VO2 max exercise testVVO2 max exercise testVO2 max exercise testEnglishCardiologyPreschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)HeartHeartTestsCaregivers Adult (19+)NA2009-11-10T05:00:00ZGareth Smith, MSc;Jennifer Russell, MD, FRCPC;Carrie Heffernan, RN, BScN, MN;Jennifer Kilburn, BScN, MN5.9000000000000078.00000000000001359.00000000000Health (A-Z) - ProcedureHealth A-Z<p>A VO2 max exercise test measures how well your child's heart and lungs send oxygen to the muscles during exercise. Learn about the VO2 max exercise test. </p><p>Your child's doctor has asked that your child complete a VO2 max exercise test. This information explains what the test is, how to prepare for it and how it is done. Parents can use this information to help their child prepare for the test.</p><h2>What is an exercise test?</h2><p>The exercise test tells your child's doctor if your child's heart beats in a regular way when they do things like walk, run and ride a bicycle. These tests give information your child's doctor cannot measure while your child sits or rests. The doctor can also see how your child's heart works compared with how other children's hearts work.</p><h2>What is the VO2 max exercise test?</h2><p>The VO2 max exercise test measures how well your child's heart and lungs send oxygen to the muscles during heavy exercise. Your child will be asked to either pedal a special bicycle or walk on a treadmill, which is like a moving sidewalk. Your child's heartbeat, blood pressure and oxygen level will be measured while they exercise.</p> <figure class="asset-c-80"> <img src="https://assets.aboutkidshealth.ca/akhassets/Exercise_test_VO2_max_MED_ILL_EN.jpg" alt="Child pedaling while wearing a saturation monitor, mouthpiece, blood pressure cuff and electrocardiograph sensor" /> <figcaption class="asset-image-caption">1: Blood pressure cuff, 2: Electrocardiograph (ECG) Sensor, 3: Blood pressure monitor, 4: Bicycle, 5: ECG monitor, 6: Mouthpiece, 7: Saturation monitor</figcaption> </figure><h2>Key points</h2> <ul> <li>The VO2 max exercise test measures how well your child's heart and lungs send oxygen to the muscles during heavy exercise. </li> <li>The test uses machines to measure your child's oxygen levels, blood pressure and heartbeat while your child rides a special bike or walks on a treadmill. </li> <li>Your child should let the technologist know right away if they have chest pain, trouble breathing, dizziness, irregular heartbeat or tired legs during the test. </li> </ul><h2>Who will give the test?</h2> <p>Two technologists will give your child the VO2 max exercise test. Technologists are people who are trained to give the test on the machines in the hospital. </p> <h2>First your child will be asked to do a breathing test</h2> <p>Before the VO2 max exercise test, your child will be asked to do a breathing test called a pulmonary function test. The pulmonary function test is done in two parts: </p> <ul> <li>The first part of the test is like blowing out the candles on a birthday cake. It measures how much and how fast your child can blow air out. </li> <li>The second part of the test measures how much air your child can breathe in and out in 15 seconds. </li> </ul> <p>Before the test, your child will be given a clip to put on their nose. The nose clip makes sure that your child's breath comes out only through the mouth. It also makes it easier to measure the amount of air going in and out of the mouth. </p> <p>Your child will be given a mouthpiece to blow in. Your child will breathe through the mouthpiece into a machine called a spirometer. The spirometer measures your child's breathing. </p> <p>These tests use a clean, sterilized mouthpiece and nose clip.</p> <h2>Machines will measure your child's oxygen levels, blood pressure and heartbeat</h2> <p>To prepare your child for the VO2 max exercise test, the technologist will do the following things:</p> <ul> <li>The technologist will put a device called a saturation monitor on your child's forehead. It measures the amount of oxygen in your child's blood. The device is kept in place with a headband. </li> <li>The technologist will put a sleeve called a blood pressure cuff on your child's arm. The blood pressure cuff will be used to check how hard your child's heart is pumping during the test. </li> <li>Your child will be hooked up to a computer called an electrocardiograph (ECG). The ECG makes pictures of how your child's heart beats during physical activity. </li> </ul> <h2>Connecting your child to the ECG</h2> <p>Here are the steps the technologist will follow to hook up your child to the ECG:</p> <ol> <li>The technologist will wipe the skin on your child's chest with water. This is to make sure the skin is very clean.</li> <li>The technologist will gently rub the cleaned skin with a scratchy pad. This will make it easier for the stickers to stay on and provide a good picture of your child's heartbeat.</li> <li>The technologist will put 10 stickers, called electrodes, on your child's chest.</li> <li>The technologist will attach one end of a wire to each electrode and the other end of each wire to the ECG machine.</li> </ol> <h2>Your child will ride a special bicycle or walk on a treadmill</h2> <p>Most VO2 max exercise tests are done on a special bicycle, but sometimes the test is done using the treadmill. If your child is using the bicycle, the technologist will adjust the seat to fit your child's height. The bicycle does not move and your child does not have to balance on it. </p> <p>Before starting the test, your child will be given a nose clip and a rubber mouthpiece to breathe into. The mouthpiece is connected to a machine called a metabolic cart. It tests how well your child's body takes in oxygen and sends it to the muscles.</p> <p>The technologist will then tell your child how fast to pedal. It will feel like riding a bike up a hill that gets steeper and steeper. Your child will be asked to pedal for between five and 10 minutes. </p> <p>When your child cannot pedal any more, the technologist will make the bike easier to pedal. After one minute the technologist will remove the mouthpiece and nose clip. Your child will then be asked to pedal slowly for two minutes to cool down. </p> <p>Your child's heart rate and blood pressure will be monitored at rest, during exercise, and during the cool down period.</p> <p>It is important that your child follows the directions the technologist gives for the test. Encourage your child to try their best. This way, the doctors can get the most accurate results. They will have a clearer picture of your child's heart and how it works. </p> <h2>Your child should let the technologist know if they have problems during the test</h2> <p>Your child should let the technologist know right away if they have any problems during the test. The technologist will show your child how to use hand signals. Your child can use the hand signals to let the technologist know if they have any of the following problems:</p> <ul> <li>pain in the chest </li> <li>trouble breathing </li> <li>dizziness </li> <li>heartbeat feels irregular </li> <li>tired legs </li> </ul> <p>If the technologists see a problem during any of the tests, they will tell the cardiologist right away.</p> <h2>You may be able to stay with your child during the test</h2> <p>You can discuss with the technologist if it is best for your child if you stay. You must not talk to your child during the test so that they can concentrate.</p><h2>Your child should sleep well and eat a good breakfast before the test</h2> <p>To get ready for the exercise test, your child should do the following:</p> <ul> <li>Your child should be well rested the night before the test. </li> <li>Your child should eat a good breakfast on the day of the test. A good breakfast includes servings of grains, protein and fruit. One example of a good breakfast is egg, peanut butter or cheese; toast; juice or fruit; and milk. </li> <li>Your child should finish eating one to two hours before they start the test. </li> <li>Your child should wear or bring a T-shirt, shorts, non-slip, closed toe, running shoes and socks for the test. </li> </ul><h2>At SickKids</h2> <p>The test is done on the 4th floor of the hospital on ward 4B. Please register at the 4B desk.</p>https://assets.aboutkidshealth.ca/akhassets/Exercise_test_VO2_max_MED_ILL_EN.jpg
Vaccines: Concerns about immunizing your childVVaccines: Concerns about immunizing your childVaccines: Concerns about immunizing your childEnglishInfectious DiseasesChild (0-12 years);Teen (13-18 years)NAImmune systemHealthy living and preventionAdult (19+) CaregiversNA2019-07-12T04:00:00ZShaun Morris, MD, MPH, FRCPC, FAAP10.700000000000048.80000000000001264.00000000000Flat ContentHealth A-Z<p>Many parents have questions about vaccines. Find information about how many diseases vaccines protect children against in Canada. Also learn about the safety of vaccines and what side effects your child may experience. Finally, learn about how vaccines are given and what you can do to make it less stressful for your child.</p> <p>As a parent, do you have concerns about vaccinating your children? You are not alone. One in three parents in Canada have said they have some minor doubts and concerns about vaccinating their child. For example, in Ontario, the average vaccination rate for seven year olds for measles was 88% for the 2017-18 school year. Areas such as Toronto, however, only had a 74% vaccination rate for measles for seven year olds. The reasons why people choose not to vaccinate their children are complex.</p><p>In addition to all of the questions you might have, you may not be sure what and who to believe or where to get your information. You hear about vaccines from your child’s primary health-care provider, in the media, from friends and family, or by reading information on the Internet. Often, the information seems to conflict.</p> <h2>Key points</h2><ul><li>All diseases that children are vaccinated against are serious and can cause illness, complications and even death.</li><li>Children who are not vaccinated are at risk in their own communities, when travelling or when infections are brought into the country.</li><li>Vaccines are very safe and thoroughly tested before being approved for use, and most provide over 90% protection against the disease. </li><li>There is a lot of scientific evidence that vaccines do not cause autism and none to support the belief that they do.</li><li>Receiving multiple vaccines at a single time is safe for your child and most side effects are minor and temporary.</li></ul><h2>References</h2><p>Caring for Kids. (2016, November). <em>Vaccine safety: Canada’s system</em>. Retrieved from <a href="https://www.caringforkids.cps.ca/handouts/vaccine_safety">https://www.caringforkids.cps.ca/handouts/vaccine_safety</a></p><p>Caring for Kids. (2016, November). <em>Vaccines: Common concerns</em>. Retrieved from <a href="https://www.caringforkids.cps.ca/handouts/vaccines-common-concerns">https://www.caringforkids.cps.ca/handouts/vaccines-common-concerns</a></p><p>Caring for Kids. (2016, November). <em>Vaccines: Myths and facts</em>. Retrieved from <a href="https://www.caringforkids.cps.ca/handouts/vaccines-myths-and-facts">https://www.caringforkids.cps.ca/handouts/vaccines-myths-and-facts</a></p><p>Centers for Disease Control and Prevention. (2015). Measles. In Hamborsky, J., Kroger, A., Wolfe, S. (Eds.), <em>Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th ed.</em> (pp. 209-30). Washington D.C. Public Health Foundation. Retrieved from <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html">https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html</a></p><p>Centers for Disease Control and Prevention. (2018). <em>Multiple Vaccines and the Immune System</em>. Retrieved from <a href="https://www.cdc.gov/vaccinesafety/concerns/multiple-vaccines-immunity.html">https://www.cdc.gov/vaccinesafety/concerns/multiple-vaccines-immunity.html</a></p><p>EKOS Research Associates. (2018). <em>Survey for the Development of the Childhood Vaccination Campaign Findings Report Prepared for Health Canada</em>. Retrieved from <a href="http://epe.lac-bac.gc.ca/100/200/301/pwgsc-tpsgc/por-ef/health/2018/022-17-e/report.pdf">http://epe.lac-bac.gc.ca/100/200/301/pwgsc-tpsgc/por-ef/health/2018/022-17-e/report.pdf</a></p><p>Hviid, A., Hansen, J.V., Frisch, M., Melbye, M. (2019). Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. <em>Annals of Internal Medicine</em>, 170, 513–520. doi: <a href="https://annals.org/aim/fullarticle/2727726/measles-mumps-rubella-vaccination-autism-nationwide-cohort-study">10.7326/M18-2101</a></p><p>Public Health Agency of Canada. (2016, September 1). <em>Canadian Immunization Guide: Part 1 - Key Immunization Information</em>. Retrieved from <a href="https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-1-key-immunization-information.html">https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-1-key-immunization-information.html</a></p><p>Public Health Agency of Canada (2018, October 18). <em>Vaccines for children: Deciding to vaccinate</em>. Retrieved from <a href="https://www.canada.ca/en/public-health/services/vaccination-children.html">https://www.canada.ca/en/public-health/services/vaccination-children.html</a></p><p>Public Health Ontario (2019, May). <em>Immunization Coverage Report for School Pupils in Ontario: 2017-18 School Year</em>. Retrieved from <a href="https://www.publichealthontario.ca/-/media/documents/immunization-coverage-2017-18.pdf">https://www.publichealthontario.ca/-/media/documents/immunization-coverage-2017-18.pdf</a></p><p>Statistics Canada. (2019). <em>Childhood National Immunization Coverage Survey, 2017</em>. Retrieved from <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/190326/dq190326d-eng.htm">https://www150.statcan.gc.ca/n1/daily-quotidien/190326/dq190326d-eng.htm</a></p><p>World Health Organization. (2019). <em>Ten threats to global health in 2019</em>. Retrieved from <a href="https://www.who.int/emergencies/ten-threats-to-global-health-in-2019">https://www.who.int/emergencies/ten-threats-to-global-health-in-2019</a></p>
