Heart Murmurs

The American Academy of Pediatrics defines a heart murmur as “simply a noise heard between the beats of the heart”. (http://www.healthychildren.org/English/health-issues/conditions/heart/Pages/Heart-Murmur.aspx)

HEART MURMUR:

A heart murmur is a swishing sound that blood makes as it moves through the heart. Most children have a heart murmur at some time in their life. These murmurs come and go during childhood and do not affect the child’s health. As the child gets older, they go away on their own. These are called "innocent" or "functional" murmurs.

Sometimes a heart murmur is a sign of a problem in the heart. If the child's doctor suspects this, the child will be referred to a heart specialist (cardiologist). Special tests will be ordered. These include an EKG (tracing of the electric pattern of the heart), a chest x-ray and an echocardiogram (“echo”). (An echo is like an ultrasound of the heart.)

Heart murmurs can also be caused by a Congenital Heart Defect (CHD). Babies born with CHD may have symptoms at birth. Others may develop symptoms later in childhood or teen years. Others may never develop any symptoms at all.

There are two common types of Congenital Heart Defects:

 A hole in the center wall of the heart that divides the chambers

 A narrowed or leaky heart valve

A hole in the center wall of the heart may close on its own as the child grows older, or it may be so small that it does not cause any problem. Sometimes surgery is needed to repair a larger hole. A defect in the heart valve may require medication, treatment with a special catheter (no surgery) or an operation.

Home Care

Innocent heart murmurs require no special care or treatment. If medicine was prescribed, take exactly as directed.

A teen with a congenital heart defect should avoid body piercings. Piercings increase the risk of bacteria getting into the body and infecting the heart.

GET PROMPT MEDICAL ATTENTION if any of the following occur:

In children and teenagers:

 Tiredness, difficulty exercising

 Trouble gaining weight

 Chest pains

When a child has a Heart Murmur the heart makes sounds as it beats. These sounds occur as the heart valves open and close to allow blood to flow through the heart. A heart murmur is an extra noise. The noise is caused by the blood not flowing smoothly through the heart. This is called turbulence. Heart murmurs can be innocent (harmless) or pathologic (caused by a heart problem).

What Causes a Heart Murmur?

An innocent heart murmur is caused by mild turbulence in blood flow within the heart. A pathologic heart murmur is often caused by a structural heart defect. This can include:

 Septal defects (holes in the dividing walls of the heart that allow blood to pass through)

 Heart valve problems (valve has trouble opening or closing)

 Artery-vein fistulas (abnormal connections between a blood vessel on the left side of the heart and a blood vessel on the right side of the heart)

What Are the Symptoms of a Heart Murmur?

Innocent heart murmurs cause no symptoms. Symptoms related to a pathologic heart murmur depend on the underlying cause of the murmur.

How Is a Heart Murmur Diagnosed?

The doctor or healthcare provider may detect a heart murmur during a physical exam. Heart noises are heard with a stethoscope. A heart murmur is classified by how loud it is, its location, when it occurs during the heart’s pumping cycle, and its sound qualities. If the doctor suspects the murmur is pathologic, your child may be referred to a pediatric cardiologist. This is a doctor who diagnoses and treats heart problems in children. The following tests may be done:

 Chest x-ray: This test takes a picture of the heart and lungs. The picture can show the child’s heart size and shape. It can show whether there are problems in the heart or lungs.

 Electrocardiography (ECG or EKG): During this test, the electrical activity of the heart is recorded to check for arrhythmias (abnormal heart rhythms) or problems with heart structure.

 Echocardiography (echo): During this test, sound waves are used to create a picture of the heart. This test can show problems with heart structure or heart function. This includes showing how well the heart pumps, if the heart is enlarged, or if there are any valve problems.

How Is a Heart Murmur Treated?

An innocent heart murmur requires no treatment because it’s not caused by a heart problem. Treatment for a pathologic murmur depends on the underlying cause. The cardiologist will evaluate the child’s condition and discuss treatment options if needed.

What Are the Long-term Concerns?

Most innocent murmurs go away by the time children become adolescents or young adults. If pathologic heart murmurs aren’t diagnosed or treated, severe symptoms may result and cause serious health problems. These can include heart failure, arrhythmias, or respiratory problems.

