KNOWING THE SIGNS
allergies vs colds
SHE’S SNEEZING. HER EYES ARE SCRATCHY AND WATERING. HIS NOSE KEEPS RUNNING. YOUR CHILD IS MISERABLE.
STEVE SUTTON, MD practices with Allergy and Asthma Associates, Inc., in Cincinnati
Is it a cold or allergy? “The hallmark of an allergic reaction is itching or sneezing, usually within minutes of exposure,” says allergist Steve Sutton, MD. So if your child has bouts of sneezing and runny nose that seem to come on suddenly, review what he was doing just before the symptoms started. Was he playing with the cat, or running around outside just after you’d mowed the lawn? Does the condition improve when your child is away from the cat, or the grass? On the other hand, if it’s a cold, your child will continue to have symptoms, whether she’s with the cat or not. And in addition to sneezing and a runny nose, she might complain of a sore throat, feel achy, and even run a fever. A cold won’t be helped much by medication, Sutton says, whereas your child will probably get relief from an antihistamine if the problem is an allergic one. If that’s not enough to help you decide, consider your child’s age and
the time of year. “Colds tend to peak in the fall and winter. Allergies are more likely to occur in spring and early fall,” Sutton says. He adds that runny noses and other respiratory symptoms in infants and children under the age of three are more likely to be colds. “Although eczema, asthma and food allergies can be seen early in life, most symptoms related to nasal allergies don’t begin until after age 2 or 3,” Sutton says. “We see allergies peaking in school age kids.” If your child is bothered by chronic upper respiratory problems, ask your pediatrician to take a look. The doctor can determine if the problems are caused by a cold, a blockage (such as enlarged adenoids) or an allergic reaction – and can refer you to an allergy specialist or an ENT (ear, nose and throat specialist) for further care, if necessary.
what causes an allergy? All allergies (food, skin and respiratory) are the result of a problem with your immune system. The immune system reacts to substances that are harmless to most people and mistakenly creates antibodies to that substance. Thereafter, when you are exposed to the substance through your mouth, nose or skin, your immune system detects it and creates an inflammatory response, which is what you recognize as your allergy symptoms. Allergies are often, but not always, hereditary. And kids who are allergic early in life can experience what doctors term the “allergic march,” so a child might have eczema as an infant, a food allergy as a toddler, then develop environmental allergies or asthma in later childhood.
pediatrician advocate FOR YO U R CHILD’S H E A LT H THE FAMILY RESOURCE CENTER The center helps families, community providers and agencies find health information, community resources and support. Call 513-636-7606 for assistance.
SPECIA L N E E D S RESOUR C E DIRECT O RY Use this directory to find information, resources and advocacy strategies at www.cincinnatichildrens.org/ special-needs.
JOIN SP E C I A L CONNEC T I O N S Our new online community connects with others parenting a child with special healthcare needs: www.cincinnatichildrens. inspire.com.
NICK DEBLASIO, MD Division of General and Community Pediatrics Pediatric Primary Care Clinic at Cincinnati Children’s President, Cincinnati Pediatric Society
My 11-year-old son has started complaining of headaches. Should I be concerned, and what should I give him for them? A lot of pediatric patients have headaches. The vast majority of headaches are nothing to worry about. But if your child’s headaches are frequent or severe, it’s best to have him evaluated by your pediatrician.
Here are some possible causes of occasional headaches: ■
One of the big reasons for headaches is inadequate hydration – not taking in enough fluid. This is especially true as the weather gets warmer and kids become more active outside and lose fluid through sweating. If your child has become more active and begins to complain of headaches, the cure might be as simple as having him drink more water. ■
Elevated blood pressure can cause headaches. ■
Your child might be getting headaches from straining to see the board at the front of the classroom. ■
Do you have a family history of headaches? Many times, if a parent gets headaches, a child might as well. ■
If you have a question for the pediatrician, email email@example.com
Does your child eat a healthy diet (plenty of fresh fruits and veggies and breakfast each morning) and get exercise? Does he drink a lot of caffeinated sodas or other beverages? Certain foods and caffeine can trigger headaches. Lack of sleep can cause headaches. Kids in middle and high school typically need at least 10 to 12 hours a night. Fewer than 10 hours of sleep each night is not really enough for kids of that age. Is your child under a lot of stress or pressure at school? Have things changed at home recently, such as a divorce or a move or other big changes in your life?
