Index:

HEALTHY LIFE::
Puberty // Adolescent Children // 
SAFETY:
In case of bullying // Correct use of the expansion chamber // 
HEALTH PROBLEMS:
Specific learning difficulties // Anaphylaxis // Scabies // My child has hit his/her head // Childhood obesity // My child has diarrhoea // Managing fever in adolescence

HEALTHY LIFE

Puberty

Text by Paediatrician: Dra. Marisol Anselmo

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Puberty is considered to be a transition period between childhood and adulthood. It is characterized by the appearance of secondary sexual characters and growth in height.

There are several factors that are thought to be determinant for the onset of puberty, such as genetic, physiological, environmental and socioeconomic factors (for example, poverty and malnutrition can condition puberty).

The early onset of puberty will cause bone maturation, increase in the speed of growth and an early stagnation, thus being able to condition the final height of these children. It can also cause emotional problems because the body matures, but emotional development does not follow this new phase.

In girls, the normal development of puberty occurs with the appearance of the breast button, usually between 9 and 12 years old. Menarche (first menstrual period) appears on average about 2.6 years after the start of breast development.

In boys, the marker of onset of puberty is the increase in the volume of the testicles, usually between 10 and 13 years old, which usually precedes the increase in the size of the penis and the appearance of pubic hair.

Find out more about puberty, such a challenging phase for parents and children in the article Early publicity when should it be evaluated? Written by Dr. Marisol Anselmo.

Adolescent Children

Text by Paediatrician: Dr. Luís Gonçalves

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The important thing is to continue to promote an empathic dialogue with your children so that they feel security and support from their caregivers. Destructive criticism is one of the biggest causes of the gap between parents and children.

We challenge you to think and list: in which situations is your child autonomous? In how many more situations could it begin to be? Start making some changes to your child's routine to make them more independent.

Develop a weekly habit of sharing which rules were difficult to follow and negotiating rules for the following week.

The always turbulent groups of teenagers are an important space for the development of social skills. The affection, respect, understanding and listening to your adolescent children are essential strategies to help you live in the enormous pressure that you feel in being accepted by the group and not feeling isolated or displaced. The home and parents may be the teen's safe place.

The war on spots and the weight on the scales
Do not devalue, listen carefully and try to understand their discomfort. Acknowledge any suffering they may be experiencing and help with the proper resolution.

Image concerns
Defining limits of what is “appropriate” or “possible”, the exploratory experiences of the image are part of the process of discovering the individuality of each adolescent.

Dating and sexuality
Do not be afraid to discuss this with your child. By talking, we demystify, clarify and avoid mistakes.

Homosexuality
It is difficult to come out, so it is important that your child feels supported by you. Talk about their difficulties, ensuring that you will always be there to support them.

Disinterest in school
Help your child to think about his/her future. What are their interests and vocations? What will it take to get there? Together, do research, visit places, clarify doubts.

Whenever possible, give them your personal examples as a teenager (or examples of people they know).

SAFETY

In case of bullying
 

Text by Paediatrician: Dr. Luís Gonçalves

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Promote dialogue by increasing proximity to your child so that he/she feels safe and supported.

After knowing what happened, avoid phrases like "it serves you right", "didn't I warn you?". The situation they are experiencing is already problematic and humiliating for them.

Promote the sharing of solutions to the problem - Help them build all possible solutions.

Praise and value your child, teach him/her to like you and face problems. Hang phrases like "I believe in myself" or "I have value!" In their room.

Tell your child that together they will be able to overcome the situation. And how this has happened to other children / young people who have managed to overcome it!

Prevention plan:

• Keep a safe distance from bullies;
• Guarantee a support network, sharing this subject with a friend (or group);
• Ask for help from adults at school who can help you
• In the event of a confrontation:
• Stop and think - Think about the consequences if he/she also hurts someone;
• Act with confidence, determination and stay calm - "Enough, I don't like what you are doing";
• Leave or escape the place and look for a safe place and / or an adult.

After the confrontation:

• Do not stop going to school as long as there is no real danger - and face fear with the support of colleagues and teachers;
• Stay close to others;
• Always choose more effective ways to interact and relate to others.

Correct use of the expansion chamber

Text by Paediatrician: Dra. Inês Serras e Dr. Luís Gonçalves

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The inhalation method is the one used for administering drugs for the treatment of respiratory diseases.

