Mental Health and Illness

About 450 million people suffer from mental and behavioural disorders worldwide, reports the World Health Organisation. In many parts of the world socio economic conditions have a negative impact to mental health: poverty, illiteracy, war, violence discrimination on various aspects are all detrimental factors. Awareness that some behaviours and symptoms are signs of illnesses, is lacking. There is a stigma to voicing mental problems and seeking help.

Mental Illness covers a wide spectrum where the boundaries between “normal” and “abnormal” are not very sharply defined. Illnesses can be classified in different ways. Some broad categories are:

*

Organic, where there are structural/physiological abnormalities in the brain or nerves, leading to illness
* Functional where there are no structural abnormalities identifiable
* Neurosis - severe forms of normal experiences
* Psychosis – severe distortion of perception of reality.

Illnesses are also grouped as:

* Mood disorders
* Anxiety disorders.
* Substance-related disorders.
* Schizophrenia related disorders
* Dementia and Memory Related Disorders
* Developmental disorders
* Personality disorders.

While it is difficult to define what is normal when a behaviour interferes with your ability to cope with life on a daily basis, then it is better to seek help.

sourcer : http://www.webhealthcentre.com/Healthcorners/mental_health_index1.aspx

Acquired Heart Diseases

These are not defects from birth but problems acquired in a person’s lifetime due to various factors.

The most common among acquired heart diseases are:

* Coronary Artery Disease
* Infective Heart Diseases
* Valvular Diseases
* Others

Coronary Artery Disease

A Heart Attack

What is a heart attack?

The death of heart muscle is a heart attack. In medical terms it is called Myocardial Infarction (MI).

A block in the artery impedes the supply of blood to the heart. The heart is deprived of oxygen, so crucial for its functioning. This causes the death of heart muscle.

What happens before a heart attack?

The heart performs important functions like pumping oxygenated blood to the rest of the body and sending the impure blood from the rest of the body to the lungs for purification. To perform these functions, the heart needs a supply of blood. This is provided by the coronary arteries.

When a person has Coronary Heart Disease the arteries become narrow due to deposits on the inner walls. The blood flow to the heart is reduced. This may eventually result in a portion of the heart being suddenly deprived of its blood supply leading to the death of that area of heart tissue, resulting in a heart attack.

Who is at risk?

You are at risk if any of the following pertain to you

* A high level of cholesterol in the blood
* Chronic diabetes
* Chronic hypertension (high blood pressure)
* A family history of atherosclerosis
* Obesity
* Cigarette smoking
* A sedentary lifestyle

Men are more at risk than women.

Classic Symptoms of a Heart Attack

The typical symptoms of a heart attack are:

* Pain or a sense of compression or tightness in the middle of the chest.
* This pain is felt in the central chest and may sometimes radiate down the left arm, to the jaw or to the back.
* The pain is usually aggravated by exercise and relieved by rest, though variant forms may occur
* The pain may be accompanied by sweating.

But often pain may not be so specific.

* Pain may not seem critical.
* Pain may be present in the back, abdomen, shoulders, or arms.
* Nausea and vomiting, or merely a feeling of heartburn, may be the only symptom.

What should you do when you experience these symptoms?

* Get yourself to a hospital at once. ( Don’t keep waiting, hoping the pain will subside)
* Take an aspirin
* Do not drive
* Try to rest, and stay anxiety free till you can get medical help.

What is the emergency treatment that is given?

If the patient reaches a hospital within three to six hours, he can get the best chance of minimising damage to the heart. It will help avert possible fatality.

A clot-busting drug can help dissolving the clot and help the circulation of blood thereby save heart muscle from damage. Read more on clot busters

What Happens after a heart attack?

After a heart attack the patient needs to be monitored for a couple of days when ECG and Echo tests are taken at periodic intervals.

* When a large portion of the heart muscle dies, the patient can develop heart failure. The heart may not be able to pump enough blood to the rest of the body. The risk of death is high. Emergency surgery may be performed.
* When not much of the muscle is affected, heart failure does not occur immediately.

However there are changes in the heart.

* Some portion of the muscle has died and natural healing process begins in the heart.
* Because some part of the muscle is dead, there is more pressure on the rest of the muscle to work. The efficiency of the heart may reduce.

About two weeks after the heart attack, the cardiologist advises the patient to take a test called “coronary angiography”. This is the most direct form of assessing the damage, but it is also an invasive procedure. This test reveals the extent to which the coronary artery disease has progressed. That is, it becomes clear where and to what extent the patient’s coronary arteries are blocked. Using this information, the doctor decides on whether surgical intervention is necessary, or if the patient can be put on diet and medication to control the progress of the coronary artery disease.

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source : http://www.webhealthcentre.com/Healthcorners/cardiac_Acquired_Heart_Diseases.aspx

Congenital Heart Diseases

Heart defects that are present from birth are called congenital heart defects.

The circulatory system of the foetus is a little different from that of the newborn. The foetus gets its oxygen supply and nutrition from the mother through the placenta. The foetal heart does not have to perform certain functions as the lungs do not process air. At the time of birth, when the lungs fill with air, the newborn’s heart routs blood in a path similar to yours. This requires some changes in the heart and blood vessels near the heart. When these do not take place effectively, there are malformations in the heart leading to Congenital Heart Diseases.

What Causes Congenital Heart Diseases?

There is no definitive evidence yet. But the following are suspected to be contributing factors:

* Genetic Disorders
* Viral infections like German Measles.
* Intake of drugs/alcohol by the mother.

Types of Congenital Heart Defects

Due to malformation of the heart two things can happen:

Too little blood from the heart reaches the lungs. So there is not enough oxygenated blood to keep the body energetic and robust. Mixing of the pure and impure blood due to defects in the structure of the heart or the blood vessels is also possible. The child’s skin, nail beds and lips get a bluish tinge. The malformations that cause this are called Cyanotic Disorders. Quite often babies with Cyanotic Diseases have multiple problems in the heart.

Too much blood can also flow from the heart to lungs due to defects in the heart. These defects are called Acyanotic Disorders.

The most common acyanotic disorders are:

* Septal defects (Hole in the heart)
* Patent Ductus Arteriosus

Septal Defects

In the fetal heart there is an opening between the left and right atria called the foramen ovale, which allows blood to circulate more directly from the right atrium to the left atrium.

When the baby is born the foramen ovale closes. In a small percentage of babies it does not. This leads to what is called Atrial Septal Defect.(ASD).

Similarly, when there is a malformation in the wall between the left and right ventricle, causing a “ hole” in the septum in between the two lower chambers of the heart, it is called Ventricular Septal Defect(VSD).

Symptoms

ASD can be without symptoms. Common symptoms of septal defects could be one or more of the following:

* The child’s height and weight are below normal.
* Breathlessness
* Irregular heartbeat
* Fatigue
* Poor Feeding

Treatment

Sometimes the septal defects close on their own. However, if this does not happen surgery may be necessary.

Patent Ductus Arteriosus

Your pulmonary artery, which carries impure blood to the lungs, does not do so in the foetus. It carries pure blood. From here the pure blood is shunted to the aorta through a small tube called ductus arteriosus. When the child is born, The ductus arteriosus closes. When it does, the condition is called Patent Ductus Arteriosus(PDA)

A child with PDA is likely to have the following symptoms:

* Breathing difficulties
* Heart murmur
* Change in heart rate

Treatment

The first option the doctor considers is to see if it will close on its own.

Medication can be used to narrow the duct.

If neither is effective, surgery or catheterisation may be necessary. A small cut is made in the chest and the tube is tied off. Or a coil is inserted through a catheter and placed on the ductus arteriosus to grip it close.

Pneumonia

About pneumonia

If you have pneumonia, the infection causes the air sacs (alveoli) and smaller airways in your lungs to become inflamed and fill with fluid. Your lungs can't work properly and don't get enough oxygen from the air into your blood.

Pneumonia affects about eight in every 1,000 adults annually. It's more common in the very young and the elderly. Most infections occur in the autumn or winter. About a quarter of patients with pneumonia are admitted to hospital.

Pneumonia is often divided into two main types ('community-acquired' pneumonia and 'hospital-acquired' pneumonia) depending on whether you were infected while living at home (in the community) or while staying in hospital. You can also get pneumonia if you live in a nursing home ('nursing home-acquired pneumonia').