Vaginal birth after caesarean sectionVVaginal birth after caesarean sectionVaginal birth after caesarean sectionEnglishPregnancyAdult (19+)Body;UterusReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC11.000000000000050.1000000000000680.000000000000Flat ContentHealth A-Z<p>Learn about the conditions under which you may be offered vaginal birth after a Caesarean section, and the considerations/precautions you should take.</p><p>Some women who have a caesarean section may be able to have a vaginal birth in their next pregnancy. In 50% to 85% of cases, a vaginal birth after caesarean section, or VBAC, is successful for both mother and baby. If the reason for the previous caesarean section was cephalopelvic disproportion, where the baby’s head was too big for the woman’s pelvis, the chances of a successful VBAC is 30% to 50%. Certain women who have had a previous caesarean section may be offered a trial of labour and VBAC for their next pregnancy. If you are considering VBAC, it is important to accept the possibility that you may still require a caesarean section after going through the trial of labour. </p><h2>Key points</h2> <ul><li>Some women who have a caesarean section may be able to have a vaginal birth in their next pregnancy, however they may still need a caesarean after going through labour.</li> <li>Women should not have a VBAC if they had anything other than a bikini cut incision in their previous C-section, had a previous uterine rupture, or had a previous surgery to remove fibroids from the uterus.</li> <li>The main concern when a woman attempts VBAC is that her uterus may rupture, a rare but serious complication.</li></ul>
VaginoscopyVVaginoscopyVaginoscopyEnglishGenital and reproductiveChild (0-12 years);Teen (13-18 years)PelvisVaginaTestsCaregivers Adult (19+)NA2009-11-10T05:00:00ZJoley Johnstone, RN, BScN8.2000000000000059.1000000000000528.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Vaginoscopy is an examination of the vagina using a tiny tube and camera. Learn about when vaginoscopy is used and what to expect during the procedure. </p><h2>What is vaginoscopy?</h2> <p>Vaginoscopy is an examination of the inside of the vagina using a cystoscope. A cystoscope is a plastic-coated cable thinner than a pencil, with a tiny video camera on the end. As the camera films the inside of the vagina, the doctor can see what the camera sees on a video monitor. </p> <p>Vaginoscopy is a diagnostic procedure. This means that it helps the doctor find out if there is something wrong inside the vagina. </p> <p>Vaginoscopy is done when a young girl has unexplained pain or bleeding from the vagina. It is different from the kind of examination a gynaecologist or family doctor would use for a woman's vagina. For young girls, a vaginoscopy is more comfortable and easier to have done. </p><h2>Key points</h2> <ul> <li>Vaginoscopy is an examination of the inside of the vagina. </li> <li>It is done under general anaesthetic. </li> <li>Most girls who have vaginoscopy go home the same day and quickly return to their daily activities. </li> </ul><h2>When to call the doctor</h2><p>Call the doctor if your child has any of these symptoms after a vaginoscopy:</p><ul><li>pain that is very bad or gets worse </li><li>heavy bleeding from the vagina </li><li><a href="/Article?contentid=30&language=English">fever</a><br></li><li>trouble urinating (peeing) <br></li></ul><h2>Vaginoscopy is done under general anaesthesia</h2><p>Before the examination, your child is put to sleep with medicines. This is called <a href="/Article?contentid=1261&language=English">general anaesthesia</a>. The examination usually takes a few minutes, but the whole procedure including putting your child to sleep may take about an hour. </p><p>The doctor will gently put the cystoscope into the vagina. This will not harm any tissues, including the hymen. The doctor will then look at the monitor to see if there is anything wrong. Sometimes a foreign object such as a piece of toilet paper is the problem. If this is the case, the doctor will be able to see the object with the cystoscope. The doctor may also take a swab from the vagina to test for infection. A swab is a small sample of liquid taken from the wall of the vagina with a clean Q-Tip. </p><p>Some parents worry that this procedure will affect the child's virginity. It will not. No tissues are damaged and the child will not remember the event. </p><h2>In the recovery room after a vaginoscopy</h2> <p>After a vaginoscopy, your child will go to the recovery room until the general anesthetic wears off. When she wakes up, and is able to drink water, you can take her home. </p>
Valve dilation in the heart catheterization labVValve dilation in the heart catheterization labValve dilation in the heart catheterization labEnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartHeartProceduresCaregivers Adult (19+)NA2009-11-10T05:00:00ZJackie Hubbert, BScN;Lee Benson, MD, FRCP(C), FACC, FSCAI;Carrie Morgan, RN, MN;Cindy Wasyliw, RN, BNSc7.8000000000000064.10000000000001038.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Valve dilation uses heart catheterization to open a narrowed valve in the heart. Read about valve dilation, possible complications and recovery.</p><h2>What is a heart valve?</h2><p>Heart valves are like gates that control the flow of blood between the upper and lower chambers of the heart, as well as the flow out of the heart.</p><p>There are four heart valves:</p><ul><li>the tricuspid valve, between the right atrium and the right ventricle</li><li>the mitral valve, between the left atrium and the left ventricle</li><li>the pulmonary valve, between the right ventricle and the pulmonary artery</li><li>the aortic valve, between the left ventricle and the aorta</li></ul><p>If the opening of a valve is too narrow, the heart cannot pump blood through it easily. A narrow valve is called stenotic.</p><h2>What is a valve dilation?</h2><p>A valve dilation is done to open a heart valve that is abnormally narrow. A valve dilation is also called a balloon valvotomy.</p><p>A valve dilation can be done on any heart valve. The procedure is done in the heart catheterization laboratory.</p> <figure class="asset-c-80"><span class="asset-image-title">Valve dilation</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Valve_dilation_MED_ILL_EN.png" alt="Heart with narrow valve and heart with catheter and balloon through blood vessel and valve" /> <figcaption class="asset-image-caption">A catheter with a deflated balloon on its tip is threaded through a blood vessel in the body up to the heart. When the balloon reaches the narrow valve it is inflated, which opens up the valve. The balloon is deflated and the catheter is removed.</figcaption> </figure> <h2>What is heart catheterization?</h2><p>During heart catheterization, the doctor carefully puts a long, thin tube called a catheter into a vein or artery in your child's neck or groin. The groin is the area at the top of the leg. Then, the catheter is threaded through the vein or artery to your child's heart.</p><p>The doctor who does the procedure is a cardiologist, which means a doctor who works on the heart and blood vessels. This may not be your child's regular cardiologist.</p><p>To learn about heart catheterization, please see <a href="/Article?contentid=59&language=English">Heart catheterization: Getting ready for the procedure</a>.</p><h2>Key points</h2> <ul> <li>Valve dilation is a procedure to widen a narrowed heart valve. </li> <li>There is a small risk that your child will have complications from the procedure. Your child's doctor will explain the risks to you before the procedure. </li> <li>Your child will need to have an anaesthetic. Your child will probably need to stay overnight in the hospital after the procedure. </li> </ul><h2>What happens during the procedure</h2> <p>The procedure is performed while your child is under a general anaesthetic. This means that your child will be asleep during the procedure. </p> <p>During the catheterization, the doctor threads a special catheter through your child's blood vessels to the valve. The team takes X-ray pictures and measurements of the valve. Then the team threads a deflated balloon on the tip of the catheter to the narrowed valve. The balloon is then inflated to open up the narrowed valve. Sometimes a second larger balloon is used to dilate the area further. </p> <p>Then the balloon is deflated. The doctor takes out the balloon and catheter, and covers the cuts on your child's leg with a bandage. </p> <h2>The procedure will take two to four hours</h2> <p>The procedure usually takes two to four hours. After the procedure, your child will go to the recovery room to wake up from the anaesthetic. </p><h2>After the procedure</h2> <p>Your child will probably need to spend the night in hospital after the procedure. If your child needs to spend the night, they will be transferred to the inpatient unit from the recovery room. </p> <p>The cardiologist will let you know when your child can go home and when you should bring your child back for a check-up.</p> <p>For information on what to do after your child goes home, please see <a href="/Article?contentid=1214&language=English">Heart catheterization: Caring for your child after the procedure</a>.</p> <h3>Coming back for a check-up</h3> <p>Your child will be given a date and time to see their cardiologist after the procedure.</p> <p>Write the date and time of the appointment here:</p> <p> </p> <h3>Antibiotics to prevent infectious endocarditis</h3> <p>Depending on your child's specific heart condition, your child may need to take antibiotics before and after some dental and other procedures. These drugs help prevent a heart infection called infectious endocarditis. Speak to your cardiologist for more information. </p>https://assets.aboutkidshealth.ca/akhassets/Valve_dilation_MED_ILL_EN.png
Varicocele embolization using image guidanceVVaricocele embolization using image guidanceVaricocele embolization using image guidanceEnglishOtherChild (0-12 years);Teen (13-18 years)ScrotumVeinsProceduresCaregivers Adult (19+)NA2016-02-09T05:00:00ZMichelle Cote BScN RN;Joao Amaral, MD9.8000000000000050.80000000000001077.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn what a varicocele is and how embolization is used to treat is using image guidance.</p><h2>What is a varicocele?</h2><p>A varicocele is an enlargement of the veins in the scrotum. This may cause pain or a heavy sensation in the scrotum. It may also contribute to infertility. A varicocele develops over time.</p> <figure class="asset-c-80"><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_varicocele_EN.png" alt="Illustration of normal veins of the testes and of varicocele (enlarged veins)" /> </figure> <h2>What is a varicocele embolization?</h2><p>Embolization is a procedure in which a blood vessel is intentionally blocked to divert blood flow. This procedure is done using image guidance by an interventional radiologist.</p><h2>Key points</h2> <ul> <li>A varicocele is an enlargement of the veins in the scrotum.</li> <li>A varicocele embolization is a procedure where the enlarged veins in the scrotum are blocked, diverting blood to other veins.</li> <li>Varicocele embolization is done using image guidance by an interventional radiologist.</li> <li>Varicocele embolizations are considered low-risk procedures.</li> <li>Most children go home on the same day as their procedure.</li> </ul><h2>On the day of the varicocele embolization</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 varicocele embolization and the anaesthetist who will be giving your child medication to make them comfortable during the procedure.</p><p>During the varicocele embolization 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. For varicocele embolization, most children are given <a href="/Article?contentid=1261&language=English">general anesthesia</a> and <a href="/Article?contentid=3001&language=English">local anesthesia</a> to make sure they are comfortable. The type of medicine that your child will have for the procedure will also depend on your child’s condition.</p><h2>How is a varicocele embolization done?</h2><p>The interventional radiologist will insert a tiny plastic tube, called a catheter, into a vein in the groin or neck through a small (0.5cm) cut in the skin. The catheter is guided through the veins to the varicocele. The interventional radiologist then inserts material through the catheter that blocks the varicocele and diverts blood to other veins. After the vessel has been successfully blocked, the catheter is removed and pressure is applied to the groin or neck to stop bleeding. No stitches are needed.</p><p>The procedure usually takes two hours.</p><h2>After the Varicocele Embolization</h2> <p>Once the varicocele embolization is complete, your child will be moved to the recovery area. The interventional radiologist will come and talk to you about the details of the procedure. As soon as your child starts to wake up, a nurse will come and get you.</p> <h2>Going home</h2> <p>In most cases, children go home the same day after the varicocele embolization. Your doctor will let you know when they are well enough to go home.</p><h2>Visiting the interventional radiologist before the procedure</h2><p>Your child will 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=French">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>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 varicocele embolization 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 procedure, let you doctor know. Your child 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">Your child’s stomach must be empty</a> before sedation or general anaesthetic.<br></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">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">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">Coming for surgery</a>.</p>https://assets.aboutkidshealth.ca/akhassets/IMD_varicocele_EN.png
Varicocele embolization: Caring for your child at home after the procedureVVaricocele embolization: Caring for your child at home after the procedureVaricocele embolization: Caring for your child at home after the procedureEnglishOtherTeen (13-18 years)TesticleVeinsNon-drug treatmentCaregivers Adult (19+)NA2013-03-27T04:00:00ZJoao Amaral, MD;Candice Sockett, RN(EC), MN:APN9.0000000000000060.4000000000000544.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Your child has had embolization of a varicocele. This brochure explains how to look after your child at home after the procedure, and when to call for help. </p><p>Your child has had <a href="/Article?contentid=2473&language=English">varicocele embolization</a>. This brochure explains how to care for your child at home after the procedure, and when to call for help. </p><h2>Key points </h2> <ul> <li>Phone IGT or go to the nearest Emergency Department if your child has a fever, severe pain, or bleeding in the groin.</li> <li>Go the nearest Emergency Department if your child has severe pain in the testicle.</li> <li>Leave the dressing on for 24 hours after the procedure.</li> <li>You may give your child acetaminophen for pain.</li> <li>Your child should avoid all physical activities for six full weeks after the procedure.</li> </ul><h2>When to see a doctor </h2><p>Phone your specialist or Image Guided Therapy (IGT) or go to the nearest Emergency Department right away if your child has any of the following:</p><ul><li>throwing up (<a href="/Article?contentid=746&language=English">vomiting</a>) that does not stop</li><li>severe pain and swelling in the groin where the catheter was inserted or in the testicle</li><li>bleeding or a growing bruise in the groin</li><li>dizziness and pale colour </li><li>general weakness </li><li>severe and sudden shortness of breath </li><li>blood in the urine </li></ul><h2>At SickKids</h2> <p>If you have any concerns in the first 48 hours, call the IGT clinic during working hours at (416) 813-6054 and ask to speak to an IGT nurse. After 48 hours, please call your urologist. If you have concerns and it is after working hours, see your family doctor or go to the nearest Emergency Department or call the Hospital for Sick Children switchboard at (416) 813-1500 and ask them to page your specialist or the interventional radiologist on call. </p>https://assets.aboutkidshealth.ca/AKHAssets/varicocele_embolization_caring_for_your_child_at_home.jpg
Vascular access for hemodialysis: Caring for your child after the procedureVVascular access for hemodialysis: Caring for your child after the procedureVascular access for hemodialysis: Caring for your child after the procedureEnglishNephrologyChild (0-12 years);Teen (13-18 years)ArmArteries;VeinsNon-drug treatmentCaregivers Adult (19+)NA2011-11-30T05:00:00ZMaria Di Mola, RN6.5000000000000071.5000000000000743.000000000000Health (A-Z) - ProcedureHealth A-Z<p>The following information will help you to properly care for your child after vascular access surgery.</p><p>Your child has had a procedure to improve <a href="/Article?contentid=1034&language=English">vascular access</a> for hemodialysis. This brochure explains how to care for your child at home after the procedure, and when to call for help.</p> <h2>When can my child go home?</h2> <ul> <li>Your child can go home on the same day as the surgery. </li> </ul><h2>Key points</h2> <ul> <li>You can remove your child's bandage after 48 hours. Wash the area with mild soap and water and then pat dry.</li> <li>Listen for the "bruit" or feel for the "thrill" in your child's fistula or graft four times a day (first thing in the morning and the last thing at night).</li> <li>Your child should keep their arm up when resting to reduce swelling. </li> <li>If your child is showing signs of infection or thrombosis call your doctor right away or take your child to the nearest emergency department.</li> </ul><h2>Possible complications of AV fistula and AV graft</h2> <h3>Two major complications are possible:</h3> <ul> <li>infection</li> <li>thrombosis (clotting of fistula or graft)</li> </ul> <h3>Signs of infection</h3> <ul> <li>warm painful area over your child's access site</li> <li>redness and swelling over your child's access site</li> <li>fever of more than 38.0°C (100.4°F)</li> </ul> <h3>Signs of thrombosis</h3> <ul> <li>no "bruit" or sound over your child's access site</li> <li>painful, hard welling over your child's access site</li> </ul><h2>When to seek help</h2> <p>Call the hospital immediately if you think your child is suffering from an infection or thrombosis. </p> <p>Nephrologist (on call): (416) 813-7500</p> <p>Hemodialysis unit: (416) 813-7653</p> <h3>After hours:</h3> <p>Go to the nearest Emergency Department.</p><h2>At SickKids</h2> <h3>Pain Medication </h3> <p>Before you leave, we will give your child a prescription for _____________________________. If your child has an allergy to this medication, we will provide them with a different prescription. Most people need medication for only a few days.</p> <h3>Other Medications</h3> <p>If your child stopped taking their blood thinning medication before the surgery, please speak to a doctor about restarting this medication before leaving the hospital.</p>https://assets.aboutkidshealth.ca/AKHAssets/vascular_access_hemodialysis_caring_for_child_at_home.jpg
Vascular ringVVascular ringVascular ringEnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2009-12-04T05:00:00ZFraser Golding, MD, FRCPC8.3000000000000059.1000000000000190.000000000000Flat ContentHealth A-Z<p>Read about vascular rings, which are blood vessels that develop, surround, and squeeze nearby structures such as the windpipe.</p><p>A vascular ring is a blood vessel that develops, surrounds, and squeezes nearby structures such as the trachea (windpipe). These rings, which result from the abnormal development of the aortic arch, can cause respiratory or feeding problems.</p><h2> Key points </h2> <ul><li>A vascular ring can be difficult to diagnose because it does not present symptoms typical of a heart condition.</li> <li> Children who have symptoms will have surgery to open up the ring.</li></ul>
Vegetables and fruitVVegetables and fruitVegetables and fruitEnglishNutritionChild (0-12 years);Teen (13-18 years)NADigestive systemHealthy living and preventionCaregivers Adult (19+) Educators Hospital healthcare providers Community healthcare providers Remote populations First nationsNA2013-09-27T04:00:00ZTheresa Couto, RD;Elly Berger, BA, MD, FRCPC, FAAP, MHPE;Francy Pillo-Blocka RD, FDC7.5000000000000065.5000000000000180.000000000000Flat ContentHealth A-Z<p>Learn about the nutrients in and recommended serving sizes for vegetables and fruit, one of the four food groups in Canada's Food Guide.</p><ul><li>Source of fibre</li><li>Good source of vitamin A and C, potassium, magnesium and some B vitamins such as folate</li><li>May reduce risk of some cancers and heart disease<br></li></ul><h2>Key points</h2><ul><li>Vegetables and fruit are a good source of fibre, folate, vitamins A and C and potassium and magnesium. </li><li>Have your child eat at least one vegetable or fruit at each meal or snack.</li><li>Your child should eat at least one dark green and one orange vegetable every day.</li></ul><br>
Vegetarian childVVegetarian childVegetarian childEnglishNutritionChild (0-12 years);Teen (13-18 years)NANAHealthy living and preventionCaregivers Adult (19+)NA2008-07-04T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPC9.1000000000000056.1000000000000909.000000000000Flat ContentHealth A-Z<p>This article describes what to do when your child decides to become a vegetarian.</p><p>Vegetarian diets can be very healthy - even for growing children. Parents should know that a good vegetarian diet can provide many health benefits and protect against certain diseases. In fact, the whole family may benefit from even a slight vegetarian shift in diet. </p><h2>Key points</h2> <ul> <li>Vegetarian diets can be perfectly healthy for children.</li> <li>There are different kinds of vegetarian diets. </li> <li>Vegetarians must take special care to get enough calories and essential nutrients.</li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/vegetarian_child.jpg
Veno-Occlusive disease after a blood and marrow transplantVVeno-Occlusive disease after a blood and marrow transplantVeno-Occlusive disease after a blood and marrow transplantEnglishHaematology;Immunology;OncologyChild (0-12 years);Teen (13-18 years)BodyImmune systemConditions and diseasesAdult (19+)NA2010-01-06T05:00:00ZJohn Doyle, MD, FRCPC, FAAPChristine Armstrong, RN, MScN, NP Peds8.5000000000000062.2000000000000558.000000000000Flat ContentHealth A-Z<p>Learn about veno-occlusive disease, which is an uncommon complication after blood and marrow transplant.</p><p>Veno-Occlusive disease (VOD) is an uncommon, but serious liver problem. In VOD, the blood vessels that transport blood through the liver become inflamed and blocked. This causes the liver to swell. Because of the lack of blood supply, the liver cannot remove toxins, drugs and other waste products from the blood, which is one of the liver’s essential functions. Eventually, fluids build up inside the liver, making it more tender. The kidneys may keep excess water and salt, causing the arms, legs and abdomen to swell.</p> <p>In most cases, VOD is not severe, and the damage to the liver can be reversed. But serious VOD can be life-threatening. In this case, extra fluid in the abdomen puts pressure on the lungs, making it difficult to breath. </p><h2>Key points</h2> <ul><li>In Veno-Occlusive disease (VOD) is an uncommon liver problem in which the liver cannot function properly.</li> <li>Symptoms of VOD include jaundice, pain or tenderness in the liver, rapid weight gain, edema, and ascites.</li> <li>To reduce the damage to the liver, your child’s health care team will balance the amount of fluid and/or perform abdominocentesis.</li></ul>https://assets.aboutkidshealth.ca/akhassets/Liver_location_MED_ILL_EN.jpg
Venting a G tube to manage fullness and bloatingVVenting a G tube to manage fullness and bloatingVenting a G tube to manage fullness and bloatingEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)Abdomen;Stomach;Small IntestineDigestive systemProceduresAdult (19+) CaregiversVomiting;Abdominal pain2019-08-01T04:00:00ZHolly Norgrove, RN, BScN;Silvana Oppedisano, MN, RN(EC)7.3000000000000072.8000000000000413.000000000000Health (A-Z) - ProcedureHealth A-Z<p>If your child is feeling too full or bloated during a feed, you may need to vent the G tube. Discover how to vent a G tube, as well as other ways to manage fullness and bloating problems at home.</p><h2>What are G and GJ tubes?</h2><p>Gastrostomy tubes (G tubes) and gastrojejunostomy tubes (GJ tubes) are feeding devices. A G tube gives liquid nutrition, medication and other fluids directly into the stomach. A GJ tube gives liquid nutrition, medication and other fluids directly into the small intestine (the jejunum). Both G tubes and GJ tubes are placed in a surgical opening in your child's tummy (abdomen) called the stoma. The tunnel from the outside into the stomach is called the tract.</p><h2>Key points</h2><ul><li>If your child experiences pain or discomfort during feeds, or is vomiting or burping, they may be feeling full or bloated.</li><li>Venting a G tube means letting gas from your child’s stomach and bowels out through the end of the G tube.</li><li>Never vent a GJ tube.</li></ul><h2>What is venting?</h2><p>Venting a G tube means letting gas from your child’s stomach and bowels out through the end of the G tube. Venting before a feed allows air to escape the stomach before it is filled. This helps to prevent fullness and bloating.</p><p> <strong>Do not vent a GJ tube.</strong></p><h3>What are fullness and bloating?</h3><p>If your child experiences pain or discomfort during feeds, or is vomiting or burping, they may be feeling full or bloated. This may be caused by:</p><ul><li>giving feeds too quickly</li><li>giving too large a volume of feed</li><li>swallowing air or giving extra air through the feeding tube during feeds</li><li><a href="/Article?contentid=6&language=English">constipation</a> </li></ul><h2>How to vent a G tube</h2><p>Before every feed:</p><ol><li>If your child has a non low-profile tube: Open the cap at the end of the tube. </li><li>If your child has a low-profile tube: Attach the feeding tube extension and open the end to allow gas to flow out. </li><li>Hold the tube up to allow air to escape, or pull air from the stomach with a large syringe. Let the air flow into a diaper or cloth, in case stomach contents also leak out.</li><li>Once you see stomach contents or feeds coming back out of the stomach from the end of the tube or extension set, stop venting and <a href="/Article?contentid=3817&language=English&hub=tubefeeding">flush</a> the tube.</li><ul><li>Do not allow too much stomach content to escape. Talk to your health-care team about what is considered ‘too much’ and if re-feeding of stomach contents is necessary for large volumes.</li></ul><li>Close the end of the tube or extension set.</li></ol><p>If your child has a combination G/GJ tube, you can feed into the jejunum at the same time as you vent from the stomach.</p>
Ventricular septal defect (VSD)VVentricular septal defect (VSD)Ventricular septal defect (VSD)EnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2009-12-04T05:00:00ZFraser Golding, MD, FRCPC8.4000000000000060.7000000000000485.000000000000Flat ContentHealth A-Z<p>Learn about ventricular septal defects (VSD). These defects are holes that develop in the heart that force it to overwork, making it get bigger.</p><p> An opening in the wall between the two lower chambers of the heart is known as a ventricular septal defect. A VSD causes oxygen-rich blood to leak from the left side of the heart, where the pressure is higher, to the right side. With large holes, this is a problem because too much blood flows to the lungs. This forces the heart to overwork and makes it get bigger. There are four types of VSDs, named according to where they occur in the septum: membranous defect, muscular defect, inlet defect, and outlet defect. </p><h2> Key points </h2> <ul><li>With ventricular septal defects (VSD), an excess of blood can travel to the lungs. </li> <li>VSD is usually detected when a doctor hears a heart murmur. </li> <li>Treatment for VSDs depends on the size of the hole and can range from no treatment to open heart surgery.</li> <li> The outlook for children with this condition is very good. </li></ul>