There are two forms of administration: by aerosol or via an expansion chamber. The aerosol is less and less recommended, as it is more expensive and time-consuming to administer. The expansion chamber is the preferred means of administration, as it is faster, more practical and more comfortable for the child. The sizes of the chambers vary according to the child's age:

• 0-18 months: small mask (yellow)
• 1-5 years: medium mask (orange)
• Above 5 years: without mask the application is oral.

The effectiveness of the treatment depends on the correct use of the device. You should always take your inhalation device when you go to consultations / permanent care.

Preparation

The child should be standing or sitting, ideally calm.

• Remove the cylindrical container from the packaging, heat it between your hands and adapt it again; remove the protective cap and with the inhaler upright (L) insert the mouthpiece at the back of the expansion chamber
• If the child is under 5 years old, adapt the mask to the mouth of the expansion chamber. The mask must adapt to the face so that there are no leaks. Apply the mask to the child's face.
• If the child is over 5 years old, apply the mouthpiece of the expanding chamber between the teeth, with the tongue under it.

Taking medication

• Press the inhaler only once (1 "puff")
• If the child is under 5 years old: wait for 5 slow breaths (the valve must move during breathing)
• If the child is over 5 years old: ask them to inhale slowly and pause 4 seconds, keeping their lips tightly closed.
• If more than one puff has been prescribed, remove from the mouth and wait 30 seconds to 1 minute for further inhalation.
• Shake the inhaler and repeat steps 1 and 2/3.

Cleaning the chamber

• Disassemble all possible parts and place them in a container with warm water and dishwashing liquid for 15 minutes.

HEALTH PROBLEMS

Specific learning difficulties

Text by Paediatrician: Dr. Filipe Fernandes

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We speak of learning difficulties when a child is unable to learn a subject or task for which there are supposed to be no difficulties at his/her age.

It is important to distinguish between general learning disabilities, such as delayed cognitive development or autism spectrum disorder, and specific learning difficulties (SpLDs).

SpLDs are the most common cause of school failure, resulting from a specific deficit in the brain's ability to receive, process or communicate information. These difficulties should not result from lack of practice, the teaching method used, anxiety and depression, behavioural disorders or due to peripheral perceptual deficits (vision or hearing). 

The main sign of an SpLD is a significant difference between the expectations placed on the child's school performance (taking into account his intellectual functioning, behavioural and family adequacy and emotional well-being) and the child's effective school performance. The child shows an adequate level of reasoning and understanding of tasks and subjects but fails in their learning and evaluations.

It is necessary to properly assess children who have school learning difficulties in order to obtain a diagnosis that allows the support and monitoring that the child needs. It is necessary to collect information in an interview with parents, teachers, observe the child and apply standardised tests of cognitive performance. Early detection makes it possible to establish interventions aimed at the child's difficulties, significantly improving the child's performance and decreasing frustration.

The most common SpLDs:

• Dyslexia - difficulty in learning to read;
• Dysgraphia / Dystography - difficulties in learning to write;
• Dyscalculia - difficulties in learning calculus, arithmetic facts or quantities;
• Dyspraxia - difficulties in motor skills or motor coordination;

The Attention Deficit (difficulties in orienting, maintaining and dividing the attention focus, impulsivity, difficulties in planning), with or without hyperactivity, is also frequently present together with SpLDs.

The SpLDs are permanent and the child needs follow-up to rehabilitate or remedy his/her difficulties. Support and adequacy measures in the school environment are often necessary to minimise the impact of SpLDs on the child's school career.

It is important to reiterate that SpLDs are independent of the child's intellectual functioning. An SpLD should not prevent any child from growing up in a healthy way, from fulfilling their intellectual potential and being happy. Einstein and Steve Jobs had SpLDs (dyslexia) and were extremely successful individuals.

Anaphylaxis

Text by Paediatrician: Dr. João Tavares

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What is Anaphylaxis?
It is an immediate, acute, and systemic hypersensitivity reaction, in which the signs and symptoms reflect the physiological effects of the release of cellular mediators (peripheral mast cells and basophils from the blood) that cause vasodilation and smooth muscle spasm, particularly at the bronchial level. It occurs after exposure to a specific antigen.

