Juvenile Diabetes

Dr. Sadeghi-Nejad Abdollah Sadeghi-Nejad, MD, Chief of Pediatric Endocrinology at Tufts Medical Center and Floating Hospital for Children, answers some common questions about juvenile diabetes.   

Q: What is Juvenile diabetes?

A: Juvenile diabetes literally refers to diabetes mellitus (DM) in juveniles (i.e. in children and adolescents). There are several different types of diabetes mellitus. The two major types are type 1 and type 2. The former (type 1, also called insulin dependent) is caused by an absolute deficiency of insulin, and the latter (type 2 or non-insulin dependent) is primarily the result of insulin resistance. In the past type 1 was mostly seen in children and adolescents and was often referred to as juvenile diabetes or childhood-onset diabetes. In contrast type 2 was virtually limited to adults and at times was called adult type diabetes. Over the past 20–30 years, with the marked increase in the prevalence of obesity in children, the incidence of type 2 diabetes in patients under the age of 18 years has increased and the term juvenile diabetes no longer implies an absolute deficiency of insulin (type 1). Data from the U. S. and elsewhere indicate that currently some 40% of newly diagnosed diabetic children have type 2 diabetes mellitus. Thus the term juvenile diabetes no longer can be used synonymously with insulin deficiency diabetes mellitus (type 1). Similarly the terms childhood-onset and adult-onset DM should no longer be used.

Q: How is Juvenile diabetes treated?

A: Insulin, and its newer short or long acting analogs, is the mainstay of therapy for type 1 diabetes mellitus. In contrast, oral hypoglycemic agents may be useful for treatment of type 2 DM. Currently all types of insulin that are available in the U.S. (Regular, NPH, and 70/30 — a mixture of 70% intermediate-acting and 30% short-acting) are structurally identical to human insulin and are manufactured using biosynthetic techniques. We now also have several long-acting and ultra-short-acting analogs of insulin.

Type 2 DM can best be treated with lifestyle changes such as increased physical activity and decreased caloric intake. It can also be treated with oral medications. However, most type 2 patients eventually require insulin unless lifestyle changes are implemented.

Q: Is there a cure for Juvenile diabetes?

A: Although we have made great strides in the treatment of diabetes mellitus, sadly the answer to this question is no, at the present time there is no cure for type 1 diabetes. However a great deal of time and effort, and huge sums of money are spent in the quest for a cure. Thus, there is reason to be hopeful that a cure might be possible in a not too distant future.

In contrast, type 2 DM responds very well to increased physical activity and decreased caloric intake and can be “cured” if weight loss is achieved and maintained early in the course of the disease.

Q: What complications can arise as a result of having Juvenile diabetes?

A: There is little doubt that the complications of DM are primarily the result of long-standing poor glycemic control. These include micro-vascular and macro-vascular abnormalities, neuropathy, nephropathy, retinopathy, and cardio-vascular disorders, many of which are irreversible. These serious complications usually manifest decades after the onset of diabetes and years of inadequate glycemic control. It is therefore imperative to strive for the best glucose control possible in order to avert or diminish the risk of diabetic complications.

Q: What are symptoms or early signs of Juvenile diabetes we should be aware of?

A: Early symptoms and signs are usually mild and are often overlooked for months by parents and relatives, friends, and school personnel. A history of increased drinking and urination, urination in the middle of the night, increased appetite and weight loss should alert us to the possibility of DM, and to look for high blood glucose and presence of glucose in the urine.

Q: Are there genetic predispositions for Juvenile diabetes? Are any gender/race/ethnicities at greater risk?

A: Type 1 diabetes mellitus is a multi-factorial disorder. Among them, there are known genetic predisposing risk factors (HLA linked). An identical twin (monozygotic) of a patient with type 1 DM has a 50% likelihood of developing the disease (.6% for a dizygotic twin and 3–6% for a non-twin sibling). The risk of developing DM type 1 is 10% if both parents have the disease (2–5% if one parent is diabetic). For a patient with DM type 1 the risk of having a child with DM is about 1%.

