Endocrine Glands, Growth & Diabetes

Acanthosis nigricans (ah-kan-THO-sis NY-gruh-kans) is a skin condition. It causes thicker and darker patches or streaks around joints and body areas with many creases and folds (such as knuckles, armpits, elbows, knees, and the sides and back of the neck).

Some people also develop acanthosis nigricans on their palms, groin, lips, or, in very rare cases, non-crease areas like the face, back, arms, or legs. The skin may stay soft, which is why the word “velvety” is often used to describe the symptoms of acanthosis nigricans.

Acanthosis nigricans is not an infection and isn’t contagious. A few kids might have mild itching, but otherwise acanthosis nigricans is harmless. Still, a doctor will run tests to rule out underlying causes that could require treatment.

Managing acanthosis nigricans means treating the conditions that are causing the skin darkening.

Causes

Acanthosis nigricans is most commonly found in children with high blood insulin levels, a condition often associated with kids who are overweight or obese or have diabetes.

Sometimes acanthosis nigricans can be a warning sign of other more serious conditions, such as certain cancers and endocrine problems, along with type 2 diabetes and the health issues associated with obesity.

In rare cases, acanthosis nigricans can be caused by certain medicines, such as oral contraceptives and cholesterol medicine. In some cases, it can be hereditary (passed on to a person by his or her parents).

Symptoms

Usually, the only signs of acanthosis nigricans will be dark, thick, velvety patches of skin in creases and folds, usually in the neck, armpits, or groin. But it’s sometimes found in the lips, palms, knuckles, soles of the feet, and other areas. In rare cases, children may have mild itching in the affected areas.

The patches of skin will usually change color slowly, over the course of months or even years. If your child’s skin changes color rapidly, call your doctor right away. It could be a sign of a serious medical condition.

Diagnosis

If your child develops acanthosis nigricans, see your doctor, who can determine whether there’s a serious cause. Doctors can generally make a diagnosis of acanthosis nigricans by taking a look at the affected skin.

To test for other conditions, the doctor may order blood tests or an X-ray.

Treatment

Most cases of acanthosis nigricans only involve changes in skin color and thickness, and there is no set treatment for it. For many kids, acanthosis nigricans requires no treatment at all; for some, the dark skin will eventually fade on its own.

For cases of acanthosis nigricans where an underlying cause is found, treating the cause can make the dark patches of skin fade or disappear entirely. This can mean stopping any medicine that might be causing the problem or treating any health issues.

For most kids, the best treatment for acanthosis nigricans is to maintain a healthy weight and get plenty of exercise. Encourage your child to eat a good diet and make healthy lifestyle choices. Several studies show that eating well and exercising can help lessen, and in some cases prevent or reverse, acanthosis nigricans.

Living With Acanthosis Nigricans

Acanthosis nigricans can be highly visible and hard to cover up — especially if it happens on the neck or hands. So having it it can be embarrassing for kids. They may feel self-conscious and might be teased by classmates.

To help kids feel better about their appearance, doctors often prescribe creams and lotions that can help lighten the skin. Ask as many questions as you need to in order to understand when and how to follow the treatment plan.

Don’t believe the hype about bleaches, skin scrubs, and over-the-counter exfoliating treatments — these aren’t likely to work and can irritate the skin, not to mention waste money.

As a parent, you can do a lot to help your child manage worry and feel less embarrassed. Talk openly about acanthosis nigricans and let your child know that he or she is not alone. Ask a doctor about local support groups or other resources that can help your child feel more confident.

Parents want to protect their kids from everything, which is virtually impossible, of course. But can you prevent your child from getting diabetes?

About Diabetes

Diabetes is a disease that affects how the body uses glucose, the main type of sugar in the blood. Glucose, which comes from the foods we eat, is the major source of energy needed to fuel the body’s functions. To use glucose, the body needs the hormone insulin. But in people with diabetes, the body either can’t make insulin or the insulin doesn’t work in the body like it should.

The two major types of diabetes are:

1. Type 1 diabetes, in which the immune system attacks the pancreas and destroys the cells that make insulin
2. Type 2 diabetes, in which the pancreas can still make insulin, but the body doesn’t respond to it properly

In both types of diabetes, glucose can’t get into the cells normally. This causes a rise in blood sugar levels, which can make someone sick if not treated.

Can Type 1 Diabetes Be Prevented?

Type 1 diabetes can’t be prevented. Doctors can’t even tell who will get it and who won’t.

No one knows for sure what causes type 1 diabetes, but scientists think it has something to do with genes. But just getting the genes for diabetes isn’t usually enough. In most cases, a child has to be exposed to something else — like a virus — to get type 1 diabetes.

Type 1 diabetes isn’t contagious, so kids and teens can’t catch it from another person or pass it along to friends or family members. And eating too much sugar doesn’t cause type 1 diabetes, either.

While type 1 diabetes can’t be prevented, some research suggests that breastfeeding, avoiding early introduction of solid foods, and other factors might play a role in lowering the risk of developing the disease. There’s no reliable way to predict who will get type 1 diabetes, but blood tests can detect early signs of it. These tests aren’t done routinely, however, because doctors don’t have any way to stop a child from developing the disease, even if the tests are positive.

Can Type 2 Diabetes Be Prevented?

Unlike type 1 diabetes, type 2 diabetes can sometimes be prevented. Excessive weight gain, obesity, and a sedentary lifestyle are all factors that put a person at risk for type 2 diabetes.

In the past, type 2 diabetes almost exclusively affected adults, usually those who were overweight. Doctors even referred to type 2 diabetes as adult-onset diabetes. But now, more children and teens are being diagnosed with type 2 diabetes, which experts say is related to the rapidly increasing number of overweight kids.

Although kids and teens may be able to prevent or delay the onset of type 2 diabetes by managing their weight and increasing physical activity, other risk factors for type 2 diabetes can’t be changed. Kids with one or more family members with type 2 diabetes have an increased risk of developing the disease. Also, certain ethnic and racial groups tend to be more prone to developing it, including those of Native American, African, Hispanic/Latino, or Asian/Pacific Island descent.

Taking Steps to Prevent Type 2 Diabetes

These simple strategies can help reduce your kids’ risk for developing type 2 diabetes and other associated health problems:

• Make sure kids eat a healthy diet. Encouraging your kids to eat low-fat, nutrient-rich foods — like whole-grain cereals and breads, fruits, vegetables, dairy products, and lean proteins — can help prevent excessive weight gain, a major risk factor for type 2 diabetes.
• Limit sugary foods and beverages. Consuming lots of sugar-filled foods and beverages — like sodas, juices, and iced teas — also can lead to excessive weight gain.
• Encourage increased physical activity. Staying active and decreasing the amount of time spent in sedentary activities — like watching TV or playing video or computer games — can also reduce the risk of weight gain and help prevent the onset of type 2 diabetes. Being active can be as simple as walking the dog or mowing the lawn. Try to do something that gets you and your kids moving every day.

If you think your child may be overweight and, therefore, at increased risk of type 2 diabetes, talk to your doctor or a registered dietitian. They can help you determine what your child’s weight goals should be and how to reach them.

It’s important for growing kids to get enough calories and nutrients for normal growth and development, while preventing the excessive weight gain that can set the stage for type 2 diabetes and other health problems.

Most kids steadily gain weight and grow quickly within the first few years of life. But in some cases, kids don’t meet these expected standards of growth. When this happens, it’s called “failure to thrive.”

Doctors say children “fail to thrive” when they don’t gain weight as expected. Often, these kids also have poor linear (height) growth.

Many things can cause failure to thrive, including illnesses and eating problems. Once doctors find the cause of the problem, they can work with families to help get a child back into a healthy growth pattern.

About Failure to Thrive

Although it’s been recognized for more than a century, failure to thrive lacks a clear definition, in part because it’s not a disease or disorder itself. Rather, it’s a sign that a child is undernourished. In general, kids who fail to thrive don’t receive or cannot take in, keep, or use the calories that would help them grow and gain enough weight.

Doctors usually diagnose the condition in infants and toddlers — an important time of physical and mental development. After birth, a child’s brain grows as much in the first year as it will grow for the rest of a child’s life. Poor nutrition during this period may have lasting harmful effects on brain development.

