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Dysthymic disorder can be characterized as a chronic low-grade depression, persistent irritability, and a state of demoralization, often with low self-esteem. Major depressive disorder is a more extreme form of depression that can occur in children with ADHD and even more frequently among adults with ADHD. Dysthymic disorder and MDD typically develop several years after a child is diagnosed with ADHD and, if left untreated, may worsen over time. Bipolar disorder is a severe mood disorder that has only recently been recognized as occurring in children. Unlike adults who experience distinct periods of elation and significant depression, children with bipolar disorder present a more complex disturbance of extreme emotional instability, behavioral difficulties, and social problems. There is significant overlap with symptoms of ADHD, and many children with bipolar disorder also qualify for a diagnosis of ADHD. What to Look For Every child feels discouraged or acts irritable once in a while. Children with ADHD, who so often must deal with extra challenges at school and with peers, may exhibit these behaviors more than most. If your child claims to be depressed, however, or seems irritable or sad a large portion of each day, more days than not, she may have a coexisting dysthymic disorder. To be diagnosed with dysthymic disorder, a child must also have at least 2 of the following symptoms: Poor appetite or overeating Insomnia or excessive sleeping Low energy or fatigue Low self-esteem Poor concentration or difficulty making decisions Feelings of hopelessness Before dysthymic disorder can be diagnosed, children must have had these symptoms for a year or longer, although symptoms may have subsided for up to 2 months at a time within that year. The symptoms also must not be caused by another mood disorder, such as MDD or bipolar disorder, a medical condition, substance abuse, or just related to ADHD itself (low self-esteem stemming from poor functioning in school, for example). Finally, the symptoms must be shown to significantly impair your child’s social, academic, or other areas of functioning in daily life. Major depressive disorder is marked by a nearly constant depressed or irritable mood or a marked loss of interest or pleasure in all or nearly all daily activities. In addition to the symptoms listed previously for dysthymic disorder, a child with MDD may cry daily; withdraw from others; become extremely self-critical; talk about dying; or even think about, plan, or carry out a suicide attempt. Unlike the brief outbursts of temper exhibited by a child with ODD who does not get her way, a depressed child’s irritability may be nearly constant and not linked to any clear cause. Her inability to concentrate differs from ADHD-type inattention in that it is accompanied by other symptoms of depression, such as loss of appetite or loss of interest in favorite activities. Finally, the depression itself stems from no apparent cause—as opposed to being demoralized as a result of specific obstacles posed by ADHD or becoming depressed in response to parental divorce or any other stressful situation. (In fact, research has shown that the intactness of a child’s family and its socioeconomic status have little or no effect on whether a child develops MDD.) While children with ADHD/CD alone are not at higher than normal risk for attempting suicide, children with ADHD/CD who also have an MDD and are involved in substance abuse are more likely to make such an attempt and should be carefully watched. Talk of suicide (even if you are not sure whether it is serious), a suicide attempt, self-injury, any violent behavior, or severe withdrawal should be considered an emergency that requires the immediate attention of your child’s pediatrician, psychologist, or local hospital. A depressed child may admit to feeling guilty or sad, or she may deny having any problems. It is important to keep in mind the fact that many depressed children refuse to admit to their feelings, and parents often overlook the subtle behaviors that signal a mood disorder. By keeping in close contact with her teacher, bringing your child to each of her treatment reviews with her pediatrician, and including her in all discussions of her treatment as appropriate to her age, you can improve the chances that her pediatrician or mental health professional will detect any signs of developing depression, and that she will have someone to talk to about her feelings. A child with bipolar disorder and ADHD is prone to explosive outbursts, extreme mood swings (high, low, or mixed mood), and severe behavioral problems. Such a child is often highly impulsive and aggressive, with prolonged outbursts typically “coming out of nowhere” or in response to trivial frustrations. She may have a history of anxiety. She may also have an extremely high energy level and may experience racing thoughts and inflated self-esteem or grandiosity, extreme talkativeness, physical and emotional agitation, overly sexual behavior, and/or a reduced need for sleep. These symptoms can alternate with periods of depression or irritability, during which her behavior resembles that of a child with MDD. A child with ADHD/ bipolar disorder typically has poor social skills. Family relationships are often strained because of the child’s extremely unpredictable, aggressive, or defiant behavior. Early on the symptoms may only occur at home, but often begin to occur in other settings as the child gets older. Bipolar disorder is a serious psychiatric disorder that can sometimes include psychotic symptoms (delusions/hallucinations) or self-injurious behavior such as cutting, suicidal thoughts/impulses, and substance abuse. Many children with bipolar disorder have a family history of bipolar disorder, mood disorder, ADHD, and/or substance abuse. Children with ADHD and bipolar disorder are at higher risk than those with ADHD alone for substance abuse and other serious problems during adolescence. If your child has ADHD with coexisting bipolar disorder, her pediatrician will generally refer her to a child psychiatrist for further assessment, diagnosis, and recommendations for treatment. Treatment As with ADHD with anxiety disorders, treatment of ADHD with depression usually involves a broad approach. Treatment approaches may include a combination of cognitive-behavioral therapy, interpersonal therapy (focusing on areas of grief, interpersonal relationships, disputes, life transitions, and personal difficulties), traditional psychotherapy (to help with self-understanding, identification of feelings, improving self-esteem, changing patterns of behavior, interpersonal interactions, and coping with conflicts), as well as family therapy when needed. Medication management approaches, as with ADHD and other coexisting conditions, include treating the most disabling condition first. If your child’s ADHD-related symptoms are causing most of her functioning problems, or the signs of depression are not completely clear, your child’s pediatrician is likely to start with stimulant medication to treat the ADHD. In cases when the depressive symptoms turn out to stem from poor functioning due to ADHD and not to a depressive disorder, they may diminish as the ADHD symptoms improve. If the ADHD and depressive symptoms improve, your child’s pediatrician will probably maintain stimulant treatment alone. If her ADHD symptoms improve but her depression remains the same, even after a reasonable trial of the type of broad psychotherapeutic approach described previously, her pediatrician may add another medication, most commonly an SSRI—a class of medications including Prozac, Zoloft, Paxil, Luvox, and Celexa. Selective serotonin reuptake inhibitors can make the symptoms of bipolar disorder worse, so a careful evaluation must be completed before starting medication. If this approach is unsuccessful, you may be referred to a developmental/behavioral pediatrician or a psychiatrist, who may try other classes of medications. Last Updated 11/21/2015 Source ADHD: A Complete and Authoritative Guide (Copyright © 2004 American Academy of Pediatrics)" }, "62": { "health_issue_x_health_issue_article.id": 62, "health_issue.id": 2, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "ADHD", "health_issue_article.id": 62, "health_issue_article.ts": "2018-04-19 03:05:35", "health_issue_article.title": "Myths and Misconceptions about ADHD", "health_issue_article.content": "Myths and Misconceptions about ADHD Page Content Article BodyMuch misinformation has circulated about ADHD and its causes, diagnosis, and treatment over recent decades. Following are a number of untrue assumptions about the disorder, along with explanations aimed at clarifying the issues. “My preschooler is too young to have ADHD.” Many parents believe that ADHD is a problem of school-aged children. But, in fact, the symptoms of ADHD, and the diagnosis of the condition, can occur as early as the preschool years. At times, even doctors have difficulty differentiating “normal” behavior from those suggesting ADHD in a preschooler. Although a young child may normally have characteristics like impulsive or hyperactive behavior, these can be symptoms of ADHD as well. A pediatrician will evaluate the intensity of these behaviors in a preschooler to help in making the diagnosis. Attention-deficit/hyperactivity disorder is diagnosed when these problems get to the point where they are significantly and consistently interfering with a preschooler’s life, development, self-esteem and general functioning. “He’s just lazy and unmotivated.” This assumption is a common response to the behavior exhibited by a child who is struggling with ADHD. A child who finds it nearly impossible to stay focused in class, or to complete a lengthy task such as writing a long essay, may try to save face by acting as though he does not want to do it or is too lazy to finish. This behavior may look like laziness or lack of motivation, but it stems from real difficulty in functioning. All children want to succeed and get praised for their good work. If such tasks were easy for children with ADHD to accomplish, and provided rewarding feedback, those children would seem just as “motivated” as anyone else. “He’s a handful—or, she’s a daydreamer—but that’s normal. They just don’t let kids be kids these days.” It is true that all children are impulsive, active, and inattentive at times, sometimes to the extreme. A child with ADHD, however, is more than just a “handful” for his parents and teachers, or a “daydreamer” who tends to lose herself in thought. His or her hyperactivity and/or inattentiveness constitute a real day-to-day functional disability. That is, it seriously and consistently impedes the ability to succeed at school, fit into family routines, follow household rules, maintain friendships, interact positively with family members, avoid injury, or otherwise manage in his or her environment. As you will learn in Chapter 2, this clear functional disability is what pediatricians look for when diagnosing ADHD and recommending treatment. “Treatment for ADHD will cure it. The goal is to get off medication as soon as possible.” Attention-deficit/hyperactivity disorder is a chronic condition that often does not entirely go away, but instead changes form over time. Many older adolescents and adults are able to organize their lives and use techniques that allow them to forego medical treatment, although a significant number continue various forms of treatment and support throughout their life spans. Depending on the circumstances and demands as a person matures, this may or may not include continuing with medication or other treatments for ADHD at different times, even through adult life. The true goal is to function well at each stage of childhood and adolescence, and as an adult, rather than to stop any or all treatments as soon as possible. “He focuses on his video games for hours. He can’t have ADHD.” For the most part ADHD poses problems with tasks that require focused attention over long periods, not so much for activities that are highly engaging or stimulating. School can be especially challenging for a person with ADHD because the typical classroom lecture, compared with a video game, can be relatively unstimulating in terms of visuals, sound, and physical activity. Assignments can be long and require sustained, organized thought and effort, and the daily routine can be less structured and predictable than a child with ADHD might require. Most children with ADHD are diagnosed during their school years precisely because the academic, social, and behavioral demands during these years are so difficult for them. The difficulties that such children experience may make it seem that school is the problem (and, certainly, that possibility should be considered), but it is more likely to be a result of the child’s struggle to manage in this environment. Other situations that can be problematic for children with ADHD include social interactions, with their constant, subtle exchange of emotional and social information; sports that require a high degree of focus or concentration; and extracurricular activities that require them to sit still, listen, or wait their turn for long periods. “ADHD is caused by poor parental discipline.” Attention-deficit/hyperactivity disorder is not a result of poor discipline—although behaviors that stem from ADHD can challenge otherwise effective parenting styles. Inconsistent limit-setting and other ineffective parenting practices can, however, worsen its expression. You will find a number of proven parenting techniques that can help children with ADHD manage their behavior. “If, after a careful evaluation, a child doesn’t receive the ADHD diagnosis, she doesn’t need help.” Attention-deficit/hyperactivity disorder is diagnosed on a continuum, which means that a child can exhibit a number of ADHD-type behaviors yet not to the extent that she is diagnosed with ADHD. This does not mean she needs no help coping with the problems that she does have. The family of a child who does not meet the criteria for ADHD but has similar problems may be offered pediatric counseling, education about the range of normal developmental behaviors, home behavior management tools, school behavior management recommendations, social skills interventions, and help with managing homework flow and with organization and planning. “Children with ADHD outgrow this condition.” Parents and many doctors once believed that as children with ADHD enter adolescence and then move into adulthood, their ADHD will no longer be an issue. But recent studies have shown that some aspects of ADHD can persist well into adult life for as many as 85% of these children. Some adults can still benefit from the use of ADHD medication for the rest of their lives. Others have demonstrated enough improvement that this medication becomes unneeded depending on what occupation they choose and their ability to succeed in