What will my child experience during and after the procedure?

CT exams are generally painless, fast and easy. With multidetector CT, the amount of time that the patient needs to lie still is reduced.

Though the scanning itself causes no pain, your child may experience some discomfort from having to remain still for several minutes.

If an intravenous contrast material is used, your child will feel a slight pin prick when the IV is inserted, usually into the hand or arm. The child may have a warm, flushed sensation during the injection of the contrast materials and a metallic taste in his/her mouth that lasts for a few minutes. Occasionally, a patient will develop itching and hives, which can be relieved with medication, if necessary. If your child becomes light-headed or experiences difficulty breathing, you should notify the technologist or nurse, as it may indicate a more severe allergic reaction. If your child experiences any kind of reaction to the intravenous contrast, it is important that you and/or your child remember to tell health care providers in the future.

If the contrast material is swallowed, your child may find the taste mildly unpleasant even if mixed with soda or juice; however, most patients can easily tolerate the oral contrast. Your child can expect to experience a sense of abdominal fullness and an increasing need to expel the liquid in the rare situation where the contrast material is given by enema. In this case, encourage your child to be patient, as the mild discomfort will not last long.

When your child enters the scanner, special lights may be used to ensure that he/she is properly positioned. With modern CT scanners, your child will hear only slight buzzing, clicking and whirring sounds as the CT scanner revolves around him/her during the imaging process.

The technologist will leave the room to perform the CT scan. However, the technologist will be able to see, hear and speak with your child at all times. A parent may be allowed in the room but will be required to wear a lead apron to prevent radiation exposure. The radiation dose directly outside of the CT scanner itself is very low. If you suspect you may be pregnant, however, it would be better for someone else to be with your child.

Some imaging facilities may use 

How is the procedure performed?

The technologist begins by positioning the patient on the CT examination table, usually lying flat on his/her back, but sometimes in other positions. Straps and pillows may be used to help the patient maintain the correct position and to hold still during the exam.

You should encourage your child to report any discomfort during positioning because it is important to keep very still during the exam. Once the child is correctly positioned, the CT technologist will go to the adjacent room, seen through the window, to begin the scan.

If contrast material is used, depending on the type of exam, it will be swallowed, injected through an intravenous line (IV) or, rarely, administered by enema.

Next, the table will move quickly through the scanner to determine the correct starting position for the scans. Then, the table will move slowly through the machine as the actual CT scanning is performed. Depending on the type of CT scan, the machine may make several passes.

Patients may be asked to hold their breath during the scanning, especially if the chest is being scanned.

Most children older than six years are able to hold their breath long enough to complete the scan although they may need coaching and practice. Younger children may not be able to hold their breath long enough to complete the scan. It is better in this circumstance to have young children breathe quietly and regularly during the scan.

When the examination is completed, the patient will be asked to wait until the technologist determines that the images are of high enough quality for the radiologist to read.

How does the procedure work?

In many ways, CT scanning is like other x-ray examinations. X-rays are a form of radiation, like light or radio waves that can be directed at the body. Different body parts absorb the x-rays in varying degrees.

In a conventional x-ray exam, a small burst of radiation passes through the body, recording an image on photographic film or a special image recording plate Bones appear white on the x-ray; soft tissues show up in shades of gray and air appears black.

With CT scanning, numerous x-ray beams and a set of electronic x-ray detectors rotate around the patient. At the same time, the examination table is moving through the scanner, so that the x-ray beam follows a spiral path. A special computer program processes this series of pictures, or slices of the body, to create two-dimensional cross-sectional images, which are then displayed on a monitor. Special software can also generate three-dimensional (3-D) images when requested by your physician or the radiologist interpreting the exam.

CT imaging is sometimes compared to looking into a loaf of bread by cutting the loaf into thin slices. When the image slices are reassembled by computer software, the result is a very detailed multidimensional view of the body's interior.

Refinements in detector technology allow new CT scanners to obtain multiple slices in a single rotation. These scanners, called "multislice CT" or "multidetector CT," allow thinner slices to be obtained, resulting in more detail of the body, in a shorter period of time.

Modern CT scanners are so fast that they can scan through large sections of the body in just a few seconds. Such speed is beneficial for all patients but especially children, the elderly and critically ill.

For some CT exams, a contrast material is used to enhance visibility in the area of the body being studied.

What does the equipment look like?