It isn't always possible to identify the particular micro-organism (which include bacteria, viruses and fungi) that causes pneumonia. The most common micro-organisms that cause pneumonia are bacteria, particularly Streptococcus pneumoniae. You can also get pneumonia from fungi, allergies or by inhaling substances such as chemicals
Symptoms of pneumonia

If you develop pneumonia you may have:

* a cough - dry at first but which becomes a cough with phlegm that is often green/yellow or rust-coloured and may be smelly
* fever
* breathlessness or faster breathing
* pain in your chest
* night sweats
* confusion

Not everyone gets all these symptoms and you may have some that aren't in this list. For example, if you are over 65, you may be more likely to have confusion or be unsteady on your legs.
Complications of pneumonia

Complications of pneumonia are more common in older people and may include:

* a build-up of fluid around your lungs - this is called a pleural effusion
* severe breathing difficulties
* spread of the infection to other parts of your body, including to your blood - this is called septicaemia ("blood poisoning")

If you are being treated at home and develop complications, you will be admitted to hospital.

If you have diabetes, you are more likely to have complications if you get pneumonia. This is because of the way your body reacts to infections.
Causes of pneumonia

The micro-organisms that cause pneumonia may be present in your body for some time before you become ill. Alternatively you may breathe in droplets that are in the air from other people coughing and sneezing. You may also breathe in organisms from the environment (for example in Legionnaire's disease, a form of pneumonia caused by Legionella pneumophilia).

The most common bacterium that causes community-acquired pneumonia is Streptococcus pneumoniae - this is called pneumococcal pneumonia. Bacteria that commonly cause hospital-acquired pneumonia (also called nosocomial pneumonia) include Haemophilus influenzae, Klebsiella pneumoniae and Staphylococcus aureus. Viruses, including the influenza (flu) virus can also cause pneumonia.

Pneumonia may also be caused by inhaling substances, for example, vomit, a peanut, a chemical or smoke. It can also occur from allergy, for example. 'Farmers lung' is from an allergy to mouldy hay.

If children, particularly those under school age, get pneumonia, it's more often because of a virus than bacteria.

You are more likely to get pneumonia if you:

* are in poor health
* are over 65 or very young
* smoke (smoking damages your lungs and therefore makes it easier to get an infection)
* drink too much alcohol
* have a long-term illness, such as cancer - particularly if this affects your body's ability to fight infection
* have a weakened immune system, for example if you have HIV/AIDS

Diagnosis of pneumonia

Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your doctor will tap on your chest and listen to your breath sounds with a stethoscope. He or she may suggest that you have an X-ray to find out exactly where the infection is and how severe it is. He or she may also do a test using a device that clips on your finger and measures the amount of oxygen in your blood.

You may be asked to give a sample of blood or phlegm, which will be sent to a laboratory for testing. This will help your doctor to decide how to treat you. However, if you got pneumonia while you were living at home, you may not have this performed unless your GP suspects infection by unusual micro-organism.
Treatment of pneumonia

You will probably be treated at home if your pneumonia was diagnosed by your GP, but if you are very ill, he or she may decide to refer you to hospital. About one person in four will be ill enough to need to go to hospital.

You are most likely to be treated with antibiotics, either with tablets or through a drip (if you are in hospital).

If your pneumonia was caused by a virus, antibiotics won't help (as they don't work against viruses, only bacteria). If your doctor isn't sure which type of micro-organism has caused the pneumonia, he or she may give you antibiotics to see if they work.

After antibiotic treatment, most people begin to feel better within three to five days. How long your treatment lasts will depend on how serious your pneumonia is. If you are being treated at home and you aren't feeling better within a few days your GP may refer you to hospital.

After you are feeling better you may have a follow-up X-ray, especially if you are a smoker.

If you are very ill in hospital you might need to have oxygen to help your breathing or might even need help to breathe with a ventilator - an artificial breathing machine.
Self-help

If you have pneumonia you should:

* stop smoking
* drink plenty of fluids
* rest
* take paracetamol if you have chest pain - always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice

Medicines

The medicines you may be given will vary depending on how serious your pneumonia is and whether or not you are admitted to hospital for treatment.

* You may be given antibiotic tablets or antibiotics through a drip depending on how serious your illness is and where you are treated.
* As you get better you may be able to come off the drip and take antibiotic tablets.

Prevention of pneumonia

Your GP may recommend that you are vaccinated against pneumonia if he or she thinks you could develop it, for example if:

* you are over 65
* you have heart or lung problems, kidney disease, liver disease or diabetes
* you have a condition that means your immune system isn't able to fight infection as well as that of a healthy person, for example human immunodeficiency virus (HIV) infection, or because you are being treated with steroids

A pneumococcal vaccine can prevent pneumonia caused by S. pneumoniae infection. There are two pneumococcal vaccines called Pneumovax II and Prevenar. Both of these vaccines are given by injection.

Prevenar and Haemophilus influenzae B (HiB) and meningitis (Men C) vaccines are now also part of the childhood immunisation schedule.

Influenza vaccination can prevent you getting flu. This annual vaccination is now recommended for adults and children over six months with long-term lung, heart, liver or kidney diseases, or with a weakened immune system, and for all people over 65. You can get vaccinated at your local GP surgery each autumn. Alternatively, vaccines are available from private clinics.

source: http://hcd2.bupa.co.uk/fact_sheets/html/Pneumonia.html

Stem Cell Transplants

About Stem Cell Transplants

Hematopoietic stem cells are immature cells that are capable of developing into the three types of blood cells:

1. red blood cells that carry oxygen
2. white blood cells that fight infection
3. platelets that help blood to clot

Hematopoietic stem cells can be found in bone marrow (the spongy tissue inside bones), the bloodstream, or the umbilical cord blood of newborn babies.

A stem cell transplant can replenish a child's supply of healthy hematopoietic stem cells. It's used to treat a wide range of diseases, including cancers like leukemia, lymphoma, neuroblastoma, Wilms tumor, and certain testicular or ovarian cancers; blood disorders; immune system diseases; and bone marrow syndromes.

Transplanted hematopoietic stem cells are introduced (or infused) into the bloodstream through an intravenous (IV) line, much like a blood transfusion. Once in the body, they can produce healthy new blood and immune system cells.
Types of Transplants

The two main types of stem cell transplants are autologous and allogeneic. The type of transplant needed will depend on the child's specific medical condition and the availability of a matching donor.

* Autologous hematopoietic stem cell transplant. With this type of transplant, patients act as their own donor. That is, a child who is about to undergo cancer treatment will have his or her own stem cells removed (harvested) and frozen for later use. After the child receives chemotherapy and/or radiation, the stem cells are thawed and put back into the child's body. This procedure may be done once or many times, depending on the need. Sometimes doctors will use extra-high doses of chemotherapy during treatment (to kill as many cancer cells as possible) if they know a patient will be getting a stem cell transplant soon after.
* Allogeneic hematopoietic stem cell transplant. With an allogeneic transplant, the stem cells come from a donor — often a sibling but sometimes another volunteer — whose cells are considered a "match" for the patient. The process of finding a match is called tissue typing (or HLA [human leukocyte antigen] typing). HLA is a protein on the surface of blood cells. Basically, the more "HLA markers" a child and the potential donor have in common, the greater the chance that the transplant will be successful.

Unlike with an autologous transplant, there is a risk of rejection. Sometimes, despite the donor being a good match, the transplant simply may not take. Other times, the donor cells can begin to make immune cells that attack the recipient's body. This condition is called graft-versus-host disease, and can be quite serious. Fortunately, most cases are successfully treated with steroids and other medications.

Sometimes, an upside of graft-versus-host disease is that the newly transplanted cells recognize the body's cancer cells as different or foreign, and actually work to fight them
Transplantation

Stem cell transplantation is a very complex process that may span several months. A team of doctors is usually involved in determining if a child is a candidate and, if so, whether the transplant will be autologous or allogeneic.

For an allogeneic transplant, a compatible donor will be sought among family members or through a national registry of volunteers. Once a match is found, the donor's stem cells will be harvested. Three different types of hematopoietic stem cells can be collected or harvested:

1. Peripheral blood stem cells are harvested from donated blood. The stem cells are separated and collected and the rest of the blood is returned to the donor.
2. Bone marrow stem cells are collected from the patient's hip bone through a surgical procedure.
3. Cord blood stem cells are collected from a mother's placenta immediately after a child is born.

While all three types can replenish a patient's blood and bone marrow cells, there are advantages and disadvantages to each. The doctor will suggest the best type of stem cell for your child's illness.

The next step in the transplantation process is conditioning therapy, which is when very high doses of chemotherapy and/or radiation are given to the child to kill cancer cells. These treatments have side effects: They'll destroy the child's bone marrow and weaken the immune system. But from a transplant standpoint, these consequences are potentially useful. They not only help to make room in the bone marrow for the new cells to take hold, but they also suppress the immune system, thus lessening the chance of rejection.

Soon after the conditioning phase, the transplant itself will be done through infusion and healthy stem cells will be introduced to the child's body. After the infusion, the child will be watched very closely to make sure the new stem cells are settling into the marrow and beginning to manufacture new blood cells (called engrafting). Doctors will watch for any signs of rejection as well as graft-verses-host disease in kids with allogeneic transplants.

