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After a careful physical examination, your pediatrician will need to ask you specific questions about your child’s health. The information you give your pediatrician will help determine if your child has asthma. Your pediatrician will need information about Your child’s symptoms, such as wheezing, coughing, and shortness of breath What triggers the symptoms or when the symptoms get worse Medications that were tried and if they helped Any family history of allergies or asthma It is very important that your pediatrician test your child’s airway function. One way to do this is with a pulmonary function test using a device called a spirometer. This device measures the amount of air blown out of the lungs over time. Your pediatrician may also want to test your child’s pulmonary function after giving her some asthma medication. This helps confirm that the blockage in the air passages that shows up on pulmonary function tests goes away with treatment. Some children do not find relief from their symptoms even after using medications. If that is your child, your pediatrician may want to test your child for other conditions that can make asthma worse. These conditions include allergic rhinitis (hayfever), sinusitis (sinus infection), and gastroesophageal reflux disease (the process that causes heartburn). It is important to remember that asthma is a complicated disease to diagnose, and the results of airway function testing may be normal even if your child has asthma. Also keep in mind that not all children with repeated episodes of wheezing have asthma. Some children are born with small lungs, and their air passages may get blocked by infections. As their lungs grow they no longer wheeze after an infection. This type of wheezing usually occurs in children without a family history of asthma and in children whose mothers smoked during pregnancy. Last Updated 11/21/2015 Source AAP Section on Allergy and Immunology (Copyright © 2003)" }, "92": { "health_issue_x_health_issue_article.id": 92, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 92, "health_issue_article.ts": "2018-04-19 03:08:10", "health_issue_article.title": "Diagnosing Asthma in Babies & Toddlers", "health_issue_article.content": "Diagnosing Asthma in Babies & Toddlers Page Content Article BodyOne of the difficulties of diagnosing asthma in babies and toddlers is that it’s not very easy to measure lung function in small children. So in trying to make a diagnosis, your pediatrician will rely heavily on your child’s symptoms and other information. Wheezing, Coughing, or Fast Breathing Your pediatrician will ask whether your baby tends to wheeze, cough, or breathe fast when he has a “cold,” is near animals, or is in a place that’s dusty or tainted by smoke. Make sure you tell your pediatrician about any excessive coughing that your child has, particularly nighttime cough and prolonged cough after a “cold,” even if there is no wheezing, because asthma can be present with coughing being the only symptom. Your Family's Medical History Your pediatrician will also ask whether you or other family members have asthma, hay fever, or eczema, or if there’s anyone in the family with recurrent bronchitis or sinus problems.When Asthma is Not the CauseYour pediatrician will listen carefully to make sure that the sounds your baby is making are coming from the airways of the lungs, and not from the baby’s voice box higher up in the throat or the nose. Sometimes babies breathe noisily as a result of laryngotracheomalacia, a temporary weakness in the cartilage near the vocal cords. They grow out of this as the tissues become firmer. If your baby starts wheezing after breathing in a foreign object (eg, a bit of food, a small toy) that has become lodged in a bronchial tube, he needs urgentmedical attention. Unusual conditions related to airway development or prematurity can also cause wheezing in infants. In general, an unexplained frequent cough or daily cough in infants may mean serious disease and should be evaluated by your pediatrician or pediatric pulmonologist.Growth & Development Your pediatrician will check to make sure your baby is maintaining a satisfactory rate of growth and development. Most infants with asthma make good progress and are otherwise healthy. If your pediatrician is concerned that your baby may be growing too slowly or failing to thrive, tests for conditions other than asthma will be ordered. Certain tests, including a sweat test to rule out cystic fibrosis, may be necessary when your doctor wants to be sure your baby’s wheezing and chest symptoms are not caused by a condition with symptoms that are similar to asthma.Chest RadiographsChest radiographs may be ordered during your baby’s first wheezing bout to make sure that there isn’t a problem in the lungs. If asthma is diagnosed, repeated radiographs are rarely needed because the problem is in the bronchial tubes, which cannot be seen very well in radiographs. Allergy Testing Your pediatrician is not likely to recommend allergy testing right away for your baby unless you suspect that wheezing always occurs after your child has been around a certain item, like an animal, or consumed a certain food. However, keep in mind that food allergy is rarely a cause of asthma in infants and toddlers, although it may be a trigger for eczema.Asthma Medications & Treatment Sometimes the easiest and best way to diagnose asthma in a young child is to treat with asthma therapy and see if the child improves. This is because for the most part, medications for asthma only help asthma and not other conditions. If improvement is seen, asthma is the likely diagnosis. If this approach is taken with your child, help your pediatrician by monitoring your child’s symptoms carefully so you can give good feedback as to whether the medications have helped. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" }, "93": { "health_issue_x_health_issue_article.id": 93, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 93, "health_issue_article.ts": "2018-04-19 03:08:16", "health_issue_article.title": "Dust Mite Control: Tips for Parents", "health_issue_article.content": "Dust Mite Control: Tips for Parents Page ContentWhen you know that dust mites are among the causes of your child’s allergic symptoms, you may want to reach for the vacuum cleaner every time you spy a trace of dust on the furniture. Why Vacuuming May Not Be the Solution:Use of a normally efficient vacuum cleaner stirs up clouds of fine dust that can hang about in the air for up to 8 hours and make sneezing, runny nose, and itchiness worse. It’s best to wait until your allergic child is out of the house—at school for the day, for example—before vacuuming. Or to avoid stirring up dust, invest in a vacuum cleaner with a high-efficiency particulate air (HEPA) filter. To keep household dust levels down:Clean all non-carpeted floors at least once a week with a damp mop.Use a damp cloth to wipe flat surfaces, louver blinds, window ledges, and picture frames.Air-conditioning and keeping doors and windows closed are effective ways to keep your home free of allergens and irritants brought in by air from the outside. While it may be too costly to install air-conditioning throughout your home, you may find an economical way to install a unit in your allergic child’s bedroom. This could help your child sleep better at night and provide a low-allergen retreat on days when the pollen count is high. Air-conditioner filters should be checked and cleaned regularly, and sprayed with an anti-mildew aerosol to control the growth of molds.Families may find their allergic members have fewer symptoms when room air is filtered through a HEPA air cleaner. However, air filtration should complement, not replace, measures to control mites. In fact, air cleaners do not significantly reduce mite exposure and should not be recommended for dust mite control. A HEPA air cleaner can be installed centrally in a forced-air ventilation system, or used as a portable room unit and left on at night in your child’s bedroom (see below). When you run a room HEPA cleaning unit, make sure the windows of the room are shut and the bedroom door is closed.Dust Mites to Dust:Dust mites are the main source of allergens in house dust. It’s difficult for many people who are allergic to accept that these creatures, invisible except under a microscope, can be present in large numbers even in a thoroughly cleaned home. Some are convinced only when symptoms improve as a result of mite-containment measures.Dust mites are members of the same family as spiders. Too small to be seen with the naked eye, they find a home wherever humans live. Dust mites don’t ask for much in life. They feed on any protein that comes their way and find easy pickings in the dead skin scales that humans shed every day. Apart from this simple diet, they need only a moderately warm, moist atmosphere, with a temperature of 65°F or higher and humidity around 65%. Bedding is the ideal dust mite home; after all, bedding offers warmth, sufficient moisture, plenty of skin, and fibrous materials to which dust mites can cling with their barbed legs. They also thrive in upholstered furniture, clothing, soft toys, and carpets.The dust mite eats and excretes pellets of feces that are about the size of pollen grains, and finds other dust mites, with which it produces many offspring. Their fecal pellets enter the general household dust to become the main source of allergens. Eventually, as mites die off, their dried-out carcasses, composed of allergenic proteins, also join the dust. Over years, they can add many pounds to the weight of a mattress.Keep Humidity Low to Discourage Mites:Dust mites flourish when the humidity is around 75% to 80%. These tiny cousins of spiders need water to survive but have no means of conserving it in their tissues. When the surrounding humidity falls below 50%, mites soon shrivel up and die. Thus, reducing household humidity can drastically reduce the dust mite population. A dehumidifier is useful for drying out the air. Take care to empty the water pan daily and scour it to stop the growth of microscopic molds.Humidifier Use Can Promote Growth of Mites and Molds:Any increase in humidity, such as when a humidifier is used, will encourage mites and molds to grow in your child’s room. If your child has problems with croup or other breathing difficulties, ask your pediatrician’s advice about the best way to ensure that the air in the bedroom is moist enough to breathe comfortably but dry enough to discourage mites and molds.Additional Information from HealthyChildren.org:Hay Fever Triggers: Tips for ParentsAsthma Triggers and What to do About ThemCleaners, Sanitizers & DisinfectantsEnvironmental HazardsMake Baby's Room Safe Article Body Last Updated 1/6/2011 Source Allergies and Asthma: What Every Parent Needs to Know (Copyright © 2010 American Academy of Pediatrics)" }, "94": { "health_issue_x_health_issue_article.id": 94, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 94, "health_issue_article.ts": "2018-04-19 03:08:19", "health_issue_article.title": "Exercise and Asthma", "health_issue_article.content": "Exercise and Asthma Page Content Article BodyAlmost every child (and adult) with asthma can benefit from sports and physical activity. Also, asthma should not prevent young athletes from enjoying a full athletic career. The following is information from the American Academy of Pediatrics about asthma and exercise. What is asthma Asthma is the most common chronic medical problem in children. Children with asthma can have different symptoms at different times. The most common problems are cough, wheeze, difficulty breathing, chest “tightness,” and chest pain. Almost all children with asthma will have one or more of these symptoms when they have a cold or with exercise. Many symptoms are brought on with allergies or exposure to cigarette smoke, laughing, or crying. Most children with asthma have symptoms while they exercise or right after they exercise. Children with asthma symptoms only with exercise may have exercise-induced asthma. What causes asthma? The cause of asthma is unknown. Genetics may play a role—children are more likely to have asthma if other people in the family have asthma. However, many children with no family history of asthma have asthma. Asthma is also more common in children with allergies. However, some children with allergies do not have asthma and some children with asthma do not have allergies. Exposure to secondhand cigarette smoke or pollutants makes children more likely to develop asthma. How does exercise cause asthma symptoms? The symptoms of asthma are caused by narrowing of the small bronchial tubes in the lung. The narrowing is caused by inflammation and swelling within these tubes and by spasm of the muscles in the bronchial walls. It is unknown why exercise causes airways to narrow. In general, exercise-induced asthma is most likely to occur with endurance exercise in cool, dry air. However, there are exceptions, including exercising in warm humid