tag:theconversation.com,2011:/ca/topics/kids-health-28784/articlesKids health – The Conversation2024-02-13T02:26:14Ztag:theconversation.com,2011:article/2233412024-02-13T02:26:14Z2024-02-13T02:26:14ZWhy ban ham from school canteens? And what are some healthier alternatives for kids’ lunches?<figure><img src="https://images.theconversation.com/files/575144/original/file-20240212-18-jxuhh8.jpg?ixlib=rb-1.1.0&rect=37%2C37%2C4100%2C2773&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/toasted-sandwich-ham-cheese-176817788">Shutterstock/Joe Gough</a></span></figcaption></figure><p>Western Australia has introduced a limit on ham in school canteens. Parents are reportedly <a href="https://www.news.com.au/lifestyle/parenting/school-life/western-australia-introduces-new-limits-on-ham-at-school-canteens-banning-iconic-lunch/news-story/19b927b35e1122a01ab4539bc477a95d">confused and frustrated</a>. So what has changed and what evidence is it based on?</p>
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<h2>Reclassifying processed meats</h2>
<p>The WA Department of Health has reconfigured its system for classifying food and drink in public schools. It uses a traffic light approach, allocating green, amber or red colours to foods and drinks. </p>
<p>Ham and other processed red meats <a href="https://www.health.wa.gov.au/%7E/media/Corp/Documents/Health-for/Obesity-physical-activity-and-nutrition/WA-school-food-and-drink-criteria-FAQ.pdf">have been moved</a> from an “amber” label to a “red” label. </p>
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Read more:
<a href="https://theconversation.com/yes-we-still-need-to-cut-down-on-red-and-processed-meat-124486">Yes, we still need to cut down on red and processed meat</a>
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<p>Each colour is <a href="https://www.health.wa.gov.au/%7E/media/Corp/Documents/Health-for/Obesity-physical-activity-and-nutrition/WA-school-food-and-drink-criteria-FAQ.pdf">associated with restrictions</a> on how food and drinks can be sold:</p>
<ul>
<li>green items must account for at least 60% of items on a menu</li>
<li>amber items must account for less than 40% of items on a menu</li>
<li>red items cannot be on the menu.</li>
</ul>
<p>There’s one catch. The new guidelines allow ham to be sold as if it is an amber item, only two days per week, if ham was already on a canteen’s menu prior to the reconfiguration. </p>
<figure class="align-center ">
<img alt="Kids sit in a lunchroom" src="https://images.theconversation.com/files/575145/original/file-20240212-22-ey3jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575145/original/file-20240212-22-ey3jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575145/original/file-20240212-22-ey3jk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575145/original/file-20240212-22-ey3jk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575145/original/file-20240212-22-ey3jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575145/original/file-20240212-22-ey3jk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575145/original/file-20240212-22-ey3jk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ham can still be sold two days a week if it’s already on the canteen’s menu.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-schoolchildren-having-meal-canteen-452918419">Shutterstock/WBMUL</a></span>
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<h2>Why restrict ham?</h2>
<p>Singling out nutrients or foods as “good” or “bad” can lead to <a href="https://www.scopus.com/inward/record.url?eid=2-s2.0-84907554121&partnerID=10&rel=R3.0.0">confusion and polarised views</a> on diet. Rather than focusing on individual foods, long-term health outcomes are more closely linked to overall <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071223/">dietary patterns</a>.</p>
<p>Ham itself is not inherently considered junk food. It’s a source of protein and many other nutrients. </p>
<p>However, certain types of ham products – especially highly processed or cured hams – are less healthy options for several reasons:</p>
<p><strong>High sodium content</strong></p>
<p>Many commercially available hams, especially highly processed and cured varieties, can be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267163/">high in sodium</a>, which is salt.</p>
<p>Excessive sodium intake is <a href="https://pubmed.ncbi.nlm.nih.gov/32992705/">associated</a> with health issues such as high blood pressure and can increase the risk of heart disease and strokes. </p>
<p>On average, Australian children <a href="https://www.sciencedirect.com/science/article/pii/S2212267218302569">consume more sodium</a> than the <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/salt">recommended upper limit</a>: 600 mg a day for children aged four to eight and 800 mg a day for those aged nine to 13. </p>
<p>The World Health Organization says reducing sodium is <a href="https://www.who.int/news-room/fact-sheets/detail/salt-reduction#:%7E:text=Excess%20sodium%20is%20linked%20to,as%20milk%2C%20meat%20and%20shellfish.">one of the most cost-effective ways</a> nations can improve the health of their populations.</p>
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Read more:
<a href="https://theconversation.com/health-check-how-much-salt-is-ok-to-eat-58594">Health Check: how much salt is OK to eat?</a>
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<p><strong>Additives</strong></p>
<p>Some processed hams may contain <a href="https://www.sciencedirect.com/science/article/pii/S1051227621002120">additives</a>, preservatives and flavour-enhancers we should limit.</p>
<p><strong>Saturated fat</strong></p>
<p>While ham is a good source of protein, certain cuts can be higher in saturated fat. </p>
<p>Any ham sold in canteens under the new rules (where ham is treated as an “amber” food until the canteen menu changes) must have <a href="https://www.health.wa.gov.au/%7E/media/Corp/Documents/Health-for/Obesity-physical-activity-and-nutrition/Selected-RED-items">less than 3g of saturated fat per 100g</a>. </p>
<p>Diets high in saturated fat are <a href="https://www.heartfoundation.org.au/bundles/healthy-living-and-eating/fats-oils-and-heart-health#:%7E:text=Unhealthy%20saturated%20and%20trans%20fats%20can%20heighten%20your%20risk%20of,and%20mortality%20from%20heart%20disease.">linked to an increased risk of heart disease</a>. However, not all research <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824152/#:%7E:text=Conclusions%3A%20A%20meta%2Danalysis%20of,risk%20of%20CHD%20or%20CVD.">supports this claim</a>.</p>
<p><strong>Processing methods</strong></p>
<p>The methods to process and cure ham may involve smoking, which can produce compounds such as polycyclic aromatic hydrocarbons. In large quantities, these <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537007/">may cause health concerns</a>, including increasing the risk of bowel cancer.</p>
<h2>What are some ham alternatives?</h2>
<p>Lean, minimally processed ham, prepared without excessive sodium or additives, can potentially be a part of a healthy overall diet. And parents in WA can <a href="https://www.health.wa.gov.au/%7E/media/Corp/Documents/Health-for/Obesity-physical-activity-and-nutrition/WA-school-food-and-drink-criteria-FAQ.pdf">continue packing ham</a> in their child’s lunchbox. </p>
<p>When choosing ham, read the labels and select products with a lower sodium content, minimal additives and healthier preparation methods. </p>
<figure class="align-center ">
<img alt="Girl picks up celery while shopping with her brother and dad" src="https://images.theconversation.com/files/575150/original/file-20240212-16-ey3jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575150/original/file-20240212-16-ey3jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575150/original/file-20240212-16-ey3jk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575150/original/file-20240212-16-ey3jk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575150/original/file-20240212-16-ey3jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575150/original/file-20240212-16-ey3jk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575150/original/file-20240212-16-ey3jk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Involve kids in preparing their lunchboxes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-shopping-son-daughter-supermarket-149629991">sirtravelalot/Shutterstock</a></span>
</figcaption>
</figure>
<p>When looking for low-salt alternatives to ham, there are several options to consider: </p>
<ul>
<li><p><strong>turkey breast</strong>. Turkey is a lean meat and can be a good substitute for ham. Look for low-sodium or no-salt-added varieties</p></li>
<li><p><strong>chicken breast</strong>. Skinless, boneless chicken breast is a versatile and low-sodium option. Grilling, baking or roasting can add flavour without relying on salt</p></li>
<li><p><strong>smoked salmon</strong>. While salmon naturally contains some sodium, smoked salmon tends to be lower in sodium than cured ham. Choose varieties with little or no added salt</p></li>
<li><p><strong>roast beef</strong>. Choose lean cuts of roast beef and consider seasoning with herbs and spices instead of relying on salt for flavour</p></li>
<li><p><strong>homemade roasts</strong>. Prepare your own roasts using lean meats such as pork loin, beef sirloin or lamb. This way, you have more control over the ingredients and can minimise added salt</p></li>
<li><p><strong>grilled vegetables</strong>. These can be a tasty alternative to meat. Eggplant, zucchini, capsicum and portobello mushrooms have a satisfying texture and flavour</p></li>
<li><p><strong>beans and legumes</strong>. Beans, lentils and chickpeas can be used as alternatives in various dishes. They are naturally low in sodium and high in protein and fibre.</p></li>
</ul>
<h2>What are some other lunchbox tips?</h2>
<p>Packing lunchboxes can be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10107882/">challenging and frustrating</a> for parents. </p>
<p>Consider planning ahead, involving your kids, reducing pre-packaged foods, balancing cost and convenience, and giving your kids lunchbox accountability. </p>
<p>Many websites provide <a href="https://www.bestrecipes.com.au/budget/galleries/lunch-box-recipes-kids-31-back-school-lunches/vy6bf9xp">ideas for parents</a>, including websites focused on <a href="https://www.frugalandthriving.com.au/frugal-lunchbox-ideas/">low-cost foods</a>. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sick-of-packing-school-lunches-already-heres-how-to-make-it-easier-179675">Sick of packing school lunches already? Here's how to make it easier</a>
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<p>Remember to keep portions appropriate for kids and to consider any allergies or school regulations when packing lunches. </p>
<p>Making the lunch experience interactive and enjoyable can encourage kids to <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-019-0798-1">embrace healthier eating habits</a>.</p><img src="https://counter.theconversation.com/content/223341/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Ball works for The University of Queensland and receives funding from the National Health and Medical Research Council, Queensland Health and Mater Misericordia. She is a Director of Dietitians Australia, a Director of the Darling Downs and West Moreton Primary Health Network and an Associate Member of the Australian Academy of Health and Medical Sciences.</span></em></p>Western Australia has introduced a limit on ham in school canteens. Here’s what has changed and the evidence it’s based on.Lauren Ball, Professor of Community Health and Wellbeing, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1898802022-12-26T20:52:03Z2022-12-26T20:52:03ZStructured school days can keep kids healthy. How can we maintain it over school holidays?<figure><img src="https://images.theconversation.com/files/495000/original/file-20221114-14-xsitk7.jpg?ixlib=rb-1.1.0&rect=26%2C44%2C5853%2C2935&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-girl-playing-outdoor-child-kids-1040657719">shutterstock</a></span></figcaption></figure><p>Every parent knows kids spend their time differently when they’re on holidays. Our new research found out just how differently.</p>
<p>During the school term, kids get up around 7am, get into their uniforms, make their way to school, eat food from their lunchboxes or canteens, play at recess and lunch, have PE lessons, sit and get bored or excited in class, and then head home. Their day is highly structured. </p>
<p>However during school holidays, all this goes out the window. Our <a href="https://pubmed.ncbi.nlm.nih.gov/31646994/">new research</a> shows in the summer holidays, kids are getting less physical activity, more screentime, and eating more junk food and less fruit than they do during term time.</p>
<p>So what can families do to counter this?</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/richer-schools-students-run-faster-how-the-inequality-in-sport-flows-through-to-health-185681">Richer schools' students run faster: how the inequality in sport flows through to health</a>
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<h2>What our research found</h2>
<p>We asked 358 children aged nine to 11 years from 24 primary schools across Adelaide to wear an activity band for four weeks across the school year and one week during the summer holidays. At the same time, we asked the children to tell us about the activities they did and what they ate. </p>
<p>From the activity band data, we found during the summer holidays, kids sit for an extra 27 minutes, and spend 12 minutes less doing physical activity. From asking the kids about the activities they did, we found kids get 73 minutes more screen time each day, they spend an extra 22 minutes in cars, buses and trains, and 23 more minutes eating or grooming. They also spend an extra 16 minutes just chilling (sitting listening to music or doing nothing).</p>
<p>These findings mean their overall energy expenditure is about 13% lower. We also found kids’ diet quality is lower — more junk food and about half a serve less fruits each day than in school time.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cars-have-taken-over-our-neighbourhoods-kid-friendly-superblocks-are-a-way-for-residents-to-reclaim-their-streets-187276">Cars have taken over our neighbourhoods. Kid-friendly superblocks are a way for residents to reclaim their streets</a>
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<h2>Why does it matter?</h2>
<p>More physical activity and less screen time are <a href="https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-children-and-young-people-5-to-17-years">linked</a> to better physical and mental health, higher levels of fitness, better school grades, and lower risk of becoming overweight. Overweight and obesity in childhood can lead to an increased risk of developing type 2 diabetes, problems sleeping, and <a href="https://www.healthdirect.gov.au/obesity-in-children#complications">low self-esteem</a>. </p>
<p>During the school year kids don’t gain much weight, but they do in the <a href="https://pubmed.ncbi.nlm.nih.gov/24921899/">summer holidays</a>. We found on average, all participating kids’ weight increased six times faster during the summer holidays than during term time. In fact, if kids lived every day like they do when they’re on summer holidays, they’d put on an extra 6 kilograms a year. Kids are also <a href="https://pubmed.ncbi.nlm.nih.gov/30800015/">losing fitness</a>, and their <a href="https://pubmed.ncbi.nlm.nih.gov/35065629/">mental health</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/30925676/">wellbeing</a> suffer over the summer holidays. </p>
<p>These effects are <a href="https://pubmed.ncbi.nlm.nih.gov/24921899/">worse</a> in children from poorer, less educated backgrounds, and kids who are <a href="https://pubmed.ncbi.nlm.nih.gov/34877011/">already overweight</a>.</p>
<h2>How can we maintain the benefits of kids being at school, during the holidays?</h2>
<p>Some have called for <a href="https://theconversation.com/should-we-shorten-the-long-summer-break-from-school-maybe-not-92423">shorter school holidays</a>. But Australian summer holidays are quite short by <a href="https://www.nature.com/articles/s41597-022-01120-z">world standards</a>. Parents in Australia might welcome the four weeks enjoyed by Singaporean students, and children the 14 weeks endured by parents in Egypt.</p>
<p>In the United States and Europe, many children go to summer camps in the summer holidays. These can be overnight camps, where kids stay overnight, or day camps where kids go home at the end of each day. The length of these camps <a href="https://www.acacamps.org/resources/whats-difference-between-camps-programs-sessions">varies widely </a>and can be short (1 to 2 weeks), mid-length (3 to 5 weeks) or the full summer session (7 weeks or more).</p>
<p>Research has <a href="https://pubmed.ncbi.nlm.nih.gov/32514369/">shown</a> where kids go to a summer camp daily (Monday to Thursday) for six weeks over the summer, kids are more active, less stationary and eat healthier diets on the days they go to summer day camp, compared to the days when they stay at home. These camps may be residential or day camps, and may combine physical activity with specific learning activities, such as coding, art or drama.</p>
<p>Families may also try getting their kids outdoors. <a href="https://pubmed.ncbi.nlm.nih.gov/20412582/">Research</a> has shown kids are likely to be more active when they are outdoors. Families may also try getting their kids to do something physically active before allowing them screen time - this could even be doing chores like mopping the floor. </p>
<p>Families may try to add extra structure to their children’s holiday days, but it’s pretty hard to resist the opportunity to sleep in, snack and binge on Netflix and video games, when the content is precisely designed to keep kids watching. </p>
<p>Big problems need bold solutions – is it time for school administrators and policy makers to reconsider the length of the school holidays, or the lack of summer holiday programming, for the sake of our kids’ health? </p>
<p>Summer holiday programming might come from a variety of organisations such as sports and activity clubs, schools, religious organisations, museums and art galleries, disability groups, as well as the private sector which also offers summer camps.</p>
<p>Some ways to get everyone out of the house and moving could include the family enjoying a day out at the zoo, going climbing at [Tree Climb], spending the day swimming and sliding at your local aquatic centre, or spending time with the animals at <a href="https://www.farmbarn.com.au/">Hahndorf’s Farm Barn</a>.</p><img src="https://counter.theconversation.com/content/189880/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Watson receives funding from the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Carol Maher receives funding from the Medical Research Future Fund, the National Health and Medical Research Council, the National Heart Foundation, the SA Department for Education, the SA Department for Innovation and Skills, Healthway, Hunter New England Local Health District, the Central Adelaide Local Health Network, and LeapForward. </span></em></p><p class="fine-print"><em><span>Tim Olds receives funding from the Australian Research Council and the National Health and Medical Research Council.</span></em></p>Kids have structure during the school year which facilitates regular physical activity and healthy eating habits. But this ends during school holidays. How can we maintain these healthy habits?Amanda Watson, Research Associate, University of South AustraliaCarol Maher, Professor, Medical Research Future Fund Emerging Leader, University of South AustraliaTim Olds, Professor of Health Sciences, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1616732021-06-15T05:48:40Z2021-06-15T05:48:40ZGreen space around primary schools may improve students’ academic performance<figure><img src="https://images.theconversation.com/files/404389/original/file-20210603-13-wbcepa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/children-rucksacks-standing-park-near-school-664225237">Shutterstock</a></span></figcaption></figure><p>Greenery around primary schools may improve students’ academic performance, while traffic pollution may be detrimental, <a href="https://www.sciencedirect.com/science/article/pii/S0013935121006198?dgcid=author">our study</a> shows.</p>
<p>With increasing urbanisation in Australia and globally, consideration needs to be given to the location of schools. Children need to grow and learn in environments that promote their physical health, as well as their cognitive development and academic learning.</p>
<p>Our research mapped greenery and traffic exposure around 851 primary schools across greater Melbourne.</p>
<p>We examined how greenery and traffic-related air pollution were associated with the average 2018 NAPLAN scores in years 3 and 5. The scores were in five domains: reading, writing, spelling, grammar, punctuation and numeracy. </p>
<p>People tend to see green leafy suburbs as more wealthy, and socioeconomic status is a significant predictor of academic scores. So to ensure we were looking at the effects of the greenery itself, we compared schools in the same socioeconomic bracket. We found more greenery was associated with better NAPLAN scores. Meanwhile, higher exposure to traffic-related pollution was associated with poorer scores.</p>
<h2>The importance of urban greenery</h2>
<p>A growing body of evidence shows access to green space — which includes parks, trees, shrubs and grass — <a href="https://www.pnas.org/content/112/26/7937">is linked to</a> children’s healthy development. </p>
<p>We know greenery in urban areas may <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2739050">boost mental health</a> among older adults <a href="https://pubmed.ncbi.nlm.nih.gov/25862991/">and can offset</a> traffic emissions.</p>
<p>Research conducted internationally suggests greenness surrounding schools can lead to <a href="https://www.pnas.org/content/112/26/7937">better cognitive development</a> in primary school-aged children. But there is <a href="https://pubmed.ncbi.nlm.nih.gov/30717301/">still debate</a> over whether greenery around schools can boost academic performance.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/406360/original/file-20210615-3759-1j7f3ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three girls sitting in a park with their arms around each other." src="https://images.theconversation.com/files/406360/original/file-20210615-3759-1j7f3ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/406360/original/file-20210615-3759-1j7f3ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/406360/original/file-20210615-3759-1j7f3ko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/406360/original/file-20210615-3759-1j7f3ko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/406360/original/file-20210615-3759-1j7f3ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/406360/original/file-20210615-3759-1j7f3ko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/406360/original/file-20210615-3759-1j7f3ko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Green space is linked to healthy development in children.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-cute-girls-seated-on-273209597">Shutterstock</a></span>
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<p>Exposure to traffic-related air pollution at school, where children spend much of their waking hours, has been <a href="https://pubmed.ncbi.nlm.nih.gov/30216772/">associated with poorer performance</a> in tests of brain health and development. Air pollution may be <a href="https://pubmed.ncbi.nlm.nih.gov/25495759/">more detrimental to the health</a> of children compared with adults, due to children’s physiology and rapid growth.</p>
<p>We wanted to investigate if greenery and traffic pollution have clear links with academic performance, an indicator of cognitive development.</p>
<h2>Children perform better with more greenery</h2>
<p>We measured the amount of greenery in the school grounds, and then the traffic pollution and greenery around the school grounds within distances of 100m, 300m, 1,000m and 2,000m.</p>
<p>We found school-level academic performance in reading, numeracy, grammar and punctuation was better on average for schools located in areas with more greenery.</p>
<p>Our statistical modelling included data on socioeconomic levels of the area as well as variations in schools, such as parental occupation and proportion of Indigenous students. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/peoples-odds-of-loneliness-could-fall-by-up-to-half-if-cities-hit-30-green-space-targets-161989">People's odds of loneliness could fall by up to half if cities hit 30% green space targets</a>
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</p>
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<p>We compared the NAPLAN scores of similar socioeconomic-status schools and found higher scores in greener areas. For example, when comparing schools with the highest and lowest levels of green within 300 m, we found statistically significant differences of an average 20 points in reading scores for year 5.</p>
<p>Poorer performance was associated with higher levels of traffic-related air pollution surrounding schools. Reading scores in year 5 were around 16 points lower, on average, in schools with the highest levels of traffic-related air pollution within 300m of schools, compared with those with lowest levels. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/406362/original/file-20210615-21-l09ixs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Boy kicking soccer ball." src="https://images.theconversation.com/files/406362/original/file-20210615-21-l09ixs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/406362/original/file-20210615-21-l09ixs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/406362/original/file-20210615-21-l09ixs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/406362/original/file-20210615-21-l09ixs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/406362/original/file-20210615-21-l09ixs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/406362/original/file-20210615-21-l09ixs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/406362/original/file-20210615-21-l09ixs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There is a link between more green space around schools and higher academic scores.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/boy-kicking-ball-while-playing-street-1792638313">Shutterstock</a></span>
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<p>The specifics of the NAPLAN scores aren’t as important as the associations we found with greenery and traffic pollution. Our findings show preliminary evidence that greener environments with low traffic levels around primary schools may promote children’s academic performance.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/higher-density-cities-need-greening-to-stay-healthy-and-liveable-75840">Higher-density cities need greening to stay healthy and liveable</a>
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</em>
</p>
<hr>
<p>Our exploratory study is the first of its kind in Melbourne, a metropolis with <a href="https://www.planning.vic.gov.au/policy-and-strategy/planning-for-melbourne/plan-melbourne">projected growth and plans</a> for future school developments and traffic infrastructure.</p>
<h2>How can greenery help?</h2>
<p>Greenery can <a href="https://pubmed.ncbi.nlm.nih.gov/25862991/">help reduce air pollution in several ways</a> including filtering the air through plant surfaces and foliage.</p>
<p>But other factors (not examined in our study) that may play a role in the association between greenery and academic performance are related to the type and location of greenery.</p>
<p>Better performance among children in greener areas could be due to attention restoration, stress reduction or reducing harmful environmental exposures (such as noise from traffic and air pollution). </p>
<p>Town and school planners, as well as educators, should consider where schools are located and how their surrounding environments may be improved to promote childhood learning and health.</p>
<p>Additional steps to reduce traffic levels around schools should be encouraged where possible, as well as active transport and use of public transport to reduce the number of vehicles on the roads.</p><img src="https://counter.theconversation.com/content/161673/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The research in this article was conducted in collaboration with Joep Claesen and Dr Gonnie Klabbers at Maastricht University in the Netherlands, and Professor Mark Nieuwenhuijsen, ACU and ISGlobal, Spain.</span></em></p><p class="fine-print"><em><span>Amanda J. Wheeler does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A study showed that, on average, more greenery around primary schools was associated with better NAPLAN scores. Higher exposure to traffic-related pollution was associated with poorer scores.Alison Carver, Senior Research Fellow, Behaviour Environment and Cognition Program, Mary MacKillop Institute for Health Research, Australian Catholic UniversityAmanda J. Wheeler, Senior Research Fellow Behaviour, Environment and Cognition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1474152020-10-13T18:10:27Z2020-10-13T18:10:27Z6 tips to prepare your child for easy COVID-19 testing<figure><img src="https://images.theconversation.com/files/362089/original/file-20201007-22-lql17v.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C4904%2C3536&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">One-year-old Quentin Brown is held by his mother, Heather Brown, as he eyes a swab while being tested for COVID-19 at a new walk-up testing site at Chief Sealth High School in Seattle on Aug. 28, 2020.</span> <span class="attribution"><span class="source">(AP Photo/Elaine Thompson)</span></span></figcaption></figure><p>Back to school means more germs, but familiar symptoms like sore throats, fevers and sniffles have taken on a new meaning during the COVID-19 pandemic. Public health policies across the country and around the world may require children to <a href="https://www.theglobeandmail.com/canada/article-why-parents-now-dread-the-common-cold/">get tested for COVID-19</a> and be symptom-free before returning to school. This means more kids are receiving nasopharyngeal swabs (also called “nasal swabs”) or throat swabs to test for COVID-19. </p>
<p>As child health psychologists, we have studied and prepared hundreds of children and their families to undergo medical procedures with ease. While testing for the novel coronavirus may be new, effective ways to prepare kids for pain- and distress-free medical procedures are not. In fact, scientists and health-care providers have been working at this for a long time! We’ve put together six top tips to prepare your child for easy COVID-19 testing.</p>
<h2>What to do before</h2>
<p><strong>1. Prepare your child by sharing child-friendly information.</strong> </p>
<p>When children or their parents are nervous about upcoming medical procedures, parents sometimes think that the less information they share with their child the better. The opposite is actually true. </p>