Engrafting takes an average of 2 weeks, but can be as quick as 1 week or as long as 6 weeks. Your child will receive medicines to promote engrafting and prevent rejection and graft-verses-host disease
Recovery

Kids who receive stem cell transplants have a high risk of infection because during conditioning therapy and while the transplant is grafting, their immune systems are compromised and unable to fight bacteria and other germs that enter the body. Children who receive an allogeneic transplant have an even greater risk of infection because they require medications to further suppress their immune systems to reduce the chance of rejection.

Because of these risks, a child who's had a stem cell transplant will not be released from the hospital until doctors are sure the transplant has successfully engrafted and the child is otherwise doing well.

Once released, a child needs very close monitoring and follow-up care. School and other public indoor areas may be off limits for 6 months to a year, and other places might be restricted as well. This is because for kids with a compromised immune system, even a simple infection like a common cold can be serious and even life-threatening if untreated.
Coping

The stress of having a child who is being treated for any type of cancer can be overwhelming for a family. That stress can be magnified when treatment requires a long "isolation period," as is necessary with a stem cell transplant.

To find out about support that may be available to you or your child, talk to your doctor, a hospital social worker, or child life specialist. Many resources are available that can help you get through this difficult time.

Reviewed by: Edward A. Kolb, MD
source : http://kidshealth.org/parent/medical/allergies/stem_cells.html

Human Respiratory Syncytial virus (HRSV)

Human respiratory syncytial virus (hRSV or RSV) is the type species of the genus Pneumovirus. Along with other members of the family Paramyxoviridae, hRSV is an enveloped virus with a negative sense, single-stranded RNA genome. These viruses are 150-200nm in diameter with a helical nucleocapsid

Other members of the family include human parainfluenzavirus 1 (HPIV-1; genus Respirovirus), mumps virus (MuV), human parainfluenzavirus 2 and 4 (HPIV-2 and HPIV-4; genus Rubulavirus), measles virus
(MeV; genus Morbillivirus), Hendravirus and Nipahvirus (genus Henipavirus) and human metapneumovirus (hMPV; genus Metapneumovirus).

A distinguishing feature among genera is the possession (Paramyxovirus) or absence (e.g. Morbilliviruis and Pneumovirus) of neuraminidase (NA).

Figure 1.

Schematic representation of the respiratory syncytial virus (hRSV, RSV) (-)ssRNA genome. Based on GenBank accession no. NC_001781.

The hRSV virion enters its target cell by fusion of the hRSV envelope with the cell membrane and release of the viral genome into the cell's cytoplasm where translation will occur. The nucleopretein (N), large (L) and phosphoproteins (P) together with the RNA genome form the nucleoprotein core. These together with the matrix (M), fusion (F), and glycoprotein (G) are classified as structural proteins. The nonstructural proteins include NS1 and 2, small hydrophobic (SH) and M2 (formerly 22-kDa).

The respiratory syncytial virus genome is transcribed from the 3' end into monocistronic (each species only encodes a single protein) mRNA molecules. New viruses are released form the infected cell buy budding. In the presence of newly synthesized hRSV fusion (F) protein, neighbouring infected cells may form a clump whose membranes have fused to form a "giant cell" called a syncytium (Greek syn = with, and kytos = cell), . New virions can then spread more effectively from cell-to-cell.

The disease

Human respiratory syncytial virus (hRSV or RSV) is the most common cause of lower respiratory tract disease in infants and young children. HRSV infects the majority of infants by 2yrs of age usually causing symptoms resembling those of the common cold. In some prematurely born infants or those with chronic lung disease, hRSV can cause life-threatening disease. HRSV infection most commonly occurs in epidemics during the cooler months (exact months will depend on which hemisphere we look at e.g. the Northern hemispahere's peak season occurs from October to March/April while the Southern hemisphere peak is usually around April to October). The majority of cases are seen in children under 4yrs of age, with the peak of severely ill cases found among children less than 6mths of age, particularly in infants with pre-existing heart and lung disease.

The Lab Diagnosis

Virus can be isolated from contiuous cell lines e.g. HeLa cells, which can take 2 to 10 days. A more rapid method is indirect immunofluorescence (IIF) during which viral antigens are detected within the patient's cells present in a nasopharygeal aspirate (NPA) or washing (NPW).

The polymerase chain reaction (PCR) frequently used to provide specific and rapid results using a range of patient specimens, including those with very low cell content.

The Therapies

Oral ("Copegus®", "Rebetol®") and aersol ("Virazole®") ribavirin are antiviral drugs that have been used successfully in some patients to combat both DNA and RNA viruses. Ribavirin is a nucleoside analogue

ith the chemical name of 1-(beta)-D-ribofuranosyl-1 H-1,2,4-triazole-3-carboxamide. the drug interrupts viral protein synthesis by interfering with mRNA transcription.

HRSV intravenous immune globulin (RSV-IVIG) was the first approved immunoprophylactic for hRSV therapy when it was released as Respigam in 1996. RSV-IVIG was prepared from pooled high titre sera containing protective and neutralising antibodies. RSV-IVIG is administered monthly for for 4 to 5mths over the peak season of virus activity to prevent infection. Palivizumab ("Synagis") is next a generation prophylactic consisting of a humanised monoclonal antibody (MAb). Palivizumab is given intramuscularly rather than IV but still requires administration throughout peak hRSV season.

A successful vaccine has not yet been marketed however this area is the focus of much research. In the mid-1960's, a formalin-inactivated whole-virus hRSV vaccine was trialled in infants who had no previous exposure to infection as determined by an absence of anti-hRSV antibodies. When these children were later infected during an hRSV outbreak, the resulting illnesses, especially in children under 2yrs of age, were severe. The incidence of pneumonia (60%) and hospitalisation (21%) was much higher than in children given a placebo (8% and 1.5%, respectively). The cotton-rat animal model has been widely used in studies attempting to explain the nature of enhanced disease. In particular, the lungs of animals immunized with a formalin-inactivated hRSV vaccine and challenged by infection with hRSV have been extensively examined to gain insight into the immune-mediated pathology that occurred.

source :http://www.uq.edu.au/vdu/VDUHumanRespiratorySyncytialVirus.htm

Diphtheria

* Diphtheria is a very contagious and potentially life-threatening bacterial disease.
* Diphtheria usually attacks the throat and nose. In more serious cases, it can attack the heart and nerves.
* Because of widespread immunization, diphtheria is very rare in the United States.
* Diphtheria is re-emerging in some areas of the world where immunization practices are lax. Routine vaccination of both children and adults is essential to prevent the re-emergence of diphtheria in the United States.

Diphtheria is a very contagious and potentially life-threatening infection that usually attacks the throat and nose. In more serious cases, it can attack the nerves and heart. Because of widespread immunization, diphtheria is very rare in the United States. However, some people are not adequately vaccinated, and cases still occur.
Diphtheria is caused by Corynebacterium diphtheriae, a bacterium. The bacterium produces a toxin (poison) that is carried in the bloodstream.
Diphtheria is common in many parts of the world. Diphtheria bacteria live in the mouth, nose, throat, or skin of infected persons.
Diphtheria spreads from person to person very easily. People get diphtheria by breathing in diphtheria bacteria after an infected person has coughed or sneezed. People also get diphtheria from close contact with discharges from an infected person's mouth, nose, throat, or skin.
Usually, diphtheria develops in the throat. Early symptoms are a sore throat and mild fever. A membrane that forms over the throat and tonsils can make it hard to swallow. The infection also causes the lymph glands and tissue on both sides of the neck to swell to an unusually large size.

Some people can be infected but not appear ill. They can also spread the infection.
Symptoms usually appear 2 to 4 days after infection.
Diagnosis is by physician examination and throat culture.Diphtheria is most common in areas where people live in crowded conditions with poor sanitation. Persons, especially children, who are not immunized or who did not receive adequate immunization are most at risk.If diphtheria is not properly treated, or not treated in time, the bacteria can produce a powerful toxin (poison). This poison can spread through the body and cause serious, often life-threatening complications. The diphtheria toxin can damage the heart muscles and cause heart failure or paralyze the breathing muscles. The membrane that forms over the tonsils can also move deeper into the throat and block the airway.
Diphtheria is a medical emergency. A delay in treatment can result in death or long-term heart disease. A person with diphtheria should be hospitalized until fully recovered. The person should be given a medicine (diphtheria antitoxin) to fight the diphtheria poison and antibiotics to fight the diphtheria bacteria. Some patients might need mechanical help in breathing (respirator).

Persons who have been in close contact with the patient should have throat cultures and be given antibiotics. They should be closely watched for possible symptoms. Close contacts who have not been immunized should receive a complete series of diphtheria shots. A booster vaccine can be given to persons who have been immunized before.
Diphtheria was once one of the most common causes of death in children. Since the introduction and widespread use of diphtheria vaccine, diphtheria has been rare in the United States. Between 1980 and 1995, 41 cases of diphtheria were reported to health authorities.

