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Children's Health: Physical Therapy
Physical Therapy Basics
Doctors often recommend physical therapy for kids who have been injured or have movement problems from an illness, disease, or disability.
After an injury, physical therapists are often able to relieve pain and help kids resume daily activities. Physical therapists teach kids exercises designed to help them regain strength and range of motion, and also show them how to prevent a recurring injury.
Physical therapy (PT) may be needed any time a child has difficulty moving in such a way that it limits daily activities.
Doctors may recommend PT for kids with:
sports injuries
developmental delays
cerebral palsy
genetic disorders
orthopedic disabilities/injuries
heart and lung conditions
birth defects (such as spina bifida)
effects of in-utero drug or alcohol exposure
acute trauma
head injury
limb deficiencies
muscle diseases
What Physical Therapists Do
Physical therapists use a variety of treatments to help build strength, improve movement, and strengthen skills needed to complete daily activities.
Physical therapists might guide kids through:
developmental activities such as crawling and walking
training to build strength around an injury
flexibility exercises to increase range of motion
balance and coordination activities
adaptive play
aquatic (water) therapy
safety and prevention programs
instruction on how to avoid injuries
improving circulation around injuries by using heat, cold, exercise, electrical stimulation, massage, and ultrasound
During a visit, a physical therapist may:
measure the child's flexibility and strength
analyze the way the child walks and runs (a child's gait)
identify potential and existing problems
consult with other medical, psychiatric, and school personnel about an individual education plan (IEP)
provide instructions for home exercise programs
recommend when returning to sports is safe
What to Look for in a Physical Therapist
As of 2010, entry-level physical therapists must earn a master's degree or receive a doctoral degree in physical therapy (a DPT) from an accredited college program. Physical therapists also must pass a state-administered national exam.
States also may impose their own regulations for practicing PT. You can find out more information about any other requirements for local physical therapists by contacting your state's licensure board.
Finding a Physical Therapist
Physical therapists typically work in hospitals, private practices, fitness centers, and rehabilitation and research facilities. Ask your doctor for recommendations or contact your state's physical therapy association for names of local licensed physical therapists. Coaches or phys-ed teachers at your child's school also might be able to recommend a physical therapist.
Reviewed by: Carolyn T. Giles, PTA
Children's Health: Osgood-Schlatter Disease
Good news: Osgood-Schlatter disease (OSD) is far less frightful than its name. Though it's one of the most common causes of knee pain in adolescents, it's really not a disease, but an overuse injury. OSD can be quite painful, but usually resolves itself within 12 to 24 months.
About Osgood-Schlatter Disease
Osgood-Schlatter disease is an inflammation of the bone, cartilage, and/or tendon at the top of the shinbone (tibia), where the tendon from the kneecap (patella) attaches. Most often only one knee is affected.
OSD usually strikes active adolescents around the beginning of their growth spurts, the approximately 2-year period during which they grow most rapidly. Growth spurts can begin any time between the ages of 8 and 13 for girls, or 10 and 15 for boys. OSD has been more common in boys, but as more girls participate in sports, this is changing.
Teens increase their risk for OSD if they play sports involving running, twisting, and jumping, such as basketball, football, volleyball, soccer, tennis, figure skating, and gymnastics. Doctors disagree about the mechanics that cause the injury but agree that overuse and physical stress are involved.
Growth spurts make kids vulnerable because their bones, muscles, and tendons are growing quickly and not always at the same time. With exercise, differences in size and strength between the muscle groups place unusual stress on the growth plate at the top of the shinbone. (A growth plate is a layer of cartilage near the end of a bone where most of the bone's growth occurs. It is weaker and more vulnerable to injury than the rest of the bone.)
Most parents call the doctor after their child complains of intermittent pain over several months. The pain may be anywhere from mild and felt only during activity to severe and constant.
Other symptoms may include:
pain that worsens with exercise
relief from pain with rest
swelling or tenderness under the knee and over the shinbone
limping after exercise
tightness of the muscles surrounding the knee (the hamstring and quadriceps muscles)
Symptoms that aren't typical of OSD include pain at rest, thigh pain, or very severe pain that awakens kids from sleep or makes them cry. If your child has any of these symptoms, talk to your doctor.
How Is It Treated?
OSD usually goes away by age 18 or when a teenager's bones mature. Until then, only the symptoms need treatment. Rest is the key to pain relief. Parents find it a cruel irony that the most active kids are most likely to get OSD — and also the ones least likely to rest the affected area.
In mild cases, doctors advise that kids limit the activities that cause pain. They might be able to continue their sports as long as the pain remains mild. When symptoms flare up, a short break from sports might be necessary.
After your child gets back in the game, shock-absorbent insoles can decrease stress on the knee. Applying moist heat for 15 minutes before or icing for 20 minutes after activity can minimize swelling. Wrestling gel pads and basketball knee pads (available at sporting goods stores) can protect a tender shin from bumps and bruises. A good stretching program, focusing primarily on the hamstring and quadriceps muscles, before and after activity is important. Your doctor might also suggest over-the-counter pain medicines, such as ibuprofen, or prescription anti-inflammatory medicines.
More severe cases require more rest, usually a total break from sports and physical activities. Active kids may find this very difficult, but the knee cannot heal without rest. Some teens wind up with a cast or brace to enforce the doctor's orders. After a prolonged time off, kids will need to ease back into activity carefully, usually with physical therapy to learn stretching and strengthening exercises.
Long-term consequences of OSD are usually minor. Some kids may have a permanent, painless bump below the knee. In rare cases, they may develop a painful, bony growth below the kneecap that must be surgically removed. About 60% of adults who had OSD as kids experience some pain with kneeling.
Sports Safety
Sports and exercise offer many benefits, but also the risk of injury. According to the National Youth Sports Safety Foundation, sports activities are the second most frequent cause of injury for both male and female adolescents.
Although OSD cannot be prevented, its impact can be minimized by following sports safety guidelines:
Parents and coaches must teach young athletes to protect their bodies as their skills develop.
Trained coaches should supervise sports programs.
Kids should warm up and stretch for 15 to 30 minutes before and after activities.
Injured kids should never be encouraged to "play through the pain."
Always remember that sports exist for the emotional and physical good of the kids, not the team or interested adults.
Reviewed by: Peter G. Gabos, MD
Children's Health: Old Wives' Tales
Rooted in Oral Traditions
Old wives' tales are perhaps as old as language itself. They're part of our oral tradition, originating long before pen and ink, books and movies, and certainly before the Internet. Why do we cling to such tales about common ailments and our health when we live in a world rich with medical expertise and proven treatments and cures?
Some probably have survived through the ages because they offer comforting advice about experiences we all share, have little control over, and usually worry about, such as childbirth and sickness.
Many old wives' tales, especially those surrounding pregnancy and childbirth, have been proven false or irrelevant by advances in medicine and technology. One example is the use of prenatal ultrasound to detect the sex of a fetus instead of dangling a ring suspended on a string over the expectant woman's belly. According to the tale, if the ring swings from side to side, it's a girl, and if it swings in a circle, it's a boy. An ultrasound reading may not be as much fun, but the test results are certainly more accurate.
Some old wives' tales about health and sickness have some basis in fact, whereas other, newer ones seem to reflect a kind of technophobia, such as those related to watching television. Though some old wives' tales are true, most are harmless — and at least one described here is dangerous.
Tales About Pregnancy
If the fetal heart rate is under 140 beats per minute (BPM), it's a boy.
False. A baby girl's heart rate is usually faster than a boy's, but only after the onset of labor. There's no difference between fetal heart rates for boys and girls, but the rate does vary with the age of the fetus. By approximately the fifth week of pregnancy, the fetal heart rate is near the mother's — around 80 to 85 BPM. It continues to accelerate until early in the ninth week, when it reaches 170 to 200 BPM and then decelerates to an average of 120 to 160 BPM by the middle of the pregnancy. Normal fetal heart rate during labor ranges from 120 to 160 BPM for boys and girls.
Extra weight out front means a girl; weight around the hips and bottom indicates a boy.
False. If a woman has a short torso, there's no place for the baby to grow but out. A long torso may mean roomier accommodations for a baby, making it less likely for a woman's belly to bulge outward. And a wide belly may just mean that the baby is sideways.
If a woman's carrying low, it's a boy; if she's carrying high, it's a girl.
