Neck and shoulder pain

The head is supported by the neck, which is made up of seven bones (vertebrae) stacked one on top of the other. The vertebrae are cushioned by discs of cartilage and bound together with ligaments. Muscles provide movement and additional support. The neck is very mobile, which means it is less stable than other areas of the body and more susceptible to injury. Trauma, poor posture and degenerative diseases, such as arthritis, are the most common causes of neck pain.

The shoulder is a ball and socket joint with a large range of movement. Once again, a mobile joint tends to be more susceptible to injury. The shoulder joint relies heavily on the shoulder muscles for stability. Any dysfunction of these muscles or other anatomical structures such as the collar bone, shoulder blade or joint itself can cause pain and mobility problems.

Both neck and shoulder pain can be successfully treated with physiotherapy.

Whiplash injury to the neck
An injury to the neck that results from increased forces in opposite directions during a short time span or increased speed is often called a whiplash. This may occur as a result of a motor vehicle accident, diving accident or similar mishap. This type of injury can overstretch the neck and upper back region, resulting in a strain or tear to the supporting ligaments, muscles and discs, and even irritating the nerves.

The common symptoms of a whiplash injury are pain, stiffness, dizziness and headache. Recovery depends on the individual and extent of the injury, but can take weeks to months. Treatment options may include:

* Pain-killing medication
* Anti-inflammatory drugs or muscle relaxants
* Icepacks for three days
* Gentle mobilisation exercises
* Gentle soft tissue mobilisation (massage) from a physiotherapist.

Maintaining your normal daily activities is ideal, although modifications may be necessary to assist in the recovery of your neck. Be adaptable and remain positive. If pain persists, a further examination or investigation may be required.

Posture problems and neck pain
Poor posture can cause neck pain by putting extra strain on ligaments and muscles. Standing with the shoulders slouched and chin jutted forward, working with your head down for long periods of time, slumping while seated and sleeping face-down are common postural problems that affect the neck.

Suggestions on how to prevent posture-related neck pain include:

* Correct your posture when standing or sitting, adjust your pelvic position, lift your chest gently, nod your chin slightly and relax your shoulders.
* Ensure your workstation is set up to help you sit properly.
* Stretch and change position frequently while you are working.
* Try not to sleep on your stomach, which overextends your neck.
* Choose a urethane or down pillow for neck support while you sleep.
* Combat the muscle-tightening effects of stress with relaxation techniques.
* Exercise regularly to improve muscle tone and posture.

Osteoarthritis can affect the neck
Osteoarthritis is one of the most common types of arthritis. Anyone can be affected. However, since osteoarthritis is the result of altered usage of the joints of the body over prolonged periods of time, older people are particularly prone. Osteoarthritis is characterised by the breakdown of cartilage, the firm cushion found between two bones to stop them from grinding together.

Symptoms include pain, stiffness and muscle weakness. Commonly affected areas include the neck, lower back, hands, hip and knee. There is no cure for osteoarthritis, but it can be managed with exercise. Keeping the joint mobile and in its proper alignment are the best ways to improve the health of the cartilage.

Common shoulder injuries
Diagnosing the cause of shoulder pain involves assessing the degree of movement and strength in the joint, and possibly taking an x-ray and/or ultrasound. Some of the conditions that commonly cause shoulder pain include:

* Strains, due to overexertion
* Tendonitis, due to overuse
* Shoulder joint instability
* Dislocation
* Collar or upper arm bone fractures
* ‘Frozen’ shoulder
* Pinched nerves.

Physiotherapy can help
Neck and shoulder pain can be successfully treated with physiotherapy. You don’t need a doctor’s referral. The physiotherapist will investigate the pain and determine its cause. Treatment depends on the cause, but may include:

* Soft tissue massage
* Mobilisation to stretch tight muscles and other soft tissue structures
* Mobilisation or manipulation of the joint
* Specific exercise programs
* Taping to stabilise the shoulder joint
* Relaxation therapy
* Various treatments such as electrotherapy, heat, laser or ultrasound treatment
* Information on how to correct postural problems.