Diphtheria is still common in many other parts of the world, including the Caribbean and Latin America. During the last few years, large epidemics of diphtheria have occurred in the former Soviet republics. Outbreaks have also been reported in Algeria, China, and Ecuador. The majority of cases in many of these epidemics have been in adults and adolescents. Diphtheria has re-emerged in the newly independent states of the former Soviet Union and in some other parts of the world at near-epidemic levels. The increases have generally been the result of failed public health and immunization programs in areas weakened by economic and social turmoil.

In the United States, the diphtheria threat is shifting from children to adults and adolescents. Cases are occurring in persons who have not been immunized or in vaccinated persons who did not receive periodic booster doses to maintain their immunity. Routine vaccination of both children and adults is essential to prevent the re-emergence of diphtheria in the United States. There is a vaccine for diphtheria. The diphtheria vaccine is usually given in a combination shot with tetanus and pertussis vaccines, known as DTP vaccine. A child should have received four DTP shots by 18 months of age, with a booster shot at age 4 years to 6 years. After that, diphtheria and tetanus boosters should be given every 10 years to provide continued protection.

As is the case with all immunizations, there are important exceptions and special circumstances. Health-care providers should have the most current information on recommendations about diphtheria vaccination.

source : http://www.dhpe.org/infect/dip.html

HIB disease

What Is Hib Disease? Hib, which stands for Haemophilus influenzae type b, is not a disease itself, but rather is the name of a bacteria that causes several serious and often life-threatening illnesses. One. bacterial meningitis, may cause mental retardation in young children. Hib infection is the most common cause of bacterial meningitis, an inflammation of the membranes protecting the brain and spinal cord.

The same Hib bacteria also can cause pneumonia, an infectious arthritis called septic arthritis, epiglottitis (inflammation of the trachea or "windpipe"), otitis media middle ear infection), cellulitis (skin inflammation), and a dangerous heart disease, pericarditis. Although the word "influenzae" is part of the scientific name, Hib is not related to the virus that causes the respiratory infections generally called -flu." Healthy children may become mentally retarded if they develop bacterial meningitis caused by Hib Disease. Until December 1987, only children age two and older could effectively be vaccinated for protection from Hib disease. Now, a new vaccine using conjugate technology has been approved by the Food and Drug Administration for children as young as 18 months of age. With tests of the vaccine continuing on infants as young as two months it is hoped that mental retardation acquired by Hib disease will be totally preventable in the future. Who Is Most Susceptible To Hib? It is estimated that there are 20,000 - 30,000 cases of Hib disease annually, of which 12,000 - 15,000 are bacterial meningitis. The Hib bacteria primarily attacks children under age five. Statistically, one in every 200 children will contract Hib disease within the first five years of life. The risk of contracting Hib disease is greatest in environments where several children are in close contact for extended periods. These include group living situations, households with more than one child under age five, day-care centers and nurseries. Since Hib is present in respiratory secretions, it can be transmitted from one child to another by coughing, sneezing or through close facial contact. For reasons that are not fully understood, Hib disease is especially prevalent among certain ethnic groups. The incidence of Hib among Alaskan Eskimos has been 10 times that of the general United States' population, while the incidence among American Indians is five times as great as that in the general population. How Serious Is Bacterial Meningitis? Bacterial meningitis in the very young child is most commonly caused by Hib infection. It is nearly always fatal without treatment. Even with the use of modem antibiotics, three to five percent of meningitis victims die. Of those who survive, 25-35 percent suffer permanent brain damage resulting in mental retardation, hearing loss, partial blindness, speech disorders, paralysis of one side of the body, behavioral problems or seizures. How Is Hib Treated? Hib infections can be treated with antibiotics. However, there may be problems that remain after treatment. One reason for this is that many Hib diseases do not exhibit symptoms early, so that therapies often are begun too late. For instance, by the time severe symptoms signal parents that their child may have meningitis, brain cells may have already been permanently damaged or destroyed. Similarly, an Hib infection that results in epiglottitis often can block a child's windpipe within six to 12 hours (or even faster) after symptoms appear. Since antibiotics do not take effect immediately, emergency surgery often is required to save the child's life. In addition, sometimes antibiotic therapy is ineffective because certain strains of Hib bacteria have become resistant and do not respond to the antibiotics, ampicillin and chloramphenicol, which are usually used to treat the illness. How Can Hib Disease Be Prevented? The primary strategy for preventing Hib disease is immunization. As discussed earlier, a new vaccine is now available for use in children as young as 18 months old. The new vaccine utilizes a vaccine technology called conjugate technology which stimulates an enhanced immune reaction, enabling the poorly developed immune systems of young children to respond to the vaccine. Parents whose child's doctor had told them to wait for a Hib vaccine until their children reached 24 months should contact their doctor again to have their 18-month-olds vaccinated with the new vaccine. Only a single injection is required to help provide protection against Hib disease. If your child has been exposed to the disease, a drug may be administered that will lessen the risk of contracting the disease. How Many Children Can Now Be Protected From Hib Disease? The new vaccine extends protection against Hib disease to nearly 50 percent more children than were previously protected. This is because children between two and five years of age account for about 25 percent of Hib cases annually, while children between 18 and 24 months account for more than 12 percent of Hib cases. Because most children (63 percent) who contract Hib disease are under 18 months old, a substantial number remain at risk. However, early results of field trials of the newly approved vaccine on infants show promise that it will be effective in immunizing them against the disease.

source : http://findarticles.com/p/articles/mi_m0816/is_n4_v11/ai_9142291/?tag=content;col1

Human papillomavirus

Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it.

HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems.

Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years.

* But sometimes, certain types of HPV can cause genital warts in males and females. Rarely, these types can also cause warts in the throat -- a condition called recurrent respiratory papillomatosis or RRP.
* Other HPV types can cause cervical cancer. These types can also cause other, less common but serious cancers, including cancers of the vulva, vagina, penis, anus, and head and neck (tongue, tonsils and throat).

The types of HPV that can cause genital warts are not the same as the types that can cause cancer. There is no way to know which people who get HPV will go on to develop cancer or other health problems.

Signs and symptoms of HPV-related problems:

Genital warts usually appear as a small bump or groups of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. Health care providers can diagnose warts by looking at the genital area during an office visit. Warts can appear within weeks or months after sexual contact with an infected partner—even if the infected partner has no signs of genital warts. If left untreated, genital warts might go away, remain unchanged, or increase in size or number. They will not turn into cancer.

Cervical cancer usually does not have symptoms until it is quite advanced. For this reason, it is important for women to get regular screening for cervical cancer. Screening tests can find early signs of disease so that problems can be treated early, before they ever turn into cancer.

Other HPV-related cancers might not have signs or symptoms until they are advanced and hard to treat. These include cancers of the vulva, vagina, penis, anus, and head and neck. For signs and symptoms of these cancers, see www.cancer.gov.

RRP causes warts to grow in the throat. It can sometimes block the airway, causing a hoarse voice or troubled breathing.

HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms.

A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV.

Very rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. In these cases, the child can develop RRP.
HPV can cause normal cells on infected skin to turn abnormal. Most of the time, you cannot see or feel these cell changes. In most cases, the body fights off HPV naturally and the infected cells then go back to normal. But in cases when the body does not fight off HPV, HPV can cause visible changes in the form of genital warts or cancer. Warts can appear within weeks or months after getting HPV. Cancer often takes years to develop after getting HPV.
HPV (the virus). Approximately 20 million Americans are currently infected with HPV. Another 6 million people become newly infected each year. HPV is so common that at least 50% of sexually active men and women get it at some point in their lives.

Genital warts. About 1% of sexually active adults in the U.S. have genital warts at any one time.

Cervical cancer. Each year, about 12,000 women get cervical cancer in the U.S.

Other cancers that can be caused by HPV are less common than cervical cancer. Each year in the U.S., there are about:

* 3,700 women who get vulvar cancer
* 1,000 women who get vaginal cancer
* 1,000 men who get penile cancer
* 2,700 women and 1,700 men who get anal cancer
* 2,300 women and 9,000 men who get head and neck cancers. [Note: although HPV is associated with some of head and neck cancers, most of these cancers are related to smoking and heavy drinking.]

Certain populations are at higher risk for some HPV-related health problems. This includes gay and bisexual men, and people with weak immune systems (including those who have HIV/AIDS).