The CT scanner is typically a large machine with a hole, or short tunnel, in the center. A moveable examination table slides into and out of this tunnel. In the center of the machine, the x-ray tube and electronic x-ray detectors are located opposite each other on a ring, called a gantry, which rotates around the patient. The computer that processes the imaging information and monitor are located in a separate room where the CT technologist sits. The technologist will always be able to see your child in the CT scanner.

How should we prepare?

Your child should wear comfortable, loose-fitting clothing to the exam. He or she may be given a gown to wear during the procedure.

Metal objects including jewelry, eyeglasses, hearing aids, non-permanent retainers and hairpins may affect the CT images and may have to be removed prior to your child's exam. This can be discussed with the CT technologist, the specialist who will be performing the CT scan.

Your child may be asked not to eat or drink anything for several hours beforehand, especially if a sedative or anesthesia  will be used in the exam. With sedation or anesthesia, your child probably will not be allowed to eat for several hours prior to the exam. In general, children who have recently been ill will not be sedated or anesthetized. If this is the case, or if you suspect that your child may be getting sick, you should talk with your physician about rescheduling the CT exam.

You should also inform your physician of any medications your child is taking and if he/she has any allergies, especially to intravenous (IV) iodinated contrast (or iodine itself) or oral contrast materials. The allergy information should also be discussed with the CT technologist or nurse at the time of the CT examination. If your child has a known contrast material allergy, you should inform the doctor and technologist prior to the exam so that appropriate preparation can be made.

Also inform your doctor of any recent illnesses or other medical conditions your child may have, and if there is a history of heart disease, asthma, diabetes, kidney disease or thyroid problems. Any of these conditions may influence the decision on whether contrast material will be given to your child for the CT examination.

What are some common uses of the procedure?

CT is used to help diagnose a wide range of conditions due to injury or illness.

In children, CT is typically used to diagnose causes of abdominal pain, evaluate for injury after trauma, diagnose and stage cancer, monitor response to treatment for cancer, and diagnose and monitor infectious or inflammatory disorders.

CT may also be performed to evaluate blood vessels throughout the body. With CT, it is possible to obtain very detailed pictures of the heart and blood vessels in children, even newborn infants.

Except for the chest x-ray, CT is the most commonly used imaging procedure for evaluating the chest. CT of the chest is used to evaluate:

• complications from infections such as pneumonia
• a tumor that arises in the lung or has spread there from a distant site
• airway disease such as inflammation of the bronchi (breathing passages)
• birth defects
• trauma to blood vessels or lung

CT is well-suited for visualizing diseases or injury of important organs in the abdomen including the liver, kidney and spleen. CT is sometimes used to:

• diagnose appendicitis
• detect abdominal tumors or birth defects

In the pelvic region, CT scans can help:

• detect cysts or tumors in the pelvis
• evaluate for stones in the urinary tract
• assess disease of the pelvic bones

What is Children's CT?

Computed tomography, more commonly known as a CT or CAT scan, is a diagnostic medical test that, like traditional x-rays, produces multiple images or pictures of the inside of the body.

The cross-sectional images generated during a CT scan can be reformatted in multiple planes, and can even generate three-dimensional images. These images can be viewed on a computer monitor, printed on film or transferred to a CD or DVD.

CT images of internal organs, bones, soft tissue and blood vessels typically provide greater detail than traditional x-rays, particularly of soft tissues and blood vessels.

CT scans may be performed on newborns, infants and older children.

Children's (Pediatric) CT (Computed Tomography)

Pediatric computed tomography (CT) is a fast, painless exam that uses special x-ray equipment to create detailed images of your child’s internal organs, bones, soft tissues and blood vessels. It may be used to help diagnose abdominal pain or evaluate for injury after trauma.

Tell your doctor about your child’s medications and allergies. Inform your doctor and the technologist prior to the exam if your child has a known allergy to contrast material. Your child should wear loose, comfortable clothing and may be asked to wear a gown. You may be instructed to withhold food or drink beforehand, especially if sedation or anesthesia is to be used. In general, children who have recently been ill will not be sedated or anesthetized.

What are the limitations of Cardiac CT for Calcium Scoring?

A person who is very large may not fit into the opening of a conventional CT scanner or may be over the weight limit—usually 450 pounds—for the moving table.

CAD, especially in people below 50 years of age can be present without calcium (non-calcified plaque) and may not be detected by this exam.

