)EnglishNeonatology;GastrointestinalPremature;Newborn (0-28 days);Baby (1-12 months)Stomach;Small Intestine;Large Intestine/Colon;EsophagusDigestive systemConditions and diseasesPrenatal Adult (19+) CaregiversNA2018-11-20T05:00:00ZHailey Barootes, MBChB (Hons), BSc (Hons);Aideen Moore, MD, FRCPC, MRCPI, MHSc;Nicole de Silva, RN, BScN, MSc9.7000000000000050.30000000000001333.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Necrotizing enterocolitis (NEC) is a rare but serious disease that affects the bowels of premature or newborn infants. Learn more about the symptoms, causes and treatment of the condition.</p><p>Necrotizing enterocolitis (NEC) is a condition that typically affects the <a href="/Article?contentid=1467&language=English">small or large bowels (intestines)</a> of babies who are born prematurely or at a low birth weight (<1500g). NEC can also affect full-term infants who have underlying health problems, such as heart defects or serious infections. NEC may affect only one part of the bowel or it may affect several parts. In rare cases, it can affect the entire bowel. </p><p>NEC causes inflammation and infection of the bowels. This disrupts the blood supply to the gut, making the bowels become very weak. In severe cases, the bowel becomes so weak that a hole forms (perforation). This hole allows bacteria and waste products, which are normally contained in the bowels, to leak into the abdomen and cause a dangerous infection. </p><p>NEC can be a life-threatening disease; however, most babies respond well to treatment. The bowel recovers and resumes normal function in most babies.</p> <figure class="asset-c-100"><span class="asset-image-title">Necrotizing enterocolitis (NEC)</span><img src="https://assets.aboutkidshealth.ca/akhassets/NEC_V7.png" alt="Cross section of healthy small intestine compared to cross section of NEC intestine showing inflamed wall with gas bubbles" /><figcaption class="asset-image-caption">Necrotizing enterocolitis is a condition that affects the small or large intestine (bowels) of premature or low birth weight babies. A portion of the bowel can become inflamed and infected. This can cut off blood flow causing the bowel to become weak and damaged.</figcaption> </figure><h2>Key points</h2><ul><li>Necrotizing enterocolitis (NEC) is a condition that affects the small or large intestines of newborn infants. Most commonly, it affects those born prematurely or with low birth weight.</li><li>Several factors can increase a newborn’s risk of developing NEC, including: prematurity, formula feeding, difficult birth delivery, and an overgrowth of germs or bacteria in the intestines.</li><li>Symptoms of NEC include poor feeding, a swollen belly and bloody stools.</li><li>Treatment depends on the severity of the disease. NEC may be treated with antibiotics or in some cases, surgery to remove the affected bowel.</li><li>Most babies respond well to treatment and grow up without any bowel problems.</li></ul> <h2>Signs and symptoms of NEC</h2><p>NEC usually occurs three to ten days following birth. Signs and symptoms of NEC include:</p><ul><li>a red, swollen belly</li><li>problems tolerating feeds</li><li>bloody stools, including diarrhea containing blood</li><li>vomit, containing bile<br></li><li>irregular breathing</li><li>low blood pressure</li><li>a high, low or unstable temperature.</li></ul><p>Diagnosing NEC can be difficult since its symptoms, such as not tolerating feeds, vomiting, and altered bowel movements, are similar to signs of other less serious bowel conditions.</p><h2>Causes and risk factors of NEC</h2><p>While NEC can occur in any newborn baby, most cases are seen in premature babies. It is estimated that NEC affects approximately 5% of infants weighing less than 1500 grams at birth.</p><p>It is not known exactly what causes NEC, but several different factors may contribute.</p><h3>Prematurity</h3><p>Babies born <a href="/prematurebabies">prematurely</a> typically have underdeveloped immune systems and may not be able to fight infection on their own. The lower the birth weight, the more at risk a premature baby is of developing NEC.</p><h3>Formula feeding</h3><p>Babies who are given breast milk have a lower chance of developing NEC.</p><h3>Difficult delivery</h3><p>In some difficult deliveries, not enough blood, oxygen and nutrients get to the bowels. The lack of oxygenated blood to the bowels can cause damage to the intestinal wall.</p><h3>Bacteria growth</h3><p>A premature baby’s immature immune system is not able to protect the bowels from an overgrowth of bacteria and germs. This can cause swelling and infection. Taking antibiotic medication for more than ten days may also impact bacterial growth in the bowel, increasing the risk of developing NEC.</p><h2>Diagnosis of NEC</h2><p>An abdominal X-ray is used to confirm a diagnosis of NEC and to determine how severe it is. Doctors will look for swelling of the bowels, gas in the bowel walls (pneumatosis intestinalis) and free air in the belly (air outside of the bowels), which indicates that a hole has formed in the weak bowel. </p> <figure class="asset-c-100"> <span class="asset-image-title">Necrotizing enterocolitis (NEC) abdominal X-ray</span> <img src="https://assets.aboutkidshealth.ca/akhassets/NEC_pneumatosis_XRAY_MEDIMG_PHO_EN.png" alt="X-ray of healthy small and large intestines and x-ray of intestine affected by necrotizing enterocolitis" /> <figcaption class="asset-image-caption">In necrotizing enterocolitis, there is typically swelling of the bowels, gas in the bowel walls and free air in the abdomen (belly). This makes the baby’s belly appear swollen. </figcaption> </figure> <p>An ultrasound of the abdomen can also help confirm NEC by identifying parts of the bowel that have become thinner or if there is a change in blood flow to certain parts of the bowel.</p><p>NEC can significantly affect the absorption of nutrients into the body and the removal of waste products. In addition to imaging scans, a baby with suspected NEC will have blood tests to check for:</p><ul><li>evidence of infection (white blood cell count, blood culture, c-reactive protein)</li><li>the balance of nutrients and chemicals in their blood.</li></ul><h2>Treatment of NEC</h2><p>When there is a concern that a baby may have NEC or when the diagnosis has been confirmed, the baby is not given any food into their stomach. Liquids and nutrients (fat, sugar and salt) are given intravenously. A tube is placed into the stomach, either through the nose — <a href="/Article?contentid=984&language=English">nasogastric (NG)</a> — or the mouth — orogastric (OG) — to remove any extra liquids or air. Babies may be given IV (intravenous) antibiotics to treat the infection. The baby will be on antibiotics for seven to 14 days. In most cases, this treatment is effective and surgery will not be required. </p><p>About one third of babies may need surgery to remove the diseased bowel. In most surgical cases, the diseased bowel is removed and the healthy pieces are joined back together. </p><p>However, if there is disease in several areas of the bowel the surgeon may pull the end of the healthy section through the abdomen, creating an opening in the skin called an ostomy. Stool or poop will pass through the ostomy into a bag. This allows the affected areas of the bowel to heal. </p> <figure class="asset-c-100"> <span class="asset-image-title">Surgery as treatment for necrotizing enterocolitis (NEC)</span><img src="https://assets.aboutkidshealth.ca/akhassets/NEC_surgeryv2.png" alt="Removing diseased part of bowel and creating ostomy in first surgery and joining cut ends of bowel in second surgery" /><figcaption class="asset-image-caption">One third of babies with NEC may require surgery for treatment. Two separate surgeries will be performed. The first surgery is to remove the diseased part of the bowel (1a). A healthy end of the bowel will then be attached to the abdomen, creating an opening in the skin called an ostomy (1b). After several weeks a second surgery will attach the end of the bowel used for the ostomy to another healthy end of the bowel.</figcaption> </figure> <p>Once the bowel has healed, the baby will need a second surgery to close the stoma and reconnect the healthy section to the healed part of the bowel. Your child will no longer have an ostomy and will be able to pass stool normally through the anus.<br></p><p>While your baby’s bowel heals, fluids and nutrients will be given by IV into their bloodstream. Once the bowel becomes healthy enough, approximately one to two weeks after treatment, your baby may be fed milk through an NG tube into their stomach. </p><p>If possible, it is best to feed your baby breast milk once they can receive feedings again.</p><p>SickKids Neonatology Clinic: <a href="http://www.sickkids.ca/Neonatology/">http://www.sickkids.ca/Neonatology/</a></p><p>American Pediatric Surgical Association: <a href="https://eapsa.org/parents/conditions/f-o/necrotizing-enterocolitis-%28nec%29/">https://eapsa.org/parents/conditions/f-o/necrotizing-enterocolitis-(nec)/</a> </p><p>Children’s Hospital Los Angeles: <a href="https://www.chla.org/necrotizing-enterocolitis">https://www.chla.org/necrotizing-enterocolitis</a></p><p>The Children’s Hospital of Philadelphia: <a href="https://www.chop.edu/conditions-diseases/necrotizing-enterocolitis">https://www.chop.edu/conditions-diseases/necrotizing-enterocolitis</a><br></p><p>Gephart SM, McGrath JM, Effken JA, Halpern MD. Necrotizing Enterocolitis Risk: State of the Science. Adv Neonatal Care 2012; 77–89.</p><p>Neu J. Neonatal Necrotizing Enterocolitis. Karger Publishers, 2013: 122–7.</p><p>Alexander V, Northrup V, Bizzarro M. Antibiotic Exposure in the Newborn Intensive Care Unit and the Risk of Necrotizing Enterocolitis. The Journal of Pediatrics 2011; 392-397.</p><p>Necrotizing Enterocolitis. Child. Hosp. Los Angeles. 2016. <a href="https://www.chla.org/necrotizing-enterocolitis">http://www.chla.org/necrotizing-enterocolitis</a> (accessed June 22, 2018).</p><p>Necrotizing Enterocolitis (NEC). Am. Pediatr. Surg. Assoc. http://www.pediatricsurgerymd.org (accessed June 22, 2018).</p>https://assets.aboutkidshealth.ca/akhassets/NEC_V7.png
Needing a brace after scoliosis surgeryNNeeding a brace after scoliosis surgeryNeeding a brace after scoliosis surgeryEnglishOrthopaedics/MusculoskeletalChild (0-12 years);Teen (13-18 years)Vertebrae;SpineMuscular system;Skeletal systemNon-drug treatmentAdult (19+)NA2008-06-01T04:00:00ZSandra Donaldson, BA;Andrew Howard, MD, MSc, FRCSC;James G. Wright, MD, MPH, FRCSC7.4000000000000067.3000000000000587.000000000000Flat ContentHealth A-Z<p>Following scoliosis surgery, some teenagers may need to wear a brace. Learn about how the brace is made, and why and when it is used.</p><p>After spinal surgery, some surgeons will prescribe a brace to help support your teen’s spine and ribs as they are healing. The pressure of this spinal brace on your teen’s abdomen will also provide some pain relief. </p><h2> Key points </h2> <ul><li>After spinal surgery, some surgeons will prescribe a brace to help support your teen’s spine and ribs as they are healing. </li> <li>Your teen will be measured for and will receive their brace about five days after surgery. They will gradually build up their wear time over the course of a week to 20 to 22 hours per day. They will need to wear this spinal brace for approximately two to four months after surgery.</li> <li>A San-Splint spinal brace is made of plastic with a cotton corset and is the most common spinal brace used after surgery.</li> <li>Your teen will see her orthotist within two weeks of discharge from the hospital. It is common to have swelling in the abdomen in the first few weeks after surgery. Once the swelling goes down, the spinal brace will be re-molded.</li> <li>The post-operative spinal brace is approximately $700.00. It is not covered by the government’s Assistive Devices Program but most private insurance policies will cover the cost.</li></ul>https://assets.aboutkidshealth.ca/akhassets/SpinalBrace_EN.jpg
Needle pokes: Reducing pain in children aged 18 months or overNNeedle pokes: Reducing pain in children aged 18 months or overNeedle pokes: Reducing pain in children aged 18 months or overEnglishPain/AnaesthesiaToddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)BodyNervous systemNon-drug treatmentCaregivers Adult (19+)NA2018-12-18T05:00:00ZLorraine Bird, RN, BScN, APN;Fiona Campbell, BSc, MD, FRCA(UK);Mary McAllister, RN, BScN, MHSc, PhD (c), NNP7.5000000000000071.9000000000000696.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Find out how to reduce the pain of needle pokes in children aged 18 months or over.<br></p><p>Your child might need a needle poke to receive a vaccine, have blood work or receive fluids intravenously (through an IV) during a hospital visit. All these procedures are important for protecting or helping to treat your child, but they can cause pain. This can be stressful for both children and parents.</p><p>You can use a number of methods to help reduce the pain and anxiety associated with needle pokes. These include numbing cream, distractions and comfort positions.</p><div class="asset-video"> <iframe src="https://www.youtube.com/embed/TGGDLhmqH8I?rel=0" frameborder="0"></iframe> </div><h2>Key points</h2><ul><li>Needle pokes (such as vaccines, blood work and IV starts) can cause pain, which can be stressful both for children and parents.</li><li>There are methods you can use to help reduce your child’s pain and distress during needle pokes.</li><li>Before the procedure you can use a topical anaesthetic and distract your child.</li><li>During the procedure, you can hold your child, rub your child's skin and stay calm.<br></li></ul><h2>Planning ahead</h2><h3>Talk to your doctor</h3><p>Discuss your plan to ease your child's pain with your child’s healthcare team so they can support you.</p><h3>Talk to your child</h3><p>If your child is aged four years or older, talk to them about the needle poke ahead of time in language they can easily understand.<br></p><ul><li>Tell your child what is going to happen, for example, “The doctor is going to use a needle to give you a vaccine in your arm."</li><li>Explain why your child needs the needle poke, for instance, “The vaccine will protect you from getting sick."</li><li>Describe how the needle poke will feel, for example, “It might feel like a little pinch."</li><li>Say what will be done to manage your child’s pain, for instance, "We’ll play a game so you don’t notice the needle poke much."<br></li></ul> <h2>During the needle poke</h2><h3>Hold your child</h3><p> <a href="/Article?contentid=3629&language=English">Holding your child</a> comfortably in your lap helps to calm them during their needle pokes and encourages them to stay still.</p><h3>Rub your child's skin</h3><p>Rub your child's arm before, during and after the needle poke. As you rub an area of the arm away from the injection site, the feeling of touch from your hand competes with the pain your child experiences from the needle. This will help reduce your child's perception of pain.</p><h3>Stay calm</h3><p>If you are feeling anxious before and during your child’s needle poke, your child is likely to pick up on it and feel anxious themselves. Even though you may be nervous about the procedure, try your best to remain calm. Use your normal speaking voice and take slow, deep breaths.</p><p>For more detailed information on these suggestions, especially for vaccinations, please download the fact sheet <a href="https://immunize.ca/sites/default/files/Resource%20and%20Product%20Uploads%20%28PDFs%29/Products%20and%20Resources/Pain%20Management/Parents/painreduction_under3_web_e.pdf" target="_blank"><em>Reduce the pain of vaccination in children under 3 years</em></a> or <a href="https://immunize.ca/sites/default/files/Resource%20and%20Product%20Uploads%20%28PDFs%29/Products%20and%20Resources/Pain%20Management/Parents/painreduction_kidsandteens_web_e.pdf" target="_blank"><em>Reduce the pain of vaccination in kids and teens</em>.</a><br></p><h2>Before the needle poke<br></h2><h3>Numbing cream</h3><p>You can help reduce the pain of needle pokes by applying a topical anaesthetic (<a href="/Article?contentid=3627&language=English">numbing cream</a> or gel) to the area where your child will receive their vaccine. In Canada, numbing creams are available over the counter.</p><ul><li>Discuss this option with your child’s team in advance.</li><li>Make sure your child is not allergic to any ingredients in the numbing cream or gel.</li><li>Apply the numbing cream or gel 30 to 60 minutes before the needle poke, according to the specific product's instructions. Once it is applied, the cream lasts up to three hours.<br></li></ul><h3>Distract your child</h3><p>Use items such as favourite toys, mobile devices or bubbles to help <a href="/Article?contentid=3629&language=English">distract your child</a> during needle pokes. You can also sing, talk or tell jokes to distract them from any pain they might be experiencing.</p><p>Your healthcare team can also offer you items from a <a href="/Article?contentid=1258&language=English">comfort kit</a> to help distract your child. Ask your healthcare provider about the kit before your appointment.</p><h2>Further information</h2><p>​For more information about the Comfort Promise bundle of options to reduce the pain of needle pokes, please see the following pages:</p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=989&language=English">Needle pokes: Reducing pain in infants aged up to 18 months</a><br></p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=1258&language=English">Pain relief: Comfort kit</a><br></p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=3627&language=English">Needle pokes: Reducing pain with numbing cream</a><br></p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=3628&language=English">Needle pokes: Reducing pain with sucrose or breastfeeding</a></p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=3629&language=English">Needle pokes: Reducing pain with comfort positions and distraction</a><br></p>https://assets.aboutkidshealth.ca/AKHAssets/pain_free_injections_children.jpg