<p>Children have vivid imaginations that fill in the missing details, sometimes imagining things as much worse or scarier than they are in real life. Sharing age-appropriate information about medical procedures with children early on is a more effective way of reducing fears. </p>
<p>For the COVID-19 test, parents should describe in detail what children can expect — almost like telling a story. Important details include where they will go, who will be there, what they will see, how long it will take, what will happen and how it might feel. </p>
<figure class="align-center ">
<img alt="A child sticks his head out a car window and winces as a health-care worker is about to insert a swab in his nose." src="https://images.theconversation.com/files/362094/original/file-20201007-16-1auxnu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362094/original/file-20201007-16-1auxnu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362094/original/file-20201007-16-1auxnu9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362094/original/file-20201007-16-1auxnu9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362094/original/file-20201007-16-1auxnu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362094/original/file-20201007-16-1auxnu9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362094/original/file-20201007-16-1auxnu9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Alex Rodgers, 6, cries and tries to squirm away from a medical assistant attempting to take a swab sample up his nose at a drive-thru coronavirus testing site in Seattle on April 29, 2020. Preparation and a coping plan could have made this an easier experience.</span>
<span class="attribution"><span class="source">(AP Photo/Elaine Thompson)</span></span>
</figcaption>
</figure>
<p>Be honest with your child, stick to the facts, and use neutral language. For example, when describing how it might feel when the swab goes in: “Some kids say that it feels weird like having fizzy water up their nose and hurts a bit but others say it doesn’t really bother them.” </p>
<p>There are <a href="https://www.rchsd.org/documents/2020/04/mask-compliance.pdf/">brief scripts</a> and <a href="https://www.childlife.org/docs/default-source/covid-19/preparing-for-a-nasal-swab-pdf">pictures</a> about COVID-19 testing that you can use. There are also short videos created just for children from <a href="https://youtu.be/AhC6_JXagxE">B.C. Children’s Hospital</a>, <a href="https://youtu.be/nO1L-oYo9TA">the Hospital for Sick Children</a> or the <a href="https://youtu.be/mCIDZ9DsaKU">Mayo Clinic</a>. Watch these together to give you ideas for coping strategies. </p>
<p><strong>2. Create a coping plan.</strong></p>
<p>It’s important to plan the strategies you will use leading up to, during and after the COVID-19 test. And, it gives time to practise your strategies. Knowing the plan makes it easier for children and their parents, especially if anyone is feeling nervous. </p>
<p>No matter your child’s age, they can be part of developing the coping plan. Younger children will need more parental support, but having “a job,” even one as simple as being in charge of sitting still, can increase their confidence. Older children and teenagers will have their own ideas of what helps them to feel relaxed and stay calm, and giving them choice when appropriate helps them feel empowered. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/362093/original/file-20201007-18-1kqp9ev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A masked woman hugs her masked child between orange pylons behind a sign for a mobile testing facility that instructs people to keep two metres apart." src="https://images.theconversation.com/files/362093/original/file-20201007-18-1kqp9ev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362093/original/file-20201007-18-1kqp9ev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=464&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362093/original/file-20201007-18-1kqp9ev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=464&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362093/original/file-20201007-18-1kqp9ev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=464&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362093/original/file-20201007-18-1kqp9ev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=584&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362093/original/file-20201007-18-1kqp9ev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=584&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362093/original/file-20201007-18-1kqp9ev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=584&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A woman and child wait in line at a mobile COVID-19 testing clinic on May 12, 2020, in Montréal.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
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</figure>
<p>It’s especially important to plan for any aspects that might be particularly tricky for your child — when you help prepare them ahead of time (see No. 1), you might get some extra clues about when they need the most support.</p>
<p><strong>3. Distract your child while you wait with something fun and interactive.</strong></p>
<p>You and your child will likely <a href="https://www.ctvnews.ca/health/coronavirus/long-lines-for-covid-19-tests-reported-across-canada-feds-announce-more-funding-1.5107864">wait in line</a> in the car or on foot, which can lead to boredom, frustration or increased worry about what is about to happen. Use this time to distract your child and engage them in something fun or interactive. Listen to music, ask your child about their favourite show, make up a story, let them play a game or watch a video on your phone or tell some jokes. Earphones may be helpful. </p>
<h2>What to do during the swab</h2>
<p>If you have multiple family members getting tested at the same time, have the child who is the most relaxed or least worried go first. Or go first as a parent to model coping strategies and show how easy and quick the test can be.</p>
<p><strong>4. Use comfort positioning.</strong> </p>
<p><a href="https://www.youtube.com/embed/YPi3xT6UCOs?rel=0">Comfort positions</a> (not restraint) help children to feel safe and calm during medical procedures. If you are in a drive-through testing site, <a href="https://bit.ly/3c1bzln">parents can sit side by side in the car next to their child with their arm wrapped around their child</a>. If you are in a testing centre, <a href="https://www.childlifesaver.com/post/how-to-use-comfort-positioning-for-medical-procedures-how-to-hold-your-child-for-shots">younger children can sit on their parents’ lap either facing sideways or with their back to their parents’ chest</a>. Parents then hold their child close, like a hug. Gently wrapping your child in a blanket before hugging them may help. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fear-of-needles-5-simple-ways-to-ease-vaccination-pain-for-your-child-and-yourself-134328">Fear of needles: 5 simple ways to ease vaccination pain for your child (and yourself)</a>
</strong>
</em>
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<hr>
<p>For some children, it may be helpful for parents to gently hold their child’s forehead to keep their head still during the swab. For older children and teens, parents can be seated next to them with a hand on their shoulder or leg to provide physical comfort while the swab is in. </p>
<p><strong>5. Tell your child to look up, take deep breaths, count and close their eyes.</strong></p>
<p>Coaching your child to take some deep belly breaths from their mouth during the swab helps them to stay relaxed. Counting together to 20 (or even the parent counting alone) keeps your child’s attention on something other than the swab and helps them understand when it will be finished. Suggesting your child close their eyes may also help. </p>
<h2>What to do after</h2>
<figure class="align-center ">
<img alt="A white-coated health-care worker swabs a woman's nose while a girl watches." src="https://images.theconversation.com/files/362099/original/file-20201007-24-1a9ykog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362099/original/file-20201007-24-1a9ykog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362099/original/file-20201007-24-1a9ykog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362099/original/file-20201007-24-1a9ykog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362099/original/file-20201007-24-1a9ykog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362099/original/file-20201007-24-1a9ykog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362099/original/file-20201007-24-1a9ykog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A medical professional administers a COVID-19 test in front of the Kew Gardens Cinemas movie theatre in the Queens borough of New York City on Oct. 5, 2020.</span>
<span class="attribution"><span class="source">(AP Photo/Frank Franklin II)</span></span>
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</figure>
<p><strong>6. Talk to your child about what they did well.</strong> </p>
<p>It’s very likely that your child will have to get more than one COVID-19 test in their life. Helping children remember the test experience in a factual or positive way makes it more likely that the next test will go well or even better. </p>
<p>Talk about something that they did well from their coping plan: for example, “You did a great job taking your big belly breaths.” You may even want to record a mini video interview with them on your phone afterwards talking about what they did well — this could help for the next time. </p>
<p>Some children may be worried that getting tested for COVID-19 means that they have the virus. Remind them that this isn’t necessarily true, that the test results will come in a few days, and that you and others are here to help. </p>
<p><em>This story is part of a series produced by SKIP (<a href="https://www.kidsinpain.ca/">Solutions for Kids in Pain</a>), a national knowledge mobilization network whose mission is to improve children’s pain management by mobilizing evidence-based solutions through co-ordination and collaboration. Find these <a href="https://www.kidsinpain.ca/covid-testing">COVID-19 testing resources</a> on the SKIP website. #ItDoesntHaveToHurt</em></p><img src="https://counter.theconversation.com/content/147415/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathryn Birnie receives funding from the Canadian Institutes of Health Research and the Canadian Pain Society. She is Assistant Scientific Director of Solutions for Kids in Pain (SKIP)</span></em></p><p class="fine-print"><em><span>C. Meghan McMurtry has received funding from the Canadian Institutes of Health Research and the Canadian Foundation for Innovation. </span></em></p>Child health psychologists offer research-based strategies to prepare kids for pain-free and distress-free COVID-19 testing.Kathryn Birnie, Assistant Professor and Psychologist in Pediatric Pain, University of CalgaryMeghan McMurtry, Associate Professor in Psychology at the University of Guelph; Clinical and Health Psychologist, Pediatric Chronic Pain Program, McMaster Children's Hospital, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1460592020-09-17T16:54:12Z2020-09-17T16:54:12ZKids, masks & back-to-school FAQs: Are cloth masks best to protect against COVID-19? How often should masks be washed?<figure><img src="https://images.theconversation.com/files/358242/original/file-20200915-16-kv8lhd.jpg?ixlib=rb-1.1.0&rect=0%2C6%2C3639%2C2850&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A student adjusts his protective mask as he walks off the bus at the Bancroft Elementary School as students go back to school in Montréal, on Aug. 31, 2020. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span></figcaption></figure><p>With kids heading back to school in masks this year, many parents are wondering about different types of masks and how to care for them. Here are answers to some of the most common mask questions.</p>
<h2>Are cloth or disposable masks best for all-day wear?</h2>
<p>When considering the best choice of face covering for a child to wear for the duration of a school day, one should look at the mask fabric, whether it absorbs sweat and oil secreted from the skin and is not irritating to the skin, and the size of the face mask and whether it fits well on the child’s face.</p>
<figure class="align-right ">
<img alt="Girl wearing a white cloth face mask." src="https://images.theconversation.com/files/358247/original/file-20200915-14-zooyin.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/358247/original/file-20200915-14-zooyin.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358247/original/file-20200915-14-zooyin.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358247/original/file-20200915-14-zooyin.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358247/original/file-20200915-14-zooyin.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358247/original/file-20200915-14-zooyin.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358247/original/file-20200915-14-zooyin.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It is important to pay attention to the fabric, design and fit of the cloth face masks.</span>
<span class="attribution"><span class="source">(Unsplash/Insung Yoon)</span></span>
</figcaption>
</figure>
<p>Both cloth and disposable face masks, when worn properly on the face with little to no gaps around the nose, cheeks or underneath the chin, <a href="https://dx.doi.org/10.1063%2F5.0016018">perform equally well in terms of reducing the respiratory droplets expelled by the wearer</a>. Therefore, it is reasonable to look out for cloth masks that may offer the wearer less face irritation. However, it is important to pay attention to the fabric, design and fit of the cloth face masks. </p>
<p><a href="https://doi.org/10.1021/acsnano.0c03252">Tests have shown cotton, flannel and polyester face masks with two or more layers filter out 80 per cent of the respiratory droplets</a>, but neck gaiters did not filter out the respiratory droplets. On the contrary, <a href="https://doi.org/10.1126/sciadv.abd3083">neck gaiters appear to increase the number of micro-droplets filtered through them</a>, likely by breaking up larger droplets. </p>
<p>In addition, cloth masks are offered in different sizes (adult, youth and kid sizes) and disposable masks (made from plastic material such as polypropylene) may only come in a single size, which is often too big for children. Hence, cloth masks could be the best option for children.</p>
<p>However, it should be recognized that wearing a face mask, no matter how comfortable it may be, still does not come naturally to any of us and can cause discomfort when worn for long hours at a stretch, especially for young children. It’s a good idea to take breaks from it whenever possible, such as during lunch and recesses.</p>
<h2>How often should cloth masks be washed?</h2>
<p>And do I have to wash them separately from other laundry? </p>
<p>For cloth masks, the frequency of washing depends on the use of the mask. If you wear the mask indoors or outdoors where you are exposed to close interactions with other people, interactions with many people or for long hours, consider washing the mask at the end of the day or put it aside and wash it later. </p>
<p>Laundry detergent will destroy the virus particles. You can think of virus particles like oil stains on your clothes. The effect that a detergent has on oil stains is similar to its effect on the virus particles: it will break the virus particles apart and render them non-infectious. As such, it is safe to wash your cloth masks with the other clothes. </p>
<p>To add an extra assurance that the virus particles are completely destroyed, you can dry masks in the dryer together with other clothes. Research has shown that <a href="http://doi.org/10.1101/2020.08.10.20171728">heat (60-95C) destroys the virus particles</a>. Make sure the fabric of your masks can sustain the heat of the dryer.</p>
<figure class="align-center ">
<img alt="A stack of colourful cloth masks" src="https://images.theconversation.com/files/358248/original/file-20200915-22-1izo6u0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358248/original/file-20200915-22-1izo6u0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358248/original/file-20200915-22-1izo6u0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358248/original/file-20200915-22-1izo6u0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358248/original/file-20200915-22-1izo6u0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358248/original/file-20200915-22-1izo6u0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358248/original/file-20200915-22-1izo6u0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cloth face masks can be machine washed or hand washed.</span>
<span class="attribution"><span class="source">(Unsplash/Vera Davidova)</span></span>
</figcaption>
</figure>
<p>Cloth face masks can also be washed very effectively by hand using soap (or dishwashing detergent) and hot water. Let them air dry in a clean place, and iron them once they are dry to offer a similar effect to the dryer.</p>
<p>If a face mask is used only for an hour or two, and it is handled carefully and is not touched or removed very often, it can be re-used for a second day if it’s stored in a cloth bag or cardboard box (a porous material, not plastic, so it can dry out). This might be a better option for high school students than younger children.</p>
<h2>Where should kids put their mask when they take it off?</h2>
<p>And, is it safe to put it back on after lunch or recess, or do kids need more than one mask per day?</p>
<figure class="align-left ">
<img alt="A woman puts a mask on a child, who is wearing a backpack and appears to be ready for school. The mask has a cat whisker motif." src="https://images.theconversation.com/files/358249/original/file-20200915-16-17h65se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/358249/original/file-20200915-16-17h65se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358249/original/file-20200915-16-17h65se.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358249/original/file-20200915-16-17h65se.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358249/original/file-20200915-16-17h65se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358249/original/file-20200915-16-17h65se.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358249/original/file-20200915-16-17h65se.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Provide children with two masks to take to school so they have a spare in case one is lost, damaged or soiled.</span>
<span class="attribution"><span class="source">(Pexels/August de Richelieu)</span></span>
</figcaption>
</figure>
<p>How the face mask is treated during the intermittent breaks from it, such as during lunch and recesses, is also very important. </p>
<p>To remove the mask, first wash or sanitize hands. Then carefully remove the mask from the face, fold it inward in two and place it in a cloth bag or inside a clean plastic box that can be washed or disinfected, respectively. </p>
<p>It is very safe to use the same cloth face mask again the same day, provided that it is stored properly and it is not soiled or damaged. </p>
<p>Face masks should be personal protective gear, not to be shared with (or handled by) anyone else. It is advisable to provide children with two face masks, so they will have a spare in case one gets compromised (soiled, damaged or lost).</p>
<h2>How should masks be managed at the end of the school day?</h2>
<p>School kids will be in contact, albeit at a safe distance, with a number of kids from the same cohort. In addition, they will probably touch their face mask often in order to remove it and put it back on as they go through different parts of the day at school, such as lunch, recesses and outside teaching. They will likely be breathing through the masks for several hours, although not at a stretch. </p>
<p>Considering these factors, cloth masks must be washed at the end of the school day or put aside (safely) to be washed when possible with other laundry. Think of the face mask the same way you would underwear: wash after wearing for a day. </p>
<p>However, if children are using a disposable face mask, this mask should be properly disposed of at the end of the day. </p>
<figure class="align-center ">
<img alt="Little girl in a pink dress wearing a black face mask holding the hand of an adult who is out of the frame." src="https://images.theconversation.com/files/358244/original/file-20200915-24-g96jvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358244/original/file-20200915-24-g96jvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358244/original/file-20200915-24-g96jvr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358244/original/file-20200915-24-g96jvr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358244/original/file-20200915-24-g96jvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358244/original/file-20200915-24-g96jvr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358244/original/file-20200915-24-g96jvr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Both cloth and disposable masks help prevent respiratory droplets from escaping.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>In the case of the cloth face mask, at the end of the school day (or at the end of the school bus ride, or taking public transit) the mask should be put in a resealable bag (labelled “soiled mask”) and either washed upon arrival at home, or put safely with other laundry and washed when time permits. </p>
<p>I would recommend equipping children with two bags: one to be used for the clean face masks (where the spare mask can be kept), and the other to carry the used one (this could be a resealable bag). </p>
<h2>Can I clip my child’s mask to her sleeve or bag?</h2>
<p>Absolutely not! One only needs to see how much “cleaning” the child’s sleeves do by the end of the day; you do not want the child to breathe in all that dirt. </p>
<p>We should be concerned not only about COVID-19, but also about other potential diseases, including respiratory diseases, that kids are prone to, such as strep infection, pneumonia and flu, to name a few. If carrying a cloth bag around the shoulder, for storing the face mask when outside for recess, is not something that your child feels comfortable with, then use clothing (pants or shirts) that have pockets (deep enough) to carry the face mask. </p>
<p>Children should be taught to fold the mask inward, in two, when storing (in a cloth bag, box, resealable bag or pocket), so the inner portion of the mask is protected from dirt and contamination as much as possible (and ask the child to keep their mask pocket clean and not use it for any other items). </p>
<p>A lot of attention is placed on face masks, but we should not forget the clothing that kids wear at school. Although transmission of SARS-CoV-2 through contaminated surfaces (including clothes) poses lesser risk than transmission of the virus through respiratory droplets, the hygiene of the clothes that kids wear is very important too, especially when kids live with elderly family members. I strongly recommend that children wash their hands and remove their school clothes upon arrival at home and change into clothes designated to be used at home only.</p><img src="https://counter.theconversation.com/content/146059/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dasantila Golemi-Kotra does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Back-to-school routines under COVID-19 look a little different than previous years. For one thing, kids need to wear masks. Which means many parents have mask questions.Dasantila Golemi-Kotra, Professor, Biology, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1316392020-03-15T11:41:06Z2020-03-15T11:41:06ZKeeping kids active despite the weather: Promoting outdoor activity all year round<figure><img src="https://images.theconversation.com/files/319956/original/file-20200311-116232-nysm05.jpg?ixlib=rb-1.1.0&rect=71%2C0%2C2923%2C2034&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Although colder weather is linked to lower levels of physical activity, changing seasons provide unique opportunities to be active.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span></figcaption></figure><p>Given the climate in much of Canada, cold, wet or snowy conditions are inescapable for many months of the year. And like it or not, <a href="https://doi.org/10.1123/pes.22.1.81">weather and seasonality</a> are a barrier to Canadian children engaging in physical activity. Consequently, we need to find a way to help children (as well as parents and educators) embrace the outdoors and stay active all year round. </p>
<p>This is particularly important as kids are more active outdoors than indoor. Since children’s activity levels <a href="https://doi.org/10.1016/j.puhe.2007.04.009">vary with the seasons</a>, getting kids outside year-round is important for meeting movement guidelines.</p>
<h2>Physical activity in cold, wet months</h2>
<p><a href="https://dx.doi.org/10.3390%2Fijerph6102639">Snow and cold temperatures</a> are tied to low levels of physical activity. Parents have identified warmer seasons as more conducive to physical activity for their children and colder seasons as posing <a href="https://dx.doi.org/10.1007%2FBF03405170">greater challenges</a>. </p>
<p>What’s more, children’s social and built environments are not very accommodating of active living in the winter. When temperatures are low, social norms among Canadians encourage staying indoors participating in more sedentary behaviours, like watching movies, streaming shows, playing video games, reading books or doing crafts. Likewise, extremely hot and humid days also have the tendency to drive kids indoors. </p>
<p>Many of the environments in which children spend the majority of their waking hours during the week (schools and childcare) often have strict <a href="https://globalnews.ca/news/5027337/indoor-recess-canada-winter/">policies prohibiting outdoor play when temperatures drop below a particular level</a>. Even when kids can get outside, there are <a href="https://dx.doi.org/10.2105%2FAJPH.2013.301319">many safety regulations</a> these settings must abide by (such as prohibiting some outdoor equipment, splashing in puddles, and making snow hills off limits), which hamper children’s innate desire to move their bodies outdoors.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&rect=57%2C50%2C4718%2C3128&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Physical activity is an important part of children’s healthy development.</span>
<span class="attribution"><span class="source">AP Photo/Knoxville News Sentinel, Saul Young</span></span>
</figcaption>
</figure>
<p>Fortunately, changing seasons also present unique opportunities to be active, try different activities and improve healthy behaviours. Different settings — including water, ice, and snow — provide opportunities to develop or enhance new skills, like balance, co-ordination, agility, lifting and lowering, running, crawling, throwing and hopping. </p>
<h2>How to help kids stay active all year long</h2>
<p>Based on current research, there are numerous <a href="https://www.cps.ca/en/documents/position/physical-activity-guidelines#TABLE%202">evidence-informed recommendations</a> that can be drawn upon to help <a href="https://csepguidelines.ca/children-and-youth-5-17/">support, encourage, and promote increased activity levels</a> among children.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children enjoy themselves on a playground at Wasaho Cree Nation School in Fort Severn, Ontario’s most northerly community, in this April 2018 photo.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Colin Perkel</span></span>
</figcaption>
</figure>
<p><strong>Keep it fun and positive</strong>. Children have different interests and enthusiasms, so it is important to suggest and enable activities that your child will enjoy. This may involve some trial and error: you might make mistakes and you might find different children in your home enjoy different activities. </p>
<p><strong>Stick to a routine</strong>. Find the times for activity that work best for your family and stick with them. In certain cases, you may need to get creative and consider new ways to get active if it’s not possible to play outside (heat or cold weather advisories). Also be mindful that it gets dark early during the winter months. </p>
<p><strong>Make it a family affair</strong>. Physical activity should be valued by the whole family and maintained as a priority. Getting everyone involved (including the family dog!) provides key opportunities to model healthy behaviours and provide positive behavioural prompts. Bonus: physical activities are a great way to spend time and bond as a family.</p>
<p><strong>Break it up</strong>. Kids do not need to accumulate the <a href="https://csepguidelines.ca/children-and-youth-5-17/">recommended 60 minutes of daily moderate-to-vigorous physical activity</a> in a single bout. It is OK to break it up and still reap the health benefits. Every little bit helps! </p>
<p><strong>Dress to impress</strong>. Wear layers (this will help children regulate their body temperature) made of breathable materials that repel water, and wear gloves, hats and warm boots when frostbite is a risk. From a health and safety perspective, wear reflective gear (to be seen at night), wear sunscreen and sunglasses (UVA/UVB rays are present, and water and snow-covered surfaces reflect the sun), and remember that helmets are as essential for tobogganing, skiing, and skating as they are for cycling, skateboarding, and rollerblading.</p>
<h2>Need some ideas to get your kids moving?</h2>
<p>There are plenty of options to keep children moving in any season, many of which can be done in groups, with the family, or even solo. </p>
<p>When the opportunity arises to get kids outdoors, consider some of the following activities: play tag, go for walks, rake leaves, swim in a pool or lake, go cycling or wheeling with friends. </p>
<p>In colder weather, build a snowman/snow angel, go tobogganing, have a snowball fight, go skiing (cross-country or downhill), try snowshoeing, go skating, help with snow shovelling, build a snow fort or try snow painting.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Keep sunscreen and helmets handy for tobogganing, skiing or skating, as well as for biking, skateboarding and rollerblading.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
</figcaption>
</figure>
<p>And in those instances when it’s not safe to be outdoors, don’t let this deter children from moving their bodies. Either take the fun indoors or just venture outside for a short time — <a href="https://dx.doi.org/10.3390%2Fijerph120606475">kids need the fresh air for a brain break and to expend energy</a>. </p>
<p>Some indoor activities include: have a dance party, play hide and seek, help with household chores, do yoga, participate in an indoor scavenger hunt or obstacle course. If you don’t have a ton of space indoors, venture to a community recreation centre or sports facility. </p>