RRP is very rare. It is estimated that less than 2,000 children get RRP every year in the U.S.
There are several ways that people can lower their chances of getting HPV:

* Vaccines can protect males and females against some of the most common types of HPV. These vaccines are given in three shots. It is important to get all three doses to get the best protection. The vaccines are most effective when given before a person's first sexual contact, when he or she could be exposed to HPV.
o Girls and women: Two vaccines (Cervarix and Gardasil) are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines (Gardasil) also protects against most genital warts. Both vaccines are recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. These vaccines can also be given to girls as young as 9 years of age. It is recommended that females get the same vaccine brand for all three doses, whenever possible.
o Boys and men: One available vaccine (Gardasil) protects males against most genital warts. This vaccine is available for boys and men, 9 through 26 years of age.
* For those who choose to be sexually active, condoms may lower the risk of HPV. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV.
* People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That's why the only sure way to prevent HPV is to avoid all sexual activity.
There are ways to prevent the possible health effects of HPV, including the two most common problems: genital warts and cervical cancer.

* Preventing genital warts: A vaccine (Gardasil) is available to protect against most genital warts in males and females (see above).
* Preventing Cervical Cancer: There are two vaccines (Cervarix and Gardasil) that can protect women against most cervical cancers (see above). Cervical cancer can also be prevented with routine cervical cancer screening and follow-up of abnormal results. The Pap test can find abnormal cells on the cervix so that they can be removed before cancer develops. An HPV DNA test, which can find HPV on a woman's cervix, may also be used with a Pap test in certain cases. Even women who got the vaccine when they were younger need regular cervical cancer screening because the vaccine does not protect against all cervical cancers.
* Preventing Anal and Penile Cancers: There is no approved screening test to find early signs of penile or anal cancer. Some experts recommend yearly anal Pap tests to screen for anal cancer in gay and bisexual men and in HIV-positive persons. This is because anal cancer is more common in those populations. These tests are not routinely recommended for anal cancer screening because more information is still needed to find out if they are effective.
* Preventing Head and Neck Cancers: There is no approved test to find early signs of head and neck cancer, but tests are available by specialized doctors for persons with possible symptoms of these cancers. [see www.cancer.org]
* Preventing RRP: Cesarean delivery is not recommended for women with genital warts to prevent RRP in their babies. This is because it is not clear that cesarean delivery prevents RRP in infants and children.
The HPV tests on the market are only used to help screen for cervical cancer. There is no general test for men or women to check one’s overall “HPV status,” nor is there an HPV test to find HPV on the genitals or in the mouth or throat. But HPV usually goes away on its own, without causing health problems. So an HPV infection that is found today will most likely not be there a year or two from now.

source :http://www.cdc.gov/std/hpv/stdfact-hpv.htm

Pertusis Disease

Background

Pertussis, commonly known as whooping cough, is a respiratory tract infection characterized by a paroxysmal cough. It was first identified in the 16th century. In 1906, Bordet isolated the most common causative organism, Bordetella pertussis. Bordetella parapertussis has also been associated with whooping cough in humans. Before the advent of vaccinations, pertussis was a major cause of morbidity and mortality among infants and children. Reported cases of pertussis decreased by more than 99% after the introduction of pertussis vaccine combined with diphtheria and tetanus toxoids in the 1940s. However, despite considerable advances in the control of infectious diseases in children through global immunization programs, pertussis remains a disease of public health concern.
Pathophysiology

Humans are the sole reservoir for B pertussis and B parapertussis. B pertussis is a gram-negative pleomorphic bacillus that spreads via aerosolized droplets from coughing of infected individuals. B pertussis attaches to and damages ciliated respiratory epithelium.
Frequency
United States

Since the early 1980s, pertussis incidence has cyclically increased, with peaks occurring every 2-5 years.1 Most cases occur between June and September. Neither acquisition of the disease nor vaccination provides complete or lifelong immunity. Protection against typical disease wanes 3-5 years after vaccination and is not measurable after 12 years.

From 1980-2005, the reported incidence of pertussis in the United States dramatically increased across all age groups. Although the largest increase in pertussis cases has been among adolescents and adults, the annual reported incidence remained highest among infants younger than one year, at 55.2 cases per 100,000 population.2,3
International

The worldwide incidence is estimated to include 48.5 million cases and nearly 295,000 deaths per year.4 The case-fatality rate among infants in low-income countries may be as high as 4%.
Mortality/Morbidity

Infants born prematurely and patients with underlying cardiac, pulmonary, neuromuscular, or neurologic disease are at high risk for complications of pertussis (eg, pneumonia, seizures, encephalopathy, death). Older children, adolescents, and adults often have mild or atypical illness. Approximately one half of adolescents with pertussis cough for 10 weeks or longer. Complications among adolescents and adults include syncope, sleep disturbance, incontinence, rib fractures, and pneumonia.

Compared with older children and adults, infants younger than 6 months with pertussis are more likely to have severe disease, to develop complications, and to require hospitalization. From 2001-2003, 69% of infants younger than 6 months with pertussis required hospitalization.2

Pneumonia, either from B pertussis infection or from secondary infection with other pathogens, is a relatively common complication, occurring in approximately 13% of infants with pertussis.5

CNS complications such as seizures and encephalopathy are less common and are thought to result from severe paroxysm-induced cerebral hypoxia and apnea, metabolic disturbances such as hypoglycemia, and small intracranial hemorrhages.

Reported deaths due to pertussis in young infants have substantially increased over the past 20 years.6,7,8 From 1990-1999, the case fatality rate was approximately 1% in infants younger than 2 months and less than 0.5% in infants aged 2-11 months. Pertussis has been reported as a cause of sudden infant deaths.
Race

Data on race were available for 75% of patients younger than 20 years from 1997-2000.9 Of these patients, 88% were white, 8% were black, 2% were Asian/Pacific Islander, and 2% were American Indian/Alaska Native. In comparison, the national population estimates for persons younger than 20 years in 1998 were 79% white, 16% black, 4% Asian/Pacific Islander, and 1% American Indian/Alaska Native.
Sex

From 1997-2000, among pertussis cases in patients younger than 20 years, males and females were equally affected.9
Age

From 2001-2003, of patients with pertussis, 23% were younger than 1 year, 12% were aged 1-4 years, 9% were aged 5-9 years, 33% were aged 10-19 years, and 23% were older than 20 years.5
Clinical
History

Typically, the incubation period of pertussis ranges from 3-12 days. Pertussis is a 6-week disease divided into catarrhal, paroxysmal, and convalescent stages, each lasting from 1-2 weeks. The 3 stages of disease progression are as follows:

* Stage 1: The initial (catarrhal) phase is indistinguishable from common upper respiratory infections with nasal congestion, rhinorrhea, and sneezing, variably accompanied by low-grade fever, tearing, and conjunctival suffusion. Pertussis is most infectious when patients are in the catarrhal phase, but pertussis may remain communicable for 3 or more weeks after the onset of cough.
* Stage 2: Patients in the second (paroxysmal) phase present with paroxysms of intense coughing lasting up to several minutes. In older infants and toddlers, the paroxysms of coughing occasionally are followed by a loud whoop as inspired air goes through a still partially closed airway. Infants younger than 6 months do not have the characteristic whoop but may have apneic episodes and are at risk for exhaustion. Posttussive vomiting and turning red with coughing are common in affected children.
* Stage 3: Patients in the third (convalescent) stage have a chronic cough, which may last for weeks.

Older children, adolescents, and adults may not exhibit distinct stages. Symptoms in these patients include uninterrupted coughing, feelings of suffocation or strangulation, and headaches.
Physical

In patients with uncomplicated pertussis, physical examination findings contribute little to the diagnosis. In all patients with pertussis, fever is typically absent. Most patients do not have signs of lower respiratory tract disease. Conjunctival hemorrhages and facial petechiae are common and result from intense coughing.
Causes

B pertussis and B parapertussis are the causative organisms for pertussis infection in humans. Bacteria spread via aerosolized droplets from coughing of infected individuals. Humans are the sole reservoir for the organisms.

Transmission can occur through direct face-to-face contact, sharing a confined space, or through contact with oral, nasal, or respiratory secretions from an infected source. Pertussis is highly contagious, with as many as 80% of susceptible household contacts becoming infected after exposure. Family members or relatives were the suspected source of infection in 75% of cases.10

Young infants, especially those born prematurely, and patients with underlying cardiac, pulmonary, neuromuscular, or neurologic disease are at high risk for contracting the disease and for complications.


source : http://emedicine.medscape.com/article/967268-overview

Kawasaki Disease

Kawasaki disease is an illness that involves the skin, mouth, and lymph nodes, and most often affects kids under age 5. The cause is unknown, but if the symptoms are recognized early, kids with Kawasaki disease can fully recover within a few days. Untreated, it can lead to serious complications that can affect the heart.

Kawasaki disease occurs in 19 out of every 100,000 kids in the United States. It is most common among children of Japanese and Korean descent, but can affect all ethnic groups.
Signs and Symptoms

Kawasaki disease can't be prevented, but usually has telltale symptoms and signs that appear in phases.