Most babies double their birth weight by 4 months and triple it by age 1, but kids who fail to thrive usually don’t meet those milestones. Sometimes, a child who starts out “plump” and seems to be growing well may gain less weight later. After a while, height growth may slow as well.

If the condition continues, undernourished kids might:

• lose interest in their surroundings
• avoid eye contact
• become fussy
• not reach developmental milestones like sitting up, walking, and talking at the usual age

Causes

A number of things can cause failure to thrive, including:

• Not enough food offered. In some cases, parents mistakenly cause the problem. Sometimes a parent measures formula incorrectly, causing an infant to get too few calories. Problems with breastfeeding or transitioning to solids also can cause failure to thrive. Parents who worry their child will get fat may restrict the amount of calories they give their infants. And sometimes parents don’t pay enough attention to their children’s hunger cues or can’t afford enough food for their children.
• The child eats too little. Some children have trouble eating enough food because of prematurity, developmental delays, or conditions like autism in which they do not like eating foods of certain textures or tastes.
• Health problems involving the digestive system. Several health conditions can prevent a child from gaining weight. These include gastroesophageal reflux (GER), chronic diarrhea, cystic fibrosis, chronic liver disease, and celiac disease.

  With reflux, the esophagus may become so irritated that a child refuses to eat because it hurts. Persistent diarrhea can make it hard for the body to hold on to the nutrients and calories from food. Cystic fibrosis, chronic liver disease, and celiac disease all cause problems with the body’s ability to absorb nutrients. The child may eat a lot, but the body doesn’t absorb and retain enough of that food. Kids with celiac disease are allergic to gluten, a protein found in wheat and other grains. The immune system’s abnormal response to this protein damages the lining of the intestine so it can’t absorb nutrients properly.

• Food intolerance. A food intolerance, which is different from a food allergy, means the body is sensitive to certain foods. For example, milk protein intolerance means the body can’t absorb foods that have milk proteins, such as yogurt and cheese, which could lead to failure to thrive.
• An ongoing illness or disorder. A child who has trouble eating — because of prematurity or a cleft lip or palate, for example — may not take in enough calories to support normal growth. Other conditions involving the heart, lungs, or endocrine system can increase the amount of calories a child needs and make it hard for the child to eat enough to keep up.
• Infections. Parasites, urinary tract infections (UTIs), tuberculosis, and other infections can force the body to use nutrients rapidly and decrease appetite. This can lead to short- or long-term failure to thrive.
• Metabolic disorders. Metabolic disorders are health conditions that make it hard for the body to break down, process, or take energy from food. They also can cause a child to eat poorly or vomit.

Sometimes a mix of medical problems and environmental factors leads to failure to thrive. For instance, if a baby has severe GER and is reluctant to eat, feeding times can be stressful. The baby may become upset and frustrated, and the caregiver might be unable to feed the child enough food.

Other times, doctors aren’t sure exactly what causes the problem.

Diagnosis

Many babies go through brief periods when their weight gain levels out, or they even lose a little weight. This is not unusual. However, if a baby doesn’t gain weight for 3 months in a row during the first year of life, doctors usually become concerned.

Doctors use standard growth charts to plot weight, length, and head circumference, which are measured at each well-child exam. Children may have failure to thrive if they fall below a certain weight range for their age or fail to gain weight at the expected rate.

To see if there’s a problem, doctors will ask for a child’s detailed health history, including a feeding history. This helps doctors see whether underfeeding, household stresses, or feeding problems might be to blame. A nutritionist or other health care professional also may track the calories in a child’s diet to make sure the child is getting enough.

Doctors might order tests (such as a complete blood count or urine test) to check for underlying medical problems. If a particular disease or disorder is suspected, the doctor might order other tests to check for that condition.

Treatment

Treatment for kids who fail to thrive involves making sure that the child gets the calories needed to grow and addressing any underlying feeding issues. This often requires the help of a care team that may include:

• the primary care doctor or pediatrician
• a registered dietitian to evaluate the child’s dietary needs
• occupational therapists to help caregivers and the child develop successful feeding behaviors
• speech therapists to address any sucking or swallowing problems
• a social worker if a family has trouble getting enough food for the child
• psychologists and other mental health professionals if there are any behavioral issues
• specialists (such as a cardiologist, neurologist, or gastroenterologist) to treat underlying health conditions

Usually, kids who have failure to thrive can be treated at home along with regular doctor visits. The doctor will recommend high-calorie foods and may place an infant on a high-calorie formula. Depending on the child’s feeding habits, doctors may recommend offering foods of certain textures, spacing out meals to make sure children are hungry, avoiding “empty” calories like juices and candies, and other strategies depending on the child’s condition and family situation.

In cases of severe failure to thrive, a child who is not growing with initial treatment may need tube feedings. In tube feedings, a tube is put in that runs from the nose into the stomach. Liquid nutrition is provided at a steady rate through the tube and is usually given at nighttime only. The child can continue with daily activities and eat freely during the day. Once he or she starts getting more calories, the child will feel better and will probably start to eat more on his or her own. At that point, the tube can be removed.

Children with extreme failure to thrive might need to be treated in a hospital. There, they will be fed and monitored around the clock for 10 to 14 days (or longer), until they gain some weight. After that, it still can take months until the symptoms of severe malnutrition are gone.

How long treatment lasts can vary. Weight gain takes time, so it might be several months before a child is back in the normal range. When the condition is due to a chronic illness or disorder, kids may have to be monitored regularly at their doctor’s office. In those cases, treatment may take even longer, perhaps for a lifetime.

Does My Child Have Failure to Thrive?

If you’re worried that your child is failing to thrive, remember that many things can cause slower weight gain. For instance, breastfed babies and bottle-fed babies often gain weight at different rates in the early newborn period.

Genetics also play a big role in weight gain. So if a baby’s parents are slim, the baby may not put on pounds quickly. However, infants should still gain weight steadily. As a general guideline, babies usually eat often in a 24-hour period and should gain about 1 ounce a day in the first month of life. It can be hard to judge this from home (even if you have a scale), so it’s important to see your child’s doctor regularly. Doctors can check for problems at regular well-child checkups, so it’s important to keep these appointments.

When to Call the Doctor

If you notice a drop in weight gain or your baby doesn’t seem to have a normal appetite, call your doctor. Also call about any major change in eating patterns. Toddlers and older kids may have days and sometimes weeks when they show little interest in eating, but that shouldn’t happen in infants.

If you have trouble feeding your baby, your doctor can help. When a child doesn’t readily eat, parents can become frustrated and feel they’re doing something wrong. That can make the problem worse, causing stress for you and your baby. Instead, get help for both of you by talking to your doctor.

Babies come in all sizes. Some are just naturally larger or smaller than others.

But in certain cases, babies in the womb are smaller than they should be. When this happens, it is called intrauterine growth restriction, or IUGR.

About IUGR

IUGR is when a baby in the womb fails to grow at the expected rate during the pregnancy. In other words, at any point in the pregnancy, the baby is not as big as would be expected for how far along the mother is in her pregnancy (this timing is referred to as an unborn baby’s “gestational age”).

Babies who have IUGR often have a low weight at birth. If the weight is below the 10th percentile for a baby’s gestational age (meaning that 90% of babies that age weigh more) the baby is also referred to as “small for gestational age,” or SGA.

It’s important to note that not all babies who are small for gestational age had IUGR while in the womb. For example, some are healthy babies who are just born smaller than average because their parents are small in stature.

The two types of IUGR are:

1. Symmetrical IUGR, in which a baby’s body is proportionally small (meaning all parts of the baby’s body are similarly small in size).
2. Asymmetrical IUGR, which is when the baby has a normal-size head and brain but the rest of the body is small.

Causes

In many cases, IUGR is the result of a problem that prevents a baby from getting enough oxygen and nutrients. This lack of nourishment slows the baby’s growth.

It can happen for a number of reasons. A common cause is placental insufficiency, in which the tissue that delivers oxygen and nutrients to the baby is not attached properly or isn’t working correctly.

Other possible causes during a woman’s pregnancy include:

• certain behaviors, such as smoking, drinking alcohol, or abusing drugs
• exposure to infections (passed from the mother), such as cytomegalovirus, German measles (rubella), toxoplasmosis, and syphilis
• taking certain medications
• high blood pressure
• genetic disorders or birth defects
• living in high altitudes

Risk Factors

IUGR is more likely to occur in women who are carrying more than one baby or who had a previous baby who was SGA or had IUGR. Certain medical conditions, such as some types of heart, lung, blood, or autoimmune disease, and anemia also can increase a woman’s risk of developing IUGR. So can eating poorly or being underweight before or during pregnancy.

Diagnosis

Since not all babies who are small have IUGR, an accurate diagnosis is important. This starts with correctly determining the baby’s gestational age by accurately dating the pregnancy.

At first, gestational age is estimated using the first day of a woman’s last menstrual period. Later in the pregnancy (usually between weeks 8 and 13), it is confirmed through an ultrasound. Once a baby’s gestational age is known, doctors use it to watch the baby’s growth and compare it with the expected growth rate. If the baby is growing more slowly than expected (sometimes referred to as “small for dates”), doctors will continue to watch the baby’s growth and may do more tests to see whether the baby has IUGR.

Watching growth is done in several ways. A measurement called the uterine fundal height helps estimate a baby’s size by measuring a mother’s belly from the top of the pubic bone to the top of the uterus.

Another way is to use ultrasounds. In fact, IUGR is usually diagnosed through an ultrasound examination.

During an ultrasound, a technician coats the woman’s belly with a gel and then moves a probe (wand-like instrument) over it. High-frequency sound waves “echo” off the body and create pictures of the baby on a computer screen. These pictures can be used to estimate the baby’s size and weight.

Although these estimates might not be exact, they help health care providers track the baby’s growth and see if there’s a problem. Ultrasounds also can help identify other issues, such as problems with the placenta or low amniotic fluid levels.

Health care providers also might do other tests if they believe a baby has IUGR, such as:

• fetal monitoring to track the baby’s heart rate and movements
• screenings for infections
• amniocentesis to help find the cause of IUGR (and sometimes to help determine lung maturity and whether the baby is likely to be able to breathe on his or her own)

If a Baby has IUGR

When IUGR is diagnosed, treatment is decided based on the baby’s condition and the woman’s month of pregnancy. The baby will be closely watched (usually with frequent prenatal visits and ultrasounds) to keep track of growth and watch for other potential problems.

Treatment also might include managing any maternal illness and ensuring that the mother eats a healthy and nutritious diet and gains the appropriate amount of weight. Some women are placed on bed rest to try to improve blood flow to the baby.

In some cases, health care providers will recommend inducing labor and delivery early if monitoring shows that a baby has stopped growing or has other problems. Although early delivery might be necessary, the goal is to keep the baby safe in the womb for as long as possible.

A cesarean section (C-section) might be done if the stress of a vaginal delivery is considered too risky for the baby.

Outlook

Unfortunately, babies with IUGR are more likely to have health problems both before and after birth. Those who are born prematurely or are very small at birth are more likely to have problems that result in longer hospital stays. They also might need special care after birth, such as help breathing or medicine to prevent infections.

Other problems that can be related to IUGR include:

• increased likelihood of C-section delivery
• problems with breathing and feeding
• trouble maintaining body temperature
• abnormal blood cell counts
• low blood sugar level (hypoglycemia)
• decreased ability to fight infection
• neurological problems
• increased likelihood of stillbirth (dying in the womb before birth)

The long-term effects of IUGR may depend on the condition that caused the problem in the first place.

Coping

When a woman learns that her baby has or might have IUGR, the best thing she can do is to keep all of her prenatal visits and testing appointments and follow her health care provider’s recommendations. She also should take care of herself by eating a healthy diet; getting enough sleep; and avoiding alcohol, drugs, and tobacco.

Some boys are slower to develop than their peers, and many boys are quiet and shy. There’s a normal range when it comes to physical and social development. But sometimes these qualities show up alongside learning problems or trouble paying attention in school. When this happens, it could be an indication that something else is going on.

If you’re worried about your son’s emotional or physical development, talk to your doctor. Occasionally, symptoms like these can be linked to a condition called Klinefelter syndrome.

About Klinefelter Syndrome

Klinefelter syndrome, also known as XXY syndrome, is a fairly common genetic condition found in males only. It occurs when a boy is born with an extra sex chromosome in most or all of his cells. Many boys with Klinefelter syndrome have no signs or symptoms, and some don’t even know they have it until later in life.

Klinefelter syndrome typically causes a boy’s testicles to grow at a slower rate than those of other boys. It also prevents the testicles from producing normal amounts of sperm and the hormone testosterone. Testosterone affects the way a boy develops both physically and sexually. Low hormone levels and problems with sperm production make it difficult or sometimes impossible for a boy with Klinefelter syndrome to father a child later in life.

The XXY condition that causes Klinefelter syndrome can’t be changed, but medical treatment and working with therapists can help a boy’s development and help lessen the condition’s effects. Even without treatment, most boys with Klinefelter syndrome grow up to live productive, healthy lives.

Cause

Everyone’s genetic material, or DNA, is contained in tiny structures called chromosomes that are found inside their cells. A person’s physical gender (whether they have male or female sex organs) is determined by their sex chromosomes. Females have two X chromosomes, or XX. Most males have one X chromosome and one Y chromosome, or XY. Males with Klinefelter syndrome are born with cells that have an extra X chromosome, or XXY.

Klinefelter syndrome is a genetic condition, meaning people are born with it, but it’s not passed down through families like some genetic diseases. Instead, Klinefelter syndrome occurs randomly due to an error in cell division when a parent’s reproductive cells are being formed. If one of these defective cells contributes to a successful pregnancy, the baby will have the XXY condition in some or all of his cells. Some boys will even have more than two X chromosomes (XXXY or XXXXY, for example), which increases the risk of severe symptoms and other health concerns.

When a boy is born with the XXY condition in only some of his cells, it’s called mosaic Klinefelter syndrome. Often, boys and men with this condition can have milder signs and symptoms than others with the XXY condition.

Signs & Symptoms

Not all boys with Klinefelter syndrome will have noticeable symptoms. Other boys can have symptoms that are physically apparent or problems with speech, learning, and development.

Babies with Klinefelter syndrome typically have weak muscles, reduced strength, and quiet personalities. They also can take longer to do things like sit up, crawl, walk, and speak.

Compared with other kids their age, boys with Klinefelter syndrome might have some or all of the following symptoms:

• a taller, less muscular body
• broader hips and longer legs and arms
• larger breasts (a condition called gynecomastia)
• weaker bones
• a lower energy level
• smaller penis and testicles
• delayed or incomplete puberty (some boys won’t go through puberty at all)
• less facial and body hair following puberty

In addition to physical symptoms, many boys with Klinefelter syndrome will also show symptoms related to their development of social and language skills. They may have difficulty paying attention. A lot of boys learn to talk late or have trouble using words to express their emotions. They also can have trouble with things like learning to spell, read, and write.

Socially, boys with Klinefelter syndrome tend to have quiet, docile personalities. They rarely cause trouble and are often more helpful and thoughtful than other boys. They are often shy and sensitive, and many are less self-confident and less active than other boys their age.

Since boys with Klinefelter syndrome can have problems with schoolwork and sports, they may feel like they don’t fit in with other kids their age. But by the time they are men, most will have normal social relationships with friends, family members, and others.

Related Problems

The main complications of Klinefelter syndrome are related to problems with speech, learning, and physical and social development. Most boys aren’t likely to have major health problems, but the condition can bring some other challenges later in life. Klinefelter syndrome puts males at greater risk of breast cancer, some other cancers, and some other diseases like type 2 diabetes, varicose veins and problems with blood vessels, problems with sexual function, and osteoporosis (weak bones) later in life.

Most boys with Klinefelter syndrome can have sex when they become men, usually with the help of testosterone treatment. However, problems with their testicles prevent them from making enough normal sperm to father children.

The vast majority of men with Klinefelter syndrome are infertile and can’t father a child the normal way. At present, options for becoming natural parents are limited, but fertility researchers are working on new treatments. By the time a child with Klinefelter syndrome is ready to become a dad, there may be new options.

