Can Children Get Type 2 Diabetes?

Diabetes is a condition that affects the body’s blood glucose levels. There are two main types of diabetes that are diagnosed in children and adults: type 1 and type 2. In type 1 diabetes, the pancreas can’t make enough insulin, which is a hormone that helps spread glucose (sugar) into the body’s cells to produce energy. Those diagnosed with type 1 diabetes are most often born with the condition.

Type 2 diabetes is diagnosed when the pancreas creates enough insulin, but the body won’t use it. This is referred to as insulin resistance. Diabetes affects the way the body makes and uses insulin. That means rising levels of blood glucose and, ironically, a body starved for energy.

In the United States, over 30 million Americans suffer from diabetes. In 2017, 18,000 children below the age of 20 were diagnosed with type 1 diabetes, and over 5,000 children were found to have type 2 diabetes. November is Diabetes Awareness Month–the perfect time to learn about a disease that affects so many people of all ages every day. If you believe your child is at risk of being diagnosed with diabetes here is what you need to know.

Child Risk Factors for Type 2 Diabetes

Once referred to as adult-onset diabetes, type 2 diabetes has become a more common diagnosis in children. This is because of rising levels of childhood obesity over the past twenty years. Most cases of childhood diabetes are diagnosed in puberty, though children can get it as young as 8 years old. There has also been an increase in mothers who are diagnosed with gestational diabetes during pregnancy. Gestational diabetes increases the risk for developing diabetes later in life in both the mother and her baby.

Children, most often girls, are also at an increased risk for developing type 2 diabetes if they have a family history for either diabetes or obesity. If your child is of African American, Hispanic, Asian American, Pacific Islander, or Native American descent, he/she also has a higher chance of developing type 2 diabetes as a child.

Obesity is linked with insulin resistance, the leading cause of type 2 diabetes. Childhood obesity affects around 12.7 million children and teenagers in the United States. As the childhood obesity epidemic grows, so do the number of children who become insulin resistant and go on to be diagnosed with type 2 diabetes.

Can Diabetes Type 2 Be Prevented?

Children with prediabetes are at risk for developing type 2 diabetes. In prediabetes, blood glucose rises to levels approaching type 2 diabetes. If your child has prediabetes, the doctor may make recommendations to help lower your child’s blood glucose levels. Following the doctor’s recommendations may prevent your child from developing type 2 diabetes.

Encouraging children to eat healthier foods can help prevent the development of diabetes. Eating a diet low in carbohydrates with adequate protein and healthy fats, can reduce the risk of excess weight gain. Such a diet should also result in weight loss in children who have gained too much weight. Obesity is a major cause of type 2 diabetes development.

Another common type 2 diabetes prevention tactic is getting regular exercise sessions of around 30 minutes each, five days a week. Participating in physical activities can prevent not only diabetes, but many other serious health complications and diseases like, for instance, cancer. Limiting TV and video game time and encouraging children to be active reduces their risk for being diagnosed with type 2 diabetes.

Healthy Activities Prevent Type 2 Diabetes

Here are some fun activities that can help prevent diabetes type 2 in children:

  • School sports like baseball, lacrosse, and soccer
  • Walking the family dog
  • Physical chores like shoveling snow and raking leaves
  • Walking or bike-riding to school
  • Physical family activities like hiking or sledding
  • Daily runs or walks
  • Dance or gymnastics class
  • Karate

Signs & Symptoms of Type 2 Diabetes

In the beginning stages of type 2 diabetes, signs and symptoms of the disease are uncommon. Only as time passes do the symptoms begin to appear. Some of the most common symptoms include:

  • Extreme Thirst
  • Frequent Hunger
  • Unexplained Weight Loss
  • Dry Mouth
  • Frequent Urination
  • Itchy Skin
  • Blurred Vision
  • Numbness or Tingling in Hands or Feet
  • Heavy Breathing
  • Slow Healing of Sores and Cuts
  • Darkened Skin in Armpits and Neck

Complications of Type 2 Diabetes

A diagnosis of type 2 diabetes can lead to complications that come on faster in children than in adults. Diabetes is the leading cause of vision loss and blindness from a group of eye conditions called diabetic eye disease. These conditions include diabetic retinopathy, diabetic macular edema, glaucoma, and cataracts, and affect most major portions of the eye. Other complications of diabetes can include coronary artery disease, stroke, heart attack, kidney failure, and sudden death.

Children at risk or already diagnosed with type 2 diabetes should receive an annual flu shot. The flu can increase the risk of diabetes-related complications. Any illness at all, in fact, can make diabetes more difficult to manage.

Children who are at risk for developing type 2 diabetes are also at risk for diabetes complications. For this reason, at-risk children should be screened for the disease on a regular basis. Early diagnosis means a chance to begin treatment as soon as possible. Early treatment of diabetes helps to prevent later complications from the disease.

Complications of Diabetes Treatment

Insulin therapy is often necessary to control type 2 diabetes. But as diabetic children and teens grow into young adults, the doctor may add further medication to their treatment plans. Some of these prescription drugs are known to have side effects far worse than the symptoms they are used to treat.

One such class of drugs is SGLT2 inhibitors. SGLT2 inhibitor medications regulate blood sugar levels by keeping the body from absorbing glucose back into the blood. Invokana is an example of an SGLT2 inhibitor. This drug has come under fire for increasing the risk of rare genital infections, lower-limb amputations, and ketoacidosis in adults over the age of 18 who use this medication.

Diabetes medications are often prescribed as part of an overall treatment plan. Ask your doctor about the possible side effects and complication of the various prescription drugs for diabetes. Having this information can help you decide see which medication is right for the child approaching adulthood.

What Can Parents Do?

A diagnosis of type 2 diabetes sounds scary. After all, diabetes, whether type 1 or type 2, cannot be cured. In spite of this fact, with proper management, most people with diabetes live a happy, healthy life. If your child or teen has been diagnosed with type 2 diabetes, you can help manage the disease by encouraging your child to engage in physical activity and eat healthy meals.

If you believe your child is at risk for type 2 diabetes, there’s so much you can do to avoid that dreaded diagnosis. You can help your child fit in more exercise and other healthy activities. You can make sure your child eats right and loses weight. Most of all, if you notice any possible symptoms of diabetes in your child, you’ll want to speak to your child’s pediatrician right away. Early diagnosis and treatment are the best way to keep your child’s life as normal and as healthy as possible

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Taking Your Child to the ER

Taking your child to the ER can be a nerve-wracking experience. It’s hard to be rational and calm when your child is injured or experiencing frightening symptoms. The first thing to think about is which emergency room to choose. If you live in a city with a choice of emergency rooms, pick an ER you know to be child-friendly. Or call the doctor’s office for advice on the best ER for your child.

The ideal time to study up on the right ER for your child is actually before there is an emergency. Ask friends about their children’s ER experiences to get recommendations. At your child’s regular check-up ask your child’s pediatrician for advice on the most child-friendly, area ER.

Another way to prepare in advance for emergencies is for parents to keep and maintain a notebook with all the child’s health information. In the notebook, you can list all past and present illnesses, vaccinations, allergies, current medications, and the time of your child’s most recent dose of medicine. These are things the ER staff will want to know. Keep the notebook in your bag so you never lose it and will always have it close at hand, even (and especially) when you’re running out the door to the emergency room.

By the same token, always keep your child’s health-insurance card or information in the same space in your wallet. That way you’ll never have to waste precious time searching for the card during an emergency. It will be one less thing to think about.

Not sure whether your child should go to the ER at all? It could be a call to the doctor can help you decide. For more on this topic, read When to Take a Child to the ER.

Expect a Long Wait

Two kids and a dad (from waist down) in ER waiting room

Once you decide to go to the ER, be aware that a visit to the emergency room may mean a wait of many hours. Make sure you bring change with you, as cell phones are sometimes banned in hospitals. Change is also handy when you want something from the vending machine. Bring toys or activities, and something to eat and drink (check with hospital staff before offering a child food and drink).

Unless your child is three months old or younger, you can feel free to treat a child’s fever before you leave for the ER. It helps the child feel better and can make the wait easier. Bring some more fever-reducing medication along with you to the hospital, in case the wait is many hours long. Your child may need another dose before he is seen.

Try not to bring brothers and sisters to the ER. If you can find a sitter or someone to watch your child’s siblings, it’s best not to bring them along to the ER. Your child needs your full attention. Also, why expose children unnecessarily to diseases that are floating around the hospital?