relationships and other social activities. No matter what the circumstances of particular adults may be, however, they can make adjustments in their environment, take full advantage of their own strengths, and lead very productive adult lives, even when aspects of ADHD still persist. Last Updated 1/1/2004 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics)" }, "63": { "health_issue_x_health_issue_article.id": 63, "health_issue.id": 2, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "ADHD", "health_issue_article.id": 63, "health_issue_article.ts": "2018-04-19 03:05:39", "health_issue_article.title": "Neurofeedback, Hypnotherapy, and Guided Imagery", "health_issue_article.content": "Neurofeedback, Hypnotherapy, and Guided Imagery Page Content Article BodyA number of proposed treatments for ADHD—including hypnotherapy, self-hypnosis, guided imagery, neurofeedback, and relaxation training—are aimed at helping a child begin to regulate his own behavior and psychological state. The fact that these techniques can be used quite successfully for children in other areas of self-regulation (headache management, teaching bowel control, etc) increases their appeal as a form of treatment. Hypnotherapy has not been shown to significantly improve the core symptoms of ADHD, though it may improve such accompanying problems as sleep problems and tics when used as part of an integrated treatment approach. One difference between the use of hypnotherapy for headaches versus ADHD is that children learn to institute the self-hypnosis at the early signs of a headache. There is no comparable “trigger” with ADHD, and children cannot do self-hypnosis all day long. Neurofeedback treatment involves placing electrodes on a child’s head to monitor brain activity. Children are asked, for example, to change the aspects of a video game (for example “making the sun set with your mind”), which happens when their brainwaves are of a desired frequency. The theory is that learning to do this increases their arousal levels, improves their attention, and results in reductions in hyperactive-impulsive behaviors. This is based on findings that many children with ADHD show low levels of arousal in frontal brain areas, with excess of theta (daydreamy) waves and deficit of beta waves (indicators of a highly focused mind), thereby reducing ADHD. The studies on the use of neurofeedback to date have been criticized for lacking the appropriate controls or the random assignment of test subjects to the treatment or sham treatment groups. It should also be pointed out that neurofeedback treatment is an expensive approach to treating ADHD. Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics)" }, "64": { "health_issue_x_health_issue_article.id": 64, "health_issue.id": 2, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "ADHD", "health_issue_article.id": 64, "health_issue_article.ts": "2018-04-19 03:05:44", "health_issue_article.title": "Non-Stimulant Medications Available for ADHD Treatment", "health_issue_article.content": "Non-Stimulant Medications Available for ADHD Treatment Page ContentSome non-stimulant medications may be appropriate for children who have been diagnosed with Attention Deficient Hyperactivity Disorder (ADHD) and certain coexisting conditions—such as ADHD with accompanying tic disorders (such as Tourette Syndrome)—because they can in some cases treat both conditions simultaneously. Proven alternate choices to stimulant medications include Atomoxetine, Guanfacine XR, Clonidine XR, and Bupropion. Note: The first three are newer FDA approved medications that have not been used as long as stimulants. Bupropion is not FDA approved but has had several small trials for ADHD. Atomoxetine, guanfacine XR and clonidine XR are considered second-line (second-choice) treatments. Bupropion is a third line agent.AtomoxetineAtomoxetine (Strattera) is a non-stimulant approved by the FDA for the treatment of ADHD. It is in the class of medications known as selective norepinephrine reuptake inhibitors. Because atomoxetine does not have a potential for abuse, it is not classified as a controlled substance. Atomoxetine is a newer medication and the evidence supporting its use is more limited than for stimulants. Atomoxetine, unlike stimulants, is active around the clock. However, atomoxetine has been found to be only about two-thirds as effective as stimulant medications. After starting atomoxetine it may take up to 6 weeks before it reaches its maximum effectiveness. Possible side effectsAtomoxetine has a warning on it that it may, in a very small number of cases, have some potential for causing suicidal thoughts in the first few weeks of treatment. Atomoxetine may be helpful in the treatment of children who have both ADHD and anxiety, since stimulants may worsen anxiety symptoms. Side effects are generally mild but can include decreased appetite, upset stomach, nausea or vomiting, tiredness, problems sleeping, and dizziness. Jaundice (turning yellow) is mentioned in a warning on the medication, but is extremely rare. Taking atomoxetine with food can help avoid nausea and stomachaches. Atomoxetine should be used in lower doses in children also taking certain antidepressants like fluoxetine (Prozac) or paroxetine (Paxil), because they can raise the atomoxetine levels in the bloodstream.Atomoxetine is now considered an option for first-line therapy for ADHD, and is the first non-stimulant to fall into the first-line category. Parents concerned about the possibility that stimulants may be used for substance abuse may choose atomoxetine as the first-line agent for their child. It is often used for children who have had unsuccessful trials of stimulants.Long-Acting Guanfacine Long-acting guanfacine (Intuniv) is in the group of medications known as alpha agonists. These medications were developed for the treatment of high blood pressure but have also been used to treat children with ADHD who have tics, sleep problems, and/or aggression. It has recently been approved by the FDA for the treatment of children with ADHD. Long-acting guanfacine is a pill, but it cannot be crushed, chewed, or broken and must be swallowed whole. Like atomoxetine, it is not a controlled substance. Possible side effectsIt does not cause much appetite suppression, so may be a good choice for children who lost a significant amount of weight when taking a stimulant. Side effects can include sleepiness, headaches, fatigue, stomachaches, nausea, lethargy, dizziness, irritability, decreased blood pressure, and decreased appetite. Although sleepiness occurs in a large number of children when children start taking long-acting guanfacine, it seems to get better as they continue to take it. It may take 3 to 4 weeks to see medication benefit. Long-Acting ClonidineLong-acting clonidine (Kapvay) is also FDA approved for the treatment of ADHD. It is taken twice a day while long acting guanfacine is once a day. Both long acting alpha agonists have been studied for use alone or as an add-on to stimulants when the stimulant alone does not eliminate all the symptoms of ADHD. Two other shorter-acting alpha agonists are available for use, but not approved by the FDA for ADHD. These are clonidine (Catapres) and short-acting guanfacine (Tenex). These can be used as adjunctive medications, or if FDA-approved medications are not helpful. If no FDA-approved medication has been found helpful for your child, you should also consider whether ADHD is the correct diagnosis, and whether additional coexisting conditions might be present. BupropionBupropion is a unique type of antidepressant that has been less frequently studied as a treatment for ADHD. It is also not FDA approved for ADHD or as an antidepressant in people under the age of 18. Some research indicates that bupropion is effective in reducing ADHD symptoms in some children, but it seems to have less effect than stimulants or atomoxetine. Its use in ADHD is not widespread. Possible side effectsThe side effects, though usually minimal, can include irritability, decreased appetite, insomnia, and a worsening of existing tics. It is important to note that at higher doses, bupropion may make some individuals more prone to seizures and cause hallucinations, so it should be used cautiously in children who have seizure disorders.Additional Information from HealthyChildren.org: How ADHD Treatments Are Proven Effective Common ADHD Medications & Treatments for ChildrenADHD and Substance Abuse: The Link Parents Need to KnowFDA's Role in the Drug Approval ProcessGeneric Drugs: What Parents Need to Know Article Body Last Updated 6/17/2016 Source American Academy of Pediatrics (Copyright © 2016)" }, "65": { "health_issue_x_health_issue_article.id": 65, "health_issue.id": 2, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "ADHD", "health_issue_article.id": 65, "health_issue_article.ts": "2018-04-19 03:05:50", "health_issue_article.title": "Parenting Teenagers with ADHD", "health_issue_article.content": "Parenting Teenagers with ADHD Page ContentAchieving independence is a primary developmental goal of adolescence. Your teenager will experience this urge as strongly as his peers without ADHD, but his or her impulsivity, inattention, and aspects of delayed maturity may mean moving slower toward this goal. Specifically, you may need to:Remove loss of privileges in response to a broken rule. Know that long-standing loss of privileges, however, harbors resentment and has little teaching value.Work at consciously modeling responsible behavior. Watch the video Offering Boundaries & Being Role Models for more information and tips.Break down tasks and responsibilities into smaller steps. Reward your teen for accomplishing them.Develop a plan for transferring responsibilities over to your teenager as he or she works toward independence.Addressing Your Concerns Directly It's easy to imagine that a teenager would resent a 10:00 pm curfew, if his or her friends are, for example, were allowed to stay out until midnight. Talk with your teen about the reasons if you worry about his staying out later. You may be concerned that parties tend to get wilder after about 10:00 pm, a time where you have observed that his or her impulsivity usually increases, or that driving is potentially riskier late at night because his medication will have worn off by then. If your teen feels he or she is ready to take responsibility for staying out later, and you have made the necessary adjustments to ensure success (such as possibly changing his or her medication routine to enhance attention while driving), then extend the curfew for 1 hour. If he or she arrives home on time with no evidence of high-risk activity, give praise. Reward your teen with a continued 11:00 pm curfew. Moving in these small steps allows you to continue to build a mutual trust and respect—vital for your teen's self- esteem.Providing Structure & SupportDuring your child's earlier years, you were encouraged to actively monitor his or her behavior in the classroom and at home. Now that your teenager is growing more independent, you may feel it is time to stop this type of monitoring. However, many teens with ADHD continue to need more parental monitoring and structure.While it is best for parents of many other 15-year-olds to back off and let their child manage his or her own homework, for example, a teen with ADHD may need continued monitoring to see that he or she is completing work and turning it in on time. While other parents may grow laxer about knowing where their older teenagers are every minute, you may have reason to continue monitoring where your teenager is, with whom, what he or she is doing, and when he or she will be home, particularly when you sense that he or she might be in a high-risk situation that may be difficult to manage. While monitoring is necessary, it must be done in a way that is also respectful of your teenager and his or her developmental needs.Establishing & Enforcing RulesAny teen might have an argumentative style, and your teen's resistance to your continued monitoring may lead to a great deal of boundary testing, negotiating, and possibly outright rebellion. When warranted, you may feel better— and will be able to save some energy—if you identify 4 or 5 nonnegotiable rules based on the issues you consider essential for your family. You may decide, for example, that use of illegal drugs of any kind—including marijuana, alcohol, and cigarettes—will not be tolerated in your house, or that driving can only be done at times when stimulant medication still has an active effect. These strict, nonnegotiable rules should be reserved for critical issues of safety or family functioning.When you have arrived at the 4 or 5 basic rules, write them down and discuss them with your teenager. Explain that the trust built through compliance with these rules can open the door to negotiating the other freedoms he or she craves. Discuss the rewards for compliance (i.e. extended privileges in other areas) and the consequences (i.e. increased restrictions) for breaking these rules. Enforce these consequences consistently. Catch your teen doing something good. Remember, rewards are much more powerful than negative consequences.Negotiating with Your TeenOnce your teenager has shown he or she is able to follow these few essential rules, you are likely to feel more at ease when negotiating other issues. Negotiation is based on the assumption that, as a teen matures, he or she will take a more active role in creating the rules by which he or she lives. It is important to establish the fact that as the parent, right now you assume the final responsibility for rules and consequences. A good way to negotiate rules or solutions to family conflicts is to use a technique called problem-solving training. This technique consists of the following steps:Define the problem and its effect.Come up with a variety of possible solutions.Choose the best solution.Plan how to implement the solution.Renegotiate a new solution if necessary.When first attempting to solve problems in this way, it is best to start with issues that are important but not emotionally intense for your teenager or for you. Eventually you may become so adept at this rational form of problem solving that you and your teenager will be able to resolve arguments on the spot, in most cases, using informal versions of this technique.Providing Appropriate ConsequencesYou will need to \"stick to your guns\" in enforcing the rules and procedures on which you have all already agreed. Provide rewards and consequences consistently, and as soon as possible after the behavior has occurred. Pre–agreed-on losses of privileges, for example, may be temporarily losing car key rights for coming home late. The tighter the link between the behavior and the consequences the better. Try to let these negotiated consequences take the place of argument, recrimination, yelling, or nitpicking. Keep the conflicts and emotions out of it. Simply provide the appropriate response to keep family life