Occupational Therapy Basics

Occupational therapy treatment focuses on helping people achieve independence in all areas of their lives. OT can help kids with various needs improve their cognitive, physical, and motor skills and enhance their self-esteem and sense of accomplishment.
Some people may think that occupational therapy is only for adults; kids, after all, do not have occupations. But a child's main job is playing and learning, and occupational therapists can evaluate kids' skills for playing, school performance, and daily activities and compare them with what is developmentally appropriate for that age group.

According to the American Occupational Therapy Association (AOTA), in addition to dealing with an someone's physical well-being, OT practitioners address psychological, social, and environmental factors that can affect functioning in different ways. This approach makes OT a vital part of health care for some kids.

Kids Who Might Need Occupational Therapy

According to the AOTA, kids with these medical problems might benefit from OT:

• birth injuries or birth defects
• sensory processing disorders
• traumatic injuries (brain or spinal cord)
• learning problems
• autism/pervasive developmental disorders
• juvenile rheumatoid arthritis
• mental health or behavioral problems
• broken bones or other orthopedic injuries
• developmental delays
• post-surgical conditions
• burns
• spina bifida
• traumatic amputations
• cancer
• severe hand injuries
• multiple sclerosis, cerebral palsy, and other chronic illnesses

Occupational therapists might:

• help kids work on fine motor skills so they can grasp and release toys and develop good handwriting skills
• address hand-eye coordination to improve kids' play skills (hitting a target, batting a ball, copying from a blackboard, etc.)
• help kids with severe developmental delays learn basic tasks (such as bathing, getting dressed, brushing their teeth, and feeding themselves)
• help kids with behavioral disorders learn anger-management techniques (i.e., instead of hitting others or acting out, using positive ways to deal with anger, such as writing about feelings or participating in a physical activity)
• teach kids with physical disabilities the coordination skills needed to feed themselves, use a computer, or increase the speed and legibility of their handwriting
• evaluate a child's need for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids
• work with kids who have sensory and attentional issues to improve focus and social skills

How Physical Therapy and OT Differ

Although both physical and occupational therapy help improve kids' quality of life, there are differences. Physical therapy (PT) deals with pain, strength, joint range of motion, endurance, and gross motor functioning, whereas OT deals more with fine motor skills, visual-perceptual skills, cognitive skills, and sensory-processing deficits.

Occupational Therapy Practitioners

There are two professional levels of occupational practice — occupational therapist (OT) and occupational therapist assistant (OTA).

Since 2007, an OT must complete a master's degree program (previously, only a bachelor's degree was required). An OTA is only required to complete an associate's degree program and can carry out treatment plans developed by the occupational therapist but can't complete evaluations.

All occupational therapy practitioners must complete supervised fieldwork programs and pass a national certification examination. A license to practice is mandatory in most states, as are continuing education classes to maintain that licensure.

Occupational therapists work in a variety of settings, including:

• hospitals
• schools
• rehabilitation centers
• mental health facilities
• private practices
• children's clinics
• nursing homes

Finding Care for Your Child

If you think your child might benefit from occupational therapy, ask your doctor to refer you to a specialist. The school nurse or guidance counselor also might be able to recommend someone based on your child's academic or social performance.

You also can check your local yellow pages, search online, or contact your state's occupational therapy association or a nearby hospital or rehabilitation center for referrals.

However you find an occupational therapist for your child, make sure that your health insurance company covers the program you select.

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

Be on the lookout for my new highly anticipated book; “Don’t Let the 4 Wheels F.O.O.L. You”!!!If you have ever felt as though society has counted you out! You won’t want to miss this inspirational road map to success!

Neurofibromatosis Information

Neurofibromatosis (NF) is a neurocutaneous syndrome that can affect many parts of the body, including the brain, spinal cord, nerves, skin, and other body systems. NF can cause growth of non-cancerous tumors on nerve tissue, producing skin and bone abnormalities.

Effects of NF vary widely — some children live almost unaffected by it; rarely, others can be severely disabled.

NF is defined by tumors, called neurofibromas, that grow along nerves in the body or on or under the skin. As the tumors increase in size, they can press on vital areas of the body, causing problems in the way the body functions.

Neurofibromas often first appear in childhood, especially during puberty. NF is occasionally diagnosed in infancy (in children with more apparent cases), but more often in kids between 3 and 16 years old.

The first noticeable sign is almost always the presence of brown café au lait spots. These distinctive spots don't hurt or itch and never progress to anything more serious than spots. They can be found anywhere on the body, though not usually on the face. Tiny ones — freckles — may be seen under the arms or in the groin area.

Many neurofibromas can be removed. Although usually benign (noncancerous), an estimated 3%-5% become cancerous.

There's no specific cure for NF, but tumors usually can be removed and complications treated. Because learning disabilities occur in about half the children with NF, some might need extra help in the classroom.

Types of NF

Of the two types of neurofibromatosis — NF1 and NF2 — NF1 is more common, occurring in 1 of every 2,500-3,000 births and affecting an estimated 100,000 Americans. It is also known as von Recklinghausen disease.

NF2 is characterized by the presence of bilateral acoustic neurofibroma-like tumors and is rarer, seen in 1 in 25,000 births. People with NF2 usually develop benign tumors on the nerves in their ears, causing hearing loss, eventual deafness, and problems with balance.

The severity of both types of neurofibromatosis varies greatly. In families where more than one person has NF, it can present with different physical signs and complications for each person. At diagnosis, it isn't possible to know right away whether a case will be mild or lead to severe complications.

Causes of NF

Both types of neurofibromatosis are autosomal dominant genetic disorders, which means an affected person has 1 chance in 2 of passing it on with each pregnancy.