False. If a woman's carrying high, this may be her first pregnancy or her body's in good shape. Stomach muscles have a tendency to become more elastic with each pregnancy, so a belly that's seen more than one pregnancy may hang a little low.
Dark nipples indicate a boy.
False. This color change has nothing to do with the sex of the child — an increase in the hormones secreted by the placenta and ovaries and the melanocyte-stimulating hormone (which regulates skin pigmentation) causes dark areas of the body to become more pronounced in most pregnant women. Nipples, birthmarks, moles, or beauty marks may appear darker during pregnancy. A dark line also may appear down the middle of the belly. Called the linea nigra (black line), it runs from above the navel to the pubic area. Darkened areas usually fade soon after childbirth.
Don't breastfeed a toddler during pregnancy because the new baby needs all the nourishment it can get.
False. If a woman is healthy, breastfeeding during pregnancy won't harm her, the fetus, or her toddler. (A doctor may recommend that a pregnant woman not breastfeed, though, if she has a nutritional deficiency, is underweight, or is at risk for pre-term labor.)
Tales About Caring for Babies and Toddlers
Wearing shoes will help a baby learn to walk sooner.
False. Just the opposite is true in this case. Keeping a baby barefoot can help strengthen his or her foot muscles and help the child learn to walk earlier.
A toddler who is walking, though, needs comfortable shoes that fit well — they shouldn't be rigid. Shoes should conform to the shape of a child's feet and provide a little extra room for growth.
An infant walker will help a baby learn to walk sooner.
False. Babies who spend their active hours in walkers may learn to sit, crawl, and walk later than children who have to learn these skills on their own if they want to get around. Sitting in an infant walker, with its wide tray and small leg openings, blocks the visual feedback so important to a baby learning muscle coordination.
More important, baby walkers are dangerous. Nearly 14,000 injuries are treated in emergency rooms every year as a result of walkers. And 34 children have died since 1973 because of baby walkers. Stairway falls in walkers can be especially severe. In a policy statement, the American Academy of Pediatrics (AAP) recommended a ban on the manufacture and sale of mobile infant walkers in the United States.
Cats can steal the air from a baby's mouth.
False. This tale goes back hundreds of years to a time when cats were associated with witchcraft and evil spirits. Cat-lovers, rest easy — it's anatomically impossible for a cat or other animal to suffocate a baby by sealing the baby's mouth with its own.
Even so, cats and other pets should be supervised around small children and introduced to a baby gradually. You should also keep cats (just as you should keep other pets and items such as blankets and plush toys) out of your baby's crib or bassinet.
Tales About Foods and Drinks
Feed a cold, starve a fever.
False. Both high fevers and colds can cause fluid loss. Drinking plenty of liquids such as water, fruit juice, and vegetable juice can help prevent dehydration. And with both fevers and colds, it's fine to eat regular meals — missing nutrients may only make a person sicker.
Wait an hour after eating before swimming.
False. According to the American Red Cross, it's usually not necessary for you or your child to wait an hour before going in the water. However, it is recommended that you wait until digestion has begun, especially if you've had a big fatty meal and you plan to swim strenuously. The Red Cross also advises against chewing gum or eating while in the water, both of which could cause choking.
Coffee stunts your growth.
False. Coffee won't affect growth, but too much caffeine doesn't belong in a child's diet. Excess caffeine can prevent the absorption of calcium and other nutrients.
Fish is brain food.
True. Fish is a good source of omega-3 fatty acids that have been found to be very important for brain function. Certain fish, however, have significant levels of mercury. Therefore, the Food and Drug Administration (FDA) suggests that pregnant women and women of child-bearing age decrease their exposure to mercury by either not eating swordfish, shark, and tuna, or limiting their consumption of these fish to once per month.
Chocolate causes acne.
False. Although eating too many sugary, high-fat foods is not a good idea for anyone, studies show that no specific food has been proven to cause acne.
Spicy foods can cause ulcers.
False. Spicy foods may aggravate ulcer symptoms in some people, but they don't bring about ulcers. A bacterial infection or overuse of pain medications such as aspirin or anti-inflammatory drugs is the usual cause.
Eating carrots will improve your eyesight.
False. This tale may have started during World War II, when British intelligence spread a rumor that their pilots had remarkable night vision because they ate lots of carrots. They didn't want the Germans to know they were using radar. Carrots — and many other vegetables high in vitamin A — do help maintain healthy eyesight, but eating more than the recommended daily allowance won't improve vision.
Tales About Health and Medical Conditions
If you go outside with wet hair, you'll catch a cold.
False. Cold weather, wet hair, and chills don't cause colds; viruses do. People tend to catch colds more often in the winter because these viruses are spread more easily indoors, where there may be more contact with dry air and people with colds. Dry air — indoors or out — can lower resistance to infection.
Reading in dim light will damage your eyes.
False. Although reading in a dimly lit room won't do any harm, good lighting can help prevent eye fatigue and make reading easier.
Too much TV is bad for your eyes.
False. Watching television won't hurt your eyes (no matter how close to the TV you sit), although too much TV can be a bad idea for kids. Research shows that children who consistently spend more than 10 hours a week watching TV are more likely to be overweight, aggressive, and slower to learn in school.
If you cross your eyes, they'll stay that way.
False. Only about 4% of the children in the United States have strabismus, a disorder in which the eyes are misaligned, giving the appearance that they're looking in different directions. Eye crossing does not lead to strabismus.
Thumb sucking causes buck teeth.
True ... and false. Thumb sucking often begins before birth and generally continues until age 5. If a child stops around the ages of 4 to 5, no harm will be done to the jaws and teeth.
However, parents should discourage thumb sucking after the age of 4, when the gums, jaw, and permanent teeth begin their most significant growth. Therefore, after this age it's possible for thumb, finger, or pacifier sucking to contribute to buck teeth.
Cracking knuckles causes arthritis.
False. However, habitual knuckle cracking tends to cause hand swelling and decreased grip strength, and can result in functional hand impairment.
Too much loud noise can cause hearing loss.
True. Just 15 minutes of listening to loud, pounding music; machinery; or other noises can cause temporary loss of hearing and tinnitus, a ringing in the ears. Loud noise causes the eardrum to vibrate excessively and can damage the tiny hairs in the cochlea, a cone-shaped tube in the inner ear that converts sound into electrical signals for the brain to process.
Although temporary hearing loss usually disappears within a day or two, continuous exposure to extreme noise can result in permanent hearing loss. And if someone is wearing headphones and those around him or her can hear the music, the volume is too high.
Reviewed by: Steven Dowshen, MD
Children's Health: Occupational Therapy
Jason, 10, was left with a brain injury after a bicycle accident. To improve some of his cognitive (thinking) skills, comprehension skills, and coordination, Jason's doctors recommended that he receive occupational therapy (OT).
At first, his parents were doubtful that OT could benefit their son and wondered if it was more appropriate for adults. But after watching the activities and seeing Jason's improvements, they felt hopeful that Jason was on the road to recovery.
Occupational Therapy Basics
Occupational therapy treatment focuses on helping people achieve independence in all areas of their lives. OT can help kids with various needs improve their cognitive, physical, and motor skills and enhance their self-esteem and sense of accomplishment.
Some people may think that occupational therapy is only for adults; kids, after all, do not have occupations. But a child's main job is playing and learning, and occupational therapists can evaluate kids' skills for playing, school performance, and daily activities and compare them with what is developmentally appropriate for that age group.
According to the American Occupational Therapy Association (AOTA), in addition to dealing with an someone's physical well-being, OT practitioners address psychological, social, and environmental factors that can affect functioning in different ways. This approach makes OT a vital part of health care for some kids.
Kids Who Might Need Occupational Therapy
According to the AOTA, kids with these medical problems might benefit from OT:
birth injuries or birth defects
sensory processing disorders
traumatic injuries (brain or spinal cord)
learning problems
autism/pervasive developmental disorders
juvenile rheumatoid arthritis
mental health or behavioral problems
broken bones or other orthopedic injuries
developmental delays
post-surgical conditions
burns
spina bifida
traumatic amputations
cancer
severe hand injuries
multiple sclerosis, cerebral palsy, and other chronic illnesses
Occupational therapists might:
help kids work on fine motor skills so they can grasp and release toys and develop good handwriting skills
address hand-eye coordination to improve kids' play skills (hitting a target, batting a ball, copying from a blackboard, etc.)
help kids with severe developmental delays learn basic tasks (such as bathing, getting dressed, brushing their teeth, and feeding themselves)
help kids with behavioral disorders learn anger-management techniques (i.e., instead of hitting others or acting out, using positive ways to deal with anger, such as writing about feelings or participating in a physical activity)
teach kids with physical disabilities the coordination skills needed to feed themselves, use a computer, or increase the speed and legibility of their handwriting
evaluate a child's need for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids
work with kids who have sensory and attentional issues to improve focus and social skills
How Physical Therapy and OT Differ
Although both physical and occupational therapy help improve kids' quality of life, there are differences. Physical therapy (PT) deals with pain, strength, joint range of motion, endurance, and gross motor functioning, whereas OT deals more with fine motor skills, visual-perceptual skills, cognitive skills, and sensory-processing deficits.
