Canker Sore Education

About 1 in 5 people regularly gets bothersome canker sores, which can make eating, drinking, and even brushing teeth a real pain. But just because they're relatively common doesn't mean these small open sores inside the mouth should be ignored.

About Canker Sores

Also known as aphthous ulcers, canker sores are small sores that can occur inside the mouth, cheeks, lips, throat, or sometimes on the tongue. But don't confuse canker sores with cold sores or fever blisters, which are sores that are caused by the herpes simplex virus and are found outside the mouth around the lips, on the cheeks or chin, or inside the nostrils. Whereas cold sores are contagious, canker sores are not contagious — so kissing cannot spread them.

Although canker sores aren't contagious, the tendency to have outbreaks of canker sores can run in a family. If you're prone to canker sores, your child has a 90% chance of getting them as well.
Although no one knows exactly what causes canker sores, many factors are thought to put a person at risk. Diet may be a factor. People who have nutritional deficiencies of folic acid, vitamin B12, and iron seem to develop canker sores more often, as do people who have food allergies. Canker sores may also indicate that a person has an immune system problem.

Mouth injuries, such as biting the inside of your lip or even brushing too hard and damaging the delicate lining inside the mouth, also seem to bring on canker sores. Even emotional stress seems to be a factor. One study of college students showed that they had more canker sores during stressful periods, such as around exam time, than they did during less stressful times, such as summer break.
Although anyone can get them, young people in their teens and early twenties seem to get them most often, and women are twice as likely to develop them as men. Some girls and women find that they get canker sores at the start of their menstrual periods.

Signs and Symptoms

Canker sores usually appear as painful, red spots that can be up to 1 inch (2.5 centimeters) across, although most of them are much smaller. Sometimes the area will tingle or burn before a spot actually appears. Once it does, the canker sore may swell and burst in about a day. The open sore may then have a white or yellowish coating over it as well as a red "halo" around it. Most often, canker sores pop up alone, but they can also occur in small clusters.

Although uncommon, canker sores can be accompanied by such symptoms as fever, swollen lymph nodes, and a lethargic or slightly ill feeling.

It takes about 2 weeks for canker sores to heal. During this time, the sores can be painful, although the first 3 to 4 days are usually the worst.

If your child develops canker sores that last longer than 2 weeks or is unable to eat or drink because of the pain, contact your doctor. Also call the doctor if the sores appear more than two or three times a year.

Diagnosis

If your child has recurrent canker sores, the doctor may want to perform tests to look for possible nutritional deficiencies (which can be corrected with dietary changes or using prescription vitamin supplements), immune system deficiencies, and food or other allergies.

Treatment

Often, canker sores can be easily treated with over-the-counter or even home remedies. Carbamide peroxide is a combination of peroxide and glycerin that cleans out the sore while coating it to protect the wound.

Many over-the-counter remedies have benzocaine, menthol, and eucalyptol in them. These may sting at first and need to be applied repeatedly, but they can reduce pain and shorten the duration of the sore.

You can also have your child rinse his or her mouth with a homemade solution for about a minute, four times a day, as needed. It's extremely important to remember, though, that these rinses should not be swallowed, so they shouldn't be used in kids too young to understand not to swallow.
You can try these rinse recipes:

• 2 ounces (59 milliliters) of hydrogen peroxide and 2 ounces (59 milliliters) of water
• 4 ounces (118 milliliters) of water mixed with 1 teaspoon (5 milliliters) of salt and 1 teaspoon (5 milliliters) of baking soda

Another option to help reduce discomfort and speed healing is dabbing a mixture of equal parts water and hydrogen peroxide directly on the sore, followed by a bit of milk of magnesia.

Some doctors suggest applying wet black tea bags to the sore. Black tea contains tannin, an astringent that can help relieve pain. You can also get tannin in over-the-counter medications. Ask the pharmacist for more information.

If the doctor prescribes a medicine that should be applied directly to the canker sore, first dry the area with a tissue. Use a cotton swab to apply a small amount of the medication. Finally, have your child avoid eating or drinking for at least 30 minutes to make sure that the medicine isn't immediately washed away and has time to work.

In some cases of severe mouth sores, the doctor may prescribe immunosuppressive drugs or mouth rinses or gels that contain steroids.