Neurofibromatosis also can be the result of a spontaneous change (mutation) in the genetic material of the sperm or egg at conception in families with no previous history of NF. About half of cases are inherited, and the other half are due to spontaneous genetic mutation.
NF 1 and NF 2 are each related to changes in separate genes:

• The NF1 gene is located on chromosome 17.
• NF2 has been traced to chromosome 22.

These findings are important because they have led to the development of a genetic test that can reliably confirm NF in affected individuals.

Signs and Symptoms

NF1 is sometimes diagnosed in younger children, especially those with more severe forms of the disorder. One key to early diagnosis of mild NF is the appearance of café-au-lait spots on the skin.
Many people who do not have NF have a few café-au-lait spots. But if a young child has five or more, at least ½ inch in size (roughly the size of a dime), a doctor will look for other clues that may indicate NF, including neurofibromas — tumors on, under, or hanging off the skin — and Lisch nodules, tiny, noncancerous tumors on the iris (the colored part of the eye). Lisch nodules are of no clinical significance except that they help confirm a diagnosis of NF.

Neurofibromas often become evident on various parts of the body, beginning at the arms, around 10 years of age. A child may also develop freckling in the folds of the skin of the armpit or groin or on other parts of the body where the skin creases.

Abnormalities of the skeleton, such as the thinning or overgrowth of the bones in the arms or lower leg, curvature of the spine (scoliosis), and other bone deformities also may be features of NF1.

NF2 is usually not diagnosed until a child is older. Hearing loss in the late teens and early twenties is often among the first symptoms of the disorder, and is caused by tumors growing on the auditory nerves (which carry electrical impulses from the inner ear to the brain, allowing us to hear) on one or both sides.

Other symptoms of NF2 include continuous ringing in the ears, headache, facial pain or weakness, and feeling unsteady or off balance.

Diagnosis

Neurofibromatosis is usually diagnosed based on a combination of findings. A child must have at least two of the following signs to be diagnosed with NF1:

• café-au-lait spots of a certain number, size, and location
• the appearance of two or more neurofibromas (often resembling pea-sized bumps on the skin)
• Lisch nodules on the irises
• an optic glioma (tumor along the main nerve of the eye that is responsible for sight)
• certain skeletal abnormalities
• a family member with NF1
• freckling under the arms or in the groin

Tests like magnetic resonance imaging (MRI) and X-rays may be used to screen for tumors or evidence of skeletal problems. A child's head circumference will be measured, as kids with symptoms of NF can have a circumference that's larger than normal for their age. Blood pressure will be monitored. Doctors also take a detailed personal history, looking for signs of learning difficulties.
To diagnose NF2, doctors will check for any evidence of hearing loss. They'll order audiometry (hearing tests) as well as imaging tests to look for tumors in the nerves of the ears, spinal cord, or brain. They'll also determine if there's a family history of NF2.

Genetic testing is now available for people with a family history of either NF1 or NF2. Although testing is still not 100% sensitive, recent advances have increased sensitivity to over 90%. Amniocentesis or chorionic villus sampling can sometimes determine if an unborn child has the condition.

Treatment

Treatment for NF1 includes removal of the neurofibromas for cosmetic purposes, treating the complications, and getting intervention for children with learning disabilities. Kids will be referred to appropriate medical specialists to monitor and treat complications, which may include:

• seizures (up to 40% of children with NF1 have them)
• high blood pressure
• scoliosis
• speech impairment
• optic nerve tumors (which can cause vision problems leading to blindness)
• early or delayed onset of puberty

Rarely, neurofibromas can become cancerous (3%-5% of cases). In these occurrences, surgery, chemotherapy, or radiation may be necessary.

With NF2, surgeons will likely need to remove the auditory nerve tumors, which may cause deafness afterward. When parts of the auditory nerve are removed, hearing aids won't work.

In 2000, the U.S. Food and Drug Administration (FDA) approved an auditory brainstem implant for people with NF2 who have lost their hearing. This device transmits sound signals directly to the brain, enabling the person to hear certain sounds and speech.

Currently, researchers are conducting trials with medications in the hopes they'll be able to offer more treatment options.

Caring for Your Child

The first noticeable sign of neurofibromatosis usually is the presence of multiple café-au-lait spots. If your child has several of these spots, ask your doctor to do a thorough examination; he or she may need to screen your child for other signs of NF.

If your child has already been diagnosed with NF and you notice that a growing tumor is beginning to cause a problem, tell your doctor immediately.

One of the most important things you can do is get early intervention if your child has learning disabilities. It also helps to seek out support groups that can provide your family with practical advice and encouragement.

Remember, most people (about 60%) diagnosed with NF1 have only relatively mild signs of the disorder, like café-au-lait spots and a few neurofibromas on the surface of the skin, which require little or no treatment.

Kids diagnosed with mild NF who remain fairly healthy into early adulthood are less likely to develop more serious complications later in life. Kids diagnosed with more serious forms often have correctable complications and with appropriate help and support can lead happy and productive lives.

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

Be on the lookout for my new highly anticipated book; “Don’t Let the 4 Wheels F.O.O.L. You”!!!If you have ever felt as though society has counted you out! You won’t want to miss this inspirational road map to success!

