Tag Archives: Pediatrics

Reacting to an autism diagnosis: what’s next?

This article has moved to: http://www.raisingarizonakids.com/2012/04/reacting-to-an-autism-diagnosis-whats-next/

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Understanding pediatric sudden cardiac arrest (SCA)

Would you recognize the warning signs of pediatric sudden cardiac arrest (SCA)? If not treated in minutes, SCA can result in death.

In a new policy statement to be published online on Monday, March 26, the American Academy of Pediatrics (AAP) provides guidance for pediatricians on underlying cardiac conditions that may predispose children to SCA.

Although the risk for SCA increases when children with underlying cardiac disorders participate in athletics, SCA can occur at very young ages and also when a child is at rest.

Research supports the need for a SCA registry, says the AAP. A registry would help experts gain a better understanding of the nuances of the condition.

Plus, many cardiac disorders are known to be genetic, so the evaluation of family members, even if asymptomatic, could be a critical step in the overall diagnosis of disorders predisposing to pediatric and young adult SCA.

We asked Arizona Pediatric Cardiology Consultants (APCC), members of the Arizona Chapter of the American Academy of Pediatrics, to weigh in on what parents need to know about SCA.

How common is SCA?  

According to the Centers for Disease Control, each year 2,000 individuals less than 25 years of age will die suddenly with the majority of these having a cardiac etiology.

What causes SCA?

Pediatric sudden cardiac arrest and sudden cardiac death can occur with various types of cardiac causes, including conditions in the heart muscle (such as hypertrophic cardiomyopathy), unusual positioning of a coronary artery, or an electrical disturbance within the heart. (Long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia).

More on genetic cardiac conditions from the Sudden Arrhythmia Death Syndrome Foundation (SADS)

How are family members evaluated, and what symptoms may be indicators that a child is pre-disposed to this? 

Signs that may suggest an increased risk for SCD include fainting or seizure with exercise, excitement, or startle, significant dizziness with exertion, unusual and consistent shortness of breath or chest pain with exercise.

If a family member has died suddenly or unexpectedly at a young age, has unexplained seizure disorder, died at a young age from a heart problem, or has a history of fainting, then screening is appropriate.

How do doctors determine if a child is at risk? What tests are performed?

Evaluation by a pediatric cardiologist will include a thorough individual and family history, ECG, physical exam and perhaps an echocardiogram, an exercise stress test, and genetic testing if necessary.

Would automatic external defibrillators (AED) on playing fields and in schools help?

A great majority of these deaths relate to a life-threatening arrhythmia, ventricular fibrillation. CPR and use of an AED may be life saving.  AEDs are often found in airports, casinos, and government buildings.

However, there is no law in Arizona currently requiring AED within schools, recreational sports fields, or other private facilities.

Are efforts being made to increase the availability of AEDs?

The decision about whether to have an AED on location is left up to the individual organization.  APCC’s electrophysiologists are making an effort to educate schools, sports organizations, and families regarding the importance preparation to prevent SCD.

The role of an ECG in all sports physicals remains a debated topic within the United States.  It is, however, very important to ask specific questions (use the attached screening tool) for risk factors and then refer to a pediatric cardiologist for further assessment.

What should parents or caregivers do if they believe a child might be at risk?

Once an individual is identified as having any of the conditions listed above, it is very important for first degree relatives to also be evaluated by a pediatric cardiologist even if they are not experiencing symptoms.

Sudden Cardiac Death is devastating to not only the families of those affected but to the communities in which they live.  Educating  families, schools, sports leagues, and primary care providers about quick and effective screening for children at risk for SCD is a first step in prevention.

Increased community awareness and the availability of AEDs in schools and sporting venues will help avert a tragedy.

Karen S. Eynon, RN, MSN, CPNP, MATS,  compiled these answers with support from Mitchell Cohen, MD, Andrew Papez, MD, and Jennifer Shaffer, RN, MS, CPNP, all of Arizona Pediatric Cardiology Consultants along with information from SADS.org.  