Review the Facts

As you make your way to the ER, mentally review the facts of your child’s illness or injury, and write them down in your child’s health notebook if your hands are free. That way you’ll be ready to tell the nurse or doctor what has happened and how you’ve treated your child until now. Think back to when your child became ill or injured and make a note of the day and time. If your child has swallowed poison, bring the bottle with you to the ER.

Think over the progression of your child’s illness or injury: how has it changed over time? Has your child had a fever or a rash? Has your child gone to the bathroom? How many times a day? What medications, if any, has your child taken? Does your child have any allergies? These are all things the ER staff will want to know.

Prepare your child on the way to the ER. Tell the child that a doctor (not the pediatrician he knows) will be examining him. At each step of the ER experience, explain the truth about what will happen next. A clear, honest explanation makes your child less anxious. Anxiety over the unknown worsens pain and fear. Knowing what will happen next, even if it’s going to hurt, relieves that anxiety, and helps your child feel better.

Eating and Drinking

On arriving at the ER, ask if your child is allowed to eat and drink. Sometimes you’ll be asked not to give your child food and drink. Some procedures, for instance some CT scans and blood tests, have to be done while fasting. It can be difficult to ignore a child’s pleas to drink and eat, but remember it’s in her own best interests. Reassure her as much as possible.

Remember that a long wait is a good sign. It means your child’s condition isn’t so serious that it cannot wait a bit for treatment. Try to be patient and calm. If your child seems to be getting worse, ask that he be reassessed.

ER waiting room animation

Never lie to a child. Don’t say, “It won’t hurt,” if you know it will. If you know something will hurt, say so, but add something to give the child hope. You might say, “It will hurt, but only for as long as it takes to blink your eye.”

Your Child’s Advocate

If your child needs stitches, a shot, or a blood test, ask if numbing cream can be applied to the area, first. The cream takes about 20 minutes to kick in. If your child’s pain medication is wearing off, let the staff know. Remember that you are your child’s advocate, if you don’t speak up, no one else will.

Do what you can to comfort your child and ease her fears. Hold her, talk to her. Try to keep her from seeing anything scary, such as a tray of instruments or a bloody patient. Read to your child or play a game like “I Spy” to take her mind off of her pain and fear.

Stay by your child’s side as much as possible. Ask if you can stay with your child for procedures like blood tests and x-rays. But if you feel like you’re going to pass out from seeing blood, for instance, make sure you inform the staff.

Your ER Questions

Doctors and nurses seem so busy parents may be afraid to disturb them with their questions. But it’s a parent’s right to ask questions and receive answers. If you want to know why this or that test has been ordered, go ahead and ask. Just be polite.

Make sure you understand the discharge instructions. Are you sure you know when the bandage can be taken off? How to clean your child’s wound? Do you know what to do if your child’s symptoms don’t get better or he feels worse? Do you know how to give your child his medication?

The hospital often recommends a follow-up visit with the child’s pediatrician. Bring your child’s discharge papers with you to the visit. Even if your child needs no follow up visit, drop off a copy of the child’s discharge papers at the doctor’s office. That way, a record of the visit will be included in your child’s medical history.

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When to Take a Child to the ER

Should you take your child to the ER, call the doctor, or wait and see? When you’re just not sure, call the doctor. Even if the pediatrician can’t speak with you, someone in the office should be able to advise you. And if you do need to take your child to the ER, the doctor’s office can call ahead and let them know you’re on the way. That’s a plus.

But let’s back up a bit to the original question: ER or pediatrician? It’s a dilemma just about every parent wrestles with at one point or another. And it’s so hard to think straight when your child is injured or ill.

To the ER or Not? Three Deep Breaths

Even when you’re frightened and anxious, sometimes you can figure things out on your own. That is if you can calm down enough to do a proper assessment of your child’s condition. To help calm down, take three deep breaths. Then remember that being calm and in control of your emotions means you’ll be better able to take care of your child.

Sometimes making decision of what to do next is easy. If your child is just lying there completely out of it, or has severe injuries, don’t wait. Call 911. Ditto if your child’s lips are turning blue. That’s not only the ER, but a ride in an ambulance, most likely. So pick up the phone and dial 911.

Just do it.

Going to the ER Means a Long Wait

But let’s say none of this applies to your child’s condition and it’s the middle of the night. And you know that going to the ER is unpleasant, with a long wait and procedures that might make your child cry. Your child is uncomfortable enough. Do you really need to add to her discomfort? How do you know whether to wait until morning when you can have the doctor decide for you, or whether you need to get moving to the ER now?

Let’s take a look at some common events that may mean a trip to the ER:

Dehydration

Lots of viruses cause diarrhea and vomiting in children. When your child gets a bug with these symptoms, you have to worry about dehydration. Dehydration is definitely a reason to visit the ER, even in the middle of the night. But it usually takes about 24 hours of vomiting and diarrhea to cause dehydration. So the first thing you want to consider is how long your child has been vomiting and experiencing diarrhea. If it’s under 24 hours, you can probably wait.

If your child has been sick for over a day with symptoms of vomiting and diarrhea, you need to watch for signs of dehydration such as:

  • Cracked lips
  • Cold skin
  • Dry mouth
  • Decreased urination
  • Low energy

If your child’s tummy trouble persists, and she can’t keep down even small amounts of liquid, call the doctor. You should try to get the child to take two teaspoons of fluid every 30 minutes. If your child has almost no saliva, can’t make tears when crying, and isn’t peeing at least twice a day, it’s time to go to the ER.

Fever

In small infants (newborn to three months), a rectal temperature of over 38C or 100.4F means: go to the ER now. In this case, don’t give your baby medicine to reduce the fever. The ER doctor will want to see the baby as is, without the effects of medication.

Babies and children three months and older can be given a dose of acetaminophen or ibuprofen for fever according to the dosage instructions on the bottle. Then wait 30 minutes. If your child looks a lot better, is responding to you, and is drinking fluids, you can continue to treat the child at home.

If the child’s symptoms continue, the fever continues past 72 hours, or there’s wheezing, a strange rash, or extreme lethargy, call the doctor.

Breathing Issues

When a child is wheezing or grunting, or her breathing is noisy, fast, or high-pitched, it means your child is having trouble getting air. This can happen when there is a respiratory infection or during an asthma attack. But panting or fast breathing can also occur when kids get fevers. So if your child has a fever, give fever-reducing medication like acetaminophen or ibuprofen and wait 15 minutes. If the fever goes down, and her breathing settles, you can stay home.

If your child has a cough so severe that she cannot sleep or eat, or she has a barking cough, call the doctor.

If the child has so much trouble breathing that she cannot speak, go to the ER.

If the child’s lips are turning blue, call 911.

Odd Rash/Stiff Neck

Does your child have a rash? Press on it. The rash should go back to normal skin color for a second or so. If it does, this means your child has a simple virus and will get better in a couple of days. You can stay home.

If the rash doesn’t pale when you press on it and your child has a fever, this may mean a more serious illness, for instance meningitis. Call the doctor. If your child has neck pain, finds it hard to move his neck, and also has a fever, go to the ER now.

Bad Cuts

Clean the cut well with soap and water. Put pressure on the cut with a clean towel for 10 minutes and then reassess. If the bleeding is under control, but the cut is deep, call the doctor.

Go to the ER if:

  • The child can’t move the injured part
  • There’s lots of bleeding
  • There’s numbness
  • There’s severe swelling

Bump On the Head

A bump on the head isn’t always an emergency. If your child has no dizziness, headaches, or vomiting, you can stay home and the child can return to normal activities. But if your child passes out within a couple hours of bumping his head, call the doctor. Check the child’s head with your hands. If there is a part that seems squishy, go to the ER. If the child can’t stop crying, vomits more than once, or you see blood or fluid coming from the ears or nose, or bruising around the eyes or ears, go to the ER.

Remember that your child takes her cue from you. If you remain calm as you assess your child, your child will feel less anxious and find it easier to cope with the fear and pain of illness. Cuddle your child, and do what you can to distract her from her worries and discomfort.

Mother feels little girl's head for fever, keeps her calm

Next week: Taking Your Child to the ER

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Type 1 Diabetes in Children and Teens

Type 1 diabetes (T1D) is a disease that is marked by the body’s inability to manufacture insulin. Without insulin, the body cannot process the glucose from the food we eat. The result is that glucose levels rise dangerously high which can lead to a variety of serious health problems. There is currently no cure for run-of-the-mill diabetes with no complications, but the disease can be managed with daily doses of insulin. Type 1 diabetes affects some 450,000 U.S. children.

Type 1 diabetes is scary for parents of newly diagnosed children and their parents. The disease is unfortunately, all too common. Each year, some 13,000 children are diagnosed with type 1 diabetes in the United States, alone. There’s no magic wand to wave type 1 diabetes away, but the disease can be controlled and managed, with careful attention.