Not all health insurance plans cover cardiac CT for calcium scoring.

A high heart rate may interfere with the image quality of the test.

Exactly how your treatment or prevention for heart attacks should be modified according to your calcium score remains uncertain.

EBCT scanners have fewer rows of detectors and lack the spatial resolution of the latest generation CT scanners.

What are the benefits vs. risks?

Benefits

• Cardiac CT for calcium scoring is a convenient and noninvasive way of evaluating whether you may be at increased risk for a heart attack.
• The exam takes little time, causes no pain, and does not require injection of contrast material.
• An EBCT scan takes less than 20 minutes and you can return to normal activities immediately afterward.
• No radiation remains in a patient's body after a CT examination.
• X-rays used in CT scans should have no immediate side effects.

Risks

• There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
• The effective radiation dose for this procedure varies.
• Women should always inform their physician and x-ray or CT technologist if there is any possibility that they are pregnant. 
• CT scanning is, in general, not recommended for pregnant women unless medically necessary because of potential risk to the baby in the womb.
• A high calcium score may sometimes be followed by other diagnostic tests for heart disease, which may or may not provide results with clinical value and can be associated with side effects.

Who interprets the results and how do I get them?

A radiologist with expertise in supervising and interpreting radiology examinations will analyze the images and send an official report to your primary care physician or physician who referred you for the exam, who will discuss the results with you.

A negative cardiac CT scan for calcium scoring shows no calcification within the coronary arteries. This suggests that CAD is absent or so minimal it cannot be seen by this technique. The chance of having a heart attack over the next two to five years is very low under these circumstances.

A positive test means that CAD is present, regardless of whether or not the patient is experiencing any symptoms. The amount of calcification—expressed as the calcium score—may help to predict the likelihood of a myocardial infarction (heart attack) in the coming years and helps your medical doctor or cardiologist decide whether the patient may need to take preventive medicine or undertake other measures such as diet and exercise to lower the risk for heart attack.

What will I experience during and after the procedure?

This CT exam is painless, fast and easy.

Though the scanning itself causes no pain, there may be some discomfort from having to remain still for several minutes and with placement of an IV. If you have a hard time staying still, are very nervous or anxious or have chronic pain, you may find a CT exam to be stressful. The technologist or nurse, under the direction of a physician, may offer you some medication to help you tolerate the CT scanning procedure.

For exams (excluding head and neck) your head will remain outside the hole in the center of the scanner. The scanner is approximately 24 inches wide, therefore, your entire body will be "inside" the scanner at one time such as with MRI.

When you enter the CT scanner room, special light lines may be seen projected onto your body, and are used to ensure that you are properly positioned. With modern CT scanners, you will hear only slight buzzing, clicking and whirring sounds as the CT scanner's internal parts, not usually visible to you, revolve around you during the imaging process.

You will be alone in the exam room during the CT scan, unless there are special circumstances. For example, sometimes a parent wearing a lead shield may stay in the room with their child. However, the technologist will always be able to see, hear and speak with you through a built-in intercom system.

After the CT exam, you can return to your normal activities.

How is the procedure performed?

The technologist begins by positioning you on the CT examination table, usually lying flat on your back. Straps and pillows may be used to help you maintain the correct position and to help you remain still during the exam.

Electrodes (small, sticky discs) will be attached to your chest and to an electrocardiograph(ECG) machine that records the electrical activity of the heart. This makes it possible to record CT scans when the heart is not actively contracting.

Next, the table will move quickly through the scanner to determine the correct starting position for the scans. Then, the table will move slowly through the machine as the actual CT scanning is performed. Depending on the type of CT scan, the machine may make several passes.

Patients are asked to hold their breath for a period of 10 to 20 seconds while images are recorded.

When the examination is completed, you will be asked to wait until the technologist verifies that the images are of high enough quality for accurate interpretation.

The entire procedure including the actual CT scanning is usually completed within 10 minutes.

For an EBCT scan, you will lie on a table under an arch-shaped scanner. You may remain clothed and your head will not be enclosed at any time. During the scan, you will be asked to hold your breath at times to help you remain motionless. The procedure takes about 10 to 15 minutes, although the actual scanning time is only a few seconds.

How does the procedure work?

In many ways CT scanning works very much like other x-ray examinations. X-rays are a form of radiation—like light or radio waves—that can be directed at the body. Different body parts absorb the x-rays in varying degrees.

