AboutKidsHealth is a health education website for children, youth and their caregivers.



COVID-19COVID-19COVID-19CEnglishInfectious DiseasesChild (0-12 years);Teen (13-18 years)NAImmune systemConditions and diseasesAdult (19+) CaregiversNA2020-03-26T04:00:00Z000Landing PageLearning Hub<p>Learn about COVID-19 and how to talk to and support your family. Also find resources such as videos and audio meditations to help you cope.</p><p>This hub includes resources on COVID-19 and how to help you cope. There are resources on how to support your child's mental health and general wellbeing through physical activity, sleep, nutrition and learning. Also included are videos and audio meditations to help you cope with stressful thoughts and experiences that occur throughout your day.<br></p> <br> <div class="asset-video"> <iframe src="https://www.youtube.com/embed/fBkA2ZTUnyI"></iframe> <p>View Dr. Ronni's chat with Dr. Cheddar above.</p></div> <br> <div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">COVID-19 information</h2></div><div class="panel-body list-group" style="display:none;"><p>Find information about COVID-19 from AboutKidsHealth.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=3872&language=English">Coronavirus disease 2019 (COVID-19) </a></li><li class="list-group-item"><a class="overview-links" href="https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html">Coronavirus disease (COVID-19) (Public Health Agency of Canada)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=3863&language=English">COVID-19: Information for parents of immunocompromised children and children with chronic medical conditions</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=3870&language=English&hub=COVID-19">COVID-19: Information for parents of children with congenital heart disease</a></li><li class="list-group-item"><a class="overview-links" href="https://covid19healthliteracyproject.com/#languages">COVID-19 fact sheets in 34 different languages (Harvard Health Publishing)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-coronavirus/public-resources">COVID-19 public resources (Public Health Ontario)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.pcmch.on.ca/covid-19-resources-for-children-youth-and-families/">COVID-19 resources for children, youth, and families (Provincial Council for Maternal and Child Health)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.caringforkids.cps.ca/handouts/the-2019-novel-coronavirus-covid-19">The 2019 Novel Coronavirus (COVID-19) (Caring for Kids)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.ontario.ca/page/2019-novel-coronavirus">The 2019 Novel Coronavirus (COVID-19) (Ontario Ministry of Health)</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/9Ay4u7OYOhA">6 steps to prevent COVID-19 (Centers for Disease Control and Prevention)</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Talking to your child about COVID-19</h2></div><div class="panel-body list-group" style="display:none;"><p>Helpful resources that provide information about how to explain and talk to your child about COVID-19. </p></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=3866&language=English">How to talk to your child about COVID-19</a></li><li class="list-group-item"><a class="overview-links" href="http://hollandbloorview.ca/services/family-workshops-resources/family-resource-centre/explaining-covid-19-kids">Explaining COVID-19 and Coronavirus to children (Holland Bloorview)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.cps.ca/en/blog-blogue/how-can-we-talk-to-kids-about-covid-19">How can we talk to kids about COVID-19? Be “realistically reassuring” (Canadian Pediatric Society)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.pbs.org/parents/thrive/how-to-talk-to-your-kids-about-coronavirus#.XmuZ3QV_gax.twitter">How to Talk to Your Kids About Coronavirus (PBS)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=3869&language=English">Supporting your child with a neurodevelopmental disorder through the COVID-19 crisis</a></li><li class="list-group-item"><a class="overview-links" href="https://www.cmho.org/blog/blog-news/6519918-talking-to-your-anxious-child-about-covid-19">Talking to your anxious child about COVID-19 (Children's Mental Health Ontario)</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Coping</h2></div><div class="panel-body list-group" style="display:none;"><p>Information on how to help your child cope with stress during the COVID-19 crisis and how to help them deal with separation from family and friend. </p></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=3868&language=English">Coping with separation from family and friends during COVID-19</a></li><li class="list-group-item"><a class="overview-links" href="https://www.caringforkids.cps.ca/handouts/disaster">Helping children and teens cope with stressful public events (Caring for Kids)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.cps.ca/en/blog-blogue/how-to-help-youth-tackle-the-blues-during-covid-19">How to help youth tackle the blues during COVID-19 and #physicaldistancing (Canadian Pediatric Society)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=3867&language=English">Is my child or adolescent feeling stressed about COVID-19?</a></li><li class="list-group-item"><a class="overview-links" href="https://afirm.fpg.unc.edu/supporting-individuals-autism-through-uncertain-times">Supporting individuals with autism through uncertain times (Autism Focused Intervention Resources & Modules)</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Mental health</h2></div><div class="panel-body list-group" style="display:none;"><p>Taking care of your mental health during difficult and stressful times is important. Learn more about anxiety and depression.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=18&language=English">Anxiety: Overview</a></li><li class="list-group-item"><a class="overview-links" href="https://teens.aboutkidshealth.ca/Article?contentid=3810&language=English">Anxiety and anxiety disorders</a></li><li class="list-group-item"><a class="overview-links" href="https://assets.aboutkidshealth.ca/AKHAssets/Anxiety%20Individual%20handout_Eng%2004_03_2020_v2.pdf">CARD: Coping with your own fears and anxiety</a></li><li class="list-group-item"><a class="overview-links" href="https://assets.aboutkidshealth.ca/AKHAssets/Anxiety%20caregiver%20handout_Eng%2004_03_2020.pdf">CARD: Helping your child cope with anxiety</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=19&language=English">Depression: Overview</a></li><li class="list-group-item"><a class="overview-links" href="https://www.camh.ca/en/health-info/mental-health-and-covid-19">Mental health and the COVID-19 pandemic (CAMH)</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Parenting</h2></div><div class="panel-body list-group" style="display:none;"><p>Find some helpful information on parenting during the COVID-19 crisis. </p></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://www.caringforkids.cps.ca/handouts/health_information_on_the_internet">A parent’s guide to health information on the Internet (Caring for Kids)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.cps.ca/en/blog-blogue/covid-youth-and-substance-use-critical-messages-for-youth-and-families">COVID, youth, and substance use: Critical messages for youth and families (Canadian Pediatric Society)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.cps.ca/en/blog-blogue/parenting-during-covid-19-a-new-frontier">Parenting during COVID-19: A new frontier (Canadian Pediatric Society)</a></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Learning</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=651&language=English&hub=COVID-19">Reading milestones</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=3871&language=English&hub=COVID-19">Writing milestones</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=722&language=English&hub=COVID-19">Mathematics milestones</a></li></ol></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Wellbeing</h2></div><div class="panel-body list-group" style="display:none;"><p>Find out how physical activity, a healthy sleep routine, screen time limits and balanced nutrition can boost your child's mental health and support them to achieve better academic success and help them through difficult times. </p></div><ol class="list-group" style="display:none;"><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Handwashing</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=1981&language=English">Hand hygiene</a></li><li class="list-group-item"><a class="overview-links" href="https://www.caringforkids.cps.ca/handouts/handwashing">Handwashing for parents and children (Caring for Kids)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.youtube.com/watch?time_continue=9&v=7PKwE1jIuws&feature=emb_title">Protect don’t infect (CHEO)</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Sleep</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=645&language=English">Sleep: Benefits and recommended amounts</a></li><li class="list-group-item"><a class="overview-links" href="https://teens.aboutkidshealth.ca/Article?contentid=3632&language=English">Sleep and your mental health: Overview</a></li><li class="list-group-item"><a class="overview-links" href="https://teens.aboutkidshealth.ca/Article?contentid=3633&language=English">Sleep and mental health: Sorting out your sleep routine</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=646&language=English">How to help your child get a good night's sleep</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=647&language=English">How to help your teen get a good night's sleep</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Physical activity</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://teens.aboutkidshealth.ca/Article?contentid=3783&language=English">Physical activity and mental health: Overview</a></li><li class="list-group-item"><a class="overview-links" href="https://teens.aboutkidshealth.ca/Article?contentid=3784&language=English">Physical activity and mental health: Types of physical activity</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=641&language=English">Physical activity: Benefits of exercise for health and wellbeing</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=642&language=English">Physical activity: Guidelines for children and teens</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Nutrition</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://teens.aboutkidshealth.ca/Article?contentid=3773&language=English">Nutrition and mental health: The basics of a healthy diet</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=639&language=English">How a balanced diet and healthy eating habits can help your child's mental health</a></li><li class="list-group-item"><a class="overview-links" href="https://teens.aboutkidshealth.ca/Article?contentid=3774&language=English">Nutrition and mental health: Developing positive eating habits</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=1464&language=English&hub=COVID-19">Meal ideas for school-aged children, tweens and teens</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=638&language=English">Healthy eating for teens</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Screen time and social media</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=643&language=English">Screen time: Overview</a></li><li class="list-group-item"><a class="overview-links" href="https://teens.aboutkidshealth.ca/Article?contentid=3775&language=English">Screen time for teens: Overview</a></li><li class="list-group-item"><a class="overview-links" href="https://www.aboutkidshealth.ca/Article?contentid=644&language=English">How to help your child set healthy screen time limits</a></li><li class="list-group-item"><a class="overview-links" href="https://teens.aboutkidshealth.ca/Article?contentid=3776&language=English">Setting limits and staying safe with screen time</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Stress and resilience</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://teens.aboutkidshealth.ca/Article?contentid=3777&language=English">Stress and health</a></li><li class="list-group-item"><a class="overview-links" href="https://teens.aboutkidshealth.ca/Article?contentid=3778&language=English">How to become more resilient</a></li></ol></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Tools, videos and resources for you and your child</h2></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://assets.aboutkidshealth.ca/AKHAssets/Anxiety%20Individual%20handout_Eng%2004_03_2020_v2.pdf">CARD: Coping with your own fears and anxiety</a></li><li class="list-group-item"><a class="overview-links" href="https://assets.aboutkidshealth.ca/AKHAssets/Anxiety%20caregiver%20handout_Eng%2004_03_2020.pdf">CARD: Helping your child cope with anxiety</a></li><li class="list-group-item"><a class="overview-links" href="https://www.brainson.org/shows/2020/03/10/understanding-coronavirus-and-how-germs-spread-for-kids?fbclid=IwAR21Y_n6fsy33QD2s07In2Q892xQoI5OEFMMZ5vcMyVoLdkH8tv4yZjaZsc">Understanding coronavirus and how germs spread (Brains On!)</a></li><li class="list-group-item"><a class="overview-links" href="https://kidshelpphone.ca/get-info/were-here-for-you-during-covid-19-novel-coronavirus/">We’re here for you during COVID-19 (novel coronavirus) (Kids Help Phone)</a></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Videos</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://www.youtube.com/watch?v=HU8TX2eADJ4">Nasopharyngeal (NP) swab (video for children)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.youtube.com/watch?v=r51gYrDzpHQ">Physical distancing (video for children)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.youtube.com/watch?v=sNinywG7BtY">What is personal protective equipment (PPE) (video for children)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.youtube.com/watch?v=fBkA2ZTUnyI&feature=youtu.be">Dr. Cheddar chats with Dr. Ronni from SickKids (video for children)</a></li><li class="list-group-item"><a class="overview-links" href="https://www.youtube.com/watch?time_continue=9&v=7PKwE1jIuws&feature=emb_title">Protect don’t infect (CHEO)</a></li></ol></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Videos to support sleep and mindfulness</h2></div><div class="panel-body list-group" style="display:none;"><p>Find videos that will help you prepare for sleep and for when you need a moment of peace, to understand your situation more clearly and coping with stressful thoughts and experiences.</p></div><ol class="list-group" style="display:none;"><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Sleep video</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://youtu.be/2fbaoqkY0Qk">Sleep: A bed time story</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Mindfulness videos</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://youtu.be/nQdM_Cku9pA">A moment of peace</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/cFCiUlFKuO4">Two wings to fly</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/jaNAwy3XsfI">Being with all of your experiences</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/0QXmmP4psbA">You are not your thoughts</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/Ty93GRPplJo">Dealing with difficult moments</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/QTsUEOUaWpY">Everyday mindfulness</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/GgBVIZAEQqU">STOP for mindfulness</a></li><li class="list-group-item"><a class="overview-links" href="https://www.youtube.com/watch?v=KYcLfBf-T9c">Stress and thinking: The mind/body connection</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/EWzDHN7Jdg8">Dealing with flares: Controlling the controllables</a></li></ol></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Audio meditations for mindfulness and coping</h2></div><div class="panel-body list-group" style="display:none;"><p>Listen to these meditations in a quiet, comfortable spot to practise mindfulness, learn about ways to cope with physical and emotional pain or discomfort and to help you with stress throughout your day.</p></div><ol class="list-group" style="display:none;"><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Mindfulness</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://youtu.be/3cevA6EjCbE">5 senses</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/gqMu6kFfQcE">Dropping the anchor</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/O5F3-Xw2XPE">The mountain</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/84Tr734KXO8">Dilute the yuck</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/YnL-hjXo4EQ">Self-compassion</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/fZdw6wm3A3E">Body scan</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/jc64ap852FU">Circle of gratitude</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/LMu-r-KZ_l8">Tree meditation</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/xcO8IIeV12M">Mindfulness of thought</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Coping with physical and emotional pain</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://youtu.be/84Tr734KXO8">Dilute the yuck</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/3IK7yWuEs3k">Visualize your pain</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/UbTyPgHf8z4">Soften, soothe, allow</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/NN7fz8lMTIM">Ice cube</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/e0JMtabUVvQ">Comfort your pain</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Finding calm/coping with stress</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="https://youtu.be/RQJNdVtHxlY">Time for rest</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/RpHvQkHYrZ0">Allowing rest</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/gqMu6kFfQcE">Dropping the anchor</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/EnrNtaMskik">Breathing meditation</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/CMcx9tJ70rA">Joy</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/EL_fvAepwv8">Equal breathing</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/QSf0JS0O16Q">Key word guided meditation</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/Tsi2np8xtVY">Bell meditation</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/263e093H5eM">Bell sounds</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/Jqu3SOEKtvE">Progressive muscle relaxation with tension</a></li><li class="list-group-item"><a class="overview-links" href="https://youtu.be/4ilNITE3-fE">Relaxation with imagery</a></li></ol></li></ol></div> <br> <br> <div class="asset-video"> <iframe src="https://www.youtube.com/embed/videoseries?list=PLjJtOP3StIuU99GGMBBV2N_b2tsRwMx0m"></iframe> <br> <p>Above is our COVID-focused playlist. See "Tools, videos and resources for you and your child" in the menu above for more videos or visit the <a href="https://www.youtube.com/user/Aboutkidshealth">AboutKidHealth YouTube channel</a>.</p></div> <br>https://assets.aboutkidshealth.ca/AKHAssets/iStock-1157093074.jpgCOVID-19,COVID19COVID-19Main
