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."

Sleepwalking

About Sleepwalking

Hours after bedtime, do you find your little one wandering the hall looking dazed and confused? If you have a sleepwalking child, you're not alone. It can be unnerving to see, but sleepwalking is very common in kids and most sleepwalkers only do so occasionally and outgrow it by the teen years. Still, some simple steps can keep your young sleepwalker safe while traipsing about.

Despite its name, sleepwalking (also called somnambulism) actually involves more than just walking. Sleepwalking behaviors can range from harmless (sitting up), to potentially dangerous (wandering outside), to just inappropriate (kids may even open a closet door and urinate inside). No matter what kids do during sleepwalking episodes, though, it's unlikely that they'll remember ever having done it!

As we sleep, our brains pass through five stages of sleep — stages 1, 2, 3, 4, and REM (rapid eye movement) sleep. Together, these stages make up a sleep cycle. One complete sleep cycle lasts about 90 to 100 minutes. So a person experiences about four or five sleep cycles during an average night's sleep.

Sleepwalking most often occurs during the deeper sleep of stages 3 and 4. During these stages, it's more difficult to wake someone up, and when awakened, a person may feel groggy and disoriented for a few minutes.

Kids tend to sleepwalk within an hour or two of falling asleep and may walk around for anywhere from a few seconds to 30 minutes.

Causes of Sleepwalking

Sleepwalking is far more common in kids than in adults, as most sleepwalkers outgrow it by the early teen years. It may run in families, so if you or your partner are or were sleepwalkers, your child may be too.

Other factors that may bring on a sleepwalking episode include:

• lack of sleep or fatigue
• irregular sleep schedules
• illness or fever
• certain medications
• stress (sleepwalking is rarely caused by an underlying medical, emotional, or psychological problem)

Behaviors During Sleepwalking

Of course, getting out of bed and walking around while still sleeping is the most obvious sleepwalking symptom. But young sleepwalkers may also:

• sleeptalk
• be hard to wake up
• seem dazed
• be clumsy
• not respond when spoken to
• sit up in bed and go through repeated motions, such as rubbing their eyes or fussing with their pajamas

Also, sleepwalkers' eyes are open, but they don't see the same way they do when they're awake and they often think they're in different rooms of the house or different places altogether.
Sometimes, these other conditions may accompany sleepwalking:

• sleep apnea (brief pauses in breathing while sleeping)
• bedwetting (enuresis)
• night terrors

Is Sleepwalking Harmful?

Sleepwalking itself is not harmful. However, sleepwalking episodes can be hazardous since sleepwalking kids aren't awake and may not realize what they're doing, such as walking down stairs or opening windows.

Sleepwalking is not usually a sign that something is emotionally or psychologically wrong with a child. And it doesn't cause any emotional harm. Sleepwalkers probably won't even remember the nighttime stroll.

How to Keep a Sleepwalker Safe

Although sleepwalking isn't dangerous by itself, it's important to take precautions so that your sleepwalking child is less likely to fall down, run into something, walk out the front door, or drive (if your teen is a sleepwalker).
To help keep your sleepwalker out of harm's way:

• Try not to wake a sleepwalker because this might scare your child. Instead, gently guide him or her back to bed.
• Lock the windows and doors, not just in your child's bedroom but throughout your home, in case your young sleepwalker decides to wander. You may consider extra locks or child safety locks on doors. Keys should be kept out of reach for kids who are old enough to drive.
• To prevent falls, don't let your sleepwalker sleep in a bunk bed.
• Remove sharp or breakable things from around your child's bed.
• Keep dangerous objects out of reach.
• Remove obstacles from your child's room and throughout your home to prevent a stumble. Especially eliminate clutter on the floor (i.e., in your child's bedroom or playroom).
• Install safety gates outside your child's room and/or at the top of any stairs.

Other Ways to Help a Sleepwalker

Unless the episodes are very regular, cause your child to be sleepy during the day, or your child is engaging in dangerous sleepwalking behaviors, there's usually no need to treat sleepwalking. But if the sleepwalking is frequent, causing problems, or your child hasn't outgrown it by the early teen years, talk to your doctor. Also talk to your doctor if you're concerned that something else could be going on, like reflux or trouble breathing.