Causes of Chest Pain

Chest pain may be serious and you should always seek urgent medical help. Chest pain may be caused by poor blood flow to the heart leading to angina or by a sudden blockage in the coronary arteries resulting in a heart attack.

However, there are other possible causes of chest pain such as indigestion and muscle strain. Aside from the heart, the many parts of the chest that can cause chest pain include the lungs, oesophagus (gullet), muscle, bone and skin.

Because of the complex system of nerves in the body, the cause of the chest pain may come from elsewhere in the body, such as the abdomen. If in doubt about the cause of your chest pain, call an ambulance.

Symptoms of a heart attack
Symptoms of a heart attack include:

* Severe crushing pain in the centre of your chest or behind the breastbone. You may feel this as a squeezing, tightening, choking or heavy pressure feeling.
* Pain may spread to the shoulders, arms, neck, throat or jaw.
* Sweating.
* Feeling anxious, dizzy or unwell.
* A sick feeling in the stomach.
* Being short of breath.
* Symptoms that often last 10 to 15 minutes or more.

Symptoms may vary from person to person, and some people have few symptoms or none at all.

Angina and heart attack
Angina is a short-lived chest pain that occurs when the heart has to work harder than usual. This often occurs with exercise or high emotion, cold weather or after eating a large meal. It eases when you rest.

Angina does not cause damage to the heart but, if it is not treated, it may lead to a heart attack. Many Australians die of heart attack because they don’t know the signs or wait too long to act. New treatments for heart attack can save lives and prevent serious heart damage.

Heart disease risk factors
The risk factors for heart disease include:

* Smoking
* Lack of exercise
* High blood pressure
* Obesity
* High cholesterol
* Diabetes
* Family history of heart disease
* Gender, since males are at greater risk than females
* Age, since the risk increases as we get older.

It is important to remember that people without these risk factors can also have heart disease.

Other common causes of chest pain
The symptoms of a heart attack are similar to other conditions, so your chest pain may have nothing to do with your heart. Common causes include:

* Indigestion or stomach acid coming up the oesophagus (reflux). This common problem can be made worse by smoking, alcohol, coffee, fatty foods and some drugs. You may feel this as a burning pain in the chest. It often goes away quickly with antacid or milk.
* Muscle strains.
* Inflammation in the rib joints near the breastbone (costochondritis).
* Herpes zoster or shingles can cause chest pain before a rash forms.

Seek urgent medical help
With chest pain, every minute counts. The faster a person gets to hospital for treatment, the better. If any activity brings on chest pain, stop what you are doing and call an ambulance to report a possible heart attack. If you have any doubt about your pain, call an ambulance anyway. While you are waiting for the ambulance, suggestions include:

* Stop and rest quietly by sitting or lying down.
* Chew half an aspirin straight away, unless your doctor has told you to avoid them.
* Do not attempt to drive yourself to hospital. Wait for the ambulance. It has specialised staff and equipment that may save your life.

Diagnosis methods
Before medical treatment can begin, the cause of the pain must be found. You may have a lot of tests done including:

* ECG - electrical tracing of the heart activity.
* Blood tests - to measure markers from the heart and other organs.
* Chest x-ray - to look at the lungs, heart and major blood vessels of the chest.
* If angina is suspected - further tests may be needed to check the state of the blood vessels that supply the heart. An exercise stress test (on an exercycle or treadmill) may be arranged. You may be referred to a cardiologist (heart doctor) for more tests.
* Other tests - it is not always easy to diagnose the cause of chest pain. Your doctor may need to see you more than once to be sure, and further tests may be needed.

Taking care of yourself at home
If your doctor has ruled out serious causes of chest pain, it is likely you will make a full recovery. General self-care suggestions include:

* Follow your doctor’s advice about treatment.
* In the first few days at home, try to take it easy.
* Rest if you feel tired.
* Slowly increase your activity, as you are able.
* There is no need to limit work or strenuous activity, including sex, if you feel well.
* Even if you feel well, follow-up with your doctor is important. See your local doctor in the next day or two.