Needle pokes: Reducing pain in infants aged up to 18 monthsNNeedle pokes: Reducing pain in infants aged up to 18 monthsNeedle pokes: Reducing pain in infants aged up to 18 monthsEnglishPain/AnaesthesiaNewborn (0-28 days);Baby (1-12 months);Toddler (13-24 months)BodyNervous systemNon-drug treatment;Procedures;Drug treatment;SymptomsCaregivers Adult (19+)Pain2018-12-18T05:00:00ZLorraine Bird, RN, BScN, APN;Fiona Campbell, BSc, MD, FRCA(UK);Mary McAllister, RN, BScN, MHSc, PhD (c), NNP7.8000000000000067.1000000000000661.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Find out how to reduce the pain of needle pokes for your baby.<br></p><p>Your infant might need a needle poke to receive a vaccine, have blood work or receive fluids intravenously (through an IV) during a hospital visit. All these procedures are important for protecting or treating your child, but they can cause pain. This can be stressful both for children and parents. </p><p>You can use a number of methods to help reduce the pain and anxiety associated with needle pokes. These include numbing cream, distractions, sucrose, breastfeeding and comfort positions.<br></p> <span class="asset-image-title">Reduce the pain of vaccination in babies</span> <div class="asset-video"> <iframe src="https://www.youtube.com/embed/5Oqa1Fag5eQ?rel=0" frameborder="0"></iframe> <br></div><h2>Key points</h2><ul><li>Needle pokes can be painful, which can cause stress both for babies and parents.</li><li>Before a needle poke, you can help reduce your baby’s pain and anxiety by using a numbing cream, distracting your baby, and/or using sucrose or breastfeeding.</li><li>During a needle poke, you can calmly hold your baby and/or breastfeed them.<br></li></ul><br><h2>Planning ahead</h2><p>Discuss your plan for pain reduction with your health-care team so they can support you.</p><h2>During the needle poke</h2><h3>Hold your infant</h3><p><a href="/Article?contentid=3629&language=English">Holding your infant</a> helps comfort them and keep them still during the needle poke.</p><h3>Breastfeed your infant</h3><p><a href="/Article?contentid=3628&language=English">Breastfeeding</a> before, during and after a needle poke is another option to reduce pain. It distracts your baby, allows you to hold them and provides a sweet taste, all of which soothe your baby. If you do not breastfeed, you can still comfort your baby with bottle feeding or sucrose.</p><h3>Stay calm</h3><p>If you are anxious before and during your baby’s needle poke, your baby might also feel more anxious. Even though you may be nervous about the procedure, try your best to remain calm. Use your usual speaking voice and take slow, deep breaths.</p><p>For more detailed information on these suggestions, especially for vaccinations, please download the fact sheet <a href="https://immunize.ca/sites/default/files/Resource%20and%20Product%20Uploads%20%28PDFs%29/Products%20and%20Resources/Pain%20Management/Parents/painreduction_under3_web_e.pdf" target="_blank"> <em>Reduce the pain of vaccination in children under 3 years</em></a> from Immunize Canada.<br></p><h2>Before the needle poke<br></h2><h3>Numbing cream<br></h3><p>You can help reduce the pain of needle pokes by applying a topical anaesthetic (<a href="/Article?contentid=3627&language=English">numbing cream</a> or gel) to the area where the needle will be inserted. In Canada, numbing creams are available over the counter.<br></p><ul><li>Discuss this option with your infant’s healthcare team in advance.</li><li>Make sure your infant is not allergic to any ingredients in the numbing cream or gel.</li><li>Apply the numbing cream or gel 30 to 60 minutes before the needle poke. Once it is applied, the cream lasts up to three hours.</li></ul><h3>Distracting your infant<br></h3><p>Use items such as toys, pacifiers or bubbles to help <a href="/Article?contentid=3629&language=English">distract your infant</a> during needle pokes. You can also sing, talk or direct your infant’s attention to other things in the room so they are not focused on the procedure and pain.</p><p>Your healthcare team can also offer you items from a <a href="/Article?contentid=1258&language=English">comfort kit</a> to help distract your child. Ask your healthcare provider about the kit before your appointment.</p><h3>Sucrose</h3><p>A small amount of <a href="/Article?contentid=3628&language=English">sucrose solution</a> (sugar water) one to two minutes before a needle poke has been shown to reduce pain in infants.</p><ul><li>To make your own sucrose solution, mix one packet of sugar with two teaspoons of water.</li><li>Ask your healthcare provider to give the sucrose. If the healthcare provider asks you to give it, use a syringe or dropper to place it one drop at a time onto the front of your baby's tongue. You can also dip your infant's pacifier into the sucrose.<br></li><li>Only use sucrose to relieve the pain of needle pokes. It is not safe to use it simply to calm infants.</li></ul><h2>Further information</h2><p>​For more information about the Comfort Promise bundle of options to relieve the pain of needle pokes, please see the following pages:</p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=990&language=English">Needle pokes: Reducing pain in children aged 18 months or over</a></p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=1258&language=English">Pain relief: Comfort kit</a><br></p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=3627&language=English">Needle pokes: Reducing pain with numbing cream</a></p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=3628&language=English">Needle pokes: Reducing pain with sucrose or breastfeeding</a></p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=3629&language=English">Needle pokes: Reducing pain with comfort positions and distraction</a><br></p>infantneedlepokeshttps://assets.aboutkidshealth.ca/AKHAssets/pain_free_injection_babies.jpg
Needle pokes: Reducing pain with comfort positions and distractionNNeedle pokes: Reducing pain with comfort positions and distractionNeedle pokes: Reducing pain with comfort positioning and distractionsEnglishPain/AnaesthesiaChild (0-12 years);Teen (13-18 years)NANANon-drug treatment;Procedures;SymptomsAdult (19+) CaregiversPain2018-12-18T05:00:00ZLorraine Bird, RN, BScN, APN;Fiona Campbell, BSc, MD, FRCA(UK);Mary McAllister, RN, BScN, MHSc, PhD (c), NNP; Natalie Wilson, CCLS; Leanne Brister, CCLS8.0000000000000060.6000000000000689.000000000000Flat ContentHealth A-Z<p>​Find out how you can use comfortable positions and distractions with your child to ease pain from needle pokes.<br></p><h2>Key points</h2> <ul><li>​Use age-appropriate comfort positions and distractions, along with other forms of pain relief, to help your child cope with needle pokes.</li><li>Infants and young children can be held chest to chest or back to chest. Older children and teens should, ideally, sit upright.</li><li>Some children and teens may benefit from holding a comfort object such as a blanket or stuffed animal.<br></li><li>Distractions can include light-up and brightly coloured toys for infants through to drawing, books, video games and deep breathing for older children and teens.<br></li></ul><h2>Further information</h2><p>​For more information about the Comfort Promise bundle of options to reduce the pain of needle pokes, please see the following pages:</p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=989&language=English">Needle pokes: Reducing pain in infants aged up to 18 months</a></p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=990&language=English">Needle pokes: Reducing pain in children aged 18 months or over</a><br></p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=1258&language=English">Pain relief: Comfort kit</a></p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=3627&language=English">Needle pokes: Reducing pain with numbing cream</a></p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=3628&language=English">Needle pokes: Reducing pain with sucrose or breastfeeding</a><br></p> https://assets.aboutkidshealth.ca/AKHAssets/playtime_at_hosptial_school-aged.jpg
Needle pokes: Reducing pain with numbing creamNNeedle pokes: Reducing pain with numbing creamNeedle pokes: Reducing pain with numbing creamEnglishPain/AnaesthesiaChild (0-12 years);Teen (13-18 years)NANADrug treatmentCaregivers Adult (19+)Pain2018-12-18T05:00:00ZLorraine Bird, RN, BScN, APN;Fiona Campbell, BSc, MD, FRCA(UK);Mary McAllister, RN, BScN, MHSc, PhD (c), NNP5.3000000000000081.50000000000001111.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn when, where and how to apply numbing cream to ease the pain of needle pokes for your child.</p><p>​To help reduce needle poke pain, your child may benefit from numbing cream. You can buy numbing cream over-the-counter at your local pharmacy without any prescription.</p><h2>Key points</h2><ul><li>​Numbing creams help reduce the pain of a needle poke when placed on your child's skin.</li><li>Apply numbing cream to the needle site at least 30 minutes in advance and cover it with plastic wrap or a clear bandage.</li><li>Never apply numbing cream to an open wound such as a cut or scratch.</li><li>Call your child's health-care team if you are not sure where to place the cream, if your child develops a skin reaction or if any cream gets in your child's mouth or eyes.</li></ul><h2>Does numbing cream have any side effects?</h2><p>When used as directed, numbing cream has few side effects.</p><ul><li>Your child’s skin may be whiter for a short time. This is normal.</li><li>Your child may develop itching, redness or a rash. If this happens, remove the cream and contact your child's health-care provider for further instructions.</li></ul> <h2>Do I need to take any safety precautions with numbing cream?</h2><h3>Expiry dates</h3><p>To make sure the cream is still safe to use, check the expiry date on the tube before you apply it.</p><h3>Disposing of numbing cream</h3><p>Ask your pharmacist what to do with expired or unused cream. If the pharmacy does not have a "take back" program, empty the tube of cream into the trash.</p><h3>Storing numbing cream</h3><p>Store numbing cream in its original container out of children’s reach and away from direct sunlight, heat and humid places such as the bathroom. Make sure any caps are closed tightly and, if possible, lock the cream away with other medicines.</p><h2>When should I call the health-care team?</h2><p>Call the health-care team if:</p><ul><li>you have questions about where to place the cream or about the health of a site, for instance if there’s a small scrape or cut where the cream should be applied</li><li>your child shows signs of a skin reaction, such as redness, itching or a rash</li><li>your child gets the cream in their mouth or eyes. In this case, call the health-care provider only after rinsing the area with plain water.</li></ul><p>Call 911 <strong>immediately</strong> if your child shows signs of an allergic reaction to the cream. These include:</p><ul><li> <a href="https://www.aboutkidshealth.ca/Article?contentid=30&language=English">fever</a> or chills</li><li> <a href="https://www.aboutkidshealth.ca/Article?contentid=789&language=English">hives</a></li><li>swelling<br></li><li>wheezing or shortness of breath.</li></ul><h2>How do numbing creams work?</h2><p>Numbing creams (also called topical anaesthetics) contain lidocaine. When placed on your child’s skin they numb the area, so helping to reduce the pain of a needle poke.</p><h2>When to apply numbing cream</h2><p>For best results, put the cream onto the skin at least 30 minutes before the needle poke. It can be left on your child’s skin for up to two hours.</p><h2>Where to apply numbing cream</h2><p>The area where you apply the cream is called a site.</p><h3>For needle pokes and IV starts</h3><p>Common sites include the inside forearm or the top of the hand.</p><h3>For vaccines</h3><p>The site will depend on your child’s age, the size of the needle and the type of vaccine. The most common sites include the deltoid (upper arm) or the front outer side of the thigh.</p><p>Sometimes your child will have a needle poke in more than one site on the same day. Before you apply the cream, make sure you confirm the correct site(s) with your child's health-care provider.</p><h2>How to apply numbing cream</h2><ol><li>Wash and dry the site where your child will receive the needle poke. <strong>Never</strong> put the cream on an open wound such as a cut or scratch.</li><li>If opening a new tube of cream, use the point on the top of the cap to break the seal over the tube.</li><li>Put the correct amount of cream on the site: <ul><li>a dime-sized spot if child weighs less than 22 pounds (10 kg)</li><li>a quarter-sized spot if child weighs 22 pounds (10 kg) or more.</li></ul></li><li>Cover each site with plastic wrap or a clear bandage (such as Tegaderm®) to keep cream in place and prevent your child from touching it and getting it in their mouth or eyes. </li><ul><li>If using a clear bandage, remove the center cut-out piece and leave on the paper frame.</li><li>Peel the paper liner off.</li><li>Holding the paper frame, cover the cream, but do not press down on the centre. The cream works better in a thick layer.</li><li>Smooth down the edges of the clear bandage.</li><li>Remove the paper frame. </li></ul><li>Once the cream is covered, it works best if it is not touched. Do not let your child chew, suck or prod it.</li><li>If cream oozes out from under the covering, wipe it away with a cloth. <strong>Avoid contact with the mouth, eyes or nose.</strong> Rinse your hands with water after applying the cream.</li></ol><h2>How do I prepare my child?</h2><p>Explain to your child that the cream will be put on their skin and covered up while it works. Just before the needle poke, the health-care provider will remove the covering. You can tell your child that this might sometimes feel like having a bandage removed. Also tell your child that the cream keeps working for up to an hour after it is wiped off, so they might still feel a slight pressure on their skin after it is removed.</p><h2>At SickKids<br></h2><p>If your child needs support during the procedure, please call the Child Life department or tell your health-care team.</p><h2>Further information</h2><p>​For more information about the Comfort Promise bundle of options to reduce the pain of needle pokes, please see the following pages:</p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=989&language=English">Needle pokes: Reducing pain in infants aged up to 18 months</a><br></p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=990&language=English">Needle pokes: Reducing pain in children aged 18 months or over</a></p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=1258&language=English">Pain relief: Comfort kit</a></p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=3628&language=English">Needle pokes: Reducing pain with sucrose or breastfeeding</a></p><p> <a href="https://www.aboutkidshealth.ca/Article?contentid=3629&language=English">Needle pokes: Reducing pain with comfort positions and distraction</a></p>https://assets.aboutkidshealth.ca/AKHAssets/iStock-1021028232.jpg
Needle pokes: Reducing pain with sucrose or breastfeedingNNeedle pokes: Reducing pain with sucrose or breastfeedingNeedle pokes: Reducing pain with sucrose or breastfeedingEnglishPain/AnaesthesiaBaby (1-12 months);Toddler (13-24 months)NANANon-drug treatment;Procedures;SymptomsCaregivers Adult (19+)Pain2018-12-18T05:00:00ZLorraine Bird, RN, BScN, APN;Fiona Campbell, BSc, MD, FRCA(UK);Mary McAllister, RN, BScN, MHSc, PhD (c), NNP7.0000000000000070.1000000000000960.000000000000Health (A-Z) - ProcedureHealth A-Z<p>​Find out how to offer sucrose or breastfeeding to ease your child's pain from needle pokes.<br></p><p>Sucrose or breastfeeding is effective in helping to block needle poke pain in infants under 18 months.<br></p><h2>Key points</h2><ul><li>Place sucrose solution or sugar water on your child's tongue one or two minutes before a needle poke.</li><li>Do not use sucrose if your infant is premature, has low birth weight, has unstable sugar levels or has a GI disorder.</li><li>If you breastfeed, start feeding your infant two to five minutes before a needle poke and continue feeding until the procedure is finished.</li><li>If you do not breastfeed, you can comfort your child with bottle feeding or sucrose.</li></ul><br><h2>Does sucrose have any side effects?</h2><p>If used as directed, sucrose does not have any side effects.</p><h2>Is sucrose ever unsafe?</h2><p>Sucrose is safe for all babies aged up to 18 months, except those who:<br></p><ul><li>are premature</li><li>have low birth weight</li><li>have unstable sugar levels</li><li>have a gastrointestinal disorder (such as necrotizing enterocolitis).<br></li></ul><p>If you are worried about using sucrose with your infant, ask your health-care team for advice.<br></p><h2>What else do I need to know about sucrose?</h2><p>Only use sucrose to relieve the pain of needle pokes. It is <strong>not safe</strong> to use it simply to calm your infant.<br></p><h2>​How does sucrose ease my infant's pain?</h2><p>When given to infants (babies 18 months or younger), and combined with other forms of pain relief, sucrose can ease pain during procedures such as needle pokes.</p><p>You can buy a tube of 24% sucrose without a prescription or make your own sucrose solution by mixing one packet of sugar with two teaspoons of water.</p><h2>How does breastfeeding ease my infant's pain?</h2><p>Breastfeeding before, during and after needle pokes reduces perceived pain in your baby. It offers your baby the benefits of distraction, being held and tasting something sweet. These all work to soothe them during a needle poke.<br></p><h2>Giving sucrose</h2><p>Ask your health-care team for sucrose before the procedure. Sucrose works best when given <strong>one or two minutes before</strong> a needle poke.</p><p>If you are using a tube of sucrose, squirt one to two drops (0.1 mL total) onto the front of your baby's tongue according to the tube instructions. If you are using your own solution, use a syringe or dropper to place one drop at a time onto the front of their tongue.</p><p>You can also squeeze or place one or two drops of the solution onto a pacifier and let your baby suck on it before and during the needle poke.</p><p>Your baby does not swallow sucrose; they simply absorb it through their mouth. This means you can use sucrose even if your child cannot eat or drink anything before a procedure. Sucrose will also not affect any blood test results.</p><h2>Breastfeeding</h2><p>Start breastfeeding your infant <strong>two to five minutes before</strong> the needle poke. To help your infant stay calm, continue feeding until the needle poke is finished.</p><p>If you do not breastfeed, you can still comfort your baby with bottle feeding or sucrose.<br></p><br> <h2>Further information</h2><p>​For more information about the Comfort Promise bundle of options to reduce the pain of needle pokes, please see the following pages:</p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=989&language=English">Needle pokes: Reducing pain in infants aged up to 18 months</a></p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=990&language=English">Needle pokes: Reducing pain in children aged 18 months or over</a></p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=1258&language=English">Pain relief: Comfort kit</a><br></p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=3627&language=English">Needle pokes: Reducing pain with numbing cream</a></p><p><a href="https://www.aboutkidshealth.ca/Article?contentid=3629&language=English">Needle pokes: Reducing pain with comfort positions and distraction</a></p>https://assets.aboutkidshealth.ca/AKHAssets/breast_feeding_learning_hub.jpg