For kids who sleepwalk often, doctors may recommend a treatment called scheduled awakening. This disrupts the sleep cycle enough to help stop sleepwalking. In rare cases, a doctor may prescribe medication to help a child sleep.

Other ways to help minimize sleepwalking episodes:

• Have your child relax at bedtime by listening to soft music or relaxation tapes.
• Establish a regular sleep and nap schedule and stick to it — both nighttime and wake-up time.
• Make your child's bedtime earlier. This can improve excessive sleepiness.
• Don't let kids drink a lot in the evening and be sure they go to the bathroom before going to bed. (A full bladder can contribute to sleepwalking.)
• Avoid caffeine near bedtime.
• Make sure your child's bedroom is quiet, cozy, and conducive to sleeping. Keep noise to a minimum while kids are trying to sleep (at bedtime and naptime).

The next time you encounter your nighttime wanderer, don't panic. Simply steer your child back to the safety and comfort of his or her bed.

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

Preschoolers Need Sleep!

Establishing a Bedtime Routine
Preschoolers sleep about 10 to 12 hours during each 24-hour period, but there's no need to be rigid about which 10 to 12 hours these are. The most important thing is to help kids develop good habits for getting to sleep.

A bedtime routine is a great way to ensure that your preschooler gets enough sleep.

Here are a few things to keep in mind when establishing that routine:

Include a winding-down period during the half hour before bedtime.
Stick to a bedtime, alerting your child both half an hour and 10 minutes beforehand.
Set fixed times for going to bed, waking up, and taking naps.
Keep consistent playtimes and mealtimes.
Avoid stimulants, such as sugar, near bedtime.
Make the bedroom quiet, cozy, and conducive to sleeping.
Use the bed only for sleeping — not for playing or watching TV.
Limit food and drink before bedtime.
Allow your child to choose which pajamas to wear, which stuffed animal to take to bed, etc. Consider playing soft, soothing music.
Tuck your child into bed snugly for a feeling of security.

A Note on Naps

Most preschoolers do still need naps during the day. They tend to be very active — running around, playing, going to school, and exploring their surroundings — so it's a good idea to give them a special opportunity to slow down. Even if your child can't fall asleep, try to set aside some quiet time during the day for relaxing. (And you'll probably benefit from a break too!)

The best way to encourage napping is to set up a routine for your child, just as you do for bedtime. Your preschooler, not wanting to miss out on any of the action, may resist a nap, but it's important to keep the routine firm and consistent. Explain that this is quiet time and that you want your child to start out in bed, but that it's OK to play in the bedroom quietly if he or she can't sleep.

How long should naps last? For however long you feel your child needs to get some rest. Usually, about an hour is sufficient. But there will be times when your child has been going full tilt and will need a longer nap, and others when you hear your child chattering away, playing through the entire naptime.

Sleeping Problems

Preschoolers may have nightmares, or night terrors, and there may be many nights when they have trouble falling asleep.

It may help if you create a "nighttime kit" to keep near your child's bed for these times. That kit might include a flashlight, a favorite book, and a cassette or CD to play. Explain the kit, then put it in a special place where your child can get to it in the middle of the night.

Objects like stuffed animals and blankets also can help kids feel safe. If your child doesn't have a favorite toy and getting to sleep has become consistently difficult, then it might be worth going out together to pick out a warm, soft blanket or stuffed animal.

Some parents get into the habit of lying down next to their young kids until they fall asleep. While this may do the trick temporarily, it won't help sleeping patterns in the long term. It's important to provide comfort and reassurance, but kids need to fall asleep independently for when parents aren't around. If you establish a routine where you have to be there for your child to go to sleep, then it will be difficult for both of you — and unfair to your child — if you start leaving beforehand.

If you're worried about your child's sleeping patterns, talk with your doctor. Although there isn't one sure way to raise a good sleeper, most kids have the ability to sleep well and work through any sleeping problems. The key is to try from early on to establish healthy bedtime habits.

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

Positional Plagiocephaly

Passage through the birth canal often makes a newborn's head appear pointy or elongated for a short time. It's normal for a baby's skull, which is made up of several separate bones that will eventually fuse together, to be slightly misshapen during the few days or weeks after birth.