Type 2 DM is also more common in some families and ethic groups. In the U.S. the risk is highest in females, and in African- Americans, Hispanics, Asians, and Native Americans. Obesity is the major risk factor for the development of type 2 DM. At the present time over one fifth of adults in the U.S. are obese (from 15% in Colorado to greater than 30% in West Virginia, Mississippi, and Hawaii) and their numbers are increasing. The percentage of obese individuals in the rest of the world is similarly skyrocketing. In some Pacific islands (e.g. New Guinea) the prevalence of obesity is as high as 70–80%. Correspondingly, we have seen a dramatic increase in the prevalence of type 2 DM, paralleling the increasing worldwide incidence of obesity. Because obesity is more common in lower educated individuals and lower socioeconomic families, there an increased prevalence of type 2 DM in these groups.

It should be kept in mind that type 2 diabetes is primarily the result of obesity and as such is a preventable disease. Parents can avert the risk of type 2 DM by making sure that their child or adolescent has an appropriate diet, gets adequate age appropriate physical activity, and does not gain excess weight.

Q: How does diet and physical activity prevent juvenile diabetes?

A: Increased physical activity and adherence to an optimal diet do not prevent or cure type 1 DM but significantly contribute to achievement and maintenance of optimal glycemic control and prevention of long-term complications.

In contrast these measures tend to alleviate obesity and prevent type 2 DM. They can also potentially cure type 2 DM if implemented early in the course of disease.

Q: How will Juvenile diabetes treatment affect my child’s lifestyle?

A: Type 1 diabetes, like other chronic diseases, has a major impact not only on the life of the affected individual, but on the lives of the whole family. Ideally treatment would result in optimal glycemic control with little or no negative impact on the life of the child or his/her family. Unfortunately intensive therapeutic regimens that might achieve near-optimal glycemic control are burdensome and are not compatible with a “normal” lifestyle for many children and their families. As a result, by individualizing the therapy, we attempt to achieve a balance between the best glycemic control possible and minimal negative impact on the children and their families’ lifestyle.

The impact of long-standing type 2 DM is similar to that of type 1. However with decreased caloric intake and increased physical activity early on, the disease would be “cured” and would have little or no other impact.

Q: Due to the increasing rate of Juvenile diabetes in our society, how does this impact our rising healthcare costs now and in the future?

A: The incidence of type 1 diabetes mellitus has remained relatively stable. In contrast there has been an epidemic-like increase in obesity and type 2 DM in both children and adults. In 2003 there were 13.5 million diabetics in the U.S. It is estimated that the number will increase to 36 million by 2025. The worldwide prevalence for those years is 194 and 333 million respectively. In the last year for which we have complete data (2007) the annual cost of health care for a patient with DM in the U.S. was $11,744 compared to $5,106 for a non-diabetic individual. Thus there is no doubt that the increasing prevalence of DM will impose not only a heavy human burden but also a massive financial cost. 

Sometimes ”Just Enough” Might Not Be Enough

By: Dawn Thompson

The other day my 11-and-a-half-year-old was upset because he only had 47 stamps and he needed 50 to attend a school Halloween Dance on Friday. The stamp program is part of an incentive to reward children based on their effort. The children have all month to earn and collect their stamps then cash them in at the end of each month. Homework is a BIG factor in determining how many stamps one may receive. In addition to schoolwork, teachers may allow students to earn stamps at their discretion, which is where it gets tricky.

Not all teachers are available to hand out the extra stamps the minute a child is ready to receive them. (The student must have their agenda book on them in order to collect them.) Sometimes coordinating all of this can be overwhelming, especially when there are time constraints. A way to avoid coming up short is for the kids to do all their work on time and to do plenty of it.  If you have stamps to spare, it won’t be a problem if some roll in late or get lost. While this works well for children that are motivated, it doesn’t do much for those who struggle to just make the cut.

The reason Dylan was so upset is because he insisted he earned the 50 but could not collect the last 3 in time. He said he had agreed to pick up cardboard for a teacher in exchange for 3 stamps. Dylan did not have his agenda book on him at the time and could not collect the stamps.  When he did get his book, the teacher was not available to give him the stamps.  Unfortunately, that was the last day he could collect them to be included in the October dance.

School personnel had a hard time sympathizing with him because he had plenty of opportunity to earn MORE than enough but didn’t put the effort in. At first I thought it wasn’t “fair,” but the more I thought about it, the more I realized this is going to be a problem for him the rest of his life if we don’t address it now with “tough love.”