The first phase, which can last for up to 2 weeks, usually involves a persistent fever higher than 104° Fahrenheit (39° Celsius) and lasts for at least 5 days.

Other symptoms that typically develop include:

* severe redness in the eyes
* a rash on the stomach, chest, and genitals
* red, dry, cracked lips
* swollen tongue with a white coating and big red bumps
* sore, irritated throat
* swollen palms of the hands and soles of the feet with a purple-red color
* swollen lymph nodes

During the second phase, which usually begins within 2 weeks of when the fever started, the skin on the hands and feet may begin to peel in large pieces. The child also may experience joint pain, diarrhea, vomiting, or abdominal pain. If your child shows any of these symptoms, call your doctor.
Complications

Doctors can manage the symptoms of Kawasaki disease if they catch it early. Symptoms often disappear within just 2 days of the start of treatment. If Kawasaki disease is treated within 10 days of the onset of symptoms, heart problems usually do not develop
Cases that go untreated can lead to more serious complications, such as vasculitis, an inflammation of the blood vessels. This can be particularly dangerous because it can affect the coronary arteries, which supply blood to the heart.

In addition to the coronary arteries, the heart muscle, lining, valves, and the outer membrane that surrounds the heart can become inflamed. Arrhythmias (changes in the normal pattern of the heartbeat) or abnormal functioning of some heart valves also can occur.
Diagnosis

No single test can detect Kawasaki disease, so doctors usually diagnose it by evaluating the symptoms and ruling out other conditions.

Most kids diagnosed with Kawasaki disease will have a fever lasting 5 or more days and at least four of these symptoms:

* redness in both eyes
* changes around the lips, tongue, or mouth
* changes in the fingers and toes, such as swelling, discoloration, or peeling
* a rash in the trunk or genital area
* a large swollen lymph node in the neck
* red, swollen palms of hands and soles of feet

If Kawasaki disease is suspected, the doctor may order tests to monitor heart function (such as an echocardiogram) and might take blood and urine samples to rule out other conditions, such as scarlet fever, measles, Rocky Mountain spotted fever, juvenile rheumatoid arthritis, or an allergic drug reaction.
Treatment

Treatment should begin as soon as possible, ideally within 10 days of when the fever begins. Usually, a child is treated with intravenous doses of gamma globulin (purified antibodies), an ingredient of blood that helps the body fight infection. The child also might be given a high dose of aspirin to reduce the risk of heart problems.

Reviewed by: Joel Klein, MD
source : http://kidshealth.org/parent/medical/allergies/kawasaki.html#

Abusive head trauma

Abusive head trauma/inflicted traumatic brain injury or AHT (also called shaken baby/shaken impact syndrome or SBS) is a form of inflicted head trauma.

AHT can be caused by direct blows to the head, dropping or throwing a child, or shaking a child. Head trauma is the leading cause of death in child abuse cases in the United States.
How These Injuries Happen

Unlike other forms of inflicted head trauma, abusive head trauma results from injuries caused by someone vigorously shaking a child. Because the anatomy of infants puts them at particular risk for injury from this kind of action, the vast majority of victims are infants younger than 1 year old. The average age of victims is between 3 and 8 months, although these injuries are occasionally seen in children up to 4 years old.

The perpetrators in these cases are most often parents or caregivers. Common triggers are frustration or stress when the child is crying. Unfortunately, the shaking may have the desired effect: although at first the baby cries more, he or she may stop crying as the brain is damaged.

Approximately 60% of identified victims of shaking injury are male, and children of families who live at or below the poverty level are at an increased risk for these injuries as well as any type of child abuse. It is estimated that the perpetrators in 65% to 90% of cases are males — usually either the baby's father or the mother's boyfriend, often someone in his early twenties.

When someone forcefully shakes a baby, the child's head rotates about the neck uncontrollably because infants' neck muscles aren't well developed and provide little support for their heads. This violent movement pitches the infant's brain back and forth within the skull, sometimes rupturing blood vessels and nerves throughout the brain and tearing the brain tissue. The brain may strike the inside of the skull, causing bruising and bleeding to the brain.

The damage can be even greater when a shaking episode ends with an impact (hitting a wall or a crib mattress, for example), because the forces of acceleration and deceleration associated with an impact are so strong. After the shaking, swelling in the brain can cause enormous pressure within the skull, compressing blood vessels and increasing overall injury to its delicate structure.

Normal interaction with a child, like bouncing the baby on a knee, will not cause these injuries, although it's important to never shake a baby under any circumstances because gentle shaking can rapidly escalate.

What Are the Effects?

AHT often causes irreversible damage. In the worst cases, children die due to their injuries.

Children who survive may have:

* partial or total blindness
* hearing loss
* seizures
* developmental delays
* impaired intellect
* speech and learning difficulties
* problems with memory and attention
* severe mental retardation
* cerebral palsy

Even in milder cases, in which babies looks normal immediately after the shaking, they may eventually develop one or more of these problems. Sometimes the first sign of a problem isn't noticed until the child enters the school system and exhibits behavioral problems or learning difficulties. But by that time, it's more difficult to link these problems to a shaking incident from several years before.
Signs and Symptoms

In any abusive head trauma case, the duration and force of the shaking, the number of episodes, and whether impact is involved all affect the severity of the infant's injuries. In the most violent cases, children may arrive at the emergency room unconscious, suffering seizures, or in shock. But in many cases, infants may never be brought to medical attention if they don't exhibit such severe symptoms.

In less severe cases, a child who has been shaken may experience:

* lethargy
* irritability
* vomiting
* poor sucking or swallowing
* decreased appetite
* lack of smiling or vocalizing
* rigidity
* seizures
* difficulty breathing
* altered consciousness
* unequal pupil size
* an inability to lift the head
* an inability to focus the eyes or track movement
Diagnosis

Many cases of AHT are brought in for medical care as "silent injuries." In other words, parents or caregivers don't often provide a history that the child has had abusive head trauma or a shaking injury, so doctors don't know to look for subtle or physical signs. This can sometimes result in children having injuries that aren't identified in the medical system.

And again, in many cases, babies who don't have severe symptoms may never be brought to a doctor. Many of the less severe symptoms such as vomiting or irritability may resolve and can have many non-abusive causes.

Unfortunately, unless a doctor has reason to suspect child abuse, mild cases (in which the infant seems lethargic, fussy, or perhaps isn't feeding well) are often misdiagnosed as a viral illness or colic. Without a diagnosis of child abuse and any resulting intervention with the parents or caregivers, these children may be shaken again, worsening any brain injury or damage.

If shaken baby syndrome is suspected, doctors may look for:

* hemorrhages in the retinas of the eyes
* skull fractures
* swelling of the brain
* subdural hematomas (blood collections pressing on the surface of the brain)
* rib and long bone (bones in the arms and legs) fractures
* bruises around the head, neck, or chest
The Child's Development and Education

What makes AHT so devastating is that it often involves a total brain injury. For example, a child whose vision is severely impaired won't be able to learn through observation, which decreases the child's overall ability to learn.

The development of language, vision, balance, and motor coordination, all of which occur to varying degrees after birth, are particularly likely to be affected in any child who has AHT.

Such impairment can require rigorous physical and occupational therapy to help the child acquire skills that would have developed on their own had the brain injury not occurred.

As they get older, kids who were shaken as babies may require special education and continued therapy to help with language development and daily living skills, such as dressing themselves.

Before age 3, a child can receive speech or physical therapy through the Department of Public Health/ Early Intervention. Federal law requires that each state provide these services for children who have developmental disabilities as a result of being abused.

Some schools are also increasingly providing information and developmental assessments for kids under the age of 3. Parents can turn to a variety of rehabilitation and other therapists for early intervention services for children after abusive head trauma. Developmental assessments can assist in improving education outcomes as well as the overall well-being of the child.

After a child who's been diagnosed with abusive head trauma turns 3, it's the school district's responsibility to provide additional special educational services.
Preventing AHT

Abusive head trauma is 100% preventable. A key aspect of prevention is increasing awareness of the potential dangers of shaking.

Finding ways to alleviate the parent or caregiver's stress at the critical moments when a baby is crying can significantly reduce the risk to the child. Some hospital-based programs have helped new parents identify and prevent shaking injuries and understand how to respond when infants cry.

The National Center on Shaken Baby Syndrome offers a prevention program, the Period of Purple Crying, which seeks to help parents and other caregivers understand crying in normal infants. By defining and describing the sometimes inconsolable infant crying that can sometimes cause stress, anger, and frustration in parents and caregivers, the program hopes to educate and empower people to prevent AHT.

