Headaches affect between 10 and 20% of school-aged children, with a steady increase in prevalence into the teen years,1 and are a major contributor to school absenteeism and reduced quality of life.2 Pain is an obvious challenge for these patients, but children with headaches also frequently have comorbid conditions that further affect quality of life and disability.
“The kids that we see in neurology often have primary headache disorders that have spun out of control – often related to comorbidities or life stressors,” Réjean Guerriero, DO, a neurology fellow at Boston Childen's Hospital, told Neurology Advisor. “Comorbidities may include neurobehavioral or psychiatric conditions or tendencies, ranging from an anxious personality or depressed mood to clinical anxiety or depression.”
A study published in 2012 in the International Journal of Immunopathology and Pharmacology investigated comorbidities in 280 children with primary headaches, as compared with the same number of healthy controls.3 After interviewing the children and their parents and administering psychological assessments, the researchers found that “no other psychiatric and systemic conditions are more frequent in children with primary headaches” than depression and anxiety, study co-author Piero Pavone, MD, of the department of pediatrics and pediatric emergency at the University Hospital Policlinico-Vittorio Emanuele in Catania, Italy, told Neurology Advisor. Approximately 31% of children with headaches had co-morbid depression or anxiety, compared with 8% of controls, and children with headaches showed five times the odds of having these disorders than controls.
A 2013 review from the Journal of Headache and Pain found that headache is also associated with epilepsy, attention deficit hyperactivity disorder, and Tourette syndrome, as well as atopic diseases and heart disease.1 Other problems that commonly occur with pediatric headaches are sleep disturbances4 and life stressors related to family, school, friends, and significant others.
“Often a combination of comorbidities may be a trigger for a headache exacerbation. These factors end up creating a downward cycle to perpetuate the headaches,” said Guerriero. For example, consider a child who is prone to headaches that is stressed about poor school performance and interpersonal problems. A couple of nights of poor sleep may trigger a headache, causing the child to become more anxious because the headache further impairs school performance – which can then exacerbate the headache and sleep disturbance, leading to an ongoing cycle that is difficult to break.
“Thus, it becomes very difficult to just treat the headache alone with medication without addressing the bigger psychosocial context in which the headache exacerbation is occurring,” said Guerriero.
A multi-faceted approach may be needed that emphasizes helping the child live as normal a life as possible, including no absences from school and continuing to spend time with friends or engage in activities they enjoy. Additionally, staying well-hydrated, maintaining a consistent sleep schedule and healthy sleep hygiene (like a no-electronics rule after a certain time of day), and regular physical exercise can be helpful.
Findings reported in Cephalalgia in May 2015 show that children who liked to play sports in their free time had significantly lower PedMIDAS scores than children who did not like playing sports.5
Guerriero suggests that more soothing types of exercise, such as yoga, walking, and dancing, can also confer benefits.
“Lastly, addressing the behavioral or psychiatric conditions are key,” said Guerriero. “Cognitive behavioral therapy (CBT) is the most well-proven to help kids with chronic headaches, pain, somatic symptoms, and anxiety.” It may also be important to involve a school guidance counselor if academic plans or goals need to be addressed.
Of course, medication may have a valuable role in managing chronic headaches in some patients. “Drugs used in symptomatic treatment should be chosen carefully according to headache type, frequency, type of symptoms, and adverse-effect profile,” said Pavone. “It is advisable to include comorbidities in the choice, such as depression and insomnia, which a tricyclic antidepressant helps to control along with migraine.” For chronic headaches, a low dosage of a daily medication may help, and melatonin may be used as a gentle sleep aid, Guerriero said.
The more adept pediatric headache patients and their parents become at recognizing the child's headache triggers, the better they will be able to manage them. Parents should refrain from constantly asking their child about their headaches, “but rather observing the child's behavior to assess how they are doing can be really valuable at shifting the focus away from the headache itself,” said Guerriero. “Distraction can be a valuable treatment as well!”
Kinston Community Development Planner Tatiana Height addresses the crowd at Holloway Recreation Center during this week's meeting about the N.C. Neighborhood Grant application. Photo by Junious Smith III / Neuse News
Citizens turned up in droves this week to voice their opinions regarding possible grant money that could affect their community.
The Kinston Planning Department held an event at Holloway Recreation Center Tuesday to discuss community and economic development activities, which would be included in the 2018 N.C. Neighborhood Grant application. The $750,000 grant is designed for non-entitlement communities and must incorporate equitable affordable housing, the support of existing communities or valuing communities and neighborhoods.
Dozens of citizens came to the meeting to listen and voice their opinions at the final public meeting before the Planning Department began work on a proposal to present to the Kinston City Council in September.
“I didn’t know how many people would show up because the last meeting didn’t have nearly as much participation,” Community Development Planner Tatiana Height said. “I was really pleased with the turnout here. Both recreation and housing were really high priorities and both impact the community in many ways.
“It was a very passionate forum and the community output was very positive. It really showed the community really cares about what’s going on. We hope to have internal discussions later with a couple of people at this meeting as well before September.”
A long-time Holloway staffer and retired coach, Skeet Davis, said he appreciated the event and hopes the conversation will continue.