I asked Dylan, “If I needed $5.00 worth of gas to get to the circus in Boston by 6:00 and I put $5.00 in the tank and left by 5:00 would I make it?” Of course, he said yes knowing Boston is only 45 minutes away.  Then I asked him what about if there was traffic and what if the traffic was so much that I ran out of gas. I told him how I might not make it there at all.  He was very surprised to learn that just enough is ONLY enough if things go PERFECTLY, which they hardly ever do. Although it was a tough lesson to learn, he realized that in order to achieve our goals, sometimes we need to allow room for error, Targettime for traffic, to get more than enough gas, or to allow an extra day to collect stamps or earn more than he needed, just in case.

After he agreed to try harder next month, the assistant principal called to let us know that Dylan DID have enough stamps to go to the dance because there was three in the front of his book that he forgot to count. Even though it has been a stressful past few days for him, Dylan learned one of the most valuable lessons in life.  Sometimes “just enough” might not be enough. Next time he will reach higher and aim better, realizing nothing in life is perfect. He always knew he doesn’t need a bulls-eye, but now he’s aware that he needs to hit somewhere on the target and not just on the edge :)

Autism in Kids

According to the National Institutes of Health, three to six children out of every 1,000 will Dr. Choueirihave an autism spectrum disorder (ASD), and males are four times more likely to be affected than females. Scientists aren’t certain what causes ASD, but it is likely that both genetics and environmental factors play a role. 

Roula N. Choueiri, MD, Neurodevelopmental Pediatrician in the Division of Developmental-Behavioral Pediatrics at Floating Hospital for Children at Tufts Medical Center, answers some basic questions about this condition. 

Q: What is autism?

A: Autism was first described in 1943, by Leo Kanner, an Austrian psychiatrist. He described children with aloofness, indifference to others, who reacted differently to their environment and had speech delays. Autism: derives from the Greek autos: self.

As we know it today: Autism is part of the Pervasive Developmental Disorders (PDD) which include deficits in three core areas: social skills, language and communication, and repetitive behaviors and/or restricted interests. Onset is seen in the first three years of life.

Under the umbrella of PDD are:

  • Autistic Disorder
  • Asperger Syndrome
  • Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)
  • Childhood Disintegrative Disorder
  • Rett Syndrome

Autism, Asperger Syndrome and PDD-NOS are grouped into the Autism Spectrum Disorders (ASD). Sometimes autism and ASD are used interchangeably.Q: Does Autism have grades of severity?

A: Yes — The “spectrum” in ASD means that there is a wide range of intensity, symptoms and behaviors. Children with Autism Spectrum Disorders may be non-verbal with significant social delays, as in the case of many with “classic” autism, or Autistic Disorder. Or, they can present with delays in their social skills and play, but with normal to superior cognitive skills and normal language development, such as seen in children with Asperger or high-functioning PDD-NOS. All ASDs have delays in the three core areas of: social interaction, communication and repetitive behaviors/restricted interests.

Q: How early can autism be diagnosed?

A: Autism is usually diagnosed by the age of three years, although it can be recognized and diagnosed by the age of 18 months. Children with Asperger Syndrome and some children with high-functioning PDD-NOS might be diagnosed later, typically by the time they enter kindergarten or first grade.

Previous studies have shown that parents start being concerned between the ages of 12–24 months because of delays in language, play, difficulties with eye contact, but also with repetitive behaviors such as lining up toys or spinning objects or themselves. Other concerns that parents may have at this age: uncontrollable temper tantrums, extreme resistance to change, over- or under-sensitivity to sights and sounds and/or a regression in language and/or play skills.

Q: Can a child be screened for autism?

A: The American Academy of Pediatrics (AAP) is recommending regular screening for Autism Spectrum Disorders at ages 18 months and 24 months if there are no other risk factors or concerns. This would be part of a well-child visit. However, screening is recommended at any age if there are risk factors and concerns. Several screening tools are validated for ages older than 18 months and there is active research to identify screening tools for children younger than 18 months.

If the child fails the screening test, then he/she needs a referral for early intervention services and at the same time, a referral to a subspecialist for a final diagnosis. Sometimes the pediatrician can give the diagnosis. The earlier the child starts receiving the appropriate intensive services, the better the prognosis.