COVID-19: Information for parents of immunocompromised children and children with chronic medical conditionsCOVID-19: Information for parents of immunocompromised children and children with chronic medical conditionsCOVID-19: Information for parents of immunocompromised children and children with chronic medical conditionsCEnglishInfectious DiseasesChild (0-12 years);Teen (13-18 years)NAImmune systemConditions and diseasesAdult (19+) CaregiversFever;Cough;Runny nose2020-03-18T04:00:00Z10.000000000000051.1000000000000798.000000000000Flat ContentHealth A-Z<p>Children who are immunocompromised and children with chronic medical conditions may be at higher risk of complications from the novel coronavirus COVID-19.</p><p>Children who are immunocompromised and children with chronic medical conditions may be at higher risk of complications from the novel coronavirus COVID-19. The following questions and answers may help you during this outbreak.</p> <h2>Key points</h2><ul><li>SickKids is safe for you and your child to come to for assessment as directed by your primary care team.</li><li>Children who are immunocompromised and children with chronic medical conditions may be at higher risk of developing complications if they do get COVID-19.</li><li>Washing your hands frequently using an alcohol-based hand sanitizer, or by using soap and water for 20 seconds will help to prevent you from getting COVID-19.</li><li>Your child should continue to take their regular medications as prescribed by their primary care team unless specifically instructed otherwise.</li></ul> <h2>What is novel coronavirus (COVID-19)?</h2><p>A new or novel strain of coronavirus was identified in late 2019, and has now spread across the globe. The World Health Organization has named this novel coronavirus COVID-19 and has declared the outbreak a pandemic.</p><h2>Is my child immunocompromised?</h2><p>Immunocompromised children have weak immune systems. A weak immune system could be caused by many different medical conditions or medications. Some examples include children who have:</p><ul><li>had a solid organ transplant (i.e. heart, kidney, lung, liver, intestinal)</li><li>had a bone marrow transplant</li><li>cancer</li><li>congenital or primary immunodeficiency</li><li>HIV/AIDS</li><li>rheumatological disease</li><li>gastrointestinal disease</li><li>severe burns</li></ul><p>And those who are:</p><ul><li>taking selective immunomodulators (i.e. anti-TNF agents, azathioprine, MMF and all immunosuppressive agents).</li><li>taking long-term steroid therapy</li><li>in a severely malnourished state</li></ul><p>If you are unsure if your child is immunocompromised, please check with your primary care team at the hospital.</p><h2>Is my child at higher risk of getting COVID-19?</h2><p>There is still a lot being learned about COVID-19. At this time, serious illness in children appears to be less common than it is in adults. It is not yet clear whether children with underlying or chronic medical conditions are at greater risk of being infected with COVID-19, or of serious illness if they get the infection. Based on what is known about the influenza virus, it would not be unexpected for immunocompromised children, or children with an underlying chronic medical condition (i.e. chronic lung disease) to be at increased risk of complications from a COVID-19 infection.</p><h2>How do I know if my child has COVID-19?</h2><p>Your child may have COVID-19 if they have some or all of the following symptoms:</p><ul><li> <a href="https://www.aboutkidshealth.ca/Article?contentid=30&language=English">fever</a></li><li> <a href="https://www.aboutkidshealth.ca/Article?contentid=774&language=English">cough</a> or sneezing</li><li> <a href="https://www.aboutkidshealth.ca/Article?contentid=748&language=English">sore throat</a></li><li>difficulty breathing or fast breathing</li><li>body aches</li><li> <a href="https://www.aboutkidshealth.ca/Article?contentid=29&language=English">headache</a></li><li>chills</li><li>fatigue</li><li> <a href="https://www.aboutkidshealth.ca/Article?contentid=7&language=English">diarrhea</a> and <a href="https://www.aboutkidshealth.ca/Article?contentid=746&language=English">vomiting</a></li><li>runny or stuffy nose that progresses to one of the above symptoms</li></ul><p>While fever may be the main symptom in immunocompromised children, not all children with COVID-19 will have a fever. For children who have a runny or stuffy nose you should be most concerned about a possible COVID-19 infection if other symptoms develop. It is not yet known if immunocompromised children with a COVID-19 infection have different symptoms.</p><h2>Should I come to the hospital if I think my child has COVID-19?</h2><p>If your child has symptoms of COVID-19 contact your primary care team at the hospital before coming. They will help you determine if your child needs to be seen and where you should go.</p><p>You should come to the hospital right away if your child has the following symptoms:</p><ul><li>fast breathing or trouble breathing</li><li>bluish skin color</li><li>not drinking enough fluids</li><li>not waking up or not interacting</li><li>being so irritable that the child does not want to be held</li><li>fever with a rash</li></ul><p>In an emergency please call an ambulance and tell the emergency services team that you are concerned your child may have a COVID-19 infection.</p><h2>Is testing for COVID-19 available at SickKids?</h2><p>Yes, testing is available at SickKids for children with weakened immune system that have concerning symptoms, such as fever and cough. Testing is usually done with a nose swab to try to identify various viruses. These swabs now test for COVID-19 as well.</p><h2>If my child is diagnosed with COVID-19, how long will they be sick?</h2><p>There is still a lot to be learned about COVID-19. Children with weakened immune systems may be sick for a longer period of time than other children. How long will vary from child to child.</p><h2>Should my child avoid public places such as shopping malls, public transit and playgrounds?</h2><p>At this time, it is recommended that social distancing including avoiding crowded environments is appropriate, in keeping with current public health recommendations. In crowded situations that cannot be avoided, extra precautions should be taken such as frequent handwashing. If you have alcohol-based hand sanitizer carry it with you to use when soap and water are not available. At this point, firm recommendations regarding summer camps cannot be made, however such camps will likely be cancelled if the outbreak continues unabated.</p><h2>What are effective measures to prevent COVID-19 spread?</h2><ul><li>Like other respiratory viruses, including influenza, it is recommended that you wash your hands frequently by using alcohol-based hand sanitizer, or by using soap and water for 20 seconds.</li><li>Limit touching your face, nose and eyes.<br></li><li>Avoid close contact with people who have a fever or cough.</li><li>Practice cough etiquette by keeping a distance from other people, coughing and sneezing into your sleeve or a tissue or a respiratory mask, and practicing frequent hand washing.</li></ul><h2>Are there any extra precautions that my child or I should be taking?</h2><p>Encourage your child to wash or sanitize their hands frequently. For example, if they are in school, you can provide older children with a bottle of alcohol-based hand sanitizer. Hand sanitizer can be dangerous if swallowed. Be careful to keep it away from young children. Avoid having your child be in close contact with anyone who has symptoms of COVID-19. Be vigilant for signs of infection in your child.</p><h2>Should my child wear a face mask when in public?</h2><ul><li>There is no current evidence that wearing a mask in public spaces will help your child to avoid infection from COVID-19. Other measures, such as careful hand washing and social distancing have been demonstrated to be effective in reducing transmission of the infection. However, you and your child may consider wearing a face covering (sucha as a cloth mask or bandana) in public spaces if physical distancing is not possible.</li><li>If your child has respiratory symptoms (i.e. fever, cough) and they are at the hospital for assessment, it is important that they wear a mask to avoid spreading infection to others. If you do not have a mask for this purpose you should ask for one when you arrive at the hospital.</li><li>Your primary care team may also advise your child to wear a mask for other reasons and you should follow this advice.</li></ul><h2>Should my child continue on their immunosuppressive medications?</h2><p>Your child should continue to take their regular medications as prescribed, unless directed differently by your primary care team at the hospital. Make sure you have enough medication and supplies on hand to last for 30 days, in case you need to stay home for a prolonged period of time.</p><h2>Should we cancel our upcoming trip or vacation?</h2><p>Yes. At this time, it is recommended that any upcoming trips or vacations be cancelled until further notice.</p><h2>Can my child go to school?</h2><p>Please follow the guidance from the Ontario Ministry of Education and your child’s local school regarding mandatory school closure. If your child has any signs or symptoms of COVID-19 do not send them to school even if their school remains open.</p><h2>What should I do if I am unwell myself, or my child’s sibling becomes unwell with symptoms of COVID-19 infection?</h2><p>Contact your family doctor or paediatrician as it is recommended that unwell siblings or parents of children who are immunocompromised be tested for COVID-19. It is also advised that you practice social distancing at home as much as possible. You can also refer to Ontario general guidelines of who should be tested for COVID-19 and ways of accessing testing at <a href="https://www.ontario.ca/page/2019-novel-coronavirus">https://www.ontario.ca/page/2019-novel-coronavirus</a>.</p><h2>What should I do if a member of my household has recently returned from travel outside of Canada?</h2><p>People returning from travel outside of Canada should self-isolate for 14 days, in keeping with current public health recommendations. During that time period your child should avoid close contact with this person as much as possible.</p><h2>Should I or my teen who is immunocompromised go to work?</h2><p>Follow public heath guidelines and practice social distancing when appropriate. This may include avoiding work environments that involve contact with large groups of people. It is recommended that you or your teen who is immunocompromised try to work from home as much as possible.</p><h2>If my child requires assessment for symptoms other than COVID-19 infection what should we do?</h2><p>Continue to follow the recommendations for getting your child assessed according to your primary care team’s instructions, as you would do normally. For example, if your child is on medication that causes them to have a low white blood cell count and they develop a fever, you should still go to the hospital for assessment and let the primary care team know about your child’s symptoms as per normal procedure.</p><h2>Should I reschedule my upcoming routine appointment?</h2><p>Clinic appointments are being reviewed and many upcoming visits may be rescheduled or moved to virtual care by video or telephone, if possible. Medically necessary appointments will continue. Please contact your primary care team at the hospital for questions regarding your upcoming appointments.</p><h2>What if the province orders a lockdown and mandates people staying in their homes? Will we be able to get to the hospital?</h2><p>Even in those countries that have ordered lockdowns, people have still been able to travel for medically necessary reasons.</p><h2>Is it safe for my child to come to SickKids during the current outbreak?</h2><p>Yes, the hospital is safe for you and your child to go to for assessment as directed by your primary care team. At all times SickKids has clear procedures in place for protecting your child from getting an infection when visiting the hospital. During this time additional measures to protect you and your child have been put in place. Please follow SickKids instruction regarding the number of visitors permitted to accompany your child. Please see <a href="https://www.sickkids.ca/coronavirus"> https://www.sickkids.ca/coronavirus</a> for further information.</p>https://assets.aboutkidshealth.ca/AKHAssets/COVID-19--Information_for_parents.jpgCOVID-19: Information for parentsMain
How to talk to your child about COVID-19How to talk to your child about COVID-19How to talk to your child about COVID-19HEnglishPsychiatryChild (0-12 years);Teen (13-18 years)NANAConditions and diseasesAdult (19+) CaregiversNA2020-03-31T04:00:00Z9.1000000000000058.90000000000001632.00000000000Flat ContentHealth A-Z<p>Parents and caregivers play an important role in making sure their children receive honest and accurate information during the COVID-19 pandemic.</p><h2>Introduction</h2><p>The COVID-19 pandemic is interrupting our daily lives and children are impacted by this. They are not in school and their daily routines have been disrupted. Many may hear or see things about the COVID-19 pandemic and be worried and have questions. Parents and caregivers have an important role to play in making sure their children receive honest and accurate information that is appropriate for their developmental level.</p> <h2>Key points</h2><ul><li>Share ‘need to know’ information with your child, using age appropriate language.</li><li>Answer questions directly and honestly and do not make false promises.</li><li>It is okay if you do not know all the answers; focus on the short-term plan for the whole family.</li><li>If children are distressed, let them know that it is OK and understandable to have these feelings.</li><li>Model healthy coping skills and attend to your own physical and mental health.</li><li>Consider seeking out additional resources and supports for children with special needs or who are having trouble coping.</li> </ul><h2>How do I talk to my child about COVID-19?</h2><p>It is important for adults to provide accurate information that is appropriate to their child’s developmental level. For younger children, simple statements of facts are often enough. For example, you might say:</p><p> <em>“Lots of people have been getting sick with sore throats and coughs. We know that germs can cause this, so for now, places like schools, parks and stores are closed. This will help to stop the germs from spreading. We also need to wash our hands a lot, to keep ourselves and others healthy.”</em></p><p>Older children and teens may ask additional questions about where or how the pandemic began, what the leaders of our community and country are doing about it, how the pandemic affects them and how long the pandemic will last. Parents and caregivers should provide accurate, balanced and non-blaming or stigmatizing information to their children. For example, you might say:</p><p> <em>“The world is facing this challenge together and many people are working hard to come up with ways to help. As a matter of fact, the reason we are staying home is because scientists have learned this is the best way to reduce the impact of the virus. By staying home, you help to protect those that are more vulnerable such as the elderly and people with weaker immune systems.”</em></p><p>Or you could say:</p><p> <em>“This is not the first time the world has faced a challenge like this, and people become resourceful and start working together during such times to get things done. Researchers are sharing their findings to speed up progress to find treatments. Doctors and scientists across the world are talking to each other about what treatments may work and what treatments do not work. It is important you are aware not everything posted online is true. Many sites use clickbait to get you to look at information that is exaggerated, misleading or untrue.”</em></p><p>It is okay to say you do not know all the answer to your child’s questions, or that you are feeling worried as well. When talking to your child, try to present a hopeful positive outlook and tone. Be mindful of news, radio, or social media information your children are exposed to and minimize their exposure if not appropriate to their level of understanding.</p><p>Also, emphasize that your family is taking the right steps to stay safe going forward. Remember your child is not only learning from what you are explaining with words, but also, perhaps more so, from how you behave. If your actions show you are nervous and stressed, then your child will “learn” that the situation is stressful and being nervous and stressed is the best way to deal with it. In contrast, if you remain calm and composed about the situation, your child will feel safer and learn that staying calm is the best way to deal with it. Children pick up on and mirror your cues. Your children will also notice if you are ‘hiding’ things from them or having whispered conversations with other adults; this will add to a child’s stress. If you are having difficulty managing your own anxiety, ask for help from family, friends, and if needed, your health-care provider.</p><h2>How do I answer my child’s questions about COVID-19?</h2><p>When answering your child’s questions, try to find out what your child already knows. Provide accurate and honest information that is appropriate for their developmental level. Do not make false promises about how long the pandemic will last, as things are changing every day. The Centers for Disease Control has provided some <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/talking-with-children.html">child friendly answers to common health related questions about COVID-19</a>.</p><h2>Encourage children to help with planning and focus on the short-term</h2><p>Parents and caregivers can acknowledge the uncertainty regarding the coming weeks and months. They can encourage the whole family to be flexible with their plans and focus on the short-term. It can be helpful for everyone to focus on their community and their family and find safe ways to help others during the pandemic. Both children and adults feel better if they can do something. It is important to realize that even simple actions can be of great importance; for example, calling someone regularly who you know is alone or has difficulty coping with the situation. Where possible you can consider involving your child in these actions. Some examples include reaching out to relatives, friends and neighbors using methods such as social media, email, phone calls or video chat; writing letters or cards; or coming up with activities that can be shared remotely with other families. Reaching out to local online community and school groups may be another good place to start.</p><p>Work with your child to develop a daily schedule. This could include academic and learning activities, leisure and creative activities, and physical activities. It can be helpful to schedule or limit non-academic screen time from the beginning, to avoid overuse and a future need to cut back. Refer to the family schedule throughout the day. For some children an entire day can be overwhelming, so break the schedule down into shorter periods of time (for example, a morning schedule and an afternoon schedule). Try to stick to a consistent routine for waking up, meals and snacks, and bedtime. Routines offer security and predictability to children.</p><h2>If your child is upset, validate their feelings</h2><p>It is common for children (and adults) to feel scared, upset, anxious or distressed during stressful times. For some children, this may take the form of tantrums and difficult behaviours such as aggression. Other children may have more trouble getting to sleep. Some children might show regression, temporarily losing a previously acquired skill, as a symptom of anxiety. Examples include if your child starts wetting the bed or asking for more help with daily tasks such as getting dressed.</p><p>Parents and caregivers should validate their children’s feelings by saying for example: <em>“I can see you are really scared right now” or “You really miss your school and friends, it is hard to be home all day.”</em> Avoid providing false reassurance or trying to fix their distress. Offer concrete reassurance by saying for example: <em>“I am here for you when you are ready, or if you need me”</em> and <em>“We will get through this together.”</em> For younger children, distraction and redirection can also be helpful. For example, you can suggest reading a book together. Remember that children are adaptable and resilient by nature.</p><h2>Model healthy coping skills and attend to your own physical and mental health</h2><p>It is vital that parents and caregivers take care of their own physical health and stress level during the pandemic. Look after yourself because your children depend on you. This includes eating nutritious food, getting adequate sleep, taking care of your grooming, and trying to include exercise in your day. Find a few quiet moments each day and listen to music, meditate or pray, do yoga and connect with loved ones.</p><p>Children take their cues from parents and caregivers. If you as a parent or caregiver are anxious or panicked, then your child will pick up on this and likely feel the same way. Social isolation and high levels of stress can be overwhelming for everyone; it is okay for parents to step away, take breaks, and seek help when needed.</p><p>Parents and children should avoid listening to and looking at too much news and media content as this can cause and increase anxiety. You should pick a reliable news source and check in no more than once or twice each day. Reach out to your family physician or other supports if you are having trouble coping. See the <a href="https://www.camh.ca/en/health-info/mental-health-and-covid-19">Centre for Addition and Mental Health</a> website for recommendations and supports for adults.</p><h2>Consider seeking out additional resources for your child</h2><p>For children with unique communication needs or developmental disabilities, consider seeking out additional resources to explain what is happening. For example, visit Autism Speaks Canada for a <a href="https://www.autismspeaks.org/sites/default/files/flu_teaching_story_final%20%281%29.pdf">flu teaching story</a> to share with your child.</p><p>For children and youth who are experiencing ongoing increased distress or anxiety, consider reaching out to your regular health-care providers. Most providers should be able to offer virtual or phone check-ups. Some helpful online apps to help parents (and children) cope are listed below.</p><ul><li><a href="https://www.anxietycanada.com/">Anxiety Canada</a> website has helpful information and guides to develop an anxiety plan for people of all ages.</li><li>Mental health apps: <a href="https://www.anxietycanada.com/resources/mindshift-cbt/">MindShift</a>, <a href="https://www.calm.com/">Calm</a>, <a href="https://www.headspace.com/headspace-meditation-app">Headspace</a>, <a href="https://www.stopbreathethink.com/">Stop, breathe and think</a> and <a href="https://www.stopbreathethink.com/kids/">Stop, breathe and think kids</a>. These offer general coping strategies and introductions to cognitive behavioural therapy. All of them have some free content or trials.</li><li>Mindfulness and meditation: <a href="https://www.smilingmind.com.au/">Smiling mind</a> (meditation for all ages), and <a href="https://www.uclahealth.org/marc/ucla-mindful-app">UCLA Mindful</a>.</li><li><a href="https://teens.aboutkidshealth.ca/mentalhealth?topic=guidedmeditations">Guided meditations</a> from AboutKidsHealth, a health education resource for children, youth and caregivers that is approved by health-care providers at The Hospital for Sick Children.</li></ul><h2>References</h2><p>Autism Speaks Canada. Visual Supports and Autism Spectrum Disorder tool kit. Retrieved from <a href="https://www.autismspeaks.ca/science-services-resources/resources/tool-kits/visual-supports-and-autism-spectrum-disorder-1/">https://www.autismspeaks.ca/science-services-resources/resources/tool-kits/visual-supports-and-autism-spectrum-disorder-1/</a></p><p>Centers for Disease Control and Prevention. (2020, March 16). Handwashing: Clean Hands Save Lives. Retrieved from <a href="https://www.cdc.gov/handwashing/">https://www.cdc.gov/handwashing/</a></p><p>Centers for Disease Control and Prevention. (2020, March 30). Talking with children about Coronavirus Disease 2019. Retrieved from <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/talking-with-children.html">https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/talking-with-children.html</a></p><p>Centre for Addition and Mental Health. (2020). Mental Health and the COVID-19 Pandemic. Retrieved from <a href="https://www.camh.ca/en/health-info/mental-health-and-covid-19">https://www.camh.ca/en/health-info/mental-health-and-covid-19</a></p><p>National Association for School Psychologist. (2020, February 29). Talking to Children About COVID-19 (Coronavirus). Retrieved from <a href="https://www.camh.ca/en/health-info/mental-health-and-covid-19">https://higherlogicdownload.s3.amazonaws.com/NASN/3870c72d-fff9-4ed7-833f-215de278d256/UploadedImages/PDFs/02292020_NASP_NASN_COVID-19_parent_handout.pdf</a></p> https://assets.aboutkidshealth.ca/AKHAssets/How_to_talk_to_your_child_about_COVID-19.jpgMain
Iron deficiency anemia and protein-losing enteropathy related to excessive milk intakeIron deficiency anemia and protein-losing enteropathy related to excessive milk intakeIron deficiency anemia and protein-losing enteropathy related to excessive milk intakeIEnglishNutritionChild (0-12 years)NANAConditions and diseasesAdult (19+) CaregiversNA2019-01-16T05:00:00Z9.0000000000000055.40000000000002219.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Milk can be a part of a healthy, balanced diet. However, drinking too much milk can lead to low levels of iron in the blood and some children can then lose protein from the gut.<br></p><h2>Excessive milk intake</h2><p>The recommended amount of cow’s milk for toddlers is 250 to 500 mL (1–2 cups or 8–16 oz.) per day. Some toddlers drink more milk than the recommended number of servings. This "milk diet" can lead to iron deficiency. A small group of these children also experience protein loss from the digestive system or gut. Iron deficiency can lead to anemia (low red blood cell count) and protein loss leads to hypoalbuminemia (low levels of albumin in the blood). Treatment usually requires limiting milk intake, offering iron rich solid food, and in children with moderate to severe anemia, iron supplements.</p> <p>Breast milk or formula is a good source of iron for the first six months of life. Iron stores in babies naturally decrease by four to six months of age. After six months, the amount of iron in breast milk is not enough, and solid foods are usually introduced.</p><p>When introducing solid foods, infants should start with meat or meat alternatives, in order to get enough iron and protein in their diet. Meat alternatives include fish, egg yolk, tofu, lentils and cheese. Iron-fortified cereals are also a good source of iron that can be started at four to six months of age. Breast milk and/or formula should continue until nine to 12 months of age, when homogenized (3.25%) cow’s milk may be started to complement solid food.</p><h3>Iron deficiency anemia</h3><p>Iron is an important mineral that we get from our diet that is needed to make haemoglobin. Haemoglobin is a protein in red blood cells that allows the cells to carry oxygen to the tissues in our body. Anemia occurs when you have low levels of haemoglobin in your body. When the anemia is caused by not having enough iron this is called iron deficiency anemia.</p><p>When a child has anemia, they are not getting enough oxygen delivered to the tissues in their body. This can cause them to look pale and tired, and cause weakness.</p><h3>Protein losing enteropathy</h3> <p>Drinking too much milk can also cause protein loss from the gut (protein losing enteropathy).</p><p>Children with protein losing enteropathy have severe protein loss through the gut and this results in low protein levels in the blood.</p><p>The main protein found in the blood is called albumin. Having low levels of the protein albumin in the blood (hypoalbuminemia) can cause the blood vessels to leak fluid into the tissue. Extra fluid in the tissue can cause swelling (edema) of the legs, back and face. Hypoalbuminemia also puts you at risk for infections.</p><p>Hypoalbuminemia and edema can be caused by other disorders. Your child’s doctor will ask questions about your child’s overall health, symptoms of diarrhea or blood in the stool, and family history of gut, liver, kidney or heart diseases.</p><p>If there are no other causes for protein loss, it is possible that too much milk is the cause.</p><h2>Key points</h2><ul><li>Too much milk can lead to iron deficiency anemia and protein loss from the gut.</li><li>Milk intake should be limited to a maximum of 500 mL (2 cups or 16 oz.) per day for toddlers and young children.</li><li>The main treatment for iron deficiency and protein loss from the gut due to excess milk intake is to reduce the amount of milk your child drinks and to increase the amount iron rich foods in their diet. For moderate to severe anemia, iron supplements are also needed.</li><li>See a doctor if your child drinks a lot of milk and is tired, weak, pale or has a swollen face, legs and feet.</li> </ul> <h2>Signs and symptoms of iron deficiency anemia and protein losing enteropathy</h2><p>Symptoms of anemia depend upon its severity, how fast the drop in levels of haemoglobin occurred and its cause. It also depends on how well a child’s body adapts to a low level of haemoglobin.</p><p>Symptoms of anemia include:</p><ul><li>pale skin</li><li>lack of energy</li><li>shortness of breath after exercise or play</li></ul><p>Protein losing enteropathy and hypoalbuminemia causes the blood vessels to leak fluid into surrounding tissue.<br></p><p>Symptoms of protein losing enteropathy and hypoalbuminemia include:</p><ul><li>progressive swelling of the feet, legs and face</li><li>muscle cramps or weakness</li><li>extra fluid around the lungs (pleural effusion)</li><li>swelling of the abdomen (ascites)</li></ul> <h2>Risk factors and prevalence of iron deficiency anemia</h2><p>Iron deficiency anemia is the most common type of anemia.</p><p>Around the world, iron deficiency anemia affects approximately 750 million children. In Canada, it is seen in 3.5% to 10.5% of the general population. Children have a greater risk of iron deficiency anemia due to their rapid growth, particularly in the first two years of life.</p><p>Children who are most at risk of developing iron deficiency anemia are those who are fed only breast milk or non-iron fortified cow’s milk formulas after six months of age, and those who drink an excess of cow’s milk. Children who are given cow’s milk before 12 months may also be at increased risk of developing iron deficiency anemia because their gut may not be ready to digest cow’s milk yet.</p> <h2>Cause of iron deficiency anemia and protein losing enteropathy</h2><h3>Iron deficiency anemia</h3><p>Iron deficiency anemia from excessive milk intake is caused by three things.</p><ul><li><strong>Not enough iron:</strong> Milk contains very little iron. In addition, if a child drinks too much milk, they will be too full to eat good amounts of iron rich foods.</li><li><strong>Poor iron absorption:</strong> Milk and other dairy products can interfere with the gut’s ability to absorb iron from other sources, such as meat and meat alternatives, and dark green vegetables.</li><li><strong>Microscopic bleeding:</strong> Too much milk can damage the lining of the gut (milk enteropathy). Milk enteropathy causes microscopic bleeding from the gut that you may not be able to see. Any type of bleeding from the body results in a loss of iron. Over time, this bleeding can cause very low levels of haemoglobin, contributing to the iron deficiency anemia.</li></ul><h3>Protein losing enteropathy</h3><p>It is not fully understood how milk intake leads to protein loss in the gut. One theory suggests a process called villous atrophy. The small intestine part of our gut has finger-like projections on its walls called villi. The villi play an important role in the absorption of nutrients. It is believed that an excess intake of cow’s milk can cause the villi to shrink (villous atrophy) and not absorb nutrients well. Villous atrophy causes the bowel walls to become leaky, allowing protein to leak through.</p><h2>Diagnosis of anemia and protein losing enteropathy</h2><h3>Iron deficiency anemia</h3><p>Iron deficiency anemia can be diagnosed by your child’s doctor. They will do a physical exam and ask about your child’s energy levels, general health, diet and family history.</p><p>A blood test, called a complete blood cell count (CBC), can make the diagnosis of anemia by measuring haemoglobin levels. When the anemia is caused by iron deficiency, the red blood cells will also look smaller and lighter in colour when seen under a microscope.</p><p>A ferritin test may also be done. Ferritin is a protein found in the body that stores iron. A low ferritin level can indicate iron-deficiency.</p><p>Additional useful tests that measure the body’s iron are called iron studies.</p><h3>Protein losing enteropathy</h3><p>Protein losing enteropathy and hypoalbuminemia are suspected in children with swelling and low albumin levels in the blood. Your child’s doctor will examine them for swelling of the legs, feet and face. They will also examine your child’s heart, lungs and abdomen for extra fluid.</p><p>A blood test is often done to check the blood albumin level. A urine test may also be done to make sure there is no protein loss from the kidneys. When the cause of low albumin is not clear, further tests may be done including stool tests. One of the stool tests that may be performed is a 24-hour collection of stool to check for a protein called alpha-1-antitrypsin. By comparing the amount of this protein in the stool to the amount in the blood, doctors can tell whether there is protein loss through the gut.</p> <h2>Treatment of iron deficiency</h2><h3>Diet</h3><p>Limiting milk intake to a maximum of 16 ounces per day is usually the only treatment needed. The iron levels will gradually rise and protein loss from the gut will decrease.</p><p>Iron rich foods can also help to treat iron deficiency. Many iron rich foods, such as meat and meat alternatives, are also high in protein. Offer your child foods such as meat and meat alternatives, and iron-fortified cereals a few times each day. From one year of age, young children should begin to have a regular schedule of meals and snacks. In general, you may follow the advice in <a href="https://food-guide.canada.ca/en/">Canada’s Food Guide</a>.</p><p>Limiting milk does not mean stopping it completely. It is known that milk is a good source of calcium, vitamin A and vitamin D. From one to two years of age, children should drink 250 to 500 mL (1–2 cups or 8–16 oz.) of homogenized (3.25% M.F.) cow’s milk per day. They should not drink more than 500 mL (2 cups or 16 oz.) per day.</p> <h3>Iron supplement</h3><p>Your child’s doctor might also prescribe iron supplements. After a few weeks, values such as the haemoglobin level generally start to improve. Treatment is usually continued for at least three months to fully replenish iron stores in the body.</p><p>Iron supplementation can cause an upset stomach. Your doctor might divide the dose in half and ask you to give it two times per day instead of as one large daily dose.</p><p>Dairy products (milk, cheese, yogurt) can have a negative effect on the absorption of iron. Try to give iron supplements two hours before or after eating or drinking any dairy products.</p><p>Vitamin C can help iron absorption from foods. Oranges and other citrus fruit are good sources of vitamin C. Be careful with offering too much juice, as it is high in sugar.</p><p>Protein losing enteropathy and hypoalbuminemia caused by too much milk gets better fairly quickly when the milk intake is limited to an appropriate amount.</p><h2>Complications of anemia and hypoalbuminemia</h2><p>Untreated anemia in children can have serious effects on a child’s growth. Untreated anemia can affect intellectual ability and overall development. This can lead to problems with attention, reading ability and school performance. In rare cases, extreme anemia can cause a stroke.</p><p>Hypoalbuminemia can also have serious effects on a child’s growth. Excess fluid around the lungs can cause problems with breathing. In rare cases, excess fluid can build up around the heart making it harder for the heart to pump. Protein loss in the gut can also cause a loss of the proteins needed to fight infection and prevent clots, putting children at risk of severe infections or blood clots.</p> <h2>Helping your child</h2><p>Limiting milk intake can be challenging. Many toddlers enjoy drinking milk in a bottle, and associate drinking milk with their bedtime ritual.</p><p>Here are some tips on how to help limit your child’s milk intake:</p><ul><li>If your child drinks more than 1200 mL (5 cups or 40 oz.) of milk per day, wean them slowly to smaller amounts. Cut the amount by half to start.</li><li>Offer solid foods first and only offer milk at the end of the meal. Alternatively, you could offer water with meals and milk only a couple of times a day with a snack. This way your child will not fill up on milk first.</li><li>Switch to a sippy cup early. This will prevent your child from taking the milk to bed and associating drinking milk with falling asleep.</li><li>Do not allow your child to sleep with a bottle of milk in bed. If you are having trouble with this then slowly start to dilute the milk with water until you are offering just water. This will also help in avoiding dental caries.</li> </ul> <h2>Follow-up</h2><p>Iron supplementation should be continued for at least three to six months to replenish the amount of iron that is stored in the body.</p><p>After starting treatment, your doctor will schedule a follow-up appointment. A repeat blood test is not always needed if your child’s symptoms improve with iron treatment and changes in diet.</p> <h2>References</h2><ol><li>Abdullah, K., Zlotkin, S., Parkin, P. & Grenier, D. Iron-deficiency Anemia in Children. Canadian Paediatric Surveillance Program, resource article, 2011 (Accessed December 3, 2017).</li><li>Allen, R.E. & Myers, A.L. Nutrition in Toddlers. American Family Physician. 2006; 74(9): 1526-1532.</li><li>Bondi, S.A. & Lieuw, K. Excessive Cow’s Milk Consumption and Iron Deficiency in Toddlers: Two Unusual Presentations and Review. Infant, Child, & Adolescent Nutrition. 2009; 1(3). DOI: 10.1177/1941406409335481.</li><li>Critch, J.N. Nutrition for healthy term infants, six to 24 months: An overview. Paediatric Child Health. 2014; 19(10): 547-549.</li><li>Food Sources of Iron. Dietitians of Canada. (Accessed December 3, 2017).</li><li>Grueger, B. Weaning from the Breast. Paediatric Child Health 2013; 18(4): 210.</li><li>Kazal, L.A. Prevention of Iron Deficiency in Infants and Toddlers. American Family Physician. 2002; 66(7): 1217-1224.</li><li>Rabinowitz, S. & Ebigbo, N. Pediatric Protein-Losing Enteropathy. Medscape, Pediatrics; General Medicine, 2017 < https://emedicine.medscape.com/article/931647-overview> (Accessed December 3, 2017).</li></ol> https://assets.aboutkidshealth.ca/AKHAssets/Drinks_for_your_toddler_or_preschooler.jpgExcessive milk intake Milk is part of a healthy diet. But too much milk can lead to low levels of iron in the blood and some children can lose protein from the gut. Main
Mental healthMental healthMental healthMEnglishPsychiatryChild (0-12 years);Teen (13-18 years)NANANACaregivers Adult (19+)NALanding PageLearning Hub<p>Learn how to support your child’s wellbeing with activity, sleep and nutrition; and how to recognize and manage various mental health conditions.</p><p>This hub includes resources for parents on how to support your child's mental health and general wellbeing through physical activity, sleep and nutrition. It also provides information on the signs, symptoms and treatments of different mental health conditions, including anxiety, bipolar disorder, depression, behavioural disorders, anorexia nervosa and attention deficit hyperactivity disorder.<br></p><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Wellbeing</h2></div><div class="panel-body list-group" style="display:none;"><p>The everyday pressures of growing up can put a strain on any child's mental wellbeing. Find out how physical activity, a healthy sleep routine, screen time limits and balanced nutrition can boost your child's mental health and support them through difficult times.</p></div><ol class="list-group" style="display:none;"><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h3>Physical activity</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=642&language=English">Physical activity: Guidelines for children and teens</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=641&language=English">Physical activity: Benefits of exercise for health and wellbeing</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h3>Sleep</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=645&language=English">Sleep: Benefits and recommended amounts</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=646&language=English">How to help your child get a good night's sleep</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=647&language=English">How to help your teen get a good night's sleep</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h3>Screen time</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=643&language=English">Screen time: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=644&language=English">How to help your child set healthy screen time limits</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h3>Nutrition</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=639&language=English">Nutrition: How a balanced diet and healthy eating habits can help your child's mental health</a></li></ol></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Anxiety disorders</h2></div><div class="panel-body list-group" style="display:none;"><p>Every child feels anxiety at some point as a natural part of growing up. An anxiety disorder, however, is when anxious feelings interfere with a child's everyday routine. Learn more about the signs, symptoms and range of anxiety disorders and how they ​are treated.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=18&language=English">Anxiety: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=271&language=English">Anxiety: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=270&language=English">Types of anxiety disorders</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=701&language=English">Anxiety: Treatment with medications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=702&language=English">Anxiety: Psychotherapy and lifestyle changes</a></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h3>Resources for coping with anxiety</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="https://assets.aboutkidshealth.ca/AKHAssets/Anxiety%20caregiver%20handout_Eng%2004_03_2020.pdf">The CARD System - Coping with your child's anxiety (for parents/caregivers)</a></li></ol></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Obsessive compulsive disorder</h2></div><div class="panel-body list-group" style="display:none;"><p>Obsessive compulsive disorder (OCD) occurs when a person suffers from troubling and intrusive thoughts and/or follows repetitive or strict routines to feel less worried. Learn about the causes, signs and impact of this disorder and how you can help your child.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=285&language=English">Obsessive compulsive disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=288&language=English">OCD: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=286&language=English">How OCD affects your child's life</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=709&language=English">OCD: Psychotherapy and medications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=287&language=English">OCD: How to help your child at home</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Depression</h2></div><div class="panel-body list-group" style="display:none;"><p>Depression is an illness that causes someone to feel deep sadness or a lack of interest in activities that they once enjoyed. Discover how this condition affects a child's mood, sleep, concentration and energy levels, and how it can be treated.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=19&language=English">Depression: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=284&language=English">Depression: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=707&language=English">Depression: Treatment with medications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=708&language=English">Depression: Psychotherapy and lifestyle changes</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Bipolar disorder</h2></div><div class="panel-body list-group" style="display:none;"><p>When a person has bipolar disorder, they alternate between low and elevated moods for days, weeks or months at a time. Learn about the bipolar disorder spectrum, the symptoms of manic and depressive episodes and how medications, therapy and lifestyle changes can help.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=279&language=English">Bipolar disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=280&language=English">Bipolar disorder: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=704&language=English">Bipolar disorder: Treatment with medications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=705&language=English">Bipolar disorder: Psychotherapy and lifestyle changes</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Suicide and self-harm</h2></div><div class="panel-body list-group" style="display:none;"><p>A child who experiences thoughts of suicide or self-harm is often suffering from overwhelming emotional pain. Find out how to help your child cope with difficult emotions, how to support and protect your child and where to find professional help.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=291&language=English">Suicide in children and teens: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=289&language=English">Self-harm in children and teens: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=290&language=English">Signs and symptoms of suicide risk</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=293&language=English">How to help your child with difficult emotions</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=292&language=English">How to protect your child from harm</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Eating disorders</h2></div><div class="panel-body list-group" style="display:none;"><p>An eating disorder not only risks your child's health but can also disrupt family life. Find out about the symptoms and treatment of anorexia, bulimia, avoidant/restrictive food intake disorder and binge eating disorder and how you can help your child recover.</p></div><ol class="list-group" style="display:none;"><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h3>Anorexia nervosa</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=268&language=English">Anorexia nervosa: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=269&language=English">Anorexia: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=267&language=English">Anorexia: Medical complications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=700&language=English">Anorexia: Treatment options</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=266&language=English">Anorexia: How to help your child at home</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h3>Bulimia nervosa</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=282&language=English">Bulimia nervosa: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=283&language=English">Bulimia: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=281&language=English">Bulimia: Medical complications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=706&language=English">Bulimia: Treatment options</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=294&language=English">Bulimia: How to help your child at home</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h3>Avoidant/restrictive food intake disorder (ARFID)</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=274&language=English">Avoidant/restrictive food intake disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=275&language=English">ARFID: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=273&language=English">ARFID: Medical complications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=703&language=English">ARFID: Treatment options</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=272&language=English">ARFID: How to help your child at home</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h3>Binge eating disorder (BED)</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=277&language=English">Binge eating disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=278&language=English">BED: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=640&language=English">Obesity: Medical complications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=276&language=English">BED: How to help your child at home</a></li></ol></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Attention deficit hyperactivity disorder (ADHD)</h2></div><div class="panel-body list-group" style="display:none;"><p>Attention deficit hyperactivity disorder (ADHD) involves difficulties with controlling attention and regulating behaviour. Discover the main symptoms of ADHD in children and teens, how the disorder is diagnosed and how to help your child at home and at school.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1922&language=English">Attention deficit hyperactivity disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1923&language=English">ADHD: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1997&language=English">ADHD: How to help your child at home</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1999&language=English">ADHD: Communicating with your child's school</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1998&language=English">ADHD: Treatment with medications</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Behavioural disorders</h2></div><div class="panel-body list-group" style="display:none;"><p>Behavioural disorders include oppositional defiant disorder and conduct disorder. Learn how these disorders differ from typical misbehaviour, how therapy and medications can help and how you can manage problematic behaviour at home.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1924&language=English">Behavioural disorders: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1925&language=English">Behavioural disorders: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=2000&language=English">Behavioural disorders: Treatment with psychotherapy and medications</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=2001&language=English">Behavioural disorders: How to help your child at home</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Post-traumatic stress disorder (PTSD)</h2></div><div class="panel-body list-group" style="display:none;"><p>Post-traumatic stress disorder (PTSD) is triggered by experiencing or witnessing a terrifying event. Learn about the main symptoms of PTSD, how the condition is diagnosed and how psychotherapy and medications can help your child.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1927&language=English">Post-traumatic stress disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1928&language=English">PTSD: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=2005&language=English">PTSD: Treatment with psychotherapy and medications</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Brain disorders and mental health</h2></div><div class="panel-body list-group" style="display:none;"><p>A brain disorder includes a condition, illness or injury that affects the brain and how it develops before or after birth. Find out how a brain disorder can affect your child's learning, mood and social skills, how its impact on mental health is assessed and how to help your child cope.