© 2018-2020- Krames StayWell, 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

Online Resources:

 American Academy of Pediatrics: http://www.healthychildren.org/English/health-issues/conditions/heart/Pages/Heart-Murmur.aspx

 National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/health/health-topics/topics/heartmurmur/

 Kids Health: https://kidshealth.org/en/parents/murmurs.html

 Mayo Clinic: http://www.mayoclinic.com/health/heart-murmurs/DS00727

Diabetes

Understanding Type 1 Diabetes

This means the body has trouble using a sugar called glucose for energy. Diabetes is a lifelong condition. Left untreated, it can lead to serious health problems. Diabetes can be managed in order to live a full and healthy life.

How the Body Gets Energy

When food is eaten, the digestive system breaks down the food. Some of this food is turned into glucose in the intestine. Glucose (also called blood sugar) gives energy to the body’s cells. It travels through the blood to reach the cells. But glucose needs the help of a hormone called insulin to enter cells. Insulin is made by an organ called the pancreas. Insulin is released into the blood, and travels to the cells just like glucose. When insulin reaches a cell, it acts like a key. It opens a “door” into the cell so glucose can enter.

When a child has Type 1 Diabetes

In children with type 1 diabetes, the pancreas stops making insulin. Food is still broken down into glucose. And glucose still travels to the cells. But without insulin, glucose can’t enter the cells. Instead, it builds up in the blood. Too much glucose in the blood is called hyperglycemia (high blood sugar). Without glucose, the child’s cells don’t get the energy they need. And over time, high blood sugar can cause other health problems.

What Are the Causes of Type 1 Diabetes?

The exact cause of type 1 diabetes is not known. We do know that it’s NOT caused by eating too much sugar. Type 1 diabetes can run in families. Or a child may be the only person in the family to develop type 1 diabetes.

What Are the Symptoms of Type 1 Diabetes?

When the pancreas stops making insulin, the body’s cells become starved for energy. This can cause the child to feel tired and rundown. They may feel or have:

 Very strong thirst

 Increased urination

 Blurry vision

 Tiredness for no obvious reason

 Nausea

 Extreme hunger

 Headaches

 Flu-like symptoms

 Bed wetting

 Unexplained weight loss

How Is Type 1 Diabetes Diagnosed?

Simple blood tests can help the healthcare provider determine if a child has type 1 diabetes. These tests check for a high level of glucose in the blood. Glucose tests may need to be repeated in order to confirm the diagnosis.

How Is Type 1 Diabetes Treated?

There is no cure for type 1 diabetes. But the good news is that the condition can be managed. If the pancreas is not making insulin, insulin must be put into the child’s body. But insulin can’t be taken as a pill. Instead, it is most commonly taken by injection (shot). The idea of giving shots might seem scary at first. But most parents and children find that it’s easier than they thought. The child’s healthcare provider will provide education on how to check the level of the child’s blood sugar. This tells you how much insulin to give the child to keep blood sugar in a healthy range.

What Are the Long-Term Concerns?

People with a blood sugar level that is too high over many years can develop health problems. These problems can affect the heart, eyes, kidneys, and nerves.

The “Honeymoon” Phase

After diagnosis, the child’s pancreas may still be making a little insulin on its own. This is called the “honeymoon” phase. At this time, the child’s blood sugar may be managed with very little insulin. The honeymoon phase may last months, or even years. As time goes on, the child’s pancreas will stop being able to make any insulin at all. Talk to the healthcare provider about managing blood sugar during the honeymoon phase.

NOTE: This sheet does not give all the information you need to care for a child with diabetes. Work with the healthcare provider for more information.

© 2000-2012 Krames StayWell, 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

Understanding Type 2 Diabetes

This means the body has trouble using a sugar called glucose for energy. Diabetes is a lifelong condition. Left untreated, it can lead to serious health problems. Diabetes can be managed in order to live a full, healthy life. Type 2 diabetes has not been common in children. But in recent years, more and more children are developing Type 2 Diabetes.