Check with your child’s physician if you are concerned about risks for SCA.

More from Parent Heart Watch, a network of parents and partners dedicated to reducing the effects of SCA.

 

Coping with dementia: a workshop for kids and families

It’s tough to deliver the news that a beloved grandparent has Alzheimer’s disease. But no one ever expects to have to tell his or her own children that a parent has been diagnosed with dementia.

But it happens.

About 10% of people under 65 will have a dementia, says Jan Dougherty, RN, director of Family and Community Services for Banner Alzheimer’s Institute.

More on Alzheimer’s disease and dementia

With the number of parents having children over 40, adds Dougherty, chances are that if a parent does develop early onset dementia, they may have adolescents or teens in the home.

No matter if it is a parent or a grandparent, kids are embarrassed by the changes they are seeing, says Dougherty, so finding others who are in similar situations can be very helpful.  Children and adults can become easily overwhelmed by the disruption that a dementia diagnosis can cause.

It’s important for parents and caregivers to be open and honest with children in any situation where rapid and significant change, such as memory loss, is likely to occur, says Cardon Children’s Child Life Specialist Courtney Kissel. That helps to maintain a trusting relationship.

Explaining a diagnosis to younger children about a parent- or a grandparent – can be a challenge.

One of the tips Kissel recommends is to ask the child to picture the memories that the person has in list form, written on a chalkboard that will, over time, be erased. The more recent memories at the top of the chalkboard will disappear first, and the memories from the early years of life at the bottom of the chalkboard will be the last to fade away.


A workshop, sponsored by the Banner Alzheimer’s Institute, aims to help families to come together to learn more about dementia and how to cope with the changes.

Dougherty hopes that her team will identify some ways to keep kids and families connected on an ongoing basis –so they won’t feel alone.

Kids, Families and Dementia Workshop
Saturday, March 31
8:30am-12:30pm
Franciscan Renewal Center, 5802 E. Lincoln Drive, Scottsdale, AZ

Families participating in this workshop with their children will gain age-appropriate information about Alzheimer’s disease/related dementias, explore methods to provide age-appropriate support for kids living with a person with dementia, identify ways for adults and children to stay connected to the person with dementia, join with others in like situations and explore ongoing ways to stay connected and supported.

Cost:
Individual: $10
Family of 3 or more: $25

TO REGISTER:
Pre-registration is required for the conference. The deadline is March 26. Call: 602-839-6850 or email deidra.colvin@bannerhealth.com.

Additional information, including the workshop schedule of activities.

Car seat safety check this Saturday

Wondering if your car seat still fits your child? Confused about when to turn your child from rear-facing to front facing? Need the eye of a trained professional car seat fitter to make sure your safety system works the way it should?

On Saturday, March 24, the Governor’s Office of Highway Safety Car Seat Check Event takes place at the Target store located at  1525 W. Power Road in Mesa.

Cardon Children’s Medical Center Safety and Injury Prevention staff will have 100 car seats to give out to families who need one.

Four out of five car seats are used incorrectly, according to the American Automobile Association. Don’t make these tragic mistakes!

Families can have a child’s car seat recertified, learn how to install a seat correctly or get a free car seat.

More RAK Resources on vehicle safety seats

Watch this video to see what a safety check event looks like:

 

Snoring linked to behavior problems in children

Children who snore or who have other sleep-related breathing problems are more likely to have behavioral problems years later, says a new study to be published in the April 2012 issue of Pediatrics.

Researchers asked a group of parents about their children’s snoring, mouth breathing, observed apnea and behavior, starting at age 6 months and then periodically until age 7 years.

By age 4, the children with sleep-disordered breathing were 20 percent to 60 percent more likely to have behavioral difficulties. By age 7, the likelihood jumped to 40 to 100 percent.

The worst symptoms were associated with the worst behavioral outcomes, meaning that the kids who faced more serious sleep-related breathing problems also tended to be more likely to struggle with behavior issues.