air with a lot of pollutants or in swimming in a poorly ventilated space with strong chlorine fumes. How can you prevent exercise-induced asthma? The first thing to do to prevent asthma symptoms with exercise is to make sure that the asthma unrelated to exercise is well controlled. For many children this means the regular use of inhaled steroid medicines and use of medicines before exercise. Ask your child’s doctor about what medicine is best for your child and make sure your child learns the proper technique for using an inhaler. If the asthma is well controlled but your child still has problems during or after exercise, let your child’s doctor know. The following are other ways that may help prevent exercise-induced asthma: When exercising in the cold, wrap a scarf or mask around the face to warm up and humidify the air. Avoid exercise in the early morning or try exercising inside. Increase fitness level (exercise-induced asthma symptoms improve as fitness improves). Try a different sport or cross-training. Do a short warm-up exercise before the main exercise session. Warning: If a child still has symptoms even with treatment, the exercise bout should be stopped. Asthma can be life-threatening if the athlete tries to play through the symptoms. Once the symptoms are controlled, the child can return to exercise. What problems can “look like” asthma? Probably the most common situation that is mistaken for exercise-induced asthma is that a child is not in very good athletic shape. It is normal for all of us to breathe harder when we exercise, and this is especially true for someone who isn’t very active. Sometimes this normal heavy breathing can be mistaken for asthma. The good news is that it’s easy to “cure” this problem by doing more exercise! In athletes, another problem called vocal cord dysfunction (VCD) can occur, and seems a lot like exercise-induced asthma. The vocal cords are located in the throat, at the opening to our trachea (windpipe), not in our lungs. They help us form words by opening and closing to let different amounts of air out of the lungs. In VCD, the vocal cords close when they are supposed to open, making it harder to breathe in air. Signs of VCD include a high-pitched noise while breathing in, breathing too fast, and a “tight” feeling in the throat. It can be very difficult to distinguish VCD from asthma and may require referral to an asthma specialist or ear, nose, and throat specialist. Last Updated 11/21/2015 Source Care of the Young Athlete Patient Education Handouts (Copyright © 2011 American Academy of Pediatrics)" }, "95": { "health_issue_x_health_issue_article.id": 95, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 95, "health_issue_article.ts": "2018-04-19 03:08:25", "health_issue_article.title": "Hay Fever Triggers: Tips for Parents", "health_issue_article.content": "Hay Fever Triggers: Tips for Parents Page Content Article BodyPollens and Outdoor MoldsAs with other types of allergies, the ideal way to manage hay fever is to find out what your child is allergic to and then avoid it. It sounds simple, but this is much easier said than done. To start with, many children are allergic to pollens and molds, both of which are found everywhere outdoors and cannot be completely avoided. Children need to go outside to play, so pollen exposure when outdoors is unavoidable. What Parents Can Do: Exposure to outdoor pollen and mold that enters the house can be decreased by closing windows and using air conditioning, showering and changing clothes as soon as children come inside at the end of the day, and by making sure bedding is dried in a dryer, not outside on a clothes line.Dust Mites and Indoor MoldsIn addition to outdoor allergens, a child may be allergic to routinely encountered indoor substances such as dust mites or indoor molds. These everyday allergens can be kept at low levels when certain changes are made. Still, they are almost impossible to eliminate altogether, no matter how carefully you clean your home. Your child is also bound to run into indoor allergens and irritants when he ventures away from home and into other environments, such as school or friends’ homes.Dust had a reputation for causing sneezing and irritation long before allergies were called allergies. Not only does it irritate the nose, throat, and eyes, but it can also contain allergenic materials. A major cause of allergic symptoms lies beyond the dust itself. It has been traced to dust mites—tiny creatures that, like Dr Seuss’ Whos down in Whoville, make their homes among dust specks. But whereas the Whos asked only to be left in peace, there’s no getting away from dust mites. They live wherever humans live; in fact, they clean up after us. They can live on any organic debris, but their preferred diet is the half gram or so of worn-out skin cells that every human sheds daily. They also thrive on tiny fungi—like the mites, too small to be seen with the naked eye—that flourish where the relative humidity is fairly high, at 70% or more. Spores from these fungi are a major cause of allergic symptoms in humans.Dust mites congregate where food is plentiful. They are especially numerous in beds, pillows, upholstered furniture, and rugs. Although vacuuming and dusting can help decrease dust levels inside the home, these measures don’t work very well against dust mites. As gross as it is, your child is actually allergic to a protein in dust mite feces. So steps are taken to kill dust mites and to use a containment approach to avoid mites’ feces. Padded furnishings such as mattresses, box springs, pillows, and cushions should be encased in allergen-proof, zip-up covers, which are available through catalogs and specialized retailers. Covers made of nonwoven synthetic fabrics are more comfortable than plastic covers and work at least as well. The microscopic dust mite fecal particles are too large to pass thorough allergy-proof covers.What Parents Can Do: Choose blankets and pillows made of synthetic materials. Because dust mites can survive in warm soapy water, wash linens weekly and other bedding, such as blankets, every 2 to 3 weeks in hot water, then put them through the hottest cycle of a clothes dryer. Pillows should be replaced every 2 or 3 years. Dust mites also abound in cuddly stuffed toys. When possible, replace soft, plush-covered toys with others that have smooth plastic bodies and washable clothes. If your child has a favorite soft toy from which she can’t be parted, wash it every other day or so in hot water and dry it at the highest setting. Or seal soft toys in plastic bags and put them in the freezer for at least 5 hours or overnight once a week. Dust mites cannot survive longer than 5 hours at freezing temperature; you can then rinse the toys in warm water and put them in the dryer to get rid of the dead mites. These steps will not necessarily remove all of the allergenic dust mite feces, but they help! Keep bulky fabrics and dust-catching clutter out of your child’s room. Remove wall-to-wall carpeting, if possible. Floors should be wooden, tile, or vinyl—anything but carpet. Damp mopping and electrostatic floor mops are helpful for clean up. If you prefer rugs for comfort, use small cotton or synthetic throw rugs that can be washed weekly in hot water. Curtains should be easily washable. When it comes to the walls, the aim is to eliminate horizontal surfaces that trap dust. There should be no picture frames or shelves displaying books or ornaments, and all surfaces—on dressers, bedside tables, and other furniture—should be easy to wipe clean. Avoid humidifiers and vaporizers. Dust mites need humidity to live, and humidification will only further help the mite population grow. For the same reason, using a dehumidifier in certain moist geographical locations can be beneficial by helping to keep the humidity below the range that suits mites and molds. However, if you use a dehumidifier, it’s essential not only to empty the water pan but also to scour it daily to prevent the growth of invisiblesome airborne allergens but are not generally useful for dust mites. No matter how careful you may be, you can’t protect a child as if she were a hothouse plant. And even if you were to succeed in eliminating most environmental allergens in your home, children still get exposed at school and at playmates’ homes. Furthermore, it’s hard to avoid the normally harmless kinds of nonallergenic irritants that can set off symptoms in a nose already primed and twitchy from allergen exposure. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" }, "96": { "health_issue_x_health_issue_article.id": 96, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 96, "health_issue_article.ts": "2018-04-19 03:08:32", "health_issue_article.title": "Healthy Children Radio: Cold vs Allergies", "health_issue_article.content": "Healthy Children Radio: Cold vs Allergies Page Content Article BodyIt's sometimes difficult to know whether the problem is allergies or a common cold. The diagnosis is often made when parents seek their pediatrician's advice for a lingering cold that their child can't shake. Pediatrician David Hill, MD, FAAP, comes on the Healthy Children radio to talk about a few, telling differences. Segment 1: Is It a Cold or Allergies Last Updated 1/22/2016 Source American Academy of Pediatrics (Copyright © 2013)" }, "97": { "health_issue_x_health_issue_article.id": 97, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 97, "health_issue_article.ts": "2018-04-19 03:08:37", "health_issue_article.title": "HealthyChildren Radio: Asthma", "health_issue_article.content": "HealthyChildren Radio: Asthma Page Content Article BodyIn recent years, research into the diagnosis and treatment of childhood asthma has made a real difference in the control of asthma among children. Asthma is the most common lasting disorder in childhood, currently affecting around 6.2 million Americans under 18 years of age. Pediatrician Chitra Dinakar, MD, a specialist in asthma, allergies and immunology, comes on the Healthy Children Radio show on RadioMD to talk about diagnosis, severity, and treatments. Segment 1: Asthma 101: Grading the Severity of this Disease Segment 2: Asthma Medications: Are They Safe For Your Child? Segment 3: Exercise and Asthma: Are They Compatible? Last Updated 1/23/2016 Source American Academy of Pediatrics (Copyright © 2013)" }, "98": { "health_issue_x_health_issue_article.id": 98, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 98, "health_issue_article.ts": "2018-04-19 03:08:42", "health_issue_article.title": "Indoor Allergies", "health_issue_article.content": "Indoor Allergies Page Content Article Body1 in 6 kids suffers from indoor allergies, such as allergies to dust, mold, or animal dander. Replacing air duct filters once a month, sweeping and vacuuming regularly, and avoiding wall to wall carpeting can help reduce your child's reaction to these allergens. Click here to listen Last Updated 1/23/2016 Source A Minute for Kids" }, "99": { "health_issue_x_health_issue_article.id": 99, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 99, "health_issue_article.ts": "2018-04-19 03:08:49", "health_issue_article.title": "Is It Allergies or a Cold? How to Tell the Difference", "health_issue_article.content": "Is It Allergies or a Cold? How to Tell the Difference Page Content Article BodyIt’s sometimes difficult to know whether the problem is hay fever or a common cold (upper respiratory infection). The diagnosis is often made when parents seek their pediatrician’s advice for a lingering “cold” that their child can’t shake. While symptoms of allergies and colds often overlap, there are a few telling differences. The tip-offs for hay fever are A clear, watery nasal discharge Itching of the eyes, ears, nose, or mouth Spasmodic sneezing Fever is never from an allergy; it almost always suggests an infection. Antibiotics will not help allergies or a common cold from a virus. Colds or allergies can sometimes lead to ear or sinus infections; when this happens, antibiotics can be helpful. With a cold, nasal secretions are often thicker than in allergy and can be discolored (as compared with the clear, watery discharge of allergies). The child who has a cold may have a sore throat and a cough, and the child’s temperature is sometimes slightly raised but not always. Itchiness is not usually a complaint with a cold, but it is the hallmark of an allergy problem. A plain old cold usually doesn’t last much more than several days before it starts to get better and go away; allergy symptoms can go on for weeks to months. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" }, "100": { "health_issue_x_health_issue_article.id": 100, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 100, "health_issue_article.ts": "2018-04-19 03:08:58", "health_issue_article.title": "Managing Asthma", "health_issue_article.content": "Managing Asthma Page Content Article BodyDevices to Help Deliver Asthma Medications Medications for asthma can be given to your child using a variety of devices including the following: Nebulizer—This is often used with younger children. This device uses an air compressor and cup to change liquid medication into a mist that can be inhaled through a mouthpiece or mask. Inhaled steroids and quick-relief medications can be given this way. Metered-dose inhaler (MDI)—This is the most commonly used device for asthma medications. However, your child will need to learn how to use it properly, which means pressing (or actuating) the device while taking a deep breath at the same time. The technique is reviewed on the following pages. Some MDIs are “breath actuated,” that is, they give out a puff of medication when you start to take a breath. These types of MDIs are much easier to use, but are only available for one type of quick-relief medication. Spacers can be used to help relieve some of the coordination problems in using MDIs and should always be used when using inhaled steroids. Dry powder inhaler (DPI)—This device is available for some medications. It is easier to use because you do not need to coordinate breathing with actuation. It also has less taste, and often has a built-in counter to help keep track of doses taken and doses left. Some asthma medications only come in pill form. However, inhaling the medication using one of the devices listed above is usually better because the medication passes straight into the airways. As a result, side effects are reduced or avoided altogether. Because there are several different inhalers on the market, your health care provider will suggest the one that is best for your child. There are important differences in the way they are used and in the amounts of medications they deliver to the airways. Your child will be taught how to use the inhaler, but her technique should be checked regularly to make sure she is getting the right dose of medication. Peak Flow Meter To help control asthma, your child may need to use a peak flow meter. This is a handheld device that measures how fast a person can blow air out of the lungs. Asthma treatment plans using peak flow meters use 3 zones—green, yellow, and red, like traffic lights—to help you determine if your child’s asthma is getting better or worse. Peak flow rates decrease (the numbers on the scale go down) when your child’s asthma is getting worse or is out of control. Peak flow rates increase (the numbers on the scale go up) when the asthma treatment is working and the airways are opening up. When to Use the Peak Flow Meter Check your child’s asthma using the peak flow meter at the following times: Every morning, before he takes any medications. If your child’s symptoms worsen or if he has an asthma attack. Check the peak flow rate before and after using medications for the attack. This will help you to see if the medications are working. Other times during the day, if your health care provider suggests. Keep in mind, there are differences in peak flow rate measurements at different times of the day. These differences are minimal when asthma is well controlled. Increasing differences may be an early sign of worsening asthma. Also, children of different sizes and ages have different peak flow rate measurements. Keep a record of your child’s peak flow numbers each day. This will help you and your health care provider see how your child’s asthma is doing. Bring this record with you when you visit the pediatrician. Last Updated 11/21/2015 Source AAP Section on Allergy and Immunology (Copyright © 2003)" }, "101": { "health_issue_x_health_issue_article.id": 101, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 101, "health_issue_article.ts": "2018-04-19 03:09:04", "health_issue_article.title": "Medications Used to Treat Asthma in Children", "health_issue_article.content": "Medications Used to Treat Asthma in Children Page Content Article BodyThe goals of treatment for asthma are to minimize symptoms and allow children to participate in normal physical activities with minimum side effects. It is also important to prevent emergency department visits and hospitalizations due to asthma attacks. Ideally, this means a child should not experience asthma symptoms more than once or twice per week, asthma symptoms should not wake a child at night more than twice per month, and a child should be able to participate in all play, sports, and physical education activities.Asthma medications come in a variety of forms, including the following: Metered-dose inhalers Dry powder inhalers Liquids that can be used in nebulizers Pills Injectable medications Note: Inhaled forms are preferred because they deliver the medication directly to the air passages with minimal side effects.Types of Asthma MedicationsAsthma is different in every patient, and symptoms can change over time. The child's doctor will determine which asthma medication is best based on the severity and frequency of symptoms and the child's age. Children with asthma symptoms that occur only occasionally are given medications only for short periods. Children with asthma whose symptoms occur more often may need a controller medication based on the severity and frequency of symptoms and their age.Sometimes, it is necessary to take several medications at the same time to control and prevent symptoms. The child's doctor may give several medications at first, to get the asthma symptoms under control, and then decrease the medications as needed. They may also recommend a peak flow meter for a child to use at home to monitor lung function. This can help parents and caregivers make decisions about changing therapy or following the effects of changes made by the doctor.Asthma medications are divided into 2 groups: quick-relief medications and controller medications.Quick-Relief Medications Quick-relief medications are for short-term use to open up narrowed airways and help relieve the feeling of tightness in the chest, wheezing, and breathlessness. They can also be used to prevent exercise-induced asthma. These medications are taken only on an as-needed basis. The most common quick-relief medication is albuterol.Controller Medications Controller medications are used on a daily basis to control asthma and reduce the number of days or nights that your child has symptoms. Controller medications are not used for relief of symptoms. Children with symptoms more than twice per week or who wake up more than twice per month should be on controller medications. The number and severity of asthma attacks also determine whether a controller medication is needed. Controller medications include the following: Inhaled steroids Combination products that contain inhaled steroids and long-acting bronchodilators Leukotriene receptor antagonists (only available in pill form) Inhaled nonsteroids (e.g., cromolyn or nedocromil) Methylxanthines (e.g., theophylline) Omalizumab injection Inhaled corticosteroids are the preferred controller medication for all ages. When used in the recommended doses, they are safe for most children. However, the child's doctor may recommend another type of controller medication based on the specific needs of the child.Asthma Action PlanAll people with asthma should have an asthma action plan (or asthma management plan). The plan shows the child's treatment information, such as what kind of medicines to take and when to take them. It also describes how to control asthma long term and how to handle an asthma attack. Additionally, the plan explains when to call the child's doctor or go to the emergency room.All of the people who care a child should know about the child's asthma action plan. These include family members, child care providers, schools, camps, team coaches, and instructors. In an emergency, these people can help the child follow their asthma action plan. The Centers for Disease Control and Prevention (CDC) provides easy-to-use examples and forms. Click here to learn more. Additional Information Asthma Management at School Asthma Triggers and What to do About Them Asthma Inhalers Managing Asthma Last Updated 11/21/2015 Source American Academy of Pediatrics (Copyright © 2015)" }, "102": { "health_issue_x_health_issue_article.id": 102, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 102, "health_issue_article.ts": "2018-04-19 03:09:12", "health_issue_article.title": "Mild, Moderate, Severe Asthma: What Do Grades Mean?", "health_issue_article.content": "Mild, Moderate, Severe Asthma: What Do Grades Mean? Page Content Article BodyAfter confirming an asthma diagnosis, your pediatrician will grade the severity of your child’s condition. This grading takes into account the frequency and severity of past and current asthma symptoms and the physical examination, and may include measures of lung function including spirometry or peak flow measurements. This information enables your pediatrician to select the right medication and determine the proper dose to keep the condition in check. (See “What Really Matters Is Control, Not Severity” below.) In making a decision about a child’s asthma severity level, the first distinction to be made is whether your child has intermittent asthma (ie, just occasional problems) or persistent asthma (ie, more than occasional). Patients with persistent asthma can have mild, moderate, or severe asthma. Following are more details about the 4 asthma severity levels that arise by making this kind of distinction. What Really Matters Is Control, Not Severity It turns out that asthma severity categories are somewhat arbitrary and, in fact, were actually created more with adults in mind than children. They are just a general guide for the doctor seeing your child; your doctor realizes that asthma severity levels, particularly in children, can change over time, so reassessments need to take place on an ongoing basis to verify an individual child’s present asthma severity. Furthermore, the 2007 National Heart, Lung, and Blood Institute “National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma” make a strong point that the overall control of your child’s asthma is really what is most important, not what the severity level happens to be at any time. Adjustments of treatment are based mainly on how well-controlled your child’s asthma is when assessed at follow-up visits. Intermittent Asthma A child who has symptoms of wheezing and coughing no more than 2 days a week is con-sidered to have intermittent asthma; nighttime flare-ups occur twice a month at most. Outside of these few episodes, a child with intermittent asthma is free of asthma symptoms. Any child with asthma symptoms more often than 2 days a week or 2 nights per month, on average, is felt to no longer have intermittent asthma but persistent asthma. Persistent asthma has 3 levels of severity. Mild Persistent Asthma In mild persistent asthma, symptoms occur more than twice a week but less than once a day, and flare-ups may affect activity. Nighttime flare-ups occur more often than twice a month but less than once a week. Lung function is 80% of normal or greater. Moderate Persistent Asthma Asthma is classified as moderate persistent if symptoms occur daily. Flare-ups occur and usually last several days. Coughing and wheezing may disrupt the child’s normal activities and make it difficult to sleep. Nighttime flare-ups may occur more than once a week. In moderate persistent asthma, lung function is roughly between 60% and 80% of normal, without treatment. Severe Persistent Asthma With severe persistent asthma, symptoms occur daily and often. They also frequently curtail the child’s activities or disrupt his sleep. Lung function is less than 60% of the normal level without treatment. Severe is the least-common asthma level. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" }, "103": { "health_issue_x_health_issue_article.id": 103, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 103, "health_issue_article.ts": "2018-04-19 03:09:20", "health_issue_article.title": "Nickel Allergy: Electronic Devices & Food Can Cause Rash", "health_issue_article.content": "Nickel Allergy: Electronic Devices & Food Can Cause Rash Page ContentIf your child complains of an itchy rash after wearing a belt with a buckle or jeans with a metal button, she might be allergic to nickel. The metal is used in clothes and jewelry and also can be found in cellphones, tablets, and even food. Regardless of whether your child wears an item made with nickel or eats food containing nickel, the allergic reaction is the same. Symptoms include an itchy rash on the skin with redness, scaling and possibly a crusty appearance. Called nickel-allergic contact dermatitis, the allergy affects about 11 million children. Symptoms appear hours to days after exposure to a product containing nickel. A rash can appear on the area of the skin exposed to nickel, or it can be more widespread, according to a study from the American Academy of Pediatrics' journal Pediatrics. Contact your pediatrician if you suspect your child has an allergy to nickel. Your doctor might suggest using an ointment or antihistamine.If your child has a nickel allergy, take these precautions to avoid future reactions: Look for belts, watches and jewelry that are labeled \"nickel-free,\" or buy items that are hypoallergenic or made from surgical-grade stainless steel, gold, silver, or platinum.Use clear nail polish to coat the metal on parts that touch the skin. Buy a case for your tablet or phone that covers the parts made of metal.Avoid foods containing nickel, including chocolate and cocoa powder, nuts, soy products, black tea, seeds, and commercial salad dressings. Avoid eating canned food, and avoid cooking acidic foods like tomato, vinegar, or lemon in stainless steel cookware. Run tap water for a few seconds before washing, drinking, and cooking to help flush out any nickel that leaches from pipes and fixtures. Additional Information: Rashes and Skin ConditionsAllergy Medicine for ChildrenAllergy Causes in Children: What Parents Can Do Article Body Last Updated 2/29/2016 Source AAP News (Copyright © 2016 American Academy of Pediatrics)" }, "104": { "health_issue_x_health_issue_article.id": 104, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 104, "health_issue_article.ts": "2018-04-19 03:09:27", "health_issue_article.title": "Peak Flow Meter", "health_issue_article.content": "Peak Flow Meter Page Content Article BodyA peak flow meter (or, rarely, a small electronic portable spirometer) is sometimes recommended as part of a treatment plan. These handheld devices measure how fast a person can blow air out of the lungs. Asthma causes patients to not be able to blow air out fast because their airways are narrowed, so a low measurement with this device suggests problems are occurring with your child’s asthma. These measurements can help warn a patient or parent that extra medication is needed to fend off more severe asthma symptoms. The results can also be useful for the patient who does not adequately perceive worsening airway obstruction or who has difficulty distinguishing anxiety or hyperventilation attacks from asthma. When your child is having asthma problems, a peak flow reading puts a number on how she is doing, much as a thermometer shows how high a temperature is. Your pediatrician or asthma specialist will show you how to record your child’s baseline measurements at a time when she is doing well with her asthma. This is referred to as her “personal best.” When your child’s asthma is not doing well or is at risk of flaring up (eg, during a “cold”), a peak flow reading can be obtained and the value compared to the child’s personal best. Using a simple range of color zones—green, yellow, and red, like traffic lights—specific recommendations can be spelled out as to what needs to be done to prevent a full-blown asthma attack based on what color zone the patient falls into with her peak flow measurement. How to Use a Peak Flow Meter Your child’s peak flow–based asthma treatment plan uses his own personal best peak flow reading because every child is unique. Your child’s peak flow may be higher or lower than that of another child even though their age, sex, and height are identical. To find your child’s personal best, your pediatrician will instruct him to use the peak flow meter at the same time every day for 2 to 3 weeks during a period when he doesn’t have any symptoms and asthma is under good control. To obtain a peak flow measurement, have your child do the following: Stand up. Place the peak flow device indicator at 0. Take a deep breath, then place the device well in to the mouth. Close his lips around the mouthpiece and keep his tongue clear of the opening. Blow once as hard and fast as he can. Note the reading. Repeat steps 2 through 5 twice more and write down the highest score. After your child has established his personal best your doctor may ask him to use the meter for readings when he is beginning to have symptoms, or when he has a “cold” (a time when asthma commonly gets worse). The doctor may also ask you to monitor his peak flow when adjustments have been made to his medication program, whether it be up or down, to detect any change in asthma control. Starting at about age 4 or 5 years, your child can learn how to use a peak flow meter. The following color zone system is commonly used with peak flow monitoring: Green means that the airflow score is at 80% to 100% of your child’s personal best peak flow (the targeted peak flow value determined by your child’s pediatrician); his medications don’t need to be adjusted and he may continue full activity. Yellow means caution, just as it does on the road with a traffic light; airflow is between 50% and 80% of your child’s personal best and certain additional asthma medications should be started or increased to ward off symptoms. Red means danger; your child’s score is less than 50% of his peak flow. Have your child take his quick-relief medications (usually a bronchodilator at a high dose to open up the airways and steroid pills or liquid to calm inflammation) if it is part of the asthma action plan worked out between you and your pediatrician or asthma specialist. Call or see your physician soon, or go for emergency care, if the peak flow reading stays below 50% despite the treatment. The peak flow meter provides one way to measure asthma objectively, but it’s critical that the child and everyone else in the family not rely on just a peak flow number for assessment of how a child’s asthma is doing. Symptoms are as important, probably even more important, than a peak flow reading. It is not uncommon for symptoms to detect a flare-up of asthma even before peak flow measurements do. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" }, "105": { "health_issue_x_health_issue_article.id": 105, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 105, "health_issue_article.ts": "2018-04-19 03:09:32", "health_issue_article.title": "Peanut Allergies: What You Should Know About the Latest Research & Guidelines", "health_issue_article.content": "Peanut Allergies: What You Should Know About the Latest Research & Guidelines Page ContentBy: Claire McCarthy, MD, FAAPWhen I was growing up, peanut butter and jelly sandwiches were really common in the school lunchroom. These days, most parents wouldn't even think of sending one. We've moved from peanut-free lunch tables to peanut-free schools—and many camps and afterschool programs have banned anything peanut too.They do it to save lives. Not only has the prevalence of peanut allergy doubled in Western countries over the past 10 years, it is the leading cause of food allergy related death in the United States.Finally we may have an answer, and it is the simplest answer of all: eating peanuts. Not actual peanuts—they are a serious choking hazard—but things made from peanuts, like peanut butter. Previous Recommendations:For many years, experts thought that the best way to fight peanut allergy was to avoid peanut products in the first years of life—that's why in 2000 the American Academy of Pediatrics (AAP) recommended that any child at high risk of peanut allergy (like those with a family history of it, or with other food allergies, or eczema) not eat any before they turned 3. But that didn't help, which is why in 2008 the AAP stopped recommending it.New Research on Peanut Allergies: Around this time, researchers in the UK noticed something interesting: peanut allergy in Jewish children living in the UK was about 10 times more common than it was in Jewish children living in Israel. Since these children shared a similar ancestry, the difference had to be something that they were doing.It turned out there was a big diet difference. Children in the UK rarely ate peanut products in the first year or so of life—whereas children in Israel commonly ate a snack called Bamba, a corn puff made with peanut butter. The researchers wondered: Could this be the important difference—that the Israeli children ate peanut products from an early age?So they tested it. They did a study on about 600 babies who had severe eczema or egg allergy, which are known to increase the risk of peanut allergies. They divided them up into two groups: one was given Bamba to eat regularly (if they didn't like Bamba, they could eat smooth peanut butter), and the other was told to stay away from foods containing peanuts. They did this until the children were 5 years old.At 5 years, only 3 percent of the kids who ate peanut products were allergic to them—compared with 17 percent of those who didn't eat peanuts. This included children who tested positive for a peanut allergy as infants (those with strong positive tests, however, were not included in the study).This is huge, amazing news.New Guidelines on the Introduction of Peanut ProductsSince this news, the National Institute of Allergy and Infectious Diseases has come out with guidelines to help pediatricians and parents understand and use this news—and do it safely. The guidelines divide babies into three groups: those with severe eczema (persistent or recurrent eczema who need prescription creams frequently) and/or egg allergy, those with mild to moderate eczema, and those who don't have any eczema or food allergy. For the first group, those with severe eczema and/or egg allergy, testing for peanut allergy is recommended—and parents should talk with their doctors about how and when to give peanut products. If testing shows an allergy, it may be a good idea to do that first taste of peanut product in the doctor's office. Parents of babies in this group should talk to their doctor early, like at the 2 or 4-month checkup, because the recommendation is that these babies should get peanut products between 4 and 6 months. There is no testing needed for babies with mild to moderate eczema, although they should still talk with their doctors about their child's situation and needs. These babies should try peanut products at around 6 months of age. The babies who don't have any eczema or food allergy can have peanut products along with other foods based on their family's preferences and cultural practices. It's not so important to do it early, but it's fine if parents do. It's very important that parents not give babies whole peanuts or chunks of them (or chunky peanut butter) because babies could choke. Smooth peanut butter mixed into a puree is better, as are snacks or foods made with peanut butter. We don't know if this will work for other food allergies, so if there are other allergies you are looking to prevent, talk to your doctor. Additional Information & Resources: Ask the Pediatrician: When can I start giving my baby peanut butter? Diagnosing Food Allergies in ChildrenAvoid a Food Allergy Scare on HalloweenManagement of Food Allergy in the School Setting (AAP Clinical Report)Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-Sponsored Expert Panel (AAP-Endorsed Guidelines)About Dr. McCarthy:Claire McCarthy, MD, FAAP is a primary care pediatrician at Boston Children's Hospital, an Assistant Professor of Pediatrics at Harvard Medical School, a senior editor for Harvard Health Publications, and an official spokesperson for the American Academy of Pediatrics. Along with serving on the HealthyChildren.org Editorial Advisory Board, she writes about health and parenting for Boston.com and Huffington Post. Article Body Author Claire McCarthy, MD, FAAP Last Updated 2/6/2017 Source American Academy of Pediatrics (Copyright © 2015)" }, "106": { "health_issue_x_health_issue_article.id": 106, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 106, "health_issue_article.ts": "2018-04-19 03:09:37", "health_issue_article.title": "Seasonal Allergies in Children", "health_issue_article.content": "Seasonal Allergies in Children Page Content Article BodyEvery fall, 5-year-old Timmy develops a runny nose, itchy, puffy eyes, and attacks of sneezing. His mother shares the problem, which she dismisses as mild hay fever, and something her son has to learn to live with. Lately, however, Timmy has also suffered attacks of wheezing and shortness of breath when he visits his grandmother and plays with her cats. Timmy’s pediatrician suspects allergic asthma, and wants him to undergo some tests. Timmy’s symptoms are by no means rare among children across the United States. Allergies and asthma often start in childhood and continue throughout life. Although neither can be cured, with proper care they can usually be kept under control. Allergies are caused by the body’s reaction to substances called “allergens,” which trigger the immune system to react to harmless substances as though they were attacking the body. When to Suspect an Allergy Some allergies are easy to identify by the pattern of symptoms that follows exposure to a particular substance. But others are subtler, and may masquerade as other conditions. Here are some common clues that could lead you to suspect your child may have an allergy. Repeated or chronic cold-like symptoms that last more than a week or two, or that develop at about the same time every year. These could include: Runny nose Nasal stuffiness Sneezing Throat clearing Nose rubbing Sniffling Snorting Sneezing Itchy, runny eyes Itching or tingling sensations in the mouth and throat. Itchiness is not usually a complaint with a cold, but it is the hallmark of an allergy problem. Coughing, wheezing, difficulty