In a conventional x-ray exam, a small burst of radiation is aimed at and passes through the body, recording an image on photographic film or a special image recording plate. Bones appear white on the x-ray; soft tissue shows up in shades of gray and air appears black.

With CT scanning, numerous x-ray beams and a set of electronic x-ray detectors rotate around you, measuring the amount of radiation being absorbed throughout your body. The scanner will take a set of images and then the table will move (axial scan). Sometimes the examination table will move during the scan so that the x-ray beam follows a spiral path (spiral or helical scan). A special computer program processes this large volume of data to create two-dimensional cross-sectional images of your body, which are then displayed on a monitor.

CT imaging is sometimes compared to looking into a loaf of bread by cutting the loaf into thin slices. When the image slices are reassembled by computer software, the result is a very detailed multidimensional view of the body's interior.

Refinements in detector technology allow new CT scanners to obtain multiple slices in a single rotation. These scanners, called multislice CT or multidetector CT, allow thinner slices to be obtained in a shorter period of time, resulting in more detail and additional view capabilities.

Modern CT scanners are so fast that they can scan through large sections of the body in just a few seconds. Such speed is beneficial for all patients but especially children, the elderly and critically ill.

Electron beam computed tomography (EBCT) is an alternative to conventional CT for measuring coronary calcium. In EBCT, an electron beam is sent to a target ring located around the patient. The beam creates x-rays at the target rings, which radiate through the patient to the detector on the opposite end of the scan tube. Because the machine has no moving parts, it can acquire as many as 20 images every second—fast enough so that it avoids any blurring caused by the beating of the heart. While EBCT and CT have been shown to have similar accuracy in determining calcium scores, EBCT is not as commonly available, as it is less versatile than the latest generation of high-speed CT scanners.

What does the equipment look like?

The CT scanner is typically a large, box-like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate control room, where the technologist operates the scanner and monitors your examination in direct visual contact and usually with the ability to hear and talk to you with the use of a speaker and microphone.

How should I prepare?

No special preparation is necessary in advance of a cardiac CT examination. You should continue to take your usual medications, but should avoid caffeine and smoking for four hours prior to the exam.

You should wear comfortable, loose-fitting clothing to your exam. You may be given a gown to wear during the procedure.

Metal objects, including jewelry, eyeglasses, dentures and hairpins, may affect the CT images and should be left at home or removed prior to your exam. You may also be asked to remove hearing aids and removable dental work. Women will be asked to remove bras containing metal underwire. You may be asked to remove any piercings, if possible.

Women should always inform their physician and the CT technologist if there is any possibility that they may be pregnant. 

What are some common uses of the procedure?

The goal of cardiac CT scan for calcium scoring is to determine if CAD is present and to what extent, even if there are no symptoms. It is a screening study that may be recommended by a physician for patients with risk factors for CAD but no clinical symptoms.

The major risk factors for CAD are:

• high blood cholesterol levels
• family history of heart attacks
• diabetes
• high blood pressure
• cigarette smoking
• overweight or obese
• physical inactivity

What is Cardiac CT for Calcium Scoring?

Computed tomography, more commonly known as a CT or CAT scan, is a diagnostic medical test that, like traditional x-rays, produces multiple images or pictures of the inside of the body.

The cross-sectional images generated during a CT scan can be reformatted in multiple planes, and can even generate three-dimensional images. These images can be viewed on a computer monitor, printed on film or transferred to a CD or DVD.

CT images of internal organs, bones, soft tissue and blood vessels typically provide greater detail than traditional x-rays, particularly of soft tissues and blood vessels.

A cardiac CT scan for coronary calcium is a non-invasive way of obtaining information about the presence, location and extent of calcified plaque in the coronary arteries—the vessels that supply oxygen-containing blood to the heart muscle. Calcified plaque results when there is a build-up of fat and other substances under the inner layer of the artery. This material can calcify which signals the presence of atherosclerosis, a disease of the vessel wall, also called coronary artery disease (CAD). People with this disease have an increased risk for heart attacks. In addition, over time, progression of plaque build up (CAD) can narrow the arteries or even close off blood flow to the heart. The result may be chest pain, sometimes called "angina," or a heart attack.

Because calcium is a marker of CAD, the amount of calcium detected on a cardiac CT scan is a helpful prognostic tool. The findings on cardiac CT are expressed as a calcium score.Another name for this test is coronary artery calcium scoring.