The ER

When your child is sick or injured, it's natural to panic and head straight for the emergency room (ER), because you know that you can get care, regardless of the time, day, or severity of your child's injury. In some cases, it is a true medical emergency and the ER is the most appropriate place to get care. In other cases, the illness or injury can be handled at an urgent care clinic, or treatment can wait until your child's doctor can see you. When the ER is the right place to go, it's important to know what to expect once you get there. Having this information ahead of time can help make the experience a little less stressful. Finding the Right ER at the Right Time In certain situations, you should dial 911 to get an ambulance instead of taking your child to the ER yourself. Call 911 if: Your child is having trouble breathing and is turning blue. There has been a car accident and your child is unconscious or seriously injured. Your child is having a seizure that lasts 3-5 minutes, is having difficulty breathing, or is turning blue. Your child loses consciousness or is not responsive. Your child might have a neck or spine injury. Your child has a head injury with a loss of consciousness, persistent vomiting, or is not responding normally. Your child has significant uncontrolled bleeding. Your child has a possible poisoning and is not responding normally or having difficulty breathing. In any possible poisoning, call the Poison Control Center (1-800-222-1222) for expert advice and they may direct you to the ER. Planning Ahead Talk with your doctor about what to do — and which ER to go to — before you're in a situation where you might need to visit one. The doctor may direct you to an ER that's close to you or one in a hospital where he or she regularly sees patients. Should your child go to an ER at a children's hospital? Because they're dedicated to caring for kids, children's hospitals probably have the most pediatric staff, specialists, and facilities. So if it's an emergency and a children's hospital is conveniently located, consider going there. Otherwise, the community hospital nearest you will provide the medical care needed. If for any reason the hospital isn't equipped to treat your child's specific condition, the doctors there will arrange a transfer to a facility that is. Preparing to Go to the ER When you go to the ER, it's important to have a good handle on your child's symptoms. It's also important to know your child's medical history — allergies, past illnesses, injuries, surgeries, immunization history, or chronic conditions. Even if you know the medical history by heart, consider writing it down so it's handy during the chaos of an emergency. And keeping a written record readily available at home will let anyone caring for your child — such as a babysitter — provide it should your child be taken to the ER. To prepare a medical history, include: medications your child is taking allergies history of previous hospitalizations any previous surgeries illnesses relevant family history immunization history You also might be asked when your child last had anything to eat or drink. You should know the name and number of your child's primary care provider. And it's good to know the name and number of the pharmacy where you usually get your prescriptions filled. If you go to the ER because your child has ingested a particular medication or household product, bring the container of whatever was ingested. That will help the doctors understand what kind of treatment is required. If your child has swallowed an object, bring an example of that object, if possible. At any ER, except in the most serious emergencies, be prepared to wait. If you have time before you leave the emergency room, consider bringing something to do while you wait, such as a book, magazines, or bills to pay. You may also want to bring pen and paper to write down any questions you have for the doctor. If your child is not too ill, bring things for him or her to do as well, such as crayons, books, toys, and comforting objects, like stuffed animals. If you think there's a chance that your child might have to be admitted to the hospital, you may want to grab a change of clothes and toothbrushes for you and your child. Most ERs have some translation services or someone who can help translate. If you do not speak English fluently, consider bringing along a family member or friend who can help you translate. What to Expect at the ER There's no way to predict how long you'll have to wait to be seen at the ER. If your child has a severe medical problem, be assured that the doctors will provide whatever attention is needed right away. Because doctors attend to the most severe injuries and illnesses first, there's a good chance that if you are there with a minor injury, you'll have to wait longer. Even if the waiting room is empty, you still may have to wait if the exam rooms are filled or many doctors and nurses are attending to a particularly serious case. If your child's condition becomes worse while you are waiting to see a doctor, tell the medical staff. Before offering any food or drink to your child, make sure to ask the medical staff if it is OK. In some situations, your doctor would prefer your child has nothing to eat or drink. While you wait, there's a chance that you — and your child — may see some very sick and injured people come into the ER. The sights and sounds of those who are seriously hurt or sick can be frightening. So assure your child that the ER is the best place for the hurt people to be and that this is where the doctors can help them feel better. You might even give an example of a time when someone you know was injured and, as scary as it was at the time, all was fine after the doctor's care. Soon after arriving at the ER, your child probably will be seen by a nurse, who will ask about symptoms, check vital signs, and make a quick assessment. This evaluation, also called triage, will prioritize your child's medical needs based on the severity of his or her condition. You'll also go through a registration process where you'll be asked to sign consent for treatment forms. And if you have health insurance, be sure to have your member card with you. When you're in the ER, try to write down important information that you hear. It's scary and stressful when your child is in the ER, so it can be hard to remember details you may need later, such as: the names of the doctors what they say about the illness or injury any medications or treatment they give your child any directions for follow-up or care at home If your child is being discharged, make sure you understand the home care instructions and ask questions if you don't. A specialist might not be on-site if you go to the ER on the weekend or at night, but if the problem requires it, one will be called in. If it requires surgery, a surgeon will be contacted. Some hospitals even have a child life specialist. They can help children cope with the stress of being in the ER, help prepare them for procedures, and provide them with non-pharmacological pain management techniques even at very young ages. In many cases, the doctor who treats your child in the ER will contact your primary care doctor afterward. If your child is admitted to the hospital, the emergency room doctor will let your doctor know. Some ERs provide written or computer-generated documentation of the visit and others dictate and fax the report to the primary care doctor. Carry a copy of the papers you receive when your child is discharged to share with your doctor. "I pray that this article empowers you to Get A L.I.F.E." Be on the lookout for my new highly anticipated book; “Don’t Let the 4 Wheels F.O.O.L. You”!!!If you have ever felt as though society has counted you out! You won’t want to miss this inspirational road map to success!

About G6PD

G6PD deficiency is an inherited condition in which the body doesn't have enough of the enzyme glucose-6-phosphate dehydrogenase, or G6PD, which helps red blood cells (RBCs) function normally. This deficiency can cause hemolytic anemia, usually after exposure to certain medications, foods, or even infections.