Reduce your risk of heart attack
Ways to reduce your risk of heart attack include:

* Stop smoking - call Quitline for help and support.
* Be physically active - enjoy moderate physical activity for 30 minutes or more on most if not all days of the week.
* Eat a healthy diet - enjoy a diet low in fat and eat plenty of cereals, grains, vegetables and fruit.
* Watch your weight - keep a healthy weight by eating a good diet and exercising regularly.
* Regular check-ups - see your doctor for regular check-ups. Take your pills as directed. Don’t stop your pills unless your doctor tells you to.

Things to remember

• Chest pain may be caused by poor blood flow to the heart leading to angina or by a sudden blockage in the coronary arteries resulting in a heart attack.
• Other causes of chest pain include indigestion, reflux, muscle strain, inflammation in the rib joints near the breastbone, and herpes zoster or shingles.
• If in doubt about the cause of your chest pain, call an ambulance.

Risks Involved in Tattooing

* Infection. Unsterile tattooing equipment and needles can transmit infectious diseases, such as hepatitis and skin infections caused by Staphylococcus aureus ("staph") bacteria*. Tattoos received at facilities not regulated by your state or at facilities that use unsterile equipment (or re-use ink) may prevent you from being accepted as a blood or plasma donor for twelve months.

* Removal problems. Despite advances in laser technology, removing a tattoo is a painstaking process, usually involving several treatments and considerable expense. Complete removal without scarring may be impossible.
* Allergic reactions. Although reports of numerous adverse ractions associated with certain shades of ink in permanent makeup, marketed by a particular manufacturer, reports of allergic reactions to tattoo pigments have been rare. However, when they happen they may be particularly troublesome because the pigments can be hard to remove. Occasionally, people may develop an allergic reaction to tattoos they have had for years.
* Granulomas.These are nodules that may form around material that the body perceives as foreign, such as particles of tattoo pigment.
* Keloid formation. If you are prone to developing keloids -- scars that grow beyond normal boundaries -- you are at risk of keloid formation from a tattoo. Keloids may form any time you injure or traumatize your skin. Micropigmentation: State of the Art, a book written by Charles Zwerling, M.D., Annette Walker, R.N., and Norman Goldstein, M.D., states that keloids occur more frequently as a consequence of tattoo removal.
* MRI complications. There have been reports of people with tattoos or permanent makeup who experienced swelling or burning in the affected areas when they underwent magnetic resonance imaging (MRI). This seems to occur only rarely and apparently without lasting effects.

Osteonecrosis

Osteonecrosis occurs when your bones lose their blood supply. The bones die and eventually collapse, leading to pain and arthritis. You can have osteonecrosis in one or several bones. It is most common in the upper leg. Other common sites are your upper arm and your knees, shoulders and ankles. The disease can affect men and women of any age, but it usually strikes in your thirties, forties or fifties.

Early in the disease you might not have any symptoms. Later, you will probably have joint pain that becomes more severe as the disease gets worse.

No one is sure what causes the disease. Risk factors include

* Long-term steroid treatment
* Alcohol abuse
* Joint injuries
* Having certain diseases, including arthritis and cancer

Treatments include medicines, using crutches, limiting activities that put weight on the affected joints, electrical stimulation and surgery.

Heel pain

Causes

Most frequently heel pain is not the result of any single injury, such as a fall or twist, but rather the result of repetitive or excessive heel pounding.

Plantar fasciitisPlantar fasciitis is inflammation of the thick connective tissue on the sole of your foot that attaches to your heel. The pain is usually felt at the bottom of your heel and is often worse in the morning because of stiffness that occurs overnight. The following increase your risk of developing this painful problem:

* Shoes with poor arch support or soft soles
* Quick turns that put stress on your foot
* Tight calf muscles
* Repetitive pounding on your feet from long-distance running, especially running downhill or on uneven surfaces
* Pronation -- landing on the outside of your foot and rolling inward when walking or running; to know if you pronate, check the soles of your shoes to see if they are worn along the outer edge

Bone spurs in the heel can accompany plantar fasciitis, but are generally not the source of the pain. If you treat the plantar fasciitis appropriately, the bone spur is likely to no longer bother you.