But if a baby develops a persistent flat spot, either on one side or the back of the head, it could be a sign of document.write(defpositional_plagiocephaly244) positional plagiocephalypositional plagiocephaly. Also known as flattened head syndrome, this can occur when a baby sleeps in the same position repeatedly or because of problems with the neck muscles.

Fortunately, positional plagiocephaly can be treated without surgery and does not cause lasting cosmetic problems.

About Positional Plagiocephaly

Positional plagiocephaly is a disorder in which the back or one side of an infant's head is flattened, often with little hair growing in that area. It's most often the result of babies spending a lot of time lying on their backs or often being in a position where the head is resting against a flat surface (such as in cribs, strollers, swings, and playpens).

Because infants' heads are soft to allow for the incredible brain growth that occurs in the first year of life, they're susceptible to being "molded" into a flat shape.

Causes of Positional Plagiocephaly

The most common cause of a flattened head is a baby's sleep position. Because infants sleep so many hours on their backs, the head sometimes assumes a flat shape.

In almost all infants with plagiocephaly, there is some limit of active neck movement that leads to a preference to turn the head to one side and not to the other. The medical term for this is torticollis. The cause and effect relationship between torticollis and plagiocephaly goes both ways. Many infants are born with torticollis — perhaps related to fetal positioning in the uterus during late pregnancy — and subsequently develop plagiocephaly after birth.

But infants with severe flattening on one side must expend much more energy than normal to turn the head to the other side, so they do not do so, and their necks become stiff from disuse. In many infants with torticollis, their head will be turned to one side (usually to the right, for unknown reasons) while their chin is tilted toward the other.

Premature babies are more prone to positional plagiocephaly — their skulls are softer than those of full-term babies, and they spend a great deal of time on their backs without being moved or picked up because of their medical needs and extreme fragility after birth, which usually requires a stay in the neonatal intensive care unit (NICU).

A baby might even start to develop positional plagiocephaly before birth, if pressure is placed on the baby's skull by the mother's pelvis or a twin. In fact, it's not at all unusual to see plagiocephaly in multiple birth infants.

If your infant has a misshapen head, your physician will need to decide whether the cause is plagiocephaly, which is very common and does not require surgery, or a condition called craniosynostosis, which is much less common and generally requires surgical treatment.

Craniosynostosis happens when adjacent skull bones become fused together ahead of the normal developmental schedule. This fusion limits the growth of the head in the direction perpendicular to the fused border between the affected bones, and the head grows excessively in other directions. This produces distinctive patterns of skull deformity that look very different from plagiocephaly.

Plagiocephaly is usually easy to recognize, because the deformity affects the back of the head most severely.

Signs and Symptoms

Positional plagiocephaly is usually easy for parents to notice. Typically, the back of the child's head (called the occiput) is flattened on one side, and the ear on the flattened side may be pushed forward as viewed from above.

In severe cases, there may be bulging on the side opposite from the flattening and the forehead may be asymmetrical (or uneven). If torticollis is the cause, the neck, jaw, and face may be asymmetrical. But although other aspects of the head and face may be affected, in positional plagiocephaly the back of the head is always most involved.

Diagnosis

Most often, a doctor can make the diagnosis of positional plagiocephaly simply by examining a child's head, without having to order lab tests or X-rays.

The doctor will also note whether regular repositioning of the child's head during sleep successfully reshapes the growing skull over time (craniosynostosis, on the other hand, typically will worsen).

If there's still some doubt, consultation with a specialist — a pediatric neurosurgeon or a craniofacial plastic surgeon — may be needed. X-rays and CT scans play no role in the management of plagiocephaly and are not necessary to distinguish it from craniosynostosis.

Treatment

Treatment for positional plagiocephaly caused by sleeping position is usually easy and painless, entailing simple repositioning of babies during sleep to encourage them to alternate their head position while sleeping on their backs.

Even though they'll probably move around throughout the night, alternating sides is still beneficial. Wedge pillows are available that keep babies lying on one side or the other, but be sure to check with your doctor before using one to ensure that it's appropriate and safe for your baby. The American Academy of Pediatrics (AAP) does not recommend routinely using any devices that might restrict the movement of an infant's head.

