Is Your Child’s Headache Cause for Concern?

When your child complains of a headache, it can be anything from a plea to stay home from school in hopes of avoiding a test, to a sign of something more serious. But how can you tell the difference? And when is it time to see the pediatrician? Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s, offers advice on what parents can do to keep headaches at bay, the importance of identifying a pattern in your child’s headaches, options for treatment, and what types of headache warrant a trip to the emergency department.

Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s, offers advice for parents concerned about their child’s headaches.

First, it’s important to be able to identify what type of headache your child may be suffering from.

What type of headache does my child have?

Migraine symptoms in kids

At least 5 attacks that meet the following criteria:

  • Headache lasting 1 – 72 hours
  • Headache has at least two of the following features:
    • Pain on both sides or only one side of the head
    • Pain is pulsating
    • Moderate to severe intensity
    • Aggravated by routine physical activities
  • At least one of the following:
    • Nausea and/or vomiting
    • Sensitivity to light or noise

If your child has more than 15 headache days per month over a three-month period, and at least half of those are migraines, they may be suffering from chronic migraines.

It’s a common misconception to assume that only adults suffer from migraines, which isn’t true, says Dr. Taraman. If your child has migraines, they are not alone. About 1 out of every 20 kids, or about 8 million children in the United States, gets migraines. Before age 10, an equal number of boys and girls get migraines. But after age 12, during and after puberty, migraines affect girls three times more often than boys.

Tension headache symptoms in kids

  • Headache lasting from 30 minutes to seven days
  • Headache has at least two of the following characteristics:
    • Pain in two locations
    • Pressing or tightening feeling (not a pulsing pain)
    • Mild to moderate intensity
    • Not aggravated by routine physical activity such as walking or climbing stairs
  • No nausea or vomiting – many children experience a loss of appetite
  • Either sensitivity to light or sensitivity to sound
  • Tension headaches occur most often in children ages 9-12

Cluster headache symptoms in kids

  • At least five headaches that meet the following criteria:
    • Severe pain in one location: within the eye, above the eyebrow, or on the forehead, that lasts from 15 minutes to three hours when left untreated
  • Headache is accompanied by at least one of the following symptoms on the same side of the body as their pain:
    • Conjunctival injection and/or lacrimation
    • Nasal congestion and/or excess mucus in the nose
    • Eyelid swelling
    • Forehead and facial swelling
    • Droopy eyelid and/or small pupil
    • A restlessness or agitation
  • Cluster headaches usually start in children at around 10 years old

Post traumatic headache symptoms in kids

  • Acute post traumatic headache: lasts less than three months and caused by a traumatic injury to the head
  • Persistent post traumatic headache: lasts more than three months and caused by a traumatic injury to the head
  • Both acute and persistent headaches develop within one week of: the injury to the head, regaining of consciousness following injury to the head, or discontinuing medicine that impairs the ability to sense a headache following a head injury
  • Extended recovery risk factors:
    • Prolonged loss of consciousness or amnesia
    • Females
    • Initial symptom severity
    • Premorbid history of ADHD, mood disorders, and migraines

Sleep apnea headache symptoms in kids

  • Typically occurs in the morning
  • Pain is present on both sides of the head
  • Lasts more than four hours
  • Not accompanied by nausea, nor sensitivity to light or sound

Medication overuse headache symptoms in kids

  • Headaches on 15 or more days per month
  • Takes over-the-counter medication for headaches more than three times per week over a three-month period
  • Headache has developed or gotten worse during medication overuse
  • Pattern of headaches resolves or improves within two months after discontinuing the overused medication

What to do when your child has a headache

A variety of non-medical interventions can be helpful for children who are suffering from headaches. These non-medical interventions for headaches include: ice packs; warm baths; taking a nap in a cool, dark room; neck and back massage; and taking a walk.