Diabetes affects the way the body uses glucose, which is a type of sugar in the blood. Glucose is a byproduct of the food we eat. Most people use this glucose as the main source of energy to fuel the various functions of the body.

After eating a meal, the body breaks down food into nutrients, such as glucose. These nutrients are released into your bloodstream by way of the gastrointestinal tract. This causes the level of glucose in the blood to rise after a meal. In healthy people, this rise in the level of glucose, or blood sugar, tells the pancreas to make a hormone called insulin, and to release this hormone into the bloodstream.

Type 1 Diabetes and Insulin

In people with type 1 diabetes, however, the body stops making insulin. This makes it impossible for the body to get energy from glucose-producing foods, without help. Since the body can’t use glucose without insulin, glucose remains in the bloodstream, with blood levels of glucose rising higher each time food is eaten.

An easy way to understand the role of insulin is to think of it as a key that unlocks the potential of the glucose we get from the food we eat. Insulin unlocks the “doors” of the blood cells, letting the glucose in. When there is no insulin, it’s like not having the key to the door: the glucose can’t enter the cells. That means the glucose remains in the bloodstream, unused. As blood glucose rises, a number of health problems can occur.

Type 1 diabetes used to be called juvenile diabetes, or insulin-dependent diabetes. This type of diabetes occurs when the body attacks itself, and the immune system destroys the cells in the pancreas responsible for producing insulin. Once these cells are destroyed, the body has no way of making insulin, ever again.

Type 1 Diabetes Causes

No one knows why this autoimmune response, of the body attacking the pancreatic cells that make insulin, occurs. Scientists think it may be partly genetic, running in families. There is probably at least one more factor that causes type 1 diabetes. It could be a virus or something like a virus that causes the body to attack itself.

As it stands, there is no practical way to prevent type 1 diabetes. There is also no way to know in advance who will contract the disease. This means that a child or adult can’t be said to have done something to cause the disease.

Once someone has type 1 diabetes, that person will always have type 1 diabetes. The person with type 1 diabetes will need to treat the disease, every day, for his or her entire life. Children, teens, and adults with type 1 diabetes are dependent on daily doses of insulin to control their blood glucose levels. Insulin is given by injection or with a pump.

Sometimes the symptoms of type 1 diabetes are subtle. It can take a while for a parent to figure out that a child is sick, which means it can take time for the child to be diagnosed with type 1 diabetes. Type 1 diabetes can develop over time, or all of a sudden.

Type 1 Diabetes Symptoms

Here are some common early symptoms a parent might see in a child with type 1 diabetes:

  • Pees large amounts, often. When the body fails to make insulin, the kidneys try to flush out the excess glucose in the blood by causing the child to urinate (pee) frequently and in larger amounts than usual.
  • Extreme thirst. Because the child is peeing so much and so often, dehydration (loss of body fluids) becomes a problem. The child become very thirsty, to offset the drying effect of all that peeing. The child with type 1 diabetes will seem to constantly want drinks. This is an effort to keep body levels of fluids in balance.
  • Weight loss or lack of weight gain as the child grows. The child eats plenty, but is either losing weight, or not gaining as is normal in a growing child. Children and teenagers who develop type 1 diabetes seem to eat more than usual, yet stay the same or lose weight. This happens because the body can’t access the glucose in the body for fuel. The result is that the body begins to use its fat stores, and even breaks down muscle in its effort to feed its starving cells.
  • Tired much of the time. Since the body can’t access glucose for fuel, the child gets no energy from food, and feels tired.

Uncommon Symptoms

Less common early symptoms of type 1 diabetes include:

  • Bedwetting in a child who had been dry at night.
  • A vaginal yeast infection (Candida) in a girl who has not yet reached puberty.

Serious Symptoms

If these early symptoms of type 1 diabetes go unnoticed and untreated, more significant symptoms can occur. These symptoms are the result of a build-up in the blood of chemicals called ketones. When ketones build up in the bloodstream of a person with type 1 diabetes, this results in a serious condition called diabetic ketoacidosis (DKA). The symptoms of diabetic ketoacidosis can be mistaken for those of appendicitis, or the flu. Here are common symptoms of diabetic ketoacidosis:

  • Stomach pain
  • Nausea
  • Vomiting
  • Breath smells like fruit
  • Difficulty breathing
  • Loss of consciousness

Adult Complications

Type 1 diabetes can cause long-term health problems in adults, though not in children. These health issues come with having type 1 diabetes for a long time. Children and teens haven’t had diabetes long enough to have these issues.  The kinds of health problems that comes from having type 1 diabetes for many years, also tend to happen in cases where the person wasn’t doing a good job of managing the disease. Here are some of the common health problems that are associated with type 1 diabetes over the long-term:

  • Heart disease
  • Stroke
  • Kidney damage
  • Vision impairment
  • Various problems with the blood vessels, nerves, and gums

The important thing to know about type 1 diabetes is that it can be controlled, and the risk greatly reduced through proper treatment. It’s also easy to diagnose diabetes through a simple blood test that measures the level of glucose in the blood. Children, and especially teens with type 1 diabetes, may need lots of support and encouragement. They don’t like feeling different than their peers and may take risks with treatment. For this reason, researchers are always looking into new and easier ways of administering insulin, such as the insulin pump.

If your child’s doctor suspects or makes a diagnosis of type 1 diabetes, your child may be referred to a pediatric endocrinologist. A pediatric endocrinologist is a doctor who is a specialist in childhood diseases having to do with the endocrine system, for instance diabetes. The endocrine system is made up of the glands in the body, such as the pancreas. In type 1 diabetes, the pancreas sustains damage and stops producing insulin.

Girl Tests her glucose levels

Children and teens can find it painful or demanding to test their blood glucose. Testing blood glucose involves producing a drop of blood to test for glucose by means of a pin prick. Children can feel the same way about insulin injections as a way of replacing the body’s lack of insulin. It’s also awkward for teens and children to treat their disease when their friends are around. It can be a challenge to find privacy for treating type 1 diabetes, and (insensitive) peers might make them feel uncomfortable about their differences.

Type 1 Diabetes Medical Advances

Medical advances have been made to make treatment of type 1 diabetes easier on children and teens. There is now, for instance, the insulin pump, which mimics the natural way the pancreas reacts to glucose in the bloodstream in healthy people. The insulin pump is a portable device that attaches to the body. The pump delivers a continuous amount of short-acting insulin by way of a catheter that is placed under the skin. The device takes the place of multiple injections over the course of the day. The user also has more control over blood glucose levels because the insulin pump can be programmed to give faster or slower rates of insulin at specified times, such as while the user is asleep. The pump is slightly larger than a pack of cards.

Diabetic teen with insulin pump eating source of glucose

Another device in the works is the artificial pancreas. This device will be implanted or wearable and is an insulin pump that is connected to a device that automatically measures the blood glucose levels at all times.

Not relevant to most children and teens with type 1 diabetes is the major step of a pancreas transplant. While the transplant can cure diabetes, and remove the need for blood glucose monitoring and treatment, the transplant comes with the potential for a host of problems. In general, a person is only considered for a pancreas transplant when there are complications from diabetes, for instance, kidney damage necessitating dialysis. A pancreas transplant is often, in fact, done in conjunction with a kidney transplant. The child who would be considered for a pancreas transplant would be rare, indeed.

While no one thinks it a good thing for a child or teen to develop type 1 diabetes, it is not the worst thing in the world, and certainly not a death sentence. It helps to maintain a positive attitude as you guide your child through learning how to adapt to having a chronic disease. If your child sees you can cope, he or she will understand that everyone has challenges, and the main thing is to meet them face on, with bravery.

Does your child have type 1 diabetes?

How did you feel when you learned your child has type 1 diabetes?

Does your child with type 1 diabetes take risks with monitoring blood glucose levels and treatment? How have you coped with this situation?

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Croup Treatment: The Dreaded Barking Cough

Croup treatment is all about getting that child into a steamy bathroom; using a cool mist humidifier; or taking the child out into the cool night air. These are all effective ways to ease the dreaded barking cough of croup. Other than that, acetaminophen (or ibuprofen for older children) can make the child more comfortable, especially if there’s fever.

Croup Treatment: What is Croup?

Croup is an infection in a child’s upper airway. The infection causes swelling. The swelling makes it hard to breathe. The swelling of the airway also causes the barking cough.

Croup affects children between the ages of 3 months and 5 years. The most common age for a case of croup is at around 24 months. Croup occurs more often in the fall and in early winter. Boys are more likely to get croup than girls. Croup stays contagious for a few days or until the fever is gone.