Heel bursitisbursitis (inflammation of the back of the heel) can be caused by landing hard or awkwardly on the heel, or by pressure from shoes.

Achilles tendinitisAchilles tendinitis is inflammation of the large tendon that connects your calf muscle to your heel. This can be caused by:

* Running, especially on hard surfaces like concrete
* Tightness and lack of flexibility in your calf muscles
* Shoes with inadequate stability or shock absorption
* Sudden inward or outward turning of your heel when hitting the ground

Home Care

* Rest as much as possible for at least a week.
* Apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes, more often in the first couple of days.
* Take acetaminophen for pain or ibuprofen for pain and inflammation.
* Wear proper-fitting shoes.
* A heel cup, felt pads in the heel area, or an orthotic device may help.
* Night splints can stretch the injured fascia and allow it to heal.

Additional steps:

* Apply moleskin to avoid pressure if you have bursitis.
* See a physical therapist to learn stretching and strengthening exercises. These help prevent plantar fasciitis or Achilles tendinitis from returning.

When to Contact a Medical Professional

* Your pain is getting worse despite home treatment
* There is little progress after 2 to 3 weeks of home treatment
* Your pain is sudden and severe
* You have redness or swelling of your heel or you cannot bear weight

What to Expect at Your Office Visit

Your doctor will take your medical history and perform a physical examination, including a full exam of your feet and legs.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

* Have you had this type of heel pain before? If so, what was the diagnosis and what caused the problem?
* When did this episode of pain begin?
* Do you have pain upon your first steps in the morning or after your first steps after rest?
* Where exactly is your pain?
* Is the pain dull and aching or sharp and stabbing?
* Is it worse after you exercise?
* Is it worse when you are standing?
* Do you have any swelling or redness of your heel?
* Have you had a fall or have you twisted your foot recently?
* Are you a runner? How far do you run? How often do you run? On what type of surface do you run?
* Do you walk or stand on your feet for long periods of time?
* What kind of shoes do you wear?
* Do you have any other symptoms?

Diagnostic tests that may be performed include a foot x-rayfoot x-ray, focusing on the heel.

If either plantar fasciitis or bursitis is diagnosed and if shoe changes and the use of orthotics have not been successful, cortisone injections may be tried. Surgery is a last resort and is seldom necessary.

If Achilles tendinitis is diagnosed, anti-inflammatory medicine may be prescribed. Heel lifts may be used. Stretching can be helpful. In particularly unresponsive cases, a walking cast or boot may be helpful. Surgery is usually not necessary.

Prevention

To prevent plantar fasciitis and Achilles tendinitis, maintain flexible and strong muscles in your calves, ankles, and feet. Always stretch and warm-up prior to athletic activities.

Wear comfortable, properly fitting shoes with good arch support and cushioning. If you pronate, look for athletic shoes with an antipronation device. If orthotics are prescribed by your provider, wear them in all of your shoes, not just while exercising.

Foot pain

Pain or discomfort can be felt anywhere in the foot, including the heel, toes, arch, instep, sole, or ankles.

Foot pain can be caused by:

* BunionsBunions -- a protrusion at the base of the big toe, which can become inflamed. Bunions often develop over time from wearing narrow-toed shoes.
* Hammer toesHammer toes -- toes that curl downward into a claw-like position.
* Calluses and cornsCalluses and corns -- thickened skin from friction or pressure. Calluses are on the balls of the feet or heels. Corns appear on your toes.
* Plantar warts -- from pressure on the soles of your feet.
* Fallen archesFallen arches -- also called flat feet.

Poorly fitting shoes often cause these problems. Aging and being overweight also increase your chances of having foot problems.