Q: What causes autism?

We still don’t know a lot about the causes of ASDs. We are able to find a cause up to 10 percent of the time. We know that there is a strong genetic basis from family studies. Parents who have a child with an ASD have a 2–8 percent chance of having a second child who is also affected. This genetic basis seems very complex and research is extremely active in this area. ASDs are frequently associated with: Fragile X, tuberous sclerosis, congenital rubella syndrome, and untreated Phenylketonuria (PKU). There are several reported associations with different chromosomal anomalies.

Q: What treatments are available currently?

A: There are several treatment options currently available but they can be grouped into four categories, with the behavioral and educational interventions being the most proven, researched and the one that addresses treatment of the core features of autism spectrum disorders.

Treatments include:

  • Applied Behavior Analysis (ABA): remains the foundation of most comprehensive programs; it is based on positive reinforcers and breaking down directions and tasks to simple tasks which leads to learning through repetition.
  •  Floortime: which is less structured but emphasizes the role of parents and family members; the child leads and the therapist supports the child’s social development and play.
  • Treatment and Education of Autistic and Communication- related Handicapped children (TEAACH): This program uses visuals and structure for learning.
  • Relationship Development Intervention (RDI): is a parent- based treatment that focuses on social and emotional development.

Other clinical therapies that are essential in therapeutic programs are speech therapy, occupational therapy, and social skills group teaching.

Alternative treatments such as Chelation, megavitamin doses supplementation, and dietary changes such as the gluten/caseine-free diet, are not proven and some can have side-effects. There is an ongoing study looking at environmental factors and heavy metals. The last category is the use of medications to help with associated disorders such as attention, hyperactivity, sleep issues, anxiety, depression, seizures or treating aggressive behaviors.

Q: What advice can one give to parents who have a child with an ASD?

A: Parenting a child with an ASD can be emotionally and physically exhausting. Keeping up with new research, theories and treatments can be extremely stressful. Parents should be sure to:

  • Take care of yourselves: rest and schedule times for yourselves.
  • Talk to other parents and families and learn what worked and what did not work for them; join support groups, online listserves.
  • Go to seminars and conferences organized by academic centers, scientific and knowledgeable groups to learn more about ASDs and the scientific basis of treatments.

Your child is unique in his/her differences. Learn to appreciate him/her, and be ready to be surprised by his/her progress and don’t forget to still enjoy the ride!

Cootie Bugs and Dinosaurs

By: Dawn Thompson

The other day while we were in the Neurofibromatosis clinic, we learned about a new kind of dinosaur. I don’t really remember the name of the dinosaur but I do recall the nurse repeating it and saying she would never forget the name of it.  What brought the subject up was the fact that the nurse had to go get a smaller cuff for Dylan in order to take his blood pressure.  We were in the NF/Cancer center and most of the patients there are adults.  She told the tale as she approached Dylan with the prehistoric, colorful “baby cuff.”

Dylan, being an 11-and-a-half-year-old pre-teen and all, was kind of making faces at the kiddie cuff. He realized that because of his small stature, the baby cuff was meant for him. The nurse could sense his awkwardness by the rolling of his eyes and the excessive use of his BIG man voice and mature conversation. In her attempt to distract Dylan, we got to learn about this funny named dinosaur.  Her efforts were not all in vain though, it got him through the toughest part of the exam.

Dinosaur

This doctor’s visit  was a different one than he is used to. For the first time in a long time, it was a healthy visit!  We had just gotten good results regarding his brain MRI and MRA. We had recently learned that Dylan had put on 10 pounds and grew nearly two inches since having his feeding tube placed in March. And best of all, Dylan was looking and feeling great.

We went home around dinner time that Friday and I reminded Dylan that we absolutely needed to change his Mickey button (feeding tube) that evening.  Dylan grew very anxious, as it has been stinging him and bugging him the entire week.  All the more reason we thought it was time for the change.

We put off changing it until his cousins came over later that night to visit. While they were there, Dylan thought he had mustered enough courage and said, “I will do it myself”  Although it took him quite sometime to get it out of his stomach, he did it. The problem was getting the new one in. Dylan was very upset and wouldn’t let me help at all because it hurt. He finally gave me one good chance and the new button bent instead of going in. My sister realized we needed a water soluble lubricant but all we had was petroleum jelly and that wasn’t working.