Croup Treatment: The Barking Cough

Croup is caused by a virus. The virus causes the vocal cords (larynx), windpipe (trachea), and bronchial tubes (bronchi) to swell. It is the swelling of these parts of the upper airway that causes the barking cough, scratchy voice, and high, squeaky, breathing sounds. When the child coughs, air is pushed through passageways narrowed by swelling. The results are a cough that sounds like a seal barking, and breathing that sounds like a whistle (stridor).

Croup is frightening to parents and their children. The good news is that croup usually sounds worse than it is. Most of the time, croup is not serious. Croup can usually be managed at home. Kids with croup tend to recover within 3-5 days.

Croup Treatment: How Croup Begins

We parents know it’s croup when we’re awaked by that dreaded barking cough in the middle of the night. But when we look back on how it all began, a parent may recall that the child already had symptoms of a cold, for instance a stuffed-up or runny nose, and maybe some fever. Once the airways begin to swell, the child’s breathing becomes more difficult. In addition to the whistling noise made when the child breathes in (stridor), you might also see the child’s skin pulling in between the ribs (retractions). In more serious cases of croup, the child may seem pale or blue around the lips, which suggests the child may not be getting enough oxygen.

Croup Treatment: Symptoms of Croup

Croup symptoms tend to worsen at night. The symptoms also worsen when a child is crying and upset. Of course, when your cough sounds like a seal or a dog; you have a fever; and it’s hard to breathe, it’s natural to feel upset and to cry, which only makes things worse. This is why it’s important to appear calm to your child and to make an effort to calm the child down. If your child sees you are calm, he has less reason to be afraid or nervous.

Here are common symptoms of croup:

  • Barking cough (sounds like a seal or a dog)
  • High-pitched breathing (like a whistle)
  • Hoarse, raspy voice
  • Breathing fast
  • Labored breathing
  • Noisy breathing
  • Stuffy nose
  • Runny nose
  • Fever

Children under the age of 3 years have smaller airways. That means their symptoms are likely to be more severe. You can expect your child to have symptoms of croup for three to five days.

Croup Treatment: Causes of Croup

Croup comes in two varieties: viral croup and spasmodic croup. The symptoms of both are the same. Croup is caused by the same sort of viruses that bring on the common cold. The most common virus behind croup is the parainfluenza virus.

There seems to be a seasonal component to croup, since children are more likely to have croup in fall and early winter. Age and gender also play a factor in a bout of croup. Boys get croup more than girls. The peak age for a bout of croup is 24 months. Kids generally don’t get croup after the age of 5 years.

Croup is contagious. Your child may catch a virus by breathing near someone who sneezes. Sneezing can release droplets of virus into the air. That’s why it’s smart to sneeze into a tissue, instead of into the air.

Child sneezes into elbow
Sneezing into an elbow can help prevent others from getting sick.

When someone sneezes into air, the droplets of virus can fall onto toys or other surfaces that children handle. The virus can live on such surfaces for quite a while. If another child should touch a contaminated item or surface, and then touch his eyes, nose, or mouth, a virus may set in.

Even when children use tissues, some droplets of virus can escape. These droplets can end up on the hands or clothes. Teaching children to wash their hands after sneezing is one way to prevent the spread of viruses.

Croup Treatment: Diagnosing Croup

The doctor diagnoses croup by listening to the child’s barking cough, and the high whistling sound of the child’s breathing (stridor). You may be asked whether the child has had any recent cold symptoms such as a stuffy or runny nose, and/or a fever. The doctor may also want to know if the child has had past problems with croup or health issues of the upper airway.Doctor applies stethoscope to child's back.

If symptoms of croup are severe, and don’t respond quickly to treatment, the doctor may order a neck x-ray. If the child has croup, the x-ray will show the “steeple sign” in which the top of the airway narrows to a point.

Croup Treatment: Treating Croup

Croup sounds scary but children tend to quickly get better with home treatment. The main thing is to keep the child calm, since crying and being upset worsens the symptoms of croup. If the child has a fever, acetaminophen can help the child feel better. If the child is older than 6 months, you can offer ibuprofen. Your doctor can give you instructions on dosing: how much, how, and when to give acetaminophen, or for the older child, ibuprofen.

Children with croup feel better when they breathe moist air. You can offer moist air to your child through any of these methods:

  • Run a cool-mist humidifier in the child’s bedroom
  • Run a hot shower in the bathroom (with door closed) until the room fills with steam. Sit there with your child for ten minutes
  • Take your child outside in cooler weather
  • Go for a ride in the car with the windows open a bit to let in the cool breeze
  • Sit with the child near an open window

Make sure your child is drinking lots of liquids. Kids tend to dry out from the coughing, difficulty breathing, and fever. If your child resists drinking, try using a spoon, or even a medicine dropper to offer fluids. Your child should also rest as much as possible.

Some children need stronger measures to combat the symptoms of croup. These children may need to go to the hospital for more intensive croup treatment. Croup treatment in these cases may include a breathing treatment, or steroid medication to lessen the swelling in the upper airway. Sometimes kids with croup will need to spend a short stay in the hospital until their breathing improves.

Croup Treatment: When to Get Help

For most children, croup goes away quickly and everything is once again fine. Some children, however, are prone to complications from croup. Children who were born prematurely, or who have asthma or other lung problems, for example, are more susceptible to complications of croup and may need further croup treatment. Even so, only around 5 percent of children who go to the emergency room for croup need to be hospitalized.

If your child has any of the following symptoms with croup, call the doctor or get immediate medical attention:

  • Makes loud, high-pitched whistling sounds (stridor) both when breathing in and breathing out
  • Breathing sounds are becoming noisier
  • Has trouble swallowing, drools
  • Seems nervous and hyper
  • Is listless, lacks energy, hard to awaken
  • Child’s breathing is faster than usual
  • Child is struggling to breathe
  • The skin around the nose, mouth, or fingernails looks blue or gray (cyanosis)
  • The child is too short of breath to walk or talk
  • You can see the neck and chest muscles pulling in as the child breathes
  • The child is dehydrated (not peeing enough, pee is dark, eyes look sunken, few or no tears when child cries, dry or sticky mouth)

Croup Treatment: Preventing Croup

Defending your child against the viruses that cause croup means staying away from people with colds. It also means washing hands often and well. Teach your child to stay away from people who are sick. Have your child learn to sneeze into the elbow, when tissue is not available.

Has your child had croup?

What helped your child most?

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Spanking? The Jury is in: It’s BAD

Spanking was never proven to be a bad thing, at least not scientifically. That is until now. University of Michigan researchers have looked at the data and finally and absolutely concluded that being spanked as a child may lead to an assortment of mental health issues in adulthood.

This new study was undertaken by Andrew Grogan-Kaylor and Shawna Lee, both assistant professors of social work at the University of Michigan. The work they did in tandem with their colleagues points to spanking in childhood as a form of violence, which leads to mental health issues such as depression, attempts at suicide, and moderate-to-heavy levels of substance abuse, such as alcohol or illegal drug use, later in life.

“Placing spanking in a similar category to physical/emotional abuse experiences would increase our understanding of these adult mental health problems,” says Grogan-Kaylor.

Spanking and Physical Abuse

The researchers noted the similarities between spanking and physical abuse: both involve using force and inflicting pain. Both are linked to similar mental health outcomes. These similarities caused the researchers to wonder whether spanking should be categorized as an “adverse childhood experience.” That would place spanking in the same basket with, for instance, abuse, neglect, and household dysfunction. Household dysfunction would include, among other things, divorce, or a parent in prison.

To a layman, the questions that comes to mind are: are the scientists looking to label spanking as abuse? Could it be that parents who are likely to spank their children are also more likely to use physical abuse, neglect their children, or run dysfunctional households? Just how big a study was this?

Also: can we finally lay this to rest and rule, unequivocally, that spanking is bad? Or is this just some psychobabble being spouted? Must we, as parents, pay attention?

It bears noting here that the study is based on data pulled from the CDC-Kaiser ACE study. “ACE” stands for “adverse childhood experiences.” The ACE study definitely represents a large enough sample to be statistically relevant. The number of participants stands at over 8,300, with an age range of 19-97 years. As for the methodology, the data was gathered by having people answer questionnaires when visiting an outpatient clinic for routine checkups.

Clinic patients were asked how often they were spanked during the first 18 years of life. They were also asked to describe their childhood households and whether an adult had abused them. Physical abuse was defined for the participants as pushing, grabbing, slapping, or shoving. Emotional abuse was described as being insulted or cursed.