In addition, you will want to consider how you lay your baby down in the crib. Most right-handed parents carry small infants cradled in their left arms and lay them down with the heads to their left. In this position, the infant must turn to the right to look out into the room — and, indeed, torticollis to the right with flattening of the right side of the head is far more common than the left.

Whichever side of your infant's head is flattened, you will want to position your baby in the crib to encourage active turning of the head to the other side.

Always be sure your baby gets plenty of supervised time on the stomach while awake during the day. Not only does "tummy time" promote normal shaping of the back the head, it also helps in other ways. Looking around from a new perspective encourages your baby's learning and discovery of the world. Plus, it helps babies learn to push up on their arms, which helps develop the muscles needed for crawling and sitting up. It also helps to strengthen the neck muscles.

As most infants with plagiocephaly have some degree of torticollis, a course of physical therapy and a home exercise program will usually be part of the recommended treatment. A physical therapist can teach you exercises to do with your baby involving stretching techniques that are gradual and progressive. Most moves will consist of stretching your child's neck to the side opposite the tilt. Eventually, the neck muscles will be elongated and the neck will straighten itself out. Although they're very simple, the exercises must be performed correctly.

For kids with severe positional plagiocephaly, doctors may prescribe a custom-molded helmet or head band. These work best if started between the ages of 4 and 6 months, when a child grows the fastest, and are usually less helpful after 10 months of age. They work by applying gentle but constant pressure on a baby's growing skull in an effort to redirect the growth.

But never purchase or use any devices like these without having your child evaluated by a doctor. Only a small percentage of babies wear helmets. The decision to use helmet therapy is made on a case-by-case basis (for example, if the condition is so severe that a baby's face is becoming misshapen or the parents are very upset). Although helmets might not improve the outcome in all children, some kids with severe torticollis can benefit from their use.

Prognosis

The outlook for babies with positional plagiocephaly is excellent. As babies grow, they begin to reposition themselves naturally during sleep much more often than they did as newborns, which allows their heads to be in different positions throughout the night.

After babies are able to roll over, the AAP still recommends that parents put them to sleep on their backs, but then allow them to move into the position that most suits them without repositioning them onto their backs.

As a general rule, once an infant has attained independent sitting, plagiocephaly will not get any worse. Then, over months and years, as the skull grows, even in severe cases the flattening will improve. The head will never be perfectly symmetrical, but for a variety of developmental reasons the asymmetry becomes much less conspicuous as well. In later childhood the face becomes more prominent in relation to the skull, hair thickens, and children grow into lives of continual motion. Experience and clinical research have shown that by school age, plagiocephaly is no longer a social or cosmetic problem.

It's important to remember that plagiocephaly itself does not affect a child's brain growth or cause developmental delays or brain damage.

Prevention

Babies should be put down to sleep on their backs to help prevent sudden infant death syndrome (SIDS), despite the possibility of developing an area of flattening on the back of the head.

However, alternating their head position every night while they sleep and providing lots of tummy time and stimulation during the day while they're awake can reduce the risk of positional plagiocephaly.

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

Children & Nightmares

It's not clear at what age kids begin to dream, but even toddlers may speak about having dreams — pleasant ones and scary ones. While almost every child has an occasional frightening or upsetting dream, nightmares seem to peak during the preschool years when fear of the dark is common. But older kids (and even adults) have occasional nightmares, too.

Nightmares aren't completely preventable, but parents can set the stage for a peaceful night's rest. That way, when nightmares do creep in, a little reassurance and comfort from you can quickly restore your child's peace of mind.

Helping kids conquer this common childhood fear also equips them to overcome other scary things that might arise down the road.

When Do Nightmares Happen?

Nightmares — like most dreams — occur during the stage of sleep when the brain is very active and sorting through experiences and new information for learning and memory. The vivid images the brain is processing can seem as real as the emotions they might trigger.

This part of sleep is known as the rapid eye movement or REM stage because the eyes are rapidly moving beneath closed eyelids. Nightmares tend to happen during the second half of a night's sleep, when REM intervals are longer.

When kids awaken from a nightmare, its images are still fresh and can seem real. So it's natural for them to feel afraid and upset and to call out to a parent for comfort.

