Constipation

Constipation is a very common problem in kids. A child is considered constipated when he or she has fewer than three bowel movements in a week; has trouble having a bowel movement; or when the stool (poop) is hard, dry, and unusually large.

Constipation usually isn’t a cause for concern, and easy to avoid by adopting healthy eating and exercise habits.

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Causes of Constipation

Constipation usually is due to a diet that doesn’t include enough water and fiber, which help the bowels move properly. Kids who eat lots of processed foods, cheeses, white bread and bagels, and meats may become constipated fairly often. Eating a healthier diet with high-fiber foods like fruits, vegetables, and whole grains can keep stool from getting hard and dry.

Sometimes, medicines like antidepressants and those used to treat iron deficiencies can cause constipation. Constipation can happen in babies as they move from breast milk to baby formula, or from baby food to solid food. Toddlers who are toilet training sometimes can become constipated, especially if they’re pushed to toilet train before they’re ready.

Some kids avoid going to the bathroom, even when they really have the urge to go. They might ignore internal urges because they don’t want to use a restroom away from home, stop playing a fun game, or have to ask an adult to be excused to go to the bathroom. Ignoring the urge to go makes it harder to go later.

Stress also can lead to constipation. Kids can get constipated when they’re anxious about something, like starting at a new school or problems at home. Research has shown that emotional upsets can affect how well the gut functions and can cause constipation and other conditions, like diarrhea.

Some kids get constipated because of irritable bowel syndrome (IBS), which can happen when they’re stressed or eat certain trigger foods, which often are fatty or spicy. A child with IBS may have either constipation or diarrhea, as well as stomach pain and gas.

In rare cases, constipation is a sign of other medical illnesses. So talk to your doctor if your child continues to have problems or if the constipation lasts for 2 to 3 weeks.

Symptoms of Constipation

Keep in mind that different kids have different bathroom habits. A child who doesn’t have a bowel movement every day isn’t necessarily constipated. One child might go three times a day, while another might go once every 3 days.

Generally, signs of constipation in kids include:

  • going less than usual
  • having trouble or pain when going to the bathroom
  • feeling full or bloated
  • straining to poop
  • seeing a little blood on the toilet paper

It’s also common for kids with constipation to sometimes stain their underwear with bits of stool.

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Concussions

A concussion is a brain injury that causes temporary changes in the way the brain works. You might think they happen when someone is knocked unconscious while playing sports. But concussions can happen with any head injury, often without a loss of consciousness.

We often hear about head injuries in athletes, but most concussions happen off the playing field — in car and bicycle accidents, in fights, and even minor falls.

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About Concussions

A concussion is a type of traumatic brain injury. The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. The brain can move around inside the skull and even bang against it. If the brain bangs against the skull — for example, in a fall on a playground or a whiplash-type of injury — blood vessels can tear and the nerves inside the brain can be injured. These injuries can cause a concussion.

Anyone who has a head injury should be watched closely for signs of a concussion, even if the person feels OK. An undiagnosed concussion can put someone at risk for brain damage and even disability. So anyone who has any symptom of a concussion should be seen right away by a doctor.

Sports-related concussions get a lot of attention. Doctors now recommend these steps after a suspected sports concussion:

  1. The player should immediately stop playing or practicing.
  2. The player should get checked out by a doctor before returning to practice or play.

All injured body parts take time to heal, even brains. By resting and taking certain important precautions, kids with concussions usually recover within a week or two without lasting health problems.

Signs and Symptoms

Someone with a concussion may be knocked unconscious, but this doesn’t happen in every case. In fact, a brief loss of consciousness or “blacking out” doesn’t mean a concussion is any more or less serious than one where a person didn’t black out.

If your child might have had a concussion, go to the emergency roomif you see any of these symptoms:

  • loss of consciousness
  • severe headache, including a headache that gets worse
  • blurred vision
  • trouble walking
  • confusion and saying things that don’t make sense
  • slurred speech
  • unresponsiveness (you can’t wake your child)

Call your doctor right away to report other problems, such as vomiting, dizziness, headache, or trouble concentrating. Then you can get advice on what to do next. For milder symptoms, the doctor may recommend rest and ask you to watch your child closely for changes, such as a headache that gets worse.

Symptoms of a concussion don’t always show up right away, and can develop within 24 to 72 hours after an injury. Young children usually have the same physical symptoms as older kids and adults, but cognitive and emotional symptoms (such as irritability and frustration) can appear later, be harder to notice, and last longer. Sleep-related issues are more common in teens.