Almost 55 percent of those who filled out the questionnaires reported having been spanked as children. Men were more likely to have been spanked compared to women. Minorities, except for Asians, were more likely, compared to whites, to say they’d been spanked.

Spanking and mental health connection according to gender and color
(photo credit: Michigan News)

Participants who reported being spanked as children, were more likely to be suffering from depression and other mental health problems.

What constitutes “spanking” in this study? Is spanking any time the hand is applied to the bottom, whether or not the parent is angry at the time? The researchers came up with this definition: “spanking is defined as using physical force with the intention of causing a child to experience pain, but not injury, to correct or control the youth’s behavior.”

A fair enough definition. But how do we know it’s spanking that is causing the mental health issues later in life and not some other factor? This author put the question to researcher Grogan-Kaylor, who responded as follows: “The question is a great one. The key question is whether we are comparing children who are otherwise alike. That is to say, are we comparing families and children that are otherwise alike with the exception of spanking? Statistical techniques allow us to ensure that we are comparing like to like, and to rule out a number of other alternative factors as possible causes.”

Spanking as “Adverse Childhood Reaction”

Grogan-Kaylor shared with this author two other papers he’d co-authored, The Case Against Physical Punishment, and, Unpacking the impact of adverse childhood experiences on adult mental health. Both papers lend evidence to the theory that spanking can be seen as an “adverse childhood experience,” and therefore causes harm to the child, which may manifest only in adulthood, in the form of mental health issues. The former study illustrates this harm to the child through three theories: the attachment theory, the social learning theory, and finally, the coercion theory.

The attachment theory suggests that a child needs to feel absolutely sure of a parent’s love and care in order to flower. This sense of secure attachment to the parent is founded on parental empathy and sensitivity to children. Spanking then, is a way of responding to a child’s need for attention that erodes the child’s secure attachment to the parent by making the child feel degraded and rejected. Such children can develop feelings of being unworthy, which in turn can lead to depression and anxiety.

The social learning theory has children learning from example. The theory here is that when parents punish children for bad behavior by spanking them, children learn that violence is an acceptable method for correcting the misbehavior of others. Further complicating the message, is the fact that spanking stops the poor behavior, so that children learn that violence is an effective way to control and cope with interpersonal relations and for dealing with social interactions in general. In other words: violence is the way to work things out with people/relationships.

Coercion theory describes a cycle that occurs when the child rebels against the parent’s punishment. The parent may say, “If you don’t stop doing that, I’m going to spank you.”

Spanking: Vicious Cycle

The child may react with hostility to this situation, which causes the parent to “step up his game.” The intensification of the parent’s response comes with anger from the parent, which makes the child more rebellious. This “coercive cycle” continues to worsen until one side gives in. The parent may give up disciplining the child or the child may give in to his fear and pain and do as the parent wishes. In any event, one side “loses” and feels defeated. Defeated, one might emphasize, as opposed to feeling as though a problem has been resolved, or a lesson learned.

The latter paper shared with this author by Grogan-Kaylor does a fairly good job of showing that spanking in childhood is a risk factor for later mental illness independent of such adverse childhood experiences such as neglect; a parent in jail; or divorce. This suggests that spanking should also be included in an expanded understanding of the “adverse childhood experience.” This idea led to the current study, which concludes that spanking is absolutely an adverse childhood experience.

In terms of real life examples of how spanking is or isn’t used as a parent-rearing method, this author has often heard one mother say, “I don’t need to hit my children.”

The implication here is that there are other ways to make children behave, and they don’t involve violence.

Spanking as negative association

Another friend said she spanked her child just once, when her child ran out into traffic. This mother spanked her child out of equal measures of love and fear, out of a desire to preserve her child’s safety. It was a protective, knee-jerk reaction. In spanking her child this one single time, this mother meant to create an association: run into traffic=receive an unpleasant smack on the butt.

That child is today, what seems to be, to this author’s eyes, a well-adjusted adult, with no apparent mental illness. Also, that child never again ran into traffic. Thus, at least on a basic level, the parent achieved her aim: to create a negative association so the child would never repeat the behavior. Would that lesson have been driven home as effectively in any other manner?

There may be a generational factor in parents who did spank and parents who never do. Today, there is a greater awareness of abuse in all its forms. A parent may be reluctant to spank due to the perceived association between spanking and physical abuse. Back in the 1980’s, however, there was much less awareness of abuse and its effects. Even today, this is study is groundbreaking in that it suggests that spanking actually hurts children in terms of their future mental health.

Lead author of this study, Tracie Afifi, associate professor at the University of Manitoba, suggests we too often think about child abuse and its prevention, but not so much about harsh parenting. Afifi believes we need to put thought and effort into preventing this sort of parenting before it occurs. “This can be achieved by promoting evidence-based parenting programs and policies designed to prevent early adversities, and associated risk factors,” says co-author Shawna Lee, who is also a faculty associate at the U-M Institute for Social Research. “Prevention should be a critical direction for public health initiatives to take.”

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What is Fifth Disease?

Fifth disease. It’s the common name for a usually minor virus that mostly affects preschool and school-age children aged 5-15 years in the springtime. The medical name for fifth disease is erythema infectiosum and it is caused by parvovirus B19.

Fifth disease passes quickly and most children get better without complications. A parent might think the child coming down with fifth disease has a cold virus. At the start, there’s low fever, a headache and a stuffy or runny nose. Then the symptoms leave and the child seems to be all better.

A few days later, the rash comes out. The rash is bright red and starts with the face, eventually traveling down to the chest and back, buttocks, arms, legs, and bottoms of the feet. At first the child will look like someone slapped his face. In fact, doctors call it the “slapped cheek rash.” As the rash spreads downward, it looks more like red blotches.

By Andrew Kerr (Own work) [Public domain], via Wikimedia Commons

Fifth Disease: A Lacy Pink Net

After a few days, the rash changes and begins to look like a lacy pink net, covering the skin. Sometimes the rash itches. It can take from 1-3 weeks for the rash to go away.

Fifth disease got its name by being the fifth childhood virus with a rash. The other viral rash diseases of childhood are measles, rubella, chicken pox, and roseola.

Not every child with fifth disease gets the rash. The rash is more common in kids below the age of 10 years. In 78% of older teens and adults, fifth disease can come with swollen, painful joints. The swelling and pain may last weeks or months. In rare cases, chronic joint pain and swelling can last for as many as 9 years.

Some adults with fifth disease only have painful joints and no other symptoms. This is called polyarthropathy syndrome. The affected joints are usually in the hands, feet, and knees. More women develop polyarthropathy syndrome than men. Most of the time (in 90% of cases), the pain lasts 1-3 weeks and goes away without any long-term issues.

It’s less common, but sometimes fifth disease comes with sore throat, reddened eyes, swollen glands, and diarrhea. Sometimes the rash is different and looks more like bruises or blisters. In other cases, some 20% of the time, a person with fifth disease will have no symptoms at all. Even without symptoms, the infection can spread to others.

Because of the way the rash spreads, a parent may think the child is getting worse. As the rash spreads and becomes lacy, however, it’s getting ready to fade away for good. Here’s the ironic thing about fifth disease: when you see the rash, the illness is usually no longer contagious.

The rash is the body’s way of reacting to the infection. This immune system reaction to parvovirus B19 happens only after the infection has cleared out of the system. Fifth disease is contagious during the early days of mild fever and cold symptoms, and usually not when the telltale bright red rash appears. In other words, fifth disease is only contagious when you don’t yet know what it is!

Fifth disease is difficult to prevent. There’s no vaccination for fifth disease. It’s hard not to spread the disease, since it seems like just a mild cold during the time fifth disease is contagious. The best thing to do is to wash your hands a lot whenever you or anyone you care for has cold symptoms.

It takes 4-14 days to develop fifth disease after being exposed to the virus. Parvovirus B19 is usually spread through the saliva, phlegm, or nasal mucus of an infected person who coughs or sneezes. The virus can also be spread through the blood, which is why a pregnant woman can pass fifth disease to her baby.

The doctor usually knows your child has fifth disease by looking at the rash. In the case where there is no rash, the doctor may need to do blood tests to find out if your child has fifth disease. A blood test can identify antibodies to parvovirus B19 only during the first two months after becoming infected. After that, a blood test can determine only whether someone had the virus at some point in the past.

Rest up!

As for treatment, well, it’s a virus. You can’t cure a virus with antibiotics. Antibiotics kill bacteria germs but do nothing for viruses. Fifth disease is mostly about resting up until it passes. The rash may be a bit uncomfortable. Talk to the doctor. Sometimes antihistamines may be prescribed for the itch. For joint pain, acetaminophen can be helpful. Just DO NOT give aspirin to your child, since aspirin use in children has been linked to Reye syndrome, a serious illness.