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=1926&language=English">Brain disorders and mental health: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=2002&language=English">Brain disorders: Assessing your child for neuropsychological difficulties</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=2003&language=English">Brain disorders: How to help your child cope</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=2004&language=English">Brain disorders: Common treatments</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Parenting a child with a chronic condition</h2></div><div class="panel-body list-group" style="display:none;"><p>A chronic conditions can affect a child's mental health and everyday routines. Discover how parents and caregivers can help manage both their child's health care and routines, and support their own mental health.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=3400&language=English">Living with a chronic condition: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=3401&language=English">Living with a chronic condition: Helping your child manage their health</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=3402&language=English">Living with a chronic condition: Maintaining your child's everyday routines</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=3403&language=English">Living with a chronic condition: Supporting yourself as a caregiver</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Substance use disorder</h2></div><div class="panel-body list-group" style="display:none;"><p>Substance use is the use of alcohol, tobacco and other drugs for pleasure or enjoyment. Learn about the signs and symptoms of substance use and how you can help your teen if you suspect they have a substance use disorder.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=3663&language=English">Substance use disorder: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=3664&language=English">Substance use disorder: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=3665&language=English">Substance use disorder: How to help your teen at home</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"><i class="mdi mdi-chevron-down"></i></span> <h2 class="panel-title">Understanding functional symptoms and somatization</h2></div><div class="panel-body list-group" style="display:none;"><p>Somatization involves expressing distress through physical symptoms. Find out about the mind-body connection, signs of somatization and the various ways to support your child or teen.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=3666&language=English">Functional symptoms: Overview</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=3667&language=English">Mind-body connection</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=3668&language=English">Somatization: Signs and symptoms</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=3669&language=English">Somatization: Common treatments</a></li><li class="list-group-item"> <a class="overview-links" href="/Article?contentid=3770&language=English">Somatization: How to help your child or teen cope</a></li></ol></div>https://assets.aboutkidshealth.ca/AKHAssets/Mental_health_landing-page.jpgmentalhealthhealthylivingMain
Moles (acquired nevi)Moles (acquired nevi)Moles (acquired nevi)MEnglishDermatologyChild (0-12 years);Teen (13-18 years)SkinSkinConditions and diseasesCaregivers Adult (19+)NAhttps://assets.aboutkidshealth.ca/akhassets/PMD_nevus_EN.jpg2015-05-06T04:00:00Z7.6000000000000067.00000000000001150.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Moles are common skin growths that vary in size, colour and appearance. Find out how to tell the difference between benign and potentially harmful moles.</p><h2>What is a mole?</h2><p>A mole, or nevus, is a very common skin growth that occurs when skin colour cells, known as melanocytes, build up under the surface of the skin. Moles vary in size, colour and appearance and can also change over time. They are usually round, but they may also have an oval or jagged shape. Their colour ranges from pinkish red or light brown to dark brown or black.</p> <figure class="asset-c-80"> <span class="asset-image-title">Healthy and benign moles</span> <img src="https://assets.aboutkidshealth.ca/akhassets/PMD_nevus_EN.jpg" alt="" /> </figure> <p>Moles can be flat, bumpy or verrucous (like a wart). They usually occur in body parts that are frequently exposed to the sun, but they can be found anywhere, even inside the mouth, eyes and genitals.</p><p>Moles fall into two main groups:</p><ul><li>congenital melanocytic nevi – moles that your child has at birth or are noticed shortly after birth</li><li>acquired nevi – moles that develop later in life</li></ul><h2>Key points</h2> <ul> <li>Moles occur when there is a build-up of melanocytes under the skin. This can happen as a result of sun exposure, high levels of growth hormones or chemotherapy.</li> <li>Most moles are benign. They are symmetrical and have a regular border and even pigment throughout.</li> <li>The ABCDE acronym can help you, your child or a dermatologist identify any potentially harmful moles.</li> <li>To reduce the risk of harmful moles (melanoma), avoid too much sun exposure, use sunscreen and check your child’s skin at least once every six months.</li> </ul><h2>How do moles affect the body?</h2> <p>Moles are usually benign (harmless), but they can sometimes change and become skin cancer (melanoma). This can be very serious and sometimes lead to death if not treated in time.</p> <h2>Benign moles</h2> <p>A benign mole has the following three features.</p> <ul> <li>It is symmetrical – you can draw an imaginary line and divide it into two identical pieces.</li> <li>It has a regular border – there is a clear difference between the colour of the mole and skin around it.</li> <li>It has a uniform pigment – every area of the mole is the same colour.</li> </ul> <p>In general, benign moles:</p> <ul> <li>grow as your child grows, becoming bigger as the skin stretches</li> <li>get darker or lighter with time</li> <li>may sometimes have coarse hair growing from them</li> <li>will normally change a little throughout life, for example become raised over several years</li> </ul> <h2>Potentially harmful moles</h2> <p>A mole that is potentially harmful might:</p> <ul> <li>change shape</li> <li>rapidly grow (out of proportion with the child’s growth)</li> <li>develop an uneven colour</li> <li>form a scab or bleed without any injury</li> </ul> <p>A dermatologist (skin specialist) should examine your child’s skin if it looks different than it used to, if an area opens up, bleeds and has a hard time healing or if a new mole suddenly appears.</p><h2>What causes moles to appear?</h2><p>Several factors can cause moles to appear:</p><ul><li>sun exposure (more time in the sun increases the number of moles on your skin)</li><li>higher levels of cortisone, corticotropin and other hormones that help the body grow</li><li>chemotherapy (medication that treats cancer)</li><li> <a href="/article?contentid=1170&language=English">immunosuppression</a> (a weakened immune system that prevents the body from fighting infections).</li></ul><h2>Can children develop melanoma?</h2><p>Yes they can, although melanoma in children is very rare. Only one child in one million children below age 15 develops melanoma.</p><p>The risk factors for developing melanoma during childhood include:</p><ul><li>having dysplastic nevi (irregular looking moles)<br></li><li>having a close family member, such as a parent or grandparent, with a history of melanoma</li><li>having a large number (more than 100) of melanocytic nevi, or moles</li><li>being immunosuppressed or having inherited immunodeficiency (weakened immune system)</li><li>having a sun-sensitive phenotype (very fair skin, light coloured eyes and red or light hair)</li><li>being exposed to ultraviolet radiation from the sun</li><li>having a history of malignancy (any form of cancer)</li><li>having a genetic disorder that makes the skin more sensitive to sun damage (for example xeroderma pigmentosum)</li></ul><h2>How is a potentially harmful mole diagnosed?</h2><p>Dermatologists and other health-care professionals use the letters "ABCDE" as a guide when checking the skin for potentially harmful changes in existing or new moles. You can also use this guide when checking your child’s skin at home. </p><ul><li> <strong>A </strong>stands for asymmetry (having two sides or halves that are not the same)</li><li> <strong>B</strong> stands for border irregularity (the borders of the mole are not well defined)</li><li> <strong>C </strong>stands for colour variation (different colour tones in the same mole, for example light and dark brown)</li><li> <strong>D </strong>stands for diameter larger than 6 mm</li><li> <strong>E </strong>stands for evolving (including any dramatic change in shape, colour or appearance in existing moles)</li></ul><p>If a mole has any of these characteristics, it should be examined more closely. A dermatoscopic examination (examining the skin using a special magnifying glass) or a <a href="/article?contentid=2464&language=English">skin biopsy</a> (examining a small sample of the mole’s cells under a microscope) can tell your dermatologist or doctor if the mole is benign or malignant.<br></p> <figure class="asset-c-100"> <span class="asset-image-title">ABCDEs of potentially harmful moles</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_mole_ABCDE_EN.jpg" alt="Illustration of normal moles and potentially harmful moles according to ABCDE guide" /> </figure><h2>How can I or my child inspect my child’s skin at home?</h2><ol><li>Do the inspection in a well-lit area.</li><li>If you are inspecting your child’s skin, gather a hair dryer, two chairs or stools, a camera or smartphone, a ruler and a pen and paper. If your child is inspecting their own skin, they will need these tools and two mirrors, one that is hand-held mirror and one hanging on a wall or a door.</li><li>Inspect the different parts of the body in the same order each time. For example, always work from the head down or the feet up.</li><li>If working down from the head, for example, start by parting your child’s hair with a hair dryer or your hands to check their scalp. This is easier to do when the hair is wet.</li><li>Check your child’s shoulders, chest and genital area.</li><li>Check the back of their shoulders, their upper and lower back and their buttocks.</li><li>Check their upper arms, elbows, forearms, wrists, hands, palms and fingers, including the space between their fingers.</li><li>Check their inner and outer legs, front and back, including their knees and ankles.</li><li>Check their feet and toes, including the soles and the space between the toes.</li><li>Take a photo of any moles with a ruler beside them so you can record the size and keep track of any changes over time.<br></li></ol><br><h2>What can I do to reduce the risk of melanoma?</h2><ul><li> <a href="/article?contentid=308&language=English">Avoid too much sun exposure</a> (use a hat and special SPF clothing at the beach or in sunny places).</li><li>Do not let your child or teenager use tanning beds.</li><li>Use sunscreen (SPF 30 or higher, covering both UVA and UVB rays) every day, even during winter months, and reapply it periodically during the day.</li><li>Check the skin using the ABCDE acronym at least once every six months.</li><li>Talk to your child’s doctor if you notice any change that concerns you.</li></ul><div class="asset-video"> <iframe src="https://www.youtube.com/embed/7n9wjuEEwio?rel=0" frameborder="0"></iframe>  </div> <div class="asset-video"> <iframe src="https://www.youtube.com/embed/_ek6RydayLY?rel=0" frameborder="0"></iframe>  <br></div> Moles are common skin growths. Find out how to tell the difference between benign and potentially harmful moles. Main



Celiac disease: Tips to maintain the gluten-free dietCeliac disease: Tips to maintain the gluten-free dietCeliac disease: Tips to maintain the gluten-free dietCEnglishGastrointestinalBaby (1-12 months);Toddler (13-24 months);Preschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)Small IntestineSmall intestineNon-drug treatmentCaregivers Adult (19+)NA2017-02-06T05:00:00Z8.9000000000000057.00000000000001725.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Children with celiac disease must follow a strict gluten-free diet. This article contains tips to help your child maintain their special diet.</p><h2>What is celiac disease?</h2><p><a href="/Article?contentid=816&language=English">Celiac disease</a> is an autoimmune condition in which contact with gluten (a family of food proteins) triggers a reaction by the body’s defense (immune) system. The immune response to gluten—no matter where in the body the contact happened—damages the lining of the gut (small intestine) making it difficult to absorb nutrients.</p><p>Common symptoms of celiac disease include <a href="/article?contentid=7&language=English">diarrhea</a>, <a href="/article?contentid=6&language=English">constipation</a>, <a href="/article?contentid=29&language=English">headaches</a>, tiredness and <a href="/article?contentid=841&language=English">anemia</a>. Some people experience no symptoms at all.<br></p><p>Celiac disease is a life-long condition. There is no medication for celiac disease. The only treatment is a strict gluten-free diet for life. The gluten-free diet will help heal the gut, improve symptoms that may have been present, and keep your child healthy.<br></p><figure class="asset-small"><img src="https://assets.aboutkidshealth.ca/akhassets/gluten_free_symbol_EN.jpg" alt="" /> </figure> <h2>What is the gluten-free diet?</h2><p>A strict <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=956&language=English">gluten-free diet</a> means no trace amounts of gluten. Gluten is naturally found in all forms of:</p><ul><li>wheat</li><li>rye</li><li>barley</li><li>triticale (rye and barley mix).</li></ul><p>Wheat-based products, such as breads, pasta and baked goods, are obvious sources of gluten. However, there are also many foods where gluten is hidden, such as soups, salad dressings and ice creams. </p><p>Always read the labels of all foods and non-food items (such as medications) to find out if they contain any sources of gluten.</p><h2>Key points</h2><ul><li>Celiac disease is an autoimmune condition in which any contact with gluten (a family of food proteins) triggers a reaction from the body’s defense (immune) system.</li><li>Gluten is found in rye, barley, triticale and all forms of wheat.</li><li>The only treatment for celiac disease is a strict <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=956&language=English">gluten-free diet</a> for life. The gluten-free diet will help heal the gut, improve symptoms that may have been present, and keep your child healthy.</li><li>To maintain a strict gluten-free diet, you should avoid cross-contamination (gluten transferred from one food or object to a gluten-free food or object) at home and outside your home.</li><li>When eating out, make sure everyone understands that your child’s gluten-free diet is the only medical treatment for celiac disease.</li></ul><br><h2>Tax credit</h2> <p>The purchase of gluten-free products for a person with celiac disease is considered a medical expense and can be filed as such with your taxes with <a href="http://www.cra-arc.gc.ca/menu-eng.html">Canada Revenue Agency</a>. You will be required to have the following documentation:</p> <ul> <li>a letter from a health-care practitioner certifying that the person requires gluten-free products due to celiac disease</li> <li>a summary of each item purchased during the 12-month period for which the expenses are being claimed</li> <li>a receipt to support the cost of each gluten-free product claimed</li> </ul> <p>For more information, visit the <a href="http://www.cra-arc.gc.ca/menu-eng.html">Canada Revenue Agency</a> website. <br></p><h2>How to avoid cross-contamination</h2><p>Cross-contamination occurs when gluten is not intentionally (not on purpose) transferred from one food or object to another food or object. It is important to avoid all sources of cross-contamination.</p><h3>At home</h3><p>Washing:</p> <ul><li> <a href="/Article?contentid=1981&language=English">Wash hands</a> between handling gluten-containing and gluten-free foods.</li><li>Wash hands and toys that have been contaminated with gluten.</li><li>Wash the counters carefully before preparing a gluten-free meal.</li><li>Clean all pots, pans, utensils and counter tops with soap between uses.</li></ul><p>In the kitchen:</p><ul><li>Keep gluten-free foods separated from foods that contain gluten.</li><li>Use a separate toaster, grill, colander and cutting board for all gluten-free products. If you use your grill for foods that contain gluten, wrap the gluten-free item in foil before cooking.</li><li>Use plastic or metal baking utensils and cutting boards instead of wooden ones because gluten sticks to wood.</li><li>Use condiments from a squeeze bottle when available or have separate containers for those used with gluten-free products (for example, butter or margarine dish).</li></ul><p>Avoid foods potentially contaminated with gluten: </p><ul><li>Do not buy foods that have no nutrition or allergy information on the label.</li><li>Do not eat gluten-free foods that are on the same plate as gluten-containing food (for example trays with fruits, cheese and gluten-containing crackers).</li></ul><h3>Outside of the home</h3><p>You have no control over your environment when you and your family are outside your home. Keep in mind that:</p><ul><li>Toys and play surfaces at day cares, school or others’ homes may be contaminated with gluten. Avoid touching or placing your child’s food on these surfaces.</li><li>Do not buy foods from bulk bins. Products in bulk bins can become contaminated when scoops are used in more than one bin. There is no assurance that the other customers will be as cautious as you.</li><li>Do not buy foods from stores where no nutrition or allergy information are on the label. This may happen with foods imported from other countries.</li><li>Contact food companies when in doubt about processing and gluten contamination.</li><li>Choose packaged deli meats. At the deli counter gluten-free meats are cut using the same slicer without cleaning between uses, which is a source of contamination.