What are the causes?
The most common causes are hypersensitivity to food, drugs, and stings. Among the food antigens, the most common are eggs, milk, nuts, peanuts, and seafood, rarely presenting before 12 months of age. Antibiotics, namely penicillin and cephalosporins, and topical anaesthetics are frequent agents at later ages.

What are the symptoms?
Symptoms usually appear seconds to minutes after exposure to the antigen (which may or may not have been previously known). There is usually flushing, itching that is localized to generalized, cutaneous lesions, dizziness, tearing, red eye, lip, and perioral oedema. It may be associated with shortness of breath, difficulty in swallowing, cramps, nausea, vomiting. Anaphylactic shock, angioedema, and bronchial obstruction are usually manifestations of serious illness and, in these cases, represent a paediatric emergency.

How can I help my child? Should I go to the hospital?

If an anaphylactic reaction is suspected, medical observation should take place. In mild cases, supportive treatment may be sufficient, and an analytical study may help to define the ethology. The treatment of choice is adrenaline (increases peripheral vascular resistance, relaxes smooth muscle, and relieves oedema and urticaria) and can be administered through injectable pens previously prescribed by the attending physician or in a hospital setting in cases with no prior history.

Depending on the severity of the situation, there may be additional therapies. Due to the risk of biphasic reaction with reappearance of symptoms 6-24 hours after the initial manifestation, they should be kept under clinical observation during this period.

What happens after discharge?
Confirmed cases of anaphylaxis should be referred to an Immuno-allergology consultation, in order to identify / optimize eviction of the antigen and conduct of action in the event of a new anaphylactic reaction.
For further clarification, consult your attending physician.

Scabies

Text by Paediatrician: Dr. João Tavares

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What is Scabies?
Scabies, also known as sarcoptosis, is a cutaneous ectoparasitosis caused by the Sarcoptes scabiei variant hominis, with high worldwide incidence and is frequent in paediatric ages. It is highly contagious, with transmission by direct skin contact or, less frequently, by fomites, that is, through surfaces/objects, reaching all age groups and social classes.

How can it manifest itself?
It is usually manifested by an initially localised rash (with posterior spread), which is very itchy and frequently affects multiple cohabitants or those who have had direct contact. In the youngest children (usually in the first two years of life), this may be more predominant on the palms and soles and may be associated with a non-specific conditions, itchiness being often absent and, initially manifested as sleep/eating disorders and irritability. Even after effective treatment, itchy skin can be maintained for 2-4 weeks after treatment, without indicating a lack of cure.

How is the diagnosis made and where should I go?
The diagnosis is clinical and can be made by a paediatrician / dermatologist. You can go to the Permanent Assistance Service or schedule a Paediatrics / Dermatology appointment. After the treatment is carried out, a clinical reassessment is recommended after two weeks to confirm the cure. In particular cases, due to clinical doubt or lack of therapeutic response, confirmation by microscopic observation may be used.

How is it treated?
Curative treatment is generally topical, adapted to age and on a case-by-case basis, and is generally extended to the entire household (classmates and asymptomatic teachers do not require treatment). Supportive treatment should not be overlooked, with a view to minimizing itching and associated secondary injuries and optimizing skin regeneration. Concomitant treatment of fomites (sheets, clothes, etc.) is essential to prevent reinfection.

Can the child return to school after treatment?
After 24 hours of effective treatment, the child can return to school activities and parents can return to their daily routines - all without restrictions.

For further clarification, consult your attending physician.

My child has hit his/her head

Text by Paediatrician: Dr. António Salgado

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Head injuries are common in paediatrics, especially in the first years of life, mainly due to accidents.

Most of them are mild and without consequences, but a major cause for concern for parents, with some symptoms that, if present, should prompt a check-up by a medical professional, due to the increased risk of intracranial injury.

After a head injury, children and/or young people should be monitored for signs and symptoms that can determine the severity of the situation. These, although more frequent in the first 12 hours after the trauma, should be monitored until about 48 hours later.

If present, they may require an image examination.