If your child isn’t uncomfortable from the rash of fifth disease, there’s no reason for him not to go to school. He isn’t contagious once the rash comes out. The teacher may want to see a doctor’s note confirming that the child is not contagious.

It’s important to note that while fifth disease is usually no big deal in healthy children, it can be a much bigger hazard for a child with a weakened immune system from leukemia or other cancer, an organ transplant, or HIV infection. The parvovirus B19 can slow or even stop the body from producing red blood cells. When this happens, there’s a danger of serious, chronic anemia. This complication may require treatment in the hospital. A person with a weakened immune system may also remain contagious with fifth disease for a longer period of time.

A pregnant woman who gets fifth disease is also in a special category. The developing fetus can be endangered by the mother’s infection with parvovirus B19. This is especially true during the early months of pregnancy. If you are pregnant and your child has fifth disease, it’s a good idea to consult your physician. A blood test may show you’ve already had fifth disease. If not, you should be monitored with extra care.

There isn’t much to do about fifth disease except to let it pass. But if your child develops a rash, or joint pain, it’s a good idea to speak to your doctor. Otherwise, make sure your child gets plenty of rest, drinks lots of fluids, and eats a healthy diet.

It’s no fun getting sick or having a rash. The good news is that once your child has had fifth disease, he’ll most likely have lifelong immunity and won’t ever get it again.

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Science is Sheepish: Spirituality Makes Us Healthier, Happier People

All along, the majority position of Psychiatry has been that Psychiatry has nothing to do with religion and spirituality. Religious beliefs and practices have long been thought to have a pathological basis, and psychiatrists over a century have understood them in this light. Religion was considered as a symptom of mental illness. Jean Charcot and Sigmund Freud linked religion with neurosis. DSM3 portrayed religion negatively by suggesting that religious and spiritual experiences are examples of psychopathology. But recent research reports strongly suggest that to many patients, religion and spirituality are resources that help them to cope with the stresses in life, including those of their illness. Many psychiatrists now believe that religion and spirituality are important in the life of their patients.

The above is the introduction to a study published in 2008 on the subject of Spirituality and Mental Health. The semi-apologetic nature of this lead in to a rigorous scientific study underscores the irony of scientists encountering the spirit and religion as therapeutic and beneficial to their patients.

Here is the thing: science doesn’t like to acknowledge the existence of a higher power. Science likes to acknowledge nice, hard, provable facts. Which is why it may be an irksome thing for scientists to acknowledge the absolute fact that spirituality and religion can have a positive impact on health, both physical and mental.

And so, when forced to acknowledge the benefits of belief, they, the scientists, must remain detached and apologetic, explaining that while religion is a crock, if it helps their patients, it’s no skin off their teeth. But for the rest of us, those of us who are regular people, we are quite happy to acknowledge that striving to be spiritual people makes us better. We don’t care who says we’re being silly or imagining things. We believe what we believe.

And it makes us well. Makes us better people.

Yes. Everyone knows, for instance, that 12 step programs help people get sober. One of the reasons these programs work is that acknowledging a Higher Power is at the core of all of these programs, beginning with the mother of them all: Alcoholics Anonymous. That is what really sets apart 12-step programs from other types of substance abuse treatments and makes them work.

And this can be proven. In a study of teens aged 14-18, for instance, increased spirituality concurrent with receiving treatment for substance abuse was found to improve the likelihood that the participants would achieve abstinence, increase positive social behaviors, and lessen narcissistic behavior. One-third of the teens in this particular study entered this program for substance abuse as self-declared agnostics or atheists. Two-thirds of them were subsequently discharged claiming a spiritual identity.

What about mental health, quality of life, happiness? There too, it can be proven that having a spiritual side makes everything better. Scientists studied 320 children and found that strong spiritual beliefs were a strong predictor of greater happiness. In fact, the researchers found that it was possible to attribute up to 27% of the difference in happiness levels to spirituality.

But here’s a study that will really make your head spin: scientists found that people with a family history of deep spiritual ties were at a lower risk for depression. The reason? They had a relatively thicker cortex, the region of the brain found to be thinner in those with depression. In other words, if your mom believes in God (and maybe your grandmother before her), you’re less likely to become depressed. A family history of spirituality actually changes the physical contours of the brain! Mind-blowing (well, let’s hope not!).

By Patric Hagmann et.al. [CC BY 2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons
The funny thing is, it doesn’t matter what religion you are, or what you believe in. It’s all good from the standpoint of your mental health. Dan Cohen, an assistant teaching professor of religious studies at the University of Missouri says that’s because it’s more about spirituality acting as a personality trait. In the study he authored, no matter what faith the participants: Buddhist, Muslim, Jewish, Catholic, or Protestant, the more spiritual they were, the better their mental health. The more spiritual participants had lower levels of neuroticism and tended to be more outgoing.

“Our prior research shows that the mental health of people recovering from different medical conditions, such as cancer, stroke, spinal cord injury and traumatic brain injury, appears to be related significantly to positive spiritual beliefs and especially congregational support and spiritual interventions,” said Cohen. “Spiritual beliefs may be a coping device to help individuals deal emotionally with stress.

Cohen thinks that being a spiritual person aids mental health by reducing self-centeredness and by helping people see they are a part of a much larger whole. Forgiveness is also part of the dynamic, as it is a central theme for all the major religions. Being able to forgive means being able to let go of blame and recrimination after an accident or during serious illness.

With all of this evidence that having a spiritual life is healthy, there’s a tendency to sneer at the religious, to see them as immature or even a bit weird. Those who embrace spirituality, however, couldn’t care less what others think. Hunger Games actress Jennifer Lawrence, for instance, spoke about her spiritual life in a 2012 interview with Marie Claire, “In the South it’s very normal. It would be weird for me to go to sleep without praying,” said Lawrence.

Meanwhile, Jim Gaffigan, of Comedy Central, expressed the belief that, “When we were kids it didn’t matter if someone was religious, it just mattered if they were annoying.

Could it be Gaffigan longs to return to that time when no one cared what you believed as long as you didn’t foist it on others? It’s not difficult to empathize. No one likes to have a belief foisted on them.

Oprah Winfrey said it well in a talk she gave at Stanford University on spiritual practice, “I’m not telling you what to believe or who to believe, or what to call it,” said Winfrey. “But there is no full life, no fulfilled or meaningful, sustainably joyful life without a connection to the spirit.”

Rabbi Avi Davidowitz is Camp Rabbi at TheZone, Oorah’s summer camp facility. Oorah, of course, is a Kars4Kids affiliate charity, with the latter funding many of Oorah’s programs. At TheZone, Rabbi  D., as he is known to the campers, sees daily evidence of the power of spirituality and the interplay between religious development and personal growth.

Spirituality: Elisheva E.

One day, Rabbi D. was approached by a girl at the beginning of his lesson. She asked if she could tell her personal story to the assembled campers and Rabbi D., of course, gave his consent. “We were spellbound as Elisheva E. spoke about her reading disability and how she pined to pray the shmoneh esrei prayer, also known as the Silent Benediction just once in her life. This young girl said it took her 45 minutes to say shmoneh esrei. She wanted to stop when almost all the other campers had already gone on to their activities, but her camper partner, Alana L. who also struggles with reading from the prayer book, stood there next to her as if she too were still praying, and with this friendship and encouragement, Elisheva kept going until she finished.”

The two of them stayed at it until they both were able to read through the entire prayer.  Rabbi D. remarked that, “They spoke to us about never giving up: if we keep trying, Hashem (God) will help us out.”

This aptly illustrates the power of belief and spirituality: the idea that a difficulty can be conquered if you believe in God and if you try hard enough. It also shows how belief in God led to empathy between two individuals, both struggling with difficulties, one in the past, one in the present.

Spirituality: The Donation

Another striking Oorah story that shows how belief helps children strive to be better comes from Rabbi Avraham Krawiec, who served as Director of TheZone for many years.  “A girl just back from a camp outing walked over to me, telling me that she had to speak with me. She became emotional and said, ‘I just won some money in a raffle and I want to give back to Oorah knowing how much you do for my family.'”

Rabbi Krawiec was torn. On the one hand, he didn’t want to take her money, at the same time, he didn’t want to take away her right to a good deed, either, and that is what made him accept her modest donation of $15

As Rabbi Krawiec put it, “It was only $15 but it was the best $15 donation I ever received.”

Here a child has learned the value of charity, a central belief of Judaism. Her spiritual development has led her to the concept of paying it forward and helping others. As a result, the girl is growing up to be a kind person—someone who will surely be an asset to any community lucky enough to include her as a future adult!