By about preschool age, kids begin to understand that a nightmare is only a dream — and that what's happening isn't real and can't hurt them. But knowing that doesn't prevent them from feeling scared. Even older kids feel frightened when they awaken from a nightmare and may need your reassurance and comfort.

What Causes Nightmares?

No one knows exactly what causes nightmares. Dreams — and nightmares — seem to be one way kids process thoughts and feelings about situations they face, and to work through worries and concerns.

Most times nightmares occur for no apparent reason. Other times they happen when a child is experiencing stress or change. Events or situations that might feel unsettling — such as moving, attending a new school, the birth of a sibling, or family tensions — might also be reflected in unsettling dreams.

Sometimes nightmares occur as part of a child's reaction to trauma — such as a natural disaster, accident, or injury. For some kids, especially those with a good imagination, reading scary books or watching scary movies or TV shows just before bedtime can inspire nightmares.

Themes of a nightmare tend to reflect whatever the child is going through at that age, whether it's struggles with aggressive feelings, independence, or fears of separation. The cast of characters might include monsters, bad guys, animals, imaginary creatures, or familiar people, places, and events combined in unusual ways.

Young kids might have nightmares of being gobbled up, lost, chased, or punished. Sometimes a nightmare contains recognizable bits and pieces of the day's events and experiences, but with a scary twist. A child might not remember every detail, but can usually recall some of the images, characters, or situations, and the scary parts.

Encouraging Sweet Dreams

Parents can't prevent nightmares, but can help kids get a good night's sleep — and that encourages sweet dreams.

To help them relax when it's time to sleep and associate bedtime with safety and comfort, be sure that kids:

have a regular bedtime and wake-up time
have a sleep routine that helps them slow down, and feel safe and secure as they drift off to sleep. This might include a bath, a snuggle from you, reading, or some quiet talk about the pleasant events of the day.
have a bed that's a cozy, peaceful place to quiet down. A favorite toy, stuffed animal, night-light, or dream catcher can help.
avoid scary movies, TV shows, and stories before bed — especially if they've triggered nightmares before.
know that nightmares aren't real, that they're just dreams and can't hurt them.

After a Nightmare

Here's how to help your child cope after a nightmare:

Reassure your child that you’re there. Your calm presence helps your child feel safe and protected after waking up feeling afraid. Knowing you'll be there helps strengthen your child's sense of security.

Label what’s happened. Let your child know that it was a nightmare and now it's over. You might say something like, "You had a bad dream, but now you're awake and everything is OK." Reassure your child that the scary stuff in the nightmare didn't happen in the real world.

Offer comfort. Show that you understand that your child feels afraid and it's OK. Remind your child that everyone dreams and sometimes the dreams are scary, upsetting, and can seem very real, so it's natural to feel scared by them.

Do your magic. With preschoolers and young school-age kids who have vivid imaginations, the magical powers of your love and protection can work wonders. You might be able to make the pretend monsters disappear with a dose of pretend monster spray. Go ahead and check the closet and under the bed, reassuring your child that all's clear.

Mood lighting. A night-light or a hall light can help kids feel safe in a darkened room as they get ready to go back to sleep. A bedside flashlight can be a good nightmare-chaser.

Help your child go back to sleep. Offering something comforting might help change the mood. Try any of these to aid the transition back to sleep: a favorite stuffed animal to hold, a blanket, pillow, night-light, dream catcher, or soft music. Or discuss some pleasant dreams your child would like to have. And maybe seal it by giving your child a kiss to hold — in the palm of his or her hand — as you tiptoe out of the room.

Be a good listener. No need to talk more than briefly about the nightmare in the wee hours — just help your child feel calm, safe, and protected, and ready to go back to sleep. But in the morning, your child may want to tell you all about last night's scary dream. By talking about it — maybe even drawing the dream or writing about it — in the daylight, many scary images lose their power. Your child might enjoy thinking up a new (more satisfying) ending to the scary dream.

For most kids, nightmares happen only now and then, are not cause for concern, and simply require a parent's comfort and reassurance. Talk to your doctor if nightmares often prevent your child from getting enough sleep or if they occur along with other emotional or behavioral troubles.

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