breathing, and other respiratory symptoms. Recurrent red, itchy, dry, sometime scaly rashes in the creases of the skin, wrists, and ankles also may indicate an allergy. Eczema When it comes to rashes, the most common chronic inflammatory skin condition in children is eczema, also called atopic dermatitis. Although not strictly an allergic disorder, eczema in young children has many of the hallmarks of allergies and is often a sign that hay fever and asthma may develop. The rate of eczema, like that of asthma, is increasing throughout the world. Where asthma is rare, the rate of eczema is also low. When to Suspect Asthma Although allergies and asthma often go together, they are actually two different conditions. Asthma is a chronic condition that starts in the lungs. Allergies are reactions that start in the immune system. Not everybody with allergies has asthma, but most people with asthma have allergies. Asthma Attacks The airways of the typical child with asthma are infl amed or swollen, which makes them oversensitive. When they come in contact with an asthma “trigger” — something that causes an asthma attack — the airways, called bronchial tubes, overreact by constricting (getting narrower). Many different substances and events can “trigger” an asthma attack: Exercise Cold air Viruses Air pollution Certain fumes Other allergens In fact, about 80 percent of children with asthma also have allergies and, for them, allergens are often the most common asthma triggers. Common Allergens in Home and School In the fall, many indoor allergens cause problems for children because they are inside of home and school for longer periods. Dust: contains dust mites and finely ground particles from other allergens, such as pollen, mold, and animal dander Fungi: including molds too small to be seen with the naked eye Furry animals: cats, dogs, guinea pigs, gerbils, rabbits, and other pets Clothing and toys: made, trimmed, or stuffed with animal hair Latex: household and school articles, such as rubber gloves, toys, balloons; elastic in socks, underwear, and other clothing; airborne particles Bacterial enzymes: used to manufacture enzyme bleaches and cleaning products Certain foods Controlling Allergy Symptoms It’s helpful to use air conditioners, where possible, to reduce exposure to pollen in both your home and your car. Molds are present in the spring and late summer, particularly around areas of decaying vegetation. Children with mold allergies should avoid playing in piles of dead leaves in the fall. Dust mites congregate in places where food for them (e.g , flakes of human skin) is plentiful. That means they are most commonly found in upholstered furniture, bedding, and rugs. Padded furnishings, such as mattresses, box springs, pillows, and cushions should be encased in allergen-proof, zip-up covers, which are available through catalogs and specialized retailers. Wash linens weekly, and other bedding such as blankets, every 2 to 3 weeks in hot water to kill the dust mite. Pillows should be replaced every 2 to 3 years. Working With Your Child’s Pediatrician Your child’s allergy and/or asthma treatment should start with your pediatrician. If needed, your pediatrician may refer you to a pediatric allergy specialist for additional evaluations and treatments, depending on how severe the child’s symptoms are. Although there are many over-the-counter antihistamines, decongestants, and nasal sprays, it is very important that you work with a pediatrician over the years to make sure that your child’s allergy and asthma are correctly diagnosed and the symptoms properly treated. Last Updated 11/21/2015 Source Healthy Children Magazine, Allergy/Asthma 2007" }, "107": { "health_issue_x_health_issue_article.id": 107, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 107, "health_issue_article.ts": "2018-04-19 03:09:42", "health_issue_article.title": "Skin Tests - The Mainstay of Allergy Testing", "health_issue_article.content": "Skin Tests - The Mainstay of Allergy Testing Page Content Article BodySkin tests, first developed almost a century ago, are still the mainstay of allergy testing. They are easy and safe to do, give fast results, and are relatively inexpensive, which makes them the best way to start looking for specific allergies. In performing scratch skin tests, drops of allergen extracts (eg, pollens, dust mites, molds, animal danders, foods) are allowed to seep through shallow scratches made in the patient’s skin. The tests can also be performed by the deeper, intradermal technique, in which extracts are injected under the skin. There are pros and cons to both testing methods. Scratch tests are painless and very easy to do. They are somewhat less sensitive than intradermal tests; they are also less likely to cause a severe reaction in someone who is highly allergic. The intradermal tests, which let the allergen extracts penetrate deeper into the skin, are highlysensitive, but they can occasionally result in false-positive reactions, indicating allergies where none exist. Your physician may decide to start with scratch tests, then go on to intradermal testing if further information is needed. Before testing, your doctor will ask you not to give your child any antihistamines for 3 to 5 days, as they will interfere with the results of the tests. If your child has formed specific IgE antibodies through earlier exposure to one of the substances being tested, the skin test area will redden and swell into a disk that looks like a mosquito bite around the puncture site. This skin reaction usually peaks within 15 to 20 minutes after the test extracts are applied, and then gradually clears up. The skin where the tests were done may feel itchy for a few hours. Skin Tests Must Be Done by an Experienced Physician Although a positive result to scratch or intradermal skin testing strongly suggests that your child has formed lgE antibodies against a specific allergen, it does not follow that your child will definitely develop allergy symptoms when exposed to that particular allergen in the environment. As a rule, the bigger the skin test reaction, the higher the chances are that your child is allergic and will sneeze, itch, or break out in a rash. However, in some cases the skin reaction is trivial while the symptoms are overwhelming, and vice versa. Further, even though your child may have diminished symptoms as he gets older, the skin test result can remain positive. It is important that tests be conducted and results interpreted by someone trained and experienced in allergy skin testing. This Is Only a Test Many parents and children are afraid of having allergy skin testing because they’ve heard false reports that it is painful and upsetting. Scratch tests, the form of testing most often used in children, are mostly painless because they are done on the surface of the skin, where there aren’t any nerve endings to register pain. Furthermore, new test devices are available that can do up to 8 tests at a time and allow scratch testing to be done quickly and without injury. The intradermal technique uses a very fine needle to penetrate the surface of the skin. It is “felt” a little more than scratch testing but is still not very painful. Many people also falsely believe that children have to reach a certain age before they can be tested. In fact, age is no barrier to skin testing; positive results can be obtained at any age. For example, in infants and toddlers who have eczema and suspected food allergy, skin tests often reveal sensitivity to milk or egg. Once parents have this information, they can keep those foods out of their child’s diet to control allergy symptoms. Finally, experienced doctors and nurses perform allergy testing on a daily basis. They know how to take away fears and put children—and parents—at ease. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" }, "108": { "health_issue_x_health_issue_article.id": 108, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 108, "health_issue_article.ts": "2018-04-19 03:09:49", "health_issue_article.title": "Tests Used to Diagnose Allergies", "health_issue_article.content": "Tests Used to Diagnose Allergies Page Content Article BodyInstead of skin tests, your pediatrician or allergy specialist may order a blood test that has various names, including specific IgE blood test, in vitro IgE test, and radioallergosorbent test (RAST). (When the test was first invented years ago, it was called RAST, based on the specific way the test was done in the laboratory. Even though that technique is no longer used, the name RAST has kind of hung on.) The specific IgE blood test is especially useful if skin tests cannot be done because, for instance, a child has eczema over much of his body or cannot be taken off medication that interferes with skin testing. This blood test shows specific sensitivities, as skin tests do, but does so by detecting the presence of allergy antibodies circulating in the blood. If antibodies are in the blood, it usually means the same antibodies are also in other tissues. The method is not quite as versatile as skin testing because certain extracts are not available for measuring specific IgE using this technique. For example, a specific IgE blood test cannot be used to detect sensitivity to medications and is rarely used to detect insect venom allergy. However, the specific IgE blood test, in general, is adaptable and sensitive enough to detect a wide range of allergies. The procedure costs more per test than skin testing. It requires only a few minutes of the patient’s time to draw a blood sample and there is no risk of any allergic reaction. The results take from 1 to 5 days, whereas skin test results are available immediately. Radiographs and Imaging Tests While sometimes useful, radiographs (x-ray films) are not essential for diagnosing asthma or allergies. In fact, people with asthma usually have normal chest radiographs. However, chest radiographs are sometimes done to make sure children do not have other conditions that can mimic asthma. Sinus infection can produce symptoms similar to those of respiratory allergies, and children who have respiratory allergies are prone to sinus infections. Your pediatrician may order an imaging test to see if your child simply has a prolonged or recurrent infection, or whether a sinus infection is complicating his allergies. An imaging test can be done the old-fashioned way, with a radiograph of the head, or it can be performed by computed tomography (CT). A CT scan is more sensitive than a radiograph and shows finer details of the anatomy of the sinuses, which can help your pediatrician decide on the best way to treat your child’s sinus problem. Finally, imaging tests can sometimes help your pediatrician identify the reason your child snores or has a permanently stuffed-up nose. A radiograph of the upper neck area can show if the stuffiness is caused by enlargement of the adenoid tissue, which sits in the upper throat just behind the nose. Lung Function Tests If your child has symptoms indicating possible asthma, your pediatrician or asthma specialist may perform tests to evaluate his lung function. Lung function tests are performed in your pediatrician’s office or a pulmonary function laboratory where special equipment is available. An instrument called a spirometer is used to measure how much air your child can breathe out, as well as how fast the air flows. The technician will place a clip over your child’s nose to prevent air escaping from the nostrils. The technician will then ask your child to perform breathing maneuvers into a mouthpiece attached to a pulmonary function monitor. The maneuvers aren’t difficult or painful. All your child has to do is take a deep breath, then breathe out forcefully through the mouthpiece. Instead of using a spirometer, the doctor may ask your child to blow into a simpler device called a peak flow meter. Your pediatrician usually has your child perform the lung function test at least 3 times at a sitting to make sure results are consistent. If lung function testing shows that your child cannot blow air out fast enough, your pediatrician may perform further tests for asthma. Your pediatrician may give your child a dose of bronchodilator medication to see if there is a change in airflow. If airflow is normal or improved after the medication, the result strongly suggests that asthma is present. Sweat Test Cystic fibrosis is an inherited disorder that involves many body systems. It causes symptoms in the respiratory and digestive tracts that can mimic those of asthma and allergies. A child with cystic fibrosis may have asthma or allergies, as well. Your pediatrician may order tests to measure the levels of certain minerals in your child’s sweat (commonly called a sweat test). If the results indicate cystic fibrosis, further tests will be done to confirm the diagnosis. Last Updated 11/21/2015 Source Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)" }, "109": { "health_issue_x_health_issue_article.id": 109, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 