Though most kids recover quickly from concussions, some symptoms — including memory loss, headaches, and problems with concentration— may linger for several weeks or months. It’s important to watch for these symptoms and call your doctor if they last. Often, in these cases, children need further evaluation and treatment.

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About ANSD

Hearing loss is a common problem in newborns. Some cases are due to auditory neuropathy spectrum disorder (ANSD), a problem in the transmission of sound from the ear’s innermost part (the inner ear) to the brain.

The causes of ANSD are unknown, but children who are born prematurely or have a family history of the condition are at higher risk for it. Symptoms can develop at any age, but most kids with ANSD are born with it and diagnosed in the first months of life.

As ANSD becomes better understood, it is diagnosed more frequently and now accounts for about 10% to 15% of cases of hearing loss.

Fortunately, kids with ANSD can develop strong language and communication skills with the help of medical devices, therapy, and visual communication techniques. Proper diagnosis and early intervention are essential, so if you suspect that your child has any difficulty hearing, talk with your doctor as soon as possible.

How Hearing Works

To understand ANSD, it’s helpful to review how the ear hears. Hearing begins when sound waves that travel through the air reach the outer ear, or pinna, the part of the ear that’s visible. The sound waves go through the ear canal into the middle ear, which includes the eardrum(a thin layer of tissue) and three tiny bones called ossicles. The sound causes the eardrum to vibrate. The ossicles amplify these vibrations and carry them to the inner ear.

The inner ear is made up of a snail-shaped chamber called the cochlea, which is filled with fluid and lined with four rows of tiny hair cells. When the vibrations move through this fluid, the outer hair cells contract back and forth and amplify the sound. When the vibrations are big enough, the inner hair cells translate them into electrical nerve impulses in the auditory nerve, which connects the inner ear to the brain. When the nerve impulses reach the brain, they are interpreted as sound.

Normal Ear diagram

How ANSD Affects Hearing

When someone has ANSD, sound enters the ear normally, but because of damage to the inner row of hair cells or synapses between the inner hair cells and the auditory nerve, or damage to the auditory nerve itself, sound isn’t properly transmitted from the inner ear to the brain.

As a result, the sound that arrives at the brain isn’t organized in a way that the brain can understand. It is disorganized and in some cases the sound never even makes it to the brain. In other cases, ANSD is due to a problem with the auditory nerve.

ANSD has only been understood and diagnosed in recent years. As a result, many questions remain about it. Not all newborn hearing screening programs can identify ANSD, so many kids and adults might have it but not know it.

The symptoms of ANSD can range from mild to severe. Some kids with ANSD hear sounds but have trouble determining what those sounds are. For others, all sounds seem the same, like static or white noise. For example, a voice might sound the same as water running, a dog barking might sound the same as a car horn, or a bird chirping might sound the same as a pan banging.

For some people, ANSD improves over time. For others, it remains the same or gets worse.

Causes

The causes of ANSD aren’t known. But some factors do put a child at risk, including:

Symptoms

Even if a child passes a newborn hearing screening, symptoms of hearing problems might only be noticed over time. Talk with your doctor if you think that your child is having trouble hearing or if you notice any of these symptoms:

  • your infant doesn’t startle when there are loud or sudden noises or doesn’t turn toward sound
  • your baby isn’t cooing, babbling, or laughing by 8 months
  • your child is not trying to imitate sounds and actions by 12 months or isn’t responding to simple commands

If hearing problems seem likely, your doctor might refer you to an audiologist (someone who specializes in diagnosing and treating hearing loss and balance problems). Your doctor also might have your child see an otolaryngologist (also called an ears, nose, and throat [ENT] doctor).

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Bedwetting:

What Is Bedwetting?

Bedwetting is when kids who are old enough to control their bladder pee at night during sleep. It’s a common problem in kids, especially those under 6 years old.

Why Does Bedwetting Happen?

Doctors don’t know for sure what causes bedwetting or why it stops. But it’s often a natural part of development, and kids usually grow out of it. It’s most common in young kids, but can last into the teen years. Most of the time, bedwetting is not a sign of any deeper medical or emotional issues.

Bedwetting often runs in families: many kids who wet the bed have a relative who did too. If both parents wet the bed when they were young, it’s very likely that their child will.

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How Can We Cope With Bedwetting?

Bedwetting is an issue that millions of families face every night, and can be very stressful. Kids can feel embarrassed and guilty about wetting the bed and anxious about spending the night at a friend’s house or at camp. Parents often feel helpless to stop it.

