Tourette's syndrome (TS)
Tourette’s syndrome is a condition affecting the brain and nervous system (a neurological condition) that is characterised by involuntary, random sounds and movements, known as tics.
It usually begins in childhood.
Examples of simple physical tics include:
blinking of the eyes
jerking their head
twitching their nose
grinding their teeth
rolling their eyes
twisting their neck
rotating their shoulders
Simple phonic tics
Examples of simple phonic tics include:
grunting
clearing your throat
coughing
screaming
sniffing
squeaking
blowing
Examples of complex physical tics include:
shaking of the head
hitting or kicking objects
jumping
shaking
touching themselves or others
copying the movements of other people – the medical term for this is "echopraxia"
making obscene gestures, such as giving somebody "the finger" – known as copropraxia
Complex phonic tics
Examples of complex phonic tics include:
repeating other people’s phrases – known as "echolalia"
repeating the same phrase over and over again – known as "palilalia"
shouting swear words or inappropriate or words and phrases – known as "coprolalia"
While many people associate shouting swear words with Tourette’s, it’s actually a relatively uncommon symptom and only affects a minority of people with the syndrome.
Premonitory sensations
Complex physical tics
The tics do not usually pose a serious threat to a person's physical health, although physical tics, such as jerking of the head, can often be painful. However, children and adults affected by Tourette’s syndrome can experience associated problems such as social isolation, embarrassment and low self-esteem.
Most people with Tourette’s syndrome find that they experience uncomfortable or unusual physical feelings before they have a tic and this feeling is then only relieved once they carry out the tic – much like an itch that can only be relieved by scratching it.
These types of feelings are known as premonitory sensations.
Examples of premonitory sensations include:
a burning feeling in the eyes that feels as if it can only be relieved by blinking
tension in a muscle that can only be relieved by twitching or stretching the muscle
a dry and sore throat that can only be relieved by grunting or by clearing your throat
an itchy joint or limb that can only be relieved by twisting the joint or limb
Pattern of tics
If your child has Tourette’s syndrome, you will probably find that their tics follow a set pattern. Tics tend to be worse during periods of:
anxiety
stress
tiredness
illness
nervous excitement
On the other hand, the tics tend to be calmer when the child is taking part in an enjoyable activity that involves a high level of concentration, such as:
reading an interesting book
playing competitive sports
playing a computer game
You may find that your child is able to control their tics to a certain extent when they are in a place where they would be particularly noticeable, such as a classroom or lecture hall. However, maintaining control over tics can be difficult and tiring over prolonged periods of time.
Many children with Tourette’s syndrome often experience a sudden "release" of tics after trying to suppress them (for example, after returning home from school).
Treating Tourette’s syndrome
Some people with Tourette’s syndrome only experience tics occasionally and do not require treatment.
When the tics are more frequent, there are several medications that have proved reasonably effective in helping to control them.
A type of psychotherapy known as behavioural therapy can also be effective in many people with Tourette’s syndrome.
Associated conditions
Children who develop Tourette’s syndrome will usually also have one or more other developmental or behavioural conditions. The two most commonly reported conditions are described below:
Obsessive compulsive disorder (OCD) is a condition that causes persistent obsessive thoughts and compulsive behaviour. For example, feeling compelled to constantly wash your hands because you are obsessed with the fear that you will catch a serious illness if you don’t.
Attention deficit hyperactivity disorder (ADHD) is a behavioural condition that causes symptoms such as short attention span, being easily distracted and being unable to sit still because you are constantly fidgeting (hyperactivity).
In addition, children with Tourette’s syndrome may have other behavioural problems, such as flying into sudden rages or engaging in inappropriate or anti-social behaviour with other children.
In many cases, these associated conditions and behavioural problems can be more disruptive and troublesome than Tourette’s itself.
Causes
The cause of Tourette’s syndrome is unclear but it appears to be strongly associated with a part of the brain called the "basal ganglia", which plays an important role in regulating body movements.
In people with Tourette’s syndrome the basal ganglia appears to "misfire", resulting in the tics associated with the condition.
Who is affected by Tourette’s syndrome?
Tourette’s syndrome is a lot more common than most people realise, as it affects around 1 in every 100 people.
The symptoms usually begin at around the age of seven and become most pronounced during the teenage years.
Boys are more likely to be affected by Tourette’s syndrome than girls. It is unclear why this is the case.
Outlook
Two thirds of people will experience a marked improvement in their symptoms, usually around 10 years after they first began. Many of these people will no longer require medication or therapy to control their tics.
For some people the Tourette symptoms become much less troublesome and frequent, while for others they can disappear entirely.
In the remaining third of people with Tourette’s syndrome, their symptoms will persist throughout their life, but the symptoms will usually become milder as they grow older. This means their need for medication and therapy may pass over time.
When to seek medical advice
It is always recommended that you contact your GP for advice if either you or your child starts having tics.
Many children have tics for several months before growing out of them, so the appearance of tics does not automatically mean that your child has Tourette’s syndrome.
However, symptoms such as tics need further investigation and probably a referral to a doctor who specialises in conditions that affect the brain and nervous system (neurologist).
Tuesday, 30 April 2013
Saturday, 27 April 2013
Milk Allergy
Cows' Milk Allergy (CMA) – An introduction
The first months of your baby's life bring much joy. But equally there may be times when you have cause for concern. Even if you have had a baby before, no two infants are the same and it is often difficult to know what is part of an individual baby's development and when there is something amiss.
Because your baby can't tell you when there is a problem, it's right that you trust your instincts. The symptoms of Cows' Milk Allergy can be confused with other conditions but the allergy is more common than you think. In fact, 1 in 20 children under 3 years are allergic to cows' milk. This can make frequently used formula milks unsuitable – and in some cases even breast milk can be an irritant.
CMA can only be confirmed by healthcare professionals. So if you suspect your child's symptoms may be linked to cows' milk, it's important that you make an appointment to ask your doctor's advice.
What is a food allergic reaction?
In short, an allergic reaction to food occurs when the body’s immune system responds inappropriately to something in a particular food. The symptoms caused by this are called 'food allergic reactions'.
What happens in the body?
We all have an immune system to protect us from infections. Our immune system attacks the viruses and bacteria that can make us ill. An allergic reaction is simply an overreaction of that system. With a food allergy, the body’s immune system mistakenly recognises common “proteins” that are present in the foods we eat as potentially harmful. An immune response is set in motion aimed at neutralising the “harmful protein” and is responsible for the symptoms experienced when a child or adult is allergic to a certain food.
What makes diagnosis difficult is that the symptoms don’t always appear straight away. The immune system may respond to a food allergy within minutes of your child eating or drinking. In these cases, there are reliable tests which help doctors make the diagnosis.
Sometimes, the immune system can take longer to react - several hours or even days. This makes it difficult to diagnose through allergy testing.
Which foods are the typical culprits?
Cows' milk
Fish and shellfish
Hens' eggs
Peanuts and tree nuts
Soya beans
Although around a quarter of parents suspect their child has a food allergy, only 1 or 2 in every 20 young children are truly suffering from food allergy.
Food for thought
Food allergies are thought to be occurring more frequently - particularly in developed countries. Most food allergies are acquired in the first years of life and disappear again over time. Children who suffer from one food allergy might be hypersensitive to other foods as well.
Good news! Just because a child is allergic to one food doesn’t mean you have to automatically avoid all the foods which other children are allergic to. Your child’s doctor or dietitian will be able to advise which foods are likely to trigger an allergic reaction in your child.
By getting a correct diagnosis of a food allergy you can eliminate the food that is causing the allergy while ensuring that your child gets the right, nutritionally balanced, diet. Do tell your child’s doctor and/or dietitcian if you suspect symptoms which may be related to food allergies.
Cows’ Milk Allergy in children
When infants and children are fed cows’ milk or any parts of it, this can trigger allergic reactions. By avoiding the ‘proteins’ in cows’ milk completely, the symptoms caused by this reaction can be eliminated.
Cows’ milk – and the proteins it contains - is often one of the first complementary foods to be introduced into the infant’s diet. Cows’ milk is also commonly consumed throughout childhood as part of a balanced diet. Cows’ milk allergy (CMA) is the most common food allergy in infants and young children – up to 1 in 20 of all children may suffer.
The symptoms caused by CMA can be varied and may affect several parts of the body.
How the body is affected:
Skin – including rashes and eczema
Digestion – including vomiting, diarrhoea, colic
Breathing - including wheezing
Excessive crying
Allergic reactions can set in very rapidly (e.g. breathing problems, vomiting), but they can also be delayed or require more of the food (say a bottle of milk) to set them off.
In formula-fed infants and older children, avoiding whole cows’ milk proteins will be necessary to eliminate the symptoms of CMA. This may mean substitutes will need to be included in your child’s diet – your doctor or dietician is best placed to advise what’s best in each case.
If you are breastfeeding - it may be recommended that you avoid milk products – speak with a doctor or dietitian to ensure your diet remains adequate though before avoiding milk or dairy products.
If your baby is being bottle fed - there are alternative formulas containing ‘proteins’ which have been changed so that they are not like cows’ milk protein at all. Your doctor or dietitian will be able to recommend the best CMA management option for your child.
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Why does CMA occur?
It is not clearly understood why some children’s immune systems try to ‘fight’ certain foods or the ‘proteins’ they contain. In general, infants and young children are much more sensitive as their immune systems are still quite immature. Children coming from a family with an extensive history of allergy have a greater risk of developing food allergy than those with allergy-free relatives. However, even infants and children having no family history of allergy at all can have allergic symptoms.
What are common food allergy symptoms?
It’s not always easy to spot the symptoms of food allergies – even for doctors. That’s because the signs of food allergy can be mistaken for other common conditions seen in babies and infants.
The following may be clues to a food allergy, especially if accompanied by restless sleep or excessive crying:
• Eczema
• Diarrhoea
• Colic
• Constipation
• Wheezing
• Vomiting/Reflux
Sometimes the allergy in question can be to cows’ milk. Cows’ milk allergy (CMA) typically develops in the first year of life.
CMA or lactose intolerance?
Although Cows' Milk Allergy (CMA) and lactose intolerance can cause similar symptoms, they are two completely different conditions and affect the body in different ways. It is quite easy to confuse them, but the following information should help to explain the difference.
The main difference is that CMA is a food allergy, which means that the immune system overreacts to one or more “proteins” contained in cows' milk. To avoid a food allergic reaction, it is important to avoid the intake of the protein.
Lactose intolerance is the inability to digest the milk sugar which is called lactose. It is a food intolerance which means that the body cannot deal with this nutrient. The immune system is not involved so no allergic reaction takes place. Symptoms such as bloating, abdominal pain, flatulence, or diarrhoea can be signs of lactose intolerance. The skin and breathing are not usually affected. However like CMA, the symptoms of lactose intolerance can only be managed by avoiding certain foods. In this instance, any foods containing lactose – which means all sorts of milk and dairy products. Fortunately, lactose-free milk and dairy products are available in most shops and can be a good alternative.
Please go and see your child’s doctor or dietitian if you are worried or not sure about your child’s symptoms.
How is CMA diagnosed?
How can you find out for sure if your child is allergic to cows' milk? What will your child's doctor do to confirm the diagnosis?
What might happen at the doctor’s?
Diagnosing CMA can mean a bit more than a single test at the doctor’s.Your child’s symptoms, medical history and overall assessment will be taken into account along with any test results when deciding if your child has a food allergy.
Here are some questions your child’s doctor may ask:
How old was your child when you first noticed the symptoms?
How quickly do symptoms develop?
How severe are the symptoms?
How long do they last?
How often do they happen?
Where do symptoms usually appear? (For example at home, or at school?)
Do the same symptoms happen each time your child eats a particular food?
Do you suspect a specific food is involved – if so, how much of the suspected food does your child need to eat for symptoms to appear?
How you can best prepare for your doctor’s appointment:
When it comes to diagnosing allergies, the child’s medical history may be as important as any diagnostic test results. So do make a note of any information about your family’s medical history as well as the medical history of your child before visiting the doctor.
Identifying the symptoms is the first step in providing relief for your baby. So the more you tell your doctor, the better.
Why not keep a diary to see how different foods affect your baby?
There is a lot to cover at the doctor’s appointment so it’s a good idea to make a note of any questions you might like to ask your doctor so you don’t forget. Questions parents often ask include:
Could my child’s symptoms be caused by food allergy?
Is it possible to confirm if my child has a food allergy?
Which tests will have to be performed?
Do I need to see a specialist?
What will be the next steps?
Which tests might your doctor want to do to diagnose food allergy:
Your child’s doctor will use all of the information you provide to help decide whether allergy tests are called for. Allergy testing can involve:
Skin tests
Diets to aid a diagnosis
Elimination diet
Skin Prick Tests
Food challenges
Can it happen in breast-fed babies?
Very rarely, babies who only receive breast milk can react to cows’ milk proteins. These proteins can be passed on through their mother’s milk if she has been consuming dairy products. In this situation, healthcare professionals recommend that breast-feeding is continued due to its benefits and the mother tries to eliminate cows’ milk protein from her diet.
Breastfeeding and CMA
The first few months of a baby’s life are a crucial period for its growth and development. The World Health Organization (WHO) recommends breastfeeding exclusively for the first six months as breast milk contains antibodies which will help your baby’s immune system develop and protect against certain infections. Normally babies will not develop allergic symptoms while being exclusively breastfed.
If my baby has CMA do I have to stop breastfeeding?
Although breastfeeding is best for most children, very sensitive babies can have allergic reactions. This does not mean that they are allergic to breast milk itself. What happens is that they react to the small amounts of cows’ milk proteins (from milk or dairy products you have eaten) that pass from mother to baby in the breast milk. Should this happen, you may be advised to eliminate cows’ milk, dairy products, and all products containing cows’ milk from your diet. Please talk to a dietitian when eliminating any foods from your diet in order to be sure you – and your baby - are getting all the vital nutrients to stay healthy.
If your child shows allergic symptoms while being exclusively breast-fed, the ideal solution is to avoid foods containing cows’ milk proteins but still carry on breastfeeding. If you have any questions or concerns it is important that you ask your healthcare professiona
How are CMA symptoms managed?
CMA symptoms can be managed by eliminating cows’ milk protein from your child's diet. There are several substitutes available - including formulas containing cows’ milk proteins which have been changed or broken down (these are called ‘hydrolysed formulas’)and formulas that contain no cows’ milk protein at all (these are sometimes called ‘amino acid-based formulas’).
Because all children need proteins for growth and development, proteins can’t be completely removed from your child’s diet. So milk proteins must be replaced by alternatives. However, the majority of infant milk formulas you may be familiar with contain ‘intact or whole’ milk proteins and protein fragments (in other words, cows’ milk proteins which haven’t been changed or broken down). So many baby milk formulas aren’t suitable either.
What are the types of infant formula?
Standard infant formulas that you can buy in a supermarket or local shop
These are not suitable for babies allergic to certain proteins. This is because they are made with cows’ milk powder which has been modified to provide what is needed in a baby’s diet but still contain whole cows’ milk proteins. These proteins can cause allergic reactions in babies with CMA.
Extensively hydrolysed formulas (eHF)
These are formulas considered ‘foods for special medical purposes’ and are prescribed by a doctor for the management of CMA. Here the cows’ milk protein has been broken down into small fragments. However, depending on the type of milk allergy (immediate or delayed), eHFs may cause allergic symptoms in some children with severe cows’ milk allergy.
Amino acid-based formulas (AAF)
These formulas are also prescribed by the doctor for infants with CMA. They are similar to most other infant milks except for one important difference. Instead of being based on whole or broken down cows’ milk protein, they are based on amino acids, sometimes known as the building blocks of protein. These individual amino acids are so small that they are not recognised by the immune system and so are very unlikely to provoke any allergic reaction in children with cows’ milk allergy.
Soya milk
Soya formula used to be the only product that could be given to infants and children with CMA. Nowadays, formulas based on amino acids or hydrolysed proteins are widely available and are generally deemed to be more appropriate.
Soya infant formulas contain soya protein derived from soya flour, and a mixture of carbohydrates in the form of sucrose and corn syrup. Medical guidelines in the UK and the USA do not recommend soya products for infants under the age of 6 months and so should only be used in specified circumstances. If your child is over 6 months and your child’s doctor suggests a soya formula because of CMA, tolerance to soya protein may well need to be checked first.
Other milks
In some countries, milk from other mammals such as goats and sheep, have traditionally been used for feeding infants with CMA. Such milks are not always tolerated by babies allergic to cows’ milk as the proteins are very similar in structure to cows’ milk protein. Cereal milks could be another option, but if these milks are not fortified, some vitamins and minerals may be missing, and there could be inadequate amounts of essential nutrients your baby needs. Equally, it is recommended by the UK's Food Standard Agency that children under the age of 4.5 years do not consume rice milk.
Check with your child’s doctor or dietitian before feeding your child any of the alternatives above to make sure they can tolerate them and whether they meet your baby’sdietary requirements.
What can I do to relieve the symptoms?
Usually, symptoms will disappear once the allergic food has been identified and eliminated from the baby’s diet. Until this happens, here are some tips to help you and your baby:
What can I do if my baby has skin reactions?
Use a daily skin care routine regularly applying moisturising creams to prevent flares and further skin damage. Ask your pharmacist for suitable creams which won’t irritate the skin further. Try and prevent scratching or rubbing whenever possible. It will also help to keep rooms at a cool, stable temperature and consistent humidity levels. Try not to expose your baby’s skin to general irritants, such as
wool or synthetic fibres
soaps and detergents
perfumes and cosmetics
dust
sand
cigarette smoke
other chemicals such as chlorine, mineral oil, or solvents
What can I do if my baby has colic or cramps?
Baby colic usually improves on its own at around three to four months of age. In the meantime, prevent your baby swallowing air by sitting him or her as upright as possible during feeding. Remember also to let your baby burp often, sitting him upright or holding him upright on your shoulder, while supporting his neck and head. Gently rub his back and tummy until he burps. It is quite normal if he or she brings up a small amount of milk when you do this. Also, when bottle feeding, don’t let your baby drink too quickly.
What can I do if my baby has reflux?
Reflux is when liquid comes back up after being swallowed and is a natural mechanism that affects all babies, some more often than others. Here are some general feeding guidelines which should limit reflux to a minimum:
feed your baby in an upright position in a calm environment
feed smaller portions more often rather than larger meals
after feeding avoid jiggling your baby and allow time to burp
You can also try to adjust your baby’s sleeping position by raising the head of the cot. Tight clothing and pressure on the baby’s tummy e.g. in car seats should be avoided. Dummies can also help to neutralise some acidity in the reflux.
When should all the symptoms have disappeared?
If your child has been correctly diagnosed with CMA and is successfully eliminating cows' milk protein from it's diet then you are already half-way there!
After adjusting your child to a suitable formula, it may take a little while for their body to get back to normal – rather like waiting for a cut to heal. Of course, if you stop feeding the formula that suits your baby when the symptoms have disappeared or consume cows’ milk protein as part of your own diet while breastfeeding – symptoms could come back in a flash. Your child's doctor will be able to advise you on how long to avoid cows’ milk.
Some formulas prescribed by doctors (known as 'eHF') can still cause allergies in some children with CMA
If your infant is prescribed an extensively hydrolysed formula (eHF) and symptoms do not improve after two to four weeks, your doctor might consider switching to an amino-based formula (AAF). If symptoms do not disappear on an AAF, it may be time for another look at the diagnosis.
• What are eHFs?
Cows' milk-based formula treated with enzymes in order to break down most of the proteins that cause symptoms in allergic infants.
• What are AAFs?
Infant formula based on synthetic amino acids. It is suitable for the dietary management of children allergic to cows' milk or with multiple food protein intolerance.
When should my child’s condition be reviewed?
All children with CMA should be regularly checked by doctors for their general health, improvement in symptoms and, eventually, to find out if they have grown out of their allergy.
What is the doctor checking for?
Your child’s doctor will be looking out for:
Growth
Height
Ongoing signs and symptoms
Objective measures of food allergy
Check-ups should occur periodically so that the condition and the clearing of symptoms can be monitored appropriately.
Will my child grow out of cow’s milk allergy?
Many, but not all, children outgrow their food allergies. This depends on the individual child and can vary by type of foods.
Good news! The majority of children who are allergic to milk will grow out of their allergy by the age of 3 - 5 years.
Your doctor will re-evaluate your child to check. This process may include several tests, such as skin testing, blood tests, and/or oral food challenges depending on the type of the allergic reaction.
Types of allergic reactions
Don’t worry if your child still shows ‘positive’ reactions in skin or blood tests! It may be that a food challenge under the direction of a paediatric specialist may be necessary to prove that CMA has finally gone away.
TIP – Arrange regular check-ups of your child by their doctor. Ideally after the age of 12 months and not before 6 - 12 months after you noticed the last allergic reactions.
Why is weaning so important?
Weaning is an important time for families as it provides the ideal opportunity to introduce the infant to a variety of new tastes and textures. These early experiences have a strong effect on later eating habits as infants who miss important flavour and texture milestones may become faddy or difficult feeders in childhood and this may persist into adulthood. This means that obtaining a varied and balanced nutritional intake will be more difficult.
Why do parents of cows’ milk allergic infants find weaning so difficult?
Introduction of solid foods can be daunting for most, but for parents dealing with a cows’ milk allergic infant, this is potentially an even more challenging experience. Traditionally, mothers start weaning with baby rice, fruit and vegetables, followed shortly by fromage frais and yogurt. Finger foods such as bread sticks or toast fingers served with soft cheese are also popular weaning foods. Many of these foods , as well as other favourites such as broccoli in a cheese sauce cannot be given to cows’ milk allergic infants and should be avoided.
The most difficult question that remains however is at what point other foods that commonly cause allergies, such as egg, fish, soya, wheat, peanuts and tree nuts, can be safely introduced. Parents are understandably cautious when it comes to feeding their baby these foods.
Weaning is further complicated by additional restrictions on the use of soya milk (shouldn’t be used until 6 months of age) and rice milk (shouldn’t be used until 4.5 years) based products for all infants in the UK.
How can a dietitian help?
A dietitian can help to make weaning a less stressful event and will be able to advise parents on how to wean their infant confidently.
The dietitian can advise parents on:
When to wean
Each infant should be managed individually and developmental signs of readiness for solid food in the infant and parental opinions should be taken into consideration when advising on the ideal age to begin weaning.
Signs of developmental readiness:
Can sit up unsupported
Shows interest in other people’s eating
Chewing fists
Waking during the night when previously had slept through
Crying between feeds
What to do with the other foods commonly causing allergic reactions on infancy?
Some parents may ask if their cows’ milk allergic infant should be tested for other possible food allergies prior to introducing new foods. Unfortunately there is no clear guidance for health care professionals about whether to test or not, and practices may vary across the UK and indeed across the world.
It is however known that up to 50% of infants with CMA can also develop allergies to other foods.
The following is therefore recommended:
Introduce only one new food at a time and start with single ingredients
Your dietitian can provide you with a list of foods to introduce and start with small amounts, ideally cooked, of each food first and increase the amount of food if no reaction occurs.
Try to introduce new foods earlier during the day, so that you can observe any possible reactions and get advice if necessary.
Discuss clear steps with your doctor to follow in case of an allergic reaction to a food, particularly what to do if your child’s breathing is affected.
What if CMA continues beyond the first birthday?
Although many children will grow out of their cows’ milk allergy, for others it will continue, and for some, it may persist into their teenage years. During this time, children will be regularly reviewed, and possibly undergo further allergy tests and dietary challenges to see when they have outgrown CMA.
When CMA does persist beyond the early years, this can be particularly challenging because;
Energy requirements and the need for certain nutrients change as children grow
By this time, the child is developing his or her own taste preferences and can increasingly choose for themselves what they do and don’t eat
Food shopping for a child with CMA can be tricky because milk proteins are present in a wide range of products that are not always clearly labelled on the packaging
It is important to continue to exclude all cows’ milk protein from the diet whilst offering a healthy balanced diet in terms of calories, protein, calcium and vitamin content. Nutritional needs will vary between children and change as the child grows.
Even if CMA persists beyond the early years, you don’t need to manage alone. The advice of a dietitian can be invaluable in tailoring the diet to meet the child’s specific nutritional needs.
What diet should be followed as a child with CMA grows?
Growing children need calcium and other nutrients which are found in milk. Fortunately this can be obtained from a growing range of products that can be substituted in place of cows’ milk in a child’s diet.
These products vary in terms of taste, appearance and nutritional content and it will be important to tailor the choice of product to the dietary needs and preferences of the child.
It is important that parents and children think carefully before introducing any milk proteins. For instance, CMA reactions are often worse if the child is unwell, so it’s worth being extra careful with diet if they have a cold or other illness. If you are in any doubt, discuss these decisions with your healthcare professional.
Thinking ahead
It’s difficult to predict when children will grow out of CMA. You and your healthcare professional will want your child reviewed periodically to see if they still react to cows milk, however it is important to be prepared in case CMA persists into the school years. There are a wide range of modified products and milk protein alternatives available, and your healthcare professional is there to guide and support you, no matter how long CMA persists.
Allergies: Living with a soya allergy
Soya beans are legumes. Other foods in the legume family include kidney beans, string beans, black beans, pinto beans, chickpeas, lentils, carob, liquorice and peanuts. Many people are allergic to more than one legume. If your doctor is unable to identify which soya product is causing your allergy, you may be advised to avoid them all.
It is not always easy to avoid these foods since many surprising products may contain soya.
Who is allergic to soya?
Soya allergy is more common in infants. The average age at which the allergy manifests is three months but the majority of infants outgrow it by the age of two. Although adults do suffer from soya allergy, it is rare.
What are the symptoms?
There are many symptoms of soya allergy, including:
• Skin conditions, such as eczema
• Swelling
• Nasal congestion
• Anaphylaxis
• Asthma
• Mouth ulcers
• Colitis and other gastrointestinal problems, including diarrhoea
• Conjunctivitis
• Shortness of breath
• Fever, fatigue, weakness and nausea
• Low blood pressure
• Itching
• Hives
How do I avoid exposure?
Always check the ingredients on the label before you use a product. In addition, check the label each time you use a product. Manufacturers occasionally change recipes and a trigger food may be added to the new recipe.
Soya products include:
• Soya flour
• Soya nuts
• Soya milk
• Soya sprouts
• Soya bean granules or curds
• Tofu
Soya-containing ingredients include:
• Soya protein
• Textured vegetable protein (TPV)
• Hydrolysed plant protein
• Hydrolysed soya protein
• Hydrolysed vegetable protein
• Natural and artificial flavouring (may be soya based)
• Vegetable gum
• Vegetable starch
Soya-containing food includes:
• Miso
• Soy sauce
• Worcestershire sauce
• Tamari
• Tempeh
• Vegetable broth
• Some cereals
• Some infant formula
• Baked goods
http://www.webmd.boots.com/allergies/guide/allergies-living-with-soya-allergy
htthttp://www.bbc.co.uk/food/diets/dairy_free
p://www.cowsmilkallergy.co.uk/
http://www.theidbandco.com/Kids-Dairy-Allergy-Wristband-1120
The first months of your baby's life bring much joy. But equally there may be times when you have cause for concern. Even if you have had a baby before, no two infants are the same and it is often difficult to know what is part of an individual baby's development and when there is something amiss.
Because your baby can't tell you when there is a problem, it's right that you trust your instincts. The symptoms of Cows' Milk Allergy can be confused with other conditions but the allergy is more common than you think. In fact, 1 in 20 children under 3 years are allergic to cows' milk. This can make frequently used formula milks unsuitable – and in some cases even breast milk can be an irritant.
CMA can only be confirmed by healthcare professionals. So if you suspect your child's symptoms may be linked to cows' milk, it's important that you make an appointment to ask your doctor's advice.
What is a food allergic reaction?
In short, an allergic reaction to food occurs when the body’s immune system responds inappropriately to something in a particular food. The symptoms caused by this are called 'food allergic reactions'.
What happens in the body?
We all have an immune system to protect us from infections. Our immune system attacks the viruses and bacteria that can make us ill. An allergic reaction is simply an overreaction of that system. With a food allergy, the body’s immune system mistakenly recognises common “proteins” that are present in the foods we eat as potentially harmful. An immune response is set in motion aimed at neutralising the “harmful protein” and is responsible for the symptoms experienced when a child or adult is allergic to a certain food.
What makes diagnosis difficult is that the symptoms don’t always appear straight away. The immune system may respond to a food allergy within minutes of your child eating or drinking. In these cases, there are reliable tests which help doctors make the diagnosis.
Sometimes, the immune system can take longer to react - several hours or even days. This makes it difficult to diagnose through allergy testing.
Which foods are the typical culprits?
Cows' milk
Fish and shellfish
Hens' eggs
Peanuts and tree nuts
Soya beans
Although around a quarter of parents suspect their child has a food allergy, only 1 or 2 in every 20 young children are truly suffering from food allergy.
Food for thought
Food allergies are thought to be occurring more frequently - particularly in developed countries. Most food allergies are acquired in the first years of life and disappear again over time. Children who suffer from one food allergy might be hypersensitive to other foods as well.
Good news! Just because a child is allergic to one food doesn’t mean you have to automatically avoid all the foods which other children are allergic to. Your child’s doctor or dietitian will be able to advise which foods are likely to trigger an allergic reaction in your child.
By getting a correct diagnosis of a food allergy you can eliminate the food that is causing the allergy while ensuring that your child gets the right, nutritionally balanced, diet. Do tell your child’s doctor and/or dietitcian if you suspect symptoms which may be related to food allergies.
Cows’ Milk Allergy in children
When infants and children are fed cows’ milk or any parts of it, this can trigger allergic reactions. By avoiding the ‘proteins’ in cows’ milk completely, the symptoms caused by this reaction can be eliminated.
Cows’ milk – and the proteins it contains - is often one of the first complementary foods to be introduced into the infant’s diet. Cows’ milk is also commonly consumed throughout childhood as part of a balanced diet. Cows’ milk allergy (CMA) is the most common food allergy in infants and young children – up to 1 in 20 of all children may suffer.
The symptoms caused by CMA can be varied and may affect several parts of the body.
How the body is affected:
Skin – including rashes and eczema
Digestion – including vomiting, diarrhoea, colic
Breathing - including wheezing
Excessive crying
Allergic reactions can set in very rapidly (e.g. breathing problems, vomiting), but they can also be delayed or require more of the food (say a bottle of milk) to set them off.
In formula-fed infants and older children, avoiding whole cows’ milk proteins will be necessary to eliminate the symptoms of CMA. This may mean substitutes will need to be included in your child’s diet – your doctor or dietician is best placed to advise what’s best in each case.
If you are breastfeeding - it may be recommended that you avoid milk products – speak with a doctor or dietitian to ensure your diet remains adequate though before avoiding milk or dairy products.
If your baby is being bottle fed - there are alternative formulas containing ‘proteins’ which have been changed so that they are not like cows’ milk protein at all. Your doctor or dietitian will be able to recommend the best CMA management option for your child.
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Why does CMA occur?
It is not clearly understood why some children’s immune systems try to ‘fight’ certain foods or the ‘proteins’ they contain. In general, infants and young children are much more sensitive as their immune systems are still quite immature. Children coming from a family with an extensive history of allergy have a greater risk of developing food allergy than those with allergy-free relatives. However, even infants and children having no family history of allergy at all can have allergic symptoms.
What are common food allergy symptoms?
It’s not always easy to spot the symptoms of food allergies – even for doctors. That’s because the signs of food allergy can be mistaken for other common conditions seen in babies and infants.
The following may be clues to a food allergy, especially if accompanied by restless sleep or excessive crying:
• Eczema
• Diarrhoea
• Colic
• Constipation
• Wheezing
• Vomiting/Reflux
Sometimes the allergy in question can be to cows’ milk. Cows’ milk allergy (CMA) typically develops in the first year of life.
CMA or lactose intolerance?
Although Cows' Milk Allergy (CMA) and lactose intolerance can cause similar symptoms, they are two completely different conditions and affect the body in different ways. It is quite easy to confuse them, but the following information should help to explain the difference.
The main difference is that CMA is a food allergy, which means that the immune system overreacts to one or more “proteins” contained in cows' milk. To avoid a food allergic reaction, it is important to avoid the intake of the protein.
Lactose intolerance is the inability to digest the milk sugar which is called lactose. It is a food intolerance which means that the body cannot deal with this nutrient. The immune system is not involved so no allergic reaction takes place. Symptoms such as bloating, abdominal pain, flatulence, or diarrhoea can be signs of lactose intolerance. The skin and breathing are not usually affected. However like CMA, the symptoms of lactose intolerance can only be managed by avoiding certain foods. In this instance, any foods containing lactose – which means all sorts of milk and dairy products. Fortunately, lactose-free milk and dairy products are available in most shops and can be a good alternative.
Please go and see your child’s doctor or dietitian if you are worried or not sure about your child’s symptoms.
How is CMA diagnosed?
How can you find out for sure if your child is allergic to cows' milk? What will your child's doctor do to confirm the diagnosis?
What might happen at the doctor’s?
Diagnosing CMA can mean a bit more than a single test at the doctor’s.Your child’s symptoms, medical history and overall assessment will be taken into account along with any test results when deciding if your child has a food allergy.
Here are some questions your child’s doctor may ask:
How old was your child when you first noticed the symptoms?
How quickly do symptoms develop?
How severe are the symptoms?
How long do they last?
How often do they happen?
Where do symptoms usually appear? (For example at home, or at school?)
Do the same symptoms happen each time your child eats a particular food?
Do you suspect a specific food is involved – if so, how much of the suspected food does your child need to eat for symptoms to appear?
How you can best prepare for your doctor’s appointment:
When it comes to diagnosing allergies, the child’s medical history may be as important as any diagnostic test results. So do make a note of any information about your family’s medical history as well as the medical history of your child before visiting the doctor.
Identifying the symptoms is the first step in providing relief for your baby. So the more you tell your doctor, the better.
Why not keep a diary to see how different foods affect your baby?
There is a lot to cover at the doctor’s appointment so it’s a good idea to make a note of any questions you might like to ask your doctor so you don’t forget. Questions parents often ask include:
Could my child’s symptoms be caused by food allergy?
Is it possible to confirm if my child has a food allergy?
Which tests will have to be performed?
Do I need to see a specialist?
What will be the next steps?
Which tests might your doctor want to do to diagnose food allergy:
Your child’s doctor will use all of the information you provide to help decide whether allergy tests are called for. Allergy testing can involve:
Skin tests
Diets to aid a diagnosis
Elimination diet
Skin Prick Tests
Food challenges
Can it happen in breast-fed babies?
Very rarely, babies who only receive breast milk can react to cows’ milk proteins. These proteins can be passed on through their mother’s milk if she has been consuming dairy products. In this situation, healthcare professionals recommend that breast-feeding is continued due to its benefits and the mother tries to eliminate cows’ milk protein from her diet.
Breastfeeding and CMA
The first few months of a baby’s life are a crucial period for its growth and development. The World Health Organization (WHO) recommends breastfeeding exclusively for the first six months as breast milk contains antibodies which will help your baby’s immune system develop and protect against certain infections. Normally babies will not develop allergic symptoms while being exclusively breastfed.
If my baby has CMA do I have to stop breastfeeding?
Although breastfeeding is best for most children, very sensitive babies can have allergic reactions. This does not mean that they are allergic to breast milk itself. What happens is that they react to the small amounts of cows’ milk proteins (from milk or dairy products you have eaten) that pass from mother to baby in the breast milk. Should this happen, you may be advised to eliminate cows’ milk, dairy products, and all products containing cows’ milk from your diet. Please talk to a dietitian when eliminating any foods from your diet in order to be sure you – and your baby - are getting all the vital nutrients to stay healthy.
If your child shows allergic symptoms while being exclusively breast-fed, the ideal solution is to avoid foods containing cows’ milk proteins but still carry on breastfeeding. If you have any questions or concerns it is important that you ask your healthcare professiona
How are CMA symptoms managed?
CMA symptoms can be managed by eliminating cows’ milk protein from your child's diet. There are several substitutes available - including formulas containing cows’ milk proteins which have been changed or broken down (these are called ‘hydrolysed formulas’)and formulas that contain no cows’ milk protein at all (these are sometimes called ‘amino acid-based formulas’).
Because all children need proteins for growth and development, proteins can’t be completely removed from your child’s diet. So milk proteins must be replaced by alternatives. However, the majority of infant milk formulas you may be familiar with contain ‘intact or whole’ milk proteins and protein fragments (in other words, cows’ milk proteins which haven’t been changed or broken down). So many baby milk formulas aren’t suitable either.
What are the types of infant formula?
Standard infant formulas that you can buy in a supermarket or local shop
These are not suitable for babies allergic to certain proteins. This is because they are made with cows’ milk powder which has been modified to provide what is needed in a baby’s diet but still contain whole cows’ milk proteins. These proteins can cause allergic reactions in babies with CMA.
Extensively hydrolysed formulas (eHF)
These are formulas considered ‘foods for special medical purposes’ and are prescribed by a doctor for the management of CMA. Here the cows’ milk protein has been broken down into small fragments. However, depending on the type of milk allergy (immediate or delayed), eHFs may cause allergic symptoms in some children with severe cows’ milk allergy.
Amino acid-based formulas (AAF)
These formulas are also prescribed by the doctor for infants with CMA. They are similar to most other infant milks except for one important difference. Instead of being based on whole or broken down cows’ milk protein, they are based on amino acids, sometimes known as the building blocks of protein. These individual amino acids are so small that they are not recognised by the immune system and so are very unlikely to provoke any allergic reaction in children with cows’ milk allergy.
Soya milk
Soya formula used to be the only product that could be given to infants and children with CMA. Nowadays, formulas based on amino acids or hydrolysed proteins are widely available and are generally deemed to be more appropriate.
Soya infant formulas contain soya protein derived from soya flour, and a mixture of carbohydrates in the form of sucrose and corn syrup. Medical guidelines in the UK and the USA do not recommend soya products for infants under the age of 6 months and so should only be used in specified circumstances. If your child is over 6 months and your child’s doctor suggests a soya formula because of CMA, tolerance to soya protein may well need to be checked first.
Other milks
In some countries, milk from other mammals such as goats and sheep, have traditionally been used for feeding infants with CMA. Such milks are not always tolerated by babies allergic to cows’ milk as the proteins are very similar in structure to cows’ milk protein. Cereal milks could be another option, but if these milks are not fortified, some vitamins and minerals may be missing, and there could be inadequate amounts of essential nutrients your baby needs. Equally, it is recommended by the UK's Food Standard Agency that children under the age of 4.5 years do not consume rice milk.
Check with your child’s doctor or dietitian before feeding your child any of the alternatives above to make sure they can tolerate them and whether they meet your baby’sdietary requirements.
What can I do to relieve the symptoms?
Usually, symptoms will disappear once the allergic food has been identified and eliminated from the baby’s diet. Until this happens, here are some tips to help you and your baby:
What can I do if my baby has skin reactions?
Use a daily skin care routine regularly applying moisturising creams to prevent flares and further skin damage. Ask your pharmacist for suitable creams which won’t irritate the skin further. Try and prevent scratching or rubbing whenever possible. It will also help to keep rooms at a cool, stable temperature and consistent humidity levels. Try not to expose your baby’s skin to general irritants, such as
wool or synthetic fibres
soaps and detergents
perfumes and cosmetics
dust
sand
cigarette smoke
other chemicals such as chlorine, mineral oil, or solvents
What can I do if my baby has colic or cramps?
Baby colic usually improves on its own at around three to four months of age. In the meantime, prevent your baby swallowing air by sitting him or her as upright as possible during feeding. Remember also to let your baby burp often, sitting him upright or holding him upright on your shoulder, while supporting his neck and head. Gently rub his back and tummy until he burps. It is quite normal if he or she brings up a small amount of milk when you do this. Also, when bottle feeding, don’t let your baby drink too quickly.
What can I do if my baby has reflux?
Reflux is when liquid comes back up after being swallowed and is a natural mechanism that affects all babies, some more often than others. Here are some general feeding guidelines which should limit reflux to a minimum:
feed your baby in an upright position in a calm environment
feed smaller portions more often rather than larger meals
after feeding avoid jiggling your baby and allow time to burp
You can also try to adjust your baby’s sleeping position by raising the head of the cot. Tight clothing and pressure on the baby’s tummy e.g. in car seats should be avoided. Dummies can also help to neutralise some acidity in the reflux.
When should all the symptoms have disappeared?
If your child has been correctly diagnosed with CMA and is successfully eliminating cows' milk protein from it's diet then you are already half-way there!
After adjusting your child to a suitable formula, it may take a little while for their body to get back to normal – rather like waiting for a cut to heal. Of course, if you stop feeding the formula that suits your baby when the symptoms have disappeared or consume cows’ milk protein as part of your own diet while breastfeeding – symptoms could come back in a flash. Your child's doctor will be able to advise you on how long to avoid cows’ milk.
Some formulas prescribed by doctors (known as 'eHF') can still cause allergies in some children with CMA
If your infant is prescribed an extensively hydrolysed formula (eHF) and symptoms do not improve after two to four weeks, your doctor might consider switching to an amino-based formula (AAF). If symptoms do not disappear on an AAF, it may be time for another look at the diagnosis.
• What are eHFs?
Cows' milk-based formula treated with enzymes in order to break down most of the proteins that cause symptoms in allergic infants.
• What are AAFs?
Infant formula based on synthetic amino acids. It is suitable for the dietary management of children allergic to cows' milk or with multiple food protein intolerance.
When should my child’s condition be reviewed?
All children with CMA should be regularly checked by doctors for their general health, improvement in symptoms and, eventually, to find out if they have grown out of their allergy.
What is the doctor checking for?
Your child’s doctor will be looking out for:
Growth
Height
Ongoing signs and symptoms
Objective measures of food allergy
Check-ups should occur periodically so that the condition and the clearing of symptoms can be monitored appropriately.
Will my child grow out of cow’s milk allergy?
Many, but not all, children outgrow their food allergies. This depends on the individual child and can vary by type of foods.
Good news! The majority of children who are allergic to milk will grow out of their allergy by the age of 3 - 5 years.
Your doctor will re-evaluate your child to check. This process may include several tests, such as skin testing, blood tests, and/or oral food challenges depending on the type of the allergic reaction.
Types of allergic reactions
Don’t worry if your child still shows ‘positive’ reactions in skin or blood tests! It may be that a food challenge under the direction of a paediatric specialist may be necessary to prove that CMA has finally gone away.
TIP – Arrange regular check-ups of your child by their doctor. Ideally after the age of 12 months and not before 6 - 12 months after you noticed the last allergic reactions.
Why is weaning so important?
Weaning is an important time for families as it provides the ideal opportunity to introduce the infant to a variety of new tastes and textures. These early experiences have a strong effect on later eating habits as infants who miss important flavour and texture milestones may become faddy or difficult feeders in childhood and this may persist into adulthood. This means that obtaining a varied and balanced nutritional intake will be more difficult.
Why do parents of cows’ milk allergic infants find weaning so difficult?
Introduction of solid foods can be daunting for most, but for parents dealing with a cows’ milk allergic infant, this is potentially an even more challenging experience. Traditionally, mothers start weaning with baby rice, fruit and vegetables, followed shortly by fromage frais and yogurt. Finger foods such as bread sticks or toast fingers served with soft cheese are also popular weaning foods. Many of these foods , as well as other favourites such as broccoli in a cheese sauce cannot be given to cows’ milk allergic infants and should be avoided.
The most difficult question that remains however is at what point other foods that commonly cause allergies, such as egg, fish, soya, wheat, peanuts and tree nuts, can be safely introduced. Parents are understandably cautious when it comes to feeding their baby these foods.
Weaning is further complicated by additional restrictions on the use of soya milk (shouldn’t be used until 6 months of age) and rice milk (shouldn’t be used until 4.5 years) based products for all infants in the UK.
How can a dietitian help?
A dietitian can help to make weaning a less stressful event and will be able to advise parents on how to wean their infant confidently.
The dietitian can advise parents on:
When to wean
Each infant should be managed individually and developmental signs of readiness for solid food in the infant and parental opinions should be taken into consideration when advising on the ideal age to begin weaning.
Signs of developmental readiness:
Can sit up unsupported
Shows interest in other people’s eating
Chewing fists
Waking during the night when previously had slept through
Crying between feeds
What to do with the other foods commonly causing allergic reactions on infancy?
Some parents may ask if their cows’ milk allergic infant should be tested for other possible food allergies prior to introducing new foods. Unfortunately there is no clear guidance for health care professionals about whether to test or not, and practices may vary across the UK and indeed across the world.
It is however known that up to 50% of infants with CMA can also develop allergies to other foods.
The following is therefore recommended:
Introduce only one new food at a time and start with single ingredients
Your dietitian can provide you with a list of foods to introduce and start with small amounts, ideally cooked, of each food first and increase the amount of food if no reaction occurs.
Try to introduce new foods earlier during the day, so that you can observe any possible reactions and get advice if necessary.
Discuss clear steps with your doctor to follow in case of an allergic reaction to a food, particularly what to do if your child’s breathing is affected.
What if CMA continues beyond the first birthday?
Although many children will grow out of their cows’ milk allergy, for others it will continue, and for some, it may persist into their teenage years. During this time, children will be regularly reviewed, and possibly undergo further allergy tests and dietary challenges to see when they have outgrown CMA.
When CMA does persist beyond the early years, this can be particularly challenging because;
Energy requirements and the need for certain nutrients change as children grow
By this time, the child is developing his or her own taste preferences and can increasingly choose for themselves what they do and don’t eat
Food shopping for a child with CMA can be tricky because milk proteins are present in a wide range of products that are not always clearly labelled on the packaging
It is important to continue to exclude all cows’ milk protein from the diet whilst offering a healthy balanced diet in terms of calories, protein, calcium and vitamin content. Nutritional needs will vary between children and change as the child grows.
Even if CMA persists beyond the early years, you don’t need to manage alone. The advice of a dietitian can be invaluable in tailoring the diet to meet the child’s specific nutritional needs.
What diet should be followed as a child with CMA grows?
Growing children need calcium and other nutrients which are found in milk. Fortunately this can be obtained from a growing range of products that can be substituted in place of cows’ milk in a child’s diet.
These products vary in terms of taste, appearance and nutritional content and it will be important to tailor the choice of product to the dietary needs and preferences of the child.
It is important that parents and children think carefully before introducing any milk proteins. For instance, CMA reactions are often worse if the child is unwell, so it’s worth being extra careful with diet if they have a cold or other illness. If you are in any doubt, discuss these decisions with your healthcare professional.
Thinking ahead
It’s difficult to predict when children will grow out of CMA. You and your healthcare professional will want your child reviewed periodically to see if they still react to cows milk, however it is important to be prepared in case CMA persists into the school years. There are a wide range of modified products and milk protein alternatives available, and your healthcare professional is there to guide and support you, no matter how long CMA persists.
Allergies: Living with a soya allergy
Soya beans are legumes. Other foods in the legume family include kidney beans, string beans, black beans, pinto beans, chickpeas, lentils, carob, liquorice and peanuts. Many people are allergic to more than one legume. If your doctor is unable to identify which soya product is causing your allergy, you may be advised to avoid them all.
It is not always easy to avoid these foods since many surprising products may contain soya.
Who is allergic to soya?
Soya allergy is more common in infants. The average age at which the allergy manifests is three months but the majority of infants outgrow it by the age of two. Although adults do suffer from soya allergy, it is rare.
What are the symptoms?
There are many symptoms of soya allergy, including:
• Skin conditions, such as eczema
• Swelling
• Nasal congestion
• Anaphylaxis
• Asthma
• Mouth ulcers
• Colitis and other gastrointestinal problems, including diarrhoea
• Conjunctivitis
• Shortness of breath
• Fever, fatigue, weakness and nausea
• Low blood pressure
• Itching
• Hives
How do I avoid exposure?
Always check the ingredients on the label before you use a product. In addition, check the label each time you use a product. Manufacturers occasionally change recipes and a trigger food may be added to the new recipe.
Soya products include:
• Soya flour
• Soya nuts
• Soya milk
• Soya sprouts
• Soya bean granules or curds
• Tofu
Soya-containing ingredients include:
• Soya protein
• Textured vegetable protein (TPV)
• Hydrolysed plant protein
• Hydrolysed soya protein
• Hydrolysed vegetable protein
• Natural and artificial flavouring (may be soya based)
• Vegetable gum
• Vegetable starch
Soya-containing food includes:
• Miso
• Soy sauce
• Worcestershire sauce
• Tamari
• Tempeh
• Vegetable broth
• Some cereals
• Some infant formula
• Baked goods
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fetal alcohol syndrome x
Treatment
Treatment for children GPs can refer children with FAS and FASD to community paediatricians who are likely to investigate problems further with:
psychologists,
psychiatrists,
speech and language therapists
specialists for organ defects.
Research shows that people who have FAS or FASD go on to experience “secondary disabilities” – those not present at birth – which could be prevented with appropriate support.
So, one study found that of 414 people with FASD, 94% had mental health problems and nearly half (42%) ended up in the criminal justice system.
Secondary Disabilities
Loneliness
School Expulsions
Addictions
Chronic Unemployment
Promiscuity
Unplanned Pregnancies
Poverty
Criminality
Prison
Homelessness
Depression and Suicide
Advice for mums-to-be
We don’t know how much alcohol is safe to drink in pregnancy. It depends on various factors such as how fast a mum-to-be absorbs alcohol, her physical health, diet and what medication she is on. It’s why the government advises pregnant women and those trying to conceive to avoid alcohol altogether.If you didn’t know you were pregnant and you have been drinking above the government’s daily unit guidelines, don’t panic. Talk to your GP or midwife about any concerns you may have. Just because you may have drunk does not mean you have necessarily done damage.
Alcohol and conception
If you are trying to conceive, you should aim to reduce your alcohol consumption to a minimum, and ideally stop drinking altogether. If you are a regular drinker, try cutting down on alcohol gradually. Start off by reducing your drinking each day, and then try having a few alcohol free days a week before aiming to have only an occasional drink or preferably stop drinking altogether. Ask your partner to help you by cutting down drinking as well. If you are trying to conceive this is vital, as drinking impairs sperm count and heavy drinking can cause temporary impotence.
More information
The FASD Trust – www.fasdtrust.co.uk. The FASD Trust operates a helpline for parents and carers of children with FASD. Call 01608 811 599.
National Organisation on Foetal Alcohol Syndrome UK – www.nofas-uk.org. Or call their helpline on 08700 333 700.
Treatment for children GPs can refer children with FAS and FASD to community paediatricians who are likely to investigate problems further with:
psychologists,
psychiatrists,
speech and language therapists
specialists for organ defects.
Research shows that people who have FAS or FASD go on to experience “secondary disabilities” – those not present at birth – which could be prevented with appropriate support.
So, one study found that of 414 people with FASD, 94% had mental health problems and nearly half (42%) ended up in the criminal justice system.
Secondary Disabilities
Loneliness
School Expulsions
Addictions
Chronic Unemployment
Promiscuity
Unplanned Pregnancies
Poverty
Criminality
Prison
Homelessness
Depression and Suicide
Advice for mums-to-be
We don’t know how much alcohol is safe to drink in pregnancy. It depends on various factors such as how fast a mum-to-be absorbs alcohol, her physical health, diet and what medication she is on. It’s why the government advises pregnant women and those trying to conceive to avoid alcohol altogether.If you didn’t know you were pregnant and you have been drinking above the government’s daily unit guidelines, don’t panic. Talk to your GP or midwife about any concerns you may have. Just because you may have drunk does not mean you have necessarily done damage.
Alcohol and conception
If you are trying to conceive, you should aim to reduce your alcohol consumption to a minimum, and ideally stop drinking altogether. If you are a regular drinker, try cutting down on alcohol gradually. Start off by reducing your drinking each day, and then try having a few alcohol free days a week before aiming to have only an occasional drink or preferably stop drinking altogether. Ask your partner to help you by cutting down drinking as well. If you are trying to conceive this is vital, as drinking impairs sperm count and heavy drinking can cause temporary impotence.
More information
The FASD Trust – www.fasdtrust.co.uk. The FASD Trust operates a helpline for parents and carers of children with FASD. Call 01608 811 599.
National Organisation on Foetal Alcohol Syndrome UK – www.nofas-uk.org. Or call their helpline on 08700 333 700.
Drugs in pregnancy and the effects
Is it safe to take illegal drugs while I'm pregnant?
There's a lot we don't yet know about the exact effects of certain illegal drugs on unborn babies. But we do know about the harmful effects of other drugs. This is enough to make us sure that illegal drugs must always be considered unsafe, even in small amounts.
How do drugs affect my baby?
Drugs such as cannabis (mariujana), heroin and cocaine pass through the placenta to reach your baby.
Drugs in your body may reduce the amount of oxygen that can reach your baby. Early in pregnancy, some drugs may affect your baby's development. Your baby may not grow as well as expected in your uterus (womb).
Taking illegal drugs may cause problems later on in your pregnancy, too, as they can affect how well the placenta works. There is a risk that the placenta may come away from the side of your uterus, sometimes causing severe bleeding. This is called placental abruption. Placental abruption is a serious condition and can be life-threatening for you and your baby.
Your baby may have withdrawal symptoms if you regularly take certain drugs, such as heroin and cocaine, during your pregnancy. Your baby may need to stay in hospital, so nurses and doctors can check him for signs of withdrawal. Some babies need to have painkilling medicines to help them cope with the withdrawal symptoms.
What if I took drugs before finding out I was pregnant?
We know many people take drugs as part of their social life. If you took a drug without realising you were pregnant on a one-off occasion, be reassured that it's very unlikely to have affected your baby.
However, if illegal drugs are part of your life, getting help can really improve the outlook for you and your baby.
Marijuana:
Common slang names: pot, weed, grass and reefer
What happens when a pregnant woman smokes marijuana? Marijuana crosses the placenta to your baby. Marijuana, like cigarette smoke, contains toxins that keep your baby from getting the proper supply of oxygen that he or she needs to grow.
How can marijuana affect the baby? Studies of marijuana in pregnancy are inconclusive because many women who smoke marijuana also use tobacco and alcohol. Smoking marijuana increases the levels of carbon monoxide and carbon dioxide in the blood, which reduces the oxygen supply to the baby. Smoking marijuana during pregnancy can increase the chance of miscarriage, low birth weight, premature births, developmental delays, and behavioral and learning problems.
What if I smoked marijuana before I knew I was pregnant? According to Dr. Richard S. Abram, author of Will it Hurt the Baby, “occasional use of marijuana during the first trimester is unlikely to cause birth defects.” Once you are aware you are pregnant, you should stop smoking. Doing this will decrease the chance of harming your baby.
Cocaine:
Common slang names: bump, toot, C, coke, crack, flake, snow, and candy
What happens when a pregnant woman consumes cocaine? Cocaine crosses the placenta and enters your baby’s circulation. The elimination of cocaine is slower in a fetus than in an adult. This means that cocaine remains in the baby’s body much longer than it does in your body.
How can cocaine affect my baby? According to the Organization of Teratology Information Services (OTIS), during the early months of pregnancy cocaine exposure may increase the risk of miscarriage. Later in pregnancy, cocaine use can cause placental abruption. Placental abruption can lead to severe bleeding, preterm birth, and fetal death. OTIS also states that the risk of birth defects appears to be greater when the mother has used cocaine frequently during pregnancy. According to the American Congress of Obstetricians and Gynecology (ACOG), women who use cocaine during their pregnancy have a 25 % increased chance of premature labor. Babies born to mothers who use cocaine throughout their pregnancy may also have a smaller head and be growth restricted. Babies who are exposed to cocaine later in pregnancy may be born dependent and suffer from withdrawal symptoms such as tremors, sleeplessness, muscle spasms, and feeding difficulties. Some experts believe that learning difficulties may result as the child gets older. Defects of the genitals, kidneys, and brain are also possible.
What if I consumed cocaine before I knew I was pregnant? There have not been any conclusive studies done on single doses of cocaine during pregnancy. Birth defects and other side effects are usually a result of prolonged use, but because studies are inconclusive, it is best to avoid cocaine altogether. Cocaine is a very addictive drug and experimentation often leads to abuse of the drug.
Heroin:
Common slang names: horse, smack, junk, and H-stuff
What happens when a pregnant woman uses heroin? Heroin is a very addictive drug that crosses the placenta to the baby. Because this drug is so addictive, the unborn baby can become dependent on the drug.
How can heroin affect my baby? Using heroin during pregnancy increases the chance of premature birth, low birth weight, breathing difficulties, low blood sugar (hypoglycemia), bleeding within the brain (intracranial hemorrhage), and infant death. Babies can also be born addicted to heroin and can suffer from withdrawal symptoms. Withdrawal symptoms include irritability, convulsions, diarrhea, fever, sleep abnormalities, and joint stiffness. Mothers who inject narcotics are more susceptible to HIV, which can be passed to their unborn children.
What if I am addicted to heroin and I am pregnant? Treating an addiction to heroin can be complicated, especially when you are pregnant. Your health care provider may prescribe methadone as a form of treatment. It is best that you communicate with your health care provider, so he or she can provide the best treatment for you and your baby.
PCP & LSD:
What happens when a pregnant woman takes PCP and LSD? PCP and LSD are hallucinogens. Both PCP and LSD users can behave violently, which may harm the baby if the mother hurts herself.
How can PCP and LSD affect my baby? PCP use during pregnancy can lead to low birth weight, poor muscle control, brain damage, and withdrawal syndrome if used frequently. Withdrawal symptoms include lethargy, alternating with tremors. LSD can lead to birth defects if used frequently.
What if I experimented with LSD or PCP before I knew I was pregnant? No conclusive studies have been done on one time use effects of these drugs on the fetus. It is best not to experiment if you are trying to get pregnant or think you might be pregnant.
Methamphetamine:
Common slang names: meth, speed, crystal, glass, and crank
What happens when a pregnant woman takes methamphetamine? Methamphetamine is chemically related to amphetamine, which causes the heart rate of the mother and baby to increase.
How can methamphetamine affect my baby: Taking methamphetamine during pregnancy can result in problems similar to those seen with the use of cocaine in pregnancy. The use of speed can cause the baby to get less oxygen, which can lead to low birth weight. Methamphetamine can also increase the likelihood of premature labor, miscarriage, and placental abruption. Babies can be born addicted to methamphetamine and suffer withdrawal symptoms that include tremors, sleeplessness, muscle spasms, and feeding difficulties. Some experts believe that learning difficulties may result as the child gets older.
What if I experimented with methamphetamine before I knew I was pregnant? There have not been any significant studies done on the effect of one time use of methamphetamine during pregnancy. It is best not to experiment if you are trying to get pregnant or think you might be pregnant.
What does the law say?
Currently there are no states that holds prenatal substance abuse as a criminal act of child abuse and neglect. But many have expanded their civil child-welfare requirements to include substance abuse during pregnancy as grounds for terminating parental rights in relation to child abuse and neglect. The laws that adress prenatal substance abuse are as follows:
Iowa, Minnesota, and North Dakota’s health care providers are required to test for and report prenatal drug exposure. Kentucky health care providers are only required to test.
Alaska, Arizona, Illinois, Louisiana, Massachusetts, Michigan, Montana, Oklahoma, Utah, Rhode Island and Virginia’s, health care providers are required to report prenatal drug exposure. Reporting and testing can be evidence used in child welfare proceedings.
Some states consider prenatal substance abuse as part of their child welfare laws. Therefore prenatal drug exposure can provide grounds for terminating parental rights because of child abuse or neglect. These states include: Arkansas, Colorado, Florida, Illinois, Indiana, Iowa, Louisiana, Minnesota, Nevada, Rhode Island, South Carolina, South Dakota, Texas, Virginia, and Wisconsin.
Some states have policies that enforce admission to an inpatient treatment program for pregnant women who use drugs. These states include: Minnesota, South Dakota, and Wisconsin.
In 2004, Texas made it a felony to smoke marijuana while pregnant, resulting in a prison sentence of 2-20 years.
There's a lot we don't yet know about the exact effects of certain illegal drugs on unborn babies. But we do know about the harmful effects of other drugs. This is enough to make us sure that illegal drugs must always be considered unsafe, even in small amounts.
How do drugs affect my baby?
Drugs such as cannabis (mariujana), heroin and cocaine pass through the placenta to reach your baby.
Drugs in your body may reduce the amount of oxygen that can reach your baby. Early in pregnancy, some drugs may affect your baby's development. Your baby may not grow as well as expected in your uterus (womb).
Taking illegal drugs may cause problems later on in your pregnancy, too, as they can affect how well the placenta works. There is a risk that the placenta may come away from the side of your uterus, sometimes causing severe bleeding. This is called placental abruption. Placental abruption is a serious condition and can be life-threatening for you and your baby.
Your baby may have withdrawal symptoms if you regularly take certain drugs, such as heroin and cocaine, during your pregnancy. Your baby may need to stay in hospital, so nurses and doctors can check him for signs of withdrawal. Some babies need to have painkilling medicines to help them cope with the withdrawal symptoms.
What if I took drugs before finding out I was pregnant?
We know many people take drugs as part of their social life. If you took a drug without realising you were pregnant on a one-off occasion, be reassured that it's very unlikely to have affected your baby.
However, if illegal drugs are part of your life, getting help can really improve the outlook for you and your baby.
Marijuana:
Common slang names: pot, weed, grass and reefer
What happens when a pregnant woman smokes marijuana? Marijuana crosses the placenta to your baby. Marijuana, like cigarette smoke, contains toxins that keep your baby from getting the proper supply of oxygen that he or she needs to grow.
How can marijuana affect the baby? Studies of marijuana in pregnancy are inconclusive because many women who smoke marijuana also use tobacco and alcohol. Smoking marijuana increases the levels of carbon monoxide and carbon dioxide in the blood, which reduces the oxygen supply to the baby. Smoking marijuana during pregnancy can increase the chance of miscarriage, low birth weight, premature births, developmental delays, and behavioral and learning problems.
What if I smoked marijuana before I knew I was pregnant? According to Dr. Richard S. Abram, author of Will it Hurt the Baby, “occasional use of marijuana during the first trimester is unlikely to cause birth defects.” Once you are aware you are pregnant, you should stop smoking. Doing this will decrease the chance of harming your baby.
Cocaine:
Common slang names: bump, toot, C, coke, crack, flake, snow, and candy
What happens when a pregnant woman consumes cocaine? Cocaine crosses the placenta and enters your baby’s circulation. The elimination of cocaine is slower in a fetus than in an adult. This means that cocaine remains in the baby’s body much longer than it does in your body.
How can cocaine affect my baby? According to the Organization of Teratology Information Services (OTIS), during the early months of pregnancy cocaine exposure may increase the risk of miscarriage. Later in pregnancy, cocaine use can cause placental abruption. Placental abruption can lead to severe bleeding, preterm birth, and fetal death. OTIS also states that the risk of birth defects appears to be greater when the mother has used cocaine frequently during pregnancy. According to the American Congress of Obstetricians and Gynecology (ACOG), women who use cocaine during their pregnancy have a 25 % increased chance of premature labor. Babies born to mothers who use cocaine throughout their pregnancy may also have a smaller head and be growth restricted. Babies who are exposed to cocaine later in pregnancy may be born dependent and suffer from withdrawal symptoms such as tremors, sleeplessness, muscle spasms, and feeding difficulties. Some experts believe that learning difficulties may result as the child gets older. Defects of the genitals, kidneys, and brain are also possible.
What if I consumed cocaine before I knew I was pregnant? There have not been any conclusive studies done on single doses of cocaine during pregnancy. Birth defects and other side effects are usually a result of prolonged use, but because studies are inconclusive, it is best to avoid cocaine altogether. Cocaine is a very addictive drug and experimentation often leads to abuse of the drug.
Heroin:
Common slang names: horse, smack, junk, and H-stuff
What happens when a pregnant woman uses heroin? Heroin is a very addictive drug that crosses the placenta to the baby. Because this drug is so addictive, the unborn baby can become dependent on the drug.
How can heroin affect my baby? Using heroin during pregnancy increases the chance of premature birth, low birth weight, breathing difficulties, low blood sugar (hypoglycemia), bleeding within the brain (intracranial hemorrhage), and infant death. Babies can also be born addicted to heroin and can suffer from withdrawal symptoms. Withdrawal symptoms include irritability, convulsions, diarrhea, fever, sleep abnormalities, and joint stiffness. Mothers who inject narcotics are more susceptible to HIV, which can be passed to their unborn children.
What if I am addicted to heroin and I am pregnant? Treating an addiction to heroin can be complicated, especially when you are pregnant. Your health care provider may prescribe methadone as a form of treatment. It is best that you communicate with your health care provider, so he or she can provide the best treatment for you and your baby.
PCP & LSD:
What happens when a pregnant woman takes PCP and LSD? PCP and LSD are hallucinogens. Both PCP and LSD users can behave violently, which may harm the baby if the mother hurts herself.
How can PCP and LSD affect my baby? PCP use during pregnancy can lead to low birth weight, poor muscle control, brain damage, and withdrawal syndrome if used frequently. Withdrawal symptoms include lethargy, alternating with tremors. LSD can lead to birth defects if used frequently.
What if I experimented with LSD or PCP before I knew I was pregnant? No conclusive studies have been done on one time use effects of these drugs on the fetus. It is best not to experiment if you are trying to get pregnant or think you might be pregnant.
Methamphetamine:
Common slang names: meth, speed, crystal, glass, and crank
What happens when a pregnant woman takes methamphetamine? Methamphetamine is chemically related to amphetamine, which causes the heart rate of the mother and baby to increase.
How can methamphetamine affect my baby: Taking methamphetamine during pregnancy can result in problems similar to those seen with the use of cocaine in pregnancy. The use of speed can cause the baby to get less oxygen, which can lead to low birth weight. Methamphetamine can also increase the likelihood of premature labor, miscarriage, and placental abruption. Babies can be born addicted to methamphetamine and suffer withdrawal symptoms that include tremors, sleeplessness, muscle spasms, and feeding difficulties. Some experts believe that learning difficulties may result as the child gets older.
What if I experimented with methamphetamine before I knew I was pregnant? There have not been any significant studies done on the effect of one time use of methamphetamine during pregnancy. It is best not to experiment if you are trying to get pregnant or think you might be pregnant.
What does the law say?
Currently there are no states that holds prenatal substance abuse as a criminal act of child abuse and neglect. But many have expanded their civil child-welfare requirements to include substance abuse during pregnancy as grounds for terminating parental rights in relation to child abuse and neglect. The laws that adress prenatal substance abuse are as follows:
Iowa, Minnesota, and North Dakota’s health care providers are required to test for and report prenatal drug exposure. Kentucky health care providers are only required to test.
Alaska, Arizona, Illinois, Louisiana, Massachusetts, Michigan, Montana, Oklahoma, Utah, Rhode Island and Virginia’s, health care providers are required to report prenatal drug exposure. Reporting and testing can be evidence used in child welfare proceedings.
Some states consider prenatal substance abuse as part of their child welfare laws. Therefore prenatal drug exposure can provide grounds for terminating parental rights because of child abuse or neglect. These states include: Arkansas, Colorado, Florida, Illinois, Indiana, Iowa, Louisiana, Minnesota, Nevada, Rhode Island, South Carolina, South Dakota, Texas, Virginia, and Wisconsin.
Some states have policies that enforce admission to an inpatient treatment program for pregnant women who use drugs. These states include: Minnesota, South Dakota, and Wisconsin.
In 2004, Texas made it a felony to smoke marijuana while pregnant, resulting in a prison sentence of 2-20 years.
Miscarriage
A miscarriage is the loss of a pregnancy that happens sometime during the first 23 weeks. Around three quarters of miscarriages happen during the first 12 weeks of pregnancy (the first trimester).
The main symptom of a miscarriage is vaginal bleeding, which may be followed by cramping and pain in your lower abdomen. If you have vaginal bleeding, contact your maternity team or early pregnancy unit at your local hospital straight away.
While a miscarriage does not usually seriously affect a woman’s physical health, it can have a significant emotional impact. Many couples experience feelings of loss and grief.You may also need treatment to remove any tissue that left in your womb. For most women, a miscarriage is a one-off event and they go on to have a successful pregnancy in the future.
What causes a miscarriage?
It is thought that two thirds of early miscarriages are due to abnormal chromosomes in the baby. Chromosomes are genetic "building blocks" that guide the development of a baby. If a baby has too many or not enough chromosomes, the pregnancy can end in miscarriage. In later miscarriages, a problem with the womb or cervix (neck of the womb) may be the cause.
How common are miscarriages?
Miscarriages are much more common than most people realise. This may be because many women who have had a miscarriage prefer not to talk about it.
Among women who know they are pregnant, it is estimated that 12% of these pregnancies will end in miscarriage. This is around one in eight pregnancies. Many more miscarriages occur before a woman is even aware that she has become pregnant.
Losing three or more pregnancies in a row (recurrent miscarriages) is uncommon and affects around 1 in 100 women. Even in cases of recurrent miscarriages, an estimated three quarters of women go on to have a successful pregnancy in the future.
Symptoms of a miscarriage
Light vaginal bleeding is common during the first trimester of pregnancy (the first 12 weeks), so having this symptom does not necessarily mean that you have had a miscarriage. However, if you have vaginal bleeding, contact your maternity team or early pregnancy unit at your local hospital straight away.
Other symptoms
Other symptoms of a miscarriage include:
cramping and pain in your lower abdomen
a discharge of fluid from your vagina
a discharge of tissue from your vagina
no longer experiencing the symptoms of pregnancy, such as feeling sick and breast tenderness
When to seek urgent medical help
On rare occasions, miscarriages happen because the pregnancy develops outside the womb. This is known as an ectopic pregnancy. Ectopic pregnancies are potentially serious because there is a risk that you could experience internal bleeding.
Symptoms of an ectopic pregnancy include:
heavy vaginal bleeding (soaking more than one sanitary pad every hour)
persistent and severe abdominal pain
pain in your shoulder tip
feeling very faint and light-headed, and possibly fainting
Symptoms of an ectopic pregnancy usually appear between weeks 5-14 of the pregnancy.
If you experience any of the symptoms above, visit your nearest accident and emergency (A&E) department immediately. If you are unable to travel, you can call up and get advice from NHS Direct on 0845204647
Molar pregnancies
Vaginal bleeding can also be caused by a molar pregnancy. This is a pregnancy that has not developed normally, resulting in a mass of abnormal cells within the womb instead of a baby. A molar pregnancy is usually identified during the first ultrasound scan, at 10-16 weeks of pregnancy.
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The main symptom of a miscarriage is vaginal bleeding, which may be followed by cramping and pain in your lower abdomen. If you have vaginal bleeding, contact your maternity team or early pregnancy unit at your local hospital straight away.
While a miscarriage does not usually seriously affect a woman’s physical health, it can have a significant emotional impact. Many couples experience feelings of loss and grief.You may also need treatment to remove any tissue that left in your womb. For most women, a miscarriage is a one-off event and they go on to have a successful pregnancy in the future.
What causes a miscarriage?
It is thought that two thirds of early miscarriages are due to abnormal chromosomes in the baby. Chromosomes are genetic "building blocks" that guide the development of a baby. If a baby has too many or not enough chromosomes, the pregnancy can end in miscarriage. In later miscarriages, a problem with the womb or cervix (neck of the womb) may be the cause.
How common are miscarriages?
Miscarriages are much more common than most people realise. This may be because many women who have had a miscarriage prefer not to talk about it.
Among women who know they are pregnant, it is estimated that 12% of these pregnancies will end in miscarriage. This is around one in eight pregnancies. Many more miscarriages occur before a woman is even aware that she has become pregnant.
Losing three or more pregnancies in a row (recurrent miscarriages) is uncommon and affects around 1 in 100 women. Even in cases of recurrent miscarriages, an estimated three quarters of women go on to have a successful pregnancy in the future.
Symptoms of a miscarriage
Light vaginal bleeding is common during the first trimester of pregnancy (the first 12 weeks), so having this symptom does not necessarily mean that you have had a miscarriage. However, if you have vaginal bleeding, contact your maternity team or early pregnancy unit at your local hospital straight away.
Other symptoms
Other symptoms of a miscarriage include:
cramping and pain in your lower abdomen
a discharge of fluid from your vagina
a discharge of tissue from your vagina
no longer experiencing the symptoms of pregnancy, such as feeling sick and breast tenderness
When to seek urgent medical help
On rare occasions, miscarriages happen because the pregnancy develops outside the womb. This is known as an ectopic pregnancy. Ectopic pregnancies are potentially serious because there is a risk that you could experience internal bleeding.
Symptoms of an ectopic pregnancy include:
heavy vaginal bleeding (soaking more than one sanitary pad every hour)
persistent and severe abdominal pain
pain in your shoulder tip
feeling very faint and light-headed, and possibly fainting
Symptoms of an ectopic pregnancy usually appear between weeks 5-14 of the pregnancy.
If you experience any of the symptoms above, visit your nearest accident and emergency (A&E) department immediately. If you are unable to travel, you can call up and get advice from NHS Direct on 0845204647
Molar pregnancies
Vaginal bleeding can also be caused by a molar pregnancy. This is a pregnancy that has not developed normally, resulting in a mass of abnormal cells within the womb instead of a baby. A molar pregnancy is usually identified during the first ultrasound scan, at 10-16 weeks of pregnancy.
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Thursday, 18 April 2013
Spina Bifida
What causes spina bifida?
During the first month of life, an embryo (developing baby) grows a structure called the neural tube that will eventually form the spine and nervous system.
In cases of spina bifida, something goes wrong and the spinal column (the bone that surrounds and protects the nerves) does not fully close. Spina bifida is also known as split spine.
The exact reasons why this happens are unknown but several risk factors have been identified, the most significant being a lack of folic acid before and at the very start of pregnancy.
The most effective way to prevent spina bifida (myelomeningocele) is to take folic acid supplements both before and during pregnancy.
Folic acid
The Department of Health recommends all women who might get pregnant should take a daily supplement of 0.4mg of folic acid. You should also take this supplement for the first 12 weeks of pregnancy because this is when your baby's spine is developing.
Women thought to be at higher risk of having a child with spina bifida may need a higher dose of folic acid. This includes women who:
• have diabetes, a condition caused by too much glucose (sugar) in the blood
• are taking medicines, such as carbamazepine, used to treat epilepsy, a condition that causes repeated seizures (fits)
Your GP will advise you about this.
Folic acid tablets are available on prescription or from pharmacies, large supermarkets and health food stores. Natural sources of folic acid include:
• broccoli
• peas
• asparagus
• brussels sprouts
• chickpeas
• brown rice
• some bread
• some breakfast cereals
If you are taking medication for a condition such as epilepsy, it is important you check with your GP before taking folic acid. This is because some types of medication can cancel out the effects of folic acid supplements.
Myelomeningocele – one in one thousand pregnancies
There are a number of different types of spina bifida, the most serious being myelomeningocele (affecting one pregnancy in every 1,000 in Britain).
These pages focus on myelomeningocele and this is the type of spina bifida referred to whenever the term spina bifida is used.
In myelomeningocele, the spinal column remains open along the bones that make up the spine. The membranes and spinal cord push out to create a sac in the baby’s back. This sometimes leaves the nervous system vulnerable to infections that may be fatal.
In most cases of myelomeningocele, surgery can be carried out to close the defect. However, damage to the nervous system will usually have already taken place, resulting in a range of symptoms including:
• partial or total paralysis of the lower limbs
• bowel incontinence and urinary incontinence
• loss of skin sensation
Read more about the symptoms of spina bifida.
Most babies with myelomeningocele will also develop hydrocephalus, which is excess cerebrospinal fluid (CSF) surrounding the brain.
Hydrocephalus needs to be treated urgently with surgery as the pressure on the brain can cause brain damage.
Read more about hydrocephalus.
Different types of spina bifida
Spina bifida occulta
Spina bifida occulta is the least serious type of spina bifida. In this type of spina bifida, the opening in the spine is very small, with a gap in one or more vertebrae (disc-shaped bones of the spine). The opening in the spine is covered with skin, so the gap is not visible from the outside.
Spina bifida occulta does not usually cause any symptoms and most people are unaware they have the condition. In such cases, no treatment is required. In other cases, some symptoms may be apparent, such as bladder and bowel problems, or scoliosis (an abnormal curvature of the spine).
Spina bifida meningocele
Spina bifida meningocele is the rarest type of spina bifida. In this type the protective membranes that surround the spinal cord (the meninges) are pushed out between openings in the vertebrae. The membranes can usually be removed during surgery and no further treatment is required.
In spina bifida meningocele, the nervous system is undamaged. However, it may lead to other problems, including bladder and bowel problems.
Treating spina bifida
A number of different treatments can be used to treat symptoms or conditions associated with spina bifida.
These can include:
• surgery on the spine - at birth to repair the spine and corrective surgery later in life if further problems develop
• surgery to treat hydrocephalus - for example, placing a shunt
• therapies to help improve day to day life and boost independence - such as physiotherapyand occupational therapy
• assistive technology - such as a manual or electric wheelchair or computer software to help with schoolwork and writing
• treatments for bowel and urinary problems
Read more about how spina bifida is treated andcomplications of spina bifida.
It is likely that children with spina bifida will survive well into adulthood. It can be a challenging condition to live with, but many adults with spina bifida are able to lead independent and fulfilling lives.
During the first month of life, an embryo (developing baby) grows a structure called the neural tube that will eventually form the spine and nervous system.
In cases of spina bifida, something goes wrong and the spinal column (the bone that surrounds and protects the nerves) does not fully close. Spina bifida is also known as split spine.
The exact reasons why this happens are unknown but several risk factors have been identified, the most significant being a lack of folic acid before and at the very start of pregnancy.
The most effective way to prevent spina bifida (myelomeningocele) is to take folic acid supplements both before and during pregnancy.
Folic acid
The Department of Health recommends all women who might get pregnant should take a daily supplement of 0.4mg of folic acid. You should also take this supplement for the first 12 weeks of pregnancy because this is when your baby's spine is developing.
Women thought to be at higher risk of having a child with spina bifida may need a higher dose of folic acid. This includes women who:
• have diabetes, a condition caused by too much glucose (sugar) in the blood
• are taking medicines, such as carbamazepine, used to treat epilepsy, a condition that causes repeated seizures (fits)
Your GP will advise you about this.
Folic acid tablets are available on prescription or from pharmacies, large supermarkets and health food stores. Natural sources of folic acid include:
• broccoli
• peas
• asparagus
• brussels sprouts
• chickpeas
• brown rice
• some bread
• some breakfast cereals
If you are taking medication for a condition such as epilepsy, it is important you check with your GP before taking folic acid. This is because some types of medication can cancel out the effects of folic acid supplements.
Myelomeningocele – one in one thousand pregnancies
There are a number of different types of spina bifida, the most serious being myelomeningocele (affecting one pregnancy in every 1,000 in Britain).
These pages focus on myelomeningocele and this is the type of spina bifida referred to whenever the term spina bifida is used.
In myelomeningocele, the spinal column remains open along the bones that make up the spine. The membranes and spinal cord push out to create a sac in the baby’s back. This sometimes leaves the nervous system vulnerable to infections that may be fatal.
In most cases of myelomeningocele, surgery can be carried out to close the defect. However, damage to the nervous system will usually have already taken place, resulting in a range of symptoms including:
• partial or total paralysis of the lower limbs
• bowel incontinence and urinary incontinence
• loss of skin sensation
Read more about the symptoms of spina bifida.
Most babies with myelomeningocele will also develop hydrocephalus, which is excess cerebrospinal fluid (CSF) surrounding the brain.
Hydrocephalus needs to be treated urgently with surgery as the pressure on the brain can cause brain damage.
Read more about hydrocephalus.
Different types of spina bifida
Spina bifida occulta
Spina bifida occulta is the least serious type of spina bifida. In this type of spina bifida, the opening in the spine is very small, with a gap in one or more vertebrae (disc-shaped bones of the spine). The opening in the spine is covered with skin, so the gap is not visible from the outside.
Spina bifida occulta does not usually cause any symptoms and most people are unaware they have the condition. In such cases, no treatment is required. In other cases, some symptoms may be apparent, such as bladder and bowel problems, or scoliosis (an abnormal curvature of the spine).
Spina bifida meningocele
Spina bifida meningocele is the rarest type of spina bifida. In this type the protective membranes that surround the spinal cord (the meninges) are pushed out between openings in the vertebrae. The membranes can usually be removed during surgery and no further treatment is required.
In spina bifida meningocele, the nervous system is undamaged. However, it may lead to other problems, including bladder and bowel problems.
Treating spina bifida
A number of different treatments can be used to treat symptoms or conditions associated with spina bifida.
These can include:
• surgery on the spine - at birth to repair the spine and corrective surgery later in life if further problems develop
• surgery to treat hydrocephalus - for example, placing a shunt
• therapies to help improve day to day life and boost independence - such as physiotherapyand occupational therapy
• assistive technology - such as a manual or electric wheelchair or computer software to help with schoolwork and writing
• treatments for bowel and urinary problems
Read more about how spina bifida is treated andcomplications of spina bifida.
It is likely that children with spina bifida will survive well into adulthood. It can be a challenging condition to live with, but many adults with spina bifida are able to lead independent and fulfilling lives.
Wednesday, 17 April 2013
Cervical Cancer
Cervical cancer is an uncommon type of cancer that develops in a woman’s cervix. The cervix is the entrance to the womb from the vagina.
Cervical cancer often has no symptoms in its early stages. If you have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause.
Abnormal bleeding doesn't mean that you definitely have cervical cancer, but it's a cause for concern. It’s important to see your GP as soon as possible. If your GP suspects you might have cervical cancer, you should be referred to see a specialist within two weeks.
Screening for cervical cancer
Over the course of many years, the cells lining the surface of the cervix undergo a series of changes. In rare cases, these changed cells can become cancerous. However, cell changes in the cervix can be detected at a very early stage, and treatments can reduce the risk of cervical cancer developing.
The NHS offers a national screening programme for all women over 24 years old. During screening, a small sample of cells is taken from the cervix and checked under a microscope for abnormalities. This test is commonly referred to as a cervical smear test.
It is recommended that women who are between 25 and 49 years old are screened every three years, and women between 50 and 64 are screened every five years. You should be sent a letter telling you when your screening appointment is due. Contact your GP if you think that you may be overdue for a screening appointment.
Treating cervical cancer
If cervical cancer is diagnosed at an early stage, it's usually possible to treat it using surgery. In some cases, it's possible to leave the womb in place, but sometimes it will need to be removed. The surgical procedure that is used to remove the womb is known as a hysterectomy. Radiotherapy is an alternative to surgery for some women with early stage cervical cancer.
More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy. Radiotherapy can also cause infertility as a side effect.
Causes of cervical cancer
Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). HPV is a very common virus that's spread during sex. It's a common cause of genital warts.
There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can disrupt the normal functioning of the cells of the cervix. This causes them to reproduce uncontrollably and trigger the onset of cancer.
Two distinct strains of the HPV virus are known to be responsible for 70% of all cases of cervical cancer. They are HPV 16 and HPV 18. Most women who are infected with these two types of HPV are unaffected, which means that there must be additional factors that make some women more vulnerable to HPV infection than others.
HPV vaccination
In 2008, a national vaccination programme was launched to vaccinate girls against HPV 16 and HPV 18. The vaccine is most effective if it's given a few years before a girl becomes sexually active, so it's given to girls between the ages of 12 and 13.
The vaccine used is gardasil - which provides protection against cervical cancer and genital warts
The vaccine protects against the two strains of HPV responsible for more than 70% of cervical cancers in the U.K. However you should still attend your future screening appointments even if you have been vaccinated.
Complications of cervical cancer
Many women with cervical cancer will have complications. Complications can arise as a direct result of the cancer or as a side effect of treatments such as radiotherapy, surgery and chemotherapy.
Complications that are associated with cervical cancer can range from the relatively minor, such as minor bleeding from the vagina or having to urinate frequently, to being life-threatening, such as severe bleeding from the vagina or kidney failure.
Who is affected by cervical cancer?
Due to the success of the NHS screening programme, cervical cancer is now an uncommon type of cancer in the UK. However, it's still a common cause of cancer-related death in countries that don't offer screening.
It's possible for women of all ages to develop cervical cancer. However, the condition mainly affects sexually active women between 25 and 45 years old. Many women who are affected did not attend their screening appointments.
In 2007, nearly 2,800 cases of cervical cancer were diagnosed in UK. In addition, about 25,000 cases were diagnosed with a precancerous condition of the cervix called cervical intraepithelial neoplasia (CIN).
Outlook
The stage at which cervical cancer is diagnosed is an important factor in determining a woman’s outlook. For example, if the cancer is still at an early stage, the outlook will usually be very good and a complete cure is often possible. See diagnosing cervical cancer for more information about staging.
More than 90% of women with stage one cervical cancer will live at least five years after receiving a diagnosis. Many women will live much longer. Researchers used five years as a cut-off point because cancer is unlikely to recur after five years and most women can consider themselves cured after five years.
Around 1 in 3 people with the more advanced type of cervical cancer will live at least five years.
Another important factor is a woman’s age when cervical cancer first develops. Older women usually have a worse outlook than younger women.
In the UK there were around 950 deaths due to cervical cancer in 2008.
Cervical cancer often has no symptoms in its early stages. If you have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause.
Abnormal bleeding doesn't mean that you definitely have cervical cancer, but it's a cause for concern. It’s important to see your GP as soon as possible. If your GP suspects you might have cervical cancer, you should be referred to see a specialist within two weeks.
Screening for cervical cancer
Over the course of many years, the cells lining the surface of the cervix undergo a series of changes. In rare cases, these changed cells can become cancerous. However, cell changes in the cervix can be detected at a very early stage, and treatments can reduce the risk of cervical cancer developing.
The NHS offers a national screening programme for all women over 24 years old. During screening, a small sample of cells is taken from the cervix and checked under a microscope for abnormalities. This test is commonly referred to as a cervical smear test.
It is recommended that women who are between 25 and 49 years old are screened every three years, and women between 50 and 64 are screened every five years. You should be sent a letter telling you when your screening appointment is due. Contact your GP if you think that you may be overdue for a screening appointment.
Treating cervical cancer
If cervical cancer is diagnosed at an early stage, it's usually possible to treat it using surgery. In some cases, it's possible to leave the womb in place, but sometimes it will need to be removed. The surgical procedure that is used to remove the womb is known as a hysterectomy. Radiotherapy is an alternative to surgery for some women with early stage cervical cancer.
More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy. Radiotherapy can also cause infertility as a side effect.
Causes of cervical cancer
Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). HPV is a very common virus that's spread during sex. It's a common cause of genital warts.
There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can disrupt the normal functioning of the cells of the cervix. This causes them to reproduce uncontrollably and trigger the onset of cancer.
Two distinct strains of the HPV virus are known to be responsible for 70% of all cases of cervical cancer. They are HPV 16 and HPV 18. Most women who are infected with these two types of HPV are unaffected, which means that there must be additional factors that make some women more vulnerable to HPV infection than others.
HPV vaccination
In 2008, a national vaccination programme was launched to vaccinate girls against HPV 16 and HPV 18. The vaccine is most effective if it's given a few years before a girl becomes sexually active, so it's given to girls between the ages of 12 and 13.
The vaccine used is gardasil - which provides protection against cervical cancer and genital warts
The vaccine protects against the two strains of HPV responsible for more than 70% of cervical cancers in the U.K. However you should still attend your future screening appointments even if you have been vaccinated.
Complications of cervical cancer
Many women with cervical cancer will have complications. Complications can arise as a direct result of the cancer or as a side effect of treatments such as radiotherapy, surgery and chemotherapy.
Complications that are associated with cervical cancer can range from the relatively minor, such as minor bleeding from the vagina or having to urinate frequently, to being life-threatening, such as severe bleeding from the vagina or kidney failure.
Who is affected by cervical cancer?
Due to the success of the NHS screening programme, cervical cancer is now an uncommon type of cancer in the UK. However, it's still a common cause of cancer-related death in countries that don't offer screening.
It's possible for women of all ages to develop cervical cancer. However, the condition mainly affects sexually active women between 25 and 45 years old. Many women who are affected did not attend their screening appointments.
In 2007, nearly 2,800 cases of cervical cancer were diagnosed in UK. In addition, about 25,000 cases were diagnosed with a precancerous condition of the cervix called cervical intraepithelial neoplasia (CIN).
Outlook
The stage at which cervical cancer is diagnosed is an important factor in determining a woman’s outlook. For example, if the cancer is still at an early stage, the outlook will usually be very good and a complete cure is often possible. See diagnosing cervical cancer for more information about staging.
More than 90% of women with stage one cervical cancer will live at least five years after receiving a diagnosis. Many women will live much longer. Researchers used five years as a cut-off point because cancer is unlikely to recur after five years and most women can consider themselves cured after five years.
Around 1 in 3 people with the more advanced type of cervical cancer will live at least five years.
Another important factor is a woman’s age when cervical cancer first develops. Older women usually have a worse outlook than younger women.
In the UK there were around 950 deaths due to cervical cancer in 2008.
Tuesday, 16 April 2013
Single Parents
Ignore people who are critical of you.
An important thing to remember is that your health and well being is vital. Take steps to ensure that you are taking care of yourself, if you are struggling and feeling depressed don't be afraid to seek help from friends, family or a health care professional.
Believe in yourself. Know that while it might take a great deal of time to finish college while being a single parent, you can succeed.
Fight loneliness. When you get lonely, paint, draw, read, sing, mend something, call a friend or family member.
^^ Women of any age can become single parents through death of a spouse, divorce, abandonment or choice. Here are a few suggestions to maintain mental health, thrive as an individual and nurture your children in the best possible manner.
An important thing to remember is that your health and well being is vital. Take steps to ensure that you are taking care of yourself, if you are struggling and feeling depressed don't be afraid to seek help from friends, family or a health care professional.
Believe in yourself. Know that while it might take a great deal of time to finish college while being a single parent, you can succeed.
Fight loneliness. When you get lonely, paint, draw, read, sing, mend something, call a friend or family member.
^^ Women of any age can become single parents through death of a spouse, divorce, abandonment or choice. Here are a few suggestions to maintain mental health, thrive as an individual and nurture your children in the best possible manner.
ADHD
Behaviour / ADHD
We all know kids who can’t sit still, who never seem to listen, who don’t follow instructions no matter how clearly you present them, or who blurt out inappropriate comments at inappropriate times. Sometimes these children are labeled as troublemakers, or criticized for being lazy and undisciplined. However, they may have ADD/ADHD.
Attention deficit hyperactivity disorder (ADHD) is a disorder that appears in early childhood. You may know it by the name attention deficit disorder, or ADD. ADD/ADHD makes it difficult for people to inhibit their spontaneous responses—responses that can involve everything from movement to speech to attentiveness.
The signs and symptoms of ADD/ADHD typically appear before the age of seven. However, it can be difficult to distinguish between attention deficit disorder and normal “kid behavior.”
If you spot just a few signs, or the symptoms appear only in some situations, it’s probably not ADD/ADHD. On the other hand, if your child shows a number of ADD/ADHD signs and symptoms that are present across all situations—at home, at school, and at play—it’s time to take a closer look.
Once you understand the issues your child is struggling with, such as forgetfulness or difficulty paying attention in school, you can work together to find creative solutions and capitalize on strengths.
The three primary characteristics of ADD/ADHD are inattention, hyperactivity, and impulsivity. The signs and symptoms a child with attention deficit disorder has depends on which characteristics predominate.
Children with ADD/ADHD may be:
Inattentive, but not hyperactive or impulsive.
Hyperactive and impulsive, but able to pay attention.
Inattentive, hyperactive, and impulsive (the most common form of ADD/ADHD).
Children who only have inattentive symptoms of ADD/ADHD are often overlooked, since they’re not disruptive. However, the symptoms of inattention have consequences: getting in hot water with parents and teachers for not following directions; underperforming in school; or clashing with other kids over not playing by the rules.
innatention: Doesn’t pay attention to details
Makes careless mistakes
Has trouble staying focused; is easily distracted
Appears not to listen when spoken to
Has difficulty remembering things and following instructions
Has trouble staying organized, planning ahead, and finishing projects
Gets bored with a task before it’s completed
Frequently loses or misplaces homework, books, toys, or other items
hyperactivity: Constantly fidgets and squirms
Often leaves his or her seat in situations where sitting quietly is expected
Moves around constantly, often runs or climbs inappropriately
Talks excessively
Has difficulty playing quietly or relaxing
Is always “on the go,” as if driven by a motor
May have a quick temper or a “short fuse”
impulsivity: Acts without thinking
Blurts out answers in class without waiting to be called on or hear the whole question
Can’t wait for his or her turn in line or in games
Says the wrong thing at the wrong time
Often interrupts others
Intrudes on other people’s conversations or games
Inability to keep powerful emotions in check, resulting in angry outbursts or temper tantrums
Guesses, rather than taking time to solve a problem
We all know kids who can’t sit still, who never seem to listen, who don’t follow instructions no matter how clearly you present them, or who blurt out inappropriate comments at inappropriate times. Sometimes these children are labeled as troublemakers, or criticized for being lazy and undisciplined. However, they may have ADD/ADHD.
Attention deficit hyperactivity disorder (ADHD) is a disorder that appears in early childhood. You may know it by the name attention deficit disorder, or ADD. ADD/ADHD makes it difficult for people to inhibit their spontaneous responses—responses that can involve everything from movement to speech to attentiveness.
The signs and symptoms of ADD/ADHD typically appear before the age of seven. However, it can be difficult to distinguish between attention deficit disorder and normal “kid behavior.”
If you spot just a few signs, or the symptoms appear only in some situations, it’s probably not ADD/ADHD. On the other hand, if your child shows a number of ADD/ADHD signs and symptoms that are present across all situations—at home, at school, and at play—it’s time to take a closer look.
Once you understand the issues your child is struggling with, such as forgetfulness or difficulty paying attention in school, you can work together to find creative solutions and capitalize on strengths.
The three primary characteristics of ADD/ADHD are inattention, hyperactivity, and impulsivity. The signs and symptoms a child with attention deficit disorder has depends on which characteristics predominate.
Children with ADD/ADHD may be:
Inattentive, but not hyperactive or impulsive.
Hyperactive and impulsive, but able to pay attention.
Inattentive, hyperactive, and impulsive (the most common form of ADD/ADHD).
Children who only have inattentive symptoms of ADD/ADHD are often overlooked, since they’re not disruptive. However, the symptoms of inattention have consequences: getting in hot water with parents and teachers for not following directions; underperforming in school; or clashing with other kids over not playing by the rules.
innatention: Doesn’t pay attention to details
Makes careless mistakes
Has trouble staying focused; is easily distracted
Appears not to listen when spoken to
Has difficulty remembering things and following instructions
Has trouble staying organized, planning ahead, and finishing projects
Gets bored with a task before it’s completed
Frequently loses or misplaces homework, books, toys, or other items
hyperactivity: Constantly fidgets and squirms
Often leaves his or her seat in situations where sitting quietly is expected
Moves around constantly, often runs or climbs inappropriately
Talks excessively
Has difficulty playing quietly or relaxing
Is always “on the go,” as if driven by a motor
May have a quick temper or a “short fuse”
impulsivity: Acts without thinking
Blurts out answers in class without waiting to be called on or hear the whole question
Can’t wait for his or her turn in line or in games
Says the wrong thing at the wrong time
Often interrupts others
Intrudes on other people’s conversations or games
Inability to keep powerful emotions in check, resulting in angry outbursts or temper tantrums
Guesses, rather than taking time to solve a problem
7-9 year olds
Ages 7-9 are a period of rapid development in social skills and by the time your child is nine she will be a vastly different child than when she was seven. Here are some of the changes you can expect during this time period:
1. An increasing ability to negotiate and work through conflicts with friends.
2. May go through periods of extreme melodrama and can be very sensitive.
3. Can be incredibly bossy or demanding.
4. Wants to be a part of a peer group and may begin to be embarrassed by parents.
5. Makes friends with children of the same sex easily.
6. Prefers play in groups to one on one play.
7. May begin to choose and design own activities by starting clubs, writing a newsletter, or performing plays with friends.
8. Creative play is an important part of friendships.
A 6 year olds development
His Physical Development....6 Years Old
His Fine Manipulative Skills
Can build a tower of cubes that's virtually straight
Is able to sew stitches
Cuts off shapes accurately and neatly
Handwriting is evenly spaced and may be joined
Drawings are detailed and representative
Makes a simple sandwich
Ties and unties laces
Can hold a pencil in a hold similar to an adult (the dynamic tripod grip)
Able to write a number of letters of similar size
Can write his last name as well as his first name
May begin to write simple stories.
His Gross Manipulative Skills
Runs
Chases and dodges others
Rides a bicycle without stabilisers
Hops, skips and jumps confidently
Kicks a ball with direction
Balances on a beam or wall gaining control in both strength and agility
Can kick a ball up to 6m (9 feet) away
Can catch and throw balls with accuracy
Can skip in time to music, alternating his feet.
Your Role To Developing Your 6 Year Old Child
Your child at this age is independent and is able to do many day-to-day tasks e.g. tidying away, laying the table etc.
He's gaining in confidence and enjoys trying out new activities e.g. making models, origami, cooking etc. Encourage him to join in some of these physical activities.
Toys and Equipment to stimulate your 6 year old Child's Intellectual Development
Bicycles
Skateboards
Roller-skates
Balls
Bats and rackets
Kits e.g. modelling kits, origami etc.
Jigsaw puzzles
Board games.
His Fine Manipulative Skills
Can build a tower of cubes that's virtually straight
Is able to sew stitches
Cuts off shapes accurately and neatly
Handwriting is evenly spaced and may be joined
Drawings are detailed and representative
Makes a simple sandwich
Ties and unties laces
Can hold a pencil in a hold similar to an adult (the dynamic tripod grip)
Able to write a number of letters of similar size
Can write his last name as well as his first name
May begin to write simple stories.
His Gross Manipulative Skills
Runs
Chases and dodges others
Rides a bicycle without stabilisers
Hops, skips and jumps confidently
Kicks a ball with direction
Balances on a beam or wall gaining control in both strength and agility
Can kick a ball up to 6m (9 feet) away
Can catch and throw balls with accuracy
Can skip in time to music, alternating his feet.
Your Role To Developing Your 6 Year Old Child
Your child at this age is independent and is able to do many day-to-day tasks e.g. tidying away, laying the table etc.
He's gaining in confidence and enjoys trying out new activities e.g. making models, origami, cooking etc. Encourage him to join in some of these physical activities.
Toys and Equipment to stimulate your 6 year old Child's Intellectual Development
Bicycles
Skateboards
Roller-skates
Balls
Bats and rackets
Kits e.g. modelling kits, origami etc.
Jigsaw puzzles
Board games.
A 5 year old development
5 years old - his fine manipulative skills
Forms letters and writes own name
Draws recognisable pictures of trees, houses, people and animals
Colours neatly in pictures
Easily dresses and undresses
Completes a 20-piece jigsaw puzzle
Cuts out shapes using scissors quite accurately
Draws around a template
Can competently use a knife and fork, but may still need to have meat cut up for him
May be able to thread a large-eyed needle and sew with large stitches
Has good control over pencils and paint brushes
Can draw a person with a head, body, legs, nose, mouth and eyes
Can copy elaborate models, such as a four-step model using ten cubes
Can do jigsaw puzzles with interlocking pieces
Can count the fingers on one hand using the index finger of the other hand
Can print name on paper.
Your Role To Developing Your 5 Year Old Child
Your 5 year old is starting to enjoy playing games with rules e.g. snakes and ladders. Help him by introducing new games into his play e.g. hide-and-seek... and encourage him to come up with his own games.
Your support and encouragement is needed as there may be times when arguments break out. Encourage him to be as independent as possible e.g. folding his clothes when changing, hanging up his coats etc.
Toys and Equipment To Stimulate Your 5 Year Old Child's Intellectual Development
Hoops
Balls
Roller-skates
Bicycles with stabilisers
Creative materials e.g. paints, crayons, card and paper
Construction toys
Board games.
A 4 year old development
At 4 years of age your child develops...
His Fine Manipulative Skills
He uses his hand and fingers to do day-to-day-tasks. He...
Can button and unbutton his clothing
Can cut out simple shapes
Can draw a person with a head, trunk and legs
Puts together 12 piece puzzle
Can build a tower of ten or more cubes
Can copy a building pattern of three steps using six cubes or more
Is able to thread small beads on a lace
Hold and use a pencil in adult fashion
Can draw on request a fine figure that resembles a person, showing head, legs and body
Can spread his hand and bring his thumbs into opposition with each finger in turn
Uses scissors
Cuts and pastes simple shapes
Prints few letters
Draws a simple house.
His Gross Manipulative Skills
Your 4 year old child uses his large muscles in his body. He...
Can walk on a fine line
Aims and throws ball
Bounces and catches a large ball
Runs, changing direction
Hops on one foot
Can pedal and steer a tricycle confidently
Can stand, walk and run on tiptoe
Can catch, kick, throw and bounce a ball
Can bend at the waist to pick up objects from the floor
Enjoys climbing trees and on frames
Can run up and down stairs and make sharp turns easily
Balances on one foot and jumps down from a step
Catches large ball with two hands when thrown from a near distance.
Toys and equipment to stimulate your 4 year old Balls
Climbing frames
Slides
Materials for creative activities
Crayons
Glue
Scissors
Puzzles
Construction toys
Books
His Fine Manipulative Skills
He uses his hand and fingers to do day-to-day-tasks. He...
Can button and unbutton his clothing
Can cut out simple shapes
Can draw a person with a head, trunk and legs
Puts together 12 piece puzzle
Can build a tower of ten or more cubes
Can copy a building pattern of three steps using six cubes or more
Is able to thread small beads on a lace
Hold and use a pencil in adult fashion
Can draw on request a fine figure that resembles a person, showing head, legs and body
Can spread his hand and bring his thumbs into opposition with each finger in turn
Uses scissors
Cuts and pastes simple shapes
Prints few letters
Draws a simple house.
His Gross Manipulative Skills
Your 4 year old child uses his large muscles in his body. He...
Can walk on a fine line
Aims and throws ball
Bounces and catches a large ball
Runs, changing direction
Hops on one foot
Can pedal and steer a tricycle confidently
Can stand, walk and run on tiptoe
Can catch, kick, throw and bounce a ball
Can bend at the waist to pick up objects from the floor
Enjoys climbing trees and on frames
Can run up and down stairs and make sharp turns easily
Balances on one foot and jumps down from a step
Catches large ball with two hands when thrown from a near distance.
Toys and equipment to stimulate your 4 year old Balls
Climbing frames
Slides
Materials for creative activities
Crayons
Glue
Scissors
Puzzles
Construction toys
Books
SPD - Symphysis Pubis Dysfunction
What is symphysis pubis dysfunction?
The two halves of your pelvis are connected at the front by a stiff joint called the symphysis pubis. This joint is strengthened by a dense network of tough, flexible tissues, called ligaments. To help your baby pass through your pelvis as easily as possible, your body produces a hormone called relaxin. Relaxin softens your ligaments.
As a result, your pelvic joints move more during and just after pregnancy, causing inflammation and pain. This condition is known as symphysis pubis dysfunction (SPD).
A related condition is diastasis symphysis pubis (DSP), in which the gap in the pubic joint widens too far. The average gap between the bones in a non-pregnant woman is between 4mm and 5mm. During pregnancy it's normal for this gap to widen by 2mm or 3mm. If the gap is 10mm or more, DSP is diagnosed. It's rare, and can only be identified by X-ray.
What causes SPD?
SPD is thought to be caused by a combination of hormones that you produce during pregnancy and the way your body moves. If one side of your pelvis moves more than the other when you walk or move around, the area around the symphysis pubis becomes tender.
The size of the gap in your joint doesn't bear any relation to the amount of pain you may feel. Many women with a normal-sized gap feel a lot of pain.
You may be more likely to develop SPD if you started your periods before you were 11, or are overweight.
When does SPD happen?
SPD can occur at any time during your pregnancy or after giving birth. You may notice it for the first time around the middle of your pregnancy.
If you have SPD in one pregnancy, it is more likely that you'll have it next time you get pregnant. The symptoms may also come on earlier and progress faster, so it is important to seek help promptly. It can help if you allow the symptoms from one pregnancy to settle before trying to get pregnant again.
How is SPD diagnosed?
SPD is becoming more widely understood by doctors, physiotherapists and midwives. Your doctor or midwife should refer you to a specialist women's health physiotherapist who will have experience in treating it.
Your physiotherapist will test the stability, movement and pain in your pelvic joints and muscles. She'll also want to hear you describe your symptoms.
How is SPD treated?
SPD is often managed in the same way as pelvic girdle pain, and treatment will include:
• Exercises, especially focused on your tummy and pelvic floor muscles. These will improve the stability of your pelvis and back (Richardson et al 2002, Van Wingerden et al 2004, Vleeming et al 2005). You may need gentle, hands-on treatment of your hip, back or pelvis to correct stiffness or imbalance. Exercise in water can sometimes help.
• You should also be given advice on how to make daily activities less painful and on how to make the birth of your baby easier. Your midwife should help you to write a birth plan which takes into account your SPD symptoms.
• Acupuncture may help and is safe during pregnancy. Make sure your practitioner is trained and experienced in working with pregnant women (Bourne 2007, Elden et al 2007, Elden et al 2008, Kvorning et al 2004, Lund et al 2006, Ternov et al 2001).
• Osteopathy and chiropractic treatment may help, but again, see a registered practitioner who is experienced in treating pregnant women (Licciardone et al 2010).
• A pelvic support belt will give quick relief (Mens et al 2006, Ostgaard et al 1994, Vleeming 1992).
Are there any self-help tips I can follow?
There are things you can do yourself to ease your pain:
• Do pelvic floor and tummy exercises. Get down onto your hands and knees and level your back so that it is roughly flat. Breathe in and then as you breathe out, squeeze in your pelvic floor muscles and pull your belly button in and up. Hold this contraction for between five and 10 seconds, breathing through it. Relax your muscles slowly at the end of the exercise.
• Try not to move your legs apart when your back is slumped or you are lying down. Take care when getting in and out of the car, bed or bath. If you are lying down, pulling your knees up as far as you can stops your pelvis from moving and makes it easier to part your legs. If you are sitting, try arching your back and sticking your chest out before parting or moving your legs.
• Avoid pushing through any pain. If something hurts, if possible, don't do it. If the pain is allowed to flare up, it can take a long time to settle down again.
• Move little and often. You may not feel the effects of what you are doing until later in the day or after you have gone to bed.
• Rest regularly by sitting on a birth ball or by getting down on your hands and knees. This takes the weight of your baby off your pelvis and holds it in a stable position.
• Try not to do heavy lifting or pushing. Supermarket trolleys can often make your pain worse, so shop online or ask someone to shop for you.
• When climbing stairs, take one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step.
• Avoid swimming breaststroke and take care with other strokes. You may feel swimming is helping your pain while you are in the water, but it could make you feel worse when you get out.
• When getting dressed, sit down to pull on your knickers or trousers.
Will I recover from SPD after I've had my baby ?
You're very likely to recover after your baby is born (Owens et al 2002). If you can, carry on with physiotherapy after the birth. Try to get help with looking after your baby during the early weeks.
You may find you get twinges every month just before your period is due. This is caused by hormones which have a similar effect to the pregnancy hormone relaxin.
Where can I get help and support?
You can get in touch with other women in your situation by contacting The Pelvic Partnership, a charity which was set up to offer support to women with SPD. If you live in Scotland, contact the Pelvic Instability Network Scotland.
The Association of Chartered Physiotherapists in Women's Health can provide a list of physiotherapists in your area.
What about the birth?
You should inform the midwifes present at your birth that you have suffered with pelvic pain during your pregnancy so that they will be able to support you accordingly. Generally, more active birth positions such as kneeling or all fours are more comfortable however you should do whatever feels best for you at the time. If you do have trouble parting your legs during the latter stages of pregnancy do ensure that your midwife knows this especially if you have an epidural as they will be able to keep you focused on not over widening your hips.
Fortunately for the vast majority of women pelvic pain lessens and gradually disappears in the months after their baby arrives. Treatments such as osteopathy and physiotherapy area also a great help in speeding up the recovery process.
Is it safe to take pain medications for spd whilst pregnant?
If you are finding it hard to cope with the pain that can be caused by spd, speak to your doctor as they will be able to prescribe pain killers that are safe to take in pregnancy. Hot water can help to ease the pain caused by spd as well.
Myths about pelvic girdle pain
Women are often told that their pelvic pain is due to:
• round ligament pain
• hormones
• sciatica
• trapped nerve
• normal aches and pains of pregnancy
• low back pain
• nerve irritation; and that it is not treatable and will get better on its own, or as soon as the baby is born.
Many women have discovered later that it was pelvic girdle pain and could have been treated as soon as symptoms occurred. If this sounds like you, you may well have pelvic girdle pain and need to take action.
Please note that here at *Mums World* we cannot be sure that there are any medical experts on the page, if you are experiencing any symptoms or issues related to our topic please speak you your doctor.
Many thanks to the following webisites which have used to gather this information www.babycentre.co.uk
www.askbaby.com
www.pelvicpartnership.org.uk
We hope you found tonight’s topic helpful. If it has helped you understand the causes and treatment of SPD, then we at *MumsWorld* have done what we set out to do.
Feed back on tonight’s topic is gratefully received. PP’s will resume shortly but in the mean time please feel free to check out our ‘Posts by others’. Enjoy the rest of your evening Nic, Becks, Dani.
There are no medical professionals on *Mums World*all information has beencollected from reputable websites and links will be posted at the end of the topic. If you are worried about anything please contact your GP.
The two halves of your pelvis are connected at the front by a stiff joint called the symphysis pubis. This joint is strengthened by a dense network of tough, flexible tissues, called ligaments. To help your baby pass through your pelvis as easily as possible, your body produces a hormone called relaxin. Relaxin softens your ligaments.
As a result, your pelvic joints move more during and just after pregnancy, causing inflammation and pain. This condition is known as symphysis pubis dysfunction (SPD).
A related condition is diastasis symphysis pubis (DSP), in which the gap in the pubic joint widens too far. The average gap between the bones in a non-pregnant woman is between 4mm and 5mm. During pregnancy it's normal for this gap to widen by 2mm or 3mm. If the gap is 10mm or more, DSP is diagnosed. It's rare, and can only be identified by X-ray.
What causes SPD?
SPD is thought to be caused by a combination of hormones that you produce during pregnancy and the way your body moves. If one side of your pelvis moves more than the other when you walk or move around, the area around the symphysis pubis becomes tender.
The size of the gap in your joint doesn't bear any relation to the amount of pain you may feel. Many women with a normal-sized gap feel a lot of pain.
You may be more likely to develop SPD if you started your periods before you were 11, or are overweight.
When does SPD happen?
SPD can occur at any time during your pregnancy or after giving birth. You may notice it for the first time around the middle of your pregnancy.
If you have SPD in one pregnancy, it is more likely that you'll have it next time you get pregnant. The symptoms may also come on earlier and progress faster, so it is important to seek help promptly. It can help if you allow the symptoms from one pregnancy to settle before trying to get pregnant again.
How is SPD diagnosed?
SPD is becoming more widely understood by doctors, physiotherapists and midwives. Your doctor or midwife should refer you to a specialist women's health physiotherapist who will have experience in treating it.
Your physiotherapist will test the stability, movement and pain in your pelvic joints and muscles. She'll also want to hear you describe your symptoms.
How is SPD treated?
SPD is often managed in the same way as pelvic girdle pain, and treatment will include:
• Exercises, especially focused on your tummy and pelvic floor muscles. These will improve the stability of your pelvis and back (Richardson et al 2002, Van Wingerden et al 2004, Vleeming et al 2005). You may need gentle, hands-on treatment of your hip, back or pelvis to correct stiffness or imbalance. Exercise in water can sometimes help.
• You should also be given advice on how to make daily activities less painful and on how to make the birth of your baby easier. Your midwife should help you to write a birth plan which takes into account your SPD symptoms.
• Acupuncture may help and is safe during pregnancy. Make sure your practitioner is trained and experienced in working with pregnant women (Bourne 2007, Elden et al 2007, Elden et al 2008, Kvorning et al 2004, Lund et al 2006, Ternov et al 2001).
• Osteopathy and chiropractic treatment may help, but again, see a registered practitioner who is experienced in treating pregnant women (Licciardone et al 2010).
• A pelvic support belt will give quick relief (Mens et al 2006, Ostgaard et al 1994, Vleeming 1992).
Are there any self-help tips I can follow?
There are things you can do yourself to ease your pain:
• Do pelvic floor and tummy exercises. Get down onto your hands and knees and level your back so that it is roughly flat. Breathe in and then as you breathe out, squeeze in your pelvic floor muscles and pull your belly button in and up. Hold this contraction for between five and 10 seconds, breathing through it. Relax your muscles slowly at the end of the exercise.
• Try not to move your legs apart when your back is slumped or you are lying down. Take care when getting in and out of the car, bed or bath. If you are lying down, pulling your knees up as far as you can stops your pelvis from moving and makes it easier to part your legs. If you are sitting, try arching your back and sticking your chest out before parting or moving your legs.
• Avoid pushing through any pain. If something hurts, if possible, don't do it. If the pain is allowed to flare up, it can take a long time to settle down again.
• Move little and often. You may not feel the effects of what you are doing until later in the day or after you have gone to bed.
• Rest regularly by sitting on a birth ball or by getting down on your hands and knees. This takes the weight of your baby off your pelvis and holds it in a stable position.
• Try not to do heavy lifting or pushing. Supermarket trolleys can often make your pain worse, so shop online or ask someone to shop for you.
• When climbing stairs, take one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step.
• Avoid swimming breaststroke and take care with other strokes. You may feel swimming is helping your pain while you are in the water, but it could make you feel worse when you get out.
• When getting dressed, sit down to pull on your knickers or trousers.
Will I recover from SPD after I've had my baby ?
You're very likely to recover after your baby is born (Owens et al 2002). If you can, carry on with physiotherapy after the birth. Try to get help with looking after your baby during the early weeks.
You may find you get twinges every month just before your period is due. This is caused by hormones which have a similar effect to the pregnancy hormone relaxin.
Where can I get help and support?
You can get in touch with other women in your situation by contacting The Pelvic Partnership, a charity which was set up to offer support to women with SPD. If you live in Scotland, contact the Pelvic Instability Network Scotland.
The Association of Chartered Physiotherapists in Women's Health can provide a list of physiotherapists in your area.
What about the birth?
You should inform the midwifes present at your birth that you have suffered with pelvic pain during your pregnancy so that they will be able to support you accordingly. Generally, more active birth positions such as kneeling or all fours are more comfortable however you should do whatever feels best for you at the time. If you do have trouble parting your legs during the latter stages of pregnancy do ensure that your midwife knows this especially if you have an epidural as they will be able to keep you focused on not over widening your hips.
Fortunately for the vast majority of women pelvic pain lessens and gradually disappears in the months after their baby arrives. Treatments such as osteopathy and physiotherapy area also a great help in speeding up the recovery process.
Is it safe to take pain medications for spd whilst pregnant?
If you are finding it hard to cope with the pain that can be caused by spd, speak to your doctor as they will be able to prescribe pain killers that are safe to take in pregnancy. Hot water can help to ease the pain caused by spd as well.
Myths about pelvic girdle pain
Women are often told that their pelvic pain is due to:
• round ligament pain
• hormones
• sciatica
• trapped nerve
• normal aches and pains of pregnancy
• low back pain
• nerve irritation; and that it is not treatable and will get better on its own, or as soon as the baby is born.
Many women have discovered later that it was pelvic girdle pain and could have been treated as soon as symptoms occurred. If this sounds like you, you may well have pelvic girdle pain and need to take action.
Please note that here at *Mums World* we cannot be sure that there are any medical experts on the page, if you are experiencing any symptoms or issues related to our topic please speak you your doctor.
Many thanks to the following webisites which have used to gather this information www.babycentre.co.uk
www.askbaby.com
www.pelvicpartnership.org.uk
We hope you found tonight’s topic helpful. If it has helped you understand the causes and treatment of SPD, then we at *MumsWorld* have done what we set out to do.
Feed back on tonight’s topic is gratefully received. PP’s will resume shortly but in the mean time please feel free to check out our ‘Posts by others’. Enjoy the rest of your evening Nic, Becks, Dani.
There are no medical professionals on *Mums World*all information has beencollected from reputable websites and links will be posted at the end of the topic. If you are worried about anything please contact your GP.
Toddler (1-3years) Development and Discipline
Toddlers are children ages 1 - 3.
Early use of instruments or tools
Following visual (then later, invisible) displacement (moving from one place to another) of objects
Understanding that objects and people are there even if you can't see them (object and people permanence)
Erik H. Erikson's personal-social development theory says the toddler stage represents Autonomy (independence) vs. Shame or Doubt. The child learns to adjust to society's demands, while trying to maintain independence and a sense of self.
These milestones are typical of children in the toddler stages. Some variation is normal. If you have questions about your child's development, contact your health care provider.
PHYSICAL DEVELOPMENT
The following are signs of expected physical development in a toddler:
GROSS MOTOR SKILLS (use of large muscles in the legs and arms)
Stands alone well by 12 months
Walks well by 12 - 15 months (if the child is not walking by 18 months, he or she should be evaluated by a health care provider)
Learns to walk backwards and up steps with help at about 16 - 18 months
Throws a ball overhand and kicks a ball forward at about 18 - 24 months
Jumps in place by about 24 months
Rides a tricycle and stands briefly on one foot by about 36 months
FINE MOTOR SKILLS (use of small muscles in hands and fingers)
Makes tower of three cubes by around 15 months
Scribbles by 15 - 18 months
Can use spoon and drink from a cup by 24 months
Can copy a circle by 36 months
LANGUAGE DEVELOPMENT
Uses 2 - 3 words (other than Mama or Dada) at 12 - 15 months
Understands and follows simple commands ("bring to Mommy") at 14 - 16 months
Names pictures of items and animals at 18 - 24 months
Points to named body parts at 18 - 24 months
Begins to say his or her own name at 22 - 24 months
Combines 2 words at 16 to 24 months -- there is a range of ages at which children are first able to combine words into sentences; if a toddler cannot do so by 24 months, parents should consult their health care provider
Knows gender and age by 36 months
SOCIAL DEVELOPMENT
Indicates some needs by pointing at 12 - 15 months
Looks for help when in trouble by 18 months
Helps to undress and put things away by 18 - 24 months
Listens to stories when shown pictures and can tell about immediate experiences by 24 months
Can engage in pretend play and simple games by 24 - 36 months
BEHAVIOR
Toddlers are always trying to be more independent. This creates not only special safety concerns, but discipline challenges. The child must be taught -- in a consistent manner -- the limits of appropriate vs. inappropriate behavior.
When toddlers try out activities they can't quite do yet, they can get frustrated and angry. Breath-holding, crying, screaming, and temper tantrums may be daily occurrences.
It is important for a child to learn from experiences and to be able to rely on consistent boundaries between acceptable and unacceptable behaviors.
SAFETY
Toddler safety is very important.
It is important for parents to recognize that the child can now walk, run, climb, jump, and explore. This new stage of movement makes child-proofing the home essential. Window guards, gates on stairways, cabinet locks, toilet seat locks, electric outlet covers, and other safety features are essential.
As during the infancy period, place the toddler in a safety restraint (toddler car seat) when riding in a car.
Do not leave a toddler unattended for even short periods of time. Remember, more accidents occur during the toddler years than at any other stage of childhood.
Introduce and strictly stick to rules about not playing in streets or crossing without an adult.
Falls are a major cause of injury. Keep gates or doors to stairways closed, and use guards for all windows above the ground floor. Do not leave chairs or ladders in areas that are likely to tempt the toddler into climbing up to explore new heights. Use corner guards on furniture in areas where the toddler is likely to walk, play, or run.
Childhood poisonings are a frequent source of illness and death during the toddler years. Keep all medications in a locked cabinet. Keep all toxic household products (polishes, acids, cleaning solutions, chlorine bleach, lighter fluid, insecticides, or poisons) in a locked cabinet or closet. Many household plants may cause illness if eaten. Toad stools and other garden plants may cause serious illness or death. Get a list of these common plants from your pediatrician.
If a family member owns a firearm, make sure it is unloaded and locked up in a secure place.
Keep toddlers away from the kitchen with a safety gate, or place them in a playpen or high chair. This will eliminate the danger of burns from pulling hot foods off the stove or bumping into the hot oven door.
Toddlers love to play in water, but should never be allowed to do so alone. A toddler may drown even in shallow water in a bathtub. Parent-child swimming lessons can be another safe and enjoyable way for toddlers to play in water. Never leave a child unattended near a pool, open toilet, or bathtub. Toddlers cannot learn how to swim and cannot be independent near any body of water.
PARENTING TIPS
The toddler years are the time to begin instilling values, reasoning, and incentives in the child, so that they learn accepted rules of behavior. It is important for parents to be consistent both in modeling behavior (behaving the way you want your child to behave),and in addressing appropriate versus inappropriate behavior in the child. Recognize and reward positive behavior. You can introduce time-outs for negative behavior, or for going beyond the limits you set for your child.
The toddler's favorite word may seem to be "NO!!!" It is important for parents not to fall into a pattern of negative behavior with yelling, spanking, and threatening of their own.
Teach children the proper names of body parts.
Stress the unique, individual qualities of the child.
Teach concepts of please, thank you, and sharing with others.
Read to the child on a regular basis -- it will enhance the development of verbal skills.
Toddlers thrive on regularity. Major changes in their routine are challenging for them. Toddlers should have regular nap, bed, snack, and meal times.
Toddlers should not be allowed to eat many snacks throughout the day. Multiple snack times tend to suppress their appetite for regular meals, which tend to be more balanced.
Travel and guests can be expected to disrupt the child's routine and make them more irritable. The best responses to these situations are reassurance and reestablishing routine in a calm way.
Your child's learning
You can get your young child off to a good start by getting involved in their learning early. It’s easy and fun, and research shows it will help your child’s learning for life.
You can help your child learn by:
talking about what’s around you and what’s happening
encouraging your child to talk by listening and responding
providing materials that can be used in lots of ways and that encourage your child to imitate and pretend (for example, toy telephones, dolls or hats)
sharing songs, stories and rhymes.
Your child and books
You should try to read to your child every day. Toddlers, and even babies, can start experiencing books very early.
They can learn:
how to hold a book
that the front of a book is different from the inside
how to hold the book and turn the pages at the same time
to look for interesting things in the pictures
that pictures and stories stay the same each time you look at a book
that some books contain exciting stories
that some books contain printed words and language.
Play-based learning
Play offers children many valuable opportunities that contribute to their learning. Evidence shows that play can support learning across physical, social, emotional and intellectual areas of development. In the first three years particularly, play helps children to learn about the world through listening, looking, touching, tasting and smelling.
Following are a few suggestions of things you can do with your child:
Put several different objects in a bag and ask your child to put a hand in and feel one. Ask questions such as ‘How does it feel?’ Describing objects helps your child’s language development.
Encourage your child to stack blocks and then take some away. Activities like this help your child begin to learn skills and an understanding for maths.
Fill plastic containers with sand, pebbles, rice and water. Encourage your child to shake them and discover the different sounds they make.
Provide your child with opportunities to socialise more widely.
Communicating with your child
Toddlers listen to everything you say. They often understand more than we think they do. They can be very sensitive and may get grumpy or burst into tears because of the way someone speaks to them or laughs at them.
Toddlers have strong feelings and emotions and their communication skills let them down at times. Their feelings can sometimes be too much for them, but they often don’t have the words or understanding to tell you what’s wrong. Their communication skills are improving all the time. When toddlers can communicate well with words it will be easier for them to get help with their everyday needs. Feeling secure, understood and accepted by their family helps them through trying times.
Following are some tips for good communication:
really listen to what your child is trying to say and try to recognise the emotions behind it
make regular time to communicate one-on-one with your child
whenever your child wants to talk, try to pay full attention
get down to your child’s level to talk by kneeling or squatting and facing the child
let your child finish sentences – don’t interrupt.
Your child's behaviour
By this age, many children start to control their urges, change their behaviour and do as you ask - not all the time, of course.
The name for this ability is self-regulation. It’s one of life’s most important milestones.
Some tips for helping your child learn to behave in acceptable ways include:
try to create situations where your child can explore life without lots of ‘don’t’ and ‘no’
show your child how you feel about their behaviour
give your child positive feedback for behaviour that you approve of
explain the consequences of your child’s behaviour so they can figure out why something is wrong
be patient.
Early use of instruments or tools
Following visual (then later, invisible) displacement (moving from one place to another) of objects
Understanding that objects and people are there even if you can't see them (object and people permanence)
Erik H. Erikson's personal-social development theory says the toddler stage represents Autonomy (independence) vs. Shame or Doubt. The child learns to adjust to society's demands, while trying to maintain independence and a sense of self.
These milestones are typical of children in the toddler stages. Some variation is normal. If you have questions about your child's development, contact your health care provider.
PHYSICAL DEVELOPMENT
The following are signs of expected physical development in a toddler:
GROSS MOTOR SKILLS (use of large muscles in the legs and arms)
Stands alone well by 12 months
Walks well by 12 - 15 months (if the child is not walking by 18 months, he or she should be evaluated by a health care provider)
Learns to walk backwards and up steps with help at about 16 - 18 months
Throws a ball overhand and kicks a ball forward at about 18 - 24 months
Jumps in place by about 24 months
Rides a tricycle and stands briefly on one foot by about 36 months
FINE MOTOR SKILLS (use of small muscles in hands and fingers)
Makes tower of three cubes by around 15 months
Scribbles by 15 - 18 months
Can use spoon and drink from a cup by 24 months
Can copy a circle by 36 months
LANGUAGE DEVELOPMENT
Uses 2 - 3 words (other than Mama or Dada) at 12 - 15 months
Understands and follows simple commands ("bring to Mommy") at 14 - 16 months
Names pictures of items and animals at 18 - 24 months
Points to named body parts at 18 - 24 months
Begins to say his or her own name at 22 - 24 months
Combines 2 words at 16 to 24 months -- there is a range of ages at which children are first able to combine words into sentences; if a toddler cannot do so by 24 months, parents should consult their health care provider
Knows gender and age by 36 months
SOCIAL DEVELOPMENT
Indicates some needs by pointing at 12 - 15 months
Looks for help when in trouble by 18 months
Helps to undress and put things away by 18 - 24 months
Listens to stories when shown pictures and can tell about immediate experiences by 24 months
Can engage in pretend play and simple games by 24 - 36 months
BEHAVIOR
Toddlers are always trying to be more independent. This creates not only special safety concerns, but discipline challenges. The child must be taught -- in a consistent manner -- the limits of appropriate vs. inappropriate behavior.
When toddlers try out activities they can't quite do yet, they can get frustrated and angry. Breath-holding, crying, screaming, and temper tantrums may be daily occurrences.
It is important for a child to learn from experiences and to be able to rely on consistent boundaries between acceptable and unacceptable behaviors.
SAFETY
Toddler safety is very important.
It is important for parents to recognize that the child can now walk, run, climb, jump, and explore. This new stage of movement makes child-proofing the home essential. Window guards, gates on stairways, cabinet locks, toilet seat locks, electric outlet covers, and other safety features are essential.
As during the infancy period, place the toddler in a safety restraint (toddler car seat) when riding in a car.
Do not leave a toddler unattended for even short periods of time. Remember, more accidents occur during the toddler years than at any other stage of childhood.
Introduce and strictly stick to rules about not playing in streets or crossing without an adult.
Falls are a major cause of injury. Keep gates or doors to stairways closed, and use guards for all windows above the ground floor. Do not leave chairs or ladders in areas that are likely to tempt the toddler into climbing up to explore new heights. Use corner guards on furniture in areas where the toddler is likely to walk, play, or run.
Childhood poisonings are a frequent source of illness and death during the toddler years. Keep all medications in a locked cabinet. Keep all toxic household products (polishes, acids, cleaning solutions, chlorine bleach, lighter fluid, insecticides, or poisons) in a locked cabinet or closet. Many household plants may cause illness if eaten. Toad stools and other garden plants may cause serious illness or death. Get a list of these common plants from your pediatrician.
If a family member owns a firearm, make sure it is unloaded and locked up in a secure place.
Keep toddlers away from the kitchen with a safety gate, or place them in a playpen or high chair. This will eliminate the danger of burns from pulling hot foods off the stove or bumping into the hot oven door.
Toddlers love to play in water, but should never be allowed to do so alone. A toddler may drown even in shallow water in a bathtub. Parent-child swimming lessons can be another safe and enjoyable way for toddlers to play in water. Never leave a child unattended near a pool, open toilet, or bathtub. Toddlers cannot learn how to swim and cannot be independent near any body of water.
PARENTING TIPS
The toddler years are the time to begin instilling values, reasoning, and incentives in the child, so that they learn accepted rules of behavior. It is important for parents to be consistent both in modeling behavior (behaving the way you want your child to behave),and in addressing appropriate versus inappropriate behavior in the child. Recognize and reward positive behavior. You can introduce time-outs for negative behavior, or for going beyond the limits you set for your child.
The toddler's favorite word may seem to be "NO!!!" It is important for parents not to fall into a pattern of negative behavior with yelling, spanking, and threatening of their own.
Teach children the proper names of body parts.
Stress the unique, individual qualities of the child.
Teach concepts of please, thank you, and sharing with others.
Read to the child on a regular basis -- it will enhance the development of verbal skills.
Toddlers thrive on regularity. Major changes in their routine are challenging for them. Toddlers should have regular nap, bed, snack, and meal times.
Toddlers should not be allowed to eat many snacks throughout the day. Multiple snack times tend to suppress their appetite for regular meals, which tend to be more balanced.
Travel and guests can be expected to disrupt the child's routine and make them more irritable. The best responses to these situations are reassurance and reestablishing routine in a calm way.
Your child's learning
You can get your young child off to a good start by getting involved in their learning early. It’s easy and fun, and research shows it will help your child’s learning for life.
You can help your child learn by:
talking about what’s around you and what’s happening
encouraging your child to talk by listening and responding
providing materials that can be used in lots of ways and that encourage your child to imitate and pretend (for example, toy telephones, dolls or hats)
sharing songs, stories and rhymes.
Your child and books
You should try to read to your child every day. Toddlers, and even babies, can start experiencing books very early.
They can learn:
how to hold a book
that the front of a book is different from the inside
how to hold the book and turn the pages at the same time
to look for interesting things in the pictures
that pictures and stories stay the same each time you look at a book
that some books contain exciting stories
that some books contain printed words and language.