Morton's neuroma is a type of foot pain that is usually centered between the third and fourth toes. It results from thickening and swelling of tissue around a nerve in the area. Symptoms include tingling and sharp, shooting, or burning pains in the ball of your foot (and sometimes toes), especially when wearing shoes or pressing on the area. Pain gradually gets worse over time. Morton's neuroma is more common in women than men.

Other common causes of foot pain include:

* Broken bonesBroken bones
* Stress fracture
* ArthritisArthritis
* GoutGout -- common in the big toe, which becomes red, swollen, and very tender
* Plantar fasciitisPlantar fasciitis
* Bone spur
* SprainsSprains
* Bursitis of the heel
* Tendinitis
Home Care
Home Care

* Apply ice to reduce pain and swelling. Do this just after an activity that aggravates your pain.
* Elevate your painful foot as much as possible.
* Reduce activity until the problem improves.
* Wear foot pads in areas of friction or pressure. This will prevent rubbing and irritation.
* Take over-the-counter pain medicine, like ibuprofen or acetaminophen. Try this for 2 to 3 weeks (unless you have a history of an ulcer, liver disease, or other condition that does not allow you to take one of these drugs).

For plantar warts, try an over-the-counter wart removal preparation.

For calluses, soak in warm water and then rub them down with a pumice stone. Do NOT cut or burn corns or calluses.

For foot pain caused by a stress fracture, an extended rest period is often necessary. Crutches may be used for a week or so to take the pressure off, if your foot is particularly painful.

For foot pain due to plantar fasciitis, shoe inserts and stretches may help.

When to Contact a Medical Professional
When to Contact a Medical Professional

Call your doctor if:

* You have sudden, severe pain.
* Your pain began following an injury -- especially if there is bleeding, bruising, deformity, or you cannot bear weight.
* You have redness or swelling of the joint, an open sore or ulcer on your foot, or a fever.
* You have new foot pain and have been diagnosed with diabetes or peripheral vascular disease (a condition characterized by poor circulation).
* You do not respond to self-care within 1 to 2 weeks.

What to Expect at Your Office Visit
What to Expect at Your Office Visit

Your doctor will perform a physical examination, paying particular attention to your feet, legs, and back, and your stance, posture, and gait.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

* Are both of your feet affected? If only one, which one?
* Exactly what part of your foot is affected?
* Does the pain move from joint to joint, or does it always occur in the same location?
* Did your pain begin suddenly and severely or slowly and mildly, gradually getting worse?
* How long have you had the pain?
* Is it worse at night or when you first wake up in the morning?
* Is it getting better?
* Does anything make your pain feel better or worse?
* Do you have any other symptoms?

X-rays may be useful in making a diagnosis.

For bunions, plantar fasciitis, bone spurs, Morton's neuroma, or other conditions, your doctor may inject cortisone. This will be considered if oral medication, changing your shoes, and other measures have not helped. No more than three injections in a year should be attempted in most cases.

A broken foot will be casted. Broken toes will be taped.

Orthotics fit by an orthotist or other specialist can help many structurally related problems. Physical therapy is also quite helpful for conditions related to overuse or tight muscles, such as plantar fasciitis or achilles tendinitis.

Removal of plantar warts, corns, or calluses may be necessary. This may be performed by a medical doctor or a podiatrist.

Surgery may be considered for certain conditions like bunions or hammer toes if the pain interferes with walking or other activities.
Prevention
Prevention

The following steps can prevent foot problems and foot pain:

* Wear comfortable, properly fitting shoes. They should have good arch support and cushioning.
* Wear shoes with adequate room around the ball of your foot and toe.
* Wear sneakers as often as possible, especially when walking.
* Avoid narrow-toed shoes and high heels.
* Replace running shoes frequently.
* Warm up before exercise, cool down after exercise, and stretch adequately.
* Increase your amount of exercise slowly over time to avoid putting excessive strain on your feet.
* Lose weight if you need to.
* Learn exercises to strengthen your feet and avoid pain. This can help flat feet and other potential foot problems.
* Keep feet dry to avoid friction. This may help prevent corns and calluses.
* Avoid alcohol to prevent attacks of gout.