Caring for Your Child

Help make canker sores less painful and prevent them from recurring by encouraging your child to:

• avoid eating abrasive foods, such as potato chips and nuts, which can irritate gums and other delicate mouth tissues
• try brushing and rinsing with toothpastes and mouthwashes that do not contain SLS
• use only soft-bristle toothbrushes and be careful not to brush too hard
• avoid any foods he or she is allergic to
• avoid spicy, salty, and acidic foods (such as lemons and tomatoes), which can aggravate tender mouth sores

Although they can certainly be a pain, in most cases, canker sores aren't a huge problem. Many people have learned to deal with them — and your child can, too.

"I pray that this article empowers you to Get A L.I.F.E."

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These Are the Breaks

The harder kids play, the harder they fall. The fact is, broken bones, or fractures, are common in childhood and often happen when kids are playing or participating in sports.

Most fractures occur in the upper extremities: the wrist, the forearm, and above the elbow. Why? When kids fall, it's a natural instinct for them to throw their hands out in an attempt to stop the fall.
Although many kids will have a broken bone at some point, it can be scary for them and parents alike. Here's the lowdown on what to expect.

How Do I Know if It's Broken?

Falls are a common part of childhood, but not every fall will result in a broken bone. The classic signs of a fracture are pain, swelling, and deformity (which looks like a bump or change in shape of the bone). However, if a break isn't displaced (when the pieces on either side of the break are out of line), it may be harder to tell.

Some telltale signs that a bone is broken are:

• You or your child heard a snap or a grinding noise during the injury.
• There's swelling, bruising, or tenderness around the injured part.
• It's painful for your child to move it, touch it, or press on it; if the leg is injured, it's painful to bear weight on it.
• The injured part looks deformed. In severe breaks, the broken bone might poke through the skin.

What Do I Do?

If you suspect that your child has a fracture, you should seek medical care immediately.
Do not move your child and call for emergency care if:

• your child may have seriously injured the head, neck, or back
• the broken bone comes through the skin. Apply constant pressure with a clean gauze pad or thick cloth, and keep the child lying down until help arrives. Don't wash the wound or push in any part of the bone that's sticking out.

For less serious injuries, try to stabilize the injury as soon as it happens by following these quick steps:

1. Remove clothing from or around the injured part. Don't force a limb out of the clothing, though. You may need to cut clothing off with scissors to prevent causing your child any unnecessary additional pain.
2. Apply a cold compress or ice pack wrapped in cloth. Do not apply it directly on the skin.
3. Place a makeshift splint on the injured part by:
   • keeping the injured limb in the position you find it
   • placing soft padding around the injured part
   • placing something firm (like a board or rolled-up newspapers) next to the injured part, making sure it's long enough to go past the joints above and below the injury
   • keeping the splint in place with first-aid tape
4. Seek medical care and don't allow the child to eat, in case surgery is needed.

Different Types of Fractures

A doctor might be able to tell whether a bone is broken simply by looking at the injured area. But the doctor will order an X-ray to confirm the fracture and determine what type it is.

Reassure your child that, with a little patience and cooperation, getting an X-ray to look at the broken bone won't take long. Then, he or she will be well on the way to getting a cool — maybe even colorful — cast that every friend can sign.

For little ones who may be scared about getting an X-ray, it can help to explain the process like this: "X-rays don't hurt. Doctors use a special machine to take a picture to look at the inside of your body. When the picture comes out, it won't look like the ones in your photo album, but doctors know how to look at these pictures to see things like broken bones."

A fracture through the growing part of a child's bone (called the growth plate) may not show up on X-ray. If this type of fracture is suspected, the doctor will treat it even if the X-ray doesn't show a break.

Children's bones are more likely to bend than break completely because they're softer. Fracture types that are more common in kids include:

• buckle or torus fracture: one side of the bone bends, raising a little buckle, without breaking the other side
• greenstick fracture: a partial fracture in which one side of the bone is broken and the other side bends (this fracture resembles what would happen if you tried to break a green stick)

Mature bones are more likely to break completely. A stronger force will also result in a complete fracture of younger bones. A complete fracture may be a:

• closed fracture: a fracture that doesn't break the skin
• open (or compound) fracture: a fracture in which the ends of the broken bone break through the skin (these have an increased risk of infection)
• non-displaced fracture: a fracture in which the pieces on either side of the break line up
• displaced fracture: a fracture in which the pieces on either side of the break are out of line (which might require the doctor to realign the bones or require surgery to make sure the bones are properly aligned before casting)

Other common fracture terms include:

• hairline fracture: a thin break in the bone
• single fracture: the bone is broken in one place
• segmental: the bone is broken in two or more places in the same bone
• comminuted fracture: the bone is broken into more than two pieces or crushed

Getting a Splint or Cast

The doctor might decide that a splint is all that's needed to keep the bone from moving so it can heal. Whereas a cast encircles the entire broken area and will be removed by the doctor when the bone is healed, a splint usually supports the broken bone on one side.