Cardiac CT for Calcium Scoring

Cardiac computed tomography (CT) for Calcium Scoring uses special x-ray equipment to produce pictures of the coronary arteries to determine if they are blocked or narrowed by the buildup of plaque – an indicator for atherosclerosis or coronary artery disease (CAD). The information obtained can help evaluate whether you are at increased risk for heart attack.

Tell your doctor if there’s a possibility you are pregnant and discuss any recent illnesses, medical conditions, medications you’re taking, and allergies. You will be instructed not to eat or drink anything and to avoid caffeine and smoking for four hours prior to the exam. If you have a known allergy to contrast material, your doctor may prescribe medications to reduce the risk of an allergic reaction. These medications must be taken 12 hours prior to your exam. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.

Computed Tomography

Computed tomography (CT) is a diagnostic imaging test used to create detailed images of internal organs, bones, soft tissue and blood vessels. The cross-sectional images generated during a CT scan can be reformatted in multiple planes, and can even generate three-dimensional images which can be viewed on a computer monitor, printed on film or transferred to electronic media. CT scanning is often the best method for detecting many different cancers since the images allow your doctor to confirm the presence of a tumor and determine its size and location. CT is fast, painless, noninvasive and accurate. In emergency cases, it can reveal internal injuries and bleeding quickly enough to help save lives.

Subspecialties for Diagnostic Radiologists

A radiologist, through extensive clinical work and related research, may also specialize in one or more radiology subspecialties.

Breast imagingThe radiology subspecialty devoted to the diagnostic imaging and diagnosis of breast diseases and conditions. This includes mammography, breast ultrasound, breast MRI, and breast procedures such as breast biopsy

Radiologic Technologist

Radiologic technologists perform diagnostic imaging examinations and perform radiation therapy treatments. Radiologic technologists who perform medical imaging examinations work closely with radiologists and are responsible for accurately positioning patients and ensuring that a quality diagnostic image is produced. Radiologic technologists work directly with patients and are responsible for explaining procedures, positioning patients on the examining table and adjusting immobilization devices to obtain optimum views of specific body areas. The technologist moves the imaging equipment into position and adjusts equipment controls based on his or her knowledge of the procedure.

The technologist also is responsible for using radiation safety techniques to ensure exposures for team members and patients meet ALARA (As Low As Reasonably Achievable) standards. To prevent unnecessary radiation exposure, a technologist uses radiation protective devices like lead aprons and shields. In addition, the technologist sets the appropriate collimation to minimize scatter radiation. Collimation is the process of adjusting the x-ray beam to the anatomic area appropriate for the procedure.

The technologist also may operate mobile x-ray or ultrasound equipment to obtain images in the emergency room, operating room or at the patient's bedside. Technologists also assist radiologists with general radiology, computed tomography, magnetic resonance imaging and ultrasound procedures.

Radiologic technologists also work on the radiation oncology team. Radiation therapists administer targeted doses of radiation to the patient’s body to treat cancer or other diseases. Radiation therapists are highly skilled medical specialists educated in physics, radiation safety, patient anatomy and patient care.

Registered radiologic technologists must complete at least two years of formal education in an accredited hospital-based program or a two- or four-year educational program at an academic institution and must pass a national certification examination. With additional education and training, a technologist can specialize in a particular diagnostic imaging area. 

Radiologist Assistant

Radiologist assistants are experienced, registered radiographers who have obtained additional education and certification that qualifies them to serve as radiology extenders. They work under the supervision of a radiologist to provide patient care in the diagnostic imaging environment. Specifically, an RA takes a leading role in patient management and assessment. In addition, an RA performs selected radiology examinations and procedures under the supervision of a radiologist. The RA also may be responsible for evaluating image quality, making initial image observations and forwarding those observations to the supervising radiologist.

Although RAs can perform functions beyond those of a radiologic technologist, the position holds certain limitations. An RA may make initial observations of images, but may not draft an official written interpretation.

Radiologist assistants complete an academic program and a radiologist-supervised clinical internship. An RA must be certified by the American Registry of Radiologic Technologists. Currently, there are nine Registered Radiologist Assistant programs in the country recognized by ARRT and seven of the programs offer master's degrees.

Radiation OncologyThe radiology subspecialty devoted to the treatment of cancer using radiation. The radiation may be delivered from an outside x-ray source or may be placed or injected into the body.