Therefore, they must be observed if:

• Exaggerated drowsiness with difficulty awakening and outside the usual sleep times
• Change in habitual behaviour (agitation, irritability)
• Persistent vomiting (3 or more)
• Severe and worsening headache (no improvement with paracetamol)
  Seizure or fainting
• Lack of strength or “numbness” on one side of the body
• Change in vision, speech or gait (imbalance)
• Exit of blood or liquid through the nose or ear
• If he/she is less than 2 years old and there is a bulging of the anterior fontanelle (“soft spot”)
• Haematoma (bruising) on the head that was not previously present
• High impact fall: drop of more than 90 centimetres in children under 2 years old or more than 1.5 meters in children over 2 years old, road accident, being hit by a moving vehicle or a penetrating wound
• If you have a bleeding wound or enlarging bruise

If you do not have any of these signs and symptoms, you can apply ice on the spot, administer paracetamol (except when the headache worsens - should be checked by a medical professional), and promote a calm environment.

Do not forget that prevention is better than cure.

Children should always wear a helmet when they ride a bicycle or skateboard, they should always have an adult nearby when they ride, comply with safety rules for transportation by car and the rules of traffic should be taught as soon as they are understood, stairway barriers should be put in place and infants should never be left on high places without adult supervision.

Childhood obesity

Text by Paediatrician: Dr. Víctor Miranda

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Childhood obesity has become a major public health problem in recent years.

Given the current knowledge that wrong eating habits and being overweight can have a detrimental effect on life, it is essential to give due importance to this topic.

The calculation of the body mass index, based on height and weight, is the parameter that defines excess weight and obesity, according to percentile curves adjusted for the child's age and gender.

Overweight and obese children are at increased risk for various diseases in paediatric and adult age, including asthma, high blood pressure, osteoarticular pathology (knees and back), liver disease, sleep apnoea, diabetes, myocardial infarction, and some types of cancer.

The balance between genetic factors, food intake (in quantity and quality), and physical activity, result in an appropriate or exaggerated weight in each situation. In assessing excess weight and obesity, additional tests may be necessary to understand the case in question more completely.

To help children have a healthy weight, it is necessary to invest in adequate food (with several servings of fruit and vegetables a day, it is important to make good choices in the food bought for home), in reducing “screen time” and sedentary activities, schedule daily physical activity, drink water (avoid juices and soft drinks), promote adequate hours of sleep.

The goals must be realistic and phased, and the whole family must be involved in the purpose of achieving a healthier weight for the child. You can always seek help from your attending physician and nutritionist/exercise technicians.

My child has diarrhoea

Text by Paediatrician: Dr. António Salgado

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What is diarrhoea?
Diarrhoea is an increase in the volume of stools compared to what is normal for your child.

In babies, who usually have more intestinal transits, it means that the stools are more watery or even more frequent.

Older infants may show only an increase in the number of daily stools (usually 3 or more).

What causes diarrhoea?
The most common causes of diarrhoea are viral infections and side effects after taking antibiotics. Bacterial infections are less frequent.
 
If the dejections are accompanied by blood and mucus (similar to “snot”), the probability of bacterial infection is greater and the child must be observed and eventually, a culture from the faeces collected, to exclude these causes.

What should I do?
Your child can continue to eat a normal diet, namely: white meats, rice, bread, pasta, milk and yogurt (lactose-free), fruits and vegetables (except, for example, some fruits such as plum and green leafy vegetables).

Fatty foods and sugary drinks should be avoided.

If he/she is being breastfed, you must maintain this.
Food should be offered, without insisting, as he/she may have less appetite.
Liquids should be reinforced, being offered more times a day and an oral hydration solution (which exists to promote balanced hydration) can be administered.

To promote normalisation of intestinal transit, pre and probiotics can be administered (with several options available).
 

There are other medications, such as antisecretaries, among others, that should be administered only on the recommendation of your doctor.

When should he/she be checked?

• If he/she shows signs of dehydration, such as dry tongue, crying without tears, less urination, sunken eyes or depressed fontanelle (“soft spot”)
• If he/she is prostrate (sleepy and less reactive to stimuli) or with irritability and moaning.
• If the bowel movements are very frequent (more than 6 in 12 hours) and/or they leak out of the nappy.
• If there is persistent vomiting (after the second consecutive)
• If the diarrhoea is bloody.
• If he/she is less than 12 months old and has not eaten or drunk anything for more than a few hours.
• If he/she has continuous, severe and/or persistent abdominal pain.
• If he/she has a high fever (> 39.5 ° axillary) which is proving difficult to lower (even after medication).

Managing fever in adolescence

Text by Paediatrician: Dr. António Salgado

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What is fever and how to measure it?
It is the temperature 1°C above the average of the individual daily basal temperature, in the same measurement location.