109, "health_issue_article.ts": "2018-04-19 03:09:55", "health_issue_article.title": "Understanding UV and Pollen Indexes", "health_issue_article.content": "Understanding UV and Pollen Indexes Page Content Article BodyIn the warmer months, if you have allergies, asthma, or another respiratory condition, it is recommended that you check the pollen and mold counts for the day. And if you plan to be ouside, protect your skin by checking to see the intensity of the UV rays. Click here to listen Last Updated 1/23/2016 Source A Minute for Kids" }, "110": { "health_issue_x_health_issue_article.id": 110, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 110, "health_issue_article.ts": "2018-04-19 03:10:01", "health_issue_article.title": "What is Asthma?", "health_issue_article.content": "What is Asthma? Page Content Article BodyAsthma is a chronic disease of the tubes that carry air to the lungs. These airways become narrow and their linings become swollen, irritated, and inflamed. In patients with asthma, the airways are always irritated and inflamed, even though symptoms are not always present. The degree and severity of airway inflammation varies over time. Children with asthma can have symptoms start or worsen when they are exposed to many indoor substances such as Dust and dust mites Cockroaches Animals such as cats and dogs Molds Secondhand cigarette smoke Children with asthma may also be sensitive to colds and other viral infections, cold air, and particles or chemicals in the air. Ongoing exposures to these substances will not only worsen asthma symptoms, but also continue to aggravate airway inflammation. Inflammation of the airways causes them to be oversensitive and “twitchy,” often called “hyperreactive.” When the airways are hyperreactive, they can go into spasms, causing blockage and symptoms of wheezing, chest tightness, and shortness of breath. Who Gets Asthma? Asthma is a common condition in childhood. In the United States, 10% to 15% of children in grade school have or have had asthma. It can cause a lot of sickness and result in hospital stays and even death. The number of children with asthma is increasing, and the amount of illness due to asthma may also be increasing in some parts of the country. The reasons for these increases are not exactly known; however, outdoor air pollution and increased exposure to allergens are not likely causes. Recent studies suggest that how often and how early a child is exposed to certain infections and animals can influence the development of asthma. For example, children who come from large families, live with pets, or spend a considerable amount of time in child care in the first year of life are less likely to develop asthma. This early exposure to common allergens may actually protect against the development of asthma. Studies have also shown that a child’s exposure to infections early in life can determine whether he develops allergies or asthma. Some infections seem to decrease the risk of developing asthma, whereas one infection, respiratory syncytial virus, increases the risk. How Is Asthma Treated? Any child who has asthma symptoms more than twice per week should be treated. One of the most important treatments of asthma is to control the underlying inflammation of the airways. This can be done with medications or by avoiding environmental factors that cause or aggravate airway inflammation. Knowing the causes and triggers for asthma can allow families to reduce or avoid these triggers and reduce ongoing airway inflammation and hyperreactivity. This can reduce the severity and frequency of asthma symptoms and, hopefully, the need for as much asthma medication. Last Updated 11/21/2015 Source AAP Section on Allergy and Immunology (Copyright © 2003)" }, "111": { "health_issue_x_health_issue_article.id": 111, "health_issue.id": 3, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Allergies & Asthma", "health_issue_article.id": 111, "health_issue_article.ts": "2018-04-19 03:10:06", "health_issue_article.title": "When Pets Are the Problem", "health_issue_article.content": "When Pets Are the Problem Page Content Article BodyFurry pets are among the most common and potent causes of allergy symptoms. However, fur usually is not the only animal allergen. Even shorthaired, “non-shedding” animals leave a trail of dander and saliva. Cats are commonly more allergenic than dogs. Although certain breeds of dogs are said to be less allergenic than others, studies don’t support the claim. Comparisons of dogs also show wide differences in levels of allergen-creation between individual dogs of the same breed. Reptiles, fish, and amphibians are not generally causes of allergy. Making Adjustments For families with a member allergic to an animal that are deeply attached to their animals, the notion of finding another home for a pet is hard to accept. Many prefer to keep the animal and battle on against allergy symptoms. If you can’t part with your pet, at least keep it out of your allergic child’s bedroom, and sweep, dust, and vacuum frequently. Another solution may be to keep your cat or dog permanently outdoors with adequate shelter. Weekly bathing in tepid water has also been shown to lower a pet’s potential allergens, including animals that never venture out of doors, but doing this regularly and consistently is often not realistic. Long after an animal has left the family home, animal allergens can persist due to hair and dander left behind. Before You Consider a New Pet … It is unwise to bring home a furry pet if you have a strong family history of allergies and, consequently, a high risk that infants and young children in your home could develop allergies. Better to wait a few years and, then, if there are no signs of trouble and your child’s allergy tests are clear, you may want to look into pet ownership. Try to expose your child to the pet a few times before bringing the pet home, just to see if there are any allergic symptoms that would indicate this is not the right move for your child. A household pet may be unjustly blamed for causing allergy symptoms. Don’t automatically banish Fido to the doghouse unless your child’s been tested and the results suggest that your child has an animal allergy. Occasionally, symptoms that seem to be caused by an animal may be, in fact, due to other allergies, such as to pollen or mold. What happens is that Fido and Felix explore outdoors, then come back into the house with a load of pollen granules and mold spores in their coats. Every time the hay fever sufferer pats the pets, he stirs up an invisible cloud of allergens that triggers symptoms. Tips for Handling Pet Allergies More than 70 percent of U.S. households have a dog or cat, according to the American College of Allergy, Asthma, and Immunology (ACAAI). People with allergies should be cautious in deciding what type of pet they can safely bring into their home. The ACAAI offers the following advice: Pet exposure may cause sneezing and wheezing. An estimated 10 percent of the population may be allergic to animals, and 20 to 30 percent of individuals with asthma have pet allergies. The best types of pets for an allergic patient are pets that don’t have hair or fur, shed dander, or produce excrement that creates allergic problems. Tropical fish are ideal, but very large aquariums could add to the humidity in a room, which could result in an increase of molds and house dust mites. Other hypoallergenic pets include reptiles and turtles, but be aware that turtles can spread salmonella, a highly contagious bacterial disease. If the family is unwilling to remove the pet, it should at least be kept out of the patient’s bedroom and, if possible, outdoors. Allergic individuals should not pet, hug, or kiss their pets because of the allergens on the animal’s fur or saliva. Indoor pets should be restricted to as few rooms in the home as possible. Isolating the pet to one room, however, will not entirely limit the allergens to that room. Air currents from forced-air heating and air-conditioning will spread the allergens throughout the house. Homes with forced-air heating and/or air-conditioning may be fitted with a central air cleaner. This may remove significant amounts of pet allergens from the home. The air cleaner should be used at least four hours per day. The use of heating and air-conditioning filters and HEPA (High Efficiency Particulate Arresting) filters as well as vacuuming carpets, cleaning walls and washing the pet with water are all ways of reducing exposure to the pet allergen. When it comes to diagnosing pet allergies, most are pretty obvious — symptoms occur soon after exposure. But sometimes the allergy is subtler. Skin tests or special allergy blood tests can be done, if necessary, to confirm a suspicion of an animal allergy. One way to confirm a pet’s significance as an allergen, is to remove the pet from the home for several weeks and do a thorough cleaning to remove the residual hair and dander. It is important to keep in mind that it can take weeks of thorough cleaning to remove all the animal hair and dander before a change in the allergic patient is noted. Allergy shots (immunotherapy) may be needed for cat or dog allergies, particularly when the animal cannot be avoided. They are typically given for at least three years and may decrease symptoms of asthma and allergy. They are not recommended as routine treatment for pet allergy in children, though. Avoidance and pet elimination are the preferred approach. 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" }, "112": { "health_issue_x_health_issue_article.id": 112, "health_issue.id": 4, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Autism", "health_issue_article.id": 112, "health_issue_article.ts": "2018-04-19 03:10:11", "health_issue_article.title": "Autism Spectrum Disorder", "health_issue_article.content": "Autism Spectrum Disorder Page ContentWhat is Autism Spectrum Disorder?Autism spectrum disorder (ASD) is a neurologically-based disability that affects a child's social skills, communication, and behavior.Because most children with ASD will sit, crawl, and walk on time, you may not notice delays in social and communication skills right away. Looking back, many parents can recall early differences in interaction and communication. See What are the Early Signs of Autism?.ASD symptoms may change as children get older and with intervention. However, as many children with autism develop, they may likely have other developmental, learning, language, or behavioral issues or diagnoses. Others, while not very common, may improve so much that they might no longer be considered to have a diagnosis of ASD.How Common is ASD?ASD affects about 1 in 68 children. Boys are diagnosed with ASD about 5 times more often than girls.The number of children reported to have autism has increased since the early 1990s. The increase could be caused by many factors. Many families are more aware of ASD. Pediatricians are doing more screening for ASD, as recommended by the AAP, and children are identified earlier—which is a good thing.Also, there have been changes in how ASD is defined and diagnosed. In the past, only children with the most severe autism symptoms were diagnosed. Now children with milder symptoms are being identified and helped.The Benefits of Early IdentificationEach child with autism has different needs. The sooner autism is identified, the sooner an early intervention program directed at the child's symptoms can begin.The American Academy of Pediatrics (AAP) recommends that all children be screened for ASD at their 18- and 24-month well-child checkups. Research shows that starting an intervention program as soon as possible can improve outcomes for many children with autism.See Where We Stand: Autism.Additional InformationWhat are the Early Signs of Autism?If Autism is Suspected, What's Next?What is Early Intervention?Where We Stand: AutismHow is Autism Diagnosed?How Doctors Screen for Autism Article Body Last Updated 8/4/2015 Source Adapted from Understanding Autism Spectrum Disorders (ASDs): An Introduction (Copyright © 2012 American Academy of Pediatrics)" }, "113": { "health_issue_x_health_issue_article.id": 113, "health_issue.id": 4, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Autism", "health_issue_article.id": 113, "health_issue_article.ts": "2018-04-19 03:10:18", "health_issue_article.title": "How Pediatricians Screen for Autism", "health_issue_article.content": "How Pediatricians Screen for Autism Page ContentPediatricians start screening your baby for signs of developmental or communication challenges like autism spectrum disorder (ASD) from his or her very first well-child visit. Your pediatrician observes how your baby giggles, looks to you for reassurance, tries to regain your attention during a conversation, points or waves, responds to his or her name, and cries. Those observations in combination with family history, health examinations, and parental perspectives remain extremely valuable in helping identify children at risk for ASD.Formalized Autism Screening Recommended at the 18- and 24-Month Well-Child