Diagnostic Medical Physicists

A diagnostic medical physicist is a qualified medical physicist who works with radiologists and other physicians on image modalities such as CT (computed tomography), x-rays (radiography), fluoroscopy, mammography, ultrasound and MRI (magnetic resonance imaging).

As an integral part of the imaging team, the diagnostic medical physicist develops and directs quality control programs that ensure imaging equipment and procedures are safe, comply with various regulatory and accrediting agency requirements, and provide images of the highest quality. Diagnostic medical physicists perform radiation dose calculations and often consult on patient or personnel radiation dose and associated risks. They also act as a resource for physicians and technologists, helping them better understand the technical aspects of imaging methods so that they can use them most effectively.

Diagnostic medical physicists have doctorates or master's degrees. They have completed four years of college, two to four years of graduate school and typically one to two years of clinical physics training. 

Pediatric RadiologyThe radiology subspecialty devoted to the diagnostic imaging and diagnosis of diseases of children. This includes x-rays, CT (computed tomography or CAT), Ultrasound, MRI and procedures such as fluoroscopy, biopsy and drainage of fluid or abscess collections.

Interventional Radiology
The radiology subspecialty devoted to the imaging, diagnosis and treatment of patients utilizing minimally invasive interventional techniques. This includes imaging and treatment of the blood vessels (such as angiography, angioplasty and stent placement), biopsy procedures, line and tube placement, uterine fibroid removal, fluid and abscess drainage. These may be performed with imaging guidance using x-rays, fluoroscopy, CT (computed tomography or CAT), Ultrasound or MRI.

Nuclear Radiology
The radiology subspecialty devoted to the imaging, diagnosis and treatment of patients using trace doses of radioactive material. This includes imaging of the heart, the skeletal system, and most organs in the body (for example the thyroid and parathyroid glands, liver, spleen, kidneys, lungs, etc.). It also includes the treatment of various conditions in the body such as a hyperactive thyroid gland and thyroid cancer. The imaging modalities include gamma imaging, PET, and PET/CT.

Head and Neck RadiologyThe radiology subspecialty devoted to the diagnostic imaging and diagnosis of diseases of the head and neck. This includes x-rays, CT (computed tomography or CAT), Ultrasound and MRI.

Musculoskeletal Radiology
The radiology subspecialty devoted to the diagnostic imaging and diagnosis of the muscles and the skeleton. This includes x-rays, CT (computed tomography or CAT), Ultrasound and MRI.

NeuroradiologyThe radiology subspecialty devoted to the diagnostic imaging and diagnosis of the brain and nervous system, head, neck and spine. This includes x-rays, CT (computed tomography or CAT), Ultrasound and MRI.

Genitourinary Radiology
The radiology subspecialty devoted to the diagnosis and treatment of the organs of the reproductive and urinary systems. This includes x-rays, CT (computed tomography or CAT), MRI and procedures such as biopsy, kidney stone removal, and uterine fibroid removal.

Emergency Radiology
The radiology subspecialty devoted to the diagnostic imaging and diagnosis of trauma and non-traumatic emergency conditions. This includes x-rays, CT (computed tomography or CAT), Ultrasound and MRI.

Chest RadiologyThe radiology subspecialty devoted to diagnostic imaging and diagnosis of diseases of the chest, especially the heart and lungs. This includes x-rays, CT (computed tomography or CAT), Ultrasound, MRI and chest procedures, such as lung biopsy and thoracentesis or drainage of fluid from the chest.

When to see your GP

See your GP if your symptoms continue, despite drinking plenty of fluids, or if you think your baby or toddler is dehydrated.

If your GP suspects dehydration, you may have a blood test or a urine test to check the balance of salts (sodium and potassium) in your body.

Contact your GP, out-of-hours service straight away if you have any of the following symptoms:

• extreme thirst
• feeling unusually tired (lethargic) or confused
• not passing urine for eight hours
• rapid heartbeat
• dizziness when you stand up that doesn't go away after a few seconds

You should also contact your GP if your baby has had six or more episodes of diarrhoea in the past 24 hours, or if they have vomited three times or more in the past 24 hours. 

How much should I drink?

Studies have tried to establish a recommended daily fluid intake, but it can vary depending on the individual and factors such as age, climate and physical activity.

A good rule is to drink enough fluid so that you're not thirsty for long periods, and to steadily increase your fluid intake when exercising and during hot weather. Passing clear urine (wee) is a good sign that you're well hydrated.

You should drink plenty of fluid if you have symptoms of dehydration, such as feeling thirsty and lightheaded, or passing dark-coloured urine. It is also important to replace fluid lost after an episode of diarrhoea

Who is at risk from dehydration?

Anyone can become dehydrated, but certain groups are particularly at risk. These include:

• babies and infants – they have a low body weight and are sensitive to even small amounts of fluid loss
• older people – they may be less aware that they are becoming dehydrated and need to keep drinking fluids
• people with a long-term health condition – such as diabetes or alcoholism
• athletes – they can lose a large amount of body fluid through sweat when exercising for long periods 

What to do

If you're dehydrated, drink plenty of fluids such as water, diluted squash or fruit juice. These are much more effective than large amounts of tea or coffee. Fizzy drinks may contain more sugar than you need and may be harder to take in large amounts.
If you're finding it difficult to keep water down because you're vomiting, try drinking small amounts more frequently.
Infants and small children who are dehydrated shouldn't be given large amounts of water alone as the main replacement fluid. This is because it can dilute the already low level of minerals in their body too much and lead to other problems.
Instead, they should be given diluted squash or a rehydration solution (available from pharmacies). You might find a teaspoon or syringe can be helpful for getting fluid into a young child.
If left untreated, severe dehydration can be serious and cause fits (seizures), brain damage and death.

Dehydration

Introduction 

Dehydration occurs when your body loses more fluid than you take in.

When the normal water content of your body is reduced, it upsets the balance of minerals (salts and sugar) in your body, which affects the way it functions.

Water makes up over two-thirds of the healthy human body. It lubricates the joints and eyes, aids digestion, flushes out waste and toxins, and keeps the skin healthy.

Some of the early warning signs of dehydration include:

• feeling thirsty and lightheaded
• a dry mouth
• tiredness
• having dark coloured, strong-smelling urine
• passing urine less often than usual
A baby may be dehydrated if they:
• have a sunken soft spot (fontanelle) on their head
• have few or no tears when they cry
• have fewer wet nappies
• are drowsy
The body is affected even when you lose a small amount of fluid.
What causes dehydration?
Dehydration is usually caused by not drinking enough fluid to replace what we lose. The climate, the amount of physical exercise you are doing (particularly in hot weather) and your diet can contribute to dehydration.
You can also become dehydrated as a result of an illness, such as persistent vomiting and diarrhoea, or sweating from a fever.

What treatments are available?

Treatment isn't always necessary for mild, short-term coughs because it's likely to be a viral infection that will get better on its own within a few weeks. You can look after yourself at home by resting, drinking plenty of fluids, and taking painkillers such as paracetamol or ibuprofen

Cough medicines and remedies

Although some people find them helpful, medicines that claim to suppress your cough or stop you bringing up phlegm are not usually recommended. This is because there's little evidence to suggest they're any more effective than simple home remedies, and they're not suitable for everyone.

The Medicines and Healthcare products Regulatory Agency (MHRA) recommends that over-the-counter cough and cold medicines shouldn't be given to children under the age of six. Children aged 6 to 12 should only use them on the advice of a doctor or pharmacist.

A homemade remedy containing honey and lemon is likely to be just as useful and safer to take. Honey shouldn't be given to babies under the age of one because of the risk of infant botulism

Treating the underlying cause

If your cough has a specific cause, treating this may help. For example:

• asthma can be treated with inhaled steroids to reduce inflammation in your airways
• allergies can be treated by avoiding things you're allergic to and taking antihistamines to dampen down your allergic reactions
• bacterial infections can be treated with antibiotics
• GORD can be treated with antacids to neutralise your stomach acid and medication to reduce the amount of acid your stomach produces
• COPD can be treated with bronchodilators to widen your airways
If you smoke, quitting is also likely to help improve your cough.

Coughs in children

Coughs in children often have similar causes to those mentioned above. For example, respiratory tract infections, asthma and GORD can all affect children.

