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Children's Health: Mumps
About Mumps
Mumps is a disease caused by a virus that usually spreads through saliva and can infect many parts of the body, especially the parotid salivary glands. These glands, which produce saliva for the mouth, are found toward the back of each cheek, in the area between the ear and jaw. In cases of mumps, these glands typically swell and become painful.
The disease has been recognized for several centuries, and medical historians argue over whether the name "mumps" comes from an old word for "lump" or an old word for "mumble."
Mumps was common until the mumps vaccine was licensed in 1967. Before the vaccine, more than 200,000 cases occurred each year in the United States. Since then the number of cases has dropped to fewer than 1,000 a year, and epidemics have become fairly rare. As in the pre-vaccine era, most cases of mumps are still in kids ages 5 to 14, but the proportion of young adults who become infected has been rising slowly over the last two decades. Mumps infections are uncommon in kids younger than 1 year old.
After a case of mumps it is very unusual to have a second bout because one attack of mumps almost always gives lifelong protection against another. However, other infections can also cause swelling in the salivary glands, which might lead a parent to mistakenly think a child has had mumps more than once.
Signs and Symptoms
Cases of mumps may start with a fever of up to 103° Fahrenheit (39.4° Celsius), as well as a headache and loss of appetite. The well-known hallmark of mumps is swelling and pain in the parotid glands, making the child look like a hamster with food in its cheeks. The glands usually become increasingly swollen and painful over a period of 1 to 3 days. The pain gets worse when the child swallows, talks, chews, or drinks acidic juices (like orange juice).
Both the left and right parotid glands may be affected, with one side swelling a few days before the other, or only one side may swell. In rare cases, mumps will attack other groups of salivary glands instead of the parotids. If this happens, swelling may be noticed under the tongue, under the jaw, or all the way down to the front of the chest.
Mumps can lead to inflammation and swelling of the brain and other organs, although this is not common. Encephalitis (inflammation of the brain) and meningitis (inflammation of the lining of the brain and spinal cord) are both rare complications of mumps. Symptoms appear in the first week after the parotid glands begin to swell and may include: high fever, stiff neck, headache, nausea and vomiting, drowsiness, convulsions, and other signs of brain involvement.
Mumps in adolescent and adult males may also result in the development of orchitis, an inflammation of the testicles. Usually one testicle becomes swollen and painful about 7 to 10 days after the parotids swell. This is accompanied by a high fever, shaking chills, headache, nausea, vomiting, and abdominal pain that can sometimes be mistaken for appendicitis if the right testicle is affected. After 3 to 7 days, testicular pain and swelling subside, usually at about the same time that the fever passes. In some cases, both testicles are involved. Even with involvement of both testicles, sterility is only a rare complication of orchitis.
Additionally, mumps may affect the pancreas or, in females, the ovaries, causing pain and tenderness in parts of the abdomen.
In some cases, signs and symptoms are so mild that no one suspects a mumps infection. Doctors believe that about 1 in 3 people may have a mumps infection without symptoms.
Contagiousness
The mumps virus is contagious and spreads in tiny drops of fluid from the mouth and nose of someone who is infected. It can be passed to others through sneezing, coughing, or even laughing. The virus can also spread to other people through direct contact, such as picking up tissues or using drinking glasses that have been used by the infected person.
People who have mumps are most contagious from 2 days before symptoms begin to 6 days after they end. The virus can also spread from people who are infected but have no symptoms.
Prevention
Mumps can be prevented by vaccination. The vaccine is given as part of the measles-mumps-rubella (MMR) immunization, which is usually given to children at 12 to 15 months of age. A second dose of MMR is generally given at 4 to 6 years of age. As is the case with all immunization schedules, there are important exceptions and special circumstances.
If they haven't already received them, students who are attending colleges and other post-high school institutions should be sure they have had two doses of the MMR vaccine.
During a measles outbreak, your doctor may recommend additional shots of the vaccine, if your child is 1 to 4 years old. Your doctor will have the most current information.
Incubation
The incubation period for mumps can be 12 to 25 days, but the average is 16 to 18 days.