Ventricular septal defect: Closure in the heart catheterization labVVentricular septal defect: Closure in the heart catheterization labVentricular septal defect: Closure in the heart catheterization labEnglishCardiologyChild (0-12 years);Teen (13-18 years)HeartHeartProceduresCaregivers Adult (19+)NA2009-11-10T05:00:00ZLee Benson, MD, FRCP(C), FACC, FSCAI;Susan Johnston, RN, BScN;Jennifer Kilburn, RN, MN;Carrie Morgan, RN, MN;Cindy Wasyliw, RN, BNSc7.6000000000000067.40000000000001334.00000000000Health (A-Z) - ProcedureHealth A-Z<p>A ventricular septal defect is a hole in the membrane that separates the two ventricles of the heart. Read how heart catheterization fixes this defect.</p><h2>What is a ventricular septal defect?</h2><p>A ventricular septal defect (VSD) is an opening or hole in the wall that separates the two lower chambers of the heart. This wall is called the ventricular septum. The hole causes oxygen-rich blood to leak from the left side of the heart to the right side. This causes extra work for the right side of the heart, since more blood than necessary is flowing through the right ventricle to the lungs.</p><p>The hole is usually closed with surgery. However, in certain situations, your child's cardiologist and surgeon may think it is best to close the hole with a special device. This procedure is done in the heart catheterization lab.</p><h2>What is heart catheterization?</h2><p>During heart catheterization, the doctor carefully puts a long, thin tube called a catheter into a vein or artery in your child's neck or groin. The groin is the area at the top of the leg. Then, the catheter is threaded through the vein or artery to your child's heart.</p><p>The doctor who does the procedure is a cardiologist, which means a doctor who works on the heart and blood vessels. This may not be your child's regular cardiologist.</p><p>To learn about heart catheterization, please see <a href="/Article?contentid=59&language=English">Heart catheterization: Getting ready for the procedure</a>.<br></p> <figure class="asset-c-80"><span class="asset-image-title">VSD closure with catheterization</span> <img src="https://assets.aboutkidshealth.ca/akhassets/VSD_closure_device_MED_ILL_EN.png" alt="Heart with ventricular septal defect and heart with catheter and closure device inserted into VSD" /> <figcaption class="asset-image-caption">A catheter is threaded through a blood vessel in the body up to the heart. A closure device is threaded through the catheter and placed into the VSD. Once the device is in place, the catheter is taken out.</figcaption> </figure><h2>Key points</h2> <ul> <li>A ventricular septal defect is a hole between the two lower chambers of the heart. To close the hole, the doctor will place a special device in your child's heart. </li> <li>If the hole is too big to close with the device or in the wrong position, the hole will be closed with surgery. </li> <li>There is a small risk that your child will have complications from the procedure. Your child's doctor will explain the risks to you before the procedure. </li> <li>Your child will need to have an anaesthetic. Your child will need to stay overnight in the hospital after the procedure. </li> </ul> <h2>What does the closure device look like and how does it stay in place?</h2> <p>The closure device is made of metal and mesh material. It looks like a short tube with different-sized discs (circles) on either end. Before it is put in, the discs are folded so the device will fit in the catheter. When it is in the right place, one disc opens up as the device is moved out of the catheter. The tube portion plugs the hole and the other disc opens up on the opposite side of the hole. </p> <h2>What happens during the closure procedure</h2> <p>The procedure is performed while your child is under a general anaesthetic. This means that your child will be asleep during the procedure. </p> <p>Not every VSD can be closed with heart catheterization. Therefore, we first need to measure the VSD to make sure it can be closed with a device in the catheterization lab. </p> <p>When your child is asleep, we will do a test called a transesophageal echocardiogram. Echocardiogram means a heart ultrasound. Transesophageal means we do the ultrasound with a small probe that is placed in your child's esophagus, the tube that connects the mouth to the stomach. This test will measure the size of the hole and help place the closure device. </p> <ul> <li>If the test shows that the hole is too big to close with the device, we will wake up your child and send them to the recovery room. Your child's cardiologist will discuss the next steps with you and your child. </li> <li>If the hole is small enough and in the right position, we will go on with the catheterization. </li> </ul> <p>During the catheterization, the doctor puts a catheter with a small deflated balloon on the tip through the blood vessel to the hole. The balloon is inflated to measure the size of the hole again. If the hole can be closed with the device, the doctor puts the closure device inside the catheter and places the device into the hole. </p> <p>Once the device is in place, the doctor takes out the catheter and covers the cut on your child's leg with a bandage.</p> <h2>The procedure will take three to four hours</h2> <p>The procedure usually takes three to four hours. After the procedure, your child will go to the recovery room to wake up from the anaesthetic. </p><h2>After the procedure</h2> <p>Most children will spend the night in hospital after the procedure. If your child needs to spend the night, they will be transferred to the inpatient unit from the recovery room. We will do an echocardiogram the next morning to check the placement of the device. </p> <p>The cardiologist will let you know when your child can go home.</p> <p>For information on what to do after your child goes home, please see <a href="/Article?contentid=1214&language=English">Heart catheterization: Caring for your child after the procedure</a>.</p>https://assets.aboutkidshealth.ca/akhassets/VSD_closure_device_MED_ILL_EN.png
Ventriculostomy and shunts for brain tumoursVVentriculostomy and shunts for brain tumoursVentriculostomy and shunts for brain tumoursEnglishNeurology;OncologyChild (0-12 years);Teen (13-18 years)BrainNervous systemNon-drug treatmentAdult (19+)NA2009-07-10T04:00:00ZEric Bouffet, MD, FRCPCUte Bartels, MD7.2000000000000066.20000000000001272.00000000000Flat ContentHealth A-Z<p>An in-depth description of the option of shunts for children suffering from brain tumours.<br></p><p>Your child may need a ventriculostomy or shunt if they have hydrocephalus. This is the build-up of cerebrospinal fluid (CSF). The ventriculostomy or shunt will help the CSF drain away from the ventricle. </p><h2>Key points</h2> <ul><li>Hydrocephalus occurs when too much cerebrospinal fluid builds up, causing the ventricles to become larger and increasing pressure inside the head.</li> <li>Your child may require a ventriculostomy or a shunt to drain the CSF and relieve the pressure.</li> <li>In some cases, the shunt can become blocked or infected, meaning your child will need an operation or an external ventricular drain to fix the problem.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/Shunt_MED_ILL_EN.jpg
VesicostomyVVesicostomyVesicostomyEnglishUrologyNewborn (0-28 days);Baby (1-12 months);Toddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years)BladderBladderProceduresCaregivers Adult (19+)NA2009-11-10T05:00:00ZDalia Bozic, RN, BScN;Cathy Daniels, RN, MS, ACNP7.6000000000000064.3000000000000632.000000000000Health (A-Z) - ProcedureHealth A-Z<p>A vesicostomy is an operation that creates an opening from the bladder to the outside of the body. Read about what to expect after a vesicostomy surgery.</p><h2>What is a vesicostomy?</h2><p>A vesicostomy (say: vess-i-COSS-tom-ee) is an operation that makes an opening from the bladder to the outside of your child's body. This opening is in the abdomen (belly), just below the navel (belly button).</p><p>The opening lets urine drain out and prevents urine from being trapped inside the bladder. If urine is trapped in the bladder, it can back up to the kidneys and cause damage. Trapped urine may also cause infections.<br></p><p>Vesicostomies are usually performed on babies and very young children. A vesicostomy is usually temporary. Later, your child's doctor will decide on a more permanent solution to drain urine from your child's bladder.</p> <figure class="asset-c-80"> <span class="asset-image-title">Vesicostomy</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Vesicostomy_MED_ILL_EN.jpg" alt="Bladder with vesicostomy in a baby and location of stoma and navel" /> <figcaption class="asset-image-caption">A vesicostomy is an operation that makes an opening from the bladder to the abdomen just below the belly button. This opening lets urine drain from the bladder.</figcaption> </figure><h2>Key points</h2> <ul> <li>A vesicostomy is an operation that makes an opening from the bladder to the abdomen just below the belly button. The opening lets urine drain out of the bladder.</li> <li>A vesicostomy is usually a temporary solution to allow urine to drain from the bladder for babies and very young children.</li> <li>Your child will need to have an anaesthetic. Your child will stay in the hospital two to three days after the surgery.</li> <li>The stoma needs to be dilated using a catheter each day. This will stretch the skin around the stoma and make sure it stays open enough for urine to drain out.</li> </ul><h2>The surgery takes about one hour</h2> <p>After the surgery, your child will spend one or two hours in the hospital's recovery room. After that, your child will return to the hospital's Urology Unit. </p> <p>A child will usually stay in hospital for two or three days after surgery.</p><h2>Managing your child's pain</h2> <p>At first, your child will receive pain medication, usually <a href="/Article?contentid=194&language=English">morphine</a>, through an intravenous (IV) line. As your child recovers, they will take <a href="/Article?contentid=62&language=English">acetaminophen</a> or <a href="/Article?contentid=110&language=English">codeine</a> by mouth to manage the pain. By the time your child goes home, they should not need pain medication any more. </p> <h2>After the operation</h2> <p>Your child will have an intravenous line (IV). An IV is a thin tube that lets us give liquids and medicines directly into your child's veins. Your child will have the IV in place until they are drinking well. </p> <p>Your child may have a small amount of bleeding at the place where the cut was made.</p> <h2>Dilating the stoma</h2> <p>The opening on your child's belly is called the stoma. It usually needs to be dilated (stretched) each day, sometimes several times a day. The dilation stretches the skin around the stoma. This makes sure that it stays open enough for urine to drain out. Dilations are done with a catheter. </p> <p>Your child's nurse will teach you how to do these dilations. Your doctor will let you know how often they need to be done at home and for how long. </p> <h2>Your child's skin</h2> <p>You will need to pay special attention to the condition of your child's skin after surgery. The nurse will show you how to diaper your child. This will make sure the urine is absorbed and your child's clothing is protected. Once you are home, your child can have a bath as usual. </p><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 www.sickkids.ca </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="http://www.cua.org/" target="_blank">www.cua.org</a> </p>https://assets.aboutkidshealth.ca/akhassets/Vesicostomy_MED_ILL_EN.jpg
Viral gastroenteritis (stomach flu)VViral gastroenteritis (stomach flu)Viral gastroenteritis (stomach flu)EnglishInfectious Diseases;GastrointestinalChild (0-12 years);Teen (13-18 years)Stomach;Small Intestine;Large Intestine/ColonImmune systemConditions and diseasesCaregivers Adult (19+)Abdominal pain;Diarrhea;Fever;Headache;Vomiting2019-03-12T04:00:00ZLaurie Streitenberger, RN, BSc, CIC;Anne Matlow, MD, FRCPC;Natasha Collia, MD10.000000000000048.1000000000000861.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Viral gastroenteritis, often called "stomach flu," is an infection that causes inflammation of the stomach and intestines. Learn the symptoms and treatment of viral gastroenteritis.</p><h2>What is viral gastroenteritis?</h2><p>Gastroenteritis is the inflammation of the stomach and small and large intestines. Viral gastroenteritis means the inflammation is caused by infection from a virus. It often causes <a href="/Article?contentid=746&language=English">vomiting</a> (throwing up), <a href="/Article?contentid=7&language=English">diarrhea</a> or both.</p><p>Viral gastroenteritis is often called "stomach flu," but it is not caused by the influenza virus. Viruses that cause viral gastroenteritis include rotaviruses, torovirus, adenoviruses, caliciviruses, astroviruses, and a group of Norwalk-like viruses.</p><h3>Viral gastroenteritis is NOT caused by any of the following, although the symptoms may be similar:</h3><ul><li>bacteria such as salmonella or E. coli </li><li>parasites such as Giardia </li><li>medications </li><li>other medical conditions </li></ul><h2>Key points</h2><ul><li>Viral gastroenteritis is an infection of the stomach and intestines, caused by a virus.</li><li>The main symptoms include diarrhea and vomiting.</li><li>Diarrhea and vomiting can cause a loss of fluids, also called dehydration.</li><li>If dehydration is severe, patients may have to be given fluid intravenously (IV) at the hospital.</li><li>Viral gastroenteritis can spread by sharing food, water and utensils. Frequent hand washing can help prevent the spread of infection to others.</li><li>Viral gastroenteritis is usually not a serious illness. However, people who have weak immune systems are at risk for more serious infection.</li></ul><h2>What are the symptoms of viral gastroenteritis?</h2><p>Diarrhea and vomiting are the main symptoms of viral gastroenteritis.</p><p>In addition to diarrhea and vomiting, a child with viral gastroenteritis may have the following symptoms. </p><ul><li> <a href="/Article?contentid=30&language=English">Fever</a></li><li>Stomach cramps or a sore stomach</li><li> <a href="/Article?contentid=29&language=English">Headache</a></li><li>Sore throat</li><li>Decreased activity level</li><li>Increased sleepiness</li><li>Decreased appetite </li></ul><p>In general, the symptoms begin one to two days after catching the virus. They can last for one to 10 days.</p><h2>Viral gastroenteritis can be spread</h2><h3>Viral gastroenteritis can spread through the following methods:</h3><ul><li>sharing food, water or eating utensils such as forks and knives with someone who has the virus</li><li>not washing hands after touching items that may have the virus on their surface</li><li>not washing hands after diaper changes or toileting</li></ul><p>It is important to clean and disinfect surfaces and items that your child touches, including toys, and wash laundry thoroughly to remove the virus from your home. </p><h2>Anyone can catch viral gastroenteritis</h2><p>People of all ages and backgrounds can get viral gastroenteritis. However, different groups often get different viruses:</p><ul><li>Babies and toddlers tend to get rotaviruses and torovirus more often. </li><li>Adenoviruses and astroviruses tend to cause diarrhea mostly in young children. </li><li>Norwalk-like viruses are more likely to cause diarrhea in older children and adults. </li></ul><h2>Treating viral gastroenteritis</h2><p>The best treatment for viral gastroenteritis in children and adults is to prevent <a href="/Article?contentid=776&language=English">dehydration</a>. Dehydration happens when more fluid leaves the body than enters it.