CT Scans of Children

Although estimates vary a CT scan of the chest is equal to several hundred chest X-rays. Due to their age and the sensitivity of their developing organs children are more vulnerable than adults to radiation. A dose of radiation that does not harm an adult can place a child at an increased lifetime risk for cancer. Another issue concerns CT accessibility. CT scans have been available for many years but now they are much faster than in the past. Consequently, when a CT scan was ordered in the past sedation was often needed. Today, distraction is often successful and this is a smaller roadblock to obtaining a CT. Two areas where CT scans are frequently obtained and are unnecessary are for minor head injury and for abdominal pain.

Many children who experience a head injury and are seen in an emergency room do not need to have a head CT done. they can be managed by taking a careful history, performing a thorough exam and providing close follow-up. Although a parent may be reassured by the normal result the reassurance does not justify the radiation their child is exposed to.

Another situation concerns the use of an abdominal CT scan in the diagnosis of appendicitis in children. Although CT scans are very good at making the diagnosis of appendicitis clinical diagnosis and the use of other non-radiation tests such as ultrasound can be very successful in the diagnosis and CT scans can be used on a limited basis depending on clinical course and examination findings.

CT scans are also frequently obtained to evaluate children who have their first seizure. In this situation as in the above examples the most important determinant of whether a CT actually needs to be obtained is the history and physical examination. If the history and physical examination do not point to structural problem with the brain a CT scan is not needed.

What should you do as a parent? Ask questions and listen to the answers. If you feel a CT is being done for reasons that do not justify the risk discuss your concerns with your child’s doctor. Almost always such a discussion will allow your child to receive the best care possible. If there is justification to do the test then do it.  If not, seek more advice and another opinion. As always, trust yourself and trust your doctor.


The United States Centers for Disease Control reports an estimated 2 million patients get a hospital-realated infection each year and 90,000 die from their infection. In terms of admissions that is 1 infection for every 20 patients. Proper handwashing techniques are the fastest and most important way to decrease the spread of communicable illness in children, teens and adults.

Every parent must play an active role in preventing the spread of microorganisms that cause disease. This is important in your home, your child’s daycare or school, your workplace, public places and in the hospital. The use of body and hand protective garb including gowns, gloves and eye protection are vital in a hospital setting; but, the first and most important protection is handwashing.

The first step is to make hand washing a habit. Every time you are in contact with someone who is ill wash your hands. Always remember to wash before eating, after using the bathroom, after coming in from outside, after touching a pet or animal, after sneezing and covering your mouth with your hand and whenever your hands look dirty. The more often you wash the safer you will be.

The best handwashing is with warm water and regular soap. Start out with wet hands and then apply the soap to serve as a lubricant and a degreaser to lift off any dirt. Rub the hands vigorously together and then rinse well for 15 seconds to wash the germs and grime down the drain. Antibacterial soaps are not needed and alcohol based hand sanitizers should not be used when the hands are visibly dirty. If no sink is available then hand sanitizers should still be used.

Headache Questions To Ask Your Child

  • Ask your child to make a drawing of the head pain. Date and time the episode and try not to give your child “hints” as to what to draw.
  • Describe the type of head pain your child has. Include information on location, time of onset, frequency, severity, associated symptoms and duration.
  • Be specific about the exact way your child’s headache begins in terms of any associated factors or triggers.
  • Does anything bring on a headache?
  • Does anything improve or relieve the headache?
  • Does anything make the pain worse or better?
  • Are the headaches changing?
  • Does the pain move or radiate to other locations?
  • Describe the quality and characteristics of the Pain.
  • Does your child take anything for the headache? What and how much? How often?
  • Does medication help?
  • Has anyone prescribed medication? What medication? Who prescribed it? How often is it taken?
  • Does anyone in the family have headaches?
  • Does your child have any medical problems?
  • Has your child missed school due to the headaches? How many? How often?
  • What do you think causes your child’s headaches?

Where Do Our Expectations Come From?

Deep within every parent’s heart is a spirit called expectation. Dreams of what could be and what can be. Expectations are affected by the demands of others and the reality of the present. Self imposed expectations heightened by the media surround each of us whether we are the mall or the grocery store. We see parent-child interactions and wonder what we would have done or should have done.

Your life is busy. Working, parenting, maintaining the household, doing laundry, yard chores, working out and eating rarely allow our minds to become quiet. Even sleep can become a fitful activity filled with strange dreams and unexplained fears. Allow of these tasks distract us from purposeful contemplation about our own needs, wants, feelings and aspirations. In this absence our brains are constantly recycling thoughts about what we could have done, should have done or would have done.

Our survival depends on the brain’s automated ability to perform functions without our active thought and participation. We breathe, digest food and maintain our balance blood pressure and heart rate without the slightest awareness. These autopilot capabilities of our central nervous system are unparalleled. Checks and balances, feedback systems and internal debriefing systems abound within each of us and function daily without us being aware.

This autopilot capability also manages our mental attitude. This is why the patterns of thinking we pursue and prefer are so important. Our thoughts train our brain in the same way as our movements and actions. By affirming happiness, fulfillment and opportunity our brain becomes trained to perform this same way when we are busy with decisions at work, at home or at play. If we affirm sadness, loss and inadequacy then our brain will mirror and recycle these patterns. By building brain circuitry upon a foundation of positive affirmations your automated thoughts and expectations will always be playing in this ” hidden brain” within each of us.