WHEN TO BE MORE
Does your child wake up in the morning or in the middle of the night with a headache? Does the headache cause vomiting? These symptoms require a little more investigation. Your pediatrician would perform a physical exam and decide what, if any, tests need to be done. Brain MRIs and CT scans are rarely needed. If your doctor thinks the headaches are migraines, your child might be referred to a neurologist who is familiar with medications to prevent the headaches or methods to treat them more effectively.
Researchers at Cincinnati Children’s conduct hundreds of studies each year to figure out why people get sick and what treatments might help them. Discoveries researchers make in the lab can lead to even better treatments and ways to prevent diseases from happening in the first place. Did you know you could be part of the process of helping our scientists solve medical mysteries? You can participate by joining a research study. Here’s what we’re recruiting volunteers for now.
PRESCHOOL CHILDREN WITH SELF-CONTROL DIFFICULTIES
What: A research study to develop and test an intervention that teaches self-control, memory and the ability to concentrate and focus to preschoolers and their parents. Who: Preschool children 3 and 4 years old who have self-control problems may be eligible to participate. Pay: $100 for their time. Contact: firstname.lastname@example.org • 513-803-1345. FOOD CHALLENGE RESEARCH STUDY
Has your child been tested at an allergist’s office for a milk, egg or peanut food allergy? What: We want to study a blood test that looks at the specific proteins found in food so we can possibly give more accurate results regarding food allergies. Who: Infants, children and teens up to 18 years old who have a milk, egg or peanut allergy based on an oral food challenge may be eligible to participate. An oral food challenge is a test done where an individual is exposed to a certain food in the physician’s office to determine if that food will trigger a reaction in the body. Pay: $10 gift card for this one study visit where they will have one blood draw. Contact: Kelly Thornton at email@example.com • 513-636-0604 FOCuS: AN INVESTIGATIONAL MEDICATION RESEARCH STUDY
Has your child or teen had a moderate to severe head injury? Do they have trouble with concentration or staying focused? What: We want to learn more about how a medication that helps with attention problems can help children who have had a moderate to severe head injury. Who: Children ages 6 to 17 years old who have had a moderate to severe head injury (6 months to 4 years ago) and now have attention difficulties may be eligible for participation. Pay: $125 for time and travel Contact: Jessica King at firstname.lastname@example.org • 513-636-9631
ABOUT THIS ISSUE
S P R I N G 2014 | VOL27 ISSUE1
The Department of Marketing & Communications Cincinnati Children's Hospital Medical Center 3333 Burnet Ave., MLC 9012, Cincinnati, OH 45229-3026 Phone: 513-636-4420 Advisers: Chris Peltier, MD, and Zeina Samaan, MD Editorial Consultant: Nick DeBlasio, MD Editorial Staff: Mary Silva/managing editor Photography: Tine Hofmann, tm photography Design: Christina Ullman & Alix Nothrup, Ullman Design
YOUNG AND HEALTHY is a quarterly publication from Cincinnati Children's Hospital Medical Center. For more health news and patient stories, subscribe to our monthly eNewsletter online at www.cincinnatichildrens.org/subscribe © 2014 Cincinnati Children's Hospital Medical Center
sl e e p m e d i c i n e
D O E S YOUR CHILD
Snoring isn't just the funny noise that grandpa makes when he takes a nap. It can be a troublesome sign, especially in kids.
“Snoring in kids is not normal,” says Stacey Ishman, MD, MPH, a pediatric otolaryngologist at Cincinnati Children’s who is also certified in Sleep Medicine. “About 10 to 20 percent of children snore. And we know there are decreases in school and learning performance in children who snore versus those who don’t.” THE SNORING-BEHAVIOR LINK
A number of studies have been published about the harm that sleep-related breathing problems can cause – from poor memory and lower IQ scores to behavioral problems and hyperactivity. Experts believe that the problems stem from the poor quality of sleep experienced by children who snore.