“I thought it was a very productive meeting and I think we need more like this,” Davis said. “We also need to have more city officials out here to give answers to the people at the meetings. If the community is more involved, things would be better.”
There were a pair of members of the Kinston City Council in attendance — Sammy Aiken and Kristal Suggs — along with Lenoir County Commissioner Roland Best.
“I’m very grateful the community came out and provided a lot of passion with great suggestions,” Aiken said. “We should have more of these meetings and the community needs to get together, including the city council meetings, to voice their opinions.”
There were numerous discussions throughout the meeting, especially between housing and parks and recreation. Among the concerns were acquiring abandoned houses, redevelopment actions to include Kinston citizens and accountability toward people’s properties.
As for parks and recreation, the conversation turned toward making East Kinston more walkable, along with improvements to Emma Webb Park and Holloway.
“We started off in a good direction when we talked about revitalizing the neighborhoods, but we weren’t all in agreement,” Kinston resident Debra Tyson said. “We’ve got plenty of abandoned homes and many of them can be fixed. You have people without places to stay, but (the conversation) went back toward putting money into Holloway when they receive money in the parks and rec budget.”
Overall, Kinston resident Lori Carmon felt like there should be more accountability toward those in authority.
“If we didn’t know about the grant, it wouldn’t be discussed,” Carmon said. “Everything being discussed tonight, the city should’ve had it in place — you’ve got taxpayer money going toward busing kids to Holloway, but Emma Webb was shut down.
“I’m petrified for our city. As long as we have that crab mentality — not wanting to see others succeed — I just don’t know what the future will hold.”
Baby nurse is an antiquated term and legally cannot be used unless the person is a registered nurse. Many agencies and clients still use this term but we do not use it for liability purposes and we also do not want to misrepresent our providers (who are usually not RN’s and do not provide medical services). Our Postpartum Doulas and Newborn Care specialists provide very similar services to a “baby nurse” we just use different terms to describe our providers so we can legally and accurately represent our candidates.
At The Newborn Care Agency we group our Postpartum Doulas (Doulas) and Newborn Care Specialists (NCS) into the same category. We encourage our providers to do both courses as we think it is beneficial to have a well rounded provider that is knowledgeable about newborns as well as assisting the family during the postpartum period. The main difference between the two is that NCS usually focus more on baby care where a Doula focuses more on caring for mom and the whole family. However, most of our providers are happy to help in both capacities and customize their services for your families needs and wants. If you have a specific request for either a Doula or NCS we are happy to accommodate that however we encourage you to define your requests by what services you are looking for so you can interview a variety of personality types and individuals and make your choice based on who meshes best with your family rather than just basing it off the training they have taken.
All of our Postpartum Doulas and Newborn Care Specialist are carefully screened and our process includes the following:
2. Application with the company to gather personal information including experience and qualifications
We are happy to accommodate a flexible schedule. Most of our providers will need a general time frame you will need care (for example, 1 month or 3 months) so they can block off their schedule for you. Some providers prefer a set schedule but we do have some that are willing to be available/flexible to change the schedule as needed to meet your needs. We also have temp or fill-in providers available if you just need a couple days here and there.
All services are based on a 20% referral fee and billed weekly based on the hours you book with our providers.
We would be happy to send a fill-in or another provider if your regular person is not available. Please give us as much notice as possible to ensure availability.
Most clients have the provider start either as soon as they return home from the hospital or within a day or two after in order to get settled in on their own first. We can send someone to help at the hospital, but normally there are plenty of nurses there to assist. It is really up to you on what you prefer.
Most clients book between 2-6 months of care. If you are interested in sleep training or establishing a routine, most babies can be taught to sleep through the night by 3-4 months old if you have a consistent feeding and sleeping schedule that everyone caring for the baby is adhering to (and of course if baby is healthy and gaining weight appropriately).
The minimum for overnight shifts is 8 hours, however most of our clients book 10-12 hours so they can get a full nights sleep and also have some time for learning from the provider about their new baby. Depending on how many weeks you book, the provider may want to take a day off once a week or every other week (we can send a fill in if that's the case). Or, if you are booking 7 days a week we will usually break it up between two providers to avoid burnout (usually 3 days with one person and 4 days with the other person or 5 days with one and 2 days with another). For daytime shifts we have a 4-hour minimum but most families book 6-8 hours for daytime help. For shifts during the day the provider can help with household and/or baby related tasks so you can focus on your new baby and/or getting some much needed rest, time to eat or time for self care.
If you are interested in round-the-clock care, the provider will typically work 18-20 hours a day and have a 4-6 hour break each day mid day to rest. In most cases for 24/7 care the client will provide a separate room or space where the provider can rest during the break periods. If desired, we can send another provider to fill in during breaks. The client also normally provides all food/meals for the provider when they are working.
All of our care providers are given the opportunity to rest/cat nap at night when the baby sleeps (after baby related tasks such as washing bottles or folding laundry have been completed). Client must provide an adequate resting space for the provider during overnight and 24-hour shifts. 24-hour care providers may also sleep during the day when the baby naps to ensure they are well rested and can provide the best care for your child and family. *If you are interested in "Awake Care" where the provider is fully awake all night (normally for medically fragile babies that need constant monitoring), it can be arranged at an additional cost.