Study authors conclude that sleep-disordered breathing early in life can have a strong effect on behavior later in childhood.

Kids who have these difficulties may miss out on critical periods of brain development that researchers believe take place during deep sleep.

The study findings suggest that these symptoms may require attention as early as the first year of life.

Dr. Mark Brown, pediatric pulmonologist at the University of Arizona College of Medicine, and a member of the Arizona Chapter of the AAP, weighs in on kids and snoring:

 When should a parent be concerned about snoring?

  •  When a child can be heard snoring outside of their room.
  • When a child has disrupted sleep with short “pauses, snorts, or gasps” in their sleep.
  • If the child is having behavioral problems, a short attention span and problems at school.
  • If the child, especially an older child, frequently falls asleep during the day (i.e. in the car, during a TV show or movie, while reading).
  • In severe cases, there can be difficulty with weight gain or obesity, or high blood pressure.

Is a little light snoring okay?

Light snoring without any of the above associated signs/symptoms may be “normal.” If there is any concern, the parent should consult with their child’s primary care physician.

How do you know when snoring needs medical attention?

 If any of the above signs/symptoms are seen or if the parent is unsure about the significance of their child’s snoring they should consult with their child’s primary care physician.

RAK Archives: More on the consequences of too little sleep, and what families can do about it.

RAK Resources on respiratory issues: Take a Deep Breath by Dr. Nina Shapiro

Find out what technicians at the Sleep Center at Cardon Children’s Medical Center learn by watching children sleep:


Hearing loss in newborns and toddlers: when to worry

According to the Arizona Department of Health Services, approximately 300 newborns each year in the state have an inherited disorder that could be identified through screening.

Hearing loss is the most common of these disorders.

Babies born in hospitals are screened for hearing loss within the first few hours after birth.

Watch a newborn hearing screening at Cardon Children’s Medical Center/Banner Desert Medical Center

If a baby doesn’t pass the initial test, parents need to make sure they return for a repeat screening two to four weeks later, says Patty Shappell, AuD., CCC-A, an audiologist with Neonatology Associates, Ltd.

“Parents may get home and think the baby is responding normally, says Shappell, “but they still need to have a follow-up evaluation to assess hearing and rule out even mild or unilateral hearing loss.”

What happens if screening results are not within the normal range? Read about Brooke Gammie’s journey after her daughter, Payton, did not pass her newborn hearing screening.

For babies born outside of a hospital, screenings are available at outpatient clinics such as Neonatal Associates. Most insurance companies, including AHCCCS, cover the costs of the screenings.

What do babies miss if they are born with even a mild hearing loss? Hearing acuity directly affects the development of speech and verbal language skills. A baby with hearing loss, even during the first year, can be short-changed in his or her social, emotional, cognitive and academic development.

Diagnosis and early intervention are critical during the first year for the child with any degree of loss.

 How do you know if your baby is at risk for hearing loss?

Risk factors for hearing loss, according to the Arizona Department of Health Services include:

  • Babies who stay in the NICU for more than 5 days
  • Babies who have had an infection before or after birth such as CMV, herpes, rubella or meningitis
  • Babies who have a family member with hearing loss from birth or childhood

Follow-up with a physician is critical for babies at risk as it is possible that they may pass a hearing screening at birth but will still need more testing later.

New parents, says Shappell, should be sure to talk to their baby’s doctor and make an appointment with a pediatric audiologist or hearing specialist for further testing.

Normal milestones for the first year:

By 2 months of age a baby with normal hearing should be able to:

  • Quiet when hearing a familiar voice
  • Make sounds like ahh and ohh

By 4 months of age a baby with normal hearing should be able to:

  • Look for sounds with his eyes
  • Make sounds like squeals, whimpers or chuckles

By 6 months of age a baby with normal hearing should be able to:

  • Turn his head toward a sound
  • Make sounds like ba-ba, ma-ma, da-da

By 9 months of age a baby with normal hearing should be able to:

  • Imitate speech sounds made by others
  • Understand no-no or bye-bye
  • Turn his head toward a soft sound

By 12 months of age a baby with normal hearing should be able to:

  • Correctly use ma-ma or da-da
  • Respond to singing or music

Still, it is important to remember that babies with mild hearing loss may also be able to do these things.