(left) PATRICIA NORTON, RN, MSN Program Manager, Upper Airway Center (right) STACEY ISHMAN, MD, MPH Pediatric Otolaryngologist at Cincinnati Children’s
There are a number of possible causes, but the number one reason for troubled breathing and snoring in kids, says Ishman, is enlarged tonsils or adenoids. If you hear your child snoring, or if he develops otherwise unexplainable problems with school or behavior changes and you suspect it might be because he is losing sleep, it’s best to get to the bottom of it – and soon.
(right) Data from a sleep study is essential to diagnosing sleep apnea, says Dr. Stacey Ishman
W H AT T O D 0
“The first step is to talk with your pediatrician,” Ishman says. “The most important thing is to figure out if it’s snoring or sleep apnea.” In sleep apnea, breathing is briefly and repeatedly interrupted during sleep. Left untreated, it can have long-term health consequences. But it’s not easy to identify in children. So the best approach to start may be “watchful waiting,” Ishman says. “Kids’ tonsils and adenoids grow between the ages of 2 and 6. So I would likely say to the parent of a 7-year-old, ‘Your child’s tonsils might get smaller over the next 6 months, so let’s just watch.’ A study in the last year reported that nearly 40 percent of mild sleep apnea in kids resolves with just waiting.” If the problem doesn’t improve with time, a sleep study in a special pediatric sleep laboratory is the only way to determine whether or not your child has apnea, Ishman says. Some sleep apnea and snoring can be managed with medications. If the problem is caused by enlarged tonsils and adenoids, surgery might be recommended. IMPROVEMENT AFTER SURGERY
Regardless of the cause, seeking help for your child’s snoring is important, because it can be fixed. “And a number of studies have shown that the problems associated with children’s snoring are reversible,” says Ishman.
Sleep-related breathing problems can cause poor memory , lower IQ scores, behavioral problems and hyperactivity.
SNORING AND DOWN SYNDROME
The American Academy of Pediatrics recommends every child with Down syndrome have a sleep study between 3 and 5 years of age. Children with Down syndrome are at greater risk of sleep disorders and sleep apnea.
screening Cincinnati Children’s offers this screening for children with Down syndrome by referral from your primary care physician: Upper Airway Center, 513-636-3730 or email@example.com.
B E I N G P R E PA R E D
EV E RY PA R E N T S H O U L D K N OW
Th i s Lifes av i ng S kill If your child’s heart stops, would you know what to do? Sudden cardiac arrest (SCA) is a life threatening condition in which the heart’s electrical system malfunctions and the heart can no longer pump oxygen-rich blood to the brain and vital organs. SCA can happen to children as well as adults. There are many causes, including underlying heart disease, a blow to the chest, asthma, drowning, electrocution, diabetes, and allergic reaction. When sudden cardiac arrest occurs, every second counts. Knowing how and when to administer cardiopulmonary resuscitation (CPR) and use an automated external defibrillator (AED) can make all the difference. When CPR and an AED are used within the first three to five minutes of collapse, it can triple the chance of survival. CPR pumps oxygen-rich blood to the brain and major organs to sustain life; an AED can deliver a lifesaving shock to the heart and get it beating effectively again.
CPR CLASSES Cincinnati Children’s provides CPR classes on a regular basis. Call 513-636-1096 for a schedule of classes.
When CPR and an AED are used within the first three to five minutes of collapse, it can triple the chance of survival.