Visits:The American Academy of Pediatrics (AAP) recommends screening all children for autism at the 18 and 24-month well-child visits in addition to regular developmental surveillance. This type of screening can identify children with significant developmental and behavioral challenges early, when they may benefit most from intervention, as well as those with other developmental difficulties. For screening to be effective, it must be applied to all children – not only those with symptoms. Modified Checklist for Autism in Toddlers (M-CHAT): In most offices, pediatricians use the M-CHAT, a 23-point questionnaire filled out by parents. Most families find it easy to fill out. Using this standardized screening, pediatricians can pick up children at risk for ASD and will be prompted to start conversations about language delay, concerns about behavior, or possible next steps for a child at risk with additional genetic, neurologic, or developmental testing.Screening Isn’t Diagnosing!It’s important to note that screening isn’t diagnosing. If your child has a positive screen for an ASD, it doesn’t mean he or she will be diagnosed on the spectrum. And further, if your child screens normally but you continue to worry about ASD, don’t be shy. Screening tests are just that—screening—and don’t identify all children with ASD. The rate of success for the M-CHAT, for example, isn’t 100%, so it is used in combination with health and family history to identify children at risk. Your opinions as a parent are irreplaceable and of the most importance.If You Are Concerned and Your Child Has Not Been Formally Screened:Talk with your pediatrician about doing a formal screening. Many screening tools are available.But know this: If you are concerned about your child’s communication or behavior due to a family history of ASD, the way he or she talks or acts, or other people’s comments about his or her behavior, don’t wait to talk with your pediatrician about doing more. If the first doctor doesn’t respond to you or take you seriously, get a second opinion.Additional Information: Assessing Developmental Delays When Not to Worry About Autism? Early Signs of Autism Spectrum Disorders Diagnosing Autism Identification and Evaluation of Children With Autism Spectrum Disorders (AAP Policy Statement) Article Body Last Updated 2/18/2016 Source Adapted from Mama Doc Medicine: Finding Calm and Confidence in Parenting, Child Health, and Work-Life Balance (Copyright © 2014 Wendy Sue Swanson)" }, "114": { "health_issue_x_health_issue_article.id": 114, "health_issue.id": 4, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Autism", "health_issue_article.id": 114, "health_issue_article.ts": "2018-04-19 03:10:28", "health_issue_article.title": "How is Autism Diagnosed?", "health_issue_article.content": "How is Autism Diagnosed? Page Content Article BodyIt would be so much easier if autism spectrum disorer (ASD) could be diagnosed with a blood test or an x-ray, but it's not that simple. Diagnosis is ultimately made based on your description of your child's development, plus careful observations of certain behaviors by autism experts, medical tests, and your child's history. Parent and Pediatrician PartnershipEarly diagnosis requires a partnership between parents and pediatricians. Within this partnership you, as the parent, should feel comfortable bringing up any concerns you have about your child's behavior or development—the way she plays, learns, speaks, and acts. Likewise, your child's pediatrician's role in the partnership is to listen and act on your concerns.During your child's visits, the pediatrician may ask specific questions or complete a questionnaire about your child's development. Pediatricians take these steps because they understand the value of early diagnosis and intervention and know where to refer you if concerns are identified. The importance of this partnership cannot be stressed enough.ASD Screening for All ChildrenIf your child does have autism, an early diagnosis is better because then your child can start receiving the help he or she needs. This is why the American Academy of Pediatrics (AAP) recommends that all children be screening for ASD at their 18- and 24-month well-child checkups. Talk with your doctor if you feel your child needs to be screened (regardless of their age) and share your concerns — you know your child the best! RememberIt can be difficult to learn that your child has a lifelong developmental disability. Naturally, you as a parent, other caregivers, and extended family need to grieve about this. You will undoubtedly worry about what the future holds. Keep in mind during these difficult times that most children with ASD will make significant progress in overall function. Some children with ASD can do exceptionally well and may even remain in a regular education classroom. Many will have meaningful relationships with family and peers and achieve a good level of independence as adults. It is important to remember that while a diagnosis of autism may change what you thought your parenting experience would be, we now know that children with ASD can achieve so much more in life as long as they are given appropriate support and opportunities. See Words of Support for Parents of a Child with Autism. Additional InformationIf Autism is Suspected, What's Next?How Doctors Screen for Autism When Not to Worry About AutismWhat is Early Intervention? Last Updated 9/4/2015 Source Adapted from Autism Spectrum Disorders: What Every Parent Needs to Know (Copyright © American Academy of Pediatrics 2012)" }, "115": { "health_issue_x_health_issue_article.id": 115, "health_issue.id": 4, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Autism", "health_issue_article.id": 115, "health_issue_article.ts": "2018-04-19 03:10:36", "health_issue_article.title": "If Autism is Suspected, What’s Next?", "health_issue_article.content": "If Autism is Suspected, What’s Next? Page Content Article BodyWhen autism spectrum disorder (ASD) is suspected, your child will need a full assessment or evaluation and should be referred for early intervention (EI) services. This assessment includes asking parents and caregivers a number of questions, observing the child, performing a physical examination, and administering any tests that may assist in arriving at a specific diagnosis. Ideally, this is done by a team of professionals. Assessing Language and Social DelaysTypically, an evaluation to assess language and social delays can include: Careful observation of play and child-caregiver interactions. Detailed history and physical examination. Review of records of previous early intervention services, school, or other evaluations. Developmental assessment of all skills (motor, language, social, self-help, cognitive). ASD is suspected when the child's social and language functioning are significantly more impaired than the overall level of motor, adaptive, and cognitive skills. Hearing test. All children with any speech delays or those suspected of having ASD should have their hearing formally tested. Language evaluation that provides standardized scores of expressive language (including speech) and receptive language, as well as an evaluation of pragmatic language (social use of language) and articulation (pronunciation).Medical TestsAutism may be associated with a known syndrome or medical condition. Laboratory tests may be indicated to rule out other possible medical conditions that could cause ASD symptoms based on the child's history and physical examination. If needed, the child may be referred to other specialists, such as a geneticist or a pediatric neurologist, to help diagnose medical conditions that might cause or be associated with symptoms of ASD.Medical tests may include: Genetic tests. It is recommended that families be offered genetic testing, such as cytogenetic microarray testing. At present, up to 10% to 20% of children with ASD have abnormalities of their chromosomes identified using cytogenetic microarray testing. Genetic testing should be strongly considered if a child has unusual physical features or developmental delays or if there is a family history of fragile X syndrome, intellectual disability of unknown cause, or other genetic disorders. Other genetic tests may be needed in certain cases. Recommendations for genetic testing may change as new tests are developed. See Ethical and Policy Issues in Genetic Testing and Screening of Children (AAP Policy Statement). Lead test.Lead screening is an important component of primary care. A lead level should be performed when a child lives in a high-risk environment, such as older buildings, or continues to put things in his mouth. Other tests. Based on the child's medical history and physical examination, an electroencephalogram (EEG), a magnetic resonance imaging (MRI) scan, or tests for metabolic disorders may be ordered. Children with ASD may be picky eaters, so your child's pediatrician may recommend looking for evidence of iron or vitamin deficiencies (especially vitamin D).Medical tests not recommended:There is not enough clinical evidence to recommend any of the following tests specifically for ASD: Hair analysisRoutine measurement of multiple vitamin or nutrient levelsIntestinal permeability studiesStool analysisUrinary peptidesMeasurement of mercury or other heavy metalsDiagnosis of ASDDiagnosis of ASD is made by using all the information collected by history, observation, and testing. See How is Autism Diagnosed?If you have concerns about your child's behavior or development, talk to your pediatrician. Additional Information What is Early Intervention? Individualized Education Program (IEP) Words of Support for Parents of a Child with Autism Where We Stand: Autism Last Updated 1/27/2016 Source Adapted from Understanding Autism Spectrum Disorders (ASDs): An Introduction (Copyright © 2012 American Academy of Pediatrics)" }, "116": { "health_issue_x_health_issue_article.id": 116, "health_issue.id": 4, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Autism", "health_issue_article.id": 116, "health_issue_article.ts": "2018-04-19 03:10:42", "health_issue_article.title": "Keep Kids with Autism Safe from Wandering: Tips from the AAP", "health_issue_article.content": "Keep Kids with Autism Safe from Wandering: Tips from the AAP Page Content By: Susan Hyman, MD, FAAP & Lori McIlwainAnyone who's been a parent long enough has felt that panic—often only temporary—when a child wanders out of sight. Kids can get lost anywhere—at an amusement park, in a store, in a crowd, and sometimes even right in your own neighborhood. Many parents of children with autism spectrum disorder (ASD) know this feeling all too well.The Scope of the Problem: The first study to quantify the scope of the problem was published in Pediatrics in 2012. Results were significant. Of the 1,218 children with ASD who were studied, almost half of those children had wandered off from home, school, or another safe place at least once after age 4. Many were missing long enough to cause concern, were in danger of drowning, or were at risk of being hurt by traffic. What Parents Can Do: There are things parents can do to protect their children with ASD from this very real and scary danger. Here are tips from the American Academy of Pediatrics: Know wandering triggers. Children with ASD can be impulsive and typically wander or bolt from a safe setting to get to something of interest, such as water, the park, or train tracks—or to get away from a situation they find stressful or frightening, such as one with loud noises, commotion, or bright lights. Secure your home—regardless of your child's age. Shut and lock doors that lead outside. Consider putting alarms on doors to alert you if a door has been opened. Reinforce water and swimming safety. Home swimming pools should be surrounded by a fence that prevents a child from getting to the pool from the house. There is no substitute for at least a four-foot-high, non-climbable, four-sided fence with a self-closing, self-latching gate. Pool alarms and door alarms are also protection products that may have some benefits. Note, however, that swimming lessons are not enough to prevent drowning; swimming lessons in wet clothes and shoes could be suggested for children with ASD who tend to wander. Work on communication and behavior strategies. Teaching your child strategies to self-calm when stressed and appropriately respond to \"no\" can make a big difference. Make sure your child's teachers and other family members understand how important it is to keep your child engaged and busy to reduce his or her urge or opportunity to wander. Set expectations. Before going out in a public place, communicate the plan with your child and other family members—including the timeline and rules to follow. Consider noise-canceling headphones if noise is a trigger, and use the \"tag team\" approach to make certain your child is always supervised by a trusted adult. Consider monitoring technology and identification. More than 1/3 of children with ASD who wander are never or rarely able to communicate their