Neonatal abstinence syndromeNNeonatal abstinence syndromeNeonatal abstinence syndromeEnglishPregnancyAdult (19+)BodyReproductive systemConditions and diseasesPrenatal Adult (19+)NA2009-09-10T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPC11.700000000000040.10000000000001014.00000000000Flat ContentHealth A-Z<p>Read about neonatal abstinence syndrome. In-depth information regarding the effects of certain drugs and available types of treatment are included.</p><p>Neonatal abstinence syndrome is a condition that some babies experience when withdrawing from certain drugs that their mother has taken during pregnancy. When a woman is pregnant and takes one of these drugs, her unborn baby can become accustomed to the drug while in the uterus. Once born, the baby is still dependent on the drug; since the drug is no longer available, the baby experiences withdrawal symptoms.</p><h2>Key points</h2> <ul><li>Neonatal abstinence syndrome refers to withdrawal from illicit drugs, alcohol and certain medications.</li> <li>Symptoms of neonatal abstinence syndrome include excessive crying, tremor, seizures and poor feeding.</li> <li>Swaddling and frequent small feedings of a high calorie formula are common ways to manage this condition.</li> <li>All mothers should consult their physicians when taking a medication during breastfeeding. </li></ul>https://assets.aboutkidshealth.ca/AKHAssets/neonatal_abstinence_syndrome.jpg
Neonatal neurodevelopmental follow-up recommendations: 12 month visitNNeonatal neurodevelopmental follow-up recommendations: 12 month visitNeonatal neurodevelopmental follow-up recommendations: 12 month visitEnglishDevelopmental;NeonatologyBaby (1-12 months)NANANon-drug treatmentAdult (19+) CaregiversNA2018-04-05T04:00:00ZJacqueline Jackson, MN, NP-Paediatrics, RN (EC) (original author);​​Andrea Riekstins, MN, NP-Paediatrics, RN (EC);Jane Brettschneider, M. Sc. (A), Reg. CASLPO;Linh Ly, MD, MEd, FRCPC, FAAP;​​Lori Burton, M.Ed., BSc, O.T. Reg (Ont.);​​Lynelle Phillips, M9.7000000000000048.8000000000000984.000000000000Health (A-Z) - ConditionsHealth A-Z<p>This page provides recommendations to encourage development in babies aged 12 months who have spent time in the NICU or CCCU, or who require care a neonatal follow-up clinic.</p><p>Talking and playing with babies are two of the most important things parents and caregivers can do to help them develop. There are many ways to encourage development. The recommendations provided are general and not all inclusive. The recommendations provide strategies to help promote gross motor skills, fine motor skills, early language development, and socialization.</p><ul><li>Gross motor skills include big movements such as rolling, crawling, standing or walking.</li><li>Fine motor skills include hand movements such as reach and grasp.</li><li>Early language development includes cooing, babbling, and a baby’s first words.</li></ul><h2>Key points</h2><ul><li>Babies who have been in the NICU or CCCU may be at risk for developmental issues due to medical problems before delivery, during delivery or after birth.</li><li>Recommendations at 12 months focus on encouraging standing, developing more intricate fine motor skills, and further encouraging verbal communication.</li><li>Parents and caregivers should follow these recommendations to encourage neurodevelopment.</li></ul><h2>Neonatal neurodevelopmental recommendations at 12 months</h2><h3>Gross motor:</h3><ul><li>Practice standing at a stable surface (e.g. couch) to play. Encourage flat feet when baby is standing. Check to make sure the surface is low enough to promote flat feet.</li><li>Hold your child low on their body (pelvis, thighs, or lower) when practicing standing to help activate stomach muscles.</li><li>Encourage cruising on the floor using furniture as a support by putting toys at one end of the couch and your child at the other. Do this so that your child moves in both directions along the floor.</li><li>Your child benefits more by practicing cruising and early stepping without hand-holding. If you are holding hands, hold hands at or below shoulder level. You can also hold low on the body (pelvis or lower) when practicing stepping.</li><li>Practice gross motor skills, including coordination, on riding toys. In playgrounds practice coordination and climbing over small things on the small climbers and slides.</li><li>Practice ball games such as kicking and throwing. Do not expect catching yet.</li></ul><h3>Fine motor:</h3><ul><li>The high chair is an excellent place to finger feed or practice pincer grasp. Build it into your daily routine. You can sit opposite your child (face-to-face) and enjoy this time together. As you play, verbally label toys to encourage development of early language skills.</li><li>Provide opportunities for container play and introduce shape sorters and simple puzzles for play.</li><li>Practice stacking for refinement of release skills (e.g., nesting cups, rings on pole, small blocks).</li><li>Continue with cause and effect toys that have to be pushed, pulled or turned (e.g., pop-up toy).</li><li>Introduce thick crayons and encourage scribbling. Introduce connecting toys, blocks (e.g., “Duplo”) and a variety of objects with different textures, shapes, sizes for exploration with hands.</li><li>Handedness (left/right) – encourage use of non-dominant hand by presenting toys and objects to non-dominant side.</li></ul><h3>Communication/Social:</h3><ul><li>Be face to face with your baby. Use short phrases and lots of gestures to communicate. Repeat what you say and do.</li><li>Watch what your child is doing, wait, listen and respond. Imitate actions and keep the interaction going.</li><li>Play vocal turn-taking games.</li><li>Make sure there are reasons to communicate; avoid anticipating all of their needs.</li><li>Use simple picture books with real life photos, and books that have “patterns”. Try to read to your baby every day.</li></ul><h3>Play:</h3><ul><li>Functional play – introduce playing with toys/objects as they were intended to be used.</li><li>Encourage pretend play (e.g. feeding a doll or farm animals).</li><li>Provide opportunities for interaction with peers (e.g., Ontario Early-Years Drop-In Centres, library programs or community groups) for greater socialization and early language development.</li><li>Electronic media use by children younger than two years old is not recommended. This includes phones, television, computers, and tablet devices.</li></ul><h3>Feeding/Growth:</h3><ul><li>Continue regular visits to your family doctor/paediatrician to monitor growth.</li><li>Transition to homogenized milk at 12 months corrected age. Avoid juice.</li><li>Present a variety of cubed or chopped foods for finger feeding and introduce own spoon at mealtime.</li></ul><h3>Sleep:</h3><ul><li>Establish a regular sleep schedule and bedtime routine. Consider reading to your child as part of routine.</li><li>Practice safe sleep habits; back to sleep, on a separate, firm surface.</li></ul><p>For more information on neonatal neurodevelopmental recommendations at different ages, please see the links below:</p><ul><li> <a href="/Article?contentid=3397&language=English">Six week visit</a></li> <li> <a href="/Article?contentid=3031&language=English">Four month visit​</a></li><li> <a href="/Article?contentid=3200&language=English">Eight month visit</a></li><li> <a href="/Article?contentid=3202&language=English">Eighteen month visit</a><br></li><li> <a href="/Article?contentid=3203&language=English">Thirty-six month visit​</a></li></ul><h2>At SickKids</h2><p>For more information on the Neonatal Developmental Follow-Up Clinic at The Hospital for Sick Children, please visit: </p><p> <a href="http://www.sickkids.ca/Neonatology/What-We-Do/Neonatal-Developmental-Follow-up-Program/Followup-Clinic/index.html">http://www.sickkids.ca/Neonatology/What-We-Do/Neonatal-Developmental-Follow-up-Program/Followup-Clinic/index.html</a></p><h2>Resources</h2><p> <a href="http://www.caringforkids.cps.ca/">http://www.caringforkids.cps.ca/</a></p><h2>References</h2><p>Sinai Health Systems Neonatal Follow-Up Clinic recommendations</p><p>Neonatal developmental recommendations have been adapted with permission from Mount Sinai Hospital in Toronto.</p>https://assets.aboutkidshealth.ca/AKHAssets/Neonatal%20neurodevelopmental_12.jpg
Neonatal neurodevelopmental follow-up recommendations: 18 month visitNNeonatal neurodevelopmental follow-up recommendations: 18 month visitNeonatal neurodevelopmental follow-up recommendations: 18 month visitEnglishDevelopmental;NeonatologyToddler (13-24 months)NANANon-drug treatmentAdult (19+) CaregiversNA2018-04-05T04:00:00ZJacqueline Jackson, MN, NP-Paediatrics, RN (EC) (original author);​​Andrea Riekstins, MN, NP-Paediatrics, RN (EC);Jane Brettschneider, M. Sc. (A), Reg. CASLPO;Linh Ly, MD, MEd, FRCPC, FAAP;​​Lori Burton, M.Ed., BSc, O.T. Reg (Ont.);​​Lynelle Phillips, M10.600000000000045.00000000000001027.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Recommendations to encourage neurodevelopment in babies at 18 months old who have spent time in the neonatal neurodevelopment follow-up clinic.</p><p>Talking and playing with babies are two of the most important things parents and caregivers can do to help them develop. There are many ways to encourage development. The recommendations provided are general and not all inclusive. The recommendations provide strategies to help promote gross motor skills, fine motor skills, early language development, and socialization.</p><ul><li>Gross motor skills include big movements such as rolling, crawling, standing or walking.</li><li>Fine motor skills include hand movements such as reach and grasp.</li><li>Early language development includes cooing, babbling, and a baby’s first words.</li></ul><h2>Key points</h2><ul><li>Babies who have been in the NICU or CCCU may be at risk for developmental issues due to medical problems before delivery, during delivery or after birth.</li><li>Recommendations at 18 months focus on walking, structural and functional play, and encouraging speech development.</li><li>Parents and caregivers should follow these recommendations to encourage neurodevelopment.</li></ul><h2>Neonatal neurodevelopmental recommendations at 18 months</h2><h3>Gross motor</h3><ul><li>Practice gross motor development as a whole, including coordination, on riding toys. In playgrounds practice climbing on the small climbers and slides and walking on different terrain.</li><li>Practice ball games such as kicking and throwing. Do not expect catching yet.</li><li>Play a simplified version of “Simon Says”, encouraging your child to copy some of your body movements, such as raising your arms.</li></ul><h3>Fine motor</h3><ul><li>The high chair is an excellent place for structured play and ongoing development of attention skills. </li><li>As you play, verbally label the toys your child is playing with. This encourages both fine motor practice and language skills development.</li><li>Provide opportunities for container play and introduce shape sorters and simple puzzles for play.</li><li>Practice stacking for refinement of release skills (e.g., nesting cups, rings on pole, small blocks).</li><li>Continue with cause and effect toys that have to be pushed, pulled or turned (e.g., pop-up toy).</li><li>Introduce thick crayons and encourage scribbling. Encourage these early drawing skills in a variety of ways including painting with water on a chalkboard or sidewalk chalk outdoors. Introduce connecting toys, blocks (e.g., “Duplo”) and a variety of objects with different textures, shapes, and sizes for exploration with hands.</li><li>Encourage your child to use a spoon or fork during mealtimes. </li></ul><h3>Communication/Social</h3><ul><li>Be face to face with your child. Use single words or short phrases to label, comment or ask questions. </li><li>Watch what your child is doing, wait, listen and respond. Imitate actions or sounds and keep the interaction going.</li><li>Make sure there are reasons to communicate; avoid anticipating all of your child’s needs.</li><li>Use simple picture books, with real life photos and board books when reading together. </li><li>Use simple language- always stay one step above your child’s level of communication.</li><li>Praise your child for behavior you would like to promote, such as sharing or waiting for their turn with a toy.</li><li>If there are any concerns about your child’s speech, contact your region’s Preschool Speech and Language Services.</li></ul><h3>Play</h3><ul><li>Functional play — continue playing with toys/objects as they were intended to be used.</li><li>Encourage pretend play (e.g., feeding a doll or farm animals) and taking turns.</li><li>Attendance at structured play groups, activities, and daycare will provide opportunities for interaction with peers and assist with development of routines, socialization, self-help skills, and ongoing language development.</li><li>Sing rhymes with gestures or play games to label body parts, such as “Head, shoulders, knees & toes” or “If you’re happy and you know it, clap your hands”. </li><li>Electronic media use by children younger than two years is not recommended. This includes phones, television, computers, and tablet devices.</li><li>Encourage daily, unstructured playtime, and read to your child daily to promote the developing brain.</li></ul><h3>Feeding/Growth</h3><ul><li>Continue regular visits to your family doctor/paediatrician to monitor growth.</li><li>Gradually stop giving your child a bottle and transition to using an open cup.</li><li>Limit homogenized milk intake to 500 ml per day (16 ounces) to promote a balanced diet. Juice intake is discouraged. Water is best.</li><li>Have your child see a dentist as part of routine oral health care. Healthy Smiles Ontario is a government-funded program that provides free dental care for children and youth under the age of 17 years. For eligibility requirements and enrollment details visit: <a href="https://www.ontario.ca/page/get-dental-care">https://www.ontario.ca/page/get-dental-care​</a>.<br></li></ul><h3>Sleep</h3><ul><li>Maintain a regular bedtime routine.</li><li>Develop a regular sleep schedule and let your child fall asleep independently.</li></ul><p>For more information on neonatal neurodevelopmental recommendations at different ages, please see the links below:</p><ul><li> <a href="/Article?contentid=3397&language=English">Six week visit</a></li> <li> <a href="/Article?contentid=3031&language=English">Four month visit​</a></li><li> <a href="/Article?contentid=3200&language=English">Eight month visit</a></li><li> <a href="/Article?contentid=3201&language=English">Twelve month visit</a><br></li><li> <a href="/Article?contentid=3203&language=English">Thirty-six month visit​</a></li></ul><h2>At SickKids</h2><p>For more information on the Neonatal Developmental Follow-Up Clinic at The Hospital for Sick Children, please visit: </p><p> <a href="http://www.sickkids.ca/Neonatology/What-We-Do/Neonatal-Developmental-Follow-up-Program/Followup-Clinic/index.html">http://www.sickkids.ca/Neonatology/What-We-Do/Neonatal-Developmental-Follow-up-Program/Followup-Clinic/index.html</a></p><h2>Resources</h2><p><a href="http://www.caringforkids.cps.ca/">http://www.caringforkids.cps.ca/</a></p><h2>References<br></h2><p>Sinai Health Systems Neonatal Follow-Up Clinic recommendations</p><p>Neonatal developmental recommendations have been adapted with permission from Mount Sinai Hospital in Toronto.</p>https://assets.aboutkidshealth.ca/AKHAssets/Neonatal%20neurodevelopmental_18.jpg