relatively pleasant and upbeat.Fostering a Positive Attitude & Giving Each Other BreaksResearch suggests that the presence of one fully supportive adult in the life of a child with ADHD is one of the key factors in determining that child's future success. Be sure to invest plenty of quality time in your teenager—and make it fun and rewarding for both of you. Sometimes, when things get too tough at home, it is a good idea to take a break from one another. A weekend that you spend away can restore your awareness that your problems at home can be solved, and can give all of you the space you need to maintain a healthy relationship. Parents need support too!As any teenager explores newly accessible choices, he or she will inevitably make some good and bad decisions. This is a normal and an important part of becoming a responsible adult. Additional Information from HealthyChildren.org: How to Help New High School Grads Transition into AdulthoodEncouraging Teens to Take Responsibility for Their Own HealthParent-Teen Driving Agreement ADHD and Substance Abuse: The Link Parents Need to KnowBehavior Therapy for Children with ADHD Article Body Last Updated 5/13/2016 Source Mental Health Leadership Work Group (Copyright © 2016 American Academy of Pediatrics)" }, "66": { "health_issue_x_health_issue_article.id": 66, "health_issue.id": 2, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "ADHD", "health_issue_article.id": 66, "health_issue_article.ts": "2018-04-19 03:05:53", "health_issue_article.title": "Resisting to Take ADHD Medication", "health_issue_article.content": "Resisting to Take ADHD Medication Page Content Article BodyMy 14-year-old daughter began taking stimulants for her ADHD 6 months ago. Though we were all hesitant at first to try medication, the results were so clearly positive when she did try it that we had no problem continuing. Lately, though, my daughter has begun “forgetting” to take her pill in the morning. The more we remind her, the more resistant she gets. Her typical response is, “OK, Mom, I’ll take it! Do you think I forgot for a minute that I have ADHD?” So far, she hasn’t missed her medication more than one or two days in a row, but we fear these lapses may grow more frequent if we don’t figure out why they’re happening. Is this kind of resistance common with most kids with ADHD? Medication continues to carry with it a stigma that many children with ADHD—particularly early adolescents—feel acutely as they try to fit in with their peer group in the neighborhood and at school. In addition, adolescents with ADHD must negotiate the same process of seeking independence from parents that all teenagers do. Your daughter’s resistance to taking medication despite its obvious benefits is not unusual, though it is an issue that needs to be addressed. While there is no one-size-fits-all solution to your situation, you should work with your daughter and the rest of your treatment team toward a positive approach. This may involve allowing her more control of the medication process—letting her make decisions about when and where she takes the medication— as well as control over the dosage schedule. Because she is first starting medication in her teenage years, it is important that she had buy-in to the initial trial of medication and that it was carried out in a manner that clearly demonstrated to her that the medication had a clear, positive effect. It is also important that she remain as informed as possible about the medication and all aspects of her medication management. Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics)" }, "67": { "health_issue_x_health_issue_article.id": 67, "health_issue.id": 2, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "ADHD", "health_issue_article.id": 67, "health_issue_article.ts": "2018-04-19 03:05:59", "health_issue_article.title": "Simplifying, Organizing, and Structuring the Home Environment: For Parents of Children with ADHD", "health_issue_article.content": "Simplifying, Organizing, and Structuring the Home Environment: For Parents of Children with ADHD Page Content Article BodyYou will find that your child’s ability to progress in nearly all areas of self-management and social interaction increases when his environment is organized and structured to meet his unique needs. If your child is physically impulsive or accident-prone, take the time to unclutter and safety-proof your home. Some children with ADHD may benefit from an orderly physical environment with a place for each object, while keeping the environment (eg, your child’s room) organized may be a hopeless task for others. Try helping your child organize his room at a level he can manage. Daily routines are an absolute necessity for many children with ADHD. Consistent limitsetting with predictable consequences, along with limited choices (not “What do you want to eat?” but “Do you want an apple or a boiled egg?”), also make your child’s world more manageable and help him meet his goals. Written lists of chores or other daily tasks are especially useful in helping your child keep track of what he needs to do, and is an excellent habit for him to carry into adolescence and adulthood. When considering how to structure your child’s day-to-day experiences, it may help to picture your growing child as a construction project in progress. The limits, lists, routines, and other measures you are putting in place today are like scaffolding that will provide the necessary support as he develops fully. As he turns these routines into daily habits and becomes more self-directed, some of these supports can be gradually removed while his underlying functioning remains well in place. (You may no longer have to create homework checklists with him, for example, because he has learned to make them himself.) Far from “babying” your child, helping to structure and organize his world allows him to add to his competencies and experience many more small triumphs, increasing his self-esteem. Just as you have observed that your child may feel less overwhelmed when his home life is well organized, so you may find that organizing your own family life as thoroughly as possible will help you feel calmer and more in control. (This is even more likely to be the case, of course, if you have ADHD.) With the number of medical visits, teachers’ conferences, and treatment reviews necessary to maintain your child’s well-being and continued progress, a family calendar including all scheduled activities can be an essential for many families. Daily lists of tasks to perform and errands to run will help you stay organized just as they help your child. Many parents find it worthwhile to devote a private 10 minutes to half an hour before the kids get up in the morning to “regroup”—thinking about everything that must be accomplished that day and arranging tasks in order of priority. Make sure that any plan is realistic and not overwhelming. Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics)" }, "68": { "health_issue_x_health_issue_article.id": 68, "health_issue.id": 2, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "ADHD", "health_issue_article.id": 68, "health_issue_article.ts": "2018-04-19 03:06:06", "health_issue_article.title": "Special Education Services and Federal Laws", "health_issue_article.content": "Special Education Services and Federal Laws Page Content Article BodyFor most children with ADHD, staying in a regular classroom with an excellent teacher, trained in and adept at behavior management, is the preferred situation. This is especially true if any necessary accommodations for your child can be put into place in that setting. Children with ADHD whose academic or behavior struggles cannot be managed effectively in a regular classroom using typical strategies may require special education services. These services may be delivered in a variety of settings, including the regular classroom and separate classrooms for part or all of a school day. The setting is determined by the needs of the eligible child. The federal law Individuals with Disabilities Education Act (IDEA) guarantees your child’s right to be evaluated for and receive such services if eligible, free of charge. IDEA The IDEA was designed to guarantee the provision of special services for children whose disabilities severely affect their educational performance. A child can receive services under IDEA if she is learning disabled, emotionally disturbed, or “other health impaired.” Your child may qualify for IDEA coverage if she has been diagnosed with ADHD and her condition has been shown to severely and adversely affect school performance. Note that both conditions must be met: an ADHD diagnosis alone does not guarantee coverage for your child unless it or another disorder is adversely affecting her educational performance. In most cases, it is a child’s coexisting learning, disruptive behavior, anxiety, or other functional problem—not the ADHD itself—that qualifies her for IDEA coverage. The IDEA is based on providing services for categories of disability. It includes 13 categories that require coverage “without undue delay.” Under this law, schools are responsible for identifying and evaluating children who are suspected of having disabilities and who may need special education services. Depending on her diagnoses and assessment, your child’s disability may be categorized as “specific learning disability,” “serious emotional disturbance,” or “other health impairment.” After these needs are evaluated, documented, and eligibility determined, an IEP can be created to detail the special education services that are necessary. Specific Learning Disabilities The IDEA criteria for specific learning disabilities can vary from state to state. Children qualify for learning disabilities under this law if they have significant needs in the areas of Oral expression Listening comprehension Written expression Basic reading skills Reading comprehension Mathematics calculation Mathematics reasoning Testing for learning disabilities generally includes assessment by the school psychologist. In addition to learning disabilities, children with ADHD and significant emotional problems can also receive services through IDEA. To receive these services, a child’s educational performance needs to be adversely affected by emotional and behavioral concerns: An inability to learn that can be best explained on a behavioral basis An inability to build or maintain relationships with peers and teachers Inappropriate types of behavior or feelings A persistent mood of unhappiness or depression A tendency to develop physical symptoms or fears associated with personal or schoolproblems A comprehensive evaluation that meets federal and state guidelines needs to be completed before children can qualify for services as emotionally disturbed. A note from your child’s pediatrician that your child has ADHD or is depressed or anxious will not be enough to qualify her for services. All children, including those with ADHD, are also eligible for services if they have the disabilities below and can be shown to need special education in order to benefit from their educational program. Intellectual or cognitive disabilities Hearing impairment, including deafness Speech or language impairment Visual impairment, including blindness Serious emotional disturbance Orthopedic impairment Autism spectrum disorders Traumatic brain injury Other health impairment, including ADHD and Tourette disorder Specific learning disabilities Developmental delay (used in some states for children aged 3–9 who have problems with development of their physical, cognitive, communication, social/emotional, or adaptive skills [everyday life skills]). Additional considerations for eligibility include (1) schools cannot be overidentifying children in terms of race or ethnicity; (2) a child is not eligible for special education solely because of lack of instruction in academic areas; and (3) in newer IDEA legislation, children no longer need to demonstrate a severe discrepancy between their ability (IQ) and their achievement. An alternative way to assess a child’s need for special services, as mentioned previously, is RTI, an approach where a student with academic delays is given one or more research-validated interventions. The student’s academic progress is monitored frequently to see if those interventions are sufficient to help the student catch up with his or her peers. If the student fails to show significantly improved academic skills despite several well-designed and implemented interventions, this failure to “respond to intervention” can be viewed as evidence of an underlying learning disability. One advantage of RTI in the diagnosis of educational disabilities is that it allows schools to intervene early to meet the needs of struggling learners and not require them to fail before anything is done. Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics)" }, "69": { "health_issue_x_health_issue_article.id": 69, "health_issue.id": 2, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "ADHD", "health_issue_article.id": 69, "health_issue_article.ts": "2018-04-19 03:06:12", "health_issue_article.title": "Treatment & Target Outcomes for Children with ADHD", "health_issue_article.content": "Treatment & Target Outcomes for Children with ADHD Page ContentOnce the diagnosis is confirmed, the outlook for most children who receive treatment for ADHD is encouraging. There is no specific cure for ADHD, but there are many treatment options available. Each child's treatment must be tailored to meet his individual needs. In most cases, treatment for ADHD should include: A long-term management plan withTarget outcomes for behaviorFollow-up activitiesMonitoringEducation about ADHDTeamwork among doctors, parents, teachers, caregivers, other health care professionals, and the childMedicationBehavior therapy including parent trainingIndividual and family counselingTreatment for ADHD uses the same principles that are used to treat other chronic conditions like asthma or diabetes. Long-term planning is needed because these conditions are not cured. Families must manage them on an ongoing basis. In the case of ADHD, schools and other caregivers must also be involved in managing the condition. Educating the people involved about ADHD is a key part of treating your child. As a parent, you will need to learn about ADHD. Read about the condition and talk with people who understand it. This will help you manage the ways ADHD affects your child and your family on a day-to-day basis. It will also help your child learn to help himself. Setting target outcomesAt the beginning of treatment, your pediatrician should help you set around 3 target outcomes (goals) for your child's behavior. These target outcomes will guide the treatment plan. Your child's target outcomes should focus on helping her function as well as possible at home, at school, and in your community. You need to identify what behaviors are most preventing your child from success. Here are examples of target outcomes: Improved relationships with parents, siblings, teachers, and friends (e.g., fewer arguments with brothers or sisters or being invited more frequently to friends' houses or parties)Better schoolwork (e.g., completing class work or homework assignments)More independence in self-care or homework (e.g., getting ready for school in the morning without supervision)Improved self-esteem (e.g., increase in feeling that she can get her work done)Fewer disruptive behaviors (e.g., decrease in the number of times she refuses to obey rules)Safer behavior in the community (e.g., when crossing streets)The target outcomes should be: RealisticSomething your child will be able to doBehaviors that you can observe and count (e.g., with rating scales)Your child's treatment plan will be set up to help her achieve these goals. Keeping the treatment plan on track:Ongoing monitoring of your child's behavior and medications is required to find out if the treatment plan is working. Office visits, phone conversations, behavior checklists, written reports from teachers, and behavior report cards are common tools for following the child's progress. Treatment plans for ADHD usually require long-term efforts on the part of families and schools. Medication schedules may be complex. Behavior therapies require education and patience. Sometimes it can be hard for everyone to stick with it. Your efforts play an important part in building a healthy future for your child. Ask your pediatrician to help you find ways to keep your child's treatment plan on track. What if my child does not reach his target outcomes?Most school-aged children with ADHD respond well when their treatment plan includes both medication and behavior therapy. If your child is not achieving his goals, your pediatrician will assess the following factors: Were the target outcomes realistic?Is more information needed about the child's behavior?Is the diagnosis correct?Is another condition hindering treatment?Is the treatment plan being followed?Has the treatment failed?While treatment for ADHD should improve your child's behavior, it may not completely eliminate the symptoms of inattention, hyperactivity, and impulsivity. Children who are being treated successfully may still have trouble with their friends or schoolwork. However, if your child clearly is not meeting his specific target outcomes, your pediatrician will need to reassess the treatment plan. Unproven treatments:You may have heard media reports or seen advertisements for \"miracle cures\" for ADHD. Carefully research any such claims. Consider whether the source of the information is valid. At this time, there is no scientifically proven cure for this condition. The following methods need more scientific evidence to prove that they work: Megavitamins and mineral supplementsAnti–motion-sickness medication (to treat the inner ear)Treatment for candida yeast infectionEEG biofeedback (training to increase brain-wave activity)Applied kinesiology (realigning bones in the skull)Reducing sugar consumptionOptometric vision training (asserts that faulty eye movement and sensitivities cause the behavior problems)Always tell your pediatrician about any alternative therapies, supplements, or medications that your child is using. These may interact with prescribed medications and harm your child. Will there be a cure for ADHD soon?While there are no signs of a cure at this time, research is ongoing to learn more about the role of the brain in ADHD and the best ways to treat the disorder. Additional research is looking at the long-term outcomes for people with ADHD. Will my child outgrow ADHD?ADHD continues into adulthood in most cases. However, by developing their strengths, structuring their environments, and using medication when needed, adults with ADHD can lead very productive lives. In some careers, having a high-energy behavior pattern can be an asset. Additional Information on HealthyChildren.org:Understanding ADHD: Information for ParentsCommon ADHD Medications & Treatments for ChildrenBehavior Therapy for Children with ADHDHow Schools Can Help Children with ADHDAdditional Resources:The following is a list of support groups and additional resources for further information about ADHD. Check with your pediatrician for resources in your community. National Resource Center on AD/HD Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) or 800/233-4050Attention Deficit Disorder Association or 856/439-9099Center for Parent Information and Resources National Institute of Mental Health or 866/615-6464Tourette Association of America or 888/4-TOURET (486-8738) Article Body Last Updated 1/9/2017 Source Understanding ADHD: Information for Parents About Attention-Deficit/Hyperactivity Disorder (Copyright © 2007 American Academy of Pediatrics, Updated 6/2016)" }, "70": { "health_issue_x_health_issue_article.id": 70, "health_issue.id": 2, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "ADHD", "health_issue_article.id": 70, "health_issue_article.ts": "2018-04-19 03:06:18", "health_issue_article.title": "Understanding ADHD: Information for Parents", "health_issue_article.content": "Understanding ADHD: Information for Parents Page ContentAlmost all children have times when their behavior veers out of control. They may speed about in constant motion, make noise nonstop, refuse to wait their turn, and crash into everything around them. At other times they may drift as if in a daydream, unable to pay attention or finish what they start. However, for some children, these kinds of behaviors are more than an occasional problem. Children with attention-deficit/hyperactivity disorder (ADHD) have behavior problems that are so frequent and severe that they interfere with their ability to live normal lives. These children often have trouble getting along with siblings and other children at school, at home, and in other settings. Those who have trouble paying attention usually have trouble learning. An impulsive nature may put them in actual physical danger. Because children with ADHD have difficulty controlling this behavior, they may be labeled \"bad kids\" or \"space cadets.\" Left untreated, ADHD in some children will continue to cause serious, lifelong problems, such as poor grades in school, run-ins with the law, failed relationships, and the inability to keep a job. Effective treatment is available. If your child has ADHD, your pediatrician can offer a long-term treatment plan to help your child lead a happy and healthy life. As a parent, you have a very important role in this treatment. What is ADHD?ADHD is a condition of the brain that makes it difficult for children to control their behavior. It is one of the most common chronic conditions of childhood. It affects 4% to 12% of school-aged children. ADHD is diagnosed in about 3 times more boys than girls. The condition affects behavior in specific ways. What are the symptoms of ADHD?ADHD includes 3 groups of behavior symptoms: inattention, hyperactivity, and impulsivity. The table below explains these symptoms. Are there different types of ADHD?Not all children with ADHD have all the symptoms. They may have one or more of the symptom groups listed in the table above. The symptoms usually are classified as the following types of ADHD: Inattentive only (formerly known as attention-deficit disorder [ADD])—Children with this form of ADHD are not overly active. Because they do not disrupt the classroom or other activities, their symptoms may not be noticed. Among girls with ADHD, this form is more common.Hyperactive/impulsive—Children with this type of ADHD show both hyperactive and impulsive behavior, but they can pay attention. They are the least common group and are frequently younger.Combined inattentive/hyperactive/impulsive—Children with this type of ADHD show a number of symptoms in all 3 dimensions. It is the type that most people think of when they think of ADHD.How can I tell if my child has ADHD?Remember, it is normal for all children to show some of these symptoms from time to time. Your child may be reacting to stress at school or home. She may be bored or going through a difficult stage of life. It does not mean she has ADHD. Sometimes a teacher is the first to notice inattention, hyperactivity, and/or impulsivity and bring these symptoms to the parents' attention. Perhaps questions from your pediatrician raised the issue. At routine visits, pediatricians often ask questions such as: How is your child doing in school?Are there any problems with learning that you or your child's teachers have seen?Is your child happy in school?Is your child having problems completing class work or homework?Are you concerned with any behavior problems in school, at home, or when your child is playing with friends?Your answers to these questions may lead to further evaluation for ADHD. If your child has shown symptoms of ADHD on a regular basis for more than 6 months, discuss this with your pediatrician. Additional Information on HealthyChildren.org:Causes of ADHD: What We Know TodayTreatment & Target Outcomes for Children with ADHDCommon ADHD Medications & Treatments for ChildrenHow Schools Can Help Children with ADHDAdditional Resources:The following is a list of support groups and additional resources for further information about ADHD. Check with your pediatrician for resources in your community. National Resource Center on AD/HD Understanding ADHD (Understood.org) Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) or 800/233-4050Attention Deficit Disorder Association or 856/439-9099Center for Parent Information and Resources National Institute of Mental Health or 866/615-6464Tourette Association of America or 888/4-TOURET (486-8738) Article Body Last Updated 1/9/2017 Source Understanding ADHD: Information for Parents About Attention-Deficit/Hyperactivity Disorder (Copyright © 2007 American Academy of Pediatrics, Updated 6/2016)" }, "71": { "health_issue_x_health_issue_article.id": 71, "health_issue.id": 2, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "ADHD", "health_issue_article.id": 71, "health_issue_article.ts": "2018-04-19 03:06:22", "health_issue_article.title": "Vision, Inner-Ear, Auditory Integration, and Sensory Integration Problems", "health_issue_article.content": "Vision, Inner-Ear, Auditory Integration, and Sensory Integration Problems Page Content Article BodyAn entire class of theories about the causes of ADHD and effective treatments for it centers on the workings of the senses. Problems relating to sight, hearing, balance controlled by the inner ear, sensory integration, and so on have been proposed as underlying conditions that lead to ADHD and accompanying problems and disorders. Each theory is linked to a treatment approach, and each form of treatment is supported by a large number of vocal enthusiasts. Again, none of these theories or methods has yet been proven valid in diminishing or eliminating the behaviors related to ADHD. Optometric Training Optometric training, a kind of eye training for children with learning disabilities, is based on the theory that faulty eye movements and problems in visual perception can cause dyslexia, language disorders, and other learning problems that frequently accompany ADHD. Named behavioral optometry by the optometrists who developed and support this form of therapy, the treatment consists of teaching children specific visual skills as a way of improving learning. These skills include tracking moving objects, fixating on or locating objects quickly and accurately, encouraging both eyes to work together successfully, and changing focus efficiently. The skills are taught through the use of eye exercises and special colored or prismatic lenses. Optometric training is often supplemented with training in academic skills, nutrition, and personal relationships. This treatment is frequently quite expensive. However, little research has supported the theory that dyslexia or other learning disabilities are caused by vision defects or problems, and thus vision training is an ineffective approach to reading and learning disabilities. In 1984 the American Academy of Pediatrics (AAP), along with the American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Ophthalmology, issued a policy statement affirming that no known scientific evidence “supports the claims for improving the academic abilities of dyslexic or learning-disabled children with treatment based on visual training, including muscle exercises, ocular pursuit or tracking exercises, or glasses (with or without bifocals or prisms).” Because vision training is not only ineffective but may delay more effective treatment for coexisting learning disabilities, it is not recommended. Motion-Sickness Medication Dr Harold Levinson, a New York physician, is responsible for the popular theory that inner-ear problems can cause problems with balance, coordination, and energy regulation, which in turn can lead to ADHD and learning disabilities—as well as dyslexia, obsessive-compulsive disorder, panic disorder, and many other difficulties. In his book, Total Concentration, Levinson states that ADHD symptoms are often related to a kind of dizziness or motion sickness resulting from inner-ear problems. He recommends treatment with anti–motion-sickness medications, often in combination with antihistamines, tricyclic antidepressants, the antipsychotic drug thioridazine (Mellaril), vitamin B complex, gingerroot, or stimulants. To date no studies have revealed a link between ADHD and inner-ear deficiencies, and Levinson’s theory conflicts with much that is currently known about ADHD. His claims rest almost entirely on anecdotal information, and the published reports of his work consist of individual case studies rather than scientific research. Because insufficient research has been conducted to prove this treatment effective, and because it contradicts many of the known facts about the causes of ADHD, it is not recommended as a treatment option. Sound Treatment Difficulties with auditory integration—that is, organizing, attending to, and making sense out of information while listening—have also been suspected as a cause of ADHD. The Tomatis Method, devised by the French physician Alfred Tomatis, is perhaps the best-known treatment approach aimed at this proposed deficiency. A large number of individual accounts testify to the effectiveness of Tomatis’ auditory-stimulation sessions—in which children listen to high-frequency modifications of the human voice, classical music, and Gregorian chant through special headphones called “electronic ears,” and are given listening training to improve focus and attention. The effects of music and sound on brain function have been insufficiently studied to date, however. While one study did show that boys with ADHD were better able to solve arithmetic problems when listening to their favorite music—implying that auditory stimulation may help to improve performance on specific tasks—no scientifically controlled studies have yet supported the claim that the Tomatis