Angina (Chest pain)

Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when an area of your heart muscle doesn't get enough oxygen-rich blood. Angina may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

Angina isn't a disease; it's a symptom of an underlying heart problem. Angina usually is a symptom of coronary heart disease (CHD), also called coronary artery disease.

CHD is the most common type of heart disease in adults. It occurs if a fatty material called plaque (plak) builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart.


Figure A shows a normal artery with normal blood flow. The inset image shows a cross-section of a normal artery. Figure B shows an artery with plaque buildup. The inset image shows a cross-section of an artery with plaque buildup

Plaque narrows and stiffens the coronary arteries. This reduces the flow of oxygen-rich blood to the heart muscle, causing chest pain. Plaque buildup also can lead to a heart attack if the plaque ruptures (breaks open) and causes a blood clot to form that blocks the artery.

Angina also can be a symptom of coronary microvascular disease (MVD). This is heart disease that affects the heart’s smallest coronary arteries. Unlike traditional CHD, coronary MVD doesn’t always create blockages in the arteries. Studies have shown that coronary MVD is more likely to affect women than men.

Coronary MVD also is called cardiac syndrome X and nonobstructive CHD.
Types of Angina

The types of angina are stable, unstable, variant (Prinzmetal's), and microvascular. Knowing how the types differ is important. This is because they have different symptoms and require different treatments.
Stable Angina

Stable angina is the most common type of angina. It occurs if the heart is working harder than usual. Stable angina has a regular pattern.

If you know you have stable angina, you can learn to recognize the pattern and predict when the pain will occur. The pain usually goes away a few minutes after you rest or take your angina medicine.

Stable angina isn't a heart attack, but it suggests that a heart attack is more likely in the future.
Unstable Angina

Unstable angina doesn't follow a pattern. It can occur with or without physical exertion, and it may not be relieved by rest or medicine.

Unstable angina is very dangerous and requires emergency treatment. This type of angina is a sign that a heart attack may happen soon.
Variant (Prinzmetal's) Angina

Variant angina is rare. It usually occurs while you're at rest, and the pain can be severe. Variant angina usually happens between midnight and early morning. Medicine can relieve this type of angina.
Microvascular Angina

Microvascular angina can be more severe and last longer than other types of angina; medicine may not relieve it. This type of angina may be a symptom of coronary MVD.
Overview

Experts believe that nearly 7 million people in the United States suffer from angina. About 400,000 people go to their doctors with new cases of angina every year. The condition occurs equally in men and women.

Angina can be a sign of heart disease, even if initial tests don't show evidence of CHD. However, not all chest pain or discomfort is a sign of a heart problem.

Other conditions also can cause chest pain, such as a pulmonary embolism (a blockage in a lung artery), a lung infection, aortic dissection (tearing of a major artery), pericarditis (inflammation in the tissues that surround the heart), or a panic attack.

All chest pain should be checked by a doctor.

Know more on Anxiety and Anxiety Disorders

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder can begin at any age though it is most likely to start in childhood.iv People with Generalized Anxiety Disorder (GAD) will worry excessively about a variety of everyday problems for at least 6 months.v Children, pre-teens, and teens with GAD can’t relax, may startle easily, have trouble focusing, and will sometimes have trouble sleeping. Other signs of GAD can include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes. When their anxiety is bothering them, children with GAD can have trouble completing tasks, like homework.

If you think your son or daughter might have GAD, talk to a health care provider like a nurse or doctor, the counselor at your child’s school, or a mental health professional.


Obsessive-Compulsive Disorder (OCD)

Children, pre-teens, or teens with obsessive-compulsive disorder (OCD) constantly have thoughts that bother them (obsessions). They will develop routines and rituals (compulsions) in an attempt to control the stress these thoughts cause. At their worst, these rituals can take over a young person’s life.

Parents concerned about OCD should look for the most common OCD compulsions:vi

* Excessive hand washing due to fear of germs

* Counting constantly

* Repeating words silently

* Repeatedly rechecking completed tasks

OCD affects about 2.2 million Americans.vii It usually appears in childhood, adolescence, or early adulthood.viii OCD can change over time, and the effects of OCD can get weaker or stronger. Sometimes these effects fade completely.