</p><h3>Symptoms of dehydration include:</h3><ul><li>Dry, cracked lips and a dry or sticky mouth </li><li>Thirst </li><li>Low or no urine output; concentrated urine appears dark yellow </li><li>Not producing tears </li><li>Being fussy or cranky </li><li>Seeming bored or uninterested </li><li>Headache </li><li>Dizziness </li><li>Cramps </li><li>Chills </li><li>Fatigue </li></ul><h3>In severe cases, dehydration can cause:</h3><ul><li>Sunken eyes </li><li>Sunken fontanelle (soft spot) on the top of a baby's head </li><li>Nausea or vomiting </li><li>Irritability</li><li>Lethargy (little to no energy)</li></ul><p>If your child becomes severely dehydrated, they may need to be treated at the hospital. In the hospital, fluids can be replaced through an intravenous line (IV) if necessary. </p><h2>Viral gastroenteritis is rarely a serious illness</h2><p>For most people, viral gastroenteritis is not a serious illness. People who get viral gastroenteritis almost always recover completely without any long-term problems. How fast a child recovers from viral gastroenteritis partly depends on which virus is causing the illness.</p><p>Viral gastroenteritis can be a serious illness in people who are unable to drink enough fluids to replace what they lose through vomiting or diarrhea. Babies, young children, and people who are unable to care for themselves, such as the disabled or elderly, are at risk for dehydration from losing too much of the body's water.</p><p>People with immune system problems are at risk for dehydration because they may get more severe symptoms, including more vomiting and diarrhea. People with severe symptoms may need to stay in the hospital to treat or prevent dehydration.</p><h2>If your child is in hospital, help stop viral gastroenteritis from spreading</h2><ul><li>Your child may be placed in a single room and will not be able to visit the playroom until they are feeling better. </li><li>Wash your hands often before and after touching your child and before leaving your child's room. Expect hand washing by hospital staff as well. </li><li>If you or anyone else who has visited becomes ill with symptoms of viral gastroenteritis, let your child's doctor or nurse know.</li><li>If your child has symptoms of viral gastroenteritis and they are in the hospital, all staff caring for your child should wear gloves and a gown. </li></ul>stomachfluhttps://assets.aboutkidshealth.ca/AKHAssets/viral_gastroenteritis_flu.jpg
Viral infections in pregnancyVViral infections in pregnancyViral infections in pregnancyEnglishPregnancyAdult (19+)BodyReproductive systemConditions and diseasesPrenatal Adult (19+)Fever;Fatigue;Abdominal pain;Nausea;Vomiting;Joint or muscle pain2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC10.500000000000050.40000000000002518.00000000000Flat ContentHealth A-Z<p>Learn about viral infections, which can be harmful to your developing fetus during pregnancy. Rubella, hepatitis, HIV, and chickenpox are discussed.</p><p>When you are pregnant, you need to careful about infections and infectious diseases. Unborn and newborn babies have weak immune systems compared with older children and adults, and therefore are very susceptible to infection. </p><h2>Key points</h2> <ul><li>Enteroviruses can cause widespread infection of the central nervous system, skin, heart and lungs.</li> <li>Speak to your doctor about different viral infections that could harm your baby, and receive any required vaccines before becoming pregnant.</li> <li>It is possible for women with HIV to have a high likelihood of delivering a healthy baby.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/viral_infection_in_pregnancy.jpg
Viral respiratory infection (VRI)VViral respiratory infection (VRI)Viral respiratory infection (VRI)EnglishRespiratoryChild (0-12 years);Teen (13-18 years)Trachea;LungsTrachea;LungsConditions and diseasesCaregivers Adult (19+)Cough;Fever;Runny nose;Sneezing;Sore throat;Vomiting2009-11-10T05:00:00ZLaurie Streitenberger, RN, BSc, CIC;Anne Matlow, MD, FRCPC6.9000000000000066.2000000000000873.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Viral respiratory infection (VRI) is a general term for lung and airway infections. Read about different viruses that can cause VRI and treatment options.<br></p><h2>What is a viral respiratory infection (VRI)?</h2><p>Viral respiratory infections (VRIs) include colds, the flu and bronchiolitis.</p><p>Respiratory means something that affects the lungs and airways (breathing passages). VRIs may cause coughing, sneezing, runny noses, sore throats or fever. </p><p>Viral means something that is caused by a virus. Viruses that cause VRIs include respiratory syncytial viruses (RSV), influenza viruses, parainfluenza viruses, adenoviruses and rhinoviruses. Rhinoviruses are the viruses that cause the common cold.</p><p>VRIs are not caused by any of the following things, although the symptoms may be similar:</p><ul><li>bacteria, such as group A streptococcus (Strep) or pertussis </li><li>medicines </li><li>other medical conditions. </li></ul> <figure class="asset-c-80"> <span class="asset-image-title">Respiratory system</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Respiratory_system_MED_ILL_EN.jpg" alt="Location of the lungs, trachea, bronchus, bronchioles and diaphragm in a boy, with close-up on bronchioles and alveoli" /> </figure><h2>Key points</h2><ul><li>Viral respiratory infection (VRI) is a name for several types of infections of the lungs and airways. </li><li>VRIs are caused by different viruses. </li><li>VRIs spread through contact with mucus from the mouth or nose. </li><li>VRI can be a serious illness for people who are already ill or weakened in some other way. </li><li>Good hygiene practices, including handwashing, and covering the mouth and nose when coughing, can help prevent the spread of VRI.<br></li></ul><h2>Symptoms of a viral respiratory infection</h2><p>A person with a VRI may have the following symptoms:</p><ul><li><a href="https://akhpub.aboutkidshealth.ca/Article?contentid=774&language=English">coughing</a></li><li>sneezing </li><li>runny nose </li><li> <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=748&language=English">sore throat</a></li><li> <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=30&language=English">fever</a><br></li><li>trouble breathing.</li></ul><p>The person may also have a <a href="/Article?contentid=29&language=English">headache</a> or sore muscles, or they may feel very tired.</p><p>In general, the symptoms start one to two days after the person catches the virus. They may last for one to 10 days, depending on which virus is causing the illness. </p><h2>Anyone can get a viral respiratory infection</h2> <p>People of all ages and backgrounds can get a VRI. Babies and toddlers tend to get RSV more often. This can cause a condition called bronchiolitis. </p> <h2>A viral respiratory infection can be a serious illness for some people</h2> <p>For most people, a VRI is not a serious illness. People who get a VRI almost always get completely well. They do not have any long-term problems. </p> <p>For some people, though, a VRI can be a serious illness. People who are more at risk from a VRI include the following:</p> <ul> <li>babies </li> <li>young children </li> <li>people with an immune system problem </li> <li>people who cannot care for themselves well, such as the disabled or elderly </li> </ul> <p>These people may develop more serious complications, like pneumonia. They may get more severe symptoms than healthy people. People with severe symptoms may need to stay in the hospital for treatment to help with their breathing. </p><h2>Treating a viral respiratory infection</h2><p>To treat a VRI in children and adults:</p><ul><li>make sure the person gets plenty of rest<br></li><li>give the person lots of clear fluids to drink, such as water and apple juice. This will help make sure they do not get <a href="https://akhpub.aboutkidshealth.ca/article?contentid=776&language=English">dehydrated</a>. In the hospital, a person can be given fluids directly into the blood through an intravenous line (IV) if necessary. </li></ul><p>A doctor may prescribe medicine to help the infected person breathe more easily. The doctor will probably not prescribe antibiotics. Because VRIs are caused by viruses, antibiotics usually will not help. </p><h2>If your child has a viral respiratory infection in the hospital</h2><p>Your child may be placed in a single room and will not be able to visit the playroom until they are feeling better. Ask the Child Life Specialist to bring toys and supplies to your room.</p><p>Hospital staff will be wearing a mask, eye protection, gloves and gowns when they visit. Always wash your hands before and after touching your child and before leaving your child's room. Hospital staff should wash their hands as well. </p><p>If you or anyone else who has visited becomes ill with symptoms of a viral respiratory infection, let your child's doctor or nurse know.</p>https://assets.aboutkidshealth.ca/AKHAssets/viral_respiratory_infection.jpg
Vision in the first yearVVision in the first yearVision in the first yearEnglishNABaby (1-12 months)EyesNANAAdult (19+)NA2009-10-18T04:00:00Z7.7000000000000070.4000000000000674.000000000000Flat ContentHealth A-Z<p>Learn about the development of a baby's vision in the first year of life, including the development of spatial perception and depth perception.</p><p>Babies are born with very near-sighted vision and are not able to focus on items further than 25 cm (10 inches) from their face. Over the first year a baby's vision will steadily grow stronger, improving to near normal.</p><h2>Key points</h2> <ul><li>While babies are near-sighted at birth, their vision continues to improve over the first year of life, and by month eight they should have near normal vision.</li></ul>https://assets.aboutkidshealth.ca/AKHAssets/vision_in_the_first_year.jpg
Visiting your brother or sister at the hospitalVVisiting your brother or sister at the hospitalVisiting your brother or sister at the hospitalEnglishNAChild (0-12 years);Teen (13-18 years)NANASupport, services and resourcesChild (0-12 years) Teen (13-18 years)NA2010-03-17T04:00:00ZKimberly O'Leary, MEd;Jessica Miller, CCLS, MA;Ceilidh Eaton Russell, BA, CLSt. Dip., CCLS;Barbara Neilson, MSW, Res. Dip. SW, RSW5.2000000000000081.0000000000000878.000000000000Flat ContentHealth A-Z<p>This page has advice for kids visiting a brother or sister in the hospital. </p><h2>What to expect and how you can help</h2>​ <p>This page explains what to expect when you are visiting your brother or sister in the hospital. It also explains what you can do to help your brother or sister get well.</p><h3>Fill in the blanks</h3><p>My name is ____________________ .</p><p>I am __________ years old.</p><p>My brother or sister's name is ____________________ .</p><p>They are __________ years old.</p><p>These pages have ideas for things to do for your brother or sister, and yourself, too. If there is anything you want to know more about, you can ask the nurses and doctors. It is their job to answer your questions.</p><h2>Key points</h2><ul><li>You may see a lot of things such as equipment and machines at the hospital that you have never seen before.</li><li>You may have a lot of questions about what is happening to your sibling. This is okay, it is a good idea to ask questions and talk about your worries.</li><li>Think of something that you can do for your sibling that will help them feel more at home.</li> </ul><h2>At SickKids</h2> <p>Child life staff can be reached at 416-813-6216.</p>https://assets.aboutkidshealth.ca/AKHAssets/visiting_your_brother_sister_at_hospital.jpg
Visuomotor skillsVVisuomotor skillsVisuomotor skillsEnglishDevelopmentalPremature;Newborn (0-28 days);Baby (1-12 months);Toddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years)NANANAPrenatal Adult (19+)NA2009-10-31T04:00:00ZVirginia Frisk, Ph.D., C. Psych8.8000000000000058.20000000000001357.00000000000Flat ContentHealth A-Z<p>Learn about visuomotor skills, which are the control of small muscles in the fingers. Vision and movement work together to produce actions.</p><p>Fine motor skills are the control of small muscles in the fingers for grasping and manipulation. Typically, these skills are coordinated with or in response to visual input. In other words, vision and movement work in concert to produce actions. The term “visuomotor skills” is often used to describe this process.</p><h2>Key points</h2> <ul><li>Visuomotor skills refers to when vision and movement work together to produce actions.</li> <li>Visuomotor skills begin development in infancy, and continue to develop through the toddler and preschool years.</li> <li>For visuomotor skills to develop, a child must have reached certain milestones in terms of growth and control of movements.</li> <li>Visuomotor integration is dependent upon efficient control of eye movements, adequate vision, and the ability to plan the motor act and carry out the required motor skill.</li></ul>https://assets.aboutkidshealth.ca/akhassets/Pencil_grip_age3_4_EQUIP_ILL_EN.png
Vitamin B12VVitamin B12Vitamin B12EnglishNutritionChild (0-12 years);Teen (13-18 years)NADigestive systemHealthy living and preventionCaregivers Adult (19+) Educators Hospital healthcare providers Community healthcare providers Remote populations First nationsNA2013-09-27T04:00:00ZTheresa Couto, RD;Elly Berger, BA, MD, FRCPC, FAAP, MHPE;Francy Pillo-Blocka RD, FDC9.0000000000000053.7000000000000125.000000000000Flat ContentHealth A-Z<p>Discover the role of vitamin B12 in the body.</p><p></p><figure> <img src="https://assets.aboutkidshealth.ca/akhassets/INM_NRC_track1-8-1_illustration_food_B12.jpg" alt="Milk products and alternatives and meats and alternatives containing Vitamin B12" /> </figure> <p>Vitamin B12 works with vitamin B9, also known as <a href="/Article?contentid=1449&language=English">folate</a>, to make new cells. Vitamin B12 also helps make healthy blood cells and keeps nerves working properly.</p><h2>Key points</h2> <ul><li>Vitamin B12 is mostly found in the milk and alternatives and meat and alternatives food groups.</li> <li>Vegans may need to take B12 supplements or foods fortified with B12.</li> <li>Pregnant and breastfeeding women need more vitamin B12 than other women.<br></li></ul>https://assets.aboutkidshealth.ca/akhassets/INM_NRC_track1-8-1_illustration_food_B12.jpg