</li><li>Avoid buffets as foods may become contaminated with gluten when customers use the same serving utensils between dishes.</li><li>Avoid french fries and other gluten-free foods if they have been cooked in oil which has been contaminated with gluten. This may be the case if battered foods or seasoned foods have been fried in the same fryer.</li><li>Meat can become contaminated if it is cooked on a grill which is also used to cook gluten-containing foods.</li></ul><p>At school</p><ul><li>Speak to your child’s school about the need for your child to be on a strict gluten-free diet.</li><li>Ask the school about gluten-free menu options. It is important to check directly with the food provider about potential sources of contamination.</li><li>Make sure your child understands why they should not trade food with other students.</li></ul><h3>Before going out to eat</h3><p>Call the restaurant beforehand. Tell them that your child’s gluten-free diet is medical treatment for celiac disease, and not an intolerance or sensitivity.</p><p>Visit the restaurant’s website to check its menu, list of ingredients and allergy warnings.</p><p>Select a restaurant where communication will be easy and where the specifics of the strict gluten-free diet will be understood. For example, you should make sure that language will not be a barrier to communication.</p><p>If you do not have time to call ahead, inform your server and the chef of the strict gluten-free diet when you arrive. Try to go to restaurants during hours when it is less busy. With more time, restaurant staff may have more resources to focus on the specifics of the strict gluten-free diet.</p><p>Bring gluten-free breads, crackers and favourite condiments—including salad dressing—to the restaurant.</p><h3>At the restaurant</h3><p>Remember to always ask about cross-contamination. You may want to explain what cross-contamination is. You can say, “Cross-contamination happens when gluten from one food or object comes in contact with another food or object.” Ask for food to be prepared on clean surfaces with clean utensils and gloves.</p><p>Avoid all seasonings, sauces (for instance soy sauce), croutons, soups and gravies. Be specific when ordering. You can say “I want no gravy on my plate.” </p><p>Ask what food is deep fried in the same oil or fryer. You can explain that french fries, tofu, nachos and wings cooked in the same oil as nuggets or onion rings (which are sources of gluten) will be cross-contaminated and are unsafe for your child.</p><p>Ask for allergy or nutrition information lists.</p><p>Avoid buffets.</p><h2>Tips for calling food companies</h2><h3>Finding contact information</h3><p>If you are not sure about a food product or an ingredient in a non-food product, call the company. Find and write down or take a picture of the contact information for the company from the package. In Canada, this is usually a 1-800 phone number.</p><p>If you cannot find a contact phone number, record the name of the company. You can look for the company’s name in the phonebook or search for the contact information on the Internet.</p><p>Record the name of the product and the UPC code number; this is the number at the bottom of the bar code.</p><h3>What to ask</h3><p>Call the company and ask to speak with customer service. Ask specific questions about the product, such as “Is this product gluten-free?” or “Does the product contain oats, barley, wheat, rye, triticale, or any components of these ingredients?”</p><p>If the company is unable to confirm that the product is gluten-free, then do not eat or use that product. Remember that ingredient lists change and you may need to update this information at a later date. </p><p>Some companies maintain a list of products that are considered “gluten-free”. The company can send you the list at your request. Some companies list gluten-free information on their website. Make sure that the information has been recently updated (within the last year). </p><h2>Resources</h2> <h3>Websites</h3> <p>The <a href="http://www.celiac.ca/">Canadian Celiac Association</a> and its local chapters offer many resources to help maintain a gluten-free diet and more.</p> <p>The <a href="http://www.glutenfreecert.com/about-us/gluten-free-certification-program/">Gluten-Free Certification Program</a> provides information about gluten-free products that are safe to eat for people with celiac disease.</p> <h3>Handbook</h3> <p><em>Acceptability of Foods and Food Ingredients for Gluten-free Diets</em> is a pocket dictionary published by the Canadian Celiac Association. It references food ingredients and additives under "allowed" or "not allowed" categories to guide people on gluten-free diets.</p> <h3>App</h3> <p><em>Acceptability of Foods and Food Ingredients for Gluten-free Diets</em> pocket dictionary is also available as an iTunes application. Search “<a href="http://www.glutenfree247.ca/">Gluten free 247</a>” for the version created by the Canadian Celiac Association.</p> <p>Other apps to help manage celiac disease are available. Check each app review and ask other families for their opinion to choose an app best suited for your needs.</p> <h3>Books</h3> <p><strong>Celiac disease</strong></p> <ul> <li><em>Managing Diabetes and Celiac Disease Together</em>, by the Canadian Celiac Association</li> <li><em>Gluten-Free Diet: A Comprehensive Resource Guide</em>, by Shelley Case</li> </ul> <p><strong>Children’s books</strong></p> <ul> <li><em>Growing up Celiac</em>, by the Canadian Celiac Association</li> <li><em>Eating Gluten-Free with Emily: A Story for Children with Celiac Disease</em>, by Bonnie J. Kruszka (5 year olds)</li> <li><em>No More Cupcakes and Tummy Aches: A Story for Parents and their Celiac Children to Share</em>, by Jax Peters Lowell (3-8 year olds)</li> <li><em>Kids with Celiac Disease: A Family Guide to Raising Happy, Healthy, Gluten-Free Children</em>, by Danna Korn</li> <li><em>The GF Kid: A Celiac Disease Survival Guide</em>, by Melissa London (8-12 year olds)</li> </ul> <p><strong>Cook books</strong></p> <ul> <li><em>Incredible Edible Gluten-Free Foods for Kids: 150 Family-tested recipes</em>, by Sheri L. Sanderson</li> <li><em>Great Food Gluten Free</em>, by Jeanette Mahoney</li> <li><em>Gluten Free on a Shoestring</em>, by Nicole Hunn</li> <li><em>The How Can It Be Gluten Free Cookbook</em>, by America’s Test Kitchen<br></li> </ul><div><strong>Virtual care services for children</strong><br></div><div><span style="font-size:13px;"><br></span></div><div><span style="font-size:13px;">Boomerang health was opened by SickKids <span class="ms-rteThemeFontFace-1" style="color:#373f47;background-color:#ffffff;">to provide communities in Ontario with greater access to community-based services for children and adolescents. For more information on virtual care services in Ontario to support celiac disease, visit <a href="http://www.boomeranghealth.com/services/gastroenterology/">Boomerang Health</a> powered by SickKids. </span><br></span></div>https://assets.aboutkidshealth.ca/AKHAssets/Nutrition_and_JIA.jpgMaintaining a gluten-free diet Children with celiac disease must follow a strict gluten-free diet. This article contains tips to help your child maintain their special diet. Main
Nutrition and mental health: Developing positive eating habitsNutrition and mental health: Developing positive eating habitsNutrition and mental health: Developing positive eating habitsNEnglishNutrition;Psychiatry;AdolescentTeen (13-18 years)BodyNAHealthy living and preventionTeen (13-18 years)NA2019-03-22T04:00:00Z10.000000000000061.0000000000000453.000000000000Flat ContentHealth A-Z<p>Developing positive eating habits can be difficult. Find out some things you can do every day to work toward having a healthy attitude toward food.</p><h2>Plan and prepare meals</h2><p>Get involved in planning, shopping and preparing family meals. Doing so will help you learn to shop smartly, understand food labels and develop your skills in the kitchen. You may even enjoy sharing some of your favourite recipes with friends and family.</p><p>If you find yourself always rushing out the door to school or work, try preparing a breakfast wrap or some yogurt and fruit the night before. Breakfast is an important meal that will set you up for the day ahead!</p><h2>Eat as a family</h2><p>Busy schedules and after-school activities can make it hard to sit down to eat with your family every night. But sharing a meal with those closest to you even a few times a week without any distractions is a great way to strengthen family bonds, have fun and, if needed, share support after a tough day. These all help to boost self-confidence and communication skills, help improve how you perform at school and lower the incidence of weight issues and substance use disorders.</p><h2>Develop a healthy body image </h2><p>Like many teens, you probably see a constant stream of images and messages about physical appearance. With such highly promoted but narrow standards of beauty and fitness, it is hard to escape the idea that you should look a certain way. </p><p>When you feel overwhelmed by pressure to conform to an ideal body type, try to remember all the great things your body can do instead of simply how it looks. Eating disorders such as anorexia nervosa, bulimia nervosa or binge eating disorder can take root when someone feels badly about themselves and their appearance. Be sure to share any concerns about your body image with a parent, caregiver or another trusted adult. </p><h2>Keep a healthy attitude to food</h2><p>While most of your diet should be <a href="/Article?contentid=3773&language=English">rich in nutrients</a>, it is also ok to have some treats now and then. Rather than latching onto the latest fad diet or banning particular foods (unless you have an allergy):</p><ul><li>focus on eating the right amount of calories for your stage of growth and level of physical activity</li><li>consider eating more of one thing and less of another (for instance, more fruit and less juice or more grilled food and less fried)</li><li>consume a variety of foods, from all food groups, to help your brain and body work as well as possible</li></ul><p>The less control you feel you need to exert over food, the healthier your attitude towards it. That said, if you have any concerns about eating a balanced diet and maintaining a healthy weight for you and your needs, talk to a healthcare provider, your doctor or a dietitian.</p><h2>Resources</h2><p> <a href="https://www.health.harvard.edu/staying-healthy/listing_of_vitamins">Harvard Health Publishing - Listing of vitamins</a></p><p> <a href="https://www.mind.org.uk/information-support/tips-for-everyday-living/food-and-mood/#.XJU1eBNKiWZ">Mind (UK) - Food and mood</a><br></p><p><a href="https://meant2preventkitchen.ca/">Meant2Prevent: Kitchen</a></p>https://assets.aboutkidshealth.ca/AKHAssets/developing_positive_eating_habits.jpgDeveloping positive eating habits Developing positive eating habits can be difficult. Find out what your teen can do every day to develop a healthy attitude toward food. Teens
Cystic fibrosis (CF)Cystic fibrosis (CF)Cystic fibrosis (CF)CEnglishGeneticsChild (0-12 years);Teen (13-18 years)Lungs;PancreasPancreas;LungsConditions and diseasesCaregivers Adult (19+)NA2014-04-25T04:00:00Z7.4000000000000067.00000000000001341.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn what causes cystic fibrosis, what the signs and symptoms are, and what treatments are available.</p><h2>What is cystic fibrosis?</h2><p>Cystic fibrosis or CF is a disease that mainly affects the <a href="https://pie.med.utoronto.ca/htbw/module.html?module=lung-child">lungs</a> and digestive system (or digestive tract). Although CF can be treated and CF patients can usually lead fairly normal lives, there is no cure for CF. Today, half of Canadians with CF live into their 40s and beyond.</p> <figure> <span class="asset-image-title">Cystic fibrosis</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Cystic_fibrosis_MED_ILL_EN.jpg" alt="Stomach, pancreas, small intestine and lung identified in upper body of a child, with a close-up showing mucus in the airways" /> <figcaption class="asset-image-caption">In cystic fibrosis, mucus in the lungs and digestive tract is stickier than normal. Mucus builds up and causes lung congestion and problems with digestion.</figcaption> </figure> <h3>CF affects the lungs</h3><p>Normal mucus is thin and slippery. It keeps the lungs clean by removing dirt and germs from the lungs' airway tubes. In CF, mucus is sticky and clogs the tubes. This can make breathing difficult. Bacteria can collect in the tubes because the mucus cannot clear as quickly as it should. This leads to cycles of infection and inflammation (swelling in the airway tubes). These infections can damage the lung tissues.</p><h3>CF may also affect the digestive system</h3><p>CF may also affect the digestive system, especially the pancreas. The pancreas is an organ just below the stomach that makes enzymes to help digest food in the small intestine. Enzymes help with digestion and break down the food particles small enough to be absorbed. In CF, mucus blocks the ducts (tube-like channels that carry fluid) of the pancreas.</p><p>When the ducts from the pancreas to the small intestine are blocked by mucus, the enzymes cannot reach the small intestine. This means food is not properly digested. When this happens, a child with CF does not get enough nutrition from their food. As a result, a child with CF may take replacement enzymes in order to grow normally and may have to eat a bit more food.</p><h2>Key points</h2> <ul> <li>CF is a genetic disease that affects the lungs and digestive system.</li> <li>It is not contagious.</li> <li>With treatment and regular follow-up, most children with CF can live fairly normal lives.</li> </ul><h2>Signs and symptoms of cystic fibrosis</h2> <p>In most children, CF mainly affects both the lungs and the digestive system. The symptoms of CF are variable ranging from mild to severe.</p> <h3>Signs and symptoms of CF include:</h3> <ul> <li>trouble breathing</li> <li>cough that produces thick mucus</li> <li>difficulty gaining weight</li> <li>bowel movements that are bulky, frequent and foul-smelling</li> <li>skin that tastes salty</li> <li>repeated lung infections</li> <li>delayed passage of <a href="/Article?contentid=1115&language=English">meconium</a> or meconium ileus (a blockage in the small intestine by the newborn's feces)</li> </ul> <p>The symptoms of CF are often confused with other conditions such as asthma, chronic bronchitis, pneumonia or celiac disease because they have similar symptoms as CF.</p><h2>Cystic fibrosis is a genetic disease</h2><p>About one in every 3,600 children are born with CF. CF is a genetic disease, meaning it is passed from parents to their children. About one in every 25 Canadians carries the mutated gene that can cause CF. The probability may be lower depending on your ethnic background.</p><p>A gene is a section of DNA that gives an instruction to a cell. Most of the time, the instruction is a "recipe" for making a protein.</p><p>CF is caused by a mutation in the gene for the CFTR (cystic fibrosis transmembrane conductance regulator) protein. CF is a recessive genetic condition. This means that a person needs to have two copies of the mutated gene to develop CF. People with only one copy of the CF mutation are called "carriers" and do not have symptoms. Most parents do not know they are carriers of the CF gene. To develop CF, a child must inherit two copies of the CF gene, one from each parent.<br></p><p>Two parents with the CF gene may have children with CF, children who are carriers or children who are not. The risk of having a child with CF is the same with each pregnancy.</p><p>CF is not contagious. You cannot catch it from someone else.</p> <figure class="asset-c-80"> <span class="asset-image-title">Inheritance of cystic fibrosis</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Cystic_fibrosis_inheritance_MED_ILL_EN.jpg" alt="Chromosome distribution from parents carrying cystic fibrosis" /> <figcaption class="asset-image-caption">In this example, both parents are carriers of one normal cystic fibrosis (CF) gene and one mutated CF gene. Their children may inherit one, two, or no copies of the CF gene. If a baby inherits one copy of the mutated gene, they will be carriers like their parents, but will not have CF. If a baby inherits two mutated copies, they will have CF.</figcaption> </figure><h2>How cystic fibrosis is diagnosed</h2> <p>In almost all of Canada, babies are diagnosed with CF in the first two weeks of life through the <a href="http://www.sickkids.ca/CGenetics/What-we-do/Newborn-screening-program/index.html">Newborn Screening Program</a>.</p> <ul> <li>Genetic tests are used to diagnosis CF. Genetic tests can diagnose CF before a child is born.</li> <li>Shortly after a baby is born, the doctor may take a small sample of blood from the baby as part of the newborn screening program. Testing starts by looking for an enzyme called IRT. If the level of IRT is high, the doctor will perform a DNA test looking for the most common CF mutations. If the screen is positive, the doctor will refer your child to a specialist centre for confirmation and follow-up.</li> <li>Doctors usually order a sweat test if they suspect CF. This is a simple test that measures the amount of salt in the sweat. It will not hurt your child. Heat or medicine is applied to a local (small) area of the skin. If the sweat contains more salt than usual, this may mean your child has CF.</li> <li>Doctors may perform a test to check for enzymes in the intestine.</li> </ul><h2>How cystic fibrosis is treated</h2> <p>There is no cure for CF. With appropriate treatment and regular follow-up, most children with CF can live fairly normal lives up to at least their 40s.</p> <p>CF treatment is tailored to your child's needs. It also depends upon the stage of the disease and which organs are affected.</p> <h3>Treating the lungs</h3> <p>A lot of CF treatments focus on the lungs. The treatments work to loosen and thin the mucus that clogs the airways. Chest X-rays may be taken to see if there are any changes in the lungs.