<p>Check your local recreation centre for classes and activities, or your YMCA, indoor pool, ice rink or gym. Try ice skating or roller skating, go bowling or take a long walk inside the local mall.</p>
<p>Physical activity is an important part of children’s healthy development — ensuring this need is met in every season is equally important!</p><img src="https://counter.theconversation.com/content/131639/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leigh Vanderloo is affiliated with ParticipACTION. </span></em></p><p class="fine-print"><em><span>Trish Tucker receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council. </span></em></p>Keeping kids active in winter can be a challenge, as cold temperatures and icy conditions often mean more time indoors. Here’s how to maintain a healthy activity level throughout Canadian winters.Leigh Vanderloo, Adjunct Professor, Child Health and Physical Activity Lab, School of Occupational Therapy, Western UniversityTrish Tucker, Associate Professor and Director of the Child Health and Physical Activity Lab, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1269262019-11-13T05:47:49Z2019-11-13T05:47:49ZBushfires can make kids scared and anxious: here are 5 steps to help them cope<p>More than 600 <a href="https://www.news.com.au/technology/environment/full-list-of-schools-closed-due-to-bushfire-risk-on-monday-tuesday-in-new-south-wales/news-story/dd2649ec5c9a3b030f5b976948dca381">schools have been closed</a>, and <a href="https://www.theguardian.com/australia-news/live/2019/nov/09/nsw-and-queensland-fires-more-than-100-homes-destroyed-and-three-people-missing-live">some damaged</a>, in recent days as bushfires rage across Queensland and New South Wales. Some students have been urgently evacuated while in school. People have lost homes and animals and are experiencing significant distress.</p>
<p>Research shows <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-623">somewhere between</a> 7% and 45% of children suffer depression after experiencing a natural disaster. Children more at risk of depression include those who were trapped during the event; experienced injury, fear, or bereavement; witnessed injury or death; and had poor social support.</p>
<p>The Victorian Education Department commissioned us after the 2009 Black Saturday fires to train teachers in seven fire-affected regions in methods to foster resilience in children. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mr-morrison-i-lost-my-home-to-bushfire-your-thoughts-and-prayers-are-not-enough-126754">Mr Morrison, I lost my home to bushfire. Your thoughts and prayers are not enough</a>
</strong>
</em>
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<p>Teachers told us their students had experienced distressing emotions including high anxiety, fear and even panic during the event. Comments from teachers included: </p>
<blockquote>
<p>Their world had changed forever; they became more fearful.</p>
<p>Some children were very frightened and for a long time stayed close to their parents.</p>
<p>Many children became scared and anxious about worldwide issues.</p>
<p>Their anxiety was triggered by the smell of smoke, a fire engine’s siren or a foggy day. </p>
</blockquote>
<p>The teachers we interviewed also noted children’s profound sense of loss (of their homes, pets and livestock). Many students knew someone who had lost a family member or friend. </p>
<p>One teacher said:</p>
<blockquote>
<p>The fires opened students’ eyes to what a disaster is. Not just something you see on TV. </p>
</blockquote>
<p>We trained teachers using our <a href="https://education.nsw.gov.au/teaching-and-learning/professional-learning/scan/past-issues/vol-37/bounce-back!-a-positive-education-approach">Bounce Back</a> program – a research-based social and emotional learning program first published in 2003. Most <a href="https://education.nsw.gov.au/teaching-and-learning/professional-learning/scan/past-issues/vol-37/bounce-back!-a-positive-education-approach">children are resilient</a> and will bounce back quickly. Only a small minority may be at risk of ongoing anxiety and there are ways to minimise that risk.</p>
<h2>How to help kids cope now</h2>
<p>Try to stay calm and reassuring. Children <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277953616302052">take cues</a> from the adults in their lives. If adults show fear and nervousness, children tend to mirror these emotions. </p>
<p>Try to focus on the small positives such as “we are all safe”. You can list the things that haven’t changed, such as your children’s friends. Reassure them other people such as family, friends, teachers and their community will help and that life will return to normal. </p>
<p>Everyone feels sad, anxious or upset when a bushfire burns near their home. By helping your child name their feeling, you are helping them feel more in control. Here are five steps to encourage your children to do this:</p>
<ol>
<li> take notice when your child is feeling sad, frightened, angry or upset </li>
<li> encourage your child to talk about what’s troubling them, and listen and show you understand how they are feeling </li>
<li> name the emotion in words your child can understand – are they “worried”, “scared”, “a bit frightened” or “sad”?</li>
<li> help your child understand it’s normal to feel that strong emotion and help them to sit with their feelings</li>
<li> finish with a hopeful or optimistic statement they can do something to help make things feel better. This may include something physical (such as going for a walk or throwing a basketball through a hoop), something that creates positive feelings (like playing with a pet or friend, or drawing), or doing something kind or helpful for someone else.</li>
</ol>
<p>Resilience is the capacity to <a href="https://education.nsw.gov.au/teaching-and-learning/professional-learning/scan/past-issues/vol-37/bounce-back!-a-positive-education-approach">bounce back</a> after hardship.</p>
<p>To help your child bounce back, you can communicate that:</p>
<ul>
<li>life is mainly good but now and then everyone has a difficult or unhappy time</li>
<li>although things aren’t good now and it might take a while to improve, it’s important to stay hopeful and expect things to get better</li>
<li>you will feel better and have more ideas about what to do if you talk to someone you trust about what’s worrying or upsetting you</li>
<li>unhelpful thinking (“our family will never get a nice home again”) isn’t necessarily true and makes you feel worse</li>
<li>helpful thinking (“it might take a while to get our home back again but it will happen”) makes you feel better because it is more accurate and helps you work out what to do.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ignoring-young-peoples-climate-change-fears-is-a-recipe-for-anxiety-123357">Ignoring young people's climate change fears is a recipe for anxiety</a>
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</em>
</p>
<hr>
<h2>Coping after the event</h2>
<p>Children with <a href="http://positivetimes.com.au/prosper-a-roadmap-for-positive-schools-by-dr-toni-noble/">strong emotional support</a>, such as from family and friends, are better able to cope with adversity. </p>
<p>Friendships may be disrupted after bushfires because of family relocations. Helping children connect via social media or phone with friends can reduce their sense of isolation. </p>
<p>Getting children back to school and regular routines can be one of the best ways to help their resilience.</p>
<p>Teachers are encouraged to allow time for children to talk about the bushfires and their feelings about them during class. </p>
<p>The teachers who participated in the Bounce Back program after Black Saturday explicitly taught children the skills for being optimistic and resilient – such as to challenge their unhelpful thinking and understand everybody, not just you, experiences setbacks sometimes. </p>
<p>They also taught kids skills for regulating their emotions and everyday courage to face their fears.</p>
<p>They used circle-time discussions of picture books and media stories to allow them to talk about their own experiences in a safe way.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-real-to-them-so-adults-should-listen-what-children-want-you-to-know-to-help-them-feel-safe-113834">'It's real to them, so adults should listen': what children want you to know to help them feel safe</a>
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</em>
</p>
<hr>
<p>We held focus groups with children of different ages in five of the primary schools that used our Bounce Back program. The children told us they: “know now what to do when something goes wrong”; “focus on more positives”; “don’t think the worst now”; “know things change”; “have learnt that sometimes you just have to put up with it”; and “now feel it’s easier to get back up in bad times”. </p>
<p>While a disaster can be challenging for children, a supportive home and school environment, together with coping skills, can help children recover reasonably quickly and get back to normal life.</p><img src="https://counter.theconversation.com/content/126926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Toni Noble does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most kids bounce back quickly after a disaster and there are several strategies you can use to help.Toni Noble, Adjunct Professor, Institute for Positive Psychology & Education, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1060692018-11-28T02:44:39Z2018-11-28T02:44:39ZCurious Kids: Why do people get cancer?<figure><img src="https://images.theconversation.com/files/247140/original/file-20181125-149311-j6g2ja.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A lot of people have spent a very long time wondering what causes cancer -- and scientists still can't say for certain why an individual person might have it.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/marinadelcastell/15123637900/in/photolist-p3qADA-attcLe-pGzdsK-97nH3D-2jpqDi-8fL2Zr-o5UP3n-8PVW7L-7ojh9A-7g1BVw-288wvGe-VFnJj1-gZtiT-d9FKxv-6gxECD-c2ZWYf-bxZCCW-7y4aZ-7NqN9e-bwAzyD-4Et28P-67FT3v-FdXFg4-26LD9mn-aYXvLv-dAeS22-peG81g-JV6R1a-4KxHrW-aAK5Ry-85pVPw-7Q79FC-fnoz5f-dy4QAh-6Jz4Hm-rmDhi-9JG5DX-9zTWFe-i15x3R-248k8yj-4oedpp-9LC5DU-gjY9U-8U3f5r-fnpAd7-jAnpRv-iVAF-WJ526X-3jjnDe-o1GsGu">Marina del Castell/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>This is an article from <a href="https://theconversation.com/au/topics/curious-kids-36782">Curious Kids</a>, a series for children. The Conversation is asking kids to send in questions they’d like an expert to answer. All questions are welcome – serious, weird or wacky! You might also like the podcast <a href="http://www.abc.net.au/kidslisten/imagine-this/">Imagine This</a>, a co-production between ABC KIDS listen and The Conversation, based on Curious Kids.</em> </p>
<hr>
<blockquote>
<p><strong>Why do people get cancer? – Sascha, age 8, Hurstbridge, Victoria.</strong></p>
</blockquote>
<hr>
<p>This is a really tough question, Sascha. Lots of very clever people are working hard to try to answer it. I have worked on this problem for many years, and to be honest it still blows my mind to really think about just how complex it is.</p>
<p>Before we talk about <em>why</em> we get cancer, it helps to understand <em>how</em> we get cancer.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/interactive-body-map-what-really-gives-you-cancer-52427">Interactive body map: what really gives you cancer?</a>
</strong>
</em>
</p>
<hr>
<p>All living things are made of <a href="https://vimeo.com/259704641">tiny building blocks called cells</a>. In humans there are hundreds of different kinds of cells, all with special jobs to do. They build our various organs like our skin, brain and bones. Some cells (such as brain and bone) can live for many years, while others (like red blood cells) live only a few weeks.</p>
<p>A human body is made up of trillions of individual cells, many more than all the stars you can see in the night sky.</p>
<p>As we grow, our body needs to make new cells. And as cells get old or damaged, they die and need to be replaced. That helps to keep us healthy.</p>
<p>The simplest way to think of a cancer is that sometimes, one of those trillions of cells starts to grow out of control and refuses to die. This out-of-control cell then divides and makes millions of copies of itself. It can grow to form a tumour - or, in some cases such as leukaemia, spreads through our blood.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=202&fit=crop&dpr=1 600w, https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=202&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=202&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=253&fit=crop&dpr=1 754w, https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=253&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=253&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An out-of-control cell can divide and make millions of copies of itself, and can grow to form a tumour.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Cancer cells can also spread to other parts of our body where they would not normally be found. This can cause important organs to stop doing their job and make us very unwell, or die.</p>
<h2>Copying the code - and making mistakes</h2>
<p>The really incredible thing about cells is that they contain the instructions for making copies of themselves. These instructions are stored in a code called the genome, made of a quite beautiful chemical called DNA.</p>
<p>And if you took the DNA from all the cells in a human and lined it all up, it would stretch around the Moon and back six or seven times.</p>
<p>The alphabet cells use to write this DNA code is made of just four different chemical “letters”: A,C,T, and G. And the instructions in each cell are made of about 6 billion of these chemical letters, which need to be copied exactly every time a cell divides to make a copy of itself.</p>
<p>To help you understand this amazing feat of biology, imagine trying to copy the entire Harry Potter book series in handwriting a thousand times over. That’s what a cell needs to do every time it divides, and it’s happening millions of times every day in our bodies.</p>
<p>You can watch an animation of the incredible, tiny machine cells use to copy DNA here:</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/OjPcT1uUZiE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>With all that DNA to copy, cells are bound to make the occasional spelling mistake - we call these mistakes “mutations”. Sometimes, those mutations change the meaning of a cell’s instruction book, causing it to grow out of control and form a tumour. </p>
<p>This is what we call cancer.</p>
<h2>But why?</h2>
<p>Now, back to the question of <em>why</em> we get cancer.</p>
<p>Different scientists are having a bit of an argument over this question, but it seems to come down to a combination of bad luck and various experiences you might have in life. Things like too much sunshine, certain chemicals (such as tobacco smoke), alcohol, some foods and even some viruses can increase our chances of getting mutations in our DNA.</p>
<p>Because those mutations in DNA take time to build up, cancer is most commonly seen in older adults. Children do sometimes get cancer but thankfully it is relatively rare. Usually, evolution would mean not many people would get such a horrible disease like cancer. But because most people get cancer after they have had kids, evolution is almost blind to cancer. People who might have a higher cancer risk because of their genes live long enough to pass those genes onto their kids.</p>
<p>You can reduce your chance of cancer by making healthy, sensible lifestyle decisions but it is not possible to completely prevent it. Unfortunately, as I said before, it’s at least partly down to bad luck. </p>
<p>Importantly, we can almost never say for sure why an individual person has cancer.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-is-there-anything-hotter-than-the-sun-105748">Curious Kids: Is there anything hotter than the Sun?</a>
</strong>
</em>
</p>
<hr>
<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to us. They can:</em></p>
<p><em>* Email your question to curiouskids@theconversation.edu.au
<br>
* Tell us on <a href="https://twitter.com/ConversationEDU">Twitter</a></em></p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p><em>Please tell us your name, age and which city you live in. You can send an audio recording of your question too, if you want. Send as many questions as you like! We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/106069/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Darren Saunders receives funding from NHMRC, US DoD, and MNDRIA. He is secretary of Science and Technology Australia.</span></em></p>I have worked on this problem for many years, and to be honest it still blows my mind to really think about just how complex it is.Darren Saunders, Associate professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/977012018-06-10T20:05:21Z2018-06-10T20:05:21ZLooking online for info on your child’s health? Here are some tips<figure><img src="https://images.theconversation.com/files/222096/original/file-20180607-137312-10mv1ui.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most parents look online for information about their child's health.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Many parents can be anxious when their child is sick. So looking online for health information can help them understand their child’s medical condition and take an active role in treatment. Seeking health information can also be a coping strategy for parents coming to terms with their child’s illness. </p>
<p>But parents <a href="https://www.ncbi.nlm.nih.gov/pubmed/18564080">have reported</a> being worried about whether the online health information they find is reliable and relevant, and are concerned about the possibility of misdiagnosis. They can also feel overwhelmed by the amount of information online, which can be difficult to understand. </p>
<p>Just more than half of the parents we surveyed for a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jpc.14068">recent study</a> were hesitant to act on, or present the information they found online, to the treating doctor. This was despite the fact 73% believed the information influenced the questions they asked the doctor.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dr-google-probably-isnt-the-worst-place-to-get-your-health-advice-73835">Dr Google probably isn't the worst place to get your health advice</a>
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</em>
</p>
<hr>
<p>Previous studies have highlighted barriers to parents discussing their online research with doctors. They include finding a suitable time, given the doctor’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/21771145">high workload</a>, and a <a href="https://www.ncbi.nlm.nih.gov/pubmed/11556771">fear of being perceived</a> as “bossy”, “a whinger”, “difficult” or “pushy”.</p>
<p>Other <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/27145497/">difficulties may arise</a> if the doctor lacks interest in the information parents find because they believe it lacks credibility or is irrelevant.</p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/24986308">2015 study</a> found that, of the 110 parents of children with cancer who searched for online medical information, only 47% shared it with their child’s oncologist, but around 86% would have liked to have done so.</p>
<p>Unlike doctors, parents aren’t trained in how to verify the information they find. When seeking health information online or in parenting forums, it’s important to make sure it’s credible and discuss it with the doctor.</p>
<h2>Parents looking for information</h2>
<p>Our interviews with parents found online health information can provide reassurance and improve adherence to treatment. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/222116/original/file-20180607-137301-bdcrt2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/222116/original/file-20180607-137301-bdcrt2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222116/original/file-20180607-137301-bdcrt2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=352&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222116/original/file-20180607-137301-bdcrt2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=352&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222116/original/file-20180607-137301-bdcrt2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=352&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222116/original/file-20180607-137301-bdcrt2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=443&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222116/original/file-20180607-137301-bdcrt2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=443&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222116/original/file-20180607-137301-bdcrt2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=443&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Seeking health information can be a coping strategy for parents coming to terms with their child’s illness.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>We surveyed 308 parents of sick children at The Children’s Hospital at Westmead. We found 90% of parents searched for health information online. Of these, almost all (95%) looked for information after seeing their child’s doctor and many (63%) did so beforehand. </p>
<p>Some parents, especially those aged under 45, used online parenting forums (29%) or social media such as Facebook (27%) for health information.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-it-means-when-kids-walk-on-their-toes-59081">What it means when kids walk on their toes</a>
</strong>
</em>
</p>
<hr>
<p>Most parents (88%) who went online for health information before seeing the doctor wanted to prepare questions. Most (84%) wanted to find out what their child’s medical condition might be. </p>
<p>Of the parents who searched for information after seeing their child’s doctor, 94% wanted to know more about their child’s condition and 90% had more questions after thinking about what the doctor said.</p>
<h2>Where to look</h2>
<p>Only some parents (29%) believed the health information they found online was correct and just 61% understood it. Only a little more than half (57%) investigated to see if a website, app or Facebook group was trustworthy before accepting or using the information. </p>
<p>Most parents said they wanted help searching for (69%) and assessing (77%) the trustworthiness of online health information. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/222098/original/file-20180607-137322-12bw99t.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/222098/original/file-20180607-137322-12bw99t.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/222098/original/file-20180607-137322-12bw99t.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=191&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222098/original/file-20180607-137322-12bw99t.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=191&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222098/original/file-20180607-137322-12bw99t.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=191&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222098/original/file-20180607-137322-12bw99t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=240&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222098/original/file-20180607-137322-12bw99t.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=240&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222098/original/file-20180607-137322-12bw99t.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=240&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Mayo Clinic features the HONcode logo, showing it’s a trustworthy source of information.</span>
<span class="attribution"><a class="source" href="https://www.mayoclinic.org/">Screenshot/Mayo Clinic</a></span>
</figcaption>
</figure>
<p>Parents can ask their child’s doctor to recommend a website so they can find out more about their child’s medical condition. And they can discuss with the doctor whether the online information they find is trustworthy and relevant.</p>
<p>Some online health information or advice from parenting forums may be untrustworthy, irrelevant to the child’s condition or incorrect. This can lead to misinformation, potentially harming the child and increasing parents’ anxiety and guilt.</p>
<p>When looking up health information online, parents can remember it’s more likely to be trustworthy if it’s on websites that are:</p>
<ul>
<li>aimed at consumers and funded or supported by state and federal health departments (<a href="http://raisingchildren.net.au/">raisingchildren.net.au</a> and <a href="https://www.healthdirect.gov.au/">healthdirect</a>) </li>
<li>operated by public health institutions such as major teaching hospitals (<a href="http://www.schn.health.nsw.gov.au/">The Sydney Children’s Hospitals Network</a> and <a href="https://www.rch.org.au/home/">The Royal Children’s Hospital Melbourne</a>), state and federal health departments (<a href="http://www.health.nsw.gov.au/Pages/default.aspx">NSW Health</a>), government organisations (<a href="http://www.abc.net.au/health/">Australian Broadcasting Corporation</a>) and universities</li>
<li>operated by not-for-profit charities, foundations and professional societies (<a href="https://www.nationalasthma.org.au/">National Asthma Council Australia</a> and <a href="https://au.reachout.com/">ReachOut</a>)</li>
<li>approved by reputable online health accrediting organisations (<a href="https://www.hon.ch/en/">Health On the Net</a>) or featuring their logo (<a href="https://www.mayoclinic.org/">Mayo Clinic</a>).</li>
</ul>
<p>Also look to see if the health information is:</p>
<ul>
<li>written by qualified health professionals</li>
<li>based on evidence-based research or the work of an expert panel (it’s helpful if the website cites the source of its information)</li>
<li>aimed at giving consumers information (such as <a href="http://www.choosingwisely.org.au/home">Choosing Wisely Australia</a>)</li>
<li>balanced, unbiased and unemotional</li>
<li>up to date, listing a recent revision date</li>
<li>separated from advertising</li>
<li>any funding is declared.</li>
</ul>
<hr>
<p><em><strong>Read More: <a href="https://theconversation.com/au/topics/kids-health-series-28783">Children’s health series</a></strong></em></p>
<hr>
<p><em>The study was conducted by Griffith Medical School student Shruti Yardi while on a University of Sydney summer research scholarship in 2015.</em></p><img src="https://counter.theconversation.com/content/97701/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Parents aren’t taught how to verify the health information they find online. So here are some ways to ensure the sources are credible and trustworthy.Karen Scott, Senior Lecturer, Discipline of Child and Adolescent Health, University of SydneyPatrina Ha Yuen Caldwell, Senior Staff Specialist, Centre for Kidney Research, The Children's Hospital at Westmead; Associate Professor, Discipline of Child and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/912372018-02-14T19:08:33Z2018-02-14T19:08:33ZWithout mandatory safety standards, indoor trampoline parks are an accident waiting to happen<figure><img src="https://images.theconversation.com/files/206093/original/file-20180213-58327-aewtkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Half of injuries at trampoline parks are among children aged ten to 14 years. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/hocolibrary/36682860954/in/photolist-XTxfxU-XTxeYY-YA2B87-ac7FS7-4Wfwdz-Uynx49-UynwX7-9zJ53z-ac4QRP-9zHZbg-QGtXqg-PsXSAF-QGtZ4M-PsY2Vx-Qtr8Tb-QDf8jG-ew4CnZ-QtqXjW-QDeV37-ouUdQU-PqgBdQ-QDf7YS-QDeVBJ-Xn8SFb-GD1WG-bVUWAY-oQqGdj-DKXjxq-ew7wQ1-5Af6fD-izyuxu-fuRSxx-ew7was-jHeWLS-qgXkc9-dfkKox-bDH7tS-21QXpdy-4WCscQ-ZNnBoL-ZNnCzd-DKXhrb-ew4o9v-ew4BUk-ew4ooP-DKXgky-ew4nXe-5YRYVV-ew4ofg-ew4oBg">Howard County Library</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Parents are always on the lookout for ways to entertain their kids, whether it’s for birthday parties, <a href="http://www.smh.com.au/lifestyle/life-and-relationships/parenting/school-holidays-are-not-designed-for-modern-parents-this-needs-to-change-20170627-gwzny5.html">school holidays</a>, or a way to escape the house on a rainy weekend. We also like to encourage physical activity, to ward off the <a href="https://theconversation.com/let-children-move-around-stand-or-walk-in-the-classroom-youll-see-the-difference-44495">obesity risks</a> from too much couch time and junk food. </p>
<p>Indoor trampoline parks have rapidly become a popular solution. The <a href="https://www.skyzone.com.au/">first park</a> opened in 2012 and there are now around 80 across the country.</p>
<p>Attendance has soared, and so too has the number of injuries, as our research – published today in the <a href="http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1753-6405">Australian and New Zealand Journal of Public Health</a> – shows. Some injuries are minor but others have resulted in permanent disability.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-prevent-injury-from-sport-and-exercise-68914">How to prevent injury from sport and exercise</a>
</strong>
</em>
</p>
<hr>
<p>While some indoor trampoline parks operate to a high safety standard, others don’t, and there’s nothing compelling them to lift their game. Voluntary Australian safety standards are currently in draft form and under review, but to make a real difference to kids’ safety these standards must be mandatory. </p>
<h2>Safety risks</h2>
<p>Emergency departments across Victoria, Queensland and Western Australia saw almost 500 injures from indoor trampoline parks between 2012 and 2016. And that’s an underestimate; our research used data from the state’s injury surveillance databases, missing those treated in private hospitals or by their GP. </p>
<p>Dislocations, sprains and strains were most common, followed by fractures. Some 15% of children presenting to hospital were admitted due the serious nature of their injuries. </p>
<p>More than half of all injuries were in children aged 10 to 14 years, with girls just as likely to be injured as boys. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/206098/original/file-20180213-170650-1t5m7h8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/206098/original/file-20180213-170650-1t5m7h8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206098/original/file-20180213-170650-1t5m7h8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206098/original/file-20180213-170650-1t5m7h8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206098/original/file-20180213-170650-1t5m7h8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206098/original/file-20180213-170650-1t5m7h8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206098/original/file-20180213-170650-1t5m7h8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are no mandatory safety standards for foam pits.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/nanpalmero/14811629014/in/photolist-oyRth3-ohyHLE-pX9gor-fe4AC7-zLbD3-c1HLFq-asbqMQ-ohyFTb-oz4HpZ-c1D5Zf-ohz8fS-87S2EG-oyRtyW-ohzBvi-87S2eb-dst1t1-87FECA-nj8mZq-duqSrJ-e3YUA9-87FFH3-cEGwqG-6HViX-ecKBPr-ohyLC1-aujRSD-LaEx6-cf73Vu-87HwC-ohz52t-c5K9cy-8Y26oE-9zZPr1-a8Yjns-8gp1tU-6HVd8-87FDS9-87S4HL-6HVdT-6HVii-jhgM5K-NP66Jh-62tVor-dXsPFT-8LXwv-9Tuc6C-un18w3-dBqAvN-cf74eQ-oz4Lsc">Nan Palmero</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The biggest problem was when multiple users were on one trampoline, attempting to do somersaults or flips, or landing awkwardly. </p>