Diagnosis

Since Klinefelter syndrome can be hard to notice, many parents don’t know their son has it until he grows up or shows delays in puberty. Sometimes, parents who are worried about their son’s development consult a doctor, and the diagnosis reveals Klinefelter syndrome. This can help, because the earlier a boy is diagnosed with Klinefelter syndrome, the more effective the treatments usually are.

To diagnose cases of Klinefelter syndrome, doctors usually begin by asking about any learning or behavior issues and examining the boy’s testicles and body proportions.

There are two main types of tests used in the diagnosis of Klinefelter syndrome:

1. Hormone testing, which is usually done by taking a blood sample to check for abnormal hormone levels.
2. A chromosome analysis, or karyotype, which is usually done on a blood sample. This test checks the number of chromosomes to see if the XXY syndrome is present.

Treatment

There’s no way to change the XXY condition if a boy is born with it, but treatments can help relieve some of the symptoms. As with many conditions, beginning treatment early can greatly increase its effectiveness.

Testosterone replacement therapy (TRT) works by increasing a boy’s testosterone levels into the normal range. Additional testosterone can help a boy with Klinefelter syndrome develop bigger muscles and a deeper voice, as well as promote growth of the penis and facial and body hair. It can also help improve bone density and reduce the growth of a boy’s breasts. Testosterone therapy cannot increase the size of a boy’s testicles or prevent or reverse infertility, however.

Educational support services can help boys and teens with Klinefelter syndrome keep pace in school. Many benefit from extra assistance when it comes to schoolwork. If your son has Klinefelter syndrome, let his teachers and school nurse know about his condition and see what kind of support is available. He may be eligible for an individualized education plan (IEP) or 504 education plan, which both can provide accommodations for kids with special needs.

Speech therapy and physical therapy can help boys with Klinefelter syndrome learn to speak, read, and write better, or improve muscle strength and coordination.

Other forms of therapy include behavioral, mental health, and occupational therapy. These can help improve low self-confidence, shyness, and delayed social development.

Supporting Your Son

It can be difficult for boys with this condition, who feel like they’re developing differently from their peers. They’re more likely to have low self-esteem, which can make things harder socially and academically.

If your son is struggling in school or having trouble making friends, talk to your doctor, school principal, or school counselor. Counselors and therapists can give boys practical skills to help them feel more confident in social settings. And many schools provide supplementary educational services or accommodations that can help your son succeed.

As a parent, you know that life is full of cause-and-effect scenarios: If you don’t go to work, then you can’t pay the bills. If you ignore that sound the car is making, then you could end up on the side of the road with engine trouble.

Unfortunately, this concept is often a little harder for kids to grasp. They tend to live in the present and don’t think too much about long-term consequences. Usually this works out just fine because you are there to offer support and, when necessary, a safety net.

But when it comes to your kids’ health, there are some long-term consequences you may not even realize they’re up against. One of the best examples of this is a condition called metabolic syndrome.

About Metabolic Syndrome

Not to be confused with metabolic disease (which happens when hormones and other chemicals in the body don’t work together properly), metabolic syndrome describes a cluster of risk factors that put kids on the road to heart disease and type 2 diabetes.

Kids with metabolic syndrome have at least three of these risk factors:

• excessive belly fat
• high blood pressure (hypertension)
• abnormal levels of blood fats (lipids), including cholesterol and triglycerides
• hyperglycemia (high blood sugar)

You might be surprised to learn that these are problems kids can have. After all, high blood pressure and high cholesterol are usually things older people grumble about.

Not so anymore. Thanks to the rising obesity epidemic in young people, kids and teens are getting these conditions — and they’re getting them earlier than ever before. Some estimates say that nearly 1 in 10 teens — and over a third of obese teens — have metabolic syndrome. And a study of 375 second- and third-graders found that 5% had metabolic syndrome and 45% had one or two risk factors for it.

This is something parents should know about, especially because they can take steps to lessen their kids’ chances of developing metabolic syndrome or the risk factors that lead to it.

Causes

Because it’s a precursor to heart disease and type 2 diabetes, metabolic syndrome (also called dysmetabolic syndrome or syndrome X) is brought on by the same problems that cause those diseases. So, having a diet that’s high in calories and low in nutrients and consuming lots of fast food and sweetened beverages can put kids at risk.

Playing video games for most of the day or sitting in front of the computer and not getting enough (or any) exercise also can increase a child’s chance of developing factors like obesity, high LDL (“bad”) cholesterol, hypertension, and high blood sugar that define metabolic syndrome.

The risk of developing the condition appears to be highest around puberty. That may be because body fat, blood pressure, and lipids are all affected by the hormones that bring about the many changes of puberty.

Kids who have a family history of heart disease or diabetes are at greater risk for metabolic syndrome. But, as with many things in life, the lifestyle habits a child adopts can push things in one direction or another. So kids who are active, fit, and eat a lot of fruits and vegetables may drastically decrease their chances of developing metabolic syndrome — even if a close relative already has it.

Effects

Metabolic syndrome itself often has no noticeable symptoms early on. But when its risk factors are left to snowball for too long, major changes may start to develop in the body, such as:

• Arteriosclerosis. This happens when cholesterol hardens and begins to build up in the walls of arteries, causing blockages that can lead to high blood pressure, heart attack, and stroke.
• Poor kidney function. The kidneys become less able to filter toxins out of the blood, which can also increase the risk of high blood pressure, heart attack, or stroke.
• Insulin resistance. This occurs when the body’s cells don’t respond to insulin (the hormone that helps to regulate sugar in the blood) normally, and that can lead to high blood sugar levels and diabetes.
• Polycystic ovarian syndrome. Thought to be related to insulin resistance, this disorder involves the release of extra male hormones by the ovaries, which can lead to abnormal menstrual bleeding, excessive hair growth, acne, and fertility problems. It is also associated with an increased risk for obesity, hypertension, and — in the long-term — diabetes, heart disease, and cancer.
• Acanthosis nigricans. A skin disorder that causes thick, dark, velvet-like patches of skin around the neck, armpits, groin, between the fingers and toes, or on the elbows and knees.

Diagnosis

For a diagnosis of metabolic syndrome, a child must have at least three of the four risk factors. The most common risk factors in teens are hypertension and high LDL cholesterol. However, even when just one risk factor is present, a doctor will likely check for the others. This is especially true if a child is overweight, has a family member with type 2 diabetes, or has acanthosis nigricans.

These exams and tests can help doctors make a diagnosis of metabolic syndrome:

• Body mass index (BMI) and waist measurement. By calculating someone’s BMI and checking for extra weight around the middle, doctors can judge if these problems are likely to have a negative effect on health. A waist measurement at or above the 90th percentile for a child’s age and sex would be considered a risk factor.
• Blood pressure. Blood pressure is the force the blood exerts against the blood vessel walls as the heart pumps. When this force is at or above the 90th percentile for a child’s age and sex, it is considered a risk factor.
• Blood tests, including:
  • Lipid profile. This test measures the levels of fats in the blood. Having low levels of good cholesterol (HDL) and high levels of bad cholesterol (LDL) or triglycerides would be considered a risk factor.
  • Fasting glucose. The fasting blood glucose test measures the amount of glucose in the blood after an 8-hour fast. After several hours without eating, a healthy person’s blood glucose level should not be higher than a certain level. A glucose level higher than this could be a risk factor.
  • Insulin. A blood insulin test may also be performed in some cases as part of a check for insulin resistance.

Diagnosing metabolic syndrome in kids and teens can be a little bit like trying to hit a moving target. That’s because as kids’ bodies change and grow, the cutoff numbers for many of these tests change too. To standardize some of this information, doctors use special charts (a lot like growth charts) to plot where a child’s numbers fall according to his or her age, sex, weight, and height. This also helps them follow the child’s progression over time.

Treating Risk Factors

If your child is diagnosed with metabolic syndrome, it does not necessarily mean that he or she will develop heart disease or diabetes, but the chances are increased — especially if the risk factors involved aren’t improved or eliminated.