Play-based learning
Play offers children many valuable opportunities that contribute to their learning. Evidence shows that play can support learning across physical, social, emotional and intellectual areas of development. In the first three years particularly, play helps children to learn about the world through listening, looking, touching, tasting and smelling.
Following are a few suggestions of things you can do with your child:
Put several different objects in a bag and ask your child to put a hand in and feel one. Ask questions such as ‘How does it feel?’ Describing objects helps your child’s language development.
Encourage your child to stack blocks and then take some away. Activities like this help your child begin to learn skills and an understanding for maths.
Fill plastic containers with sand, pebbles, rice and water. Encourage your child to shake them and discover the different sounds they make.
Provide your child with opportunities to socialise more widely.
Communicating with your child
Toddlers listen to everything you say. They often understand more than we think they do. They can be very sensitive and may get grumpy or burst into tears because of the way someone speaks to them or laughs at them.
Toddlers have strong feelings and emotions and their communication skills let them down at times. Their feelings can sometimes be too much for them, but they often don’t have the words or understanding to tell you what’s wrong. Their communication skills are improving all the time. When toddlers can communicate well with words it will be easier for them to get help with their everyday needs. Feeling secure, understood and accepted by their family helps them through trying times.
Following are some tips for good communication:
really listen to what your child is trying to say and try to recognise the emotions behind it
make regular time to communicate one-on-one with your child
whenever your child wants to talk, try to pay full attention
get down to your child’s level to talk by kneeling or squatting and facing the child
let your child finish sentences – don’t interrupt.
Your child's behaviour
By this age, many children start to control their urges, change their behaviour and do as you ask - not all the time, of course.
The name for this ability is self-regulation. It’s one of life’s most important milestones.
Some tips for helping your child learn to behave in acceptable ways include:
try to create situations where your child can explore life without lots of ‘don’t’ and ‘no’
show your child how you feel about their behaviour
give your child positive feedback for behaviour that you approve of
explain the consequences of your child’s behaviour so they can figure out why something is wrong
be patient.
Friday, 12 April 2013
HYPOTHYROIDISM - Under Active Thyroid
What causes hypothyroidism?
Autoimmune thyroiditis - the common cause in the UK
The most common cause is due to an autoimmune disease called autoimmune thyroiditis. The immune system normally makes antibodies to attack bacteria, viruses, and other germs. If you have an autoimmune disease, the immune system makes antibodies against certain tissues of your body.
With autoimmune thyroiditis, you make antibodies that attach to your own thyroid gland, which affect the gland's function. The thyroid gland is then not able to make enough thyroxine, and hypothyroidism gradually develops. It is thought that something triggers the immune system to make antibodies against the thyroid. The trigger is not known.
Hypothyroidism (underactive thyroid gland) is the term used to describe a condition in which there is a reduced level of thyroid hormone (thyroxine) in the body. This can cause various symptoms, the most common being: tiredness, weight gain, constipation, aches, dry skin, lifeless hair and feeling cold. Treatment is usually easy by taking a tablet each day to replace the missing thyroxine. Treatment usually works well and symptoms usually go.
What is hypothyroidism?
Thyroxine is a hormone (body chemical) made by the thyroid gland in the neck. It is carried round the body in the bloodstream. It helps to keep the body's functions (the metabolism) working at the correct pace. Many cells and tissues in the body need thyroxine to keep them going correctly.
Hypothyroidism results from the thyroid gland being unable to make enough thyroxine, which causes many of the body's functions to slow down. Hypothyroidism may also occur if there is not enough thyroid gland left to make thyroxine, eg after surgical removal or injury.
(In contrast, if you have hyperthyroidism, you make too much thyroxine. This causes many of the body's functions to speed up.)
What are the symptoms of hypothyroidism?
Many symptoms can be caused by a low level of thyroxine. Basically, many body functions slow down. Not all symptoms develop in all cases.
Symptoms that commonly occur include: tiredness, weight gain, constipation, aches, feeling cold, dry skin, lifeless hair, fluid retention, mental slowing, and depression.
Less common symptoms include: a hoarse voice, irregular or heavy menstrual periods in women, infertility, loss of sex drive, carpal tunnel syndrome (which causes pains and numbness in the hand), and memory loss or confusion in the elderly.
However, all these symptoms can be caused by other conditions, and sometimes the diagnosis is not obvious. Symptoms usually develop slowly, and gradually become worse over months or years as the level of thyroxine in the body gradually falls.
What are the possible complications of hypothyroidism?
If you have untreated hypothyroidism:
You have an increased risk of developing heart disease. This is because a low thyroxine level causes the blood lipids (cholesterol, etc) to rise.
If you are pregnant, you have an increased risk of developing some pregnancy complications - for example: pre-eclampsia, anaemia, premature labour, low birth weight, stillbirth, and serious bleeding after the birth.
Hypothyroid coma (myxoedema coma) is a very rare complication.
However, with treatment, the outlook is excellent. With treatment, symptoms usually go, and you are very unlikely to develop any complications.
Who gets hypothyroidism?
About 1 in 50 women, and about 1 in 1,000 men develop hypothyroidism at some time in their life. It most commonly develops in adult women, and becomes more common with increasing age. However, it can occur at any age and can affect anyone.
Autoimmune thyroiditis is more common than usual in people with:
A family history of hypothyroidism caused by autoimmune thyroiditis.
Down's syndrome. Hypothyroidism develops in 1 in 3 people with Down's syndrome before the age of 25 years. Symptoms of hypothyroidism may be missed more easily in people with Down's syndrome. Therefore, some doctors recommend that all people with Down's syndrome should have an annual blood test to screen for hypothyroidism.
Turner syndrome. Again, an annual blood test to screen for hypothyroidism is usually advised for people with this condition.
An enlarged thyroid gland (diffuse goitre).
A past history of Graves' disease, or thyroiditis following childbirth.
A personal or family history of other autoimmune disorders - for example: vitiligo, pernicious anaemia, Addison's disease, type 1 diabetes, premature ovarian failure, coeliac disease, Sjögren's syndrome.
Some people with autoimmune thyroiditis also develop a swollen thyroid gland (goitre). Autoimmune thyroiditis with a goitre is called Hashimoto's disease. Also, people with autoimmune thyroiditis have a small increased risk of developing other autoimmune conditions such as vitiligo, pernicious anaemia, etc.
Other causes
Other causes of hypothyroidism include:
Worldwide, iodine deficiency is the most common cause of hypothyroidism. (Your body needs iodine to make thyroxine.) This affects some countries more commonly than others, depending on the level of iodine in the diet.
A side-effect to some medicines - for example, amiodarone and lithium.
Other types of thyroiditis (thyroid inflammation) caused by various rare conditions.
A pituitary gland problem is a rare cause. The pituitary gland that lies just under the brain makes a hormone called thyroid-stimulating hormone (TSH). This stimulates the thyroid gland to make thyroxine. If the pituitary does not make TSH then the thyroid cannot make enough thyroxine.
Some children are born with an underactive thyroid gland (congenital hypothyroidism).
How is hypothyroidism diagnosed?
A blood test can diagnose hypothyroidism. A normal blood test will also rule it out if symptoms suggest that it may be a possible diagnosis. One or both of the following may be measured:
TSH. This hormone is made in the pituitary gland. It is released into the bloodstream. It stimulates the thyroid gland to make thyroxine. If the level of thyroxine in the blood is low, then the pituitary releases more TSH to try to stimulate the thyroid gland to make more thyroxine. Therefore, a raised level of TSH means the thyroid gland is underactive and is not making enough thyroxine.
Thyroxine (T4). A low level of T4 confirms hypothyroidism.
Note: some people have a raised TSH level but have a normal T4 level. This means that you are making enough thyroxine but the thyroid gland is needing extra stimulation from TSH to make the required amount of thyroxine. In this situation you have an increased risk of developing hypothyroidism in the future. Your doctor may advise a repeat blood test every so often to see if you do eventually develop hypothyroidism.
Other tests are not usually necessary unless a rare cause of hypothyroidism is suspected. For example, tests of the pituitary gland may be done if both the TSH and T4 levels are low.
What is the dose of levothyroxine?
Most adults need between 50 and 150 micrograms daily. A low dose is sometimes prescribed at first, especially in those aged over 60 or with heart problems, and is then gradually increased over a period of time. Blood tests are usually taken every 2-3 months, and the dose may be adjusted accordingly. The blood test measures TSH (see above). Once the blood TSH level is normal it means you are taking the correct amount of levothyroxine. It is then common practice to check the TSH blood level once a year. The dose may need adjustment in the early stages of pregnancy. Also, as you get into late middle age and older, you may need a reduced dose of levothyroxine.
Missed a tablet?
Everyone forgets to take their tablets from time to time. Don't worry as it is not dangerous to miss the odd forgotten levothyroxine tablet. If you forget to take a dose, take it as soon as you remember if this is within 2 or 3 hours of your usual time. If you do not remember until after this time, skip the forgotten dose and take the next dose at the usual time. Do not take two doses together to make up for a missed dose. However, you should try to take levothyroxine regularly each morning for maximum benefit.
Are there any side-effects or problems from treatment?
Usually not. Levothyroxine tablets replace the body's natural hormone, so side-effects are uncommon. However, if you have angina, you may find that your angina pains become worse when you first start levothyroxine. Tell a doctor if this happens.
If you take too much levothyroxine it can lead to symptoms and problems of an overactive thyroid - for example, palpitations, diarrhoea, irritability, and sweating - and increase the risk of developing osteoporosis. This is why you need blood tests to check that you are taking the correct dose.
Other medicines may interfere with the action of levothyroxine - for example: carbamazepine, iron tablets, phenytoin, and rifampicin. If you start any of these medicines, or change the dose, then you may need to alter the dose of the levothyroxine. Your doctor will advise. Also, if you take warfarin, the dose may need to be altered if you have a change in your dose of levothyroxine.
Free prescriptions
If you have hypothyroidism, you are entitled to free prescriptions. This is for all your medicines, whether related to the hypothyroidism or not. Ask at your GP surgery for a form to fill in (form FP92A) to claim this benefit.
In summary
Hypothyroidism is common.
Symptoms develop gradually. They may be confused with other conditions.
Treatment with levothyroxine tablets is usually easy and effective.
Treatment is usually for life.
Have a blood test once a year if you take levothyroxine tablets once your dose has become stabilised.
Further help and advice
British Thyroid Foundation
2nd Floor, 3 Devonshire Place, Harrogate, HG1 4AA
Tel: 01423 709 707 and 01423 709 448 Web: www.btf-thyroid.org
http://www.patient.co.uk/health/hypothyroidism-underactive-thyroid
Autoimmune thyroiditis - the common cause in the UK
The most common cause is due to an autoimmune disease called autoimmune thyroiditis. The immune system normally makes antibodies to attack bacteria, viruses, and other germs. If you have an autoimmune disease, the immune system makes antibodies against certain tissues of your body.
With autoimmune thyroiditis, you make antibodies that attach to your own thyroid gland, which affect the gland's function. The thyroid gland is then not able to make enough thyroxine, and hypothyroidism gradually develops. It is thought that something triggers the immune system to make antibodies against the thyroid. The trigger is not known.
Hypothyroidism (underactive thyroid gland) is the term used to describe a condition in which there is a reduced level of thyroid hormone (thyroxine) in the body. This can cause various symptoms, the most common being: tiredness, weight gain, constipation, aches, dry skin, lifeless hair and feeling cold. Treatment is usually easy by taking a tablet each day to replace the missing thyroxine. Treatment usually works well and symptoms usually go.
What is hypothyroidism?
Thyroxine is a hormone (body chemical) made by the thyroid gland in the neck. It is carried round the body in the bloodstream. It helps to keep the body's functions (the metabolism) working at the correct pace. Many cells and tissues in the body need thyroxine to keep them going correctly.
Hypothyroidism results from the thyroid gland being unable to make enough thyroxine, which causes many of the body's functions to slow down. Hypothyroidism may also occur if there is not enough thyroid gland left to make thyroxine, eg after surgical removal or injury.
(In contrast, if you have hyperthyroidism, you make too much thyroxine. This causes many of the body's functions to speed up.)
What are the symptoms of hypothyroidism?
Many symptoms can be caused by a low level of thyroxine. Basically, many body functions slow down. Not all symptoms develop in all cases.
Symptoms that commonly occur include: tiredness, weight gain, constipation, aches, feeling cold, dry skin, lifeless hair, fluid retention, mental slowing, and depression.
Less common symptoms include: a hoarse voice, irregular or heavy menstrual periods in women, infertility, loss of sex drive, carpal tunnel syndrome (which causes pains and numbness in the hand), and memory loss or confusion in the elderly.
However, all these symptoms can be caused by other conditions, and sometimes the diagnosis is not obvious. Symptoms usually develop slowly, and gradually become worse over months or years as the level of thyroxine in the body gradually falls.
What are the possible complications of hypothyroidism?
If you have untreated hypothyroidism:
You have an increased risk of developing heart disease. This is because a low thyroxine level causes the blood lipids (cholesterol, etc) to rise.
If you are pregnant, you have an increased risk of developing some pregnancy complications - for example: pre-eclampsia, anaemia, premature labour, low birth weight, stillbirth, and serious bleeding after the birth.
Hypothyroid coma (myxoedema coma) is a very rare complication.
However, with treatment, the outlook is excellent. With treatment, symptoms usually go, and you are very unlikely to develop any complications.
Who gets hypothyroidism?
About 1 in 50 women, and about 1 in 1,000 men develop hypothyroidism at some time in their life. It most commonly develops in adult women, and becomes more common with increasing age. However, it can occur at any age and can affect anyone.
Autoimmune thyroiditis is more common than usual in people with:
A family history of hypothyroidism caused by autoimmune thyroiditis.
Down's syndrome. Hypothyroidism develops in 1 in 3 people with Down's syndrome before the age of 25 years. Symptoms of hypothyroidism may be missed more easily in people with Down's syndrome. Therefore, some doctors recommend that all people with Down's syndrome should have an annual blood test to screen for hypothyroidism.
Turner syndrome. Again, an annual blood test to screen for hypothyroidism is usually advised for people with this condition.
An enlarged thyroid gland (diffuse goitre).
A past history of Graves' disease, or thyroiditis following childbirth.
A personal or family history of other autoimmune disorders - for example: vitiligo, pernicious anaemia, Addison's disease, type 1 diabetes, premature ovarian failure, coeliac disease, Sjögren's syndrome.
Some people with autoimmune thyroiditis also develop a swollen thyroid gland (goitre). Autoimmune thyroiditis with a goitre is called Hashimoto's disease. Also, people with autoimmune thyroiditis have a small increased risk of developing other autoimmune conditions such as vitiligo, pernicious anaemia, etc.
Other causes
Other causes of hypothyroidism include:
Worldwide, iodine deficiency is the most common cause of hypothyroidism. (Your body needs iodine to make thyroxine.) This affects some countries more commonly than others, depending on the level of iodine in the diet.
A side-effect to some medicines - for example, amiodarone and lithium.
Other types of thyroiditis (thyroid inflammation) caused by various rare conditions.
A pituitary gland problem is a rare cause. The pituitary gland that lies just under the brain makes a hormone called thyroid-stimulating hormone (TSH). This stimulates the thyroid gland to make thyroxine. If the pituitary does not make TSH then the thyroid cannot make enough thyroxine.
Some children are born with an underactive thyroid gland (congenital hypothyroidism).
How is hypothyroidism diagnosed?
A blood test can diagnose hypothyroidism. A normal blood test will also rule it out if symptoms suggest that it may be a possible diagnosis. One or both of the following may be measured:
TSH. This hormone is made in the pituitary gland. It is released into the bloodstream. It stimulates the thyroid gland to make thyroxine. If the level of thyroxine in the blood is low, then the pituitary releases more TSH to try to stimulate the thyroid gland to make more thyroxine. Therefore, a raised level of TSH means the thyroid gland is underactive and is not making enough thyroxine.
Thyroxine (T4). A low level of T4 confirms hypothyroidism.
Note: some people have a raised TSH level but have a normal T4 level. This means that you are making enough thyroxine but the thyroid gland is needing extra stimulation from TSH to make the required amount of thyroxine. In this situation you have an increased risk of developing hypothyroidism in the future. Your doctor may advise a repeat blood test every so often to see if you do eventually develop hypothyroidism.
Other tests are not usually necessary unless a rare cause of hypothyroidism is suspected. For example, tests of the pituitary gland may be done if both the TSH and T4 levels are low.
What is the dose of levothyroxine?
Most adults need between 50 and 150 micrograms daily. A low dose is sometimes prescribed at first, especially in those aged over 60 or with heart problems, and is then gradually increased over a period of time. Blood tests are usually taken every 2-3 months, and the dose may be adjusted accordingly. The blood test measures TSH (see above). Once the blood TSH level is normal it means you are taking the correct amount of levothyroxine. It is then common practice to check the TSH blood level once a year. The dose may need adjustment in the early stages of pregnancy. Also, as you get into late middle age and older, you may need a reduced dose of levothyroxine.
Missed a tablet?
Everyone forgets to take their tablets from time to time. Don't worry as it is not dangerous to miss the odd forgotten levothyroxine tablet. If you forget to take a dose, take it as soon as you remember if this is within 2 or 3 hours of your usual time. If you do not remember until after this time, skip the forgotten dose and take the next dose at the usual time. Do not take two doses together to make up for a missed dose. However, you should try to take levothyroxine regularly each morning for maximum benefit.
Are there any side-effects or problems from treatment?
Usually not. Levothyroxine tablets replace the body's natural hormone, so side-effects are uncommon. However, if you have angina, you may find that your angina pains become worse when you first start levothyroxine. Tell a doctor if this happens.
If you take too much levothyroxine it can lead to symptoms and problems of an overactive thyroid - for example, palpitations, diarrhoea, irritability, and sweating - and increase the risk of developing osteoporosis. This is why you need blood tests to check that you are taking the correct dose.
Other medicines may interfere with the action of levothyroxine - for example: carbamazepine, iron tablets, phenytoin, and rifampicin. If you start any of these medicines, or change the dose, then you may need to alter the dose of the levothyroxine. Your doctor will advise. Also, if you take warfarin, the dose may need to be altered if you have a change in your dose of levothyroxine.
Free prescriptions
If you have hypothyroidism, you are entitled to free prescriptions. This is for all your medicines, whether related to the hypothyroidism or not. Ask at your GP surgery for a form to fill in (form FP92A) to claim this benefit.
In summary
Hypothyroidism is common.
Symptoms develop gradually. They may be confused with other conditions.
Treatment with levothyroxine tablets is usually easy and effective.
Treatment is usually for life.
Have a blood test once a year if you take levothyroxine tablets once your dose has become stabilised.
Further help and advice
British Thyroid Foundation
2nd Floor, 3 Devonshire Place, Harrogate, HG1 4AA
Tel: 01423 709 707 and 01423 709 448 Web: www.btf-thyroid.org
http://www.patient.co.uk/health/hypothyroidism-underactive-thyroid
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