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Tag Archives: Pediatrics
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).
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.
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.
Families can have a child’s car seat recertified, learn how to install a seat correctly or get a free car seat.
Watch this video to see what a safety check event looks like:
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.
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.
Find out what technicians at the Sleep Center at Cardon Children’s Medical Center learn by watching children sleep:
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.
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.