• Rectal ≥ 38ºC
• Axillary ≥ 37.6ºC
• Tympanic ≥ 37.8ºC
• Oral ≥ 37.6ºC

Fever is a manifestation of fighting infections and therefore beneficial. When situations with a fever are severe (5% of cases), there are always other associated manifestations, the so-called “warning signs”.

What are the “warning signs” in a child with a fever?
In the presence of one or more of these warning signs, the child should be assessed:

• Irritability and/or groaning
• Excessive drowsiness or inability to fall asleep
• Inconsolable crying / Does not tolerate being picked up
• Pained expression
• Fast breathing with tiredness
• Purple lips or nails and/or intense and prolonged tremors in the thermal rise
• Cloudy and/or smelly urine
• Seizure
• Skin spots in the first 24 to 48 hours of fever
• Repeated vomiting between meals
• Insatiable thirst
• Total food refusal for more than 12 hours
• Difficulty in mobilizing a limb or gait change
• Fever lasting more than 5 days.

In a child with a fever, what are the "soothing signs"?
Although they may be uncomfortable for the child and may require medical observation, these signs suggest minor illness:

• Child who plays and has normal activity
• Open or easy smile
• Pain swallowing with white plaques in the throat and/or associated with red eyes and/or cough
• Painful, red, bleeding gums
• Oral thrush
• Mild (or moderate) diarrhoea without blood, mucus or pus
• Eats less, but does not refuse liquids
• Is soothed when picked up and behaves regularly
• Very frequent dry and irritating cough, which is the symptom that most disturbs the child
• Wheezing without breathing difficulty
• Red eyes with secretions
• Scattered red spots that appear only after the 4th day of fever.

What to do when the child / adolescent has a fever?

• Offer water and/or milk; adjust clothing and bedding according to the feeling of cold or heat; respect his/her appetite

• If he/she is comfortable, you don’t need to lower the temperature, but keep an eye out for “warning signs” (described above)

• If he/she is uncomfortable, you should take an antipyretic (which is also an analgesic, that is, it relieves pain); but you should not try to cool him/her with a bath, compresses, fans, etc

• As with antipyretics, you can also use paracetamol and/or ibuprofen (exceptions: allergy; age <6 months; chickenpox; diarrhoea and moderate to severe vomiting). They can be administered individually every 8h or, if febrile peaks are close, alternated up to 4h.

   

The antipyretic is considered to be effective if the temperature drops by 1.0º to 1.5ºC in 2 to 3 hours. The purpose of the antipyretic is to relieve the child's discomfort and not eliminate fever at all costs. Even if not medicated, the temperature will, as a rule, end up spontaneously dropping a few hours later, rising again after a few hours, and so on, until the disease passes.

When should a child / teenager with a fever go to the hospital/contact a paediatrician?

• Age less than 3 months of age (corrected age if premature)
• Age less than 6 months with axillary temperature ≥ 39.0ºC or rectal ≥ 40.0ºC
• Axillary temperatures greater than 40.0 ° C or rectal temperatures greater than 41.0 ° C
• Presence of one or more “warning signs” (described above)
• If a serious chronic disease coexists
• If fever has been present for 5 or more days, or if the fever reappears after2 to 3 days at normal temperatures.

Key points to remember

• Fever is just a symptom and not a disease
• The treatment of fever (antipyretics) does not shorten the duration of the fever or contribute to the resolution of the causative disease; if the temperature does not return to normal after the administration of antipyretics, alone, it is not a cause for concern as long as it drops from 1.0º to 1.5ºC
• The treatment of fever prevents febrile seizures which, globally, are uncommon (<1% of febrile episodes up to 2 years old, decreasing after that age); seizures frighten those who witness them, but, as a rule, they do not cause brain damage
• In the fever rising phase, cooling (with a bath, wet compresses, alcohol or fans) is not recommended: it does not contribute to the control of the disease, nor to the well-being of the child
• The presence of “warning signs”, the child's general condition and/or being less than 3 months old, are more important than the temperature degrees and/or the duration of the fever
• The appearance (or not) of the “warning signs” dictates the need (or not) to be observed, regardless of the day of fever
• Viruses, responsible for the vast majority of febrile episodes, last on average 4 full days (and 5 days, or more, in 30% of cases).