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This article has moved to: http://www.raisingarizonakids.com/2012/04/reacting-to-an-autism-diagnosis-whats-next/
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.
A recent study published by the American Academy of Pediatrics found that that the more exposure teens had to alcohol use in movies, the more likely they were to binge drink.
The age, affluence and rebelliousness of the teens did not seem to matter. And this pattern was observed across cultures in countries with different norms regarding teen and adult alcohol use and drinking culture.
What can parents do to make sure kids don’t pick up the cues from the many movies out these days that show alcohol use? And what are some ways that parents can prevent a child from binge drinking?
Dr. Dale Guthrie, a pediatrician in practice at Gilbert Pediatrics, says communication is the key.
Guthrie, who serves as vice president of the Arizona Chapter of the AAP, encourages parents to stay involved — and to make sure to meet and know their children’s friends, from the early days of pre-school right on through high school.
More tips from Dr. Guthrie on how to help prevent your child from using alcohol and other drugs:
- Know where your teen is at all times. Teens may act as if they don’t like it but teens are actually more secure knowing their parents care enough to know where they are and what they’re doing.
- Consciously and genuinely praise your teen for something good he does every day.
- Make sure she knows she can talk to you about anything, at any time, if it is important to her and that she won’t be interrupted judgmentally with a lecture.
- Remember you are his parent, (not his best friend, afraid to step on his toes) and offer advice when requested and at opportune teaching moments in short phrases, not long lectures which are tuned out anyway.
- Better yet, ask inspired questions of your teen—the kind which help her arrive at the correct solution.
- Attend movies with your teen and then ask open-ended questions about what he thought about it.
- At a nonthreatening time, (not right as your teen is headed out to a movie), sit down as a family and discuss what are your family goals and standards. As part of that, set family standards for what types of movies you will view and which are beneath your family standards.
- When your teen returns from being out with friends, it is helpful to have a “check-in” with parents. If the tradition has been set that he will give parents a hug (or even a kiss) no matter what time he returns, parents will know more about what he’s been doing just by being close to him, listening and observation.
Parents of younger children might not be thinking about the teenage years, but is there anything they can do to lower the risk that their child will abuse alcohol down the road?
One very simple way is for parents to make sure they truly listen to their child right from the start.
Guthrie says that children need to feel that what they say is of prime importance to their parents. “Then when she has something really serious to discuss, he adds, “she will feel comfortable coming to you.”
Modeling healthy behaviors themselves, and engaging kids in conversation at opportune moments (short snippets in lieu of lengthy lectures) are other ways parents can make a difference, says Guthrie.
RAK Archives: Talking to teens about alcohol poisoning
More on talking to kids about drugs and alcohol, and upcoming Parent Workshops from the Partnership for a Drug-Free America, Arizona Affiliate
Children who are persistently uncomfortable with their gender who display strong and consistent cross-gender behaviors may be experiencing gender identity disorder, or GID.
A new study to be published in the March 2012 issue of Pediatrics found that children who do not receive medical treatment or counseling for GID can be at high-risk for certain behavioral and emotional problems.
Researchers found that of the 97 patients younger than 21 years who met the criteria for GID, 44 percent had a prior history of psychiatric symptoms, 37 percent were taking psychotropic medications, and 21.6 percent had a history of self-mutilation and suicide attempts.
Study authors advocate for early evaluation of children exhibiting GID, but treatment with medications should not be started until they reach puberty.
Why would a child be uncomfortable with his or her gender?
Pediatric surgeon Kathy Graziano, M.D., of Pediatric Surgeons of Phoenix, treats patients who are born with reproductive anomalies. She says that one reason is that some girls are exposed to excess hormones at birth, and are born with male-looking parts. And some girls are born without some parts, like a vagina or a uterus.
Those are relatively rare conditions, says Graziano, who is a member of the Arizona Chapter of the American Academy of Pediatricians (AzAAP). “But there is a condition, also rare, in which a child is born with all the “right” reproductive organs but identifies with the other gender.”
This is known as gender identity disorder, gender dysphoria or gender incongruence. “This is a problem for the child and the parents from early on.”
Graziano recalls meeting — and being inspired by — a patient who always knew that she was a boy.
“She dressed as a boy, insisting on wearing a boy’s bathing suit for example, as early as anyone could remember,” says Graziano. “She only once wore a dress…at her sister’s wedding.”
Then, in middle school, she became deeply depressed — and even suicidal.
The patient and her family attended counseling. That’s where she was able to admit that she wanted to be a boy, says Graziano. “The family took an accommodative approach. They allowed her to change her name to a male name and act in society as a boy. They sought surgical solutions for her to start transforming her anatomy.”
This was slow-going, says Graziano, since in this country there have been few surgical interventions for children under the age of 18.
Graziano says that the patient ultimately started a support group for other adolescents with gender identity issues. She entered college as a male, although not anatomically. “Her story is a success in that her family’s intervention saved her life.”
There is also a therapeutic approach to treat, and try to reverse, gender identity disorder when it is recognized early, adds Graziano, but research on the success of these two approaches is lacking.
Pediatricians dealing with these issues should screen for depression and intervene as soon as possible. Parents who suspect that a child is dealing with GID should talk to their child’s physician.
“The most important thing,” says Graziano, “is to focus on the mental health of the child and the family.”
Pediatricians and parents should consult with experienced mental health professionals for children and adolescents experiencing gender-related issues. When patients are sufficiently physically mature to receive medical treatment, they should be referred to a medical specialist or program that treats patients with GID.
Resources for parents
According to Monitoring the Future, an ongoing study of American youth conducted by the University of Michigan and funded by the National Institute on Drug Abuse (NIDA) , daily use of marijuana is at a 30-year peak level among high school seniors — a sharp contrast to the decline reported in the last decade.
But a new drug was added to the study’s coverage in 2011.
Also known as as “K2” or “spice,” the drug consists of herbs coated with chemicals that mimic the effects of THC, the active ingredient in marijuana.
As of October, at least 40 states, including Arizona, have banned the sale of synthetic cannabinoids.
Use of this drug is relatively new. The American Association of Poison Control Centers reported an uptick in calls related to synthetic cannabinoids during 2010.
To help educate parents, community members, law enforcement and healthcare providers, the Arizona affiliate of the Partnership for A Drug-Free America is offering a free lunchtime webinar on synthetic substances.
This free webinar takes place from noon to 1pm on Wednesday, Jan. 11 and will run for about 45 minutes with time for questions at the end.
Presenters include a medical toxicologist and representatives from the Drug Enforcement Administration.
For more information, reach the Partnership at 602-264-5700.
Participants can register by using the following link: