Watery itchy eyes

• clogged sinuses

• ticklish or sore throat from postnasal drip

Consult a Doctor

A doctor should be consulted if the child:

• has trouble breathing

• is wheezing severely

• has green or yellow nasal discharge

• is miserable due to the symptoms

• has symptoms that become much worse

Diagnosis

A child with severe allergies should see an allergist to determine the actual substances that cause the allergic reactions. Skin or blood tests may be recommended to determine the specific allergen.

Treatment

An antihistamine can help relieve symptoms by blocking the allergic reaction, and a brief course of decongestants can help open up the nasal passages. The child should gently blow mucus from the nose but should not blow hard because that could lead to an ear infection or bloody nose. The child may need more rest when suffering from an allergy. In haled steroids and antihistamine eye drops can help ease stuffy noses and itchy eyes.

The home (especially the child's bedroom) should be kept as clean as possible. The child's nose and mouth should be covered with a mask while doing things that may trigger the allergic reaction. Children with an animal-dander allergy should not have pets in the bedroom; otherwise, the pet should be kept clean and well groomed. Families of children with a mold allergy should use an air conditioner with an electrostatic filter during the summer. Children with a pollen allergy should be kept indoors as much as possible during pollen season, especially on dry, windy days.

Prevention

Avoiding the known allergens is the best course of action. A series of injections to help the child become less sensitive to the allergen may help.

headache Headaches are an uncomfortable reality not just for adults but also for up to 20 percent of children from about age five to 17. Typically, chronic headaches in childhood occur most often as a result of tension (15 percent), although five percent of the time headaches are migraines. By the time they reach high school, most teenagers have experienced some type of headache, but less than 5 percent are due to serious problems such as a tumor or head injury.

If a child who has only had a headache once or twice a month suddenly starts experiencing them three or four times a week, the headaches have become chronic and a doctor should be consulted. A few children have their first headaches before they reach elementary school. If a young child cries or stops eating or has been restless or irritable, a doctor should be consulted.

Migraines

Migraines can occur in children as young as four years of age; most boys will outgrow migraines by their early teens. Girls, however, usually experience more migraines as they enter adolescence as a result of hormonal changes. Most children who have migraines have inherited the tendency, especially if they also experience motion sickness.

Cause Migraines are often called "vascular headaches" because they occur when the blood vessels constrict or expand. Although constricting blood vessels do not cause pain, they can temporarily affect vision or balance. It is when blood vessels dilate, however, that their expansion triggers pain.

In some children, certain things trigger a migraine, such as stress, a change in routine or sleep patterns, bright lights, loud noises, or certain foods and beverages.

Symptoms Unlike adults, children experience a migraine on both sides of the head, along with nausea, vomiting, dizziness, blurred vision, sensitivity to light and sound, and changes in temperament and personality. Unlike an adult's experience, a child may suffer with a migraine in only an hour, or for no longer than a day. About 15 percent of children also experience an "aura" several minutes before the onset of the migraine, featuring blurred vision, blind spots, or seeing colored or flashing lights, or wavy lines. A few children also may stumble or may have trouble expressing themselves.

Migraine variants In addition to traditional migraines, other less common forms of migraines can affect children. Hemiplegic migraine causes weakness of the arm or leg on one side of the body before, during, or after the actual headache. The weakness usually goes away within 24 hours. oral contraceptives may increase the frequency of this migraine variant.

Ophthalmoplegic migraine is a rare headache that occurs in children, affecting the nerves and characterized by drooping eyelids, dilated pupils, and paralysis of the eye muscles along with a severe headache. It may last for weeks.

Basilar artery migraines can occur in younger people and generally last just a day. Symptoms are caused by a diminished blood supply to the parts of the brain supplied by the basilar artery and include dizziness, vertigo, nausea, double vision, unsteady gait, slurred speech, confusion, and weakness.

Confusional migraines occur in adolescents, triggering headache, confusion, and disorientation that may last up to 12 hours. Rarely, teens may experience a prolonged stupor or comatose state that may last up to seven days.

Paroxysmal vertigo is a condition that occurs in children between two and six years of age in which a sudden, intense episode of loss of balance and dizziness last for a few moments.

Alice-in-Wonderland syndrome is a very rare condition in which a child experiences bizarre visual illusions and spatial distortions associated with migraines. Children describe objects that seem smaller than their actual size (micropsia) or larger than their actual size (macropsia) and other perception distortions.

Treatment Several types of medication can ease the symptoms of migraine. Acetaminophen or ibuprofen can ease migraine pain for children and adolescents, and pediatricians may prescribe a sedative to help a child rest. Young children who experience very frequent migraine attacks that interfere with school and other activities might be given preventive medications such as cyprohepta-dine, propranolol, tricyclics, or calcium-channel blockers.

Adolescents who have occasional migraines without an aura may take medications to stop the migraine, including ergotamine tartrate and caffeine (Cafergot); a combination medication (Midrin); and triptans (Imitrex, Zomig, Amerge, and Maxalt). Teens whose migraines are more frequent might be given preventive medications such as propranolol, tricyclic antidepressants, calcium-channel blockers, or anticonvulsants, such as divalproex sodium (Depakene, Depakote). None of these medications is approved for migraine treatment in children.

In addition to medication, many migraine sufferers find biofeedback and relaxation techniques may be helpful. Relaxation techniques such as deep breathing exercises, progressive muscle relaxation, mental imagery relaxation, or relaxation to music can be very effective in alleviating a migraine headache. Instruction for these techniques is available on audio tapes and CDs, and some record shops and bookstores carry them.

Prevention The best way to prevent migraines is to identify what triggers their onset:

• Stress Exercise, rest, and hobbies can reduce stress. Some children can reduce migraines by learning biofeedback techniques to control stress.

• Good diet Children should always eat three balanced meals, because skipping meals lowers the blood sugar level and can cause migraines.

• Caffeine Suddenly cutting back on caffeine can trigger a migraine, as can drinking too many caf-feinated beverages. Cutting back on caffeine should be done slowly.

• Food Certain foods or additives can trigger a migraine in some children, including aged cheeses, pizza, luncheon meats, sausages or hot dogs containing nitrates, chocolate, yogurt, and MSG (monosodium glutamate).

• Sleep Children should have consistent sleep schedules and avoid lack of sleep, which can trigger migraines.

• Hormones ovulation and menstruation can trigger migraines or increase their frequency.

Tension-Type Headaches

Tension headaches can either be episodic or chronic, and occur far more frequently in children than do migraines. The episodic headache can occur several times a month, while a child may suffer with chronic headaches almost every day.

Symptoms Episodic tension headaches produce a moderate pain that feels like a band of pressure around the head. These headaches often begin gradually in the middle of the day, lasting anywhere from a half hour to all day.

Conversely, chronic tension headaches seem to be ever-present with a dull throbbing on the front, top, and sides of the head, together with a band of pressure and soreness.

Cause Children's tension headaches are often caused by stress, depression, or insufficient rest, but they are not inherited and are not caused by disease.

Treatment Heat or an ice pack on the head can ease the pain. Because tension headaches are triggered by emotional stress related to family, school or schoolmates, or friends, the best way to eliminate the pain is to work on easing the stress. A nap, walk, or warm bath or shower may help. Relaxation techniques such as deep breathing exercises, progressive muscle relaxation, mental imagery relaxation, or relaxation to music can be very effective in reducing or eliminating the tension that produces a headache.

Counseling can help a child or adolescent better understand and appreciate where the headaches are coming from and can help children and their families to identify and manage stressful situations. Headaches also can be managed by using biofeedback, in which sensors are connected to the body to monitor changes in muscle tension, blood pressure, or heart rate. Feedback is displayed on a computer screen, so that a child can learn to recognize the signs of tension and apply a relaxation technique to ease stress.

Nonprescription medications such as acetaminophen (Tylenol), ibuprofen (Advil or Motrin), or naproxen sodium (Aleve) can ease the symptoms of either episodic or chronic headaches. Children under 14 should not take aspirin because of its connection to reye's syndrome.

Some doctors may prescribe medications to reduce the frequency and severity of chronic tension headaches. Preventive medications include antidepressants with a sedating effect, such as amitriptyline (Elavil).

Organic Headaches

Fortunately, fewer than 5 percent of children's headaches are caused by serious disease or physical problems such as an abscess, head injury, tumor, blood clots, intracranial bleeding, or meningitis. Nevertheless, a physician will want to rule out these causes.

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