When the doctor puts on a splint, a layer of cotton goes on first. Next, the splint is placed over the cotton. A splint may be made of stiff pieces of plastic or metal or can be molded out of plaster or fiberglass to fit the injured area comfortably. Then cloth or straps (which usually have Velcro) are used to keep the splint in place. The doctor might need to readjust the splint later.

However, most broken bones will need a cast. A cast, which keeps a bone from moving so it can heal, is essentially a big bandage that has two layers — a soft cotton layer that rests against the skin and a hard outer layer that prevents the broken bone from moving.
Casts are typically made of either:

• plaster of paris: a heavy white powder that forms a thick paste that hardens quickly when mixed with water. Plaster of paris casts are heavier than fiberglass casts and don't hold up as well in water.
• synthetic (fiberglass) material: made out of fiberglass, a kind of moldable plastic, these casts come in many bright colors and are lighter and cooler. The covering (fiberglass) on synthetic casts is water-resistant, but the padding underneath is not. You can, however, sometimes get a waterproof liner. The doctor putting on the cast will decide whether your child should get a fiberglass cast with a waterproof lining.

Although some kids might find casts cool when they're finally on their broken parts, the process of getting them put there can be scary, especially for a child in pain. Knowing what happens in the cast room might help alleviate some worry — both yours and your child's.

For displaced fractures (in which the pieces on either side of the break are out of line), the bone will need to be set before putting on a cast. To set the bone, the doctor will put the pieces of the broken bone in the right position so they can grow back together into one bone (this is called a closed reduction).

A closed reduction involves the doctor realigning the broken bone so that it heals in a straighter position. The child is given sedation, which is a medicine, usually through an intravenous line (IV) during the closed reduction. Because realigning the bones is a painful procedure, sedation keeps it from hurting during the procedure. A cast is then put on to keep the bone in position. You can expect another X-ray to be taken immediately after the procedure to make sure the bones are in good position after the realignment is done.

So how is a cast actually put on? First, several layers of soft cotton are wrapped around the injured area. Next, the plaster or fiberglass outer layer is soaked in water. The doctor wraps the plaster or fiberglass around the soft first layer. The outer layer is wet but will dry to a hard, protective covering. Doctors sometimes make tiny cuts in the sides of a cast to allow room for swelling.

Once the cast is on, the doctor will probably recommend that your child prop the splinted or casted area on a pillow or stool for a few days to reduce swelling. A child who has a cast on a foot or leg (called a walking cast) shouldn't walk on it until it's dry (this takes about 1 hour for a fiberglass cast and 2 or 3 days for a plaster cast).

If the cast or splint is on an arm, the doctor might give your child a sling to help support it. A sling is made of cloth and a strap that loops around the back of the neck and acts like a special sleeve to keep the arm comfortable and in place. A child with a broken leg will probably get crutches to make it a little easier to get around.

Cast Care

Some pain is expected for the first few days after getting a cast, but it usually isn't severe. The doctor may recommend acetaminophen or ibuprofen. Be sure to ask your doctor which pain medication is preferred. However, if your child seems to be in a lot of pain, call the doctor.

If the cast is causing your child's fingers or toes to turn pale, white, purple, blue, look swollen or feel numb the cast may be too tight or the swelling around the injured area has increased and you should call the doctor right away. Also be sure to call if the skin around the edges of the cast gets red or raw — that's typically a sign that the cast is wet inside from sweat or water.

Also, kids shouldn't pick at or remove the padding from the edges of fiberglass casts because the padding is protective and without it, the fiberglass edges can rub on the skin and cause irritation.
It is important to keep the splint and cast dry. Whether your child has a splint or cast the doctor should give you full instructions on how to care for it.