Neonatal neurodevelopmental follow-up recommendations: 36 month visitNNeonatal neurodevelopmental follow-up recommendations: 36 month visitNeonatal neurodevelopmental follow-up recommendations: 36 month visitEnglishDevelopmental;NeonatologyPreschooler (2-4 years)NANANon-drug treatmentAdult (19+) CaregiversNA2018-04-05T04:00:00ZJacqueline Jackson, MN, NP-Paediatrics, RN (EC) (original author);​​Andrea Riekstins, MN, NP-Paediatrics, RN (EC);Jane Brettschneider, M. Sc. (A), Reg. CASLPO;Linh Ly, MD, MEd, FRCPC, FAAP;​​Lori Burton, M.Ed., BSc, O.T. Reg (Ont.);​​Lynelle Phillips, M10.600000000000046.2000000000000993.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Recommendations to encourage neurodevelopment in babies at 36 months old who are patients in the neonatal developmental follow-up clinic.</p><p>Talking and playing with babies are two of the most important things parents and caregivers can do to help them develop. There are many ways to encourage development. The recommendations provided are general and not all inclusive. The recommendations provide strategies to help promote gross motor skills, fine motor skills, early language development, and socialization.</p><ul><li>Gross motor skills include big movements such as rolling, crawling, standing or walking.</li><li>Fine motor skills include hand movements such as reach and grasp.</li><li>Early language development includes cooing, babbling, and a baby’s first words.</li></ul><h2>Key points</h2><ul><li>Babies who have been in the NICU or CCCU may be at risk for developmental issues due to medical problems before delivery, during delivery or after birth.</li><li>Recommendations at 36 months focus on encouraging different types of movement, creativity, and cognitive development.</li><li>Parents and caregivers should follow these recommendations to encourage neurodevelopment.</li></ul><h2>Neonatal neurodevelopmental recommendations at 36 months</h2><h3>Gross motor</h3><ul><li>Practice jumping and different types of obstacle courses that involve different terrain and places to climb.</li><li>Practice riding toys with pedals (such as tricycles).</li><li>Encourage your child to practice going up and down stairs in a safe manner.</li></ul><h3>Fine motor</h3><ul><li>Let your child play with a variety of materials (sand, clay, playdough, paint, chalk) to make shapes or creative figures. Have your child roll playdough into balls or create ‘snakes.’</li><li>Encourage your child to help with dressing themselves. Have them practice doing up zippers and larger buttons on a shirt.</li><li>Encourage your child to use crayons, pencils and markers on paper to make lines and circles.</li><li>Use safety scissors to practice cutting paper.</li></ul><h3>Communication/Social</h3><ul><li>When playing with your child, point out ideas like big/small, same/different, and faster/slower.</li><li>Provide structure and routine, which builds children’s confidence.</li><li>Allow opportunities for increasing independence, such as self-dressing, washing hands, tidying toys.</li><li>Have your child listen to and follow directions (“First, get your coat, then put it on, then get your boots”).</li><li>Play games that involve turn taking, cooperation, patience and following simple rules. Some examples are board games, tag, London Bridge, and Ring around the Rosie. Play Simon Says to help your child listen, remember, follow directions and take turns--Let your child be “Simon”, too!</li><li>Continue to read with your child and talk about the story and pictures. Let your child turn pages and say the words to familiar stories and rhymes.</li><li>While reading, talk about the characters and ask your child questions about the story, encouraging your child to predict what is going to happen and talking about what did happen, commenting on how the characters feel and how we know how they might feel.</li></ul><h3>Play/Cognitive development</h3><ul><li>Functional play — continue playing with toys/objects as they were intended to be used.</li><li>Encourage pretend play (e.g., feeding a doll or farm animals) and role-playing (e.g., play doctor).</li><li>Sorting and matching small objects, pictures and toys will help your child learn concepts like size, shape, colour, and number. </li><li>Large floor jigsaw puzzles; take turns putting the puzzle together; problem-solve as to where pieces go; talk about it; ask “5 W” questions.</li><li>Charades (put pictures into a grab bag) and follow the leader games are great for following directions, guessing, asking/answering questions and visual spatial development. Visual spatial development is important in developing skills such as drawing, puzzles, mazes and other tasks that require fine motor skills and body awareness.</li><li>Attendance at structured play groups, activities and daycare will provide opportunities for interaction with peers and assist with development of routines, socialization, self-help abilities and ongoing language development.</li><li>Electronic media use by children under the age of four years is discouraged. Children aged 2-4 should have less than one hour a day of screen time. </li><li>Encourage daily, unstructured and structured playtime, and read to your child daily to promote the developing brain.</li></ul><h3>Other</h3><ul><li>Continue regular visits to family doctor/pediatrician to monitor growth.</li><li>Set a timer for two minutes while your child brushes their teeth. You can create a teeth brushing song together.</li><li>Maintain a regular sleep schedule for your child and let them fall asleep independently.</li></ul><p>For more information on neonatal neurodevelopmental recommendations at different ages, please see the links below:</p><ul><li> <a href="/Article?contentid=3397&language=English">Six week visit</a></li><li> <a href="/Article?contentid=3031&language=English">Four month visit​</a></li><li> <a href="/Article?contentid=3200&language=English">Eight month visit</a></li><li> <a href="/Article?contentid=3201&language=English">Twelve month visit</a><br></li><li> <a href="/Article?contentid=3202&language=English">Eighteen month visit​</a></li></ul><h2>At SickKids</h2><p>For more information on the Neonatal Developmental Follow-Up Clinic at The Hospital for Sick Children, please visit: </p><p> <a href="http://www.sickkids.ca/Neonatology/What-We-Do/Neonatal-Developmental-Follow-up-Program/Followup-Clinic/index.html">http://www.sickkids.ca/Neonatology/What-We-Do/Neonatal-Developmental-Follow-up-Program/Followup-Clinic/index.html</a></p><h2>Resources</h2><p> <a href="http://www.caringforkids.cps.ca/">http://www.caringforkids.cps.ca/</a></p><h2>References</h2><p>Sinai Health Systems Neonatal Follow-Up Clinic recommendations</p><p>Neonatal developmental recommendations have been adapted with permission from Mount Sinai Hospital in Toronto.</p>https://assets.aboutkidshealth.ca/AKHAssets/Neonatal%20neurodevelopmental_36.jpg
Neonatal neurodevelopmental follow-up recommendations: Eight month visitNNeonatal neurodevelopmental follow-up recommendations: Eight month visitNeonatal neurodevelopmental follow-up recommendations: Eight month visitEnglishDevelopmental;NeonatologyBaby (1-12 months)NANANon-drug treatmentAdult (19+) CaregiversNA2018-04-05T04:00:00Z​​Jacqueline Jackson, MN, NP-Paediatrics, RN (EC) (original author);​​Andrea Riekstins, MN, NP-Paediatrics, RN (EC);Jane Brettschneider, M. Sc. (A), Reg. CASLPO;Linh Ly, MD, MEd, FRCPC, FAAP;​​Lori Burton, M.Ed., BSc, O.T. Reg (Ont.);​​Lynelle Phillips, M10.800000000000044.4000000000000960.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Recommendations for babies who have spent time in the NICU or CCCU to help improve neurodevelopment at eight months. </p><p>Talking and playing with babies are two of the most important things parents and caregivers can do to help them develop. There are many ways to encourage development. The recommendations provided are general and not all inclusive. The recommendations provide strategies to help promote gross motor skills, fine motor skills, early language development, and socialization.</p><ul><li>Gross motor skills include big movements such as rolling, crawling, standing or walking.</li><li>Fine motor skills include hand movements such as reach and grasp.</li><li>Early language development includes cooing, babbling, and a baby’s first words.</li></ul><h2>Key points</h2><ul><li>Babies who have been in the NICU or CCCU may be at risk for developmental issues due to medical problems before delivery, during delivery or after birth.</li><li>Recommendations at eight months focus on continuing tummy time play, developing core strength and crawling, and encouraging verbal communication.</li><li>Parents and caregivers should follow these recommendations to encourage neurodevelopment.</li></ul><h2>Neonatal neurodevelopmental recommendations at eight months</h2><h3>Gross motor: </h3><ul><li>Practice frequent tummy time and floor time to help promote overall strength and motor development. </li><li>Encourage your baby to play in sitting position. Try to sit in front of them (not behind) to encourage flexion and core-strengthening.</li><li>Place toys off to the side to encourage your baby to reach and transition out of sitting.</li><li>Use crawling position for play by putting baby on their knees and then lower their hands down.</li><li>Motivate your baby to crawl by practicing rocking them on all fours.</li><li>Encourage them to reach for toys when on all fours.</li><li>Practice transitions such as: sitting to 4-point (i.e., on hands and knees) and lying to sitting.</li><li>Supervise your baby while they are standing at a supportive surface (e.g., couch, ottoman).</li><li>Avoid standing devices (e.g., Jolly Jumpers and Exersaucers).</li><li>Practice gross motor activities in both directions (i.e., transitions, rolling to the left and right). </li></ul><h3>Fine motor: </h3><ul><li>Introduce finger feeding and cereal play to refine pincer grasp.</li><li>Practice holding two objects and banging at the midline (middle of your baby’s body). </li><li>Provide a variety of objects in different shapes, textures, sizes for exploration with hands.</li><li>For babies with thumbs held across the palm, encourage holding thicker round rattles or squishy toys.</li><li>Handedness (left or right) — encourage use of non-dominant hand by presenting toys, objects, stimulation to non-dominant side while restricting use of preferred hand, if necessary.</li></ul><h3>Communication/Social:</h3><ul><li>Be face to face with your baby and be animated. </li><li>Use single words, repeat what you say and do, and use lots of gestures.</li><li>Watch what your child is doing, wait, listen and respond. Imitate actions and try to keep the interaction going.</li><li>Play vocal turn-taking games (e.g., imitate sounds they make and keep the interaction going).</li><li>Use simple picture books, with real life photos.</li><li>Electronic media use by children younger than two years old is not recommended. This includes phones, television, computers, and tablet devices.</li></ul><h3>Play:</h3><ul><li>Play social communication games (e.g., peek-a-boo, itsy bitsy spider) and encourage container play (putting objects in and taking out of containers).</li><li>Introduce stacking and simple cause and effect toys and activities.</li><li>Functional play — introduce playing with toys and objects as they were intended to be used.</li><li>Provide opportunities for interaction with other children (e.g., Ontario Early-Years Drop-In Centres, library programs or community groups).</li></ul><h3>Feeding and Growth:</h3><ul><li>Continue regular visits to your family doctor/paediatrician to monitor your child’s growth.</li><li>Progress to thicker pureed consistencies and forked mashed solids with daily opportunities for soft dissolvable pieces. Include a variety of foods from all food groups (e.g., fruits, vegetables, meats, fish, dairies).</li><li>Present a variety of cubed or chopped foods for finger feeding.</li><li>Avoid juice and other sweetened beverages.</li></ul><h3>Sleep:</h3><ul><li>Establish a regular sleep schedule and bedtime routine. Consider reading to your child as part of routine.</li><li>Practice safe sleep habits: back to sleep on a separate firm flat surface in your room at least for the first six months.</li></ul><p>For more information on neonatal neurodevelopmental recommendations at different ages, please see the links below:</p><ul><li> <a href="/Article?contentid=3397&language=English">Six week visit</a></li><li> <a href="/Article?contentid=3031&language=English">Four month visit​</a></li><li> <a href="/Article?contentid=3201&language=English">Twelve month visit</a></li><li> <a href="/Article?contentid=3202&language=English">Eighteen month visit</a></li><li> <a href="/Article?contentid=3203&language=English">Thirty-six month visit​</a></li></ul><h2>At SickKids</h2><p>For more information on the Neonatal Developmental Follow-Up Clinic at The Hospital for Sick Children, please visit: </p><p> <a href="http://www.sickkids.ca/Neonatology/What-We-Do/Neonatal-Developmental-Follow-up-Program/Followup-Clinic/index.html">http://www.sickkids.ca/Neonatology/What-We-Do/Neonatal-Developmental-Follow-up-Program/Followup-Clinic/index.html</a></p><h2>Resources</h2><p><a href="http://www.caringforkids.cps.ca/">http://www.caringforkids.cps.ca/</a></p><h2>References</h2><p>Sinai Health Systems Neonatal Follow-Up Clinic recommendations</p><p>Neonatal developmental recommendations have been adapted with permission from Mount Sinai Hospital in Toronto.</p>https://assets.aboutkidshealth.ca/AKHAssets/Neonatal%20neurodevelopmental_8.jpg
Neonatal neurodevelopmental follow-up recommendations: Four month visitNNeonatal neurodevelopmental follow-up recommendations: Four month visitNeonatal neurodevelopmental follow-up recommendations: Four month visitEnglishNeonatology;DevelopmentalBaby (1-12 months)NANANon-drug treatmentAdult (19+) CaregiversNA2018-04-05T04:00:00Z​​Jacqueline Jackson, MN, NP-Paediatrics, RN (EC) (original author);​​Andrea Riekstins, MN, NP-Paediatrics, RN (EC);Jane Brettschneider, M. Sc. (A), Reg. CASLPO;Linh Ly, MD, MEd, FRCPC, FAAP;​​Lori Burton, M.Ed., BSc, O.T. Reg (Ont.);​​Lynelle Phillips, M10.100000000000048.9000000000000880.000000000000Health (A-Z) - ConditionsHealth A-Z<p>This page provides recommendations to encourage development in babies who have spent time in the NICU or CCCU, or who require care a neonatal follow-up clinic.</p><p>Talking and playing with babies are two of the most important things parents and caregivers can do to help them develop. There are many ways to encourage development. The recommendations provided are general and not all inclusive. The recommendations provide strategies to help promote gross motor skills, fine motor skills, early language development, and socialization.</p><ul><li>Gross motor skills include big movements such as rolling, crawling, standing or walking.</li><li>Fine motor skills include hand movements such as reach and grasp.</li><li>Early language development includes cooing, babbling, and a baby’s first words.</li></ul><h2>Key points</h2><ul><li>Babies who have been in the NICU or CCCU may be at risk for developmental issues due to medical problems before delivery, during delivery or after birth.</li><li>Recommendations at four months focus on tummy time play, basic interactions with your baby and practicing safe sleep habits.</li><li>Parents and caregivers should follow these recommendations to encourage neurodevelopment.</li></ul><h2>Neonatal follow-up clinic recommendations at four months</h2><h3>Gross motor</h3><ul><li>Practice floor time for play as much as possible. The bed is NOT an appropriate or safe place for your baby to play. The floor provides a safer and firmer surface for your baby to practice and learn movement. Interlocking (Jigsaw) foam mats can be purchased at many different stores.</li><li>Practice tummy time (between 50-60 minutes total per day, in short periods) to improve head and trunk control.</li><li>Practice rolling to both the left and right sides.</li><li>Encourage side-lying position for play (left and right side-lying).</li><li>If your child is demonstrating right or left-sided preference – present faces, toys, objects, and other stimulation to the opposite side your baby favours.</li><li>Sitting with less support (hold your hands as low as possible on infant’s body).</li><li>Carry infant with at least one arm or leg flexed towards the midline (middle of the body) to promote trunk control.</li><li>Avoid standing devices (e.g. Jolly Jumpers and Exersaucers).</li></ul><h3>Fine motor</h3><ul><li>Encourage hands and toys to mouth to promote orientation to the midline.</li><li>Encourage open hands by stroking the back of your baby’s hand.</li><li>For babies with thumbs held across the palm, encourage holding thicker round rattles or squishy toys.</li><li>Offer toys that allow two-handed exploration and play.</li><li>Use supported and reclined sitting to encourage early reaching and grasping of toys at the midline.</li><li>Present a variety of objects with different textures, shapes, and sizes for exploration with hands and mouth.</li></ul><h3>Communication/Social</h3><ul><li>Be face to face with your baby and be animated. Use lots of gestures as you interact.</li><li>Respond to communication; smile and engage when they make sounds.</li><li>Play social communication games (i.e., peek-a-boo).</li><li>Repeat any sounds your baby makes.</li><li>Crying is a baby’s way of letting you know they need your attention, so respond by interacting with your baby to promote healthy attachment.</li><li>Sing and read books to your baby daily.</li><li>Electronic media use by children younger than two years old is not recommended. This includes phones, television, computers, and tablet devices.</li></ul><h3>Feeding/Growth</h3><ul><li>Continue regular visits to your family doctor/paediatrician to monitor your child’s growth.</li><li>Head re-shaping – position baby on their side, lying off flattened side.</li><li>Introduce solids at four to six months corrected age, if your doctor has said this is safe for your child to do.</li></ul><h3>Sleep</h3><ul><li>Start a bedtime routine.</li><li>Practice safe sleep habits: back to sleep on a separate firm flat surface in your room at least for the first six months.</li></ul><p>For more information on neonatal neurodevelopmental recommendations at different ages, please see the links below:</p><ul><li> <a href="/Article?contentid=3397&language=English">Six week visit</a></li><li> <a href="/Article?contentid=3200&language=English">Eight month visit</a><br></li><li> <a href="/Article?contentid=3201&language=English">Twelve month visit</a></li><li> <a href="/Article?contentid=3202&language=English">Eighteen month visit</a></li><li> <a href="/Article?contentid=3203&language=English">Thirty-six month visit</a><br></li></ul><h2>At SickKids</h2><p>For more information on the Neonatal Developmental Follow-Up Clinic at The Hospital for Sick Children, please visit: <a href="http://www.sickkids.ca/neonatology/what-we-do/neonatal-developmental-follow-up-program/neonatal-developmental-follow-up-program%20.html">http://www.sickkids.ca/neonatology/what-we-do/neonatal-developmental-follow-up-program/neonatal-developmental-follow-up-program%20.html</a></p><h2>Resources</h2><p><a href="http://www.caringforkids.cps.ca/">http://www.caringforkids.cps.ca/</a></p><h2>References</h2><p>Sinai Health Systems Neonatal Follow-Up Clinic recommendations</p><p>Neonatal developmental recommendations have been adapted with permission from Mount Sinai Hospital in Toronto.</p>https://assets.aboutkidshealth.ca/AKHAssets/Neonatal%20neurodevelopmental_4.jpg
Neonatal neurodevelopmental follow-up recommendations: Six week visitNNeonatal neurodevelopmental follow-up recommendations: Six week visitNeonatal neurodevelopmental follow-up recommendations: Six week visitEnglishNeonatology;DevelopmentalBaby (1-12 months)NANANon-drug treatmentAdult (19+) CaregiversNA2018-11-19T05:00:00ZRanit Beck, MsOT Reg (Ont);Sandy Spence, MSc (OT);Sandy Tung, BSc PT;Lori Burton, OT9.9000000000000051.6000000000000889.000000000000Health (A-Z) - ConditionsHealth A-Z<p>This page provides recommendations to encourage development in babies aged six weeks, who have spent time in the NICU or CCCU, or who require care from a neonatal follow-up clinic.</p><p>There are many ways to encourage development. Talking and playing with babies are two of the most important things parents and caregivers can do to help them develop. These recommendations are general and not all inclusive. The recommendations provide strategies to help promote gross motor skills, fine motor skills, early language development, and socialization.</p><ul><li>Gross motor skills include big movements such as rolling, crawling, standing or walking.</li><li>Fine motor skills include hand movements such as reach and grasp.</li><li>Early language development includes cooing, babbling, and a baby’s first words.</li></ul><h2>Key points</h2><ul><li>Babies who have been in the intensive care unit may be at risk for developmental issues due to medical problems before delivery, during delivery or after birth.</li><li>Recommendations at six weeks focus on tummy time play, basic interactions with your baby and practicing safe sleep habits.</li><li>Parents and caregivers should follow these recommendations to encourage neurodevelopment.</li></ul><h2>Neonatal follow-up clinic recommendations at six weeks</h2><h3>Gross motor</h3><ul><li>Practice tummy time for a few minutes at a time, multiple times per day to improve head and trunk control. Practice when baby is awake and settled (not crying or fussy).</li><li>Tummy time can be across your lap, lying on your chest or on the floor.</li><li>Encourage side-lying position for play (left and right side-lying). A rolled towel can be placed at your baby’s back to prevent them from rolling over.</li><li>If your baby is demonstrating right or left-sided preference, present faces, toys, objects, and other stimulation to the opposite side your baby favours.</li><li>Practice floor time for play as much as possible. The bed is NOT a safe place for your baby to play. The floor provides a safe and firm surface for your baby to practice and learn movement.</li></ul><h3>Fine motor</h3><ul><li>Encourage your baby to bring hands and toys to their mouth to promote orientation to the midline (middle of the body).</li><li>Encourage open hands by stroking the back of your baby’s hand.</li><li>For babies with thumbs held across the palm, encourage holding thicker, round rattles or squishy toys.</li><li>Offer toys that allow two-handed exploration and play.</li><li>Use supported and reclined sitting to encourage early reaching and grasping of toys at the midline.</li><li>Present a variety of objects with different textures, shapes, and sizes for exploration with hands and mouth.</li><li>Give your baby toys that are black and white or have high-contrast colours, as well as ones that rattle, to help promote hand-eye coordination.</li></ul><h3>Communication/Social</h3><ul><li>Be face to face with your baby and be animated. Use lots of gestures as you interact.</li><li>Respond to communication; smile and engage when your baby makes sounds.</li><li>Play social communication games (i.e. peek-a-boo).</li><li>Repeat any sounds your baby makes.</li><li>Crying is a baby’s way of letting you know they need your attention, so respond by interacting with your baby to promote healthy attachment.</li><li>Sing and read books to your baby daily.</li><li>Electronic media use by children younger than two years old is not recommended. This includes phones, television, computers, and tablet devices.</li></ul><h3>Growth</h3><ul><li>Continue regular visits to your family doctor/paediatrician to monitor your baby’s growth.</li><li>Head re-shaping — position baby on their side, lying off of the flattened side of their head.</li></ul><h3>Sleep</h3><ul><li>Start a bedtime routine (e.g. low lights and reading to baby before bedtime).</li><li>Practice safe sleep habits: position your baby on their back to sleep on a separate firm, flat surface in your room, at least for the first six months.</li></ul><p>For more information on neonatal neurodevelopmental recommendations at different ages, please see the links below:</p><ul><li><a href="/Article?contentid=3031&language=English">Four month visit</a></li><li><a href="/Article?contentid=3200&language=English">Eight month visit</a></li><li><a href="/Article?contentid=3201&language=English">Twelve month visit</a></li><li><a href="/Article?contentid=3202&language=English">Eighteen month visit</a></li><li><a href="/Article?contentid=3203&language=English">Thirty-six month visit</a><br></li></ul><p>For more information on the Neonatal Developmental Follow-Up Clinic at The Hospital for Sick Children, please visit:</p> <p> <a href="http://www.sickkids.ca/Neonatology/What-We-Do/Neonatal-Developmental-Follow-up-Program/Followup-Clinic/index.html">http://www.sickkids.ca/Neonatology/What-We-Do/Neonatal-Developmental-Follow-up-Program/Followup-Clinic/index.html</a></p><p> <a href="http://www.caringforkids.cps.ca/">www.caringforkids.cps.ca/</a></p>
Neonatal nursing teamNNeonatal nursing teamNeonatal nursing teamEnglishNeonatologyPremature;Newborn (0-28 days);Baby (1-12 months)NANAHealth care professionalsPrenatal Adult (19+)NA2009-10-31T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPC12.000000000000038.4000000000000419.000000000000Flat ContentHealth A-Z<p>Read about different types of nurses that take expert care of premature babies in the NICU. Nurse practitioners and APNs are discussed.</p><p>There are many different health-care professionals who make up the neonatal nursing team. They include nurses, clinical nurse specialists, nurse practitioners, clinical nurse specialist/neonatal nurse practitioners and advanced practice nurses. Each has a different and important role to play in the care of your baby.</p><h2>Key points<br></h2> <ul><li>The health-care professionals who make up the neonatal nursing team include NICU nurses, clinical nurse specialists, nurse practitioners, clinical nurse specialist/neonatal nurse practitioners and advanced practice nurses.</li></ul>https://assets.aboutkidshealth.ca/akhassets/nurse_helping_mom_with_pree_EN.jpg
Neonatal seizuresNNeonatal seizuresNeonatal seizuresEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesCaregivers Adult (19+) EducatorsNA2010-02-04T05:00:00ZElizabeth J. Donner, MD, FRCPC11.700000000000042.40000000000001625.00000000000Flat ContentHealth A-Z<p>Read about the causes and symptoms of neonatal seizures and how they are treated.</p><p>Neonatal (newborn) seizures are seizures in a baby who is less than 28 days old. Many different problems can cause neonatal seizures. </p> <p>Most neonatal seizures are considered provoked seizures, rather than a true epilepsy syndrome. A baby with neonatal seizures will not necessarily go on to have epilepsy later in life, although their chances of developing epilepsy are much higher. </p><h2>Key points</h2> <ul><li>Neonatal seizures can have many causes, including lack of oxygen before or during birth, an infection acquired before or after birth, bleeding in the brain, blood sugar or electrolyte imbalances or drug withdrawal.</li> <li>A child who has neonatal seizures is more likely to develop epilepsy if they are born prematurely, experience tonic neonatal seizures or have an underlying brain abnormality.</li> <li>Symptoms of neonatal seizures include repetitive facial movements, staring, unusual bicycling of the legs, muscle tightening or rhythmic jerking. Because many of these movements occur in healthy newborns, an EEG may be needed to confirm if a seizure is responsible.</li> <li>Neonatal seizures are treated first by addressing the cause and, if seizures still continue, giving medications.</li></ul>
Neonatology and neonatal intensive careNNeonatology and neonatal intensive careNeonatology and neonatal intensive careEnglishNeonatologyPrematureNANANAAdult (19+)NA2009-10-31T04:00:00ZJonathan Hellmann, MBBCh, MHSc, FCP(SA), FRCPC13.300000000000036.1000000000000663.000000000000Flat ContentHealth A-Z<p>Learn about neonatology, the study and care of newborns. Neonatology has led to a high survival rate of newborns admitted into NICU care.</p><p>With the introduction of neonatal intensive care units (NICUs) in the 1960s and early 1970s, survival rates for premature babies and full-term babies born with medical problems began to climb. In Canada, over 95% of all babies admitted to a NICU now survive. Survival statistics are similar for most of the developed world. This incredible improvement in survival is due to increased understanding of newborn baby physiology, better management, and application of newer technologies. </p><h2>Key points</h2> <ul><li>In Canada, more than 95% of all babies admitted to a NICU survive.</li> <li>Some premature babies will have developmental problems, which can affect body movement and coordination, hearing, understanding, behaviour, learning, socialization and emotions.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/neonatology_neonatal_intensive_care.jpg
Nephrectomy: Caring for your child at homeNNephrectomy: Caring for your child at homeNephrectomy: Caring for your child at homeEnglishUrologyChild (0-12 years);Teen (13-18 years)KidneysKidneysNon-drug treatmentCaregivers Adult (19+)NA2011-01-10T05:00:00ZNancy Gaudet, RN7.8000000000000066.4000000000000392.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Nephrectomy is an operation to remove one of your child's kidneys. Learn how to take care of your child at home after the operation. </p><p>A doctor or surgeon has performed an operation called a nephrectomy (say: nef-FREK-tomy) to remove one of your child's kidneys. Learn how to take care of your child at home after the procedure. </p><h2>Key points</h2><ul><li>A nephrectomy is a surgery to remove a kidney.</li> <li>Your child should take all their medications as directed by the doctor.</li><li>Your child should avoid rough play, contact sports and gym class until after their follow-up appointment.</li></ul><h2>Who to call if you have any concerns</h2> <p>If you have questions about your child's care while you are at home, call the Urology Clinic at the hospital where you child had the surgery. </p> <p>Write down the phone number of your child's Urology Clinic here:</p><h2>Before leaving the hospital</h2> <p>Before leaving the hospital, your child's nurse will explain to you the medications your child will take home. It is important that your child takes the medicine as prescribed until the doctor says it is all right to stop. </p><h2>At SickKids</h2> <p>If you have questions about your child's care while you are at home, telephone the Urology Clinic 416-813-6661 and ask to speak with a nurse.</p> <p>If you have concerns at night or on the weekend, you can visit your local Emergency Room or the Hospital for Sick Children Emergency Department. If you have any questions, you may also contact your family physician or paediatrician.</p>https://assets.aboutkidshealth.ca/AKHAssets/nephrectomy_caring_for_your_child_at_home.jpg
Nephrostomy tube insertion using image guidanceNNephrostomy tube insertion using image guidanceNephrostomy tube insertion using image guidanceEnglishOtherChild (0-12 years);Teen (13-18 years)KidneysKidneysProceduresCaregivers Adult (19+)NA2016-02-09T05:00:00ZCandice Sockett, RN(EC), MN:APN;Michelle Cote BScN RN;Joao Amaral, MD9.1000000000000056.70000000000001154.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn what a nephrostomy tube is and how it is inserted using image guidance.</p><h2>What is a nephrostomy tube?</h2> <p>A nephrostomy tube is a small flexible tube placed through the lower back into the kidney to drain urine. A nephrostomy tube is inserted when there is an obstruction to the normal flow of urine.</p> <p>Most nephrostomy tubes are placed in the body using image guidance by interventional radiologists.</p><h2>Key points</h2> <ul> <li>A nephrostomy tube is a small flexible tube placed through the lower back into the kidney to drain urine.</li> <li>Nephrostomy tube insertion is usually a low-risk procedure.</li> <li>When your child no longer needs the tube, it is removed without a general anaesthetic.</li> </ul><h2>On the day of the nephrostomy tube insertion</h2><p>Arrive at the hospital two hours before the planned time of your child’s procedure. Once you are checked in, your child will be dressed in a hospital gown, weighed and assessed by a nurse. You will also be able to speak to the interventional radiologist who will be doing the nephrostomy tube insertion and the anaesthetist who will be giving your child medication to make them comfortable for the procedure.</p><p>During the nephrostomy tube insertion, you will be asked to wait in the surgical waiting area.</p><h2>Your child will have medicine for pain</h2><p>Children are given medicine for treatments that may be frightening, uncomfortable or painful. This includes <a href="/Article?contentid=3001&language=English">local anaesthesia</a>, <a href="/Article?contentid=1260&language=English">sedation</a> or <a href="/Article?contentid=1261&language=English">general anaesthesia</a>. For nephrostomy tube insertions, most children are given a general anaesthetic.</p><h2>How a nephrostomy tube is inserted</h2><p>The interventional radiologist uses ultrasound and X-rays to find the kidney and insert the nephrostomy tube through the skin, aiming for the area where the urine needs to be drained. Some children need a nephrostomy tube for one kidney, others need a nephrostomy tube for each kidney.</p><p>The tube is then taped to the skin. Most children will not need stitches.</p><p>The tube is attached to a drainage bag that needs to be emptied regularly.</p> <figure class="asset-c-80"> <span class="asset-image-title">Nephrostomy tube</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_nephrostomy_EN.jpg" alt="Illustration of backed up urine in the kidney draining through a nephrostomy tube" /> <figcaption class="asset-image-caption">Nephrostomy tube is inserted into a child’s kidney when there is an obstruction to the normal flow of urine.</figcaption> </figure><h2>After the nephrostomy tube insertion</h2> <p>Once the nephrostomy tube insertion is complete, your child will be moved to the recovery area. The interventional radiologist will come and talk to you about the details of the procedure. The interventional radiologist will come to see your child later on to ensure the tube is working properly.</p> <p>The interventional radiologist will also talk to your child's doctors about any details related to the nephrostomy tube.</p> <p>Some children feel local pain or discomfort after the nephrostomy tube is placed. The tube is thin, and pain can usually be controlled by pain medicines such as <a href="/Article?contentid=62&language=English">acetaminophen</a>. After a day, most children feel no pain with the tube.</p> <h2>Going home</h2> <p>The length of hospital stay will depend on your child’s overall health. Your child may go home with the nephrostomy tube in place. Your child’s nurse will show you how to care for the tube before your child is discharged from the hospital.</p> <p>For more details on how to care for your child after a nephrostomy tube insertion, please see <a href="/Article?contentid=1218&language=English">Nephrostomy tube: Care at home</a>.</p><h2>Visiting the interventional radiologist before the procedure</h2><p>Your child may have a clinic visit with the interventional radiologist before the procedure. During the visit you should expect:</p><ul><li>A health assessment to make sure your child is healthy and that it is safe to have <a href="/Article?contentid=1260&language=English">sedation</a> or <a href="/Article?contentid=1261&language=English">general anaesthesia</a> and to go ahead with the procedure.</li><li>An overview of the procedure, and a review of the consent form with an interventional radiologist.</li><li>In some cases, an ultrasound of the kidneys.</li><li>Blood work, if needed.</li></ul><h2>Giving consent before the procedure</h2><p>Before the procedure, the interventional radiologist will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks, and will help you weigh any benefits against the risks. It is important that you understand all of these potential risks and benefits of the nephrostomy tube insertion and that all of your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.</p><h2>How to prepare your child for the procedure</h2><p>Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.</p><p>Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.</p><h2>If your child becomes ill within two days before the procedure</h2><p>It is important that your child is healthy on the day of the procedure. If your child starts to feel unwell or has a fever within two days before the nephrostomy tube insertion, let your doctor know. Your child’s procedure may need to be rebooked.</p><h2>Food, drink and medicines before the procedure</h2><ul><li> <a href="http://www.sickkids.ca/VisitingSickKids/Coming-for-surgery/Eating-guidelines/index.html" target="_blank">Your child’s stomach must be empty</a> before sedation or general anaesthetic.</li><li>If your child has special needs during fasting, talk to your doctor to make a plan.</li><li>Your child can take their regular morning medicine with a sip of water two hours before the procedure.</li><li>Medicines such as <a href="/Article?contentid=77&language=English">acetylsalicylic acid (ASA)</a>, <a href="/Article?contentid=198&language=English">naproxen</a> or <a href="/Article?contentid=153&language=English">ibuprofen</a>, <a href="/Article?contentid=265&language=English">warfarin</a>, or <a href="/Article?contentid=129&language=English">enoxaparin</a> may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by their doctor and the interventional radiologist.</li></ul><h2>At SickKids</h2><p>At SickKids, the interventional radiologists work in the <a href="http://www.sickkids.ca/IGT/index.html" target="_blank">Department of Diagnostic Imaging – Division of Image Guided Therapy (IGT)</a>. You can call the IGT clinic at (416) 813-6054 and speak to the clinic nurse during working hours (8:00 to 15:00) or leave a message with the IGT clinic nurse.</p><p>For more information on fasting see <a href="http://www.sickkids.ca/VisitingSickKids/Coming-for-surgery/Eating-guidelines/index.html" target="_blank">Eating and drinking before surgery</a>.</p><p>For more information on preparing your child for their procedure see <a href="http://www.sickkids.ca/VisitingSickKids/Coming-for-surgery/index.html" target="_blank">Coming for surgery</a>.</p>https://assets.aboutkidshealth.ca/akhassets/IMD_nephrostomy_EN.jpg