Seeing the condition Dylan was in, we took him to the Emergency room.  It was a race against the clock as the hole kept trying to close. There was a lot of granulation tissue which was complicating things. After about 20 minutes and multiple attempts, the new button finally went in. It was one of the worst experiences of both our lives, being able to see everything and having him being awake and alert through it of all. During the procedure, a nurse asked if I could come and distract Dylan. The reason I wasn’t there in the first place was that I don’t want my son to associate his mother with all that pain. I no longer him bring him comfort as he expects me to protect him from such things.

I couldn’t help but think of how I have no distractions anymore.  I couldn’t even remember the name of the dinosaur we learned about earlier, never mind come up with a tale of my own. Within one minute of my trying to help, I ended up getting hurt.  As Dylan’s procedure wound down, mine began with a quick triage, tetanus shot, an antibiotic and prescription for the road.

The next day we talked about what he went through and what happened to me.  We talked about the medical staff side of things as well as the reason for immunizations. During a long ride home from visiting my mother, I bought the subject of communicable diseases up and how best to avoid getting them. After a few minutes of silence, he reached forward and touched my shoulder.

I kind of looked back and he said, “Now you have NF, hehe!”

I said, “Dylan, if I could take NF away from you and have it myself, I would do it in a heartbeat.”

He responded, “I wouldn’t let you Mumma, I would never want you to go through all the pain I have to have.”

Needless to say, I was deeply touched and also reminded of two VERY important things: I have a really AWESOME and gallant young man and secondly, we REALLY need to find a cure for Neurofibromatosis!

Best wishes to all the other children affected by disorders, diseases, illnesses and ailments. If I am ever half as brave as the youngest of these kids, it would be a triumph.

Banana Chocolate Bread

By: Amy Dienta

Happy Friday! Here’s a favorite recipe for you to enjoy this weekend.

 

Banana Chocolate Bread 

 BakingIngredients

  •  4 – 5 0verly ripe bananas (they should be black)
  • 1 cup sugar
  • 1/4 cup water
  • 1 tsp vanilla
  • 1 3/4 cup whole wheat flour
  • 1/4 cup cocoa powder
  • 1/2 tsp baking soda
  • 1 tsp cinnamon
  • 1 tsp baking powder
  • 1/4 cup chocolate chips
  • 1/4 cup walnuts chopped

 Directions

  1. Preheat oven to 350.
  2. Mash bananas in a large bowl with fork or potato masher.
  3. Add sugar and vanilla. Mix with a fork, adding the water as you mix.
  4. In another bowl, mix the whole wheat flour, cocoa powder, baking soda, cinnamon, and baking powder.
  5. Add the dry mixture to the wet mixture, and fully mix together. Then mix in the chocolate chips and nuts.
  6. Pour the batter into a nonstick loaf pan (or into a pan spray with nonstick cooking spray).
  7. Bake for 50-60 minutes, but start checking with a toothpick after about 45 minutes. The toothpick should come out clean and the bread should start slightly splitting on the top.
  8. Let it cool before cutting and enjoying!!

Treating Rare Illnesses in Children

By: Dr. Mark Gilchrist, Chief of Pediatrics at Lowell General Hospital

Dr. GilchristOne of the great things about pediatrics is that for the most part, children get better over time.  This of course, is in stark contrast to adult medicine!  However, when it comes to the rare illnesses and disorders that do become chronic or progressive in children, it is all the more painful for everyone involved- particularly a parent.

This mother’s children, while dealing with a yet-to-be-identified condition, are thankfully part of a very sparse population.  However, it doesn’t take such dire circumstances, or such longstanding challenges, for a parent to feel overwhelmed or alone.  This is why as a pediatrician, I encourage parents to seek out support from other parents.  Whatever challenges may present: major or minor, great comfort and strength can be gained by sharing with and hearing from other parents.  While everyone’s struggles may not be the same, knowledge that others have made their way down the path one now follows can most certainly provide a degree of reassurance far greater than what a pediatrician might provide.