One method that may help is author Dr. Harvey Karp's "five S's":

1. Shushing (using "white noise" or rhythmic sounds that mimic the constant whir of noise in the womb, with things like vacuum cleaners, hair dryers, clothes dryers, a running tub, or a white noise CD)
2. Side/stomach positioning (placing the baby on the left side — to help digestion — or on the belly while holding him or her, then putting the sleeping baby in the crib or bassinet on his or her back)
3. Sucking (letting the baby breastfeed or bottle-feed, or giving the baby a pacifier or finger to suck on)
4. Swaddling (wrapping the baby up snugly in a blanket to help him or her feel more secure)
5. Swinging gently (rocking in a chair, using an infant swing, or taking a car ride to help duplicate the constant motion the baby felt in the womb)

If a baby in your care won't stop crying, you can also try the following:

* Make sure the baby's basic needs are met (for example, he or she isn't hungry and doesn't need to be changed).
* Check for signs of illness, like fever or swollen gums.
* Rock or walk with the baby.
* Sing or talk to the baby.
* Offer the baby a pacifier or a noisy toy.
* Take the baby for a ride in a stroller or strapped into a child safety seat in the car.
* Hold the baby close against your body and breathe calmly and slowly.
* Call a friend or relative for support or to take care of the baby while you take a break.
* If nothing else works, put the baby on his or her back in the crib, close the door, and check on the baby in 10 minutes.
* Call your doctor if nothing seems to be helping your infant, in case there is a medical reason for the fussiness.

To prevent potential AHT, parents and caregivers of infants need to learn how to respond to their own stress. It's important to talk to anyone caring for your baby about the dangers of shaking and how it can be prevented.

Reviewed by: Elaine Cabinum-Foeller, MD
source : http://kidshealth.org/parent/medical/brain/shaken.html#

Sudden Infant Death Syndrome (SIDS)

Reducing the Risk

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 and environment. 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
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 1992 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 over 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, the AAP said, 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.
* 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.

Reviewed by: Floyd R. Livingston Jr., MD
source : http://kidshealth.org/parent/medical/sleep/sids.html#

Epilepsy

If you have a child with epilepsy, you're not alone — 2.5 million Americans have this disorder.

Anyone can get epilepsy at any age, but the majority of new diagnoses are in kids. About two-thirds of all kids with epilepsy outgrow the seizures that accompany it by the time they're teens.
About Epilepsy

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Epilepsy is a disease of the central nervous system in which electrical signals of the brain to misfire. These disruptions cause temporary communication problems between nerve cells, leading to seizures. A seizure can be thought of as an "electrical storm" that causes the brain to do things that the person having the seizure doesn't intend.
aving a single or sometimes even several seizures is not necessarily considered epilepsy. Kids with epilepsy are prone to having multiple seizures over a fairly long period of time (months to years).

Epilepsy:

* is not the only cause of childhood seizures
* is not a mental illness
* does not necessarily affect intelligence
* is not contagious
* does not typically worsen over time
* trauma to the brain (including lack of oxygen) due to an accident before, during, or after birth or later in childhood
* underlying metabolic disorders (chemical imbalances in the brain)
* brain tumors
* blood vessel malformation
* strokes
* chromosome disorders

In children, more than half of epilepsy cases are idiopathic (meaning there's no other identifiable cause or visible problem in the brain). In most of these, there is a family history of epilepsy or the condition is believed by experts to be genetic — a child who has a parent or other close family member with epilepsy is more likely to have it, too. Researchers are working to determine what specific genetic factors are responsible for these forms of epilepsy.
Understanding Seizures

Seizures vary in severity, frequency, duration (they typically last from a few seconds to several minutes), and in their appearance. There are many different kinds of seizures, and what occurs during one depends on where in the brain the electrical signals are disrupted.

The two main categories of seizures are generalized seizures, which affect the whole brain all at once, and partial seizures, in which only part of the brain is mostly affected. Some people with epilepsy experience both kinds. Also, the electrical problem in a partial seizure can spread to cause a generalized seizure.

Seizures can be scary — a child may lose consciousness or jerk or thrash violently and may appear to stop breathing or have difficulty breathing. Milder seizures may leave a child momentarily confused or unaware of his or her surroundings. Some seizures are so brief and minor that only careful observation or an experienced eye will detect them — a child may simply blink or stare into space for a moment before resuming normal activity. Even in those cases, it is usually obvious to parents that a child is having episodes of concern.

After seizures that last more than 30 seconds, most kids are exhausted, tired, sleepy, disoriented, confused, or even combative and agitated for minutes to hours. This is known as the postictal phase.

During a seizure, it's very important to stay calm and keep your child safe. Be sure to:

* Lay your child down away from furniture, stairs, radiators, or other hard or sharp objects.
* Put something soft under his or her head.
* Turn your child on his or her right side so fluid in the mouth can come out.
* Never stick anything in your child's mouth or try to restrain him or her.

Do your best to note how often the seizures take place, what happens during them, and how long they last and report this to your doctor. Once a seizure is over, watch your child for signs of confusion or the postictal phase. He or she may want to sleep and you should allow that. Do not give extra medication unless the doctor has prescribed it.

Kids who experience partial seizures may be frightened or confused during or after the seizure. Offer plenty of comfort and reassure your child that you're there and everything is OK.

Most seizures are not life-threatening, but if one lasts longer than 5 minutes or your child seems to have trouble breathing afterward, call 911 for immediate medical attention.
Diagnosis

Talk to your doctor if your child has seizures, staring spells, confusion spells, shaking spells, or unexplained deterioration in behavior or school performance. The doctor can refer you to a pediatric neurologist, who will take a patient medical history and examine your child, looking for findings that suggest problems with the brain or with the rest of the neurological system.

If the doctor suspects epilepsy, tests will be ordered, which may include:

* an electroencephalogram (EEG), which measures electrical activity of the brain via harmless sensors secured to the scalp while the child lays on a bed. Usually the doctor will ask that a child be sleep-deprived (put to bed late and awakened early) before this painless test, which typically takes about 1 hour.
* a magnetic resonance imaging (MRI) test or a computerized tomography (CAT) scan of the brain, both of which look at images of the brain

Treating Epilepsy

Your doctor will use the test and exam results to determine the best form of treatment. Medication to prevent seizures is usually the first type of treatment prescribed for epilepsy management. Most kids are successfully treated with one medication — and if the first doesn't work, the doctor will usually try a second or even a third before resorting to combinations of medications.

No medication for epilepsy is perfect. Like all medications, side effects are possible. The most common side effects include tiredness, decreased alertness, and mood or behavioral concerns, so parents should watch for these and discuss concerns with the treating doctor.

Nowadays, many choices are available and most kids treated with antiseizure medications do not experience worrisome side effects. Nevertheless, discuss any concerns you have with the doctor so that dose adjustments or appropriate changes can be made if appropriate.

Rarely, blood tests might be needed to monitor a medication's level in the bloodstream or to watch for side effects.

If your child still has seizures after the second or third medication tried, it's less likely that subsequent medications will be fully effective. In this case, more complicated treatments may be recommended or tried. These include:

* combinations of medications
* a special ketogenic diet (a high-fat, low-carbohydrate, low-protein diet that's often difficult to follow)
* implantation of a vagal nerve stimulator (an electrical pacemaker-like device placed in the chest and neck)
* surgery to remove the affected part of the brain, if possible. In the right situation, epilepsy surgery can be very effective or may even cure a child of seizures, but overall it is done in less than 10% of seizure patients, and only after an extensive screening and evaluation process.

Even people who respond successfully to medication sometimes have seizures (called "breakthrough seizures"). These don't mean the medication needs to be changed, although you should let the doctor know if they occur.
Living With Epilepsy

To help prevent seizures, make sure your child:

* takes medication(s) as prescribed
* avoids triggers (such as fever and overtiredness)
* sees the neurologist as recommended — about one to four times a year — even if responding well to medication

Keeping your child well fed, well rested, and reducing unnecessary stress are all key factors that can help manage epilepsy. Common-sense precautions to take (based on how well-controlled the epilepsy is) include:

* Younger kids should always be supervised in the bathtub (a responsible adult should always be within arm's reach) and older kids should take showers with the bathroom door unlocked — and only when there is someone else in the house. (It's also wise to lower the temperature of hot water so a child cannot be accidentally scalded during a seizure.)
* Swimming or biking alone are not good ideas for kids with epilepsy (although they can certainly enjoy these activities with other people). A responsible adult within arm's reach is recommended during swimming for kids with epilepsy. A helmet is required during bicycling, as it is for everyone.

With these simple safety precautions, your child should be able to play, participate in sports or other activities, and generally do what other kids like to do. State driving laws vary, but teens with epilepsy will probably be able to drive with some restrictions, as long as the seizures are controlled.

It's important to make sure that other adults who care for your child — family members, babysitters, teachers, coaches, etc. — know that your child has epilepsy, understand the condition, and know what to do in the event of a seizure.