For some kids, a lifestyle change may be enough to reduce the risk for serious disease. A doctor may recommend:

• Dropping excess pounds. If your child is overweight, even a moderate amount of weight loss can translate to big improvements in blood pressure, blood lipid levels, and the body’s ability to use insulin.
• Getting more exercise. By taking just one of those hours spent in front of a screen each day and spending it on something that gets the blood flowing, kids can dramatically improve their blood pressure, cholesterol, and sensitivity to the effects of insulin.
• Eating mindfully. A child who learns to see food as fuel and not emotional compensation can start to make better choices at mealtime — for example, selecting complex instead of simple carbs (such as whole-grain instead of white bread, and brown rice instead of white); increasing fiber intake with more beans, fruits, and vegetables; choosing “healthy” fats like olive oil and nuts; and avoiding too many empty calories from soda and sweets.
• Fiber supplements. If your child might not be getting enough fiber through food, a fiber supplement may provide an added boost to help reduce the amount of LDL cholesterol in the blood.
• Not smoking. No surprise here — it’s just about the worst thing people can do to their heart and lungs. Either alone or in combination with metabolic syndrome risk factors, smoking greatly increases your child’s risk for developing heart disease.

When lifestyle changes aren’t enough, a child may be prescribed medications to treat individual risk factors. So, kids with high blood pressure might be put on antihypertension drugs. Others with high LDL cholesterol might be prescribed statins or other lipid-lowering drugs. Children with high blood sugar, who are on the brink of developing diabetes, may be given medication to decrease insulin resistance.

While bariatric surgery for weight loss is not yet approved by the U.S. Food and Drug Administration (FDA) in kids, some teens with morbid obesity or those who are obese and have developed heart disease or diabetes may be candidates for the procedure.

Changing Course

Here’s a great thing kids can learn about cause-and-effect: they have the power to positively influence many health outcomes. Eating right and staying active are two ways they can help ensure a healthier tomorrow.

Of course, it’s easier for kids to make better choices if they see their parents doing the same. So make a plan to help your entire family choose a new, healthier direction. After all, getting a late start on the right path beats staying on the wrong one.

It’s a familiar scene: Your child wakes up in the middle of the night feeling feverish, nauseated, and complaining of a stomach ache. Then come the tears, the vomiting, and the inability to keep fluids down. Usually, these symptoms add up to nothing more than a 24-hour stomach bug.

But sometimes there’s a different cause. The symptoms of pancreatitis (an inflammation of the pancreas) can sometimes appear as a stomach virus.

Pancreatitis usually goes away quickly, with no permanent damage to the pancreas. But it’s important to recognize the symptoms early to lessen the risk of complications. A child may need treatment or dietary changes for a short while.

About Pancreatitis

Pancreatitis is an inflammation of the pancreas, a large gland behind the stomach that produces digestive juices, or enzymes, that help break down food in the upper portion of the duodenum (small intestine). The pancreas also is responsible for producing insulin and glucagon, two hormones that help control levels of blood sugar, the body’s main energy source.

When the pancreas is working normally, the enzymes it secretes do not become active until they reach the duodenum. But when the pancreas is inflamed, the enzymes become activated early on (while still in the pancreas) and begin attacking internal structures. Tissues within the pancreas that produce enzymes are damaged, failing to produce new enzymes. Over time, this tissue damage can become permanent.

Types of Pancreatitis

Pancreatitis can be acute (lasting for a few days) or chronic (recurring). Acute pancreatitis develops suddenly, while chronic pancreatitis develops gradually and keeps coming back. Though rare in children, chronic pancreatitis is usually inherited.

Kids usually get the acute form of the condition, which can develop idiopathically (with no known cause) or in response to a viral infection or medication. Acute pancreatitis can result from traumatic injury to the abdomen, cystic fibrosis, or from excess fat in the blood (hyperlipidemia).

Pancreatitis or a Stomach Bug?

The main difference between pancreatitis and a stomach virus or other digestive system illness is the severity of abdominal pain. Kids with acute pancreatitis will have severe pain in the upper abdomen that makes it difficult for them to stand or sit upright, and they’ll probably sit or lie in the fetal position to get more comfortable. After the first 2 days, the pain usually intensifies.

Other signs include:

• persistent vomiting, which increases after the first 2 days of illness
• loss of appetite
• when able to eat, inability to keep food down
• vomit that is yellowish, greenish, or brownish
• jaundice (yellow discoloration of the skin)
• fever
• in some cases, back pain or left shoulder pain

Short-term symptoms can include dehydration and low blood pressure.

Diagnosis

If a doctor suspects pancreatitis, the first step is to perform blood tests, like an amylase test or lipase test, to see whether the enzymes made by the pancreas are at normal working levels. If they are elevated, the doctor might order an abdominal ultrasound to check for inflammation, blockages, or stones in the pancreatic duct that leads to the first part of the duodenum, and other abnormalities.

In some cases, the doctor may order an abdominal computed tomography scan (CT) scan, which uses X-rays and computer technology to produce detailed images of the body’s internal organs, to help confirm a diagnosis of pancreatitis.

During the initial visit, the doctor might ask you to describe the color and type of your child’s vomit. If it contains a great deal of bile (greenish digestive juices from the liver), the doctor might want to further assess your child for pancreas or liver problems.

Treatment

In most cases, pancreatitis gets better on its own. Sometimes, the doctor will recommend putting your child on a low-fat diet with plenty of fluids. This is less likely to irritate the pancreas and helps it to heal faster.

Kids with a more severe case of pancreatitis who become dehydrated may need a short stay in the hospital. Treatment involves resting the pancreas by not eating or drinking, and receiving intravenous (IV) fluids and pain medication. Other medications may help to reduce the amount of acid in the body. For some kids, this is enough and they can go home after a few days of treatment.

Other kids might need additional treatment with special IV fluids called total parenteral nutrition (TPN). TPN treatment bypasses the normal digestive process to provide the necessary nutrients of salt, glucose, amino acids, lipids, and vitamins.

Another approach is the placement of a soft plastic feeding tube called a naso-jejunal (NJ) tube. This tube is guided through the nose and ends up in the small intestine, where it delivers nutrition without stimulating the pancreas. Local anesthesia is used for this procedure, so a child will experience only slight discomfort.

Once home, most kids are placed on a low-fat diet to help heal the pancreas, which they should follow until their enzyme levels are back to normal. A follow-up blood test will probably be done to confirm normal enzyme levels.

Outlook

Fortunately, most kids who develop pancreatitis get over it quickly — in as little as 4 or 5 days — with few or no complications.

In the unlikely case that a child develops a recurrence or complications such as cysts, bleeding, infection, or persistent pain, additional tests or surgery might be needed to rule out other conditions.

The thyroid is a small gland located below the skin and muscles at the front of the neck, just at the spot where a bow tie would rest. It’s brownish red, with left and right halves (called lobes) that look like a butterfly’s wings. It’s light like a butterfly, too, and usually weighs less than an ounce.

As small as it is, though, the thyroid has an enormously important job to do, especially for teens. It makes the hormones that help control metabolism and growth. To do its job, the thyroid needs a chemical element called iodine. The body absorbs from the foods we eat and the water we drink. The entire body contains about 50 milligrams of iodine. About 1/5 to 1/3 of that supply (10 to 15 milligrams) is stored in the thyroid. The thyroid combines the iodine with tyrosine (an essential amino acid) to make important hormones.

Thyroid hormones are released from the gland and travel through the bloodstream to the body’s cells. They help control the growth and the structure of bones, sexual development (puberty), and many other body functions. By helping cells convert oxygen and sugar and other body fuels into the energy they need to work properly, these hormones are important in helping a child’s body mature as it should.

Thyroid hormones also directly affect how most organs function. So a thyroid that isn’t operating properly can cause problems in many other parts of the body.

What Is Thyroid Disease?

Thyroid disease is when the thyroid gland doesn’t supply the proper amount of hormones needed by the body. If the thyroid is overactive, it releases too much thyroid hormone into the bloodstream, resulting in hyperthyroidism. (“Hyper” is from the Greek, meaning “over” or “above.”) Hyperthyroidism causes the body to use up energy more quickly than it should, and chemical activity (like metabolism) in the cells speeds up.

An underactive thyroid produces too little thyroid hormone, resulting in hypothyroidism. (“Hypo” means “under” or “below.”) When the amount of hormone released into the bloodstream is below normal, the body uses up energy more slowly, and chemical activity (metabolism) in the cells slows down.