During the second year, parents should continue to monitor any changes in a child’s development.

Candice L. Grotsky, Au.D., a Cigna audiologist who practices at the Stapley Hearing Center in Mesa, says that by twelve months to two years, children should still be turning to sounds from either side and “look up or down” for a sound if it comes above or below them.

They get better at  “localizing” or turning directly to a sound the older they get assuming hearing is normal and there are no developmental delays,  she adds.

Grotsky says that in toddlers, hearing loss is often caused by ear infections.  She says that most parents seem to know “when something is wrong” and bring their child in for testing.

“Maybe speech is delayed or mushy sounding, maybe speech was progressing well and all of a sudden stopped or regressed,” she says. ” Sometimes the child doesn’t respond if you are behind them and make a sound or noise.  These are all clues that hearing loss could be present.”

Grotsky says that most of those children in the age range of 2-4 years that she sees are coming in for the first time  — and it is usually a speech delay that prompts parents to seek testing.

If you suspect for any reason that your child — at any age — is having difficulty hearing or seems to be delayed in speech or in any other area, talk to your child’s physician.

Kids who are bullied less likely to be physically active

Children who are bullied by their peers endure great emotional pain and suffering.

Staying active has emotional benefits, too. Courtesy YMCA of the East Bay, Oakland, CA

But a new study, to be published in the March 2012 issue of Pediatrics, found that children who are ostracized, even for brief periods, are significantly more likely to choose sedentary over physical activities.

Researchers asked children between the ages of 8 and 12 to play a virtual ball-toss game. They were told that they were playing the game online with other kids. In some of the sessions, the game was pre-programmed to exclude the child from receiving the ball for most of the game.

In the other sessions, the child received the ball one-third of the time. After the game, the kids were given a choice of any activity they liked. They were then monitored by a device that measured physical activity.

The researchers found the kids who were excluded were far more likely to choose an activity that did not require physical effort.  They concluded that being ostracized may reinforce behaviors that lead to obesity in children.

Even though this study seems small, it is important, says Dr. Farah Lokey, a member of the Arizona Chapter of the American Academy of Pediatrics.

Children who are prone to being bullied and then ostracized in school every day tend to spend more time at home and less time participating in activities with other children.

And that can damage self-esteem. “The key to getting these children active, and feeling good about themselves, says Lokey, who practices at Southwestern Pediatrics Gilbert, “is putting them into activities where they can shine on their own and meet like-minded individuals.”

Individual sports such as golf, swimming, and tennis can provide these opportunities, Lokey adds. “These sports not only allow them to become experts in the sports by learning these skills but definitely help their self- esteem and pride.”

Sports like Karate and other self-defense activities encourage treating others with respect. That keeps the concept top-of-mind for children.

When to worry

Younger school-age children typically begin their school years with a sense of excitant about learning and making new friends. But if a child seems suddenly less enthused and more fearful around school, or develops separation anxiety, that could be a red flag that bullying is going on, says Lokey.

Some children will show physical problems with no diagnosable cause, such as a tummy aches – but maybe only on the weekdays, not on weekends. Sleep problems or anxiety in social situations can also be indicators.

With older children, behavior can become more aggressive and defiant, says Lokey. Grades may suffer, and parents may notice a change in appearance as well as a tendancy to seclude themselves from others.

 What to do

If parents do see sudden changes, they should speak to school officials and enlist the help of school counselors. Lokey says that pediatricians can be a great resource when parents have questions about these behaviors.

A child’s physician can talk to their patient in confidence and offer to speak with school counselors if needed. “Bolstering confidence and self-esteem in the children we pediatricians treat,” says Lokey, “is one of our main goals.”