Occupational Therapy Practitioners
There are two professional levels of occupational practice — occupational therapist (OT) and occupational therapist assistant (OTA).
Since 2007, an OT must complete a master's degree program (previously, only a bachelor's degree was required). An OTA is only required to complete an associate's degree program and can carry out treatment plans developed by the occupational therapist but can't complete evaluations.
All occupational therapy practitioners must complete supervised fieldwork programs and pass a national certification examination. A license to practice is mandatory in most states, as are continuing education classes to maintain that licensure.
Occupational therapists work in a variety of settings, including:
hospitals
schools
rehabilitation centers
mental health facilities
private practices
children's clinics
nursing homes
Finding Care for Your Child
If you think your child might benefit from occupational therapy, ask your doctor to refer you to a specialist. The school nurse or guidance counselor also might be able to recommend someone based on your child's academic or social performance.
You also can check your local yellow pages, search online, or contact your state's occupational therapy association or a nearby hospital or rehabilitation center for referrals.
However you find an occupational therapist for your child, make sure that your health insurance company covers the program you select.
Reviewed by: Wendy Harron, BS, OTR/L
Children's Health: Neurofibromatosis
About Neurofibromatosis
Neurofibromatosis (NF) is a neurocutaneous syndrome that can affect many parts of the body, including the brain, spinal cord, nerves, skin, and other body systems. NF can cause growth of non-cancerous tumors on nerve tissue, producing skin and bone abnormalities.
Effects of NF vary widely — some children live almost unaffected by it; rarely, others can be severely disabled.
NF is defined by tumors, called neurofibromas, that grow along nerves in the body or on or under the skin. As the tumors increase in size, they can press on vital areas of the body, causing problems in the way the body functions.
Neurofibromas often first appear in childhood, especially during puberty. NF is occasionally diagnosed in infancy (in children with more apparent cases), but more often in kids between 3 and 16 years old.
The first noticeable sign is almost always the presence of brown café au lait spots. These distinctive spots don't hurt or itch and never progress to anything more serious than spots. They can be found anywhere on the body, though not usually on the face. Tiny ones — freckles — may be seen under the arms or in the groin area.
Many neurofibromas can be removed. Although usually benign (noncancerous), an estimated 3%-5% become cancerous.
There's no specific cure for NF, but tumors usually can be removed and complications treated. Because learning disabilities occur in about half the children with NF, some might need extra help in the classroom.
Types of NF
Of the two types of neurofibromatosis — NF1 and NF2 — NF1 is more common, occurring in 1 of every 2,500-3,000 births and affecting an estimated 100,000 Americans. It is also known as von Recklinghausen disease.
NF2 is characterized by the presence of bilateral acoustic neurofibroma-like tumors and is rarer, seen in 1 in 25,000 births. People with NF2 usually develop benign tumors on the nerves in their ears, causing hearing loss, eventual deafness, and problems with balance.
The severity of both types of neurofibromatosis varies greatly. In families where more than one person has NF, it can present with different physical signs and complications for each person. At diagnosis, it isn't possible to know right away whether a case will be mild or lead to severe complications.
Causes of NF
Both types of neurofibromatosis are autosomal dominant genetic disorders, which means an affected person has 1 chance in 2 of passing it on with each pregnancy.
Neurofibromatosis also can be the result of a spontaneous change (mutation) in the genetic material of the sperm or egg at conception in families with no previous history of NF. About half of cases are inherited, and the other half are due to spontaneous genetic mutation.
NF 1 and NF 2 are each related to changes in separate genes:
The NF1 gene is located on chromosome 17.
NF2 has been traced to chromosome 22.
These findings are important because they have led to the development of a genetic test that can reliably confirm NF in affected individuals.
Signs and Symptoms
NF1 is sometimes diagnosed in younger children, especially those with more severe forms of the disorder. One key to early diagnosis of mild NF is the appearance of café-au-lait spots on the skin.
Many people who do not have NF have a few café-au-lait spots. But if a young child has five or more, at least ½ inch in size (roughly the size of a dime), a doctor will look for other clues that may indicate NF, including neurofibromas — tumors on, under, or hanging off the skin — and Lisch nodules, tiny, noncancerous tumors on the iris (the colored part of the eye). Lisch nodules are of no clinical significance except that they help confirm a diagnosis of NF.
Neurofibromas often become evident on various parts of the body, beginning at the arms, around 10 years of age. A child may also develop freckling in the folds of the skin of the armpit or groin or on other parts of the body where the skin creases.
Abnormalities of the skeleton, such as the thinning or overgrowth of the bones in the arms or lower leg, curvature of the spine (scoliosis), and other bone deformities also may be features of NF1.
NF2 is usually not diagnosed until a child is older. Hearing loss in the late teens and early twenties is often among the first symptoms of the disorder, and is caused by tumors growing on the auditory nerves (which carry electrical impulses from the inner ear to the brain, allowing us to hear) on one or both sides.
Other symptoms of NF2 include continuous ringing in the ears, headache, facial pain or weakness, and feeling unsteady or off balance.
Diagnosis
Neurofibromatosis is usually diagnosed based on a combination of findings. A child must have at least two of the following signs to be diagnosed with NF1:
café-au-lait spots of a certain number, size, and location
the appearance of two or more neurofibromas (often resembling pea-sized bumps on the skin)
Lisch nodules on the irises
an optic glioma (tumor along the main nerve of the eye that is responsible for sight)
certain skeletal abnormalities
a family member with NF1
freckling under the arms or in the groin
Tests like magnetic resonance imaging (MRI) and X-rays may be used to screen for tumors or evidence of skeletal problems. A child's head circumference will be measured, as kids with symptoms of NF can have a circumference that's larger than normal for their age. Blood pressure will be monitored. Doctors also take a detailed personal history, looking for signs of learning difficulties.
To diagnose NF2, doctors will check for any evidence of hearing loss. They'll order audiometry (hearing tests) as well as imaging tests to look for tumors in the nerves of the ears, spinal cord, or brain. They'll also determine if there's a family history of NF2.
Genetic testing is now available for people with a family history of either NF1 or NF2. Although testing is still not 100% sensitive, recent advances have increased sensitivity to over 90%. Amniocentesis or chorionic villus sampling can sometimes determine if an unborn child has the condition.
Treatment
Treatment for NF1 includes removal of the neurofibromas for cosmetic purposes, treating the complications, and getting intervention for children with learning disabilities. Kids will be referred to appropriate medical specialists to monitor and treat complications, which may include:
seizures (up to 40% of children with NF1 have them)
high blood pressure
scoliosis
speech impairment
optic nerve tumors (which can cause vision problems leading to blindness)
early or delayed onset of puberty
Rarely, neurofibromas can become cancerous (3%-5% of cases). In these occurrences, surgery, chemotherapy, or radiation may be necessary.
With NF2, surgeons will likely need to remove the auditory nerve tumors, which may cause deafness afterward. When parts of the auditory nerve are removed, hearing aids won't work.
In 2000, the U.S. Food and Drug Administration (FDA) approved an auditory brainstem implant for people with NF2 who have lost their hearing. This device transmits sound signals directly to the brain, enabling the person to hear certain sounds and speech.
Currently, researchers are conducting trials with medications in the hopes they'll be able to offer more treatment options.
Caring for Your Child
The first noticeable sign of neurofibromatosis usually is the presence of multiple café-au-lait spots. If your child has several of these spots, ask your doctor to do a thorough examination; he or she may need to screen your child for other signs of NF.
If your child has already been diagnosed with NF and you notice that a growing tumor is beginning to cause a problem, tell your doctor immediately.
One of the most important things you can do is get early intervention if your child has learning disabilities. It also helps to seek out support groups that can provide your family with practical advice and encouragement.