Although they are two different conditions, in both hypothyroidism and hyperthyroidism the thyroid can become larger than normal. An enlarged thyroid gland is a lump that can be felt under the skin at the front of the neck. When it is large enough to see easily, it’s called a goiter.

People who don’t get enough iodine in their diets also can get an enlarged thyroid, but this is rare in the United States because foods here usually supply enough iodine.

Hyperthyroidism

Hyperthyroidism can cause nervousness, irritability, increased perspiration (sweating), intolerance to heat, fatigue, difficulty sleeping, a fast heartbeat, irregular menstrual periods in girls, and muscle weakness.

Graves disease, an autoimmune disease, is the most common cause of hyperthyroidism. It makes the immune system produce abnormal types of antibodies (normally, antibodies help the body fight infection). These abnormal antibodies make the thyroid gland produce more thyroid hormones.

People with this problem might lose weight even though they’re eating more than usual. Their eyes may feel irritated or look like they’re staring. Sometimes the tissues around the eyes become inflamed and swollen, and the eyes appear to bulge out, but this is less common in teens than in adults with hyperthyroidism.

Eventually, the thyroid gland enlarges, which can result in a goiter. For reasons that doctors don’t yet understand, autoimmune thyroid diseases like Graves disease are much more common in women and are most likely to affect teens and young and middle-aged adults.

Doctors usually diagnose Graves disease based on a person’s symptoms, a physical examination, and blood tests that show high levels of thyroid hormone in the blood.

Once the diagnosis is made, a teen with Graves disease will usually start taking an anti-thyroid medicine, which blocks the thyroid’s production of thyroid hormones. The medicine usually brings the hormone levels down to the normal range in 1 to 2 months.

However, in most cases, the disease doesn’t go away. Some people continue taking medicine for months or years to keep Graves disease under control. But because it can be hard to take medicine 1 to 3 times a day for a long period, many doctors recommend a permanent treatment.

Radioactive iodine (RAI) is the most commonly recommended permanent treatment for teens with Graves disease. Although usually given at a hospital, it doesn’t require a hospital stay. RAI is considered safe for teens when given in the standard amount. It is taken in capsules or mixed with a glass of water. The thyroid gland quickly absorbs the RAI from the bloodstream and, within a few months, the gland shrinks and symptoms gradually disappear. RAI has been used to treat Graves disease successfully for more than 50 years.

The other permanent treatment for Graves disease is surgery to remove most of the thyroid gland (called a thyroidectomy). The operation is done in a hospital under general anesthesia, so the patient is asleep and feels nothing during the surgery. A small incision (cut) in the lower central part of the neck usually leaves a thin scar.

After surgery, there’s often swelling in the area of the incision. People sometimes have a sore throat and some trouble swallowing following surgery, although they should be able to eat and drink normally. These symptoms usually disappear within a few days.

After treatment for hyperthyroidism, hormone production often slows down to hypothyroid (underactive) levels, so the person needs to take a thyroid hormone replacement tablet each day. This treatment is a lot easier to manage than taking pills to control the hyperthyroidism — fewer blood tests, doctor visits, and medication adjustments are necessary.

As the body adjusts to the hormone replacement tablets, a doctor may increase or reduce the dosage until the levels of thyroid hormone in a person’s blood are normal. Once the doctor finds the proper dosage, people usually feel well and free of symptoms. However, the doctor will continue to check hormone levels to make sure the dosage is right, especially for growing teens whose levels might change over just a few months.

Hypothyroidism

A person with mild hypothyroidism may feel just fine — in fact, the condition might cause no symptoms at all. However, symptoms can become more obvious if hypothyroidism progresses.

People with underactive thyroids might feel depressed and sluggish. They might gain weight, even though they’re not eating more or getting less exercise than usual. Teens with hypothyroidism also might have slow growth in height, slow sexual development, irregular menstrual periods in girls, muscle weakness, dry skin, hair loss, poor memory, and difficulty concentrating.

Hashimoto’s thyroiditis (hah-she-MOE-toes thy-roy-DYE-tiss) is also an autoimmune disease and is the most common cause of hypothyroidism in teens. In this condition, the body’s immune system attacks the cells in the thyroid gland, preventing it from producing enough thyroid hormone. The thyroid responds by working harder to make enough hormones. This can make it become enlarged and may result in a goiter.

Hypothyroidism is usually easily diagnosed with a physical examination and blood tests, and treatment with thyroid hormone replacement pills can restore normal levels of thyroid hormone in the blood. This treatment is pretty simple, but it does require doctor visits once or twice a year for an examination, blood tests, and medication adjustments as needed.

Goiters and Thyroid Nodules

It can take months or years for a goiter to develop. Visible as a swelling at the front of the neck, a goiter often is the first symptom of an autoimmune thyroid condition. People with this problem might have the sensation that food is stuck in the throat, especially when they lie down or sleep on their backs.

Treatment of the thyroid disease causing the goiter usually will decrease or control the enlargement. If the thyroid continues to get larger despite treatment and becomes large enough to cause discomfort or a lump in the neck, surgery may be required. However, this is not often the case.

A thyroid nodule is a lump or enlarged area in the thyroid gland. Sometimes a nodule can appear in a healthy gland. It may feel like a lump in the throat, or there may be tenderness or pain in the front of the neck. If the nodule is large enough, it may be visible at the front of the neck.

Most thyroid nodules are harmless. A nodule may simply be an overgrowth of normal thyroid tissue, a swelling caused by inflammation (such as in autoimmune thyroid diseases), or a collection of fluid called a cyst.

The doctor usually discovers nodules by touch during a physical examination. If the doctor finds a nodule, blood tests might be done to find out how the thyroid gland is working. A doctor also may take an ultrasound image of the gland to detect whether the nodule is a cyst or a solid growth or tumor.

Another test, called a thyroid scan, can tell the doctor what type of nodule someone has. For this test, a person swallows a pill containing a small amount of radioactive iodine or another radioactive substance. The thyroid absorbs the radioactive substance. Then a special camera measures where the radioactive substance is taken up by the thyroid gland, giving the doctor a better picture of the location, size, and type of thyroid nodule.

A fine-needle biopsy also might be done to help determine whether a nodule is cancerous. During the biopsy, the doctor inserts a thin needle through the skin into the thyroid nodule (the skin is numbed with medicine first). Through the needle, the doctor takes a sample of tissue or some fluid from a cyst. The tissue or fluid is then sent to a lab to be examined. In some cases, a person might need to have the nodule surgically removed for more detailed examination in the lab.

Fortunately, cancer is rare in children and teens, and most thyroid cancers can be cured or controlled with treatment.

Thyroid Disease, Growth, and Puberty

Once puberty starts, the body goes through some very noticeable changes. Because thyroid hormones play an important role in this process, thyroid disease may slow down or interfere with that physical development. But it’s important to know that not everyone grows or develops at the same age or at the same rate. If one child seems to grow 4 inches overnight and another hasn’t had a growth spurt yet, it doesn’t mean there’s something wrong with the thyroid.

A thyroid problem also may cause a girl to have changes in her periods. Girls with thyroid problems may have a decrease or increase in menstrual flow, or there may be a shorter or longer time between periods than usual. However, because girls who are just starting to menstruate often have irregular periods for the first year or so, changes in periods are usually nothing to worry about and don’t mean a girl has thyroid disease.

If you’re concerned that your child might have a thyroid problem, call your doctor. Chances are, the problem is something simpler. And if it is thyroid disease, diagnosing and treating it properly — including bringing the blood levels of thyroid hormones back to normal — will usually prevent or correct any problems.

If your child or teen has been diagnosed with type 1 diabetes, the next step is to create a diabetes management plan to help him or her manage the condition and stay healthy and active.

Treatment plans for type 1 diabetes are based on each child’s needs and the suggestions of the diabetes health care team. Treatment approaches differ in, among other things, the types of insulin given and the schedules for giving insulin given each day. The advantages and disadvantages of a plan should be considered for each child.

Type 1 Diabetes Treatment Basics

The blood glucose level is the amount of glucose in the blood. Glucose is the main source of energy for the body’s cells and is carried to each cell through the bloodstream. The hormone insulin allows the glucose to get into the cells. In type 1 diabetes, the body can no longer make insulin, so the glucose can’t get into the body’s cells. This causes the blood glucose level to rise.