Causes of coughs that are more common in children than adults include:

bronchiolitis – a mild respiratory tract infection that usually causes cold-like symptoms

croup – this causes a distinctive barking cough and a harsh sound known as stridor when the child breathes in

whooping cough– look out for symptoms such as intense, hacking bouts of coughing, vomiting, and a "whoop" sound with each sharp intake of breath after coughing

Occasionally, a persistent cough in a child can be a sign of a serious long-term condition, such as cystic fibrosis

When to see your GP

There's usually no need to see your GP if you or your child have a mild cough for a week or two. However, you should seek medical advice if:

• you've had a cough for more than three weeks
• your cough is particularly severe or is getting worse

Persistent coughs

A persistent cough may be caused by:

• a long-term respiratory tract infection, such as chronic bronchitis  
• asthma – this also usually causes other symptoms, such as wheezing, chest tightness and shortness of breath
• an allergy
• smoking – a smoker's cough can also be a symptom of COPD
• bronchiectasis– where the airways of the lungs become abnormally widened
• postnasal drip – mucus dripping down the throat from the back of the nose, caused by a condition such as rhinitis or sinusitis
• gastro-oesophageal reflux disease (GORD) – where the throat becomes irritated by leaking stomach acid
• a prescribed medicine, such as an angiotensin-converting enzyme inhibitor (ACE inhibitor), which is used to treat high blood pressure and cardiovascular disease
Rarely, a persistent cough can be a symptom of a more serious condition, such as lung cancer,heart failure,a pulmonary embolism (blood clot on the lung) or tuberculosis

Cough 

Introduction 

A cough is a reflex action to clear your airways of mucus and irritants such as dust or smoke. It's rarely a sign of anything serious.

A "dry cough" means it's tickly and doesn't produce any phlegm (thick mucus). A "chesty cough" means phlegm is produced to help clear your airways.

Most coughs clear up within three weeks and don't require any treatment. For more persistent coughs, it's a good idea to see your GP so they can investigate the cause.

What can cause a cough?

Some of the main causes of short-term (acute) and persistent (chronic) coughs are outlined below.

Short-term coughs

Common causes of a short-term cough include:

• an upper respiratory tract infection (URTI) that affects the throat, windpipe or sinuses – examples are a cold,flu,laryngitis,sinusitis or whooping cough
• a lower respiratory tract infection (LRTI) that affects your lungs or lower airways – examples are acute bronchitis or pneumonia
• An allergy, such as allergic rhinitis or hay fever
• a flare-up of a long-term condition such as asthma,chronic obstructive pulmonary disease (COPD) or chronic bronchitis
• inhaled dust or smoke  
In rare cases, a short-term cough may be the first sign of a health condition that causes a persistent cough.

Possible complications

Most people with chickenpox will make a full recovery. But occasionally serious complications can occur.

These are more common in adults, pregnant women, newborn babies and people with weakened immune systems.

Possible complications include:

• a bacterial skin infection – this can cause the skin to become red, swollen and painful
• a lung infection (pneumonia) – this can cause a persistent cough, breathing difficulties and chest pain
• pregnancy problems – including the infection spreading to the unborn baby
Some people with chickenpox may develop shingles later in life. This is a painful, blistery rash caused by the chickenpox virus becoming reactivated.

When to get medical advice

Chickenpox is normally mild and gets better on its own. But some people can become more seriously ill and need to see a doctor.

It's a good idea to contact your GP or NHS 111 for advice if:

• you're not sure if you or your child has chickenpox
• your baby is less than four weeks old and has chickenpox
• you develop chickenpox as an adult
• the symptoms haven't started to improve after six days
• you've been in contact with someone who has chickenpox (or you have symptoms) and you're pregnant or have a weakened immune system
• you or your child has signs of chickenpox complications, such as swollen and painful skin, difficulty breathing or dehydration
• Also consider getting advice if you're originally from a country near the equator (the tropics) and you've been in close contact with someone who has chickenpox.
  Chickenpox is much more common in adults from these areas and you may need treatment to help stop you becoming seriously ill.

  How you catch chickenpox

  Chickenpox is caused by a virus that spreads very easily to people who haven't had it before. If you have had it before, you'll usually be immune for life.
  The infection is spread in the fluid found in chickenpox blisters and the droplets in the coughs or sneezes of someone with the infection.
  You can catch chickenpox from:
  • contaminated surfaces
  • contaminated objects, such as toys or bedding
  • touching chickenpox blisters or the shingles rash
  • face-to-face contact with an infected person, such as having a conversation
  • being in the same room as an infected person for 15 minutes or more
  Someone with chickenpox is infectious from one or two days before the rash appears until all the blisters have dried out and crusted over.