Nephrostomy tube: Care at homeNNephrostomy tube: Care at homeNephrostomy tube: Care at homeEnglishOtherChild (0-12 years);Teen (13-18 years)KidneysKidneysNon-drug treatmentCaregivers Adult (19+)NA2009-11-10T05:00:00ZDalia Bozic, RN, BScN;Catherine Daniels, RN, MS, ACNP5.9000000000000073.9000000000000928.000000000000Health (A-Z) - ProcedureHealth A-Z<p>A nephrostomy tube drains urine from the kidney to the outside of the body. Learn how to care for your child's nephrostomy tube at home. </p><p>Your child is going home with a <a href="/Article?contentid=2458&language=English">nephrostomy tube</a>. The tube needs care at home. A nurse will teach you how to care for the tube before your child leaves the hospital.</p> <h2>What is a nephrostomy tube?</h2> <p>A nephrostomy tube is a small tube that drains urine from your child's kidney to the outside of your child's body. It is also called a nephrostomy catheter. </p> <p>The place where the tube comes out of your child's body is called the exit site. When your child leaves the hospital, the exit site will be covered with a dressing. <br></p><h2>Key points</h2> <ul> <li>Nephrostomy tubes require regular care at home.</li> <li>Parents can learn how to do regular maintenance of the tube.</li> <li>Parents may instil or flush a nephrostomy tube. However, only a professional should irrigate a nephrostomy tube.</li> </ul><h2>Problems that require medical attention</h2> <p>There can be problems with the nephrostomy tube that you should not try to solve by yourself. Call your child's urology clinic or hospital right away if any of the following things happen: </p> <ul> <li>The tube comes out. Do not try to put the tube back in yourself. </li> <li>There is a change in urine colour. It is normal for the urine to be a little pink from small amounts of blood. If there is a further reddening of colour, call your child's urology clinic. </li> <li>Less urine is coming out of the tube. Normally, you should see a slow, continuous flow of urine. If less urine is coming out of the tube, flush the tube and then call the urology clinic. </li> <li>Your child develops <a href="/Article?contentid=30&language=English">fever</a> or chills. This could be a sign of infection. </li> </ul><h2>At SickKids</h2> <h3>Supporting your child</h3> <p>When preparing your child for an operation, the urology team recommends that whenever possible, your child and family members attend the Pre-Admission Program offered at SickKids. For more information call 416-813-6150 or visit the website at <a href="http://www.sickkids.ca/" target="_blank">www.sickkids.ca</a> </p> <p>A Child Life Specialist can also help to prepare and support your child if they are anxious about the operation.</p><h2>Useful websites</h2><p> <a href="http://www.sickkids.ca/" target="_blank">www.sickkids.ca</a> </p><p> <a href="/" target="_blank">www.aboutkidshealth.ca</a> </p><p> <a href="http://www.cua.org/en" target="_blank">www.cua.org</a> </p>
Nerve block: Caring for your child at home after the procedureNNerve block: Caring for your child at home after the procedureNerve block: Caring for your child at home after the procedureEnglishPain/AnaesthesiaChild (0-12 years);Teen (13-18 years)BodyNervous systemNon-drug treatmentCaregivers Adult (19+)NA2009-11-10T05:00:00ZAndrew Matisoff, MD;Basem Naser, MBBS, FRCPC;Jennifer Tyrrell, RN, MN, CNeph(c)4.7000000000000084.4000000000000566.000000000000Health (A-Z) - ProcedureHealth A-Z<p>How to take care of a child at home after they have received a nerve block. Learn about when to give other medicines, and potential problems to watch for.</p><p>Your child was given a nerve block. This means your child got an injection of local anesthetic near a nerve. The injection puts the nerve to sleep and stops it from carrying messages, so your child does not feel pain anywhere in the area where the nerve goes. The effect can last for about six to 12 hours, depending on the medicine used. Nerve blocks are used to reduce or get rid of pain from a surgical procedure. </p> <p>These instructions will help you look after your child at home after the nerve block.</p><h2>Key points</h2> <ul> <li>Protect the limb that had the nerve block.</li> <li>Use the medicine prescribed or recommended by your child's doctor. </li> <li>Give your child pain medicine before the nerve block wears off. </li> </ul><h2>Problems to look out for</h2> <p>Call your child's doctor or the hospital where the procedure was done if:</p> <ul> <li>The limb has not recovered strength by the next morning. </li> <li>Your child has a lot of pain that is not controlled by medicine. </li> <li>You are concerned about your child's condition. </li> <li>You have any questions about the nerve block or the pain medicines. </li> </ul> <p>Write the hospital's number here:</p> <p>Write your child's doctor's name here:</p>https://assets.aboutkidshealth.ca/AKHAssets/nerve_block_caring_for_child_at_home.jpg
Nerve conduction studiesNNerve conduction studiesNerve conduction studiesEnglishNeurologyChild (0-12 years);Teen (13-18 years)BodyNervous systemTestsCaregivers Adult (19+)NA2009-11-10T05:00:00ZJennifer Boyd, RN, MHSc, CNN(C), MSCN;Jiri Vajsar, MD, MSc, FRCPC5.5000000000000078.8000000000000441.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Nerve conduction studies are used to try to find out what might be wrong with muscles or nerves. Learn about what is involved in nerve conduction studies. </p><h2>What is a nerve conduction study?</h2> <p>A nerve conduction study is a kind of medical test. It can show how well messages called electrical impulses travel through the nerves of the body. </p> <p>The body has sensory nerves and motor nerves. Sensory nerves send messages to the spinal cord. Motor nerves send messages to the muscles. A nerve conduction study tests both kinds of nerves. </p> <p>Nerve conduction studies tell us if there is something wrong with the nerves or muscles. For example, we use nerve conduction studies to find out what is wrong when a patient has weakness, numbness, pain or tingling in the arms, legs or face. </p><h2>Key points</h2> <ul> <li>Nerve conduction studies are used to try to find out what might be wrong with muscles or nerves. </li> <li>There is no special preparation for a nerve conduction study. </li> <li>The test takes about 30 minutes. </li> </ul><h2>Nerve conduction studies are usually done in hospital</h2> <p>Nerve conduction studies are done by doctors and nurses who are specially trained to care for nerve and muscle problems. You may stay in the room with your child during the test. </p><h2>What happens during a nerve conduction study</h2> <p>Your child will lie comfortably on a bed. The nurse will use a cold liquid to clean the part of the body to be tested. The nurse will then put two small tapes called recording electrodes on that part of the body. This lets us record the messages being sent to and from those muscles by the nerves.</p> <p>We might check to see if these messages are like the messages of other muscles and nerves that are working well. The nurse will hold a special electrode over the nerve being tested. Your child will feel a tingle or a buzzing that will make the muscle twitch for a few seconds. The study will not hurt your child. But they may find the tingling or buzzing of the muscle a little uncomfortable. This study usually takes up to 30 minutes. </p><h2>After a nerve conduction study</h2> <p>Your child will have no side effects, or problems, from the nerve conduction study. Your child may return to their usual activities right away. </p><h2>Preparing for a nerve conduction study</h2> <p>Do not put any cream or lotion on your child's arms, legs or face on the day of the test. The test may not work properly if your child has cream or lotion on their skin. Your child may eat and drink as usual before the study. </p>
Nerve-injury painNNerve-injury painNerve-injury painEnglishPain/AnaesthesiaChild (0-12 years);Teen (13-18 years)BodyCentral nervous system;Peripheral nervous system;Autonomic nervous systemSymptomsCaregivers Adult (19+)Pain2009-09-18T04:00:00ZLisa Isaac, MD, FRCPC10.500000000000053.7000000000000273.000000000000Flat ContentHealth A-Z<p>Learn about neuropathic pain. Neuropathic pain is caused by damage to the nervous system and is often described as burning or shooting pain.</p><p>Though there are several main categories of pain, health care professionals further define pain based on its source within the body. Pain that has a source external to the nerves that are detecting it is called nociceptive pain, and pain that arises from damage to the nervous system itself is called neuropathic pain or nerve-injury pain. </p>
Neural tube defectsNNeural tube defectsNeural tube defectsEnglishPregnancyAdult (19+)Body;Brain;SpineReproductive system;Nervous systemConditions and diseasesPrenatal Adult (19+)NA2009-09-10T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC Andrew James, MBChB, MBI, FRACP, FRCPC11.100000000000046.50000000000001206.00000000000Flat ContentHealth A-Z<p>Learn about neural tube defects that can arise during pregnancy. Spina bifida and various brain abnormalities such as anencephaly are discussed.</p><p>The central nervous system starts to develop in week five of pregnancy. At that time, a thickening of cells called the neural plate forms, which folds in on itself to create what we know as the neural tube. One end of the neural tube will form the brain, and the remainder of the neural tube will form the spinal cord. In week six, openings in the neural tube close. If these openings do not close properly, abnormalities called neural tube defects can form. These defects are rare, but they account for most of the abnormalities of the brain and spinal cord.</p><h2>Key points</h2> <ul><li>Neural tube defects can cause abnormalities of the spinal cord, causing spina bifida, and abnormalities of the brain.</li> <li>The unborn baby can be screened for neural tube defects using a series of prenatal screening and diagnostic tests.</li> <li>Studies show that folic acid is very important to the prevention of neural tube defects, especially in early pregnancy.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/Neural_tube_defects.jpg
Neurofibromatosis type 1 (NF1)NNeurofibromatosis type 1 (NF1)Neurofibromatosis type 1 (NF1)EnglishGeneticsChild (0-12 years);Teen (13-18 years)Eyes;SkinSkin;NervesConditions and diseasesCaregivers Adult (19+)NA2010-03-05T05:00:00ZElena Pope, MD, MSc, FRCPC;Patricia Parkin, MD, FRCPC;Stephen Meyn, MD, PhD, FRCPC, FACMG;Andrea Shugar, MS, CGC, CCGC8.0000000000000061.70000000000001128.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Neurofibromatosis or NF1 causes growths to form on nerve tissues. Learn about both the common and uncommon skin and bone abnormalities of this condition. </p><h2>What is neurofibromatosis type 1?</h2> <p>Neurofibromatosis type 1 (NF1) (say: noor-oh-fie-broh-muh-TOE-sis) is a genetic disorder that affects the way cells divide in the body. It causes skin changes and may also have other effects. </p> <p>Symptoms of NF1 range from very mild to quite severe. Complications from NF1 may occur over a person's lifetime, and some may get worse over time. But most people with NF1 will have only mild symptoms that do not need special treatment. Keep this in mind when you read about the possible complications of NF1. </p> <p>NF1 affects about one in every 3,000 people.</p><h2>Key points</h2> <ul> <li>Neurofibromatosis type 1 (NF1) is a genetic disorder. </li> <li>The most common features are café-au-lait spots, freckling and neurofibromas. </li> <li>Most children with NF1 will have only mild symptoms. </li> <li>Children should be monitored regularly for possible health complications.</li> </ul><h2>The most common features of neurofibromatosis type 1</h2> <figure class="asset-c-80"> <img src="https://assets.aboutkidshealth.ca/akhassets/Neurofibromatosis_MED_ILL_EN.jpg" alt="Lisch nodules on iris, lumps on and under the skin of hand, skin fold freckling on armpit, and café au lait spots on abdomen" /> <figcaption class="asset-image-caption">The most common features of neurofibromatosis type 1 (NF1). It is not likely that a child with NF1 will develop many or all of these features.</figcaption> </figure> <h3>Café-au-lait spots</h3><p>Café-au-lait (say: kah-fay oh LAY) spots are the most common feature of NF1. They usually appear within the first two years of life and generally do not increase in number after young childhood.</p><p>Café-au-lait spots are harmless, flat, oval-shaped marks on the skin. Café-au-lait means "coffee with milk" in French. The name refers to the colour of the spots. Their colour is at least a shade darker than the colour of your child's skin. </p><p>About one in 10 people without NF1 will have one or two of these birthmarks. But people with NF1 almost always have more than six café-au-lait spots.</p><p>There is no relationship between the number of café-au-lait spots your child has and how severe NF1 will be for them.</p><h3>Skin fold freckling</h3><p>Freckling or small spots may occur on parts of the skin that are not exposed to sunlight. Common areas for freckles are in the armpit and groin. Freckling happens over time, so very young children with NF1 may not show it. </p><h3>Neurofibromas</h3><p>Neurofibromas are benign, soft tumours that involve cells that surround the nerves. Benign means they are not cancerous. There are two types of neurofibromas: cutaneous (skin) neurofibromas are small bumps on the surface of the skin; subcutaneous (under the skin) are small lumps under the skin that are often hard.</p><p>Neurofibromas develop over time throughout the life span.</p><p>Neurofibromas usually do not need to be removed and can be difficult to remove. Removal may be considered in special circumstances.</p><h3>Lisch nodules</h3><p>Lisch nodules are small, benign growths that look like freckles on the coloured part of the eye (the iris). Most often, they cannot be seen except with a special eye exam performed by an eye doctor, using an instrument called a slit-lamp. Lisch nodules are harmless and do not affect a child's vision. But they can help your child's doctor diagnose NF1.</p><h2>Less common features of neurofibromatosis type 1</h2><h3>Developmental difficulties</h3><p>Developmental difficulties occur in about half of children with NF1. For example:</p><ul><li>They may have problems with learning, such as reading or math. </li><li>They may also have problems with their fine or gross motor skills. Fine motor skills are small movements such as moving your fingers. Gross motor skills are large movements such as running or jumping. </li><li>They may have difficulties with social skills, such as making friends. </li><li>They may have attention and behavioral difficulties. </li></ul><p>Watch your child for any movement or learning problems, speech and language delay, or developmental delay. Intervention should be given early for any difficulties or delays. </p><h3>Plexiform neurofibromas</h3><p>Plexiform neurofibromas are benign tumours that involve cells that surround the nerves. They may appear near the surface of the skin or may lie deeper in the body. Sometimes they grow to a large size, but usually do not cause any harm to the child's health. Plexiform neurofibromas usually do not need to be removed and can be difficult to remove. Removal may be considered in special circumstances. </p><p>In very rare cases, plexiform neurofibromas may become a cancerous tumor called malignant peripheral nerve sheath tumor.</p><h3>Optic nerve glioma</h3><p>The optic nerve is the nerve that connects the back of the eyeball to the brain. When this nerve becomes enlarged, it is called optic nerve glioma. This occurs in about 15% of children with NF1. However, in most cases (85%), an optic nerve glioma will not cause any problems with the child's sight or health and is considered asymptomatic (not causing symptoms). </p><p>Most often, symptomatic optic nerve gliomas are identified in the first six years of life. Your child should be assessed by an eye doctor every year to look for signs of optic nerve involvement. Parents of young children with NF1 should contact their doctor if they notice problems with their child's vision or bulging of the eyeball. </p><h3>High blood pressure</h3><p>People with NF1 are more likely to develop high blood pressure, and this may occur at any time in their life. People with NF1 should have their blood pressure checked every year by their doctor. </p><h3>Bowing of long bones</h3><p>Children with NF1 may have bowing of long bones such as the shinbone (tibia). This bowing is apparent within the first year or two of life. This would require a referral to an orthopedic surgeon. </p><h3>Scoliosis: Curving of the spine</h3><p>If your child has NF1, their doctor should check for curving of the spine (scoliosis) once a year. Until your child reaches adult height, they are at a greater risk for scoliosis. This would require a referral to an orthopedic surgeon. </p><h3>Cancerous tumours</h3><p>People with NF1 have a slightly higher risk of developing certain cancers, such as soft tissue tumors or certain brain tumours. Pay attention to any signs such as problems with your child's vision, rapid changes in the size or texture of neurofibromas, persistent and continuous pain in neurofibroma, persistent and severe headaches or dizziness. Discuss any concerns with your child's doctor. </p><h3>Growth</h3><p>Most children with NF1 have a growth rate and pattern similar to their parents. However, some children with NF1 have alterations of their growth rate and pattern leading to rapid gains in height or weight, or slowing of the growth leading to shortness. Children with NF1 should have their growth monitored regularly. </p><h3>Other complications of neurofibromatosis type 1</h3><p>Other less common complications of NF1 include:</p><ul><li>seizures </li><li>increased fluid surrounding the brain (hydrocephalus) </li><li>early (precocious) puberty </li><li>narrowing of the artery that supplies blood to the kidney (renal artery stenosis) </li><li>congenital heart defects </li><li>narrowing of an artery in the brain (Moyamoya disease) </li></ul><p>Ask your doctor if you have any specific concerns about your child.</p>https://assets.aboutkidshealth.ca/akhassets/Neurofibromatosis_MED_ILL_EN.jpg