Method improves ADHD. Any improvement that has been reported by individuals may be due to the treatment’s emphasis on individual attention for each child, with at least 75 specially designed listening sessions and targeted training in social and academic skills. Sensory Integration Training Dr Jean Ayres, an occupational therapist, developed the theory that much of the hyperactivity in today’s children is the result of poor sensory integration—that is, the failure of the brain to organize and make use of information derived from such senses as vision, hearing, smell, taste, touch, motion, and temperature. According to this theory, sensory integration dysfunction makes it difficult to concentrate and sit still, and puts children at risk for learning disabilities, problems with coordination, social difficulties, and touch sensitivity. Ayres claimed that sensory integration dysfunction is usually genetically inherited or acquired prenatally, during birth, or from environmental toxins. Recommended treatment includes exercises or experiences that provide the child with extrasensory stimulation and feedback—such as brushing and rubbing of the skin, deeppressure exercises, vibration, stretching, and so on. While this approach has some intuitive appeal, feels good to children, can be calming, and is said to address the poor coordination and social difficulties that many children with ADHD experience, no convincing evidence has surfaced to prove that deficits in sensory integration are a cause of related disorders. Studies have not shown that sensory integrative training succeeds as a treatment for children with ADHD or learning or behavior problems. While not known to be harmful in any way, the expense and time demands are such that this approach cannot be recommended as a treatment for ADHD. Last Updated 11/21/2015 Source ADHD: A Complete and Authoritative Guide (Copyright © 2004 American Academy of Pediatrics)" }, "72": { "health_issue_x_health_issue_article.id": 72, "health_issue.id": 2, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "ADHD", "health_issue_article.id": 72, "health_issue_article.ts": "2018-04-19 03:06:26", "health_issue_article.title": "When Children with ADHD are Labeled", "health_issue_article.content": "When Children with ADHD are Labeled Page Content Article BodyMy son who is in fourth grade has just been diagnosed with ADHD. Both his teacher and doctor agree. I also agree that he is overactive and has trouble focusing. He is starting to have problems with his schoolwork and friendships even though he is a very bright and loving child. I can see that he needs some help, but I am also very concerned about his getting “labeled” and what negative effects this might have on him. You share a common concern of many parents whose child has just received the diagnosis of ADHD. In a sense, the diagnosis just tells you what you already know—that the problem behaviors you described during your child’s evaluation match the diagnostic criteria for ADHD, and that they are causing your child significant problems on a daily basis. The diagnosis may serve as an entrance point for receiving different levels of help at school, and for knowledgeable teachers as a means to better understand and help your child. However, the diagnosis can be misunderstood by underinformed teachers or other adults who interact regularly with your child—but there is now a good deal of effort going into training teachers about ADHD and related disorders. You and your child’s pediatrician can also contribute a great deal to this effort with your child’s own teacher in many positive ways. Community support groups like CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) can provide you with a forum for discussing this and a place to meet parents who have already had experience with many of these challenges. Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics)" }, "73": { "health_issue_x_health_issue_article.id": 73, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 73, "health_issue_article.ts": "2018-04-19 03:06:31", "health_issue_article.title": "Allergies", "health_issue_article.content": "Allergies Page Content Article BodyAllergies and asthma, which typically start in childhood, are by far the most common chronic diseases among children in the United States. Consider the following statistics: Some 50 million Americans have allergies (about 1 in 5 people in this country). The most common type of allergy is hay fever (allergic rhinitis); the medical cost of treating it, when direct and indirect costs are added up, now exceeds $7 billion a year. More than 17 million Americans have asthma, and about one-fourth of these are younger than 18 years. Asthma accounts for about 4,000 deaths a year. Seventy to 80% of school-aged children with asthma also have allergies, which are among the most common triggers for asthma, closely tied with viral respiratory infections. If one parent has allergies, there’s a 25% chance that a child will also be allergic. The risk is more than doubled to 60% to 70% if both parents have allergies. Many aspects of allergies, eczema, and asthma still are not fully understood. But advances in the diagnosis and treatment of these disorders are helping millions of sufferers. What Are Allergies? Many people mistakenly use the word allergy to refer to a disease or almost any unpleasant or adverse reaction. We often hear someone say, “I have allergies,” “He’s allergic to hard work,” or “She’s allergic to anything that’s green.” In reality, allergies are reactions that are usually caused by an overactive immune system. These reactions can occur in a variety of organs in the body, resulting in diseases such as asthma, hay fever, and eczema. Your immune system is made up of a number of different cells that come from organs throughout the body—principally bone marrow, the thymus gland, and a network of lymph nodes and lymph tissue scattered throughout the body, including the spleen, gastrointestinal tract, tonsils, and the adenoid (an olive-shaped structure that is located at the top of the throat behind the nose). Normally, it’s the immune system that protects the body against disease by searching out and destroying foreign invaders, such as viruses and bacteria. In an allergic reaction, the immune system overreacts and goes into action against a normally harmless substance, such as pollen or animal dander. These allergy-provoking substances are called allergens. Who Is at Risk? Although allergies can develop at any age, they most commonly show up during childhood or early adulthood. A search of family medical histories of a child with allergies will usually turn up a close relative who also has allergies. If one parent, brother, or sister has allergies, there is a 25% chance that a child will also have allergies. The risk is much higher if both parents are allergic. But the child will not necessarily be allergic to the same substances as the parents or always show the same type of allergic disease (eg, hay fever, asthma, eczema). Symptoms Associated With Allergies Eyes, Ears, Nose, Mouth Red, teary, or itchy eyes Puffiness around the eyes Sneezing Runny nose Itchy nose, nose rubbing Postnasal drip Nasal swelling and congestion Itchy ear canals Itching of the mouth and throat Lungs Hacking dry cough or cough that produces clear mucus Wheezing (noisy breathing) Feeling of tightness in the chest Low exercise tolerance Rapid breathing; shortness of breath Skin Eczema (patches of itchy, red skin rash) Hives (welts) Intestines Cramps and intestinal discomfort Diarrhea Nausea or vomiting Miscellaneous Headache Feelings of restlessness, irritability Excessive fatigue When to Suspect an Allergy Allergies can result in various types of conditions. Some are easy to identify by the pattern of symptoms that invariably follows exposure to a particular substance; others are more subtle and may masquerade as other conditions. Here are some common clues that should lead you to suspect your child may have an allergy. Patches of bumps or itchy, red skin that won’t go away Development of hives—intensely itchy skin eruptions that usually last for a few hours and move from one part of the body to another Repeated or chronic cold-like symptoms, such as a runny nose, nasal stuffiness, sneezing, and throat clearing, that last more than a week or two, or develop at about the same time every year Nose rubbing, sniffling, snorting, sneezing, or drippy nose Itchy, runny eyes Itching or tingling sensations in the mouth and throat Coughing, wheezing, difficulty breathing, and other respiratory symptoms Unexplained bouts of diarrhea, abdominal cramps, and other intestinal symptoms. Where Does Asthma Fit In? Although allergies can trigger asthma and asthma is often associated with allergies, they are actually 2 different things. In simple terms, asthma is a chronic condition originating in the lungs, whereas allergies describe reactions that originate in the immune system and can affect many organs, including the lungs. Many different substances and circumstances can trigger an asthma attack—exercise, exposure to cold air, a viral infection, air pollution, noxious fumes, tobacco smoke, and for many asthma sufferers, a host of allergens. In fact, about 80% of children with asthma also have allergies. Although allergies are important in triggering asthma, severe asthma exacerbations are often set off by the good old common cold virus, totally unrelated to allergy. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" }, "74": { "health_issue_x_health_issue_article.id": 74, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 74, "health_issue_article.ts": "2018-04-19 03:06:36", "health_issue_article.title": "Allergy Causes in Children: What Parents Can Do", "health_issue_article.content": "Allergy Causes in Children: What Parents Can Do Page Content Article BodyWhat Causes Allergies? Children get allergies from coming into contact with allergens. Allergens can be inhaled, eaten, or injected (from stings or medicine) or they can come into contact with the skin. Some of the more common allergens are: Pollens from trees, grasses, and weeds Molds, both indoor and outdoor Dust mites that live in bedding, carpeting, and other items that hold moisture Animal dander from furred animals such as cats, dogs, horses, and rabbits Some foods and medicines Venom from insect stings Allergies tend to run in families. If a parent has an allergy, there is a higher chance that his or her child also will have allergies. This risk increases if both parents are allergic. How Can I Help My Child? Identifying and avoiding the things your child is allergic to is best. If your child has an allergic condition, try the following: Keep windows closed during the pollen season, especially on dry, windy days when pollen counts are highest. Keep the house clean and dry to reduce mold and dust mites. Avoid having pets and indoor plants. Avoid those things that you know cause allergic reactions in your child. Prevent anyone from smoking anywhere near your child, especially in your home and car. See your pediatrician for safe and effective medicine that can be used to help alleviate or prevent allergy symptoms. Common Allergic Conditions Condition Triggers Symptoms Anaphylaxis Foods, medicines, insect stings, latex, and others Skin, gut, and breathing symptoms that may get worse quickly. Severe symptoms could include trouble breathing and poor blood circulation. Asthma Cigarette smoke, viral infections, pollen, dust mites, furry animals, cold air, changing weather conditions, exercise, airborne mold spores, and stress Coughing, wheezing, trouble breathing (especially during activities or exercise); chest tightness Contact dermatitis Skin contact with poison ivy or oak, latex, household detergents and cleansers, or chemicals in some cosmetics, shampoos, skin medicines, perfumes, and jewelry Itchy, red, raised patches that may blister if severe. Most patches are found at the areas of direct contact with the allergen. Eczema (atopic dermatitis) Sometimes made worse by food allergies or coming in contact with allergens such as pollen, dust mites, and furry animals. May also be triggered by irritants, infections, or sweating. A patchy, dry, red, itchy rash in the creases of the arms, legs, and neck. In infants it often starts on the cheeks, behind the ears, and on the chest, arms, and legs. Food allergies Any foods, but the most common are eggs, peanuts, milk, nuts, soy, fish, wheat, peas, and shellfish Vomiting, diarrhea, hives, eczema, trouble breathing, and possibly a drop in blood pressure (shock) Hay fever Pollen from trees, grasses, or weeds Stuffy nose, sneezing, runny nose; breathing through the mouth because of stuffy nose; rubbing or wrinkling the nose and face to relieve nasal itch; watery, itchy eyes; redness or swelling in and under the eyes Hives Food allergies, viral infections, and medicines such as aspirin or penicillin. Sometimes the cause is unknown. Itchy skin patches, bumps (large and small) commonly known as welts that are more red or pale than the surrounding skin. Hives may be found on different parts of the body and do not stay at the same spot for more than a few hours. Insect sting allergy Primarily aggressive stinging insects such as yellow jackets, wasps, and fire ants Anaphylaxis Medication allergy Various types of medicines or vaccines Itchy skin rashes, anaphylaxis Last Updated 11/21/2015 Source Allergies in Children (Copyright ? 