Most people with G6PD deficiency don't have any symptoms, while others develop symptoms of anemia only after RBCs have been destroyed, a condition called hemolysis. In these cases, the symptoms disappear once the cause, or trigger, is removed. In rare cases, G6PD deficiency leads to chronic anemia.

With the right precautions, a child with G6PD deficiency can lead a healthy and active life.

About G6PD Deficiency

G6PD is one of many enzymes that help the body process carbohydrates and turn them into energy. G6PD also protects red blood cells from potentially harmful byproducts that can accumulate when a person takes certain medications or when the body is fighting an infection.

In people with G6PD deficiency, either the RBCs do not make enough G6PD or what is produced cannot properly function. Without enough G6PD to protect them, RBCs can be damaged or destroyed. Hemolytic anemia occurs when the bone marrow (the soft, spongy part of the bone that produces new blood cells) cannot compensate for this destruction by increasing its production of RBCs.

Causes of G6PD Deficiency

G6PD deficiency is passed along in genes from one or both parents to a child. The gene responsible for this deficiency is on the X chromosome.

G6PD deficiency is most common in African-American males. Many African-American females are carriers of G6PD deficiency, meaning they can pass the gene for the deficiency to their children but do not have symptoms; only a few are actually affected by G6PD deficiency.

People of Mediterranean heritage, including Italians, Greeks, Arabs, and Sephardic Jews, also are commonly affected. The severity of G6PD deficiency varies among these groups — it tends to be milder in African-Americans and more severe in people of Mediterranean descent.

Why does G6PD deficiency occur more often in certain groups of people? It is known that Africa and the Mediterranean basin are high-risk areas for the infectious disease malaria. Researchers have found evidence that the parasite that causes this disease does not survive well in G6PD-deficient cells. So they believe that the deficiency may have developed as a protection against malaria.

G6PD Deficiency Symptom Triggers

Kids with G6PD deficiency typically do not show any symptoms of the disorder until their red blood cells are exposed to certain triggers, which can be:

• illness, such as bacterial and viral infections
• certain painkillers and fever-reducing drugs
• certain antibiotics (especially those that have "sulf" in their names)
• certain antimalarial drugs (especially those that have "quine" in their names)

Some kids with G6PD deficiency can tolerate the medications in small amounts; others cannot take them at all. Check with your doctor for more specific instructions, as well as a complete list of medications that could pose a problem for a child with G6PD deficiency.

Other substances can be harmful to kids with this condition when consumed — or even touched — such as fava beans and naphthalene (a chemical found in mothballs and moth crystals). Mothballs can be particularly harmful if a child accidentally swallows one, so ANY contact should be avoided.

Symptoms of G6PD Deficiency

A child with G6PD deficiency who is exposed to a medication or infection that triggers the destruction of RBCs may have no symptoms at all. In more serious cases, a child may exhibit symptoms of anemia (also known as a hemolytic crisis), including:

• paleness (in darker-skinned children paleness is sometimes best seen in the mouth, especially on the lips or tongue)
• extreme tiredness
• rapid heartbeat
• rapid breathing or shortness of breath
• jaundice, or yellowing of the skin and eyes, particularly in newborns
• an enlarged spleen
• dark, tea-colored urine

Once the trigger is removed or resolved, the symptoms of G6PD deficiency usually disappear fairly quickly, typically within a few weeks.

If symptoms are mild, no medical treatment is usually needed. As the body naturally makes new red blood cells, the anemia will improve. If symptoms are more severe, a child may need to be hospitalized for supportive medical care.

Diagnosing and Treating G6PD Deficiency

In most cases, cases of G6PD deficiency go undiagnosed until a child develops symptoms. If doctors suspect G6PD deficiency, blood tests usually are done to confirm the diagnosis and to rule out other possible causes of the anemia.

If you feel that your child may be at risk because of either a family history or your ethnic background, talk to your doctor about performing a screening with blood tests to check for G6PD deficiency.

Treating the symptoms associated with G6PD deficiency is usually as simple as removing the trigger — that is, treating the illness or infection or stopping the use of a certain drug. However, a child with severe anemia may require treatment in the hospital to receive oxygen, fluids, and, if needed, a transfusion of healthy blood cells. In rare cases, the deficiency can lead to other more serious health problems.

Caring for Your Child

The best way to care for a child with G6PD deficiency is to limit exposure to the triggers of its symptoms. With the proper precautions, G6PD deficiency should not keep your child from living a healthy, active life.

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

Be on the lookout for my new highly anticipated book; “Don’t Let the 4 Wheels F.O.O.L. You”!!!If you have ever felt as though society has counted you out! You won’t want to miss this inspirational road map to success!

Kids & Casts

Kids who need a cast often have plenty of questions. Here are answers to some frequent inquiries about casts.

What are the different kinds of casts?

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.
These days, casts are 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, get a waterproof liner. The doctor putting on the cast will decide whether a fiberglass cast with a waterproof lining is appropriate.

How is a cast 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.

Can plaster of paris casts get wet?

Absolutely not! A wet cast may not hold the bone in place because the cast could start to dissolve in the water and could irritate the skin underneath it, possibly leading to infection. So your child shouldn't swim and should use a plastic bag or special sleeve (available online or sometimes at pharmacies) to protect the cast from water. And instead of a shower, your child may need to take a sponge bath.

Can synthetic (fiberglass) casts get wet?

Although the fiberglass itself is waterproof, the padding inside a fiberglass cast is not. So it's still important to try to keep a fiberglass cast from getting wet. If this is a problem, talk to the doctor about getting a waterproof liner. Fiberglass casts with waterproof liners let kids continue bathing or even go swimming during the healing process. Although the liner allows for evaporation of water and sweat, it's still fragile. Also, only certain types of breaks can be treated with this type of cast. Your doctor will determine if the fracture may be safely treated with a waterproof cast.

Is it OK to have people sign and draw on my child's cast?

Definitely! That often makes the whole broken bone experience more bearable for kids. Permanent markers usually work best; washable ones can smear. Feel free to encourage siblings, family members, and classmates to sign it, draw pictures on it, or decorate it with stickers. The doctor might even let your child keep the adorned cast as a souvenir.

What if my child has an itch in the cast?

Try blowing some air in the cast with a hair dryer — be sure to use the cool setting, though. And you should never pour baby powder or oils in the cast to try to relieve itching or try to reach the itch with long, pointed object such as a pencil or hanger — these could scratch or irritate your child's skin and can lead to an infection.

What if the cast gets a crack?

This can happen if the cast is hit or crushed, has a weak spot, or if the injured area begins to swell underneath. Call your doctor as soon as you notice a crack. In most cases, a simple repair can be done to the cast without needing to remove it or change it.

What if the cast causes my child's fingers or toes to turn white, purple, or blue, or if the skin around the edges of the cast gets red or raw?

The cast may be too tight. Redness and rawness are typically signs that the cast is wet inside, from sweat or water. Sometimes, kids pick at or remove the padding from the edges of fiberglass casts. They shouldn't do this, though, because the fiberglass edges can rub on the skin and cause irritation. Call your doctor to have the problem fixed right away.

Why aren't some types of broken bones put in casts right away?

Some kinds of fractures don't need casts to heal. Certain fractures of larger long bones, such as the femur (thighbone), are hard to keep straight in a cast. Although doctors used to commonly put many of these kinds of fractures in traction (a way of gently pulling the bone straight), these days, surgery is often used instead.

Do all broken bones need casts?

It's not practical to cast ribs and collarbones (clavicles). Even displaced collarbones (in which pieces on either side of the break are out of line) heal well with a sling or special strap called a "figure-of-eight clavicle strap," which the child wears like a vest. Some non-displaced finger and toe fractures (in which the pieces on either side of the break line up) that don't involve the joint or the growing part of a child's bone (called the growth plate) may heal well with a splint or buddy taping (taping the injured digit to the adjacent unaffected finger or toe).

Will my child feel pain when the broken bone is in a cast?

Some pain is expected for the first few days, but it's usually not severe. The doctor may recommend acetaminophen or ibuprofen to ease pain.

How are casts taken off?

The doctor will use a small electrical saw to remove the cast. Although it may look and sound scary to your child, the process is actually quick and painless. The saw's blade isn't sharp — it has a dull, round blade that vibrates up and down. The vibration is strong enough to break apart the fiberglass or plaster, but shouldn't hurt your child's skin and may even tickle.

What will the injured area look and feel like when the cast is removed?

Once the cast is off, the injured area will probably look and feel pretty weird to your child: The skin will be pale, dry, or flaky; hair will look darker; and the area (muscles especially) will look smaller or weaker. Don't worry, though — this is all temporary. And depending on the type and location of the fracture, the doctor may also give your child special exercises to do to get the muscles around the broken bone back in working order.

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

Be on the lookout for my new highly anticipated book; “Don’t Let the 4 Wheels F.O.O.L. You”!!!If you have ever felt as though society has counted you out! You won’t want to miss this inspirational road map to success!

Children and Fevers

You've probably experienced waking in the middle of the night to find your child flushed, hot, and sweaty. Your little one's forehead feels warm. You immediately suspect a fever, but are unsure of what to do next. Should you get out the thermometer? Call the doctor?
In healthy kids, fevers usually don't indicate anything serious. Although it can be frightening when your child's temperature rises, fever itself causes no harm and can actually be a good thing — it's often the body's way of fighting infections. And not all fevers need to be treated. High fever, however, can make a child uncomfortable and worsen problems such as dehydration.
Here's more about fevers, how to measure and treat them, and when to call your doctor.

Fever Facts

Fever occurs when the body's internal "thermostat" raises the body temperature above its normal level. This thermostat is found in the part of the brain called the hypothalamus. The hypothalamus knows what temperature your body should be (usually around 98.6° Fahrenheit or 37° Celsius) and will send messages to your body to keep it that way.

Most people's body temperatures even change a little bit during the course of the day: It's usually a little lower in the morning and a little higher in the evening and can fluctuate as kids run around, play, and exercise.

Sometimes, though, the hypothalamus will "reset" the body to a higher temperature in response to an infection, illness, or some other cause. So, why does the hypothalamus tell the body to change to a new temperature? Researchers believe turning up the heat is the body's way of fighting the germs that cause infections and making the body a less comfortable place for them.

Causes of Fever

It's important to remember that fever by itself is not an illness — it's usually a symptom of an underlying problem. Fever has a few potential causes:
Infection: Most fevers are caused by infection or other illness. Fever helps the body fight infections by stimulating natural defense mechanisms.
Overdressing: Infants, especially newborns, may get fevers if they're overbundled or in a hot environment because they don't regulate their body temperature as well as older kids. However, because fevers in newborns can indicate a serious infection, even infants who are overdressed must be evaluated by a doctor if they have a fever.
Immunizations: Babies and kids sometimes get a low-grade fever after getting vaccinated.
Although teething may cause a slight rise in body temperature, it's probably not the cause if a child's temperature is higher than 100° F (37.8° C).

When Fever Is a Sign of Something Serious

In the past, doctors advised treating a fever on the basis of temperature alone. But now they recommend considering both the temperature and a child's overall condition.