<p>Another key problem is when users jump into the foam landing pit, which is not mandated to ensure sufficient depth, padding and impact reduction. It would be possible to land on a concrete block on your head, for example. </p>
<p>Trampoline park operators ask entrants to sign a <a href="http://www.flipoutsa.com.au/pdf/Flipout%20Waiver%20Document%202017.pdf">risk warning and waiver</a>, accepting the “risk of personal injury and death”, prior to entry. While this risk might be low, in rare cases users have sustained permanent and <a href="http://www.kidspot.com.au/parenting/real-life/in-the-news/customers-sue-trampoline-franchise-flip-out-after-devastating-injuries/news-story/a55485b521e051177b7bfed97a4a5ad0">lifelong disability</a>. The case of one user sustaining <a href="https://www.dailytelegraph.com.au/news/nsw/paralysis-and-broken-necks-pitfalls-of-38m-flip-out-trampoline-empire-as-civil-suits-loom/news-story/3a4ceb610570252d69419319319ca89b">spinal cord damage</a> resulting in lifelong quadriplegia, for example, is now <a href="https://www.dailytelegraph.com.au/news/australian-and-uk-customers-file-lawsuits-against-38m-flip-out-trampoline-empire-over-injuries/news-story/81b44869213657247d942e35b8109c1b">before the courts</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-traumatic-brain-injury-75546">Explainer: what is traumatic brain injury?</a>
</strong>
</em>
</p>
<hr>
<p>This trend has been also seen internationally, where a previously fit and healthy 30-year-old man attempted a flip and landed awkwardly in a foam pit. The pit was only half the recommended depth, and the injury <a href="http://www.phoenixnewtimes.com/news/maureen-kerley-pushes-for-trampoline-park-regulations-following-2012-death-of-son-at-phoenixs-skypark-6663641">cost the man his life</a>. </p>
<h2>We need mandatory standards</h2>
<p>Entrepreneurs have cashed in on the rapid growth of trampoline park venues across Australia, with one <a href="http://www.smh.com.au/small-business/entrepreneur/trampoline-fad-launchpad-for-32m-business-20150119-12t51f.html">generating</a> A$32 million of revenue in the first two years.</p>
<p>The problem is that there is currently <a href="https://www.ausleisure.com.au/news/international-trampoline-parks-conference-raises-bar-for-industry/">no Australian standard</a> for indoor trampoline parks – voluntary or mandatory. That means anyone can set up a profitable park by importing cheap trampolines, squeezing as many as they can into a facility, and scrimping on daily safety checks and maintenance. </p>
<p>Regulators have drafted a voluntary set of safety standards – minimum safety thresholds – to reduce the risk of serious traumatic injuries at indoor trampoline parks. These are currently under review, pending publication later this year. But these are voluntary; park operators can choose to follow them or not. </p>
<p>Australian standards for indoor trampoline parks would ensure operators are consistently setting up and running safe and well-maintained venues. Recommendations to <a href="https://www.ausleisure.com.au/news/trampoline-association-to-undertake-facilities-safety-check">make these venues safer</a> include: </p>
<ul>
<li>ensuring that surrounding landing surfaces have adequate, appropriately placed protective padding in good condition<br></li>
<li>ensuing that damaged or worn equipment is replaced</li>
<li>improving the safety of those who jump into foam pits, by specifying a minimum pit depth and using thick foam blocks on concrete floors to absorb the shock or, preferably, a second trampoline </li>
<li>including a “failsafe” mechanism such as nets beneath trampoline mats, or second trampolines </li>
<li>daily pre-opening maintenance and safety checks with appropriate governance. </li>
</ul>
<p>Until park operators are mandated to adhere to safety standards, patrons have limited legal recourse in cases where trampoline parks do not comply. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206100/original/file-20180213-170643-1oxzcbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206100/original/file-20180213-170643-1oxzcbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206100/original/file-20180213-170643-1oxzcbb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206100/original/file-20180213-170643-1oxzcbb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206100/original/file-20180213-170643-1oxzcbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206100/original/file-20180213-170643-1oxzcbb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206100/original/file-20180213-170643-1oxzcbb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some indoor trampoline parks are better than others.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/145934158@N03/30926847614/in/photolist-P7UbjA-7ArkfG-87PuLL-4Pw2k6-pZvaC-87zt2-8SoP7j-6HVgv-7gDQB-BW3dLj-Bwdk2y-PPUPD7-EyNxvS-sfLLn9-dahnzW-87CA7n-dahnhX-87Hu2-87zBL-JS6xj-mH5sd-pZvaM-2H6H3L-NPngGT-PSDdgp-NLyhA3-NPndBz-PSDgxe-pMsNMw-tGzepY-6LFufp-uDPtkc-un912g-umZRay-un8Y3B-uD9rLj-un17yG-uDPtea-tGKcTF-uDAhgP-umZQrE-uBgwPh-un8Ymx-uDPwdB-uDAgXH-uDPw9i-tGKeeB-un91me-AsLuNf-rM4a1y">Pictures I Like</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>So what can you do?</p>
<p>Well, you can use your own or a friend’s outdoor trampoline. While there are, of course, risks for children jumping on backyard trampolines, <a href="https://infostore.saiglobal.com/store/PreviewDoc.aspx?saleItemID=2825165">Australian standards</a> apply to the import, enclosure systems, structural integrity, and entrapment risks to protect children falling off or being injured on elevated trampolines. The ACCC provides a <a href="http://www.productsafety.gov.au/trampolinesafety">good safety checklist</a> for choosing a backyard trampoline.</p>
<p>If you are going to send your kids to an indoor trampoline park, opt for one with <a href="http://www.atpa.org.au/accredited-members/">Australian Trampoline Park Association accreditation</a>. This is a <a href="http://www.atpa.org.au/new-member-info">code of practice</a> to which ATPA members must adhere, and which covers around one-third of parks. While we wait for mandatory regulation, indoor trampoline park users can vote with their feet and choose to jump at centres that take safety seriously. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/two-hour-screen-limit-for-kids-is-virtually-impossible-to-enforce-36656">Two-hour screen limit for kids is virtually impossible to enforce</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/91237/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Nicole Sharwood is affiliated with Standards Australia as the Epidemiologist on CS005 - Committee for Playground Safety Standards. </span></em></p><p class="fine-print"><em><span>Professor David Eager is affiliated with Engineers Australia and Standards Australia. He represents Engineers Australia and is the Chairperson on the Australian Standards Committee SF-051 Trampoline Park Facilities. For more than a decade he represented Engineers Australia and was the Chairperson on the Australian Standards Committee CS-100 Domestic Trampolines.</span></em></p><p class="fine-print"><em><span>Susan Adams is on the NSW Council of Kidsafe. </span></em></p>While some indoor trampoline parks operate to a high safety standard, others don’t, and there’s nothing compelling them to lift their game.Lisa Nicole Sharwood, Injury epidemiologist, University of SydneyDavid Eager, Professor of Risk Management and Injury Prevention and Assistant Student Ombud, University of Technology SydneySusan Adams, Paediatric Surgeon and Conjoint Lecturer in the School of Women's & Children's Health, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/860662017-12-11T01:49:16Z2017-12-11T01:49:16ZWhy simple school sores often lead to heart and kidney disease in Indigenous children<figure><img src="https://images.theconversation.com/files/195398/original/file-20171120-18528-ltzud6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Impetigo happens when itching causes the skin to break and let in disease-causing bacteria.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Impetigo, also known as school sores, is a highly contagious bacterial skin infection that occurs in children far more frequently than adults. It is one of the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26317533">most common bacterial infections</a> in children aged two to five years. Impetigo happens when a break in the skin, from scratching an insect bite for instance, lets in disease-causing bacteria.</p>
<p>The bacteria responsible for impetigo are <em>Staphylococcus aureus</em> (<em>S. aureus</em> or staph) and <em>Streptococcus pyogenes</em> (<em>S. pyogenes</em> or group A strep). People with diabetes or other conditions that may affect the immune system, such as HIV infection, and those on medications that suppress immunity, are more susceptible.</p>
<p>While the infection itself is treatable, if left untreated it can lead to more serious conditions such as <a href="https://www.healthdirect.gov.au/cellulitis">cellulitis</a> (infection of the inner layers of skin) or <a href="https://www.healthdirect.gov.au/abscesses">abscess</a> (painful collections of pus that build up under the skin). It can also progress to kidney disease, or it could <a href="http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000467">cause acute rheumatic fever</a>, which can affect the heart, joints, brain or skin.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-chronic-kidney-disease-and-why-are-one-in-three-at-risk-of-this-silent-killer-81942">Explainer: what is chronic kidney disease and why are one in three at risk of this silent killer?</a>
</strong>
</em>
</p>
<hr>
<p>Around 162 million children worldwide <a href="https://www.ncbi.nlm.nih.gov/pubmed/26317533">suffer from impetigo</a> at any one time. They mostly live in resource-poor tropical countries or underprivileged populations in developed countries. In Australia, about 15,000 Indigenous children are <a href="https://www.ncbi.nlm.nih.gov/pubmed/26317533">estimated to suffer</a> from impetigo – representing 40% of children in Indigenous communities.</p>
<h2>Causes and symptoms</h2>
<p>Impetigo can occur on top of other skin conditions, particularly itchy ones like eczema, scabies, insect bites, and head lice. Scratching the skin can break it and let the disease-causing bacteria in. A sore can be infectious for as long as it is weeping fluid, as the fluid and crusts of the sore contain infectious bacteria. </p>
<p>The time between becoming infected and developing symptoms is around four to ten days. Contact with the sore, or with things that have been in contact with the sore, can spread the infection to other people. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-do-you-catch-and-get-rid-of-head-lice-43699">Health Check: how do you catch – and get rid of – head lice?</a>
</strong>
</em>
</p>
<hr>
<p>There are two forms of impetigo: non-bullous and bullous. Non-bullous, also known as the crusted form of impetigo, accounts for about 70% of all cases and can be <a href="http://www.aafp.org/afp/2014/0815/p229.html">caused by both</a> <em>S. aureus</em> and <em>S. pyogenes</em>. It has a thick, soft, yellow crust below which is often a wet, red area. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/198074/original/file-20171207-31525-1oenrz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/198074/original/file-20171207-31525-1oenrz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/198074/original/file-20171207-31525-1oenrz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=439&fit=crop&dpr=1 600w, https://images.theconversation.com/files/198074/original/file-20171207-31525-1oenrz3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=439&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/198074/original/file-20171207-31525-1oenrz3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=439&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/198074/original/file-20171207-31525-1oenrz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=552&fit=crop&dpr=1 754w, https://images.theconversation.com/files/198074/original/file-20171207-31525-1oenrz3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=552&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/198074/original/file-20171207-31525-1oenrz3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=552&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Crusted forms of impetigo are the most common.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Impetigo_crouteux_jambes.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Non-bullous <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1470.1994.tb00092.x/abstract">impetigo spots grow slowly</a> and are smaller than the fully grown spots of bullous, or blistering, impetigo. They are not usually painful but can be itchy. The lesions generally appear on the face and extremities, often at the location of already broken skin, such as an insect bite or eczema.</p>
<p>The bullous (blistering) form of impetigo is <a href="http://www.mdedge.com/jfponline/dsm/1310/infectious-diseases/impetigo">characterised by the formation</a> of a large, fluid-filled irritating blister under the skin. It is caused exclusively by <em>S. aureus</em> and <a href="http://www.aafp.org/afp/2014/0815/p229.html">usually occurs</a> where two skin surfaces touch or rub together, such as the armpits. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/198075/original/file-20171207-31525-7kgfv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/198075/original/file-20171207-31525-7kgfv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/198075/original/file-20171207-31525-7kgfv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=884&fit=crop&dpr=1 600w, https://images.theconversation.com/files/198075/original/file-20171207-31525-7kgfv7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=884&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/198075/original/file-20171207-31525-7kgfv7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=884&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/198075/original/file-20171207-31525-7kgfv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1111&fit=crop&dpr=1 754w, https://images.theconversation.com/files/198075/original/file-20171207-31525-7kgfv7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1111&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/198075/original/file-20171207-31525-7kgfv7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1111&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Blistering impetigo infections usually occur where two skin surfaces touch, like the armpits.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Impetigo.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>The blisters grow rapidly in size and number. They burst quickly and leave slightly wet or shiny areas with a brown crust at the edge. Those spots continue to grow quickly even after they break open and can be many centimetres wide. They are not usually painful but can be itchy. </p>
<h2>What are the treatments?</h2>
<p>As impetigo is highly contagious, good <a href="https://www.ncbi.nlm.nih.gov/pubmed/16253886">hygiene practices are essential</a> for stopping the spread of infection. These include washing hands with soap, washing of infected clothes and towels, and covering the sore with a sticking plaster. </p>
<p>It’s also recommended that the infected child be <a href="https://www.ncbi.nlm.nih.gov/pubmed/21976576">kept away from other children</a> and school for 24 hours after starting treatment. </p>
<p>Impetigo is generally considered a mild disease that can resolve without treatment after a few weeks. But because it can cause more serious conditions, the child should be examined by a doctor and treated with appropriate antibiotics. </p>
<p>Topical antibiotics (creams) like mupirocin are recommended for mild forms of the infection. Oral antibiotics are used in more <a href="https://www.mayoclinic.org/diseases-conditions/impetigo/symptoms-causes/syc-20352352">severe cases of impetigo</a>, such as when multiple sores are present, or when topical treatments have been ineffective. The treatment should continue until all sores are completely healed. With treatment, symptoms are likely to be improved or cleared up after seven days.</p>
<h2>What happens if it’s not treated?</h2>
<p>A possible consequence of untreated impetigo is an autoimmune kidney disease called acute post-streptococcal glomerulonephritis (APSGN). It’s not frequently seen in developed countries but one <a href="https://www.ncbi.nlm.nih.gov/pubmed/16253886">estimate suggests</a> that more than 390,000 children in less developed countries are affected, compared with about 13,000 children in more developed countries.</p>
<p>In Australia, data collected from 1991-2008 in the Northern Territory revealed that 95% of cases occurred in <a href="https://www.ncbi.nlm.nih.gov/pubmed/21976576">Indigenous Australians</a>, with 98% of affected individuals living in remote locations. The average age was seven years old, with children younger than 15 accounting for 88% of all cases. </p>
<p>Given the association between APSGN and chronic kidney disease, it is important that predisposing skin infections are treated promptly and appropriately, and the risk of transmission or recurrences is minimised. Around 97% of deaths from APSGN occur in resource-poor countries or communities.</p>
<p>Acute rheumatic fever is another potential consequence of untreated impetigo. It is an autoimmune response to an untreated group A strep infection, and repeated episodes can <a href="https://www.ncbi.nlm.nih.gov/pubmed/19962028">damage the heart</a>, leading to rheumatic heart disease. </p>
<p>Both rheumatic fever and rheumatic heart disease are preventable and generally not seen in industrialised countries. But rates of <a href="https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/rheumatic-heart-disease-and-acute-rheumatic-fever/contents/table-of-contents">rheumatic fever and rheumatic heart diseases</a> in Indigenous communities are up to 26 times those in non-Indigenous populations.</p>
<hr>
<p><strong><em><a href="https://theconversation.com/why-are-aboriginal-children-still-dying-from-rheumatic-heart-disease-63814">Why are Aboriginal children still dying from rheumatic heart disease?</a></em></strong></p>
<hr>
<p>Between 1997 and 2013, <a href="http://www.aafp.org/afp/2014/0815/p229.html">97% of patients</a> diagnosed with acute rheumatic fever in the NT were Indigenous, despite Indigenous Australians <a href="http://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/649/1/NT%20Demography%20Factsheet%202015.pdf">representing about 30%</a> of the NT population. Similarly, 94% of people diagnosed with rheumatic heart disease during this time were Indigenous, and Indigenous patients were younger than the non-Indigenous patients.</p>
<p>Poor hygiene, close living and lack of access to medical care are associated with impetigo and its related complications. Resources that help lessen these risk factors will also reduce the burden of impetigo and the diseases that can develop as a consequence.</p>
<hr>
<p><em>Dr Kavya E. Baby, a basic physician trainee with ACT health, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/86066/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jackson Thomas received funding from government e.g. RIRDC, ACT Gov, NSW Pharmacy Council, Goodwin aged care facilities, and consultant fee and/or grants from biotech companies</span></em></p><p class="fine-print"><em><span>Asha Bowen receives research funding from the National Health and Medical Research Council of Australia for research to reduce the burden of skin sores in remote Indigenous Australians. </span></em></p><p class="fine-print"><em><span>Erin Walker, Gregory Peterson, Julia K. Christenson, and Nathan M D'Cunha do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While school sores – or impetigo – is a treatable condition, if left untreated it can lead to much more serious illness such as kidney and heart disease.Jackson Thomas, Assistant Professor/Senior Lecturer in Pharmacy, University of CanberraErin Walker, Medical Science Research Fellow, University of CanberraGregory Peterson, Deputy Dean (Research) Faculty of Health, University of TasmaniaNathan M D'Cunha, Sessional Academic, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/865312017-10-30T22:51:01Z2017-10-30T22:51:01ZHow to avoid a Halloween sugar disaster<figure><img src="https://images.theconversation.com/files/299350/original/file-20191029-183116-fu4gzt.jpg?ixlib=rb-1.1.0&rect=72%2C45%2C5889%2C3638&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For many parents, it's the haul of gummy worms, licorice, chocolate bars and other high-sugar candies that their kids bring home -- not the ghouls and zombies -- that is terrifying about Halloween. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>For many people, Halloween means dressing their kids up like cute little superheroes. Unfortunately, the holiday can also stress many parents as they try to manage the deluge of candy that children bring home from trick-or-treating. </p>
<p>Over-consumption of sugary treats on a single day is of no great concern for health. Sustained over-consumption can, however, lead to a number of negative health effects in children. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-can-kids-trick-or-treat-without-adults-125924">When can kids trick-or-treat without adults?</a>
</strong>
</em>
</p>
<hr>
<p>The good news is that there are several strategies parents can use to get rid of the candy stash and reduce the impact of what is eaten. </p>
<h2>The terrifying effects of sugar</h2>
<p>Sugary treats can have a very negative impact on dental health. Research has consistently shown that a high sugar intake is associated with <a href="http://www.ncbi.nlm.nih.gov/pubmed/24323509">increased risk of dental caries (cavities) in children</a>. Sugar is the preferred food for harmful bacteria in the mouth that produce acids, which can destroy tooth enamel and lead to cavities. </p>
<p>A high intake of sugar is also associated with an increased risk of chronic disease later in life, including <a href="https://www.dx.doi.org/10.1001/jamainternmed.2013.13563">heart disease</a> and <a href="https://doi.org/10.1371/journal.pone.0057873">Type 2 diabetes</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/192473/original/file-20171030-18735-1dmsprt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/192473/original/file-20171030-18735-1dmsprt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/192473/original/file-20171030-18735-1dmsprt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/192473/original/file-20171030-18735-1dmsprt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/192473/original/file-20171030-18735-1dmsprt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/192473/original/file-20171030-18735-1dmsprt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/192473/original/file-20171030-18735-1dmsprt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Halloween treats such as these shortbread fingers with jam ‘blood’ can be terrifying for kids and parents alike.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Eating sugar leads to a rise in glucose (sugar) in the blood. This rise has been associated with changes to the level of certain fats in the blood, specifically <a href="https://doi.org/10.1093/ajcn/62.1.250S">an increase in triglycerides</a> and <a href="https://doi.org/10.1016/S1047-2797(98)00007-6">a decrease in high-density-lipoproteins (HDL) cholesterol</a>. This can lead to higher risk of heart disease. </p>
<p>A high intake of sugar can also lead to excess weight gain, which is linked to both heart disease and diabetes risk.</p>
<p>That’s the bad news. So what can parents do about it?</p>
<h2>Eat the eyeballs after dinner</h2>
<p>The body’s response to sugar can be altered by a number of factors, including the foods that are eaten with the sugary treat. Eating a sugary treat along with foods high in protein or fibre can result in a smaller rise in blood sugar. </p>
<p>To reduce their child’s spike in blood sugar, parents should resist the urge to pack a Halloween treat in their children’s lunch where they will be unable to control what is eaten with it. Instead, parents can allow their children a treat after the dinner meal, where the children can be more closely monitored. If followed by a good teeth brushing, parents can also reduce their child’s risk of cavities. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/192471/original/file-20171030-18704-19r8bjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/192471/original/file-20171030-18704-19r8bjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/192471/original/file-20171030-18704-19r8bjl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/192471/original/file-20171030-18704-19r8bjl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/192471/original/file-20171030-18704-19r8bjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=479&fit=crop&dpr=1 754w, https://images.theconversation.com/files/192471/original/file-20171030-18704-19r8bjl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=479&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/192471/original/file-20171030-18704-19r8bjl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=479&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>Halloween can serve as a time for parents to help their children learn about balance in their diet and how to become discerning eaters in our current food environment. </p>
<p>As Sara Kirk aptly outlines in <a href="https://theconversation.com/this-is-why-child-obesity-rates-have-soared-85638">her article on the rise of childhood obesity</a>, our current food environment serves up substantially more opportunities for unhealthy food choices versus healthy ones. </p>
<p>While we advocate for change in the food environment, the goal is for children to enjoy food, including sugary Halloween treats, in the context of a healthy, balanced diet. Parents can help kids to understand that sugary treats do not provide us with the nutrients and energy we need to grow and stay healthy, therefore we need to enjoy them in smaller amounts. </p>
<p>Kids can also be encouraged to think about which treats they enjoy the most and which ones they will eat just because they are there. </p>
<h2>Call in the Switch Witch</h2>
<p>Parents of younger children often find they can toss the majority of treats after a week or two as their children lose interest, or even forget about the stash. </p>
<p>Older children may want to weigh their treats and “sell” them back to their parents for a reasonable price per pound. </p>
<p>Other parents <a href="http://www.parents.com/holiday/halloween/traditions/too-much-candy/">implement the Switch Witch</a>. This benevolent helper can visit children as they sleep, trading the big bag of candy they have left out for her — for a small prize. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/192474/original/file-20171030-18725-ez02j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/192474/original/file-20171030-18725-ez02j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=442&fit=crop&dpr=1 600w, https://images.theconversation.com/files/192474/original/file-20171030-18725-ez02j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=442&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/192474/original/file-20171030-18725-ez02j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=442&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/192474/original/file-20171030-18725-ez02j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=556&fit=crop&dpr=1 754w, https://images.theconversation.com/files/192474/original/file-20171030-18725-ez02j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=556&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/192474/original/file-20171030-18725-ez02j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=556&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children who know about the Switch Witch can be excited to gather Halloween candy for her.</span>
<span class="attribution"><span class="source">(THE CANADIAN PRESS/Justin Tang)</span></span>
</figcaption>
</figure>
<p>The <a href="http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf">World Health Organization</a> and the <a href="http://www.heartandstroke.ca/-/media/pdf-files/canada/2017-position-statements/sugar-ps-eng.ashx?la=en&hash=2A10F431AFBCEC72AD9643EA376AAE6A0C370948">Heart and Stroke Foundation</a> recommend that kids’ total intake of free sugars (defined as sugar that is added to foods, plus sugars naturally present in honey, syrups and fruit juices) not exceed 10 per cent of total daily calorie intake. For most children this works out to about four to five teaspoons of free sugar per day. </p>
<p>While kids will certainly overshoot these recommendations on Halloween, it’s their sugar intake on the other 364 days that we’re hoping will hit the mark.</p><img src="https://counter.theconversation.com/content/86531/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jess Haines receives funding from the Canadian Institutes for Health Research, Canadian Foundation for Innovation, Canadian Foundation for Dietetic Research, and the Ontario Ministry of Agriculture, Food, and Rural Affairs. </span></em></p>Halloween is upon us, and the sugar is horrible for your kids’ teeth and health. But fear not – there are things parents can do to lessen the impact of the candy binge.Jess Haines, Associate Professor of Applied Nutrition, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/838152017-10-12T19:11:32Z2017-10-12T19:11:32ZMy child has glue ear – what do I do?<figure><img src="https://images.theconversation.com/files/188489/original/file-20171003-18144-1c11wf7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Repeated ear infections and prolonged episodes of glue ear can result in permanent hearing loss.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Around <a href="http://onlinelibrary.wiley.com/doi/10.1111/jpc.12741/full">one in four Australian children</a> will have recurrent ear infections in their first three years of life. This decreases as children get older. But by the time children start school, <a href="https://www.ncbi.nlm.nih.gov/pubmed/27037737">one in ten</a> will still have glue ear, which could have a significant impact on their early learning. </p>
<p>Glue ear is a form of ear infection also known as otitis media with effusion. It occurs when the middle part of the ear (behind the ear drum) fills with a sticky, glue-like fluid instead of air. This fluid dampens the vibrations made by sound as it travels through the eardrum and to the cochlea – the spiral-shaped part of the ear where the vibrations are converted to signals sent to our brain, allowing us to hear. </p>
<p>For children with glue ear it is like someone has turned down the volume of the world. This is why these children may appear to have selective hearing.