More Serious Breaks

Although most broken bones simply need a cast to heal, other more serious fractures (such as compound fractures) might require surgery to be properly aligned and to ensure the bones stay together during the healing process.

Open fractures need to be cleaned thoroughly in the sterile environment of the operating room before they're set because the bone's exposure to the air poses a risk of infection.

With breaks in larger bones or when the bone breaks into more than two pieces, the doctor may put a metal pin in the bone to help set it before placing a cast. Don't worry, though — as with any surgery, your child will be given medicine so that he or she won't feel a thing. And when the bone has healed, the doctor will remove the pin.

When Will a Broken Bone Heal?

Fractures heal at different rates, depending upon the age of the child and the type of fracture. For example, young children may heal in as little as 3 weeks, while it may take 6 weeks for the same kind of fracture to heal in teens.
It's important for your child to wait to play games or sports that might use the injured part until your doctor says it's OK.

Preventing Broken Bones

Although fractures are a common part of childhood, some kids are more likely to have one than others. For example, those with an inherited condition known as osteogenesis imperfecta have bones that are brittle and more susceptible to breaking.

Be sure your child is getting enough calcium to decrease the risk of developing osteoporosis (a condition that also causes the bones to be more fragile and likely to break) later in life.

Also, don't forget to motivate kids to get involved in regular physical activities and exercise, which are very important to good bone health. Weight-bearing exercises such as jumping rope, jogging, and walking can also help develop and maintain strong bones.

Although it's impossible to keep kids out of harm's way all the time, you can help to prevent injuries by taking simple safety precautions, such as childproofing your home, making sure kids always wear helmets and safety gear when participating in sports, and using car seats and seat belts for kids at every age and stage.

If your child does get a broken bone, remember that even though it can be frightening, a fracture is a common, treatable injury that many kids experience at one time or another. With a little patience, your child will be back to playing and running around before you know it.

"I pray that this article empowers you to Get A L.I.F.E."

SIDS

A lack of answers is part of what makes sudden infant death syndrome (SIDS) so frightening. SIDS is the leading cause of death among infants 1 month to 1 year old, and claims the lives of about 2,500 each year in the United States. It remains unpredictable despite years of research.

Even so, the risk of SIDS can be greatly reduced. First and foremost, infants younger than 1 year old should be placed on their backs to sleep — never face-down on their stomachs.

Searching for Answers

As the name implies, SIDS is the sudden and unexplained death of an infant who is younger than 1 year old. It's a frightening prospect because it can strike without warning, usually in seemingly healthy babies. Most SIDS deaths are associated with sleep (hence the common reference to "crib death") and infants who die of SIDS show no signs of suffering.

While most conditions or diseases usually are diagnosed by the presence of specific symptoms, most SIDS diagnoses come only after all other possible causes of death have been ruled out through a review of the infant's medical history, sleeping environment, and autopsy. This review helps distinguish true SIDS deaths from those resulting from accidents, abuse, and previously undiagnosed conditions, such as cardiac or metabolic disorders.

When considering which babies could be most at risk, no single risk factor is likely to be sufficient to cause a SIDS death. Rather, several risk factors combined may contribute to cause an at-risk infant to die of SIDS.

Most deaths due to SIDS occur between 2 and 4 months of age, and incidence increases during cold weather. African-American infants are twice as likely and Native American infants are about three times more likely to die of SIDS than caucasian infants. More boys than girls fall victim to SIDS.
Other potential risk factors include:

• smoking, drinking, or drug use during pregnancy
• poor prenatal care
• prematurity or low birth weight
• mothers younger than 20
• tobacco smoke exposure following birth
• overheating from excessive sleepwear and bedding
• stomach sleeping

Stomach Sleeping

Foremost among these risk factors is stomach sleeping. Numerous studies have found a higher incidence of SIDS among babies placed on their stomachs to sleep than among those sleeping on their backs or sides. Some researchers have hypothesized that stomach sleeping puts pressure on a child's jaw, therefore narrowing the airway and hampering breathing.

Another theory is that stomach sleeping can increase an infant's risk of "rebreathing" his or her own exhaled air, particularly if the infant is sleeping on a soft mattress or with bedding, stuffed toys, or a pillow near the face. In that scenario, the soft surface could create a small enclosure around the baby's mouth and trap exhaled air. As the baby breathes exhaled air, the oxygen level in the body drops and carbon dioxide accumulates. Eventually, this lack of oxygen could contribute to SIDS.
Also, infants who succumb to SIDS may have an abnormality in the arcuate nucleus, a part of the brain that may help control breathing and awakening during sleep. If a baby is breathing stale air and not getting enough oxygen, the brain usually triggers the baby to wake up and cry. That movement changes the breathing and heart rate, making up for the lack of oxygen. But a problem with the arcuate nucleus could deprive the baby of this involuntary reaction and put him or her at greater risk for SIDS.

Going "Back to Sleep"

The striking evidence that stomach sleeping might contribute to the incidence of SIDS led the American Academy of Pediatrics (AAP) to recommend in its 1992 Back to Sleep campaign that all healthy infants younger than 1 year of age be put to sleep on their backs (also known as the supine position).

Since the AAP's recommendation, the rate of SIDS has dropped by more than 50%. Still, SIDS remains the leading cause of death in young infants, so it's important to keep reminding parents about the necessity of back sleeping.

Many parents fear that babies put to sleep on their backs could choke on spit-up or vomit. According to the AAP, however, there is no increased risk of choking for healthy infants who sleep on their backs. (For infants with chronic gastroesophageal reflux disease [GERD] or certain upper airway malformations, sleeping on the stomach may be the better option. The AAP urges parents to consult with their child's doctor in these cases to determine the best sleeping position for the baby.)
Placing infants on their sides to sleep is not a good idea, either, as there's a risk that infants will roll over onto their bellies while they sleep.

Some parents also may be concerned about positional plagiocephaly, a condition in which babies develop a flat spot on the back of their heads from spending too much time lying on their backs. Since the Back to Sleep campaign, this condition has become quite common — but it is usually easily treatable by changing your baby's position frequently and allowing for more "tummy time" while he or she is awake.

Of course, once babies can roll over consistently — usually around 4 to 7 months — they may choose not to stay on their backs all night long. At this point, it's fine to let babies pick a sleep position on their own.

Tips for Reducing the Risk of SIDS

In addition to placing healthy infants on their backs to sleep, the AAP suggests these measures to help reduce the risk of SIDS:

• Place your baby on a firm mattress to sleep, never on a pillow, waterbed, sheepskin, couch, chair, or other soft surface. To prevent rebreathing, do not put blankets, comforters, stuffed toys, or pillows near the baby.
• Do not use bumper pads in cribs. Bumper pads can be a potential risk of suffocation or strangulation.
• Make sure your baby receives all recommended immunizations. Studies have shown that immunization can reduce the risk of SIDS by 50%.
• Make sure your baby does not get too warm while sleeping. Keep the room at a temperature that feels comfortable for an adult in a short-sleeve shirt. Some researchers suggest that a baby who gets too warm could go into a deeper sleep, making it more difficult to awaken.
• Do not smoke, drink, or use drugs while pregnant and do not expose your baby to secondhand smoke. Infants of mothers who smoked during pregnancy are three times more likely to die of SIDS than those whose mothers were smoke-free; exposure to secondhand smoke doubles a baby's risk of SIDS. Researchers speculate that smoking might affect the central nervous system, starting prenatally and continuing after birth, which could place the baby at increased risk.
• Receive early and regular prenatal care.
• Make sure your baby has regular well-baby checkups.
• Breastfeed, if possible. There is some evidence that breastfeeding may help decrease the incidence of SIDS. The reason for this is not clear, though researchers think that breast milk may help protect babies from infections that increase the risk of SIDS.
• If your baby has GERD, be sure to follow your doctor's guidelines on feeding and sleep positions.
• Put your baby to sleep with a pacifier during the first year of life. If your baby rejects the pacifier, don't force it. Pacifiers have been linked with lower risk of SIDS. If you're breastfeeding, try to wait until after the baby is 1 month old so that breastfeeding can be established.
• While infants can be brought into a parent's bed for nursing or comforting, parents should return them to their cribs or bassinets when they're ready to sleep. It's a good idea to keep the cribs and bassinets in the room where parents' sleep. This has been linked with a lower risk of SIDS.

For parents and families who have experienced a SIDS death, many groups, including the Sudden Infant Death Syndrome Alliance, can provide grief counseling, support, and referrals.
And growing public awareness of SIDS and precautions to prevent it should leave fewer parents searching for answers in the future.

"I pray that this article empowers you to Get A L.I.F.E."