Duration
Children usually recover from mumps in about 10 to 12 days. It takes about 1 week for the swelling to disappear in each parotid gland, but both glands don't usually swell at the same time.
Treatment
If you think that your child has mumps, call your doctor, who can confirm the diagnosis and work with you to monitor your child and watch for complications. The doctor can also notify the health authorities who keep track of childhood immunization programs and mumps outbreaks.
Because mumps is caused by a virus, it cannot be treated with antibiotics.
At home, monitor and keep track of your child's temperature. You can use nonaspirin fever medications such as acetaminophen or ibuprofen to bring down a fever. These medicines will also help relieve pain in the swollen parotid glands. Unless instructed by the doctor, aspirin should not be used in children with viral illnesses because its use in such cases has been associated with the development of Reye syndrome, which can lead to liver failure and death.
You can also soothe the swollen parotid glands with either warm or cold packs. Serve a soft, bland diet that does not require a lot of chewing and encourage your child to drink plenty of fluids. Avoid serving tart or acidic fruit juices (like orange juice, grapefruit juice, or lemonade) that make parotid pain worse. Water, decaffeinated soft drinks, and tea are better tolerated.
When mumps involves the testicles, the doctor may prescribe stronger medications for pain and swelling and provide instructions on how to apply warm or cool packs to soothe the area and how to provide extra support for the testicles.
A child with mumps doesn't need to stay in bed, but may play quietly. Ask your doctor about the best time for your child to return to school.
When to Call the Doctor
Call the doctor if you suspect that your child has mumps. If your child has been diagnosed with mumps, keep track of his or her temperature and call the doctor if goes above 101° Fahrenheit (38.3° Celsius).
Because mumps can also involve the brain and its membranes, call the doctor immediately if your child has any of the following: stiff neck, convulsions (seizures), extreme drowsiness, severe headache, or changes of consciousness. Watch for abdominal pain that can mean involvement of the pancreas in either sex or involvement of the ovaries in girls. In boys, watch for high fever with pain and swelling of the testicles.
Reviewed by: Joel Klein, MD
Children's Health: Lumbar Puncture (Spinal Tap)
What It Is
A lumbar puncture (LP), often called a spinal tap, is a common medical test that involves taking a small sample of cerebrospinal fluid (CSF) for examination. CSF is a clear, colorless liquid that delivers nutrients and "cushions" the brain and spinal cord, or central nervous system.
In a lumbar puncture, a needle is carefully inserted into the lower spine to collect the CSF sample.
Why It's Done
Medical personnel perform lumbar punctures and test the CSF to detect or rule out suspected diseases or conditions through analysis of the white blood cell count, glucose levels, protein, and bacteria.
Special testing can look for certain bacteria and viruses, or find the presence of abnormal cells that can help identify specific diseases in the central nervous system.
Most LPs are done to test for meningitis, but they also can detect bleeding in the brain and certain conditions affecting the nervous system (such as Guillain-Barré syndrome and multiple sclerosis). LPs also can deliver chemotherapeutic medications.
Preparation
After the procedure is explained to you, you'll be asked to sign an informed consent form — this document states that you give permission for the procedure to be performed and that you understand the procedure, why it is being done, and any potential risks.
The doctor performing the lumbar puncture will know your child's medical history, but might ask additional questions such as whether your child is allergic to any medicines.
You might be able to stay in the room with your child during the procedure, or you can step outside to a waiting area.
The Procedure
A lumbar puncture takes about 30 minutes. The doctor carefully inserts a thin needle between the bones of the lower spine (below the spinal cord) to withdraw the fluid sample.
The patient will be positioned with the back curved out so the spaces between the vertebrae are as wide as possible. This allows the doctor to easily find the spaces between the lower lumbar bones (where the needle will be inserted).
Older kids might be asked to either sit on an exam table while leaning over with their head on a pillow or lie on their side. Infants and younger children are usually positioned on their sides with their knees under their chin.
Once the child in the correct position, the back is cleansed with an antiseptic like iodine solution and a sterile area is maintained to minimize infection risk. The doctor performing the procedure also wears sterile gloves while performing the procedure.