Parents shouldn’t be tempted to immediately turn to medication such as ibuprofen or naproxen, says Taraman.  Over-the-counter pain medications (such as Tylenol or Motrin) should be limited to no more than three days per week with no more than two doses per day, in order to avoid medication overuse headaches. Follow the dosing instructions on the label and ask your child’s pediatrician or pharmacist any questions before beginning a treatment regimen. Follow dosage instructions given by your physician or pharmacist, or download a guide to ibuprofen and naproxen.


How to avoid headaches

There are a number of things parents can do to prevent headaches, says Dr. Taraman. These include:

How to talk to your pediatrician about your child’s headaches:

Keep a journal of your child’s headaches so you can identify a pattern, and show your child’s primary care physician. If you don’t have a primary care provider, find one near you. In your headache journal, keep track of:

  • Headache start date and time
  • What happened just before the headache?
  • How much did your head hurt, on a 0-10 pain scale?
  • Where did your head hurt?
  • What did you feel just before and during the headache?
  • What did you do to make yourself feel better?
  • Did you feel better, on a 0-10 pain scale?
  • Headache end date and time

Your child’s pediatrician may adjust your child’s diet, headache hygiene routine, or their NSAID regime. In some cases, your primary care provider may refer you to a pediatric neurologist, who have specialized training in the nervous system (brain, spinal cord, muscles and nerves), who work in tandem with imaging and other specialists and pediatricians as necessary.

Patients should immediately be taken to the emergency department for some headaches including:

  • Thunderclap headache: severe, sudden onset of pain that occurs anywhere in the head, and grabs your attention like a clap of thunder. Pain usually peaks within 60 seconds to a few minutes.
  • Any headache that comes with weakness or numbness on one side of the body, or changes in consciousness or awareness.
  • Blurred, double or loss of vision that persists after the headache resolves.

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Kids and Throwing Up: Should You Worry?

Throwing up is no fun, for kids and parents alike. It can also be alarming. A CHOC Children’s pediatrician explains what causes children to vomit and when to be concerned.

The most common cause of throwing up is a stomach virus, otherwise known as the stomach flu or acute gastroenteritis, according to Dr. Reshmi Basu. It is often accompanied by diarrhea. Vomiting could also be caused by reflux in babies, a toddler’s aversion to certain smells or foods, motion sickness, food allergies, food poisoning, urinary tract infection, appendicitis or other less common conditions.

“It’s also really common for a child to cough so hard that they throw up,” Dr. Basu says. “This can be scary, but should go away once the underlying cause of the cough is resolved.”

Treatment for vomiting varies depending on the cause. In some cases, anti-nausea medication may be prescribed to give your child some relief. A stomach virus should clear up on its own after a few days. When vomiting is caused by reflux, food allergies or motion sickness, the underlying issue can be treated.

A child who vomits one time and has no other symptoms should be fine, Dr. Basu says. They may just have an upset stomach or strong gag reflex.

When to Call the Doctor

Call the doctor if your child:

· Is throwing up for more than two days but has no other symptoms

· Has severe abdominal pain with vomiting

· Has severe headaches with vomiting

· Has a high-grade fever with vomiting

· Has unexplained weight loss with vomiting, or

· Has any signs of dehydration (see below)

“Also, if your child or teen is throwing up periodically over a prolonged period of time, without any obvious reason, I would want to investigate that,” Dr. Basu says.

Watch Out for Dehydration

Kids who have thrown up multiple times are at risk for dehydration, and that risk goes up the younger they are or if they also have diarrhea. Signs of dehydration include extreme fatigue, tired-looking sunken eyes, going several hours without urinating, dark urine, dry lips, dry mouth, dizziness, and, in babies, crying without tears or a sunken soft spot. Your child should see a doctor immediately if they have any of these symptoms.

To prevent dehydration, encourage your child to drink lots of fluids. Pedialyte is best, but if they refuse that then offer what they will take such as water or diluted juice, although it is better to avoid milk. Your child’s stomach may only be able to handle small amounts at first. Dr. Basu recommends starting with 1 tablespoon of fluid; wait 10 minutes, then try 2 tablespoons, and gradually increase as tolerated.

Your child should see a doctor if they cannot tolerate any liquids.