Remember, most people (about 60%) diagnosed with NF1 have only relatively mild signs of the disorder, like café-au-lait spots and a few neurofibromas on the surface of the skin, which require little or no treatment.
Kids diagnosed with mild NF who remain fairly healthy into early adulthood are less likely to develop more serious complications later in life. Kids diagnosed with more serious forms often have correctable complications and with appropriate help and support can lead happy and productive lives.
Reviewed by: Louis E. Bartoshesky, MD, MPH
Children's Health: Is it a Medical Emergency?
Even healthy kids get hurt and sick sometimes. In some cases, you will know that you need to head straight to the emergency room (ER) at the nearest hospital. In other cases, it's more difficult to determine whether an injury or an illness needs the attention of a medical professional or can be treated at home.
Different problems require different levels of care. And when your child needs some sort of medical help, you have many options:
Handle the problem at home. Many minor injuries and illnesses, including some cuts, certain types of rashes, coughs, colds, scrapes, and bruises, can be handled with home care and over-the-counter (OTC) treatments.
Call your doctor. If you're unsure of the level of medical care your child needs, your doctor — or a nurse who works in the office — can help you decide what steps to take and how.
Visit an urgent care center. An urgent care center can be a good option for non-emergencies at night and on weekends when your doctor may not be in the office. At these centers, you can usually get things like X-rays, stitches, and care for minor injuries that aren't life threatening yet require medical attention on the same day.
Visit a hospital emergency room. An ER — also called an emergency department (ED) — can handle a wide variety of serious problems, such as severe bleeding, head trauma, seizures, meningitis, breathing difficulties, dehydration, and serious bacterial infections.
Call 911 for an ambulance. Some situations are so serious that you need the help of trained medical personnel on the way to the hospital. These might include if your child: has been in a car accident, has a head or neck injury, has ingested too much medication and is now hard to rouse, or is not breathing or is turning blue. In these cases, dial 911 for an ambulance.
As a parent, it can be hard to make these judgment calls. You don't want to rush to the ER if it isn't really an emergency and can wait until a doctor's appointment. On the other hand, you don't want to hesitate to get medical attention if your child needs treatment right away. As your kids grow — and inevitably incurs sicknesses and calamities — you'll learn to trust yourself to decide when it's an emergency.
Remember that in cases when you know the problem is minor, it's best to contact your child's doctor, go to an urgent care center, or handle it at home. Sometimes, ERs can be crowded and it can take a long time for minor problems to be treated.
Should I Go to the ER?
Here are some reasons to go to the ER :
if your child has difficulty breathing or shortness of breath
if your child has had a change in mental status, such as suddenly becoming unusually sleepy or difficult to rouse, disoriented, or confused
if your child has a cut in the skin that is bleeding and won't stop
if your child has a stiff neck along with a fever
if your child has a rapid heartbeat that doesn't slow down
if your child accidentally ingests a poisonous substance or too much medication
if your child has had more than minor head trauma
Other situations may seem alarming, but don't require a trip to the ER. The list below includes some of the symptoms that may require calling your doctor:
high fever
ear pain
pain in the abdomen
headache that doesn't go away
rash
mild wheezing
persistent cough
When in doubt, call your doctor. Even if the doctor isn't available, the office nurse will be able to talk with you and determine whether you should take your child to the ER. On weekends and evenings, doctors have answering services that allow them to get in touch with you if you leave a message.
Urgent Care Centers
Sometimes an injury or an illness isn't life threatening but needs medical attention on the same day. If that's the case, and your doctor doesn't have office hours at the time, consider going to an urgent care center.
Urgent care centers usually allow you to walk in without an appointment, just as you would in an ER. But they're equipped and staffed to treat minor, non-life-threatening issues. Patients usually will be seen by a doctor and also may be able to get X-rays or blood drawn.
Most of these clinics offer extended hours on evenings and on weekends for patients to receive treatment when the family doctor is not available. Some are open 24 hours a day every day.
Some cases where you might take your child to an urgent care center include:
cuts
minor injuries
vomiting or diarrhea
ear pain
sore throat
infected bug bites
mild allergic reactions
suspected sprain or broken bone
minor animal bites
The doctors who work at freestanding urgent care centers often are ER doctors or family physicians who focus on treating adult and pediatric diseases. Some urgent care centers are also staffed by nurse practitioners and physician assistants. The ERs in many children's hospitals have special sections for treatment of minor injuries and illnesses that are similar to an urgent care center.
Find out about the urgent care centers near you — before a situation comes up where you need to go to one. Your doctor may be able to recommend facilities in the area. In general, you should find a clinic that meets the state licensing requirements and is staffed by doctors who are board certified in their specialties, such as pediatrics, family medicine, or emergency medicine. Some of these clinics, in addition to accepting walk-in patients, allow you to call ahead to be seen. It's also a good idea to find out if the center accepts your family's insurance plan.
Talk with your doctor before your child gets sick about how to handle emergencies and inquire about the doctor's policy on addressing medical needs outside of office hours. Having that information ahead of time will mean one less thing to worry about when your child is sick!
Reviewed by: Kate M. Cronan, MD
Children's Health: Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a common intestinal disorder that can cause cramps, gas, bloating, diarrhea, and constipation. It is sometimes called a "nervous stomach" or a "spastic colon." Certain foods can trigger the symptoms of IBS, as can emotional stress, infections, and physical trauma.
Although IBS can be uncomfortable and embarrassing for kids, it doesn't cause serious health problems. Doctors can help kids manage IBS symptoms with medications and changes in diet and lifestyle, so that kids with IBS can lead active, healthy lives.
Causes of IBS
The specific cause of IBS is unknown, although it tends to run in families. Research has shown that kids with IBS are more sensitive to pain, discomfort, and fullness than kids without IBS. Certain foods — like milk, chocolate, caffeine, greasy foods, fast foods, and spicy foods — also tend to trigger IBS. In some cases, the triggers are never found.
Stress can also play a part in IBS in healthy kids. Some kids with IBS also tend to be particularly sensitive to stress and emotional upsets. Because nerves in the colon are linked to the brain, stress and conflict (things like family problems, moving, taking tests, going on vacation, and trauma) can affect how well the colon functions by speeding up the colon while slowing down the stomach.
Symptoms of IBS
Kids with IBS usually have at least two of the following symptoms for at least 3 months over the preceding year:
pain or discomfort that is relieved after a bowel movement
pain or discomfort that is accompanied by changes in how often the child has to go to the bathroom
pain or discomfort that is accompanied by changes in the way the child's stool (poop) normally looks. Some kids get constipated and their stools become hard (and difficult to pass); other kids develop diarrhea.
Diagnosing IBS
There is no specific test to diagnose IBS. Doctors usually diagnose it by taking the child's full medical history (including any family history of IBS) and by doing a physical exam. Answering questions about things like gas and diarrhea can be embarrassing, so assure your child that the doctor deals with issues like this every day and needs the information to help your child feel better.
The doctor will probably also ask about your child's environment at home and at school, and may suggest that you help your child keep a food diary to determine if certain foods or substances trigger IBS symptoms.
Most of the time, doctors don't need medical tests to diagnose IBS, but sometimes they order blood and stool tests and X-rays to rule out other intestinal problems.
Treatment
There's no cure for IBS. But many things can help reduce IBS symptoms, including:
Dietary changes. Some kids with IBS find that careful eating helps reduce or eliminate IBS symptoms. You might avoid serving very large meals, drinks with caffeine, spicy or fatty foods, or other foods that seem to trigger the symptoms.
Lifestyle changes. If the symptoms appear to be related to stress, talk to your child about what you can do to help manage pressures related to school, home, or friends.
Regular exercise and stress reduction. Exercise can foster good digestion and it's also a great stress release. If your child suffers from anxiety or depression, your doctor might advise a consultation with a child psychologist or another therapist.
Medications. Doctors sometimes prescribe medications to treat the individual symptoms of IBS, such as laxatives to relieve constipation, anti-diarrhea medications, muscle relaxants, or antidepressants. Talk with your doctor before giving your child any over-the-counter medications for IBS symptoms.
A number of new medicines targeting the neurotransmitter serotonin are now available to treat IBS, but must be used carefully in certain children and adolescents.
Stress reduction and coping strategies. Hypnosis, breathing exercises for relaxation, and psychotherapy are becoming increasingly popular and safe ways to manage IBS.