Treatment goals for kids with diabetes are to control the condition in a way that minimizes symptoms, prevents short- and long-term health problems, and helps them to have normal physical, mental, emotional, and social growth and development. To do this, parents and kids should aim for the goal of keeping blood sugar levels as close to normal as possible.

In general, kids with type 1 diabetes need to:

• take insulin as prescribed
• eat a healthy, balanced diet, paying special attention to the amount of carbohydrates in each meal and the diabetes meal plan
• check blood sugar levels several times a day
• get regular physical activity

Following the treatment plan helps kids stay healthy, but treating diabetes isn’t the same as curing it. Right now, there’s no cure for diabetes, so kids with type 1 diabetes will need treatment for the rest of their lives. But with proper care, they should look and feel healthy and go on to live long, productive lives, just like other kids.

Taking Insulin as Prescribed

Children and teens who have type 1 diabetes must take insulin as part of their treatment plan. Insulin is the only medicine that can keep their blood sugar levels in a healthy range.

Taking insulin as prescribed lets them use the glucose in their blood for energy. When glucose is entering and being used by the cells properly, its level in the blood generally remains within a healthy range.

Unless they’re using an insulin pump, most kids require two or more injections every day to keep blood sugar levels under control. Usually, they inject a combination of different types of insulin to handle the sugar that circulates in the blood after eating and between meals. The acids and digestive juices in the stomach and intestines can break down and destroy insulin if it is swallowed, so it can’t be taken as a pill. The only way to get insulin into the body now is by injection with a needle or with an insulin pump.

There is no-one-size-fits-all insulin schedule — the types of insulin used and number of daily injections a child needs will depend on the diabetes management plan. Also, you can’t turn off the action of insulin once it’s been injected. So insulin doses need to be adjusted to handle the rise in blood sugar that happens with meals and provide the amounts of insulin the body needs between meals and overnight.

Eating meals at regular times generally makes this easier. Although eating on schedule may work well for younger kids, sticking to a routine can be a challenge for older kids and teens, whose school, sleep, and social schedules often vary. The diabetes health care team can help you work through any problems your child might have with scheduling meals and insulin injections.

Getting insulin injections today is nearly painless, thanks to smaller needles. Insulin pumps, which deliver insulin through a small tube that is placed just under the skin, cut down on the number of injections needed.

Insulin usually is injected into the fatty layer under the skin of the abdomen, hips/buttocks, or thighs. The health care team will teach you when and how to give the insulin, as well as the best sites in which to inject it, based on your child’s weight, age, and activity patterns.

Healthy Eating and Following a Meal Plan

Eating a balanced diet and following a meal plan are important parts of type 1 diabetes treatment. Kids with diabetes benefit from the same kind of healthy diet as those without diabetes — one that includes a variety of healthy foods that help the body grow and work properly.

Kids with diabetes also have to balance the type and timing of their meals with the amount of insulin they take and with their activity level. That’s because eating some foods will cause blood sugar levels to go up more than others, whereas insulin and exercise will make blood sugar levels go down.

How much the blood sugar level goes up after eating depends on the type of nutrients the food has. The three main types of nutrients found in foods are carbohydrates (carbs), proteins, and fats, which provide energy in the form of calories. Foods containing carbs cause blood sugar levels to go up the most. Foods that are mostly protein and/or fat don’t affect blood sugar levels nearly as much.

Our bodies need many nutrients — in different amounts — to function normally. So when you and the diabetes health care team create a diabetes meal plan to help keep your child’s blood sugar within the target range, it will include a variety of nutrients.

Meal plans usually consist of breakfast, lunch, and dinner with scheduled between-meal snacks. The plan won’t restrict your child to eating specific foods, but will guide you in selecting from the basic food groups to achieve a healthy balance. Meal plans are based on a child’s age, activity level, schedule, and food likes and dislikes, and should be flexible enough to accommodate special situations like parties and holidays.

Knowing the amount of carbs in meals and snacks will help you determine how much insulin to give your child. Mismatching carbs and insulin can result in either high or low blood sugar levels.

The meal plan also might recommend limiting extra fat and “empty” calories (foods that contain lots of calories but few nutrients). Everyone should limit these foods anyway because eating too much of them can lead to excess weight gain or long-term health problems like heart disease, for which people with diabetes are already at risk.

Monitoring Blood Sugar Levels

Treating type 1 diabetes also involves checking blood sugar levels regularly and responding to the results. Controlling blood sugar levels helps kids with diabetes feel well, grow and develop normally, and also reduces the risk of long-term diabetes complications.

The diabetes treatment plan will recommend how many times a day to check blood sugar levels, which is the only way to monitor the effectiveness of your child’s day-to-day blood sugar control.

The diabetes health care team also will let you know what your child’s target blood sugar levels are. In general, kids with type 1 diabetes should test their blood sugar levels with a blood glucose meter at least four times a day. Depending on your child’s management plan and any problems that arise, blood sugar levels could need to be tested more often.

A blood glucose meter measures the blood sugar level at the moment of testing. Another blood sugar test, the glycosylated hemoglobin (hemoglobin A1c or HbA1c) test, indicates what blood sugar levels have been over the past few months.

Getting Regular Physical Activity

Exercise is good for everyone — adults and kids, with or without diabetes. Getting regular physical activity is also an important part of diabetes treatment. It helps control blood sugar levels and may reduce the risk of other chronic illnesses, like heart disease.

Besides helping keep blood sugar levels under control, exercise can help kids with diabetes:

• maintain a healthy body weight
• keep blood lipids and blood pressure under control
• get and keep their heart, lungs, and blood vessels in good shape
• feel more normal by doing things that kids without diabetes can

Encouraging kids with diabetes to exercise might make parents uneasy, but exercise actually helps insulin work better in the body. Some adjustments of meals and insulin may be needed, but they can and should exercise.

All exercise is great — from walking the dog or riding a bike to playing team sports. Encourage your child to exercise, and set 60 minutes daily as a goal. New exercise habits might be hard for kids to adopt at first, but feeling the benefits can help them stick with it.

Avoiding Problems During Exercise

To help avoid problems during exercise, kids with diabetes might need to:

• have an extra snack prior to activity
• carry snacks, water, and supplies with them when they exercise
• check their blood sugar levels before, during, or after exercise
• make sure their coaches know about their diabetes and what to do if problems occur

Make sure your child wears a medical identification bracelet (this should always be worn, but it’s even more important during exercise, sports, and and fitness activities).

The diabetes health care team will make suggestions to help your child get ready for exercise or join a sport. They’ll also provide instructions to help you and your child respond to any diabetes problems that could occur during exercise, like hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).

Putting It All Together

Treating and managing diabetes can seem overwhelming at times. But the diabetes health care team is there for you. Your child’s diabetes management plan should be easy to understand, detailed, and written down for easy reference. You also should have the names and phone numbers of the health care team members in case of emergencies or if you have questions about how to take care of your child’s diabetes.

Besides the standard diabetes treatments, you also might hear of alternative or complementary treatments, such as herbal remedies and vitamin or mineral supplements. Although research continues into their possible benefits, studies thus far haven’t proved their effectiveness. Aside from being potentially ineffective, they could even be dangerous for kids and teens with type 1 diabetes, especially if used to replace medically recommended treatments. Talk to the diabetes health care team if you have questions.

Each day, researchers all over the world are working to find a cure for diabetes, and many treatment advances have made treatment easier and more effective. Insulin might soon be available in pill, patch, and spray forms, and scientists continue efforts to improve results of pancreas or islet cell transplants. Versions of an artificial pancreas — a device that senses blood sugar and gives insulin — also are being tested.

These new developments are exciting, but they still need extensive testing — especially for use in kids — before they become available.

After kids or teens are diagnosed with type 2 diabetes, the next step is to create a diabetes management plan to help them manage the condition and stay healthy and active.

Treatment plans for type 2 diabetes are based on each child’s needs and the suggestions of the diabetes health care team.

Type 2 Diabetes Treatment Basics

The blood glucose level is the amount of glucose in the blood. Glucose is the main source of energy for the body’s cells and is carried to each cell through the bloodstream. The hormone insulin allows the glucose to get into the cells. In type 2 diabetes, the body doesn’t respond normally to insulin, so glucose is less able to enter the cells. This causes the blood glucose level to rise.