Spirituality: Delayed Gratification

Belief in the tenets of religion can also teach us about self-control and delaying gratification for a higher purpose. Aryeh, a TeenZone division head at TheZone, kept in touch with one camper calling him just after the Rosh Hashana holiday to see how he was doing. As it turns out, the boy was not doing well at all.

He’d wanted to observe the holiday with orthodox rigor, but could not stop himself from using his mobile phone, a no-no for the orthodox. The camper begged Aryeh to help him come up with a plan so he wouldn’t repeat the error on the upcoming Yom Kippur holiday, when phones are similarly off-limits for the very religious.

The boy intuited that his phone was coming between him and his relationship to the Divine. The phone was not in the spirit of the Ten Days of Repentance when we look back over the year past, to see where and when we failed to stop ourselves from doing things we wanted to do in the moment, instead of pushing to come closer to God. After discussing with Aryeh various ways he might keep himself from using the phone on the holiday, he got a brainstorm idea: he’d mail his phone to Aryeh!

Well, this plan certainly worked. Aryeh’s phone rang right after the holiday, and the boy’s voice was filled with joy. He’d done it. Observed Yom Kippur from start to finish, as it was meant to be observed. He’d felt nothing but holiness all that day.

Is it any wonder that the following summer, on the very last day of camp at TheZone, as the buses were already beginning to leave, that the boy went over to Aryeh and asked him to remind him to mail his phone to him for safe-keeping over the Rosh Hashana holiday?

Here was a boy who had learned that contrary to everything he’d always thought, it is quite possible to delay gratification, to patiently endure whatever trials and tribulations come our way, and come out all the stronger for it! Here was a boy who had learned that being a believing Jew on Rosh Hashanah meant putting away the phone and looking into his own heart instead of a screen.

The scientists may not like it, but there it is: being in touch with our spiritual side makes us better, healthier people, kids or adults.

And that’s a fact.

It makes us strive to achieve the seemingly unachievable and well, it makes us happier, too

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When to Take Your Newborn Baby to the Doctor: A Checklist

New parents can find it difficult to know when a newborn baby needs a doctor’s attention. For one thing, no baby comes with a manual. Also, it takes time to learn the habits of this new and demanding little bundle of baby.

Meantime, parents worry. They worry if the baby sneezes, or sleeps an hour longer than usual. They check the baby constantly to make sure he or she is still breathing.

Call The Doctor?

What parents really wish they had is a checklist of symptoms they can refer to to see the baby is in need of medical care. And that’s exactly what follows below. If your baby has a symptom from the checklist, you can feel safe calling your baby’s doctor for an appointment. And in fact, even if your baby doesn’t have a symptom on the checklist, but you’re still worried, you are perfectly within your rights as a new parent to make an appointment. It’s never wrong to consult an expert.

Is Baby Getting Enough fluids?

Signs of dehydration:

  • Only one or two wet diapers a day
  • Seems too sleepy, is sluggish, lethargicWhen to take baby to the doctor infographic
  • Lips and mouth are dry

Does Baby Have Tummy Trouble?

Signs of gastric distress:

  • No stool during first 48 hours home from hospital
  • Movements contain white mucus
  • Blood streaks or specks in stool

Is Baby’s Temperature Normal?

Signs of fever or low body temperature:

  • Rectal temperature is lower than 96.8 degrees Fahrenheit or higher than 100.4 Fahrenheit

Is Baby Having Trouble Breathing?

Signs of respiratory distress:

  • Makes grunting sounds
  • Nostrils are flared
  • Chest pulls in—you can see the skin being sucked in over the collarbone, between and below the ribs
  • Breathing is rapid and remains so over time
  • Breathing is heavy and noisy (wheezing, whistling, crackling)

Call 911 if:

  • Baby takes more than 60 breaths per minute
  • Area around baby’s mouth is blue

Is Baby’s Umbilical Cord Stump Not Healing As It Should?

Signs of umbilical cord stump issues:

  • Bleeding that persists
  • A foul odor at the site of the stump
  • Pus
  • Redness or swelling around the stump

Is Baby Yellow?

Signs of jaundice:

  • Whites of eyes are yellow
  • Skin is yellow (chest, stomach, arms, legs)

Is My Baby In Pain?

Signs of pain:

    • Crying that lasts for more than half an hour

Is My Baby Sleeping Too Much?

Signs that baby is too sleepy:

        • The baby isn’t awake enough to feed even four hours after the last feeding

Is My Baby Sick?

Signs of illness:

            • Coughing
            • Diarrhea
            • Skin is pale
            • Vomits forcefully after three feedings in a row
            • Sucks weakly
            • Sucking grows weaker over time
            • Doesn’t seem very hungry at feeding time
            • Wants fewer than 6 feedings in one day (one 24-hour period)

New parents may wonder whether they can trust their instincts. The truth is, trust doesn’t have to enter into the equation. If something seems wrong with your baby, or if you’re just not sure if your baby is okay, just pick up the phone and make an appointment with your baby’s doctor. It’s always better to be safe than sorry. It’s also lots better to be embarrassed that you rushed to the doctor for no reason than to take a chance that your baby’s symptom is probably nothing when it may very well be something.

Here’s to happy, healthy babies and reasonably calm parents!

Save Your Baby’s Life With Infant CPR

Maybe you know how to perform CPR, but do you know how to perform infant CPR?

Most parents knows that babies, being small, need smaller amounts of nearly everything, ranging from food to shampoo to toothpaste to doses of medicine. With regard to medical care, however, it’s important to understand that infants and children are not simply small adults. Children of varying weights and ages, for example, require varying amounts of medication which must be carefully calculated and administered.

By the same token, when a baby requires emergency medical care, it’s important to tailor that care to the age of the patient. Babies have smaller, more delicate bodies. As such, you wouldn’t perform cardiopulmonary resuscitation (CPR) as you would for an adult, by pushing down hard on the chest with the heel of your hand. Such a technique would actually prove dangerous to a baby, and might crush the child’s chest.

Yet most people know that CPR saves lives. You use CPR when someone isn’t breathing or his heart stops beating. The CPR technique involves chest compressions and mouth-to-mouth resuscitation.

Here’s why CPR is important: when the heartbeat and breathing stop, blood can no longer circulate to bring oxygen to the brain. Without blood flow to the brain, permanent brain damage or death can occur in under 8 minutes. CPR helps provide much-needed oxygen in the event of an accident or other medical emergency. The emergency medical technique may also stimulate the patient’s heart to begin beating once more, and the patient’s lungs to begin inhaling and exhaling on their own.

Infant CPR Is Different

While infant CPR is quite different from adult CPR, the principle is the same. In both cases, the sooner lifesaving methods are taken, the more likely it is that the patient will survive and with little or no permanent damage. For this reason, parents should learn how to do infant CPR, as CPR will greatly enhance a child’s chances of survival in the event of an accident or other life-threatening situation.

How likely is it that, as a parent, you will need to perform CPR on your infant or child? It’s difficult to say, but if you’re a parent, you know that kids will be kids and accidents can happen. CPR can be useful in all sorts of emergencies, from car accidents, to drowning, poisoning, suffocation, electrocution, smoke inhalation, and sudden infant death syndrome (SIDS).

A good resource to have on hand in case of emergency is a step-by-step infant CPR chart, such as this one from Carrington College.

How to Save Your Baby's Life With Infant CPR

It’s a good idea to print out several copies of this chart. That way you can store copies of the infant CPR chart where you might need them most. Stick one on your fridge with a magnet; put one in your first aid kit, keep one in your purse, wallet, or diaper bag; and store one in the glove compartment of your car for easy reference should the need arise.

Assess Baby’s Condition

Before beginning CPR you will want to assess the baby’s situation. Look the child over to see if he has injuries or bleeding. Put your face close to the baby’s mouth and nose. Do you see the baby’s chest rising and falling? Do you feel his breath on your face? Talk to the baby or flick his feet to see if you can get a response. If the baby cries, that’s good. It means he can breathe.

Begin Chest Compressions

If the infant is not moving or breathing, call out for help. Ask someone to call 911, but don’t leave the baby. It’s crucial to begin CPR as soon as possible. CPR administered within the first few minutes can double or even triple the chances of survival.

Lay the baby on his back. If, however, you suspect a neck injury, roll the baby’s body over, moving his entire body at once.

Locate the baby’s breastbone, just below the nipples on the baby’s chest. Use two fingers to push down by about an inch to an inch and a half. Each push is called a “compression.” For a baby, you want to give 2 compressions per second, or 120 compressions a minute.