A small puncture through the skin on the lower back is made and liquid anesthetic medicine is injected into the tissues beneath the skin to prevent pain. In many cases, before the injected anesthesia medication is given, a numbing cream is applied to the skin to minimize discomfort.
The spinal needle is thin and the length varies according to the size of the patient. It has a hollow core, and inside the hollow core is a "stylet," another type of thin needle that acts kind of like a plug. When the spinal needle is inserted into the lower lumbar area, the stylet is carefully removed, which allows the cerebrospinal fluid to drip out into the collection tubes.
After the CSF sample is collected (this usually takes about 2-5 minutes), the needle is withdrawn and a small bandage is placed on the site. Collected samples are sent to a lab for analysis and testing.
Sometimes doctors also measure the amount of pressure in the CSF using a special device called a manometer. High CSF pressure can happen under certain conditions, like meningitis.
What to Expect
While some notice a brief pinch and some discomfort, most people don't consider a lumbar puncture to be painful. Depending on the doctor's recommendations, your child might have to lie on his or her back for a few hours after the procedure. Your child might feel tired and have a mild backache the day after the procedure.
Getting the Results
Some results from a lumbar puncture are available within 45 to 60 minutes. However, to look for specific bacteria growing in the sample, a bacterial culture is sent to the lab and these results are usually available in 48 hours. If it's determined there might be an infection, the doctor will start antibiotic treatment while waiting for the results of the culture.
Risks
A lumbar puncture is considered a safe procedure with minimal risks. Most of the time, there are no complications. In some instances, a patient may get a headache. It's recommended that patients lie down for a few hours after the test and drink plenty of fluids to help prevent headaches, which usually resolve with rest, pain medications, and fluids.
In rare cases, infection or bleeding can occur. Also, trauma to spinal cord is extremely rare when the procedure is done correctly, because the cord ends much higher in the back than the area where the needle is inserted for the LP.
Sometimes, sedation medication may be helpful for your child in order to perform the procedure. If sedation is necessary, be sure to discuss the risks and benefits with your doctor.
Helping Your Child
You can help prepare your child for a lumbar puncture by explaining that while the test might be uncomfortable, it shouldn't be painful and won't take long. Also explain the importance of lying still during the test, and let your child know that a nurse might hold him or her in place. After the procedure, make sure your child rests and follow any other instructions the doctor gives you.
If You Have Questions
It's important to understand any procedure your child undergoes. If you have questions or concerns about the lumbar puncture procedure, be sure to speak with your doctor.
Reviewed by: Yamini Durani, MD
Children's Health: Is My Child Too Sick to Go to School?
I'm usually a pretty good judge of when my kids are too sick to go to school or daycare, but other times — like when my youngest seems to be dragging but has no fever — I'm just not sure. How can I tell when they're well enough to go to school and when they should just stay at home?
- Allyson
Many parents have a hard time deciding if their kids are well enough to go to school. After all, what well-intentioned parent hasn't sent a child off with tissues in hand, only to get that mid-morning "come get your child" phone call?
But making the right decision isn't as tough as you might think. It basically boils down to one question: Can your child still participate in school activities? After all, having a sore throat, cough, or mild congestion does not necessarily mean a child can't be active and participate in school activities.
So trust your instincts. If your son has the sniffles but hasn't slowed down at home, chances are he's well enough for the classroom. On the other hand, if he's been coughing all night and needs to be woken up in the morning (if he typically wakes up on his own), he may need to take it easy at home.
Of course, never send a child to school who has a fever, is nauseated, vomiting, or has diarrhea. Kids who lose their appetite, are clingy or lethargic, complain of pain, or who just don't seem to be acting "themselves" should also take a sick day.
If you decide that your child is well enough to go to school, check first with your child's teacher. Most daycares, preschools, and grade schools have rules about when to keep kids home. For example, pinkeye or strep throat usually necessitates a day home with appropriate treatment. Most centers won't let kids return to school until after a fever has broken naturally (without fever-reducing medicines) for at least 24 hours.
And remember, go with your gut. You know your kids best, and you know when they're able to motor through the day — and when they're not.
Reviewed by: Mary L. Gavin, MD
Children's Health: Is It a Cold or the Flu?
