Information on Children Health Concerns

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Children Health Concerns

Not all of your child's medical visits will be for routine checkups. Certain c-ow-mon problems, both acute and chronic, are worth mentioning briefly. (Most athese are reviewed in detail in the Reference section of this book.)

• Headaches. A little effort may be needed to separate the annoying butharmless ones from those that need medical attention.

(a) Tension-type (often called muscle-contraction) headaches, themost frequent in children and adults, have a typical pattern of painacross the forehead, often accompanied by a feeling of tightness arouncthe head and/or neck like a rubber band. These may be a physicalresponse to hunger, stress, or worry and usually respond to simple treat-ment: acetaminophen, a snack if he's hungry, a brief rest in a quiet envi-ronment, and a cool washcloth across the forehead.

(b) Migraine or vascular headaches involve changes in the diameter ofblood vessels, typically cause more severe, throbbing pain on one or hodsides of the head, and are often accompanied by nausea and vomiting. Amigraine in children often improves dramatically after throwing up.Often a child can tell when a headache is about to begin, and a promptdose of a nonprescription pain reliever may stop or relieve it. (Checkwith your child's physician.)

(c) Headaches caused by colds and sinus infections are usually accorn-panied by a runny nose, congestion, and pressure in the face. Decon-gestants may help relieve this discomfort, and your child's doctor mayprescribe antibiotics if a sinus infection appears likely.

(d) Headaches frequently accompany any illness that generates a fever.such as a sore throat, upper respiratory infection, or chicken pox. Theheadache will typically win, and wane with the temperature. If the pain isevere and relentless, and especially if it is accompanied by a stiff neck ofchange in behavior such as confusion or marked drowsiness, a medicalevaluation should be carried out immediately to rule out a more seriousinfection such as meningitis.

• Colds, ear infections, and other upper-respiratory infections will typi-cally occur less frequently now, but they will be easier to diagnose andtreat because your school-age child is better able to describe his symp-toms.

(a) More than one hundred types of viruses can cause colds, withtheir characteristic runny nose, scratchy throat, and hacking cough. Restfluids, a cool-mist humidifier, and seven to ten days (or less) for the immune system to banish the invaders are usually all the treatmentneeded. Over-the-counter cold and cough remedies may ease symptomsfor a few hours, although they have a better track record in adults. If oneof them helps your child feel better, you may use it as needed in theappropriate dose.

Acetaminophen or ibuprofen can help reduce aches, pains, and fever.Remember that the reason for reducing your child's fever is comfort, notmedical necessity, except in rare circumstances. Antibiotics are useless in treating a cold, but your child'sphysician may prescribe them if bacteria complicate the picture. Signsthat bacteria could be part of the problem include symptoms persistingfor more than ten to fourteen days, the appearance of discolored (yellowor green) drainage from the nose or phlegm from the chest for morethan a fern days, or fever that begins or worsens after several days ofillness.

(b)Ear infections occur less often because bacteria must travel alonger distance through the eustachian tubes now than when your childwas an infant and toddler. An infection usually causes persistent, some-times severe, pain and usually is treated with antibiotics. Because fluidcan accumulate in the middle-ear space during and after an infection, afollow-up visit to check both ear and hearing may be recommended.intense, continuous ear pain may also be caused by an infection in theouter ear canal or even by inflammation in the throat. Any ongoing earpain should be checked as soon as possible.

During a cold, your child may complain of intermittent ear pain thatmay disappear when he swallows or yawns. He probably has a congestedeustachian tube. Time and possibly decongestants should resolve theproblem, but the ear(s) should be checked by your doctor if the pain issevere, fever is present, or if there is any hearing loss or drainage fromthe ear. Occasionally, irritation of the joint where the jawbone connectswith the skull produces what seems to be an earache. A medical checkupwill be necessary to determine what is wrong.

(c)Sore throats are generally caused by viruses, although postnasaldrainage down the throat during a cold can provoke discomfort. In alimited number of sore throats, the culprit is a form of streptococcus(called group A beta hemolytic strep), which can generate a more seriousillness. If your child's throat is sore, inflamed, and accompanied by fever and headache, the doctor may do a strep test and/or a throat culture. Ifthe test is positive, antibiotics will be necessary.

• If your child is prone to allergies and/or asthma, you will probablyknow well before he reaches his fifth birthday. Nevertheless, some chil-dren who have had little trouble with the nose or chest may start tosniff, sneeze, or cough on an ongoing basis, raising concerns that "He'ssick all the time" or "She's had a cold for two months." These symp-toms are often caused by newly developed allergies. Reactive airwaysthat twitch and spasm sometimes provoke frequent coughing or overtwheezing, especially after exercise. Because allergies are often provokedby specific environmental factors (for example, house dust and mold),they can often be treated more effectively after you and your physicianor an allergist have done some detective work. If symptoms arefrequent or continuous, it's a good idea to seek medical assistance formanaging allergies, rather than relying strictly on over-the-counterantihistamines or decongestant-antihistamine combinations.

• Abdominal pains (stomach aches) will be felt occasionally by nearlyevery child, but in some they are a more frequent complaint (see side-bar). Sorting out the source of abdominal discomfort, whether a newevent or an ongoing problem, will require some investigation at homeand possibly in the doctor's office. For common patterns of pain andtheir possible causes, see abdominal pain, Reference.

• Orthopedic (bone and joint) problems are common in school-agechildren. As they develop greater body weight and stronger muscles,and then throw themselves enthusiastically into neighborhood gamesor organized sports, opportunities to sustain sprains, strains, or frac-tures increase dramatically. Depending upon your child's enthusiasmfor rough-and-tumble play, you may become well acquainted with alocal orthopedist during these years.
Another orthopedic concern is pain in an arm, leg, pelvis, back, or some °the,area of bone or muscle for no apparent reason. In general, bone/muscle/joint dis-comforts that need medical attention include:

• Pain that persists in one specific area for more than a day or two Pain that is intense enough to interfere with normal activities

• Pain associated with local redness, swelling, tenderness, or inability tomove a joint through its normal range of motion

• Limping or refusal to walk or run because of pain*

• Fever, nausea, rash, or other generalized symptoms associated with anyof the above*
The last three items marked with an asterisk (") should be evaluated as soon
as possible to avoid serious complications such as destruction of a joint or un-n_ntrolled infection. These symptoms could indicate that serious trouble is-:wing, including inflammation or infection of a bone or joint, an unsuspected--xture, or even a destructive process including the very rare instance of a tumorimplying a bone or soft tissue.

It's not uncommon for children in this age-group to mention occasional that a leg or some other area hurts. If none of the above red flags are preset wait-and-see approach is reasonable. Usually the pain will calm down on its own
within a short time and be forgotten. Some particularly vigorous play, for example, can cause overuse injuries such as minor muscle strain or irritation where muscle attaches to bone (tendonitis). Temporary aching in one or both legs
in the day or during the night has traditionally been called growing pain, although the cause is uncertain. No specific treatment is needed other that,your TLC, perhaps accompanied by gentle massage, heat, stretching, amacetaminophen or ibuprofen.

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