Though IBS isn't life threatening, it can affect quality of life. It's important to talk with the doctor about ways to manage IBS symptoms to help your child lead an active and healthy life.
Reviewed by: J. Fernando del Rosario, MD
Children's Health: Hereditary Hemochromatosis
Hereditary Hemochromatosis
Hereditary hemochromatosis is a genetic disease that causes the body to absorb and store too much iron. The condition gets its name from "hemo" for blood and "chroma" for color, referring to the characteristic bronze skin tone that iron overload can cause. Someone with hereditary hemochromatosis who has never taken an iron supplement could find out in later years that iron overload is causing serious health problems.
Iron is a trace mineral that plays a vital role in the body. Every red blood cell contains iron in its hemoglobin, the pigment that carries oxygen from the lungs to the tissues. We get iron from our diet, and normally the body absorbs about 10% of the iron found in foods. People with hemochromatosis absorb double that amount.
Once absorbed, the excess iron doesn't leave the body. Instead, it's stored in synovium (joints) and major organs such as the liver, heart, brain, pancreas, and lungs. Over many years, iron accumulates to toxic levels that can damage or even destroy an organ. The iron overload can cause many health problems, most frequently a form of diabetes that's often resistant to insulin treatment. Because of this, hereditary hemochromatosis is sometimes called "bronze diabetes."
Some people with the disease develop symptoms by age 20, although signs of the condition usually appear between ages 40 and 60, when iron in the body has reached damaging levels. Women are less likely to develop symptoms of iron buildup than men, probably due to normal iron loss during menstruation.
However, hereditary hemochromatosis should not be considered a disease of older people or men. Iron buildup is often present and silently causing problems long before symptoms occur — in men, women, adolescents, and in rare cases, children.
Causes of Hereditary Hemochromatosis
Although many people have never heard of hereditary hemochromatosis, it is not rare and affects as many as 1 in every 200 people in the United States, according to the Centers for Disease Control and Prevention (CDC).
Hereditary hemochromatosis is a genetic disorder caused by a mutation on a gene that regulates iron absorption — 1 in every 8 to 10 people in the United States carries a single copy of this defective gene, called HFE. Carriers don't necessarily have the condition themselves, but can pass the mutated gene on to their children.
Hereditary hemochromatosis is an autosomal recessive condition, which means that in order to get it, a child must inherit two mutated HFE genes — one from each parent. If a child inherits just one mutated HFE gene, the normal gene essentially balances out the defective HFE gene.
Even with two mutated genes, not everyone becomes ill. Although a majority of those with two mutated genes will eventually develop some type of iron overload, far fewer of them will absorb enough iron to develop serious problems.
In some cases, inheriting only one mutated gene may still eventually lead to iron overload, possibly affecting the heart, according to the Iron Disorders Institute. In these people, the iron overload may be triggered by a precipitating factor, such as hepatitis (inflammation of the liver) or alcohol abuse. Individuals with one mutated gene who become ill may also have mutations in other genes, yet to be discovered, that increase iron absorption.
Signs and Symptoms
Some people who test positive for hereditary hemochromatosis remain symptom-free for life. Kids who test positive rarely have any symptoms because iron takes years to accumulate.
Patients who do have symptoms may experience:
muscle aches and joint pain, primarily in the fingers, knees, hips, and ankles; one of the earliest symptoms is arthritis of the knuckles of the first and second fingers
chronic fatigue
depression, disorientation, or memory problems
stomach swelling, abdominal pain, diarrhea, or nausea
loss of body hair, other than that on the scalp
premature menopause
gray or bronze skin similar to a suntan
heart problems
diabetes
enlarged liver
increased susceptibility to bacterial infections
With such a wide range of possible symptoms, the disease can be extremely difficult to diagnose. As symptoms progress, it's frequently misdiagnosed as chronic hepatitis, other forms of diabetes, Alzheimer's disease, iron deficiency, gallbladder illness, menstrual problems, thyroid conditions, or polycythemia (an increase in the number of red blood cells).
It's important to understand that someone with hereditary hemochromatosis can have some symptoms without having all of them (i.e., heart problems without skin color changes, diabetes, or liver problems).
Diagnosis and Screening
Luckily, the damage from hereditary hemochromatosis is completely preventable if it's diagnosed and treated early. Doctors may use these blood tests to measure the amount of iron in the blood and diagnose iron overload:
serum ferritin measures the blood level of the protein that stores iron many places in the body
serum iron measures iron concentrations in the blood
total iron-binding capacity (TIBC) measures the amount of iron that can be carried in the blood
With these results, a transferrin saturation percentage (transferrin is a protein that carries iron in the blood) is calculated by dividing the TIBC into the serum iron. An elevated transferrin saturation percentage or serum ferritin level indicates iron overload.
Several gene mutations can cause hemochromatosis. A genetic test is available for the most common type of hemochromatosis, which accounts for about 85% of cases in the United States. However, only some of those who test positive will actually develop serious illness. The other 15% of individuals with symptomatic hemochromatosis will have mutations not in the HFE gene, but in other genes, which may be unknown or for which gene testing isn't routinely available.
Therefore, in cases in which high transferrin saturation and high serum ferritin are found but gene testing doesn't confirm hemochromatosis, a liver biopsy may be done to determine whether symptomatic hemochromatosis exists or is likely to develop.
Also, the doctor may recommend a DNA test to confirm hereditary hemochromatosis when a spouse or first-degree relative (parent, child, or sibling) has been diagnosed with it.
Given the prevalence of the condition, some specialists suggest screening to detect hereditary hemochromatosis before it causes problems. The following approaches to screening have been suggested:
transferrin saturation testing on all adults at age 20, and every 5 years thereafter for anyone who has a family history of the condition (recommended by the College of American Pathologists)
genetic screening for newborns to potentially benefit both the child and the rest of the family (proposed by the American Hemochromatosis Society)
routine iron testing of all kids at age 4; those who have a genetic risk, but remain symptom-free, continue to be tested every 5 years thereafter
If you have a family history of hereditary hemochromatosis and are concerned about your child, talk to your doctor about screening tests.
Treatment
Besides specific treatment for complications of the condition — such as insulin for diabetes — most individuals with hereditary hemochromatosis are treated by regularly drawing blood, a process called phlebotomy that's similar to making a blood donation.
Initially, blood may be drawn once or twice weekly during the "de-ironing" phase until the level of iron in the body has dropped to normal. In many cases, it requires 2 or 3 years of periodic phlebotomy to reach the desired level.
After the de-ironing phase, when the serum ferritin level has fallen into the normal range, the patient usually remains on a maintenance schedule of three to four phlebotomy sessions a year. Doctors check ferritin levels annually to monitor iron accumulation. For most people, this treatment will continue for life.
Complications
When detected and treated early, any and all symptoms of hereditary hemochromatosis can be prevented, and the person can live a normal life. If left untreated, however, it can lead to damaging or even fatal iron overload.
Complications of untreated iron overload include: diabetes, arthritis, depression, impotence, hypogonadism (deficient production of sex hormones by the testicles or ovaries), gallbladder disease, cirrhosis (disease and scarring of the liver), heart attack, cancer, and failure of other organs.
Caring for Your Child
Treatment for kids typically isn't as aggressive as for adults, and making some minor dietary changes can help slow iron accumulation.
Talk to your doctor about taking steps to delay or reduce iron overload. You might:
Limit red meat in your child's diet. Iron-rich vegetables are fine because the body doesn't absorb iron from plant sources very well.
Include moderate amounts of black, green, or oolong tea in your child's diet. The tannin from tea helps minimize iron absorption (note: herbal tea doesn't contain tannin).
Avoid breakfast cereals, breads, and snacks that are enriched with iron.
Ensure your child is immunized against hepatitis A and B.
Limit vitamin C supplements to less than 100 milligrams per day, because vitamin C enhances iron absorption.
Use a children's multivitamin that doesn't contain iron.
Avoid raw shellfish, which occasionally can be contaminated with bacteria that might be harmful to someone with an iron overload.
These simple steps can help ensure that your child will remain free of symptoms of the disease.
Reviewed by: Christopher N. Frantz, MD
Children's Health: Headaches
Whether they're pounding and throbbing or dull and aching, headaches are common in kids. Headaches can have a wide range of causes and many levels of severity. It's important to understand how to recognize when a headache is just a passing pain and when it's something more and requires medical attention.
Causes of Headaches
Headaches are thought to be caused by changes in chemicals, nerves, or blood vessels in the area. These changes send pain messages to the brain and bring on a headache.
In general, kids get the same types of headaches as adults. And headaches often are hereditary, so if a parent gets them, their kids might too.
Some of the many potential headache triggers include:
certain medications (headaches are a potential side effect of some)
too little sleep or sudden changes in sleep patterns
skipping meals
becoming dehydrated
being under a lot of stress
having a minor head injury
using the computer or watching TV for a long time
vision problems
menstruation
experiencing changes in hormone levels
taking a long trip in a car or bus
listening to really loud music
smoking
smelling strong odors such as perfume, smoke, fumes, or a new car or carpet
drinking or eating too much caffeine (in soda, coffee, tea, and chocolate)
consuming certain foods (such as alcohol, cheese, nuts, pizza, chocolate, ice cream, fatty or fried food, lunchmeats, hot dogs, yogurt, aspartame, or anything with the food additive MSG)
In some cases, headaches are caused by certain infections, such as:
ear infections
viral infections, like the flu or common cold
strep throat
sinus infections
Lyme disease
Most headaches aren't signs that something more is wrong, but occasionally headaches are caused by more serious medical conditions.
Common Types of Headaches
When kids get more than the occasional headache, two of the more common kinds they get are tension headaches and migraines.
Tension Headaches
Fairly common in kids, tension headaches can be brought on by a variety of emotional and physical stressors. The pain is often described as:
constant pressure around the front and sides of the head, which can feel like someone stretched a rubber band around it
constricting
dull
aching
A major distinction between tension headaches and migraines is that tension headaches typically are not accompanied by nausea or vomiting, and they're usually not made worse by physical activity — symptoms that do often occur with migraines.
Migraines
About 5% of school-age kids and at least 10% of teens get migraine headaches, recurrent headaches with additional symptoms. Often triggered by things like stress, sleep deprivation, and menstruation, migraine headaches can cause the following symptoms:
pounding, throbbing pain or dull, steady pain on one or both sides of the head
dizziness
stomachaches
nausea and/or vomiting
seeing spots or halos
sensitivity to light, noise, and/or smells
Most migraines last anywhere from 30 minutes to several hours. Some can last as long as a couple of days. Some people with migraines:
just don't feel right. Light, smell, or sound may bother them or make them feel worse. Sometimes, if they try to continue with their usual routine after the migraine starts, they may become nauseated and vomit. Often the pain begins only on one side of the head. Trying to perform physical activities can make the pain worse.
get auras, a kind of warning that a migraine is on the way (usually about 10 to 30 minutes before the start of a migraine). The auras may only be seen in one eye. Common auras include blurred vision, seeing spots, jagged lines, or flashing lights, or smelling a certain odor.
experience a migraine premonition hours to days prior to the actual headache. This is slightly different from auras and may cause cravings for different foods, thirst, irritability, or feelings of intense energy.
have muscle weakness, lose their sense of coordination, or stumble.
Unfortunately, parents of an infant or toddler who are unable to say what hurts may not be able to tell if their little one is having migraines. Young kids with headaches may be cranky, less active, may vomit, or look pale or flushed.
Migraine variants that are thought to happen only to kids and are precursors to the more common migraines of adulthood include paroxysmal vertigo and cyclic vomiting.
Paroxysmal vertigo is described as a sensation of spinning or whirling that comes on suddenly and disappears in a matter of minutes. Kids who experience this may momentarily appear frightened and unsteady, or unable to walk. The vertigo typically goes away by the time a child is 5 years old.
Cyclic vomiting also occurs in young kids and involves repeated episodes of vomiting. The episodes can last for hours or days and are not usually associated with headache. Cyclic vomiting usually goes away by the time kids grow into teens.
When to Call the Doctor
When your child has a splitting headache, it's easy to worry. Rest assured, though, that only very rarely are headaches a symptom of something serious. However, you should contact your doctor if your child has unexplained or recurring headaches over a short period of time or on a regular basis.
Call the doctor if your child's headaches:
occur once a month or more
don't go away easily
are particularly painful
Also note whether other symptoms accompany the headaches, which can help the doctor identify what might be causing them. Call the doctor if your child also has any of these symptoms:
decreased level of alertness
vomiting
headache when your child wakes up, or one that actually wakes up your child
headache following a head injury or loss of consciousness
headache accompanied by seizures
visual changes
tingling sensations
weakness
clumsiness
skin rash
difficulty walking or standing
difficulty speaking
neck pain or stiffness
fever or other signs of infection
unable to go to school or participate in everyday routines and activities
change in personality
drinking or peeing a lot
Diagnosing Headaches
Your doctor may want to do a physical exam and get your child's medical history to help discover what might be causing the headaches. Let the doctor know:
how severe and frequent the headaches are
when the headaches first started
what the headaches feel like, and where they hurt
whether the headaches have a pattern or change over time
any other symptoms that your child experiences with the headache
any injuries that have occurred recently
anything that triggers the headaches
your child's diet, habits, sleeping patterns, and what seems to help or worsen the headaches
any stresses your child might be experiencing
any past medical problems your child has had
any medications your child is taking
any allergies your child may have
any family history of headaches
To help pin down the problem, doctors often ask parents — and older kids and teens — to keep a headache diary, listing all headaches, when they happen, how long they last, and a few notes about what might have brought them on.
The doctor may do a complete physical exam including looking in the eyes, testing nerves, and having your child do things like walk or touch his or her nose. A doctor also may order blood tests or imaging tests, such as a CAT scan or MRI of the brain, to look for medical problems that might be causing headaches.
How to Help Your Child
Treatment for your child's headaches will depend on what the doctor determines is the likely cause. But most everyday headaches can be cared for at home with little medical intervention.
To help ease your child's pain, have him or her:
Lie down in a cool, dark, quiet room.
Put a cool, moist cloth across the forehead or eyes.
Relax.
Breathe easily and deeply.
Make sure your child has had something to eat and drink. Kids with migraines may just want to sleep and may feel better when they wake up. A big part of treating migraines is avoiding the triggers that may have caused them. That's where a headache diary can be especially helpful.
You also can give your child an over-the-counter pain reliever such as acetaminophen or ibuprofen. Read the label, though, to make sure that you give the right dosage at the right intervals. If you have any questions about how much to give, check with the doctor. And if your child is under age 2 or has other medical problems, call your doctor before giving your little one any pain reliever. Your doctor will be able to tell you whether you should give it and, if so, how much (based on weight and age).
Never give aspirin to kids or teens unless specifically directed to by a doctor. Aspirin can cause Reye syndrome, a potentially life-threatening condition.
If your child has chronic migraine headaches, the doctor may prescribe a medication to be taken when the headaches come on or daily as a preventive measure. In deciding whether to put your child on medication, the doctor will consider the frequency of the migraines and discuss the potential benefit of the medication versus its possible side effects.
Discuss pain management with your doctor, who will develop a treatment plan that may include approaches that don't involve medicine, such as relaxation, stress reduction techniques, and avoiding possible triggers.
Tracking your child's headaches and their symptoms and following the doctor's recommendations are the keys to finding relief for painful headaches.
Reviewed by: Larissa Hirsch, MD
Children's Health: Growing Pains
Your 8-year-old son wakes up crying in the night complaining that his legs are throbbing. You rub them and soothe him as much as you can, but you're uncertain about whether to give him any medication or take him to the doctor.
Sound familiar? Your child is probably experiencing growing pains, a normal occurrence in about 25% to 40% of children. They generally strike during two periods: in early childhood among 3- to 5-year-olds and, later, in 8- to 12-year-olds.
What Causes Them?
No firm evidence shows that the growth of bones causes pain. The most likely causes are the aches and discomforts resulting from the jumping, climbing, and running that active kids do during the day. The pains can occur after a child has had a particularly athletic day.
Signs and Symptoms
Growing pains always concentrate in the muscles, rather than the joints. Most kids report pains in the front of their thighs, in the calves, or behind the knees. Whereas joints affected by more serious diseases are swollen, red, tender, or warm, the joints of kids experiencing growing pains appear normal.
Although growing pains often strike in late afternoon or early evening before bed, pain can sometimes wake a sleeping child. The intensity of the pain varies from child to child, and most kids don't experience the pains every day.
Diagnosing Growing Pains
One symptom that doctors find most helpful in making a diagnosis of growing pains is how the child responds to touch while in pain. Kids who have pain from a serious medical disease don't like to be handled because movement tends to increase the pain. But those with growing pains respond differently — they feel better when they're held, massaged, and cuddled.