1997 American Academy of Pediatrics, Updated 4/2013)" }, "75": { "health_issue_x_health_issue_article.id": 75, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 75, "health_issue_article.ts": "2018-04-19 03:06:39", "health_issue_article.title": "Allergy Medicine for Children", "health_issue_article.content": "Allergy Medicine for Children Page Content Article BodySeveral effective, easy-to-use medications are available to treat allergy symptoms. Some are available by prescription; others, over-the-counter. As with any medications, over-the-counter products should be used only with the advice of your child's doctor.AntihistaminesAntihistamines, the longest-established allergy medications, dampen the allergic reaction mainly by suppressing the effects of histamine (itching, swelling, and mucus production) in the tissues. For mild allergy symptoms, your child's doctor may recommend one of the antihistamines widely available over-the-counter. Children who don't like to swallow tablets may prefer the medication in syrup, chewable, or melt-away form. Antihistamines can be useful for controlling the itchiness that accompanies hay fever, eczema, and hives. Your pediatrician may advise your child to take them regularly or just as needed. Antihistamine nasal sprays are also available for hay fever. They work locally in the nose to reduce symptoms. Some kids shy away from nose sprays and prefer using the antihistamines taken by mouthSome over-the-counter antihistamines, in particular the \"old-generation\" type, can cause drowsiness. For this reason, it's best to give the dose in the evening. Some new generation antihistamines may cause mild drowsiness especially after the first dose. Ask your child's doctor whether these non-sedating antihistamines are appropriate for your child.DecongestantsFor hay fever sufferers, antihistamines help stop runny nose, itching, and sneezing, but they have little effect on nasal congestion or stuffiness. To cover the range of symptoms, an antihistamine is often given together with a decongestant, sometimes combined in a single medication. In contrast to older antihistamines, which tend to make people sleepy, decongestants taken by mouth can cause stimulation. Children taking these medications may act hyper, feel anxious, have a racing heart, or find it difficult to get to sleep. Because of these possible side effects, it is best to avoid using long-term daily decongestants to control your child's nasal congestion, and instead, use another type of medication, such as a nasal corticosteroid spray.Decongestant treatment can be given topically with nose drops or sprays, but these medications have to be used carefully, and only for a short while, because prolonged use can lead to a rebound effect. The resulting stuffy nose is more difficult to treat than the original allergy symptoms.CromolynCromolyn sodium is sometimes recommended to prevent nasal allergy symptoms. This medication can be used every day for chronic problems or just for a limited period when a child is likely to encounter allergens. The medication is available without prescription as a nasal spray; it is taken 3 or 4 times a day. Nasal cromolyn has almost no side effects, but it's potency is not high, and because it requires frequent administration, it is hard to use on a regular basis in a consistent way.CorticosteroidsCorticosteroids, a category of medications also called steroids or cortisones, are highly effective for allergy treatment and are widely used to stop symptoms. They are available as skin medications (such as creams and ointments), nasal sprays, asthma inhalers, and pills or liquids. Steroid creams and ointments are a mainstay of treatment for children with eczema. They control eczema when applied once a day, or even once a day, depending on the severity of the rash or even once a day if the rash is not severe. Nasal sprays that contain a compound derived from cortisone have become the most effective form of treatment for patients with nasal allergy problems. Once-daily dosing is usually enough. These medications work best if used on a regular daily schedule, rather than with as-needed, interrupted dosing. No problems have emerged so far over many years in patients using cortisone nasal sprays over the long term.Allergy ImmunotherapyImmunotherapy, or allergy shots, may be recommended to reduce your child's sensitivity to airborne allergens. This form of treatment consists of giving a person material he is allergic to, by injection, with the goal of changing his immune system and making him less allergic to that material. Not every allergy problem can or needs to be treated with allergy shots, but treatment of respiratory allergies to pollen, dust mites, and outdoor molds is often successful. Currently, sub-lingual (under the tongue) immunotherapy is available for grass pollen and ragweed pollen only and is typically started a few months before the grass or ragweed pollen season. Immunotherapy for cat (and possibly dog) allergy can also be very effective, but allergy specialists advise that avoidance is the best way to manage animal allergies in children.Immunotherapy takes some time to work and demands patience and commitment. The treatment is given by injecting gradually stronger doses of allergen extract once or twice a week at first, then at longer intervals—for example, once every 2 weeks, then every 3 weeks, and eventually every 4 weeks. The effect of the extract reaches its maximum after 6 to 12 months of injections.After a number of months of immunotherapy, a child usually feels his allergy symptoms are better. Allergy injections are often continued for 3 to 5 years, and then a decision is made whether to stop them. Many children do fine after the shots are stopped and have little or no return of their symptoms.Additional InformationAllergy Causes in Children: What Parents Can DoAllergies and HyperactivityDiagnosing Allergies Seasonal Allergies in ChildrenWhen Pets Are the Problem Last Updated 11/21/2015 Source Adapted from Allergies and Asthma: What Every Parent Needs to Know (Copyright © 2010 American Academy of Pediatrics)" }, "76": { "health_issue_x_health_issue_article.id": 76, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 76, "health_issue_article.ts": "2018-04-19 03:06:44", "health_issue_article.title": "Asthma Fables and Facts", "health_issue_article.content": "Asthma Fables and Facts Page Content Article BodyAlthough our knowledge of asthma is expanding year by year, many people still cling to outdated beliefs about the disease. Following are some that are often repeated: Fable: Asthma comes and goes. Fact: Asthma is often an inflammatory condition that is always in the airways, even when the person is not having trouble breathing. Exposure to an asthma trigger can worsen symptoms, but the underlying condition never goes away, although it can be controlled with medications and environmental control measures. Fable: Asthma is an emotional disorder; it’s “all in the mind.” Fact: Asthma is a lung disease; it affects the airways, not the brain. It’s true that symptoms may get worse when a person is under emotional stress, but this is probably more marked in adults and less so in children. Changes in the airways in asthma occur through physiological mechanisms, not emotional ones. Fable: People with asthma should use medications only when they have attacks; otherwise, the medications lose their effect. Fact: Regularly using medications is the only way to calm the underlying airway inflammation and prevent asthma flare-ups. Used at the correct dosage, daily medications do not lose their effect or cause uncomfortable side effects. Effective antiasthma medications include inhaled beta-agonists such as albuterol to stop attacks, and inhaled steroids, long-acting beta-agonists, and leukotriene modifiers to prevent attacks from occurring at all. Fable: Asthma is just an annoying condition, not a real disease. Fact: Asthma can kill when people do not get treatment to control the underlying condition and stop severe attacks. If everybody who needed medications used the proper ones to control symptoms and prevent flare-ups, hospitalizations and deaths from asthma would be greatly reduced. Fable: Children grow out of asthma. Fact: Most people who have asthma are born with a tendency to the condition and keep it for life. It is true many children get much better with age, and their asthma appears to go away completely. However, many have it return in adulthood. Other children who still have asthma are less likely to lose their asthma as they go in to their adult years. Fable: Asthma clears up when you move to a warm, dry climate. Fact: If the proper environmental measures are taken and medications are regularly used, people with asthma can live comfortably in any climate they prefer. Very rarely do people ever have to move out of a city or other area because of their asthma. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" }, "77": { "health_issue_x_health_issue_article.id": 77, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 77, "health_issue_article.ts": "2018-04-19 03:06:49", "health_issue_article.title": "Asthma Gadgets: How to Use a Dry Powder Inhaler - Diskus", "health_issue_article.content": "Asthma Gadgets: How to Use a Dry Powder Inhaler - Diskus Page Content Article BodyDry Powder Inhalers, or DPIs, work on the principle that the patient breathes in rapidly and deeply to deliver the medication. This is in contrast to how one breathes in with an MDI, which is slowly. This video demonstrates the proper use of the diskus technique. Watch video Last Updated 1/23/2016 Source PediaLink Essentials: Asthma Gadgets 2010 (Copyright © 2010 American Academy of Pediatrics)" }, "78": { "health_issue_x_health_issue_article.id": 78, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 78, "health_issue_article.ts": "2018-04-19 03:06:56", "health_issue_article.title": "Asthma Gadgets: How to Use a Spacer with a Mask", "health_issue_article.content": "Asthma Gadgets: How to Use a Spacer with a Mask Page Content Article BodyThere are 2 major techniques when using a tube spacer. The choice depends on whether the spacer is being used with a mask (for infants and toddlers) or without a mask. This video demonstrates the proper use of the spacer with a small mask. Watch video Last Updated 11/21/2015 Source PediaLink Essentials: Asthma Gadgets 2010 (Copyright © 2010 American Academy of Pediatrics)" }, "79": { "health_issue_x_health_issue_article.id": 79, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 79, "health_issue_article.ts": "2018-04-19 03:07:00", "health_issue_article.title": "Asthma Gadgets: How to Use a Spacer without a Mask", "health_issue_article.content": "Asthma Gadgets: How to Use a Spacer without a Mask Page Content Article BodyThere are 2 major techniques when using a tube spacer. The choice depends on whether the spacer is being used with a mask (for infants and toddlers) or without a mask. This video demonstrates the proper use of the spacer without a mask. Watch video Last Updated 1/23/2016 Source PediaLink Essentials: Asthma Gadgets 2010 (Copyright © 2010 American Academy of Pediatrics)" }, "80": { "health_issue_x_health_issue_article.id": 80, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 80, "health_issue_article.ts": "2018-04-19 03:07:05", "health_issue_article.title": "Asthma Gadgets: How to Use an MDI Closed-Mouth Inhaler", "health_issue_article.content": "Asthma Gadgets: How to Use an MDI Closed-Mouth Inhaler Page Content Article BodyMetered Dose Inhalers, or MDIs, shoot medication through a nozzle to form a spray that comes out through the mouthpiece. MDIs deliver a high concentration of medicine directly to the lungs very quickly. There are 2 types of propellant-containing MDI devices: press-and-breathe and breath-actuated. This video demonstrates the proper use of the press-and-breathe inhaler using a closed-mouth technique. Watch video Last Updated 1/23/2016 Source PediaLink Essentials: Asthma Gadgets 2010 (Copyright © 2010 American Academy of Pediatrics)" }, "81": { "health_issue_x_health_issue_article.id": 81, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 81, "health_issue_article.ts": "2018-04-19 03:07:09", "health_issue_article.title": "Asthma Inhalers", "health_issue_article.content": "Asthma Inhalers Page Content Article BodyMany parents of children with asthma may already have heard of this alphabet soup of abbreviations — CFCs, MDIs, HFAs, and ODSs. They all have to do with a change in the type of metered dose inhalers (MDIs) being made to help reduce the release of chlorofluorocarbons (CFCs) into the atmosphere when taking certain asthma medications. Until recently, most MDIs in the United States, such as albuterol inhalers, contained CFCs — chemicals that propel the medicine in an inhaler into the lungs. But CFCs are ozone-depleting substances (ODSs) that hurt the environment. Manufacturers are now making CFC-free inhalers, also called hydrofluoroalkane (HFA) inhalers, that do not rob the atmosphere of ozone. “The FDA [Food and Drug Administration] and various manufacturers are reporting that the transition to HFA albuterol is occurring at a substantial pace,” says Pamela Wexler, an advisor to the U.S. Stakeholders Group on MDI Transition. This group is composed of nine leading medical societies and patient associations, including the American Academy of Pediatrics and the American Lung Association. “Estimates [near the start of 2007] indicate that as much as 50 percent of prescriptions are now being filled with HFA.” What Parents Need to Know What Is Happening? Metered-dose inhalers (MDIs) contain ozone-depleting substances, chlorofluorocarbons (CFCs), and are being phased out. All patients using a CFC-containing MDI will eventually need to transition to other products. FDA has set a phase-out date for CFC albuterol of December 31, 2009. CFC-free MDIs are safe and effective. Every other developed country is switching away from CFC MDIs without harm to patients. What Can Patients Do Now? Switch to CFC-free medications now that they are available. Use this transition as an opportunity to talk with your health care provider about your asthma management plan. Talk to your health care provider about CFC-free medications and non-MDI alternatives. Talk to your doctor, nurse, pharmacist, respiratory therapist, or other health care provider when you receive a new inhaler to make sure you and your child know how to use and maintain it properly. Check with your insurance provider to see whether the CFC-free inhaler is covered and if not, ask them to cover it. Investigate ways you may be able to receive free and discount drugs if you are unable to aff ord your medication. How Will the New Inhalers Work? CFC-free products may look, taste, and feel a little different, but the FDA has found the new products comparable in safety and effectiveness to current products. Non-CFC MDIs are used around the world, and have been found to be safe and effective, without any adverse effects to patients. What If I Cannot Afford My Medications? New CFC-free MDIs may be more expensive than the CFC-containing products they replace. Pharmaceutical companies are committed to ensuring that no patient is denied access to medication because of the transition away from CFC. There are numerous patient assistance programs to help people who cannot afford their medications. Some programs provide medicines free of charge, but have different eligibility requirements based on income. For patients who do not meet eligibility requirements for those free drugs but still need assistance, there are a number of programs that provide discounted drugs. This article was featured in Healthy Children Magazine. To view the full issue, click here. Last Updated 11/21/2015 Source Healthy Children Magazine, Allergy/Asthma 2007" }, "82": { "health_issue_x_health_issue_article.id": 82, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 82, "health_issue_article.ts": "2018-04-19 03:07:14", "health_issue_article.title": "Asthma Management at School", "health_issue_article.content": "Asthma Management at School Page Content Article BodyChildren spend a significant part of their day at school. That is why it is so important that asthma symptoms are well managed while they are there. It is also important that you are aware of your child’s symptoms and any problems with how your child’s asthma is managed in school. Effective Communication Good communication is essential to asthma care and management in school. The school needs to know about your