Seeking an Answer

By: Sue Anganes

To say that the past few months of summer have been fun, relaxing, and rejuvenating would be a lie. None of the activities that I had blogged about back in May were checked off of my summer to-do list. Instead, we have been to numerous doctor’s appointments, physical therapy appointment, and were often home bound. I couldn’t bring myself to write a blog post this summer. I was struggling so much with my emotions, and every time I wanted to write it seemed like it became an overwhelming task that I was unable to face.

Medical issues are always hard, but somehow when they affect your child they become overwhelming. My two youngest sons, Ray and Ted, have an undiagnosed metabolic or neuromuscular disease. Ray, who is fifteen, is more affected than his twelve-year-old brother Teddy.

Ray’s issues have become much worse in the past few months and have limited him to mostly staying at home. He has virtually no energy, not even enough to participate in everyday activities. Our one summer-fun excursion to Barnes and Noble wiped him out physically for days, even despite the fact he was using his wheelchair.  He often is too unwell to eat and has lost a considerable amount of weight. At current count he has seen fourteen different specialists in Boston (some he visits every three months) over the past ten years. No one can figure out what is wrong with him. He has had many, many genetic tests done along with scans and biopsies and various types of studies.

In December of 2011 one of Ray’s specialists submitted all his medical records to the National Institutes of Health’s Undiagnosed Diseases Program. The program is federally funded and accepts approximately one hundred patients a year. Almost nine months after we submitted Ray’s records we got word that Ray was chosen for the program. At the end of this October, Ray and his brother Ted will be admitted into the NIH’s hospital in Bethesda, MD for a week of testing and evaluations by twelve or more researchers and MD’s in various fields of medicine. We are hoping and praying for a diagnosis and a possible treatment. It feels as though time is quickly running out for us, and we are viewing this trip to the NIH as one of our last hopes for an answer. I will try to write about our experience at the NIH and let you all know how things work out.

I know there are other moms reading this blog who have similar struggles regarding complicated medical issues with their children. We can feel very alone at times and often have a hard time talking to others about our worries, struggles, and fears for the future. I can honestly say that finding one or two friends that are good listeners made a huge difference in my emotional well-being. I am so thankful for my friends, who often let me cry on their shoulders and are there just to listen. There are many things in life that cannot be “fixed,” but it makes a world of difference knowing that there are friends who will be by your side for you during the tough times as well as the good.

Isaiah 40:29-31

He gives strength to the weary

   and increases the power of the weak.

Even youths grow tired and weary,

    and young men stumble and fall;

but those who hope in the Lord

    will renew their strength.

They will soar on wings like eagles;

    they will run and not grow weary,

    they will walk and not be faint.

 

Pediatric Concussions: Understanding Concussions and Their Effects

Dr. HeilmanAccording to the Centers For Disease Control an estimated 1.7 million people in the United States sustain a Traumatic Brain Injury (TBI) each year. About 75 percent of TBIs that occur annually are concussions or other forms of mild TBI. Almost half a million U.S. emergency room visits for TBI are made each year by children, newborn to 14 years old.

Carl Heilman, MD, Neurosurgeon-in-Chief at Tufts Medical Center and Floating Hospital for Children, answers some common questions about childhood concussions. 

Q: What is a concussion?

A: A concussion is an immediate and transient impairment of neural function such as alteration of consciousness, memory loss, impaired vision or dysequilibrium that occurs after head trauma. Concussions are brain injuries that are caused by a bump or jolt to the head that can range from being “mild” i.e., a brief change in mental status or consciousness to “severe” i.e., an extended period of unconsciousness or amnesia after the injury.

Q: What are some of the common ways that children get concussions?

A: The most likely mechanism for suffering a concussion varies with age. In early child- hood, the most common cause is fall from a height — such as being dropped, slipping off a changing table, falling off a bed or falling out of a carried car seat. Non-accidental head injury such as child abuse is another possible mechanism. As the infant begins walking and climbing, falls down stairs or out a window cause concussions. Later on, the child may get a concussion from a bicycle accident, a sports injury (football, hockey, skiing, snow-boarding, horseback riding) or a motor vehicle accident.

Q: What are the signs or symptoms of a concussion that parents should be aware of?

A: After a head injury, parents should look for signs of a headache, nausea, vomiting, altered consciousness, memory loss, disequilibrium and/or severe fatigue. Other less apparent symptoms may include irritability, change in eating or sleeping patterns, change in the way the child plays or acts at school, loss of new skills and/or loss of balance.