Vitamin DVVitamin DVitamin DEnglishNutritionChild (0-12 years);Teen (13-18 years)NADigestive systemHealthy living and preventionCaregivers Adult (19+) Educators Hospital healthcare providers Community healthcare providers Remote populations First nationsNA2013-09-27T04:00:00ZTheresa Couto, RD;Elly Berger, BA, MD, FRCPC, FAAP, MHPE;Francy Pillo-Blocka RD, FDC11.400000000000054.7000000000000218.000000000000Flat ContentHealth A-Z<p>Discover the role of vitamin D in the body.</p><p></p><p>Vitamin D works with <a href="/Article?contentid=1448&language=English">calcium</a> to help maintain healthy bones and teeth. Our bodies make vitamin D using energy from the sun, but lack of sunshine in winter and use of sunscreen in summer mean we also need to get vitamin D from food and supplements. <br></p><h2>Key points</h2> <ul><li>Vitamin D is mostly found in egg yolks, fatty fish and fortified yogurts, cereals, milk, soy and rice drinks.</li> <li>People whose skin is not regularly exposed to the sun need to eat vitamin D-rich foods or take a supplement of 200–400 IU a day.</li></ul>https://assets.aboutkidshealth.ca/akhassets/INM_NRC_track1-8-2_illustration_food_D.jpg
VitiligoVVitiligoVitiligoEnglishDermatologyChild (0-12 years);Teen (13-18 years)SkinSkinConditions and diseasesCaregivers Adult (19+)NA2016-06-24T04:00:00ZMichael Bishara, BSc, MD, FRCPC;Irene Lara-Corrales, MSc, MD9.4000000000000054.8000000000000850.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Vitiligo is a condition that causes skin and sometimes hair to turn white. Learn about its causes and how it is diagnosed and treated.</p><h2>What is vitiligo?</h2><p>Vitiligo is a condition that causes patches of skin, and sometimes hair, to turn white. This skin condition occurs in roughly one person in a hundred and affects girls and boys equally.</p><div class="asset-2-up"> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/PMD_vitiligo_darker_skin_EN.jpg" alt="Vitiligo darker-skinned knee" /> </figure> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/PMD_vitiligo_lighter_skin_EN.jpg" alt="Viligo on lighter-skinned knee" /> </figure><br></div><h2>Key points</h2><ul><li>Vitiligo is a skin condition that makes parts of the skin or hair turn white. It is thought to be an autoimmune reaction but can also sometimes occur after a cut or other injury to the skin.</li><li>Treatments include creams and lotions, medications and light therapy. These may not always completely remove vitiligo and cannot prevent new patches from forming.</li><li>See a doctor if your child’s vitiligo does not improve or looks different than before or if you have concerns about changes in their health.</li></ul><h2>How does vitiligo affect the body?</h2> <p>Vitiligo is a condition that affects skin or hair colour only. It is usually more obvious in those with darker skin. It can occur anywhere on the body, causing skin colour differences of various shapes and sizes. However, some areas of the body are more commonly affected than others.</p> <p>In rare cases, patients with vitiligo may have other autoimmune diseases. For example, their immune system may also attack their thyroid gland. If your child is diagnosed with vitiligo, their doctor should order blood tests to check for any other autoimmune disease.</p><h2>What causes vitiligo?</h2> <p>The exact cause of vitiligo is not known, but it is thought to be an autoimmune reaction. This means that it occurs when the immune system attacks healthy cells in the body. In vitiligo, the cells that are attacked are called melanocytes. These are special cells that give skin and hair its pigment (colour).</p> <p>Vitiligo may affect more than one person in a family, suggesting that genetics may be a factor. Patients sometimes also notice that their vitiligo starts after a cut or other injury to their skin. You may hear your doctor call this a Koebner phenomenon.</p><h2>How is vitiligo diagnosed?</h2> <p>Your child’s doctor will often diagnose vitiligo simply by looking at your child’s skin. Because vitiligo is less obvious in paler skin, the doctor might sometimes use a special light called a Wood’s Lamp to help them detect changes more easily. If your child needs to be examined with the aid of a Wood’s Lamp, they may be asked to go into a dark room so that the light can be shone on their skin.</p><h2>How is vitiligo treated?</h2> <p>Different treatments are possible depending on how much vitiligo is present and where it appears on the body.</p> <h3>Topical treatments</h3> <p>Topical treatments are ointments, creams, gels or lotions that are applied directly to the skin. They include topical steroid medications.</p> <p>Calcineurin inhibitors are topical medications that help regulate the immune system in the skin. They are especially useful when applied to the face, skin folds and flexural areas such as inside the elbow or the back of the knee.</p> <p>Topical treatments are recommended for small areas of vitiligo, but they may be more challenging to use, and carry side effects, if vitiligo is more widespread. Depending on the part of their body that is affected, your child might receive different mixes and strengths of a topical steroid.</p> <h3>Light therapy</h3> <p>Light therapy involves focusing a special ultraviolet light on the affected areas of skin. The treatment usually requires several sessions and is reserved for patients with very widespread vitiligo, for whom applying a topical medication is challenging.</p> <p>This treatment requires a person to stand still in a small space with lamps around them, as they may be burned if they move. For this reason, light therapy may not be suitable for young children. Some concerns have also been raised about light therapy and the long-term increased risk for skin cancer, especially in those with paler skin.</p> <p>Other treatments such as laser therapy and skin grafting are also possible, but there is limited information about their use in children.</p> <h3>How effective are treatments for vitiligo?<br></h3> <p>Unfortunately vitiligo is a very unpredictable disease. Even with all the available treatments, some areas may not return to their usual colour. In addition, there is no way for doctors to prevent new areas of vitiligo from developing.<br></p> <p>Because treatment is not always successful, some patients may choose not to do anything or will instead use special make-up on the affected skin to make it blend in with the rest of the body.</p><h2>When to see a doctor for vitiligo</h2> <p>After initial diagnosis and treatment, see your child’s doctor if:</p> <ul> <li>your child’s vitiligo is getting larger, not improving or looks different than before</li> <li>you suspect your child has been experiencing symptoms such as gaining or losing weight easily or feeling tired easily. Their doctor can order blood tests to rule out related systemic conditions such as <a href="https://akhpub.aboutkidshealth.ca/article?contentid=841&language=English">anemia</a> or <a href="https://akhpub.aboutkidshealth.ca/article?contentid=2309&language=English">hypothyroidism</a>.<br></li> </ul>https://assets.aboutkidshealth.ca/akhassets/PMD_vitiligo_darker_skin_EN.jpg
Voiding cystourethrogram (VCUG)VVoiding cystourethrogram (VCUG)Voiding cystourethrogram (VCUG)EnglishUrologyChild (0-12 years);Teen (13-18 years)Bladder;UrethraBladder;UrethraTestsCaregivers Adult (19+)NA2009-11-10T05:00:00ZDawn-Ann Lebarron, MRT(R);Deborah Kerrigan, RPN6.5000000000000072.90000000000001334.00000000000Health (A-Z) - ProcedureHealth A-Z<p>A voiding cystourethrogram (VCUG) uses X-rays to look at how well your child's bladder works during urination. Read about what to expect during a VCUG. </p><figure><span class="asset-image-title">Urinary system (female)</span><img src="https://assets.aboutkidshealth.ca/akhassets/Urinary_female_MED_ILL_EN.jpg" alt="Identification of kidney, ureter, bladder and urethra in a girl" /> </figure> <h2>What is a VCUG?</h2><p>A VCUG is a special test that uses X-rays to show what happens when your child urinates (pees).</p><p>VCUG is short for voiding cystourethrogram. Voiding means urinating. Cysto stands for the bladder. Urethro stands for the urethra, the tube that empties urine from the bladder. Gram means the picture. So the VCUG is a picture of the urine moving from the bladder and out through the urethra.</p><p>The test uses a special liquid called contrast medium to make the urine show up better on the X-ray.</p><h2>Key points</h2> <ul> <li>A VCUG is a test that uses X-ray to see what is happening when your child pees. </li> <li>During the test, a child will have a urinary catheter put into their urethra. </li> <li>The test can be uncomfortable. You can help your child be as comfortable as possible by practicing relaxation exercises at home before the test. </li> </ul><h2>Two technologists will perform the test</h2> <p>The technologists are specially trained to place the catheter and to take the X-rays. Sometimes the radiologist must also be in the room during the test. The radiologist reads the X-ray. </p> <p>The X-ray technologist will prepare your child for the test by explaining what will happen. The technologist will carefully wash your child's penis or the opening to the urethra. Then the technologist will place a bendable catheter into the opening. The catheter is a long, thin, soft tube that goes through the urethra to the bladder. The technologist will explain each step as they do it.</p> <h3>If your child has a heart condition</h3> <p>Your child may need to take antibiotics before having any test or treatment. For example, children with heart conditions need to take antibiotics before going to the dentist. An antibiotic is a medicine that kills infection. If your child needs this medicine, please tell the doctor who wants your child to have a VCUG. The doctor will get this medicine for your child before they have the VCUG. </p> <h2>VCUGs are usually done at the hospital</h2> <p>VCUGs are done in the Department of Diagnostic Imaging, often called the X-ray department. If you are unsure about the location of the department, ask at the main reception. </p> <p>The test takes between 20 and 30 minutes. After the test, you will need to stay in the department for about 15 minutes while the images are prepared. </p> <h2>During the test</h2> <p>After you check into the Department of Diagnostic Imaging, your child will change into a hospital gown in one of the change rooms. Then your child will be taken into the X-ray room. Only one parent can go with the child. </p> <h3>In the X-ray room</h3> <p>Once you and your child are in the X-ray room, the technologist will ask you to remove your child's underwear or diaper. Then your child will lie on an X-ray table. A safety band may be placed across your child's stomach or legs to make sure your child is safe. </p> <p>A camera above the table will take the pictures. The technologist will use a television screen to see what is happening during the test. </p> <p>To get the best results, your child must lie as still as possible while the technologist takes the X-rays. You can help your child by holding hands gently up by your child's chest and by keeping your child's attention any way you can. For example, you could read or sing.</p> <h3>Placing the catheter</h3> <p>The X-ray technologist will begin the test by cleaning your child's private parts and placing the catheter. The catheter will make the bladder empty by itself. </p> <p>The catheter will then be connected by a tube to a bottle filled with contrast medium. This contrast medium flows through the tube into the bladder. It lets the technologist get a better view of the inside of the bladder and urethra. Your child may feel the contrast as it goes through the bladder. It may feel cool, but it will not feel uncomfortable. </p> <p>While the contrast medium is flowing into the bladder, the X-ray technologist will take some X-rays. When your child's bladder is full, your child will be asked to urinate into a bedpan or diaper. The catheter will come out easily by itself as your child urinates. The technologist will take some X-rays while your child is urinating. These are the most important pictures of the test. </p> <p>Once your child has finished urinating and the pictures have been taken, the test is finished. The X-ray technologist will help your child off the table and make sure that they are clean and dry. </p><h2>After the test is done</h2> <p>The X-ray technologist will tell you how to get to the change room where your child can change into their own clothes. Then you can have a seat in the waiting room. The technologist will let you know when you can leave after the X-ray images have been checked. </p> <p>If you have an appointment in the clinic to see the doctor after the test, please tell the technologist. They will make sure your results are sent to the clinic. If you are not seeing the doctor after the test, the results will be sent to your child's doctor within a week. </p><figure><span class="asset-image-title">Urinary system (male)</span><img src="https://assets.aboutkidshealth.ca/akhassets/Urinary_male_MED_ILL_EN.jpg" alt="Identification of kidney, ureter, bladder and urethra in a boy" /> </figure> <h2>Preparing your child for the test</h2><p>Take time to read this information carefully and explain it to your child. Children who know what to expect are usually less anxious. Explain the test in words you know your child will understand, including the words your family uses to describe how the body works.</p><p>As part of the test, a small tube called a catheter will be placed in your child's urethra. Placing the catheter will be uncomfortable. But your child will find it more comfortable if they can relax. You can help your child relax by teaching them to take slow deep breaths. Have your child pretend to blow out birthday candles, blow up a balloon or blow bubbles. Practise this breathing exercise at home before you come to the hospital.</p><p>Young children sometimes want to bring something comfortable to hold during the test. Your child may want to bring a stuffed toy or a blanket from home.</p><p>One parent can be with the child at all times during the test. If you are pregnant, you can stay in the room while the catheter is being placed. But you must leave the room when your child has the X-ray.</p><p>You may want to explain to your child that the doctors or technologists will need to touch your child's private parts to clean them and to place the catheter. Explain to your child that you have given them permission to touch them because the test will help the child.</p><h2>At SickKids</h2> <p>VCUGs are done in the Department of Diagnostic Imaging, often called the X-ray department. This department is on the second floor in the Elm Street Wing in the older part of the hospital.</p> <p>Please check in with the receptionist at the desk called the GI/GU Patient Check In. You will find this desk beside the Elm Wing elevators on the second floor.</p> <p>If you need to cancel your child's test, please call 416-813-6068 as soon as possible. We need to give your child's appointment to another child on our waiting list. There is a long waiting list for these tests.</p>https://assets.aboutkidshealth.ca/akhassets/Urinary_female_MED_ILL_EN.jpg