ANGIE JACKSON, RRT Cincinnati Children’s Center for Professional Excellence/Education
FA C T S A B O U T SUDDEN CARDIAC ARREST (SCA) SCA is the number one cause of death in the United States. It claims the lives of 359,400 Americans each year – including as many as 7,000 children. SCA is the number one cause of death in young athletes. Every three days, a competitive student athlete suffers a sudden cardiac arrest without warning. National primary and secondary prevention programs are in place to save more young lives from SCA. Primary prevention consists of screening young athletes prior to sports participation to detect preexisting conditions that may lead to SCA. Secondary prevention includes widespread heart health awareness and CPR/AED training.
online American Heart Association: www.heart.org Sudden Cardiac Arrest Association: www.suddencardiacarrest.org Sudden Cardiac Arrest Foundation: www.sca-aware.org Parent Heart Watch: www.parentheartwatch.org
T R AV E L
s a fe t y t i p s
Traveling Overseas? S TAY S A F E A ND HEALTHY
Extra socks. Camera batteries. A travel adaptor plug. Immunizations. Medication for travelers’ diarrhea. Wait… those last two items weren’t on your trip planning to-do list? They should be, if you plan to travel overseas with your kids – particularly if you are traveling to less developed areas.
n the excitement of planning a trip, many people don’t think about what’s important to make it safer and healthier, says Mary Allen Staat, MD, MPH, Director of the International Travel Clinic at Cincinnati Children's. The clinic specializes in preparing adults and children for international travel.
trav el tips P R E PA R AT I O N S A N D PRECAUTIONS
“One of the most important things is to learn about where you will be visiting,” Staat says, “and know the associated risks. By preparing, there are lots of things you can do to minimize those risks.” The Travel Clinic is familiar with most of the risks, and how to prepare for them.
The Travel Clinic team includes ( from left) Robin Gordon, Mary Allen Staat, MD, MPH, and Kelly Hicks, CNS, RN.
■ BE CAREFUL WITH FOOD AND WATER Avoid tap water, even for brushing teeth; steer clear of ice cubes. Use common sense in food choices: avoid raw fish, undercooked meats and food from street vendors. Use bottled water and juice.
Despite the best efforts, travelers’ diarrhea is a common travel affliction. The Travel Clinic prescribes medication to take along in case. But seek care from a medical facility if you have bloody diarrhea or high fever. ■ CAR SEATS AND TRAFFIC If traveling with young children, take a car seat along. Be especially alert to unusual driving and traffic patterns when crossing streets.
GET YOUR IMMUNIZATIONS UP TO DATE Do this well in advance of your trip - at least a month or more, since some shots must be taken in a series. Some vaccinations can be accelerated for a trip, says Staat, depending on age. And there are some immunizations needed just for travel. ■
■ DON’T GET BUGGED Insect-borne diseases are a major risk in many regions. Use bed netting if there are no screens on windows or doors to avoid illnesses carried by insects. Be aware of ticks if hiking is in your travel plans.
Also beware of animals, no matter how cute they might be. Dog and monkey bites can cause rabies or infection. ■ MEDICAL GUIDANCE make an appointment with your doctor or the Travel Clinic in advance of your trip. A little preparation goes a long way toward creating the trip of a lifetime.
make an appointment Contact the Travel Clinic at 513-636-2152.
3333 Burnet Avenue, MLC 9012 Cincinnati, Ohio 45229-3026
Visit our newly
R E N O VAT E D M A S O N C A M P U S
Cincinnati Children’s has renovated and updated our Mason, Ohio, location to better meet your family’s needs. Services offered at Mason include: ■ ■ ■
Our renovation created space for new services, including: ■
Urgent Care Laboratory and X-ray More than 20 pediatric medical and surgical specialties
Perlman Center, for children with cerebral palsy and other physical challenges Dermatology Ophthalmology
Our Mason Campus is located at: 9560 Children's Drive, Mason, OH 45040 vwww.cincinnatichildrens.org/mason No appointments needed for lab, X-ray or urgent care visits.
THI S I S S UE
COLD OR ALLERGY
Learn about the differences in symptoms to determine the best course of action
Snoring is not normal. How it affects your child, and what you can do.
SPRING 2014 VOL27 ISSUE1
A guide to your child’s good health
keeping your child
Maintain your child's health through preparation and education.
Tips for managing colds and allergies, headaches, childhood snoring and more.