Offer your child plenty of support, discuss epilepsy openly, and answer questions honestly. Kids with epilepsy may be embarrassed about the seizures or worry about having one at school or with friends.

Unfortunately, many kids with epilepsy have other neurological problems. In particular, learning and behavioral problems are common and can create more hardship for a child than the epilepsy itself. In some cases, the medication's side effects can aggravate these problems. Such difficulties might require the help of other specialists, teachers, and social workers. Consider having your child talk with a mental health counselor or psychologist if he or she struggles with these feelings or problems.

Parents caring for a child with epilepsy might benefit from advice from specialists such as psychologists, social workers, or specialized educators. For those whose kids have more severe epilepsy, this help is critical. Specialists can help parents plan for the future (transition services) by identifying social, financial, and other community resources that will improve your child's well-being.

Reviewed by: Francis Filloux, MD
source : http://kidshealth.org/parent/medical/brain/epilepsy.html#

Asperger Syndrome

An Autism Spectrum Disorder

Asperger syndrome (AS) is a neurobiological disorder that is part of a group of conditions called autism spectrum disorders. The term "autism spectrum" refers to a range of developmental disabilities that includes autism as well as other disorders with similar characteristics.

They are known as spectrum disorders because the symptoms of each can appear in different combinations and in varying degrees of severity: two children with the same diagnosis, though they may share certain patterns of behavior, can exhibit a wide range of skills and abilities.

As a result, general terms such as "low-functioning," "high-functioning," "autistic tendencies," "pervasive developmental disorder," and others are often used to describe children whose behaviors fall within the spectrum. Kids with AS share many of the same symptoms as those with "high-functioning autism."

It's estimated that more than 400,000 families are affected by AS. Because milder cases are being identified more frequently, the incidence appears to be increasing. However, like other autism spectrum disorders, AS is often difficult to diagnose and treat.
About Asperger Syndrome

The disorder is named after Hans Asperger, a Viennese pediatrician who, in 1940, first described a set of behavior patterns apparent in some of his patients, mostly males. Asperger noticed that although these boys had normal intelligence and language development, they had severely impaired social skills, were unable to communicate effectively with others, and had poor coordination.

According to the Asperger Syndrome Coalition of the United States, the onset of AS is later than what is typical in autism — or at least it is recognized later. Many kids are diagnosed after age 3, with most diagnosed between the ages of 5 and 9.

AS is characterized by poor social interactions, obsessions, odd speech patterns, and other peculiar mannerisms. Kids with AS often have few facial expressions and have difficulty reading the body language of others; they might engage in obsessive routines and display an unusual sensitivity to sensory stimuli (for example, they may be bothered by a light that no one else notices; they may cover their ears to block out sounds in the environment; or they might prefer to wear clothing made only of a certain material).
Overall, people with AS are capable of functioning in everyday life, but tend to be somewhat socially immature and may be seen by others as odd or eccentric.

Other characteristics of AS include motor delays, clumsiness, limited interests, and peculiar preoccupations. Adults with AS have trouble demonstrating empathy for others, and social interactions continue to be difficult. Experts say that AS follows a continuous course and usually lasts a lifetime. However, symptoms can wax and wane over time, and early intervention services can be helpful.
Signs and Symptoms

Because the symptoms of AS are often hard to differentiate from other behavioral problems, it's best to let a doctor or other health professional evaluate your child's symptoms. It's not uncommon for a child to be diagnosed with attention deficit hyperactivity disorder (ADHD) before a diagnosis of AS is made later.

These signs and symptoms might be present in a child with AS:

* inappropriate or minimal social interactions
* conversations almost always revolving around self rather than others
* "scripted," "robotic," or repetitive speech
* lack of "common sense"
* problems with reading, math, or writing skills
* obsession with complex topics such as patterns or music
* average to below-average nonverbal cognitive abilities, though verbal cognitive abilities are usually average to above-average
* awkward movements
* odd behaviors or mannerisms

It's important to note that, unlike kids with autism, those with AS might show no delays in language development; they usually have good grammatical skills and an advanced vocabulary at an early age. However, they typically do exhibit a language disorder — they might be very literal and have trouble using language in a social context.

Often there are no obvious delays in cognitive development or in age-appropriate self-help skills such as feeding and dressing themselves. Although kids with AS can have problems with attention span and organization, and have skills that seem well developed in some areas and lacking in others, they usually have average and sometimes above-average intelligence.
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What Causes Asperger Syndrome?

Researchers and mental health experts are still investigating the causes of autism and AS. Many believe that the pattern of behavior that characterizes AS may have many causes. There seems to be a hereditary component to AS, and research indicates that in some cases AS may be associated with other mental health disorders such as depression and bipolar disorder. Researchers are also looking into whether environmental factors that affect brain development might play a role.

Contrary to the incorrect assumptions some may make about people with the disorder, AS is not caused by emotional deprivation or the way a person has been brought up. Because some of the behaviors exhibited by someone with AS may be seen by others as intentionally rude, many people wrongly assume that AS is the result of bad parenting — it isn't. It's a neurobiological disorder whose causes are not yet fully understood.

Currently, there is no cure for the disorder — kids with AS become adults with AS. But many lead full and happy lives, and the likelihood of achieving this is enhanced with appropriate education, support, and resources.
Diagnosing Asperger Syndrome

Asperger syndrome can be very difficult to diagnose. Children with AS function well in most aspects of life, and so it can be easy to attribute their strange behaviors to just being "different."

According to mental health experts, if your child has AS, early intervention is very important. Intervention involving educational and social training, performed while a child's brain is still developing, is highly recommended.

If your child exhibits some of the symptoms and behaviors that are typical of AS, it's critical to seek help from your doctor. He or she can refer you to a mental health professional or other specialist for further evaluation.

When a specialist assesses your child, a thorough "psychosocial" evaluation will be performed. This includes a careful history of when symptoms were first recognized, the child's development of motor skills and language patterns, and other aspects of personality and behavior (including favorite activities, unusual habits, preoccupations, etc.).

Particular emphasis is placed on social development, including past and present problems in social interaction and development of friendships. A psychological evaluation and assessment of communication skills are usually conducted to determine your child's strengths and skills that may be deficient.

Treating Asperger Syndrome

Because AS can present patterns of behaviors and problems that differ widely from child to child, there isn't a "typical" or prescribed treatment regimen. However, your child may benefit from the following forms of treatment:

* parent education and training
* specialized educational interventions for the child
* social skills training
* language therapy
* sensory integration training for younger kids, usually performed by an occupational therapist, in which they are desensitized to stimuli to which they're overly sensitive
* psychotherapy or behavioral/cognitive therapy for older children
* medications

It will help if you involve all of your child's caregivers in the treatment. The health professionals who are caring for your child should know what the others are doing, and you will often find yourself acting as the "case manager" in this scenario. Teachers, babysitters, other family members, close friends, and anyone else who cares for your child also should be involved.

It's important to know that many people can provide assistance. Finding the right program for your child is key and getting help early is important. Kids with AS can and do experience great gains with the appropriate treatment and education.
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Helping Your Child

Although AS presents challenges for affected kids and their parents, you can help your child adjust and offer support in many ways:

* Look into educational or training programs for parents. You're your child's first teacher and you'll continue to be the cornerstone in supporting his or her development.
* Teach your child self-help skills. Learning these skills helps kids achieve maximum independence.
* Because it's not always obvious that a child has AS, alert others to the fact that your child has special needs. As a parent, you may have to take on the role of educator when dealing with teachers, medical personnel, and other caregivers.
* Find a program that addresses your child's specific needs or areas of "deficiency." The Autism Society of America (ASA) encourages family members to talk to the program director to determine if the curriculum or program addresses their child's particular issues.
* Choose special programs or treatments that focus on long-term outcomes and that take the developmental level of your child into consideration.
* Remember that your child is part of a family unit and that his or her needs should be balanced with the those of other family members.
* Get support for yourself and other family members. You can't help your child if you are not meeting your own emotional and physical needs. Your community may offer support groups at a local hospital or mental health center. There is considerable state-to-state variation in the types of government-sponsored services and other programs available to children with autism spectrum disorders and their families.

Your Child's Future

Currently, few facilities are specifically dedicated to providing for the needs of kids with AS. Some children are in mainstream schools where their progress depends on the support and encouragement of parents, caregivers, teachers, and classmates. However, some go to special schools for kids with autism or learning disabilities.

Many people with AS can function well in most aspects of life, so the condition does not have to prevent your child from succeeding academically and socially.

You may feel overwhelmed and discouraged if your child is diagnosed with AS. Remember that your child's treatment team can provide enormous support and encouragement for your child — and your family.

Reviewed by: Steven Dowshen, MD

source :http://kidshealth.org/parent/medical/brain/asperger.html#