Bedwetting usually goes away on its own, but may last for a while. It can be embarrassing and uncomfortable for your child, so it’s important to provide emotional support until it stops.

Reassure your child that bedwetting is a normal part of growing up and that it’s not going to last forever. It may comfort your child to hear about any other family members who struggled with it when they were young.

Try to have your child drink more fluids during the daytime hours and less at night (and avoid caffeine-containing drinks). Then remind your child to go to the bathroom one final time before bedtime. Many parents find that using a motivational system, such as stickers for dry nights with a small reward (such as a book) after a certain number of stickers, can work well. Bedwetting alarms also can be helpful.

When your child wakes with wet sheets, don’t yell or punish. Have your child help you change the sheets. Explain that this isn’t punishment, but it is part of the process. It may even help your child feel better knowing that he or she helped out. Offer praise when your child has a dry night.

When Should I Call the Doctor?

Bedwetting that begins suddenly or happens with other symptoms can be a sign of another medical condition, so talk with your doctor.

The doctor may check for signs of a urinary tract infection (UTI)constipation, bladder problems, diabetes, or severe stress.

Call the doctor if your child:

  • suddenly starts wetting the bed after being consistently dry for at least 6 months
  • begins to wet his or her pants during the day
  • snores at night
  • complains of a burning sensation or pain when urinating
  • has to pee often
  • is drinking or eating much more than usual
  • has swelling of the feet or ankles
  • is 7 years of age or older and still wetting the bed

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All About Sleep:

Sleep — or lack of it — is probably the most-discussed aspect of baby care. As new parents quickly discover, the quality and quantity of their baby’s sleep affects the well-being of everyone in the household. And sleep struggles rarely end when child moves from a crib to a bed. Instead of cries, it’s pleas or refusals; instead of a 3 a.m. feeding, it’s a nightmare or request for water.

So how do you get kids to bed through the cries, screams, and avoidance tactics? How should you respond when you’re awakened in the middle of the night? And how much sleep is enough for your kids?

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How Much Is Enough?

Sleep quantity needs vary based on age. But common “rules” about how many hours of sleep an infant or a 2-year-old need might not be helpful when it comes to your own child. These numbers are simply averages reported for large groups of kids of particular ages.

There’s no magical number of hours all kids need in a certain age group. Two-year-old Lilly might sleep for 12 hours, while 2-year-old Marcus is just as alert the next day after sleeping for only 9 hours.

Still, sleep is very important to kids’ well-being. The link between a lack of sleep and a child’s behavior isn’t always obvious. When adults are tired, they can be grumpy or lack energy, but kids can become hyper, disagreeable, and have extreme changes in behavior.

Here are some approximate numbers based on age, with age-appropriate tips to help you get your child to sleep.

Babies (Up to 6 Months)

Newborns’ internal clocks aren’t fully developed. They sleep up to 18 hours a day, divided about equally between night and day. Newborns should be wakened every 3 to 4 hours until they have good weight gain, usually within the first few weeks. After that, it’s OK if a baby sleeps for longer periods.

After those first weeks, infants may sleep for as long as 4 or 5 hours at a time — this is about how long their small bellies can go between feedings. If babies do sleep a good stretch at night, they may want to nurse or get the bottle more often during the day.

Just when parents feel that sleeping through the night is a far-off dream, their baby usually begins to sleep longer stretches at night. At 3 months, a baby averages about 14 hours of sleep total, with 8 to 9 hours at night (usually with an interruption or two) and two or three daytime naps.

It’s important to know that babies can cry and make all sorts of other noises during light sleep. Even if they do wake up in the night, they may only be awake for a few minutes before falling asleep again on their own.

But if a baby under 6 months old continues to cry, it’s time to respond. Your baby may be truly uncomfortable: hungry, wet, cold, or even sick. But routine nighttime awakenings for changing and feeding should be as quick and quiet as possible. Don’t provide any unnecessary stimulation, such as talking, playing, turning on the lights, or using a bright mobile device while waiting for your child to sleep. Encourage the idea that nighttime is for sleeping. You have to teach this because your baby doesn’t care what time it is as long as his or her needs are met.

Ideally, place your baby in the crib before he or she falls asleep. It’s not too early to establish a simple bedtime routine. Any soothing activities (bathing, reading, singing) done consistently and in the same order each night can be part of the routine. Your baby will associate them with sleeping and they’ll help him or her wind down.