Neurofibromatosis type 1 (NF1): Genetic counsellingNNeurofibromatosis type 1 (NF1): Genetic counsellingNeurofibromatosis type 1 (NF1): Genetic counsellingEnglishGeneticsChild (0-12 years);Teen (13-18 years)Eyes;SkinSkin;NervesSupport, services and resourcesCaregivers Adult (19+)NA2010-03-05T05:00:00ZElena Pope, MD, MSc, FRCPC;Patricia Parkin, MD, FRCPC;Stephen Meyn, MD, PhD, FRCPC, FACMG;Andrea Shugar, MS, CGC, CCGC10.700000000000044.2000000000000296.000000000000Flat ContentHealth A-Z<p>Genetic counselling helps people understand genetic or inherited disorders. It can help families learn about neurofibromatosis type 1 (NF1) and decide if testing is right for them. </p><h2>What is genetic counselling?</h2> <p>Genetic counselling helps people understand genetic or inherited disorders. Genetic counselling can also help families make informed choices about whether genetic testing is right for them. </p> <p>A genetic counsellor is trained and has experience in medical genetics and counselling.</p><h2>Key points</h2> <ul> <li>Genetic counselling can help families learn about neurofibromatosis type 1 (NF1) and adapt to a new diagnosis. </li> <li>Genetic counselling helps families decide if testing is right for them. </li> <li>A genetic counsellor can figure out the risk of having children with NF1, interpret and help families understand the results of genetic testing for NF1, and help families find more support and information.</li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/neurofibromatosis_genetic_counselling.jpg
Neurofibromatosis type 1 (NF1): Genetic testingNNeurofibromatosis type 1 (NF1): Genetic testingNeurofibromatosis type 1 (NF1): Genetic testingEnglishGeneticsChild (0-12 years);Teen (13-18 years)Eyes;SkinSkin;NervesTestsCaregivers Adult (19+)NA2010-03-10T05:00:00ZElena Pope, MD, MSc, FRCPC;Patricia Parkin, MD, FRCPC;Stephen Meyn, MD, PhD, FRCPC, FACMG;Andrea Shugar, MS, CGC, CCGC8.5000000000000061.2000000000000846.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Neurofibromatosis type 1 (NF1) is a skin condition that causes growths on nerves. Find out what NF1 genetic testing is, what the test results mean and why to consider testing for it.</p><h2>What can genetic testing tell you about NF1?</h2> <p>If you, your partner or child has neurofibromatosis type 1 (NF1) (say: noor-oh-fie-broh-muh-TOE-sis), or your doctor suspects NF1, your doctor or genetic counsellor may talk to you about genetic testing. </p> <p>Genetic testing is also called molecular or DNA testing.</p> <p>Most people with a clinical diagnosis of NF1 will have a mutation (change) in a gene called Neurofibromin, also called the NF1 gene. A clinical diagnosis is made by a doctor looking for signs of NF1 in your child's skin, eyes or bones. </p><h2>Key points</h2> <ul> <li>In genetic testing, the laboratory looks for a mutation (change) in the patient's NF1 gene from a blood sample. </li> <li>Genetic testing can help make an early diagnosis of NF1.</li> <li>A genetic counsellor can help you decide if genetic testing may benefit you or your family. </li> </ul>
Neurofibromatosis type 1 (NF1): How is it diagnosed?NNeurofibromatosis type 1 (NF1): How is it diagnosed?Neurofibromatosis type 1 (NF1): How is it diagnosed?EnglishGeneticsChild (0-12 years);Teen (13-18 years)Eyes;SkinSkin;NervesConditions and diseasesCaregivers Adult (19+)NA2010-03-10T05:00:00ZElena Pope, MD, MSc, FRCPC;Patricia Parkin, MD, FRCPC;Stephen Meyn, MD, PhD, FRCPC, FACMG;Andrea Shugar, MS, CGC, CCGC7.7000000000000063.7000000000000835.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn about clinical and genetic testing, two ways that doctors diagnose Neurofibromatosis Type 1 (NF1). Each of these methods has advantages and limits.</p><p>There are two ways your child's doctor can diagnose neurofibromatosis type 1 (NF1) (say: noor-oh-fie-broh-muh-TOE-sis):</p> <ul> <li>The first and most common method is a clinical diagnosis. Your child's doctor will look for signs of NF1 in your child's skin, eyes, bones or brain. </li> <li>The second method is genetic testing, also called a molecular or DNA diagnosis. Your child will need to give a blood sample. A lab will check the sample for a change (mutation) in the NF1 gene. </li> </ul> <p>Each of these methods has advantages and limitations. Both are described in more detail below.</p><h2>Key points</h2> <ul> <li>There are two ways your child's doctor can diagnose NF1: clinical diagnosis and genetic testing. </li> <li>Clinical diagnosis means the doctor looks for symptoms of NF1 on the child's body. </li> <li>In genetic testing, the doctor looks for a change (mutation) in the child's NF1 gene. </li> <li>There are advantages and limitations to both methods. </li> </ul><h2>Method 1: Clinical diagnosis</h2> <p>A clinical diagnosis is the most common way doctors diagnose NF1. A doctor will diagnose NF1 if your child has two or more of the following: </p> <ul> <li>six or more café-au-lait spots, at least 0.5 cm in children or 1.5 cm in adults </li> <li>two or more neurofibromas on or under the skin, or one plexiform (deep tissue) neurofibroma </li> <li>axillary (armpit) or inguinal (groin) freckling </li> <li>optic pathway glioma, also called a visual pathway tumour </li> <li>two or more Lisch nodules </li> <li>bone changes such as bowing of the long bones </li> <li>a close relative (parent, child or sibling) with a confirmed diagnosis of NF1 </li> </ul> <h3>Advantages of a clinical diagnosis</h3> <ul> <li>A clinical diagnosis is usually a simple and effective way for your child's doctor to diagnose NF1. </li> </ul> <h3>Limitations of a clinical diagnosis</h3> <ul> <li>Some signs of NF1 may not show up until a child is older. A definite diagnosis may be delayed until more signs appear. </li> <li>Sometimes a person has only mild signs of NF1, so it is hard to diagnose based only on the exam. </li> </ul> <h2>Method 2: Genetic testing</h2> <p>Genetic testing can find mutations (changes) in the NF1 gene. It is done by taking a blood sample. The NF1 gene can be analyzed to see if the person has a normal or a changed copy of the gene. </p> <p>Genetic testing can be very useful, but results are not always clear. There are three possible test results: positive, negative and inconclusive. </p> <h3>Positive: The test found a mutation in the child's NF1 gene</h3> <p>A positive test result confirms NF1. If the test is positive, your child has NF1. This means a mutation was found in your child's NF1 gene. </p> <p>A positive test result cannot tell you how severe the disease will be. Members of the same family who have the same mutation may have different symptoms. </p> <h3>Negative: The test did not find a mutation in the child's NF1 gene</h3> <p>A negative test result means a mutation was not found in your child's NF1 gene.</p> <p>A negative test result does not rule out NF1. About 5% of adults with a clinical diagnosis of NF1 still have negative DNA tests. So even with a negative test result, a child may still be treated for NF1 or assumed to have "probable NF1." However, a negative test result can help a doctor rule out NF1 if, as a child grows older, they continue to have very few clinical signs of NF1. </p> <p>Genetic testing may improve in the future, or new genes may be discovered, and a child with a negative test result may be offered genetic testing again. </p> <h3>Inconclusive: The test results were neither positive nor negative</h3> <p>Sometimes, the result of the genetic test is hard to interpret. Not every mutation in the NF1 gene causes neurofibromatosis. It may be unclear whether the mutation is a harmless change or one that will cause the signs of NF1. </p> <p>If your child's test is inconclusive, the doctor may need more information. The doctor may ask for blood samples and information from other members of your family. This will help them interpret your child's test results. </p> <h3>Advantages of a genetic test</h3> <ul> <li>A genetic test can diagnose a young child who does not yet have all the clinical signs of NF1. </li> <li>Once a mutation is identified, other relatives who are at higher risk to have NF1 can also have testing. </li> <li>A test can be done on a pregnancy to see if NF1 exists. </li> </ul> <h3>Limitations of a genetic test</h3> <ul> <li>A positive test result cannot predict how mild or severe problems of NF1 may be. </li> <li>A negative test result does not necessarily rule out a diagnosis of NF1. </li> <li>If the test is inconclusive, other family members may need to be tested. </li> </ul> <p>If you have questions about genetic testing, ask your doctor to refer your child to a genetic counsellor or a medical geneticist. They can explain the tests. They can also help you decide if testing is right for your child. </p>
Neurofibromatosis type 1 (NF1): ResourcesNNeurofibromatosis type 1 (NF1): ResourcesNeurofibromatosis type 1 (NF1): ResourcesEnglishGeneticsChild (0-12 years);Teen (13-18 years)Eyes;SkinSkin;NervesSupport, services and resourcesCaregivers Adult (19+)NA2010-03-10T05:00:00ZElena Pope, MD, MSc, FRCPC;Patricia Parkin, MD, FRCPC;Stephen Meyn, MD, PhD, FRCPC, FACMG;Andrea Shugar, MS, CGC, CCGC7.8000000000000059.5000000000000261.000000000000Flat ContentHealth A-Z<p>A list of websites with in-depth information on neurofibromatosis type 1 (NF1) in children.</p><p>Here are a few helpful resources on neurofibromatosis type 1 (NF1).</p><h2>Key points</h2> <ul> <li>A list on online resources about neurofibromatosis type 1 where you can get information, personal stories, and learn about living and coping with the condition.</li> </ul>
Neurofibromatosis type 1 (NF1): Treating health complicationsNNeurofibromatosis type 1 (NF1): Treating health complicationsNeurofibromatosis type 1 (NF1): Treating health complicationsEnglishGeneticsChild (0-12 years);Teen (13-18 years)Eyes;SkinSkin;NervesConditions and diseasesCaregivers Adult (19+)NA2010-03-10T05:00:00ZElena Pope, MD, MSc, FRCPC;Patricia Parkin, MD, FRCPC;Stephen Meyn, MD, PhD, FRCPC, FACMG;Andrea Shugar, MS, CGC, CCGC9.7000000000000051.5000000000000829.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn how the complications of Neurofibromatosis Type 1 (NF1) are treated. </p><p>Most children with neurofibromatosis type 1 (NF1) (say: noor-oh-fie-broh-muh-TOE-sis) live long and healthy lives. There is no cure for NF1, but proper monitoring can lead to early identification of complications, and intervention where possible. </p><h2>Key points</h2> <ul> <li>There are both common and rare complications that may affect people with NF1. </li> <li>People with NFI and their caregivers should pay attention to any troublesome symptoms and discuss them with their doctor. </li> <li>Most children with NF1 will have only mild symptoms that do not need treatment. </li> <li>If you have any concerns, call your doctor. Do not ignore new or concerning symptoms in your child. </li> </ul><h2>Common complications of NF1<br></h2><p>Here are some of the complications that can occur with NF1. People with NF1 may only develop one or two of these complications. It is very unlikely that a person with NF1 would develop many or all of the complications listed here.</p> <figure class="asset-c-80"> <img src="https://assets.aboutkidshealth.ca/akhassets/Neurofibromatosis_MED_ILL_EN.jpg" alt="Lisch nodules on iris, lumps on and under the skin of hand, skin fold freckling on armpit, and café au lait spots on abdomen" /> <figcaption class="asset-image-caption">The most common features of neurofibromatosis type 1 (NF1). It is not likely that a child with NF1 will develop many or all of these features.</figcaption> </figure> <h3>Neurofibromas</h3><p>Neurofibromas are benign, soft tumours that involve cells that surround the nerves. Benign means they are not cancerous. There are two types of neurofibromas: cutaneous (skin) neurofibromas are small bumps on the surface of the skin; subcutaneous (under the skin) are small lumps under the skin that are often hard. Neurofibromas develop over time throughout the life span. Neurofibromas usually do not need to be removed and can be difficult to remove. Removal may be considered in special circumstances.</p><h3>Plexiform neurofibromas</h3><p>Plexiform neurofibromas are benign tumours that involve cells that surround the nerves. They may appear near the surface of the skin or may lie deep in the body. Sometimes they grow to a large size, but usually do not cause any harm to the child's health. Plexiform neurofibromas usually do not need to be removed and can be difficult to remove. Removal may be considered in special circumstances.</p><p>New treatments are being studied. In very rare cases, plexiform neurofibromas may become a cancerous tumour called a malignant peripheral nerve sheath tumour.</p><h3>Optic pathway gliomas</h3><p>The optic nerve is the nerve that connects the back of the eyeball to the brain. When this nerve becomes enlarged, it is called an optic nerve glioma. This occurs in about 15% of children with NF1. However, in most cases (85%), an optic nerve glioma will not cause any problems with the child's sight or health, and is considered asymptomatic (not causing symptoms) and requires monitoring with eye examinations and MRI. Some children with NF1 have symptomatic optic nerve gliomas and these may require treatment with chemotherapy and/or surgery.</p><h3>Bony changes and scoliosis</h3><p>If your child has NF1, the doctor will check their spine (backbone) once a year. If there are abnormalities, the doctor will take an X-ray of your child's back. If scoliosis is confirmed on X-ray, your child may be referred to a bone specialist (orthopaedic surgeon). If the scoliosis is mild, this may require monitoring with X-rays and physical examinations as the scoliosis may progress as the child gets older. Treatment for high-grade scoliosis may include wearing a back brace and/or surgery.</p><h3>Learning difficulties</h3><p>Learning difficulties are more common in children with NF1. If there are concerns about how well your child is doing in school, or if your child shows signs of hyperactivity or attention problems, your child may benefit from a psycho-educational assessment. You may wish to request a psycho-educational assessment from your child's school principal. These assessments are conducted by highly trained educational psychologists using standardized testing to assess children's intelligence, learning, grade level, memory, behavior and other aspects of learning. Results of these assessments may lead to specialized recommendations for your child's classroom placement, such as the development of an Individual Education Plan (IEP). Some children with NF1 have features of Attention Deficit Disorder, with or without Hyperactivity and may benefit from medication. Some children with NF1 have features of social skills difficulties, autism or Asperger's and may benefit from specialized therapy.</p><h3>Other complications</h3><p>Other, less common complications of NF1 include:</p><ul><li>seizures</li><li>increased fluid surrounding the brain (hydrocephalus)</li><li>early (precocious) puberty</li><li>narrowing of the artery that supplies blood to the kidney (renal artery stenosis)</li><li>congenital heart defects</li><li>narrowing of an artery in the brain (Moyamoya disease)</li></ul><p>These are uncommon, but need attention from a specialist.</p><p>If you have any questions about treating NF1 in your child, talk to their doctor.</p><h2>Troublesome symptoms of NF1: When to call the doctor</h2> <p>If your child has any of the following symptoms, contact their doctor:</p> <ul> <li>long-lasting or recurring pain, or pain that wakes your child up or keeps them awake at night </li> <li>numbness, tingling or weakness in an arm or leg </li> <li>changes in neurofibromas, such as persistent and continuous pain, rapid increases in size or hardening </li> <li>problems with vision or bulging of the eyeballs </li> <li>new, lasting or changing headaches </li> </ul>https://assets.aboutkidshealth.ca/akhassets/Neurofibromatosis_MED_ILL_EN.jpg
Neuropsychological assessment before epilepsy surgeryNNeuropsychological assessment before epilepsy surgeryNeuropsychological assessment before epilepsy surgeryEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemTestsCaregivers Adult (19+)NA2017-10-10T04:00:00ZElysa Widjaja, MD, MPH ​9.6000000000000055.1000000000000875.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn how a neuropsychological assessment is done and how it helps your child's epilepsy team plan your child's treatment.</p><p>​​A neuropsychological assessment takes a day to a day and a half, depending on your child's age, and is done by a neuropsychologist or an assistant at the hospital. The assessment uses a number of tests and observations to measure your child's thinking, behaviour and problem-solving skills.</p><h2>Key points</h2> <ul><li>A neuropsychological assessment measures your child's thinking, behaviour and problem-solving skills so your child's team can plan the best treatment.</li> <li>In general, the assessment uses tests and observation to measure things such as your child's intelligence, attention, motor function, language skills, memory and behaviour.</li> <li>The assessment generally takes one day, but the precise length and tests depend on your child's age, skill level, seizure history and ability to co-operate.</li> <li>Your child will have one assessment before surgery and further assessments at set periods to assess the impact of surgery and record their functioning at important points in their life.</li></ul><figure class="asset-right"> <img src="https://assets.aboutkidshealth.ca/AKHAssets/neuropsychological_assessment_before_epilepsy_surgery.jpg" alt="Testing child using coloured blocks" /> </figure> <h2>Why does my child need a neuropsychological assessment?</h2><p>A neuropsychological assessment is intended to help your child’s team:</p><ul><li>understand the impact of your child's neurological (brain) condition on their cognitive functioning (their thinking)</li><li>plan the best treatment for your child.</li></ul><h2>When is a neuropsychological assessment done?</h2><p>A neuropsychological assessment is done before your child has surgery. It provides baseline information about your child's condition and can help predict if surgery will put your child at risk for language and memory problems.</p><p>Another assessment is done one year after surgery to see if there are any changes in your child’s thinking, behaviour and problem-solving skills and to identify areas where your child would benefit from rehabilitation.</p><p>The assessment may also be repeated later to:</p><ul><li>record any change in your child's functioning</li><li>provide up-to-date information if required</li><li>record your child’s functioning at important transition points in their life, such as starting high school or post-secondary education</li><li>help with career planning.<br></li></ul><h2>What types of tests are done during the neuropsychological assessment?</h2><p>Not all tests are done on all children. The specific tests will depend on your child's:</p><ul><li>age</li><li>level of skill</li><li>ability to co-operate</li><li>seizure history</li><li>medication history</li><li>behaviour issues</li><li>school performance.</li></ul><p>The assessment measures the following general skills:</p><ul><li>intelligence: your child's overall knowledge, thinking and problem-solving skills</li><li>perception: how well your child's brain integrates information that is coming in, for example being able to copy shapes that are shown to them</li><li>motor function: your child's muscle control</li><li>attention: your child’s ability to focus on tasks that continue for some time</li><li>memory: how well your child learns and remembers new information, for example answering questions about a story they have just been told</li><li>working memory: the ability to keep something in mind while doing another task, for example taking directions to a location and finding it on a map</li><li>language skills and vocabulary: the ability to understand and use language.</li> <figure class="asset-right"><img src="https://assets.aboutkidshealth.ca/akhassets/neuropsychological_assessment_before_epilepsy_surgery_2nd.jpg" alt="Testing child using coloured beads" /> </figure> <li>concept formation and problem solving: how well your child solve problems that they have not seen before</li><li>planning and organization: how your child plans and organizes</li><li>processing speed: how quickly your child can think</li><li>academic skills: how well your child can read, write and do basic math</li><li>behaviour, emotions and personality: whether your child is depressed or anxious or has any behaviour problems. This is based on what the tester sees during testing as well as any reports on your child’s behaviour at home or school.</li></ul><p>You may be asked to take part in some of the tests, especially with a young child.</p><h2>How long does the assessment take?</h2><p>The baseline, or first, assessment usually takes a full day, with breaks for rest and lunch. The length of the assessment partly depends on your child's age and attention level and how fast they can work. Some children may need to have more than one appointment across more than one day.</p><h2>What should I expect after the assessment?</h2> <p>Once the assessment is done, the neuropsychologist will score the tests and interpret the results in light of your child's medical history.</p> <p>The report of your child’s neuropsychological assessment will go into your child’s hospital medical record and be shared with your child’s epilepsy team when they are discussing your child’s condition at team meetings. Outside of these situations, your child’s team will treat the information as confidential and share it outside the team only if required by law.</p><h2>How do I prepare my child for the assessment?</h2> <ul><li>Explain the assessment to your child in words they understand. For instance, tell your child that the testers want to find out how they think about, learn and remember things.<br></li> <li>Help prepare a young child by explaining the tests, answering questions and using drawing and special toys such as puzzles and blocks.</li> <li>Prepare an older child by telling them the assessment is like a fun test at school.</li></ul> <p>Regardless of age, put your child at ease by explaining that there will be no injections or painful procedures.</p>https://assets.aboutkidshealth.ca/AKHAssets/neuropsychological_assessment_before_epilepsy_surgery.jpg
Neuropsychological assessments for children with brain tumoursNNeuropsychological assessments for children with brain tumoursNeuropsychological assessments for children with brain tumoursEnglishNeurology;DevelopmentalChild (0-12 years);Teen (13-18 years)BrainNervous systemNAAdult (19+)NA2009-07-10T04:00:00ZLaura Janzen, PhD, CPsych, ABPP-CNCaelyn Kaise, MHSc, SLP(C), RegCASLPO10.600000000000049.70000000000001029.00000000000Flat ContentHealth A-Z<p>In-depth information concerning the nature of neuropsychological assessments and whether your child should undergo one.</p><p>A neuropsychological assessment helps assess your child’s thinking, behaviour, and problem-solving skills. It helps to get a sense of your child's abilities. It also shows how much your child’s school performance is affected by the tumour or treatment. It consists of a series of assessments and observations. A neuropsychologist will look at the results across all the results and compare them to other children who are the same age. The assessment is used to determine the best learning environment for your child. </p><h2>Key points</h2> <ul><li>A neuropsychological assessment shows your child's thinking abilities, may be needed to get extra services for your child, and can be repeated in the future to show changes over time.</li> <li>An assessment will take place before treatment begins and then again after treatment is finished, and every two to three years after that.</li> <li>Once the assessment is complete, the neuropsychologist will provide a written report for you, the treatment team, as well as your child’s school and the school board as needed.</li> <li>If your child’s speech is affected, the may need a speech-language assessment in addition to a neuropsychological assessment.</li></ul>
Neutropenia during brain tumour treatmentNNeutropenia during brain tumour treatmentNeutropenia during brain tumour treatmentEnglishNeurology;HaematologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesAdult (19+)NA2009-08-14T04:00:00ZEric Bouffet, MD, FRCPC11.100000000000036.1000000000000471.000000000000Flat ContentHealth A-Z<p>A detailed description of neutropenia and how it could be caused, diagnosed, and treated in your child. Answers by Canadian Paediatric Hospitals.</p><p>Neutropenia is an unusually low number of white blood cells, and it can arise as a result of being on chemotherapy or radiation. Severe and persistent neutropenia can lead to potentially life-threatening infections.</p><h2>Key points</h2> <ul><li>Neutropenia is an unusually low number of white blood cells in the blood.</li> <li>Infection is the most concerning complication of infection.</li> <li>If your child has had chemotherapy or radiation, neutropenia may be an expected side effect.</li> <li>Treatment of neutropenia will depend on the cause and on the severity.</li></ul>
Newborn babies at birthNNewborn babies at birthNewborn babies at birthEnglishPregnancyNewborn (0-28 days)BodyNANAPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSCAndrew James, MBChB, MBI, FRACP, FRCPC8.7000000000000061.80000000000001110.00000000000Flat ContentHealth A-Z<p>Read about newborn babies at birth. Physical changes at birth, the physical exam at birth, and the first four weeks of life are discussed.</p><p>Your baby is finally here! At birth, they may look different from what you expect, but within a day or two they will begin to look more like a normal baby. Over the next few weeks you will learn more about your baby and watch as they change and grow.</p><h2>Key points</h2> <ul><li>A baby's first breaths fluctuate between 15 and 100 breaths per minute.</li> <li>An Apgar score is given to assess newborn babies' well-being using heart rate, respiratory effort, muscle tone, reflex ability and colour.</li> <li>Newborn babies are able to search for their mother's breast, have good reflexes, follow a light with their eyes and recognize their mother's voice.</li> <li>Breast milk also contains antibodies that can help your newborn baby fight many infectious diseases until their immune system matures.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/newborn_babies_at_birth.jpg
Newborn babies: The first monthNNewborn babies: The first monthNewborn babies: The first monthEnglishNeonatologyNewborn (0-28 days)NANANAAdult (19+)NA2009-10-18T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPC9.7000000000000061.1000000000000432.000000000000Flat ContentHealth A-Z<p>This page is an introduction to the Newborn Babies section of the Pregnancy & Babies resource centre. It gives definitions for "newborn" and "neonatal," both of which pertain to the first 28 days of life.</p><p>The World Health Organization defines the newborn period as the first 28 days of life. This is also called the neonatal period, and the medical term for your newborn baby is neonate. This section of the Pregnancy & Babies Resource Centre provides information about your newborn baby, including what they will look like at birth, medical care, newborn baby behaviour, feeding and routine care at home, and health concerns. </p><h2>Key points</h2> <ul><li>In the few minutes after birth, your newborn baby is stimulated to breathe, the amniotic fluid is dried off so they don’t lose heat, and they are carefully observed during the transition process.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/newborn_babies_the_first_month.jpg
Newborn baby behaviourNNewborn baby behaviourNewborn baby behaviourEnglishNeonatologyNewborn (0-28 days)BodyNANAAdult (19+)NA2009-09-22T04:00:00ZJoanne Cummings, PhD, CPsychBrenda S. Miles, PhD, Cpsych7.4000000000000073.5000000000000761.000000000000Flat ContentHealth A-Z<p>Learn about newborn baby behavior. States of alertness such as the quiet state or alert state, crying, sleeping, and communication are discussed.</p><figure><img src="https://assets.aboutkidshealth.ca/akhassets/Henry_EN.jpg" alt="" /> </figure> <p>Right from birth, your newborn baby comes into the world capable of doing many things. Your baby will coo and gurgle, listen to sounds, and try to orient their head towards voices. They will move their arms when excited and may also imitate some of your facial expressions. Newborn babies enjoy looking at faces. Even though your newborn baby’s vision is limited at this point in time, they can detect light, shadows, shapes, contours, and movements. </p><h2>Key points</h2> <ul><li>Be patient with yourself as you learn to read your baby’s signals that tell you how they are feeling and wants you to react.</li> <li>Newborn babies will sleep about 18 hours each day, though they will wake up frequently.</li> <li>Newborns will receive at least eight feedings per day, adding up to two and a half hours each day spent eating.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/Newborn_baby_behaviour.jpg
Newborn baby safetyNNewborn baby safetyNewborn baby safetyEnglishNeonatologyNewborn (0-28 days)NANANAAdult (19+)NA2009-10-18T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPC8.0000000000000066.4000000000000589.000000000000Flat ContentHealth A-Z<p>How to effectively keep your newborn baby safe and comforted. Tips, such as holding them to offer proper head support, are included.</p><p>Your newborn baby is not nearly as fragile as you might think. However, you should still handle your baby gently to keep them safe and help them to feel secure. </p><h2>Key points</h2> <ul><li>Things you can do to keep your newborn safe include supporting their head, make sure all the baby equipment meets national safety standards, never shake your baby and never leave your baby alone.</li> <li>Reduce the risk of sudden infant death syndrome (SIDS) by placing your newborn on their back to sleep.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/newborn_baby_safety.jpg
Newborn behaviourNNewborn behaviourNewborn behaviourEnglishDevelopmentalPremature;Newborn (0-28 days);Baby (1-12 months)NANANAPrenatal Adult (19+)NA2009-10-31T04:00:00ZBrenda S. Miles, PhD, CPsychJoanne Cummings, PhD, CPsych Andrew James, MBChB, FRACP, FRCPC8.4000000000000067.50000000000001028.00000000000Flat ContentHealth A-Z<p>Read about the difference in behavior development between premature babies and full-term newborns. This may because of a developmental delay. </p><p>Until there are indications otherwise, parents should think of their child as normal and compare their baby’s behaviour to what is expected from full-term infants. At the same time, parents should keep in mind their baby’s corrected age and realise that the range and time frame of “normal” development is vast. </p><h2>Key points</h2> <ul><li>If abnormal behaviour is spotted early, there is a higher chance the effects can be minimized through therapy.</li> <li>Corrected age is measured from the expected date of birth instead of the actual age of birth and is used to determine development and progress of a baby.</li> <li>All babies are different, but there are certain behaviour milestones that will indicate if a baby is developing normally.</li></ul>https://assets.aboutkidshealth.ca/akhassets/Henry_EN.jpg
Newborn circumcision: Caring for your child at home after the procedureNNewborn circumcision: Caring for your child at home after the procedureNewborn circumcision: Caring for your child at home after the procedureEnglishUrologyNewborn (0-28 days);Baby (1-12 months)PenisPenisConditions and diseasesCaregivers Adult (19+)NA2016-06-10T04:00:00ZDalia Bozic MN, RN(EC), NP-PHC​;Joana Dos Santos, MD9.0000000000000060.6000000000000974.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn how to take care of your newborn son after he is circumcised.<br></p><p>Your child has had a <a href="/Article?contentid=461&language=English">circumcision​</a>. It is important to know how to care for your child at home after the procedure and when to call for help.</p> <figure class="asset-c-80"> <span class="asset-image-title">Circumcision</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_circumcision_EN.png" alt="Identification of glands, foreskin and scrotum of an uncircumcised penis, and the glands and scrotum of a circumcised penis" /> <figcaption class="asset-image-caption">Circumcision involves removing the foreskin that covers the glans, or head of the penis.</figcaption> </figure><h2>​Key points</h2> <ul> <li>​Leave your infant's dressing (lubricant gauze) on for 24 hours after the circumcision.</li> <li>While your child is healing, apply a petroleum-based ointment (such as Vaseline) to the end of the penis after every bath and with each diaper change.<br></li> <li>Give your child acetaminophen for pain as instructed.</li> <li>Go to the nearest emergency department if your child has excessive bleeding, fever, worsening redness or swelling, yellow liquid draining from the incision or difficulty with urinating.</li> </ul><h2>What to expect as your child heals after a circumcision</h2> <p>Once your child is circumcised, the surgeon will apply a lubricant gauze dressing to the area. The lubricant helps to prevent the dressing from sticking to the glans. The gauze usually falls off on its own within 24 hours.</p> <p>Over the following days, your child will heal from the surgery in stages. Every child heals differently; it can take up to a month for the penis to appear fully healed.</p> <h3>Bleeding</h3> <p>Within minutes, hours or an entire day, the cut edges of the glans close up and bleeding stops.</p> <h3>​Colour changes</h3> <p>​Immediately after the circumcision, the glans may appear red and glossy or even purple. This occurs because the skin covering the glans of an uncircumcised penis is a mucous membrane. Once the membrane is exposed, it thickens and becomes darker.</p> <p>Your child's glans may have off-white or yellowish patches in the first few days after surgery. These are a type of scab and are completely normal. Two or three days after the circumcision, the skin may look green and yellow. This is a sign of normal healing, not pus.</p> <h3>Swelling</h3> <p>You may notice some swelling behind or under the head of the penis and believe it looks like a blister. The swelling is simply another sign of healing and will disappear within a week or two.</p> <h3>​Changes in size</h3> <p>​The penis may appear smaller after circumcision. This is mostly because the skin surrounding the penis is relaxed, while before circumcision it usually held the penis more erect. </p><h2>When to see a doctor after a circumcision</h2> <p>Go to the nearest emergency department (ED) <strong>right away</strong> if your child has excessive bleeding (small pools of blood or spots larger than a two-dollar coin on the diaper). To help slow down any bleeding before you go the ED, use your thumb and index finger to create a ring around the top of the penis and squeeze for five minutes.</p> <p>Also go to the nearest emergency department if your child has:</p> <ul> <li>redness of the skin spreading to abdomen and legs</li> <li><a href="/Article?contentid=30&language=English">fever</a></li> <li>poor feeding and/or <a href="/Article?contentid=746&language=English">vomiting</a></li> <li>yellow liquid draining from the incision</li> <li>difficulty with urinating (peeing) after circumcision, for example if diapers are less wet than usual.</li> </ul><h2>At SickKids</h2> <p>The Urology Clinic is at 555 University Avenue, the Atrium, Fifth Floor, Unit D. Use the Atrium elevators (near the cafeteria), exit at the 5th floor and look for the unit D. Working hours are 8:30 am to 4:30 pm, Monday to Friday.​</p> <p>If your child is healing normally, he does not need a follow-up visit with the Urology Clinic. You can follow up with your family doctor or paediatrician within a week of the circumcision.</p> <p>If you have any concerns, however, you can call the Urology Clinic during working hours at <strong> (416) 813-6661</strong> and ask to speak to a Urology nurse. If you have concerns after working hours, see your family doctor or go to the nearest emergency department. If you need to leave a message with the clinic, you can expect a call back within 24 hours.</p>https://assets.aboutkidshealth.ca/akhassets/IMD_circumcision_EN.png

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