Kids whose temperatures are lower than 102° F (38.9° C) often don't require medication unless they're uncomfortable. There's one important exception to this rule: If you have an infant 3 months or younger with a rectal temperature of 100.4° F (38° C) or higher, call your doctor or go to the emergency department immediately. Even a slight fever can be a sign of a potentially serious infection in very young infants.

If your child is between 3 months and 3 years old and has a fever of 102.2° F (39° C) or higher, call your doctor to see if he or she needs to see your child. For older kids, take behavior and activity level into account. Watching how your child behaves will give you a pretty good idea of whether a minor illness is the cause or if your child should be seen by a doctor.
The illness is probably not serious if your child:

• is still interested in playing
• is eating and drinking well
• is alert and smiling at you
• has a normal skin color
• looks well when his or her temperature comes down

And don't worry too much about a child with a fever who doesn't want to eat. This is very common with infections that cause fever. For kids who still drink and urinate normally, not eating as much as usual is OK.

Is it a Fever?

A gentle kiss on the forehead or a hand placed lightly on the skin is often enough to give you a hint that your child has a fever. However, this method of taking a temperature (called tactile temperature) is dependent on the person doing the feeling and doesn't give an accurate measure of temperature.
Use a reliable thermometer to confirm a fever (which is when a child's temperature is at or above one of these levels):

• 100.4° F (38° C) measured rectally (in the bottom)
• 99.5° F (37.5° C) measured orally (in the mouth)
• 99° F (37.2° C) measured in an axillary position (under the arm)

But how high a fever is doesn't tell you much about how sick your child is. A simple cold or other viral infection can sometimes cause a rather high fever (in the 102°-104° F / 38.9°-40° C range), but this doesn't usually indicate a serious problem. And serious infections might cause no fever or even an abnormally low body temperature, especially in infants.

Because fevers can rise and fall, a child might have chills as the body tries to generate additional heat as its temperature begins to rise. The child may sweat as the body releases extra heat when the temperature starts to drop.

Sometimes kids with a fever breathe faster than usual and may have a higher heart rate. You should call the doctor if your child is having difficulty breathing, is breathing faster than normal, or continues to breathe fast after the fever comes down.

Types of Thermometers

Whatever thermometer you choose, be sure you know how to use it correctly to get an accurate reading. Keep and follow the manufacturer's recommendations for any thermometer.
Digital thermometers usually provide the quickest, most accurate readings. They come in many sizes and shapes and are available at most supermarkets and pharmacies in a range of prices. You should read the manufacturer's instructions to determine what the thermometer is designed for and how it signals that the reading is complete. Overall, digital thermometers usually can be used for these temperature-taking methods:

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

Turn on the thermometer and make sure the screen is clear of any old readings. Digital thermometers usually have a plastic, flexible probe with a temperature sensor at the tip and an easy-to-read digital display on the opposite end. If your thermometer uses disposable plastic sleeves or covers, put one on according to the manufacturer's instructions. Remember to discard the sleeve after each use and to clean the thermometer according to the manufacturer's instructions before putting it back in its case.
Electronic ear thermometers measure the tympanic temperature — the temperature inside the ear canal. Although they're quick and easy to use in older babies and kids, they aren't as accurate as digital thermometers for infants 3 months or younger and are more expensive.
Plastic strip thermometers (small plastic strips that you press against the forehead) may be able to tell you whether your child has a fever, but aren't reliable for taking an exact measurement, especially in infants and very young children. If you need to know your child's exact temperature, plastic strip thermometers are not the way to go.
Forehead thermometers also may be able to tell you if your child has a fever, but are not as accurate as oral or rectal digital thermometers.
Pacifier thermometers may seem convenient, but again, their readings are less reliable than rectal temperatures and shouldn't be used in infants younger than 3 months. They also require kids to keep the pacifier in their mouth for several minutes without moving, which is a nearly impossible task for most babies and toddlers.
Glass mercury thermometers were once common, but the American Academy of Pediatrics (AAP) now says they should not be used because of concerns about possible exposure to mercury, which is an environmental toxin. (If you still have a mercury thermometer, do not simply throw it in the trash where the mercury can leak out. Talk to your doctor or your local health department about how and where to dispose of a mercury thermometer.)

Tips for Taking Temperatures

As any parent knows, taking a squirming child's temperature can be challenging. But it's one of the most important tools doctors have to determine if a child has an illness or infection. The best method will depend on a child's age and temperament.

For kids younger than 3 months, you'll get the most reliable reading by using a digital thermometer to take a rectal temperature. Electronic ear thermometers aren't recommended for infants younger than 3 months because their ear canals are usually too small.

For kids between 3 months to 4 years old, you can use a digital thermometer to take a rectal temperature or an electronic ear thermometer to take the temperature inside the ear canal. You could also use a digital thermometer to take an axillary temperature, although this is a less accurate method.

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

To take a rectal temperature: Before becoming parents, most people cringe at the thought of taking a rectal temperature. But don't worry — it's a simple process:

1. Lubricate the tip of the thermometer with a lubricant, such as petroleum jelly.
2. Place your child:
   - belly-down across your lap or on a firm, flat surface and keep your palm along the lower back
   - or face-up with legs bent toward the chest with your hand against the back of the thighs
3. With your other hand, insert the lubricated thermometer into the anal opening about ½ inch to 1 inch (about 1.25 to 2.5 centimeters). Stop if you feel any resistance.
4. Steady the thermometer between your second and third fingers as you cup your hand against your baby's bottom. Soothe your child and speak quietly as you hold the thermometer in place.
5. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen, noting the time of day that you took the reading.

To take an oral temperature: This process is easy in an older, cooperative child.