Voiding cystourethrogram (VCUG): Caring for your child at home after the procedureVVoiding cystourethrogram (VCUG): Caring for your child at home after the procedureVoiding cystourethrogram (VCUG): Caring for your child at home after the procedureEnglishUrologyChild (0-12 years);Teen (13-18 years)Bladder;UrethraBladder;UrethraTestsCaregivers Adult (19+)NA2009-11-10T05:00:00ZDawn-Ann Lebarron, MRT(R);Deborah Kerrigan, RPN6.7000000000000071.7000000000000387.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Following a voiding cystourethrogram (VCUG) your child may feel pain while they urinate. Learn how to reduce discomfort from VCUG catheterization.</p><p>VCUG is short for voiding cystourethrogram. A VCUG is a special test that uses X-rays and contrast medium to show what happens when your child urinates (pees). </p> <p>For a detailed description of the VCUG test, please read <a href="/Article?contentid=1294&language=English">Voiding cystourethrogram (VCUG)</a>.</p><h2>Key points</h2> <ul> <li>A voiding cystourethrogram (VCUG) is a test that uses X-rays and contrast medium to show what happens when your child pees. </li> <li>Your child's urine may be pink and they may be sore for the first couple of days after the test.</li> <li>Your child should drink a lot of water to help relieve any symptoms they have after the test.</li> </ul><h2>When to call your child's doctor</h2><p>Call your child's doctor right away if any of the following things happen: </p><ul><li>Your child complains of severe pain in the abdomen (belly). </li><li>Your child has a <a href="/Article?contentid=30&language=English">fever</a> with a temperature over 38°C (101°F), taken rectally. </li><li>Your child's urine is bright red. </li><li>If your child is under two years old: your child has not urinated four hours after the catheter was taken out. </li><li>If your child is over two years old: your child has not urinated six to eight hours after the catheter was taken out. </li></ul><p>Call your child's doctor during office hours if either of the following things happen: </p><ul><li>Your child still has burning with urination 24 hours after the procedure. </li><li>Your child still has pink-tinged urine. </li></ul><h2>Your child may have some symptoms after a VCUG</h2> <p>After the test, your child can go back to normal activities. During the first day or two after the test, you may notice these normal events: </p> <ul> <li>Your child's urine may be pink in colour when they urinate. This is caused by a small amount of blood in the urine. </li> <li>Your child may complain of pressure or stinging with the first urination. </li> <li>The area where the catheter went in may be sore, and your child may be anxious about peeing. </li> </ul>
VomitingVVomitingVomitingEnglishNAChild (0-12 years);Teen (13-18 years)Mouth;Esophagus;StomachMouth;Esophagus;StomachConditions and diseasesCaregivers Adult (19+)Abdominal pain;Nausea;Vomiting2019-03-11T04:00:00ZShawna Silver, MD, FRCPC, FAAP, Peng; Elly Berger, BA, MD, FRCPC, FAAP, MHPE8.4000000000000058.80000000000001221.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Vomiting is the forceful emptying of the stomach's contents and is usually caused by a virus.</p><h2>What is vomiting?</h2><p>Vomiting (throwing up) happens when very strong stomach contractions force a large part of the stomach contents back up the swallowing tube (esophagus) and out through the mouth or nose. </p><p>Vomiting is not the same as regurgitation. Regurgitation is the effortless spitting up of a small amount of food or liquid. Food goes up the esophagus and into the mouth. Regurgitation is very common in babies. It is not harmful.</p><p>Vomiting can become serious if your child loses too much fluid and becomes <a href="/Article?contentid=776&language=English">dehydrated</a>.​</p><h2>Key points</h2> <ul> <li>Vomiting is often caused by irritation of the stomach and digestive system from a viral infection known as gastroenteritis (stomach virus) although there are many other causes. </li> <li>Vomiting usually lasts only one or two days, but may last longer. </li> <li>Breastfed babies with gastroenteritis should continue to drink breast milk.</li> <li>Give your child small amounts of clear fluids. Avoid giving your child sugary drinks.</li> <li>Wash your hands and your child's hands well. </li> <li>Talk to your doctor if your child seems very dehydrated.</li> </ul><h2>Causes of vomiting</h2><p>Most often vomiting is caused by a viral infection known as <a href="/Article?contentid=907&language=English">gastroenteritis</a> (stomach virus). The infection irritates the stomach and digestive system. Children with vomiting from gastroenteritis may also have <a href="/article?contentid=7&language=English">diarrhea</a>.</p><p>Other causes of vomiting include headaches or <a href="/Article?contentid=766&language=English">head injury</a>, blockages in the intestinal tract, severe coughing, <a href="/article?contentid=804&language=English">food allergies</a>, severe allergic reactions (<a href="https://www.aboutkidshealth.ca/Article?contentid=781&language=English">anaphylaxis</a>) and <a href="/Article?contentid=1914&language=English">food poisoning</a>. Medications or other substances such as alcohol can also irritate the stomach and cause vomiting.</p><p>If your child has severe vomiting or vomiting that does not go away, visit a health-care professional. </p><h2>Taking care of your child at home</h2><p>Give your child clear fluids. Your child will need to replace the water and salt they have lost from vomiting. You can use your child's preferred fluid, diluted apple juice or a commercially available oral rehydration solution. Children who have had severe, prolonged diarrhea may have problems digesting milk and they may develop temporary lactose intolerance. However, if your child is vomiting, or if the diarrhea is not frequent and severe, then you can try giving your baby or child milk. In some cases, babies really want to drink their milk and this is the best way to help them stay hydrated.</p><h2>Breast milk for breastfed babies</h2><p>Breastfed babies with gastroenteritis should continue to drink breast milk. They can drink breast milk either from the breast or by taking expressed breast milk from a cup or bottle. If your baby vomits after feeding or is vomiting very often, keep breastfeeding. Feed your baby smaller amounts more often. </p><p>If you are breastfeeding and your baby is not drinking as much as usual, you may need to pump your milk to keep up your own milk supply and prevent discomfort.</p><p>If your breastfeeding baby is still thirsty after drinking breast milk, or if they keep vomiting, you may offer oral rehydration solution. Offer oral rehydration as described below. Continue to either breastfeed or pump your breast milk.</p><p>If your baby normally takes formula, then you can continue to offer formula. If the baby refuses, you can try to offer one to two ounces of oral rehydration solution every 30 minutes. If your baby is getting better, then you can try to switch back to formula.</p><p>If your baby is urinating (peeing) less often and you are not sure if you are making enough milk, offer your baby oral rehydration solution in between feedings. Do not give tea or plain water to babies who may be dehydrated.</p><p>See a doctor if you think that your baby is becoming dehydrated.</p><h3>Give your older child a clear fluid, not just water<br></h3><p>If your child seems <a href="/Article?contentid=776&language=English">dehydrated</a> (dry mouth, less active or peeing less often) give your child their preferred fluid, diluted apple juice or an oral rehydration solution. They will need a fluid that contains sugar, salt and water, not just water on its own.<br></p><p>Use a teaspoon, syringe or medicine dropper to give the fluid to your child. You can also use a bottle or cup. </p><p>Give your child a small amount of solution (5 mL or 1 teaspoon to start) every two to three minutes. If your child accepts and drinks the solution, gradually increase the amount. Increase the amount you give up to at most 1 ounce (30 mL) every five minutes. Do not give more than 1 ounce at a time. Encourage your child to drink slowly. Drinking quickly can cause vomiting.</p><h3>Offer food </h3><p>Your child should try to eat a normal diet even when they have gastroenteritis. Good nutrition is important to help your child feel better. Unless vomiting is very frequent, offer your child a food that they are familiar with. Many children prefer simple foods when they have been vomiting. It is important to be flexible and give your child something that they want to eat. Give foods like crackers, cereals, bread, rice, soup, fruits, vegetables and meat.<br></p><h3>Medications</h3><p>If your child has a fever and feels uncomfortable, give <a href="/Article?contentid=62&language=English">acetaminophen</a> or <a href="/Article?contentid=153&language=English">ibuprofen</a>.</p><p>Contact your doctor if your child takes prescription medications and is having a hard time taking them during this illness.</p><p>Medications available over the counter (such as Gravol or other brands) are not always helpful. Sometimes they can cause sleepiness which makes it hard to continue fluids by mouth. In some cases of persistent vomiting, your doctor may prescribe an anti-vomiting medication such as <a href="/Article?contentid=205&language=English">ondansetron</a>. <a href="/Article?contentid=205&language=English">Ondansetron</a> is given as a single dose. </p><h2>When to see a doctor</h2> <p><strong>Go to the nearest Emergency Department or call 911 if:</strong></p> <ul> <li>your child has a head injury or may have been exposed to something poisonous </li> <li>your child seems very dehydrated (no urine in eight hours, very dry mouth, no tears, low energy or sunken eyes) </li> <li>your child's vomit is green, bloody or dark brown (coffee colour) </li> <li>your child has severe or worsening tummy pain </li> <li>your child has trouble breathing </li> <li>your child has a very bad headache or sore neck </li> <li>your child's skin is cold or not its usual colour </li> <li>your child is very tired or difficult to wake up </li> <li>your child appears to be very sick</li> </ul> <p><strong>Make an appointment with your child's doctor if:</strong></p> <ul> <li>you think your child may be starting to get dehydrated </li> <li>the vomiting lasts longer than 24 hours if your child is under two years old</li> <li>the vomiting lasts longer than 48 hours if your child is older than two years old </li> <li>your child's fever lasts more than three days </li> <li>vomiting happens more than once a month or happens mostly at night or early morning </li> <li>you have other concerns or questions</li> </ul>vomitinghttps://assets.aboutkidshealth.ca/AKHAssets/vomiting.jpg
Von Willebrand diseaseVVon Willebrand diseaseVon Willebrand diseaseEnglishHaematologyChild (0-12 years);Teen (13-18 years)BodyCardiovascular systemConditions and diseasesCaregivers Adult (19+)NA2017-05-08T04:00:00ZVanessa Bouskill, MN, RN(EC), NP;Manuel Carcao, MD, FRCP(C), FAAP, MScsusan.ball@sickkids.ca | Susan Ball | 693A30232E777C7369636B6B6964735C737573616E2062616C6C i:0#.w|sickkids\susan ball7.8000000000000065.90000000000001436.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Von Willebrand disease is a condition that affects the blood’s ability to clot properly. Learn about the different types of this disease and how they are treated.</p><h2>What is von Willebrand disease?</h2><p>Von Willebrand disease (VWD) is an inherited condition that affects the blood’s ability to clot effectively. It is a very common bleeding disorder that affects girls and boys equally.</p><p>When a person gets a cut, a type of cell in the blood called a platelet, and a protein called von Willebrand factor (VWF), stick to the wound to plug the cut. Proteins in the blood called clotting factors then bind together to form chains called fibrin. These chains then form a net around the platelets and VWF. This holds the clot together and helps to seal the wound.</p><p>In a person with VWD, there is either not enough VWF or it does not work properly. In either case, a blood clot cannot form properly, and the injured area will continue to bleed.</p> <p>VWF also protects and maintains levels of clotting factor VIII, one of the proteins involved in blood clotting. Therefore, people with VWD may have low levels of factor VIII in addition to low levels of VWF.</p><h2>Key points</h2><ul><li>The first signs of VWD are usually prolonged nosebleeds, easy bruising and in females, heavy periods.</li><li>VWD is a lifelong condition that is usually passed down from parents to children. It equally affects both girls and boys.</li><li>Severity of VWD can vary, and thus treatments do as well. Options will be discussed between you and your child’s comprehensive health-care team.</li></ul><h2>Signs that your child may have von Willebrand disease</h2><p>If your child experiences any of the following symptoms, you should talk to your doctor about the possibility that your child may have VWD:</p><ul><li>bleeding from the gums</li><li>easy bruising</li><li>prolonged bleeding after cuts or bloodwork</li><li>frequent and prolonged nosebleeds</li><li>blood in the stool or urine</li><li>heavy or prolonged menstrual bleeding (menorrhagia) in girls</li><li>soft tissue/joint bleeding (in more severe forms).<br></li></ul><p>As VWD is usually inherited, it is possible that after a child in a family is diagnosed with VWD that other family members may be tested as well.</p><h2>How is von Willebrand disease inherited?</h2><p>VWD is a genetic condition and it is most often passed on from one or both parents to their children. Occasionally, VWD may occur when one of the child’s genes changes randomly; this is called a spontaneous genetic mutation.</p> <figure class="asset-c-80"><span class="asset-image-title">Inheritance pattern of Type 1, 2A, 2B and 2M von Willebrand disease</span><img alt="Chromosomes in a parent with mutated VWF gene, in a parent with no mutated VWF gene, and in a child with VWD" src="https://assets.aboutkidshealth.ca/akhassets/von_willebrand_inheritance_1_2A_2B_2M_EN.jpg" /> </figure> <p>The type of VWD depends on the mutation in the VWF gene. The parent may have mild symptoms or no symptoms at all. Types 1, 2A, 2B and 2M are usually inherited when one parent passes on the mutated VWF gene to their child.