The choice is yours. What will be your playlist?

Concussion And Brain Rest

After your child has been diagnosed as having a concussion the first step is to discuss the injury with your family and your child. The stress of the injury and the diagnosis can be difficult but convincing your child to allow his or her brain to “heal” can be even more difficult. Your child’s brain needs time to recover. This is a time when your child needs to avoid all physical activity beyond light walking and if light walking causes symptoms including headache, dizziness or vision changes then your child needs to avoid physical activity.  Mental activity including television, movies, video games, text messaging and any activity beyond simply quieting the brain needs to be avoided. Spend time together listening to soft music or the sounds of nature. Consider reading to your child and helping them take several naps throughout the day and always pursue a restfull sleep for 9-10 hours each night.  The sooner the recovery begins the faster the concussion symptoms will resolve. Any activity that prevents this recovery will cause the symptoms to last longer and possibly worsen.

Parents play the most important role in this recovery process. You have the relationship and capability to convince your child about the importance of rest and can intervene immediately if you see signs of anxiety or difficulty coping with injury sequellae. You know your child best. Even a trained eye can miss signs of mood, behavior or cognitive difficulty that you easily recognize. Speak up! Do not allow your child to return to activity before all symptoms have resolved. Seek help and advice and stay in close contact with your pediatrician.

Studies clearly show a concussion disrupts brain function and will only heal with time. Brain blood flow decreases after a concussion and this robs the brain of vital energy sources. Your brain relies on glucose for energy. In the days and weeks after a concussion it is as if someone blocked off several streets and you are unable to drive to the store. By decreasing activity and cognitive work load, more glucose is available for your brain to heal. This is the time when the brain is most vulnerable. It is as if you have left a bedroom window open on a cold and blustery winter day. You walk into the bedroom and feel a cold draft and know how hard your furnace has been working all day to keep up with the loss of energy. Don’t let this happen to your child’s brain.

Engage the whole family in this process. Sibs and friends need to understand the need for rest and a very gradual return to activity. These guidelines are called “return to learn and return to play” rules. Inform school staff and all who are involved in the caretaking of your child. This is a team effort and with time and patience the overwhelming majority of children recover fully within several weeks. If your child continues to have symptoms after 3 weeks of rest, has worsening symptoms or if he or she has a history of a prior concussions or an underlying neurologic problem including a seizure disorder, a migraine headache disorder, learning problems, ADHD or mental health problems then seek expert help and guidance.

Constipation Questions

What is constipation?
If your child begins to have stools less frequently than his usual stool pattern or if he is aving less than 3 stools per week he is constipated.

What other signs and symptoms are seen in constipation?
Stools that are large, painful or difficult to push out are common in constipation.

How might my child act?
Your child may act fidgety and restless, squirm in his chair, sit on his foot and squeeze his buttocks together in an attempt not to have a bowel movement. He is trying to avoid having a bowel movement which he has learned causes him pain and discomfort. These behaviors are a sign of the colicky pain seen in a child who is constipated.

How common is constipation?
It is one of the most common gastrointestinal complaints in children.

Does diet cause constipation?
Often children eat food high in fat and low in fiber and do not take in enough water. These are common dietary causes of constipation as is a diet high in milk products.

Does exercise effect constipation?
Yes. Children who move more and live an active lifestyle have a shorter transit time for food to move through their intestines. This helps prevent constipation. Children who sit for extended periods and are inactive have more problems with constipation.

Do emotional concerns play a role?
Yes. Emotional concerns depend on the child’s age and developmental level. Some toddlers can develop anxiety and be overwhelmed by a toilet training program. Other toddlers or older children use it as a way to assert their independence and engage in a power struggle with their parent. Older children often avoid using the bathroom in school and this can cause them to stop responding to signals telling them to have a bowel movement. Over time this causes the typical stooling pattern to become disrupted. This is also seen in children who are very active and on the go and do not take time to use the bathroom.

Can stress cause constipation?
Yes. Children of all ages are prone to body complaints related to moderate or severe toxic stress at home or at school. Numerous functional complaints can be seen including stool retention.

What other symptoms are seen with constipation?
Your child may have a decreased appetite and sleep disruption. There may be smearing of underwear with a small amount of stool due to a leak of liquid or soft stool.

How does the pediatrician diagnose the cause of the constipation?
By taking a thorough medical history and performing a comprehensive examination your pediatrician will determine whether the cause is functional or is due to an organic problem.

What type of information should I collect to tell my pediatrician?
If your child is less than 1 year of age the time of his first stool in the newborn period will be important as will the pattern of stooling up to the time when stool frequency decreased. For older children the pattern of onset is important as is stool description, frequency and the way your child responds to signals of needing to have a bowel movement. Keep a food log for 1 week and see how much fluids your child drinks. Check his urine color to see if it is clear throughout the day or is yellow and concentrated. Check your child’s underwear for staining and look for behaviors that may signal he is holding back the urge to defecate.