Your child is sent home from school with a sore throat, cough, and high fever — could it be the flu that's been going around? Or just a common cold?
Although the flu (or influenza) usually causes symptoms that make someone feel worse than symptoms associated with a common cold, it's not always easy to tell the difference between the two.
Symptoms Guide
The answers to these questions can help determine whether a child is fighting the flu or combating a cold:
Flu vs. Colds: A Guide to Symptoms
Questions Flu Cold
Was the onset of illness ... sudden? slow?
Does your child have a ... high fever? no (or mild) fever?
Is your child's exhaustion level ... severe? mild?
Is your child's head ... achy? headache-free?
Is your child's appetite ... decreased? normal?
Are your child's muscles ... achy? fine?
Does your child have ... chills? no chills?
If most of your answers fell into the first category, chances are that your child has the flu. If your answers were usually in the second category, it's most likely a cold.
But don't be too quick to brush off your child's illness as just another cold. The important thing to remember is that flu symptoms can vary from child to child (and they can change as the illness progresses), so if you suspect the flu, call the doctor. Even doctors often need a test to tell them for sure if a person has the flu or not since the symptoms can be so similar!
Some bacterial diseases, like strep throat or pneumonia, also can look like the flu or a cold. It's important to get medical attention immediately if your child seems to be getting worse, is having any trouble breathing, has a high fever, has a bad headache, has a sore throat, or seems confused.
While even healthy kids can have complications of the flu, kids with certain medical conditions are at more of a risk. If you think your child might have the flu, contact your doctor.
Treatment
Some kids with chronic medical conditions may become sicker with the flu and need to be hospitalized, and flu in an infant also can be dangerous. For severely ill kids or those with other special circumstances, doctors may prescribe an antiviral medicine that can ease flu symptoms, but only if it's given within 48 hours of the onset of the flu.
Most of the time, you can care for your child by offering plenty of fluids, rest, and extra comfort.
And if the doctor says it's not the flu? Ask whether your child should get a flu shot.
Reviewed by: Iman Sharif, MD
Children's Health: Talk to Your Child's Doctor
Your child's doctor can be an incredible resource when you have questions and concerns about your child's health, but finding time for regular checkups and sick visits may be a stretch for your already jam-packed schedule. The doctor may be overbooked and overscheduled, too, so making the most of your time together is important.
What are the best ways to communicate your concerns and questions? And how can you strengthen your relationship with the doctor who plays such an important role in your child's health?
The Doctor-Patient Relationship
Gone are the days of routine house calls and bartering livestock for health care and medicine. The current-day reality of insurance co-pays and crowded waiting rooms means relationships between doctors and patients have changed drastically.
Today, doctors are pressured to see more patients in less time and to spend less time with each patient. Insurance issues, such as the need for referrals, complicate patient care for parents as well as doctors and their offices.
The increasing complexities of the health care system mean that parents have to take charge of their kids' care. In the past, parents may have known far less about their kids' health, growth, and development. In today's world, the health information that's readily available on the Internet, in bookstores, and on TV suggests that parents have the ability to be more informed than ever before. This is good news, because parents who actively participate in their kids' health care help to ensure the best care possible.
In some cases, though, parents who do their own research may find incomplete or inaccurate medical and health information. Parents armed with stacks of printouts from unreliable Internet sources could find themselves at odds with a tense and frustrated doctor who doesn't have time to agree or disagree with each piece of information.
Another common problem that may hinder a good relationship with your doctor is unrealistic expectations or an unwillingness to trust a doctor's diagnosis or treatment of a minor illness. For example, many parents expect a drug or medicine for common colds, when a wait-and-see approach may be better. As a result, some doctors may feel pressured to give in to parental expectations for prescriptions or treatment, even when it's not necessary or in the best interest of the child's health.
Communicating With the Doctor
The key to building a better relationship with your child's doctor is open communication and reasonable expectations.
What can you expect from your doctor? He or she should:
help you monitor your child's health
explain your child's growth and development and what you can expect
diagnose and treat your child's minor or moderately serious illnesses
explain your child's illnesses and treatment
provide referrals and work with specialists in the case of illnesses requiring special expertise
Your pediatrician, family doctor, or nurse practitioner can also help you with other children's health issues, including exercise, nutrition, and weight issues; behavioral and emotional issues; how to cope with family issues, such as death, separation, and divorce; and how to understand and seek treatment for learning disabilities.