Q: If my child suffers a head injury, how do I know if I should bring him or her to the emergency room?

A: A child should be brought to the emergency room after an injury if he/she has a loss of consciousness, post traumatic nausea/vomiting, altered consciousness or any other neurologic symptoms (slurred speech, seizures, agitation, decreased coordination or having one pupil larger than the other).

Q: How is a concussion treated?

A: Children who have experienced a significant concussion are often evaluated with a CT scan. If there is no visible intracranial injury, then the patient is observed neurologically for evidence of deterioration. We then treat the patient symptomatically; for example, headaches can be treated with non-sedating medications and nausea/vomiting cases are treated with intravenous fluid and antiemetics. Parents and caretakers can help their child to heal by allowing him or her to rest, making sure the child avoids activities that could lead to a second concussion, only giving the child medicine that is approved by the doctor, and by sharing information of the concussion with others who interact with the child. If the child suffers a serious head injury, the doctor may require the child to be hospitalized, monitored and treated by specialists.

Q: If my child suffers a concussion in a sporting event, how long should I keep my child from playing that sport again?

A: The child should remain out of sporting activities for two weeks or until all post-concussive symptoms have completely resolved, whichever is longer. This also means that your child should not participate in physical education (PE) class or physical activity at recess during this period. It is always a good idea to check back in with your child’s primary care physician before having him or her return to physical activity.

Q: Are there any long term effects of concussions in children?

A: This depends on the severity of the concussion and whether the child has ever experienced a concussion in the past. It is important to protect your child from having repeated concussions because this may lead to long-term problems such as difficulty concentrating, headaches, memory lapses and impaired balance.

Q: How can I help to prevent my child from sustaining a head injury?

A: Never leave a child unattended on a changing table, bed or other high object. When carrying a child in a car seat, be careful not to swing the car seat too vigorously. Make sure windows are closed and locked and/or screens are securely in place. Stair cases should be closed off or blocked from access to toddlers. Make sure your child wears proper head protection when playing contact sports, as well as other sports that could involve falls (skiing, skateboarding, etc.) and always make your child wears a seat belt.

George the Everlasting Caterpillar

By: Dawn Thompson

I have always been a “puppy person” Even when my pooches got big and old like little bears, I still called them my pup!  When I was younger, my parents had cats and various stray domestic animals.  Living in the city, we even had a few mice and a hand-me-down parakeet.  :) When Brittany was little, she had a cat and a pup, but we never really went for the pocket-sized pals – but mostly because we didn’t really have the opportunity.

Captain JackDylan, on the other hand, is a total “pet person.” Anything and everything that lives and breathes is like his own! From the time he was little, he had a stuffed monkey friend. It was given to him by a nurse and he brought it to ALL of his hospital visits until recently.  Now his monkey bub just goes in with Dylan for surgery. (He is a pre-teen, after all.)

Dylan has a big old bear pooch now that brings him as much comfort as Dylan gives back. In addition, he has had a one-eyed hamster named Captain Jack.

His NEW and most recent friend is George. Dylan’s friend Denise took him to the Butterfly Place. George came home with them that day and has had a very special place in Dylan’s heart ever since. He was just a teeny, tiny little thing, but was OH so cute. He was a frisky little fella too, always creeping and crawling all over his cup house. For days Dylan checked on George, making sure he was HEALTHY and growing. One of the best days was the day George built his cocoon. It was magical and Dylan couldn’t believe how “cozy” George had made himself.  Dylan was excited and imagined just how beautiful George would be when he made the transformation from caterpillar to butterfly.

The other day Dylan noticed that the cocoon fell down. We had to have the talk that not every caterpillar was meant to be a butterfly and how that’s O.K. He said with a HEAVY heart, “I know where you’re going with this mum…he’s probably in butterfly heaven.” I told him we would have to wait and see. We researched the process together and Dylan went to bed full of HOPE that George would still get to make the transformation, even though things didn’t go as expected.

Yesterday Dylan looked at the cocoon and shook his head and we both kind of knew. Today we will talk about how full of energy George was, how many little legs he had and how adorable he truly was. Although things did not go quite as expected, George was a wonderful pet who will ALWAYS be, the EVERLASTING CATERPILLAR.