1. Wait 20 to 30 minutes after your child finishes eating or drinking to take an oral temperature, and make sure there's no gum or candy in your child's mouth.
2. Place the tip of the thermometer under the tongue and ask your child to close his or her lips around it. Remind your child not to bite down or talk, and to relax and breathe normally through the nose.
3. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen, noting the time of day that you took the reading.

To take an axillary temperature: This is a convenient way to take a child's temperature. Although not as accurate as a rectal or oral temperature in a cooperative child, some parents prefer to take an axillary temperature, especially for kids who can't hold a thermometer in their mouths.

1. Remove your child's shirt and undershirt, and place the thermometer under an armpit (it must be touching skin only, not clothing).
2. Fold your child's arm across the chest to hold the thermometer in place.
3. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen, noting the time of day that you took the reading.

Whatever method you choose, keep these additional tips in mind:

• Never take a child's temperature right after a bath or if he or she has been bundled tightly for a while — this can affect the temperature reading.
• Never leave a child unattended while taking a temperature.

Helping Kids Feel Better

Again, not all fevers need to be treated. And in most cases, a fever should be treated only if it's causing a child discomfort.
Here are ways to alleviate symptoms that often accompany a fever:

• If your child is fussy or appears uncomfortable, you can give acetaminophen or ibuprofen based on the package recommendations for age or weight. (Unless instructed by a doctor, never give aspirin to a child due to its association with Reye syndrome, a rare but potentially fatal disease.) If you don't know the recommended dose or your child is younger than 2 years old, call the doctor to find out how much to give.
  
  Infants under 2 months old should not be given any medication for fever without being evaluated by a doctor. If your child has any medical problems, check with the doctor to see which medication is best to use. Remember that fever medication will usually temporarily bring a temperature down, but won't return it to normal — and it won't treat the underlying reason for the fever.
• Giving a sponge bath can make your child more comfortable and help bring the fever down. Use only lukewarm water; cool water may cause shivering, which actually raises body temperature. Never use alcohol (it can cause poisoning when absorbed through the skin) or ice packs/cold baths (they can cause chills that may raise body temperature).
• Dress your child in lightweight clothing and cover with a light sheet or blanket. Overdressing and overbundling can prevent body heat from escaping and can cause a temperature to rise.
• Make sure your child's bedroom is a comfortable temperature — not too hot or too cold.
• Offer plenty of fluids to avoid dehydration — a fever will cause a child to lose fluids more rapidly. Water, soup, ice pops, and flavored gelatin are all good choices. Avoid drinks containing caffeine, including colas and tea, because they can cause increased urination.
• If your child also is vomiting and/or has diarrhea, ask the doctor if you should give an electrolyte (rehydration) solution made especially for kids. You can find these solutions at drugstores and supermarkets. Don't offer sports drinks — they're not designed for younger children, and the added sugars may make diarrhea worse. Also, limit your child's intake of fruits and apple juice.
• In general, let your child eat what he or she wants (in reasonable amounts) but don't force eating if your child doesn't feel like it.
• Make sure your child gets plenty of rest. Staying in bed all day isn't necessary, but a sick child should take it easy.
• It's best to keep a child with a fever home from school or childcare. Most doctors feel that it's safe to return when the temperature has been normal for 24 hours.

When to Call the Doctor

The exact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and whether there are other symptoms with the fever.
Call your doctor if you have an:

• infant younger than 3 months old with a temperature of 100.4° F (38° C) or higher
• older child with a temperature of higher than 102.2° F (39° C)

Call the doctor if an older child has a fever of less than 102.2° F (39° C) but also:

• refuses fluids or seems too ill to drink adequately
• has persistent diarrhea or repeated vomiting
• has any signs of dehydration (urinating less than usual, not having tears when crying, less alert and less active than usual)
• has a specific complaint (e.g., sore throat or earache)
• still has a fever after 24 hours (in kids younger than 2 years) or 72 hours (in kids 2 years or older)
• has recurrent fevers, even if they only last a few hours each night
• has a chronic medical problem such as heart disease, cancer, lupus, or sickle cell anemia
• has a rash
• has pain with urination

Seek emergency care if your child shows any of these signs:

• inconsolable crying
• extreme irritability
• lethargy and difficulty waking
• rash or purple spots that look like bruises on the skin (that were not there before the child got sick)
• blue lips, tongue, or nails
• infant's soft spot on the head seems to be bulging outward or sunken inwards
• stiff neck
• severe headache
• limpness or refusal to move
• difficulty breathing that doesn't get better when the nose is cleared
• leaning forward and drooling
• seizure
• abdominal pain

Also, ask your doctor for his or her specific guidelines on when to call about a fever.

Fever: A Common Part of Childhood

All kids get fevers, and in the majority of cases, most are completely back to normal within a few days. For older infants and kids (but not necessarily for infants younger than 3 months), the way they act is far more important than the reading on your thermometer. Everyone gets cranky when they have a fever. This is normal and should be expected.

But if you're ever in doubt about what to do or what a fever might mean, or if your child is acting ill in a way that concerns you even if there's no fever, always call your doctor for advice.

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

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The Concussion

The term concussion conjures up the image of someone knocked unconscious while playing sports. But concussions — temporary loss of brain function — can happen with any head injury, often without any loss of consciousness.

A concussion is also known as a mild traumatic brain injury. Although we usually hear about head injuries in athletes, many occur off the playing field in car and bicycle accidents, in fights, and even minor falls.

Kids who sustain concussions usually recover within a week or two without lasting health problems by following certain precautions and taking a breather from sports.

But a child with an undiagnosed concussion can be at risk for brain damage and even disability.
Anyone who sustains a head injury should stop participating and be removed from the activity or sport. Even without a loss of consciousness, it's important to watch for symptoms of a concussion.
Common initial symptoms include:

• a change in level of alertness
• extreme sleepiness
• a bad headache
• confusion
• repeated vomiting
• seizure

Someone with these symptoms should be taken to the emergency room.