</p> <h3>Treatments followed at home may include:</h3> <ul> <li>Physiotherapy is done by tapping or "clapping" on the chest in different positions twice a day for babies and young children.</li> <li>PEP (positive expiratory pressure) mask therapy is taught to older children and adults with CF to help clear their lungs.</li> <li>Other forms of chest physiotherapy to help loosen the mucus that clogs the lungs can also be taught by the clinic physiotherapist.</li> <li>Oral (through the mouth), inhaled (breathing) or intravenous (IV or using a needle) antibiotics are often used when someone with CF has a lung infection.</li> <li><a href="/Article?contentid=1973&language=English">Exercise</a>.</li> <li>Medications to help open the airways and thin mucus are inhaled using a puffer or a small compressor machine with a nebulizer, which makes the medication easy to inhale through a mask or a mouthpiece.</li> </ul> <h3>To avoid infection, children with CF should also:</h3> <ul> <li>Avoid contact with people with a cold or illness</li> <li>Avoid contact with other people with CF</li> <li>Have their usual <a href="/Article?contentid=1986&language=English">immunizations</a> (shots)</li> </ul> <p>In some cases, when treatments can no longer maintain a person's health or organ function, the person may require a lung transplant.</p> <h3>Treatments for the digestive tract include:</h3> <ul> <li>taking pancreatic enzymes with meals to help digestion</li> <li>taking supplements and special CF vitamins to promote good nutrition</li> <li>eating a special diet with increased calories and fat</li> <li>adding salt to the diet to replace the excess amounts lost by sweating</li> </ul><h2>Activity</h2> <p>Children with CF are encouraged to play games and sports. Ask your child's doctor how much activity they can do. Sports such as running and swimming are often helpful because they help clear the lungs of mucus.</p> <p>Children with CF lose a lot of salt during exercise and hot weather, more than people without CF do. It is important to make sure your child replaces fluids and salt by drinking enough and eating enough salt.</p><h2>For more information</h2><p>Visit:</p><ul><li> Cystic Fibrosis Canada: <a href="http://www.cysticfibrosis.ca/">www.cysticfibrosis.ca</a></li><li> The Cystic Fibrosis Foundation: <a href="http://www.cff.org/">www.cff.org</a></li><li> Canadian Society for Exercise Physiology: <a href="http://www.csep.ca/english/view.asp?x=804/">www.csep.ca</a>; see Physical Activity option.</li><li> Newborn Screening for Cystic Fibrosis: <a href="http://www.cysticfibrosis.ca/advocacy/newborn-screening/">www.cysticfibrosis.ca/advocacy/newborn-screening</a><br></li></ul><img alt="" src="https://assets.aboutkidshealth.ca/AKHAssets/cystic_fibrosis.jpg" style="BORDER:0px solid;" />https://assets.aboutkidshealth.ca/AKHAssets/cystic_fibrosis.jpg May is Cystic Fibrosis Month. Learn what causes cystic fibrosis, what the signs and symptoms are, and what treatments are available. Main
Asthma: Overview and care after a hospital visit Asthma: Overview and care after a hospital visit Asthma: Overview and care after a hospital visit AEnglishRespiratoryChild (0-12 years);Teen (13-18 years)LungsLungsConditions and diseasesCaregivers Adult (19+)Cough;Wheezinghttps://assets.aboutkidshealth.ca/akhassets/Asthma_narrow_airways_MED_ILL_EN.jpg2019-12-13T05:00:00Z7.2000000000000069.80000000000001568.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Asthma is a condition that affects the lungs and causes breathing difficulties. If your child has visited the hospital for an asthma attack, it is important that you follow up with your primary care provider <strong>within one week</strong>, even if you child is feeling better, to ensure that they continue to improve and stay healthy.</p><h2>What is asthma?</h2><p>Asthma is a condition that affects your child’s lungs. When asthma is not well controlled, the airways narrow, become swollen and produce mucus. This makes it difficult to breathe.</p> <figure class="asset-c-80"> <span class="asset-image-title">Narrowing of airways in asthma</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Asthma_narrow_airways_MED_ILL_EN.jpg" alt="Normal airways, muscles and alveoli compared to those during an asthma attack" /> <figcaption class="asset-image-caption">During an asthma attack, the muscles around the airways get tight. The airway narrow, become swollen and produce mucus, making it hard to breathe.</figcaption></figure><h2>Key points<br></h2><ul><li>When asthma is not well controlled, the airways narrow, become swollen and produce mucus, causing breathing difficulties.</li><li>Early warning signs of asthma can include coughing, wheezing and breathing problems.</li><li>Late warning signs can include feeling very short of breath, continuous coughing or wheezing, difficulty talking, and/or “pulling in” of the skin at the neck or between/below the ribs.</li><li>The medicines you will use to treat your child's asthma are guided by an "asthma action plan" that you develop with your child's health-care provider.</li><li>The most effective way to control your child's asthma is to minimize exposure to the most common asthma triggers.</li><li> <strong>After an asthma attack, it is very important that you follow up with your child’s primary care provider <u>within one week</u> of a visit to the hospital, even if your child feels better.</strong></li></ul><h2>What are the signs and symptoms of asthma?</h2><h3>Early warning signs</h3><p>Problems with asthma can start slowly over hours or days. The small changes that happen in your child's body when they are having problems with asthma are called early warning signs.</p><p>Early warning signs of asthma include:</p><ul><li>Daytime coughing or wheezing (high-pitched whistling sound)</li><li>Breathing problems:</li><ul><li>Breathing faster than normal</li><li>Feeling short of breath</li><li>Feelings of chest tightness or a heavy chest</li><li>Any other difficulty breathing</li></ul><li>Nighttime awakening due to coughing, wheezing or breathing problems, even if only occurring once during the week</li><li>Coughing or trouble breathing with regular physical activity</li></ul><h3>Late warning signs</h3> <figure> <span class="asset-image-title">Visible late warning signs of asthma</span><img src="https://assets.aboutkidshealth.ca/akhassets/AsthmaSymptoms_EN.jpg" alt="Child displaying late warning signs of asthma" /><figcaption class="asset-image-caption"></figcaption></figure> <p>Late warning signs of asthma include:</p><ul><li>Reliever puffer lasting less than 3 hours</li><li>Feeling very short of breath</li><li>Continuous coughing or wheezing</li><li>Difficulty talking</li><li>“Pulling in”of the skin at the neck or between/below the ribs</li></ul><p>If you see any of these late warning signs, <strong>go to the nearest emergency room or call 911 immediately</strong>.</p><h2>How is asthma treated?</h2><p>Asthma can be treated with a range of medicines. Medicines for asthma do not cure asthma but they can keep your child's lungs healthy and keep your child's asthma from getting worse.</p><p>Each medicine has a generic name and one or more brand names. The generic name is the chemical name for the drug. The brand name is given by the pharmaceutical company that produces the drug. Your child’s asthma medicines are part of an <a href="https://lungontario.ca/wp-content/uploads/2019/06/PediatricAsthmaActionPlan2875-1.pdf">“asthma action plan”</a> that you will develop with your child’s doctor. The action plan tells you what to do if your child is well, having mild symptoms or is worsening.</p><h3>Reliever/rescue medicine</h3><ul><li>It relieves the tightening in the airways by relaxing the muscles around them. This can provide immediate relief when your child has signs or symptoms of asthma.</li><li>This medicine should only be used as needed with symptoms.</li><li>This medicine usually comes in a blue puffer.</li><li>Examples include salbutamol, also known by the brand name Ventolin.</li></ul><h3>Controller/preventer medicine</h3><ul><li>It reduces swelling and mucus in the airways, which helps heal the lungs, and further used daily for prevention to keep the asthma under good control.</li><li>It does not provide immediate relief and should be taken even if your child has no symptoms.</li><li>It is usually prescribed for an initial period of 12 weeks.</li><li>This medicine often comes in an orange, red or brown puffer.</li><li>Examples include fluticasone propionate, also known by the brand name Flovent.</li></ul><h3>Oral steroids (liquid or tablet medicine taken by mouth)</h3><ul><li>These are strong medicines that reduce swelling in the lungs.</li><li>Your child should take them only for a short time until their asthma is back under good control.</li><li>Examples include <a href="/Article?contentid=221&language=English">dexamethasone (also known by the brand name Decadron), prednisone, or prednisolone (also known by the brand name Pediapred)</a>.</li></ul><h2>How do I use a puffer to give asthma medicine to my child?</h2><p>It is always recommended to use a spacer with a puffer to ensure the medicine is delivered directly to the lungs and nowhere else in the body. <strong>It is never recommended to use a puffer without a spacer, regardless of a person’s age.</strong></p><h3>Using a puffer and spacer with a mask</h3><ol class="akh-steps"><li> <figure><img src="https://assets.aboutkidshealth.ca/AKHAssets/Asthma_ShakePuffer_EN_V02.jpg" alt="Canister, plastic holder and cap of a puffer" /></figure> <p>Remove the cap and shake the puffer five times.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/Asthma_PufferSpacer_EN.jpg" alt="Attaching puffer to spacer" /></figure> <p>Put the puffer upright into the rubber hole of the spacer.</p></li><li><p>Have your child sit up or stand in a comfortable position and put the mask firmly on their face. Be sure the mask covers their mouth and nose.</p><div class="akh-series"><ul><li> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Asthma_OlderChildPositioning_EN.jpg" alt="Older child’s positioning while caregiver gives a puffer" /></figure> <p>Older children can sit or stand in a comfortable position while you give them their puffer.</p></li><li><p>Younger children should be held on a parent’s lap. You can then use the “one-person approach” or “two-person approach” to give medicine to a younger child.</p><div class="asset-2-up"> <figure><span class="asset-image-title">One-person approach</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Asthma_OnePersonApproach_EN.jpg" alt="Giving a young child a puffer with only one person" /> <figcaption class="asset-image-caption">Sit in a chair and place your child on your lap. Hug the child tightly with one arm and, with your other hand, press the top of the puffer firmly to release a puff of medicine.</figcaption></figure> <figure><span class="asset-image-title">Two-person approach</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Asthma_TwoPersonApproach_EN.jpg" alt="Giving a young child a puffer with two people" /> <figcaption class="asset-image-caption">Cross your leg over your child’s legs, hold their arms with your own arm and hold their forehead against your chest. Another adult will hold your child’s chin, place the mask firmly over your child’s nose and mouth and press the top of the puffer firmly to release a puff of medicine. </figcaption></figure></div></li></ul></div></li><li> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/HowToUse_MDI_with_Spacer_5_EQUIP_ILL_EN_V02.jpg" alt="Holding mask of spacer over child’s nose and mouth for six to ten breaths" /></figure> <p>Press the top of the puffer firmly. This will release one puff of medicine. Hold the mask over your child’s face and ensure they take <strong>6-10 deep breaths</strong> from the spacer.</p></li><li><p>Encourage your child to take deep breaths. If your child needs more than one puff of the medicine, remove the puffer from the spacer and repeat steps 1 to 5. Do not press the puffer more than once at a time.</p></li></ol><p>If your child is using a spacer with a mouthpiece, ensure their technique has been assessed by a trained health-care professional so that the medicine is delivered properly.</p><h2>What to do when you finish giving asthma medicine with the puffer</h2><div class="akh-series"><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/HowToUse_MDI_with_Spacer_6_EQUIP_ILL_EN.jpg" alt="Child drinking from a cup" /></figure> <p>Take the mask off your child’s face and encourage them to rinse their mouth or have a drink. Wipe their face where the mask was placed.</p></div></div></div><h2>My child does not like using their puffer. What can I do?</h2><p>Giving puffers may upset a young child. This is natural. Try to make it fun for your child by singing, counting, watching a video or showing them how to use the puffer on yourself or a teddy bear. Your child will become more comfortable with puffers over time.</p><h2>How do I know when my child’s puffer is empty?</h2><p>All puffers have a certain number of doses in them. The best way to know when a puffer is empty is to keep track of the number of doses used.</p><h2>How often do I need to replace my child’s spacer?</h2><p>The spacer you receive from the hospital should be used temporarily or as a back-up spacer. You will then need to buy a spacer from your pharmacy. Most spacers last about a year before you need to replace them.</p><h2>How do I clean my child’s spacer?</h2><p>It is very important to <a href="/Article?contentid=1478&language=English">wash the spacer regularly</a> to clear any build-up of saliva and have the spacer working properly.</p><p>Once a week, wash the spacer with soap and warm water by hand and let it air dry. If your child has a cold or virus, it should be cleaned more often to prevent the spread of infection.</p><h2>How can I control my child’s asthma?</h2><p>The most effective way to control your child's asthma is to minimize any triggers that can make it worse. It is important to understand that <a href="/Article?contentid=1484&language=English">asthma triggers</a> are different for each person, and you can work with your child’s primary health-care provider to help identify them.</p><p>The most common asthma triggers in children are infections caused by viruses such as colds and the flu. To avoid getting sick, your child should wash their hands frequently and avoid contact with others who are sick. It is highly recommended that your child get their annual flu shot.</p><p>Other possible asthma triggers include:</p><ul><li>Allergens such as dust mites, animals, or pollens</li><li>Cigarette, cannabis or vape smoke</li><li>Irritants such as air pollution or strong scents</li><li>Changes of weather, cold air, or humidity</li><li>Strong emotions such as stress or anxiety</li></ul><h2>Follow-up care</h2><p>After an asthma attack, it is very important that you <strong>follow up with your child’s primary care provider within one week of a visit to the hospital</strong>, even if your child feels better. This is to ensure that they continue to improve and stay healthy.</p><p>Even when your child seems better, they may have swollen airways for six to eight weeks or longer after their asthma was a problem. Your child should keep taking their controller medicine.</p><h2>Resources</h2><p><a href="https://www.lung.ca/">Lung Association</a></p><p><a href="https://asthma.ca/">Asthma Canada</a></p><p><a href="https://www.aboutkidshealth.ca/asthmahub">AboutKidsHealth</a></p><img alt="" src="https://assets.aboutkidshealth.ca/AKHAssets/asthma.jpg" style="BORDER:0px solid;" />asthmaasthmaAsthma: Overview and care​ Asthma is a condition that affects your child’s lungs. Learn about how to care for your child after a hospital visit. Main