Repeated ear infections and prolonged episodes of glue ear can result in permanent hearing loss. The impacts on a child’s development stretch well into adulthood. </p>
<p>So what should you do if your child has glue ear? And how can you prevent them getting it in the first place?</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=520&fit=crop&dpr=1 600w, https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=520&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=520&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=653&fit=crop&dpr=1 754w, https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=653&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=653&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">One theory is that glue ear persists after having a cold if the Eustachian tubes are unable to clear the mucus.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Why do kids get it?</h2>
<p>Otitis media can run in families and we know there is some genetic susceptibility to this disease. However, research has also shown <a href="https://www.ncbi.nlm.nih.gov/pubmed/25514446">cases of glue ear</a> in Australian children peak during winter months, related to the increase in colds, and at the start of the school year, when children may be exposed to new bugs from other kids. </p>
<p>The exact cause is poorly understood, but bacteria and viruses associated with <a href="https://www.mja.com.au/journal/2009/191/9/otitis-media-viruses-bacteria-biofilms-and-vaccines">coughs and colds</a> are often the initial cause of ear infections. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-is-the-common-cold-and-how-do-we-get-it-60857">Health Check: what is the common cold and how do we get it?</a>
</strong>
</em>
</p>
<hr>
<p>One theory is that glue ear persists after a cold has cleared due to a dysfunctional Eustachian tube, which links the back of the throat to the middle ear. When mucus eventually clears from the nose and throat after a cold, the theory proposes that instead of draining from the ear through the Eustachian tube as it should, it gets stuck in the middle ear, resulting in glue ear.</p>
<p>Bacteria also develop something called <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0053837">biofilms</a> (slime) as a protection. This can make the bacteria up to 1,000 times more resistant to antibiotics, meaning they can’t be effectively treated. These bacteria are also able to hijack a child’s immune response, making immune cells spit out a sticky net of DNA that, instead of killing the bacteria, creates the sticky glue that provides the bacteria with a home. </p>
<p>Together these increase the ability of glue ear to persist or re-occur. This results in longer periods of hearing loss and leaves children at a greater risk of developmental problems. </p>
<h2>How can it be treated and prevented?</h2>
<p>There is no silver bullet that will prevent glue ear. But you can do to some things to reduce the risk of persistent glue ear. </p>
<p>These include reducing exposure to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053406/">cigarette smoke</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/16645502">making sure your child has had all their vaccinations</a>. Encouraging children to wash their hands and other healthy hygiene habits, like <a href="http://doyouhear.org.au/wp-content/uploads/2011/09/Breathe-Blow-Cough.pdf">blowing their noses</a>, are also important. Research has also shown <a href="http://onlinelibrary.wiley.com/doi/10.1111/coa.12652/full">breastfeeding your child</a> has some protective benefits from otitis media.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It’s important to encourage your child to wash their hands and blow their nose.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Vaccines (in particular, pneumococcal conjugate vaccines) can help reduce ear infections and subsequent glue ear. But current vaccines can cover only a small proportion of the possible bugs that cause ear infections. New vaccines are <a href="https://www.telethonkids.org.au/our-research/early-environment/infection-and-vaccines/vaccine-trials-group/">being developed</a> against this bug and also a bug called nontypeable <em>Haemophilus influenzae</em>, which is now the main cause of ear infections in children.</p>
<p>Once glue ear is identified, there will usually be a <a href="http://www.aafp.org/afp/2013/1001/p435.pdf">“watch and wait”</a> period of around three months. This is particularly important if glue ear is identified during one of the peak periods when it may resolve by itself without intervention. Antibiotics may offer very <a href="http://www.cochrane.org/CD009163/ENT_antibiotics-otitis-media-effusion-glue-ear-children">limited benefit</a> and <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/B8A6602C7714B46FCA257EC300837185/%24File/Recommendation-for-clinical-guidelines-Otitis-Media.pdf">will not be recommended</a> in many cases.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-should-kids-be-given-antibiotics-in-their-first-year-61289">Health Check: should kids be given antibiotics in their first year?</a>
</strong>
</em>
</p>
<hr>
<p>For children who have persistent glue ear, a small operation commonly known as <a href="https://www.kidshealth.org.nz/grommets-tympanostomy-or-ventilation-tubes">grommet insertion</a> is performed. Grommets are devices that ventilate the middle ear and prevent fluid accumulating. These surgeries are one of the <a href="http://www.healthinfonet.ecu.edu.au/key-resources/bibliography?lid=13789">most common surgical procedures</a>, with over 30,000 performed every year in Australia. </p>
<p>Grommets are usually an effective treatment for glue ear and improve hearing almost immediately. However, like any surgery, there are risks and potential complications. </p>
<p>New drug therapies are also being developed, including one that <a href="https://www.telethonkids.org.au/news--events/news-and-events-nav/2016/may/a-new-job-for-a-specialised-drug/">dissolves the glue</a> in glue ear. This may reduce the need for repeat grommet surgeries in cases of persistent glue ear. </p>
<h2>Why is it such a problem?</h2>
<p>One of the key challenges in treating glue ear is to identify it in the first place. It can be hard for parents to <a href="http://www.rch.org.au/kidsinfo/fact_sheets/Glue_Ear/">spot the signs</a>, which can include hearing difficulties (such as your child asking you to repeat words) and occasional pain and pressure. Undiagnosed and untreated glue ear can have serious developmental consequences for children. </p>
<p>A recent <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/HearingHealth/Report_1">parliamentary inquiry</a> into hearing health has suggested all children be screened for hearing loss during their first year of school. This could be hugely beneficial in identifying children with glue ear who have no other obvious signs. </p>
<p>Aboriginal children experience more ear infections, longer periods of glue ear, and more severe hearing losses than other children. In fact, Aboriginal children in Australia have the highest rates of otitis media in the world. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/bulging-ear-drums-and-hearing-loss-aboriginal-kids-have-the-highest-otitis-media-rates-in-the-world-64165">Bulging ear drums and hearing loss: Aboriginal kids have the highest otitis media rates in the world</a>
</strong>
</em>
</p>
<hr>
<p>Initiatives to provide early identification and treatment for ear infections and glue ear, such as the <a href="https://www.telethonkids.org.au/our-research/early-environment/infection-and-vaccines/ear-health/a-cohort-study-of-otitis-media/">Nyoongar Djarli Waakinj</a> ear health program at the Telethon Kids Institute in Perth, the <a href="http://www.ruralhealthwest.com.au/about-us/publications/wa-child-ear-health-strategy">WA Child Ear Health Strategy </a>and other programs like <a href="https://www.childrens.health.qld.gov.au/chq/our-services/community-health-services/deadly-ears/">Deadly Ears</a>, are helping to reduce the developmental impact of otitis media and close the gap for ear health in Aboriginal children.</p><img src="https://counter.theconversation.com/content/83815/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Brennan-Jones receives funding from the NHMRC CRE for Ear and Hearing Health of Aboriginal and Torres Strait Islander People (CRE_ICHEAR). </span></em></p><p class="fine-print"><em><span>Ruth Thornton receives funding from the BrightSpark Research Foundation in the form of a research fellowship, as well as from the NHMRC, the Western Australian Health Department and the Princess Margaret Hospital Foundation in the form of research grants . </span></em></p>Children with glue ear constantly struggle to hear at school, which may leave them frustrated, disengaged and unlikely to reach their full potential.Chris Brennan-Jones, Senior Research Fellow, Telethon Kids Institute, The University of Western AustraliaRuth Thornton, BrightSpark Foundation Research Fellow, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/765752017-06-05T20:03:17Z2017-06-05T20:03:17ZSix ways to improve meal times with your children<figure><img src="https://images.theconversation.com/files/171400/original/file-20170530-16284-1cor4e9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children don't always want to eat what's in front of them.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Meal times with young children can be stressful, especially after a day at work or a day caring for them. And if they refuse to eat the nutritious dinner you’ve cooked, this can easily lead to frustration.</p>
<p>Here are six things you could do to make meal times a bit less stressful.</p>
<h2>Tip 1: Get them involved</h2>
<p>Avoid doing it all yourself, because kids can help in the kitchen too. Get them involved in food preparation and they may become more interested in food and willing to taste new things.</p>
<p>Most often, adults prepare meals for children to eat. But involving children in preparing, cooking and even growing food can be an opportunity to teach them about healthy eating. Research shows <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222785/">involving children in this way can influence</a> their food preferences, attitudes and behaviours.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/171219/original/file-20170527-6396-1sgtwut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/171219/original/file-20170527-6396-1sgtwut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171219/original/file-20170527-6396-1sgtwut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171219/original/file-20170527-6396-1sgtwut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171219/original/file-20170527-6396-1sgtwut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171219/original/file-20170527-6396-1sgtwut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171219/original/file-20170527-6396-1sgtwut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171219/original/file-20170527-6396-1sgtwut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Getting children to help with all aspects of meal times has many benefits.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Even very young children can help with setting the table, washing ingredients, measuring and mixing. Involving kids in food-related activities leads to increased <a href="https://www.ncbi.nlm.nih.gov/pubmed/24709485">positive emotions in children</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/22578854">more confidence</a> in selecting and eating healthy foods, and a <a href="https://www.ncbi.nlm.nih.gov/pubmed/24709485">greater liking and eating</a> of fruit and vegetables – as well as being more willing to taste new ones. </p>
<h2>Tip 2: Make sure they come to the table hungry</h2>
<p>There’s nothing like hunger to encourage a child to try something they might not like. Eating in the hour or two before dinner is enough to put anyone off their meal. This is particularly true for children.</p>
<p>The best way to avoid this is to set up a meal-time routine. Children <a href="https://www.ncbi.nlm.nih.gov/pubmed/22578854">respond well to knowing</a> what is going to happen and when, so consistently offer three meals and three snacks each day (every two to three hours, for instance). </p>
<p>Importantly, children should not graze in between on anything other than water – even a little milk, juice or a few crackers can spoil a child’s appetite. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/171220/original/file-20170527-6377-orm93q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/171220/original/file-20170527-6377-orm93q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171220/original/file-20170527-6377-orm93q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171220/original/file-20170527-6377-orm93q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171220/original/file-20170527-6377-orm93q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171220/original/file-20170527-6377-orm93q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171220/original/file-20170527-6377-orm93q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171220/original/file-20170527-6377-orm93q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children shouldn’t graze on anything between meal and snack times other than water.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Tip 3: Turn off all the screens</h2>
<p>With access to screens and devices within arm’s reach, it can be hard to switch off. You should aim to turn off all screens and other devices and connect with each other as a family. </p>
<p>Connecting as a family over a shared meal is <a href="https://www.ncbi.nlm.nih.gov/pubmed/10728109">associated with a healthy diet</a> and promotes a positive eating environment for children. Eating meals together as a family <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599132/">encourages mindful eating</a> and family discussion about the day. </p>
<p>Family meals are important for both young <a href="https://theconversation.com/science-says-eat-with-your-kids-34573">children</a> and <a href="http://www.sciencedirect.com/science/article/pii/S1555415510002503">teenagers</a> – so start this healthy habit with your family today. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/171223/original/file-20170527-6377-r1or4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/171223/original/file-20170527-6377-r1or4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171223/original/file-20170527-6377-r1or4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171223/original/file-20170527-6377-r1or4p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171223/original/file-20170527-6377-r1or4p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171223/original/file-20170527-6377-r1or4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171223/original/file-20170527-6377-r1or4p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171223/original/file-20170527-6377-r1or4p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Make sure there are no distractions, like iPads, at the table.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Tip 4: Let them decide how much to eat</h2>
<p>Sometimes it can be tempting to force kids to eat all of what’s on their plate, or to bribe them with dessert in exchange for eating more of their meal. But children have a natural ability to self-regulate their eating in response to internal hunger cues, which can easily be overridden by emotional cues or demands from adults. </p>
<p>So instead of pushing for your child to eat a certain amount , apply a “division of responsibility” at meal times. You can use what is called the <a href="http://trove.nla.gov.au/work/6901092">“parent provides, child decides”</a> strategy. Here you provide nutritious food to your child and allow him or her to use their <a href="https://www.ncbi.nlm.nih.gov/pubmed/1985244">innate ability to self-regulate their appetite</a> and decide if, and how much, they eat. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/171221/original/file-20170527-6373-16g44vp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/171221/original/file-20170527-6373-16g44vp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171221/original/file-20170527-6373-16g44vp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171221/original/file-20170527-6373-16g44vp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171221/original/file-20170527-6373-16g44vp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171221/original/file-20170527-6373-16g44vp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171221/original/file-20170527-6373-16g44vp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171221/original/file-20170527-6373-16g44vp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children have a natural ability to self-regulate in response to internal hunger cues.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/family-dinner?photo=PMxoh8zJNb0">Kelly Sikkema/Unsplash</a></span>
</figcaption>
</figure>
<h2>Tip 5: Serve only one meal for the whole family</h2>
<p>Save time, money and stress by offering one meal for the whole family. It can be disappointing if your child doesn’t eat or won’t even try the meal you have made. But you shouldn’t force or bribe your child to eat. So, what do you do? </p>
<p>As above, ensuring your child comes to the table hungry will help. Try not to offer an alternative or enter into any trade-offs with your child. This will tell your child they have control over the situation when you should ultimately be in control. </p>
<p>Regularly or willingly offering alternatives you know they will like won’t give them the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2531152/">repeated exposure they need</a> to accept and like new foods. It is also important for all family members (adults and children) to have the same family meal where possible as <a href="https://www.ncbi.nlm.nih.gov/pubmed/18559129">role modelling of eating behaviours</a> improves children’s intake.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/171399/original/file-20170530-16295-7s1bt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171399/original/file-20170530-16295-7s1bt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171399/original/file-20170530-16295-7s1bt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171399/original/file-20170530-16295-7s1bt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171399/original/file-20170530-16295-7s1bt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171399/original/file-20170530-16295-7s1bt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171399/original/file-20170530-16295-7s1bt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It is important for all family members to have the same family meal where possible.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Tip 6: Stay calm!</h2>
<p>Pressuring or encouraging children to eat is a strategy often used by parents to increase a child’s eating. But such practices are <a href="https://www.ncbi.nlm.nih.gov/pubmed/17341215">not effective in improving children’s intake</a> and can lead to an <a href="https://www.ncbi.nlm.nih.gov/pubmed/10448516">unhealthy relationship with specific foods</a>. </p>
<p>This works both ways, such as explicitly encouraging or praising children for eating a lot or everything on their plate (“Good girl for eating all of that, Lily”) or making meals a battleground if not much is eaten (“Be a good girl for mummy and eat a bit more please, Lily”). </p>
<p>The best results come from responding in a neutral way, with as little emotion as possible (“Are you finished, Lily?”). Adding stress to the situation <a href="https://www.ncbi.nlm.nih.gov/pubmed/16626838">will only result in less food eaten</a>.</p>
<p>Children do not eat well when they are pressured to eat and will not starve to death if they miss a meal or two. If your child refuses a meal or does not eat anything in about 15 to 20 minutes, calmly remove his or her food.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/171222/original/file-20170527-6385-1yi3csb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/171222/original/file-20170527-6385-1yi3csb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171222/original/file-20170527-6385-1yi3csb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171222/original/file-20170527-6385-1yi3csb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171222/original/file-20170527-6385-1yi3csb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171222/original/file-20170527-6385-1yi3csb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171222/original/file-20170527-6385-1yi3csb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171222/original/file-20170527-6385-1yi3csb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Don’t force your children to eat their food.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure><img src="https://counter.theconversation.com/content/76575/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carly Moores is an employee of Flinders University which holds the licence for the Parenting, Eating and Activity for Child Health (PEACH™) Program. She has previously received personal funding for research from the Australian Government, CSIRO, and the Sax Institute, and has worked on projects funded by the Queensland Department of Health, NHMRC, National Partnership Agreement on Preventive Health, The National Heart Foundation, The Channel 7 Children's Research Foundation, and Flinders Medical Centre Foundation. She is a current member of the Nutrition Society of Australia, the Public Health Association of Australia, the Australian and New Zealand Obesity Society, and Healthy Development Adelaide.</span></em></p><p class="fine-print"><em><span>Jacqueline Miller has previously received funding from Queensland University of Technology for the evaluation of the Parenting, Eating and Activity for Child Health (PEACH™) Program and from the Channel 7 Children's Research Foundation and the Sax Institute.
She is an Advanced Accredited Practising Dietitian and a member of the Dietitians' Association of Australia.