</p> <figure class="asset-c-80"><span class="asset-image-title">Inheritance pattern of Type 2N and 3 von Willebrand disease</span><img alt="Chromosomes in parents who both have a mutated VWF gene and in a child with VWD" src="https://assets.aboutkidshealth.ca/akhassets/von_willebrand_inheritance_2N_3_EN.jpg" /> </figure> <p>Types 2N and 3 VWD are usually inherited when both parents pass on the mutated gene to their child. A child receives two mutated genes, one from each parent. Each parent may have only mild symptoms or have no symptoms at all.</p> <figure class="asset-c-80"><span class="asset-image-title">Inheritance pattern of Type 2N von Willebrand disease</span><img alt="Chromosomes in parent with Type 1 or 2N mutated VWF gene, parent with Type 2N mutated VWF gene, and child with Type 2N VWD" src="https://assets.aboutkidshealth.ca/akhassets/von_willebrand_inheritance_2N_EN.jpg" /> </figure> <p>Type 2N VWD occurs when a child inherits one Type 1 (or Type 2N) gene from one parent and one Type 2N gene from the other parent.</p> <figure class="asset-c-80"><span class="asset-image-title">Inheritance pattern of Type 3 von Willebrand disease</span><img alt="Chromosomes in parents who both have Type 1 mutated VWF gene and in child with Type 3 VWD" src="https://assets.aboutkidshealth.ca/akhassets/von_willebrand_inheritance_3_EN.jpg" /> </figure> <p>Type 3 VWD occurs when a child inherits a gene responsible for Type 1 VWD from both parents. In most (but not all) cases parents of a child with Type 3 VWD, despite having a gene for type 1 VWD, usually have normal levels of VWF and show no signs of bleeding.</p><h2>Diagnosis of von Willebrand disease</h2><p>While VWD has a genetic cause, VWF can also be affected by many other things such as blood type, age, stress, medications and hormone levels.</p><p>Often, the symptoms of Type 1 VWD are very mild. For this reason, it can take time to diagnose.</p><p>A diagnosis of VWD involves a series of blood tests measuring VWF levels and function as well as factor VIII levels in the blood. A physical exam, a review of family medical history and a bleeding questionnaire will also be performed.</p><h2>Treatment of von Willebrand disease</h2><p>Children diagnosed with VWD are cared for by a comprehensive team of health care specialists. This team will include a nurse co-ordinator, hematologist (blood doctor), physiotherapist, social worker, dentist and, for female teens and adults, a gynecologist.<br></p><h3>Medications may be used to treat all types of von Willebrand disease</h3><p><em><strong>Tranexamic acid</strong></em></p><p>Tranexamic acid is used to hold a blood clot together once it has already formed. It is often used when a person with VWD is undergoing a surgical or dental procedure, and for nosebleeds or mouth bleeds. For females, it can also be used for heavy periods.</p><p><em><strong>Fibrin glue</strong></em></p><p>Fibrin is the final product when a blood clot is formed. Fibrin glue is made up from several blood clotting agents. It is applied directly to wounds to stop bleeding. Fibrin glue is often used when people with VWD undergo surgical or dental procedures.</p><p><em><strong>Desmopressin (DDAVP)</strong></em></p><p>DDAVP is a chemical that helps to release factor VIII and VWF that is already stored in the blood. Before using this method, your child’s comprehensive care team will perform a “DDAVP Challenge”. This test is done to see if the use of DDAVP releases enough factor VIII and VWF in your child’s body to treat bleeds. If it does, your child is a "responder". Treatment of VWD with DDAVP is not recommended until your child is at least three years of age because of potential side effects. DDAVP does not work in some Type 2 subtypes and Type 3 VWD.</p><p><em><strong>Von Willebrand factor product</strong></em></p><p>Von Willebrand factor product is a plasma derived factor concentrate (a powder) that has been engineered from human plasma. It undergoes viral inactivation steps to make sure the product is safe. VWF product is used in more moderate or severe bleeds, to replace the VWF and FVIII in the body immediately to stop bleeding.</p><h3>Treatment by type</h3><p>Medical treatment of VWD will vary by patient, and should be discussed with your child’s healthcare team.</p><table class="AKH-zebra-table"><thead><tr><th style="width:50%;">Type of von Willebrand disease</th><th style="text-align:center;width:50%;">Most common treatment options</th></tr></thead><tbody><tr><td><strong>Type 1</strong></td><td>DDAVP (if a responder); von Willebrand factor product</td></tr><tr><td><strong>Type 2</strong></td><td>DDAVP (if a responder); von Willebrand factor product</td></tr><tr><td><strong>Type 3</strong></td><td>von Willebrand factor product</td></tr></tbody></table>https://assets.aboutkidshealth.ca/AKHAssets/von_willebrand_disease.jpg
VulvovaginitisVVulvovaginitisVulvovaginitisEnglishGenital and reproductiveChild (0-12 years);Teen (13-18 years)NAVaginaConditions and diseasesCaregivers Adult (19+)NA2019-09-18T04:00:00ZJoley Johnstone, RN, BScN;Anjali Aggarwal, MD;Justin Losier, BHSc (Hons), MD, CCFP (EM)7.7000000000000064.70000000000001650.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Vulvovaginitis is skin irritation around the vulva and vagina that is common in young children. Read about the symptoms and treatment of vulvovaginitis.</p><h2>What is vulvovaginitis?</h2><p>Vulvovaginitis is an inflammation or irritation of the delicate skin of the vulvar and vaginal area. The vulva is the outside area of the female genitals; the vagina connects the vulva and the uterus. Vulvovaginitis may cause soreness, itchiness, redness and burning. Sometimes children with vulvovaginitis have a slight discharge from the vagina, which will stain the underpants and produce a strong odour.</p><p>Parents often first become aware of the problem when their child complains about the redness and soreness of the skin, which is the most common sign of vulvovaginitis.</p> <figure class="asset-c-80"> <span class="asset-image-title"> Vulvovaginitis</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Vulvovaginitis_MED_ILL_EN.png" alt="Normal female genitals and female genitals with red irritated skin" /> <figcaption class="asset-image-caption"> Vulvovaginitis is an irritation of the skin in the vulvar and vaginal area. It causes soreness, itching, burning and can be seen as red and irritated skin.</figcaption></figure><h2>Key points</h2><ul><li>Vulvovaginitis has many different causes.</li><li>Parents can help their child treat and prevent vulvovaginitis with good hygiene measures.</li><li>Parents can help make sure their child keeps their vaginal area clean and dry, and avoids moisture, irritation and heat.</li><li>Parents can also help their child avoid products and activities that cause irritation. </li></ul><h2>Vulvovaginitis can have several causes</h2><p>Most often, vulvovaginitis is caused when the vulvar and vaginal skin become irritated. This irritation can be caused by the use of products that are too strong for the delicate vulvar skin, clothing that rubs, dampness and less commonly, a skin or vaginal infection. Vulvovaginitis can also be caused by sexual abuse. Other skin problems, such as <a href="/Article?contentid=773&language=English">eczema</a>, can also affect the vulvar skin. Vulvovaginitis may result from several of these causes at the same time. </p><h3>Skin in the vaginal area changes over time</h3><p>In young children, before puberty, the skin in the vaginal area is thin and delicate. This delicate skin is easily irritated. When they grow and begin to produce their own sex hormones, pubic hair and thickened skin will develop and protect the vaginal area. Normal vulvar skin should not look reddish or raw.</p><h3>Activities and clothing</h3><p>Many normal things children do can irritate the skin around the vagina. For example, playing in sandboxes or on slides and teeter-totters, and wearing wet clothes, bathing suits or tight ballet leotards can irritate the skin.</p><h3>Sometimes chidren wait too long to go to the bathroom</h3><p>Children who are playing often forget to go to the bathroom until the last minute. Sometimes they do not wipe themselves properly. When this happens, bacteria from the anus can get into the vagina. Dirty underwear can also bring bacteria into contact with the vagina and the surrounding skin. Most children will not wash their vaginal area at bath time. Children need to be helped with bathing so they clean themselves properly.</p><h3>Other problems: soaps and the weather</h3><ul><li>Soaps, bubble baths and perfumes can irritate a child's skin. Strong laundry detergents and fabric softeners can also be a source of irritation.</li><li>Dry winter air can be irritating to the skin.</li><li>Heat and humidity can also irritate the skin, especially if combined with wet bathing suits or tight clothing.</li></ul><h2>Diagnosing vulvovaginitis</h2><p>If your child develops skin irritation in the vaginal area, develops an odour in the area or has discharge from the vagina, they should see their health-care provider. Depending on the problem and how severe the symptoms are, the doctor may refer them to a gynaecology clinic.</p><p>The gynaecologist will ask questions about your child's health and do a physical examination. The doctor will want to make sure that there is no infection or skin problem that needs treatment. Sometimes, a small vaginal swab will be taken to look for infection. If there has been any bleeding, the doctor may need to examine further.</p><p>The doctor will also ask questions and examine your child to make sure that they have not been subject to any sexual abuse. Tell your child what the examination is about, using words they can understand. The goal is to let your child feel comfortable with the examination and make sure they do not have a painful or frightening experience.</p><p>After the examination, the doctor will tell you what the best treatment is. Whatever treatment is recommended, there will be some things that you can do to help at home.</p><h2>Treating vulvovaginitis</h2><p>The treatment of vulvovaginitis will depend on the cause of the irritation. Usually, the irritation comes from hygiene measures. It may be that your child is not cleaning themselves well enough. It is important to remember that the most common cause of vaginal discharge in children with vulvovaginitis is skin irritation. It is rare to find an infection. If there is an infection, it can be treated with antibiotics or antifungals.</p><p>You can help your child by starting some simple habits and routines. Because your child's skin is so delicate, anything you can do to help keep the vaginal area clean, dry and healthy will help. Here are some of the things you can do.</p><h3>Clean and dry underwear and clothes</h3><p>Make sure your child changes into clean underwear often, especially if their underwear has gotten dirty. Try to have your child change their underwear more than once a day. White cotton underwear are best. Your child should change out of wet or tight-fitting clothing as soon as possible. Encourage your child to not wear underwear at night.</p><p>Do not use pantiliners to contain vaginal discharge as this will actually increase symptoms. It is better to make sure your child changes their underwear often.</p><h3>Wiping properly after the bathroom</h3><p>Make sure your child knows how to clean themselves well after using the toilet. This is a particular problem for parents whose children go to daycare or to babysitters, because the parents are not there to help their child. Children should wipe themselves from front to back. Use only white toilet paper. Many children can clean themselves better with alcohol- and perfume-free wet wipes. These wipes are easier on the skin than dry toilet paper. A little packet of wet wipes tucked into your child's things when they go off to daycare may be helpful.</p><h3>Bathing</h3><p>If using wet wipes does not solve the problem, have your child take a shallow sitz bath when they get home to make sure that they are nice and clean. A sitz bath is a small tub that can be placed on the toilet and filled with warm water to soak the vulvar region. You can purchase a sitz bath at most drug stores. Do not use soaps, bubble baths or perfumed products on your child. When they have signs of vulvovaginitis, it is a good idea to have your child bathe two to three times a day. Adding non-allergenic skin softeners to the water will help soften and soothe the vulvar skin. You can consider applying a barrier cream such as petroleum jelly or a zinc oxide after bathing to help soothe the skin.</p><p>Encourage your childr not to scratch their bottom because scratching can cause more irritation and infection.</p><h3>After a bath</h3><p>After the bath, gently blot or pat dry the child's vaginal area. Do not use scratchy towels or rub the skin too hard. You may find it helpful to use a hairdryer on a low, cool setting to dry the area gently. It is all right for the child to run around the house wearing skirts or loose shorts without underwear to let the air reach their bottom.</p><h3>A good daily hygiene routine</h3><p>Your child needs to learn how to take care of their vaginal area. It is an important part of their body that needs special cleaning, just as their teeth need special care. If creams have been recommended, your child can learn how to put their own cream on. They can learn to wash their hands before and after and use a hand mirror so that they can put the cream exactly where it is needed. In this way, your child will learn that this is their body and they have a responsibility to care for it.</p><h2>Vulvovaginitis often comes back</h2><p>About half the girls who have this problem will have it more than once during their childhood. It usually gets better as girls grow up, and will not cause them any long-term harm.</p><p>If the irritation comes back, begin strict hygiene measures again. Your child may need to be seen at the clinic again. Sometimes, if the inflammation comes back it may be caused by something different.</p><p>The better your child gets at being clean and dry, the less likely they are to get vulvovaginitis again.</p><p>If your child has any pain or bleeding, see your health-care provider.</p>vulvovaginitishttps://assets.aboutkidshealth.ca/akhassets/Vulvovaginitis_MED_ILL_EN.png

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