Growing pains are what doctors call a diagnosis of exclusion. This means that other conditions should be ruled out before a diagnosis of growing pains is made. A thorough history and physical examination by your doctor can usually accomplish this. In rare instances, blood and X-ray studies may be required before a final diagnosis of growing pains is made.
Helping Your Child
Some things that may help alleviate the pain include:
massaging the area
stretching
placing a heating pad on the area
giving ibuprofen or acetaminophen (Never give aspirin to a child under 12 due to its association with Reye syndrome, a rare but potentially fatal disease.)
When to Call the Doctor
Alert your doctor if any of the following symptoms occur with your child's pain:
persistent pain, pain in the morning, or swelling or redness in one particular area or joint
pain associated with a particular injury
fever
limping
unusual rashes
loss of appetite
weakness
tiredness
uncharacteristic behavior
These signs are not due to growing pains and should be evaluated by the doctor.
Although growing pains often point to no serious illness, they can be upsetting to a child — or a parent. Because a child seems completely cured of the aches in the morning, parents sometimes suspect that the child faked the pains. However, this usually is not the case. Support and reassurance that growing pains will pass as kids grow up can help them relax.
Reviewed by: Steven Dowshen, MD
Children's Health: Going to the Emergency Room
When your child is sick or injured, it's natural to panic and head straight for the emergency room (ER), because you know that you can get care, regardless of the time, day, or severity of your child's injury.
In some cases, it is a true medical emergency and the ER is the most appropriate place to get care.
In other cases, the illness or injury can be handled at an urgent care clinic, or treatment can wait until your child's doctor can see you.
When the ER is the right place to go, it's important to know what to expect once you get there. Having this information ahead of time can help make the experience a little less stressful.
Finding the Right ER at the Right Time
In certain situations, you should dial 911 to get an ambulance instead of taking your child to the ER yourself. Call 911 if:
Your child is having trouble breathing and is turning blue.
There has been a car accident and your child is unconscious or seriously injured.
Your child is having a seizure that lasts 3-5 minutes, is having difficulty breathing, or is turning blue.
Your child loses consciousness or is not responsive.
Your child might have a neck or spine injury.
Your child has a head injury with a loss of consciousness, persistent vomiting, or is not responding normally.
Your child has significant uncontrolled bleeding.
Your child has a possible poisoning and is not responding normally or having difficulty breathing. In any possible poisoning, call the Poison Control Center (1-800-222-1222) for expert advice and they may direct you to the ER.
Planning Ahead
Talk with your doctor about what to do — and which ER to go to — before you're in a situation where you might need to visit one. The doctor may direct you to an ER that's close to you or one in a hospital where he or she regularly sees patients.
Should your child go to an ER at a children's hospital? Because they're dedicated to caring for kids, children's hospitals probably have the most pediatric staff, specialists, and facilities. So if it's an emergency and a children's hospital is conveniently located, consider going there.
Otherwise, the community hospital nearest you will provide the medical care needed. If for any reason the hospital isn't equipped to treat your child's specific condition, the doctors there will arrange a transfer to a facility that is.
Preparing to Go to the ER
When you go to the ER, it's important to have a good handle on your child's symptoms. It's also important to know your child's medical history — allergies, past illnesses, injuries, surgeries, immunization history, or chronic conditions.
Even if you know the medical history by heart, consider writing it down so it's handy during the chaos of an emergency. And keeping a written record readily available at home will let anyone caring for your child — such as a babysitter — provide it should your child be taken to the ER.
To prepare a medical history, include:
medications your child is taking
allergies
history of previous hospitalizations
any previous surgeries
illnesses
relevant family history
immunization history
You also might be asked when your child last had anything to eat or drink. You should know the name and number of your child's primary care provider. And it's good to know the name and number of the pharmacy where you usually get your prescriptions filled.
If you go to the ER because your child has ingested a particular medication or household product, bring the container of whatever was ingested. That will help the doctors understand what kind of treatment is required. If your child has swallowed an object, bring an example of that object, if possible.
At any ER, except in the most serious emergencies, be prepared to wait. If you have time before you leave the emergency room, consider bringing something to do while you wait, such as a book, magazines, or bills to pay. You may also want to bring pen and paper to write down any questions you have for the doctor. If your child is not too ill, bring things for him or her to do as well, such as crayons, books, toys, and comforting objects, like stuffed animals.
If you think there's a chance that your child might have to be admitted to the hospital, you may want to grab a change of clothes and toothbrushes for you and your child.
Most ERs have some translation services or someone who can help translate. If you do not speak English fluently, consider bringing along a family member or friend who can help you translate.
What to Expect at the ER
There's no way to predict how long you'll have to wait to be seen at the ER. If your child has a severe medical problem, be assured that the doctors will provide whatever attention is needed right away.
Because doctors attend to the most severe injuries and illnesses first, there's a good chance that if you are there with a minor injury, you'll have to wait longer. Even if the waiting room is empty, you still may have to wait if the exam rooms are filled or many doctors and nurses are attending to a particularly serious case.
If your child's condition becomes worse while you are waiting to see a doctor, tell the medical staff.
Before offering any food or drink to your child, make sure to ask the medical staff if it is OK. In some situations, your doctor would prefer your child has nothing to eat or drink.
While you wait, there's a chance that you — and your child — may see some very sick and injured people come into the ER. The sights and sounds of those who are seriously hurt or sick can be frightening. So assure your child that the ER is the best place for the hurt people to be and that this is where the doctors can help them feel better. You might even give an example of a time when someone you know was injured and, as scary as it was at the time, all was fine after the doctor's care.
Soon after arriving at the ER, your child probably will be seen by a nurse, who will ask about symptoms, check vital signs, and make a quick assessment. This evaluation, also called triage, will prioritize your child's medical needs based on the severity of his or her condition.
You'll also go through a registration process where you'll be asked to sign consent for treatment forms. And if you have health insurance, be sure to have your member card with you.
When you're in the ER, try to write down important information that you hear. It's scary and stressful when your child is in the ER, so it can be hard to remember details you may need later, such as:
the names of the doctors
what they say about the illness or injury
any medications or treatment they give your child
any directions for follow-up or care at home
If your child is being discharged, make sure you understand the home care instructions and ask questions if you don't.
A specialist might not be on-site if you go to the ER on the weekend or at night, but if the problem requires it, one will be called in. If it requires surgery, a surgeon will be contacted.
Some hospitals even have a child life specialist. They can help children cope with the stress of being in the ER, help prepare them for procedures, and provide them with non-pharmacological pain management techniques even at very young ages.
In many cases, the doctor who treats your child in the ER will contact your primary care doctor afterward. If your child is admitted to the hospital, the emergency room doctor will let your doctor know.
Some ERs provide written or computer-generated documentation of the visit and others dictate and fax the report to the primary care doctor. Carry a copy of the papers you receive when your child is discharged to share with your doctor.
Reviewed by: Yamini Durani, MD
Children's Health: G6PD Deficiency
G6PD deficiency is an inherited condition in which the body doesn't have enough of the enzyme glucose-6-phosphate dehydrogenase, or G6PD, which helps red blood cells (RBCs) function normally. This deficiency can cause hemolytic anemia, usually after exposure to certain medications, foods, or even infections.
Most people with G6PD deficiency don't have any symptoms, while others develop symptoms of anemia only after RBCs have been destroyed, a condition called hemolysis. In these cases, the symptoms disappear once the cause, or trigger, is removed. In rare cases, G6PD deficiency leads to chronic anemia.
With the right precautions, a child with G6PD deficiency can lead a healthy and active life.
About G6PD Deficiency
G6PD is one of many enzymes that help the body process carbohydrates and turn them into energy. G6PD also protects red blood cells from potentially harmful byproducts that can accumulate when a person takes certain medications or when the body is fighting an infection.
In people with G6PD deficiency, either the RBCs do not make enough G6PD or what is produced cannot properly function. Without enough G6PD to protect them, RBCs can be damaged or destroyed. Hemolytic anemia occurs when the bone marrow (the soft, spongy part of the bone that produces new blood cells) cannot compensate for this destruction by increasing its production of RBCs.
Causes of G6PD Deficiency
G6PD deficiency is passed along in genes from one or both parents to a child. The gene responsible for this deficiency is on the X chromosome.