Good communication is a two-way street. You can aid communication by letting the doctor know that you trust him or her to care for your child. It's good to ask questions, but let the doctor know that you want decisions, diagnoses, and prescriptions to be based on the best decision for the health of your child, not what's easier for you or makes you feel better.
You should also be as prepared as possible with details during your doctor visits. When asked how your child is doing, be ready to share any concerns or ask any questions. It's best to be specific. Be sure to tell the doctor details about symptoms — for instance, if your child vomited three times last night, had a temperature of 102° Fahrenheit (39° Celsius), or is having diarrhea. This helps the doctor assess your child's condition more readily and accurately than if you just say that "my child is sick."
Consider jotting down your questions and concerns before the appointment so that you'll remember everything you want to bring up. And if you're worried about symptoms your child is having, mention them to the doctor even if he or she doesn't ask. Tell the doctor what you've tried to make the symptoms better and what worked and what didn't. The more information you provide, the better the doctor will be able to assess your child's health.
Tips for Building a Better Relationship
Make the most of your relationship with the doctor (and the doctor's office) by following these tips:
Be informed, but don't overwhelm. The Internet is a tremendous tool that can help you learn more about your child's health and development, but it's unrealistic to expect your child's doctor to evaluate every health resource or breakthrough you find on the Web or see on TV. If you have a particular article that you'd like the doctor to review or comment on, mail, email, fax, or drop off the article well in advance of the office visit, giving the doctor plenty of time to review and do any necessary research. Keep these requests to a minimum, though. If you're looking for information on a particular children's health topic, talk to the office staff or a nurse about whether they provide informational brochures. Ask the doctor to recommend some reliable resources where you can get health information.
Be focused during the visit. Avoid distractions so you can focus your full attention on answering the doctor's questions. Turn off your cell phone and leave other kids with a spouse, babysitter, or relative, if possible. Also try to stick to the reason for the visit — for example, don't use a sick visit to discuss behavior problems that may require an in-depth evaluation. Instead, schedule a separate visit and let the office staff know the nature of your child's problem so that a longer appointment time can be allotted.
Follow the rules. Respect the doctor's time by arriving for appointments on time or a few minutes early. If you're unavoidably late, let the office know, and give at least 24 hours' notice to cancel or reschedule. Many office schedules are packed weeks in advance, so schedule well-child or non-sick visits early. You should also familiarize yourself with the office's payment requirements and your insurance company's co-pays and referral policy to make appointments go more smoothly.
Follow up. Before you leave the doctor's office, make sure you understand what follow-up appointments, lab tests, or blood work your child needs. Take notes about any instructions so you don't forget them, and if you don't understand how to administer medication, ask the nurse or doctor before leaving the office. Communicate with the office, too, if the medication prescribed isn't working or your child develops worsening or additional symptoms.
Save time by making time. In most cases, it's best if you or your partner attend your child's doctor visits. This is especially true for complicated issues like behavior problems. Relying on a substitute like a nanny or grandparent may mean that information or instructions may be misunderstood or miscommunicated by the time they get to you or that in-depth questions the doctor asks can't be answered.
Use good judgment. Using the phone for questions about symptoms can save you and the doctor time and money, but don't abuse the privilege. Save non-urgent questions about your child's health and development for well-child visits. Many knowledgeable nurses or nurse practitioners answer phone questions for pediatric practices; use these medical professionals as a resource for non-urgent questions instead of demanding to speak with the doctor each time you call. Nighttime calls should be reserved for more urgent issues — remember, the doctor is at home when you're calling.
The stress of having a sick or hurt child can strain communication between doctors and parents, and the many issues covered in well-child visits may leave little room for your questions. But don't hesitate to ask your doctor questions, no matter how insignificant you may think they are. Many times, problems with your child can be resolved easily with the help of the doctor.