</span></em></p><p class="fine-print"><em><span>Lucinda Bell is an employee of Flinders University and currently receives funding from the Channel 7 Children's Research Foundation to undertake her research. She has worked on projects funded by the South Australian Department of Health, National Health and Medical Research Council, Sax Institute, Flinders University and Flinders Medical Centre Foundation. She is a current member of the Nutrition Society of Australia, Dietitians Association of Australia, Australia and New Zealand Obesity Society and Healthy Development Adelaide.</span></em></p>Having trouble getting your kids to eat? Here are six things you could do at the table, and before, to make meal times a bit less stressful.Carly Moores, Post-doctoral research assistant in childhood overweight, Flinders UniversityJacqueline Miller, Senior Lecturer and SAHMRI Fellow, Flinders UniversityLucinda Bell, Research Associate, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/673102016-11-03T19:05:58Z2016-11-03T19:05:58ZWe need better treatments for childhood cancer, with fewer side effects<figure><img src="https://images.theconversation.com/files/144324/original/image-20161103-25346-x6aex3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Childhood cancer desperately needs more research.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>The Australian government today announced A$20 million for research to find <a href="http://malcolmturnbull.com.au/media/childhood-cancer-network-receives-20-million-to-help-children-with-cancer">targeted treatments for childhood cancer</a>. In announcing the grant, for the <a href="https://ccia.org.au/home/research-overview/zerochildhoodcancer/">Zero Childhood Cancer Program</a> led by the Children’s Cancer Institute and Sydney Children’s Hospital, Health Minister Sussan Ley said:</p>
<blockquote>
<p>Cancer has just passed cardiovascular disease as the leading cause of death in Australia and there is no more tragic diagnosis than when it’s in a child. We’ve invested A$12 billion into research since the year 2000… we know we’ve got more dollars to allocate to this really, really important research cause.</p>
</blockquote>
<p>This generous funding will be major step toward finding better treatments for children with cancer. Australians have access to the world’s best treatments, doctors and health systems, yet there is a lack of safe, effective and affordable drugs to treat the most aggressive childhood cancers, such as some brain tumours.</p>
<p>One of main reasons for this is that children’s cancer is a rare cancer. This means it is less economically viable for pharmaceutical companies to search for its causes and develop drugs to treat them.</p>
<h2>What’s wrong with current treatments?</h2>
<p>Treatment for children’s cancer is more successful than ever. Over 80% of <a href="https://theconversation.com/childhood-cancer-deaths-have-fallen-in-australia-but-some-types-remain-more-of-a-challenge-61666">children diagnosed with cancer today</a> will survive. But such success has mostly been achieved by using very old, general chemotherapy and radiotherapy – which has its own costs.</p>
<p>Most child cancer hospital wards are full of children suffering from the side effects of treatment, rather than from the cancer itself. And in the long term, <a href="https://www.ccia.org.au/our-research/life-after-cancer/long-term-follow-project/">one third of childhood cancer survivors</a> will have a significant health problem from the treatment that cured their cancer.</p>
<hr>
<p><em><strong>Further reading: <a href="https://theconversation.com/life-interrupted-young-people-need-help-moving-forward-after-cancer-63704">Life interrupted: young people need help moving forward after cancer</a></strong></em></p>
<hr>
<p>This is why teams like ours are working to find drugs specifically targeted to individual tumours. Also known as <a href="https://theconversation.com/how-cancer-doctors-use-personalised-medicine-to-target-variations-unique-to-each-tumour-47349">personalised medicine</a>, targeted therapy uses small molecules to specifically and more effectively hit the gene and protein responsible for the cancer.</p>
<p>A goal of targeted therapy is to only kill cancer cells, while healthy ones are left alone. Obviously this means fewer side effects - both in the short and long term. </p>
<p>Unlike many adult cancers, childhood cancer is not caused by <a href="https://theconversation.com/interactive-body-map-what-really-gives-you-cancer-52427">lifestyle choice or environmental hazards</a> such as smoking. Instead it’s likely a result of genetics and some as yet unknown aspects of the early life environment. </p>
<p>The result is childhood cancers have different gene drivers compared to adult cancer, needing specific drug development. </p>
<h2>Why isn’t there more research?</h2>
<p>Cancer is the leading cause of death from disease in childhood. About <a href="https://ccia.org.au/home/our-purpose/childhood-cancer-information/">three Australian children or young</a> adults die from cancer every week. Yet overall, <a href="https://www.iarc.fr/en/media-centre/iarcnews/2010/globocan2008.php">cancer in children accounts</a> for only 1% of all cancer incidence.</p>
<p>And that 1% is further broken down into a constellation of more than 100 rare and ultra rare diseases. Some childhood cancers have very small sub-populations. For instance, <a href="http://www.nature.com/nrclinonc/journal/v11/n12/full/nrclinonc.2014.149.html">only two or three children in the United Kingdom</a> have a type of Wilms tumour, found in the kidneys.</p>
<p>Being a rare disease means the market is small and there is no commercial incentive for drug companies to research or develop drugs. On the part of big pharma this is not a crime – their businesses need to be profit-driven.</p>
<hr>
<p><em><strong>Further reading: <a href="https://theconversation.com/unfair-if-rare-should-the-pbs-change-the-way-it-lists-cancer-drugs-59157">Unfair if rare: should the PBS change the way it lists cancer drugs?</a></strong></em></p>
<hr>
<p>The consequence though is that childhood cancer is under-researched. Drugs specifically designed for childhood cancer are almost non-existent. The drug development process is designed for adult cancer, with clinical trials for children only performed once an adult drug is approved for use, often taking five to ten years from the first human trials. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/144334/original/image-20161103-25346-1sow4gg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/144334/original/image-20161103-25346-1sow4gg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/144334/original/image-20161103-25346-1sow4gg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/144334/original/image-20161103-25346-1sow4gg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/144334/original/image-20161103-25346-1sow4gg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/144334/original/image-20161103-25346-1sow4gg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/144334/original/image-20161103-25346-1sow4gg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/144334/original/image-20161103-25346-1sow4gg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The drug development process is designed for adult cancer.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Prioritising potential drugs to take from the lab to clinical trials is still uncertain. For instance, several new therapies that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3618498/">looked promising in animal trials</a>, have fallen over because the lack of efficacy in a large adult cancer patient population led to pharmaceutical companies losing interest.</p>
<p>Of the 120 drugs approved by the United States Food and Drug Administration between 1948 and 2003, <a href="http://www.nature.com/nrclinonc/journal/v11/n12/full/nrclinonc.2014.149.html">only 30 have been used</a> in children.</p>
<p>And despite the anaplastic lymphoma kinase (ALK) gene being <a href="https://www.cancer.gov/types/lymphoma/patient/child-nhl-treatment-pdq">identified in paediatric lymphoma</a> 22 years ago, drugs that inhibited the gene were only developed for clinical use when they <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215402/">were found to work</a> in adult lung cancers. </p>
<h2>What other barriers are there?</h2>
<p>Even once the drug has passed the initial stages and has been approved for human trials, there are a number of barriers when it comes to those for child cancers.</p>
<p>For instance, accessing the ALK inhibitor drugs has been difficult. Even though they work well in child cancers driven by that particular gene, there has been a lack of incentive for pharmaceutical companies to apply to license the drug for use in children.</p>
<p>If an adult trial fails, a clinical trial for children will not proceed. It takes a decade or more, multiple clinical trials and around US$1.8 billion, <a href="http://www.nature.com/nrclinonc/journal/v11/n12/full/nrclinonc.2014.149.html">to get a drug to market</a>, with lots of hurdles along the way.</p>
<p>Last month, the Australian government <a href="http://www.abc.net.au/news/2016-09-15/medicine-approval-process-allow-quicker-access-breakthrough-drug/7846206">announced reforms that will bring new medicines</a> to the Australian market quicker by piggybacking on drug assessments made by the FDA and regulatory agencies in Europe, potentially making cancer medicines available up to two years earlier. </p>
<p>This is a step in the right direction, but much more needs to be done to advocate for child cancer patients.</p>
<p>Single agent trials of anticancer drugs are unlikely to cure patients due to the cancer’s capacity to mutate and develop resistance to treatment. It is only by using combinations of anticancer drugs that cure is achieved. Moreover, combining several anticancer drugs allows lower doses of individual agents to be used, reducing the side-effects. </p>
<p>Our own research suggests combination therapies, aimed at a single disease, have the greatest chance of success. Yet current early trial systems are mostly conducted with single agents across a variety of cancer types. </p>
<p>Pharmaceutical companies are often reluctant to combine their drugs with agents from their market competitors. This does not serve children well, slowing down the search for optimal treatment regimens in the clinic.</p>
<p>These roadblocks are a global phenomenon. They have led to a huge unmet clinical need for safe and effective cancer therapies for children. The solutions will be complex and will need collaboration between doctors, researchers, governments and pharmaceutical companies, to come up with a new system which advocates for our youngest and most vulnerable citizens.</p><img src="https://counter.theconversation.com/content/67310/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glenn Marshall is part of the research team that has received the latest federal government grant. He also receives funding from NHMRC, CINSW, CCNSW.</span></em></p><p class="fine-print"><em><span>David Ziegler works at the Kids Cancer Centre, Sydney Children's Hospital - recipient of the latest federal government grant.</span></em></p>Children’s cancer is a rare disease, which means the market is small and pharmaceutical companies have few incentives to develop drugs for these cancers.Glenn Marshall, Professor, Children's Cancer InstituteDavid Ziegler, Associate professor (conjoint), Children's Cancer InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/603652016-07-28T19:43:50Z2016-07-28T19:43:50ZWhat are ‘flat feet’ in children and are they something to worry about?<figure><img src="https://images.theconversation.com/files/130646/original/image-20160715-2120-1rq9jhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If your child has flat feet do you have to do something about it?</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This is part of our series on kids’ health. Read the other articles in our series <a href="https://theconversation.com/au/topics/kids-health">here</a>.</em></p>
<hr>
<p>Children with flat feet, also called <em>pes planus</em>, have a flattening of the arch during standing and walking. Flat foot is normal in infants and young children (<a href="http://www.ncbi.nlm.nih.gov/pubmed/16882817">up to 44% of three- to six-year-olds</a>). At this age, in the absence of any associated symptoms, treatment is highly debatable.</p>
<p>Flat foot usually naturally corrects itself as muscles strengthen and soft tissues stiffen. The height of the arch in the foot increases with age <a href="http://link.springer.com/article/10.1186/s13047-016-0156-3">until about nine years</a>. The problem is when flat foot persists, spontaneously occurs in older children or later in life, or is associated with pain and disability.</p>
<p>Flat feet can be flexible or rigid, painful or painless and associated with a tightness of the calf muscles (Achilles tendon). The majority of flat feet are painless, but when pain is present it is usually during weight-bearing activities such as walking and running. The pain can be in the sole of the foot, the ankle, or non-specific pain all around the foot area.</p>
<h2>What causes flat feet?</h2>
<p>A complex and sophisticated interaction of bones, ligaments, muscles and nerves within and above the foot defines its anatomy and function. Anything that interrupts the integrity of these structures leading to a collapsed arch can cause symptomatic flat feet. </p>
<p>Examination of the foot begins with an examination of the entire child, because the flat foot may have an underlying cause. Common disorders causing symptomatic flat foot include: <a href="http://www.ncbi.nlm.nih.gov/pubmed/24977941">cerebral palsy</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/15991869">some forms of muscular dystrophy</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/26058561">juvenile arthritis</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=burns+evolution+pes+cavus">inherited disorders affecting the nervous system</a>, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/17143900">some</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/25821089">connective tissue</a> <a href="http://www.bjj.boneandjoint.org.uk/content/53-B/1/72">disorders</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/130648/original/image-20160715-2144-40j19w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/130648/original/image-20160715-2144-40j19w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/130648/original/image-20160715-2144-40j19w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/130648/original/image-20160715-2144-40j19w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/130648/original/image-20160715-2144-40j19w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/130648/original/image-20160715-2144-40j19w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/130648/original/image-20160715-2144-40j19w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/130648/original/image-20160715-2144-40j19w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A normal foot compared to a flat foot.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Flat foot can also originate from unusual anatomy such as a tarsal coalition (bones joined together), ligament or muscle damage, restricted ankle movement, outward rotated lower legs, and knock knees (where the legs bow inwards at the knee). </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/20567243">Obesity</a> can result in collapse of the arches by the increased load on the foot. If <a href="http://www.ncbi.nlm.nih.gov/pubmed/24889987">knock knees</a> also develop, the middle of the foot will tend to turn out (abduct). The foot will point outwards when walking, instead of straight ahead, which is inefficient and can cause early fatigue.</p>
<p>Footwear in early childhood has been thought to cause flat foot. Recent research <a href="http://www.tandfonline.com/doi/abs/10.1080/19424280903386411">questions</a> this theory, as populations that habitually walk barefoot have flatter arches than populations that wear shoes. It is likely that children who wear shoes, are not physically active and have flat feet will have decreased muscle activation in their feet and thus impaired foot function and weakness.</p>
<p>Some older children and adolescents develop flat feet in the absence of any disorder or associated factors. Understanding the role of the <a href="http://www.ncbi.nlm.nih.gov/pubmed/25818718">small foot muscles</a> in stabilising the arch and promoting normal function of the foot and entire lower extremity might hold the answer. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/130649/original/image-20160715-2122-43d1gd.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/130649/original/image-20160715-2122-43d1gd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/130649/original/image-20160715-2122-43d1gd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=368&fit=crop&dpr=1 600w, https://images.theconversation.com/files/130649/original/image-20160715-2122-43d1gd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=368&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/130649/original/image-20160715-2122-43d1gd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=368&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/130649/original/image-20160715-2122-43d1gd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=462&fit=crop&dpr=1 754w, https://images.theconversation.com/files/130649/original/image-20160715-2122-43d1gd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=462&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/130649/original/image-20160715-2122-43d1gd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=462&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Whether or not flat foot needs to be treated is up for debate.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Does flat foot need to be treated?</h2>
<p>Treatment of flat foot is subject to great controversy. Reaching an agreement between health-care providers on how we should define and classify a flat foot is difficult. Consequently, evidence from the published research is too limited to draw definitive conclusions about treatments for children’s flat feet. </p>
<p>A recent <a href="http://www.ncbi.nlm.nih.gov/pubmed/23147627">review of studies</a> found limited evidence to justify non-surgical treatments for flat foot.</p>
<p>Flat feet require treatment only if clearly associated with pain or decreased function. Managing the underlying cause or disease is of highest priority; just treating the symptoms should be secondary. </p>
<p>If flat foot is observed in a child who is overweight and has knock knees, or in a child with excess joint flexibility and poor footwear, each of these factors could be contributing to the symptoms, and each should be addressed. </p>
<p>If a child’s quality of life is affected by how their feet look, feel or function, then the associated issues should be addressed.</p>
<hr>
<p><em>Further reading:</em></p>
<p><a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277"><em>Do kids grow out of childhood asthma?</em></a></p>
<p><a href="https://theconversation.com/a-snapshot-of-childrens-health-in-australia-62500"><em>A snapshot of children’s health in Australia</em></a></p>
<p><em><a href="https://theconversation.com/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal-60257">Nightmares and night terrors in kids: when do they stop being normal?</a></em></p>
<p><a href="https://theconversation.com/bed-wetting-in-older-children-and-young-adults-is-common-and-treatable-60248"><em>Bed-wetting in older children and young adults is common and treatable</em></a></p>
<p><a href="https://theconversation.com/migraines-in-childhood-and-adolescence-more-than-just-a-headache-60712"><em>Migraines in childhood and adolescence: more than just a headache</em></a></p>
<p><a href="https://theconversation.com/drafts/61902/edit"><em>‘Slapped cheek’ syndrome: a common rash in kids, more sinister in pregnant women</em></a></p>
<p><a href="https://theconversation.com/teenage-pain-often-dismissed-as-growing-pains-but-it-can-impact-their-lives-62827"><em>Teenage pain often dismissed as ‘growing pains’, but it can impact their lives</em></a></p>
<p><a href="https://theconversation.com/is-hip-dysplasia-in-my-newborn-something-to-worry-about-61901"><em>Is hip dysplasia in my newborn something to worry about?</em></a></p>
<p><a href="https://theconversation.com/what-it-means-when-kids-walk-on-their-toes-59081"><em>What it means when kids walk on their toes</em></a></p>
<p><a href="https://theconversation.com/childhood-shyness-when-is-it-normal-and-when-is-it-cause-for-concern-60364"><em>Childhood shyness: when is it normal and when is it cause for concern?</em></a></p><img src="https://counter.theconversation.com/content/60365/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joshua Burns receives funding from: NHMRC (National Health and Medical Research Council of Australia, Centre of Research Excellence #1031893, European Union Collaborative Research Scheme #1055131), NIH (Inherited Neuropathies Consortium RDCRC #U54NS065712 supported by NINDS/ORDR and NCATS), Muscular Dystrophy Association, CMT Association of Australia, Multiple Sclerosis Research Australia, Sydney Southeast Asia Centre, New Zealand Neuromuscular Research Foundation Trust, Thyne Reid Foundation, Elizabeth Lottie May Rosenthal Bone Bequest. </span></em></p><p class="fine-print"><em><span>David Little receives funding from: NHMRC (National Health and Medical Research Council of Australia, Project Grants #1106982 and #1066357), Australian Orthopaedic Association Research Foundation, NF Clinical Trials Consortium, Elizabeth Lottie May Rosenthal Bone Bequest. He is a paid consultant for Orthopediatrics. In the past he has received research support from Novartis Pharma, Amgen, Celgene, and N8 Medical.</span></em></p><p class="fine-print"><em><span>Polina Martinkevich does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Flatfoot is normal in infants and young children, and in the absence of any associated symptoms, treatment is highly debatable.Joshua Burns, Professor of Allied Health (Paediatrics), Children's Hospital at Westmead, University of SydneyDavid Little, Professor Paediatrics & Child Health, University of SydneyPolina Martinkevich, Research assistant, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/603642016-07-27T18:10:33Z2016-07-27T18:10:33ZChildhood shyness: when is it normal and when is it cause for concern?<figure><img src="https://images.theconversation.com/files/131868/original/image-20160726-26512-1qp0too.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If the child is shy with other kids their age, or doesn't warm up to strangers after a time, this may be a concern.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/brontelockwood/4182757885/">Bronte Lockwood/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>This is part of our series on kids’ health. Read the other articles in our series <a href="https://theconversation.com/au/topics/kids-health">here</a>.</em></p>
<hr>
<p>When parents observe shyness in their child, they may wonder if it is normal or cause for concern. For instance, in social situations, the child may cling to their parent, be hesitant to speak, reluctant to interact with others, and play alone when in groups more often than other children their age.</p>
<p>Shyness is of more concern if it is <a href="http://www.ncbi.nlm.nih.gov/pubmed/9249961">persistent rather than temporary</a>. Some children are “slow to warm up” or engage with others, but do engage well after initial hesitancy. Also, some children grow out of shyness during primary school. However, other children demonstrate persistent shyness over time.</p>
<p>Shyness <a href="http://www.ncbi.nlm.nih.gov/pubmed/20205182">with other children</a> is of more concern than shyness with adults. It is common for children to be wary of adults, particularly men, but less common for children to be wary of children around their own age.</p>
<p>Shyness is of concern if it results in playing alone when in groups of children. When children engage in interaction with peers they learn skills that serve as a foundation for normal development, such as how to understand other people’s feelings and perspectives, take turns in play and conversation, negotiate a mutually enjoyable joint activity, reciprocate friendly overtures and express their point of view in a way that is acceptable to others. </p>
<p>Children who engage in very little social interaction in comparison to children their age are <a href="http://www.ncbi.nlm.nih.gov/pubmed/18851686">missing out on these</a> important, cumulative learning experiences. As a result, their social cognition, social skills and sense of self may be less mature than those of other children their age.</p>
<h2>Shyness and making friends</h2>
<p>Shyness with familiar social partners <a href="http://onlinelibrary.wiley.com/doi/10.1002/icd.1853/abstract">is of more concern</a> than shyness with strangers. It is of particular concern if children are shy with other children their own age they see regularly, such as childcare or school classmates. Shyness with familiar classmates suggests children may be worried about how other kids treat them, or whether they will be liked and accepted.</p>
<p>Shyness is of more concern if a child is poorly treated by other children than if a shy child is well treated by other children. Shy children are <a href="http://www.ncbi.nlm.nih.gov/pubmed/18999325">more likely than other children</a> to be excluded and victimised by kids their own age and to have <a href="http://www.ncbi.nlm.nih.gov/pubmed/12625449">trouble making friends</a>. Being excluded and victimised are damaging to children’s emotional health and sense of self, especially when these conditions persist over time. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/132092/original/image-20160727-7041-ub58nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/132092/original/image-20160727-7041-ub58nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/132092/original/image-20160727-7041-ub58nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132092/original/image-20160727-7041-ub58nf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132092/original/image-20160727-7041-ub58nf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132092/original/image-20160727-7041-ub58nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132092/original/image-20160727-7041-ub58nf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132092/original/image-20160727-7041-ub58nf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hiding behind a parent is pretty normal, but usually kids warm up to strangers fairly quickly.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Although shyness tends to be equally prevalent in boys and girls, <a href="http://onlinelibrary.wiley.com/doi/10.1002/icd.1853/abstract">shy boys sometimes encounter more</a> difficulties with friends <a href="http://www.ncbi.nlm.nih.gov/pubmed/12625449">than shy girls</a>. This is probably because shyness is a violation of norms for males to be bold and self-assertive. However, it is important to keep in mind <a href="http://link.springer.com/article/10.1007/s11199-014-0361-0#page-1">both shy boys and girls</a> can encounter peer exclusion and victimisation.</p>
<h2>What you can do</h2>
<p>Children need help from adults to stop exclusion and victimisation by other children. When parents become aware their child is being excluded or victimised by other children at childcare or school, they should contact the childcare centre or school to advocate on their child’s behalf.</p>
<p>Shyness is of concern if it interferes with your child’s or family’s routines or activities, or if your child often appears miserable or complains of being lonely. For instance, if shyness prevents your child from attending other children’s birthday parties or school, or prevents your family from visiting friends, then you <a href="http://www.ncbi.nlm.nih.gov/pubmed/19707867">should consider seeking help</a> from a child psychologist.</p>
<p>Online programs to help children and parents cope with child shyness and anxiety are starting to become available and provide convenient help for a lower cost (<a href="http://www.brave-online.com/">Brave Online</a>, <a href="http://www.centreforemotionalhealth.com.au/pages/coolkidsonline.aspx">Cool Kids Online</a>). </p>
<p>Parents can also do many things themselves to help their shy child. They can arrange play dates and help the child join a group extracurricular activity. Parents can also talk to children about their friendships and act as a sympathetic source of encouragement and constructive ideas. </p>
<p>If a child is upset about a problem with a friend, parents can encourage the child to try to resolve the problem in a way that preserves the friendship, instead of ending the friendship, as well as encourage the child to develop other friendships.</p>
<hr>
<p><em>Further reading:</em></p>
<p><a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277"><em>Do kids grow out of childhood asthma?</em></a></p>
<p><a href="https://theconversation.com/a-snapshot-of-childrens-health-in-australia-62500"><em>A snapshot of children’s health in Australia</em></a></p>
<p><em><a href="https://theconversation.com/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal-60257">Nightmares and night terrors in kids: when do they stop being normal?</a></em></p>
<p><a href="https://theconversation.com/bed-wetting-in-older-children-and-young-adults-is-common-and-treatable-60248"><em>Bed-wetting in older children and young adults is common and treatable</em></a></p>
<p><a href="https://theconversation.com/migraines-in-childhood-and-adolescence-more-than-just-a-headache-60712"><em>Migraines in childhood and adolescence: more than just a headache</em></a></p>
<p><a href="https://theconversation.com/drafts/61902/edit"><em>‘Slapped cheek’ syndrome: a common rash in kids, more sinister in pregnant women</em></a></p>
<p><a href="https://theconversation.com/teenage-pain-often-dismissed-as-growing-pains-but-it-can-impact-their-lives-62827"><em>Teenage pain often dismissed as ‘growing pains’, but it can impact their lives</em></a></p>
<p><a href="https://theconversation.com/is-hip-dysplasia-in-my-newborn-something-to-worry-about-61901"><em>Is hip dysplasia in my newborn something to worry about?</em></a></p>
<p><a href="https://theconversation.com/what-it-means-when-kids-walk-on-their-toes-59081"><em>What it means when kids walk on their toes</em></a></p><img src="https://counter.theconversation.com/content/60364/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heidi Gazelle has received funding from the National Institute of Mental Health and the National Institute of Child Health and Human Development . </span></em></p>If a child is shy and poorly treated by other children their age, this may be cause for concern.Heidi Gazelle, Senior Lecturer in Developmental Psychology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/590812016-07-26T19:51:28Z2016-07-26T19:51:28ZWhat it means when kids walk on their toes<figure><img src="https://images.theconversation.com/files/122809/original/image-20160517-15937-1yzsovy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are a number of reasons some children struggle to walk with a flat foot. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This is part of our series on kids’ health. Read the other articles in our series <a href="https://theconversation.com/au/topics/kids-health">here</a>.</em></p>