The goal is for babies to fall asleep by themselves and learn to soothe themselves and go back to sleep if they should wake up in the middle of the night.

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About Growth Charts:

Look at any class picture, and you’ll see kids of the same age in all shapes and sizes. Some kids look tiny next to their peers, while others literally stand head and shoulders above their classmates.

As easy as it is to make these comparisons and to draw conclusions about what you see, the reality is that kids grow at their own pace. Big, small, tall, short — there is a wide range of healthy shapes and sizes among children.

Genetics, gender, nutrition, physical activity, health problems, environment, hormones, and lifestyle factors like nutrition and physical activity all influence a child’s height and weight. And many of these factors can vary widely from family to family.

So how does a doctor figure out whether a child’s height and weight measurements are “normal”? Whether he or she is developing on track? Whether any health problems are affecting growth?

A doctor uses growth charts to help answer those questions. Here are some facts about growth charts and what they say about a child’s health.

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Why Do Doctors Use Growth Charts?

Growth charts are a standard part of any checkup, and they show health care providers how kids are growing compared with other kids of the same age and gender. They also allow doctors and nurses to see the pattern of kids’ height and weight gain over time, and whether they’re developing proportionately.

Let’s say a child was growing along the same pattern until he was 2 years old, then suddenly started growing at a much slower rate than other kids. That might indicate a health problem. Doctors could see that by looking at a growth chart.

Does a Different Pattern Indicate a Problem?

Not necessarily. The doctor will interpret the growth charts in the context of the child’s overall well-being, environment, and genetic background. Is the child meeting other developmental milestones? Are there other signs that a child is not healthy? How tall or heavy are the child’s parents and siblings? Was the child born prematurely? Has the child started puberty earlier or later than average? These are all factors that the doctor will use to help understand the numbers on the growth chart.

Are All Kids Measured on One Growth Chart?

No. Girls and boys are measured on different growth charts because they grow in different patterns and at different rates.

And one set of charts is used for babies, from birth to 36 months. Another set of charts is used for kids ages 2 to 20 years old. Also, special growth charts are used for children with certain conditions, such as Down syndrome.

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How to Take Your Child’s Temperature:

All kids get a fever from time to time. A fever itself causes no harm and can actually be a good thing — it’s often the body’s way of fighting infections. But a high fever sometimes is a sign of a problem that needs your doctor’s attention.

Here’s how to take your child’s temperature, safely and accurately.

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Digital Thermometers

Digital thermometers give the quickest, most accurate readings, and are the only kind that doctors currently recommend. Available in a variety of sizes and shapes, they’re sold at most supermarkets and drugstores.

Read the manufacturer’s instructions to see what the thermometer is designed for and how it signals that the reading is complete.

Usually, digital thermometers can be used for these temperature-taking methods:

  • rectal (in the bottom)
  • oral (in the mouth)
  • axillary (under the arm)

What About Other Types of Thermometers?

These types of thermometers aren’t recommended because they’re less accurate:

  • electronic ear thermometers
  • temporal artery (forehead) thermometers
  • plastic strip thermometers
  • pacifier thermometers

Glass mercury thermometers were once common, but should not be used because of possible exposure to mercury, an environmental toxin.

Tips for Taking Temperatures by Age

As any parent knows, taking a squirming child’s temperature can be a challenge. The best method will depend on a child’s age and temperament.

Turn on the digital thermometer and clear the screen of any old readings. Digital thermometers usually have a plastic, flexible probe with a temperature sensor at the tip and an easy-to-read digital display on the other end. If your thermometer uses disposable plastic sleeves or covers, put one on according to the manufacturer’s instructions. Throw away the sleeve afterward and clean the thermometer according to the manufacturer’s instructions before putting it back in its case.

For babies younger than 3 months, you’ll get the most reliable reading by using a digital thermometer to take a rectal temperature. Call the doctor if your infant is younger than 3 months old and has a temperature of 100.4°F (38°C) or higher.

For babies between 3 months and 6 months old, a digital rectal thermometer is still the best choice.

For kids between 6 months and 4 years old, you can use a digital thermometer to take a rectal temperature, or you can also use a digital thermometer to take an axillary temperature, although this is a less accurate method.

For kids 4 years or older, you can usually use a digital thermometer to take an oral temperature if your child will cooperate. But kids who are coughing a lot or breathing through their mouths because of stuffy noses might not be able to keep their mouths closed long enough for an accurate oral reading. In these cases, you can use the rectal or axillary method (with a digital thermometer).

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