And don't be afraid to give the doctor feedback about your office visit experience, such as whether you felt rushed during the appointment or needed more information about a prescription or procedure. A good doctor will want to work with you to provide the best care possible for your child.
Reviewed by: Steven Dowshen, MD
Children's Health: Febrile Seizures
Febrile seizures are full-body convulsions that can happen during a fever (febrile means "feverish"). They affect kids 6 months to 5 years old, and are most common in toddlers 12 to 18 months old. The seizures usually last for a few minutes and are accompanied by a fever above 100.4° F (38° C).
While they can be frightening, febrile seizures usually end without treatment and don't cause any other health problems. Having one doesn't mean that a child will have epilepsy or brain damage.
About Febrile Seizures
During a febrile seizure, a child's whole body may convulse, shake, and twitch, and he or she may moan or become unconscious. This type of seizure is usually over in a few minutes, but in rare cases can last up to 15 minutes.
Febrile seizures stop on their own, while the fever continues until it is treated. Some kids might feel sleepy afterwards; others feel no lingering effects.
No one knows why febrile seizures occur, although evidence suggests that they're linked to certain viruses. Kids with a family history of febrile seizures are more likely to have one, and about 35% of kids who have had one seizure will experience another (usually within the first 1-2 years of the first).
Febrile seizures are not considered epilepsy, but kids who've had a seizure are at a slightly increased risk for developing epilepsy, especially if there is a family history.
Treating Febrile Seizures
If your child has a febrile seizure, stay calm and:
Make sure your child is in a safe place and cannot fall down or hit something hard.
Lay your child on his or her side to prevent choking.
Watch for signs of breathing difficulty, including any color change in your child's face.
If the seizure lasts more than 10 minutes, or your child turns blue, it is probably a more serious type of seizure — call 911 right away.
It's also important to know what you should not do during a febrile seizure:
Do not try to hold or restrain your child.
Do not put anything in your child's mouth.
Do not try to give your child fever-reducing medicine.
Do not try to put your child into cool or lukewarm water to cool off.
Again, unless the seizure lasts for more than 10 minutes or your child has trouble breathing, there's no need to rush to the ER.
When the seizure is over, call your doctor for an evaluation. The doctor will examine your child and ask you to describe the seizure. In most cases, no additional treatment is necessary. The doctor may recommend the standard treatment for fevers, which is acetaminophen or ibuprofen. But if your child is under 1 year old, looks very ill, or has other symptoms such as diarrhea or vomiting, the doctor may recommend some testing.
Febrile seizures can be scary to witness but remember that they're fairly common, are not usually a symptom of serious illness, and in most cases don't lead to other health problems. If you have any questions or concerns, talk with your doctor.
Reviewed by: Nicole Green, MD
Children's Health: EMG (Electromyography)
Electromyography (EMG) measures the response of muscles and nerves to electrical activity. It's used to help determine muscle conditions that might be causing muscle weakness, including muscular dystrophy and nerve disorders.
How Is an EMG Done?
Muscles are stimulated by signals from nerve cells called motor neurons. This stimulation causes electrical activity in the muscle, which in turn causes the muscle to contract or tighten. The muscle contraction itself produces electrical signals.
For the purpose of EMG, a needle electrode is inserted into the muscle (the insertion of the needle might feel similar to an injection). The signal from the muscle is then transmitted from the needle electrode through a wire (or more recently, wirelessly) to a receiver/amplifier, which is connected to a device that displays a readout. The results are either printed on a paper strip or, more commonly, on a computer screen.
What Can an EMG Diagnose?
EMGs help diagnose three kinds of diseases that interfere with normal muscle contraction:
diseases of the muscle itself (most commonly, muscular dystrophy in children)
diseases of the neuromuscular junction, which is the connection between a nerve fiber and the muscle it supplies
diseases "upstream" in nerves and nerve roots (which can be due to either nerve damage or ongoing nerve injury)
When Are Results Ready?
Results are available immediately but a trained medical specialist, usually neurologist, is needed to analyze and interpret them.
Reviewed by: Steven Dowshen, MD
Children's Health: EKG (Electrocardiography)
Electrocardiography (EKG) measures the heart's electrical activity to help evaluate its function and identify any problems that might exist. The EKG can help determine the rate and regularity of heartbeats, the size and position of the heart's chambers, and whether there is any damage present.