name, address, or phone number. It may be helpful to have things like GPS devices, medical alert tags, and even their name marked in clothing. Project Lifesaver and SafetyNet Tracking or other programs may be available through your local law enforcement agencies. Rest. Children with ASD may be less hyperactive and less likely to wander during the night if they have a sleep management plan and a regular sleep schedule. Caregivers who get enough sleep are also more vigilant. Worried about Wandering? Talk with your child's pediatrician about creating a family wandering emergency plan. The diagnostic code for wandering is Z91.83, which can be used in your visits with medical professionals. Your pediatrician can give you additional strategies that may be helpful in increasing your child's safety, as well as information about local resources. Editor's note: Wandering behavior isn't unique to children with ASD. A variety of different developmental disorders, such as attention-deficit hyperactivity disorder, can also lead to children running off at any given moment.Additional Information & Resources: Drowning Prevention: Information for Parents Occurrence and Family Impact of Elopement in Children with Autism Spectrum Disorders (study published in Pediatrics, October 2012) Safety of Children with Disabilities: Wandering (Elopement) (Centers for Disease Control and Prevention) awaare.org (Autism Wandering Awareness Alerts Response and Education Collaboration)National Center for Missing & Exploited Children (NCMEC): 1-800-THE-LOST (1-800-843-5678) About Dr. Hyman: Susan Hyman, MD, FAAP is Associate Professor at the Department of Pediatrics at Golisano Children's Hospital at the University of Rochester Medical Center. She is board-certified by the American Board of Pediatrics in Developmental-Behavioral and Neurodevelopmental Disabilities. Within the American Academy of Pediatrics, Dr. Hyman is a member of the Council on Children with Disabilities Executive Committee, the Section on Developmental & Behavioral Pediatrics, and the Section on Integrative Medicine. As former Chair of the AAP Autism Subcommittee, Dr. Hyman led in the revision of the AAP publication, Autism: Caring for Children with Autism Spectrum Disorders: A Resource Toolkit for Clinicians, 2nd Edition. About Ms. McIlwain: Lori McIlwain is the mother of a teenage son with autism spectrum disorder and co-founder of the National Autism Association. In 2007, she began advocating for federal resources to reduce and eliminate injuries and deaths associated with autism-related wandering. She has been a contributor in The New York Times, and featured in USA Today, Time, Education Week, FBI's National Academy Associate Magazine, and NPR. In 2012, Ms. McIlwain assisted the National Center for Missing & Exploited Children in creating federal search and rescue guidelines for missing children with special needs, and in 2017 she presented on the topic of wandering among children with autism spectrum disorder at the federal Interagency Autism Coordinating Committee. Article Body Last Updated 10/10/2017 Source Council on Children with Disabilities (Copyright © 2017 American Academy of Pediatrics)" }, "117": { "health_issue_x_health_issue_article.id": 117, "health_issue.id": 4, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Autism", "health_issue_article.id": 117, "health_issue_article.ts": "2018-04-19 03:10:45", "health_issue_article.title": "Public Health Minute: Early Identification of ASD", "health_issue_article.content": "Public Health Minute: Early Identification of ASD Page ContentAutism spectrum disorder (ASD) affects about 1 in 68 children. In this Public Health Minute, pediatrician Susan Levy, MD, FAAP, explains why early diagnosis is so important.The American Academy of Pediatrics (AAP) recommends that all children be screened for ASD at their 18- and 24-month well-child checkups. Segment: Early Identification of ASD Additional Information:Early Signs of Autism Spectrum DisordersDiagnosing AutismIdentification and Evaluation of Children With Autism Spectrum Disorders (AAP Policy Statement) Article Body Last Updated 6/10/2016 Source PublicHealthMinute.com (Copyright © 2016)" }, "118": { "health_issue_x_health_issue_article.id": 118, "health_issue.id": 4, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Autism", "health_issue_article.id": 118, "health_issue_article.ts": "2018-04-19 03:10:50", "health_issue_article.title": "Sound Advice on Autism", "health_issue_article.content": "Sound Advice on Autism Page Content Article BodyTo answer parents' questions about autism spectrum disorders, the American Academy of Pediatrics (AAP) offers a collection of interviews with pediatricians, researchers and parents. Autism Research, Diagnosis and Treatment James M. Perrin, MD, FAAP (Recorded January 2013) Dr. James M. Perrin is a former president of the American Academy of Pediatrics. He is a professor of pediatrics at Harvard Medical School and heads the division of General Pediatrics at the MassGeneral Hospital for Children. Dr. Perrin leads the Clinical Coordinating Center for the National Autism Speaks Autism Treatment Network to improve care for children with autism and other developmental disorders. Listen to the entire interview Choose an individual question: Can you address the upcoming changes to the DSM-V? What is driving the increase in autism diagnoses? What have we learned recently about the causes of autism? What are the most effective treatments for autism? Do you have any final thoughts? Edited transcript Last Updated 1/27/2016 Source American Academy of Pediatrics (Copyright © 2013)" }, "119": { "health_issue_x_health_issue_article.id": 119, "health_issue.id": 4, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Autism", "health_issue_article.id": 119, "health_issue_article.ts": "2018-04-19 03:10:57", "health_issue_article.title": "What are the Early Signs of Autism?", "health_issue_article.content": "What are the Early Signs of Autism? Page Content Article Body Editor's Note: Autism and ASD will be used interchangeably in this article.Many children with autism spectrum disorder (ASD) may show developmental differences when they are babies—especially their social and language skills. Because they usually sit, crawl, and walk on time, less obvious differences in the development of gesture, pretend play, and social language often go unnoticed. In addition to delays in spoken language and behavioral differences, families may notice differences in their child interacts with his or her peers.One child with ASD will not have exactly the same symptoms as another child with ASD—the number and severity of symptoms can vary greatly. Social Differences in Children with AutismDoesn't keep eye contact or makes very little eye contactDoesn't respond to a parent's smile or other facial expressionsDoesn't look at objects or events a parent is looking at or pointing toDoesn't point to objects or events to get a parent to look at themDoesn't bring objects of personal interest to show to a parentDoesn't often have appropriate facial expressionsUnable to perceive what others might be thinking or feeling by looking at their facial expressionsDoesn't show concern (empathy) for othersUnable to make friends or uninterested in making friendsCommunication Differences in Children with Autism Doesn't point at things to indicate needs or share things with othersDoesn't say single words by 16 monthsRepeats exactly what others say without understanding the meaning (often called parroting or echoing)Doesn't respond to name being called but does respond to other sounds (like a car horn or a cat's meow)Refers to self as \"you\" and others as \"I\" and may mix up pronounsOften doesn't seem to want to communicateDoesn't start or can't continue a conversationDoesn't use toys or other objects to represent people or real life in pretend playMay have a good rote memory, especially for numbers, letters, songs, TV jingles, or a specific topicMay lose language or other social milestones, usually between the ages of 15 and 24 months (often called regression)Behavioral Differences (Repetitive & Obsessive Behaviors) in Children with Autism Rocks, spins, sways, twirls fingers, walks on toes for a long time, or flaps hands (called \"stereotypic behavior\")Likes routines, order, and rituals; has difficulty with changeObsessed with a few or unusual activities, doing them repeatedly during the dayPlays with parts of toys instead of the whole toy (e.g., spinning the wheels of a toy truck)Doesn't seem to feel painMay be very sensitive or not sensitive at all to smells, sounds, lights, textures, and touchUnusual use of vision or gaze—looks at objects from unusual anglesHow to Distinguish a Child with Autism from Other Typically Developing ChildrenHere are some examples that may help a parent identify the early signs of autism. At 12 Months A child with typical development will turn his head when he hears his name. A child with ASD might not turn to look, even after his name is repeated several times, but will respond to other sounds.At 18 Months A child with delayed speech skills will point, gesture, or use facial expressions to make up for her lack of talking. A child with ASD might make no attempt to compensate for delayed speech or might limit speech to parroting what is heard on TV or what she just heard.At 24 Months A child with typical development brings a picture to show his mother and shares his joy from it with her. A child with ASD might bring her a bottle of bubbles to open, but he does not look at his mom's face when she does or share in the pleasure of playing together. Trust Your InstinctsIf you have concerns about how your child plays, learns, speaks, acts, or moves, talk with your pediatrician. Before you go to the appointment, complete a free developmental milestone checklist, and read these tips about \"How to Talk with the Doctor.\" Remember, you know your child best and your concerns are important. Together, you and your pediatrician will find the best way to help your child. If you're uneasy about the doctor's advice, seek a second opinion. Don't wait. Acting early can make a big difference!Additional Information: How Doctors Screen for Autism When Not to Worry About Autism What is Early Intervention? Language Delay Learn the Signs. Act Early (CDC.gov) - Aims to improve early identification of children with autism and other developmental disabilities so children and families can get the services and support they need. Last Updated 9/4/2015 Source Adapted from Autism Spectrum Disorders: What Every Parent Needs to Know (Copyright © American Academy of Pediatrics 2012)" }, "120": { "health_issue_x_health_issue_article.id": 120, "health_issue.id": 4, "health_issue.ts": "2018-04-19 02:48:19", "health_issue.title": "Autism", "health_issue_article.id": 120, "health_issue_article.ts": "2018-04-19 03:11:09", "health_issue_article.title": "When Not to Worry About Autism", "health_issue_article.content": "When Not to Worry About Autism Page Content Article BodyMany parents worry about their child’s development at one point or another. Competitive Parenting - Stop Comparing! Competitive parenting makes us all a little nuts; the act of comparing what our children do against what the cousins or our friends’ children do is very difficult to stop. And can make anyone unnerved. Talk with Your Child’s Doctor If You Are Worried at Any Time If at any time you worry that your child isn’t expressing joy, communicating thoughts, or reflecting an understanding of your language, visual cues, and behavior, talk with your child’s doctor. If you don’t feel heard or you continue to worry, schedule another visit. If you still worry, contact another doctor for a second opinion. Instincts serve us very well when it comes to parenthood. Further, find some peace of mind if your child is doing many of the behaviors listed here! Reassuring Developmental Milestones for Infants & Children The following are a few signs that your child is developing great communication skills on time: Responds to her name between 9 and 12 months of age Smiles by 2 months of age; laughs and giggles around 4 to 5 months; expresses great joy to your humor around 6 months Plays and thinks peek-a-boo is funny around 9 months of age Makes eye contact with people during infancy Tries to say words you say between 12 and 18 months of age Uses 5 words by 18 months of age Copies your gestures like pointing, clapping, or waving Imitates you, i.e., pretends to stir a bowl of pancake mix when you give him a spoon and bowl or pretends to talk on the phone with a play cell phone Shakes head “no” Waves bye-bye by 15 months of age Points to show you something interesting or to get your attention by 18 months of age Additional Resources: Assessing Developmental Delays How Doctors Screen for Autism Early Signs of Autism Spectrum Disorder Diagnosing Autism Author Wendy Sue Swanson, MD, MBE, FAAP Last Updated 9/4/2015 Source Mama Doc Medicine: Finding Calm and Confidence in Parenting, Child Health, and Work-Life Balance (Copyright © 2014 Wendy Sue Swanson)" } } } }