Hand hygieneHand hygieneHand hygieneHEnglishPreventionChild (0-12 years);Teen (13-18 years)HandSkinNon-drug treatmentCaregivers Adult (19+)NAhttps://assets.aboutkidshealth.ca/akhassets/HandWashing_1_EQUIP_ILL_EN.jpg2019-10-25T04:00:00Z7.3000000000000063.50000000000001244.00000000000Health (A-Z) - ProcedureHealth A-Z<p>The best way to prevent transmission of disease is good hand hygiene. Learn about proper hand hygiene and how to teach it to your children.<br></p><p>As we go through the day, our hands pick up germs from many different sources. Even surfaces and objects that seem clean can carry germs such as bacteria, viruses or fungi. The <a href="/article?contentid=912&language=English">influenza virus</a>, for example, can be infective for between two and eight hours on hard surfaces such as desks and doorknobs; some bacteria can survive for weeks or months.</p> <p>When we eat or touch our eyes or nose, those germs can enter our bodies and can make us sick. Often these germs are more annoying than serious. But they can also include dangerous and deadly infections.</p> <p>Hand hygiene is the most important thing you can do to help prevent common illnesses like colds, flu, and <a href="/article?contentid=907&language=English">gastroenteritis</a>. Proper handwashing with soap and warm water is one of the best ways to remove bacteria and viruses from the hands, especially if your hands are visibly dirty or greasy. Use an alcohol-based hand sanitizer when in a health-care setting or when water is not available. Cleaning with an appropriate alcohol-based hand sanitizer is as effective as handwashing for the majority of infections.</p><h2>When to clean your hands</h2> <p>Always clean your hands in these situations:<br></p> <ul> <li>when your hands are dirty, especially if you can see dirt</li> <li>before, during and after you prepare food</li> <li>before you eat, feed a child or give medication</li> <li>after you use the bathroom<br></li> <li>after you change your child’s diaper or help them use the bathroom</li> <li>after you touch blood or other body fluids such as saliva or vomit</li> <li>after sneezing, coughing or blowing your nose</li> <li>after you touch animals or pick up their waste</li> <li>after you handle garbage</li> <li>more often when someone in your home is sick</li> </ul><h2>Key points</h2><ul><li>The best way to protect yourself and your child from germs is proper hand hygiene.</li><li>Wash your hands frequently with soap and warm water for at least 20 seconds, scrub every surface and rinse off all trace of soap.</li><li>In a health-care setting or when you do not have access to water, use an alcohol-based hand sanitizer. Make sure it contains between 60% and 95% alcohol. Rub your hands with the sanitizer until they become dry.</li></ul><h2>Using soap and water</h2><p>Liquid, foaming and bar soap are all effective for cleaning your hands, if used properly. The type of soap is not as important as the right technique. It is the soap combined with the scrubbing action that helps loosen and remove germs from your skin. The running water washes them away. Antibacterial soap is not necessary. As long as you wash your hands properly, antibacterial soap does not work any better than regular soap.</p><h2>How to wash your hands properly<br></h2><p>Washing your hands will help only if it is done properly. Here is what to do:</p><ol class="akh-steps"><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/HandWashing_1_EQUIP_ILL_EN.jpg" alt="Wetting hands under a tap" /> </figure> <p>Wet your hands thoroughly with warm water.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/HandWashing_2_EQUIP_ILL_EN.jpg" alt="Applying soap to hand" /> </figure> <p>Apply enough liquid, foam or clean bar soap to cover the entire surface of the hand.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/HandWashing_3_EQUIP_ILL_EN.jpg" alt="Washing hands away from water" /> </figure> <p>With your hands away from the water, rub your hands vigorously together.<br></p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/HandWashing_4_EQUIP_ILL_EN.jpg" alt="Washing palms" /> </figure> <p>Scrub all surfaces.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/HandWashing_5_EQUIP_ILL_EN.jpg" alt="Washing between fingers" /> </figure> <p>Make sure to get between the fingers and under the fingernails.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/HandWashing_6_EQUIP_ILL_EN.jpg" alt="Washing back of hand" /> </figure> <p>Wash the wrists and lower arms, if necessary.<br></p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/HandWashing_7_EQUIP_ILL_EN.jpg" alt="Washing wrist" /> </figure> <p>Continue for at least 20 seconds or about the length of time it takes to hum a short song such as Happy Birthday twice. It is the soap combined with the scrubbing action that helps dislodge and remove germs.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/HandWashing_8_EQUIP_ILL_EN.jpg" alt="Rinsing hands under a tap" /> </figure> <p>Rinse well, removing all soap residue.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/HandWashing_9_EQUIP_ILL_EN.jpg" alt="Drying hands on a towel" /> </figure> <p>Dry your hands on a clean towel or paper towel.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/HandWashing_10_EQUIP_ILL_EN.jpg" alt="Using towel to turn off the tap" /> </figure> <p>Use the towel to turn the tap off.<br></p></li></ol><h2>Teaching children to wash their hands</h2><p>Even young children can learn to wash their hands properly. Some tips:</p><ul><li>Start teaching your child when they are young. Handwashing should be an essential part of going to the bathroom right from the start. Wash your hands after changing your child’s diaper, and if your baby touched the diaper or the diaper area, wash their hands too. When your child uses the potty, even if you wipe them off, both of you should wash your hands afterwards.</li><li>Lead by example. Always wash your hands using the correct technique.</li><li>Make it easy for your child. Have a stable stool in front of the sink for your child to stand on, and make sure the soap and towels are within your child’s reach. Bar soap can be slippery and hard to handle, so you may want to use liquid or foam soap instead.</li><li>Explain why. Tell your child that germs can get on their hands when they play with animals or go to the bathroom, even if their hands look clean. Germs can make them sick, so it is important to wash them off, especially before eating.</li><li>Keep your child safe. To avoid <a href="/article?contentid=1116&language=English">scalds</a>, turn on the water and adjust the temperature for your child until they are old enough to do it themselves.</li><li>Get backup. Find out if your child’s school or daycare centre teaches proper handwashing. Check to make sure handwashing and infection control are priorities.</li></ul><h2>Use hand sanitizer when water is not readily available</h2><p>As long as hands are not wet, greasy or visibly dirty, alcohol-based hand sanitizer can be used. Hand sanitizers work because the alcohol in them denatures or “cooks” the proteins in the germs.</p><p>Read the label to make sure the hand sanitizer you buy contains 60% to 95% ethyl alcohol (ethanol) or isopropyl alcohol (isopropanol). Products with less than 60% alcohol do not kill germs. Products with more than 95% alcohol do not work as well, because there needs to be some water present for proteins to deteriorate.</p><p>To use hand sanitizer, place a thumbnail-sized amount on your hands and rub for about 20 seconds or until your hands are dry. If your hands are dry before then, you may not have used enough.</p><p>Hand sanitizer is not as harsh on your hands and it is often more convenient. However, hand sanitizer should not replace handwashing with soap and water, especially after a visit to the bathroom. Send older children to school with a small bottle of hand sanitizer in their bags so they can clean their hands when they need to, when they do not have access to water and soap.</p><h3>Precautions when using hand sanitizer:</h3><ul><li>Do not leave hand sanitizer where small children might be able to drink it. Hand sanitizer contains 50% more alcohol by volume than most brands of vodka.</li><li>Always supervise small children when using hand sanitizer.</li><li>Do not put your hands near a spark, flame or source of static electricity while they are still wet with hand sanitizer, because the alcohol can catch fire and cause injury. Rub your hands together until they are completely dry.</li></ul><div class="asset-video"> </div><p>Aiello AE, Larson EL, Levy SB. (2007). Consumer antibacterial soaps: Effective or just risky? <em>Clinical Infectious Diseases, 45(Suppl2),</em> S137-S147.</p><p>Cottingham A. (2004). “Now wash your hands please”: Teaching health concepts to very young children. <em>Paediatric Nursing, 16(8),</em> 33-35.</p><p>Fact Sheet on Hand Sanitizers. (2007, August 23). <em>Ontario Poison Centre</em>. Retrieved from <a href="http://www.ontariopoisoncentre.ca/pdf/44813-Hand%20Sanitizers%20FactSheet.pdf">http://www.ontariopoisoncentre.ca/pdf/44813-Hand%20Sanitizers%20FactSheet.pdf</a>.</p><p>Preventing Seasonal Flu Illness. (2013, September 25). <em>Centers for Disease Control and Prevention</em>. Retrieved from <a href="https://www.cdc.gov/flu/prevent/">https://www.cdc.gov/flu/prevent/</a>.<br></p><p>Reynolds SA, Levy F, Walker ES. (2006). Hand sanitizer alert [letter]. <em>Emerging Infectious Diseases, 12(3),</em> 527-527.</p><p>Show Me the Science - When to Use Hand Sanitizer. (2013, December 11). <em>Centers for Disease Control and Prevention</em>. Retrieved from <a href="http://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html">http://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html</a>.</p><p>The Benefits of Hand Washing. (2012, March 14). <em>Health Canada</em>. Retrieved from <a href="https://www.canada.ca/en/health-canada/services/healthy-living/your-health/diseases/benefits-hand-washing.html">https://www.canada.ca/en/health-canada/services/healthy-living/your-health/diseases/benefits-hand-washing.html</a>.</p>handwashinghandwashingMain
E-cigarettes and vapingE-cigarettes and vapingE-cigarettes and vapingEEnglishRespiratoryTeen (13-18 years)Lungs;BrainRespiratory systemHealthy living and preventionAdult (19+) CaregiversNA2019-11-04T05:00:00Z10.900000000000048.20000000000001075.00000000000Flat ContentHealth A-Z<p>Learn about e-cigarettes, how they work and who is using them. Also find information about the health risks associated with vaping.</p><h2>About e-cigarettes</h2><p>E-cigarettes belong to a group of devices commonly known as electronic nicotine delivery systems (ENDS). While there are many types of ENDS, they have a few things in common including a:</p><ul><li>battery</li><li>heating coil or atomizer</li><li>mouthpiece</li><li>reservoir or tank</li><li>sensor or button to activate the heating coil</li></ul><p>E-cigarettes can be disposable, or have a reloadable cartridge or a refillable reservoir for the vaping solution. In some e-cigarettes the wattage and voltage can also be modified.</p><p>E-cigarettes are known by many different names, such as:</p> <figure> <img alt="Small vaping device that looks like a flash drive" src="https://assets.aboutkidshealth.ca/AKHAssets/vaping.jpg" /></figure> <ul><li>cig-a-like</li><li>vape/dab pen</li><li>box-mod</li><li>pod device (JUUL, Blu, Phix, Suorin, STIG)</li><li>Chronic/Dank Vapes</li></ul><p>E-cigarettes are available in many different shapes and sizes. Some are small and look like a flash drive or pen, while others are much larger.</p><h2>Key points</h2><ul><li>The use of e-cigarettes, or vaping, is very common among teens and young adults and has been increasing over the past several years.</li><li>Vaping solutions can contain nicotine and other chemicals such as tetrahydrocannabinol (THC) and cannabidiol (CBD) oil.</li><li>Nicotine is highly addictive and can quickly become a long-term addiction, especially for teens and young adults whose brains are still developing.</li><li>The chemicals in vaping solutions can lead to short-term health problems and increase the risk of long-term health problems.</li><li>If you are trying to quit using tobacco cigarettes, talk to your health-care professional to come up with a plan that makes sense for you.</li></ul> <h2>How e-cigarettes work</h2><p>The action of using an e-cigarette is called vaping. When a user inhales from the mouthpiece of the e-cigarette, the heating coil is activated. The energy from the battery allows the heating coil to heat the vaping liquid and the vapor is then generated, which is inhaled, mimicking the use of a tobacco cigarette. The vapor that is generated is actually an aerosol that contains fine particles.</p><h2>Vaping solutions</h2><p>Vaping solutions are sometimes known as e-juice or e-liquid, and can contain a number of different chemicals.</p><ul><li>Propylene glycol: One of the main liquids (along with glycerin) used to carry the other chemicals</li><li>Glycerin: One of the main liquids (along with propylene glycol) used to carry the other chemicals</li><li>Nicotine: The main addictive chemical found in tobacco cigarettes and vaping solutions</li><li>Flavorings: Various chemicals, including diacetyl, used to create different tastes and smells</li><li>Tetrahydrocannabinol (THC) and cannabidiol (CBD) oil: Two chemicals that are sometimes added to vaping solutions</li></ul><p>Moreover, various heavy metals (nickel, tin and lead) can also be found in vaping solutions.</p><h2>Who is using e-cigarettes?</h2><p>The most recent studies from 2018 show that 37% of teens (aged 16-19) in Canada have tried e-cigarettes. This is an increase of 8% compared to 2017. Most of these teens do not use tobacco cigarettes. About 3.6% of 16 to 19 year olds in Canada when surveyed in 2018 had used e-cigarettes on more than 15 days in the past 30 days.</p><p>In addition, less than 1% of North American adults (45 year of age and older) use e-cigarettes on a daily basis whereas about 8% of 18 to 24 year olds use e-cigarettes daily. Currently, e-cigarettes are used disproportionally by young people.</p><h2>Health risks and vaping</h2><p>There are both short- and long-term health risks associated with vaping. One rare short-term risk is that devices have caught fire or exploded causing physical injury. Seizures have also been described. More seriously, severe, life threatening lung injury has been associated with e-cigarette use. Some people have died from this lung injury. While it is not known why the lungs of these people were injured in this way, there is evidence that it is related to one or more of the chemicals found in vaping solutions.</p><p>A long-term risk associated with vaping is that nicotine use by teens can have a negative impact on their brain development. It can harm the parts of their brain that control attention, learning, mood and impulse control.</p><p>Another important risk is nicotine addiction. The developing brains of teens and young adults are highly susceptible to the addictive properties of nicotine. In a single pod, e-cigarettes can deliver more nicotine to a person than a pack of cigarettes. Moreover, while high doses of nicotine can lead to nausea and headache, there is no irritating smoke and no need to light a new cigarette, so a person can receive large amounts of nicotine in a day.</p><p>Nicotine is not harmless. Nicotine is toxic to the lungs and long-term use may increase the risk of chronic lung disease.</p><p>While vaping has not been around long enough to be sure of the long-term effects health effects, research studies in cells and animal models suggest that the other chemicals in vaping solutions may also lead to health problems with long-term use.</p><h2>E-cigarettes as a type of nicotine replacement therapy</h2><p>E-cigarettes that contain nicotine have sometimes been used as a type of nicotine replacement therapy to help adults, who are not pregnant, to quit using tobacco cigarettes or to reduce the use tobacco cigarettes. There is some data that suggests that e-cigarettes can help tobacco cigarette users to quit. However, there is also data that the use of e-cigarettes does not lead to more people quitting using tobacco cigarettes.</p><p>There are other types of nicotine replacement and other ways to quit using tobacco cigarettes that do not involve nicotine replacement therapy. If you are considering vaping in order to help you to quit using tobacco cigarettes, talk to a health-care professional and explore the different options that may work for you.</p><h2>Summary</h2><p>With the information that is currently available about e-cigarettes, the recommendation is, if you do not smoke then do not vape. If you do smoke and want to vape, know your options, and the risks and benefits so you can make an informed choice.</p><h2>Resources</h2><p>The Substance Abuse Program at the Hospital for Sick Children is for teens up to 18 years of age to help them with alcohol and other substance abuse related issues: <a href="http://www.sickkids.ca/adolescentmedicine/programs/substance-abuse-program/substance-abuse-program.html">http://www.sickkids.ca/adolescentmedicine/programs/substance-abuse-program/substance-abuse-program.html</a></p><p>The Nicotine Dependence Clinic located at CAMH is for anyone who wants to quit or reduce their tobacco use: <a href="https://www.camh.ca/en/your-care/programs-and-services/nicotine-dependence-clinic">https://www.camh.ca/en/your-care/programs-and-services/nicotine-dependence-clinic</a></p><p>The Youth Addiction and Concurrent Disorders Service at CAMH is for teens and young adults (ages 14-24) who have substance use challenges and/or concerns, with or without concurrent mental health concerns: <a href="https://www.camh.ca/en/your-care/programs-and-services/youth-addiction--concurrent-disorders-service">https://www.camh.ca/en/your-care/programs-and-services/youth-addiction--concurrent-disorders-service</a></p><p>Find resources from the Canadian Cancer Society to help you to quit using tobacco cigarettes: <a href="https://www.smokershelpline.ca/">https://www.smokershelpline.ca/</a></p> <h2>References</h2><p>Dai, H. & Leventhal, A.M. (2019, September 16). Prevalence of e-Cigarette Use Among Adults in the United States, 2014-2018. <em>The Journal of the American Medical Association</em>. Retrieved from <a href="https://doi.org/10.1001/jama.2019.15331">https://doi.org/10.1001/jama.2019.15331</a></p><p>Government of Canada. (2019, July 25). Talking with your teen about vaping: a tip sheet for parents. Retrieved from <a href="https://www.canada.ca/en/services/health/publications/healthy-living/talking-teen-vaping-tip-sheet-parents.html">https://www.canada.ca/en/services/health/publications/healthy-living/talking-teen-vaping-tip-sheet-parents.html</a></p><p>Government of Canada. (2019, August 6). About vaping. Retrieved from <a href="https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping.html">https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping.html</a></p><p>Hammond, D., Reid, J.L., Rynard, V.L., Fong, G.T., Cummings, K.M., McNeill, A.,…White, C.M. (2019). Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys. <em>The British Medical Journal, 365</em>. <a href="https://doi.org/10.1136/bmj.l2219">https://doi.org/10.1136/bmj.l2219</a></p><p>Stanwick, R. (2018, February 28). E-cigarettes: Are we renormalizing public smoking? Reversing five decades of tobacco control and revitalizing nicotine dependency in children and youth in Canada. <em>Canadian Paediatric Society</em>. Retrieved from <a href="https://www.cps.ca/en/documents/position/e-cigarettes">https://www.cps.ca/en/documents/position/e-cigarettes</a></p><p>US Department of Health and Human Services. (2016). E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Retrieved from <a href="https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf">https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf</a></p><p>Walley, S.C., Wilson, K.M., Winickoff, J.P., & Groner, J. (2019). A Public Health Crisis: Electronic Cigarettes, Vape, and JUUL. <em>Pediatrics, 145</em>. Retrieved from <a href="https://pediatrics.aappublications.org/content/143/6/e20182741">https://pediatrics.aappublications.org/content/143/6/e20182741</a></p>https://assets.aboutkidshealth.ca/AKHAssets/vaping_devices.jpgMain