<hr>
<p>When toddlers are learning to walk, many spend some time walking up on their tip toes, which is known as toe walking. Commonly this is to get into things they aren’t meant to, but as they perfect their walking, they walk more with their whole foot on the ground. </p>
<p>The majority of toddlers will walk with their whole foot by the time they are three. Some toddlers are unable to walk with their whole foot, and this is something that should be checked out by a health professional.</p>
<h2>Causes</h2>
<p>Toe walking can be <a href="http://www.ncbi.nlm.nih.gov/pubmed/20692159">classified</a> into four groups. Some neurological conditions such as cerebral palsy or muscular dystrophy cause the calf muscle to be tighter or change the way it works. This makes it hard or impossible for the child to get their heels onto the ground to walk with their whole foot. </p>
<p>There are also orthopaedic conditions such as congenital talipes equinovarus (also known as club foot) or <a href="https://en.wikipedia.org/wiki/Sever%27s_disease">calcaneal apophysitis</a> (inflammation of the growth plate in the heel) which cause toe walking. The structural change in the foot or leg makes getting the heel to the ground impossible or painful. </p>
<p>However, some children who can get their heels to the ground prefer to walk up on their tip toes. This group of children also has other behavioural characteristics, such as delays in achieving milestones or ritualistic behaviours. Here toe walking is associated with autism spectrum disorders or <a href="http://www.rch.org.au/uploadedFiles/Main/Content/cdr/Dev_Delay.pdf">developmental delay</a>. </p>
<p>Then there are healthy children with no medical conditions who still persist in walking on their toes. This is known as <a href="http://www.merriam-webster.com/medical/idiopathic">idiopathic</a> toe walking and is diagnosed through exclusion of all other medical conditions known to cause toe walking. Idiopathic toe walking has historically been called <a href="http://europepmc.org/abstract/med/3293753">habitual toe walking</a> with the presumption that the child has formed a habit of walking on their tip toes. It has also been called <a href="http://europepmc.org/abstract/med/6185459">familial toe walking</a>, as some studies report family members sharing the trait. </p>
<p>Idiopathic toe walking affects between <a href="http://pediatrics.aappublications.org/content/130/2/279.short">5%</a> and <a href="http://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-12-61">12%</a> of healthy children and researchers don’t know its causes. </p>
<p>There may be a genetic cause as it is often seen in multiple family members. There are also other features often observed in children with this gait type. In some small studies, children with idiopathic toe walking have also shown <a href="http://www.jpeds.com/article/S0022-3476(97)70236-1/abstract">speech and language delays</a> and challenges with <a href="http://jcn.sagepub.com/content/29/1/71.short">motor skills and sensory processing</a> such as difficulty with balance and seeking out movement. </p>
<p>The most common observation in idiopathic toe walkers is tight calf muscles. This can make getting the heel to the ground even harder and can cause pain when children are trying to play sport. As you can imagine, children may be teased for walking differently. </p>
<h2>What can be done?</h2>
<p>No single treatment permanently fixes idiopathic toe walking. Often time is the greatest fixer as the children get heavier and the toe walking gets harder to maintain. </p>
<p>However, as many children with idiopathic toe walking also have tight calf muscles, many health professionals recommend treatment primarily focused on making these muscles longer. Tightness in calf muscles in adults has been known to cause trips, falls and foot and leg pain. </p>
<p>Treatment for idiopathic toe walking can be broken into two types: conservative and surgical. </p>
<p>Conservative treatment includes verbal reminders, stretching, heavy footwear, full-length orthotics, ankle foot orthotics, <a href="http://jcn.sagepub.com/content/early/2016/04/08/0883073816643405.abstract">whole-body vibration</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/26733505">vinyl, carpet or gravel flooring</a>, plaster casts to stretch the calf muscles, and injections of Botox into the calf muscles. Surgical intervention has primarily focused on lengthening the Achilles tendon.</p>
<p>Many of these treatments have limited evidence supporting their use. </p>
<p>At present, the <a href="http://www.ingentaconnect.com/content/mjl/sreh/2014/00000046/00000010/art00001">best evidence</a> supports plaster casts or surgery. Both of these treatments have shown the greatest improvement in the length of the calf muscles. Yet <a href="http://journals.lww.com/jpo-b/Abstract/2000/01000/Idiopathic_Toe_Walking__Does_Treatment_Alter_the.10.aspx">one longitudinal study</a> found that many children who had been treated with serial casts or surgery still continued to toe-walk for up to 13 years after treatment.</p>
<p>Having multiple treatment options with varied success makes it hard for parents to choose the best treatment option. It’s also a challenge for doctors in knowing what treatment to recommend. </p>
<p>Researchers agree that keeping calf muscles long enough to easily make heel contact with the ground is important for children who are diagnosed with idiopathic toe walking. If this isn’t able to happen, a health professional will commonly then encourage treatment. There is also agreement that any child who is unable to get their heels to the ground at any time or continues to toe walk after three, should be assessed by a health professional.</p>
<hr>
<p><em>Further reading:</em></p>
<p><a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277"><em>Do kids grow out of childhood asthma?</em></a></p>
<p><a href="https://theconversation.com/a-snapshot-of-childrens-health-in-australia-62500"><em>A snapshot of children’s health in Australia</em></a></p>
<p><em><a href="https://theconversation.com/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal-60257">Nightmares and night terrors in kids: when do they stop being normal?</a></em></p>
<p><a href="https://theconversation.com/bed-wetting-in-older-children-and-young-adults-is-common-and-treatable-60248"><em>Bed-wetting in older children and young adults is common and treatable</em></a></p>
<p><a href="https://theconversation.com/migraines-in-childhood-and-adolescence-more-than-just-a-headache-60712"><em>Migraines in childhood and adolescence: more than just a headache</em></a></p>
<p><a href="https://theconversation.com/drafts/61902/edit"><em>‘Slapped cheek’ syndrome: a common rash in kids, more sinister in pregnant women</em></a></p>
<p><a href="https://theconversation.com/teenage-pain-often-dismissed-as-growing-pains-but-it-can-impact-their-lives-62827"><em>Teenage pain often dismissed as ‘growing pains’, but it can impact their lives</em></a></p>
<p><a href="https://theconversation.com/is-hip-dysplasia-in-my-newborn-something-to-worry-about-61901"><em>Is hip dysplasia in my newborn something to worry about?</em></a></p><img src="https://counter.theconversation.com/content/59081/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Williams consults in private practice and for an education company providing paediatric podiatry education. Dr Williams in the past has received funding from the Australian Podiatry Education and Research Foundation for research into idiopathic toe walking. </span></em></p>Some toddlers are unable to walk with their whole foot on the ground. This should be checked out by a health professional.Cylie Williams, Adjunct Post Doctoral Research Fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/619012016-07-25T19:45:23Z2016-07-25T19:45:23ZIs hip dysplasia in my newborn something to worry about?<figure><img src="https://images.theconversation.com/files/129136/original/image-20160704-19127-810odr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dysplasia of the hips is more likely where they baby has less space - like when they come out upside down (breech). </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This is part of our series on kids’ health. Read the other articles in our series <a href="https://theconversation.com/au/topics/kids-health">here</a>.</em></p>
<hr>
<p>Developmental dysplasia of the hip, sometimes termed congenital dysplasia or dislocation of the hip, is a chronic condition present from early childhood which can cause permanent disability if not identified and <a href="http://link.springer.com/article/10.1007/s12098-016-2160-9">treated early</a>.</p>
<p>Hip dysplasia affects <a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">up to 10 people in every 1,000</a>, and is characterised by underdevelopment of the hip bones (dysplasia). This may be associated with laxity (looseness) or even dislocation of the <a href="http://link.springer.com/article/10.1007/s12098-016-2160-9">hip joints</a>. It may affect <a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">one or both hips</a>.</p>
<p>The hips are <a href="http://onlinelibrary.wiley.com/doi/10.1002/ebch.1891/epdf">ball-and-socket joints</a>. These <a href="http://www.ncbi.nlm.nih.gov/pubmed/25552425">develop</a> while a baby is still in the uterus, as well as in <a href="http://us.bestpractice.bmj.com/best-practice/monograph/742.html">early childhood</a>. In a newborn infant, most of the hip joint is cartilage, which is soft and may contribute to the laxity of the joint. During the baby’s first year, the cartilage is replaced by bone.</p>
<p>In normal hip development, the ball component grows faster than the <a href="http://us.bestpractice.bmj.com/best-practice/monograph/742.html">socket</a>. The development of the joint is dependent on the ball component remaining <a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">within the socket</a>. Various factors may affect the development of the joint, along with the ligaments which support the joint and hold the two bony components together. </p>
<p>In hip dysplasia, the socket component (acetabulum) is underdeveloped, so the ball component is not well fixed in the socket. This means that the hip is more prone to dislocation, where the ball slides out of the socket. This can cause serious problems for the blood supply to the hip, and also affect walking. </p>
<h2>Causes</h2>
<p>Anything that reduces or prevents movement of the hip joint increases the risk of <a href="http://www.ncbi.nlm.nih.gov/pubmed/25552425">hip dysplasia</a>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25552425">Large babies</a>, <a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">reduced amniotic fluid</a> or a <a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">first pregnancy</a> (with a less “stretchy” uterus) reduce the space a baby has to move around when still in the uterus. </p>
<p><a href="http://us.bestpractice.bmj.com/best-practice/monograph/742.html">Being breech</a> (bottom instead of head first) at delivery and tight <a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">swaddling</a> during early childhood also increase the risk of hip dysplasia.</p>
<p>Babies who have someone in their immediate family with hip dysplasia are <a href="http://us.bestpractice.bmj.com/best-practice/monograph/742.html">more likely to be affected</a>. Females are <a href="http://www.ncbi.nlm.nih.gov/pubmed/25552425">four times</a> more likely to be affected than <a href="http://us.bestpractice.bmj.com/best-practice/monograph/742.html">males</a>. This is probably related to hormones the mother produces, which cause ligaments to be more relaxed around the time of birth. Girls may be more sensitive to these hormones than boys.</p>
<h2>Diagnosis</h2>
<p>There are usually no symptoms of hip dysplasia at birth, as babies are not able to walk or crawl. Because of the risks of disability if not detected, all babies <a href="http://www.aafp.org/afp/2014/1215/p843.html">undergo screening</a>, usually physical examination by a trained midwife or doctor at <a href="http://www.aafp.org/afp/2014/1215/p843.html">birth</a> and again at the routine six-week check. </p>
<p>Ongoing examinations take place over the first 12 months. At these examinations, clinicians feel for <a href="http://www.aafp.org/afp/2014/1215/p843.html">laxity</a> of the hip joints. This may be felt as a looseness of the joint, or hips which do not stay in the joint (dislocate) when <a href="http://onlinelibrary.wiley.com/doi/10.1002/ebch.1891/epdf">moved</a>.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/129137/original/image-20160704-19098-1e2rvdw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/129137/original/image-20160704-19098-1e2rvdw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/129137/original/image-20160704-19098-1e2rvdw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=540&fit=crop&dpr=1 600w, https://images.theconversation.com/files/129137/original/image-20160704-19098-1e2rvdw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=540&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/129137/original/image-20160704-19098-1e2rvdw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=540&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/129137/original/image-20160704-19098-1e2rvdw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=679&fit=crop&dpr=1 754w, https://images.theconversation.com/files/129137/original/image-20160704-19098-1e2rvdw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=679&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/129137/original/image-20160704-19098-1e2rvdw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=679&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An illustration of a dislocated hip.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Other signs may include an <a href="http://www.aafp.org/afp/2014/1215/p843.html">asymmetry</a> of the buttock creases or leg lengths (due to one hip not being fully located in the joint). Not all cases of laxity <a href="http://www.ncbi.nlm.nih.gov/pubmed/27247747">mean that the child has dysplasia</a>, and not every case of dysplasia will be detected by this clinical examination as the condition develops with <a href="http://www.aafp.org/afp/2014/1215/p843.html">time</a>.</p>
<p>Those with <a href="http://us.bestpractice.bmj.com/best-practice/monograph/742.html">risk factors</a> such as being <a href="http://link.springer.com/article/10.1007/s12098-016-2160-9">born breech</a> often have <a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">enhanced screening</a>, such as an ultrasound. </p>
<p>An X-ray may be used in older children or adults to demonstrate the <a href="http://link.springer.com/article/10.1007/s12098-016-2160-9">underdeveloped socket</a> of the hip. An X-ray is less useful in younger infants as the hips still contain a large proportion of <a href="http://us.bestpractice.bmj.com/best-practice/monograph/742.html">cartilage</a>, which is not so well seen on X-ray.</p>
<p>If dysplasia is not detected through infant screening, older children or adults may present with difficulty walking, a limp, arthritis, or <a href="http://us.bestpractice.bmj.com/best-practice/monograph/742.html">pain</a>.</p>
<h2>Treatment</h2>
<p>Most babies with slightly lax hips at birth usually <a href="http://www.ncbi.nlm.nih.gov/pubmed/25552425">resolve</a> by six weeks without any <a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">treatment</a>. Those with lax hips that don’t resolve should begin treatment by <a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">six to eight weeks</a>. If a baby has a dislocated hip, treatment should start immediately.</p>
<p>A harness is usually used to treat dysplasia in <a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">infants</a>. This holds the hips bent forward and held out, to maximise the contact between the ball and socket. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/129135/original/image-20160704-19121-7f5lkw.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/129135/original/image-20160704-19121-7f5lkw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=980&fit=crop&dpr=1 600w, https://images.theconversation.com/files/129135/original/image-20160704-19121-7f5lkw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=980&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/129135/original/image-20160704-19121-7f5lkw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=980&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/129135/original/image-20160704-19121-7f5lkw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1232&fit=crop&dpr=1 754w, https://images.theconversation.com/files/129135/original/image-20160704-19121-7f5lkw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1232&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/129135/original/image-20160704-19121-7f5lkw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1232&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The harness worn by infants to correct dysplasia.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>The harness is removable for washing and is otherwise worn continuously for three to seven months. Previously, wearing two or three nappies instead of one was used as a treatment. This has not been shown to be effective, and may delay treatment with an <a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">appropriate harness</a>. </p>
<p>The main (but rare) possible side effect to wearing a harness is <a href="http://link.springer.com/article/10.1007/s12098-016-2160-9">avascular necrosis</a> (the death of bone tissue). This is thought to be caused by the ball component of the hip being pressed hard against the socket. The result is squashing of the blood vessels supplying the bone, which might reduce the <a href="http://onlinelibrary.wiley.com/doi/10.1002/ebch.1891/epdf">blood supply</a> there. This can result in arthritis and damage to the <a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">bone</a>. It is more likely if treatment starts <a href="http://www.aafp.org/afp/2014/1215/p843.html">late</a>.</p>
<p>Surgery is sometimes undertaken, although most cases (up to 95%) resolve with early application of a harness. Surgery is only used if harness treatment is <a href="http://us.bestpractice.bmj.com/best-practice/monograph/742.html">unsuccessful</a>, or if a patient presents later than infancy. Surgery for hip dysplasia has a <a href="http://www.aafp.org/afp/2014/1215/p843.html">higher risk</a> of avascular necrosis than <a href="http://www.ncbi.nlm.nih.gov/pubmed/25552425">harnesses</a>.</p>
<h2>Long term effects</h2>
<p>Developmental dysplasia of the hip can cause significant long term problems <em>if</em> it is not identified and <a href="http://link.springer.com/article/10.1007/s12098-016-2160-9">treated early</a>. These include early (from <a href="http://onlinelibrary.wiley.com/doi/10.1002/ebch.1891/epdf">before age 30</a>) arthritis, back pain, need for multiple surgeries, and a shorter leg on one <a href="http://www.aafp.org/afp/2014/1215/p843.html">side</a>. </p>
<p>With early treatment, the rate of later hip problems requiring further treatment is very low (<a href="http://www.wjgnet.com/2218-5836/full/v6/i11/886.htm">around 4%</a>). </p>
<p>To minimise risk of later disability, parents whose newborn has some of the risk factors should discuss this with their doctor to ensure adequate examination and screening.</p>
<hr>
<p><em>Further reading:</em></p>
<p><a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277"><em>Do kids grow out of childhood asthma?</em></a></p>
<p><a href="https://theconversation.com/a-snapshot-of-childrens-health-in-australia-62500"><em>A snapshot of children’s health in Australia</em></a></p>
<p><em><a href="https://theconversation.com/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal-60257">Nightmares and night terrors in kids: when do they stop being normal?</a></em></p>
<p><a href="https://theconversation.com/bed-wetting-in-older-children-and-young-adults-is-common-and-treatable-60248"><em>Bed-wetting in older children and young adults is common and treatable</em></a></p>
<p><a href="https://theconversation.com/migraines-in-childhood-and-adolescence-more-than-just-a-headache-60712"><em>Migraines in childhood and adolescence: more than just a headache</em></a></p>
<p><a href="https://theconversation.com/drafts/61902/edit"><em>‘Slapped cheek’ syndrome: a common rash in kids, more sinister in pregnant women</em></a></p>
<p><a href="https://theconversation.com/teenage-pain-often-dismissed-as-growing-pains-but-it-can-impact-their-lives-62827"><em>Teenage pain often dismissed as ‘growing pains’, but it can impact their lives</em></a></p><img src="https://counter.theconversation.com/content/61901/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kirsten Thompson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Developmental dysplasia of the hip is a chronic condition present from early childhood which can cause permanent disability if not identified and treated early.Kirsten Thompson, Senior clinical lecturer, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/628272016-07-24T20:03:49Z2016-07-24T20:03:49ZTeenage pain often dismissed as ‘growing pains’, but it can impact their lives<figure><img src="https://images.theconversation.com/files/131531/original/image-20160722-21037-qied6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Between a third and half of all adolescents aged 13 and over report back pain about every month or more often.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This is part of our series on kids’ health. Read the other articles in our series <a href="https://theconversation.com/au/topics/kids-health">here</a>.</em></p>
<hr>
<p>Most of us know someone who has “a bad back”. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25572198">Research</a> tells us up to 70% of people will experience back pain at some stage during their lives. But what about when a child or teenager complains of musculoskeletal pain such as back or neck pain?</p>
<p>The most common type of musculoskeletal pain is spinal (back or neck pain), and many more adolescents complain of pain than is commonly recognised. Between one-third and half of all adolescents aged 13 and over report <a href="http://www.scielo.br/pdf/rbfis/2016nahead/1413-3555-rbfis-bjpt-rbf20140149.pdf">back pain about every month or more often</a>. In fact, the prevalence of these conditions rises so sharply in early adolescence the rates approach adult levels by 18 years.</p>
<p>It’s becoming increasingly clear so-called non-specific “musculoskeletal conditions”, the leading causes of disability worldwide, are significant health issues in children. By non-specific conditions we mean pain that cannot be attributed to a defined and diagnosable anatomical cause. In adults, these conditions are recognised as complex disease states that have biological, psychological and socio-environmental underpinning.</p>
<h2>Aren’t they just growing pains?</h2>
<p>In the absence of an identifiable injury such as a sprain or fracture, we often disregard childhood and adolescent spinal and musculoskeletal pain. A common belief is that pain in kids will just go away or be forgotten when life takes over.</p>
<p>However, for a significant proportion of adolescents, non-specific pain has extensive impacts on health and quality of life. For example, in a study in <a href="http://www.ncbi.nlm.nih.gov/pubmed/22304903">Western Australia</a>, about 20% of 17-year-olds reported either missing school, seeking health care, taking medication, interference with normal activities, or interference with physical/sporting activities due to back pain. </p>
<p>Worryingly, there is <a href="http://www.ncbi.nlm.nih.gov/pubmed/16481960">evidence</a> persistent pain symptoms in adolescence predict chronic pain problems in adulthood.</p>
<p>The blame for pain in kids is often directed at school bags, computer and small-screen device usage, posture, or other biomechanical targets. It is also sometimes believed (permanent) damage is being done to the spine, with lifelong consequences. </p>
<p>However, there is little evidence this is true. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22078064">Studies</a> show socioeconomic, lifestyle, cognitive and psychological factors are just as strongly, or even more strongly, related to pain, particularly chronic pain, as physical factors. </p>
<p>These societal beliefs about physical causes of pain may be not only incorrect, but detrimental if they cause worry about the spine being fragile and discourage children from physical activity.</p>
<h2>Back pain and health</h2>
<p>Health issues such as excess weight and obesity, diabetes, substance use and poor mental health among children are causes for concern, and the targets of national public health campaigns. </p>
<p>Recent <a href="http://www.scielo.br/pdf/rbfis/2016nahead/1413-3555-rbfis-bjpt-rbf20140149.pdf">evidence</a> has shown these general risk factors for poor health and chronic disease cluster in children with spinal pain. At this point, it is not possible to say whether pain precedes poorer general health or vice-versa. Relationships between them are likely to be complex. </p>
<p>However, given the high rates of musculoskeletal pain across the population, and in particular in kids with other health risks, a case can be made for considering the influence of pain in the effectiveness of lifestyle-related public health campaigns. For instance, pain could be an important barrier to participation in physical activity. </p>
<p>Addressing health behavioural risk factors, such as inactivity, weight gain, diet and even substance use, when treating young patients with pain is likely to be important. This will be important whether these behavioural risks are (partially) responsible for the pain itself or develop in response to painful symptoms.</p>
<p>Unfortunately, to date we don’t really understand the complex interaction between painful events, the growing body and broader health influences, and other social or environmental influences from family, health care providers and schooling. In particular, we know very little about what brings on the initial episodes of painful conditions and whether this underpins the link with future chronic pain.</p>
<p>Given wide recognition that early life events are critical in shaping health as people grow older, understanding the context of common painful conditions in early life is critical to inform future health.</p>
<h2>Overdiagnosis and overtreatment</h2>
<p>It is important we provide effective treatment to those at risk of developing persistent pain. It is also important we don’t create medical problems out of transient aches and pains. We definitely don’t want to be sending every child who complains of back or neck pain off for diagnostic tests and intensive treatments. A problem currently is we don’t have sufficient quality evidence to enable us to decide who we should be concerned about, and who can be reassured and sent on their way.</p>
<p>While we don’t have good evidence about what specific treatments are effective for childhood and adolescent spinal pain, it is possible to engage the community in better conversation about what causes “non-specific” musculoskeletal conditions.</p>
<p>The role of social influences needs closer examination, and pain must be considered within the broader context of chronic disease and long-term health risk factors. A shift away from the narrow and outdated focus on school bags, posture and damaged spines is a must. Efforts to update the narrative around pain are as important for children as for adults.</p>
<hr>
<p><em>Further reading:</em></p>
<p><a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277"><em>Do kids grow out of childhood asthma?</em></a></p>
<p><a href="https://theconversation.com/a-snapshot-of-childrens-health-in-australia-62500"><em>A snapshot of children’s health in Australia</em></a></p>
<p><em><a href="https://theconversation.com/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal-60257">Nightmares and night terrors in kids: when do they stop being normal?</a></em></p>
<p><a href="https://theconversation.com/bed-wetting-in-older-children-and-young-adults-is-common-and-treatable-60248"><em>Bed-wetting in older children and young adults is common and treatable</em></a></p>
<p><a href="https://theconversation.com/migraines-in-childhood-and-adolescence-more-than-just-a-headache-60712"><em>Migraines in childhood and adolescence: more than just a headache</em></a></p>
<p><a href="https://theconversation.com/drafts/61902/edit"><em>‘Slapped cheek’ syndrome: a common rash in kids, more sinister in pregnant women</em></a></p><img src="https://counter.theconversation.com/content/62827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Williams receives funding from National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Steve Kamper receives research funding from the National Health and Medical Research Council of Australia</span></em></p>The blame for pain in kids is often directed at school bags, computer and small-screen device usage, posture, or other biomechanical targets.Christopher Williams, Research Fellow at Hunter Medical Research Institute, Hunter New England Local Health District, University of NewcastleSteve Kamper, Senior Research Fellow, Musculoskeletal Division, The George Institute for Global Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/619022016-07-21T20:06:05Z2016-07-21T20:06:05Z‘Slapped cheek’ syndrome: a common rash in kids, more sinister in pregnant women<figure><img src="https://images.theconversation.com/files/129662/original/image-20160707-30685-w0jonf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While very common and not too serious in kids, slapped cheek can be serious, and even fatal, if a foetus is infected through its mother.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/71894657@N00/5898031994/">Jon Large/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>This is part of our series on kids’ health. Read the other articles in our series <a href="https://theconversation.com/au/topics/kids-health">here</a>.</em></p>
<hr>
<p>In 1974, while screening blood donations for hepatitis B, an Australian virologist <a href="http://www.ncbi.nlm.nih.gov/pubmed/46024">accidentally discovered</a> a new parvovirus (parvo meaning “small”). Many other parvoviruses that cause infection in animals were known, but this was the first to be found in humans.</p>
<p>This human parvovirus (hPV) was named B19 because it was found in sample 19 of panel B in the batch of tests. It was not known what disease, if any, it caused <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC497769/">until 1981</a>, when it was found to be a cause of “aplastic crisis” – severe, life-threatening anaemia in children.</p>
<p>Then, in 1983, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129271/pdf/jhyg00013-0091.pdf">it was shown to be the cause</a> of the common childhood rash-illness, erythema infectiosum (also known as “slapped cheek” syndrome or “fifth disease”). Now that rubella and measles are rare in countries with widespread immunisation, erythema infectiosum is the commonest cause of infectious childhood rash.</p>