How Is an EKG Done?
There is nothing painful about getting an EKG. The patient is asked to lie down, and a series of small metal tabs (called electrodes) are fixed to the skin with sticky papers. These electrodes are placed in a standard pattern on the shoulders, the chest, the wrists, and the ankles. After the electrodes are in place, the person is asked to hold still and, perhaps, to hold his or her breath briefly while the heartbeats are recorded for a short period. The patient also might be asked to get up and exercise for a while.
The information is interpreted by a machine and drawn as a graph. The graph consists of multiple waves, which reflect the activity of the heart. The height, length, and frequency of the waves are read in the following way:
The number of waves per minute on the graph is the heart rate.
The distances between these waves is the heart rhythm.
The shapes of the waves show how well the heart's electrical impulses are working, the size of the heart, and how well the individual components of the heart are working together.
The consistency of the waves provides relatively specific information about any heart damage present.
A person's heartbeat should be consistent and even. EKGs look for abnormally slow and fast heart rates, abnormal rhythm patterns, conduction blocks (short-circuits of the heart's electrical impulses that cause rhythm inconsistencies between the upper and lower chambers) — and four types of heart damage:
ventricular hypertrophy — an abnormal thickening of the heart muscle
ischemia — caused by an abnormally decreased blood supply
cardiomyopathies — abnormalities in the heart muscle itself
electrolyte and drug disturbances — these can alter the heart's electrochemical environment
Computerized EKGs can be combined with other tests to provide a multimedia account of the heart. These additional tests include echocardiograms (which are basically "ultrasound" tests that bounce sound off the heart and use the echoes to produce an image) and thallium scans (which are kind of like X-rays and use a radioactive tracer, injected into the bloodstream, to help draw a picture of the heart).
In the past, the EKG was recorded on a machine that drew on long strips of paper, with records from each electrode presented in a standard sequence. Now the EKG tracings are stored as computer files that can be called up and printed.
How Long Will it Take to Get Results?
Results of the EKG are available immediately. In fact, the EKG machine's computer even provides an instant interpretation of the findings as it makes the report. However, the doctor also might ask an expert, usually a cardiologist, to help analyze and interpret the EKG.
Reference ranges for heart rate and the relative lengths and sizes of the various components of the heartbeat figures vary, and diagnostic differences may be subtle, requiring an expert eye to detect them.
Reviewed by: Steven Dowshen, MD
Children's Health: EEG (Electroencephalogram)
What It Is
An electroencephalogram (EEG) is a test used to detect abnormalities related to electrical activity of the brain. This procedure tracks and records brain wave patterns. Small metal discs with thin wires (electrodes) are placed on the scalp, and then send signals to a computer to record the results. Normal electrical activity in the brain makes a recognizable pattern. Through an EEG, doctors can look for abnormal patterns that indicate seizures and other problems.
Why It's Done
The most common reason an EEG is performed is to diagnose and monitor seizure disorders. EEGs can also help to identify causes of other problems such as sleep disorders and changes in behavior. EEGs are sometimes used to evaluate brain activity after a severe head injury or before heart or liver transplantation.
Preparation
If your child is having an EEG, preparation is minimal. Your child's hair should be clean and free of oils, sprays, and conditioner to help the electrodes stick to the scalp.
Your doctor may recommend that your child stop taking certain medications before the test that can alter results. It's often recommended that kids avoid caffeine up to 8 hours before the test. If it's necessary for your child to sleep during the EEG, the doctor will suggest ways to help make this easier.
The Procedure
An EEG can either be performed in an area near the doctor's office or at a hospital. Your child will be asked to lie on a bed or sit in a chair. The EEG technician will attach electrodes to different locations on the scalp using adhesive paste. Each electrode is connected to an amplifier and EEG recording machine.
The electrical signals from the brain are converted into wavy lines on a computer screen. Your child will be asked to lie still because movement can alter the results.
If the goal of the EEG is to mimic or produce the problem your child is experiencing, he or she may be asked to look at a bright flickering light or breathe a certain way. The health care provider performing the EEG will know your child's medical history and will be prepared for any issues that may arise during the test.