Pediatric Infectious Diseases

Vaccinations for children are a critical part of their healthy development. However, many questions have arisen surrounding these shots over the Dr. Meissnerlast few years. Parents wonder when, and sometimes if, they should vaccinate their children. Everyone wonders what the flu season will be like and how they should prepare and respond.

H. Cody Meissner, MD, Chief of Pediatric Infectious Diseases at Floating Hospital for Children at Tufts Medical Center and a national expert on the vaccinations and the flu, answers questions to help parents best understand how to care for their children. 

Q: There has been a lot of discussion around immunizations lately. What are the benefits and risks of childhood vaccinations?

A: Every human activity from riding in a car to eating an egg carries some risk. There is no such thing as a risk free activity. The risks associated with immunization are either so minor (sore arm) or so rare (seizure), they are far outweighed by the lives saved and the illness prevented by immunization. A typical five-year-old child will experience an average of six infections during the year. Do the benefits of vaccination (avoiding infection) out- weigh the risks (side effects)? Yes. For all vaccines, the benefits clearly outweigh the risks.

Q: What would happen if we stopped vaccinating?

A: Before long we would see epidemics of diseases that have disappeared or are nearly under control now. This is because the germs that cause these diseases are still around us but controlled by vaccines. Vaccine preventable diseases may be either eliminated or very uncommon, but the bacteria and viruses that cause these diseases are still present, so it is important for every child to continue to receive all recommended vaccinations.

Q: What vaccinations should every child receive?

A: The following immunizations are recommended for all children in the United States: hepatitis B, rotavirus, diphtheria, tetanus, pertussis, Haemophilus influenzae type b, pneumococcal, poliovirus, influenza, measles, mumps, rubella, chickenpox, hepatitis A, meningococcal and HPV.

Q: What about autism. Is there a link between vaccines and autism?

A: There is no scientific evidence to support the existence of a link between any vaccine and autism. In fact, many scientific studies show there is no link between vaccines and autism.

Q: I hear about different components in vaccinations that may be harmful or that I should be aware of — for example thimerosal and aluminum. What should I know about these?

A: Thimerosal is a mercury containing preservative used in some vaccines since the 1930s. There is no convincing scientific evidence of harm caused by the low doses of thimerosal used in vaccines except for minor reactions like redness and swelling that sometimes occur at the injection site. Since 2001, all vaccines recommended for children six years of age and under in the United States have been produced without thimerosal as a preservative, with the exception of inactivated influenza vaccine. There is no scientific proof of any adverse consequence from the small amount of aluminum in any vaccine.

Q: Should I delay when my child has certain vaccinations?

A: The recommended immunization schedule from the CDC and the American Academy of Pediatrics has evolved over many years with much deliberation. The recommended time for administration of each immunization is provided in this schedule. Parents should work hard to comply with the recommended schedule to be certain their children are protected against any of the vaccine preventable diseases. Parents can view the recommended immunization schedule at http://www.cdc.gov/vaccines/recs/. Any delay in administering a recommended vaccine will leave your child susceptible to that vaccine-preventable disease until the vaccine is administered.

Q: I am concerned about the influenza virus. How can I best protect myself and my child from this infection?

A: The best way to prevent the flu is by getting a flu vaccination each year. Yearly flu vaccination should begin in September or as soon as the vaccine is available and continue throughout the influenza season, into December, January, and beyond. This is because the timing and duration of influenza seasons vary. While influenza outbreaks can happen as early as October, most of the time influenza activity peaks in January or later.

In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, certain people should get vaccinated each year either because they are at high risk of having serious flu-related complications or because they live with or care for high risk persons. It is recommended that all children aged six months up to 19 years get vaccinated each year.

Here are some steps you can take to reduce the risk of getting influenza:

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If a tissue is not available, you should cough into your elbow and not your hands.
  • Wash your hands with soap and water, especially after you cough or sneeze. Alcohol based hand cleansers are also effective.
  • Avoid touching your eyes, nose and mouth. Germs spread this way.
  • Try to avoid close contact with sick people.
  • Stay home if you are sick until you have been symptom-free for 24 hours. This is to keep from infecting others and spreading the virus further.
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