When a child has Type 2 Diabetes

With type 2 diabetes, food is still broken down into glucose and glucose still travels to the cells. But the pancreas may not make enough insulin for the amount of glucose in the blood. The liver may release too much glucose at once. And the body’s cells may not respond the right way to insulin. This is called insulin resistance. Because of this, the cells receive less glucose than they need. At first, the pancreas makes more insulin to try to keep up. But as time passes, the pancreas can’t make enough insulin to overcome resistance. When this happens, glucose builds up in the bloodstream. Too much glucose in the blood is called hyperglycemia (high blood sugar). Without glucose, cells don’t get the energy they need. And over time, high blood sugar can cause other health problems.

What Are the Causes of Type 2 Diabetes?

Type 2 diabetes often runs in families. African American, Latino, Native American, Asian American, and Pacific Islander families are often affected. A child may be more likely to develop diabetes if:

 He or she spends more time sitting than being active.

 He or she is overweight for his or her age and height.

 A parent or sibling has diabetes.

 The mother had gestational diabetes (diabetes during pregnancy).

What Are the Symptoms of Type 2 Diabetes?

When a child has type 2 diabetes, the body’s cells become starved for energy. The child may feel or have:

 Very strong thirst

 Increased urination

 Blurry vision

 Tiredness during the day

 Nausea

 Extreme hunger

 Headaches

 Bedwetting

Or, they may not feel symptoms at all. But high blood sugar can still be causing problems.

How Is Type 2 Diabetes Diagnosed?

Simple blood tests can help the healthcare provider determine if a child has Type 2 Diabetes. These tests check for a high level of glucose in the blood. Glucose tests may need to be repeated in order to confirm the diagnosis.

How Is Type 2 Diabetes Treated?

There is no cure for Type 2 Diabetes. But the good news is that the condition can be managed. The healthcare provider will create a treatment plan. Following the plan will help keep the blood sugar in a healthy range. Type 2 Diabetes is most commonly treated by:

 Eating healthy meals

 Being active

 Losing weight

 Taking medication (if needed)

What Are the Long-Term Concerns?

People with a blood sugar level that is too high over many years can develop health problems. These problems can affect the heart, eyes, kidneys, and nerves.

NOTE: This sheet does not give all the information you need to care for a child with diabetes. Work with the healthcare provider for more information.

Diabetes and High Blood Sugar

High blood sugar (hyperglycemia) occurs when there is too much glucose (sugar) in the bloodstream. Blood sugar that is often high causes long-term complications, so try to prevent it. And treat it quickly when it happens.

High blood sugar can result from the following:

 Taking too little insulin or diabetes medication

 Using insulin that’s not stored properly or that’s past the expiration date

 Eating too much food at once

 Being sick

 Being less active than usual

 Being under stress

 A rebound in response to low blood sugar

 Hormonal changes during puberty

How to Recognize High Blood Sugar

Excessive thirst and the need to urinate often are additional symptoms. Severe high blood sugar may cause nausea, blurry vision, weakness, or dizziness. Encourage the child to learn to recognize the symptoms of high blood sugar and tell an adult about them right away. But keep in mind that sometimes there are no symptoms.

How to Treat High Blood Sugar

 Check the blood sugar.

 If blood sugar is over the target range, give water or sugar-free and caffeine-free drinks.

 If blood sugar is over 240, check urine for ketones.

 If blood sugar stays over 240 and/ or ketones are present in the urine, call the doctor.

 Follow the plan given by the healthcare provider, which may include giving extra insulin.

If Ketones are present

A moderate to high level of ketones in the blood or urine is a sign of diabetic ketoacidosis (DKA). Follow the healthcare team’s guidelines for giving additional insulin and notifying the office. Check blood sugar often and don’t let the child exercise until ketones are back to normal. Left untreated, DKA may require hospitalization.

Sick Days

When a child is ill, their blood sugar may be higher than usual. This may be true even if they are not eating as much as usual. To handle this, follow the sick-day plan outlined by the healthcare provider. This plan may involve additional monitoring and extra insulin.

How to Prevent High Blood Sugar

Make sure that:

 Insulin is administered on time and in the right amount.

 Meals and snacks are spread throughout the day.

 The sick-day plan is followed during an illness.

 Insulin is stored properly so that it doesn’t spoil.