G6PD deficiency is most common in African-American males. Many African-American females are carriers of G6PD deficiency, meaning they can pass the gene for the deficiency to their children but do not have symptoms; only a few are actually affected by G6PD deficiency.
People of Mediterranean heritage, including Italians, Greeks, Arabs, and Sephardic Jews, also are commonly affected. The severity of G6PD deficiency varies among these groups — it tends to be milder in African-Americans and more severe in people of Mediterranean descent.
Why does G6PD deficiency occur more often in certain groups of people? It is known that Africa and the Mediterranean basin are high-risk areas for the infectious disease malaria. Researchers have found evidence that the parasite that causes this disease does not survive well in G6PD-deficient cells. So they believe that the deficiency may have developed as a protection against malaria.
G6PD Deficiency Symptom Triggers
Kids with G6PD deficiency typically do not show any symptoms of the disorder until their red blood cells are exposed to certain triggers, which can be:
illness, such as bacterial and viral infections
certain painkillers and fever-reducing drugs
certain antibiotics (especially those that have "sulf" in their names)
certain antimalarial drugs (especially those that have "quine" in their names)
Some kids with G6PD deficiency can tolerate the medications in small amounts; others cannot take them at all. Check with your doctor for more specific instructions, as well as a complete list of medications that could pose a problem for a child with G6PD deficiency.
Other substances can be harmful to kids with this condition when consumed — or even touched — such as fava beans and naphthalene (a chemical found in mothballs and moth crystals). Mothballs can be particularly harmful if a child accidentally swallows one, so ANY contact should be avoided.
Symptoms of G6PD Deficiency
A child with G6PD deficiency who is exposed to a medication or infection that triggers the destruction of RBCs may have no symptoms at all. In more serious cases, a child may exhibit symptoms of anemia (also known as a hemolytic crisis), including:
paleness (in darker-skinned children paleness is sometimes best seen in the mouth, especially on the lips or tongue)
extreme tiredness
rapid heartbeat
rapid breathing or shortness of breath
jaundice, or yellowing of the skin and eyes, particularly in newborns
an enlarged spleen
dark, tea-colored urine
Once the trigger is removed or resolved, the symptoms of G6PD deficiency usually disappear fairly quickly, typically within a few weeks.
If symptoms are mild, no medical treatment is usually needed. As the body naturally makes new red blood cells, the anemia will improve. If symptoms are more severe, a child may need to be hospitalized for supportive medical care.
Diagnosing and Treating G6PD Deficiency
In most cases, cases of G6PD deficiency go undiagnosed until a child develops symptoms. If doctors suspect G6PD deficiency, blood tests usually are done to confirm the diagnosis and to rule out other possible causes of the anemia.
If you feel that your child may be at risk because of either a family history or your ethnic background, talk to your doctor about performing a screening with blood tests to check for G6PD deficiency.
Treating the symptoms associated with G6PD deficiency is usually as simple as removing the trigger — that is, treating the illness or infection or stopping the use of a certain drug. However, a child with severe anemia may require treatment in the hospital to receive oxygen, fluids, and, if needed, a transfusion of healthy blood cells. In rare cases, the deficiency can lead to other more serious health problems.
Caring for Your Child
The best way to care for a child with G6PD deficiency is to limit exposure to the triggers of its symptoms. With the proper precautions, G6PD deficiency should not keep your child from living a healthy, active life.
Reviewed by: Steven Dowshen, MD
Children's Health: Frequently Asked Questions About Casts
Kids who need a cast often have plenty of questions. Here are answers to some frequent inquiries about casts.
What are the different kinds of casts?
A cast, which keeps a bone from moving so it can heal, is essentially a big bandage that has two layers — a soft cotton layer that rests against the skin and a hard outer layer that prevents the broken bone from moving.
These days, casts are made of either:
plaster of paris: a heavy white powder that forms a thick paste that hardens quickly when mixed with water. Plaster of paris casts are heavier than fiberglass casts and don't hold up as well in water.
synthetic (fiberglass) material: made out of fiberglass, a kind of moldable plastic, these casts come in many bright colors and are lighter and cooler. The covering (fiberglass) on synthetic casts is water-resistant, but the padding underneath is not. You can, however, get a waterproof liner. The doctor putting on the cast will decide whether a fiberglass cast with a waterproof lining is appropriate.
How is a cast put on?
First, several layers of soft cotton are wrapped around the injured area. Next, the plaster or fiberglass outer layer is soaked in water. The doctor wraps the plaster or fiberglass around the soft first layer. The outer layer is wet but will dry to a hard, protective covering. Doctors sometimes make tiny cuts in the sides of a cast to allow room for swelling.
Can plaster of paris casts get wet?
Absolutely not! A wet cast may not hold the bone in place because the cast could start to dissolve in the water and could irritate the skin underneath it, possibly leading to infection. So your child shouldn't swim and should use a plastic bag or special sleeve (available online or sometimes at pharmacies) to protect the cast from water. And instead of a shower, your child may need to take a sponge bath.
Can synthetic (fiberglass) casts get wet?
Although the fiberglass itself is waterproof, the padding inside a fiberglass cast is not. So it's still important to try to keep a fiberglass cast from getting wet. If this is a problem, talk to the doctor about getting a waterproof liner. Fiberglass casts with waterproof liners let kids continue bathing or even go swimming during the healing process. Although the liner allows for evaporation of water and sweat, it's still fragile. Also, only certain types of breaks can be treated with this type of cast. Your doctor will determine if the fracture may be safely treated with a waterproof cast.
Is it OK to have people sign and draw on my child's cast?
Definitely! That often makes the whole broken bone experience more bearable for kids. Permanent markers usually work best; washable ones can smear. Feel free to encourage siblings, family members, and classmates to sign it, draw pictures on it, or decorate it with stickers. The doctor might even let your child keep the adorned cast as a souvenir.
What if my child has an itch in the cast?
Try blowing some air in the cast with a hair dryer — be sure to use the cool setting, though. And you should never pour baby powder or oils in the cast to try to relieve itching or try to reach the itch with long, pointed object such as a pencil or hanger — these could scratch or irritate your child's skin and can lead to an infection.
What if the cast gets a crack?
This can happen if the cast is hit or crushed, has a weak spot, or if the injured area begins to swell underneath. Call your doctor as soon as you notice a crack. In most cases, a simple repair can be done to the cast without needing to remove it or change it.
What if the cast causes my child's fingers or toes to turn white, purple, or blue, or if the skin around the edges of the cast gets red or raw?
The cast may be too tight. Redness and rawness are typically signs that the cast is wet inside, from sweat or water. Sometimes, kids pick at or remove the padding from the edges of fiberglass casts. They shouldn't do this, though, because the fiberglass edges can rub on the skin and cause irritation. Call your doctor to have the problem fixed right away.
Why aren't some types of broken bones put in casts right away?
Some kinds of fractures don't need casts to heal. Certain fractures of larger long bones, such as the femur (thighbone), are hard to keep straight in a cast. Although doctors used to commonly put many of these kinds of fractures in traction (a way of gently pulling the bone straight), these days, surgery is often used instead.
Do all broken bones need casts?
It's not practical to cast ribs and collarbones (clavicles). Even displaced collarbones (in which pieces on either side of the break are out of line) heal well with a sling or special strap called a "figure-of-eight clavicle strap," which the child wears like a vest. Some non-displaced finger and toe fractures (in which the pieces on either side of the break line up) that don't involve the joint or the growing part of a child's bone (called the growth plate) may heal well with a splint or buddy taping (taping the injured digit to the adjacent unaffected finger or toe).
Will my child feel pain when the broken bone is in a cast?
Some pain is expected for the first few days, but it's usually not severe. The doctor may recommend acetaminophen or ibuprofen to ease pain.
How are casts taken off?
The doctor will use a small electrical saw to remove the cast. Although it may look and sound scary to your child, the process is actually quick and painless. The saw's blade isn't sharp — it has a dull, round blade that vibrates up and down. The vibration is strong enough to break apart the fiberglass or plaster, but shouldn't hurt your child's skin and may even tickle.
What will the injured area look and feel like when the cast is removed?
Once the cast is off, the injured area will probably look and feel pretty weird to your child: The skin will be pale, dry, or flaky; hair will look darker; and the area (muscles especially) will look smaller or weaker. Don't worry, though — this is all temporary. And depending on the type and location of the fracture, the doctor may also give your child special exercises to do to get the muscles around the broken bone back in working order.
Reviewed by: Peter G. Gabos, MD