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  • 3 Surprising Causes of Stomach Pain in Kids
    Some sources of stomach pain are obvious, but here are three surprising causes of stomach pain in children.

Longtime CHOC Pediatrician Retires

Dr. Michael Shannon can’t walk through the lobby of Sea View Pediatrics without at least one parent coming in for a hug.

After nearly 45 years in pediatric health care in Orange County, he’s earned more than a few fans – and the respect is mutual.

“Much of what a pediatrician learns is after training,” Dr. Shannon says.

Bring on the hugs though: At the end of this month, the 73-year-old will retire, completing a career that has spanned more than four decades and thousands of patients.

Born in Kansas, Dr. Shannon crisscrossed the country as a youth and young adult before ultimately attending medical school at Northwestern University in Illinois.

Dr. Shannon pursued a career in medicine following a childhood with frequent visits to doctors’ offices.

“I had bad allergies as a kid, an early tonsillectomy, a hernia at 7, appendicitis and asthma,” he says. “I was in the doctor’s office quite a bit. My parents seemed to like him, so I thought that would be a good thing to do.”

When it came to choosing his specialty, Dr. Shannon settled on pediatrics because he enjoyed the innocent nature of children.

“I always liked kids. Children don’t judge you, and their charts were really thin,” he says with a laugh.

When it came time for his residency and internship, Dr. Shannon and his wife, who’d long grown tired of cold Midwestern winters, headed west to California.

Ultimately, the pair settled in Orange County, where Dr. Shannon began a private pediatrics practice in July 1973. He practiced near Mission Hospital until 1995, when he joined Sea View Pediatrics, now a part of the CHOC Children’s Network.

Over more than four decades of practice, Dr. Shannon has treated thousands of Orange County children.

“I remember him being a cool doctor,” says Steve Concialdi, a patient of Dr. Shannon’s as a child and who is now a captain with the Orange County Fire Authority. “He was hip and he was fun.”

Steve Concialdi with Dr. Michael Shannon, who cared for him as a child and now cares for the next generation of Steve’s family.

The doctor reached an icon status for a young Steve when he was about 10. He’d been battling a cold and his mother thought he should skip a school whale watching trip. After hearing Dr. Shannon’s opinion, mom Bonnie was swayed and Steve went on the trip.

“I went and I had a blast,” he says. “I ended up throwing up, but that’s because I got sea sick. But I just remember as little boy, what a cool doctor he was. We saw Dr. Shannon for years.”

And so, when Steve and his sister, Carrie, started their own families, Dr. Shannon was a clear choice for their children’s pediatrician – and Bonnie agreed.

Dr. Shannon with Gracie Concialdi at her first appointment; her father, Steve Concialdi; grandmother, Bonnie; and her brother, Andy Concialdi.

“I told them, you’ve got to go to Dr. Shannon,” she said. “I wouldn’t stand for anyone else. I went to their first appointments too. I wanted to see Dr. Shannon because I missed him.”

The Concialdis are just one of many families in Orange County that have had generations of children see Dr. Shannon. The phenomenon is a testimony to Dr. Shannon’s long career and strong relationships with his patients and families.

And that bond was never more evident than in March 2011, when he was seriously injured in a car accident. His patients and families – past and present – showed an outpouring of concern for him during a long recovery period.

The swell of support clarified for Dr. Shannon the impact his career had made on patients and families.

“The accident made me feel even more than ever before that I didn’t want anything happening to my babies,” he says of his patients.

And now, nearly seven years later, Dr. Shannon says he’s ready to hang up his stethoscope and entrust the care of his babies to the other Sea View physicians.

Dr. Shannon plans to spend his retirement traveling and focusing on his grandchildren. His future trips include travel to Louisville, Ky., to visit his daughter, Vanessa, and Ireland and Spain.

Looking for a pediatrician? Find one near you.

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3 Surprising Causes of Stomach Pain in Kids

Children complaining of stomach pain is common, and some sources – like constipation, food allergies or even appendicitis – are obvious.