Diabetes and Low Blood Sugar

Low blood sugar (hypoglycemia) occurs when there is too little glucose (sugar) in the blood. It can be caused by skipping meals or snacks, eating too little food, or taking too much insulin or diabetes medication. A lot of physical activity can also cause low blood sugar, even hours later. In severe cases, low blood sugar can lead to seizures or passing out.

How to Recognize a Low

Everyone’s symptoms are different. The child may feel dizzy, weak, hungry, headachy, or shaky. They may seem cranky or confused. If lows happen very often, over time, the child may no longer be able to sense them. Encourage the child to recognize their symptoms and tell an adult about them right away.

What to Do

 Stay calm so you can better help the child

 Check blood sugar to make sure that it is low. If you are not able to check, treat for low blood sugar anyway.

 Follow the protocol outlined by the healthcare provider. Diet soda will not help. Chocolate, cookies, and other fatty sweets will not work as quickly.

 If possible, recheck blood sugar in 15 minutes. If it is still low, continue to follow the protocol outlined by the healthcare provider

 Once blood sugar is normal, give a snack or meal to eat.

 If the blood sugar does not go back up, call the doctor or 911 as indicated

How to Prevent Lows

 Be sure the child eats meals and snacks on time and eats before exercising.

 Carry fast-acting sugar

 Don’t inject insulin near a muscle that’s going to be exercised.

 Check blood sugar often, especially after exercise and at bedtime.

Tips

 Keep fast-acting sugars handy.

 Check blood sugar often, especially after activity and before bed.

Long-Term Complications of Diabetes

Diabetes can cause health problems over time. These are called complications. They are more likely to occur if blood sugar is often too high. Over time, high blood sugar can damage blood vessels. It is important to keep blood sugar in target range. This can help prevent or delay complications.

Possible Complications

Complications of diabetes include:

 Eye problems, including damage to the blood vessels in the eyes (retinopathy), pressure in the eye (glaucoma), and clouding of the eye’s lens (a cataract)

 Tooth and gum problems (periodontal disease), causing loss of teeth and bone

 Blood vessel (vascular) disease leading to circulation problems, heart attack, or stroke

 Kidney disease (nephropathy)

 Nerve problems (neuropathy), causing pain or loss of feeling in your feet and other parts of your body

 High blood pressure (hypertension), putting strain on your heart and blood vessels

 Serious infections, possibly leading to loss of toes, feet, or limbs

How to Avoid Complications

Complications can be avoided by managing Diabetes appropriately. This is accomplished by adequately tracking blood sugar, taking insulin as prescribed, participating in healthy lifestyle activities such as regular exercise and following a low-fat diet.

© 2000-2012 Krames StayWell, 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

Online Resources

 World Health Organization:

 https://www.who.int/health-topics/diabetes#tab=tab_1

 American Diabetes Association:

 www.diabetes.org



1-800-DIABETES or 1-800-342-2383

 Email: AskADA@diabetes.org

 Kansas City Area American Diabetes Association:

 913-383-8210

 Juvenile Diabetes Research Foundation:

 www.jdrf.org



1-800-533-CURE or 1-800-533-2873

 Email: info@jdrf.org

 Fax: 1-212-785-9595

 JDRF Kansas City Chapter:

 215 W Pershing Rd, Ste 300 KC, MO 64108

 816-472-7997

 Fax:472-7617

 Email: kansascity@jdrf.org

 http://kansascity.jdrf.org/

 American Academy of Pediatrics:

 http://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Diabetes.aspx

 http://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/DiabetesTreatment.aspx

 http://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Type-2-Diabetes-AManageable-Epidemic.aspx

 National Diabetes Education Program:

 https://www.niddk.nih.gov/health-information/communication-programs/ndep

 http://niddk.nih.gov/

 National Diabetes Information Clearinghouse (NDIC):

 https://www.niddk.nih.gov/health-information/communication-programs/information-clearinghouses

 1-800-860-8747

 TTY: 1-866-569-1162

 healthinfo@niddk.nih.gov

2023-2024 / Version [1.0]

Copyright © 2023, Oracle and/or its affiliates / Public

Seizures

The American Academy of Pediatrics describes a seizure as a “sudden temporary changes in physical movement, sensation, or behavior caused by abnormal electrical impulses in the brain”. (http://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/Seizures.aspx)

How Seizures Affect the Body

The brain is the “control center” of the body. It manages everything from movement and balance to emotions and memory. When a seizure occurs, some or all brain functions are affected.