Treatment goals for kids with diabetes are to control the condition in a way that minimizes symptoms, prevents short- and long-term health problems, and helps them to have normal physical, mental, emotional, and social growth and development. To do this, parents and kids should aim for the goal of keeping blood sugar levels as close to normal as possible.

It is also important to treat other conditions that can be associated with type 2 diabetes, like obesity, high blood pressure, or abnormal blood lipid (fat) levels.

In general, kids with type 2 diabetes need to:

• eat a healthy, balanced diet and follow a meal plan
• get regular exercise
• take medications as prescribed
• monitor blood sugar levels regularly

Helping kids with type 2 diabetes switch to healthier habits is a key part of treatment. Because most kids are overweight when they’re diagnosed, it’s important to promote healthy eating and physical activity to prevent further weight gain or to encourage weight loss while making sure they grow and develop properly.

Healthy Eating and Following a Meal Plan

Weight gain happens when someone consumes more calories than he or she uses up through physical activity. The body stores those extra calories as fat. Over time, excessive weight gain can lead to obesity and diseases related to obesity, such as type 2 diabetes and heart disease.

Kids with type 2 diabetes who are trying to manage their weight still need energy to develop normally. To get it, they’ll need enough calories to grow without gaining too much fat. The best way is to eat nutritious foods and get regular exercise.

Many parents worry about what to feed their kids with type 2 diabetes. The key is a balanced, healthy diet. Kids with diabetes benefit from the same kind of diet as those without diabetes — one that includes a variety of nutritious foods that help the body grow and function properly.

The three main types of nutrients found in foods are carbohydrates (carbs), proteins, and fats, which provide energy in the form of calories. Foods containing carbs cause blood sugar levels to go up the most. Foods that are mostly protein and/or fat don’t affect blood sugar levels nearly as much.

Our bodies need many nutrients — in different amounts — to work properly. So when you and the diabetes health care team create a diabetes meal plan to help keep your child’s blood sugar within the target range, it will include a variety of nutrients.

Meal plans usually consist of breakfast, lunch, and dinner with small, scheduled between-meal snacks. The plan won’t restrict your child to specific foods, but will guide you in selecting from the basic food groups to achieve a healthy balance.

Meal plans are based on a child’s age, activity level, schedule, and food likes and dislikes, and should be flexible enough to account for special situations like parties and holidays. The meal plan should make it easier to keep your child’s blood sugar within his or her goal range.

The meal plan also might recommend limiting extra fat and “empty” calories (foods that contain lots of calories but few nutrients). Everyone should limit these foods anyway — eating too much of them can lead to excess weight gain or long-term health problems like heart disease, for which people with diabetes are already at risk.

Controlling Portions

Portion control — even of healthy foods — is important for kids with type 2 diabetes because they generally weigh more than kids who don’t have the disease. As you follow your child’s meal plan, be wary of special foods marketed to people with diabetes. Sugar-free and fat-free foods are not always calorie-free or even low-calorie foods.

A registered dietitian (RD) can help you choose and cook healthier foods, read food labels, and learn how much food your child should be eating in a day. The RD also can adjust meal plans depending on how your child is doing regarding meeting weight management goals. If you don’t have a dietitian on the diabetes health care team, ask your doctor for a referral to see one.

Getting Regular Exercise

Regular physical activity is an important part of diabetes treatment. Overweight kids and teens with type 2 diabetes tend to be less active, so exercise is a very important part of the treatment plan.

Exercise helps improve the body’s response to insulin, which helps to control blood sugar levels. It also helps the body burn more calories, which can reduce excess body fat. And it’s healthier for growing kids who are overweight to burn more calories through exercise than to severely restrict the food they eat.

Regular physical activity also can help reduce the risk of other chronic illnesses, like cancer. Besides all of these benefits, exercise also can help kids with diabetes:

• keep blood lipids and blood pressure under control
• get and keep their heart, lungs, and blood vessels in good shape
• feel more normal by doing things that kids without diabetes can do

Kids don’t have to be athletic to get the benefits of physical activity. Things like walking the dog, helping around the house, and playing outside with friends are great — anything that gets them moving regularly can go a long way toward helping control diabetes.

Avoiding Problems During Exercise

To help avoid problems during exercise, kids with type 2 diabetes might need to:

• have an extra snack before the activity
• carry snacks, water, and supplies with them when they exercise
• check their blood sugar levels before, during, and after exercise
• make sure their coaches know about their diabetes and what to do if problems happen

Make sure your child wears a medical identification bracelet (this should always be worn, but it’s even more important during exercise, sports, and and fitness activities).

The diabetes health care team will make suggestions to help your child get ready for exercise or join a sport. They’ll also give instructions to help you and your child respond to any diabetes problems that could occur during exercise, like hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).

Taking Medicines as Prescribed

Sometimes, a combination of diet and exercise are enough to control blood sugar levels in kids with type 2 diabetes. Other times, pills that help insulin work better also need to be taken. These pills are not a form of insulin.

Sometimes pills for diabetes — even when combined with diet and exercise — still aren’t enough to keep blood sugar levels under control, and a child with type 2 diabetes must take insulin. The acids and digestive juices in the stomach and intestines would break down and destroy insulin if it was swallowed, so it can’t be taken in a pill. The only way to get insulin into the body is with an injection or an insulin pump.

There is no-one-size-fits-all insulin schedule — the types of insulin used and number of daily injections a child needs will depend on the diabetes management plan. Usually, kids inject a combination of different types of insulin to handle the sugar that circulates in the blood after eating and between meals. Also, you can’t turn off the action of insulin once it’s been injected, so insulin doses need to be adjusted to handle the rise in blood sugar that occurs with meals and provide the amounts of insulin the body needs between meals and overnight.

Eating meals at regular times can make this easier. Eating on schedule may work well for younger kids, but sticking to a routine can be a challenge for older kids, whose school, sleep, and social schedules vary. The diabetes health care team can help you work through problems with scheduling meals and insulin injections.

The promising news about type 2 diabetes is that by following a balanced diet, getting regular physical activity, and achieving a healthy weight, blood sugar levels can improve significantly. In some kids, following the treatment plan for type 2 diabetes can even eliminate the need for medication altogether.

Monitoring Blood Sugar Levels

Treating type 2 diabetes also involves checking blood sugar levels regularly and responding to the results. Controlling blood sugar levels helps kids with diabetes feel well, grow and develop normally, and reduce the risk of long-term diabetes complications.

The diabetes treatment plan will recommend how many times a day to check blood sugar levels, which is the only way to know the effectiveness of your child’s day-to-day blood sugar control.

The diabetes health care team also will explain what your child’s target blood sugar levels are. In general, kids with type 2 diabetes should test their blood sugar levels with a blood glucose meter at least twice a day, but might need to test more often if they’re taking insulin, have been just diagnosed, or are having problems with blood sugar control.

A blood glucose meter measures the blood sugar level at the moment of testing. Another blood sugar test, the glycosylated hemoglobin (hemoglobin A1c or HbA1c) test, indicates what blood sugar levels have been over the past few months.

Putting it All Together

Treating and managing diabetes can seem overwhelming at times. But the diabetes health care team is there for you.

Your child’s diabetes management plan should be easy to understand, detailed, and written down for easy reference. You also should have the names and phone numbers of the health care team members in case of emergencies or if you have questions about how to take care of your child’s diabetes.

Besides the standard diabetes treatments, you also might hear of alternative or complementary treatments, such as herbal remedies and vitamin or mineral supplements. Although research continues into their possible benefits, studies thus far haven’t proved their effectiveness. Aside from being potentially ineffective, they could even be dangerous for kids and teens with type 2 diabetes, especially if used to replace medically recommended treatments. Talk to the diabetes health care team if you have questions.

Each day, researchers all over the world are working to find a cure for diabetes, and advances have made treatment easier and more effective. Insulin might soon be available in pill, patch, and spray forms, and scientists continue to improve results of pancreas or islet cell transplants. Versions of an artificial pancreas — a device that senses blood sugar and gives insulin — also are being tested.

These new developments are exciting, but they still need extensive testing — especially for use in kids — before they become available.