In some cases, OCD can prevent children from feeling comfortable and behaving normally at home, at school, or in social situations. Some people with OCD may try to help themselves by avoiding situations that will upset them. In some cases, teens with OCD will turn to alcohol or drugs to try to calm themselves.ix, x

If your son or daughter shows signs of OCD, or you have any questions, talk to a health care provider like a nurse or doctor, the counselor at your child’s school, or a mental health professional.


Panic Disorder

Panic disorder causes sudden attacks of terror. These attacks are called panic attacks and can last minutes to hours. During these panic attacks, a teen can experience:

* A pounding heart

* Weakness, dizziness, or feeling faint

* Nausea

* Chest pain

* Numbness in the hands

* Feeling like they are being smothered

Children can suffer a panic attack at any time, even during sleep. Panic attacks often begin in late adolescence or early adulthood.xi However, just because a teen has a panic attack doesn’t mean that he or she has panic disorder – one panic attack does not equal panic disorder.

If you are concerned that your son or daughter might have panic disorder, talk to a health care provider like a nurse or doctor, the counselor at your child’s school, or a mental health professional.


Post-Traumatic Stress Disorder (PTSD)

We often hear about Post-Traumatic Stress Disorder (PTSD) as something that affects adults (such as war veterans), but it can happen to a child who has experienced or witnessed trauma or traumatic events.

PTSD can affect children who have survived some sort of trauma. Children don’t have to be physically harmed to suffer from PTSD. Children can suffer from PTSD if something bad happens to them, if they witness a traumatic event, or a trauma happens to someone they love.

Children suffering from PTSD can show the following signs:

* Difficulty sleeping

* Emotional numbness (not feeling happiness or sadness, for example, when they should)

* Losing interest in favorite activities or hobbies

* Aggression

* Displays of violence

* Flashbacks

* Frequent bad dreams

PTSD affects about 7.7 million American adultsxii, but it can occur at any age, including childhood.xiii Children suffering from PTSD may also face depression, substance abuse, or one or more of the other anxiety disorders.xiv

If you believe that you child is suffering from PTSD, please talk to a health care provider like a nurse or doctor, the counselor at your child’s school, or a mental health professional.


Social Anxiety Disorder (Social Phobia)

Children with social anxiety disorder, also called social phobia, are so self-conscious that they find it very, very hard to take part in social situations. Children with social anxiety disorder have an intense and often constant fear of being watched and judged by others. They are very afraid of doing something that will embarrass them.

Sometimes this fear is caused by one specific thing or situation. For example, a child might worry for days, even weeks, leading up to a school test or oral presentation. Sometimes this fear is not caused by anything specific. In this case, a child with social anxiety disorder may be uncomfortable around anybody except family. This can make it very hard for a child or youth to make friends or attend school.

Signs of social phobia in children and youth include:

* Being overly sensitive to criticism

* Having trouble being assertive

* Suffering from low self-esteem

Social phobia affects about 15 million Americans.xv It usually begins in childhood or early adolescence.xvi People with social anxiety disorder may also have other anxiety disorders or depression.xvii, xviii Some people with social anxiety disorder may also develop problems with substance abuse.xix, xx

Dentures

Dentures are false teeth made to replace teeth you have lost. Dentures can be complete or partial. Complete dentures cover your entire upper or lower jaw. Partials replace one or a few teeth.

Advances in dentistry have made many improvements in dentures. They are more natural looking and comfortable than they used to be. But they still may feel strange at first. In the beginning, your dentist may want to see you often to make sure the dentures fit. Over time, your mouth will change and your dentures may need to be adjusted or replaced. Be sure to let your dentist handle these adjustments.

Speaking and eating may feel different with dentures. Be careful when wearing dentures because they may make it harder for you to feel hot foods and liquids. Also, you may not notice things like bones in your mouth.