child’s asthma, how severe it is, what medications your child takes, and what to do in an emergency. This communication can be helped by having your health care provider complete an asthma action plan for the school, as well as a medication permission form that includes whether your child should be allowed to carry and use her own inhaler. You should also sign a release at school and at your health care provider’s office to allow the exchange of medical information between you, the school, and your health care provider. Your child’s school needs to communicate to you its policies on how your child will get access to her medications and how they deal with emergencies, field trips, and after-school activities. The school should also inform you about any changes or problems with your child’s symptoms while she is at school. Peak Flow Meter Peak flow meters can be helpful for school staff in determining the severity of an asthma attack. If your child’s health care provider has recommended a peak flow meter, determine your child’s best peak flow (your health care provider should tell you how to do this). Then keep a peak flow meter at school. School Environment The environment at school is as important as the environment at home. Coping With Asthma at School Students with asthma face a number of problems related to school. Talk to your child about how well his asthma is being managed in school. Also talk to your child’s teachers, school nurse, coaches, and other school personnel to get their opinions on how well your child is coping with asthma in school and to see if asthma symptoms are causing any of the following problems: Missing school due to asthma symptoms or doctor visits. Avoiding school or school activities. Work with your health care provider and school personnel to encourage your child to participate in school activities. Not taking medication before exercise. Your child may avoid going to the school office or nurse’s office to use his inhaler before exercise. Schools that allow children to carry their inhalers with them can help avoid this problem. Side effects from medication. Some asthma medications may alter your child’s ability to perform in school. Teachers need to know if and when your child takes asthma medication so that you can be notified if there are any problems. Physical activity is important for your child’s physical and mental health. Children with asthma should be able, and encouraged, to participate completely in physical education, sports, and other activities in school. All students should have some knowledge of asthma basics and management. Encourage your school to offer asthma awareness education as part of the health education curriculum. Know Your Rights Learn about the federal laws that can help you with asthma management concerns at school. These include the following: Section 504 of the Civil Rights Act of 1973 Americans with Disabilities Act (ADA) Individuals with Disabilities Education Act (IDEA) Last Updated 11/21/2015 Source AAP Section on Allergy and Immunology (Copyright © 2003)" }, "83": { "health_issue_x_health_issue_article.id": 83, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 83, "health_issue_article.ts": "2018-04-19 03:07:21", "health_issue_article.title": "Asthma Medicines: Long-term Control", "health_issue_article.content": "Asthma Medicines: Long-term Control Page Content Article BodyCorticosteroids Synthetic versions of hormones produced in the adrenal glands, corticosteroids are the most powerful anti-inflammatory medications now available for treating asthma. In inhaled form, they are used exclusively for long-term control; they are not very effective for acute symptoms. Systemic corticosteroids taken by mouth as pills or liquid, or injected, are sometimes of value to get asthma quickly under control when a child is beginning long-term asthma therapy. Inhaled corticosteroids are the agents preferred and recommended as first-line treatment of chronic asthma by various asthma expert panels that publish guidelines on the proper treatment of asthma. They are available in various forms and different dosage forms, which make them convenient for patients to take, such as an aerosol in a metered-dose inhaler (MDI), a dry powder inhaler (DPI), and a liquid form that can be used in a nebulizer for small children. Leukotriene Modifiers These compounds act by decreasing the effects of an inflammatory chemical made by the body known as leukotrienes. The 2 leukotriene modifiers currently in use, montelukast and zafirlukast, are used as control medications. They have only mild to moderate beneficial effects at best but are very safe. They are taken in pill form; chewable and sprinkle forms are available for young children. Long-Acting Beta2-Agonists Medications in the beta2-agonist class work by relaxing the muscles that wrap around the bronchi of the lungs and tend to squeeze down and narrow the airways in those who have asthma. The short-acting forms of beta2-agonists, such as albuterol, are used as first-line agents for relief of asthma in all patients with asthma. Long-acting versions of beta2-agonists were made by making some chemical changes in the short-acting beta2-agonists. These long-acting beta2-agonists are almost always prescribed together with anti-inflammatory medications for long-term control, rarely if ever by themselves. They are usually added when a conventional dose of an inhaled steroid is not adequate for control of daily symptoms. There is evidence that rare patients experience loss of effect from their rapid-acting bronchodilator (eg, albuterol, levalbuterol) with taking long-acting bronchodilators. While this is quite uncommon, patients should be advised of this potential and instructed to notify their physician if the addition of a long-acting bronchodilator is associated with increased symptoms instead of the usual increased benefit. Theophylline Theophylline, usually taken by mouth as a timed-release pill, opens up the airways for an extended period. It can be used alone or together with inhaled corticosteroids. It can be particularly helpful in preventing nighttime symptoms in mild to moderate asthma. Although once used extensively, theophylline is currently infrequently prescribed for asthma, mainly because it requires careful monitoring of blood levels to avoid side effects and because other asthma medications often work as well or better. Cromolyn Sodium and Nedocromil These are very mildly effective anti-inflammatory medications rarely used anymore in long- term therapy of mild to moderate asthma in children. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" }, "84": { "health_issue_x_health_issue_article.id": 84, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 84, "health_issue_article.ts": "2018-04-19 03:07:25", "health_issue_article.title": "Asthma Medicines: Quick Relief", "health_issue_article.content": "Asthma Medicines: Quick Relief Page Content Article BodyShort-Acting Beta2-Agonists These are used for the rapid relief of acute asthma symptoms and to prevent exercise-induced asthma in children. They are first-line treatment of acute asthma symptoms—all patients with asthma need to have available a short-acting beta2-agonist. Children may use them by MDI or nebulizer; either form is effective if used properly. The medication should be available at home, in school, and at the site of sports participation. This class of medication used to be called “rescue” medicine, but this term is no longer used because it implies that a patient must be in terrible shape to use it, which should not be the case. The new preferred term is quick relief. It turns out that almost all patients use albuterol (or a close cous-in called levalbuterol, which acts very similar to albuterol) for their quick-relief medication. Albuterol should be used for any asthma symptom, including wheeze, chest tightness, and cough, and not just reserved for asthma attacks. Anticholinergics Ipratropium bromide, a rapid-acting bronchodilator, may be used as an alternative to dilate the airways when inhaled beta2-agonists cannot be used, or given together with an inhaled beta2-agonist in severe asthma. Systemic Corticosteroids These are given by mouth or injection to reduce inflammation inside the airways and speed recovery when a youngster is having an asthma flare-up. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" }, "85": { "health_issue_x_health_issue_article.id": 85, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 85, "health_issue_article.ts": "2018-04-19 03:07:29", "health_issue_article.title": "Asthma Predictive Index", "health_issue_article.content": "Asthma Predictive Index Page Content Article BodyMost wheezing during the first 3 years of life is related to viral respiratory infections. Respiratory viruses and symptoms of early asthma may be hard to tell apart, making diagnosis and treatment tricky. But doctors and parents now have a tool to help them predict with reasonable accuracy if the child will develop asthma or simply outgrow it. The asthma predictive index (API) is a guide to determining which small children will likely have asthma in later years. Children younger than 3 years who have had 4 or more significant wheezing episodes in the past year are much more likely to have persistent (ie, lifelong) asthma after 5 years if they have either of the following: One major decisive factor Parent with asthma Physician diagnosis of eczema (atopic dermatitis) Sensitivity to allergens in the air (as determined by physician through positive skin tests or blood tests to allergens such as trees, grasses, weeds, molds, or dust mites) OR Two minor decisive factors Food allergies Greater than 4% blood eosinophils (a type of white blood cell often seen in allergic disease) Wheezing apart from colds The API was developed after following almost 1,000 children through 13 years of age. It turned out that a wheezy child with a positive API at around 2 to 3 years of age meant there was about an 80% chance that child would have a definite diagnosis of asthma when entering first grade. Using the API, doctors and parents can watch more closely for symptoms of asthma as the child grows and if needed, start the right medications earlier. Earlier and better treatment can help keep children active and healthy, and their asthma in good control. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" }, "86": { "health_issue_x_health_issue_article.id": 86, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 86, "health_issue_article.ts": "2018-04-19 03:07:34", "health_issue_article.title": "Asthma Triggers and What to do About Them", "health_issue_article.content": "Asthma Triggers and What to do About Them Page Content Article BodyAsthma Triggers Certain things cause asthma “attacks” or make asthma worse. These are called triggers. Some common asthma triggers are Things your child might be allergic to. These are called allergens. (Most children with asthma have allergies, and allergies are a major cause of asthma symptoms.) House dust mites Animal dander Cockroaches Mold Pollens Infections of the airways Viral infections of the nose and throat Other infections, such as pneumonia or sinus infections Irritants in the environment (outside or indoor air you breathe) Cigarette and other smoke Air pollution Cold air, dry air Odors, fragrances, volatile organic compounds in sprays, and cleaning products Exercise (About 80% of people with asthma develop wheezing, coughing, and a tight feeling in the chest when they exercise.) Stress Be sure to check all of your child’s “environments,” such as school, child care, and relatives’ homes, for exposure to these same things. Help Your Child Avoid Triggers While it is impossible to make the place you live in completely allergenor irritant-free, there are things you can do to reduce your child’s exposure to triggers. The following tips may help. Do not smoke or let anyone else smoke in your home or car. Reduce exposure to dust mites. The most necessary and effective things to do are to cover your child’s mattress and pillows with special allergy-proof encasings, wash their bedding in hot water every 1 to 2 weeks, remove stuffed toys from the bedroom, and vacuum and dust regularly. Other avoidance measures, which are more difficult or expensive, include reducing the humidity in the house with a dehumidifier or removing carpeting in the bedroom. Bedrooms in basements should not be carpeted. If allergic to furry pets, the only truly effective means of reducing exposure to pet allergens is to remove them from the home. If this is not possible, keep them out of your child’s bedroom and consider putting a high-efficiency particulate air (HEPA) filter in their bedroom, removing carpeting, covering mattress and pillows with mite-proof encasings, and washing the animals regularly. Reduce cockroach infestation by regularly exterminating, setting roach traps, repairing holes in walls or other entry points, and avoiding leaving exposed food or garbage. Mold in homes is often due to excessive moisture indoors, which can result from water damage due to flooding, leaky roofs, leaking pipes, or excessive humidity. Repair any sources of water leakage. Control indoor humidity by using exhaust fans in the bathrooms and kitchen, and adding a dehumidifier in areas with naturally high humidity. Clean existing mold contamination with detergent and water. Sometimes porous materials such as wallboards with mold contamination have to be replaced. Pollen exposure can be reduced by using an air conditioner in your child’s bedroom, with the vent closed, and leaving doors and windows closed during high pollen times. (Times vary with allergens, ask your allergist.) Reduce indoor irritants by using unscented cleaning products and avoiding mothballs, room deodorizers, or scented candles. Check air quality reports in weather forecasts or on the Internet. When the air quality is poor, keep your child indoors and be sure he takes his asthma control medications. Decreasing your child’s exposure to triggers will help decrease symptoms as well as the need for asthma medications. Last Updated 11/21/2015 Source AAP Section on Allergy and Immunology (Copyright © 2003)" }, "87": { "health_issue_x_health_issue_article.id": 87, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 87, "health_issue_article.ts": "2018-04-19 03:07:41", "health_issue_article.title": "Asthma and Food Allergies", "health_issue_article.content": "Asthma and Food Allergies Page Content Article BodyA family history of any type of allergy increases the risk that a child may develop asthma. Children with asthma and food allergies are at increased risk for anaphylaxis, a severe allergic reaction, even when their asthma is well controlled. For children with known food allergies, especially those who also have asthma, parents should be thoroughly familiar with food ingredients. If their child has an anaphylactic reaction to foods, they should also carry an emergency dose of epinephrine at all times and make