Do 30 chest compressions and then check for breathing by placing your ear above the baby’s mouth for no more than ten seconds. Watch that you don’t block the baby’s airway. While you do this, watch the baby’s chest for movement that might indicate breathing.

Open The Airway

Next, check that the baby’s airway is not blocked. To do this, tilt the baby’s head back and lift his chin. Sometimes, tilting the head back is enough to open up the baby’s airway and allow for breathing to begin again. Be aware that a baby who is gasping for air is not really breathing; only coughing or steady breathing indicates that breathing has returned to normal and CPR can be discontinued.

Look inside the baby’s mouth. If the baby is choking on a visible object, you may be able to remove it with your little finger.

If, after a few seconds (no more than 10 seconds), the baby is still not breathing, offer two rescue breaths (mouth-to-mouth resuscitation). A baby’s lungs are small so two gentle puffs of air of about one second each, are just right. Make sure that the baby’s neck is straight, the head tilted back, as you blow into the child’s mouth. That way, you ensure your rescue breaths make their way through the baby’s airways into his lungs. If the baby begins to breathe, you should see his chest clearly rise and fall.

Continuing CPR

If the baby doesn’t respond, continue CPR in cycles of 30 compressions followed by two rescue breaths. If you are alone, yell for help after each cycle of 30 compressions and 2 breaths, and request anyone in the area to dial 911. If there is no one to hear you, continue doing compressions and breaths, calling for help and checking the baby’s status every 30 compressions. After 2 minutes (4 rounds of 30 compressions/checks), if the baby is still unresponsive and there is still no one to make the call, make the call to 911 yourself, but keep the baby with you and continue to do compressions and breaths, as much as possible.

Once the call to 911 is made, the dispatcher will be able to guide you through the best way to help your child until emergency medical personnel arrive. It is likely you will need to continue to give CPR (30 compressions followed by 2 rescue breaths) until the baby breathes on his own or help arrives.

Risk Prevention

Some emergency situations such as car accidents may be unavoidable. Most incidents that require infant CPR, however, are preventable. Store chemicals and cleaning products out of baby’s reach. Offer your baby only age-appropriate toys to prevent choking risks. Babies are curious and active, so it is our duty as parents to provide a safe environment in which they can explore.

Better Safe Than Sorry

At the same time, knowing CPR may save your baby’s life, or the life of someone else’s child. Go over the steps and practice on a doll, so you’re all ready should the worst occur. You may never need to use infant CPR, but it’s better to learn the skill than be caught not knowing what to do in a time of dire emergency.

May all our babies stay safe!

Growth Hormones: Who Needs Them?

Growth hormones: it’s a treatment some parents think about when they see their children are shorter than their peers. Doctors call this short stature. Short stature can be inherited. But sometimes, kids are low on growth hormones, the stuff that makes us grow.

Parents of a child with short stature may worry how being short will affect their child. They may be concerned that a child who is shorter than his friends will be teased. This is especially true for parents of boys. Being tall may be seen as being masculine and strong. A short boy’s parents may worry their child will be seen as a wimp—that being short will somehow hold their child back from fulfilling his potential.

Research shows that tall people do have some advantages. Tall people tend to have higher salaries. Some studies show that people prefer taller partners. And when faced with a choice of two presidential candidates, voters lean toward the taller of the two.

Weighing all this research, a parent might come to the conclusion that being short is a disadvantage. A parent might fear that a child will feel somehow less than his peers, not quite up to scratch. And yet, that’s not the case.

Growth Hormones: An Ethical Dilemma

Most children of short stature feel just fine about themselves and do just as well as their taller friends. And short children grow up to do just as well as their colleagues. Parents should therefore weigh whether their desire to treat a child with short stature is based on their own concerns or on the child’s.  If the child doesn’t mind being short, treatment may not be the right path to take.

Growth Hormones For A Healthy Child?

Also, parents of a child with short stature would be wise to look at the bigger picture. Are the parents short? Is the child healthy, as is usually the case in children of short stature? In such a case, it might be reasonable to let the child be, and not begin treatment. If, on the other hand, the child’s short stature is due to a medical condition, for instance, an underactive thyroid, treatment may be important.

Growth Hormone: Weighing The Risks

There are other reasons why treating a child with a mild case of short stature might not be the right thing to do. There are ethical concerns. For one thing, growth hormone treatment is not risk-free. Should a parent treat a child for short stature because of worries about the child’s psychological well-being, when treatment brings serious health risks?

One study, for instance, found that the risk for stroke was doubled in young  adults who’d had growth hormone treatment as kids. Worse yet, the risk for a type of stroke that causes bleeding in the brain, hemorrhagic stroke, was seven times that of the general population.  Meantime, a 2012 study found that the risk for early death was higher after growth hormone treatment.  Finally, children treated with growth hormones may be six times as likely to develop type two diabetes.

And those are only the risks we know about.

A parent who want to treat a child with short stature might want to weigh whether a child’s self-esteem is worth the very real risks to that child’s life. Is it a little difficult for the child to reach things on a high shelf? Or is the child so short that he or she is pretty much disabled?

The thing is, not all kids are just short. Some are really, really short. And with the lack of height comes some very real issues. These are issues that make it reasonable to consider treatment, in spite of the risks. Because the risks of not taking treatment can be serious, too.

A driver who isn’t even 5 feet tall, for instance, is going to have shorter legs and arms. That means he or she will have to pull the car seat forward to reach the steering wheel, brakes, gas pedal, and clutch. That puts the driver at risk of injury or death for being too close to the air bag in the event of an accident. In other words, a driver of very short stature runs the risk of being killed by an air bag during a car accident.

How Effective Is Growth Hormone Treatment?

Many parents look to growth hormone therapy, hoping their very short children will be as tall as their friends. In actual fact, some kids will grow as much as 2 inches with growth hormone therapy, with about half those treated growing somewhat more or less than that. A slightly higher dose of  growth hormones may yield a child an extra   3-4 1/2 inches. But a higher dose may come with greater risks.

Then there’s cost.  Health insurance may cover part or all of the treatment. That varies. There may be copayments. But the actual cost of growth hormone shots can come in anywhere from $10,000 to $60,000 a year. Which means we’re talking about paying  a whopping  $52,000 per inch. But if your child is  4′ 11″, still growing, but with low natural levels of growth hormones, an inch or two could make all the difference.

Evaluation And Growth Hormone Treatment

In considering whether or not to begin treatment with growth hormones, your child’s doctor will want to evaluate whether or not there is a true growth disorder. There are many causes of short stature. The doctor will examine your child and based on his or her findings, will decide which on which tests to order. Blood tests may be ordered to look for hormone and chromosome irregularities. An x-ray may be ordered to see your child’s bone age. A child’s bone age may be different than the child’s actual age.  An x-ray can tell the doctor whether the child’s bones are still growing.

Other imaging scans may be used to get a look at the child’s pituitary gland. The pituitary gland makes and stores some hormones; stimulates the body to make others; and is responsible too, for how the body uses these hormones. A good working pituitary gland is necessary for growth.

Sometimes the doctor will decide to do a growth hormone stimulation test. This involves the doctor giving the child medications that make the pituitary gland produce growth hormones. The doctor will take blood samples from time to time to measure the child’s growth hormone levels.

If the tests show the child is a good candidate for growth hormone treatment, the child will likely have daily injections. Some children will receive only six injections  per week, while still others will have treatment only three times a week. Parents and child may see a quick spurt of growth within 3 or 4 months. The speed of the child’s growth during treatment will tend to become slower over time.

Treatment  for short stature is continued over the course of several years, until the child reaches a height considered acceptable, or until he’s reached the maximum height he can achieve. The rate of growth may seem very slow to parent and child after the initial growth spurt. Here it is important to have realistic expectations of what growth hormone treatment can achieve.

Other Reasons For Poor Growth

Sometimes tests may reveal a child has other hormone deficiencies that can affect growth. The child may be deficient in thyroid hormone, cortisol, or sex hormones. There are medications available to replace all of these hormones. Here, balance is very important. Only when all of these important hormones are at good levels, can a child achieve normal growth. For this reason, taking the medications exactly as directed, is important.

While the rest of us tend to think of growth as an automatic process, for children of short stature, it is no such thing. In the fight for gaining height, even the smallest tools can make a difference. That’s why in addition to taking medication to replace deficient hormones, children need to eat a healthy, balanced diet and get enough rest. Good nutrition and sleep habits are important for all children, even more so for children who are struggling for normal growth.

Does your child have short stature? Have you considered having him tested and treated? Do you feel confident you’ve made the right choice?