About Concussions

The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. The brain can move around inside the skull and even bang against it. If the brain does bang against the skull — for example, due to a fall on a sidewalk or a whiplash-type of injury — it can be bruised, blood vessels can be torn, and the nerves inside the brain can be injured. These injuries can lead to a concussion.

Many different systems have been used to grade or describe concussions. The severity of a concussion is determined by how long signs and symptoms last and so can only be known after someone has recovered. The longer the symptoms of changes in brain function, the more severe the concussion.

Signs and Symptoms of a Concussion

Someone with a concussion may lose consciousness, but this doesn't happen in every case. In fact, a brief loss of consciousness or "blacking out" isn't a factor in determining concussion severity.
Other signs of a concussion include:

• headache
• sleepiness or difficulty falling asleep
• feeling confused and dazed
• difficulty concentrating, thinking, or making decisions
• dizziness
• difficulty with coordination or balance (such as being able to catch a ball or other easy tasks)
• trouble remembering things, such as what happened right before or after the injury
• blurred vision
• slurred speech or saying things that don't make sense
• nausea and vomiting
• feeling anxious or irritable for no apparent reason

Concussion symptoms may not appear initially and can develop over the first 24-72 hours. Anyone showing any of these signs should be seen by a doctor. Young kids can have the same concussion symptoms as older kids and adults, but changes in mood and behavior may be more subtle.
Call an ambulance or go to the ER right away if, after a head injury, your child:

• can't be awakened
• has one pupil — the dark part of the eye — that's larger than the other
• has convulsions or seizures
• has slurred speech
• seems to be getting more confused, restless, or agitated

Though most kids recover quickly from concussions, some symptoms — including memory loss, headaches, and problems with concentration — may linger for several weeks or months. Nearly 15% of kids age 5 and older have symptoms and/or changes in functioning lasting 3 months or longer. It's important to watch for these symptoms and contact your doctor if they persist.

Diagnosis

If a concussion is suspected, the doctor will ask about how the head injury happened, when, and its symptoms. The doctor also may ask basic questions to gauge your child's consciousness, memory, and concentration ("Who are you?"/"Where are you?"/"What day is it?").

The diagnosis of a concussion is made by health care provider based on history and physical exam. The doctor will perform a thorough examination of the nervous system, including testing balance, coordination, nerve function, and reflexes.

Sometimes a doctor may order a CT scan of the brain (a detailed brain X-ray) or an MRI (a non-X-ray brain image) to rule out bleeding or other serious brain injury. Concussions can change the way the brain works, but in most cases, imaging tests will show normal results.

Treatment

If the concussion is not serious enough to require hospitalization, the doctor will provide instructions on how to take care of your child at home. The doctor may have you wake your child up at least once during the night.

If your child cannot be easily awakened, becomes increasingly confused, or has other symptoms (such as continued vomiting), it may mean there is a more serious problem that requires contacting the doctor again.

The primary treatments for a concussion include both physical and mental rest. While your child has symptoms, he or she should not:

• attend school or have a normal workload
• take any high-stakes testing (for example, state testing, PSATs, SATs, etc.)
• participate in physical activity including gym class, recess, and sports
• participate in wheel activities (for example, biking, rollerblading, scootering, or skateboarding)
• drive or operate heavy machinery
• return to work

After a concussion, the brain needs time to heal. Recovery time will depend on how long the symptoms last. It's very important for kids to wait until all symptoms have ended before resuming normal activities. Physical symptoms, balance and coordination, and thinking and personality all should return to the pre-injury level.

Be sure to get the OK from the doctor before your child resumes sports or other physical activities. Sometimes kids feel better even though their thinking, behavior, and/or balance have not yet returned to normal. Even if your child pleads that he or she feels fine or a competitive coach or school official urges you to go against medical instructions, it's essential to wait until the doctor has given the OK.
Healthy kids can usually resume their normal activities within a few weeks, but each situation is different. The doctor will monitor your child closely to ensure that recovery is going well and might recommend acetaminophen, ibuprofen, or other aspirin-free medications for headaches.

Even mild concussions require a player to sit out for the remainder of the game. People are much more likely to sustain a concussion if they've had one previously. And evidence shows that repeated concussions can result in lasting brain damage, even when the injuries occur months or years apart.
Kids who have resumed normal activities and no longer have symptoms might be allowed to slowly return to sports. This is a gradual process that can take anywhere from a few days to weeks. A person should never return to play or other strenuous activities on the same day of the injury and should see a doctor.

Preventing Concussions

All kids should wear properly fitting, appropriate headgear and safety equipment when biking, rollerblading, skateboarding, snowboarding or skiing, and playing contact sports. Safety gear has been shown to reduce the occurrence of severe head trauma.

Childproofing your home will go a long way toward keeping an infant or toddler safe from concussions and other injuries. Babies reach, grasp, roll, sit, and eventually crawl, pull up, "cruise" along furniture, and walk. Toddlers may pull themselves up using table legs; they'll use bureaus and dressers as jungle gyms; they'll reach for whatever they can see.

All of these activities can result in a head injury that leads to a concussion. Be sure your child has a safe place to play and explore, and never leave a baby or toddler unattended.

The time you spend taking these safety precautions — and getting your kids into the habit of abiding by your safety rules and regulations — will help keep your family safe and sound!

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

Be on the lookout for my new highly anticipated book; “Don’t Let the 4 Wheels F.O.O.L. You”!!! If you have ever felt as though society has counted you out! You won’t want to miss this inspirational road map to success!