sure there is some with the child care provider and at school. Epinephrine, a drug that stops or slows down anaphylaxis, is available in spring-loaded self-injectable syringes. Though not a cure, a dose of epinephrine administered soon after symptoms begin should stall severe symptoms long enough to get necessary medical attention by calling emergency medical services (911). Sulfites, which are used to stop discoloration, overripening, and spoiling, are known to trigger asthma attacks. These additives are found in processed beverages and foods, including fruit juices, soft drinks, cider vinegar, potato chips, dried fruits and vegetables, maraschino cherries, and wines. Numerous reports of allergic reactions—mostly among people with asthma—and of deaths associated with sulfite ingestion have led the Food and Drug Administration to ban the use of sulfites in fresh fruits and vegetables. Sulfites may be used in certain processed foods, provided they are listed on labels in quantities higher than 10 parts per million, or when used at all in manufacturing. Processed potatoes and some canned foods may contain sulfites. If your child has asthma or is sensitive to sulfites, be cautious about any processed or prepared food. Last Updated 11/21/2015 Source Nutrition: What Every Parent Needs to Know (Copyright © American Academy of Pediatrics 2011)" }, "88": { "health_issue_x_health_issue_article.id": 88, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 88, "health_issue_article.ts": "2018-04-19 03:07:46", "health_issue_article.title": "Corticosteroids", "health_issue_article.content": "Corticosteroids Page Content Article BodyWhat are corticosteroids? If your child has asthma or allergic rhinitis (hay fever), your pediatrician may prescribe a corticosteroid, also commonly referred to as a steroid. These medicines are the best available to decrease the swelling and irritation (inflammation) that occurs with persistent asthma or allergy. They are not the same as the anabolic steroids that are used illegally by some athletes to build muscles. The medicine works in 2 ways. Systemic corticosteroids must go through the body to treat the inflammation. Inhaled or intranasal corticosteroids go directly to where the inflammation is. In general, corticosteroids are safe and work well if the medicine is taken as recommended by your pediatrician. However, as with all medicines, you should know about the possible side effects. There are far fewer risks with inhaled or intranasal corticosteroids than with the side effects of systemic corticosteroids because much less medicine is given. The amount of medicine given in a systemic corticosteroid can be 10 to 100 times more. Systemic Corticosteroids May be given for a short period if your child has a bad asthma attack. In some cases, these medicines can save lives. Form. Your child may take a pill, tablet, or liquid. Medicine may also be given by a shot or through the vein (IV). Side effects can include behavior change, increased appetite, acne, thrush (a yeast infection in the mouth), stomach upset, or trouble sleeping. These all go away when the medicine is stopped. More serious side effects can happen if this medicine is used often or for 2 weeks or longer. They include cataracts (clouding of the lens of the eye), weight gain, worsening of diabetes, bone thinning, slowing of growth, reduced ability to fight off infections, stomach ulcers, and high blood pressure. Inhaled Corticosteroids May be given to prevent or control asthma symptoms. Inflammation inside the bronchial tubes of the lungs is felt to be an important cause of asthma. Inhaled corticosteroids work by decreasing this inflammation. Inhaled corticosteroids are the most effective long-term medicine for the control and prevention of asthma. They can reduce asthma symptoms, and your child may not need to take as many other medicines. Inhaled corticosteroids also can improve sleep and activity and prevent asthma attacks. Form. Medicine is breathed in through an inhaler. Side effects are much less common and less serious than those that occur from long-term systemic use. They may include a yeast infection in the mouth or hoarseness. The risk can be reduced using a spacer or holding chamber, rinsing the mouth after use, or using the lowest dose needed. Intranasal Corticosteroids May be given to prevent or control a runny nose and congestion from allergies. Intranasal corticosteroids work very well in treating allergy symptoms, and your child may not need to take as many other allergy medicines. Form. Medicine is sprayed into the nose. Side effects may include irritation of the nose, or feeling that something is \"running down the throat\" at the time the nose spray is used. Occasionally, a child can have nosebleeds from using the spray. If this occurs, stopping the nose spray for a few days often allows the child to be able to restart the medicine and continue using it. Your Child's Growth Recent studies have shown that inhaled corticosteroids for asthma may slow down growth in some children during the first year of treatment, but this is only temporary. These children ended up with their normal expected heights as adults. To reduce the risk of any side effects, your pediatrician will prescribe the lowest dose needed to control the symptoms. Your child's height will also be measured regularly during office visits. Last Updated 11/21/2015 Source Inhaled and Intranasal Corticosteroids and Your Child (Copyright © 2006 American Academy of Pediatrics)" }, "89": { "health_issue_x_health_issue_article.id": 89, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 89, "health_issue_article.ts": "2018-04-19 03:07:52", "health_issue_article.title": "Create an Allergy and Anaphylaxis Emergency Plan: AAP Report Explained", "health_issue_article.content": "Create an Allergy and Anaphylaxis Emergency Plan: AAP Report Explained Page ContentBy: Michael Pistiner, MD, MMSc, FAAPSevere allergic reactions are unpredictable—they can happen anywhere, anytime. Symptoms can even go away with treatment and come back later. Parents of children with severe allergies to certain foods, insect stings, latex, and medication know this all too well. What's the Plan?In an effort to appropriately treat anaphylaxis—a potentially life-threating, severe allergic reaction—the American Academy of Pediatrics (AAP) developed the clinical report, Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan. The report explains to pediatricians and other health care providers how to create and use the new AAP Allergy and Anaphylaxis Emergency Plan. This new emergency care plan (ECP) is based on the most up to date and appropriate treatment of anaphylaxis. It's also clearly written and easy to understand. See for yourself! Download the AAP Allergy and Anaphylaxis Emergency Plan (PDF) here. The plan also emphasizes the important role of epinephrine and de-emphasizes the role of antihistamines (e.g., Benadryl). It lists symptoms and clearly tells the caregiver or child when to use the epinephrine auto-injector. Allergy and anaphylaxis emergency plans are especially important to provide to schools and child care facilities. Anaphylaxis emergency care plan overview: Includes simple criteria to identify potential allergic emergencies for use by patients, families, school staff, and all caregiversIs accessible and understandable to anyone caring for your child Given to school, child care, after school programs, or any place where others care for your childTrains others using your child's specific ECPWhen creating an ECP, it is also important to customize it to the specific needs of your child, allergies, family, and your state and local regulations. (Some may have their own forms already in place; you can encourage them to use this new one.)If in Doubt, Give Epinephrine! The AAP report also includes more evidence for why epinephrine is so important and safe and that delaying the use of epinephrine and relying on antihistamines is a bad idea! Epinephrine is the first line treatment for anaphylaxis, because it works quickly by delivering a dose of medicine directly into a child's muscle. The auto-injectors are especially designed for easy use in non-medical settings. Delays in giving epinephrine for anaphylaxis can increase the risk of death, long hospitalization, and a second anaphylactic reaction called a biphasic reaction.Things to know about epinephrine: First-line treatment of choiceActs where it is neededWill make you feel betterFast acting Delays in administration increase risk of deathErr on the side of caution and give if any doubtSafe medicineAnyone caring for a child with an allergy that can be life threatening must know how to recognize anaphylaxis and know when and how to give the lifesaving treatment for severe allergic reactions. The AAP Allergy and Anaphylaxis Emergency Plan and clinical report were designed to help with this—wherever your child is and whomever is caring for him or her.Be Better Prepared for an Allergic Emergency: Together, these new AAP resources will help pediatric teams give families the information and written plans needed to ensure that they are ready to deal with an allergic emergency in any setting—school, child care, sports practice, play dates, etc. In situations when you are not with your child, these written plans will also arm nurses, teachers, coaches, parents, relatives, babysitters, etc. with the tools they need in the event of an emergency.If you already have an ECP, discuss this newly available one with your pediatrician.If you don't have an ECP, pass along this new resource to your pediatrician.Additional Information & Resources: Peanut Allergies: What You Should Know About the Latest Research How to Use an Epinephrine Auto-InjectorHealthy Children Radio: Helping Children with Food Allergies (Audio)Healthy Children Radio: Food Allergies in the Community (Audio) Management of Food Allergy in the School Setting (AAP Clinical Report) About Dr. Pistiner: Michael Pistiner, MD, MMSc, FAAP is a Boston based pediatric allergist for Atrius Health. He is a member of the American Academy of Pediatrics Section on Allergy and Immunology Executive Committee and has a special interest in food allergy and anaphylaxis education and advocacy. Dr. Pistiner is also the father of a child with food allergy and cofounder and content creator of AllergyHome.org, a free food allergy and anaphylaxis educational resource. Article Body Last Updated 2/13/2017 Source American Academy of Pediatrics (Copyright © 2017)" }, "90": { "health_issue_x_health_issue_article.id": 90, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 90, "health_issue_article.ts": "2018-04-19 03:07:55", "health_issue_article.title": "Diagnosing Allergies", "health_issue_article.content": "Diagnosing Allergies Page Content Article BodyDiagnosis follows an orderly process that starts with a careful medical history. Your pediatrician or allergy specialist will ask a lot of questions about your child’s symptoms and medical background, and about your family’s medical history as well. Does your child cough, wheeze, or get extra short of breath when she’s running or playing hard? Does your child cough a lot? Is the coughing worse at night? Is she wheezing? Does she have trouble breathing? Does her chest feel tight sometimes? What happens when she laughs or becomes upset? Does your child sneeze frequently? Does she rub her nose often? Does she blow her nose or wipe it a lot? Is the nasal discharge clear and runny? (A clear discharge is typical of allergic rhinitis, also called hay fever, the most common form of allergy) Or is it thick and greenish or yellowish? (A yellow or green color suggests that your child may have an infection, separate or possibly in addition to allergy symptoms.) Are her eyes itchy and watery? Does she have more than her share of colds? Do they last longer than a week? Does she ever have a rash or itchy bumps on the skin? How often does she have symptoms? How long do they last? Do particular events or exposures seem to bring on symptoms, or make them better or worse? Have the symptoms ever gotten better after your child has taken medicine? What kind of medication helped? Your pediatrician will ask whether your child’s symptoms often appear during a particular season of the year, at a certain location, or when your child is around animals, such as cats. Your pediatrician will also ask whether symptoms come on after your child has eaten a particular food. Your pediatrician will ask whether other members of the family have hay fever, asthma, or eczema because allergy and asthma run in families. However, even if you can’t recall a single relative who sneezes and wheezes, your doctor will not discount allergy and asthma in your child because, like many disorders, they can appear with no prior family history. Parents sometimes try over-the-counter medications before asking their pediatricians about a persistent cough, a rash, or respiratory symptoms. Although it’s recommended that you talk with your pediatrician before giving medications to your child, it’s helpful to tell the doctor whether a medication had any effect because this can give clues about the possible cause of symptoms. For example, if a runny nose and itchiness bothered your child less and she stopped sneezing for a while after taking an antihistamine, chances are she has an allergy and not an infection. Conversely, if her coughing and wheezing did not change after she took a dose of an over-the-counter medication, your pediatrician may decide to test or even go ahead and treat for asthma before looking for other underlying conditions. Symptoms: All in the Timing Allergy symptoms that come and go with the seasons may be caused by seasonal plants such as trees, grasses, and weeds. Coughing, sneezing, or other chest and nose symptoms that get much better when your child is away from home may indicate that your child is sensitive to substances normally found indoors, such as pets. By contrast, symptoms that always clear up on weekends and school vacations suggest that there may be a problem with something in the environment at school. Coughing at night with hoarseness and frequent throat clearing may be caused by postnasal drip from allergic rhinitis or sinusitis. But coughing, wheezing, and related symptoms that get worse at night may also raise suspicions about asthma because asthma symptoms are often worse at night. Your pediatrician may suspect exercise-induced asthma if your child frequently coughs or wheezes when running or playing energetically. Allergies Tend to Run in Families Many types of allergy problems, including hay fever, asthma, and eczema, tend to run in families. If both parents have allergies, each child has about a 60% to 70% chance of being allergic. However, allergic responses to insect venom, medications, and latex are the exceptions to the rule. Having a parent with one of these allergies does not increase the chance a child will be allergic. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" } } } }