<p>“Slapped cheek” describes the typical bright red rash on the face caused by hPV infection; on the limbs and body the rash typically has a lacy appearance. Other symptoms, if any, are mild and short-lived in most people, but adults, particularly, can have pain in the joints of the hands, wrists and knees. </p>
<p>One in five people will have <a href="http://www.health.nsw.gov.au/Infectious/factsheets/Pages/parvovirus-B19-and-(fifth-disease).aspx">only vague symptoms</a>, such as mild fever or feeling generally unwell, or none at all. Children who contract the virus are not excluded from childcare, school or work, but are <a href="http://www.health.nsw.gov.au/Infectious/factsheets/Pages/parvovirus-B19-and-(fifth-disease).aspx">advised to rest at home</a> until they feel better.</p>
<h2>How hPV causes disease</h2>
<p>Human parvovirus infects the precursors of red blood cells in the bone marrow and temporarily stops them developing. This causes anaemia, which is usually mild, short-lived and insignificant in otherwise healthy people.</p>
<p>As the body’s immune system responds, hPV is removed and red blood cell production resumes normally. The rash and joint pains are due to the body’s immune response.</p>
<p>People whose immune systems are suppressed for any reason can have prolonged, chronic infection with severe anaemia, but no rash. Other very rare complications <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-cdi-2000-cdi2403s-cdi24msa.htm">have been reported</a>, including include encephalitis (inflammation of the brain) and various blood and autoimmune diseases, but their overall frequency and significance are unknown.</p>
<p>The virus spreads by droplets in our breath or, rarely, by transfusion of blood. It can also spread from a pregnant woman to her foetus. Typically, a week or two after contact with an infected person, there are some vague symptoms such as mild fever and malaise and the rash appears a few days later. </p>
<p>Outbreaks of hPV infection occur in prolonged epidemics lasting many months, usually in late winter and early spring. Epidemics mainly occur among primary-school-aged children and usually last for a year or more. Then there are few if any cases for two to four years, then another epidemic starts.</p>
<p>During outbreaks about 50% of susceptible children (those who haven’t had it before and thus aren’t immune) in affected schools and their household contacts will be infected. The rate of infection in other susceptible contacts, such as schoolteachers, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059196/">is about 20%</a>.</p>
<p>The proportion of people with hPV antibodies in their blood, indicating past infection and immunity, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059196/">increases with age</a> from about 15% in preschool children, to 50% in young adults and 85% in the elderly.</p>
<h2>Pregnancy and hPV infection</h2>
<p>When a pregnant woman is infected with hPV, the <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-cdi-2000-cdi2403s-cdi24msa.htm%20**">likelihood that her foetus will be infected</a> is about 50%. Most will have no significant ill-effect – the only evidence that the foetus has been infected is hPV antibodies in the baby’s blood. However, when the mother’s infection is in the first trimester, there is an <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-cdi-2000-cdi2403s-cdi24msa.htm**">increased risk of miscarriage</a> (about 10%). </p>
<p>Later in the first half of pregnancy, between nine and 20 weeks, foetal infection can cause severe anaemia (about 3% risk). Foetuses have a high turnover of red blood cells. When new red cell development is interrupted by infection of their precursors, production cannot keep up with demand. </p>
<p>Severe foetal anaemia can cause heart failure, which in turn causes swelling throughout the body – a potentially fatal condition known as hydrops fetalis.</p>
<p>Hydrops usually develops five to eight weeks after the mother’s infection. It causes foetal death <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-cdi-2000-cdi2403s-cdi24msa.htm">in up to a third of cases</a>. A similar proportion of cases recover spontaneously. If detected in time, hydrops often can be treated successfully by blood transfusion into the uterus. </p>
<p>In skilled hands this is a safe procedure, which has been used to treat foetal hydrops for many years. Because timing is critical, it is important to confirm the mother’s hPV infection as soon as possible after it is suspected. This is done by testing her blood for a type of hPV antibody that is detectable for only a few weeks (immunoglobulin M), or by showing an increase in the level of immunoglobulin G, which persists indefinitely after infection.</p>
<p>Once the mother’s infection has been confirmed, frequent ultrasound examinations over the next few months are recommended, to detect the rare cases of hydrops. If it occurs, the mother should be referred to an experienced foetal medicine specialist.</p>
<p>There is no specific treatment or vaccine for hPV infection. Fortunately, it is nearly always mild or asymptomatic, but we need to know more about the very rare, but potentially serious, complications.</p>
<hr>
<p><em>Further reading:</em></p>
<p><a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277"><em>Do kids grow out of childhood asthma?</em></a></p>
<p><a href="https://theconversation.com/a-snapshot-of-childrens-health-in-australia-62500"><em>A snapshot of children’s health in Australia</em></a></p>
<p><em><a href="https://theconversation.com/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal-60257">Nightmares and night terrors in kids: when do they stop being normal?</a></em></p>
<p><a href="https://theconversation.com/bed-wetting-in-older-children-and-young-adults-is-common-and-treatable-60248"><em>Bed-wetting in older children and young adults is common and treatable</em></a></p>
<p><a href="https://theconversation.com/migraines-in-childhood-and-adolescence-more-than-just-a-headache-60712"><em>Migraines in childhood and adolescence: more than just a headache</em></a></p><img src="https://counter.theconversation.com/content/61902/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lyn Gilbert does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>“Slapped cheek” describes the typical bright red rash on the face caused by human parvovirus infection.Lyn Gilbert, Clinical Professor in Medicine and Infectious Diseases, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/607122016-07-20T20:05:10Z2016-07-20T20:05:10ZMigraines in childhood and adolescence: more than just a headache<figure><img src="https://images.theconversation.com/files/131170/original/image-20160720-7910-13e4qch.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Childhood migraine has been found to be associated with early stress. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p><em>This is part of our series on kids’ health. Read the other articles in our series <a href="https://theconversation.com/au/topics/kids-health">here</a>.</em></p>
<hr>
<p>Headaches are uncommon in toddlers. But between the ages of three and seven, around 5% to 50% of children experience headaches of some type. From seven to 15 years, <a href="http://www.ncbi.nlm.nih.gov/pubmed/24641507">headache prevalence peaks at up to 75%</a>. The vast majority of headaches experienced are tension-type headaches that don’t need specific treatment. But a quarter of these troublesome headaches are migraines.</p>
<p>Migraine headaches are the most common type of severe headache. They occur when networks of sensory and regulatory nerves deep in the brain are disordered. The details of exactly how migraines work are not yet fully understood but research in this area has made <a href="http://www.ncbi.nlm.nih.gov/pubmed/25926442">rapid progress</a>, especially in the last decade.</p>
<p>Many adults who have a lifelong problem with migraines first experience them in childhood or adolescence. Migraine headaches occur in 15% to 18% of children, and the prevalence peaks between the ages of 11 and 13. </p>
<p>These figures are <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1468-2982.2003.00568.x/abstract;jsessionid=FD02A127FD1AA7945BFA23D52E93FF69.f02t02?userIsAuthenticated=false&deniedAccessCustomisedMessage=">similar in adults</a>. The worst 10% of adult sufferers account for 85% of the overall time lost to headaches. This suggests that if you don’t get effectively treated or grow out of your adolescent migraines, they <a href="http://link.springer.com/article/10.1007/s10194-009-0133-3">may get progressively worse</a>.</p>
<p>Much of <a href="http://www.ncbi.nlm.nih.gov/pubmed/27322543">the risk of having migraines is genetic</a> so it is no surprise that two-thirds of childhood migraine sufferers have a <a href="http://www.ncbi.nlm.nih.gov/pubmed/25304765">family history of disabling migraine</a>.</p>
<h2>What causes childhood migraine?</h2>
<p>There are some significant differences between migraines that occur early in life and those that occur later. A clear link between <a href="https://www.sciencedaily.com/releases/2010/01/100106003608.htm">childhood adversity</a> and migraine predisposition throughout life is <a href="https://consumer.healthday.com/head-and-neck-information-17/migraine-news-477/emotional-abuse-during-childhood-linked-to-migraine-risk-708301.html">emerging from current research</a>. </p>
<p>The <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2009.01558.x/full">influence is likely to be complex</a> and is currently poorly understood. It may well be that prolonged exposure of a developing brain to excessive stress causes neuroplastic changes or altered biochemistry that create a migraine-prone brain forever after.</p>
<p>Early onset of migraine symptoms indicates a child is at increased risk of a number of other conditions characterised by severe episodes of symptoms that occur in a cyclical fashion, such as abdominal pain, vertigo and <a href="https://en.wikipedia.org/wiki/Torticollis">torticollis</a> (where the position of the head or neck is abnormal or asymmetrical). These “<a href="http://bit.ly/29PldsO">episodic syndromes</a>” are highly distressing and disabling. They may reflect a common disorder of pain processing and are considered variants of migraine.</p>
<p>There are documented associations of early-onset migraine with <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1468-2982.2003.00486.x/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=">emotional and behavioural difficulties</a>. Understanding these relationships better will contribute enormously to potential prevention strategies but also perhaps to new treatment approaches. </p>
<p>The most <a href="http://www.ncbi.nlm.nih.gov/pubmed/21044280">common triggers</a> for childhood migraine are similar to adults: emotional stress, sleep deprivation, skipping food, menstruation and <a href="http://www.ncbi.nlm.nih.gov/pubmed/19545255">weather</a>. </p>
<p>Hormonal fluctuations during <a href="http://www.ncbi.nlm.nih.gov/pubmed/27017029">young women’s periods</a> are one of the most consistently disabling trigger factors and many sufferers may need oral contraceptives to regulate hormone levels. It seems these common triggers may all <a href="http://www.ncbi.nlm.nih.gov/pubmed/26639834?log$=activity">increase oxidative stress</a> (chemical not emotional stress) in the brain. </p>
<p>It will no doubt be welcome news that while chocolate remains a common scapegoat in headache causation, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/25567457">scientific evidence for this belief is thin</a>.</p>
<h2>How to treat childhood migraines</h2>
<p>It’s important to accurately evaluate frequent or severe childhood headaches given these children’s quality of life is <a href="http://pediatrics.aappublications.org/content/112/1/e1.short">severely impaired</a> and the long-term impacts may be substantial. </p>
<p>The doctor needs to thoroughly explore psychological and social factors, which may require tact and time for trust to develop. School absences must be prevented or mitigated so the child does not fall behind her peers either academically or socially. Having a <a href="https://www.migrainetrust.org/wp-content/uploads/2015/12/CIRC_School-Policy-Guideline-Headache-FINAL-10Oct11.pdf">formal plan</a> may help the school accommodate young headache sufferers. </p>
<p>The Royal Australian College of General Practitioners has published <a href="http://www.racgp.org.au/afp/2015/june/managing-childhood-migraine/#15">recommendations for GPs</a> to use analgesics or migraine drugs (known as triptans) to treat migraine, but to also focus on addressing possible environmental, social, and psychological factors that could be at play. </p>
<p>Treatment of migraines in childhood support the idea that it is virtually a different disorder compared to adults. Thankfully, simple pain relief such as non-steroidal anti-inflammatories (NSAIDs) including aspirin and ibuprofen are more effective than in adults. Allowing the child to sleep if they want to is also very effective. </p>
<p>The triptans – standard drugs for aborting attacks in adults – <a href="http://www.neurology.org/content/48/4/1100.short">do not seem to work</a> as well in children. The response to medication becomes more <a href="http://www.ncbi.nlm.nih.gov/pubmed/27316535">“adult-like”</a> after puberty. </p>
<p>First-line preventive treatments used in adults, such as propranolol (a heart medication), amitriptyline (an antidepressant) and sodium valproate (usually used to treat epilepsy) have <a href="http://www.ncbi.nlm.nih.gov/pubmed/15012660">not been thoroughly studied</a> for efficacy in children, though they do appear safe for short- to medium-term use. </p>
<p>Decisions about prevention against frequent, disabling attacks require careful thought and are probably best done in conjunction with a paediatrician or paediatric neurologist. Treatment plans for preventing frequent and severe headaches may need to include input from a multidisciplinary team to ensure triggers are addressed by all available means, not just pharmacological ones.</p>
<p>In general, while migraine remains a lifelong predisposition when it starts in childhood or adolescence, the outlook is pretty positive. From the peak of the mid-teenage years, both the frequency and average severity of acute migraine attacks tends to drop off the older you get until a <a href="http://www.ncbi.nlm.nih.gov/pubmed/20713557">second peak in the 50s</a>. </p>
<p>For such a common and disruptive condition, it is perhaps a bit surprising we don’t know more. Effective early intervention and well-organised diagnosis and treatment of childhood migraines may save severe adult sufferers from decades of underachievement and frustration.</p>
<hr>
<p><em>Further reading:</em></p>
<p><a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277"><em>Do kids grow out of childhood asthma?</em></a></p>
<p><a href="https://theconversation.com/a-snapshot-of-childrens-health-in-australia-62500"><em>A snapshot of children’s health in Australia</em></a></p>
<p><em><a href="https://theconversation.com/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal-60257">Nightmares and night terrors in kids: when do they stop being normal?</a></em></p>
<p><a href="https://theconversation.com/bed-wetting-in-older-children-and-young-adults-is-common-and-treatable-60248"><em>Bed-wetting in older children and young adults is common and treatable</em></a></p><img src="https://counter.theconversation.com/content/60712/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Vagg does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many adults who have a lifelong problem with migraines first experience them in childhood or adolescence.Michael Vagg, Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist, Barwon HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/602482016-07-19T20:08:40Z2016-07-19T20:08:40ZBed-wetting in older children and young adults is common and treatable<figure><img src="https://images.theconversation.com/files/130164/original/image-20160712-9307-rv5oz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">About 0.5-3% of older children and young adults still wet the bed at night.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series looking at health conditions in children. Later in the week, we’ll have others about childhood migraines and slapped cheek disease. Read yesterday’s article about nightmares and night terrors <a href="https://theconversation.com/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal-60257">here</a>.</em></p>
<hr>
<p>Bed-wetting is surprisingly common in older children and young adults. Lack of public awareness and stigma associated with bed-wetting means few seek professional help despite successful treatments being available.</p>
<p>Bed-wetting (enuresis) is a sleep problem. It occurs when individuals are unable to wake to urinate when the bladder is full. </p>
<p>Three main factors affect bed-wetting:</p>
<ol>
<li><p>a large volume of urine produced at night which depends on the amount and type of drinks consumed (for example, alcohol is a diuretic), as well as the effect of inadequate amounts of the hormone vasopressin. Vasopressin is normally secreted in larger quantities at night causing the kidneys to make less urine. Some people secrete less vasopressin than normal during sleep, resulting in <a href="http://www.ncbi.nlm.nih.gov/pubmed/2705537">larger volumes of urine being produced</a>.</p></li>
<li><p>a small bladder or a bladder that contracts more than normal during sleep and holds less urine at night. Caffeine and constipation can affect the bladder. </p></li>
<li><p>people who sleep deeply as well as those with sleep problems find it difficult to wake when the bladder is full during sleep. Tiredness, medication with a sedative effect, as well as alcohol can also affect sleep arousal.</p></li>
</ol>
<p>Therefore, when the urine volume exceeds what the bladder is able to hold, wetting occurs if the person is unable to wake to void.</p>
<h2>How common is it?</h2>
<p>About <a href="http://www.ncbi.nlm.nih.gov/pubmed/16643494">0.5-3% of teenagers</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/9458510">young adults</a> wet the bed at night. Most of them have always wet, but <a href="http://www.ncbi.nlm.nih.gov/pubmed/12460356">20% start</a> after being previously dry (secondary enuresis). Reasons for secondary enuresis identified in young people include <a href="http://www.ncbi.nlm.nih.gov/pubmed/26428651">post-traumatic stress disorder</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/20354997">anorexia nervosa</a> (with <a href="http://www.ncbi.nlm.nih.gov/pubmed/16643494">resolution of bed-wetting</a> when their weight increases).</p>
<p>Unlike younger children, bed-wetting tends to persist and be more severe in older children and young adults, with 50-80% wetting <a href="http://www.ncbi.nlm.nih.gov/pubmed/14764133">at least three nights per week</a>. Those with a history of bed-wetting associated with bladder problems and those with severe bed-wetting when they were younger are <a href="http://www.ncbi.nlm.nih.gov/pubmed/16945646">more likely to continue</a> to wet as adults. </p>
<h2>Impact of bed-wetting</h2>
<p>Because of the stigma and shame associated with bed-wetting, its devastating impact on young people is often unappreciated. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708079/">Studies</a> have <a href="http://www.ncbi.nlm.nih.gov/pubmed/21784481">shown</a> young people with bed-wetting have lower self-esteem and higher risk of depression. </p>
<p><a href="http://search.informit.com.au/documentSummary;dn=047555473066657;res=IELHEA">Young adults have reported</a> their condition has affected their work performance, choice of jobs, relationships and decision to have a life partner. </p>
<h2>Treatments</h2>
<p>Although effective treatments are available, <a href="http://www.ncbi.nlm.nih.gov/pubmed/9458510">most adults erroneously believe</a> their problem is not treatable. Some <a href="http://www.ncbi.nlm.nih.gov/pubmed/9458510">20-50% of young adults</a> have never sought professional help about their problem, and continue to suffer in silence. </p>
<p>The principles for treating bed-wetting are the same for adults and children, and those who seek treatment <a href="http://www.ncbi.nlm.nih.gov/pubmed/9458510">usually respond well</a>. However a <a href="http://www.ncbi.nlm.nih.gov/pubmed/12460356">quarter of young people</a> have problems adhering to the treatment prescribed, suggesting a different approach may be needed for this population.</p>
<p>Urotherapy is conservative treatment centered around education and reinforcing good bladder and bowel habits such as drinking well, minimising caffeine and alcohol, going to the toilet regularly and managing constipation. Sometimes these simple measures can alleviate bed-wetting.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/19643460">Desmopressin</a>, a synthetically made vasopressin, <a href="http://www.ncbi.nlm.nih.gov/pubmed/7970999">has been effectively used</a> in young people. Desmopressin decreases overnight urine production, increasing the likelihood of being dry and sleeping through the night. However, there is no sustained effect, and wetting <a href="http://www.cochrane.org/CD002112/INCONT_desmopressin-for-bedwetting-in-children">usually recurs</a> when desmopressin is stopped. </p>
<p>Imipramine, an antidepressant, is an <a href="http://www.cochrane.org/CD002117/INCONT_tricyclics-and-related-drugs-treating-bedwetting-children">older treatment that has also been used</a> for bed-wetting. The exact mechanism of action is unknown but may be related to its effect on <a href="http://www.cochrane.org/CD002117/INCONT_tricyclics-and-related-drugs-treating-bedwetting-children">reducing spasm in the bladder</a>. Imipramine has risks for serious side-effects such as irregular heart rhythm and treatment effects are not sustained when stopped.</p>
<p>Bed-wetting alarm training is one of the most effective treatments for bed-wetting, and the <a href="http://www.ncbi.nlm.nih.gov/pubmed/15846643">only one that has a sustained effect</a>. Alarms train the individual to wake to urinate when their bladder is full and to withhold urinating at other times.</p>
<p>Bed-wetting alarm sensors are usually worn in the underpants or placed on the bed as a mat. They detect wetness and emit a noise or vibration. Arousal to the alarm signal and going to the toilet at that point is essential for treatment success. If the individual cannot wake to the alarm, they will need support from a family member or friend. </p>
<p>Although bed-wetting alarms are the treatment of choice for bed-wetting, young people may find alarm training embarrassing and difficult to do. Alarm training generally takes two to three months and can cease after 14 consecutive dry nights have been achieved.</p>
<p>Although treatments are available for older children at paediatric centres, there are currently no services for young adults. It is time to raise awareness that bed-wetting in young people is both common and treatable and to request more services and research to help this vulnerable population.</p>
<hr>
<p><em>Further reading:</em></p>
<p><a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277"><em>Do kids grow out of childhood asthma?</em></a></p>
<p><a href="https://theconversation.com/a-snapshot-of-childrens-health-in-australia-62500"><em>A snapshot of children’s health in Australia</em></a></p>
<p><em><a href="https://theconversation.com/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal-60257">Nightmares and night terrors in kids: when do they stop being normal?</a></em></p><img src="https://counter.theconversation.com/content/60248/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrina Ha Yuen Caldwell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Lack of public awareness and stigma associated with bed-wetting in older children means few seek professional help despite successful treatments being available.Patrina Ha Yuen Caldwell, Staff Specialist, Centre for Kidney Research, The Children's Hospital at Westmead; Senior Lecturer, Discipline of Paediatrics and Child Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/602572016-07-18T20:06:43Z2016-07-18T20:06:43ZNightmares and night terrors in kids: when do they stop being normal?<figure><img src="https://images.theconversation.com/files/127027/original/image-20160617-30170-1lf6c9z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Night terrors and nightmares are very different things and need to be managed differently. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/clement127/15444970547/">clement127/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>This article is part of our series looking at health conditions in children. Later in the week, we’ll have others about childhood migraines and bed-wetting in older kids. Read yesterday’s article about asthma <a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277">here</a>.</em></p>
<hr>
<p>Two of the most common causes of night waking in children are night terrors and nightmares. Parents often get them confused but they are different, as is how they should be managed. </p>
<p>Before we can understand night terrors and nightmares, we need to understand normal sleep. All children and adults cycle through stages of deep sleep, also known as non-rapid eye movement (non-REM), and light sleep, also known as REM. </p>
<p>We fall immediately into deep sleep where we typically stay for the first few hours of the night. Thereafter, we cycle through deep and light sleep. These sleep cycles last 30-60 minutes in children and around 90 minutes in adults. When we come into light sleep, we can wake up briefly, look around the room, adjust the bedclothes, and if everything is OK, go back to sleep again.</p>
<p>Night terrors and nightmares happen in different parts of the sleep cycle and in different parts of the night. Night terrors usually happen before midnight and occur when the child is “stuck” between a deep and light sleep stage. Their body is therefore “awake” but their mind isn’t. In contrast, nightmares tend to occur after midnight and happen during the light sleep stage, when we do most of our dreaming.</p>
<p>During a night terror, the child has a sudden onset of screaming, can have their eyes open or shut, can breathe rapidly and have a fast heartbeat. They look terrified and can get up and run around. However, because they are not truly awake, children have no memory of the event in the morning. If their parent tries to comfort them with a hug, the child will typically push the parent away.</p>
<p>During nightmares, however, children will usually wake up completely from their bad dream and be scared. They welcome a hug and can remember what happened in the morning.</p>
<h2>Managing nightmares and night terrors</h2>
<p>These differences give us an insight into how best to manage night terrors and nightmares. </p>
<p>For night terrors, parents would do best to check their child is OK (hasn’t got their leg stuck in the cot, for example) and then leave them be if it is safe to do so. Many parents continue to try to comfort their child but this usually results in the child waking up completely and being very confused and hard to re-settle. </p>
<p>Children who are having a nightmare need to be comforted by their parent and returned to bed once they have calmed down.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children will usually wake up from nightmares, remember the content, and be scared.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/whoisthatfreakwiththecamera/8184672835/">Michael Day/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>For almost all children, night terrors and nightmares are a part of normal development and not a cause for concern. Both can run in families. </p>
<p>For some children, who have frequent nightmares and show other signs of distress, such as changes in their appetite or recurrent body pains (think headaches and stomach pains), or who appear withdrawn or upset, nightmares can be a sign something else is going on. </p>
<p>These children should be seen by a health professional, who can work with the child and the family to identify and address underlying issues, such as problems at school with learning or bullying or family problems including violence.</p>
<h2>How to treat them</h2>
<p>Night terrors that persist and occur around the same time each night can be treated with a technique called “scheduled awakening”. This involves waking the child up around 30 minutes before their night terror. This is thought to reset the sleep cycle, thereby helping them avoid getting “stuck” between deep and light sleep stages. </p>
<p>Parents need to persist with this technique for at least three weeks to know if it helps or not.</p>
<p>Triggers common to both nightmares and night terrors include illnesses and lack of sleep. While illnesses are hard to avoid, parents can ensure their child has adequate sleep, starting with a good bedtime routine. </p>
<p>There are many helpful resources on how to help children sleep including the <a href="http://www.raisingchildren.net.au">Raising Children Network</a> and the <a href="http://www.sleephealthfoundation.org.au">Sleep Health Foundation</a>. Ensuring a good nights’ sleep for children can benefit not only the child, but the rest of the family as well.</p>
<hr>
<p><em>Further reading:</em></p>
<p><a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277"><em>Do kids grow out of childhood asthma?</em></a></p>
<p><a href="https://theconversation.com/a-snapshot-of-childrens-health-in-australia-62500"><em>A snapshot of children’s health in Australia</em></a></p><img src="https://counter.theconversation.com/content/60257/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harriet Hiscock is affiliated with the Sleep Health Foundation (member, GP Education subcommittee) and is an Expert Content Advisor to the Raising Children Network.
Harriet Hiscock has received NHMRC project grants to evaluate sleep strategies for infant sleep problems and sleep problems in primary school aged children and in children with ADHD.</span></em></p>Before we can understand night terrors and nightmares, we need to understand normal sleep.Harriet Hiscock, Principal Fellow, Department of Paediatrics, The University of Melbourne, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/625002016-07-17T20:09:18Z2016-07-17T20:09:18ZA snapshot of children’s health in Australia<figure><img src="https://images.theconversation.com/files/130637/original/image-20160715-2110-in0zi4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The overall infant mortality rate more than halved between 1986 and 2014. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>Today, we start our series looking at health conditions in children. Later in the week, we’ll have articles about childhood migraines, bed-wetting in older kids, and nightmares and night terrors.</em></p>
<p><em>The infographic below provides a snapshot of children’s health in Australia, from mortality and chronic conditions to the risk factors adversely affecting our children’s health.</em> </p>
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This infographic provides a snapshot of children’s health in Australia, from mortality and chronic conditions to the risk factors adversely affecting our children’s health.Alexandra Hansen, Deputy Editor and Chief of Staff, The Conversation AUNZEmil Jeyaratnam, Data + Interactives Editor, The ConversationLicensed as Creative Commons – attribution, no derivatives.