Most EEGs take about an hour to perform. If your child is required to sleep during it, the test will take longer. You might be able to stay in the room with your child, or you can step outside to a waiting area.
What to Expect
An EEG isn't uncomfortable and patients do not feel any shocks on the scalp or elsewhere; however, having electrodes pasted to the scalp can be a little stressful for kids, as can lying still during the test.
Getting the Results
A neurologist (a doctor trained in nervous system disorders) will read and interpret the results. Though EEGs vary in complexity and duration, results are typically available in several days.
Risks
EEGs are very safe. If your child has a seizure disorder, your doctor might want to stimulate and record a seizure during the EEG. A seizure can be triggered by flashing lights or a change in breathing pattern.
Helping Your Child
You can help prepare your child for an EEG by explaining that the test won't be uncomfortable. You can describe the room and the equipment that will be used, and reassure your child that you'll be right there for support. For older kids, be sure to explain the importance of keeping still while the EEG is done so it won't have to be repeated.
If You Have Questions
If you have questions about the EEG procedure, speak with your doctor. You can also talk to the EEG technician before the exam.
Reviewed by: Steven Dowshen, MD
Children's Health: Cystic Fibrosis (CF) Chloride Sweat Test
What It Is
A chloride sweat test helps diagnose cystic fibrosis (CF), an inherited disorder that makes kids sick by disrupting the normal function of epithelial cells, which make up the sweat glands in the skin and also line passageways inside the lungs, liver, pancreas, and digestive and reproductive systems. Kids who have CF are more vulnerable to repeated lung infections.
The sweat test measures the amount of chloride in sweat. Kids with cystic fibrosis can have two to five times the normal amount of chloride in their sweat. In a sweat test, the skin is stimulated to produce enough sweat to be absorbed into a special collector and then analyzed.
Doctors may test an infant suspected of having cystic fibrosis as early as 48 hours after birth, though any test conducted during a baby's first month might need to be repeated because newborns may not produce enough sweat to ensure reliable results.
Why It's Done
Doctors will order a chloride sweat test for kids with a family history of cystic fibrosis or symptoms of the disorder. Symptoms and signs include failure to grow, repeated lung infections, and digestive problems.
Preparation
No special preparation is necessary for this test. Before having this test, your child may eat, drink, and exercise as usual, and continue to take any current medications. A sweat test usually takes about an hour, so you may want to bring books or toys to help your child pass the time.
The Procedure
An area of skin on the arm will be washed and dried. Next, two electrodes are attached with straps (see illustration). One of these contains a disc with pilocarpine gel, a medication that stimulates the sweat glands to produce sweat. The medication is pushed through the skin by an electric current. After this is completed, the electrodes are removed and the skin is cleansed.
A special sweat collection device (see illustration) is then attached to the clean skin surface in the area where the sweat glands were stimulated. It's taped to the skin to keep it from moving. The sweat that's collected turns blue when it comes into contact with blue dye within the collector, making it visible to the technician.
After sufficient sweat accumulates in the tubing inside the collector, it's removed and placed in the sweat analyzer. The collector apparatus is removed and the arm is cleaned again. Your child's skin may remain red and continue sweating for several hours after the test.
What to Expect
This test shouldn't be painful, though some kids do feel a slight tingling or tickling sensation when the electrodes apply current to the skin.
Getting the Results
Results are usually available in 1-2 days.
If your child has a sweat chloride level of more than 60 millimoles per liter, it's considered abnormal and indicates a high likelihood of cystic fibrosis, though some children with cystic fibrosis do have borderline or even normal sweat chloride levels. If results are positive or unclear, a blood test may be done, especially for babies.
Risks
This test poses very little risk of complications. The electrical current may cause your child's skin to be red or to sweat excessively for a short period of time. In rare cases, the skin may look slightly sunburned.
Helping Your Child
You may choose to stay with your child to help keep him or her distracted during the test.
If You Have Questions
If you have questions about the chloride sweat test and how it's conducted, speak with your doctor.
Reviewed by: Kate M. Cronan, MD
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