But a few illnesses might not come to mind first when considering the source of a child’s stomachache. Here is information from the American Academy of Pediatrics (AAP) about some causes of stomach aches that might surprise parents.

Strep throat
Even though this diagnosis is tied to another relatively distant body part, strep throat can also cause stomach pain.

An infection caused by a bacterium called streptococci, strep throat’s more obvious symptoms are a sore throat and fever, and sometimes vomiting or headaches.

Parents who suspect their child has strep throat should visit the pediatrician, who will swab the child’s throat to test for bacteria. If positive, the physician will prescribe antibiotics.

Urinary tract infection (UTI)
Though the tell-tale sign of a UTI is pain and burning during urination, these infections can also cause discomfort in the abdomen.

UTIs are a common ailment in children, with more than 1.3 million children treated annually for the condition. Girls ages 1 to 5 are more likely than other children to experience a UTI.

Parents who suspect their child has such an infection should visit the pediatrician, who will prescribe an antibiotic following a positive diagnosis.

Learn how to prevent UTIs in children.

Emotional upset
Stomach pain can also be the result of sadness, stress or anxiety. Though this type of pain is more common in school-age children, children younger than 5 under unusual stress may also experience it.

Parents should carefully assess the child for other symptoms that might indicate an illness such as fever, vomiting, weakness, pain while urinating, sore throat or diarrhea. If none of those are present, consider other aspects, like timing: Does it wax and wane over a period of more than a week, and surface around activities that are unpleasant or stressful?

A lack of other physical symptoms and pain with curious timing could point to emotional upset. In this case, talk to the child about what’s bothering them. A pediatrician can also suggest ways to help, and, if necessary, refer the child to a therapist, psychologist or psychiatrist.

When to call the doctor

No matter the source, stomachaches should be taken seriously. Not all aches require a doctor’s appointment, but here are some signs from the AAP that medical attention is necessary:

  • Abdominal pain that comes on suddenly or persists
  • The child has other symptoms, such as a change in his bowel pattern, vomiting, fever (temperature of 100.4°F or higher), sore throat or headache
  • A baby younger than 1 year shows signs of stomach pain such as legs pulled up toward the abdomen or unusual crying
  • A child aged 4 or younger has recurrent stomachache
  • If abdominal pain awakes a child or stops him from sleeping
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How to Prepare Your Family for Flu Season

Flu season is here, and there are several things you can do to help prepare your family for flu season.  Here, Dr. Daniel Mackey, a CHOC Children’s pediatrician, answers some of parents’ most common questions about how to prepare your family for flu season.

Dr. Daniel Mackey
Dr. Daniel Mackey, a CHOC Children’s pediatrician

Is the nasal flu vaccine available this year?

An advisory committee of the Centers for Disease Control and Prevention (CDC) recently recommended that the nasal spray influenza vaccine not be used this upcoming flu season.

When should my child get a flu shot?

Vaccines are already available for the 2017-2018 influenza season. Children up to eight years of age who have not received a flu vaccine in the past may need two doses, four weeks apart.

Who needs a flu vaccine?

The CDC recommends the flu vaccine for all people age 6 months and older. Certain people are at higher risk of complications from the flu, so it’s especially important that these people (and people who live with them) get vaccinated. They include:

  • pregnant women
  • kids younger than age 5
  • people age 65 and older
  • people of any age who have long-term health conditions

Can my child get the flu from the flu vaccine?

No. You cannot get the flu from getting the flu vaccine. The vaccine prevents influenza, however it does not prevent against other strains of viruses.

What sort of flu season is expected this year?

Physicians can’t predict what the flu season will be like. Every influenza season, the severity and length varies, which is why it’s important to get vaccinated every year.

Besides ensuring their children get a flu vaccine, what else can parents do to help prevent the flu?

In addition to ensuring their child is vaccinated against the flu every year, there are many things parents and other caregivers can do to help prevent the flu. Use proper hand-washing techniques, use respiratory etiquette, and stay home from work or school if you are sick with the flu, to prevent spreading it to others.

Looking for a pediatrician? Find one near you.

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