The Brain Working Normally

The brain uses electrical signals to send messages throughout the body. Signals sent from different parts of the brain control different body functions. For instance, one part of the brain controls balance. Another part controls speech. A doctor can record brain signals using a test called an EEG (electroencephalogram).

The Brain During a Seizure

During a seizure, excessive electrical signals in the brain disrupt its normal activity. How this affects body functions depends on two main factors. First is the location of the seizure. For instance, a seizure in a part of the brain that controls movement might cause an arm or leg to jerk. Second is the type of seizure. For instance, a seizure that affects more of the brain may affect more of the body.

Types of Seizures

 Partial Seizures: Also called focal seizures, these seizures start in one part of the brain and may spread. There are two types:

 Simple Partial Seizures: These may start with an aura, or warning. Auras are seizures that can involve strange tastes or smells, stomach upset, or a feeling of fear or déjà vu. Simple partial seizures may also involve jerking movements or hallucinations. The person is awake and aware that they are having a seizure.

 Complex Partial Seizures: These may also start with an aura. The person may become motionless and have a vacant stare. Or he or she may perform “automatisms.” These are repeated movements, such as smacking lips or gesturing. The person may be awake but unaware of the seizure or may lose consciousness.

 Generalized Seizures:

These seizures affect the entire brain at once. The most common types of generalized seizures are:

 Absence Seizures (petit mal seizures): These seizures involve a brief lapse of awareness. Signs can include staring, eye blinking, and lip smacking.

 Tonic-Clonic Seizures (grand mal seizures): These may be the best-known type of seizure. The person loses consciousness and may fall to the ground. The body stiffens and then convulses, with the arms and legs jerking rhythmically.

 Myoclonic seizures: These seizures involve brief jerking movements. They usually affect both sides of the body.

 Atonic seizures (drop attacks): During these seizures, the person loses all muscle control and may fall or slump over.

© 2000-2012 Krames StayWell, 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instruction

Safety during a Seizure

All seizures should be treated with care, but tonic-clonic seizures (seizures during which you lose consciousness) require more attention.

What to Know

Seizures typically last less than 3 minutes. People recover safely from most seizures. During a tonic-clonic seizure, the person may appear to stop breathing or turn slightly blue. Afterward, the person may be tired, confused, and achy. He or she may need to sleep for several hours to fully recover.

What to Do

During any seizure, stay with the person until it is over. Note the time when the seizure starts and ends. And don’t try to stop the seizure:

 Move hard or sharp objects out of the way.

 Lay the person on a flat surface and turn them on their side.

 Place a flat, soft object under their head.

 Don’t try to restrain the person.

 Don’t put anything in the person’s mouth. They cannot swallow their tongue, and you risk breaking their teeth or being bitten.

 Don’t give the person medications during a seizure unless you’ve been trained by a doctor.

Call 911 if the seizure lasts longer than 5 minutes, there is no conscious interval between 2 seizures, or several seizures occur in a row. These events could represent status epilepticus, a medical emergency. Also call 911 if the seizure is very different from past seizures, or if the person is pregnant.

© 2000-2012 Krames StayWell, 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

2023-2024 / Version [1.0]

Online Resources:

 Epilepsy Foundation:

 https://www.epilepsy.com/

 1-800-332-1000

 Email: ContactUs@efa.org

 Epilepsy Foundation of Missouri and Kansas:

 www.efmk.org

 2340 E Meyer Blvd, Bldg 1, Ste 300B Kansas City, Mo 64132

 816-444-2800

 844-415-7152

 epilepsy@efmk.org

 American Academy of Pediatrics:

 http://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/Seizures.aspx

 Kids Health:

 http://kidshealth.org/parent/medical/brain/epilepsy.html

 CDC Training for School Nurses:

 https://www.epilepsy.com/living-epilepsy/our-training-and-education/managing-students-seizuresschool-nurse-training-program